·~.
WORLD H.EALTH ORGANIZATION
REGIONAL OFFICE FOR THE WESTERN PACIFIC BUREAU R~GIONAL DU PACIFIQUE OCCIDENTAL
•
ORGANISATION MQNDIALE ., DE LASANT!
REGIONAL COMMITTEE Thirty-second session Seoul 22-28 September 1981 Provisional agenda item 11.2
WPR/RC32/5 4 August 1981 ORIGINAL: ENGLISH
REPORT OF THE SUB-COMMITTEE OF THE REGIONAL COMMITTEE ON THE GENERAL PROGRAMME OF WORK PART I
,
.
Part I of the Report of the Sub-Committee on the General Programme of Work presents, for consideration by the Regional Committee, the Sub-Committee's recommendations on its membership (Section 2), together with (a) an explanation of the tasks undertaken in 1981; and (b) summ,aries of the reports of country visits made by its members in March/April 1981, during which they reviewed specifically the indicators used or developed at country level for the implementation, monitoring and evaluation of national strategies for health for all by the year 2000 (Annex 1) and the activities being undertaken in the context of the International Drinking-Water Supply and Sanitation Decade (Annex 2). Annex 1 should be read in close relation to Section 9.3.1 of the proposed updating of the Regional Strategy for health for all by the year 2000 '(document WPR/RC32/6 Add.l). The Regional Committee is . invited to comment on the contents of Part I and to !consider the proposals set out on page 12 of Annex 1 and the recommendation on its future membership contained in Section 2.
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WPR/RC32/5 page 2
1.
INTRODUCTION
The Sub-Committee on the General Programme of Work.met in Manila from 29 June to 3 July 1981 to review (.a) the Regional Strategy for health for all by the year 2000, in the light of the Global Strategy adopted by the Thirty-fourth World Health Assembly in May 1981, (b) the proposed global plan of action for implementing the Global Strategy and a proposed regional plan of action, (c) material for the Seventh General Programme of Work covering a specific period 0984-1989), and (d) the progress achieved in implementing in the Region the plan of action relating to WHO's structures in the light of its functions. The Sub-Committee also reviewed and finalized the report on the country visits made by members earlier in the year. The report of the Sub-Committee to the Regional Commi ttee is presented in four separate parts; Part I, (the present document), Annex 1 of which contains the findings and recommendations on the country visits made by its members with respect to the subjects chosen for review in 1981, namely (a) the indicators used/developed at country level for the implementation, monitoring and evaluation of national strategies for health for all, and (b) the activities conducted at country level in the context of the International Drinking-Water Supply and Sanitation Decade; Part II, which contains its recommendations for the updating and revision of the Regional Strategy for heal th for all by the year 2000 in the light of the Global Strategy and for the proposed global and regional plans of action and which is to be presented under item 12 of the provisional agenda of the Regional Committee; 1 Part III, which contains the Sub-Committee's comments on the progress made in implementing in the Region the recommendations of the study of WHO's structures in the lijht of its functions and which is to be presented under agenda item 14; and Part IV, which was prepared separately for presentation under agenda item 15, and which contains the Sub-Committee's comments on the material for the Seventh General Programme of Work. 3 The meeting was formally opened by Dr Hiroshi Nakajima, Regional Director, who thanked the members of the Sub-Committee for their active participation in the work of WHO. The Regional Director, referring to the recommendations of the study on WHO's structures in the light of its tunctions, pointed out that, even befiore the report on the study was presented to the World Health Assembly, the Regional Committee had been closely involved in the work of WHO in the Region, largely through the activities of the Sub-Committee on the General Programme of Work. Referring to the significance of the issues to be discussed by the Sub-Committee, he stressed that, as in previous years, a preliminary review by the Sub-Commi ttee of these important topics would greatly facilitate the work of the Regional Committee.
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lSee documents WPR/RC32/6 Add.1 Bnd WPR/RC32/6 Add.2. 2See document WPR/RC32/8. 3 See document WPR/RC32/9.
WPR/RC32/5 page 3
Dr Christmas was elected Chairman. Dr Liu, Dr Ahn, Dr Koh and Dr Foliaki were elected Rapporteurs for each of the subjects dealt with by the Sub-Committee. The following members of the Sub-Committee undertook visits in March/April 1981 and attended the meeting in June: CHINA the country
Dr Liu Xirong Chief International Organizations Division Bureau of Foreign Affairs Ministry of Public Health Beijing Dr Ezaddin bin Mohamed Director of Health Services Ministry of Health Kuala Lumpur Dr Bryan W. Christmas Deputy Director-General of Health (Public Health) Department of Health Wellington Dr Sung-Kyu Abn Director Health Planning and Research Division Korea Health Development Institute Seoul Dr Roh Thong Sam Medical Superintendent Toa Payoh Hospital Singapore Dr S. Foliaki Director of Health Ministry of Health Nuku'alofa was unable to be
MALAYSIA
NEW ZEALAND
\
\
REPUBLIC OF, KOREA
SINGAPORE
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TONGA
Samoa, although a member of the Sub-Committee, represented during the country visits and the meeting.
2.
MEMBERSHIP OF THE SUB-COMMITTEE
The members supported the Chairman's proposal that, in view of the future heavy responsibilities of the Sub-Committee, its membership should be increased from seven to eight. Membership should be as geographically representative as possible. though it was ·realized that, because of the
WPR/RC32/5 page 4
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number of Member States in the Region, some might have to be represented on both the Sub-Committee on the General Programme of Work and the Sub-Committee on Technical Cooperation a!1l0ng Developing Countries at the same time.
3.
TERMS OF REFERENCE
The terms of reference of the Sub-Committee for 1981 were as follows: (1)
to review and Member States;
analyse
the
impact
of WHO I s
collaboration with ~
(2)
to review, monitor and evaluate implementation of the Regional Strategy for health for all by the year 2000; to review the progress achieved in implementing the plan of action drawn up in pursuance of the ~ecommendations of the study of WHO's structures in the light of its functions; to review the material for the Seventh General Programme of Work, including the regional contribution to the Programme.
(3)
!
(4)
4.
REVIEW AND ANALYSIS OF WHO'S COLLABORATION WITH COUNTRIES
4.1
Subjects for review
Within the framework of its reVlew and analysis of the impact of WHO's collaboration with Member States, and particularly collaboration in the development of strategies for the achievement of health for all by the year 2000, the Sub-Committee had as its main subject for review the indicators used/developed at country level for the implementation, monitoring and evaluation of national strategies for health for all by the year 2000. t, The Sub-Committee also made a preliminary review of activities being conducted at country level in the context of the International Drinking-Water Supply and Sanitation Decade. 4.2 Country visits
Countries visited by the Sub-Committee for the purpose of the review were Australia, Malaysia, Republic of Korea and Singapore. The six members of the Sub-Committee who made the country visits assembled in Singapore on 22 March 1981. Following a briefing session on 23 March, the members started their country visits as a full group, by reviewing the situation first in Singapore from 24 to 25 March 1981 and
then in Malaysia from 26 to two groups, those from New Republic of Korea from 1 to Singapore and Tonga visiting
WPR/RC32/5 page 5/6
30 March 1981. They subsequently divided into Zealand and the Republic of Korea visiting the 4 April 1981, and those from China, Malaysia, Australia from 2 to 7 April 1981.
In each of the countries visited, the members had discussions with the national authorities, availing themselves of the questionnaires and checklists prepared by the Secretariat to facilitate the gathering of information. ~n
The findings and recommendations of the Sub-Committee are summarized the attached Annexes.
WPR/RC32/5 page 7
ANNEX 1
INDICATORS USED/DEVELOPED AT COUNTRY LEVEL FOR THE IMPLEMENTATION, MONITORING AND EVALUATION OF NATIONAL STRATEGIES FOR HEALTH FOR ALL BY THE YEAR 2000
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1.
INTRODUCTION
In 1977, the Thirtieth World Heal th Assembly decided that the main social target of governments and WHO in the coming decades should be the attainment by all the citizens of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life. l In 1979, the Thirty-second World Health Assembly, endorsing the report of the International Conference on Primary Heal th Care, including the Declaration of Alma-Ata,2 invited Member States to consider the immediate use of the document entitled "Formulating strategies for health for :'Ill by the year 2000",3 individually as 8 basis for formulating national policies, strategies and plans of action, and collectively as a bas is for formulating regional and global strategies. In the same resolution, the Executive Board was requested to submit proposals for the gl~bal strategy to the Thirty-fourth World Health Assembly.4 Guiding principles for the formulation of strategies for health for all by the year 2000 were issued by the Executive Board the same year. A number of Member States in the Western Pacific Region subsequently formulated their national strategies and submitted them to WHO. On the basis of these national strategies, regional policies and strategies for health for all were developed and presented in a working document to the WHO Regional Committee for the Western Pacific at its thirty-first session The in Manila in September 1980. 5 regional strategy adopted a two-pronged approach, the first being concerned with directional, promotional and technical support for the development of effective and efficient health systems through primary health care (PHC) and the other with the further improvement of managerial capability to facilitate the realistic formulation, implementation and evaluation of health prograIlUlles. Evaluation is increasingly recognized as an effective entry point for
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lSee resolution WHA30.43, WHO Handbook of Resolutions and Decisions, Vol. II, 4th ed., 1981, page 1. 2Alma-Ata 1978: All" Series No. 1). Primary Health Care, WHO, Geneva, 1978 ("Health for
3Formu1ating Strategies for Health· for C.enev.'1, 1979 ("Health for All" Serles No.2). 4Sef' resolution WHA32. 30, WHO Handbook Vol. II, 4th ed., 1981, pages 2-3 •.
All
by
the
Year
2000,
WHO,
01
Resolutions and Decis ions,
5 See document WPR/RC31/1S, Annex 2, Rev.l.
WPR/RC32/S Annex 1 page 8
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...
the reorientation of heal til services and health-related Bctivi ties and for the stimulation of desirable changes in the health systems to facilitate achievement of health for all objectives and targets. The need for information to assess the effectiveness and impact of the various measures taken by Member States and WHO and to monitor the progress and efficiency with which these measures are carried out is also keenly felt at national and international 1evels. l Following the directive of the Executive Board in January 1980 to the Secretariat to provide a discussion paper on indicators for use in monitoring progress towards the goal of health for a11,2 a draft paper on the subject was prepared and subsequently distributed to all Member States of WHO. In the Western Pacific Region it was distributed to Member States in April 1980. As part of the regional strategy, indicators for the national and regional monitoring of strategy implementation were identified and the proposed list of indicators was approved by the Regional Committee at its thirty-first session after lengthy discussions on the subject. 3 It was noted that the Sub-Committee on the General Prolramrne of Work would consider the subject of indicators during 1981, taking into eonsideration the various comments of representatives, and would present its recommendations to the Regional Committee at its thirty-second session in 1981. I t was decided that, to facilitate a proper understanding of the situation and the study of health indicators, members of the Sub-Committee should visit a few Member States in the Western Pacific Region. This paper presents the report of the Sub-Committee and describes the objective of and approach to the country visits, the findings from these visits, and conclusions and recommendations for future activities. 2.
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COUNTRY VISITS
2.1
Objective
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The purpose of the visits was to review the relevance and status of the use/development of indicators at country level for the implementation, monitoring and evaluation of national strategies for health for all by the year 2000. Following the visits, the members were to prepare a report for consideration by the Regional Committee at its thirty-second session on the establishment of a set of priority indicators for monitoring progress towards health for all and on the main aspects and problems of information requirements at national level for the generation of the necessary indicatcrs.
IFormulating Stra tegies for Health Geneva. ("Health for All" Series No.2).
for
All by the Year 2000 J
WHO,
2See document EB6S/1980/REC/2, page 72. 3S ee document WPR/RC3l/1S, Annex 2, Rev.1, Ope cit., pages 31-34.
-..... 2.2 Approach (1)
WPR/RC32/5 Annex 1 pale 9
The report of the Sub-Committee was to cover the following aspects: What is the situation in countries with regard to the planning, monitoring and evaluation of health programmes in general and to the health for all strategy in particular? How do countries view the usefulness and role of indicators with regard to planning, monitoring and evaluation? What is the relevance and feasibility to countries of the proposed indicators for monitoring implementation of the health for all strategy at national level?l What is the countries' reaction to the 12 indicators proposed for use at globAl level, particularly their national relevance and feasibility?2 What are the problems with regard to the processing of data related to these indicators? generation and
(2) (3)
(4)
(5)
Since the role of indicators was to be reviewed in the context of overall managerial style and functions, guidelines were provided in the form of a questionnaire, appended hereto as Appendix 1. Indicators to be used in monitoring the implementation of the health for all strategy at country and regional levels had been approved by the Regional Committee at its thirty-first session. l Indicators for use at flobal level had been approved by the Executive Board in January 1981. These two sets of indicators were used by the members of the Sub-Committee during their visits. Appendix 2 gives the checklist used by the Sub-Committee members for ascertaining the feasibility of generating information on the proposed indicators. 2.3 Findings
Wi th regard to the plann ing, nloni tor ing and eva lua t ion 0 f hea 1 th programmes in general and the health for all strategy in particular, only one of the four countries had formulated a national strategy and specified targets to be achieved by the year 2000. In some of the countries, long-term national strategies may have existed though there was no explicit evidence or reference to that effect. Two countries had developed health plans with a specific time frame and one country had developed separately
lSee document WPR/RC3l/15, Annex 2, Rev.l. 2See document EB67/l3 subsequently revised, adopted by the World Health Assembly and issued as Global Strategy for Health for All by the Year 2000, WHO, Geneva, 1981 ("Health for AU'r" Series No.3).
WPR/RC32/5 Annex I page 10
an organizational structure and mechanism for the monitoring of plans and implementation of the strategy. Three countries had been using both a subjective and objective approach to the monitoring of health and health-related programmes. With regard to the views of countries on the role and usefulness of indicators, it was noted that all four countries used indicators for monitoring programme implementation. However, only two monitored all their programmes in this way, while the others monitored some programmes only. All four countries used health indicators for programme development and recognized the need for health indicators for monitoring and evaluation. However, one country considered indicators currently available in that country to be useful while the other three found that indicators currently available in their countries were marginally useful in measuring the success or otherwise of their health programmes. With regard to the monitoring of national strategy implementation, only one country had established indicators for that purpose, while another had plans to select and establish a set of priority indicators. One country believed that the present health statistics services could not provide relevant information correctly, completely and on time for the generation of needed indicators. The other three countries believed that they either provided such information, provided some information or generally provided such information. One country had plans to reorient its health statistics activities. Three countries considered the indicators proposed for use at country level to be relevant. 1 They also considered the 12 indicators proposed for global monitoring of health for all strategy implementation relevant and feasible for the annual provision of information to WHO. 2 One country did not respond to these questions. In all four countries, data needed for the indicators relevant for the monitoring of strategy implementation were available or could be generated. Measures for community participation in health services management, mechanisms for community involvement 1n the implementation strategy, connnunity resource allocation, the prOV1S1on of essential drugs, and an index of local resources in the production of essential drugs were the indicators which were considered by more than one country to be not obtainable. With regard to the feasibility of generating information, it was found that sources for mos t of the indicators belonged to the non-health sector. Thus, factors such as reliability, accuracy and timeliness were not necessarily determined or conditioned by the requirements of the health ministry or departments.
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lSee document WPR/RC31/l5, Annex 2, Rev.l 2See document EB67/13 subsequently revised, adopted ,by the World Health Assembly and issued as Global Strategy for Health for All by the Year 2000, WHO, Geneva, 1981 ("Health for All" Series No.3).
2.4 Conclusions and recommendations
WPR/RC32/5 Annex I page 11
As a result 01 the country visits and the discussions among members of the Sub-Committee, the following comments are presented: (1) Health programme development considerably among the countries. and management styles
tilt'
vary
(2)
A number of countries have no separate monitoring procedures or mechanisms for strategy implementation. Weak relationships exist between traditional health indicators and the management process they are intended to support, since health programmes have been reoriented and the focus of health activities has changed. Most of the countries have not monitoring strategy implementation. established indicators for
(3)
(4)
(5) (6)
Available indicators are generally of marginal use. There is recognition, however, of the need indicators for monitoring and evaluation. for health-related
(7)
Indicators proposed for monitoring at national level and approved by the Regional Committee at its thirty-first session are considered to be generally relevant, and the data for them are available or can be generated. l Sources of data for some of the. proposed indicators ministries/departments other than the health ministries. exist in
(8)
It is gratifying to see that an environment favourable to the development of more relevant and user-oriented indicators exists. and the time seems to be ripe to initiate more systematic approaches to the development of indicators to support programme development and management in the context of the health for all strategy. The members of the Sub-Committee noted that, in the Wes tern Pacific Region, development of health-related indicators has been a priority area. A regional seminar on indicators relevant to maternal and child health/family planning was held in Manila in December 1978, while, in collaboration with SEAMIC, a regional workshop on operational, performance and impact indicators relevant to community health was held in Kuala Lumpur' in February 1979. To facilitate provision of the right kind of information for various kinds of health workers or managers, health management information system development projects have been and are being implemented in a number of countries. A regional workshop on the national health information system was held in
lSee document WPR/RC31/IS, Annex 2, Rev.l
WPR/RC32/5 Annex I page 12 Kuala Lumpur in June 1980, at which health man~gement informa.ti.on system development methodology was discussed by pub11c health a~m1nlstrators, statisticians and information system analysts from 18 countr1es or areas. As a follow-up to this regional workshop, national workshops are being conducted in some Member States. The WHO/ESCAP Meeting on Mortality 10 Asia: A Review of Changing Trends and Patterns, 1950-1975, held in Manila in December 1980, reviewed the relevance and significance of various indicators and identified the need to develop new indicators in view of the rapid socioeconomic developments which have made some of the traditional indicators meaningless. The members also observed the new health management information system in Malaysia, which is being implemented on a national scale to support information needs for planning, management, evaluation and coordination functions at different echelons of the Ministry of Health. All these efforts have created an awareness among Member States of the role and usefulness of indicators in measuring the status and progress l of the health for all strategy. The momentum generated by various activities to promote the development and use of indicators for health programme development and management should be continued. It is therefore proposed that, ·in making its recommendations to Member States and to the Regional Director, the Regional Committee should take the following into consideration: (1)
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It should be regional strategy to specify and formulate health-related indicators as an integral part of the formulation and development of programmes which Qave specific objectives and targets at regional and national levels. Identification of indicators needed, data to be generated to provide the necessary indicators, efficient statistical procedures to generate the data, and effective ways of computing, analysing, storing and presenting information to health administrators at different echelons, should be considered in that context as programmes are developed.
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(2)
In view of the fact that the national health information systems in many developing countries are rarely adequate to generate many indicators with accuracy, Member States with limited information support facilities should begin with the provision of reliable data for a small nu~ber of basic and essential indicators relevant to each country rather than for complex indicators. At the meeting of the regional Working Group on Indicators for Monitoring and Evaluation of Strategy for Health for All by the Year 2000~ which is scheduled for early 1982, the current status of health indicators should be further reviewed, particul~rly with regard to their use, and a framework formulated for establishing a list· of priority indicators relevant to the country context and for assessing appropriate data generation and data processing procedures for the indicators established so that
(3)
(4)
WPR/RC32/5 Annex 1 page 13 /14
they may serve as operational and managerial tools to monitor and evaluate nat ional health programmes. Members of' this Working Croup should include health planners and managers with experience in health services operations. countries of information and experience among Exchanges concerning the development of indicators, efficient procedures for their generation and their effective utilization should be promoted. To facilitate the prepare, uS1ng the health management guideline for the be followed in the use of indicators, the Regional Office should experience of Malaysia in the development of a information system as an example, a broad use of Member States, outlining the methods to development and use of health indicators.
(5)
(6)
Collaboration in training activities, as a follow-up to the regional working group and other developmental activities in this area, should be further strengthened. In view of the multiplicity of factors affecting health and the importance of the intersectoral approach to the attainment of the health for all goal, efforts should be. made to develop and refine policy indicators, including health services effectiveness and efficiency indicators, and indicators related to measures of community involvement, community resources allocation and intersectoral coordination for health. Because of difficulties in understanding the significance of socioeconomic indicators in health activities, there is a need' to make a detailed assessment of such indicators, including indicators of community development, with regard to their relationship to health improvement. Detailed investigations are needed to evolve indicators of health services efficiency and effectiveness, and it is desirable to seek the guidance of the Western Pacific Advisory Committee on Medical Research (WPACMR) 1n order to identify appropriate health services research activities that have to be undertaken in Member States for that purpose, 1n collaboration with WHO collaborating centres and health or medical research institutions. Such activities should include the development of procedures and techniques for the generation and use of such indicators.
(7)
WPR/RC32/5 Annex 1 page 15 APPENDIX 1 GUIDELINES USED BY MEMBERS OF THE SUB-COMMITTEE ON THE GENERAL PROGRAMME OF WORK FOR THE REVIEW OF-INDICATORS 1.
Has the country formulated health/2000?
B
national strategy for the achievement of
---Yes
___,No
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2.
If yes, has the country specified targets to be achieved by the year 2000 in the health sector?
---Yes 3.
_ _...:No
In the context of health/2000 or as a routine procedure, have health plans with a specific time frame been developed? A health plan is one with specific objectives and related targets.
---Yes 4.
___ No been developed
Have an organizational structure and a mechanism separately for implementation of the strategy?
---Yes 5.
---No implementation of the ___No
. If yes, is there a monitoring mechanism for health plans?
---Yes 6.
How is the monitoring of health and health-related programmes done? (tick one) Subjective/judgement Objective: Normative (against set standards) Comparative (spatial or temporal)
7.
Are any health indicators used for monitoring programme implementation?
---Yes 8. If yes, 1S
___No
it for (tick one)
all programmes? some programmes only? (If for some programmes, specify the programmes)
WPR/RC32/5 Annex 1 (Appendix 1) page 16
9.
Are health indicators used for programme development J either in the situational analysis undertaken as the initial step of plan preparation, or in the evaluation of programmes?
---Yes 10. / / Very useful
---No
How useful are the available indicators for monitoring/evaluation of programmes? (tick one)
/ / Marginally useful / / Not useful 11.
No of the national
If marginally or not useful, is there recognition of the need for health indicators for monitoring/evaluation?
---Yes 12.
Have indicators for monitoring implementation strategy for health/2000 been established?
---Yes l3.
---No
If not, is it intended to select and establish a set of priority indicators for monitoring or evaluating the.health/2000 strategy?
---Yes 14.
---No
Can the present health statistics services provide information correctly, completely and on time for the generation of needed indicators?
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---Yes 15. If not,
---No in
is it intended to reorient health statistics activities the country? Yes
---No
16.
/'Members of the Sub -Commi t tee were provided with a list of the Indicators which could be considered for use at country level as approved by the Regional Committee at its thirty-,!irst session,l in order to ask the questions below for each indicator~/ Is this relevant to the country?
16.1
---Yes
---No
lSee document WPR/RC3l/lS, Annex 2, Rev.l.
WPR/RC32/5 Annex 1 (Appendix 1) page 17 /18 16.2 Can relevant data indicator? Please (see Appendix 2) be generated and processed tick appropriate column to provide this 1n checklis t
16.3
What are the problems?
17.
/Members of the Sub-Committee were provided with a list of indicators for use at global level as approved by the Executive Board in January 1981,1 in order to ask the questions below~ Are these 12 indicators relevant to the country?
17.1
---Yes 17.2
---No ---No
Is it feasible to provide information on these 12 global indicators annually to WHO?
---Yes 17.3
If not, what are the problems?
lSee document EB67/13 subsequently revised, adopted by the World Health Assembly and issued as Global Strategy for Health for All for the Year 2000, WHO, Geneva, 1981 ("Health for All" Series No.3).
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CHECKLIST TO ASCERTAIN FEASIBILITY OF GENERATING INFORMATION SOURCES:
v-
Vital registration C - Population census S - Household sample Surveys -rou tine P - Prevalence surveys - ad hoc H - Health services data routine returns E - Epidemiological surveillance Available now Not available but can be obtained
D Disease register OE Otbers/economic sector OA - Others/agriculture sector
oc - Others/community development 00 - Others (To specify) Sources V
No.
INDICATOR Description
C
S
P
H
E
D
OE
OA
DC
00
1.
Not obtainable
GNP per capita Calorie consumption per capita Population growth Life expectancy at birth Infant mortality Maternal morra1ity \\'eight at birth New born infants with a birth weight of at least 2500 grams -----
2. 3.
4. 5. 6.
~ H N
§ ><
'"d
'g ~ ~ (D ....
QQ::S"" \0 i-' W
(D .....
("l x ""
N ..... \Jl
7. 7.1
No. 8. 9.
INDICATOR Description Incidence and prevalence of communicable diseases Incidence and prevalence of chronic degenerative diseases Anthropometric measurements (height and weight development in children) Percentage of children with weight for age that corresponds to standards Health services coverage and accessibility Provision of essential drugs Measures of community resource allocation for health action Resources are equitably distributed Measures of community participation in the management of health services
Available now
Not available but can be obtained
Sources V C
1~& D
S
P
l'
E
OE
OA
OC
00
Not obtainable
0111''''' no It __ o~
"" N IoC Cl
.... N
~ >Ut
~ I I
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10.
10.1
~ 1. ~2.
I
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I I I I
13.
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No. 14.1
INDICATOR Description Mechanisms for involving peopie in the implementation of strategies have been formed or strengthened and are actually functioning Index of the resources in of essential construction facilities use of local the production drugs and of health
Available now
Not available but can be obtained
Sources V C
S
P
H
E
D
OE
OA
OC
00
•
Not obtainable
15.
16.
Establishment of intersectoral coordination councils Mechanisms for developing national health/2000 policies, strategies and plans of action, i.e. , national health councils, national health development centres/networks Health for all has received endors~ment as policy at the highest official level Indices of adequacy and distribution of health manpower
17.
OQ CD ::.
17.1
a ___ 'gl~ ~ ~
N
~
;>:l
I- ,-...,.)
~
"" >\J'
18.
~
--
No.
INDICATOR Description Budgetary allocation to health sector in absolute and relative terms A reasonable percentage of the health budget is expended on local health care Proportion of GNP for health At least 5% of the gross national product is spent on health Coverage with immunization Pregnant mothers covered with minimal antenatal care Coverage with safe water supply Coverage with sanitary latrines Proportion of health expenditure transferred to support strategies for health for all in developing countries Adult literacy rate
Available now
Not available but can be obtained
V
C
S
P
H
Sources E D
OE
OA
OC
00
Not obtainable
~;~ ~ (JOt::! ;:::: (ti~ ? N
N n Nj-W
19.
ii:;; .! I~
19.1
::-:
f::'
20. 20.1
2l. 22.
23. 24. 25.
26.
-
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-
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.,
,
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WPR/RC32/5 page 23
ANNEX 2 PRELIMINARY REVH~W Ufo' ACTlV 1TlES AT COUNTRY LEVEL lU:LA'J'lNG TO THE INTERNATIUNAL DRINKING-WATER SUPPLY AND SANITATION DECADE
Visits were made by members of the Sub-Committee of the Regional Committee on the General Programme of Work to Australia, Malaysia, Republic of Korea and Singapore in order to review current plans and programmes in the area of drinking-water supply and sanitation. Reports of the country visits are summarized in the following paragraphs. Australia The visiting team reported that the provision of urban water supply and sanitation in Australia is at a high level, but that the level of rural services is variable because of the large and sparsely developed interior. Under the federal system, local authorities have primary responsibility for the provision of urban and rural services. Since provinces were l not visited. only a federal review was possible from data and information gathered. It was reported that national legislation and sector development plans for water supply and sanitation services are adequate. Manpower resources for the sector, including maintenance and repair services in support of facilities. are meeting existing demands in urban areas. Service coverage in cities and towns is almost complete. However, it was found that rural services are in need of improved support. The extent of rural service coverage. which could not be determined on a national basis, varies according to locality and climatic conditions. The major constraint in rural areas is financial support for local authorities. Another constraint is the shortage of water sources in the dry interior. The estimated cost of improving rural coverage in drinking-water and sanitation was not available at the federal level since this information remains with local and state authorities. However, it was reported that the Decade goals for the rural areas can be reached by 1990 and that complete coverage can be attained. Malaysia Members of the visiting team reported optimistically on the Malaysia Decade programme for drinking-water supply and sanitat~on. A national policy has been formulated and a national plan of activities developed providing for strong national commitments in the way of financial support. The national assessment report indicated a high level of urban coverage with respect to drinking-water and sanitation. However, rural sanitation is in need of further development since more than 20% of the population still dispose of excreta indiscriminately.
...
A number of steering committees, on which the National Economic Planning Unit, Minis try of Housing and Local Government. Public Works Department and the Environmental Health and Engineering Unit of the Minis try of Health are represented. have been formed to cover the entire sector.
WPR/RC32/S Annex 2 page 24
Current planning efforts An' focused on a national water resources study Bnd the dew·lopment of a national rural water supply plan. National legislation and s('ctor policy appear to be adequate. The principal COns traints are related to financial support, the construction of urban sewerage systems, the high rates charged for serv~ces, and manpower resources development. There is also need for greater community participation in rural schemes and health education programmes in general. The level of service provided for the maintenance and repair of existing infrastructures is in need of improvement. A national plan of action has been formulated providing for a total commitment under the Fourth Malaysian Plan (1981-1985) of more than M$1.4 billion for urban and provincial water systems. Urban and rural sanitation schemes under the Ministry of Health are scheduled to receive more than M$20S million during the same period. The plan provides for maintenance and repair 'support, and for health education and community participation activities. Under this national plan, it is anticipated that the Decade drinking-water supply and sanitation goals can be reached by 1990. Over the years, WHO has cooperated effectively in the Government programme for basic sanitation measures with respect to programme development, participation in training and implementation of field level activities. A sanitary engineer is currently assigned to cooperate with the Minis try of Health and Department of Public Works in the national Decade programme. Consultants are being provided through the Western Pacific Regional Centre for the Promotion of Environmental Planning and Applied Studies, who will offer specialize,d expertise ~n, among other things, the development of a programme for the monitoring and surveillance of drinking-water supplies. This WHO contribution is appreciated by the Government. Republic of Korea The visiting team reported that a policy has been developed at national level with respect to water supply and sanitation. A sector plan and programme have been developed and national budgetary support for the implementation of water supply and sanitation schemes has improved. Urban water supply provides a high level of coverage but rural water supply is inadequate. There is little provision for sanitation in either urban or rural areas. The institutional structure for the sector ~s fragmented among the construction, health, home affairs and environment agencies. However, sectoral activities have been defined and are being coordinated, as ~s indicated by the volume of financial commitments to the sector by the various agencies concerned. The visiting team reported on the need to strengthen the sector programme with a greater input of financial support and the development of adequate manpower resources, particularly for operat ~on, maintenance and repair. In addition, there is a need for greater community involvement ~n sector development, supported by a health education programme.
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WPR/RC32/5 Annex 2 page 25/26
Although good progress has been made. particularly as regards urban and rural water supply, much remainR to be done if the goals 01 tht, International Drinking-Water Supply and Sanitation Decade are to be achieved. Greater eftorts are needed in the urban and rural sanitation programme to increase the services provided and to protect and preserve environmental quality. WHO has cooperated with the Government in the national programme for the prOV1Slon of basic sanitation and rural water supply. These collaborative efforts have been particularly effective in the rural water supply programme, which has also been supported by the World Food Programme. WHO has also cooperated in the preparation of an updated sector report, which will identify programme areas for further action by the Government. An engineer in water pollution control 1S currently assigned by WHO. An increasing number of activities are being undertaken with respect ~o the design and construction of nightsoil treatment facilities, and WHO cooperation has been provided in this programme area. Singapore The visiting team reported on a very high level of water and sanitation services. This country, with a population of 2.4 million, is almost entirely urbanized, water and sanitation services being provided respectively by the Public Utilities Board and the Ministry of Environment. The institutional structures appear to be well developed and are self-supporting. National plans are geared to achieving the goals of the International Drinking-Water Supply and Sanitation Decade •
...
WPR/RC32/5
....
Annex 2 page 27
APPENDIX 1 COUNTRY VISIT SUB-COMMITTEE ON THE GENERAL PROGRAMME OF WORK INTERNATIONAL DRINKING~WATER
SUPPLY AND SANITATION DECADE
Issues for review during country visits
COUNTRY VISITED~ DATE VISITED~ 1. NATIONAL POLICY Is there a national policy regarding water supply and sanitation? Yes / / No / /
2.
NATIONAL PLAN AND PROGRAMME Is there a national plan and programme in water supply and sanitation? Yes / / No / /
3.
RAPID ASSESSMENT REPORT Has a rapid assessment report been ~repared?
Yes
/ /
No
/ /
4.
PRESENT SITUATION What is the present coverage for services (percentage)? Coverage of population(%) Population Water Sanitation Areas Urban Rural
All 5. ORGANIZATION AND ADMINISTRATION Who is responsible for the development of the water supply and sanitation sector? (health, public works, national economic planning, etc.) Areas Urban Rural Water Sanitation
WI'R/RC32/5 Annex 2 (Appendix 1) page 28
'""
6.
NATIONAL ACTION COMMITTEE IInH R
Ilul iOIJ[I
1 (Iclion
COllllllill.'.·
1.('('1\
tOrIllI'd'(
Who are represented?
7.
Has any action been taken in connexion with the achievement of the I.DWSSD goal? If yes, list major and significant activities
Ye~
1 /
No
/ /
-
8.
SECTOR CONSTRAINTS What are the major contraints to sector development? (a) (b)
Need for adequate legislation (political will and policy) Development of a national plan (strategy and progrannne) Undue priority to urban services Lack of financial support (national/ external resources) Inadequate manpower (national/local) Need for greater connnunity participation (interest/incentive) Inadequate health education progrannne (for public awareness) Inadequate maintenance/operation/repair of existing system Need for appropriate technology (low cost, etc.)
Yes Yes Yes
/ / / /
No No No
l7 / / / /
(c) (d)
1 I
Yes Yes Yes Yes Yes Yes
1-1 1 /
No No No No No No
/ /
(e) (f)
1 /
1/ / /
1-1 1 / / I
(g)
(h) (i)
I / 1 /
I /
WPR/RC32/5 Annex 2 (Appendix 1) page 29
(j) Lack of sector information (for p 1 a n II i Illl) i TIl pI eme n tat i () Jl
Yes
/ /
No
17
(k) Other constraints: 9. NATIONAL PLAN OF ACTION Has a national plan of action been formulated? If yes, are the following elements included for action: (a)
Yes
/7
No
/ /
National legislation National plan preparation Manpower development Funding for construction of water supply and sanitation
Yes Yes Yes
/ / No / / / / No
/ / / /
(b) (c) (d)
No: / /
Fund commi tmen t Urban water Urban sanitation Rural water Rural sanitation (e) (f)
US $._ _ _ __ U5$._ _ _ _ __ US $._ _ _ _ __ US $._ _ _ _ __ Yes Yes Yes Yes / / No No No No / / / / / / / /
Support for operation/maintenance/repair Health education and community participation Sector information system development Programme monitoring and evaluation
I / / / / /
(g)
(h)
10.
DECADE GOAL ATTAINMENT Is it feasible to attain the goals of safe drinking water and adequate sanitation for all by 1990? If not, give reasons;
Yes
/ /
No
/ /
WPR/RC32/5 Annex 2 (Appendix 1) page 30
.. .... Yes / / No / /
Can goals be reached by the year 2000? If yes, how?
....
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