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Third monitoring of the strategy for health for all by the year 2000 : report of the Sub-Committee of the Regional Committee on Programmes and Technical Cooperation, part II

31 décembre 1994 Organisation mondiale de la santé

Texte intégral

WORLD HEALTH ORGANIZATION

ORGANISATION MONDIAlE DE LA SANTE

REGIONAL OFFICE FOR THE WESTERN PACIFIC BUREAU R~GIONAL DU PACIFIQUE OCCIDENTAL

REGIONAL COMMIITEE Forty-fifth session

WPRJRC45/9 Rev. 1 Corr.l 29 September 1994 ORIGINAL: ENGLISH

Kuala Lumpur 19-23 September 1994 Provisional agenda item 12

TIllRD MONITORING OF THE STRATEGY FOR HEALTH FOR ALL BY THE YEAR 2000 Report of the Sub-Committee of the Regional Committee on Programmes and Technical Cooperation, Part II

CORRIGENDA

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The Pacific Basin Medical Officers' Training Program in Pohnpei, Federated States of Micronesia, also provides medical personnel to the area.

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most countries some countries

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4.4% 8.5%

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There is a renewed interest in strengthening the malaria and tuberculosis programmes where these serious conditions persist. .. .I

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WORLD HEALTH ORGANIZATION

ORGANISA'rION MONDIALE DE LA SANTE

REGIONAL OFFICE FOR THE WESTERN PACIFIC BUREAU RtGIONAL DU PACIFIQUE OCCIDENTAL

REGIONAL COMMITIEE Forty-fifth session

WPRlRC4519 Rev. I 5 September 1994 ORIGINAL: ENGLISH

Kuala Lumpur 19-23 September 1994 Provisional agenda item 12

THIRD MONITORING OF THE STRATEGY FOR HEALTH FOR ALL BY THE YEAR 2000 Report of the Sub-Committee of the Regional Committee on Programmes and Technical Cooperation, Part II

The plan of action for implementing the regional strategy for health for all by the year 2000 was accepted by the Regional Committee in its resolution WPRlRC32.R5 in 1981. The plan of action stipulates that an evaluation of national strategies will be made every six years, with a monitoring report every three years. The last evaluation was carried out in 1991. As with previous evaluation and monitoring exercises, a common framework

and format for evaluating the health-for-all strategies was used to guide the national monitoring process. Countries and areas were requested to submit their monitoring reports to the Regional Director by March 1994 for eventual incorporation in the regional monitoring report. on Programmes and The Sub-Committee of the Regional Committee Cooperation was requested by resolution Technical

WPRlRC3S.R6, to review, monitor and evaluate the implementation of the health-for-all policies and strategies as shown in the regional monitoring report. Following the Sub-Committee review, the third monitoring report has been revised as at 5 September 1994, as four more reports have been received. The report is now submitted for consideration by the Regional Committee. It provides a synthesis of the findings of country and area reports, which have used the common framework and format to assess the effect of their health-for-all strategies on national health development. Once endorsed by the Regional Committee. this report will be submitted to the Director-General for eventual inclusion in the global monitoring of the health-for-all strategies.

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The Sub-Committee had before it the draft regional monitoring report on implementation of the national strategies. The report synthesized the findings received from countries and areas in the Region, based on the common framework and format for monitoring of health-for-all strategies. After discussion by the Sub-Committee the report was amended and is attached as the annex. The document reviewed by the Sub-Committee was based on 18 monitoring reports submitted by countries and areas in the Region. review by the Regional Committee. As at 5 September 1994, a total of 22 countries and areas had responded (including Australia, Brunei Darussalam, Cook Islands and Tuvalu). Their contributions have been incorporated into the main report (Annex). The Sub-Committee noted that the quality of the country reports was variable and hoped that this was not an indication that countries and areas were showing a lack of interest in this important activity. The Regional Committee may wish to request the Secretariat to support high-quality response and reporting by countries and areas through renewed promotion of the activity. The Sub-Committee considered that, in general, the information provided by countries and areas on their monitoring process gave a clear picture of their health status, and progress in continuing to review and implement sound health development plans. Most countries and areas of the Region had achieved the basic health-for-all targets and were working on the health goals of improved access to quality services through a more cost-efficient provision of services. There have been dramatic improvements. In most countries of the Region, major efforts in health reform are taking shape. The current status of policy development in the Region reflects two levels of activity: those embarking on major changes, and those with the goal of improving the efficiency of a current strategy. In either case, the central government is playing a lesser role in the direct provision of services. This is being achieved either through the expansion of private sector services or by the decentralization of the provision for care. This trend has resulted in the evolution of a new role for central administrations. In all At that time, the Sub-Committee was informed by the Secretariat that more responses were expected and that these would be added to the document for

successful nationwide health system developments, there has been strong national-level leadership and direction. This role is relatively easy to carry out in the direct provision of services but is recognized as extremely complex in relation to tasks of coordination, resource allocation or promotion of standards. The Region has a wealth of experience in varied ways of achieving the objectives of health care access, equity, quality and cost containment.

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The Sub-Committee was very encouraged by the progress that had been made and recommended that the exchange of such experiences between countries should be encouraged. The Sub-Committee agreed with the conclusions of the regional monitoring report and recommended that the completed regional monitoring report should be accepted by the Regional Committee for submission to the Director-General for eventual inclusion in the global monitoring report.

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ANNEX

THIRD MONITORING OF THE STRATEGY FOR HEALTH FOR ALL BY THE YEAR 2000

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CONTENTS

1. 2.

INTRODUCTION.............................................................................. DEVELOPMENT OF HEALTH SYSTEMS ............................................. 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 Health policies and strategies......................................................... Organization of health systems based on primary health care.............. .... Managerial process ........ ............................................................. Intersectoral collaboration ............................................................. Community involvement ........................................... :.................. Health systems research and technology for primary health care ............. International support for health systems development ........................... Emergency preparedness and relief ........................................... ......

9 10 11 12 13 14 14 14 IS IS 16 16 17 17 17 18 18 19 19 20 20 21 22 22 24 24 26 27 27 27 27 28

DELIVERY OF HEALTH CARE .......................................................... 3. 1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 Health education and promotion ..................................................... Food supply and proper nutrition ...... .............................................. Safe water and basic sanitation ....................................................... Maternal and child health, including family planning ................ ........... Disease prevention and control... ..... ............................................... Immunization................................. ........................................... Treatment for common diseases ...................................................... Quality of care ............. ................ ............... ...............................

RESOURCES FOR HEALTH ............................................................... 4.1 4.2 4.3 Financial resources ..................................................................... Human resources....... ................................................................. Material resources ........ ..............................................................

5. 6.

TRENDS IN HEALTH STATUS ........................................................... TRENDS IN HEALTHY LIFESTYLES AND ENVIRONMENT ................... 6.1 6.2 Health promotion ....................................................................... Health protection: the environment........ ........ ......................... ........

POPULATION AND SOCIOECONOMIC TRENDS ................................... 7.1 7.2 7.3 Population trends ....................................................................... Education trends ........................................................................ Economic trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CONCLUSION.................................................................................

WPRlRC4Sf9 Rev.l page 7

Annex

TABLES: TABLE 1 TABLE 2 TABLE 3 TABLE 4 TABLE 5 DEMOGRAPHIC AND SOCIAL INDICATORS, WESTERN PACIFIC REGION .......................................... GOVERNMENT EXPENDITURE ON HEALTH, WESTERN PACIFIC REGION .......................................... COVERAGE OF POPULATION BY HEALTH CARE, WESTERN PACIFIC REGION .......................................... SELECTED INDICATORS OF HEALTH STATUS, WESTERN PACIFIC REGION .......................................... PERCENTAGE OF POPULATION WITH SAFE WATER IN THE HOME OR WITHIN 15 MINUTES' WALKING DISTANCE, AND WITH ADEQUATE SANITARY FACILITIES IN THE HOME OR IMMEDIATE VICINITY, WESTERN PACIFIC REGION .......................................... PERCENTAGE OF CHILDREN FULLY IMMUNIZED AGAINST THE TARGET DISEASES OF THE EXPANDED PROGRAMME ON IMMUNIZATION (EPI), WESTERN PACIFIC REGION .......................................... EFFECTIVENESS OF IMMUNIZATION AS SHOWN BY REPORTED NUMBER OF CASES, BY DISEASE, WESTERN PACIFIC REGION .......................................... SELECTED NUTRITIONAL INDICATORS, WESTERN PACIFIC REGION .......................................... SELECTED FAMILY HEALTH INDICATORS, WESTERN PACIFIC REGION .......................................... 31 32 33 34

TABLE 6

TABLE 7

37 38 39

TABLE 8 TABLE 9

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Annex

1. INTRODUCTION

In 1979, the Thirty-second World Health Assembly launched a global strategy for health for all by the year 2000. Member States of WHO were invited to act individually in formulating national policies, strategies and plans of action for attaining this goal, and collectively in formulating regional and global strategies. A regional strategy for health for all was formulated and adopted by the WHO Regional Committee for the Western Pacific at its thirty-first session (1980) and was subsequently revised in the light of the global strategy adopted by the Thirty-fourth World Health Assembly. I The revised strategy was adopted by the Regional Committee at its

thirty-second session, in September 1981.2 The plan of action for implementing the global strategy (approved by the Thirty-fifth World Health Assembly in May 1982) calls on Member States to review and assess periodically their national health policies, strategies and plans of action} Progress is to be monitored every three years, and effectiveness evaluated every six years. The global plan also calls on regional committees to prepare indicators for monitoring and evaluating regional health-for-a11 strategies. The Regional Committee, at its thirty-third session, approved a list of indicators that could be used in the monitoring and evaluation of health-for-all strategies. A common framework and fonnat was prepared for the monitoring and evaluation of national, regional and global strategies. 4 The fust regional monitoring report was reviewed by the Regional Committee at its thirty-fourth session in 1983 and the second at the thirty-ninth session in 1988.

The first evaluation took place in 1985 and the second in 1991. Health for al1 is the basis for national health development throughout the Region. Countries and areas have already established routine monitoring and evaluation processes in the management of their health-for-a11 strategies. Consequently, the aim of the current national monitoring activity

IG/obal strategy for health for aU by the year 2000. Series No.3).

World Health Orsanization, Geneva, 1981 ("Health for All"

2RegioTUJI strategy for health for aU by the year 2000. World Health Orsanization Regional Office for the Western Pacific, Manila, 1982.

3pIan of action for implementin/l the gwbal sr,tJlegy fo, healJh fo, aU. ("Health for All" Series No.7).

World Health Orsanization, Geneva, 1982

4Monitoring is the term used for the continuous follow-up of activities to ensure that they arc proceeding according to plan. Evaluation is the systematic assessment of the relevance, adequacy, progress, efficiency, effectiveness, and impact of health programmes (from the Glossary of Terms used in the "Health for All" Series Nos. 1-8).

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Annex

is to report to WHO on the progress being made in implementing national health-for-all strategies. The country and area reports consist of information that is being systematically collected and analysed to support national health development efforts. The present report is a summary of the current activities in the Region. It highlights two important themes: (1) new initiatives or activities to promote and achieve health-for-all goals that have been started since the 1991 evaluation; and (2) the processes which are being used to plan, implement and evaluate the health-for-all strategies. The report represents new activities or notes exceptions. significant to report since the 1991 evaluation report. Evaluation of Health for All. A country's absence from the

report does not signify a lack of activity in that country, only that there is nothing judged For a more complete picture of the development in the Region, this report should be considered in conjunction with the Second

2. DEVELOPMENT OF HEALTH SYSTEMS

All health systems in the Region are based on the assumption that they must contribute to making the population socially and economically productive and be in harmony with overall socioeconomic development efforts. s This assumption was translated into the health development goals formulated at the beginning of the 1980s. Indicators were in tum formulated to reflect the progress in achieving these goals. Tables 1 to 9 show the status of these indicators for all countries and areas in the Region. The regional health-for-a11 strategy outlines various components of the health system that should be developed to make it possible to reach these goals. They include policies, strategies, organization, managerial processes, community involvement, research and technology, and cooperation with other agencies and countries. Prior to 1991, most reports on the health-for-all strategy have concluded that the main achievement of the health-for-a11 movement has been to enable countries and areas to develop a

5Regiona/ strategy for health for alll1y the ytar 2000. World Health Organization Regional Office for the Western Pacific. Manila. 1982.

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relevant framework for national health systems.

This is in sharp contrast to previous simple

descriptions of the health system, before health for all started, as places where the i\l receive basic health services. The 1991 evaluation showed that countries and areas were beginning to see how fundamental changes in the health system might be made in response to the rapid political, social, and economic changes that they were experiencing. The current monitoring report indicates that most countries and areas are now embarking on significant health reform initiatives that will have a long-lasting impact on the existing health system.

2.1

Health policies and strategies It is quite clear that there is a strong correlation between the extent of political and economic

change in a country and the magnitude of the health sector response to this change. Three levels of change in health policies and strategies have been observed in this monitoring. (1) continued adherence to the focus of the original health-for-aIl goals; Countries and areas can be grouped according to these levels of change. In Cambodia, China, Hong Kong, Malaysia, Papua New Guinea, the Philippines, Singapore and Viet Nam, health policies have become more precise and focused. In most cases this means that policies are now formulated so that they can be translated into operational plans. These plans can be monitored and evaluated in relation to larger goals. by rapid economic change. to local government units. China has just completed a major review of its national health plan which reveals that many areas of the system are being influenced Cambodia has started a revitalization of its health system with an It is a significant aspect of the current policy formulation process in

These are:

(2) refinements in

strategy, particularly in regard to use of resources and scope of services; and (3) major reforms.

active provincial and district development strategy. The Philippines has devolved all health services these countries that the most difficult goals of the health-for-all movement are being attempted, namely, access, equity, community participation and intersectoral linkages. This is particularly apparent in the policies and strategies for Hong Kong, Malaysia, Singapore and Viet Nam. The significance of incorporating the basic fundamentals in a reformed health system has been recognized. However, such countries and areas have now reached a stage in their health development where they are able to take very specific action to address previous limitations. This is a particularly significant achievement since in all cases the health systems were already considered to have excellent results. The second group of countries and areas are working on changes that are typically concerned with financing or service-related issues such as the Republic of Korea's comprehensive national

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health insurance.

Cook Islands and Fiji are looking at various health financing options.

Fiji is

adopting contingency planning in preference to the formal comprehensive planning approach. All sectors are expected to take advantage of all growth opportunities that become available. The third group of countries includes those which, in comparing their original health-far-all policies, have not seen the need to make any major change in their policies. Brunei Darussalam,

Kiribati, Tonga, Tuvalu and Vanuatu are in this group. These countries are continuing to prepare plans based on their original health-for-all objectives.

2.2

Organization of health systems based on primary health care The eight essential elements of primary health care now form the foundation for all health

systems in the Region. Countries are at various stages of building on these basic elements. Four categories of activities characterize what is currently happening in primary health care development; (1) renewed interest in programme coordination, community participation and intersectoral linkages; (2) development of new organizational structures and management functions; (3) expanded coverage; and (4) new services. The basic tenets of primary health care namely, programme coordination, community participation and intersectoral cooperation. have been difficult to achieve. However, in Fiji, special efforts are being made and in Papua New Guinea, a national policy initiative is being launched to revive community participation in health activities. In Fiji and Hong Kong, there are intersectoral efforts, especially in health promotion issues. In Fiji, Malaysia and Papua New Guinea,

programme coordination is being promoted through various measures such as the rationalization of health facilities and coordinating the district hospital with facilities above and below that level of care. Greater collaboration with nongovernmental organizations is being promoted in

Papua New Guinea. The new district structure for organizing and implementing primary health care activities is the dominant theme for change in Cambodia, China, Hong Kong, Malaysia and Tonga. This

structure is usually supplemented by new management efforts. This can be seen in Malaysia. where there are improved referral mechanisms, and quality of care programmes have been

institutionalized.

In the Philippines, control has been given to the local government.

This is a

particularly acute issue in China, where new organizations and structures for rural areas must be developed to respond more appropriately to changes in that country.

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New initiatives in service areas are being taken in countries with comprehensive and well functioning primary health care organizations, such as Singapore. These initiatives include the national healthy lifestyle programme, weight management, new child development screening, particularly for women and children, a programme on the health of the elderly and a mental health programme in Singapore. Mental health, and issues concerning the health of the elderly, are also priority concerns in Hong Kong. Horizontal expansion of care to more distant geographical areas is rigourously pursued. However, vertical expansion of services is noted in French Polynesia, where more services are provided in peripheral units rather than in referral units. Kiribati, Tonga and Vanuatu's strategies are basically to expand coverage. In Cook Islands, the outer island services have been significantly improved.

2.3

Managerial process Three themes dominate the responses on changes in the managerial process. These are:

planning. information, implementation and accountability. recognized in the vast majority of countries and areas;

The need to improve planning is

Fiji is strengthening its central planning

umt; French Polynesia and Vanuatu are completing a five-year development plan; the Philippines has developed area-based planning, and Malaysia, Papua New Guinea and Tonga are working on broadening the scope of participation in the planning process. Malaysia is also experimenting with a new analytical tool in its planning methodology namely the DHLL (Days of Healthy Life Lost) to define needs and priorities. Planning was also a key to the success in Cambodia and the Republic of Korea in strengthening activities at district level. In almost all countries and areas, new efforts are being made to strengthen the use of information in decision-making within the managerial process. Hong Kong is working on an information system that uses improved epidemiological analysis for feedback purposes. Singapore has introduced a management accounting system which provides financial information on performance measures. information system. The concern for accountability is expressed in the different ways in which countries deal with the issue of decentralization. Cook Islands has a health board. Papua New Guinea is reviewing progress. In the Lao People's Democratic Republic, some health functions have been recentralized. The Republic of Korea is also looking at a strengthened comprehensive

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The Philippines, with a new local government code, has given increased responsibilities to provincial and municipal levels. Viet Nam is trying to be more comprehensive in its management changes, particularly in financing.

2.4

Intersectoral collaboration There has been a renewed effort by countries to initiate measures which strengthen

intersectoral collaboration.

Many countries are now realizing that real health reform includes Fiji, for example, has established new

sectors outside the traditional boundary of health. family health and disabilities. committee.

central-level committees at cabinet level to address issues concerning children, women, popUlation, Cambodia also has a national primary health care/district system Similar types of effort are noted in Hong Kong, Kiribati, Papua New Guinea and

Tonga. Decentralization has facilitated sectoral and intergovernmental agency coordination, as seen in Hong Kong and Malaysia. In the Philippines, decentralization has the potential to result in mass fragmentation of health services and programmes, consequently the Department of Health has formulated a new leadership message that will provide a national vision for health development. Similarly, in the Republic of Korea, the private sector is being called upon to provide new leadership to the health sector.

2.5

Community involvement The need for comprehensive community action has been accentuated by the new health

reform initiatives. These highlight the critical need for community participation in any new health developments. Fiji is further strengthening its already-excellent community participation record through the new Family Health Unit of the Ministry of Health. A more extensive new programme is working towards a similar goal through the Department of Village Services and Provincial Affairs in Papua New Guinea and through local government authorities in the Philippines. The new district structures, as in Hong Kong, offer opportunities to work closely with the community. Malaysia uses formal bodies and boards to support community participation, particularly in areas such as hospital organization. organizations . Tonga is working more extensively with nongovernmental

2.6

Health systems research and technology for primary health care Health systems research continues to be an important component of development strategies in

health. Cook Islands has supported a number of studies on quality of care, food and nutrition and

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financial management. In Malaysia, it is a pan of management training. Active formal training in health systems research is institutionalized in all programme areas. Hong Kong has established a health services research fund to promote interest in finding cost-effective and high-quality technologies for health. interest in institution~lizing

Papua New Guinea has shown increased

health systems research by creating a health systems research committee Other countries like Fiji, Kiribati and Tonga are

and a support unit in the Ministry of Health.

building increased interest in health systems research by promoting their planning units and information support strengthening. as well as by teaching the subject in nursing and medical schools. A specific application of health systems research is to review technology for primary health care. Papua New Guinea and Singapore have special prograrrunes to review the most appropriate technologies for the peripheral levels. Similarly in Malaysia. staff are being trained on construction and equipment standards, so that appropriate and equitable standards of technology are applied throughout the health system. In Kiribati, a substantial countrywide evaluation was carried out to review the primary health care technology being used.

2.7

International support for health systems development Health reform initiatives triggered by recent social. political and economic events have

required governments to take a greater role in directing and coordinating external resources for health. This can be seen in the way that international suppon is being more effectively used in In Malaysia, where loans Cambodia. Fiji, Kiribati, Papua New Guinea, Tonga and Viet Nam.

rather than grants are now the major forms of international suppon for health. it is now even more important that the Government not only takes a major role in its coordination but in its implementation as well.

2.8

Emergency preparedness and relief All countries which reponed on emergency preparedness and relief indicated that in the last

three years they had experienced some type of major natural disaster or industrial accident which resulted in emergencies that were beyond the capabilities of their routine services to handle. Emergencies of all types are a frequent occurrence in the Region. They continue to cause damage and to

have an impact on health services.

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Countries did not indicate much change in this area. They appeared to be satisfied with their national emergency plans and the specific health efforts which were being taken. However. in Fiji. the Cabinet has approved the relocation of a hospital out of a flood plain. and in Papua New Guinea, emergency preparedness was receiving renewed emphasis at provincial level. Palau has initiated testing of an emergency relief plan and a new organization has been established in the Department of Health, Philippines, to plan and manage disaster preparedness and relief activities.

3. DELIVERY OF HEALTH CARE

The assessment of health care delivery involves monitoring of the essential elements of primary health care in terms of coverage. utilization and quality of care. These elements are health education and promotion, food supply and nutrition, safe water, basic sanitation. maternal and child health, control of locally endemic diseases, immunization and treatment of common diseases. This section describes progress in providing the essential elements of primary health care to the people of the Region.

3.1

Health education and promotion The element of primary health care that is currently receiving the most attention in all

countries is health education and promotion. This is a direct result of two factors. In the last few health-for-all reporting periods, it was noted that coverage by biomedical-based health services has reached more than 80% in all but a few countries. medium-level or above report practically full coverage. Countries and areas with incomes of As the health status of populations has Government's role has been

improved, the emerging health factors now relate to aging, lifestyle and poverty. Individual and community responsibilities for health are therefore emphasized. implemented through health education and promotion activities. In Hong Kong, a community-based Health Ambassador serves as a role model emphasizing activities in AIDS and for the elderly. Similarly in Singapore, a new Institute of Health has been established that will be the centre for all health promotion activities. The Healthy Lifestyle campaign in Malaysia is a good example of new efforts which recognize the pivotal role played by the individual and the community in any activity that is to have a sustainable impact on improved redefined as facilitating people's achievement of their full potential. These new policies are usually

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quality of life. Various health education approaches, including the use of the mass media, are also being tried out in Cook Islands, Fiji, Kiribati, Palau, Papua New Guinea, Tonga and Viet Nam. 3.2 Food supply and proper nutrition There are two principal issues addressed under this concern; quantity and quality of diet. In most countries, there are groups of people living in poverty, whose nutritional status requires at least monitoring if not direct intervention. Most countries and areas are therefore targeting the nutritional level of people or areas most in need. The second priority issue, quality of diet. is becoming a programme activity in more and more countries. Here, the principal activity is to raise people's level of awareness about including healthier foods in their diet. 3.3 Safe water and basic sanitation Water and sanitation is another area that has greatly benefited from the overall improvement in the economic conditions of people in the Region. As personal incomes have increased to levels above basic nutritional sufficiency, the next level of need relates to housing and improved water and sanitation. In most Member States, even rural areas now have an adequate supply of water. It is only in the more remote areas, particularly in the island states, that basic water and sanitation requirements are still not met. However, the bacteriological safety of water in rural areas is still a particular -. concern. Many priority programme activities are related to securing water quality and a concern for how pollution may be related to new physical developments. 3.4 Maternal and child health, including family planning The maternal and child health, including family planning (MCH/FP) programme is the most stable of the fundamental services provided by the health system. In all but a very few countries, the coverage of basic MCH/FP services is considered quite satisfactory. This programme is typical of the development pattern for most of the basic health care services. When the coverage level reaches 85%-90%, It becomes apparent that any cost-effective improvements will be in the area of quality. For most MCH/FP programmes in the Region,

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improved quality will be the next area of development. This follows the previous trend that, as coverage approached 80 %, more emphasis was placed on targeting resources to risk issues. Countries such as Malaysia and Singapore are placing a renewed priority on child health. Malaysia has introduced a revitalized comprehensive child care strategy. This programme includes rehabilitation of malnourished children, special target groups, integrated services for diarrhoeal disease control and acute respiratory infection programmes, breast-feeding. the risk approach. and special emphasis on the use of quality assurance. Palau, for example, has a good quality assurance programme in this area. Similarly in Singapore, a revised comprehensive child health policy has been made which is to ensure that each child "gets a good start". Reports indicate a mixed reaction to family planning. basically satisfied with their population trends. In general, countries and areas are

Most countries continue to experience a slight

downward trend in population growth and in some the rate is increasing. Population control is very much a family issue and often related to economics. In mO,st parts of the Region, as long as some services are available, they will be sought out by the people.

3.S

Disease prevention and control Progress has been made in the control of diseases such as poliomyelitis, tetanus neonatorum

and leprosy.

However, tuberculosis and malaria remain important health problems for selected

countries in the Region, requiring effective control. Most countries are well aware of the need for vigilance with respect to the pandemic of HlV I AIDS.

3.6

Immunization The immunization programme is a fundamental service area that has reached maturity and is

-Almost all countries are reporting new They are therefore

achieving a generally satisfactory level of performance.

development initiatives in the areas of monitoring, targeting and quality of care. Even with high immunization coverage, most countries recognize that vigilance is required. increasing emphasis on monitoring. Technical innovation in this area is urgently needed. Targeting has proved to be a cost-effective strategy for improving immunization coverage once an 80% coverage has been achieved. The specific targeting approaches used by countries have not been fully assessed. For example, Malaysia is using the targeted health education approach. This is potentially the most cost -effective targeting strategy, which leaves the final result to individual choice.

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Eighty-five per cent of the countries and areas reporting indicated that they have included hepatitis B in their immunization scheme. The large! group for the vaccination varies from country to country. In most cases countries are in the early learning phase of the programme. 3.7 Treatment for conunon diseases

The provision of services for the treatment of common diseases has reached a very high level of coverage in all but the very poorest countries in the Region. However, at least 50% of the countries and areas still reported some initiatives to improve this aspect of primary care. These initiatives involved essential drugs, quality of care and extended services. A number of countries. Fiji, Kiribati, Malaysia, Palau and Singapore, continue to develop the use of an essential drug list or some aspect of drug policy. In Malaysia, assessment of the treatment for common diseases is included in their quality assurance programme. In French Polynesia, outpatient services. which are mostly at the hospital level, are being extended to peripheral units. Initiatives to improve the overall efficiency of primary medical care are being tried in Singapore. More stringent criteria are being used there for referral to speciality services. The use of better public information is being emphasized to improve the use of health facilities. 3.8 Quality of care

Quality of care for most countries has moved from the stage of awareness-building to actions where quality is reflected as an integral component of primary health care performance. Malaysia has one of the oldest and most comprehensive quality of care programmes in the Region. Their programme started with a national hospital-based set of quality indicators, which The national indicator component was was accompanied by a programme to encourage each hospital to supplement national indicators with additional indicators that reflected their own concerns. subsequently expanded to include all public health programmes. The quality of care programme now includes peer and utilization review activities, medical audits, medical consensus committees and public/consumer feedback forums. A total of 2000 health workers have been trained in some form of quality assurance. Singapore's quality of care programme also includes all the features of the Malaysian model. A quality service unit was recently established to coordinate and provide technical support to the

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various health units on matters of quality improvement. feedback aspect of quality of care.

Singapore also emphasizes the public

Vanuatu is developing care protocols for district services that facilitate assessment of quality of care. The quality assurance programme is quite developed in Palau. Routine review and audit procedures are used, particularly in the area of maternal and child health, and the results are immediately applied.

4. RESOURCES FOR HEALTH

The regional strategy calls for the judicious mobilization of human, financial and material resources to achieve health-for-all goals. With the exception of a few of the poorest countries with a heavy dependency on external aid, the Region's health sector is benefiting from the economic boom in Asia. In most countries and areas. the concern is to make the utilization of resources for health more efficient by various measures of managing financial, human and material resources.

4.1

Financial resources The percentage of gross national product spent by countries and areas in the Region on health

care varies. Most spend well below the 5% of gross national product that was once highlighted as a health-for-all target. Singapore allocates 9% and Hong Kong allocates 11 % of national budgets to health care. Viet Nam allocates 1 % of the gross national product and only 0.5% of the national budget to health. Almost all countries and areas indicated that they were concerned about the allocation process for directing financial resources to priority areas. Most countries which have a large, publicly run health service, have been able to get reasonable increases in the funds available to support these services. No country reports complete satisfaction with its own performance in terms of the distribution of resources. The dominant theme from the third monitoring exercise is the concern to find mechanisms which ensure that resources are effectively targeted to priority areas. China sees a growing disparity between rural and urban areas as a result of economic trends. National resource allocation decisions must readdress this situation. Fiji, for example, is attempting new methods of information-gathering to provide a solid basis for their financial decision-making processes. Malaysia has seen a significant increase in the overall funds for health and has attempted to ensure

WPR/RC45/9 Rev. I page 21 Annex

that the additional funds go to the underserved areas and the new priority programmes. Papua New Guinea is also trying various measures to improve the equity of distribution in its financial resources. The new national financial programme in Cambodia allocates funds to the highest The Republic of Korea is reviewing its national health priority concerns of the health system. considering a national insurance plan. Resources need to be more effectively used. Most countries are attempting some form of cost containment measures and many are working on their budgeting processes. especially those with decentralization strategies. resources. In Papua New Guinea, a number of financial measures are being tested in the provinces. Hospital boards may be introduced as well as other hospital financing measures, for example. More emphasis is being placed on the overall coordination of financial resources, especially external resources for health. 4.2 Human resources

insurance scheme, the Philippines is looking at expanding its insurance programme and Palau is

Most countries are increasing the involvement of the private sector.

Concerns are being raised as to what impact this policy will have on the efficient utilization of

Four primary topics arise namely, upgrading of training, continuing education, workforce planning and the size of the workforce. The main human resource response to the next phase of health sector needs is seen to be through some type of upgrading of the formal training programmes for health workers. The most comprehensive use of this strategy is seen in Malaysia where the number of graduate programmes for medical, dental and pharmacy professionals is being increased. The training courses for other health worker categories are being upgraded from certificate to diploma. New training programmes are being added in the Philippines. Papua New Guinea is also upgrading its health extension officer and health inspector programmes. Courses for nurses are being upgraded and added in Fiji, Hong Kong, Palau and Papua New Guinea. Continuing education programmes are being strengthened to support upgrading of the formal education programmes. Cambodia, Malaysia and Singapore, for example, emphasize continuing education for all health staff as a priority.

WPR/RC4S/9 Rev.1 page 22 Annex

A shortage of medical doctors mainly due to retention in the workforce is a problem for most small island countries such as Kiribati and Vanuatu. The new primary care practitioner programme at the Fiji School of Medicine was designed to relieve some of the medical doctor shortages in the small island countries. 4.3 Material resources Physical facilities are being emphasized in many health systems, as strategies for improving quality of care and improving equity are more precisely defined. Consequently, a number of countries and areas, for example, Hong Kong and Papua New Guinea, are working to upgrade as many facilities as possible as part of a response to improving quality of care. The issue of improved equity is a persistent concern. Hong Kong, Malaysia, Palau and

Papua New Guinea suggest that access can be improved by putting more health facilities in remote areas. Countries such as Fiji are building new facilities only after careful review and planning. Quality of care is the driving motivation for upgrading and improving the purchase, allocation, and distribution of other material resources for health. In the area of logistics, the top priority is to improve the essential drug system in many countries, for example in Cambodia. Fiji. Malaysia, Palau, Philippines, Tonga and Vanuatu. Improved quality of services is closely linked with a strengthened logistical system. This is being done in many countries. Malaysia, for example, is also improving the provision of X-ray and other diagnostic equipment in health centre facilities. This strategy will improve efficiency of utilization and reduce outpatient demand at major state hospitals. A number of countries simply report that they have no significant problems with their logistical system.

5. TRENDS IN HEALTH STATUS

In most countries and areas of the Region, the reported infant mortality rate is lower than the global target of 50 per 1000 live births with the exception of eight countries and areas, of which two have a rate of over 100 per 1000. The rates in most countries and areas have remained stable

WPR/RC45/9 Rev.l page 23 Annex

or have improved between 1985, the first measurement year, and 1993, the end of the second monitoring cycle. However, although the rates have gradually diminished, the actual number of infants who died increased by 14.5%, from 990 294 in 1985 to 1 133548 in 1993. Life expectancy at birth is above 60 years for most countries of the Region. Only seven

countries and areas report an average life expectancy of less than this global target. For males the average expectancy is six years less than that of females (for countries and areas able to produce estimates). Maternal mortality, the principal indicator for women's health, shows a wide disparity between countries. Some record no maternal deaths and others record rates in excess of 800 per 100 000. Four countries and areas in the Region report maternal mortality rates higher than the global target of 300 per 100 000. A correlation can be seen between mortality by cause, and disparity in socioeconomic development. The more developed countries and areas share malignant neoplasms, cardiovascular diseases and cardiovascular accidents as the three predominant causes of death. malnutrition, rank much higher. Among communicable diseases, the leading cause of morbidity is diarrhoeal disease followed closely by acute respiratory infection. Malaria and tuberculosis continue to be major problems in a number of countries and areas such as Hong Kong, the Lao People's Democratic Republic, Malaysia, the Philippines, Vanuatu and Viet Nam. In the least developed countries and areas, deaths caused by communicable diseases, exacerbated by

-. Selected studies in developed countries show the leading causes of disability to be visual impairments including blindness, mental handicaps, and physical disability whether from birth defects, trauma or other factors. In developing countries, the causes of disability are more Drug and alcohol abuse also frequently associated with malnutrition and poor .perinatal care. countries. The Region continues to be affected by problems of malnutrition and nutritional disorders. The visible effects of protein-energy malnutrition are low birth weight and growth retardation. The numbers of infants born at the appropriate weight continues to improve. Only eight countries have reported that more than 10% of their newborn weigh less than 2500 grams. With regard to weight-for-age measurement data, again the Region is showing progress. While data on this factor

contribute to increased disability, particularly among the young, in both developed and developing

WPR/RC4S19 Rev.l page 24 Annex

are available for only seven countries and

area~,

of these only four are helow the regional target

which is to achieve acceptable levels of weight-for-age for 90% of children. Breast-feeding rates show some improvement during this monitoring period. Even accepting that the data provided by many countries are incomplete, it appears that the "baby friendly" hospital efforts are achieving positive results. Breast-feeding is increasing in most countries, for at least the child's first five to six months of life. Awareness of the relationship between breast-feeding and lower fertility may be a strong contributing factor to this occurrence. The annual population growth rate for the Region as a whole has remained relatively stable at about 2%. Road traffic accidents are an increasingly high cause of monality and morbidity in the Region. Accidental deaths account for the largest number of deaths in the developing countries of the Region after cancer, stroke and cardiovascular diseases. Tobacco use also contributes to a large share of the monality from these same chronic conditions. contribution to morbidity and mortality in the Region. Alcohol and drugs make a similar Almost all countries report alarming

increases in drug dependence and abuse, and alcohol consumption continues to rise. The linkages between drug abuse and HIV infection and alcohol consumption and motor vehicle accidents and violence is also clear.

6. TRENDS IN HEALTHY LIFESTYLES AND ENVIRONMENT

6.1

Health promotion The promotion of healthy lifestyles has become an important part of country and intercountry

activities.

Mortality and morbidity trends indicate that noncommunicable diseases related to In many countries of the Region they are actually

unhealthy behaviour are still prevalent.

increasing. Only a few countries (e.g., Malaysia, Singapore) have established nationwide healthy lifestyle campaigns. Most of the countries focus on specific behaviours. Rates of smoking, alcohol consumption and drug abuse are still very high in many countries (e.g., China, Japan, Papua New Guinea). In a few countries the rates are decreasing due to strong public policies (e.g., Australia, Singapore). Legislative action against smoking has been

WPR/RC45/9 Rev.l

page 25 Annex

implemented in most countries and areas with encouraging results. However. this needs complementary action from the educational sector and support from the mass media to increase awareness of the health hazards linked to smoking. No-smoking campaigns have been undertaken in many countries and areas, however, the scope and range of the campaigns differ widely. Limitation on financial and personnel resources have inhibited stronger measures in some countries and areas. As regards nutrition, healthy diet programmes and programmes to prevent diabetes have been undertaken in many countries and areas (e.g., Cook Islands. Fiji. Hong Kong. Kiribati. the Philippines, the Republic of Korea. Singapore and Tonga). Singapore, Tonga). Regular physical exercise in increasingly promoted in many countries and areas (e.g., Australia, China. the Philippines. The promotion of condom use for the promotion of protection against HIV I AIDS and sexually transmitted diseases, and family planning is recognized as an important health promotion measure in most countries and areas. Special events such as World Health Day. World No-Tobacco Day and World AIDS Day. and related activities have received extensive coverage by the media. Measures to make lifestyles healthier are often based on community action (e.g .. Palau. Papua New Guinea, Singapore) and involve nongovernmental organizations in many countries (e.g., Viet Nam). Multisectoral collaboration has been established in several countries and areas, particularly to improve the efficiency of health promotion measures (e.g., China, Cook Islands, Hong Kong, Kiribati, Malaysia, Palau, Papua New Guinea, the Philippines, Singapore). In Papua New Guinea, collaborative measures for different sectors are well established but need further strengthening. Singapore has established a Lifestyle Coordinating Unit within the Ministry of Health to improve multisectoral collaboration. A Healthy Lifestyle Coordinating Committee has also been established with support from the Prime Minister. the national healthy lifestyle programme. Monitoring of trends in the promotion of healthy lifestyles is still weak in many countries due to financial and personnel constraints. Malaysia and Singapore, however, have a strong evaluation component in their healthy lifestyle programmes. High-level representatives from key ministries, statutory boards, employers federations, the unions and health professional bodies monitor the progress of

WPR/RC4519 Rev.l page 26

Annex

6.2

Health protection: the environment There is a growing recognition throughout the Region that a more holistic approach is

required to dealing with health and environment concerns.

This approach includes improved a clearer definition and

interprogramme and intersectoral collaboration and coordination;

prioritization of issues; and the judicious use of limited resources to address priority problems. Countries and areas experiencing rapid socioeconomic growth and development crucially need to integrate health and environment concerns in development decision-making. This preventive approach is one of the keys to ensuring sustainable development. It is an approach that is being successfully modelled in Singapore, and is drawing increasing attention among the countries of the Region as well as from the external support agency community. In less rapidly developing areas, rural water supply and sanitation continue to be matters of priority concern (e.g., Vanuatu). Rural agricultural areas pressed to respond to increasing demands for cash crops in urban growth centres (e.g., in Malaysia, the Philippines and Viet Nam) are particularly problematic. Contaminated water supplies result from the often-associated increase in indiscriminate and uncontrolled use of organic fertilizers and insecticides. Populations in the Region are becoming increasingly mobile. Combined with poor sanitation practices, this has led to a resurgence in diseases such as cholera, malaria and schistosomiasis (e.g., Cambodia, Kiribati, the Lao People's Democratic Republic and the Philippines). Countries and areas have begun to focus on developing more comprehensive environmental health legislation (e.g., Fiji, Malaysia, Papua New Guinea, and Tonga); preparing more detailed and inclusive plans of action to support implementation (e.g., Fiji); encouraging greater private sector and public involvement in problem solving (e.g., Hong Kong and Singapore); and, generating funds to support promising health and environment initiatives (e.g., Hong Kong). If this trend continues, the result will be a more timely and sustainable resolution of long-standing environmental health problems.

WPR/RC4519 Rev.1

page 27 Annex

7. POPULATION AND SOCIOECONOMIC TRENDS

7.1

Population trends Population growth is not a major issue for most countries of the Region. Some countries

such as the Philippines and Viet Nam have potential popUlation problems, however, most are satisfied with their population growth strategy. The change in population structure is most apparent as population growth rates decline and stabilize. In most of the developing countries, about 3 % of the population is older than 65 years of age. The more developed countries and areas like Hong Kong and Singapore have elderly populations representing 4.4% and 6.3% respectively. Migration from rural to urban areas is still an issue in some countries such as Kiribati, Malaysia and Vanuatu. 7.2 Education trends Most developing countries are satisfied with the encouraging positive trend that an increasing percentage of children are in school. Most developing countries have a literacy rate greater than 80 %. In countries where the rate is lower, there is a positive trend of improved education The overall economic situation is a contributing factor in school attendance. In opportunities. -

Papua New Guinea, which has by far the lowest rate of adult literacy in the Region, there is a significant rise in the rate of school attendance, particularly among females. Women in development needs to be a focus of attention in the Region. Most countries have achieved reasonable success in the traditional areas of improving access to health services for women. Recently, the awareness level has increased and more countries are articulating a specific policy for women in development, as for example in Malaysia. 7.3 Economic trends In all the Asian countries and areas of the Region, except the Philippines, the annual economic growth is 8 % and higher. Where this is coupled with a 2 % population growth and economies which allow individual families to benefit from aggregate national growth, it appears that the average family's quality of life is likely to continue to improve for at least the remainder of the

WPR/RC45/9 Rev.1 page 28

Annex

1990s. In contrast, Papua New Guinea's economic growth of more than 10% is attributable to the success of large national bodies or organizations and the average family does not share in the benefits of this national growth. This has strong implications for health policy in Papua New Guinea and other countries or areas like it. Foreign aid continues to be an important part of economic development in a number of countries and areas. In Viet Nam, where the national government contributes less than US$ 2 per capita to health, external aid is quite significant. External aid is a stabilizing factor in the economy of the small island countries. Even in a self-sufficient economy such as Fiji's, over 2 % of the gross domestic product is from foreign aid.

..-... 8. CONCLUSION

The Region continues to enjoy a period of rapid economic growth and an unprecedented level of political and social stability. Prospects for the future look even brighter. during the past decade. Middle-income and newly industrialized countries have experienced a dramatic growth in national and personal income Many small island countries also experienced reasonable economic development. While growth in Cambodia, the Lao People's Democratic Republic and Viet Nam was slower, these countries may well experience a prosperous 21st century. These economic advances have been followed by healthier lives for the people of these countries. However, they have also resulted in increased demands for a larger number of health Some of these demands relate to changed disease patterns among the Health systems services which cost more.

aging and urbanized popUlations, with increases in chronic degenerative diseases. Many countries are now re-examining the allocation of resources within their health systems. reform is now a major priority for these countries. In a number of countries and areas, despite gains such as the expected eradication of poliomyelitis, the control of tetanus neonatorum and the elimination of leprosy as a public health problem, a number of the old problems such as malaria and tuberculosis remain. In the vast majority of countries, the emerging epidemiological disease pattern is influenced by the more chronic conditions resulting from aging or lifestyle-related degenerative diseases. In addition, the possibility of an AIDS/HIV epidemic persists.

WPR/RC4S/9 Rev.l page 29

Annex

One of the original tenets of health for all. community participation and intersectoral. cooperation, is taking on a more meaningful and vital role in the newly evolving health systems. Two aspects of the changing systems account for this renewed emphasis. First, an increasing concern for the impact on health of a deteriorating environment. Second, the increasing concern for the relationship between health and individual lifestyles. Thus, the promotion of healthy behaviour and the protection of a health-sustaining environment have become major concerns of the health sector now and will continue to be principal areas of emphasis in the future.

WPR/RC45/9 Rev.1 page 30

WPR/RC45/9 Rev.l page 31 Annex

Table 1. DEMOGRAPHIC AND SOCIAL INDICATORS. WESTERN PACIFIC REGION

I Population Country/area Year Ale Total (,000s)

Birth rate

Death rate (per

Adult literacy rate Total '!ale (")

AI< >65 (~)

Ft'male

<15 ('l)

Rural (~)

1006 total population)

('"

t")

American Samoa Australia

... 1993 1993 1993 1993 1992 1992 1992

. .. 17572.00 284.00 9 308.00 I 229568.00 18.70 758.28 207.90 22.1 35.8 41.8 29.3 34.0 35.8 35.2

... I \.I

12.0 33.4 87.4 73.8 41.1 60.7 45.0

15.1 23.8 41.4 18.1 28.4 23.6 25.7 12.0

7.7 4.4 16.6 6.6 6.1 4.6 S.I

89.7 90.0 35.2 73.2 100.0 87.0 90.0 88.4 90.0 84.2 11X1.O 90.0 62.0

Brunei Darussalam Cambodia China Cook Islands Fiji French Polynesia Guam Hong Kong Japan Kiribati Lao People's Democratic Republic

2.7 2.8 6.0 8.0 3.7 3.4 8.5

1<Kl.O 84.()

... 1994

... 5816.00

. .. 20.9

. .. 4.8

5.0

... 1993 1993

... 76.81 4605.00

... 40.8 43.9

... 3.1 3.0

... 65.2 82.0

... 29.4 45.2 27.8 28.6

.. 9.2 15.2 4.6 5.3

... 65.0 80.IJ 99.0 36.0 64.0 99.0

bO.O 72.0 99.0

Macao Malaysia Mariana Islands. Nonhem Marshall Islands Micronesia, Federated States of Nauru

... 1992 1992

. .. 18606.30 52.90

... 36.4 26.0

... 6.1 1.6

... 48.5 72.0

... 1990

... 100.00

... 46.1

... 3.6

.. . 40.3 37.9 8.0 50.0

...

New Caledonia New Zealand

... ... 1994

... ... 3 541.7()i!! 15.12 3822.80 63570.59 44 056.00

... ... 23.0 30.5 40.0 18.5 24.4

...

... .. . 15.0 7.3 23.1 33.5 31.5 15.4

..'

... 15.6

... 9.0 7.1 10.6 7.1 5.8 4.7 96.5 78.0 45.0 83.0 96.3 55.0 44.0

Niue Palau Papua New Guinea Philippines Republic of Korea

... 1990 1991 1992 1993

... 6.1 2.3 3.5 5.4

.. . 33.3 84.7 57.3 25.6

... 84.0 99.1

... 83.0 93.5

Samoa Singapore Solomon Islands Tokelau Tonga Tuvalu Vanuatu Viet Nam Wallis and Futuna

... 1992

... 2818.20

... 23.1

.. . 6.3

... 0.0

.. . 17.1

... 91.1

... ...

...

... ... 1992 1992 1992 1991

...

... .. . 40.0 26.1 44.0 38.0 '"

...

... 97.52 8.50 152.10 67679.00

... 4.3 4.5 3.2 4.3

... 61.6 57.5 83.0 79.6

... ... 21.8 25.5 37.0 29.8

.. .

... 4.3 9.1 9.0 7.1

.. . 95.9 99.5 33.0 89.0

... 96.3

.. . 95.6

... ... 93.0

... ... 85.0

...

.. .

...

.. .

.. , Information not available.

~ As at 31 March 1994. Source:

Governments' reports on the implementation of strategies for htalth for all by the year 2000. Common Framework: Third Monitoring of Progress (CFM!3), World Health Organization Regional Office for the Western Pacific. Manila, 1994.

WPR/RC45/9 Rev.l page 32 Annex

Table 2. GOVERNMENT EXPENDITURE ON HEALTH, WESTERN PACIFIC REGION

Country/area

Per capita GNP (where noted. GDP) (US$)

Percentage or GNP/(GDP) spent on health

Percentage or nationlll health expenditure devoted to local health services

American Samoa

... (\992-93) (1993) (1993) (1992) (1990) (1988) (1990) (1992) (GDP) 15384.29 35967.82 222.00 380.00 350.00 3002.86 15 100.00 11992-93) (1992) (GDP) (1993) (1992) (GDP) (1993) ~

... (1991-92) 8.95

Australia

... 1.00

Brunei Darussalam Cambodia China Cook Islands Fiji French Polynesia

... 9.80 1.90 9.0 -10.00 (1992) (1992)

... 55.00 21.60

Guam Hong Kong Japan

.. 16615.00 691.92 202.00 4.37 10.00 2.00 1.68

... 0992-93) 11.00

... (1985) (1985) (1992) (1990)

... (1985) (1993) (1992)

...

Kiribati Lao People's Democratic RepUblic Macao Malaysia

... (1992) 28.80

... 2892.00 17459.00

Mariana Islands, Nonhem Marshall Islands Micronesia. Federated States of

...

... (1989) 1500.00

... (1990) 9.00 (1990) 1.00

Nauru New Caledonia New Zealand Niue Palau Papua New Guinea Philippines Republic of Korea Samoa Singapore Solomon Islands Tokelau Tonga Tuvalu

... ... (1993)

...

... II 439.00

... .. . (1993) 7.6

.. . (1993) (1993) (1993) n.5 27.00 51.00

... (1990) (1993) (GDP) (1992) (1991)

... 1913.16 856.00 855.00 6498.00

.. . (1993) (1993) (1991) (1991)

.. 10.00 3.00 1.60 5.10

... .. . (1992) .. . (1990)

... (1992)

... 13058.0011

... (1992) (GDP)

... 3.10

... .. . 13.70

... ... (1980-81) (1991) (1991) (GDP) (1993)

...

... "

... 117.18 400.00 360.00 170.00

... (1990)

... 5.00

12.00 " .

... (1989) (1993)

... 2.50 4.50

.. . (1991) (1993)

Vanuatu Viet Nam Wallis and Futuna

20.00 54.00

...

.. .

. .. Information not available. ~ Per capita indigenous GNP at current market prices.

Source:

Govem11lLnts' reports on the imp/e11lLnlaiion of strategies for I..allh for all by the year 2000. Common Framework: Third Monitoring of Progress (CFM/3), World Health Organization Regional Office for the Western Pacific, Manila, 1994.

WPR/RC45/9 Rev. 1 page 33

Annex

Table 3. COVERAGE OF POPULATION BY HEALTH CARE, WESTERN PACIFIC REGION

Country/area

'II> or population co_eredby health car.

'II> or Infants recel_1og routine care rrom trained health persoanel V,.. T....

" of prtpaDt women attended by trained pt'f5onntl durtnlpr_y

during childbirth (delinrin)

v,..

T....

U"-R....

1'''-

R....

V ...

T.... t'rbaa Rural

v,v

T ....

llrban

Rural

American Samoa

Auslralia

(1992) UXJ.O

11992)

999 S2.0

{!992) (19931

999 ~9,O

Brunei Darussalam Cambodia China

... (1993)

.... 100 .• 100.• 100.• 100.• 100.•

{l99JI (1993)

4S.3 ...

...

~lml

I14S

Cook Islams Fiji

(1992) (19901 (1993)

(1992) )(11.0 (1990) 11991) 90 .•

119921 (1990)

)00.

(1992) (1990)

'IS .• 100.0

!m.O

IIXJ.O

French Polynesia Guam

'IS .• 99.0

'IS .• 91.7

(1991)

'IS.O 99.3 ..

(1991)

980

Hong KOO8 J..... Kiribati

(1993)

11993)

...

11993) (1993)

(199))

99,3

...

... (1993)

... 100.0

.. 87.6 8. 14,0

(1993)

71.8

...

Lao People's Democratic Republic 11993) (1991) 20.0 (1993)

Macao Malaysia Marilna Islands, Northern

1B.(jI

... ...

(1992)

90.2

11992)

(l99:!)

93" ..

Marshall Islands Micronesia, Federated States of Nauru New Caledonia New Zealand Niue

...

(1993)

73 .•

(1993'

90 .• .

(99)

82.0

...

... ... ... (1993) (1992) (1993) (1990) .

...

... M.• 'IS.O 90.0

.. .

... ... (1993) (1992) 98. 3(1. (1993) (1992)

Palau Papua New Guinea Phil ippines Republic of Korea

'IS.O 66.•

(1m) (1992)

100.0

nO 98.0 'IS .• 100.0

(1993) 100.•

72.0 96 .•

{I9931 98.0 IB.I (1990)

100.0 100.0

100.0 (1992) 100.0

(1990)

98.3

au ...

Samoa Singapore Solomon blands Tokelau Toog. (1993) 100.0 (1992) 100.0 (1993) (1992) (1992) 100.0 (1992)

95.2 ..

(1993)

93.7

Tuvalu Vanuatu Viet Nam Wallis and Futuna

... (1991)

... M.O (1993) 91.8 (1991)

79.0 78.S

(1993)

78.2

(1993)

... Information not available.

Peninsular Malaysia only.

Source:

Gove17l1/lents' reports on the implementation of strategies for heallh for al/ by the year 2000, Common Framework: Third Monitoring of Progress (CPM/3), World Health Organization Regional Office for the We.rem Pacific, Manila, 1994.

WPR/RC4S/9 Rev.1 page 34 Annex

Table 4. SELECTED INDICATORS OF HEALTH STATUS, WESTERN PACIFIC REGION

I Country/area

% or ..... bom

% or tbDdren .. bose

Imant mortaUty rat • (per 1000 Un births)

..itb birth .. eight or at least 2500 grams

..eigbt-ror-ale and/or ...ilbHor-beight are acceptable

Lir. expo.ctancy at birtb Ytar Total

Malt

.'rmalt'

American Samoa Australia Brunei Darussalam Cambodia China Cook islands Fiji French Polynesia Guam Hong Kong Japan Kiribali Lao People's Democratic Republic Macao Malaysia Mariana islands. Northern Marshall Islands Micronesia. Federated Stales of Nauru New Caledonia New Zealand Niue Palau Papua New Guinea Philippines Republio of Korea Samoa Singapore Solomon Islands Tokelau Tonga Tuvalu Vanuatu Viet Nam Wallis and Futuna

(1991) (1993) (1993) (1991) (1992) (1988) (1991) (1989) (1993) (1990) (1991) (1989)

93.8 95.0 81.6 94.0 99.0 82.0 94.7 9S.0 97.0 40.0 91.7 92.7

(1993) 93.0 (1993) W/A· 80.0, W,H· >8(},0

(1992)

90.0

(1992) 70 (1992) 9.6 (1993) 117.0 (1993) Urban· 13.5 Rural - 21.5 (1992) 17.5 (1990) 16.8 11992) J!.7 (1992) (1990) 4.9

(1992) (1993) (1993) (1992) ~9.l)

74.5

RO.4

10.0 69,0 fI"i,{I

(1993 ) (lQ91-Q2J

70 70

~ f)

700 M~

()

720 oN 0 7 J I) Rtl j

(19921

6S.0 117.0 12 I 17.5

(1990) 1\993) f19Q2)

60.2

(1993) (1992)

60.0 W/A·76.8

(1992) (1992) (19931

500 6Q,O~'

Ii 7.e:'

(19871

50.0

470

520

... (1991) 69.0 (1991·93) 23.8 (1991·93) 62.2 65.9

... ... (1992) (1993) (1993) (1992) (1985) (1991)

... 94.3

... \\,,111 _ 92.0 (1993) (1993) W/A ·61.9, W-H·94.1 (1990) W/A ·81.3, WiH· 88.4

(1994) (1993) (1993) (1990) (1991) (1992)

7.1 28.1 51.0 57.0 12.8 5.0

(1994) (1990) (1993) (1992) (1991) (1992)

72.9

78.7 69 1 664 75 7 78.3

90.4 84.0 89.0 95.7 92.6

6S.1 496 646 11.6 76.0 628 67.7 737

... ... (1992) WIA ·98.4

(1992) (1991) (1992) (1993)

98.0 967 92.6 88.2

...

(1993) (1993) (1989) (1993)

13.9 73.6 45.0 51.7

(1993) (1991) (1989) (1993)

66.0 61.2

61.2 63.0

64.0 64.5 67.5

.. .

... Information not available.

~I Peninsular Malaysia only. Sourte:

Governmelll!' reports on the implemelllation of strategies for health for all by the year 2000, Common Framework: Third Monitoring of Progress (CFMI3), World Health Organization Regional Orrice for the Western Pacific. Manila. 1994.

WPRlRC45/9 Rev. 1 page 35 Annex Table 5. PERCENTAGE OF POPULATION WIlli SAFE WATER IN THE HOME OR WITIllN 15 MINUTES' WALKING DISTANCE, AND WITH ADEQUATE SANITARY FACILITIES IN THE HOME OR IMMEDIATE VICINITY, WESTERN PACIFIC REGION

Safe water supply % of population covered

Sanitary facilities % of population conred Vear Total Urban Rural

Country/area Year Total Urban Rural

American Samoa

Australia Brunei Darussalam Camhodia China Cook Islands Fiji French Polynesia

(1990) (1993) (1993) (1993) (1992) (1993) (1992)

950

.. ... '

... . .. 92.0 12.0

... (1990) (1993) (1993) (1992)

.. 90.0

100.0 20.0 82.8 95.0 560

...

71.0 68.4 100.0 98.0

51.0 5.1 95.0 ~5.0

... 95.0

100.0

95.0

... 20.0

... (1991)

80.0

Guam Hong Kong Japan Kiribati Lao People's Democratic Republic

... (1990)

... 99.0

.. , ... ... 70.0

...

... (1990) 99.0 45.0 13.0 . ..

... (1990) (1993) (1993) (1993)

... 150 90.0 97.0

... 80.0 36.0 (1990) (1993) (1993) (1993) (1991-93)

34.4

Macao Malaysia Mariana Islands, Nonhern MarshaUlslaods Micronesia, Federated States of

.. , 100.0

... 80.0

.. ... 95.0

53.6 2.0 89.0

100.0

.. , ..'

... (1991-93)

... 21.6

... .. '

... ... ...

... 39.0

Nauru New Caledonia New Zealand

... ... (1980)

... '"

... 87.0

.. ..

... ...

.. , '

Niue Palau Papua New Guinea Philippines Republic of Korea

... (1993) (1993) (1992) (1990)

... 86.0 31.0 83.0 89.0 ." 100.0 ., .

.. , 97.0

... . .. ... 18.0

... ... (1993) (1993) (1992) (1990)

... ... ... ... 95.1 25.0 72.0 100.0 100.00

... ."

..'

.. , .. '

. .. ...

... 12.0

95.0

.. , ... ..' ... ..'

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

.. ..' '

. ..

... ...

Samoa Singapore Solomon Islands Tokelau Tonga Tuvalu Vanuatu Viet Nam Wallis and Futuna

... (1992)

. .. (1992)

... ..'

... ... (1993) (1991) (1991) (1993)

...

... 100.0 100.0

.. , .. '

... (1993) (1991) (1991) (1993)

... ... 72.0 75.0 ... 60.0-70.0

.. , ...

... 75.()!I

..' .. .. ' '

... ... 17.4l!1 ...

... 41.0

... .. ,

... ...

...

. ..

...

.. ,

.. .

... Information not available. !1 Percentage of households. III VIP. water-sealed toilets.

Source:

Govtrnmen/.' report. on the impiemen/alion of .trategie. for health for aU ITy the year 2()()(), Common FTtlIMWork: Third MonitOring of Progre.. (CFMl3), World Health Organization Regional Office for the Western Pacific. Manila. 1994.

WPR/RC4S/9 Rev.1 page 36

Annex Table 6. PERCENT AGE OF CIDLDREN FULLY IMMUNIZED AGAINST THE TARGET DISEASES OF THE EXPANDED PROGRAMME ON IMMUNIZATION (EPI), WESTERN PACIFIC REGION

All EPI

Dlptberlal pertussis tetanus ('l. Meults (%)

PoUomyeHlIs (%)

Tuberculosls (%)

Neonatal Tetanm

Country/area

Year

diseases (%)

tetanus (%)

toxoid (%)

American Samoa Australia Brunei Darussalam Cambodia China Cook Islands Fiji French Polynesia Guam Hong Kong Japan Kiribati Lao People's Democratic Republic Macao Malaysia Mariana Islands, Nonhero Marshall Islands Micronesia, Federated States of Nauru New Caledonia New Zealand Niue Palau Papua New Guinea Philippines Republic of Korea Samoa Singapore Solomon Islands Tokelau Tonga Tuvalu Vanuatu VietNam Wallis and Futuna

... 1989-90 1993 1993 1993 1992 1991 1992-93

... ... ... ... >85.0

... !I 96.0 33.0

... 111 'n.0 37.0 80.0 86.0 91.1 50.5 95.0 36.0 95.0 98.0 90.5 83.0

.. £1 97.0 56.0 95.0 99.0 97.0 99.0 . ..

. ..

50.0 36.0

... 95.0 98.0 90.5

. .. ... 100.0 37.0

... ...

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

. ..

... 1992

... 82.3

... 76.9

. .. ...

... 1993 1993

... 117.2 36.0

... 88.9 37.0

... 113.2 22.0 9\.7

. .. 88.9 37.0 99.0

... 36.5

... 82.9

... 1992 1990 1990 1990-91 ...

... ... 62.0 60.0 90.9!!.' ...

... 9\.9

.. . 81.5 ...

... ...

... ... .. . ... 67.7

... ... .. .

... 1992

... .. ... ...

... ... 80.6

... .. . 82.0

... .. . .. . 68.2 90.0 93.7

.. . ... ... ... 18.0

... 1993 1992 1993 1990

... 1992

... ...

... 36.0 61.5 88.0 93.0 ... 89.0

... ... 88.9 87.0

... 22.0 63.2 89.0 93.0

... ...

38.6 68.0

'n.4 ...

... ...

... ... ...

... 92.0

.. . 99.0

... ... 1993 1993 1991 1993

... ...

... ... 95.9 100.0 80.0 90.8

... ... 85.2 64.0 6\.0 93.3

... ... 96.4 85.0 79.0 90.9

.. . ... 96.6 100.0 97.0 94.0 .. .

... ... ...

... ... 69.3 75.0 38.6 7\.0

... ... ...

... ...

.. ,

... ...

...

.. .

...

... Infonnation not available.

!! Diphtheria-tetanus: 70,0; Pertussis: 55,\.

!!,

Immunization against measles is oot recommended under 12 months of age in Australia.

£! Immunization not required. W Immunization coverage rate of all children at the age of two years.

Source:

Governments' r.pons 011 the impi.""'ntation of straugi.. for healJh for all by the ytar 2000, Ccmmon FramcworJc: Third Monitoring of Prog"ss (CFMl3), World Health Organizalion Regional Offlcc for the Wesrem Pacific, Manila, 1994,

WPRlRC4S/9 Rev. 1 page 37 Annex

Table 7. EFFECTIVENESS OF IMMUNIZATION AS SHOWN BY REPORTED NUMBER OF CASES, BY DISEASE, WESTERN PACIFIC REGION

I Country/area American Samoa Australia

Population ('000.)

Vear of data Diphtheria Pertussis Tetan..

Neonatal tetan..

PoUomyeUtls

Tuber<ulosis Measles

Brunei Darussalam Cambodia China Cook Islands Fiji French Polynesia Guam Hong Kong Japan Kiribali Lao People's Democratic Republic Macao Malaysia Mariana Islands, Northern Marshall Islands Micronesia, Federaled States of Nauru New Caledonia New Zealand Niue Palau Papua New Guinea Philippines Republic of Korea

17572.00 284.00 9308.00 1229568.00 18.70 758.28 207.90 5816.00 1529 4135.60 18606.30 56.20

1992 1990 1993 1992 1992 1993 1992 1992 1993

739

0 22 143 0 0 0

0 611 11096 0 0 31

0 154

0 88

.. ' 0 0 14

0 135 1200 33 0

903 143

I 425 12 1 262 139663 9 425 22

... 5 13 0 4 0 12 25 1 6534 (3M) 329 (! 10) 3 4 28 0 7 121

13 16 14 0

114 30

... 1992 '"

424 II 420 47

... 2 0

.,.

1992 1993

378 90

100.00

1991 ...

...

333

3541.70 15.12 3 822.80 63570.59 44 056.00 2818.20

1992 1992 1991 1992 1992 1992

327 4 3750 95 146

755 41

124 I

0 0

2293 32924 38

Samoa Singapore Solomon Islands Tokelau Tonga Tuvalu Vanuatu VietNam Wallis and Futuna I 14

...

... 0 1 747 606

.,. ... 98.00 8.50 152.10 67679.00 1993 1992 1992 1993 0 0 160 0 0 I 387 I 123 0 0 16

... 193 I 159

.,.

19 9 187 17015

171

...

Information not available.

«y) Source:

Denotes there are altogether x cases in which y cases of Vietnamese refugees are included.

Governments' repons on the implementation of strategies for healJh for all by the year 2000, Common Framework: Third Monitoring of Progress (CFMI3), World Health Organization Regional Office for the Western Pacific, Manila, 1994.

WPRlRC45/9 Rev.1 page 38

Annex

Table 8. SELECTED NUTRITIONAL INDICATORS, WESTERN PACIFIC REGION

Country/area

Dally per capita calorie availability exceeds 2500 calories ... (1987-88) (1990)

Daily per capita protein supply exceeds 70 grams . .. (1987-88) (1990) . .. (1990) . .. (1988) (1990) . .. 100.5 80.0 . .. 66.8 . .. 56.8 160.0 . .. 99.0 . ..

American Samoa Australia Brunei Darussalam Cambodia China CO(lk Islands Fiji French Polynesia Guam Hong Kong Japan Kiribati Lao People's Democratic Republic Macao Malaysia Mariana Islands, Northern Marshall Islands Micronesia. Federated States of Nauru New Caledonia New Zealand Niue Palau Papua New Guinea Philippines Republic of Korea Samoa Singapore Solomon Islands Tokelau Tonga Tuvalu Vanuatu Viet Nam Wallis and Futuna

... 3 100.0 2900.0

... (1990)

... 2485.0

... (1988) (1990)

... 2577.0 3500.0

... ... ...

... 3402.0

... (1988)

(1988)

... ... 2390.0

... ... (1989)

...

(1989)

... (1982) (1993) ... ...

...

... (1977) (1993)

...

2549.0 3200.0 ... ... ...

... ... . ..

47.7 . .. 57.6 100.0

... ... ...

... (1991) ...

... 3 121.0 ... . .. 2247.0

... (1991) ... ... (1988) ... (1991) ... (1983)

... 102.0 . ..

... (1988) ... (1991)

...

... 2883.0 . .. 2922.0 ... ... 2750.0 ... 2546.0 I 943.0

... (1983)

... (1990)

...

... ... (1990) ... (1985) (1991)

... (1985) (1991) ...

...

45.8 . .. 89.7 . .. 71.8 . .. . .. 61.2 . .. 68.4 58.0 . ..

... Infonnation not available.

Source:

Governments' reports on the implementation of strategies for health for all by the year 2000, Common Framework:

Third Monitoring of Progress (CFMI3), World Health Organization Regional Office for the Western Pacific, Manila, 1994.

WPR/RC45/9 Rev.1

page 39

Annex

Table 9. SELECTED FAMILY HEALTH INDICATORS, WESTERN PACIFIC REGION

Country/area

Maternal mortality rate (per 100 000 live births)

Annual population growth rate (%)

American Samoa Australia Brunei Darussalam Cambodia China Cook Islands Fiji French Polynesia Guam Hong Kong Japan Kiribati Lao People's Democratic Republic Macao Malaysia Mariana Islands, Northern Marshall Islands Micronesia, Federated States of Nauru New Caledonia New Zealand Niue Palau Papua New Guinea Philippines Republic of Korea Samoa Singapore Solomon Islands Tokelau Tonga Tuvalu Vanuatu VietNam Wallis and Futuna

... (1992) (1992) (1993) (1993) (1992) (1989) (1991)

... (1992) ... (1993) (1991)

. .. 3.40 0.00 50000 80.00 189.00 41.10 0.00 . .. 5.54 '"

... (1991) (1990) ... (1991-93) (1993)

225.00 300.00 . .. 20.00!i 84.00

(1990) (1993) (1993) (1990-95) (1990) (1990) (1992) ... ( 1990) ... (1990) (1993) ."

... 121.20 121.20 .

... (1992) ... (1991-93) (1993) (1990) (1992)

... (1992)

15.20 . .. 92.70 800.00 80.00 30.00 ... 4.10

(1992) (1988-90) . .. (1990-95) (1990-95) . .. (1991) ."

1.49 3.00 2.80 1.40 -0.13 1.10 2.06 ... 0.30 . .. 2.24 2.60 ... 2.30 2.30 . .. 3.46 3.50 '"

... ... (1993) (1990) (1991) (1993)

... ... 126.00 434.80 68.00 200.00 . ..

(1991-93) (1993) (1991) (1993) . .. ( 1992) ...

0.80 ... 3.20 2.20 2.30 0.90 . .. 2.00

., . (1990) (1993) (1991) (1991) ...

...

. .. 0.61 1.60 2.40 2.18 . ..

Information not available.

Peninsular Malaysia only. Govemrntllls' reports on the implerntlltatioll of strategies for health for 0/1 by the year Z()()(}, Commoll Frarntworlc: Third Monitoring of Progress (CFM/3), World Health Organization Regional Office for the Western Pacific. Manila, 1994.

Source:

Informations clés

Organisation Organisation mondiale de la santé (OMS)

Type de document Technical Documents

Date d'adoption 31 décembre 1994

Source Organisation mondiale de la santé