Organisation mondiale de la santé (OMS) · Technical Documents

Proposed programme budget estimates for the financial period 1980-1981

31 décembre 1978 Organisation mondiale de la santé

Texte intégral

WPR/RC29/4

WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR THE WESTERN PACIFIC

PROPOSED PROGRAMME BUDGET ESTIMATES FOR THE FINANCIAL PERIOD 1980-1981

' ..

Manila 1978

REGIONAL COMMITTEE FOR THE WESTERN PACIFIC Twenty-ninth session Manila, 21 to 25 August 1978

PROPOSED PROGRAMME BUDGET ESTIMATES FOR THE FINANCIAL PERIOD 1980-1981 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 1980-1981.

Manila, June 1978

ii ABBREVIATIONS The following abbreviations are used in this document: DANIDA FAO IAEA IBRD IPPF OPAS PEP AS Danish International Development Agency Food and Agriculture Organization of the United Nations International Atomic Energy Agency International Bank for Reconstruction and Development (World Bank) International Planned Parenthood Federation Operational Assistance (United Nations Development Programme) Western Pacific Regional Centre for Promotion of Environmental Planning and Applied Studies Regional Teacher Training Centre for Health Personnel, Sydney South Pacific Commission United Nations Development Programme United Nations Fund for Population Activities United Nations Children's Fund

nne SPC UNDP UNFPA UNICEF

CONTENTS

Explanatory notes · Regional Director's programme statement

....... ................................................................................ . .................................................................. SUMMARIES

vii xiii

Summary Summary Summary Regular

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 1978-1979 and 1980-1981 by appropriation section with percentages to the total PROGRAMME ANALYSES

2 8

Policy organs

1.3 2

Regional Committee for the Western Pacific

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

General programme development, management and coordination 2.1

Executive management 2.2.1 2.2.2 2.2.3

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

19 21

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

Country health programming Information systems programme

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

26 30

2.4 2.5

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

33 36

iii

Development of comprehensive health services

3.1

Health services development

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

38 38 40 45

3.1.0 3.1.1 3.1.2 3.1.3 3.1.4 3.1.5 3.1.6

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

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

48 50

3.2

Family

3.2.0 3.2.1 3.2.2 3.2.4

.............................................................. health ................................................................................ Programme planning and general activities .......................... Maternal and child health ............................................................. Nutrition ............................................................................. Health education ...................................................................... ............................................. .......................................................... .......................................................

52 58

60 60 62 65 69

3.3 3.4

Mental health Prophylactic, diagnostic and therapeutic substances

73 76 76

3.4.0 Programme planning and general activities 3.4.1 Drug policies and management 3.4.2 Pharmaceuticals and biologicals Disease prevention and control

78 81

4.1

Communicable disease prevention and control

4.1.0 4.1.1

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

84 84 86

4.1.2 4.1.3 4.1.5 4.1.6 4.1. 7 4.1.8 4.2

Malaria and other parasitic diseases Bacterial, viral and mycotic diseases Expanded programme on immunization Special programme for research and training in tropical diseases Prevention of blindness Vector biology and control

Noncommunicable disease

88 93 103 106 108 110 112

4.2.0 Programme planning and general activities 4.2.1 cancer 4.2.2 cardiovascular diseases 4.2.3 Oral health .....•.... ·· ..........................................................•...... 4.2.4 other noncommunicable diseases 5 Promotion or environmental health 5.1 Promotion of environmental health 5.1.0 5.1.1 5.1.2 5.1.3 5.1.4 Food safety 6

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

112 114 117 120 123

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

126 126 128

131 133 135

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

Health manpower development 6.1

Health manpower development

137 137

6.1.0 Programme planning 6.1.1 Health manpower planning and management 6.1.2 Promotion of training ••••••••••••••••.•••. 6.1.3 Educational development and support •••••••

139 143 146

Health .information

7.1

Health information 7 .1.1

• o •

•

• •

•

• •

•

e e •

•

• •

•

• •

• ·• • •

•

• •

•

• •

•

• •

•

~ o ,,

o;;

•

~ o o o

o;;

•

o .,

•

150 150 151t

7 .1.2 7 .1.4 7 .1.5

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

157 159

General services and·support programmes 8.1 General services and support programmes 8.1.0 8.1.1

161 161

Programme planning and general activities Staff development and training Personnel ........ ~ ............ .

8.1.2 8.1.3 8.1.4 8.1.5 8.1.6

Supplies ........... .0··················~~· . Conference, office and building services Budget Finance and accounts

·········~~···

163 165 167 169 171 173

INFORMATION ANNEXES Technical cooperation with and services to governments 177 181 189 313

ANNEX I ANNEX II ANNEX III -

Table for Regional Office by programme Individual country or area programme statements with tabulations Intercountry programme statement with tabulations

.EXPLANATORY NOTES 1. In compliance with resolution WHA30.20 adopted by the Thirtieth World Health Assembly 1 on the introduction of a biennial budget cycle, the proposed programme budget estimates presented by the Regional Director include provisions for the biennium ·1978-79 and requirements for the biennium 1980-81. The Regional Committee will need particularly to examine the requirements for the biennium 1980-81. . 2 2. In resolution WHA30.23 the Thirtieth World Health Assembly requested the Director-General to put a new programme budgeting procedure into effect and to introduce a corresponding form of budget presentation in the proposed programme budget estimates for 1980-81, whereby: "WHO and national authorities will collaborate in identifying and developing priority programmes for cooperation, directed towards attaining national health goals defined in country health programmes and expressed in terms of a general programme rather than in the form of individual projects or detailed activities" and "technical cooperation programme proposals will be presented in regional programme budgets in the form of narrative country programme statements, supported by budgetary tables in which the country planning figures are broken down by programme so as to facilitate a programme-oriented review by the respective regional committees". As a result of that resolution, the country and intercountry budgetary tables contained in the present document are broken down by programme. 3. From 1 January 1980 the changes necessary fully to introduce the biennial programme budget concept will be completed by being able to carry unobligated funds from the end of the first year of the biennium, in this case 1980, into the second year of the biennium, 1981. The Financial Regulations of the Organization as contained in the Basic Documents will reflect this change. 4. The budgetary estimates for the Regional Office are shown in detail. The estimates for personnel costs are based on averages which include salary, pension fund contributions, insurance costs, post adjustment and other allowances and entitlements uniformly applicable to all posts at the Pl/P3 and P4/D2 levels. Posts in the general service category are costed on the basis of averages by grade.

1 2

WHO Official Records, No. 240, 1977, pages 9-10.

WHo Official Records, No. 240, 1977, page 11. vii

viii

5. The programme classification structure, which follows these explanatory notes, came into effect on 1 January 1Q78. It is based pn the Organization's Sixth General Programme of Work covering a specific 1 period (1978-1Q83). · Each of the princlpal objectives, such as development of comprehensive health services, disease prevention and control, health manpower development, etc. is represented by a separate appropriation section under which detailed objectives are represented by major programmes and programmes. As indicated in paragraph 2 above budgetary provisions in the present document are shown by programme. 6. The programme statements consist of regional programme statements, country programme statements and functional statements for support to regional programmes. These programme statements contain information with regard to the present situation, the objectives to be attai.ned, and the means to be employed to realize the targets. 7. WHO cooperation with governments in the Western Pacific Region planned for 1980-81 is shown in the budgetary tables by programme and is described in the country programme statements. In the case of intercountry programmes, a budgetary table is preceded by statements under programme headings. 8. The estimates for Regional Advisers and related secretarial assistance and duty travel are included in the intercountry programme under the appropriate technical programme. 9. The estimates for WHO Representatives 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 Representative is responsible for more than one country or area, the estimates are distributed over the countries or areas concerned. 10. 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 foreseen when the programme budget estimates were developed. 11. The column headed "Other sources" in the budgetary tables includes all projects financed or expected to be financed from sources other than the regular budget. The fund codes used are as follows: DP - Uni.ted Nations Development Programme - Indicative Planning Figures FP - United Nations Fund for Population Activities UF - United Nations Chlldren's Fund See resolution WHA29.20, WHO Handbook of Resolutions and Decisions, Volume II (2nd edition), 1977, pages 2-3. 1

FT ,.. Trust Funds VD - Voluntary Fund for Health Promotion - Miscellaneous Designated Contributions (Other) VV - Voluntary Fund for Health Promotion - Miscellaneous Designated Contributions (Special Assistance to Democratic Kampuchea, Lao People's Democratic Republic and Socialist Republic of Viet Nam) VG - Voluntary Fund for Health Promotion - Medical Research (General) VI - Voluntary Fund for Health Promotion - Expanded Programme on Immunization VK - Voluntary Fund for Health Promotion - Miscellaneous Designated Contributions (DANIDA) VL - Volunatry Fund for Health Promotion - Leprosy programme PROGRAMME CLASSIFICATION STRUCTURE 1.

POLICY ORGANS 1.2

World Health Assembly Executive Board 1.3 Regional Committees 1.1

GENERAL PROGRAMME DEVELOPMENT, MANAGEMENT AND COORDINATION 2.1 2.2

Executive M8nagement 1 General Programme Development and Management 2.2.1 2.2.2 2.2.3

General Programme Develop~nt Country Health Programming Information Systems Programme

1 2

Director-General, Assistant Directors-General, Regional Directors.

Long-Term Planning, Medium-Term Programming, Evaluation, Directors of Health Services' offices.

3Including WHO Representatives.

2.3

External Coordination for Health and Socio-Economic 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.~

2.5

Research Promotion and Development Director-General's and Regional Directors' Development Programmes

DEVELOPMENT OF COMPREHENSIVE HEALTH SERVICES 3.1 Health Services Development 3.1.0 Programme Planning and General Activiti!s 3.1.1 Health Services Pla2"ing and Management 3.1.2 Pri.ary Health Care 3.1.3 Workers' Health 3.1.4 Care of the Aged, Disability Prev~ntion and Rehabilitation 3.1.5 Appropriate Technolo!Y for Health 3.1.6 Health Services Research 3.2 Family Health 3.2.0 Programme Planning and General Activities 3.2.1 Maternal and Child Health 3.2.2 Nutrition 3.2.3 Special Programme of Research, Development and Research Training in Human Reproduction Health Education 3.2.~

1Including Coordination of National Health Institutions; Organization of Medical Care; Diagnostic and Therapeutic Services; Economics and Financing of Health Services; National Health Service Information Support. 2Including Community Development and Participation 3Including Laboratory and Radiological Technology

3.3 Mental Health 3.4 Prophylactic, Diagnostic and Therapeutic Substances

3.4.0 Programme Planning and General Activities 3.4.1 Drug Policies and Management 3.4.2 Pharmaceuticals and Biologicals 4. DISEASE PREVENTION AND CONTROL 4.1 Communicable Disease Prevention and Control 4.1.0 Programme Planning and General Activities 4.1.1 Epidemiological Surveillance 4.1.2 Malaria and Other Parasitic Diseases1 4.1.3 Bacterial, Viral and Mycotic Diseases1 4.1.4 Smallpox Eradication 4.1.5 Expanded Programme on Immunization 4.1.6 Special Programme for Research and Training in Tropical Diseases 4.1.7 Prevention and Blindness 4.1.8 Vector Biology and Control

4.2 Noncommunicable Disease Prevention and Control 4.2.0 4.2.1 4.2.2 Programme Planning and General Activities Cancer cardiovascular Diseases 4.2.3 Oral Health 4.2.4 Other Noncommunicable diseases 4.2.5 Immunology

PROMOTION OF ENVIRONMENTAL HEALTH 5.1 Promotion of Environmental Health 5.1.0 5.1.1

Programme Planning and General Activities Environmental Health Planning and Management

Including Zoonoses

xii 5.1.2 5.1. 3 5.1.4

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

1.1

Health Information 7 .1.0 Programme Planning and General Activities 7.1.1 Health Statistics 7 .1.2 WHO Publications and Documents 7.1.3 Health Legislation 7.1.4 Health Literature Services 7.1.5 Health Information of the Public

GENERAL SERVICES AND SUPPORT PROGRAMMES 8.1 General Services and Support Programmes Programme Planning and General Activities Staff Development and Training 8.1.2 Personnel 8.1.3 Supplies 8.1.4 Conference, Office and Building Services 8.1.5 Budget 8.1.6 Finance and Accounts 8.1. 7 Internal Audit Services 8.1.8 Legal Services 8.1.0 8.1.1

REGIONAL DIRECTOR'S PROGRAMME STATEMENT The proposed programme budget estimates for the biennium 1980-81 have been prepared in accordance with the priorities given by the Regional Committee at its twenty-sixth and twenty-seventh sessions to the principal and detailed objectives of the Sixth General Progr~e of Work covering a specific period (1978-1983), adopted by the World Health Assembly in May 1976. The programme budget proposals are in conformity with the resolution on the development of programme budgeting2and management of WHO's resources at country level adopted by the Thirtieth World Health Assembly, whereby technical cooperation programme proposals are to be presented in regional programme budgets in the form of narrative country statements, supported by budgetary tables broken down only by programme. Details of projects will be developed at a later stage, nearer the time of programme implementation. The programme budget proposals included in this document represent government requests, by programme, according to the programme classification structure developed by the Organization on the basis of the Sixth General Programme of Work. This classification structure pr3sents some changes from those of previous years; for example, the costs of WHO Representatives' offices are now to be found under the programme heading Country health programming. This is a new way of submitting programme budget proposals; an interesting experiment for governments as well as for WHO. At the present stage it is only possible to give indications of what is requested in broad terms. The requests may be changed in the light of changing trends in health services over the next two or three years. It is hoped that, in their consideration of the details of the broad programme proposals contained in this document, Member States will bear in mind the programme objectives and policy decisions on priorities adopted by the governing bodies of the Organization. Country health and medium-term programming are of great importance in this new procedure, in defining and formulating priority programmes.

1see resolution WHA29.20, WHO Handbook of Resolutions and Decisions, Volume II (2nd edition), 1977, pages 2-3. 2 see resolution WHA30.23, WHO Official Records, No. 240, 1977, page 11. 3since the preparation of the programme budget proposals, the World Health Assembly has adopted resolution WHA31.27, as a result of which WHO Representatives are to be called WHO Programme Coordinators. xiii

xiv

In accordance with resolution WHA29.~8 and with the importance which has always been placed, in this Region, on direct cooperation with governments, the programme for 1980-81 once again encourages increasing self-reliance in implementing country health programmes and ensures that WHO's regular programme budget resources are distributed in such a way as to devote, in real terms, as much of the regional allocation as possible to direct technical cooperation with governments. More governments are now able to carry out programmes with their own resources and with the collaboration of short-term consultants instead of long-term advisers. Training of national staff, through training courses and through fellowships, to strengthen all aspects of the national health services continues to be one of the most important of the activities in the Region. Provision continues to be made for programmes in Democratic Kampuchea, but no contact has yet been possible with that Government. The regular budget provision for the Socialist Republic of Viet Nam, large though it is as a percentage of regional funds, covers only a small part of the great needs of that country and efforts continue to obtain extrabudgetary resources for the Special Assistance Programme. Technical cooperation among developing countries In line with recent decisions of the World Health Assembly, technical cooperation among developing countries for the promotion of health care will be kept in mind. Governments are urged to cooperate among themselves in the development of their health services and the training of their staff. Intercountry programmes Although the proposals for ~ntercountry programmes are also shown under broad programme headings, they have been worked out in detail in the Regional Office, since in many cases they involve long-term staff and regional advisers. Intercountry group educational meetings are again kept to a minimum, as it is believed that national courses and seminars are, in some cases, a much more effective method of collaboration than intercountry meetings. Provision is made for the continuation of intercountry teams which over a period of years have made an impact on more than one country or area in the Region, particularly in the South Pacific.

General programme development and management Under this heading are presented the different management tools for the implementation of the programme; for example, the office of the Director of Health Services appears under the programme General programme development and, as mentioned above, the offices of the WHO Representatives under Country health programming. The country health programme in Lao People's Democratic Republic has recently been revised. Other countries where country health programming is being or will be carried out are Fiji, Malaysia, Papua New Guinea, Philippines, Samoa, and Solomon Islands. If, as it is hoped, more governments undertake country health programming and intensify planning for longer periods, the new programme budgeting procedure and medium-term programmes can be most effective. The information systems programme is a component of General programme development. The importance of reliable information systems for planning, programming, implementing and evaluating health programmes is reiterated and the development by governments of such information support is urged. Research promotion and development There has been considerable progress in the biomedical research programme since the last programme budget was presented. The present proposals take cognizance of the wishes of the World Health Assembly that regional Advisory Committees on Medical Research should become more involved in defining programmes of action consonant with national and regional health priorities and that the research capabilities of Member States should be strengthened. As an example, a regional research and training centre established at the Institute for Medical Research, in Malaysia, will collaborate in work on tropical diseases and nutrition. Much remains to be done to develop the regional research programme and the regular budget provisions will not be sufficient. Extrabudgetary funds will be essential and will be actively sought. Regional Director's development programme As mentioned in the Explanatory Notes, the funds under this programme heading will be used for programmes which it was not possible to foresee when preparing the programme budget estimates. Health services development Under this major programme heading, which forms the largest group of programmes, fall those activities aimed at the strengthening of national capacities for the planning, management and delivery of all aspects of comprehensive national health services, including primary health care. XV

xvi

As in previous programming periods, a large part of the regular budget resources of the Region is concentrated on this major programme. Increased provision has been requested by governments for the primary health care programme, which is of overriding importance in the achievement of an acceptable level of health and quality of life within the foreseeable future. The intercountry promotion of primary health care team will continue to cooperate in the training of primary health care workers and the planning and operation of primary health care development and research. Family health The programmes included in this major programme are maternal and child health, nutrition and health education. The amounts requested under the regular budget for those programmes show the increasing concern of governments and the priorities given. It is not possible at present to give any final indication of the amount of extrabudgetary resources for family health, including family planning, which will become available from, for example, UNICEF and UNFPA, but is expected that, as in previous years, considerable funds will be made available. It is recognized that malnutrition must be overcome in order to attain the Organization's goal of an acceptable level of health for all by the year 2000, and governments are giving more attention to activities to be carried out under the nutrition programme. Member States have been asked to give the highest priority to combatting malnutrition. In the Western Pacific Region a team will collaborate with national staff in the development of national food and nutrition policies and programmes. In health education, emphasis will be placed on the establishment of courses to encourage community participation in health development. The Special Programme of Research, Development and Research Training in Human Reproduction also belongs under this major programme. Considerable activities are programmed in this field in the Region by WHO Headquarters, largely with extrabudgetary funding. The programme, carried out in full collaboration with Member States of the Region, has major significance for health and development. Mental health A medium-term programme has been prepared for mental health which will facilitate the planning of the programme. There is an increasing awareness of the importance of the programme, which includes control of the abuse of alcohol and drugs, but under which collaboration will be extended mainly by applying knowledge of pyschosocial factors to the promotion of community participation and the prevention and treatment of mental illness.

Prophylactic, diagnostic and therapeutic substances Growing recognition of the importance of providing essential drugs, either by producing them locally, through bulk purchasing, or by any other suitable means, has led Member States to request increased collaboration under this major programme. The study of medicinal plants and dissemination of information on the subject has become a matter of priority. Vaccine production and quality control in support of the Expanded Programme on Immunization will continue. It is anticipated that extrabudgetary funds will become available so that collaborative activities can be increased. Training of starr and consultant services will also be made available from intercountry sources. Communicable disease prevention and control Communicable disease prevention and control will continue to be of the utmost significance in the achievement of an acceptable level of health by the peoples of the Western Pacific Region. This major programme heading includes the Expanded Programme on Immunization. It is anticipated that continued cooperation will be given in the assessment of national immunization programmes for the six diseases under the programme, which are diphtheria, pertussis, tetanus, tuberculosis, poliomyelitis and measles, as well as in vaccination programmes against other_diseases prevalent in certain parts of the Region. Epidemiological surveillance of the diseases under the Expanded Programme on Immunization is being strengthened. It is hoped that Member States will request collaboration in the development of national epidemiological services. Special efforts will be made in the prevention and control of acute respiratory infections and diarrhoeal diseases, still the greatest causes of mortality and morbidity in developing countries. will include intensified research, particularly in acute respiratory illness. This

In addition to the continued attention given to the "traditional" diseases, against which control measures are already being taken, such as malaria and other parasitic diseases such as schistosomiasis and filariasis, and to the bacterial diseases, such as cholera, tuberculosis and leprosy, there is increasing awareness of the need to control diseases such as dengue haemorrhagic fever and hepatitis. Collaboration in the control of sexually transmitted disease will be emphasized. For the first time, there is a specific programme heading for the Prevention of blindness, which aims at the adequate provision of eye care for all. Intercountry teams and courses play a significant part in all the above-mentioned activities. Extrabudgetary funds are anticipated. xvii

xviii

Noncommunicable disease prevention and control The growing importance placed by Member States on noncommunicable diseases is evidenced by the greatly increased support requested under this major programme heading. Intercountry activities for cancer, cardiovascular diseases and oral health provide for consultant services and training of national staff. Attention is also being directed to the metabolic diseases, such as diabetes. Promotion of environmental health Provisions under the promotion of environmental health programme show a marked increase for the 1980-81 biennium. The regular budget will, it is anticipated, be reinforced by sizable extrabudgetary funding. A healthy environment is of paramount importance in achieving the Organization's aim of an acceptable level of health by the year 2000. Activities under this major programme relate to collaboration with Member States in the development of basic sanitary measures, in the control of environmental hazards which are now of considerable national concern and in the development of food safety programmes. A regional centre for the promotion of environmental planning and applied studies has been established in Malaysia. A large proportion of the environmental health activities will be carried out through that Centre, whose functions are set out elsewhere in this document (see page 320). In addition to endeavours to achieve the aims of the Organization, determined efforts must be made to attain the targets established for the International Drinking Water Supply and Sanitation Decade and to meet the needs of those populations deprived of such services • . Intercountry activities include consultant services and training courses and seminars under all programme headings. Health manpower development The first medium-term programme prepared in the Region was that for health manpower development. It has been endorsed by the Regional Committee for transmittal to the Director-General for inclusion in the global medium-term programme which, in turn has been endorsed by the World Health Assembly. There has,

1 see resolution WHA31.36

therefore, been an opportunity to take its contents into consideration in preparing the proposals for 1980-81. As the need for trained health personnel of all types grows, the development of health manpower continues to receive high priority in the Region. It is realized that the type of training given to prepare health workers for all types of health services is of utmost importance. This involves close collaboration with the national agencies responsible for training health personnel and those responsible for the delivery of health care. Continuing education for health workers must also be provided as well as collaboration in the support and development of institutions for the preparation of teachers of health personnel. Support from UNDP for this purpose has come to an end but it is anticipated that funding from other extrabudgetary sources will become available. Health information The work of the regional adviser responsible for health statistics also relates to other information activities, as is shown under the information systems programme. An important part of the health statistics programme is the keeping of medical records and the keeping of vital, health and hospital statistics. Interest in those activities continues and governments are encouraged to expand their services. Continuing emphasis is placed, in the health literature services programme, on the strengthening of national library services and the provision of learningand reference material. Information material on WHO and its activities is produced and distributed and a proposal is made under the intercountry activities for a workshop on the promotion of health information. General services and support programmes Proposals, given in detail later in this document, relate to the cost of maintaining the Regional Office and the various services available to the Region in support of programme activities. Extrabudgetary funds Indications have been given in the budgetary tables, where they are known, of support anticipated from UNDP, UNFPA, UNICEF and other international and bilateral agencies.

xix

Brief summary of allocations The highest proportion of resources is allocated to activities under the major programme Health services development, which is a logical development as it includes activities for the promotion of primary health care and the planning and management of health services. Next in order of importance, according to the requests made by governments, are communicable disease prevention and control and health manpower development, which indicates the growing trend for governments to concentrate more on the planning and development of health services and the education of personnel to carry them out. The effective working budget proposed for the biennium amounts to US$32 495 000.

SUMMARIES

SUMMARY OF REGIONAL HEALTH PROGRAMME:

ESTIMATED OBLIGATIONS BY SOURCE OF FUNDS

1978-1979 US$ Regular budget Other sources: Voluntary Fund for Health Promotion .••••.•••...•.....•...••••• United Nations Development Programmes .•.••••.•.••..•.•.•.••••• United Nations Fund for Population Activities •••.••••••••..••. United Nations Children's Fund ••••••..••.•••••••••••••••••.••••. Trust Funds •..•....••...•...•...................•.......•...•.

1980-1981 US$ 32 495 000

26 633 000

4 599 700 2 266 400 2 239 200

667 900 2 325 900 1 541 000 49 000

137 400 9 242 700

93 900 4 677 700

Total - Other sources Total

----------

35 875 700

----------

37 172 700

SUMMARY BY MAJOR PROGRAMME, PROGRAMME AND SOURCE OF FUNDS

1978-1979 Major programme/programme Regular budget US$ 1.3 2. 1 2.2 Regional committee •••••••••••••• Executive management •••••••••••• General programme development and management 1 043 400 1 302 300 135 800 2 lt81 500 2.1t 2.5 Research promotion and development Regional Director's development programme .•.•••••••••••••••••..•

Other sources US$

Total US$ 111 000 221 100

Regular budget US$ 131 000 241 800

1980-1981 Other sources US$

-Total US$ 131 000 241 800

111 000 221 100

2. 2. 1 General programme development 2.2.2 Country health programming .• 2.2.3 Information systems programme

350 000 42 500 392 500

1 393 400 1 344 800 135 800 2 874 000 1 249 !tOO

1 181 000 1 689 400 344 100

350 000

1 531 000 1 689 400 31tlt 100 3 561t 500 1 249 900

3 214 500 1 249 900 643 600

350 000

1 2lt9 400

643 600

3. 1 Health services development 3. 1.0 3. 1. 1 3. 1.2 3. 1. 3 3. 1. 4 3. 1. 5 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 •••• 422 200 2 713 300 377 900 247 300 112 800 581 800 333 300 4 788 600 3.2 Family health Programme planning and general activities •••••••• Maternal and child health ••• t~utri tion. .................... Health education •••••••••••• 123 000 1 125 900 115 600 1 364 500 123 1 490 580 651 000 100 300 500 166 600 336 800 335 800 110 000 588 800 4 050 100 713 700 247 300 222 800 581 800 409 500 22 800 6 836 800 645 900 3 572 600 963 700 161 900 27 000 865 000 231 600 6 467 700 328 400 51 800 179 900 98 000 7 000 974 300 3 624 400 1 143 600 161 900 125 000 872 000 231 600 7 132 800

3. 1. 6

76 200 22 800 2 048 200

665 100

3.2.0 3.2.1 3.2.2 3.2.4

138 000 504 200 195 600 837 800

2 285 200 29 100 2 314 300

2 423 200 533 300 195 600 3 152 100 198 800

364 200 580 300 535 900 480 400 404 400

2 844 900 404 400

3.3

Mental health •••.••••••••••••••••

198 800

SUMMARY BY MAJOR PROGRAMME, PROGRAMME AND SOURCE OF FUNDS

1978-1979

1980-1981

Major programme/programme

Regular budget US$

Other sources US$

Total US$

Regular budget US$

Other sources US$

Total US$

3.11

Prophylactic, diagnostic and therapeutic substances 28 000 1 171 800 396 600 1 596 1100 196 000 196 000 28 000 1 171 800 592 600 1 792 400

Programme planning and general activities •••••••• 3.11. 1 Drug policies and management 3.4.2 Pharmaceuticals and biologicals ••••••••••••••• 3.11.0

268 600 1 213 300 1 .1181 900

210 800

479 400 1 213 300

210 800

1 692 700

11. 1

Communicable disease prevention and control 534 800 659 000 1

Programme planning and general activities •••••••• 11.1.1 Epidemiological surveillance 11.1.2 Malaria and other parasitic diseases ......•.•....••... Bacterial, viral and 11.1.3 mycotic diseases •••••••••• 11.1.5 Expanded programme on immunization •••••••••••••• 11.1.6 Special prograllllle for research and training in tropical diseases ••••••••• 4. 1. 7 Prevention of blindness ••••• 4.1.8 Vector biology and control •• 11.1.0

254 600 323 200 1

534 800 913 600 1 597 500 2 903 000 820 900 602 800 141 000

498 800 626 500 1 519 1100 8511 1100 1 053 900

254 500 256 000 241 600 12 000 120 000

498 800 881 000 1 775 1100 1 096 000· 1 065 900 120 000 150 000 242 500 5 829 600

274 300

1 039 700 792 200

863 300 28 700 602 800

141 000 4 441 000 3 072 600

150 000 242 500 4 945 500 884 100

7 513 600

4.2

Noncommunicable disease prevention and control Programme planning and general activities •••••••• 47 500 8 000 230 000 30 300 315 800 47 500 8 000 230 000 30 300 315 800 199 223 107 407 000 300 300 700 199 223 107 407 000 300 300 700

4.2.0

4 .2. 1 Cancer ..••••••••••.••••••..• 4.2.2 Cardiovascular diseases ••••• 4.2.3 Oral health ••••••••••••••••• 4.2.4 Other noncommunicable disea.ses •.••••.•...•....•.

159 000 1 096 300

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 activities •••••••• Environmental health planning and management •••••••••••• Basic sanitary measures ••••• Recognition and control of environmental hazards ••••• Food safety •••••••••••••••.• 218 400 518 900 495 400 357 500 64 800 1 655 000 341 600 563 700 10 000 915 300 218 400 860 500 1 059 100 367 500 64 800 2 570 300 230 600 1 119 800 549 100 487 500 62 700 2 449 700 292 400 331 300 489 000 1 112 700 230 600 1 412 200 880 400 976 500 62 700 3 562 400

SUMMARY BY MAJOR

PROGR~~'

PROGRAMME AND SOURCE OF FUNDS

1978-1979 Major programme/programme Regular budget US$ 6.1 Health manpower development Programme planning and general activities •••••.•• Health manpower planning and management ••• -. •••••••• Promotion of training ••••••• Educational development and Support ...................

1980-1981 Total US$ " ... ,

Other sources US$

Regular budget US$

Other sources US$

Total US$

6.1.0 6.1.1 6. 1.2 6.1.3

283 700 12 000 5 016 600 555 300 5 867 600 134 500 110 000 244 500

283 700 12 000 5 151 100 665 300 6 112 100

421 600 309 900 3 417 100 1 257 000 5 405 600 61 200 61 200

421 600 309 900 3 478 300 1 257 000 5 466 800

7.1

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

7 .1.1 7. 1.2 7. 1. 4 7 .1.5

...........

171 300 352 200 80 400 149 900 753 800

42 900 416 200 52 100. 143 900 655 100

42 900 416 200 52 100 143 900 655 100

8.1

General services and support programmes Programme planning and general activities •••••••• Staff development and .training ................. .

8.1.0 8.1.1

263 300 24 000 178 600 92 800 1 311 300

263 300 5 100 26 000 13 400 44 500 24 000 183 700 92 800 1 337 300 176 000 197 100 2 274 200

290 600 24 ooo 224 500 102 800 475 700 183 300 212 200 2 513 100 28 600 15 500 44 100

290 600 24 000 224 500 102 800 1 504 300 198 800 212 200 2 557 200

8.1.2 Personnel .................. . 8. 1 •. 3 Supplies ................... . 8.1.4 Conference, office and building services •••••••••

8. 1.5 Budget ••..•••••....•........ 8.1.6 Finance and accounts ••••••••

162 600 197 100 2 229 700

Total

26 633 000

9 242 700

35 875 700

32 495 000

4 677 700

37 172 700

----------

---------

----------

---------

----------

SUMMARY BY MAJOR PROGRAMME AND ORGANIZATIONAL LEVEL

1978-1979

1980-1981

Regular budget US$ 1.3

Other sources US$

Total US$

Regular budget US$

Other sources US$

Total US$

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

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

111 000

131 000

111 000 2. 1

111 000

131 000

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

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

221 100

241 800

221 100 2.2

221 100

241 800

General programme development and management Regional Country or area .•••....•..• Intercountry ..•.•.•..••••••

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

560 200 1 302 300 619 000 2 481 500

392 500 392 500

560 200 1 302 300 1 011 500 2 874 000

611 200 1 689 400 913 900 3 214 500

350 000 350 000

611 200 1 689 400 1 263 900 3 564 500

2.~

Research promotion and development Regional .................. .

Country or area •••••••.•... Intercountry ••••••••••••.••

2'l9

~00

1 249 400 1

2'l9 900 249 900

1 249 900 1 249 900

1 2'l9 400 2.5 Regional Director's development programme Regional .................. .

2'l9 400

Country or area ••..••••••.• Intercountry •••.•••.••.•••.

643 600 643 600

3.1

Health services development Regional .................. .

Country or area •••••••••••• Intercountry ..••.........••

3 362 100 1 426 500 4 788 600

1 818 900 229 300 2 048 200

5 181 000 1 655 800 6 836 800

4 944 800 1 522 900 6 467 700

665 100 665 100

5 609 900 1 522 900 7 132 800

SUMMARY BY MAJOR PROGRAMME AND ORGANIZATIONAL LEVEL

1978-1979 Regular budget US$ 3.2 Family health Regional Country or area Intercountry ••.•••••••••••• Other sources US$ Total US$ Regular budget US$

1980-1981 Other sources US$ Total US$

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

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

287 600 550 200 837 800

1 693 000 621 300 2 314 300

1 980 600 1 171 500 3 152 100

647 100 833 300 1 480 400

749 100 615 400 1 364 500

1 396 200 1 !148 700 2 844 900

3.3

Mental health Regional Country or area ••.•••••..•• Intercountry ••••.••••••..••

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

29 500 169 300 198 800

128 600 275 800 404 400

3.4

Prophylactic, diagnostic and therapeutic substances Regional Country or area Intercountry ...............

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

1 294 100 187 800 1

11 !tOO 199 400 210 800

305 500 387 200 692 700

430 600 165 800 596 400

196 000 196 000

626 600 165 800

481 900

1 792 400

4. 1

Co~unicable

disease prevention

and control Regional ................... Country or area Intercountry .•..•..••••..••

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

1 362 100 3 078 900 4 441 000

2 007 500 1 065 100 3 072 600

3 369 600 4 144 000 7 513 600

1 504 500 3 441 000 4 945 500

579 000 305 100 884 100

2 083 500 3 746 100 5 829 600

4.2

Noncommunicable disease prevention and control Regional Country .................... Intercountry •••••••••••••.•

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

12 000 303 800 315 800

716 600 37'9 700 1 096 300

5. 1 Promotion of environmental health Regional Country •..•••.••••••••.•••• Intercountry •••••.•••.•.•••

................... 845 700 809 300 1 655 000 871 200 114 1('fl 915 300

1 716 900 853 400 2 570 300

1 17'9 900 1 269 800 2 449 700

1 018 800 93 900 1 112 700

2 198 700 1 363 700 3 562 400

SUMMARY BY MAJOR PROGRAMME AND ORGANIZATIONAL LEVEL

1978-1979

1980-1981

Regular budget US$ 6. 1

Other sources US$

Total US$

Regular budget US$

Other sources US$

Total US$

Health manpower development Regional Country or area •••••••••••• In.ter,country •••••••••••••.•

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

5 198 000 669 600 5 867 600

9 100 235 400 244 500

5 207 100 905 000 6 112 100

4 365 000 1 040 600 5 405 600

61 200 61 200

4 426 200 1 040 600 5 466 800

7. 1

Health information Regional .•••••••.••••••.••• Country or area .••••••••••• Intercountry •••••••••••..•• 497 200 161 900 94 700 753 800 497 200 161 900 94 700 753 800 574 700 42 900 37 500 655 100 574 700 42 900 37 500 655 100

8.1

General services and support programmes Regional Country or area .•.••••••.•• Intercountry •••.•.•••......

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

2 205 700 24 000 2 229 700

44 500

2 250 200 24 000

2 489 100 24 000 2 513 100

44 100

2 533 200 24 000

44 500

2 274 200

44 100

2 557 200

Total Regi ona 1 ••••••••••••••••••.

3 595 200 13 855 300 9 182 500 26 633 000

44 500 6 411 100 2 787 100 9 242 700

3 639 700 20 266 400 11 969 600 35 875 700

4 04 7 800 16 649 400. 11 797 800 32 495 000

44 100 3 269 200 1 364 400 4 677 700

4 091 900 19 918 600 13 162 200

Country or area •••. ~ .•.•••• Intercountry •....•.••.•••••

----------

---------

----------

---------

----------

37 172. 700

ll.! REGULAR BUDGET 1978-1979 AND 1980-1981 BY APPROPRIATION SECTION WITH PERCENTAGES TO THE TOTAL

Estimated obligations Appropriation section

Percentages

1978-1979 US$

1980-1981 US$

1978-1979

1980-1981

Policy organs .................................... .

111 000 3 952 000 7 307 100 4 756 800 1 655 000 5 867 600 753 800 2 229 700

131 000 5 349 800 9 948 900 6 041 800 2 449 700 5 405 600 655 100 2 513 100 32 495 000

0.42 14.84 27.44 17.86 6.21 22.03

0.40 16.46 30.62 18.59 7.54 16.64 2.02 7.73

General programme development, management and coordination. ................................. .

3. l.!. 5. 6.

Development of comprehensive health services •••••• Disease prevention and control •••••••••.•••••••••• Promotion of environmental health •••.••••••••••••• Health manpower development ••••••••••••••••••••••• Health information •••...•.•.•••.•..••...••••..••..

General services and support programmes Total

26 633 000

==========

----------

------

100.00

-----------

100.00

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 Constitution. The estimates cover expenses directly identifiable with the holding of a regular session in September 1980 and again in September 1981. 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 Developing 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.

MAJOR PROGRAMME:

1.3

REGIONAL COMMITTEE

Estimated obligations Regular budget Other sources Total

US$ 1978-1979 Regional Country or area .................................. .

US$

.......................................... Intercountry ...................................... Total 1980-1981

111 000

Regional ......................................... . Country or area ...........•.............•.....••..

131 000

Intercountry

...................................... Total 131 000 131 000

Increase (decrease) in 1980-1981 over 1978-1979 Regiooal ......................................... . Country or area .................................. . Intercountry .•......••....................•......•

20 000

Total

20 000

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 authority of the Director-General. Within the general programme of work and the policies established by the World Health Assembly, he is responsible for the planning and execution of the WHO regional programme. He formulates the proposed programme budget for submission to the Regional Committee, of which he is ex-officio secretary, and to this end maintains direct contact with governments of the Member States of the Region and with international organizations and professional bodies. The Regional Director ensures coordination of WHO regional and country programmes and keeps the Director-General informed of major developments affecting the health situation of the Region.

20 MAJOR PROGRAMME: 2.1 EXECUTIVE MANAGEMENT

Estimated obligations Regular budget Other sources Total

US$ 197B-1979 Regional Country or area .................................. .

US$

221 100

Intercountry Total 19B0-19B1 Regional Country or area .................................. . Intercountry .......................... ·· .......... .

221 100

241 Boo

241 BOO

Total Increase (decrease) in 19B0-19B1 over 197B-1979 Regional Country or area ..............................•....

241 Boo

241 BOO

20 700

Intercountry Total 20 700 20 700

Major programme: General programme development and management Programme: General programme development

No. 2.2

2.2.1

Objectives To collaborate in the preparation, execution and evaluation of health plans, programmes and development efforts in accordance with periodically revised or confirmed health policies; to promote 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 socio-economic development plans and current social and economic activities, with a view to reducing health hazards and increasing health benefits. Approach Strengthening of national capabilities in the field of management by: (a) (b) developing appropriate management methods, processes and techniques; and developing executive and middle management skills in public administration in health and related agencies.

This will be achieved through: (a) (b) (c) (d) (e) the coordinated efforts of various academic institutes; organization of regional and national workshops and seminars; related national activities in which WHO will collaborate; coordinated efforts in cooperation with health related national institutions; coordinated efforts in cooperation with multilateral and/or bilateral assistance agencies. 21

F.fforts will he made to institutionali7.e programme management support activities by organizfng available national resources for consultation, training and research. It is envisaged that national collaborating centres for health programme management will be developed to provide the necessary expertise to support country health programming on a continuous basis. The programme provides support in the development of management procedures, methods and techniques in the fields of medium-term programming, management information systems and programme evaluation aimed at strengthening capabilities for the implementation of programmes of collaboration. Such activities are undertaken through (a) close collaboration between Headquarters and the Region in development activities; (h) the organization of interregional and regional workshops in which both WHO and national staff participate; (c) consultations with national officials; and (d) the organization of training programmes for both WHO and national staff. They are carried out through the closely coordinated efforts of the Information systems and Staff development and training programmes (see 2.2.3 and 8.1.1.). Review Management training In support of the country health programming process, training courses in health programme management have been conducted for senior public administrators in health and related fields, in Malaysia, Papua New Guinea, Philippines and Tonga. Courses on the same subject have also been conducted for the staff of the South-East Asia and Western Pacific Regions with support from Headquarters. Management studies and research Operational research studies on the rural health services have been completed in the Republic of Korea, resulting in recommendations on redistribution of the functions of various health personnel and on resource utilization. Collaboration in national primary health care research and development activities has been initiated in the Philippines. Management research studies have focussed on the development of simple approaches to the planning, implementation and evaluation of community health development programmes by the communities themselves and have included assessment of information requirements. Development of national centres for health programme management In conjunction with the initiation of country health programming in the Philippines, national workshops have been held on the concept of developing a national collaborating centre for health programme management.

Preliminary studies have been undertaken with the Institute of Social and Administrative Studies, University of the South Pacific, as a potential collaborating centre which would serve all the South Pacific countries or areas. Management advisory services Consulting services in management have been provided to the Project Management Staff, Department of Health, Philippines in the implementation of the restructured rural health services project. They include consultations on executive management, proposals for project activities, design and formulation of project components such as delivery of primary health care, and provision of technical support in conducting sub-national seminars related to project implementation. Consulting services in management have also been provided to Papua New Guinea in identifying major administrative issues related to implementation of the country health programme. Activities related to country health programming and socio-economic analysis, financial analysis, programme evaluation and information systems development are carried out under separate programmes (see 2.2.2, 2.2.3, 3.1.1, 3.1.2 and 8.1.1). Office of the Director of Health Services This programme heading also covers the Office of the Director of Health Services for the Western Pacific Region, which includes the Assistant Directors of Health Services and supporting staff, and which advises the Regional Director on the technical aspects of all the Organization's health activities in the Region. 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 direct and coordinate the activities of the technical units at the Regional Office; to provide technical support to WHO Representatives and field staff in carrying out their activities, 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 in health and related activities as well as with those contributing funds for projects in which WHO cooperates. 23

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 use of savings following changes in government priorities, submission of ad hoc requests and shifts in available financial resources.

PROGRAMME:

2.2.1

GENERAL PROGRAMME DEVELOPMENT

Estimated obligations Regular budget Other sources Total

US$ 1978-1979 Regional Country or area Intercountry ......................................

US$

.......................................... ................................... Total 1980-1981

560 200 483 200 1 043 400 350 000 350 000

560 200 833 200 1 393 400

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

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

611 200 569 800 1 181 000 350 000 350 000

611 200 919

Boo

1 531 000

Increase (decrease) in 1980-1981 over 1978-1979 Regional .......................................... Country or area Intercountry Total

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

51 000 86 600 137 600

Programme: Country health programming

No. 2.2.2

Objectives To encourage the strengthening of national capacities for planning and management of comprehensive national health services, including the necessary technical, administrative and legal reforms, as well as logistical support; to promote closer cooperation among all services concerned with health promotion and to integrate them into a single system where appropriate; to collaborate in the preparation, execution and evaluation of health plans, programmes and development efforts in accordance with periodically revised or confirmed health policy. Approach The present country health programming capability of the Western Pacific Regional Office is still limited and it may be difficult to respond promptly to requests for cooperation whenever the implementation phase takes place in countries. To upgrade the Regional Office's capability, it is intended to provide short intensive training in country health programming to WHO public health advisers, country liaison officers, and senior WHO advisers to health services development programmes, so that they can provide the necessary technical collaboration and support in the management of country health programmes. It will be necessary for the country health programming capability in each country or area to be monitored, based on an inventory of staff with country health programming/national health planning training and experience. Training needs will be identified and the necessary opportunities for training will be created. In order to ensure the continuous management support in training, research and development required for country health programming, it is expected that four national collaborating centres for health programme management will be developed in Fiji, Malaysia, Papua New Guinea and Philippines. The centre in Fiji will cover the South Pacific area. Technical cooperation will be provided upon request in developing the centres.

In enumeratin~ the components for country health pro~ramming, it is to be horne in mino that its very nature requires interdisciplinary and multiprogramme involvement. The programmes most involved are the follow:in~:

General programme development (2.2.1) under which collaborative management training and research activities are undertaken; and Health services planning and management (3.1.1) under which collaborative activities for country health programming are undertaken. Review Activities in country health programming were initiated in collaboration with Member States in the Region during the period under review. Drafts of Phase 1 in their country health programmes have been prepared with Fiji, Papua New Guinea and Solomon Islands. Samoa has completed both Phase 1 and Phase 2. The country health programme of the Lao People's Democratic Republic has been reviewed and reformulated. Initial studies for developing country health programming have been undertaken in the Philippines. In support of these collaborative activities, national training courses in country health programming have been conducted in Papua New Guinea, Philippines and the South Pacific. They are intended to provide a general orientation in the country health programming process to senior administrators in health.and related sectors. They are closely related to those undertaken under General programme development (see 2.2.1.) Future of country health programming Promotional and advisory services for country health programming activities and the development of national collaborating centres for health programme management will continue in 1980-81. It is expected that regional activities for technical cooperation among developing countries will be undertaken in this field during the same period. Advisory services in health programme management and programme formulation related to country health programming will continue. National country health programming core groups will be further strengthened. By 1Q81, it is expected that seven countries in the Western Pacific Region will have initiated country health programming.

WHO representatives The system of WHO representation at country level, which is also included under this programme heading, constitutes a key element in the structure and function of the Organization in its cooperation with Member States. The aims of this representation include the following: 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 respectively; to coordinate action and cooperate with country offices or representatives of other organizations and agencies, particularly those of the United Nations.

PROGRAMME:

2.2.2

COUNTRY HEALTH PROGRAMMING

Estimated obligations Regular budget US$ 1978-1979 Regional " .......................................... Country or area Intercountry Other sources US$ Total US$

................................... ...................................... Total -

1 302 300 42 500 1 302 300 42 500

1 302 300 42 500 1 344 800

1980-1981 1 689 400 1

Regional Country or area Intercountry

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

1 689 400 1 689 400

689 400

Increase (decrease) in 1980-1981 o:ver 1978-1979 Regional country or area Intercountry

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

387 100 (42 500) 387 100 (42 500)

387 100 (42 500) 344 600

Programme: Information systems programme

No. 2.2.3

Objectives To cooperate with Member States in further developing national health information systems for the planning, management and evaluation of health services; to contribute to the development of a WHO regional information system for planning, implementation and evaluation of WHO programmes and activities. Approach Cooperating directly with governments on request, in the promotion and development of health information systems, including health statistical services. Promoting the integration of health statistics with other social, demographic and economic data/information systems. Developing and implementing a regional information system geared to the functions of the Western Pacific Regional Office but subject to overall compatibility with the global WHO Information Systems Programme. Providing methodological and technical support to staff in the development and utilization of the profiles (country, programme and project) developed as components of the information system, and in the establishment of appropriate updating and maintenance systems. Promoting interaction and interface between the WHO information system and national health information systems (or parts thereof) in countries or areas and programmes in which WHO is cooperating; promoting and participating in health information training programmes aimed at strengthening the capabilities of national and WHO staff to develop and use such systems.

Review In its efforts to improve the effectiveness and efficiency of information systems to support managerial functions at national and international level, WHO has been collaborating with Member States in the design and development of dynamic, responsive, integrated health management information systems to satisfy the information needs of ministries or departments of health in their planning and management functions. WHO has also been further improving its own internal information system, to provide adequate and appropriate support to the management functions associated with collaborative activities. Health management information systems development projects are operating in Malaysia and the Philippines. It is planned to initiate development activities in this area in Fiji and Papua New Guinea and to support the initiative being taken by the Republic of Korea. Training activities in those countries are facilitating the testing and implementation of information systems to support managerial functions at different echelons. Guidelines for the development of a national health information system are being prepared, following the experience gained in Malaysia and the Philippines. In addition regional workshops on national health information systems are scheduled for 1979. As part of the WHO regional information system, profiles of programmes and projects are being established. Country profiles will be established for a number of countries to support programme management functions in Member States of the Region. Training activities initiated through two workshops for the South Pacific area will be further expanded and courses undertaken in other countries relevant to their needs. Further effort will be directed towards the integration of WHO and national activities in health information systems development, with the active involvement of national staff.

PROGRAMME:

2.2.3

INFORMATION SYSTEMS PROGRAMME

Estimated obligations Regular budget US$ 1978-1979 Regional Country or area ••.••••••••••••••..••.••••.••••.•.• Other sources US$ Total US$

.......................................... 135 800 135 800 135 800 135 800 Total 1980-1981

Intercountry ..................................... .

Regional .......................................... Country or area .................................. . Intercountry Total Increase (decrease) in 1980-1981 over 1978-1979 Regional ......................................... . Country or area .................................. .

344 100 344 100

Intercountry Total

208 300 208 300

Major programme: Research promotion and development

No. 2.4

Objectives To plan, develop and coordinate the programme of biomedical research promotion and development within the Region; to develop new methods for the control of parasitic and infectious diseases that pose a public health problem in the countries or areas of the Region; to foster national self-sufficiency in biomedical and health services research. Approach Upgrading and supporting research institutions in fields relevant to WHO regional programmes. Developing multidisciplinary research projects which•make use of existing resources and encouraging cooperative efforts in research. Strengthening communication by exchange of research workers and through biomedical research information exchange. Regularly convening the Western Pacific Advisory Committee on Medical Research and its task forces to review programmes and formulate regional research priorities. Building up an information base of ongoing research in institutions in the Region. Promoting the rapid and effective application of existing technology. Stimulating countries to support research activities through financial or intellectual contributions. Strengthening the Institute for Medical Research, Malaysia as a regional centre which will provide epidemiological, statistical and nutritional support to scientists working in the area of parasitic and other communicable diseases within the Region. 33

34 Providing training in parasitic and infectious diseases related to modern advances in chemotherapy, immunology, 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 or have only recently been established and research planning in relation to priority health problems is almost non-existent. The policy of regional involvement in biomedical 1and health services research established by the World Health Assembly aims to rectify those deficiencies. The long-term aim is to establish national self-reliance in health research. The twenty-eighth session of the Regional Committee for the Western Pacific approved the establishment of a regional centre for research and training in tropical diseases at the Institute for Medical Research, Kuala Lumpur after a feasibility study, which it also endorsed, had been undertaken.

1 see resolution WHA30.40, WHO Official Records, No. 240, 1977, page 22.

MAJOR PROGRAMME:

2.4

RESEARCH PROMOTION AND DEVELOPMENT

Estimated obligations Regular budget US$ 1978-19 79 Regional Country or area Intercountry Other sources US$ Total US$

.......................................... ................................... ...................................... Total 1980-1981

249 400

1 249 400 1 249 400

1 249 400

Regional Country or area Intercountry

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

1 249 900 1 249 900

Increase (decrease) in 1980-1981 over 1978-1979 Regional Country or area Intercountry

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

500 500

Major programme: Regional Director's development programme

No.

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

MAJOR PROGRAMME:

2.5

REGIONAL DIRECTOR'S DEVELOPMENT PROGRAMME

Estimated obligations Regular budget Other sources Total

US$ 1978-1979 Regional Country or area .................................. .

US$

Intercountry Total 1980-1981 Regional Country or area .................................. . Intercountry Total Increase (decrease) in 1980-1981 over 1978-1979 Regional

643 600 643 600

.......................................... 643 600 Total

C6un try or area .................................. .

Intercountry

643 600 643 600

643 600

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.

PROGRAMME:

3.1.0

HEALTH SERVICES DEVELOPMENT PROGRAMME PLANNING AND GENERAL ACTIVITIES

Estimated obligations Regular budget US$ 1978-1979 Regional Country or area Intercountry Other sources US$ Total US$

.......................................... ................................... ...................................... Total 1980-1981

100 500 321 700 422 200

166 600 166 600

267 100 321 700 588 800

Regional Country or area Intercountry

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

184 700 461 200 645 900

328 400 328 400

513 100 461 200 974 300

Increase (decrease) in 1980-1981 over 1978-1979 Regional Country or area Intercountry

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

84 200 139 500 223 700

161 800 161 800

246 000 139 500 385 500

Programme: Health services planning and management

No. 3. 1. 1

Objectives To promote national capacities for the development of the various components of health services and their integration in a balanced manner as appropriate to the needs of each country or area; to collaborate in the development of regionalization and in the assignment of responsibility for integrated services at the local, regional and central level; at the local level as a support to primary health care services; to collaborate in the development of an organizational and functional relationship between health institutions and community based health services, in order to ensure their functional integration and that there is continuity in the delivery of health care at all levels for balanced prevention, treatment and rehabilitation suited to the needs of individuals, communities and countries; to collaborate in the functional and organizational design of health facilities as well as non-medical technical supportive facilities; to analyze the effects of different methods of financing health services in terms of equity and efficiency, and their effect on the-pattern of health service delivery. This includes the development of low-cost methods for the collection of relevant data; to promote development of the rural health services. Approach Continuing promotive and collaborative efforts with Member States in the Region in developing national skills, intra- and intersectorial organizational linkages and procedures for the identification of health and health services problems having priority for solution, and in formulating policies and programmes for ameliorating such problems. More specifically the approach will be through workshops preparatory to country health programming; the organization of regional and national training courses in planning and management; collaborating centres to be established; the provision of fellowships to attend degree courses and seminars; and the provision of technical information.

Promotinp;, in5tiatinp; and provi.ding advisory services in country planninp; and programming processes, including feasibi.Htv studies, and in i.mplement:lng, monitoring, and evaluating health services development programmes. Collaborating in carryinR out sociological, economic and operational studies for the development of more efficient and effective health service delivery systems, and in the broader national application of the results of such studies. Areas of research may include: patterns of operation, overall design of the health services network and its organizational structure, decentralization, en~anced community participation in collaboration with primary health care, financ:l.ng of health care, staffing and workload ana1vsis, logistics and health information. Collaborating in developing national skills in puhli.c health and hospital administration, in the architectural design of health facilities, in the maintenance and repair of medical equipment through provision of technical support to continuing activities in existing national insti.tut:ions, and in the development of training programmes. Collaborating in research activities on the financing of health services, by providing advisory services in health economics, financing and social security, and in training in these fields. Review The most pressing problem is the inadequacy of health service coverage in most Member States in the Region which, in turn, i.s traceable to problems in the following areas: appropriate technology, availability of manpower, organization and coordination (intra- and intersectori.al), physical facilities, establishment of policy, finance, and community participation. The health services development programme has addressed these constraints through training activities, provision of long-te~ advisory services, short-term consultants, research, and information exchange through seminars and the circulation of technical information. These programme activities are reviewed below under the headings of (1) training and (2) management and research. Training The WHO Regional Course in National Health Planning, which began in 1QoA, was evaluated and terminated in December 1076. The projects on health plannjng, systems analysis, and health services research were merged into a single intercountry health planning and management project which provides the necessary training with emphasis on country health programming. The first course under the intercountry project was given in 1Q76 in the Philippines with parti.cipants from other countries and WHO staff, followed hy a national course in 1977 in the Philippines, and one in Papua New Guinea j_n the same year. Another course :is pJanned i.n 1978 in Tonga. 41

The loose-leaf manual of guidelines to assist national staff in planning has been printed and distributed to Member States. It is one of the basic documents used in management/planning courses given by the intercountry project and at the University of the Philippines; it will also be used at the University of Malaya. The development of a collaborating centre/consortium in the Philippines for management and for country health programming, expected in the second half of 1978, will be of benefit to other Member States which may be able to send staff to its training courses. It could also be a source of consultants or experts for providing technical cooperation among developing countries. During the period 1978-79, three components of the intercountry hospital management, design and maintenance project are expected to be initiated: (1) (2) training in hospital administration, to take place in the Philippines; Training in the design of health facilities, to take place in the Philippines; Training in the maintenance and repair of medical equipment, to take place in New Zealand.

(3)

WHO has also been cooperating with the Philippines in the training of engineers and technicians in the repair and maintenance of X-ray and other equipment. Management and research The programme of cooperation covers the strengthening of health care organization and studies to improve the delivery of health care to the population. Such cooperation is in the form of long-term advisory staff, consultants, and visits from regional advisers and intercountry project staff. Cooperation has been extended to the Philippines in the restructuring of the rural health services and in developing primary health care. An operational research study in the Republic of Korea was completed in 1977. It is expected that further studies and developmental activities in health centres and hospitals will follow, from 1978 onwards. In New Hebrides, WHO is cooperating in such priority programmes as the promotion of E. rironmental health and development of primary health care. In Papua New Guinea, because of staff shortages, activities have been limited to the development first of nursing services and later of statistical services. By mid-1978, on recruitment of a medical officer, it is expected that the scope of activities will be expanded to include health services administration, primary health care and training.

Technical cooperation with Singapore in the construction of a medical centre began in 1975. Collaboration in developing the national hospital in Samoa, which started early in 1975, is expected to terminate in June 1978. In the areas of health economics and the financing of health services, activities carried out or planned include an indepth study on hospital expenditure (1977-78) and a proposed study on the financing of health services in Papua New Guinea, cost studies on the expanded programme on immunization in Papua New Guinea and Philippines (1978) and a cost-effectiveness analysis of the non-physician provision of family planning services in the rural Philippines (1978).

PROGRAMME:

3.1.1

HEALTH SERVICES PLANNING AND MANAGEMENT

Estimated obligations Regular budget US$ 1978-1979 Regi011al ..•...•.•..••.•••..•••.••••••.•.•••..•...•

Other sources US$

Total US$

Country or area •.••••..••.••••••••••••.•.•..•.•... Intercountry

....................................... Total 1980-1981

2 38-4 000 329 300 2 713 300

1 206 500 130 300 1 336 800

3 590 500 -459 600 -4 050 100

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

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

3 223 800 3-48 800 3 572 600

51 800 51 800

3 275 600 3-48 800 3 62-4 -400

839 800 19 500 859 300

( 1 15-4 700) (130 300) (1

(314 900) (110 800) (425 700)

Total

285 000)

Programme: Primary health care

No. 3.1.2

Objectives To collaborate with the Member States in the Region in: promotion and implementation of primary health care within the existing national health services; establishment of primary health care as part of the overall development programme; promotion and support of primary health care research and development with the aim of developing technical cooperation between countries; promotion, within a comprehensive national health system appropriate to the conditions and needs of each country or area, of the provision of primary health care to the whole population, ensuring that those who are at present underserved or at high risk and vulnerable are properly served. Approach Collaborating in: exchange of information on the development, training and technology of primary health care programmes; field studies, research, seminars and workshops on primary health care and individual and group study visits to primary health care programmes; cooperation, on request, in field projects; coordination of activities under the expanded programme on immunization and programmes in nutrition, environmental health, health laboratory services, maternal and child health and family planning, health education, community nursing, communicable disease prevention and control, traditional medicine, appropriate technology for health and any other related programmes;

organization of seminars, workshops, training courses and exchange of information on specific problems related to primary health care; coordination of activities with national and international agencies in the area of primary health care and rural development. Review Nine national seminars in seven countries or areas were held between November 1976 and October 1977 with the cooperation of WHO. A regional conference was held in November 1977 in Manila attended by participants from all Member States of the Region. A research and development programme has been initiated in Tacloban, Philippines in collaboration with the College of Medicine, University of the Philippines and the Department of Health. In 1978 and 1979, cooperation will be extended in the organization of two or three national seminars or workshops.

PROGRAMME:

3 .1. 2

PRIMARY HEALTH CARE

Estimated obligations Regular budget US$

Other sources US$

Total US$

1978-1979 Regional Country or area Intercountry

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

335 Boo 377 900 377 900 335 BOO

335 Boo 377 900 713 700

19B0-19B1 Regional Country or area Intercountry

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

505 Boo 457 900 963 700

179 900 179 900

6B5 700 457 900 1 143 600

Increase (decrease) in 19B0-19B1 over 1978-19 79 Regional Country or area Intercountry

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

505 BOO BO 000 5B5 BOO

(155 900) ( 155 900)

349 900 Bo 000 429 900

Programme: Workers' health

No. 3.1.3

Objective To promote the health of the working population, to control occupational health risks and to promote the humanization of work. Approach Cooperating in the formulation of policies, standards, guidelines and programmes for protection against occupational hazards. Cooperating in the development of occupational health programmes and services. Training various categories of personnel engaged in occupational health activities, through the organization of seminars, workshops or national courses. Developing methods for early detection of impaired health in workers. Promoting ergonomics and improvement of management-staff 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 many countries or areas of the Region, the occupational risk for workers is increasing. Lack of standards and regulations for protection against occupational hazards as well as lack of comprehensive programmes and services for workers exposed to occupational hazards can be found, even in industrialized countries. Generation of awareness of the importance of occupational ·health services has continued, with cooperation being provided to Malaysia and the Philippines and to the University of Singapore in strengthening the postgraduate course in occupational medicine.

PROGRAMME:

3.1.3

WORKERS' HEALTH

Estimated obligations Regular budget Other sources Total ---------------------------------------~--------------~------------------------------------------~

US$

1978-1979 Regional Country or area .................................. .

247 300 247 300

Intercountry Total 1980-1981 Regional Country or area .................................. .

161 900 161 900

Intercountry Total Increase (decrease) in 1980-1981 over 1978-1979 Regional Country or area ..••.....•••••••..••.•.•••...•••... Intercountry ..................................... .

(85 400) (85 400)

Total

Programme: Care of the aged, disability prevention and rehabilitation

No. 3.1.4

Objectives facilit~es

To study and analyze the extent of problems related to the physically handicapped and maintain for their rehabilitation;,

to train physiotherapists/rehabilitation specialists for the furtherdevelopment of disability prevention and rehabilitation as an integral part of national or local health planning. Appr-oach, ·. 'Providing assistance in evaluating the extent of problems related to the physically handicapped, assessing the needs, and drawing up comprehensive plans for future action taking into account the situation and resources of individual countries. Promoting collaboration and technical consultation between national and international organizations in the field of rehabilitation. Revie~

WHO has continuously provided fellowships for training the personnel required for rehabilitation services, particularly physiotherapists. Cooperation has been extended to the Lao People's Democratic Republic in health services administration and rehabilitation. The Organization is cooperating with the Republic of Korea by providing consultants and fellowships for medical rehabilitation of the disabled in industry.

PROGRAMME:

3.1.4

CARE OF THE AGED, DISABILITY PREVENTION AND REHABILITATION

Estimated obligations Regular budget US$ Other sources US$ Total US$ ~-----------------------------------------------------+------------------------------------------~

1978-1979 Regional Country or area .................................. .

112 800 112 800

110 000 110 000

222 800 222 800

Intercountry Total 1980-1981 Regional Country or area .................................. .

98 000 27 000 27 000 98 000

Intercountry Total Increase (decrease) in 1980-1981 over 1978-1979 Regional ......................................... . Country or area ................................... .

98 000 27 000 125 000

Intercountry Total

(112 800) 27 000 (85 800)

(12 000) ( 12 000)

(124 800) 27 000 (97 800)

Programme: Appropriate technology for health

No. 3.1.5

(1)

Health laboratory technology

Objectives To cooperate

developing national health laboratory services and related technical activities;

to cooperate in meeting the laboratory needs of curative and preventive health services with particular stress on the development of public health laboratory services and support to programmes for communicable diseases control and surveillance; · to promote improvement of coordination and management in laboratories including the development of standardization and quality c~ntrol; 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. Approach Where a national health laboratory service is at the initial development stage, advising on its development and organization. Defining and implementing priority laboratory programme activities related to needs at the periphery. Stress will be laid on the public health aspects of laboratory work and close cooperation with the epidemiological services. 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. Assisting in the training of laboratory personnel at regional and national levels. Supporting technical cooperation among developing countries, particularly in the training of technical laboratory staff, production and provision of reagents for laboratory work, local production of simple equipment, quality control in health laboratory technology and standardization of laboratory methods. Review Most of the problems in the organization of health laboratories in the Region are related to unbalanced and inadequate development of the laboratory services in relation to the expansion of health services; to laboratory activities being geared essentially towards curative medicine while public health or community health activities are neglected; and to 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 the comparability of results within laboratories is often 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 there is an urgent need for expansion of training programmes for technical laboratory staff, adapted to the needs of the countries concerned. (2) Objective To cooperate in the improvement and expansion of 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. Radiological technology

Approach ..;. Cooperating in establishing and developing radiation health programmes suited to the needs and resources of various countries or areas. Coordinating the activities of the radiation health programme to facilitate early optimal development of the radiation health services needed. Review Governments continue to show interest in developing and strengthening their radiological services. However, equipment and manpower continued 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 PhHippines and Singapore. Australia, Japan and New Zealand have their own primary standard dosimetry laboratories. The two SSDLs belong to the global IAEA/WHO network. Cooperation continues to be provided to the Philippines, while that extended to the Republic of Korea, which came to a standstill in 1976, is expected to resume later in 1978. It is expected that cooperation in the maintenance of X-ray and other medical equipment will be extended to the Lao People's Democratic Republic and Philippines later in 1978 and in 1979, preliminary support in the form of fellowships and supplies and equipment having already been provided. Cooperation under the intercountry project will also continue in 1978, mainly in the South Pacific. Courses on radiation protection, organized with the support of DANIDA, will be held in Manila in 1978 and 1979.

(3)

Primary health care and related relevant health technology

Objective To collaborate in the development and adaptation of simpl_e, low-cost;. and effective technologies in specific areas. Particularly to develop a mechanism for conducting research on and promoting the development of appropriate health technologies for primary health care, including traditional medicine, in the overall context of socio-economic development. Approach Collecting, evaluating and exchanging all relevant experiences, data and information on appropriate health technologies for primary health care. Collaborating in field studies and research conducted by national and international agencies. Organizing seminars and workshops at regional level. Organizing individual and group study visits. Collaborating and exchanging experience with international, bilateral and national agencies concerned with rural development. Review The development of appropriate technology for health is related to the pr:imary health care delivery system. Information exc"tange on medicinal plants was achieved through a regional seminar held ln Tokyo in 1977. A tour to study traditional medicine was carried out in Chlna in May 1Q78, with participants from three Regions of WHO, including the Western Pacific Region. As part of the research and development programme in primary health care, collaborative activities :tn the development of appropriate technology are planned for 1978 and 1Q7Q with the Institute of Health Sciences, Tacloban, Philippines. (Budgetary provisions for this part of the Appropriate technology for health programme are included under the programme Primarv health care, page 47.)

PROGRAMME:

3.1.S

APPROPRIATE TECHNOLOGY FOR HEALTH {HEALTH LABORATORY TECHNOLOGY)

Estimated obligations Regular budget US$

Other sources US$

Total US$

1978-1979 Regional Country or area Intercountry ............ ., • • • • • • • • • o . . . . . . . . . . . . oooooooooooo

oooo•••••o•ooooooooooooooo•oooooooo •<>•ooooooooooo-oo;~ooe•oooooqo

o o o o o o • o o o ..

354 300 227 500 581 800

Total 1980-1981 Regional Country or area Intercountry ...................................... •••••••••••••••••••••••• 0 ••••••••••••••••• •••••••••••••••••••••••••••••• 0 ••••

657 000 208 000 865 000

7 000 7 000

664 000 208 000 872 000

Total Increase (decrease) in 1980-1981 over 1978-1979 Regional .......................................... Country or Area .......... Intercountry "'"'"""'"''"'<11~"'"'"'*"'"'"~~"'"'•"'•11"'11"'"11"'11

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

302 700 (19 500) 283 200)

7 000 7 000

309 700 (19 500) 290 200

PROGRAMME:

3.1.5

APPROPRIATE TECHNOLOGY FOR HEALTH (RADIOLOGICAL TECHNOLOGY)

Estimated obligations ·Regular budget US$ 1978-1979 Regional Country or area Intercountry Other sources US$ Total US$

.......................................... ...................................... o o o o o o o o o o o o o o o o o o o o e o o o o o e o o o o o o o o

163 200 170 100 333 300

76 200 76 200

163 200 246 300 409 500

Total 1980-1981 Regional Country or area Intercountry GGOGOOO.G00000GOOOGOGOOG0000000.00000000000

•••••••••••••••••••••.••••••••••••

•

l/i<fi'GGGCioC!i&GG@GeG&GG$<i>0&$$GOG>G$00G00G$(!1Ge

211 600 20 000 231 600

Total Increase (decrease) in 1980-1981 over 1978-1979 Regional Country or area Intercountry •••• 0

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

48 400 ( 150 100) (101 700)

( 76 200) ( 76 200)

48 400 (226 300) ( 177 900)

Total

Programme: Health services research

No.

3.1.6

Objectives To test innovative approaches with particular reference to health services development, including primary health care and appropriate technology for health; to generate knowledge on a scientific basis with a view to providing more effective, efficient and equitable health care for defined populations. Approach Implementing research in the development of comprehensive health services throUgh research contracts, research training, a regional task force and working group, WHO collaborating centres and liaison with national medical research councils. Review The first research contract under the regional programme was awarded in February 1978, from extrabudgetary funds, to study alternative approaches to health care in an underserved area of the Philippines. The first training grant was awarded in May 1978 to a research worker from the Republic of Korea, since it is envisaged that a WHO collaborating centre in health services research will be designated in that country. It is expected that proposals for further research grants and research training grants will be generated in August 1978 when a working group organized by the Task Force on Health Services Research of the Western Pacific Advisory Committee on Medical Research will meet in Manila. The experience of the Medical Research Council of New Zealand in promoting health services research is being shared with other countries.

PROGRAMME:

3.1.6

HEALTH SERVICES RESEARCH

Estimated obligations Regular budget US$ 1978-1979 Regional Country or area ••..••.••••.•••.••••.•••••••....•.• Intercountry •••.•.•.•...•.....••...••••••.•....... Total 1980-1981 Regional Country or area .....••.••.•••••••.•.•.••..•.....•. Intercountry •..•••..••.....•.•...•.•....••.•....•. Total Increase (decrease) in 1980-1981 over 1978-1979 Regional Country or area ••.••••.• ,•...,•••••••...••••••••••.•••• Intercountry ..................................... .

Other sources US$

Total US$

22 800 22 800

(22 800) (22 800)

Total

Major progralllllle: Family health Programme: Programme planning and general activfties

No.

3.2

3.2.0

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.

PROGRAMME:

3.2.0

FAMILY HEALTH PROGRAMME PLANNING AND GENERAL

ACTIVITI~S

Estimated obligations Rep;ulAr budget US$

Other sources

Total US$

ust

1978-1979 Regional .......................................... Country or area ................................... Intercountrv ...................................... Total 1980-198_ 1 Rep;ional .......................................... Country or area Intercountry Total Increase (decrease) in 1980-1981 over 1978-1979 Regional Country or area Intercountry

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

123 000 123 000

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

123 000 123 000

Programme: Maternal and child health

No.

3. 2. 1

------------·----------·------------------------------·--------------------Objectives To reduce maternal., perinatal, infant and childhood mortality and morbidity and to promote reproductive health and the physical and psychosoc:tal' development of the child and the adolescent within the family context; to collaborate in the development and strengthen:tnp: of the family health component of health services, including family planning and welfare. More specifically: to contribute to the determination of those health problems of mothers and ch:tldren that can be controlled by prevention and early management, using modest means; those which could respond to remedial activjties in other fields; and those which require the intervention of specialized skUls; to participate in efforts to ascertain the relative importance for maternal and child health and for overall health, of the var-ious health problems of mothers and chUdren encountered in different countries, particularly under unfavourable conditions; to collaborate in the formulation and development of strategi.es and corresponding appropriate techniques · for the implementation of maternal and child health care and fertility regulation, particularly in underserved areas; to include the objectjves of maternal and child health programmes among those of the general health services; to convey adequately an understanding of the concept of maternal and child health in the training of health personnel at all levels; further to strengthen cooperation with national and other agencies responsible for aspects of development which affect health, growth, development and social adaptation, particularly with UNICEF, UNFPA and the IPPF.

Approach Identifying priorities in maternal and child health care. Determining general, particularly environmental, hazards to the health of mothers and children. Identifying and implementing modalities of service appropriate in different circumstances. Mobilizing and developing national resources to improve services, particularly to underserved communities. Coordinating activities with those of other programmes in health and other sectors. Review Pregnancy wastage is receiving increased attention. The possibility of influencing perinatal events by more adequate maternal care is being investigated. The high risk approach in maternal and child health care was implemented in a selected district of Peninsular Malaysia. Revision of training in maternal and child health, particularly programmes for nurse/midwives and auxiliary personnel, with practical training predominating, aim at promoting relevant knowledge and appropriate technology to improve the care of mothers and children, particularly in underserved communities. Growing interest in the medico-social needs of adolescents has prompted the organization of a regional working group to ascertain the various requirements and indicate possible interventions. Subjects for research reflect problems encountered in various countries or areas. They range from toxaemia in pregnancy and reduction in 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 in the outcome of diarrhoeal infections. The inclusion of oral rehydration as a tool in primary health care is the result of research undertaken in the Region on the feasibility and acceptability of that type of intervention. Evaluation of the expansion of effective fertility regulation methods, through non-medical services within the scope of maternal and child health care activities, was accelerated, mainly as a result of the recommendations of the regional seminar on new developments in fertility regulation held in November-December 1977. The multidisciplinary approach to programme development and evaluation of maternal and child health care continued to be emphasized. 63

PROGRAMME:

3.2.1

MATERNAL AND CHILD HEALTH

Estimated obligations Regular budget US$

Other sources US$

Total US$

1978-1979 Regional Country or area Intercountry o e e o • o • e o o • o o o o o o o o o o o o o o o o o o • o o e o o o o o o o o o

ooooooo••••••oeoo<~~oooo•oeoeoooooooo

ooeoooeoooooooooooo•ooooooooooeooooooo

25 000 113 000 138 000

1 663 900

621 300 2 285 200

688 900 734 300

Total 1980-1981 Regional Country or area Intercountry ooeooooo•••Q•oo&oooo•ooooe•••e•o•oooo•eo•oo

2 423 200

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

220 200 144 000 364 200

510 500 615 400 1 125 900 1

730 700 759 400 490 100

Increase (decrease) in 1980-1981 over 1978-1979 Regional Country or area Intercountry

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

195 200 31 000 226 200

( 1 153 400) (5 900) (1

(958 200) 25 100 (933 100)

159 300)

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; to collaborate with national and international bodies in conducting the operational or basic research needed for the implementation of these objectives. Approach Promoting the development of national expertise in nutrition. The extent of this expertise will vary with available resources. Thus in a large, well endowed, country the approach might be to develop a central unit, with multiple skills and professional staff at the periphery. While in a small country a single individual within the ministry, together with some skills in nutrition within teaching institutions, might have to suffice initially. In either case it is envisaged that nutrition personnel will be primarily supportive with service delivery being accomplished through regular line staff. 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 UNICEF, UNDP, World Food Programme, FAO and IBRD, in view of the multisectoral nature of the problem. Training of national staff and the provision of consultants in specialized areas.

Review The nutritional situation in the Region remains much as described in the programme statement for the previous biennium. There has been evidence of small improvements in some areas and definite improvements in some of the services being provided. Progress in the priority areas of the regional programme has been as follows: National food and nutrition policies 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 formulate 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. Nutrition surveillance From the work of WHO staff and consultants and the reports of national participants at a 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, analyzed and utilized, although most countries or areas now have some indication of community nutritional status either from surveys or from health returns. Work continued on incorporating nutritional status indicators into the routine health information reporting system, with the object of providing more specific and continuous information for use in planning. Nutrition activities in basic health services The integration of nutrition into the line health services continued, particularly good progress having been made in one country. The ability to detect malnutrition early and to rehabilitate the cases, improved slowly, the main limitation usually being the overall coverage of the health service. Although there was an expansion of source material on which to base nutrition education, the involvement of staff in education remained a weak area in several countries. With the introduction of primary health care concepts, including community involvement, this is an area needing further attention.

Nutrition training Through a total revision of the manual "Health Aspects of Food and Nutrition", the collaboration of consultants and staff and the provision of fellowships, efforts continued to upgrade the training in nutrition of those professionals who will be the leaders and trainers of health teams at different levels. With the acquisition by many countries of a basic pool of expertise in nutrition, attention tended to shift towards the incountry trai.ning of lower level workers, particularly those in pr1mary health care. Action against specific deficiencies With 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 has continued 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. A new development has been the possibility of childhood rickets being common in one country of the Region and field trials of different methods of prevention are under way.

68 PROGRAMME: 3.2.2 NUTRITION Estimated obligations Regular budget US$ 1978-1979 Regional Other sources US$ Total US$

.......................................... e . . . . . . . . . . . e • • • • • • e • • • • • • • "" • • II) •

Cou.ntry or area ....

Intercountry •••••••••••••••••••••••••••••••••••••• Total 1980-1981 Regional •••••••••oeoeeeee•oeeeoo•o•eooeoeeooooee.oo

181 200 323 000 504 200

29 100 29 100

210 300 323 000 533 300

Country or area .................................. .

Intercountry

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

196 400 383 900 580 300

Increase (decrease) in 1980-1981 over 1978-1979 Regional Country or area .................................. .

Intercountry Total

15 200 60 900 76 100

(29 100) (29 100)

(13 900) 60 900 47 000

Pro~ramme:

No. 3.2.4

Health education

Objectives To promote health education and information 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 in 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 to health programmes; to encourage and promote behavioural research in health and health education. Approach Promoting development of health education manpower, with emphasis on the preparation of medium level health education specialists, and the establishment of field practice areas in order to stress the desirability of combining classroom teaching with practical experience. Encouraging inclusion of health education in the basic training of various categories of health worker, and promoting programmes for the in-service training of field level personnel in the community approach and health education.

Supporting the development of specialization within health education, in areas such as media technology and behavioural research. Collaborating in the establishment and strengthening of national units for health education in the ministries of health and, wherever feasible, extending the network to give professional leadership to the provincial/district levels. Encouraging behavioural research on sociocultural factors which influence community response to health services, with a view to identifying and developing the health education components of priority health programmes. Strengthening national capabilities in 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 on training of teachers in school health education. Facilitating an integrated approach in health education, by encouraging multisectoral activities and interagency collaboration. Review Health education of the public continued to receive emphasis. A development of major significance was the establishment of a postgraduate course in Malaysia for training health education specialists. A special feature of this course is the emphasis placed on developing a programme for concurrent field training effectively to combine the teaching of health education theory with practical experience. A similar thrust has been made in the Philippines, by developing field practice areas for the task-orientated training of health workers in health education methods and approaches. Another important development has been the integration of health education into selected health programmes, based on community studies aimed at identification of sociocultural and behavioural factors influencing community response. A major effort in this direction was the enlisting of active community involvement in the decentralized antimalarial operations being carried out in Papua New Guinea through village councils and locally recruited spraymen. The psychosocial aspects of the leprosy control programme are also being studied in formulating strategies for enlisting community support in Papua New Guinea. A growing awareness of the need for media support for health programmes, both modern and folk media, has been observed. Facilities and resources for the use of audiovisual aids and mass media were augmented in Lao People's Democratic Republic, Malaysia and Papua New Guinea.

The team approach in promoting community self-help in improving rural water supply and sanitation in Gilbert Islands deserves special mention as an illustration of intersectoral collaboration in community development. Community support for the expanded programme on immunization in the Philippines presents still another example of an integrated approach in health education. Interagency training seminars were held in four countries as part of the approach in developing primary health care, to encourage intersectoral collaboration and promote teamwork and better understanding between those working at the community level. Attempts are under way to develop simple and practical methods for training field level health and allied workers in the community approach and health education. Progress was also made in including health education in the basic training of various categories of health worker, particularly that of health inspector and nurse. Efforts were also made to strengthen health education in relation to noncommunicable diseases, particularly in the field of drug abuse and prevention of road traffic accidents. Member States were encouraged to strengthen the health education infrastructure, and support in developing manpower through the fellowship programme was continued.

PROGRAMME:

3.2.4

HEALTH EDUCATION

Estimated obligations Regular budget US$ 1978-1979 Regional Country or area Intercountry • 0

Other sources US$

Total US$

.......................................... • 0 • 0 ••••••••••••••• 9 ••••• 0 ••••• 0 ••• •••••• 0 ••• 0 ••••••••• 0 ••• 0 •••••••••••

81 400 114 200 195 600

Total 1980-1981 Regional Country or area Intercountry eooooooooeo••••ooeoooeooo•eoeooeoo••••oooo •••••••••••••••••••••••••• 0 ••••••••

••••••••

••

•••••

•••••••••

•

•••••••

230 500 305 400 535 900

115 600 115 600

346 100 305 400 651 500

Total Increase (decrease) in 1980-1981 over 1978-1979 Regional Country or area Intercountry

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

149 100

115 600 115 600

191 200 340 300

264 700 191 200 455 900

Major programme: Mental health

No.

3.3

Objectives To promot~

mental health, including the prevention of mental diseases, alcoholism and drug abuse;

More specifically: to prevent and control psychiatric and neurological disorders and psychosocial problems such as those associated with drug and alcohol abuse; to develop strategies of intervention for the promotion of mental health, based on available resources and social relevance; to apply knowledge of psychosocial factors in promoting major public health activities, community participation and motivation of health workers to be effective. Approach Collaborating in training mental health personnel at all levels, with particular emphasis on staff delivering primary health care. Encouraging and promoting epidemiological studies and psychosocial research on problems related to mental health. Collaborating in the formulation and implementation of mental health policies. Assisting in the development of comprehensive mental health services with the aim of integrating them with general health, social and other public services. Promoting community interest and participation in all aspects of the enhancement of community mental health.

Designing appropriate mechanisms for coordination of the regional mental health programme. Providing a focus for the regular exchange of information within the Region on matters pertaining to mental health. Assisting in the identification and management of psychosocial factors adverse to health, including those associated with drug dependence and alcohol-related problems. Review Mental health has become of growing concern to many countries or areas of the Region. It is increasingly being realized that mental health services cannot be extended to the population at large from an isolated, institutionalized basis, but only through the peripheral health service system, i.e. integrated with the general health, social and other public services. This is particularly true of the mental health probJems arising from psychosocial factors now also evident in developing countries, such as those associated with drug and alcohol abuse, rapid urbanization, delinquency, and disruption of social patterns and value systems. There is also growing awareness that application of knowledge and techniques in mental health can greatly benefit other major health programme areas. To broaden the scope of the regional mental health programme, the post previously established under the intercountry prevention and control of drug abuse project has been converted into the position of Regional Adviser in Mental Health. Over the last few years high priority has been given to the training component of the mental health programme, with particular emphasis being placed on mental health nursing. A proposal for establishing a regional coordinating mechanism for the mental health programme will be submitted to the twenty-ninth session of the Regional Committee. Cooperation has been provided in the fields of drug dependence and alcoholism, and organization of a first series of working groups on drug dependence problems was completed in December 1976 with the working group on early intervention programme in drug abuse.

MAJOR

PROGRA~E:

3.3

MENTAL HEALTH

Estimated obligations Regular budget US$ 19'78-19 79 Regional Country or area •.•.••••..••••..•.•••.••...•.•••.•. Intercountry .•....•••••...••.....•..•.........•... Total 1980-1981 Regional ........................................... .

Other sources US$

Total US$

29 500 169 300 198 800

Country or area ....•.••.•••..........•...•........ Intercountry .....•...••....•....•......•....•.•... Total Increase (decrease) in 1980-1981 over 19'78-1979 Regional ••.........••.•...••.........•.•.....•..•. Country or area .....••.................•.......... Intercountry .......•••••..............•.•......... Total

128 600 275 800 404 400

99 100 106 500 205 600

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

No.

3.4

3.4.0

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.

PROGRAMME:

3.4.0

PROPHYLACTIC, DIAGNOSTIC AND THERAPEUTIC SUBSTANCES PROGRAMME PLANNING AND GENERAL ACTIVITIES Estimated obligations ~------------------------------------------

Regular budget US$

Other sources

Total US$

US$

1978-1979 Regional Country or area .................................. .

Intercountry Total 1980-1981 Regional Country or area .................................. .

28 000 28 000

Intercountry Total Increase (decrease) in 1980-1981 over 1978-1979 Regional .. ct •••• G • "' ••••••••••••••••••

o •

•••••••••

Country or area ••••..••••••.•...••••.•......•..... Intercountry ..................................... .

28 000 28 000

Total

Programme: Drug policies and management

No.

3.4.1

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 sub-regional services needed for the implementation of those policies. Approach Collaboration will be provided through: Exchanging information on drug policies and legislation for government regulatory control existing in different countries or areas. Formulating national drug policies for production, distribution, control and management, including establishment of national lists of essential drugs. r. ~ Organizing regional, intercountry or national seminars, workshops or courses on drug policies. Providing consultants. Programming, planning and organizing the production or procurement of drugs. Undertaking feasibility studies on procurement, production and distribution of drugs for the health needs of countries in order to stimulate bilateral and multilateral cooperation.

Providing fellowships. Establishing WHO collaborating centres in relevant disciplines. 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 r~s~ng costs in the provision 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 seminar on the use of medicinal plants in health care was held in Tokyo in September 1977. Cooperation was provided to the Lao People's Democratic Republic. A programme for the bulk purchasing of pharmaceuticals among countries or areas of the South Pacific has been planned for 1978-79. It will comprise preparatory technical input, a workshop and a feasibility study. Country studies of and seminars on pharmaceutical supply systems are planned for 1978-79.

Collaboration under the intercountry project on drug policies and management and pharmaceutical quality control will commence in 1979.

PROGRAMME:

3.4.1

DRUG POLICIES AND MANAGEMENT

Estimated obligations Regular budget US$ 1978-1979 Regional .......................................... Country or area Intercountry .......................... 5 ....... ' ••••••• ~

Other sources US$

Total US$

11'

.,.

...........

••

........

••

........

......

•

118 100 150 500 268 600

11 400 199 400 210 800

129 500 349 900 479 400

Total 1980-1981 Regional Country or area Intercountry • • • • ., • • • • • • • • • • • • • • e~

• • ., . . . . . . . . . . . . . . . . . . . . .

.,.,.,..,.,.,.Qo••••ooooo•oooooeooo•&oooe• 0 • 0 ••••••••••••

•••••••••••••••••••••••

059 400 112 400

1 059 400 112 400 1 171 800

Total Increase (decrease) in 1980-1981 over 1978-1979 Regional ........................................... Country or area ................................... Intercountry ...................................... Total

1 171 800

941 300 ( 38 100) 903 200

( 11 400) (199 400) (210 800)

929 900 (237 500) 692 400

Programme: Pharmaceuticals and biologicals

No. 3.4.2

(1) Objectives

Pharmaceuticals

To collaborate in establishing national lists of essential drugs and specifications for them if necessary; to establish and improve international requirements and standards for the quality, safety and efficacy of prophylactic, diagnostic and therapeutic substances. Approach Establishing national lists of essential drugs within the framework of national drug policies. Programming, planning and organizing the production of pharmaceuticals. Organizing national or intercountry training courses, seminars or workshops. Providing fellowships. Developing the services required for drug quality control. Establishing WHO collaborating centres. Review The activities under this programme heading are reviewed under 3.4.1 Drug policies and management.

(2) Objectives

Biologicals

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. Approach 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 vaccines as local technical capabilities and production increase. Introducing or further developing 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. There is a lack of organization for proper quality control in some countries or areas and this poses a great problem, particularly in vaccine-producing countries. There is a shortage of adequately trained staff for both production and control.

PROGRAMME:

3.4.2

PHARMACEUTICALS AND BIOLOGICALS

Estimated obligations Regular budget US$ 1978-1979 Regional .......................................... Country or area ................................... Intercountry ...................................... Total 1980-1981 Regional Country or area Intercountry .. 0 ......................................... 0 .....

Other sources US$

Total US$

1 176 000 37 300 1 213 300

1 1 76 000 37 300 1 213 300

ooooo'il'e•oeee6o•••••ooooo•oeGeoooooe ......................... "' ..................... 0 .. 0 ........ 0 & ....

343 200 53 400 396 600

196 000 196 000

539 200 53 400 592 600

Total Increase (decrease) in 1980-1981 over 19 78-19 79 Regional ............................................. Country or area ................................... Intercountry ...................................... Total

(832 800) 16 100 (816 700)

196 000 196 000

(636 800) 16 100 (620 700)

'----

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.

PROGRAMME:

4.1.0

COMMUNICABLE DISEASE PREVENTION AND CONTROL PROGRAMME PLANNING AND GENERAL ACTIVITIES

Estimated obligations Regular budget US$ 1978-19 79 Regional Country or area .................................. .

Other sources US$

Total US$

Intercountry Total 1980-1981 Regional Country or area ...............................•... Intercountry •.....•...•.•...........•......•...... Total Increase (decrease) in 1980-1981 over 1978-1979 Regional ......................................... . Country or area .................................. . Intercountry ....................................•. Total

205 900 328 900 534 800

146 600 352 200 498 800

(59 300) 23 300 (36 000)

Prograr~e:

No. 4.1.1

Epidemiological surveillance

Objective To strengthen epidemiological surveillance at the national and international levels giving priority to the communicable diseases which can be effectively controlled. Approach Collaborating in the development of national epidemiological services. Promoting the exchange of epidemiological information and improving the quality and usefulness of data collected. Stimulating the incorporation of surveillance into the general public health services and supporting surveys on priority diseases in order to ascertain their public health significance. Promoting the development and application of simple but effective surveillance mechanisms. Promoting basic and refresher training for medical and allied health services staff on the use of epidemiological methods. Promoting collaboration between epidemiological, health laboratory Review Epidemiological surveillance is practised in only a few countries or areas of the Region and rarely in an active manner. Where the usefulness of epidemiological services has been recognized a stable framework for development has been created. Surveillance of diseases under the expanded programme on immunization was strengthened, particularly in Fiji and the Philippines, while serological surveys supported by the WHO Serum Reference Bank, Tokyo, were carried out in Fiji and the Lao People's Democratic Republic. A survey of the prevalence of leprosy and tuberculosis and filariasis was undertaken in Samoa. Australia, Malaysia and Singapore circulate current epidemiological data accompanied by comments. Since the beginning of 1978 the WHO Regional Office for the Western Pacific has issued regional summaries on some vaccine-preventable diseases for national staff involved in the expanded programme on immunization. Training in epidemiology is not readily available in the Region because of lack of training centres of an international standard. ~nd

statistical services.

PROGRAMME:

4.1.1

EPIDEMIOLOGICAL SURVEILLANCE

Estimated obligations Regular budget US$ 1978-1979 Regional ......................................... .

Other sources US$

Total US$

Country or area .•.•..••.....••.•....••.•...••••••. Intercountry ...••.•..••..•..•...•......•••.••.••.. Total 1980-1981

432 300 226 700 659 000

127 300 127 300 254 600

559 600 354 000 913 600

Regiona 1 .....•....•...••.•.•..••...•.•.••••.••.... Country or area .......••.•......•.....••...••.•.•. Intercountry ....•.........•••...•...•...•••••.•... Total Increase (decrease) in 1980-1981 over 1978-1979 Regiona 1 ......................................... .

220 600 405 900 626 500

127 200 127 300 254 500

347 800 533 200 881 000

Country or area •••...••.••••..•••.••.••••.•.•••••. Intercountry ..................................... .

(211 700) 179 200 (32 500)

(100) (100)

(211 800) 179 200 (32 600)

Total

Programme: Malaria and other parasitic diseases

No. 4.1.2

(1)

Malaria

Objective To cooperate with countries or areas where malaria is no longer endemic in maintaining the malaria-free status and preventing the reestablishment of the disease. To advise malarious countries or areas in the planning, implementation and evaluation of antimalaria programmes. Approach Assisting countries or areas where malaria is no longer endemic in various fields, including the strengthening of malaria vigilance through orientation of general health service staff and promotion of consultation on malaria among neighbouring countries. Ensuring the continued progress of existing malaria eradication programmes, including the investigation and solution of technical problems, regular evaluation of progress and determination of areas for further cooperation. In view of the socio-economic and public health importance of malaria, as well as the technical, administrative and operational constraints, cooperation with countries or areas where malaria eradication is at present not practicable, will pertain to: (a) (b) (c) (d) development of an optimal antimalaria programme, taking into consideration the various constraints; promotion of general health service involvement in antimalaria activities, whenever feasible; training the health manpower required; continuous analysis of current operational and epidemiological methods, for the development and application of improvements.

Bu~lding up technical expertise through intercountry, regional and interregional activities, stimulating coordination among neighbouring countries and promoting investigation of common technical problems, including those related to multidrug resistant strains of P. falciparum and to the vector species A. balabacensis and A. farauti, which are less amenable to control.

Organizing courses for professional and senior technical antimalaria staff in coordination with existing training institutions. Review (1) Malaria is no longer endemic in Australia, Brunei, Hong Kong, Japan, Macao and Singapore. The malaria-free status has, in general, been maintained in those coun~ries or areas. General health services staff from countries or areas in the Region continue to participate in group educational activities on malaria and to undertake special studies in malariology. (2) Malaria eradication programmes are in operation in Peninsular Malaysia, parts of the Philippines and Solomon Islands. Over half the population of Peninsular Malaysia is now living in consolidation phase areas. Supplementary attack measures are required in parts of the country because of operational difficulties particularly in relation to land development schemes, and moving population groups. The programme is being evaluated regularly. In the Philippines the areas for malaria eradication or intensive control operations have had to be modified in accordance with administrative and operational feasibility. A trial on functional integration of the malaria eradication service into the general health services has been initiated in five provinces. A study on chloroquine resistance, including in vivo and in vitro testing techniques, has been carried out. As the removal of persistent foci of transmission has progressed in Solomon Islands, routine indoor spraying operations have been withdrawn from a major part of the Western District. Supplementary measures are now concentrated on the major remaining focus in Guadalcanal. The ultimate success of the programme will depend to a large extent on the outcome of those measures.

(3) Elsewhere in the Region, malaria eradication is not practicable at present; control programmes have therefore been undertaken with varying degrees of success, depending on the constraints; one being the inability of some governments to provide long-term support.

The extent of WHO cooperation in antimalaria programmes has been larg~ly determined by the priority given to them by governments and by the benefits anticipated. In several cases complementary international or bilateral assistance has been provided for health manpower development, procurement of essential commodities and operation of the programme. Where essential support has not been readily available from national or external sources, WHO has endeavoured to provide it. The regional malaria training programme continued, with the organization of courses and the provision of fellowships. Coordination between neighbouring countries in the South~West Pacific area and mutual coordination between Indonesia, Malaysia, Singapore, an~ Thailand are well-established. (2) Other parasitic diseases

Objective To cooperate technically with governments in the prevention and control of major parasitic diseases of public health importance, notably schistosomiasis and filariasis. Approach Cooperating in, and promoting, studies on the epidemiology and transmission dynamics of schistosomiasis, filariasis and other parasitic diseases prevalent in the Region in order to develop new and effective strategies for control. Cooperating in the monitoring and evaluation of continuing large-scale development programmes being funded by international agencies. Stressing the need for health education and community participation in areas where schistosomiasis or filariasis are endemic. Review Schistosomiasis Although control programmes have been carried out successfully in the People's Republic of China and Japan, schistosomiasis continues to be of public health importance in Democratic Kampuchea, Lao People's Democratic Republic and in the Philippines.

In Chtna, a well-organized svstem of community health anrl strong determination on the part of the Government, together with community participation, ~ave contributed to eli.mination of the disease. In Japan, an integrated control programme supplemented by mechanical farming, use of chemical fertilizers, as well as the socio-economic development o~ affected communities, have drastically decreased the incidence and prevalence of schistosomiasis within a comparatively short period. The Philippines remains the main focus of schistosomiasis in the Region. It is endemic in 22 provinces and an estimated 500 000 people are infected, with an annual death rate of about 500. Concerted efforts are being made by the different Government departments to control the disease, primarily through the proper planning and implementation of large-scale water related development projects. Renewed enthusiasm to pursue an operational type of research has been generated by the WHO special programme for research and training in tropical diseases. A multi-disciplinary working group on schistosomiasis has been formed, together with a regional steering committee,.to encourage and pursue such research. Filariasis In Samoa, a research project with the primary objective of studying the epidemiology"and dynamics of transmission and drawing up plans for new and effective strategies for filariasis control was established in Apia with cooperation from WHO in October 1977. In previous mass drug administration campaigns, using diethylcarbamazine (DEC), there had been a drastic reduction in microfilarial rates (Mfr). However, a few years after termination of mass DEC treatment, it was observed that transmission continued at a discreet level or even resumed at a high level. Entomological studies on the dynamics of transmission are in progress, and baseline data are being collected for antivector activities based on environmental sanitation, biological control and selective use of insecticides. The entomological studies will be supported by large-scale epidemiological investigations. Statistical analysis of existing data and case-control studies will be important in the planning and implementation of an effective and realistic approach to filariasis control. A working group on subperiodic bancroftian filariasis held in 1978 focused on the development of new strategies for filariasis control, to be tried out in the research project in Samoa. Information thus collected should be useful and applicable to other endemic areas in the South Pacific having similar problems.

92 PROGRAMME: 4.1.2 MALARIA AND OTHER PARASITIC DISEASES

Estimated obligations Regular budget US$ 1978-1979 Regional ..................... "' ........ ., .......... Country or area Intercountry • o

Other sources US$

Total US$

...... ................................... .,. o o o • • • • o o •

e •

e o •

o • e o o o o o • o e •

•

o •

375 !tOO 898 900 1

323 200 323 200

698 600 898 900 1 597 500

Total 1980-1981 Regional Country or area Intercountry eoeoooeooeo•eoeoooooooooooooooooe•••••••••

274 300

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

606 200 913 200 1 519 400

256 000 256 000

862 200 913 200 1 775 400

Increase (decrease) in 1980-1981 over 19"?8-1979 Regional Country or area Intercountry

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

230 800 111 300 245 100

(67 200) (67 200)

163 600 111 300 177 900

No. Bacterial, viral and mycotic diseases

4.1.3

(1) Objective

Bacterial diseases

To prevent, control and, if possible, eradicate bacterial diseases of public health significance. Approach Promoting the development 9 improvement and application of cost-effective and safe methods of control for bacterial diseases, such as immunization against diphtheria, pertussis, tetanus, and oral rehydration in the treatment of diarrhoea. Expanding and disseminating knowledge on different means of controlling bacterial diseases. Integrating control efforts as far as possible into the general health services; collaborating in particular with the epidemiological and microbiological services. Promoting training in the control of bacterial diseases. Including zoonoses control in all aspects of the above-mentioned approaches. Review Diarrhoeal diseases Often of bacterial origin, diarrhoeal diseases are widespread. Oral rehydration is increasingly accepted as treatment for all forms of this group of diseases, including shigellosis and cholera. Cholera For the first time an epidemic of cholera occurred in Gilbert Islands making the situation there similar to that existing in Malaysia, the Philippines, Singapore and the Socialist Republic of Viet Nam. Outbreaks, essentially unexplained, have been reported from Australia, Guam and Japan. Efforts have continued to change the emphasis from reliance on quarantine and vaccination to prevention, surveillance and treatment. 93

Shigellosis An outbreak has been reported from Trust Territory of the Pacific Islands and there is suspicion that the high incidence of amoebiasis reported there may be caused in part by shigellosis. Typhoid Typhoid is widespread throughout the Region. data on computer to facilitate source tracing. Plague . Plague continues to be reported from parts of the Socialist Republic of Viet Nam. available on the situation in Democratic Kampuchea. Streptococcal infections Streptococcal infections have been th& subject of studies in relation to rheumatic fever, rheumatic heart disease and acute glomerulonephritis in the Philippines and Singapore. Pneumococcal pneumonia Following a global trend, increasing attention is being given to the study of pneumococcal vaccines which have been found efficacious in several trials. A special problem with pneumonia in general, and pneumococcal pneumonia in particular, exists in Papua New Guinea. The results of a vaccine study in the highlands of Papua New Guinea are being prepared for publication. A consultant to Fiji, Papua New Guinea and the Philippines has proposed extensive research in the related field of acute respiratory infections. Leptospirosis Leptospirosis is endemic in one form or another throughout the Region. essential, is often weak. Pig bel or enteritis necroticans Pig bel is caused by C. welchii toxin and appears mostly in older children in Papua New Guinea after they have eaten pork during feasts. A vaccine has been developed which has proved successful in initial trials. Laboratory support, although No information is Singapore has placed some of the available epidemiological

Meningococcal meningitis Meningococcal meningitis is reported as a public health problem by only a few countries. vaccines against types A and C are available. Effective

For diphtheria, pertussis and tetanus see the programme statement for the Expanded programme on immunization (II .1. 5). {2) Objective To prevent, control and if possible, eradicate viral diseases of public health significance. Approach Promoting the development, improvement and application of cost-effective and safe methods of control of viral diseases, such as immunization against poliomyelitis and measles, oral rehydration in the treatment of diarrhoea and immunization of dogs and destruction of stray dogs to combat rabies. Expanding and disseminating knowledge on different means of controlling viral diseases. Integrating control efforts as far as possible into the general health services; collaborating in particular with the epidemiological and microbiological services. Promoting training in the control of viral diseases. Review Influenza The same strain of influenza virus type A which was initially identified in a diagnostic laboratory in the Region spread as a new variant called "russian" H1N1. Dengue fever/dengue haemorrhagic fever Dengue fever/dengue haemorrhagic fever occurs over wide areas of the Region. Reports have been received in particular from Lao People's Democratic Republic, Malaysia, Philippines, Singapore, Socialist Republic of Viet Nam and countries or areas of the South Pacific. The emergency application of vector control measures was successful in some areas of the South Pacific, Malaysia and Singapore. The aetiology of the haemorrhagic form of the disease remains unclear. 95 Viral diseases

Japanese encephalitis Significant outbreaks of Japanese encephalitis were reported from the Socialist Republic of Viet Nam, while there is serological evidence of a high incidence in Lao People's Democratic Republic. Rabies Rabies continues to be a significant problem in the Philippines. It has also been found in countries of continental Asia but successful control programmes exist in Malaysia and in the Republic of Korea. A pilot study for the eradication of the disease has been carried out on Guimaras Island in the Philippines. Viral hepatitis There have been significant advances in the control of hepatitis B in the developed countries of the Region as diagnosis becomes simpler and laboratory support strengthens. Developing countries often do not have the laboratory support necessary to mount systematic screening procedures. Fewer post-transfusion cases of hepatitis are seen in developing than in developed countries, through more immunity. Advances in the diagnosis and control of hepatitis A were limited to research results which promised simplified laboratory procedures for the future. The nature of hepatitis non-A-non-B is still not clear. An interregional course was held in Kuala Lumpur in 1977. Trachoma Trachoma continues to occur in most countries or areas of the Region, including those in the South Pacific, but its severity is low. Diarrhoeal diseases and acute respiratory infections Although frequently caused by viral agents diarrhoeal diseases and acute respiratory infections are reviewed under bacterial diseases above. (3)

Tuberculosis

Objective To reduce the mortality, prevalence, incidence and transmission of tuberculosis in all countries or areas c~ the Region.

Approach Controlling tuberculosis by simple, economical, acceptable and effective methods applied through the general health services at national, intermediate and peripheral levels. Those methods are: (a) (b) maintenance of a high level of immunity 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.

Selecting, according to the epidemiological picture of the disease in the community and to available resources, priority population groups for the application of control measures. Training specialized and general personnel, particularly auxiliaries, in general principles and simple techniques. 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. In order 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, the Independent State of Western Samoa and Singapore. Almost all countries or areas have established national tuberculosis programmes, many of them having 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 intensifying supervision and training health workers at various levels and of different categories.

International and regional conferences are organized periodically by the International Union Against Tuberculosis. Since 1959, a regional course for medical officers has been conducted every five years in cooperation with the South Pacific Commission. In 1959 and 1964 it was confined to tuberculosis, while the last two courses have covered both tuberculosis and leprosy. 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 constant supplies of stable BCG vaccine of standard quality, a regional freeze-dried BCG vaccine production laboratory was established in 1975 with the cooperation of UNICEF and WHO at Alabang Laboratories, Philippines. Field studies and laboratory tests have shown that the potency and safety of vaccine produced at this laboratory are comparable to the international standard vaccine produced by the Danish State Serum Institute. The vaccine will be released for national use in the Philippines from 1978 and for regional use after expansion of the production facilities has been completed. Studies are being carried out on problems encountered in the field by the national tuberculosis programmes of Japan, Philippines, and Republic of Korea with the cooperation of WHO. (4) Leprosy

Objective 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. Approach Organizing 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 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 supervision 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 · The problem of 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, Papua New Guinea, Philippines, Republic of Korea, Socialist Republic of 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 new cases are still being discovered in many countries. 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 most 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. WHO has cooperated in control activities in the 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 Lepers' Trust Board and WHO, is situated at the P.J. Twomey Memorial Hospital, Suva. It is expected to become operative in 1978. Its main objective is to train workers of various categories and levels from countries or areas in the South Pacific, including Papua New Guinea. Special assistance was provided to the Socialist Republic of 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 German Leprosy Relief Association, the Military Order of Malta, the New Zealand Lepers' Trust Board and the Japan Shipbuilding Industry Foundation.

100

(5) Objective

Sexually transmitted diseases

To reduce the transmission of sexually transmitted diseases and treponematoses and to support the eradication of yaws. Approach Promoting the provision of diagnostic and treatment services to high risk groups, patients with sexually transmitted diseases, prenatal women and other groups of public health importance. Promoting the surveillance of sexually transmitted diseases in order to ensure that the right priority is given to their control and in particular to increasing the percentage of antenatal screening in populations exposed to syphilis. Stimulating the establishment and modification, in accordance with continued susceptibility testing, of specific optimum treatment schedules for gonorrhoea. Review The appearance and spread of penicillin resistant strains of beta-lactamase-producing N. gonorrhoea has overshadowed other developments and complicated control activities. Many countries in the Region are already affected and further spread is expected. In collaboration with the Government of the Philippines and the Center for Disease Control, Atlanta, Georgia, a training course on the control of sexually transmitted diseases was held in the Philippines in 1977. Cooperation was extended to several countries in promoting surveillance and control activities. The WHO Collaborating Centre for Venereal Disease, Serology and Bacteriology, Singapore has been active and its staff have provided consultant services. Papua New Guinea has significantly strengthened control services while Malaysia is about to do the same.

(6)

Mycotic diseases

Objective To prevent and control mycotic diseases of public health significance. Approach Improving surveillance and monitoring developments that might affect the priority given to the control of mycotic diseases. Expanding knowledge on the different means of controlling mycotic diseases. Promoting training in the control of mycotic diseases wherever they are of public health significance. Health workers will be informed, on request, of recent publications particularly as they refer to the situation prevailing in the Western Pacific Region. Review Little priority has been given to the control of mycotic diseases. The situation was reviewed during a regional seminar held in 1975, when simple methods were proposed for controlling the widespread, but not threatening, mycotic infections which affect a great number of young persons.

101

102

PROGRAMME:

4.1.3

BACTERIAL, VIRAL AND MYCOTIC DISEASES

Estimated obligations Regular budget US$ 1978-1979 Regional Country or area Intercountry ••••••••••••••

Other sources US$

Total US$

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

o e o o o o o o o o o o o o o o o o o o o o o o o o a o o •

o •

o o o o o o

322 900 716 800 1

207 900 655 400 863 300

1 530 800 1

372 200

Total 1980-1981 Regional Country or area Intercountry oe000000080G000GGOOOQQOOOGGOOt1000.00900000

039 700

2 903 000

o o o o o o o o e o o o o o o o o o o •

o o •

o •

o o o o o o o o

000.00000000000.00001\tOOOOOOOOOOOO•OGOO

262 600 591 800 854 400

63 800 177 800 241 600

326 400 769 600 1 096 000

Total Increase (decrease) in 1980-1981 over 1978-1979 Regional Country or area Intercountry

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

(60 300) ( 125 000) ( 185 300)

( 1 144 100) (477 600) (1 621 700)

( 1 204 400) (602 600) ( 1 807 000)

Programme: Expanded programme on immunization

No. 4.1.5

Objective To reduce morbidity and mortality in diseases preventable by immunization, in particular diphtheria, pertussis, tetanus, poliomyelitis, tuberculosis and measles. Approach Promoting the integrated planning of national expanded programmes on immunization, with due consideration for logistics. Summarizing the potentials and the needs of countries in order to develop a balanced regional programme, using all available resources and emphasizing self-reliance. Regularly summarizing data for review, on the participation of governments and the activities of the expanded programme on immunization. Facilitating exchange of data between countries on immunization and the epidemiology of diseases under the programme. Promoting the use of safe and effective vaccines. Supporting training courses for various levels of health worker on all aspects of immunization. Review Following the initial regional seminar on immunization held in late 1975, the Philippines has consistently advanced in the development of an expanded programme on immunization. A national immunization committee was formed which first made an inventory of the status of immunization services anrt then established a plan, initially for five years, for the gradual extension of those services. The quality of vaccines (DPT, BCG), the regularity of immunization delivery, and effective coverage (starting with 30% of the population in 1977), have subsequently improved significantly. Independent evaluation of coverage has

103

recently been instituted and baseline data are becoming available. An initial survey has been carried out of the status of each of the diseases under the programme. Accelerated and improved vaccine production has been part of the programme in the Philippines and i~ the main component of that in the Socialist Republic of Viet Nam. Coordination of donors has been an important activity in this field. The Lao People's Democratic Republic has also decided to give immunization high priority in the health field, but the scope of activities is still limited. An intercountry team stationed in Manila has collaborated mainly in the Philippine programme, with extension of activities to the South Pacific early in 1q78. A field development officer has provided collaboration to Papua New Guinea. Cook Islands, Fiji, Samoa and Tonga have all shown interest in expanding their programmes. Locally-produced carriers for vaccine have been developed in the Philippines. Training courses for programme managers have been introduced for which teaching modules will be available. "Cold chain" management and costing methodology are being improved and health education kits established. By the end of 1981 the Philippines should have achieved a population coverage of 50% and should have become self-sufficient in the production of DPT and BCG vaccine, with the possibility of excess production for use elsewhere in the Region. A limited amount of deep freezers, cold boxes, thermo flasks, vaccines (poliomyelitis and measles), vehicles, motorboats, jet injectors and other materials will be available to support programme development. Promotion of integration of the programme within general health service development, particularly using the primary health care approach, will continue.

PROGRAMME:

4.1.5

EXPANDED PROGRAMME ON IMMUNIZATION

Estimated obligations . Regular budget US$ 1978-1979 Regional Country or area Intercountry Other sources US$ Total US$

.......................................... ................................... ...................................... Total 1980-1981

28 700 792 200 792 200 28 700

28 700 792 200 820 900

Regional Country or area Intercountry

.......................................... OOOOfltolrGOOGGCIIGOOGOOOOOOOG<IIOeee-&00000

ooeoooooooooooooooooeooooooooooeo••ooo

1 1

35 300 018 600 053 900

12 000 12 000

47 300 1 018 600 1 065 900

Total Increase (decrease) in 1980-1981 over 1978-1979 Regional Country or area Intercountry

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

35 300 226 400 261 700

( 16 700) ( 16 700)

18 600 226 400 245 000

105

106

Programme: Special programme for research and training in tropical diseases

No. 4.1.6

For a review of the filariasis research activities being carried out in Samoa under this programme heading, see "filariasis" under Malaria and other parasitic diseases (4.1.2, page 91).

PROGRAMME:

4.1.n

SPECIAL PROGRAMME FOR RESEARCH AND TRAINING IN TROPICAL

OJS~ASES

Estimated obligations Regular budget US$

Other sources US$

Total

1978-1079 Regional ......................................... . Country or area .................................. . Intercountry ..................................... . Total 320 400 282 400 602 800

320 400 28? 400 602

Boo

Regional Country or area .................................. . Intercountry ..................................... . Total Increase (decrease) in 1980-19A1 over 197A-1970 Regional Country or aren .............••.....•.............. Intercountry ..................................... . Total

120 000 120 000

120 000

(200 !JOO) (282 400) (482 800)

(200 400) (282 400)

(482 800)

107

108

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. Approach Promoting national planning for the control of xerophthalmia and trachoma and the provision of adequate eye care for all. Review The situation in the Region may be summarized as follows: (1) information on blindness and its causes is limited, but it is likely that loss of vision caused by infectious diseases and by malnutrition - and therefore theoretically preventable by applying available knowledge - exists in parts of the Region, especially in rural areas and other underserved communities. (2) one factor which might explain a certain lack of awareness of the problem, ~nd thus the possibility of taking effective measures to relieve it, is the almost exclusive reliance on information and the opinions provided by eye specialists. Because of their specialized training and of their clinical, hospital-based approach, they often tend to be aware only of conditions affecting the more affluent sectors of the population, usually in or near the larger cities. Conditions affecting the less affluent, especially in rural areas and in urban slums, might therefore be ignored or underrated. (3) there is an obvious need for additional information specialized eye services where they exist, but also from the blind and census data. Requests for such information should of the problem at the periphery through health education and

from all possible sources, including general health services, organizations for the be accompanied by efforts to increase awareness public information activities.

Cooperation was extended to Fiji on trachoma control in 1077 and several countries or areas in the South Pacific were visited on that occasion to ascertain needs and potentials for combatting the problem.

PROGRAMME:

4.1.7

PREVENTION OF BLINDNESS

Estimated obligations Regular budget US$

Other sources US$

Total US$

19 78-1979 Regiona 1 ............................•............. Country or area ...................•••......••..... Intercountry ..................•................... Total 1980-1981 Regiona 1 ............................•............. Country or area ...............•••..•.......••....• Intercountry .•.....•........••....•............... Total Increase (decrease) in 1980-1981 over 1978-1979 Regiona 1 ......................................... . Country or area ..............•......•............... Intercountry ...........•..•.•.•.......•.....•.•... Total 150 000 150 000 150

150 000 150 000

000

150 000

109

110

Programme: Vector biology and control

No.

4.1.8

Objective To cooperate with governments in studying the ecology, and the surveillance and control, of arthropods and rodents of public health importance. Approach Cooperating in the training of national staff, disseminating technical information, developing services for the control of vectors, including rodents, promoting the safe use of pesticides and conducting research on practical control measures, including biological control. Rendering emergency assistance in controlling disease outbreaks particularly of dengue fever or dengue haemorrhagic fever, and promoting health education, environrr· 1tal sanitation and community participation to reduce human exposure to infective mosquito bites. Review Training courses were held for national staff in the Philippines and the Republic of Korea and technical information was disseminated to health inspectors in Papua New Guinea. Programmes were arranged for fellows from Cook Islands, Fiji, French Polynesia, Niue, and the Republic of Korea. Cooperation was extended to Guam and Malaysia in rodent control and biological control studies, using fish and hydra, were implemented in the Republic of Korea. Environmental sanitation procedures, supported by health education, commenced in Tonga to supplement diethylcarbamazine mass drug treatment for filariasis control. Cooperation in training, testing of insecticide susceptibility and vector surveillance and control was carried out in American Samoa, Fiji, Gilbert Islands, and the Solomon Islands. An inventory of insecticides and equipment available in the Region and suitable for vector control is being compiled for the use of governments confronted with dengue outbreaks. Technical cooperation was provided on antilarval measures for the control of anopheline in urban areas of Papua New Guinea and in the evaluation of organophosphorus residual sprays against anophelines in Malaysia. A research project on subperiodic bancroftian filariasis was established in Samoa.

PROGRAMME:

4.1.8

VECTOR BIOLOGY AND CONTROL

Estimated obligations Regular budget Other sources Total

US$ 1978-1979 Regional Country or area .................................. .

US$

Intercountry Total 1980-1981 Regional oooooooooeeeoooooooooooooooooooooooooooooo o •••••• o • "" • • • • • • • • • • •

25 600 115 400 141 000

25 600 115 400 1!11 000

Country or area ..............

Intercountry Total Increase (decrease) in 1980-1981 over 1978-1979 Regional Country or area .................................. .

83 200 159 300 2lt2 500

83 200 159 300 2!12 500

Intercountry Total

57 600 lt3 900 101 500

57 600 43 900 101 500

111

112

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.

PROGRAMME:

4.2.0

NONCOMMUNICABLE DISEASE PREVENTION AUD CONTROL PROGRAMME PLANNING AND GENERAL ACTIVITIES

Estimated obligations

r-------------------------------·-----------------------4------------------------·------------------·---US$ US$ US$ 19 78-19 79 Regional .•....•.•..••••...•..•.....•.....••......• Country or area •••..••.•••••...........•••••.•..•. Intercountry ...................................... .

Regular budget

Other sources

Total

Total 1980-1981 Regional Country or area .....••••..••••....••••.••..•.••.•• Intercountry ......................... ,. .. (II •••••••••

83 700 115 300 199 000

Total Increase (decrease) in 1980-1981 over 1978-1979 Regional Country or area .•.•....•..•.•.•....•.•.•...•...... Intercountry .••.•.•.••.•....•......••..•....•••••• Total

83 700 115 300 199 000

113

114

Programme: Cancer

No. 4. 2. 1

Objective To promote the prevention anrl control of cancer. Approach Promoting the establishment of a cancer registry, based on WHO standard guidelines, in order to obtain information on the pattern of cancer morbidity in the community. Promoting the establishment of effective controJ 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 in the development of the disease, and new methods of diagnosis and treatment. Assisting in the training of health workers at various levels and of various categories involved in control programmes. Review WHO has cooperated in the development of cancer control services in accordance with public health principles, emphasis having been placed on the inclusion of such services in the national health structure at an early stage.

A pilot project on community cancer•control, initiated in Rizal Province, Philippines in 1968, is providing invaluable information which could only have been obtained in this practical manner. All phases of control, from participation and education of the community to early detection and referral of patlents for treatment, are covered. The most important finding has been that, without facilities for the free treatment of cases discovered, it is not advisable to introduce activities for the detection of a chronic disease such as cancer. Another conclusion has been that a community cancer control service requires a high degree of cooperation between epidemiologists, pathologists~ surgeons, chemotherapists and public health administrators as well as the full support of community leaders. A working group on the organization of comprehensive cancer programmes held in 1975 stressed that the target should be nationwide, that the programme should be planned on a permanent basis, that the control services should be made an integral part of existing health services, and that the training and utilization of health workers in other fields and community leaders should be considered of paramount importance. Finally it was urged that methods used in the programme should be effective, simple, applicable on a mass scale and acceptable to the population within the financial and manpower means of the country. Cooperation under this programme was provided to Fiji, Malaysia, Philippines and Republic of Korea.

115

116 PROGRAMME: 4.2.1 CANCER

Estimated obligations Regular budget US$ 1978-1979 Regional Country or area . e ••••••••••••••••••• " •••••••••••••

Other sources US$

Total US$

Intercountry Total 1980-1981 Regional Country or area ..... o ••• (I ......................

47 500 47 500

o •••

Intercountry Total Increase (decrease) in 1980-1981 over 1978-1979 Regional

196 300 27 000 223 300

.......................................... 196 300 (20 500) 175 800 196 300 (20 500) 175 800 Total

Country or area .................................. .

Intercountry

P~o~ramme:

No. 4.2.2

Cardiovascular diseases

Objective To cooperate in promoting the prevention and control of diseases of the cardiovascular system. Approach Promoting epidemiological surveys on the size and nature of the cardiovascular conditions existing in 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 Seminars were held in 1968 and 1975, during the latter of which it was noted that, in addition to rheumatic heart disease, ischaemic heart.disease and hypertension were increasing in many parts of the Region. Methods for the prevention and control of those three diseases are now available. Rheumatic fever and rheumatic heart disease registers have been established in Fiji, in Wairoa a high risk area of New Zealand, and in the Philippines, Singapore and Tonga. A community-based control programme for rheumatic heart disease was established, with the participation of general health workers, in Pangasinan Province, Philippines in 1977.

117

118

Reports have indicated a great variety in blood pressure patterns between the populations of different countries. Data need to be obtained from selected samples as a means of defining the problem of hvpertension and determining the frequency of its complications so that appropriate control measures may eventually be adopted for wider application. 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. The risk factors for hypertension and ischaemia 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. Consultants visited Australia, New Zealand, Philippines, Republic of Korea and Singapore in 1977. A regional training course on the epidemiology and community control of cardiovascular disease was held in Wellington in 1978.

PROGRAMME:

4.2.2

CARDIOVASCULAR DISEASES

Estimated obligations Regular budget US$ 1978-1979 Regional . . ·-... ~- ~

Other sources US$

Total US$

........ ~ ~ ...............• ......• ........ .

Country or area .••.•.••••••.•••••.••••••••••••..•• Intercountry ..............• ........................ . Total 1980-1981 Regional Country or area 0 6 0 0 •

8 000 8 000

.. "' •

••

•

131

Cll

....

•••••

•

Intercountry Total Increase (decrease) in 1980-1981 over 1978-1979 Regional Country or area .................................. . ················~·························

73 200 34 100

107 300

Intercountry Total

65 200 34 100 99 300

119

120

Programme: Oral health

No.

4.2.3

Objectives To promote the development of policies and programmes for oral health; More specifically: to provide greater population coverage by increasing the productivity of dental personnel and making more effective national dental care delivery systems; to develop organized programmes for improving the basic and continuing education of professional and auxiliary dental staff; to provide at country level training and expertise for the application of more effective techniques for the prevention and control of oral disorders; to promote collaboration between countries in the development of national dental health education programmes and to encourage intercountry activities for an educational approach to oral health; to encourage national research in priority areas of oral health. Approach Collaborating in the development of in-service training schedules at national level for increased coverage by dental care services, using non-dental and non-health personnel. Preparing guides for increasing clinical productivity through the efforts of national staff, and self-instructional texts for primary health care workers and dental health personnel. Conducting an intercountry course in public health dentistry to demonstrate to participants successful continuing programmes in relation to specific objectives.

Collaborating in national workshops with participation from nei~hbouring countries in teaching specific skills in dentistry, as part of the endeavour for technical cooperation among developing countries. Review During the bienn1um 1Q78-79 an evaluation of the coverage of the dental health services, particularly those at the periphery, was made in nine countries. ~Simultaneously, plans were made, and in some countries initiated, to increase coverage. Particular emphasis was placed on the use of dental auxiliaries. In support of this, utilizing the regional course in public health dentistry, national workshops, consultants, and regional and national staff, a start was made in developing new methods to increase clinical productivity and to incorporate them into staff training. To facilitate such new approaches, a study of the curricula for dentists and auxiliaries was made in six selected countries and teaching packages, like that on dental emergency management, were prepared. As well as expanding the use of preventive techniques, such as self-applied fluorides, it was possible to increase the number of countries having central oral health education units with defined goals and systems for the evaluation of activities. The guidelines on dental health education prepared by the Regional Office for the Western Pacific in 1977 proved useful in this respect and by 1980 it is anticipated that six such units will be operating in the Region. Finally, research activities were initiated on the relationship between diabetes and periodontal diseases and on the effectiveness of dental health education methods in different settings.

121

122

PROGRAMME:

4.2.3

ORAL HEALTH

Estimated obligations Regular budget US$

Other sources US$

Total US$

1978-1979 Regional Country or area ...••..••..•...•.....•••..••••.••.. Intercountry - e < O e < O o o • • • • • o o o o o o o o o & o o o o o o o o o o o • • • • • •

.......................................... 230 000 230 000 230 000 230 000 Total 1980-1981

Regional

o o o o o o o o o o • 'iD

•

o o o e o o •

• o o o o o o o o o • •

•

o o •

o o o o •

o o

Country or area .

••••••••••••••••

e ••••••••••••• e •••••••••••••••

Intercountry

••••••••••••••••••••••

213 400 194 300 407 700

Total Increase (decrease) in 1980-1981 over 1978-1979 Regional ......................................... . Country or area .......... ~ . . . . . . . . . . . .............. .

Intercountry

o o o o e o o o o o o •

o • •

o e o o •

•

o •

•

o •

• o •

•

213 400 (35 700) 177 700

Total

?ro~ramme:

No.

Other noncommunicable diseases

4.2.4

Metabolic diseases Objective To reduce the morbidity of Approach Promoting epidemiological surveys on the extent and nature of diabetes mellitus and gout in 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. Assisting in the training of personnel involved in control activities. Promoting exchanges of experience among national experts engaged in the prevention, diagnosis and treatment of metabolic diseases. Review Diabetes is one of the major health problems in the South Pacific area. After the introduction of a monetary economy, a big change has taken place in the life style of the population. Imported food, rich in calories, forms an increasing part of the diet instead of traditional foods and less physical exercise is taken. As a result, obesity, one of the risk factors of diabetes, has become prevalent. On remote islands where a traditional life style is maintained, the prevalence of diabetes is the same as in other parts of the Region. Such has been found to be the case by a WHO consultant to French Polynesia in 1977 and by an Australian research worker in Nauru and Tuvalu. Gout was also found to be prevalant in French Polynesia and Nauru. Control of the diet was recommended together with promotion of physical exercise through educational meta~olic

diseases, particularly diabetes mellitus and gout.

123

124

campaigns, particularly among school children and youn~ 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 the effective control methods. A WHO/SPC meeting on metabolic diseases was held in Nauru in 1978 to discuss problems and control measures. Technical cooperation was extended to French Polynesia, Samoa and Tonga.

PROGRAM!¥1:E:

4.2.4

OTHER

NONCOk~U~JIC:ABLE

DISEASES

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

F.stlmated Regular budget US$

ob~i~ations

-----------------US$ 1978-19 79 Regional ................••..........••...•........ Country or area ......•...................•........ Intercountry Total 1980-1981 Regional ..................•.....•............•..•. Country or area .................................. . Intercountry ..................................... . Total Increase (decrease) in 1980-1981 over 1978-1979 Regional ...........•...............•.•...•....•.•• Country or area ....................•...••...•.•... Intercountcy Total 146 000 ( 1 7 300.)

Other sources

Total US$

4 000

26 300 30 300

150 000 9 000 159 000

150 000 9 000

159 000

146 000 ( 1 7 300) 128

128 700

700

-----------·-·---·------------------------- --------·--------------·------------------12')

126

Appropriation section: Promotion of environmental health Major programme: Promotion of environmental health

No. 5

5.1

Programme: Programme planning and general activities 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.

PROGRAMME:

5 .1. 0

PROMOTION OF ENVIRONMENTAL HEALTH PROGRAMME PLANNING AND GENERAL ACTIVITIES

r----------------------------------------------------~------------------------------------------~

Estimated obligations Other sources

· Regular budget

Total

US$ 1978-1979 Regional Country or area .................................. . Intercountry

US$

.......................................... 218 400 218 400 218 400 218 400 Total 1980-1981

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

•••••••

...........

oeeooeoooooooooo-oooooeeoooe•••••••••••

230 600 230 600

Total Increase (decrease) in 1980-1981 over 1978-1979 Regional Ct;>untry or area ..........•....•...........•.•••..•

Intercountry Total

12 200 12 200

127

128

Programme: Environmental health planning and management

No. 5.1.1

Objective To support the work of Member States in promoting and developing environmental planning and management. Approach Cooperating technically in the analysis and development of policies, plans and programmes dealing with environmental, social, economic and health issues. Establishing the Western Pacific Regional Centre for Promotion of Environmental Planning and Applied Studies (PEPAS), and developing and implementing its programme of work. Cooperating technically in, and promoting, research or studies to elaborate the health effects of environmental factors and to identify appropriate technology for management of those factors relevant to health. Cooperating technically in, and promoting, methods and means for transferring information pertaining to environmental health and technology. Cooperating technically in conducting environmental health manpower studies and in establishing and developing the quality of curricula relevant to environmental planning and management. Promoting coordination with national and international agencies, technical cooperation, fellowships and support for training environmental health manpower. Organizing regional meetings, workshops and short courses for personnel engaged in environmental health and related activities.

Review No problem facing governments of the Region is of greater concern than those caused by unplanned and uncontrolled urban development and industrialization, with their attendant disquieting effects on environmental qualtty and human health and welfare. Because a large numher of agencies are usually involved, environmental planning is possible only when there is coordination and policy is clearly defined. Planning problems are compounded by lack of environmental information and institutional capacity. There is also a critical shortage of experienced technical staff for environmental planning and pollution control. In accordance with national and regional needs, an increased level of WHO technical cooperation in various aspects of environmental planning, pollution control, and manpower training will be facilitated by the establishment of PEPAS.

130

PROGRAMME 5.1.1

ENVIRONMENTAL HEALTH PLANNING AND MANAGEMENT

Estimated obligations Regular budget Other sources Total

US$

1978-1979 Regional Country or area Intercountry

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

·············~~~························

327 800 191 100 518 900

297 500 44 100 341 600

625 300 235 200 860 500

Total

1980-1981 Regional Country or area Intercountry oooooo~tooo•ooooooooooooeooeooeoevooooooo<~oo

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

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

347 800 772 000 1 119 800

198 500 93 900 292 400 1

546 300 865 900 412 200

Increase (decrease) in 1980-1981 over 1978-1979 Regional Country or area Intercountry • •

.......................................... ................................... • o o o o o • o • o o o o o • • o o e o o o o o o o o o o o o o o o • o

20 000 580 900 600 900

(99 000) 49 800 (49 200)

(79 000) 630 700 551 700

Total

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 of the quality of life. Approach Cooperating technically in development of legislation and institutions, policy, planning, and programming; project formulation and implementation; and assistance in securing external financial resources for water supply and sanitation programmes. Coordinating with international agencies to promote planning for human settlements. Review The provision of water supply and sanitary services remains a priority health need in most countries or areas. Major constraints are low priority given by the government in some cases and lack of financial, technical and operational capacity. At the national level, studies of sector investment needs are necessary to guide budget allocation and policy making, while pre-investment planning is required for project formulation. The development of a national policy has been promoted in three large developing countries with visible success in water supply development in two of them. Acceleration of WHO technical cooperation and development activities is foreseen in the 1q8os which have been designated the International Drinking Water Supply and Sanitation Development Decade.

131

132

PROGRAMME:

5.1.2

BASIC SANITARY MEASURES

Estimated obligations Regular budget US$ 1978-1979 Regional Country or area Intercountry •••••••••••••••••••••

Other sources US$

Total US$

...................................... Total 1980-1981

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

•••

••••••••••••••••

240 200 255 200 495 400

563 700 563 700

803 900 255 200 1 059 100

Regional Country or area Intercountry $00 ••

0<i!000.00G<t0000000000.!ilOO.G009$000000o0

Oli:IOOooooooooo•••••••••••••••••••ooo

eooooooooo~~tooooooooeoooooooooooooooooo

291 600 257 500 549 100

331 300 331 300

622 900 257 500 880 400

Total Increase (decrease) in 1980-1981 over 1978-1979 Regional Country or area Intercountry

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

51 400 2 300 53 700

(232 400) (232 400)

(181 000) 2 300 (178 700)

Programme: Recognition and control of environmental hazards

No. 5.1.3

Objective To support the work of Member States in promoting and developing programmes for the recognition and control of environmental hazards. Approach Cooperating technically with countries and with international agencies in analyzing 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 in the environment. Developing appropriate technology. Review Air pollution is already serious in most large urban areas and has the greatest potential for producing identifiable health problems. Effective control programmes have yet to be adopted in most countries. Increasing uncontrolled discharge of persistent and toxic chemicals and heavy metals has become serious, while their impact on ecological systems causing, for example, eutrophication of water bodies has serious economic and social implications. The management and disposal of solid wastes continue to pose major problems and are in much need of improvement. WHO technical cooperation in this field is expected to increase and extrabudgetary funds will be needed for some activities. The bulk of the activities foreseen will be carried out through PEPAS.

133

134···

PROGRAMME 5.1.3 ..

RECOGNITION AND CONTROL OF ENVIRONMENTAL HAZARDS

Estimated obligations Regular budget US$ 1978-1979 Other sources US$ Total US$

Regional Country or area Intercountry

••••••••

•••••••••••••••••••••••••••••••••

...................................... Total 1980-1981

o o o o o •

o o o o o o o o o o o o • o e o o o o o o o o o o o o o o

226 400 131 100 357 500

10 000 10 000

236 400 131 100 367 500

Regional Country or area Intercountry

-s:o.a-o00<00•1l>•••••ooooooeoooooooeooooooooo•e•o •••••••••••••••••• 0 •••••• 0 •••••••••

487 500 487 500

489 000 489 000

976 500 976 500

••••••••••••••••••••••••

•••••••••••••

Total Increase (decrease) in 1980-1981 over 1978-1979 Regional Country or area Intercountry

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

261 100 (131 100) 130 000

479 000 479 000

740 100 (131 100) 609 000

Total

Program:ne: Food safety

No. 5. 1. 4

Objective To support the promotion and development of food safety programmes. Approach Group training of sanitary inspectors. Programme planning, project development and evaluation. Collaborating in the improvement of legislation. Upgrading the analytical capabilities of laboratories for surveillance. Strengthening rules and regulations for monitoring and control. Developing frameworks for organization and administration. Providing fellowships. Review WHO has provided support in manpower development by conducting group training for food inspectors and food handlers. In addition, technical cooperation has been given in upgrading legislation and rules and regulations and in programme development.

135

136

PROGRAMME:

5.1.4

FOOD SAFETY

Estimated obligations Regular budget US$ 1978-1979 Regional ...•..•.........•..•.•.•••.........•..•... Country or area ......•••....•........•...••....... Intercountry ••...........•...............•••...... Total 1980-1981 Regional Country or area •.....••...••......•.....•...•...•. Intercountry .. , .................................. .

Other sources US$

Total US$

51 300 13 500 64 800

53 000 9 700 62 700

Total Increase (decrease) in 1980-1981 over 1978-1979 Regional •.•....•...•........••...•••...••........• Country or area ••........•........•........•••.... Intercountry ..................................... .

1 700 (3 800) ( 2 100)

1 700 (3 800) (2 100)

Total

Appropriation section: Heal~h

No.

manpower development

Major programme: Health manpower development Programme: Programme planning and general activities 6. 1

n. 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.

137

138

PROGRAMME:

6.1.0

HEALTH MANPOWER DEVELOPMENT PROGRAMME PLANNING AND GENERAL ACTIVITIES

Estimated obligations Regular budget US$ 1978-1979 Regional Country or area •••••••.••••.•.•.•.•••..••..•.•...• Intercountry ..................................... .

Other sources US$

Total US$

283 700 283 700

Total 1980-1981 Regional Country or area .................................. .

Intercountry Total Increase (decrease) in 1980-1981 over 1978-1979 Regional ......................................... . Country or area .................................. .

102 800 318 800 421 600

Intercountry

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

102 800 35 100 137 900

Programme: Health manpower planning and management

No. 6.1.1

Objectives To promote, and cooperate in establtshing, mechanisms for close collaboration between national agencies responsible for training health personnel and those responsible for the delivery of health care, to ensure greater relevance in the development of health manpower; to promote the development of integrated national health manpower plans and policies including provisions on appropriate conditions of service and career development patterns for different categories of health personnel, leading to conerent systems for the delivery of health care to entire populations; to promote and cooperate in the formulation of poljcies and facilities for the continuing education of health workers. Approach Promoting integration of the planning, production and management of health manpower. Participating in the development, trial and dissemination of information on suitable methods for determining health team requirements. Participating in defining balanced staffing patterns for health services at all levels, including patterns for health teams. Preparing guidelines on the analysis and formulation of health manpower policies, planning and management.

139

140

Acting in collaboration with other international organizations. Encouraging the integration of health manpower planning into the overall process of socio-economic development planning. Promoting collaboration and coordination between those responsible for the training of health personnel and those responsible for health services. Encouraging.the application of national policies for attracting and retaining health manpower in deprived areas and combatting undesirable international migration. Promoting the introduction of career development and continuing education for all categories of health personnel. Promoting and strengthening the manpower component of national health information systems. Review The growing interest in manpower planning and management was evidenced by cooperation with Papua New Guinea (1978) in developing career patterns for its health workers and with Solomon Islands (1978) in reviewing problems related to the entering characteristics of secondary school graduates into health personnel education programmes at tertiary level. Cooperation with Malaysia was specifically related to teachers of health personnel as well as to closer collaboration between national agencies concerned with the production of health manpower and those concerned with its utilization. A working group on WHO's collaborative role in nursing/midwifery in the South Pacific was held in Suva, Fiji, in May 1978. The recommendations of the group are being used as the basis for planning to meet nursing service manpower needs in the South Pacific. A workshop on collaborative planning in health service manpower development was conducted in February 1978 at the Regional Teacher Training Centre for Health Personnel, Sydney attended by 20 participants. Collaboration is being extended to the Republic of Korea in developing a medical education programme which stresses interagency collaboration.

A sturlv, based on a questionnaire, of facilities offering continuing education for health personnel in the Western Pacific Reg.ion was completed late 1Q7'3 as a preliminary step towards developinp; continu'.ng education programmes ultimately concerned with maintaining the quality of service being provided hy health personnel. Late ln 1Q78 a review ts to be held which is expected to result in a check-list of conrlitions and processes to be considered for improving the health manpower development component of the country health programming process.

141

142

PROGRAMME:

6.1.1

HEALTH MANPOWER PLANNING AND MANAGEMENT

Estimated obligations Regular budget US$

Other sources US$

Total US$

1978-1979 Regional ......................................... . Country or area .................................. .

Intercountry

...................................... Total 1980-1981

12 000 12 000

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

Intercountry

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

215 900 94 000 309 900

Increase (decrease) in 1980-1981 over 1978-1979 Regional ......................................... . Country or area .................................. . Intercountry ..................................... .

215 900 82 000 297 900

Total

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, including auxiliaries and aides, to deliver services to entire populations; to promote the application of task-orientated teaching approaches especially for health workers at the middle and lower levels. Approach Promoting the training of teams for community-orientated health work, based on the roles and functions of the various health workers and the members of the community being complementary. Participating in establishing criteria for improving the training of health personnel in quality and quantity in existing establishments, and for setting up new establishments. Promoting the development of selection policies and the tapping of new sources of manpower within the community. Review Collaboration with Member States in training programmes for health personnel, mostly through cooperation in developing specific subject areas within continuing national teaching programmes, remained an important component of WHO programmes in health manpower development. Cooperation continued with the Fiji School of Medicine in developing the paediatrics component of the medical course and in developing the medical assistant training programme. In Cook Islands, a programme is being implemented to prepare an auxiliary type of nurse who can function in either the community or the hospital setting. Nursing/midwifery personnel will continue to be prepared for leadership positions in basic and post-basic courses in New Zealand. M3

144

A conference on the fellowship programme will be held early in 1979 and is expected to be attended by representatives of all Member States in the Region. The responsibilities of governments, both those who send fellows and those who receive them, in achieving the maximum benefit from a fellowship will be discussed. Also to be discussed is the necessity to incorporate the fellowship programme into the total health manpower plans of a country.

PROGRAMME:

6.1.2

PROMOTION OF TRAINING

Estimated obligations

---------------1978-1979 Regional .......................................... Country or area Intercountry ......................................

Regular budget

Other sources

Total

US$

................................... 1980-1981

4 787 200 229 400 5 016 600

9 100 125 400 134 500

4 796 300 354 Boo 5 151 100

Total

3 085 900 331 200 3 417 100

61 200 61 200

3 14 7 100 331 200 3 478 300

( 1 701 300) 101 800 ( 1 599 500)

52 100 ( 125 400) (73

( 1 649 200) (23 600) ( 1 672 800)

300)

145

146

Programme: Educational development and support

No. 6. 1. 3

Objectives To promote, and cooperate in, applying educational planning to the formulation of relevant curricula for health personnel; to promote, and cooperate in, developing resource material in national languages for training health workers; to promote, and cooperate in, formulating policies which require the adequate preparation of teachers of health personnel; to promote, and collaborate in, establishing institutions for the preparation of teachers of health personnel. Approach Encouraging and participating in the preparation of practical guidelines for the development of learning objectives based on task analysis as well as guidelines for curricula preparation, and in the development of teaching programmes and methods appropriate to learning objectives based on the immediate and lorig-term needs of the population. Encouraging the preparation of standard curricula for basic and continuing education and promoting the establishment of international criteria for assessing educational objectives. Assisting in the development of training systems for reinforcing problem-solving and decision-making skills. Promoting the development of a coordinated programme for the production, adaptation and dissemination of low-cost learning materials. Promoting the development of evaluation mechanisms for all types of educational activity.

Preparing practical guidelines for the evaluation of training activities and for the utilization of educational methods and media. Collaborating with interested Member States in the development of training centres for teachers of health personnel. Encouraging and participating in the preparation of comprehensive educational packages for teachers. Encouraging the development and strengthening of regional and national institutions able to provide the necessary resources for teaching advisory services, technical support and educational research. Encouraging the development of training activities designed to familiarize multiprofessional groups of teachers and educational managers in educational methodology. Participating in the collection and dissemination of relevant data for the preparation of training programmes. Review UNDP support for teacher training centres for health personnel was extended up to the end of 1978. Funds have also been obtained from the Japan Shipbuilding Industry Foundation to provide additional support. The national teacher training centres in the Philippines and the Republic of Korea have continued to function, although budgetary constraints have prevented expansion to their full potential. Gratifying developments have occurred in the application of sound educational practices to the education and training of health personnel. In 1978, cooperation was extended to Malaysia in developing the food technology section of the health inspectors curriculum at the Public Health Institute using a task-orientated competence-based approach. The medical assistant training programme in Fiji is being arranged in modular form so that, where possible, modules may be used for developing a similar curriculum in Tonga, Solomon Islands and other countries or areas of the South Pacific. As a result of the 1976 interregional workshop on modular teaching in nursing and midwifery, modules have been developed and are being refined and methods will be developed for testing their validity and reliability. If these are successful it is planned to develop a modular bank for use by nursing/midwifery personnel throughout the Region. M7

148

Both Fiji and Papua New Guinea have taken steps to develop diploma in health personnel education courses, which will answer a need for subgraduate programmes on the subject. In collaboration with WHO Headquarters, a field test was conducted in several countries of the Region on the application of diagnostic flowcharts designed for the use of middle level personnel. Such decision-making aids are important components of the diagnostic tools to be used by middle level health workers.

PROGRAMME:

6.1.3

EDUCATIONAL DEVELOPMENT AND SUPPORT

Estimated obligations f---·--. ·---------

-----------.... ·-·19 78-19 79

Regular budget US$

Other sources US$

Total US$

Regional .......................................... Country or area ................................... Intercountry ...................................... Total 1980-1981 Regional .......................................... Country or area ................................... Intercountry ...................................... Total Increase (decrease) in 1980-1981 over 1978-1979 Regional .......................................... Country or area ................................... Intercountry ...................................... Total

410 800 144 500 555 300

110 000 110 000

410 800 254 500 665 300

960 400 296 600 1 257 000

549 600 152 100 701 700

(110 000) (110 000)

549 600 42 100 591 700

149-

150

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

No. 7

7. 1

7. 1.1

Objectives To collect and retrieve health information for consolidation and dissemination; to improve procedures for making uniform and standardizing health statistics concepts and definitions; to develop mechanisms and procedures for the effective and efficient collection, compilation, analysis and interpretation of statistical data at national and international level; to cooperate in the statistical, mathematical and methodological aspects of specific studies arid investigations that may be undertaken further to improve health services programmes and subprogrammes at national and international level; to collaborate in training in vital, health and hospital statistics, including the upgrading of medical records; to promote further development of procedures for the "lay reporting" of morbidity and mortality as appropriate for some countries in the Region. Approach Collecting health data from countries or areas by means of questionnaires and official government documents and consolidating and disseminating the responses and information gathered. Promoting appropriate methods for collecting, processing and analyzing data, including the utilization of already available sources of data on the health situation and national services, particularly in regard to primary health care, rural health and hospital care services, including medical records systems.

Promoting and, when requested, collaborating with governments to strengthen health statistical services, both at the centre and at the periphery, especially in establishing a system for the collection and utilization of statistical information on primary health care/rural health services. Promoting standardization in the collection of morbidity and mortality data, including implementation of the ninth revision of the Manual of the International Statistical Classification of Diseases, Injuries and Causes of Death and the "lay reporting" of mortality and morbidity where appropriate. Review The Western Pacific Region is heterogeneous, with countries falling within a wide range of sophistication, which presents a challenge in developing a programme strategy for health statistics. In some countries or areas there is a felt need to develop appropriate procedures for the "lay reporting" of morbidity and mortality. At the other extreme there is also a need to develop a sound methodological basis for the use of computer facilities to support the application of the medical, epidemiological and health services. Health statistical activities in the Region are being reorientated and expanded to support the development of information systems to satisfy technical and managerial requirements for information. Statistical, mathematical and methodological support have been provided to different programmes at national and international level. Increased emphasis is being placed on activities orientated towards development of information systems, with traditional vital, health and hospital statistics activities being integrated with and made supportive to such information systems. As a consequence, traditional statistical activities were not, as far as possible, undertaken in isolation but as part of relevant health, health-related and health services programme activities. To contribute to making uniform and standardizing the recording and reporting of morbidity and mortality statistics and to facilitate implementation of the ninth revision of the International Statistical Classification of Diseases, Injuries, and Causes of Death (ICD-9) which commences on 1 January 1979, WHO has completed Phase 1 of a training programme to reorientate trained coders in the use of ICD-9, initially by training a group of coding supervisors and senior coders who can thereafter train junior coding staff locally in Australia, Hong Kong, Japan, Malaysia, New Zealand, Philippines, Republic of Korea and Singapore. Phase II of the training, emphasizing the "lay reporting" of morbidity and mortality, will be carried out in early 1979 and will cover all countries or areas of the South Pacific.

151

152

A basis was established in the Philippines, through the improvement of medical records project, by cooperating in training national staff in an improved medical records system, finalizing the Manual of Standards on Philippine Hospital Licensure, compiling the Manual of Medical Records Department Procedures, formulating a training programme for the medical records personnel and establishing a demonstration a~ea with an improved medical records system for the purpose of training. In the Republic of Korea, cooperation was given, through the advisory services on health statistics project, in establishing a statistics division ln the Ministry of Health and Social Affairs, which is further developing and integrating statistical activities to support the national health information system needed for the planning, implementation, evaluation and coordination functions of the Ministry.

PROGRAMME:

7.1.1

HEALTH STATISTICS

Estimated obligations Regular budget US$ 1978-1979 Regional CountrY or are·a ... ~· .............................. .

Other sources US$

Total US$

Intercountry Total 1980-1981 Regional Country or area .................................. .

145 800 25 500 171 300

42 900 42 900

Intercountry Total Increase (decrease) in 1980-1981 over 1978-1979 Region.al ......................................... .

Country or area .................................. .

Intercountry Total

(102 900) (25 500) (128 400)

··---

(102 900) (25 500) ( 128 400)

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

153

154

Programme: WHO publications and documents

No. 7. 1.2

Objectives fb.provide the medical and public health profession with information on the various fields in which the Organization i~ interes~ed; to provide- within the limits of available reS91Jt:"Ces- such editorial and translation services asmay be needed in the preparation of documentation; - ·' ~

to· cooperate in the production and distribution ()f docuptents; and :t<:5'cefitralize the collection of material for reports required by Headquarters. Approach Disseminating information on WHO publications as widely as possible • . Enco~raging the translation and distribution of WHO the Organization. publication~

;,,

in other languages, at no cost to

Editing and translating into English and French, as appropriate, material on technical subjects, including documents prepared for or resulting from the meeting of the Regional Committee; and working papers and reports of conferences, seminars, working groups and other meetings. Providing a conference records service at meetings of the Regional Committee and of the WHO Representatives. Keeping a permanent check on the distribution of WHO documents. Review A special scheme for the distribution and sale of WHO publications to health workers and institutions has been established in the Regional Office. This enables interested persons to pay for WHO publications in

their local currency and in 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 any forthcoming publications in that field. Considerable progress has been made during recent years in the translation and distribution of WHO publications in other languages, particularly into Japanese. To date, 53 texts in the Technical Report Series, 14 Public Health Papers, 6 Monograph Series, 2 Offset Publications, 8 Out-of-Series, 1 Official Records, 1 WHO Bulletin article, and 1 final report on a seminar are.available in Japanese; 1 Out-of-Series in Korean; 2 Monograph Series and 2 Technical Report Series in Vietnamese; and 1 Out-of-Series in Portuguese. Rights have also been granted for the translation of a further 4 Technical Report Series, 1 Offset Publication, 5 Out-of-Series, 1 Regional Publication, European Series, and 1 final report on a working group into Japanese; 1 Public Health Paper into Korean; and 1 Out-of-Series into Pilipino.

155

156

PROGRAMME:

7.1.2

WHO PUBLICATIONS AND DOCUMENTS

Estimated obligations Regular budget US$ 1978-1979 Regional Country or area .................................. .

Other sources US$

Total US$

352 200

Intercountry

...................................... Total 1980-1981 352 200 352 200

Regional

.......................................... Country or area .................................. . Intercountry ...................................... Total Increase (decrease) in 1980-1981 over 1978-1979 Regional ......................................... . Country or area .................................. .

416 200

64 000

Intercountry

•••••••••••••••••••••

••••••••••••••••

Total

64 000

Programme: Health literature services

No. 1. 1.4

Objectives To cooperate in strengthening national health library services; to develop and provide learning and reference material, particularly to training institution~;

to provide a reference and documentation service on medical and public health subjects to WHO ~taff in the Regional Office and in the field, and on request, to other persons and in~titutions associated with WHO. Approach Providing consultant services and equipment. Providing information, on request, on medical library Giving membership of subscriptions allocated for Review Health information has been disseminated through the Regional Office library and at country level through the health literature and teaching equipment project. Cooperation has also been given in improving the library facilities in Fiji. Cooperation has been provided to the Republic of Korea for library classification and the revision of the Index Medicus Korea. Self-instructional materials in basic sciences were sent to Papua New Guinea. or~anization

and methods.

technical guidance to the WHO Regional Off.ice Library through a Li-brary Committee, the which is established by the Regional Director. The Committee reviews requirement~ for to journals and purchase of books and recommends to the Regional Director how the fund~ the purpose may best be expended.

157

158

PROGRAMME:

7.1.4

HEALTH LITERATURE SERVICES

Estimated obligations Regular budget US$ 1978-1979 Regional ......................................... .

Other sources US$

Total US$

Country or area .•.....•.....•...............•..•.. Intercountry ..................................... .

27 300 16 100 37 000 80 400

Total 1980-1981 Regional

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

32 100 20 000 52 100

Country or area .................................. .

Intercountry

Increase (decrease) in 1980-1981 over 1978-1979 Regional .......................................... Country or area .......•..••••••..•..••...........• Intercountry ................................•••..• Total 4 800 (16 100) (17 000) (28 300)

4 Boo (16 100) ( 17 000) (28 300)

Programme: Health information of the public

No. 7. 1. 5

Objectives To make the Organization and its work better known and understood by the people of all countries or areas in the Region; to inform the people of the countries or areas in the Region on matters of health. Approach Producing and distributing information material on WHO and its activities 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 and providing the technical input. Review Health is a major concern of every individual. This is reflected in the numerous publications on health for lay readers and the daily columns on health in newspapers and radio and television commentaries. WHO's information activities do not merely encourage factual reporting on health but also .stimulate individual positive action for health. Mass media networks have given prominence to WHO news reports on smallpox, cholera and diarrhoeal diseases, traditional medicine, primary health care, drugs, family planning, oral health, water and the environment. Themes for World Health Day, observed on 7 April, have been reported extensively on national media services. 159

160

PROGRAMME:

7.1.5

HEALTH INFORMATION OF THE PUBLIC

Estimated obligations Regular budget US$

Other sources US$

Total US$

1978-1979 Regional Country or area .................................. .

.......................................... Intercountry ...................................... Total 1980-1981

117 700 32 200 149 900

Regional

Country or area .................................. .

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

126 400 17 500 143 900

Intercountry

Increase (decrease) in 1980-1981 over 1978-1979 Regional Country or area .................................. .

.......................................... Intercountry ...................................... Total

8 700 (14 700) (6 000)

Appropriation section: General services and support programmes Major programme: General services and Programme: Programme planning and general activities ~upport programme~

No. 8

8.1

8.1.0

Objectives To provide administrative assistance to technical units in planning and developing regional programmes; to contribute to the development of regional policy on the administrative aspects of programme planning; to provide administrative assistance to WHO Representatives and field staff, so as to ensure the smooth operation of field activities; to coordinate the administrative functions of the Regional Office with those of other related organizations.

161

162

PROGRAMME:

8.1.0

GENERAL SERVICES AND SUPPORT PROGRAMMES PROGRAMME PLANNING AND GENERAL ACTIVITIES

Estimated obligations Regular budget US$ 1978-1979 Regional ......................................... .

Other sources US$

Total US$

263 300

Country or area ....•....•......•••.•.•.••.•..••••. Intercountry ..................................... .

Total 1980-1981 Regional Country or area ••••...•..•..••••..••.••••••.•••••. Intercountry ....................•................. Total Increase (decrease) in 1980-1981 over 1978-1979 Regional Country or area .................................. .

263 300

290 600

27 300

Intercountry Total 27 300 27 300

Programme: Staff development and training

No. 8. 1. 1

Objective To help the Organization to meet changing needs by improving the quality of its human resources through training, development and better utilization of staff. Approach Training of staff in management at all levels and from all fields; training and continuing education of specialist staff in health and allied technical fields; training of general service staff; training in the official languages of the Organization; development of staff through educational activities, such as conferences and seminars; providing advice on recruitment and career development; cooperating with national health authorities in training in management and other' areas.

163

164 PROGRAMME: 8.1.1 STAFF DEVELOPMENT AND TRAINING

Estimated obligations Regular budget US$

Other sources US$

Total US$

1978-1979 Regional Country or area .................................. .

Intercountry Total 1980-1981 Regional· .............................•.............

24 000 24 000

Country or area ................•.................• Intercountry ..................................... .

24 000 24 000

Total Increase (decrease) in 1980-1981 over 1978-1979 Regional ......................................... . Country or area .................................. . Intercountry ......................................•

Total

Programme: Personnel

No. 8. 1. 2

Objectives To formulate and administer personnel policies in support of the Organization's programme of work; to assist technical units in recruiting the necessary personnel for the smooth implementation of programmes; to coordinate personnel policies with those of other related organizations.

165

166

PROGRAMME:

8.1.2

PERSONNEL

Estimated obligations Regular budget US$ 1978-1979 Regional Country or area Intercountry Other sources US$ Total US$

.......................................... ................................... ...................................... Total 1980-1981

178 600

5 100

183 700

178 600

5 100

183 700

Regional Country or area Intercountry

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

224 500

Increase (decrease) in 1980-1981 over 1978-1979 Regional Country or area Intercountry

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

45 900 /

(5 100)

40 800

45 900

(5 100)

40 800

Programme: Supplies

No. 8. 1. 3

Objective To assist technical units in the procurement of supplies and equipment needed for programmes in the Region.

167

168

PROGRAMME:

8.1.3

SUPPLIES

Estimated obligations Regular budget US$ 1978-1979 Regional Country or area .................................. .

Other sources US$

Total US$

92 800

Intercountry

...................................... Total 1980-1981 92 800 92 800

Regi ooa 1 ......................................... .

102 800

Country or area .................................. .

Intercountry

...................................... Total 102 800 102 800

Increase (decrease) in 1980-1981 over 1978-1979 Regional ......................................... . Country or area .................................. .

10 000

Intercountry

...................................... Total 10 000 10 000

Programme: Conference, office and building services

No. 8.1.4

Objectives To provide maintenance and building services to the Regional Office; to assist technical units in arranging the necessary facilities for conferences, seminars and meetings; to provide word processing services; to provide document reproduction facilities; to provide registry, travelt visa, transport of effects and customs clearance facilities.

169

170

PROGRAMME:

8.1.4

CONFERENCE, OFFICE AND BUILDING SERVICES

Estimated obligations Regular budget US$ 1978-1979 Regional Country or area Intercountry Other sources US$ Total US$

.......................................... ................................... ...................................... Total 1980-1981

1 311 300

26 000

1 337 300

1 311 300

26 000

1 337 300

Regional Country or area Intercountry

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

1 475 700

28 600

1 504 300

1 475 700

28 600

1 504 300

Increase (decrease) in 1980-1981 over 1978-1979 Regional Country or area Intercountry

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

164 400

2 600

167 000

164 400

2 600

167 000

Programme: Budget

No. 8.1.5

Objectives To assist technical units in the budgetary aspects of the planning, preparation and implementation of the Organization's programme under all sources of funds; to prepare budgetary reports and documentation as necessary in respect of the regular budget and extrabudgetary funds.

171

172

PROGRAMME:

8.1.5

BUDGET

Estimated obligations Regular budget US$ 1978-1979 Regional Country or area Intercountry Other sources US$ Total US$

.......................................... ................................... ...................................... Total 1980-1981

162 600

13 400

176 000

162 600

13 400

176 000

Regional Country or area Intercountry

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

183 300

15 500

198 800

183 300

15 500

198 800

Increase (decrease) in 1980-1981 over 1978-1979 Regional Country or area Intercountry

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

20 700

2 100

22 800

20 700

2 100

22 800

Programme: Finance and accounts

No. 8.1.6

Objectives To provide the financial administration of all funds held by the Organization and maintain appropriate records; to prepare financial reports and documentation as necessary in respect of the regular budget and extrabudgetary funds.

173

174

PROGRAMME:

8.1.6

FINANCE AND ACCOUNTS

Estimated obligations Regular budget US$ 1978-1979

Other sources US$

Total US$

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

197 100

Intercountry Total 1980-1981 197 100 197 100

Regional

Country or area .................................. .

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

212 200

Intercountry 212 200 212 200

Increase (decrease) in 1980-1981 over 1978-1979 Regional Country or area .................................. .

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

15 100

Intercountry 15 100 15 100

INFORMATION ANNEXES

176 CONTENTS

Technical cooperation with and services to governments ••••••••••••••••••••••••••••••••••••••••••••••••••• ANNEX I ANNEX II Table for Regional Office by programme

177

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

181

Individual country or area programme statements with tabulations

American Samoa Australia People's Republic of China Cook Islands Democratic Kampuchea Fiji French Polynesia Gilbert Islands • :" Guam Hong Kong Japan Lao People's Democratic Republic Malaysia New Hebrides New Zealand Niue Papua New Guinea Philippines • Republic of Korea Samoa Singapore Socialist Republic of VietNam .•.•....••••••......•••••.••••.••...•••.•••••.•.••••••••..•.•••..•••.• Solomon Islands Tonga Trust Territory of the Pacific Islands Tuvalu ~ ~

........................................................................................... .......................................................................... ........................................................................................ ................................................................................ ................................................................................................ .................................................................................... ..................................................................................... ................................................... ..... ..... ................................ . ........................................................................................... ............................................................................................... .................................................................... ............................................................................................ ........................................................................................ ......................................................................................... ................................................................................................. ..................................................................................... ............................................. ........................................... . ................................................................................... ............................................................................................... ...................................................................... ................... . ...................................................................................... ............................................................................................... .............................................................. .............................................................................................. • • • • • • • • • • • • • • • • • • • • 41! • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •

189 193 195 196 201 202 208 215 220 223 225 226 232 241 245 247 249 256 266 272 278 283 289 295 301 306

ANNEX III -

Intercountry programme statement with tabulations •••••••••••••••••••••••••••••••••••••••••••

313

TECHNICAL COOPERATION WITH AND SERVICES TO GOVERNMENTS

Regular budget 1980-1981 1978-1979 US$ American Samoa Australia China, People's Republic of •••••• Cook Islands Democratic Kampuchea Fiji French Polynesia Gilbert Islands Guam Hong Kong Japan Lao People's Democratic Republic Malaysia New Hebrides New Zealand Niue Papua New Guinea Philippines Republic of Korea Samoa Singapore Socialist Republic of VietNam ••• Solomon Islands Tonga Trust Territory of the Pacific Islands Tuvalu Intercountry programmes (including Regional Advisers) Total US$ 100 100 100 253 000 772 60 262 66 110 68 517 059 548 60 60 693 763 455 387 319 668 548 416 000 000 000 500 000 300 000 000 000 000 000 300 300 400 000 000 400 800 300 400 900 800 400 600

Other sources 1980-1981 1978-1979 US$ US$

Total 1978-1979 1980-1981

US$ 87 300 91 600

US$ 100 100 100 279 000 894 60 308 66 123 68 095 156 945 60 60 045 815 944 667 319 813 856 676 000 000 000 900 000 300 000 000 000 200 000 900 300 800 000 000 900 600 300 700 900 500 600 700

87 300 91 600 128 542 625 52 222 67 99 61 358 926 387 58 43 231 438 324 351 357 475 381 323 200 000 600 300 000 100 300 700 500 800 500 000 300 000 800 100 700 600 500 800 900 1

49 800 185 700 54 500

26 400 122 000 46 000 13 200

1 1

478 900 326 300 250 200 662 759 10 591 800 400 000 100

578 600 97 000 397 400 352 51 489 280 500 800 000 300

1 1

1 1 1 3

1 2 1 5

2 224 300 203 700 569 300 45 100 2 787 100 9 198 200

144 700 308 200 260 100 102 000 1 364 400

178 542 811 52 276 67 99 61 837 253 637 58 43 893 198 334 942 357 699 585 893

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

2 1

2 1 1 3

178 100 41 600 9 182 500 23 037 800

207 000 52 000 11 797 800 28 447 200

178 100 86 700 11 969 600 32 236 000

207 000 154 000 13 162 200 33 080 800

----------

4 633 600

----------

177

ANNEX I TABLE FOR REGIONAL OFFICE BY PROGRAMME

Regular budget Man years/months Estimated obligations 197B-1979 19B0-19Bl 197B-1979 19B0-19Bl US$ US$ REGIONAL OFFICE

Other sources Man years/months Grade 197B-1979 19B0-19Bl

Source of Estimated obligations funds 197B-1979 19B0-19Bl US$ US$

EXECUTIVE MANAGEMENT Office of the Regional Director 2/0 2/0 2/0 6/0 6!0 210 2/0 2!0

670 6/0 -

122 65 10 198 22 221

400 500 100 6oo 500 100

134 69 13 217 24 241

500 800 000 300 500 8oo

Regional Director Administrative Officer Secretary Total established posts Duty travel GENERAL PROGRAMME DEVELOPMENT AND MANAGEMENT General programme development Office of the Director of Health Services

UG P2 M6

2/0 6/0 2/0 4/0 6/0 4/0 4/0 2810 2810 --

2/0 6!0 2/0 4/0 6!0 4/0 4/0 2810 2810 --

91 900 275 65 26 32 17 15 524 35 5b0 100 500 400 100 600 200

97 400 292 69 32 39 21 18 570 41 bll 200 800 000 000 400 400 200 000 200

4oo

800 200

Director of Health Services Assistant Directors of Health Services Administrative officer Administrative assistants Secretaries Clerk stenographers Clerk stenographers Total established posts Duty travel

D2 P6 P3 M7 M6 M5 M4

181

182

Regular budget Man years/months Estimated obligations 1978-1979 1980-1981 1978-1979 1980-1981 US$ US$ REGIONAL OFFICE

Other sources Man years/months Grade 1978-1979 1980-1981 Estimated obligation~ 1978-1979 1980-1981 US$ HEALTH INFORMATION WHO ~ublications

Source of funds

US$

and documents P4 P3 M6 M4 P3 Mx

2/0 2/0 2/0 4/0 3/2 2/0 2/0 17/2 17/2

2/0 2/0 2/0 4/0 4/0 2/0 2/0 18/0 1810 -2/0 2/0 4/0

91 65 10 15 103 30 27 345

900 500 700 200 700 700 500 200 1 000 352 200

97 69 13 18 139 37 33 408

400 800 000 400 600 200 200 600 1 600 416 200

Liaison and reports officer Editor Records clerk Clerk stenographers Translators Senior secretary Secretary Total established posts Duty travel Health literature services

2/0 2/0 4/0

Jf70 --

470 --

8 800 1 600 16 400 10 900 27 300

10 9 19 12 32

700 200 900 200 100

Librarian Assistant librarian Total established posts Library books and supplies

M5 M4

Health information of the public 2!0 2!0

2/0 2/0

470 470

476 470

91 7 99 9 9 117

900 600 500 200 000 700

97 9 106 10 9 126

400 200 6oo 200 600 lioo

Information officer Secretary Total established posts Duty travel Supplies and equipment GENERAL SERVICES AND SUPPORT PROGRAMMES Programme planning and general activities

P4 M4

2!0 2!0 2!0 2!0

2/0 2!0 2/0 2!0

91 900 91 13 8 205 45 12 263 900 200 800 BOO 500 000 300

97 400 97 16 10 221 54 14 29o 400 000 700 500 800 300 6oo

870 870

Administration and Finance P5 Officer Administration and Finance P4 Officer M7 Secretary M5 Clerk stenographer Total established posts Overtime and temporary assistance Duty travel

183

184

Regular budget Man years/months Estimated obligations 1978-1979 1980-1981 1976-1979 1960-1961 US$ US$

REGIONAL OFFICE

Other sources Source of Man years/months Estimated obligations funds Grade ~976-1979 1960-1961 1976-1979 1960-1961 US$ US$

Personnel 2/0 1/4 2/0 2/0 2/0 1/0 2/0 2/0 2/0 210

91 900 43 700 13 200 8 800

rm 2/0 2/0 2/0

2/0 2/0 2/0 2/0

1;p11 t;oo

8800 4 600 7 600

2~li

97 69 16 10 10 10 9

400 800 000 700 700 700 200

506

Personnel officer Personnel officer Personnel assistant Clerk stenographer Clinical nurse Clerk Clerk typist Total established posts Supplies

P4 P3 M7 M5 M5 M5 MJ4

1/0 170 -

5 100 5

ioo

2/0 2/0 2/0

b70 b70 -

b70 b70

65 500 13 200 7 600 ar; 300 6 500 92

noo

69 16 9 95 7 102

800 000 200 000 800

noo

Administrative services officer Administrative assistant Clerk typist Total established posts Custodial starr

P3 M7 MJ4

Conference, office and building services 2!0 2!0 4/0 2/0 2/0 2!0 2/0 2/0 2!0 6!0 2!0 2810 2!0 2/0 4/0 2!0 2!0 2/0 2!0 2!0 2!0 6!0 2!0 2810

91 16 26 10 8 8

a aoo

900 600 400 700 800 800

7 7 22 6 216 210

600 600 800 500 500 800

97 20 32 13 10 10 10 9 9 27 7 248 254

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

Administrative services officer Administrative assistant Administrative assistants Registry clerk General services clerk Travel clerk Clerk Clerk stenographer Mail clerk Clerks Typist Total established posts Custodial staff

P4 Mx M7 M6 M5 M5 M5 M4 M4 M4 M3

Common services 74 300 420 800 200 100 2810 2810

99 200 552 300 223 200

188 800 98 200 l 311 300 l 475 700

Contractual services General operating expenses Supplies and materials Acquisition of furniture, equipment and vehicle

26 000

28 600

26 000

28 600

186

Regular budget Man years/months Estimated obligations 1978-1979 1980-1981 1978-1979 1980-1981 US$ US$ Budget 2/0 2/0 2/0 6/0 2/0 14/0 2/0 2/0 2/0 6/0 2/0 14/0 91 16 13 32 8 162 900 600 200 100 800 6oo 97 20 16 39 10 183 400 200 000 000 700 300 Budget and finance officer Administrative assistant Administrative assistants Accountants Clerk stenographer Total established posts Finance and accounts 2/0 2/0 4/0 2/0 10/0 2/0 22/0 2/0 2/0 4/0 2/0 10/0 2/0 22/0 65 16 26 27 53 7 197 500 600 400 500 500 600 100 69 20 32 16 65 9 212 800 200 000 000 000 200 200 Budget and finance officer Administrative assistant Administrative assistants Cashier Accountants Clerk stenographer Total established posts TOTAL - REGIONAL OFFICE P3 Mx M7 M7

Other sources REGIONAL OFFICE Man years/months Grade 1978-1979 1980-1981

Source of Estimated obligations funds 1978-1979 1980-1981 US$ US$

Pit Mx M7

2/0 2/0 --

~too

15 500 15 500

M6 M5 13 400

M6 M4

-152/0 3 484 200 3 916 800

-3/0

----2/0

149/6

-----

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

----

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

44 500

4lt 100

ANNEX II INDIVIDUAL COUNTRY OR AREA PROGRAMME STATEMENTS WITH TABULATIONS

AMERICAN SAMOA NATIONAL HEALTH DEVELOPMENT STRATEGY A preliminary American Samoa plan for health has been developed by the State Health Planning and Development Agency (SHPDA) and adopted by the American Samoa Health Coordinating Council. The plan 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 in American Samoa should not be more than 5J 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 is 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;

189

190

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 PROGRAMMES FOR HEALTH Many priority programme areas are well covered by the Territory's own resources and by federal grants from the United States of America. The World Health Organization's cooperation during the past years has been concentrated on the fellowship programme and the provision of opportunities for health staff to participate in intercountry seminars and group educational activities. While this trend will continue, the following areas are also identified for which WHO technical cooperation is required. Development of comprehensive health services Health services development Primary health care The health delivery system of the Territory covers a very large percentage of the population. However, the development of a broader scope of health activity at the community level, with more active participation of the people, requires further effort. It is also felt that the role and functions of dispensaries in total health delivery require further study and strengthening. Technical cooperation from WHO intercountry programmes will provide for the development of a primary health care programme. Family health Technical cooperation from WHO intercountry programmes will further developments in maternal and child health, nutrition and health education. Disease prevention and control Communicable disease prevention and control Technical cooperation from WHO intercountry programmes will further national programmes of epidemiological surveillance, and programmes for the control of tuberculosis, leprosy, sexually transmitted diseases and parasitic diseases (with particular reference to filariasis), including vector control activities. Promotion of environmental health Gastroenteritis, diarrhoeal diseases, and infectious hepatitis remain prevalent. WHO's cooperation will be mainly in the improvement of water supplies, waste disposal, and food sanitation through its intercountry programmes.

191

192

AMERICAN SAMOA (continued) 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 traini,ng abroad, and to provide national staff with opportunities to participate in intercountry group educational activities. Health information Health statistics WHO will cooperate through its intercountry programmes in the further development of health statistics, health records, and a reporting system.

Regular budget AMERICAN SAMOA 1978-1979 US$ 1980-1981 US$ HEALTH MANPOWER DEVELOPMENT 87 300 87 300 100 000 Promotion of training Total - AMERICAN SAMOA

Other sources 1978-1979 US$ 1980-1981 US$

Source of Funds

-----------

=======

100 000

---------

AUSTRALIA NATIONAL HEALTH DEVELOPMENT STRATEGY Australia is a Federation of six States and two Territories. The States are New South Wales, Victoria, Queensland, South Australia, Western Australia and Tasmania. The two Territories are the Northern Territory and the Australian Capital Territory, the latter being the seat of the Federal Government of the Commonwealth of Australia. Only in the Northern Territory is the Commonwealth Government directly involved in providing health services. In the Australian Capital Territory the responsibility was recently transferred to a statutory authority, the Capital Territory Health Commission, while in the States the various State governments are responsible. Prior to an amendment to the Constitution in 1946, the only health function of the Commonwealth Department of Health was in relation to quarantine. Consequent upon this amendment the Commonwealth Government was given powers to make laws in respect to pharmaceutical, hospital and· sickness benefits and medical and dental services. The Commonwealth Government has also used its powers under Section 96 of the Constitution to make grants to the States for health purposes. In addition, the Commonwealth Government gives financial assistance to certain organizations concerned with public health matters. The Commonwealth Government, through the Department of Health, recently introduced two programmes aimed at developing and maintaining hospital and community-based health services. Those programmes are the Community Health Program and the Hospital Development Program. The Hospitals and Health Services Commission has the responsibility of submitting recommendations to the Minister for Health for allocation of funds for the two programmes which aim to promote the regionalization and modernization of hospitals, linked with the development of community-based health services and preventive health programmes. Implementation of the approved programme is undertaken by State governments. TECHNICAL COOPERATION PROGRAMMES FOR HEALTH Health manpower development The provision of health manpower and training in Australia is a complex process, Promotion of training 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.

193

194

Regular budget AUSTRALIA 1978-1979 1980-1981

Other sources 1978-1979 1980-1981

Source of Funds

US$

US$ HEALTH MANPOWER DEVELOPMENT

US$

91 600 91 600

100 000 100 000

Promotion of training Total - AUSTRALIA

-----------

=======

--------

PEOPLE'S REPUBLIC OF CHINA TECHNICAL COOPERATION PROGRAMMES FOR HEALTH Health manpower development Promotion of training The provisions· of this programme afford the People's Republic of China the opportunity for selected health personnel to visit other parts of the world for postgraduate studies in different specialities, and for training in special subjects.

Regular budget PEOPLE'S REPUBLIC OF CHINA 1978-1979 1980-1981

Other sources 1978-1979 1980-1981

Source of Funds

US$

US$ HEALTH MANPOWER DEVELOPMENT 100 000

US$

Promotion of training Total - PEOPLE'S REPUBLIC OF CHINA

------

-------

100 000

---------

195

196

COOK ISLANDS NATIONAL HEALTH DEVELOPMENT STRATEGY A public investment plan, covering 1979 to 1982, is being prepared at present. The health development plan, which will be an integral part of the public investment plan, will have as its overall long-term objective the provision of the best possible comprehensive health services, both curative and preventive, to every individual residing in Cook Islands. To that end, more attention will be paid to the development of a health delivery system for the outer islands, in order to render access to health care on a more equal basis to both the rural and the urban population. The following priority programme areas are identified for the development of the health programme during the period 1979 to 1982: (1) with an increasing number of existing health staff leaving the health services, the overseas training of professional staff and the local training of nursing and auxiliary staff will have top priority during the programming period so as to maintain a reasonable health personnel/population ratio; the community development programme has been emphasized in the national policy for development, in which two essential elements are stressed: (a) (b) the participation of the people themselves in efforts to improve their own level of living with as much reliance as possible on their own initiative; and the provision of technical and other services in ways which encourage initiative, self-help, and mutual help and make them more effective. To exploit those guiding principles, the primary health care programme will be developed as an integral part of the community development programme;

(2)

(3) (4)

continuous effort will be made to promote the health of mothers and children; environmental health will be promoted, with particular supply and waste disposal facilities. empha~is

on the improvement of water

TECHNICAL COOPERATION PROGRAMMES FOR HEALTH Development of comprehensive health services Health services development Primary health care The capacities of the island councils, village committees and district councils have been upgraded under the community development scheme. The potential of the community organizations will be further developed to promote their active participation in primary health care. It is envisaged that a national seminar will be conducted to promote the concept of primary health care. Technical cooperation will further the planning of the primary health care programme, the training of primary health care workers and the preparation of a field manual. The programme will commence on a small scale, to try out the procedures and the technical and logistical support required, before it is expanded to a national scale. The possibility of integrating traditional medical practices into the priaary health care system will also be investigated. Family Health Maternal and child health Emphasis in the programme will be placed on the further development of antenatal, natal and postnatal services, child health care, nutrition and family planning. In those areas WHO will continue to cooperate through its intercountry programmes. It is envisaged that it will be necessary to request UNFPA for an extension of support for the family health project for three years (1979-81), during which time greater emphasis will be directed towards the development of services on the outer islands. The rate of unplanned pregnancies and gonorrhoea! infections among young adults is escalating. The promotion of contraceptive practices among that age group will therefore be emphasized. Health education The programme will be further developed with close cooperation between the Departments of Health and Education. At the initial stage, the major effort will be in support of the development of primary health care and family health. Particular attention will be paid to developing the concept of family health education among school students·and protecting young adults against unplanned pregnancies and against the sexually transmitted diseases. Disease prevention and control Communicable disease prevention and control Epidemiological surveillance Technical cooperation from WHO intercountry programmes will support the national programme by providing epidemiological information and advisory services.

197

198

COOK ISLANDS (continued) Malaria and other parasitic diseases There is no malaria in the Cook Islands but filariasis is a disease of public health importance. Technical cooperation will further the national programmes for the control of filariasis including vector control activities. The Government is also interested in participating in research activities on filariasis control. Bacterial, viral and mycotic diseases Major attention will be paid to the prevention and control of sexually transmitted diseases, tuberculosis and diarrhoeal diseases. Expanded programme on immunization Emphasis will be placed on improving the "cold chain" for transport and storage of vaccines among the outer islands and the recording and reporting of immunization activities. UNICEF will provide some assistance. Noncommunicable disease prevention and control Cardiovascular diseases The incidence of cardiovascular diseases has increased during recent years. WHO will collaborate in carrying out an epidemiological survey to define the magnitude of the problem and to guide future control activities. 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 be continued. WHO will continue to collaborate in the planning of projects in the sanitation field. Training of sanitation personnel will be continued. WHO's role may also expand to collaborate in the development of basic sanitation facilities for which bilateral assistance will be provided. Health manpower development Promotion of training Shortage of health manpower is a critical constraint in the development of health services. The nursing education programme will continue to develop with WHO cooperation. 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 also continue the fellowship programme for undergraduate study in health courses not available locally, to permit existing health staff to undergo further training abroad and to provide them with opportunities to participate in intercountry group educational activities.

Health information Health statistics WHO, through its country and intercountry programmes, will cooperate in the further improvement of health records, the reporting system and data compilation.

Regular budget COOK ISLANDS 1978-1979 US$ 1980-1981 US$ GENERAL PROGRAMME DEVELOPMENT AND MANAGEMENT 23 500 1 Country health programming HEALTH SERVICES DEVELOPMENT 17 000 Primary health care FAMILY HEALTH 4 000 Maternal and child health Health education COMMUNICABLE DISEASE PREVENTION AND CONTROL 10 600 1

Other sources 1978-1979 US$ 1980-1981 US$

Source of Funds

14 800

22 400

Malaria and other parasitic diseases

Share of costs of WHO Representative's office based in Suva, Fiji.

199

200

Regular budget COOK ISLANDS 1978-1979 1980-1981

Other sources 1978-1979 1980-1981

Source of Funds

US$

US$ Bacterial, viral and mYCotic diseases Expanded programme on immunization NONCOMMUNICABLE DISEASE PREVENTION AND CONTROL 17 200

US$

9 100 5 300

4 000

cardiovascular diseases PROHOriOH OF ERVIROHMENTAL HEALTH

26 000

Basic sanitary measures HEALTH MANPOWER DEVELOPMENT

35 000

128 200

137 600

Promotion of training HEALTH INFORMATION

3 200

Health statistics Total - COOK ISLANDS

-------

128 200

253 500

-------

------

49 800

------

26 400

Regular budget DEMOCRATIC KAMPUCHEA

Other sources

1978-1979 US$

1980-1981 US$ HEALTH SERVICES DEVELOPMENT

1978-1979 US$

1980-1981 US$

Source of Funds

5~2 5~2

000 000

1 000 000 1 000 000

Health services planning and management '

Total - DEMOCRATIC KAMPUCHEA

=======

---------

201

202

FIJI NATIONAL HEALTH DEVELOPMENT STRATEGY The national health policy of Fiji is based on the place allotted to health in the overall national development policy. The health policy emphasizes the need to develop rural areas, the desire to slow down the shift of population to urban areas, the need for intersectoral coordination, the Government as the chief provider of health services, and community participation. The national health objectives are to: (1) (2) (3)

make available the manpower necessary to staff the health facilities of the country; improve the coverage of the basic health services; continue to protect the population against communicable diseases; improve services for noncommunicable disease control; develop, and maintain at a satisfactory level, basic sanitary facilities in urban and rural areas; ensure that the population growth rate is brought to a level harmonious with the growth of the economy.

(4) (5) (6)

The guiding principles in developing a health programming strategy are laid down as follows: (1)

safeguarding the health of the nation is the responsibility of the Government as well as of the people; all programming must give due regard to culture, tradition, beliefs, religion, and political ideology; primary health care must be made continuously available to the people; emphasis should be placed on preventive and promotive services. However, in extending curative services, preference must be given to the outpatient management of cases rather than to institutional care;

(2) (3)

(4)

(5) (6)

the Ministry of Health must seek close intersectoral coordination; external assistance, when sought, should be within the context or the national health plan.

National health planning commenced in Fiji in 1976. The programmes having first priority in that plan are: health manpower development, development or basic health services and family health. Areas having second priority include prevention and control of communicable diseases, environmental health and hospital services. TECHNICAL COOPERATION PROGRAMMES FOR HEALTH Development of comprehensive health services Health services development The primary health care programme aims at effecting total coverage and Primary health care enabling the population to become increasingly responsible for its own health and welfare and especially to become involved in community health services. WHO will collaborate in furthering the programme, in promoting coordination and in training. Appropriate technology for health The objectives or the health laboratory service are to extend laboratory and technical support for clinical and public health activities, to provide technical support to blood banks, and to provide support in health services research. WHO collaboration will emphasize a national programme for the expansion and further development of laboratory services. Family health Maternal and child health The basic health services include maternal and child health, nutrition, school health and family planning services in addition to the appropriate support facilities, including health education. General development has reached a level where a new approach should be adopted in formulating health policy and types or care. The new effort should be directed towards the health of the family as a whole, rather than the health or the individual. Among the major objectives are improvements in family planning and maternal and child health. The new policies and goals are included in plans for the implementation of the primary health care programme. In 1980 and 1981 WHO will collaborate with support from UNFPA to be negotiated in the development of basic and support services, the upgrading of technical skills and intensified national training .efforts.

203

2o4

FIJI (continued) Nutrition Malnutrition has been isolated as a matter for national concern. Special efforts have been made to improve the nutrition education programmes of public institutions. 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 providing current information on nutritional issues, coordinating programmes to support the country's needs, and providing training to improve the knowledge of local health workers. Mental health The national health plan emphasizes the desirability of programme plan stresses the need to develop local capability the hospital. The immediate need is to expand mental health staff with improved capabilities. WHO collaboration will be organization of the programme. Disease prevention and control Communicable disease prevention and control Epidemiological surveillance Filariasis is widely endemic. Enteritis and other diarrhoeal conditions constitute the sixth leading cause of mortality. Leptospirosis and sexually transmitted diseases are major health concerns. The objective of the national health plan for the epidemiological surveillance programme is to bring the prevalence of those conditions to a low level. WHO collaboration, which will include support from its intercountry programme, will emphasize the training of selected health personnel and the provision of specialized advice from time to time. Noncommunicable disease prevention and control Programme planning and general activities Cardiovascular disease is one of the top killers of the country and the third reason for hospital admissions. Metabolic diseases, including diabetes, are becoming an increasing problem. Accidents also make a major demand on the health service. With the shortage of resources for oral health, that programme emphasizes prevention. WHO will collaborate in enabling workers to acquire additional skills and periodically assessing specific areas of concern in the various services. having a healthy population and the to manage cases of mental illness .outside services by producing more professional in the training of staff as well as in the

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, occupational health and safety. The'health objectives for the environmental health programme are to: (1) (2) (3)

improve basic environmental health facilities; promote safety in industrial establishments and the regulation of industrial waste; and control and prevent vector-borne diseases.

With expected support from UNDP, WHO will collaborate, with other agencies, in developing the services need~ for the programme. Cooperation will also be extended through the WHO intercountry· programme. Health manpower development Promotion of training The national health plan stresses the need to upgrade the technical skills of the many support services required to maintain the health delivery system. The plan also places stress on increasing the awareness of-technical and supervisory staff.of the necessity to improve their management capabilities. WHO will collaborate in the achievement of those health manpower goals. Educational development·and support Inadequate coverage of the population by skilled professional staff is partly a result of the insufficientnumber of health manpower produced in the country. The health manpower objective, as sta:ted.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 bealth manpower are the School of Nursing and the School of Medicine. Those institutions offer a variety of courses - national and international - in professional and technical fields. WHO will continue to collaborate in 1980 and 1981 in supporting the Fiji School -of Medicine and upgrading the technical skills of health workers in general.

205

206

Regular budget FIJI 1978-1979 1980-1981

Other sources 1978-1979 1980-1981

Source of Funds

US$

US$ GENERAL PROGRAMME DEVELOPMENT AND MANAGEMENT

US$

62 400

55 300

Country health programming HEALTH SERVICES DEVELOPMENT

30 000 93 600 120 000

Primary health care Appropriate technology for health (health laboratory technology) FAMILY HEALTH

25 000

Maternal and child health Nutrition MENTAL HEALTH

104 600 29 100

70 000

FP DP

25 000

Mental health COMMUNICABLE DISEASE PREVENTION AND CONTROL

25 000

Epidemiological surveillance

1Share of costs of WHO Representative's office based in Suva, Fiji.

NONCOMMUNICABLE DISEASE PREVENTION AND CONTROL 25 000

Programme planning and general activities PROMOTION OF ENVIRONMENTAL HEALTH

48 000

Basic sanitary measures HEALTH MANPOWER DEVELOPMENT

52 000

158 400 311 200 625 600

119 000 300 000 772 300

Promotion of training Educational development and support Total - FIJI

-------

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

--------

185 700

-------

122 000

207

FRENCH POLYNESIA NATIONAL HEALTH DEVELOPMENT STRATEGY The present health policy covers a period of five years (1977-82). (1) It has two objectives:

208

for individual health care, the maintenance of human resources and equipment in order to ensure maximum coverage by the basic health services, while avoiding too great a specialization. To achieve this, services will be organized at three levels: the tertiary hospital level will be renovated through the gradual replacement of equipment; the secondary level, consisting in specialized dispensaries and hospitals in the chief towns, will be granted greater resources to achieve more autonomy (radiological services, basic facilities for laboratory tests); urban communal dispensaries and village infirmaries on the islands will provide primary health care, social services and health education of the population. Special "medical posts" staffed by community health workers will be established progressively on the sparsely populated and isolated atolls or in some valleys of the Marquesas Islands; for collective preventive medical services, it is planned to exert the maximum effort. Several services exist: hygiene and sanitation, child health, school health and dental health, which fall under the Public Health Department, as well as the autonomous endemic service. They are mainly concentrated on the most populous island of Tahiti. It is aimed to extend those services and increase preventive activities, mainly in the most remote archipelagos, especially the dental health and hygiene and sanitation services and to establish new services for collective medicine.

(2)

Priorities in the creation of new services include: (1) (2) creation of a health education service, on an equal footing with other preventive divisions; creation of a maternal and child health service as an extension of the Child Health Centre and the prenatal service, which will include a family planning service; addition of metabolic and cardiovascular disease control services to the areas covered by the endemic service which is already responsible for the control of filariasis, leprosy and tuberculosis.

(3)

Such services could benefit, under conditions to be established later, from surveys made by the Louis Malarde Institute of Medical Research, an institute subsidized by the Government but not under the Department of Public Health.

TECHNICAL COOPERATION PROGRAMMES FOR HEALTH Development of comprehensive health services Health services development Primary health care The programme for the development of primary health care aims at modifying the operation of existing services and progressively creating primary health care units on atolls or in isolated and sparsely populated valleys. This could be carried out through transfer of information. Family health Maternal and child health The establishment of a comprehensive maternal and child health service has second priority. This requires consolidation of the activities at present scattered within that discipline, construction of a centre and the planning of three divisions: maternal health, child health and family planning. Studies to implement such plans have been undertaken. Technical cooperation will be given in the organization of the service, especially with regard to possibly extending it to the various archipelagos. Health education The organization of a health education programme has top priority. A feasibility study which has been undertaken should result in the creation of a formal health education service by 1979. Such a service would include: (1) an executive level, including management, planning, coordination and programme development, which would be entrusted to university level staff assisted by a health education committee the members of which would be representatives of the social services, the Department of Education, religious groups and youth movements; an operational level, consisting in a team of health education workers (females) which would operate from the central level to the field, and health education auxiliaries working in the primary care dispensaries, who would be either multipurpose paramedical or social workers, or a trained member of the co.-unity.

(2)

WHO will collaborate in the training of health education workers.

209

210

FRENCH POLYNESIA (continued) Disease prevention and control Communicable disease prevention and control Epidemiological surveillance The prestige and resources of the Louis Halarde Institute of Medical Research make it the ideal setting for an epidemiological surveillance unit, responsible for the coordination, collection and processing of information on a routine basis for endemo-epidemic diseases and, on government request, for noncommunicable diseases. Thus, the data necessary for assessing the health status of the population would be availaple and a control programme could be developed. In this context, the establishment of a public health laboratory should be envisaged. Such an epidemiological surveillance unit, assisted by a public health laboratory could, under WHO supervision, meet not only the needs of French Polynesia in the control of human and animal diseases but possibly those of neighbouring countries. Technical cooperation, through the WHO intercountry programme, will help to prepare the basis for such activities. Malaria and other parasitic diseases Continuation of the present programme of chemoprophylaxis for endemic filariasis which could be intensified by the application of results of current research (parasitic immunity, vector biology and genetics) makes it possible to envisage the eradication of that parasitic disease. Results achieved and maintained on some of the islands show that the circulation of filariasis larvae, already considerably lowered, should gradually diminish during the coming years at a relatively low cost input. Bacterial, viral and mycotic diseases There are no special plans for developing tuberculosis control, as incidence was reduced by 37J between 1971 and 1974 and by 35% from 1974 to 1977. In view of the diminishing number of patients, control activities will be directed towards the chronic invalidating respiratory infections of non-tuberculosis origin which are becoming a major public health problem. A study of those diseases is being undertaken in 1978. Leprosy control activities, which follow the model of tuberculosis control, should lead to culmination of an effort to standardize and integrate existing routine case detection through school health and occupational health activities. Chemoprophylaxis applied to contacts would then become a regular activity.

Venereal disease control activities should be intensified, in view of the rapid increase of those diseases, constituting a public health problem. WHO cooperation could further research on certain aspects of the above-mentioned activities. Expanded programme on immunization At present, vaccination against the following diseases is compulsory: tuberculosis (BCG), smallpox, diphtheria, tetanus, typho-paratyphic fevers, poliomyelitis. Immunization covers practically the entire population: 90% of children between birth and the time they leave school (mi.n:t.mum 14 years), and part of the adult male population who are vaccinated automatically in the Armed Forces. There are two problems: (1) vaccination against rubella: a serological survey has been carried out and the results are being processed. The outcome will help decide on the advisability of a rubella vaccination programme. vaccination against measles: important epidemics have occurred in the past approximately every four years. A very strong epidemic, with a relatively low rate of serious complications, occurred in 1977-78. Vaccination could be suggested for the future. A study of the problem might be carried out, with WHO cooperation, in conjunction with a study on the advisability of rubella vaccination.

(2)

Special programme for research and training in tropical diseases The medical biology laboratory of the Louis Malarde Institute of Medical Research is in an advantageous position to undertake a basic study on parasitic immunology (of filariasis and angiostrongylosis). In addition to the exploratory techniques described under the heading of "Immunology" below, that laboratory has at its disposal the various specific antigens (infective larvae at stage III of Wuchereria bancroft! and infective larvae of Angiostrongylus). The development of in vitro study models for the destruction of those infective larvae by human leucocytes presents advantages over the animal models used at present. The epidemiological study of leprosy using the same basic techniques would require only very limited additional staff. A serum bank is also being amassed; its importance wHl increase with time.

211

212

FRENCH POLYNESIA (continued) Vector biology and control In addition to the continuation of basic activities, such as the study of vector population dynamics, medical entomology activities should be fully developed by 1980-81, with studies being carried out on larval control by different predators and the utilization of genetic and hormonal methods. Noncommunicable disease prevention and con~

Cardiovascular diseases Cardiovascular diseases constitute a major public health problem in French Polynesia at present, making desirable a study on the problem of cardiovascular diseases and collective prevention and control methods. Oral health Dental caries is a public health problem. The school dental health service created especially for the prevention of dental caries is a model service. It comprises health education based on oral health and nutrition, detection and treatment of lesions at an early stage in schools, and water fluoridation. A national technical study programme on fluoridation in the archipelago is under way with the cooperation of WHO. Additional dental hygienists, the importance of whose role is well known, need to be trained. Immunology By 1980-81 the laboratory at the Louis Malarde Institute of Medical Research w111 be equipped to carry out all the exploratory techniques for cellular mediation immunity as well as with facilities for customary radioimmunology. Those general immunological techniques, very flexible in their application, will have to be used, according to the priorities decided upon, for studies on parasitic, bacterial, viral, allergic or toxic diseases. The incidence of immune complex diseases will be ascertained by the complement fixation test (LBCF standardized micromethod). This tool can be applied if necessary to the epidemiological surveillance of diseases affecting French Polynesia or the whole of the South Pacific, or it could be adapted to local diagnostic needs. Promotion of environmental Health . Basic sanitary measures The public health laboratory mentioned under the heading "Epidemiological Surveillance"~ HilTnaturally be involved.

Recognition and control of environmental hazards In 1980-81, the medical oceanography unit will continue the ecological and physiological study of the microorganism(s) responsible for ciguatera in the various endemic areas, in order to identify the mechanism of outbreaks and possible means to control them. Studies may also be undertaken on lagoon pollution which could have some sanitary implications. The biochemistry laboratory should also contribute to the study of sea drugs. Food safety The laboratory of the hygiene service needs developing. At present, tests on food are carried out, on request, by laboratories of the Louis Malarde Institute of Medical Research. It is planned to establish a public health laboratory but specialized personnel will then be necessary. WHO will cooperate in training a laboratory technician. Health information Health statistics The establishment of a statistical service does not have priority but it will be necessary, if only to guide the activities of the preventive services. It will be necessary to standardize sources of information and to process the results. By 1980 WHO technical cooperation will be necessary to study the problem.

213

214

Regular budget FRENCH POLYNESIA 1978-1979 1980-1981

Other sources 1978-1979 1980-1981

Source of Funds

US$

US$ PROMOTION OF ENVIRONMENTAL HEALTH

US$

21 200

Recognition and control of environmental hazards HEALTH MANPOWER DEVELOPMENT

31 100 52 300

60 000 60 000

Promotion of training Total - FRENCH POLYNESIA

------

======

--------

GILBERT ISLANDS NATIONAL HEALTH DEVELOPMENT STRATEGY The national health development strategy was formulated within the context of the third national development plan (1973-76) which extended into 1977. The preparation of the fourth national development plan (1978-81) is under way and will be finalized in 1978. The Government's objectives in the health field as defined in the third national development plan were to: (1) (2) (3)

develop unified and effective preventive health services on all islands; maintain curative services in real terms at the present per capita level; and establish an influential national body to advise on matters affecting population growth.

To relate health development to national development policy and effectively to respond to recent changes and new challenges, the following four priority programme areas are identified and are to be developed during the period of the fourth national development plan: (1) (2) the rural development programme is emphasized. Opportunity will be taken to develop the primary health care programme as an integral part of the rural development programme; the separation of Tuvalu from Gilbert Islands in 1976 resulted in an acute shortage of health manpower when a number of Tuvaluan medical and nursing staff members returned to Tuvalu. The overseas training of professional staff and the local training of nursing and auxiliary staff, including the development of primary health care workers, will have top priority; the eradication of cholera and reduction of the incidence of diarrhoeal diseases in Gilbert Islands calls for a concerted effort in the development of the environmental health programme and for effective disease surveillance services; recent indicators show that the acceptance rate of family planning has reached a plateau. Efforts must be directed towards strengthening maternal and child health and family planning activities so as to maintain the low population growth rate which is so vital to the national development programme.

(3)

(4)

215

GILBERT ISLANDS (continued) TECHNICAL COOPERATION PROGRAMMES FOR HEALTH Development

216

comprehensive'h~alth services

Health services development Primary health care The objectives of the rural development programme, as defined in the national development plan, are: to spread economic opportunity as widely as possible throughout the country; to involve people in the planning and development of their own communities; to coordinate extension of services by the Government into a team approach to problems identified by the people themselves; and to provide a reasonable level of Government service to the community. The island councils are the focal points for the rural development programme and community organizations are encouraged to take part in the process of planning and implementation of community development projects. In this context, rural development will provide a fertile ground for the development of primary health care. It is envisaged that a number of primary health care workers, selected by their own local communities, will be trained to serve those communities in health matters. WHO will cooperate in planning the primary health care programme, in preparing a field manual and iri training the trainers of primary health care workers. It is envisaged that a national seminar on primary health care will be conducted with WHO cooperation. Family health The major components of the family health programme are the further development of maternal and child health activities, family planning, nutrition and health education. WHO, mainly through its intercountry programme, will continue to cooperate in the development of activities. It is envisaged that it will be necessary to request UNFPA for an extension of its support to the family health programme for a further three years ( 1979-81). Major attention, in the family planning component of the programme, will be directed towards decreasing discontinuation rates among contraceptive users; increasing the number of new acceptors, particularly among newly married couples and young adults; and educating students in the concept of regulating family size to attain a better quality of life. Disease prevention and control Communicable disease prevention and control Epidemiological surveillance WHO will continue, through its intercountry programme, to work closely with the Government in strengthening disease surveillance activities, with particular emphasis on the surveillance of diarrhoeal diseases. Epidemiological data will also be compiled and analysed to serve as guidance for the prevention and control of communicable and noncommunicable diseases.

Bacterial, viral and mycotic diseases WHO will collaborate in the prevention and control of communicable diseases, especially cholera, sexually transmitted diseases, tuberculosis and leprosy. Expanded programme on immunization WHO will continue to cooperate in further developing the national immunization programme against childhood diseases. Particular attention will be paid to improvement of the "cold chain" for the transport and storage of vaccines among the outer islands. Emphasis will also be given to improving the recording and reporting of immunization activities. Promotion of environmental health Basic sanitary measures The lack of safe water supply and waste disposal facilities and unfavourable environmental conditions were the main contributing factors to the cholera epidemic which occurred in 1977 and to the high prevalence of gastrointestinal infections. The public utility section of the national development plan lays down sound policies and objectives for the development of water supply and sanitation schemes both in South Tarawa and on the outer islands. WHO will continue to collaborate in the development of rural water supply and excreta disposal facilities. WHO's role could also expand to help in mobilizing extrabudgetary resources and collaborating with agencies extending bilateral assistance for the development of basic sanitation facilities. Health manpower development To face the problem of acute shortage of health manpower, the Government Promotion of training has taken immediate steps to employ expatriate staff and to initiate the local training of medical assistants. The training programme of the School of Nursing has been further improved and a nursing tutor, seconded from the United Kingdom, has joined the School. The local training of auxiliary personnel (medical assistants and maternal and child health aides) will be continued. WHO will continue to collaborate in the training of an increased number of health personnel in order to meet minimum requirements and in the further development of a local training programme for auxiliary personnel who will contribute to the development of primary health care.

217

218

Regular budget GILBERT ISLANDS 1978-1979 1980-1981

Other sources 1978-1979 1980-1981

Source of Funds

US$

US$ GENERAL PROGRAMME DEVELOPMENT AND MANAGEMENT

US$

ooo 1

Country health programming HEALTH SERVICES DEVELOPMENT

13 000 4 500

Primary health care Appropriate technology for health (health laboratory technology) FAMILY HEALTH

18 000

Maternal and child health Health education COMMUNICABLE DISEASE PREVENTION AND CONTROL

54 500

46 000

15 000 10 000

Bacterial, viral and mycotic diseases Expanded programme on immunization

1share of costs of WHO Representative's office based in Suva, Fiji.

PROMOTION OF ENVIRONMENTAL HEALTH 54 500 50 000

Basic sanitary measures HEALTH MANPOWER DEVELOPMENT

101 500

132 000

Promotion of training HEALTH INFORMATION

40 500 222 000

Health statistics 262 000

-------

Total - GILBERT ISLANDS

54 500

------

46 000

------

219

220

GUAM NATIONAL HEALTH DEVELOPMENT STRATEGY In the last few years, there have been some major changes in the delivery of health care to the people of Guam. This is particularly apparent in the area of direct patient care, where improvement in the private medical community has permitted the Government of Guam to redirect its health services. The gradual transition in the method of providing patient care has placed new responsibilities on the Government, particularly the Department of Public Health and Social Services. Those new responsibilities cover greater regulation of the activities of the private medical community, such as licensure of health professionals and health facilities, an increase in special supportive services, such as the provision of a reference laboratory for diagnostic confirmation, and specialized manpower training. To meet future obligations, there is an increasing demand for health professionals trained in middle management concepts to set up and administer new programmes. Additionally, there is an obvious need for individuals with adequate training in specialized areas to serve as "experts" in evaluating and regulating the services provided by the private medical community. Technical cooperation from WHO for 1980 and 1981 is directed towards those needs. TECHNICAL COOPERATION PROGRAMMES FOR HEALTH Disease prevention and control Communicable disease prevention and control Epidemiological surveillance WHO will continue, through its intercountry programme, to cooperate with the Government in strengthening disease surveillance activities and to provide advice on special problems from time to time. Promotion of environmental health Programme planning and general activities in developing the programme. Health manpower development Promotion of training The health manpower needs for the Territory of Guam reflect the concern to provide increased technical support for a population with health demands that are increasing as the population's socio-economic position improves. As the demands for health services increase, and because WHO, through its intercountry services, will collaborate

financial resources rarely increase in proportion, the key strategy in health manpower planning is the development of middle management skills, so that the health service can increase the level of technical support and regulation 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 initially include nursing services, communicable disease control, environmental health and laboratory services. The expanding level of services provided by the Department creates a unique demand for personnel with specialized skills. The strategy to meet that need is to use consultants who can provide a critical service and at the same time upgrade the skill of selected department staff through practical training sessions. Such a technique will be particularly needed for special problems in paediatrics. There remain other specialized needs, such as the development of additional public laboratory services, a priority since other Department programmes and the private medical community require the support of the laboratory. It is anticipated that selected personnel must be sent out of the Territory 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 the Department in meeting its health service objectives through health manpower development.

221

222

Regular budget GUAM 1978-1979 US$ 1980-1981 US$ FAMILY HEALTH 31 900 Health education COMMUNICABLE DISEASE PREVENTION AND CONTROL 12 400 Vector biology and control HEALTH MANPOWER DEVELOPMENT 22 800 66 000 66 000 Promotion of training Total -GUAM

Other sources 1978-1979 US$ 1980-1981 US$

Source of Funds

-------

67 100

=======

----------

---------

HONG KONG NATIONAL HEALTH DEVELOPMENT STRATEGY The health development strategy has been formulated in the medical White Paper on the further development of medical and health services in Hong Kong. The Government's objectives in the ten-year medical development programme are to: (1) (2) 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 a central health education unit; establish a school dental care service and a dental school for local training; and provide additional training facilities for doctors, nurses and paramedical personnel.

(3) (4) (5) (6) (7)

In addition, the White Paper on the further development of rehabilitation services envisaged considerable expansion of the services, under the following headings: (1) identification and assessment services: a comprehensive observation scheme for infants and children, with audiometric, vision and speech screening and a group testing programme for schoolchildren; medical services: the mental health service and rehabilitation of the sick and injured; and

(2)

(3)

educational and social welfare services.

223

224

HONG KONG (continued) TECHNICAL COOPERATION PROGRAMMES FOR HEALTH Health manpower development Promotion or training The development or a programme or such a magnitude as that described above will necessarily require considerable numbers or medical and health starr. While additional local training facilities for doctors, nurses and various categories or paramedical personnel are being established, there is still a great need for the Medical and Health Services to obtain overseas for its starr, through the WHO fellowship and other programmes such as the Regional Teacher Training Centre ror Health Personnel in Sydney, the necessary training and experience not available locally. Training will be in the fields or planning and management or health services, care or the aged, disability prevention and rehabilitation, health education, communicable disease prevention and control, industrial health, dental health, family health and nursing education. All or those training requirements are directed towards the further development or the Medical and Health Services as set out in the medical development programme. Support is expected from UNDP. \

Regular budget HONG KONG 1978-1979 1980-1981

Other sources 1978-1979 1980-1981

Source or Funds

US$

US$ HEALTH MANPOWER DEVELOPMENT

US$

99 300

110 000

Promotion or training Total - HONG KONG

13 200 13 200

------

99 300

-------

110 000

=========

---------

JAPAN TECHNICAL COOPERATION PROGRAMMES FOR HEALTH Health manpower development Promotion of training WHO technical cooperation is limited to the award of fellowships to enable senior health staff to undertake postgraduate studies, make observation tours or attend short courses abroad for the purpose of familiarizing themselves with new developments related to their particular fields and learning specific techniques which may be applicable for use in Japan; or for participation in intercountry group educational activities. Regular budget JAPAN Other sources Source of Funds

1978-1979 US$

1980-1981 US$ HEALTH MANPOWER DEVELOPMENT

1978-1979 US$

1980-1981 US$

61 700 61 700

68 000

Promotion of training Total - JAPAN

------

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

68 000

---------

225

226

LAO PEOPLE'S DEMOCRATIC REPUBLIC NATIONAL HEALTH DEVELOPMENT STRATEGY The Government of Lao People's Democratic Republic has expressed its firm intention to provide to the maximum number of people the best health services the national situation will allow. The current national health development strategy was formulated in January 1977. The Government's priorities in the field of health are: (1) (2) (3) (4) (5) (6) development of health services; disease control; health manpower development; development of a pharmaceutical industry; promotion of environmental health; rehabilitation of the handicapped.

Country health programming, initiated in 1974 and revised in 1977, helped the Government to elaborate the basic health services programme which is the cornerstone of health sector development, as well as to establish new perspectives for future WHO collaboration contributing directly to the national health plan. The three priority programmes emerging from the planning process are: (1) primary health care in the broadest context of health care services: prevention and control of disease, including the expanded programme on immunization; health education and nutrition; maternal and child health; environmental health; and analysis and dissemination of information on public health and related sectors; health manpower development; development of a pharmaceutical industry: control and research. production, management, distribution, quality

(2) (3)

TECHNICAL COOPERATION PROGRAMMES FOR HEALTH Development of comprehensive health services In the national health plan, the Government is considering: (1)

the development of health care delivery systems at the village, commune and district levels, as an integral part of overall community development through the creation of health committees at different levels and with the active participation of the community; the reconstruction and/or renovation of central, provincial and district hospitals and other central institutions, such as laboratories, schools of medicine and orthopaedic centres; the upgrading of health services at all levels through improved staffing and management; the prov1s1on of a constant supply of essential and effective drugs of quality at all levels of the health service, through production, administration and management, distribution, quality control and research; and the development of a pharmaceutical industry.

(2)

(3) (4)

WHO will collaborate through the country and intercountry programmes in: (1)

planning and managing the health services; developing primary health care activities in two demonstration areas selected by the Government, including monitoring at village, commune and district levels, in order to prepare practical guidelines and standards for the nationwide application of the primary health care concept. The activities will comprise medical care, maternal and child health, communicable disease control including immunization, environmental health, health education, mental health, nutrition, staff training, traditional medicine, data collection, analysis and dissemination of information; providing technological support for the strengthening of laboratory services at the central and peripheral levels and for the maintenance of electromedical equipment; and training radiographers; providing technical support to the overall management and development of the pharmaceutical programme.

(2)

(3)

(4)

227

LAO PEOPLE'S DEMOCRATIC REPUBLIC (continued) In reconstructing and renovating hospitals, WHO, on government request, could cooperate in planning those undertakings and in eventually contacting external donors. Substantial assistance is anticipated from UNDP and UNICEF for the development of programmes in primary health care and drug policies and management. Disease prevention and control The Government is fully aware of the high prevalence of communicable diseases such as malaria, enteric diseases, acute pulmonary infections, tuberculosis and leprosy and recognizes that those diseases are the main causes of morbidity and mortality in the country. As they particularly affect young people, as they can be prevented by available technology and as control activities can be carried out by medium level personnel, prevention and control has been integrated into the primary health care programme. WHO will collaborate in providing technical support to the primary health care activities in the two demonstration areas which will include epidemiological surveillance, implementation of an immunization programme, malaria, tuberculosis, and leprosy control and other relevant public health activities. Oral health will also be promoted. Promotion of environmental health Precarious sanitary conditions such as lack of safe, potable water, lack of excreta and refuse disposal facilities, poor food hygiene and inadequate school sanitation, are the main contributory causes of disease and death. The national health policy stipulates, as one of its main objectives, intensification of the "three cleanlinesses" programme (drink clean, eat clean, live clean) throughout the country, particularly in the rural areas, factories and schools. WHO cooperation in furthering the national programme in environmental health, which also has the support of UNICEF, will concentrate mainly on the demonstration areas to ensure proper distribution, installation and utilization of water supplies and excreta disposal facilities. It is envisaged that two wells will be provided per village and one latrine per household. WHO cooperation will also extend to other public health activities such as school sanitation, refuse disposal and food hygiene. Health manpower development The Government, convinced that shortage of health manpower is a paramount constraint to development in the health sector, has decided to implement an efficient programme of health personnel training responsive to the requirements of the health services and adapted to the needs and resources of the community.

WHO will collaborate in the planning and management of that programme by providing technical support for the revision of medical and parameQical curricula for in-service training in the demonstration areas, as well as for the further training abroad whenever necessary of highly qualified personnel. Under this programme, technical cooperation with other countries will be promoted with support from UNDP and UNICEF.

Regular budget LAO PEOPLE'S DEMOCRATIC REPUBLIC 1978-1979 1980-1981

Other sources 1978-1979 1980-1981

Source of Funds

US$

US$ GENERAL PROGRAMME DEVELOPMENT AND MANAGEMENT

US$

153 700

252 300

Country health programming HEALTH SERVICES DEVELOPMENT

302 600

233 000 296 000

Health services planning and management Primary health care Care of aged, disability prevention and rehabilitation Appropriate technology for health (health laboratory technology) (radiological technology)

8 300 91 600 110 000

59 600 98 000

VG DP DP

75 300 72 800 102 700 125 400

1 cost of WHO Representative's office based in Vientiane, Lao People's Democratic Republic.

229

230

Regular budget LAO PEOPLE'S DEMOCRATIC REPUBLIC 1978-1979 1980-1981

Other sources 1978-1979 1980-1981

Source of Funds

US$

US$ FAMILY HEALTH 19 400 19 400

US$

Nutrition Health education MENTAL HEALTH

14 800

Mental health PROPHYLACTIC, DIAGNOSTIC AND THERAPEUTIC SUBSTANCES

118 100

189 200

Drug policies and management COMMUNICABLE DISEASE PREVENTION AND CONTROL

196 000

175 100 71 400 35 500

53 000 9 700 24 100

Epidemiological surveillance Malaria and other parasitic diseases Bacterial, viral and mycotic diseases NONCOMMUNICABLE DISEASE PREVENTION AND CONTROL

160 000

158 000

9 400

Oral health

PROMOTION OF ENVIRONMENTAL HEALTH 60 000 19 400 14 800

Environmental health planning and management Recognition and control of environmental hazards HEALTH MANPOWER DEVELOPMENT

109 000

67 000

294 000

38 200 96 500

Health manpower planning and management Promotion or training Total - LAO PEOPLE'S DEMOCRATIC REPUBLIC 478 900

---------

358 500

---------

517 300

-------

578 600

=======

231

232

MALAYSIA NATIONAL HEALTH DEVELOPMENT STRATEGY The Government intends to upgrade the health services and make them accessible to more people, including the population of remote areas. The planning and development division, set up in 1969, is responsible for planning health services under the third Malaysia plan. It has been decided to convert the present three-tier system of rural health services.(main centres, sub-centres, and midwifery clinics) into a two-tier system, consisting of main centres and community health centres. In addition, mobile teams will provide coverage for the more remote areas until permanent centres can be established. A survey of underserved areas was carried out in 44 districts and the information gathered will assist in planning a primary health care strategy in those areas, for implementation in 1979. Another survey is scheduled to cover the remaining underserved areas of the country in 1980 so that, by 1981, primary health care activities will cover all underserved areas, until permanent health services can be made available by 1990. In view of the rapid industrialization of the country, the Ministry of Health has established an occupational health unit. The need to provide better health care for children of preschool and school age is recognized. Emphasis is given to strengthening the applied nutrition and school health programmes on a national scale. To intensify community development and community participation in health programmes, health education services must be strengthened. The Government has recruited a health education officer for each of the 13 states, and a postgraduate course in health education has been started at the Public Health Institute. An intensive rural broadcasting programme geared to the people in the underserved areas will be started in 1979. Malaria and tuberculosis are still major public health problems. The tuberculosis, leprosy and malaria programmes are being integrated into the general health services. Outbreaks of cholera still occur sporadically, highlighting the need to improve sanitation and food handling. The epidemiological unit has proved its value in disease control programmes, especially during epidemic outbreaks. The Ministry of Health has introduced a Disease-bearing Insect Act aimed at control of dengue haemorrhagia fever. A disease surveillance system has been set up concurrently with development of the national public health laboratory service.

Improvement of rural sanitation is still required, and the Government is strengthening rural water supply in Sabah, Sarawak and the east coast states of Peninsular Malaysia. It is also implementing a latrine construction programme. In view of the environmental pollution caused by rapid urbanization and industrialization, excessive exploitation of land with increasing use of fertilizers and pesticides, and increased motor traffic, the Government has established a Ministry of Environment. Sewerage schemes are under way in Kuala Lumpur, Johore Bahru and Klang, and one has been completed in Ipoh. An Environmental Quality Act has been passed. Since the Faculty of Medicine, established in 1963 at the University of Malaya, has a maximum intake of 160 students per year, another medical school has been set up at the National University (Kebangsaan), with an initial enrolment of 60 students in 1973. The enrolment is being increased annually until a maximum of 160 is reached. About 200 physicians are trained at overseas universities each year. The Government grants some fellowships for different forms of training. A dental faculty was established at the University of Malaya in 1972, with a maximum intake of 48 students a year. The Government provides about 20 fellowships for dental undergraduates. A school of pharmacy, opened at the University of Science, Penang, in 1971, offers a four-year course, with a maximum intake of 40 students. The Institute for Medical Research offers postgraduate courses in parasitology and entomoloey and the University of Malaya postgraduate courses in public health, pathology and psychiatry. The Ministry of Health, in conjunction Hith the Faculty of Medicine, University of Malaya, and the Royal Colleges in Australia and the United Kingdom, runs courses and conducts examinations in surgery, medicine, obstetrics and gynaecology, and anaesthesiology. Six schools provide basic nursing training (three years) with an annual total of 1800 students in training. Postbasic courses in midwifery, orthopaedic nursing, paediatric nursing, and operating theatre techniques, and a one-year course in public health nursing, are available. A postbasic nursing education unit has been established to prepare nursing teachers, nursing administrators and midwifery teachers. There are six schools for training auxiliary personnel in physiotherapy, radiography laboratory technology, medical assistants, public health inspectors and overseers. There that train assistant nurses (16), midwives (13), junior hospital assistants in psychiatry laboratory assistants (1). Provision is made for six schools for commun5ty health ~urses Malaysia plan. ' ' and medical are centres (1) and junior under the third

233

234

MALAYSIA (continued) The Public Health Institute, rural health training centres, the Institute for Medical Research, the National Tuberculosis Centre, and the Family Planning Board conduct formal courses and provide in-service training to improve the efficiency of health workers. To train auxiliary and supervisory personnel, it is planned to expand the existing rural health training centres and to set up three others in Peninsular Malaysia. A two-year project on the development of a health management information system has been launched but due to the magnitude and complexity of the undertaking the project will take longer than envisaged to complete. However, the most crucial and difficult phase of the project has been completed and the systems design phase has been reached. It is hoped to test-run the system for about a year, to evaluate it, and to implement it on a country-wide basis in 1980. TECHNICAL COOPERATION PROGRAMMES FOR HEALTH Development of comprehensive health services Health services development Health services planning and management Technical cooperation will be given in evaluating.the health management information system which will be launched in 1979. In addition, continued training programmes in national health planning methodology for public health administrators at national, international and local levels, specifically geared to the preparation of the fourth Malaysia development plan and training courses for the strengthening of management ~kills in programme implementation, monitoring and control are needed. Primarr health care Following a community resources survey in 1979, preparations will be under way in 1980 for primary health care activities to be extended to the remaining underserved areas in Malaysia from 1981 (the start of the fourth Malaysia plan, 1981-85). In-depth studies in selected districts, started.in 1979, will be continued. Technical cooperation will further the national programme and training activities for the development of primary health care. Workers' health Continuing cooperation is necessary in the expansion of occupational health services to Penang in 1980 and Johor in 1981 as well as in training activities and in the development of codes of practice.

Appropriate technology for health The public health laboratory service will have its functional capacity increased from 6oJ in 1980 to 65% in 1981. Standardization of laboratory procedures and quality control is expected to be fully implemented by 1981. By that time the vaccine control laboratory service will be 50% effective. Technical cooperation will be extended, as necessary, in specific aspects of the programme. In the programme area of health services development, cooperation from the WHO intercountry programme is expected as well as input from WHO Headquarters. Family health Maternal and child health While family planning will already be fully integrated in the maternal and child health services, priority in the development of maternal and child health care will be given to the underserved areas, and from 1981 services will begin to extend to those as yet not covered. The high risk approach will also be reviewed in 1980, based on the studies carried out in 1978 and 1979. Technical cooperation will be particularly related to primary health care activities in the underserved areas. Nutrition By the end of the period covered by the third Malaysia plan (1980) the health component of the applied food and nutrition programme will have been fully developed. Again emphasis will be on the underserved areas and WHO cooperation will extend to the development and, from 1981, further strengthening of the programme. Health education Priority in health education will be given to rural broadcasting to communities in the underserved areas in support of local pri.mary health care activities ("community health movement"). It will support in particular other educational components of primary health care activities and other programmes, including communicable and noncommunicable disease control, promotion of environmental health and food sanitation activities. WHO, with support anticipated from UNFPA, will provide technical cooperation. Mental health By 1980, community mental health services will be in operation witt 1e decentralization of psychiatric patient care services. Further consolidation will take place in 1981. WHO will cooperate in training, assessing the situation in 1980 and preparing for the fourth Malaysia plan (1981-85).

235

236

MALAYSIA (continued) Prophylactic, diagnostic and therapeutic substances Programme planning and general activities For the proper development and execution of specific national policies for drug quality control, the activities involved will cover national drug legislation and collaboration with other countries in establishing a suitable legislative framework and/or harmonising such legislation through study visits and ~egional working groups. Drug policies and management The production, procurement and distribution of drugs and the standardization and utilization of traditional medicine are important areas in improving drug policies and management. WHO will cooperate in postgraduate training for the upgrading of skills required for the execution of such policies: in pharmaceutical technology, clinical pharmacy and pharmacognosy. Pharmaceuticals and biologicals Proper utilization of pharmaceutical and biological products cannot be realized if such products are not of the right quality, or are not efficacious and safe. There is an urgent need for cooperation in improving expertise in quality control techniques and in monitoring adverse reactions. As this new and important programme develops, cooperation from WHO Headquarters and from the intercountry programme will be requested. Disease prevention and control Communicable disease prevention and control Epidemiological surveillance By 1981, epidemiological services will have been established in all states in Peninsular Malaysia and commenced in Sabah and Sarawak. Continued technical cooperation will be given by WHO. Bacterial, viral and mycotic diseases In 1980 and 1981 the sexually transmitted diseases programme will be established. The tuberculosis control programme will have 85J BCG coverage by 1971. Technical cooperation will further the national programmes through training in specific areas when requested. Expanded programme on immunization With the improvement of the "cold chain" for transport and storage of vaccines, measles immunization will be started as a trial in 1980 and as a programme in 1981. Continued technical cooperation will be given in reviewing the efficiency of the cold chain and other aspects of the programme.

Vector biology and control By 1981, vector control units will have been established in 7 states and rodent control implemented for all ports and major townships. Training of health inspectors for vector and rodent control will continue, as will research activities at the Institute for Medical Research, in all of which technical cooperation will be extended by WHO. Noncommunicable disease prevention and control Cancer With the changing pattern of diseases becoming more marked, epidemiological studies will be initiated in 1980 at the Institute for Medical Research and the cancer registry will be maintained. The health education campaign, particularly with regard to smoking, will be intensified. Technical cooperation will be given in specific aspects of the programme and with training. Cardiovascular diseases Epidemiological studies, due to commence in 1979, will be continued and a cardiovascular disease control programme started in 1981 with technical cooperation from WHO. Oral health Training activities will continue, with WHO cooperation. The water fluoridation programme planned for Sabah and the epidemiological survey of school children in Sarawak will be carried out in 1981. Promotion of environmental health Environmental health planning and management In 1980, preparations for the fourth Malaysia development plan (19B1-85) will take place and the plan will be implemented in 1981. It is expected that the different programmes will work closely with the WHO Western Pacific regional centre for promotion of environmental planning and applied studies to be established in Malaysia. Monitoring systems will be developed for drinking water quality and the operation of sewerage works. Technical cooperation from WHO will further those activities. Food safety With the gradual development of food quality control services within Malaysia, quality control of food imported and exported will commence in Port Klang in 1980. In 1981 intensified health education of food handlers will be undertaken, with technical cooperation from WHO in specific aspects of the programme. Health manpower development Health manpower planning and management Operational studies on needs and the utilization of health manpower will be initiated in 1980 and continued in 1981 with technical cooperation from WHO.

237

238

MALAYSIA (continued) Promotion of training A national teacher training centre for health personnel will start operating in 1980 and the training activities of various institutions will be intensified with technical cooperation from WHO. Continuous cooperation with the Regional Teacher Training Centre for Health Personnel, Sydney will be sought.

Regular budget MALAYSIA 1978-1979 US$ 1980-1981 US$ GENERAL PROGRAMME DEVELOPMENT AND MANAGEMENT 197 500 1 222 300 1 Country health programming HEALTH SERVICES DEVELOPMENT 20 000 26 000 117 000 10 000 Health services planning and management Primary health care Workers' health Appropriate technology for health (health laboratory technology) FAMILY HEALTH

Other sources 1978-1979 US$ 1980-1981 US$

Source of Funds

229 400

52 000

Maternal and child health

326 300

1Share of costs of WHO Representative's office based in Kuala Lumpur, Malaysia.

73 200

78 000 6 000

Nutrition Health education MENTAL HEALTH

97 000

13 000

Mental health PROPHYLACTIC, DIAGNOSTIC AND THERAPEUTIC SUBSTANCES

18 000 24 000 24 000

Programme planning and general activities Drug policies and management Pharmaceuticals and biologicals COMMUNICABLE DISEASE PREVENTION AND CONTROL

67 300

20 000 30 000 10 000 32 000

Epidemiological surveillance Bacterial, viral and mycotic diseases Expanded programme on immunization Vector biology and control NONCOMMUNICABLE DISEASE PREVENTION AND CONTROL

25 000 28 000 25 000

Cancer Cardiovascular diseases Oral health

239

240

Regular budget MALAYSIA 1978-1979 1980-1981

Other sources 1978-1979 1980-1981

Source of Funds

US$

US$ PROMOTION OF ENVIRONMENTAL HEALTH AND MANAGEMENT

US$

148 700

135 000 24 000

Environmental health planning and management Food safety HEALTH MANPOWER DEVELOPMENT

201 700 9 000 926 800

60 000 60 000

Health manpower planning and management Promotion of training Educational development and support TOTAL - MALAYSIA· 326 300

-------

---------

1 059 300

-------

91 000 r ..

------

NEW HEBRIDES NATIONAL HEALTH DEVELOPMENT STRATEGY The national health policy is to provide the necessary health services to enable the individual citizen to contribute his or her share to the country's development, through the promotion of health and the reduction of unnecessary suffering and death. Emphasis is being placed on the development of rural areas, including the organization and strengthening of primary health care and of preventive services, while at the same time maintaining the present standard of curative facilities. Objectives in the health field are to: (1) (2) strengthen and upgrade health services through the development of necessary manpower at all levels; develop health planning, coordination and management capabilities; develop programmes for the control of communicable diseases; promote environmental health, including the control of environmental pollution; develop services for the education and information of the people in the field of health.

(3) (4) (5)

Political evolution is quickening in the New Hebrides; from a condominium administered by two metropolitan powers towards a completely independent self-governing country. Complete independence is expected by 1980. r . .• Efforts have been made in the last few years to integrate the two national health services into a unified New-Hebridean service. Those efforts will continue by developing the planning and management capabilities of supervisory staff and by upgrading the working standards of field staff. Two other priority areas are prevention and control of communicable diseases, including immunization against diseases, and primary health care, with emphasis on family health services. TECHNICAL COOPERATION PROGRAMMES FOR HEALTH Development of comprehensive health services Health services development Programme planning and general activities The transition to a New-Hebridean national health system will initially involve the integration of all condominium and national services. 241

NEW HEBRIDES (continued) The objective of this organizational part of the transition is to develop a national administration which has the capacity to operate the integrated service efficiently and to plan future services to meet the needs of the people. Efforts will continue to implement and strengthen the basic health services at peripheral and at intermediat~ or supervisory level. At the same time WHO will collaborate to organize the central level of the health administration on a sound but practical basis. Primary health care The 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 consider 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 to train health workers based in the community and supported by a health service team that will meet the primary health care needs of the people wherever they may reside. WHO will cooperate in selecting the type of primary health care worker most suitable to local conditions and local needs, in training those workers, and in setting up an organizational structure for the effective functioning of the programme. Family health Health activities will continue to stress the importance of family health and of family health services as the cornerstone for community development. Services will be as comprehensive as possible, and will include maternal and child health services, immunization against childhood diseases, nutrition promotion activities and health education of the public. WHO collaboration, with support anticipated from UNFPA, will concentrate on training of staff and on upgrading the quality of servicen by the setting of standards and the preparation of manuals. Disease prevention and control Communicable disease prevention and control Malaria will continue to be an important public health concern in the 1980's and the medium-term programme for communicable disease control stresses the need to develop skilled personnel in the technical as well as the supervisory area. The programme will emphasize the setting up of a communicable disease reporting and surveillance network as well as the strengthening of preventive measures. WHO collaboration will also concentrate on training activities and the assessment of control measures for malaria and other communicable diseases through WHO country-based staff as well as the intercountry programme.

Promotion of environmental health Basic sanitary measures Improvement of environmental sanitation and of the standard of living conditions in general, are major concerns of the health administration. Efforts will continue to bring a safe water supply to the whole population, especially in rural areas, and to help the people to take the necessary measures to protect themselves from environmental hazards. Health manpower development Recruiting, training and posting health personnel at all levels of the Promotion of training health delivery system will be a top priority activity throughout the programming period. Manpower resources will be severely tested towards achieving smooth transition from the condominium services to the establishment of a unified national health system. Skilled manpower (physicians, some nurses, technicians) will continue to be sent to neighbouring countries for their education. In addition, local training facilities will be used to provide the frontline health personnel (community nurses and sanitarians). WHO collaboration in terms of fellowships will be used for long-term education programmes as well as for short-term training courses. Local training will also be organized and developed. WHO expertise will be required periodically to help in assessing the overall manpower development programme.

Regular budget NEW HEBRIDES

Other sources

1978-1979 US$

1980-1981 US$ GENERAL PROGRAMME DEVELOPMENT AND MANAGEMENT

1978-1979 US$

1980-1981 US$

Source of Funds

41 900

48 400 1

Country health programming

Share of costs of WHO Representative's office based in Suva, Fiji.

243

'244

Regular budget 1978-1979 1980-1981

Other sources

NEW HEBRIDES .

1978-1979

1980-1981

Source of Funds

US$

. HEALTH SERVICES DEVELOPMENT

US$

100 500

184 700 39 200

Programme .planning and general activities Primary health care FAMILY HEALTH Maternal and child health COMMUNICABLE DISEASE PREVENTION AND CONTROL

166 600

196 000

83 600

201 400

82 000

146 600

Programme planning and general activities PROMOTION OF ENVIRONMENTAL ,HEALTH

25 200

Basic sanitary measures HEALTH MANPOWER DEVELOPMENT

163 100

104 300 548 400

Promotion of training Total - NEW HEBRIDES

-------

387 500

-------

250 200

-------

397 400

NEW ZEALAND NATIONAL HEALTH DEVELOPMENT STRATEGY 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 by the Department of Health is directed towards a downward delegation of authority. Specific goals of the Department are to: (1) (2) develop responsibility for environmental health at local authority level; maintain a well-qualified career public health service which sets standards and advises local authorities on all health matters; develop, on the basis of existing hospital board structure, the concept of a unified medical ·care delivery service ·administered by a single health authority in each area; equip the Department so that it can effectively discharge responsibility for the direction of policy, determination of priorities, general financial control and the evaluation and surveillance of the efficiency of manage~ent. FO~ _ HEALTH

(3) (4}

TECHNICAL COOPERATION PROGRAMMES Health manpower development

The development and maintenance of professional managers and skilled Promotion of training administrators forms the backbone of the Department of Health. To this end a manpower development programme is in force to provide staff with the opportunity to experience a variety of technological advances and environmental situations in other countries. WHO collaboration in the form of fellowships to train selected staff is a valuable component of the Department's overall manpower development scheme.

245

246

Regular budget NEW ZEALAND 1978-1979 US$

Other sources 1978-1979 US$

1980-1981 US$

Source of Funds

HEALTH MANPOWER DEVELOPMENT 58 000 60 000 Promotion of training Total - NEW ZEALAND

------

58 000

-------

60 000

---------

NIUE NATIONAL HEALTH DEVELOPMENT STRATEGY The Government of Niue has recently employed a planning officer, whose major brief is to assist in the preparation of a national development plan. National health strategies will be incorporated within that plan. The draft plan should be completed by the end of 1978. The general policy of the Health Department is to provide to the people of Niue and maintain a total medical care service. This is interpreted to mean that there shall be: (1) (2) as effective a community programme of preventive and rehabilitative medicine as the community will, and can be encouraged to, accept; a hospital service offering all reasonable care to in- and outpatients; an effective system whereby patients requiring specialized treatment can be readily referred to appropriate centres.

(3)

Priority for the maintenance of health care at its existing level therefore lies in the area of health manpower development with the collaboration of WHO and the New Zealand Bilateral Aid Training Scheme. TECHNICAL COOPERATION PROGRAMMES FOR HEALTH Development of comprehensive health services Health services development Programme planning and general activities National programmes for the control of communicable diseases, including immunization, family health, health education and nutrition and environmental health, including water supply and sanitation, will be furthered by collaboration from the Government of New Zealand, the South Pacific Commission and WHO's intercountry programme. Promotion of environmental health Basic sanitary measures WHO, through its intercountry programmes, will collaborate with the Government in developing this programme. 247

248

NIUE (continued) Health manpower development Promotion of training To maintain the existing health services on the small island of Niue, which include not only those for prevention and cure but also ancillary laboratory and X-ray services, a dental division and environmental health services, it is vital that qualified personnel be available. Losses due to migration, resignation and retirements require the constant provision of fellowships for study overseas to prepare qualified staff. The New Zealand Bilateral Aid Training Scheme gives assistance for much of the basic training. WHO will collaborate mainly in shorter postgraduate training. The Government of Niue will continue to support the nurse aide training programme which is the basis for the entry of nurses into the basic nurse training programme in Fiji and also for in-service refresher courses for its nursing staff.

Regular budget NIUE

Other sources

1978-1979 US$

1980-1981 US$ HEALTH MANPOWER DEVELOPMENT

1978-1979 US$

1980-1981 US$

Source of Funds

43 300

60 000

Promotion of training Total - NIUE

------

43 300

-------

60 000

---------

PAPUA NEW GUINEA NATIONAL HEALTH DEVELOPMENT STRATEGY The current 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 health strategy outlined in the national health plan, covering the period 1974 to 1978, will continue to be followed. That plan provides comprehensive basic health services through health centres and aid posts with referral of cases requiring more specialized attention to hospitals. 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. Improved training of health personnel within the concept of primary health care is essential for the provision of improved services to rural communities, with emphasis on training an increased number of allied health personnel, such as health extension officers, nurses, aid post orderlies, nurse aides and village health workers, when and where feasible. Close liaison between the churches and the Government is a vital factor in promoting primary health care since much of the rural health service is provided by the former. With the advent of provincial government, decision making is degree, government services at the provincial level becoming more provincial health officer is becoming the true head of all health thus very important that the person holding that position be well being decentralized to a much greater integrated and coordinated. The activities within a province and it is trained and competent.

Preparations are being made by the Department of Health to commence country health programming in 1978. The results of that exercise will be reflected in the details of the programme for 1980 and 1981 to be developed nearer to the time of implementation. TECHNICAL COOPERATION PROGRAMMES FOR HEALTH Development of comprehensive health services Health services development Health services planning and management and primary health care The Government has adopted the concept of primary health care, extending the scope of the comprehensive health services, particularly in the rural areas, where 85% of the population lives, to include all health-related activities of the 249

250

PAPUA NEW GUINEA (continued) community which have a direct bearing on the promotion and maintenance of its own health, such as agricultural production, promotion of literacy for easy dissemination of health information, improvement of water supply and waste disposal facilities, improvement of road construction 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 socio-economic projects having an impact on community health. At present, the organization of a mechanism for interagency cooperation to promote community improvement is at an early stage. There is a great need for research at the local, possibly the health centre or the local government council, level. The development of health manpower for primary health care merits the special attention of the Department of Health. The preparation particularly 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. WHO cooperation in 1980-81 will be in developing a system of primary health care, in the in-service training of provincial health officers and in the provision of fellowships for overseas training. Workers' health In order to cope with the demand following the expansion of industry, steps need to be taken to train one or two physicians in occupational health who would establish a central technical unit and organize and supervise occupational health activities. Appropriate technology for health One of the problems identified within the laboratory services is the chronic shortage of trained laboratory workers to support disease and environmental control. Training of medical laboratory assistants has to be continued and improved with a view to raising the standard of diagnostic techniques at health centre level. Standardization of laboratory technology at all levels should be continued, to ensure economy and quality control. The Government needs to be self-reliant in the repair and maintenance of biomedical and radiological equipment. Family 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. There is a need to define more precisely the nature of the elementary maternal and child health care delivered by aid-post orderlies, nurse aides and village health workers at the community level. 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. One of the priority areas for the nation's development identified in the national development strategy is improved nutrition. 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 populatiqn. WHO collaboration in 1980 and 1981 from country and intercountry sources, with some support from UNFPA, will further the national programme for improving the family health services including those for nutrition. 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, from intercountry sources, by providing such training and by preparing health training curricula to include mental health. Prophylactic, diagnostic and therapeutic substances A sound national drug policy already exists. In 1980 it may need updating to include current WHO recommendations. A feasibility study for establishing a local pharmaceutical processing plant may have been completed by 1980 and collaboration in pre-investment activities may be required. WHO will collaborate in those areas from intercountry sources. Disease prevention and control Communicable disease prevention and control At present, malaria and other communicable diseases are serious public health problems, some having considerable economic impact. Respiratory disease is the foremost cause of mortality and morbidity. 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. ~1

252

PAPUA NEW GUINEA (continued) 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 malaria control programme. Insurmountable operational difficulties, especially inadequate management, supervision and logistical support, have .in the past resulted in control measures having little impact in reducing malaria incidence. This necessitated a redirection of control measures taken in the more densely populated areas. WHO will cooperate, in coordination with UNDP, in malaria control and research in view of their socio-economic implications. A start has been made in streamlining the system for the recognition and notification of communicable disease incidence 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. 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 technical cooperation from country sources and from the intercountry regional tuberculosis control team will aid in the solution of technical as well as operational problems. The Government has adopted a policy to expand the immunization programme and has commenced improvements in vaccine storage facilities at base and regional depots and the "cold chain" for transport and storage of vaccine in peripheral areas. WHO will collaborate, through its intercountry programme, in the expanded programme on immunization and will help in seeking possible bilateral donors for the supplies and equipment needed for the programme. Technical leadership and staff for the vector control programme are still inadequate. 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. WHO will collaborate in the training of a national worker on vector biology and control and in the provision of the necessary technical expertise. Noncommunicable disease prevention and control Oral health There has been considerable improvement in the training of dental therapists who are the main cadre in providing preventive dental services in the field. WHO cooperation will be with the national dental services and training institutes in updating technical proficiency.

Promotion of environmental health Poor environmental conditions, particularly lack of safe water supply and basic sanitary measures in rural areas, are contributory fact·o rs, ·not only to -the high incidence of diarrhoeal diseases, intestinal parasitism and vector bome diseases, but also to the extensive occurrence or respiratory conditions. As a result of urban drift and the consequent development of shanty towns, sewerage and water supply facilities need to be expanded (Water ·SUpply in line with the plans of action adopted by the United Nations Water Conference held in 1976. · In the wake of industrialization in certain developing areas, environ~~ental control will need to be enforced by experts. WHO collaboration will fUrther the national programme by providing pre-investment services, possibly with UNDP support, for environmental control and particularly in water supply. It will also assume the role of liaison with bilateral agencies to help mobilize additional investment. Health manpower develop.ant Expatriate manpower will continue to ·be needed for a number of posts, particularly those of medical officer and other highly specialized posts. The appointment of qualified national starr to fill such positions is fast 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 prio~ity is given to the training of a sufficient number of health workers with a broad range of skills, particularly in preventive care and in the ability to communicate their knowledge to their colleagues 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 to be imperative to make a vigorous effort to improve training programmes for aid-post orderlies and other auxiliary health workers, including 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 advising on policy 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 training of all health services personnel, particularly the nursing cadres, will be improved. The fellowship programme will include the training or national .adical and nursing teachers overseas.

253

254

Regular budget PAPUA NEW GUINEA 1978-1979 1980-1981

Other sources 1978-1979 1980-1981

Source of Funds

US$

US$ GENERAL PROGRAMME DEVELOPMENT AND MANAGEMENT

US$

163

ooo 1

293 400

Country health programming HEALTH SERVICES DEVELOPMENT

339 400

428 800 8 000 19 600 72 400

102 500

Health services planning and management Primary health care Workers' health Appropriate technology for health (health laboratory technology) FAMILY HEALTH

28 800

110 600 37 400 103 800

Maternal and child health Nutrition Health education COMMUNICABLE DISEASE PREVENTION AND CONTROL

239 300

117 900 198 000

107 600 196 000

Epidemiological surveillance Malaria and other parasitic diseases

127 300 50 QOO

127 200 98 000

VI DP

1cost of WHO Representative's orfice based in Port Moresby, Papua New Guinea.

96 600

19 400 12 600

Bacterial, viral and ~ycotic diseases Vector biology and control NONCOMMUNICABLE DISEASE PREVENTION AND CONTROL

121 700

63 800

17 400

Oral health PROMOTION OF ENVIRONMENTAL HEALTH

57 400

20 400

Environmental health planning and management HEALTII MANPOWER DEVELOPMENT

124 500

63 500

127 400 1 231 000

246 000 1 693 400

Promotion of training Total - PAPUA NEW GUINEA 662 800

---------

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

352 500

-------

255

PHILIPPINES NATIONAL HEALTH DEVELOPMENT STRATEGY The national development policy of the Philippines is "aimed primarily at rectifying grave economic and social inequities that have accumulated" over many years past. Its major areas of concern are self-reliance, social justice, rural development, effective and efficient management of national resources, development of appropriate manpower, environmental development and harmonious international relations. Guided by such concerns, the national health plan for the period 1978 to 1982 has identified the following main health objectives: (1) (2) (3)

to provide adequate promotive, preventive, curative 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 state of the whole population, with emphasis on infants, children and mothers; to attain and maintain an acceptable level of population growth.

(4)

The guiding principles in developing a health programming strategy are laid down as follows: (1) (2) (3)

effective and efficient use of existing facilities and manpower to widen service coverage; development of the appropriate health manpower; active participation of the community, based on the barangay and purok systems; promotion of intrasectoral and intersectoral coordination at all levels including the private sector, but especially of local governments, in the planning and implementation of identified programmes; greater reliance on indigenous food sources, local materials, and available local but effective technology; promotion of financing schemes to augment regular appropriations for the health services.

(4)

(5) (6)

TECHNICAL COOPERATION PROGRAMMES FOR HEALTH Development of comprehensive health services Health services development Health services planning and management The largest programme of the first national health plan was the restructuring of the rural health service delivery system, a strategy based on operational research jointly conducted by the Government and WHO. Implementation is to be continued during the second plan (1978-82) and further studies are envisaged, leading to recommendations which are expected to be implemented by 1980-81. Through that project, it is expected that the capabilities of rural health units and hospitals will be enhanced and organized for more effective and equitable health service delivery within the means of the country. Apart from changes in staffing and technical procedures, the following are expected to result: a higher managerial capability which will include improved planning and control of expenditure, an adequate system of logistics, and a simple, functional health information system. WHO will continue to cooperate in implementing the programme, from both country and intercountry resources. Primary health care The concept of primary health care was included in the first national health plan but only later, in 1976, were specific steps taken to put the concept into operation at national level. It is intended to bridge the gap between the point where the present health services delivery system terminates and the community, in order to cover underserved areas. Emphasis will be placed on developing the ability of the community to identify its own problems and, in partnership with the Government, to take the necessary steps to solve them. Efforts in this direction would include: (1) development of the necessary skills to organize and mobilize communities for health; and (2) recruitment, training and placement of a cadre of auxiliary health personnel to ensure the provision of primary health care services to remote rural communities. Uniformity with regard to the primary health care concept exists but divergent entry points and applications are considered necessary to accommodate differences among the several thousand communities in the country. WHO technical cooperation will extend to implementation of a number of research and development projects, partially through the intercountry programme. Although there have been some continuing activities, such as training and the Workers' health enforcement of regulations, an occupational health programme remains to be developed as part of the national health plan. It is intended that such a programme will be in operation by 1981 and will have been preceded by a survey of factories and other industrial establishments to assess the size of the problem and a review and updating of standards, guidelines and policies.

257

258

PHILIPPINES (continued) Appropriate technology for health The Government plans modest upgrading of public health and clinical laboratories to meet the demands of other programmes. Its main preoccupation is vaccine production which is covered under the programme for pharmaceuticals and biologicals. The radiation health services will be strengthened to enable them to satisfy present and future demands especially those from the satellite centres of the National Cancer Control Center and those developing from the need to protect the public from radiation hazards and for skills in the maintenance and repair of X-ray equipment. Technical cooperation will be extended by WHO in strengthening the radiation health programme and it is hoped that extrabudgetary resources will become available. Family health Maternal and child health Experience gained through the fertility regulation and child and maternal care components of national programmes related to primary health care, carried out with cooperation from WHO and the World Bank and with the support of UNFPA in the maternal and child health based family planning project in Bohol Province, will have to be assessed and nationwide applicability tested. Taking into consideration identified factors which are responsible for the high level of maternal and perinatal mortality in various provinces, activities in this field are closely related to those of the health services development, health information systems, nutrition, and primary health care programmes as well as to the expanded programme on immunization. Nutrition Malnutrition in different forms is highly prevalent and amelioration of the problem is considered to have top priority. The principal problems encountered are in organization and coordination, resulting in weak delivery of the nutrition service to the community, and in training, the content of which needs to be further adapted to suit the local situation. Following studies to be carried out in 1978 and 1979, the Department of Health intends to continue the integration of nutrition activities into the basic health services; upgrade training in nutrition; implement nutritional surveillance and food fortification; and carry out research in, and also provide, food supplements. These activities are to be closely related to the efforts in health services development, primary health care, maternal and child health and health education. Health education It is recognized that all programmes have health education components. Consequently, health education activities in the Philippines will provide support in attaining the objectives of different programmes. While the concept of health education is well developed, steps will be taken to strengthen field study and practice areas for training, behavioural research and media support.

Mental health Mental health activities are largely confined to institutionalized care. The non-institutional approach, though discussed over the past years, has not gained the desired momentum. The Department of Health intends to pursue community-based non-institutional approaches, relying largely on the rural health services and the community, and supported by administrative and legal reform, mental health education, the organization of six regional mental health teams and research into the epidemiology of mental disorders. While the non-institutional approach might be preferred, it is recognized that there exists a tremendous backlog of cases needing institutional care. The establishment of two regional mental hospitals by 1981 is therefore contemplated. WHO will cooperate in developing the programme. Prophylactic, diagnostic and therapeutic substances Drug policies and management Programmes to contain the problem of drug dependence are considered to be well developed. In 1980 and 1981 it is planned to adopt and implement regulations on psychotropic substances, salts, esters, isomers and other substances recommended by the 1971 Vienna Convention, to formulate policies and regulations on adverse drug reaction, to establish a drug monitoring mechanism and a centre for carrying it out, and to link the monitoring centre with similar centres in other countries. WHO will cooperate in the development of the programme, partially from its intercountry programme. Pharmaceuticals and biologicals The programmed expansion of vaccine production and improvement of quality control is being continued to respond to the needs of the expanded programme on immunization. Technical cooperation will be extended through the WHO country and intercountry programmes for pharmaceuticals and biologicals and the expanded programme on immunization. Disease prevention and control Communicable disease prevention and control Malaria and other parasitic diseases Malaria is still a serious problem in many provinces. The objective is to achieve optimal control, and eradication in areas where it is feasible. Integration of malaria control activities into the basic health services will be continued so that, by 1980, a malaria vigilance system will be fully implemented in twelve provinces. It is expected that primary health care activities will boost the programme, especially in highly endemic areas. The staff of the programme are expected to collaborate closely with the rural health units in their malaria control activities and in developing the malaria component of primary health care. Research will be continued on biological

259

260

PHILIPPINES (continued) control, use of new insecticides and drug combinations, and drug resistance. Continuing activities for the control of schistosomiasis consist in basic and applied research, most of which is carried out in Palo, Leyte; epidemiological and training activities by regional teams; diagnosis and treatment by rural health units and hospitals; health education; and environmental sanitation. By 1980 mass treatment programmes and use of the "tuba" plant as a molluscicide are expected to have been evaluated. WHO will cooperate in activities expected to start in 1981, resulting from the evaluation. Bacterial, viral and mycotic diseases Tuberculosis remains one of the leading health problems, never having descended lower than fourth leading cause of death for several years past. The disease is widespread and no locality is spared. The control programme is integrated into the basic health services. Variations in control achievements in different provinces have been observed. Effective control programmes have to be further developed in many cities. The programme has been plagued by operational rather than technical problems over the years. It is expected that improvement of the basic health services, the development of primary health care, success in the expanded programme on immunization, and health education will have a significant effect. Two major activities are planned for 1980-81, namely: strengthening of epidemiological surveillance, and operational research on case finding and ambulatory chemotherapy. The National Institute of Tuberculosis is expected to provide the necessary technical leadership, especially in research and in training; and WHO will extend technical cooperation, particularly through its intercountry programme. The leprosy programme is carried out by the rural health units, sanitaria and static and mobile teams. In spite of past efforts, the programme has not been fully integrated into the general health services for reasons traceable to deficiencies in the latter and also to the leper himself. The health education component is ineffective, and a programme for the prevention and correction of early disability still has to be developed. Major activities in 1980 and 1981 will be directed towards solving those problems with, in addition, an improved programme of research and the provision of family planning services in the eight sanitaria and government skin clinics. The programme for the control of sexually transmitted diseases may need, with WHO cooperation, to be modified and reorientated. Expanded programme on immunization Routine immunization has been practised for a long time in the Philippines but it was only when it was decided to participate in the WHO expanded programme that concerted efforts were directed towards a well-orientated and sustained programme.

DPT vaccine was formerly never administered on a large scale because of the prohibitive cost. BCG immunization had been successful in only a few provinces and support, through provision of the necessary equipment, timely arrival of vaccine in the required amount and proper care of the vaccine, received insufficient attention. Almost all unprotected children in the Philippines inevitably contract pertussis; tetanus occurs in various parts of the country, at a high level in some provinces; and diphtheria continues to be reported from the main communicable disease hospital in Manila. With cooperation from WHO, mainly through its intercountry programme, improvement of the immunization programme will continue through the rural health units; coverage will be extended; needed vaccines will be produced. Prevention of blindness the programme. WHO will cooperate, through its intercountry programme, in development of

Vector biology and control Filariasis remains endemic in certain provinces, especially in or around abaca plantations. Dengue haemorrhagia fever is a seasonal threat in urban and rural areas. Little information is available on Japanese encephalitis because of lack of consciousness about it and diagnostic difficulties. Guidelines and procedures will be established for vector-borne disease and vector control and health staff trained in control methods and techniques. An office able to provide immediate assistance in the event of epidemics and a research and training centre will also be established with technical cooperation from WHO. Noncommunicable disease prevention and control Cancer Cancer ranks among the first ten major health problems in the country but control programmes have been limited to diagnostic and therapeutic services in the National Cancer Control Center, detection in family planning clinics, and the development of a cancer registry system which still needs much improvement. Policies for the prevention and control of cancer and for research will be formulated and satellite cancer units established in the twelve regions of the country. Cardiovascular diseases Efforts need to be made to develop a programme for the control of cardiovascular diseases, since they also rank among the first ten leading causes of death. WHO will cooperate in developing the programme.

261

262

PHILIPPINES (continued) Oral health The Bureau of Dental Health Services proposes to implement a plan for fluoridation of community water supplies and for the use of mouth rinses and other supplements in areas where water fluoridation is not feasible. Subject to the availability of funds, and with WHO cooperation, it is proposed to initiate the programme by developing four demonstration areas in each of the twelve regions of the country. Two will be in cities or municipalities having a community water supply and two, where mouth rinses and other fluoride supplements will be administered, in the provinces. Promotion of environmental health In coordination with other relevant agencies and WHO, the Department of Health intends to strengthen the environmental health programme by {1) preparing a comprehensive water quality management plan for Metro Manila and a similar plan to manage air resources; {2) intensifying the control of environmental hazards such as air pollution and water pollution and activities related to the storage and retrieval of data on air and water quality and air emission; {3) professionalizing the post of sanitarian; and {4) intensifying efforts towards basic sanitary measures and food safety. Health manpower development In the Philippines there is a continuing need to make the content of training courses relevant to changes required in the skills and knowledge of health workers; to introduce more effective training methods or approaches; to develop positive attitudes among health workers; and to rationalize the distribution of health manpower. To improve the situation, and with WHO cooperation, a scheme to monitor training needs will be developed; the curricula of existing courses reorientated; new fields of specialization introduced; local teaching materials developed; training methodologies and the training of teachers/trainers improved; a continuing education programme for health staff introduced; and collaborative efforts with the Institute of Health Sciences continued.

Regular budget PHILIPPINES 1978-1979 US$ 1980-1981 US$ GENERAL PROGRAMME DEVELOPMENT AND MANAGEMENT 135 200 1 156 8oo 1 Country health programming HEALTH SERVICES DEVELOPMENT 343 400 17 900 90 400 342 700 13 600 22 800 86 200 Health services planning and management Primary health care Workers' health Appropriate technology for health (radiological technology) FAMILY HEALTH 25 000 53 800 49 500 37 600 36 600 63 700 Maternal and child health Nutrition Health education MENTAL HEALTH 29 500 40 000 Mental health

Other sources 1978-1979 US$ 1980-1981 US$

Source of Funds

51 700

51 800

347 100

1 cost of WHO Representative's office based in Manila, Philippines. 263

264

Regular budget PHILIPPINES 1978-1979 1980-1981

Other sources 1978-1979 1980-1981

Source of Funds

US$

US$ PROPHYLACTIC, DIAGNOSTIC AND THERAPEUTIC SUBSTANCES 46 200 19 200 Drug policies and management

US$

11 400

Pharmaceuticals and biologicals COMMUNICABLE DISEASE PREVENTION AND CONTROL

123 900 100 000 155 600 126 900 151 300 10 000 38 600

Programme planning and general activities Malaria and other parasitic diseases Bacterial, viral and mycotic diseases Expanded programme on immunization Special programme for research ind training in tropical diseases Vector biology and control NONCOMMUNICABLE DISEASE PREVENTION AND CONTROL

136 800 28 700 119 700

VD VI VD

54 100 27 000 37 400

Cancer Cardiovascular diseases Oral health

1 Activities carried out in the Region under the global programme.

PROMOTION OF ENVIRONMENTAL HEALTH 9 500 101 900 68 700 19 900 29 000

Environmental health planning and management Basic sanitary measures Recognition and control of environmental hazards Food safety HEALTH MANPOWER DEVELOPMENT

64 000

228 200 50 600

98 300 79 900 55 400

Health manpower planning and management Promotion of training Educational development and support HEALTH INFORMATION

26 300 1

Health statistics

---------

438 800

---------

1 763 800

Total - PHILIPPINES

759 400

-------

------

51 800

265

266

REPUBLIC OF KOREA NATIONAL HEALTH DEVELOPMENT STRATEGY The health sector plan of the fourth five year economic development plan (1977-81) has the following as its p~licy objectives: (1) to establish a health care delivery system through the development and expansion of low cost services for the urban poor as well as residents of rural areas, together with equalization of the distribution of medical resources by area, to enable adequate health care to be provided for the whole country; ~ealth

(2)

to intensify public health measures particularly in preventive medicine, including disease control; to develop and preserve ~n optimum living environment through expanded basic environmental health facilities in rural areas and minimized industrial pollution; to preserve manpower, increase productivity and reduce social expenditure for health, by promoting national health through expanded and equitable health services, intensifying preventive medicine activities and improving the living environment.

(3) (4)

Although activities in such fields as communicable disease prevention and control and family health (including maternal and child health, family planning and nutrition) continue to develop, it is the intention of the Government to expand its efforts in the fields of health services delivery, chronic and degenerative disease control and environmental control. Such expansion will entail the training of new categories of staff and upgrading of the qualifications and experience of existing staff, particularly those employed in provincial areas.

TECHNICAL COOPERATION PROGRAMMES FOR HEALTH Development of comprehensive health services Health services development Health servi ces planning and management There is at present inequitable distribution of health care resources between urban and rural areas. The health facilities that do exist are under-utilized. It is the intention of the Government to develop a country-wide comprehensive health care delivery system, based on Government sub-health centres, health centres and district and provincial hospitals, and at the same time to coordinate the system with private medical facilities.

With WHO collaboration, operational research in health care delivery at health centre and hospital level is being carried out under the auspices of the Ministry of Health and Social Affairs. The planned upgra•ing and expansion of health centre and hospital facilities commenced in 1978. WHO cooperation will further strengthen the Government's health planning activities. Concommitant with those activities, a nationwide health insurance system will be developed, starting with a system for factory workers and later extending it to other types of employee and to the self employed. Primary health care Research in primary health care will be carried out in cooperation with the WHO intercountry programme for the promotion of primary health care. Appropriate technology for health As part of the plan for hospital development, the maintenance of existing hospital scientific equipment and the purchase of appropriate new instruments, particularly X-ray and laboratory equipment, will be studied with WHO collaboration. Mental health Mental disorders are becoming of some importance. In order to plan prevention and control strategies, baseline epidemiological studies are being undertaken as well as studies on incidence. On the results of those studies prevention and control programmes will be developed with WHO collaboration. Disease prevention and control Communicable disease prevention and control With the exception of tuberculosis, and to a lesser extent leprosy, the incidence of the common communicable diseases in the Republic of Korea is of minor importance. Coupled with the decreasing incidence of the communicable diseases there has been an increase in the average life span. Technical cooperation from WHO will be extended through its intercountry programme.

267

268

REPUBLIC OF KOREA (continued) Noncommunicable disease prevention and control Noncommunicable and chronic diseases are assuming increasing significance, particularly cancer, cardiovascular· diseases and diabetes. In order to plan prevention and control strategies the Government is undertaking baseline epidemiological studies and studies on incidence. On the results of those investigations active prevention and control programmes will be developed with WHO collaboration, partially through its intercountry programme. Promotion of environmental health Rapid industrialization in the Republic of Korea and the increase in the proportion of the population living in urban areas have brought with them problems of environmental control. Basic sanitary measures All cities and towns and the majority of villages now have adequate piped supplies of safe drinking water. It is the Government's intention to provide the entire population with potable water. Nightsoil treatment plants are being constructed to serve all the major population centres and, where applicable, waterborne sewerage systems will be installed. The management of solid wastes is being further improved. WHO will collaborate with the Government in those activities. Recognition and control of environmental hazards An interministerial environmental body has been established to control and coordinate air and water pollution control activities. An institute for environmental studies has also been set up. A nationwide environmental pollution monitoring system for air and water has been developed and legislation has been promulgated to control such pollution from factories, vehicles and other sources of contamination. Technical cooperation from WHO will further the national activities in air and water pollution control. The Western Pacific regional centre for the promotion of environmental planning and applied studies will also collaborate in all these activities. Health.manpower development Although the Republic of Korea has, in many fields, adequate numbers of qualified and experienced health workers, there are certain deficiencies, particularly in administration; public health and environmental control. Staff in provincial and rural areas tend to be less qualified and experienced compared with health workers in the larger cities. Provincial training schools for health workers have not achieved the same academic level as those situated in the capital city.

The Government, with WHO cooperation, will further develop the national teacher training centre for health personnel to enable it to serve as a focal point for educational methodology for health professional training. It will also concentrate on improving provincial health personnel training institutions. Overseas training in selected fields will be undertaken with WHO cooperation. will be placed on the further development of provincial health workers. Here also, accent

Collaborative activities will include those in collaboration with the Regional Teacher Training Centre for Health Personnel, Sydney.

Health information With the development of a national health insurance scheme and the increasing accent being placed on health planning, the statistics division of the Ministry of Health and Social Affairs is assuming greater importance. The scope of activities of this division -will be expanded and a national health information system will be developed with WHO collaboration.

269

270

Regular budget REPUBLIC OF KOREA 1978-1979 US$ 1980-1981 US$ GENERAL PROGRAMME DEVELOPMENT 175 300 1 195 300 1 Country health progra.ming HEALTH SERVICES DEVELOPMENT 212 600 37 500 41 000 33 300 249 700 Health services planning and unagement Care of the aged, disability prevention and rehabilitation Appropriate technolOSY for health (radiological technology) FAMILY HEALTH 25 400 Nutrition MENTAL HEALTH 19 400 Mental health COMMUNICABLE DISEASE PREVENTION AND CONTROL 72 000 Epidemiological surveillance

Other sources 1978-1979 US$ 1980-1981 US$

Source or Funds

1cost of WHO Representative's office based in Seoul, Republic of Korea¢

26 200 13 200

Bacterial, viral and mycotic diseases Vector biology and control NONCOMMUNICABLE DISEASE PREVENTION AND CONTROL 34 200 117 200

Programme planning and general activities Cancer PROMOTION OF ENVIRONMENTAL HEALTH

185 700 205 200 51 300

38 700 53 700 252 800

Environmental health planning and management Basic sanitary measures Recognition and control of environmental hazards Food safety HEALTH MANPOWER DEVELOPMENT

10 000

489 000

143 600 40 000

122 300 305 000

Promotion of training Educational development and support HEALTH INFORMATION

79 000 16 100

33 700 1 455 300

Health statistics Health literature services Total - REPUBLIC OF KOREA

---------

1 324 100

---------

--------

10 000

489 000

---------

271

272

SAMOA NATIONAL HEALTH DEVELOPMENT STRATEGY The Samoa health development policy is an integral part of the national development plan. The plan states that the Health Department's long-term objective is to promote and safeguard, by the most efficient means available, a sound standard of health for the Samoan people. The goals of the Department of Health, reflecting the above-mentioned long-term sectoral objective, are to: (1) (2) improve the quality of all preventive and curative services; strengthen the national structure of health services delivery, in order to render more equal access to preventive and curative health care by both the rural and the urban population; increase the awareness of the people and their participation in health promotional activities; enhance the productivity of local resources applied to health sector development.

(3) (4)

The Health Department, conscious of the constraints in achieving the above-mentioned goals, .has adopted the following long-term strategies: (a) placement of emphasis on the development of the less costly primary level health care, utilizing more appropriately trained staff and less elaborate facilities, to bear the major burden of health service delivery; and further development of secondary-level health care, but only in proportion to the growth in volume of health care problems identified at the primary level that cannot be dealt with at that level.

(b)

The Health Department, with the collaboration of WHO, has developed a country health programme covering the period 1978 to 1984. The highest priority areas defined are strengthening of the basic health services, including intensification of primary health care in the villages, improvement of health administration, and development of the necessary manpower.

TECHNICAL COOPERATION PROGRAMMES FOR HEALTH Development of comprehensive health services Health services development Health services planning and management The Samoa country health programme plan has identified a number of areas in which health service delivery can be improved through restructuring the existing organization. To develop a more effective health delivery system with the manpower and resources available, reorganization would include a regrouping of services, delineation of administrative and technical duties, bringing supervisory staff closer to operating units and upgrading rural health centres to dispense better health care closer to where the people live. In addition, the country's capability for planning and management will be continuously upgraded. WHO will collaborate in those activities. In addition the capabilities of the senior Samoan staff engaged in management and planning will be upgraded through WHO fellowships and training opportunities. Primary health care Samoa has accepted the principle of primary health care and will continuously train village health workers. Primary health care is the Health Department's contribution to the Government's overall rural development programme. WHO collaboration, with support anticipated from UNDP, will be in training primary health care workers and improving the organizational structure of the system. As small-scale industry increases, it is the Government's policy to build up Workers' health occupational health services, with due attention to legislation. Appropriate technology for health In keeping with the upgrading of rural health centres, WHO will collaborate in the improvement of the network of rural laboratory services. Family health Maternal and child health The objective of the family health programme is to promote the health of mothers and children through the provision of antenatal, natal and postnatal services, child care services integrated with nutrition, and family planning services. The immunization programme is an integral part of family health activities, while health education is an important expanding area of activity. WHO collaboration will further those programmes as required and assistance in training, as well as with supplies and equipment, will be obtained through UNFPA. Health education WHO collaboration will uphold the increasing importance being given by the Government to building a health education component into its major programme. 273

274

SAMOA (continued) Disease prevention and control Communicable disease prevention and control Epidemiological surveillance WHO, through its intercountry programme, will continue its cooperation where required, particularly in respect to-quarantinable diseases. Bacterial, viral and mycotic diseases WHO will continue to cooperate closely with the Government in its programmes aimed at the control of tuberculosis, leprosy, sexually transmitted diseases and other diseases. Accent will be placed on the training of staff. Special programme for research and training in tropical diseases Filariasis is a major problem in Samoa. WHO's special programme for research and training in tropical diseases, under which the WHO/Samoa filariasis research project was initiated in 1977, will continue to give support to this activity until its satisfactory conclusion. Noncommunicable disease prevention and control As noncommunicable diseases are of growing importance in Samoa, WHO will collaborate in prevention and control programmes for cardiovascular diseases, in promoting oral health and in training staff. Promotion of environmental health Basic sanitary measures Lack of a safe water supply and only partially improved sanitation services, especially in the rural areas, still causes major problems in health. The Government of Samoa is receiving large-scale support from bilateral sources in the improvement of the water supply. WHO, however, through its intercountry programme and with support anticipated from UNDP, will continue to cooperate closely in planning the improvement of sanitation, which will include extension of the waterseal latrine programme in the rural areas, advisory services in general sanitary measures, training, and planning of large-scale projects for possible bilateral support.

Health manpower development Health manpower planning and management Shortage of trained health personnel continues to present problems in the coverage of the health services as well as in the continuity of health services management. WHO cooperation will further the programme by helping to identify health manpower needs and possibly formulating a health manpower plan. Promotion of training WHO will collaborate in the continued training of health personnel through the provision of fellowships, identification of appropriate technological expertise for training and support of existing training institutions.

Regular budget SAMOA 1978-1979 US$ 1980-1981 US$ GENERAL PROGRAMME DEVELOPMENT AND MANAGEMENT 41 900 1 48 400 1 Country health programming HEALTH SERVICES DEVELOPMENT 206 700 106 400 2 500

Other sources 1978-1979 US$ 1980-1981 US$

Source of Funds

5 000

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

2 800 244 200

110 300

FT DP

shar·e of costs of WHO Representative's office based in Suva, Fiji.

275

276

Regular budget SAMOA 1978-1979 1980-1981

Other sources 1978-1979 1980-1981

Source of Funds

US$

US$ FAMILY HEALTH 2 000

US$

Maternal and child health Health education COMMUNICABLE DISEASE PREVENTION AND CONTROL

68 800

10 000

4 000

Bacterial, viral and mycotic diseases Special programme for research and training in tropical diseases NONCOMMUNICABLE DISEASE PREVENTION AND CONTROL

200 700

120 000

8 000

1 000 5 800

Cardiovascular diseases Oral health PROMOTION OF ENVIRONMENTAL HEALTH Basic sanitary measures 65 500 40 000

HEALTH MANPOWER DEVELOPMENT 10 000

Health manpower planning and management Promotion of training Total - SAMOA 9 100

95 100 351 700

202 300

DP 280 300

-------

387 !100

-------

591 100

-------

277

278 SINGAPORE NATIONAL HEALTH DEVELOPMENT STRATEGY The Government is giving more attention to promoting preventive medicine. This includes immunization against infectious diseases, improvement of the working and living environment and education of the public in how to stay healthy. A national health campaign was launched in September 1976 as part of a sustained programme to promote public health consciousness. Experience has shown that, on a per capita basis, the outpatient services have been the most cost-effective in delivering medical treatment. The outpatient, maternal and child health and school health services have been integrated to offer more comprehensive and efficient primary health care services. Primary health care services, which include those for outpatients, maternal and child health and school health, are provided at 28 outpatient dispensaries and 35 maternal and child health clinics. The outpatient dispensaries provide curative services and the maternal and child health clinics concentrate on preventive health care for women of child-bearing age and pre-school children, and on family planning and immunization programmes. Health screening and immunization of schoolchildren are undertaken by the school health services. Singapore is free from the major epidemic diseases and has satisfactorily controlled the common infectious diseases. Effective mosquito and vector control measures brought the incidence of malaria down to a record of 184 cases in 1977, the lowest in 15 years. The control of vector borne diseases, especially dengue/dengue haemorrhagic fever and malaria, is achieved through routine larval surveillance to locate and destroy the breeding grounds of mosquitos in highly endemic areas; the fogging of areas with a premise index exceeding 5% to eliminate adult mosquitos; public health education; and strict enforcement measures. Attention is also being directed to the residual problems of sexually transmitted infections, enteric diseases, streptococcal infections, tuberculosis and leprosy. The WHO Collaborating Centres continue to operate effectively. With the introduction of the national immunization programme which has almost universal coverage, the two childhood diseases, diphtheria and poliomyelitis, have been eradicated. Indigenous poliomyelitis was last notified in 1973 and diphtheria in 1974. During the past decade, noncommunicable diseases have become the main causes of death and disability. Degenerative diseases of the circulatory system, neoplasms, allergic disorders, metabolic and blood diseases, and diseases associated with extensive industrialization, are major health problems.

The Ministry of the Environment was formed in September 1972. It is responsible for the protection and improvement of the environment; planning, development and operation of sewerage, drainage and solid waste disposal facilities; control and prevention of water pollution; and provision of other environmental public health services. It also works closely with the anti-pollution unit of the Prime Minister's Office in controlling air pollution. Water pollution is controlled mainly through modern sewerage facilities. The sewerage system is being extended and new treatment works constructed to cope with the growing volume of sewage and effluents. Today, 75' of the population is served with a modern waterborne sewerage system. To improve the effectiveness of water pollution control, new and comprehensive legislation, the Water Pollution Control and Drainage Act, was passed in 1975 and the Trade Effluent Regulations were updated in 1977. The new Act and the updated Regulations provide more effective control over the discharge of liquid wastes and in preventing pollution of the water courses and damage to the sewerage system. Hawkers and food handlers are licensed and regular inspections are made to ensure they maintain a high standard of personal and food hygiene to minimize the incidence or enteric disease. Street hawkers are being resited progressively into markets and food centres provided with proper anti-pollution facilities and piped water. Samples of local and imported foodstuffs are analyzed for wholesomeness. TECHNICAL COOPERATION PROGRAMMES FOR HEALTH Development of comprehensive health services Health services development Health services planning and management The primary health care programme is intimately linked and closely associated with the social and economic problems of living. The Home Nursing Foundation was established in 1976 to promote nursing care of the disabled, the chronically sick, the mentally ill and geriatric patients in their own homes. It is intended to extend such home nursing services to the whole island to relieve the strain on the hospitals and enable them to be put to optimum use in treating acute illnesses. Mental health WHO will collaborate in training qualified psychiatrists to deal with increasing problems associated with accelerating urbanization and industrialization.

279

280

SINGAPORE (continued) Disease prevention and control Noncommunicable disease prevention and control Oral health Dental health education is a specialized service. WHO will collaborate in training specialized staff. Promotion of environmental health Environmental health planning and management To conserve water resources, effluents from the sewage treatment works are being treated for use in industry. In areas not served with public sewers, a daily nightsoil removal service is provided. The bucket system is being phased out gradually as more and more premises become connected to the sewers or demolished under the urban redevelopment programme. The Clean Air Act, passed in 1971, empowers the anti-pollution unit to control pollution from trade and industrial premises. The Act was amended in 1975 for the more effective control of air pollution, especially from construction sites. The use of open burning to dispose of industrial wastes was prohibited in 1973 under a clean air (prohibition on use of open fires) order. Technical cooperation will be extended in different aspects of the promotion of environmental health. Health manpower development Promotion of training In Singapore, the Ministry of Health is responsible for the training of nurses and ancillary health personnel, whereas the University of Singapore is responsible for the training of doctors, dentists, and pharmacists. Cooperation will be needed in local training and with specialized training overseas in various disciplines, particularly where postgraduate training is not available locally. Health information Health statistics There is a constant need to monitor the progress of health services research for the purpose of maintaining appropriate programme formulation and evaluation, cost effect analysis and health services planning. Statisticians in the health services thus need to be trained in health information statistics. In order to improve the programme

Regular budget SINGAPORE 1978-1979 US$ 1980-1981 US$ GENERAL PROGRAMME DEVELOPMENT AND MANAGEMENT 91 100 1 104 900 1 Country health programming HEALTH SERVICES DEVELOPMENT 98 600 48 000 Health services planning and management MENTAL HEALTH 6 400 Mental health NONCOMMUNICABLE DISEASE PREVENTION AND CONTROL 2 400 Oral health PROMOTION OF ENVIRONMENTAL HEALTH 52 200 8 800 Environmental health planning and management HEALTH MANPOWER DEVELOPMENT 115 700 143 400 Promotion of training

Other sources 1978-1979 US$ 1980-1981 US$

Source of Funds

1 cost of liaison office in Singapore and share of cost of WHO Representative's office based in Kuala Lumpur, Malaysia.

281

282

Regular budget SINGAPORE 1978-1979 US$ 1980-1981 US$ HEALTH INFORMATION 6 000 357 600 Health statistics Total - SINGAPORE

Other sources 1978-1979 US$ 1980-1981 US$

Source of Funds

-------

319 900

-------

---------

SOCIALIST REPUBLIC OF VIF.T NAM NATIONAL HEALTH DEVELOPMENT STRATEGY Health is an integral part of the social and economic development of the country. The basic task of the health services remains the establishment of favourable conditions for the protection and promotion of the health of the peop~e, which was severely affected by a long and arduous war. The national political and health authorities have five main objectives in view: (1)

to extend and strengthen the health network; to provide maternal and child care; to promote the provision of medical care in dispensaries; to prevent epidemics; to develop pharmaceutical production.

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

Priority problems to be solved are the following: (1) (2) (3)

completion of the organization for health throughout the country from the central to the basic level in order to provide all individuals with medical care of improved quality; promotion of drug production within the country and importation of certain drugs and chemical substances to meet the requirements for prophylaxis, treatment and medical research; intensification of medical research activities and the application of technical progress in order to establish the necessary material and technical potential for the future; strengthening of the training of supervisory staff of all categories; improvement of the quality of treatment, in particular emergency and intensive care in large urban centres.

(4) (5)

283

284

SOCIALIST REPUBLIC OF VIET NAM (continued) TECHNICAL COOPERATION PROGRAMMES FOR HEALTH Development of comprehensive health services Health services development Health services planning and management The Ministry of Health intends to reorganize medical care, including emergency and intensive care units, in Hanoi and Haiphong in 1980 and 1981. The situation at present does not meet the increasing needs of the population because of lack of ambulances, proper supervision and means of obtaining information. The units will have to cover over three million inhabitants in both cities and their suburbs. WHO will cooperate in equipping and operating them and in training the necessary manpower. Appropriate technology for health The Ministry of Health intends to establish a radioisotope unit in 1981 to improve case detection and treatment of a number of diseases. Exploratory techniques for heart, lung, kidney and brain should be developed, as well as in vitro testing and radioimmunoassay techniques. WHO will cooperate in training the necessary staff and by providing some equipment. The Ministry of Health gives particular attention to the development of appropriate methods and techniques in traditional medicine, as well as the integration of western and traditional medicine. To that end it is planned to establish an experimental laboratory in the National Institute of Traditional Medicine, Hanoi, in 1980 to assess medicinal plants and preparations before their application. WHO will cooperate in equipping the laboratory. Family health Maternal and child health The Ministry of Health intends to intensify activities aimed at curbing population growth, regulating the uneven expansion of maternal and child health services and controlling gynaecological diseases. WHO technical cooperation will include the provision of fellowships and technical material for the in-service training of staff of the UNFPA-funded support to family planning services project. Prophylactic, diagnostic and therapeutic substances Drug policies and management The Government is endeavouring to increase drug production and, as much as possible, the number of distribution centres for pharmaceuticals in the country. Raw materials are needed for the production of certain essential drugs.

Pharmaceuticals and biologicals WHO will cooperate in purchasing chemical reagents to cover the needs of health laboratories in 19BO and 1981. It ts intended to increase research on the extraction of alkaloids, glucosides and steroids from valuable medicinal plants and on the semj-synthesis of some alkaloid derivatives. In 1980 WHO will cooperate in equipping a laboratory for research on medical substances derived from bees and research in phytochemistry. Disease prevention and control Communicable disease prevention and control Malaria and other parasitic diseases The health authorities are faced with numerous technical problems connected with the eradication of malaria such as the resistance of parasites to drugs and control of the main vectors. It is planned to establish an immunological research laboratory which WHO will cooperate in equipping. Prevention of blindness The Government wishes to improve the quality of case detection, diagnosis and ophthalmological treatment throughout the country in order to reduce the risk of blindness. It is planned to equip the National Institute of Ophthalmology for this purpose and WHO will cooperate in providing equipment. Noncommunicable disease prevention and control Oral health In 1981 the Government is planning to set up three laboratorie~ or workshops for dental prostheses and corrective dental-maxillary facial appliances. It will also be necessary to equip a dental and maxillo-facial X-ray unit and a histological and pathological laboratory. Other noncommunicable diseases The health authorities plan to extend case detection and epidemiological surveillance for endemic goitre, particularly in the highlands. It is also planned to study the application of diagnostic, prophylactic and therapeutic techniques relevant to goitre, its prevalence and subsequent complicati.ons. WHO will cooperate with equipment and technology for such studies.

285

286

SOCIALIST REPUBLIC OF VIET NAM (continued) Promotion of environmental health Recognition and control of environmental health hazards No studies have so far been made on sources of environmental pollution in the Socialist Republic of Viet Nam, their nature, accumulated effect and consequences. Data are lacking, as well as equipment and trained manpower. It is planned to initiate studies in 1980, in which WHO will cooperate by providing equipment for the measurement of air pollution. Health manpower development Promotion of training It is planned to improve the training of students in three secondary technical schools of medicine and pharmacy with a total of 4600 students (Hai Duong, Da Nang and Ho Chi Minh Ville) in 1980, and in two medical faculties with a total of 4000 students (Haiphong and Can Tho) in 1981. WHO will cooperate in providing the materials necessary for theoretical and practical training. Cooperation will also be extended through the provision of fellowships. Educational development and support It is planned to establish a pilot workshop in the School of Pharmacy, Hanoi to give basic practical training to postgraduates. WHO will cooperate in equipping the workshop to enable practical training to be given in formulations for, and the quality control of, medicines.

Regular budget SOCIALIST REPUBLIC OF VIET NAM 197A-197~

Other sources 1980-1981

Source

or Funds

1Q80-1981

1978-1979

US$

US$ GENERAL PROGRAMME DEVELOPMENT AND MANAGEMENT

US$

135 500

168 8oo

Country health programming HEALTH SERVICES DEVELOPMENT

550 000 250 000

Health services planning and management Appropriate technology for health (health laboratory technology) FAMILY HEALTH Maternal and child health PROPHYLACTIC, DIAGNOSTIC AND THERAPEUTIC SUBSTANCES

1 143 700

131 200

1~4

700

1 176 000

800 000 300 000

Drug policies and management Pharmaceuticals and bi.ologicaJ s COMMUNICABLE DISEASE PREVENTION AND CONTROL

150 000 1

Malaria and other parasitic diseases 287

Costs of WHO Representative's office based in Hanoi, Socialist Republic of Viet Nam.

288

Regular budget SOCIALIST REPUBLIC OF VIET NAM 1978-1979 1980-1981

Other sources 1978-1979 1980-1981

Source of Funds

US$

US$ Bacterial, ·viral and mycotic diseases Prevention of blindness NONCOMMUNICABLE DISEASE PREVENTION AND CONTROL 100 000 150 000

US$ (792 700 ( 50 000 (106 700

US$

vv VD VL

150 000

Or.al .health Other noncommunicable diseases PROMOTION OF ENVIRONMENTAL HEALTH

200 000

Recognition and control of environmental hazards ..

HEALTH MANPOWER DEVELOPMENT 2 164 000 3 475 500 550 000 300 000 3 668 800 P~omotion of training Educational development and support

---------

Total - SOCIALIST REPUBLIC OF VIET NAH

2 224 300

144 700

---------

-------

SOLOMON ISLANDS NATIONAL HEALTH DEVELOPMENT STRATEGY The health policy paper adopted by the Legislative Assembly in 1976 laid down five basic health aims which the Ministry of Health and Welfare is required to achieve. They are to: (1) (2) promote understanding and improvement in public health throughout the country; protect the people of Solomon Islands from health threats from overseas and within the country; control first and then eradicate the main disease threats within the country; improve overall standards of nutrition and physical well-being, especially for children; aim for a reasonable rate of population growth.

(3) (q)

(5)

Following independence in July 1978, a top priority for the Ministry of Health and Welfare is to strengthen and expand the rural health services. Coverage is aimed at the total community, from village level to council and national levels, through a well structured chain of facilities which are expected to become better equipped and staffed over the programme period. In an endeavour to provide primary health care for all, special emphasis is being placed on giving communities the responsibility of participating in the planning and delivery of their own health services. Every effort is being made to encourage individuals to become more involved in the development of the programme. Particular attention will be given to consolidation of the village health aid scheme, the comprehensive family health service, improvement of environmental health, prevention of malaria and other major diseases, together with health manpower development. The curative services, especially those of the hospitals, will also be improved further. TECHNICAL COOPERATION PROGRAMMES FOR HEALTH Development of comprehensive health services Health services development Health services planning and management WHO will cooperate with the Health Department in efforts to improve its planning and managerial capacity at all levels. The health information system, including vital statistics, will be strengthened in order to monitor the prevailing situation as well as

289

290

SOLOMON ISLANDS {continued) implementation of major health programmes and their impact on socio-economic development. In this context, the Government regards as important the need for development of programmes in the health field to be balanced and for the effective coordination of health with other disciplines. Since 1977, there has been a devolution of health services to the local councils and in 1980 and 1981 WHO will collaborate in national efforts to maximize the benefits of that decentralization. Strengthening of logistical support for the health services, including improvement of transport facilities, will also receive particular attention. Primary health care Solomon Islands, being a country of many islands, faces a difficult problem in delivering health care to much of the population, particularly the population of the outer islands. The high cost of transport and poor communication, as well as shortage of health personnel, aggravate the situation further. The Government's policy of decentralizing services, including the health services, initiated the involvement of local councils in front line health care and created a need to train and put into service primary health care workers, called VHAs. The way in which VHAs are employed and their relationship with other rural health staff so as to optimize their overall contribution have been satisfactorily resolved. In addition, consideration is being given to the positive contribution which might be made by traditional medicine to primary health care. The primary health care programme will be further consolidated during 1980-81 through the training and retraining of the VHAs so as to develop their skills and help them to participate more effectively in a multidisciplinary manner. WHO will cooperate in the training programmes and also in strengthening the organizational structure of the system so that primary health care becomes entrenched as the cornerstone of the country's health programme. Family health Programme planning and general activities The family health programme is integrated into the general health services. Maternal and child health activities, including the immunization services, are already quite well developed. They will be further strengthened through the primary health care programme. In turn, the more favourable situation is expected to affect attitudes to family planning through which the Government hopes to achieve a reasonable rate of population growth. Nutrition is also receiving particular attention in view of the socio-economic and cultural changes taking place in the community. WHO collaboration, with support anticipated from UNFPA in the broad field of family health, will concentrate on staff training and on upgrading the quality and coverage of services.

Health education The Government, fully recognizinR the vital role to be played by health education in oublic enH.Ilhtenment, will, w:tth \ffiO cooperation for wllich support will be nep:oti.ated with UNFPA, expand its acti vi. ties to cover rural areas and schools. The needs of teenagers, who comprtse 50% of the population, wi l1 be catered for. Local customs and culture are being taken into greater consideration 5.n the development of health education programmes. Disease prevention and control Communicable disease prevention and control Epidemiological surveillance WHO cooperation, through its intercountry programme, will continue where required, particularly in respect to the quarantinable diseases. Malaria and other parasitic dlseases The malaria eradication campaign has progressed considerably in the Jast decade. Malaria morbidity and mortality has been reduced significantly, especially among chi.ldren. Most of the country ts now free from the rlisease, leaving only a few residual foct. Central technical control is being maintained but some decentralization of the programme is being intr·oduced. Malaria control maintains a high priority for the Government and efforts wnl concentrate on elim:l.nating the remaining foci and maintaining the gains already achieved, by preventing the importation of cases and the subsequent resumption of transmission in areas already made malaria free. Consequently, Solomon IsJ.ands is entering a critical phase in its malaria campaign and WHO technical collaboration will remain a valuable supporting resource. In addition, cooperation will be given in the trai.ning of national staff. Bacterial, viral and mycotic diseases WHO cooperation will further national programmes aimed at the control of tuberculosis, leprosy, sexually transmitted diseases and other diseases. Noncommunicable disease prevention and control Programme planning and general activities Noncommunicable diseases, i.ncludi.ng cancer and cardiovascular and metabolic diseases, are of growing importance in Solomon Islands. During 1980-81, WHO will collaborate in the collection and anAlysis of' data as well as in the introrluct:!.on of measures to prevent and control noncommunicable diseases. Training of dental personnel and prevention activities connected with oral health will also receive special attenti.on.

291

292

SOLOMON ISLANDS (continued) Promotion of environmental health 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 will intensify its efforts to strengthen the decentralized health services by appointing better trained environmental health staff. It will also endeavour to improve sanitation by including provisions to improve the water supply, build latrines and develop waste disposal facilities in its community development programme. With industrial development, more attention will be given to pollution. WHO technical cooperation, with anticipated support from UNDP, will extend to national efforts in developing the appropriate technology to deal with environmental health problems, including pre-investment studies for the construction of water latrines, for drainage facilities, pollution control, waste disposal facilities and meat inspection for export. It will also cooperate as required in seeking financial support for the national environmental health programme from bilateral and multilateral sources. Health manpower development Health manpower planning and management Shortage of trained health personnel is a critical and principal constraint in the development of health services. Recognizing the need for a systematic and planned approach to the problem, the Government, with WHO's cooperation, will prepare a health manpower plan which will include analysis and review of the type and number of health personnel required for the health services as well as long term projections. Promotion of training Although for several years prior to independence in 1978 the Government concentrated on the training and retraining of health staff, its programme will be accelerated throughout the programming period. National facilities will be used to train frontline 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. WHO will cooperate in strengthening national courses and by providing fellowships for study abroad.

Regular budget SOLOMON ISLANDS

Other sources 1978-1979 1980-1981

1978-1979

1980-1981

Source of Funds

US$

US$ GENERAL PROGRAMME DEVELOPMENT AND MANAGEMENT

US$

41 900

48 4oo

Country health programming HEALTH SERVICES DEVELOPMENT

241 600

121 200 30 000

Health services planning and management Primary health care FAMILY HEALTH Programme planning and general activities Maternal and child health Health .education COMMUNICABLE DISEASE PREVENTION AND CONTROL 132 400 90 500 18 600

FP FT FP

6 000 9 000

108 000 9 700

Malaria and other parasitic diseases Bacterial, viral and mycotic diseases

113 200

1 share of costs of WHO Representative's office based in Suva, Fiji. 293

294

Regular budget SOLOMON ISLANDS 1978-1979 US$ 1980-1981 US$ NONCOMMUNICABLE DISEASE PREVENTION AND CONTROL 4 800 Programme planning and general activities PROMOTION OF ENVIRONMENTAL HEALTH Basic sanitary measures HEALTH MANPOWER DEVELOPMENT 9 400 216 900 548 400 Health manpower planning and management Promotion of training Total - SOLOMON ISLANDS

Other sources 1978-1979 US$ 1980-1981 US$

Source of Funds

157 200

83 300 381 800

-------

203 700

-------

308 200

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

TONGA NATIONAL HEALTH DEVELOPMENT STRATEGY The third five year development plan for Tonga has as its overall long-term ohjecti.ve the raising of the living standards and i.mprovement of the social welfare ~of the people of the Kingdom. The plan gives the hea) t.h sector P.:Oal as "the contimu~d improvement in the state of health of the people throu~h the extension and upgrading of the medical, public health, nursing and dental servi..ces, including the educati.on and the trainlng of staff". The following objectives have been established: (1)

to reduce further the rate of natural growth of the population; to reduce morbidity and mortality from preventable diseases to the lowest possible level; to improve the early diagnosis and prompt treatment of preventable diseases; to improve the capability of all levels of health service in terms of physical and manpower resources; to improve and maintain the safety of the environment through expanding anrl strengthening environmental health programmes.

(2)

{3)

{4) (5)

Priority is being given to expanding and strengthening the rural health services, with the aim of obtaining improved coverage or the community. At the same time, greater participation of communities in the organ:lzi'it1on and deliverv of their health services is encouraged. The control of communicable diseases, intensification of family health services and promotion of environmental health, in particular improvement of public water supplies, are receiving special attention. Staffing of the health servi.ces is an area for concern, especially with an increasing number of exist:f.ng staff movinp; towards retirement. Trai.ning programmes a1""e betng accelerated to prevent deterioration in the key health manpower ratios.

295

296 TONGA (continued) TECHNICAL COOPERATION PROGRAMMES FOR HEALTH Development of comprehensive health services Health services development Health services planning and management A vital aspect of the Government's programme to extend the coverage of the health services and raise their efficiency, .is the necessity to improve the Department's planning and managerial capacity. There is a need to develop clearly defined post descriptions and areas of responsibility for health workers at various levels. The national health information system, including vital statistics, calls for strengthening in order to facilitate the planning and implementation of the health programme. WHO collaboration will further the national programme in all aspects of health services planning and management. Primary health care Tonga, being a·country comprised of several islands, encounters great difficulty in providing health care at the periphery. The high cost of transport for staff and supplies, together with poor communication, adds to the problems. The Government's policy is to develop an efficient countrywide primary health care network as part of an integrated rural 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. Appropriate technology for health WHO, with assistance from UNICEF, will continue to collaborate in national efforts to strengthen the health laboratory network, particularly at the periphery. Family health Programme planning and general activities As the rural 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 fast growing, young population entering the reproductive age. The Government's aim is to

reach approximately 75~ of all married women in need of family planning by 1980. More emphasis is to be placed on antenatal, natal and postnatal services, especially in the remote areas. The immunization programme will also receive more attention. WHO will collaborate in developing the family health programme with the support of UNFPA. Disease prevention and control Communicable disease prevention and control Epidemiological surveillance WHO will cooperate, from its intercountry programme, with epidemiological surveillance particularly of quarantinable diseases. Malaria and other parasitic diseases There is no malaria in Tonga. However filariasis is a serious problem. WHO, through its country and intercountry programme, will continue to cooperate in the national filariasis control programme. Bacterial, viral and mycotic diseases Typhoid fever, leprosy and tuberculosis still rank as important health problems in Tonga. WHO will cooperate, through its intercountry programme, in national control programmes for those diseases, particularly in the field of training. Noncommunicable disease prevention and control Programme planning and general activities Noncommunicable diseases, in particular cardiovascular disorders, cancer and metabolic diseases, are of growing importance in Tonga. Oral health is also a problem of increasing concern. WHO will cooperate in the national control programmes and staff training in those fields . . Promotion of environmental health Environmental health planning and management Tonga is very short of trained personnel at the managerial and planning levels. The cooperation of WHO and UNDP will continue to be required with Operational Assistance (OPAS) for the management of the waterworks of Nuku'alofa. 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.

297

298

TONGA (continued) WHO will continue to collaborate, with support anticipated 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. Health manpower development Programme planning and general activities The training of medical assistants will commence in Tonga, with WHO cooperation, in 1979 and will be continued throughout the biennium 1980-81. To man the extended health services and also to replace many staff about to Promotion of training retire, the training programme will accelerate during the biennium 1980-81. 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 by providing fellowships for study abroad.

Regular budget TONGA 1978_;1979 1980-1981

Other sources 1978-1979 1980~1981

Source of Funds

US$

US$ GENERAL PROGRAMME DEVELOPMENT AND MANAGEMENT

US$ I'

US$

41 900

47 6oo

Country health programming '

HEALTH SERVICES DEVELOPMENT 97 100 112 700 124 000 28 000 38 600

Health services planning · and management Primary health care Appropriate technology for health (health laboratory technology) FAMILY HEALTH Programme planning and general activities Maternal and child health COMMUNICABLE DISEASE PREVENTION AND CONTROL

. ;

1 000

123 000 173 100

FP FP

5 000

Malaria and other parasitic diseases

1 Share of costs of WHO Representative's office based in Suva, Fiji.

299

- - - - - - - - - - - - - - - - - ---, 300

Regular budget TONGA 1978-1979 1980-1981

Other sources 1978-1979 1980-1981

Source of Funds

US$

US$ NONCOMMUNICABLE DISEASE PREVENTION AND . CONTROL 9 700

US$

4 000

Programme planning and general activities Other noncommunicable diseases PROMOTION OF ENVIRONMENTAL HEALTH

23 600

Environmental health planning and management Basic sanitary measures HEALTH MANPOWER DEVELOPMENT

396 200

( 48 000 ( 20 000 62 100

DP UF DP

68 200 323 900

102 800 37 300 416 600

Programme planning and general activities Promotion of training Total - TONGA 569 300

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

260 100

-------

TRUST TERRITORY OF THE PACIFIC ISLANDS NATIONAL HEALTH DEVELOPMENT STRATEGY The basic laws pertaining to health services are set forth in the Trust Territory Code. The Code establishes a Department of Health Services. The Department's programmes are designed to improve health and environmental and sanitary conditions, minimize communicable diseases, establish standards of medical and dental care, and administer all Government operated health services. The Trust Territory Coordinating Council was recently established. the Council are to: (1) (2) Some of the prime functions of

review annually and coordinate the health system plan and annual implementation plan of each of the six district Departments of Health Services; annually prepare, review and revise as necessary, a national health plan; advise the national authorities on the performance of programme activities.

(3)

As a result of a recent review of the total health care delivery system, the following goals have been emphasized as having priority for the next five years: (1) (2) manpower development and training for every level of profession in the health field, with particular attention to health personnel of the outer islands; improvement of health facilities, especially on the outer islands; improvement of communications between headquarters, the district centre and the outer islands.

(3)

TECHNICAL COOPERATION PROGRAMMES FOR HEALTH Development of comprehensive health services Health services development Primary health care The present strategy for strengthening of health services involves the development of a well trained nucleus of health personnel. The thrust of the training programme is directed towards improving and upgrading services to the population of the outer islands. The medium-term

301

302

TRUST TERRITORY OF THE PACIFIC ISLANDS (continued) programme goals include the reestablishment of the health assistant training programme to train replacements for retiring health assistants, and to continue the programme for retraining currently employed health assistants. Appropriate technology for health A component of the plan for improvement of health facilities is the development of public health laboratories in the district hospitals. That plan 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. WHO will collaborate in improving the public health laboratory services through provision of fellowships for selected personnel as well as consultants in laboratory techniques and for in-service training activities. Family health Maternal and child health The long range goals of the maternal and child health programme are to reduce infant mortality and morbidity and to improve the health status of'all mothers and children through improved comprehensive health services. The emphasis of the medium term maternal and child health programme will be to improve case load monitoring through an improved reporting and information system. In addition, steps will be taken to improve the integration of maternal and child health with the general health services. WHO collaboration will emphasize fellowships for selected health personnel to improve their technical skills. Health education The sparseness of the population makes necessary a strategy for improving the level of awareness of the people to make the best use of the health services. That goal is being achieved through the health education programme and WHO fellowships will enhance the capability of the programme to meet its objectives. Mental health WHO collaboration will involve fellowships to improve the training of health personnel in order to meet the demands of contemporary society. Prophylactic, diagnostic and therapeutic substances Programme planning and general activities The district pharmacies of Trust Territory of the Pacific Islands are staffed by technicians who are nearing retirement. WHO will cooperate, through the fellowship programme, in the training of replacements.

Disease prevention and control Communicable disease prevention and control Epidemiological surveillance WHO, through its intercountry programme, will collaborate with the Communicable Disease Center unit in improving communicable disease reporting and follow-up, mainly at district level. Noncommunicable disease prevention and control Programme planning and general activities Problems associated with a developing society are becoming more and more apparent each year, as the changing pattern of disease reveals. WHO collaboration will emphasize the need for early preventive programmes to reduce the economic losses that might be incurred if some of those health problems are not dealt with at once. Oral health The dental health services are charged with planning, developing and implementing a comprehensive dental health programme, with the primary objective of reducing dental caries. In addition, emphasis is being placed on dental health education, aimed at encouraging good oral hygiene and stressing the importance of dental health. The achievement of those goals means that more staff must be trained both inside and outside the Trust Territories. WHO collaboration will emphasize fellowships for tutor training as well as the upgrading of selected personnel in new techniques for effective prevention and control of dental disorders. Promotion of environmental health Basic sanitary measures Trust Territory of the Pacific Islands needs to improve both its urban and its rural water and sewerage systems. The rural areas need a basic system, while the urban areas need to improve the management of their existing plants. WHO collaboration will further development of the programme and training, through fellowships, to increase skills to the level required to meet the expanding needs.

303

304 TRUST TERRITORY OF THE PACIFIC ISLANDS (continued) Health manpower development Promotion of training The development of a comprehensive health service begins with a nucleus of trained manpower. The dispersion of the population of Trust Territory of the Pacific Islands, and consequently the health services, means that each major area must have its own trained support personnel to maintain those services. Many types of staff cannot be trained in the Trust Territories. WHO collaboration will play a significant role in manpower development through the award of fellowships to support and m~intain the health service system.

Regular budget TRUST TERRITORY OF THE PACIFIC ISLANDS 1978-1979 1980-1981

Other sources 1978-1979 1980-1981

Source of Funds

US$

US$ HEALTH SERVICES DEVELOPMENT 5 000 25 000

US$

Primary health care Appropriate technology for health (health laboratory technology) FAMILY HEALTH

20 000 4 000

Maternal 'and child health Health education MENTAL HEALTH

10 000

Mental health PROPHYLACTIC, DIAGNOSTIC AND THERAPEUTIC SUBSTANCES

10 000

Programme planning and general activities

COMMUNICABLE DISEASE PREVENTION AND CONTROL 15 000

Epidemiological surveillance NONCOMMUNICABLE DISEASE PREVENTION AND CONTROL

'10 000 16 000

Programme planning and general activities Oral health PROMOTION OF ENVIRONMENTAL HEALTH

20 000

Basic sanitary measures HEALTH MANPOWER DEVELOPMENT

178 100

72 000 207 000

Promotion of training Total - TRUST TERRITORY OF THE PACIFIC ISLANDS

-------

178 100

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

---------

305

306

TUVALU NATIONAL HEALTH DEVELOPMENT STRATEGY The first national development plan, covering 1978 to 1980, has just been formulated. development plan is an integral part of the national development plan. The health

The Government's objectives in the field of health, as defined in the health development plan of the national development plan, are to: {1) {2) {3) develop and maintain unified preventive health services on all islands; maintain curative services at the present level; maintain and support the advisory, motivational and promotional functions of the influential Family Planning Association of Tuvalu on matters affecting population growth.

The following priority programme areas are identified for the development of the health programme from 1978 to 1981: {1) one programme among those emphasized in the national development plan is the island development programme, in which the island councils will be given a wider responsibility in determining priorities and implementing projects. The development of health care for the outer islands has been mentioned universally by the island councils as a priority area. The Ministry of Social Services will collaborate with the Ministry of Home Affairs to develop the primary health care programme as an integral part of the island development programme; one of the eight priority areas for overall national development as identified in the national development plan is "to reduce the rate of population growth through a comprehensive family planning programme". Continuous efforts will be directed towards the strengthening of maternal and child health and family planning activities; the promotion of environmental health, with particular emphasis on the improvement of water supply and waste disposal facilities, not only for the capital island of Funafuti, but also for the outer islands; the overseas training of health personnel, in both undergraduate and postgraduate study, in order to maintain a reasonable health personnel/population ratio, and the local training of health workers at the periphery.

{2)

{3)

(4)

TECHNICAL COOPERATION PROGRAMMES FOR HEALTH Development of comprehensive health services Health services development Primary health care The capacity of the island councils will have been upgraded under the island development programme. The potential of the community organizations (such as the women's committees) will be further developed and their active participation in primary health care activities promoted. A national seminar on primary health care will be conducted, with WHO cooperation assisted by UNICEF, to promote the concept among related government agencies and the community organizations. WHO will also cooperate, through its intercountry programme, in the planning of the primary health care programme, the training of workers, and the preparation of a field manual. Family health Maternal and child health It is envisaged that it will be necessary to request UNFPA for another two year extension of the family health project for 1980 and 1981. Emphasis will be placed on the further development of antenatal, natal and postnatal services, child health care, nutrition and family planning and more attention paid to the development of such services for the outer islands. Interviews of "dropouts" from among contraceptive users will have been conducted and the findings will guide the further development of a motivational programme for family planning. More effort will be devoted to the child health services for pre-school children. WHO will cooperate in furthering the development of all such activities under the national programme. Health education The major effort in which WHO will cooperate, particularly in the training of a health educator, will be in support of the primary health care and the family health programmes. Disease prevention and control Communicable disease prevention and control Epidemiological surveillance WHO will continue to cooperate, through its intercountry programme, in providing epidemiological information. Bacterial, viral and mycotic diseases Major attention will be paid to the prevention and control of diarrhoeal diseases and tuberculosis, with cooperation from the WHO intercountry programme.

307

TUVALU (continued) Expanded programme on immunization The coverage of children by the immunization programme is to be further expanded. The "cold chain" for the transport and storage of vaccines and records and reports on immunization also require to be improved. UNICEF will be requested to provide "cold chain" facilities and the necessary vaccines. WHO will cooperate through its intercountry programme. Promotion of environmental health Basic sanitary measures A project for the improvement of basic sanitary measures has been initiated with the cooperation of WHO and UNDP. With WHO cooperation, further efforts will be made to develop sanitary facilities such as water supply, wells, cisterns and latrines, particularly on the outer islands. The services of a United Nations volunteer will be requested. Health manpower development Promotion of training The programme for local in-service training of auxiliary staff and health workers at the periphery will be reorientated in line with the development of primary health care. UNDP will be requested to provide a fellowship for the undergraduate training of a medical officer. WHO will also continue to cooperate in the fellowship programme for studies in health courses not available locally and the provision of opportunities for national staff to participate in intercountry group educational activities. Health information Health statistics WHO will cooperate in further improving health records, reporting, and data compilation through its intercountry programae.

Regular budget TUVALU 1978-1979 1980-1981

Other sources 1978-1979 1980-1981

Source of Funds

US$

US$ HEALTH SERVICES DEVELOPMENT Primary health care "

US$

10 000

FAMILY HEALTH Maternal and child health Health education COMMUNICABLE DISEASE PREVENTION AND CONTROL Expanded programme on immunization PROMOTION OF ENVIRONMENTAL HEALTH Basic sanitary measures HEALTH MANPOWER DEVELOPMENT 15 000 20 000 8 000 30 100 16 000

9 600

41 600 41 600

42 400 52 000

Promotion of training Total - TUVALU 45 100

48 000

------

======

------

-------

102 000

309

ANNEX III INTERCOUNTRY PROGRAMME STATEMENT WITH TABULATIONS

INTERCOUNTRY PROGRAMMES General programme development and management The objectives, approach and review for the regional general programme General programme development development programme appear on pages 21-24. The intercountry activities provide for technical officers in programme management training and support and operational research and supporting staff and consultants to be responsible for formulating, implementing and evaluating the programme at regional and national level, together with fellowships and supplies and equipment. Information systems programme The objectives, approach and review for the regional information systems programme appear on pages 30-31. The intercountry activities provide for a regional adviser in health information and supporting staff, to be responsible for formulating, implementing and evaluating the programme at national and regional level. A team on health information systems development is also proposed to support activities under this programme. Research promotion and development The objectives, approach and review for the regional research promotion and development programme appear on pages 33-34. The intercountry activities provide for a programme manager to implement the approaches outlined, consultants, temporary advisers and meetings of the Western Pacific Advisory Committee on Medical Research, as well as meetings of various types on selected subjects and research grants and research training grants. long-te~

The strengthening of the Institute for Medical Research, Malaysia, will be carried out by providing staff, consultants and cooperation in organizing training courses.

Regional Director'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.

311f

INTERCOUNTRY PROGRAMMES (continued) Health services de~elopment

Programme planning and general activities The objectives, approach and review for the regional health services development programme appear under the specific programme headings on pages 38-59. The intercountry activities relating to programme planning and general activities provide for three regional advisers in different aspects of the development of health services and supporting staff. Other intercountry activities are included under the specific programme headings. Health services planning and management The objectives, approach and review for the regional health services planning and management programme appear on pages lf0-lf3. The intercountry activities provide for consultants -and a public health advisory services team in the South Pacific, whtch will support the activities of the programme. Primary health care The objectives, approach and review for the regional primary health care programme appear on pages lf5-lf6. The intercountry activities provide for a team to cooperate in programme development, in the writing of manuals, training of primary health care workers and the planning and operation of research and development. Care of the aged, disability prevention and rehabilitation The objectives, approach and review for the regional eare of the aged, disability prevention and rehabilitation programme appear on page 50. The intercountry activities provide for consultants to carry out a multidisciplinary pilot study on prevention of road traffic accidents. Appropriate technology for health The objectives, approach and review for the regional appropriate technology for health programme appear on pages 52-55. The intercountry activities provide for a regional adviser in health laboratory services, with supporting staff and consultants, and the training of senior laboratory staff in modern management techniques and tools for health laboratories. Advisory services for the maintenance and repair of radiological equipment are also provided, and consultants in the development of appropriate technology for health.

Family health Maternal and child health The ohjectives, approach and review for the regional maternal and child health programme appear on pages 62-63. The intercountry activities provide for a regional adviser in maternal and child health and supporting staff. A regional working group on medico-social needs of adolescents will be convened to ascertain the various problems and to indicate possible interventions. The intercountry family health advisory services project funded by UNFPA, which includes a regional adviser in maternal and child health/family planning, will continue to cooperate in countries or areas where its services are ne~ded and to support research in human reproduction and fertility regulation. The introduction of innovative approaches and strategies in Member States is to be endorsed by provisions under an intercountry activity which include matnly short-term consultants, supplies and equipment and fellowships to conduct regional and national educational meetings. Nutrition pages 65-67. The objectives, approach and review for the regional nutrition programme appear on

The intercountry activities provide for a regional adviser in nutrition and supporting staff and a team consisting in a medical and a non-medical nutritionist together with two national workshops each year. Collaboration will be extended to national staff in achieving the objectives of the regional medium-term programme as they are relevant to particular country situations. Those objectives are: development of the health aspects of national food and nutrition po1ic1es and programmes; creation of simple, routine nutrition surveillance systems; integration of nutrition activities into the basic health services; development of nutrit~on train~ng; and control of specific deficiency diseases through fortification and supplementation. Health education appear on pages 69-71. The objectives, approach and review for the regional health education programme

The intercountry activities provide for a regional adviser in health education and supporting staff.

31c:;

316 INTERCOUNTRY PROGRAMMES (continued) In strengthening health education services in the countries or areas of the Region, two aspects deserve special attention. First, preparation of health education manpower with emphasis placed on the training of field level health workers in the community approach and health education, inclusion of health education in the baste training of health workers and establishment of field practice areas to continue the teaching of theory combined with practical experience. Second, design of curricula and strengthening of health education in schools and for out-of-school youth. Intercountry projects in health education are designed to establish collaboration in these two specific areas of activity. Mental health The objectives, approach and review for the regional mental health programme appear on pages 73-74. The intercountry activities include provision for a regional adviser in mental health and supporting staff. The training component will remain the cornerstone of the mental health programme, with increasing emphasis on the training of ground level staff; appropriate provision has been made for this. It is also proposed to hold a working group on the abuse and control of psychotropic drugs. Prophylactic, diagnostic and therapeutic substances Drug policies and management The objectives, approach and review for the regional drug policies and management programme appear on pages 78-79. The intercountry activities provide for a scientist to further the objectives of the programme under the regular budget and, from other sources, provision for training in the field of drug distribution, utilization and control and for consultants. Pharmaceuticals and biologicals The objectives, approach and review for the regional pharmaceuticals and biologicals programme appear on pages 81-82. The intercountry activities provide for consultant services to cooperate in the expansion of vaccine production and control and for the training of staff.

Communicable disease prevention and control Programme planning and general activities The objectives, approach and review for the regional communicable disease prevention and control programme appear under the specific programme headings and diseases on pages 84-111. The intercountry activities relating to programme planning and general activities provide for two regional advisers in communicable diseases and one in chronic diseases and supporting staff. Other intercountry activities are included under the specific programme headings. Epidemiological surveillance The objectives, approach and review for the regional epidemiological surveillance programme appear on page 86. The intercountry activities provide for an intercountry team stationed in the South Pacific and consultants in diarrhoeal diseases and acute respiratory diseases. Emphasis will be placed on the upgrading of training in epidemiology, on the development of national epidemiological services, giving priority to the diseases included in the expanded programme on immunization, and on the exchange of epidemiological information. · Malaria and other parasitic diseases The objectives, approach and review for the regional malaria and other parasitic diseases programme appear on pages 88-91. The intercountry activities provide for a regional adviser in malaria and supporting staff, 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. Bacterial, viral and mycotic diseases The objectives, approach and review for the regional bacterial, viral and mycotic diseases programme appear on pages 93-101. Tuberculosis The intercountry activities for tuberculosis provide for the continuation of a regional tuberculosis control team, the regional tuberculosis training course in Tokyo, and consultants to cooperate in the production of freeze-dried BCG vaccine. Leprosy The intercountry activities for leprosy provide for long-term staff in the intercountry leprosy control advisory services project in the South Pacific, and, from anticipated extrabudgetary sources, training in leprosy control, consultants, supplies and equipment.

317

ne INTERCOUNTRY PROGRAMMES (continued) Expanded programme on immunization The objectives, approach and review for the regional expanded programme on immunization appear on pages 103-104. The intercountry activities provide for the continuation of a team, whose members are stationed in Manila, in Papua New Guinea and in the South Pacific. Consultants in various aspects of the programme and training through workshops in both years are also provided. Vector biology and control The objectives, approach and review for the regional vector biology and control programme appear on page 110. The intercountry activities provide for a regional adviser in vector biology and control with supporting staff. There is also provision for a course to train participants to organize and strengthen vector control and surveillance activities in their own countries, and to bring to them up-to-date information on practical and economical approaches in preventing and combatting vector-borne diseases. Noncommunicable disease prevention and control Programme planning and general activities The objectives, approach and review for the regional noncommunicable disease prevention and control programme appear under the specific programme headings and diseases on pages 112-125. The intercountry activities relating to programme planning and general activities provide, for the first time, for a regional adviser in cardiovascular and metabolic diseases. Other intercountry activities are included under the specific programme headings. Cancer The objectives, approach and review for the regional cancer programme appear on pages 11Q-115. The intercountry activities provide for consultant services to cooperate in the formulation of a comprehensive cancer control programme, strengthening of the cancer registry, and coordination of cancer control activities in the countries or areas of the Region ready to start such a programme. Cardiovascular diseases The objectives, approach and review for the regional cardiovascular diseases programme appear on pages 117-118. The intercountry activities provide for consultant services in the planning and conduct of pilot studies and a regional workshop to exchange experiences on cardiovascular disease control and effective prevention and control methods in countries or areas of the Region.

Oral health pages 120-121.

The objectives, approach and review for the regional oral health programme appear on

The intercountry activities provide for a regional adviser in oral health and supporting staff. Three national seminars will stress areas of dental care delivery; increased clinical productivity; control of dental diseases; and special clinical skills (such as prosthetics and maxillo-facial surgery) required by national staff. A feature of the national seminars will be the selective participation of dental officers from neighbouring countries with the teaching being provided under the concept of technical cooperation among developing countries. A fourth course in public health dentistry is planned with participants from ten or eleven countries or areas in the Region. In addition to basic and continuing education and research, special emphasis will be placed on methods of increasing coverage; public health measures for the prevention and control of dental caries and periodontal diseases; dental health education; and methods for progressive monitoring of national activities for prevention of dental diseases. Other noncommunicable diseases Metabolic diseases The objectives, approach and review for the regional metabolic diseases programme appear under other noncommunicable diseases on pages 123-124. · Consultant services in the planning of a control programme for metabolic diseases will he made available upon request. Promotion of environmental health Programme planning and general activities The objectives, approach and review for the regional promotion of environmental health programme appear under the specific programme headings on pages 126-136. The intercountry activities relating to programme planning and general activities provide for two regional advisers and supporting staff. Other intercountry activities are included under the specific programme headings. 319

320 INTERCOUNTRY PROGRAMMES (continued) Environmental health planning and management The objectives, approach and review for the regional environmental health planni ng and management programme appear on pages 128-129. The intercountry activities provide for the Western Pacific Regional Centre for Promotion of Environmental Planning and Applied Studies (PEPAS) to carry out the following functions: (1)

technical cooperation in developing competent national policies in environmental health and related resource protection; technical cooperation in strengthening the capabilities of national environmental institutions for planning, data collection and assessment, and formulation of rational and efficient policies; identification, promotion and demonstration of low cost and appropriate technology; collaboration in the development and implementation of education and training programmes for personnel in environmental planning, pollution control, water supply and waste disposal management and design; service as a regional technical information and reference centre in environmental health, planning and human ecology; facilitation of technical cooperation with and between countries or areas in the Region in the monitoring, collection and processing of information for planning purposes; specialized, and/or multidisciplinary, technical cooperation with governments in the solution of problems related to the improvement/protection of environmental conditions/resources against pollution; service as a recognized and visible institutional focal point for the promotion of environmental planning and protection, for attracting extrabudgetary resources and for receiving scholars and experts.

(2) (3)

(4)

(5) (6) (7)

(8)

pro~rammP.

Rasic sanitary mP.asures appear on pa~e 1~1.

The objectives, approach and review for the

re~ional

basic san5tary measures

The intercountry activities provide for the continuation of environmental health advisory services in the South Pacific, to give technical cooperation in water supply and sanitation, programme analysis, planning and evaJuatton, project formulation, the development of environmental information systems and the fosterin~ or community participation; and advice on rules and regulations and manpower development. human It is also proposed to hold a regional semj_nar to review significant health aspects in the design of ~abitats and develop guidelines on priority areas in which improvements can be made. The objectives, approach and review for the regional food safetv programme appear on

Food safety page 135.

The intercountry activities provide for a seminar to examine the provisions contained in the most recent version of the WHO Guide to Hygiene and Sanitation in Aviation and foster their application, and for a series of national seminars to promote the development of comprehensive food control programmes. Health manpower development Programme planning and general activities The objectives, approach and review for the regional health manpower development programme appear under the specific programme headings on pages 137-149. The intercountry activities under programme planning and general activities provide for two regional advisers and supporting staff who will also handle the regional fellowships programme. Other intercountry activities are included under the specific programme headings. Health manpower planning and management The objectives, approach and review for the regional health manpower planning and management programme appear on pages 13q-141. The intercountry activities provide for consultants and educational meetings for the following purposes: (1) (2) to facilitate the integration of nat~onal hea1th manpower health care to cover the entire population; pla~s

and policies for the provision of

to establish functioning mechanisms which link national educators concerned with health services manpower development; to introduce continuing education facilities for all categories of health staff.

(3)

321

322 INTERCOUNTRY PROGRAMMES (continued) Promotion of training The objectives, approach and review for the regional promotion of training programme appear on pages 143-144. The intercountry activities provide for: (1)

participation in educational meetings; refresher training at the Regional Centre for Training of Anaesthetists following an evaluation of the programme in 1979; the establishment and review of training programmes for medical assistants. The objective is to help governments to expand training facilities, where necessary, in order to prepare health personnel in numbers and categories identified by health planners.

(2) (3)

Educational development and support The objectives, approach and review for the regional educational development and support programme appear on pages 146-148. The intercountry activities provide for the development of teaching packages for nursing and midwifery education, to enable countries to develop resource materials in national languages for the training of the health staff. They also provide partially for the Regional Teacher Training Centre for Health Personnel (RTTC) which is being supported by UNDP until the end of 1978. From that time on extrabudgetary resources will supplement the regular budgetary support to the RTTC, the Japan Shipbuilding Industry Foundation having agreed to contribute US$50 000 in 1979. The application of sound educational technology is spreading satisfactorily in the Region. Health information Health statistics The objectives, approach and review for the regional health statistics programme appear on pages 150-152. The intercountry activities are shown under the information systems programme (page 313) including the provision of a regional adviser. Further development of health statistics activities in the Region will be carried out through statisticians assigned to other intercountry teams, and the assignment of consultant statisticians in specific areas of interest.

Health literature services The objectives, approach and review for the regional health literature services programme appear on page 157. The intercountry activities provide for the supply o~

books, publications and teachinR equipment.

Health information of the public The objectives, approach and review for the regional health information of the public programme appear on page 159. The intercountry activities provide for a workshop on the promotion of health information, to review and follow up a similar workshop planned for 1979. It will seek to identify areas and activities which will enable national health information officers to keep up with trends in communication and media reporting during the 1980s. General services and support programmes Staff development and training The objective and approach of the regional staff development and training programme appear on page 163. The intercountry activities provide for the continuation of the trainin~ and development of WHO staff. 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 hy changing demands on the Organization.

323

32~

Regular budget INTERCOUNTRY PROGRAMMES 1978-1979 US$ 1980-1981 US$ GENERAL PROGRAMME DEVELOPMENT AND MANAGEMENT 483 200 135 800 569 800 3~4

Other sources 1978-1979 US$ 1980-1981 US$

Source of Funds

100

General programme development Country health programming Information systems programme RESEARCH PROMOTION AND DEVELOPMENT

350 000 ~2 500

350 000

DP VK

1 249 400

1 249 900

Research promotion and development REGIONAL DIRECTOR'S DEVELOPMENT PROGRAMME

643 600

Regional Director's development programme HEALTH SERVICES DEVELOPMENT

321 700 329 300 377 900

~61

200 800 900

3~8 ~57

27 000

Programme planning and general activities Health services planning and management Primary health care Care of the aged, disability prevention and rehabilitation

130 300

227 500 170 .100

208 000 ·2o ooo

Appropriate technology for health (health laboratory technology) ·(radiolo~ical technology) Health services;· research ·-•: ·;

76 200 22 800

FAMILY HEALTH 113 000 323·000 11ft 200 144 000 383 900 305 400

Maternal and child. health Nutrition Health education MENTAL HEALTH

621 300

615 400

169 300

275 800

Mental health PROPHYLACTIC, DIAGNOSTIC AND THERAPEUTIC SUBSTANCES

150 500 37 300

112 ltOO 53 400

Drug policies and

11ana~ent

( 21 100 (178 300

Pharmaceuticals and biologicals COMMUNICABLE DISEASE PREVENTION AND CONTROL

328 900 226 700 898 900

352 200 405 900 913 200

Progra.ae planning and seneral activities Epidemiological surveillance Malaria and other parasitic diseases

127 300

326

Regular budget INTERCOUNTRY PROGRAMMES 1978-1979 1980-1981

Other sources 1978-1979 1980-1981

Source of Funds

US$

US$ Bacterial, viral and mycotic -diseases Expanded programme on immunization Special programme for research and training in·tropical diseases Vector biology and control NONCOMMUNICABLE DISEASE.PREVENTION AND CONTROL 115 27 34 194 9 300 000 100 300 000

US$ (537 400 (118 000 282 400

US$ 177 800

716 800 792 200 115 400

591 800 1 018 600 159 300

VL VD VD

47 500 230 000 26 300

Programme planning and general activities Cancer. Cardiovascular diseases Oral health Other noncommunicable diseases PROMOTION OF ENVIRONMENTAL HEALTH

218 400 191 100 255 200 131 100 13 500

230 600 772 000 257 500 9 700

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

44 100

93 900

HEALTH MANPOWER DEVELOPMENT 283 700 12 000 229 400 144 500 318 800 94 000 331 200 296 600

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

125 400 ( 60 000 ( 50 000

VD DP VD

25 500 37 000 32 200

20 000 17 500

Health statistics Health literature services Health information of the public GENERAL SERVICES AND SUPPORT PROGRAMMES

24 000 9 182 500

24 000 11 797 800

Staff development and training Total - INTERCOUNTRY PROGRAMMES 2 787 100 1 364 400

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----------

---------

327

Informations clés

Organisation Organisation mondiale de la santé (OMS)

Type de document Technical Documents

Date d'adoption 31 décembre 1978

Source Organisation mondiale de la santé