WORLD HEALTH ORGANIZATION
ORGANISATION MONDIALE • DE LA SANTE
REGIONAL OFFICE FOR THE WIITERN PACIFIC BUREAU .. 'OIONAL OU PACIFIQUE OCCIDINTAL
REGIONAL COMMITTEE
Thirtieth session Singapore 2-8 October 1979 Supplementary agenda item 1
WPR/RC30/25 2 August 1979 ORIGINAL: ENGLISH
SEVENTH GENERAL PROGRAMME OF WORK COVERING A SPECIFIC PERIOD (1984-1989): PRELIMINARY REVIEW OF NATURE, OBJECTIVES, STRUCTURE AND METHOD OF PREPARATION
•
WORLD HEALTH .ORGANIZATION ORGANISATION MONDIALE DE LA SANT~
.000/79.1
OUTLINE OF SEVENTH GENERAL PROGRAMME OF WORK COVERING A SPECIFIC PERIOD (1984 - 1989)
Discussion Paper
List of contents
Page
I.
NATURE OF PROGRAMME
............................
2
II.
STRUCTURE. OF PROGRAMME •••. ; . . . . . . . . . . . . . . . . . .
3
III. METHOD OF PREPARATION OF PROGRAMME
6
IV.
STRUCTURE OF DOCUMENT
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,
.. .
8
v. VI.
CLASSIFIED LIST OF PROGRAMMES
13
ILLqSTRATIVE EXAMPLES OF INTERACTION BETWEEN HEALTH SYSTEMS AND H~LTH TECHNOLOGY PROGRAMMES •..•.•.•.•.....•..•.•....•.•... '.'
22
VII.
IMPLICATIONS OF PROGRAMME STRUCTURE FOR ORGANIZATIONAL STRUCTURE •..•.•..•• .•.•.. •••
31
ANNEX 1
TIMETABLE FOR PREPARATION OF SEVENTH GENERAL PROGRAMME OF WORK AND FOR FORMULATING STRATEGIES FOR HEALTH FOR
ALTJ ..•.••••.•••••••.••••••• '.' • • • •• • • • •
32
Geneva, June 1979
000/79.1 Pale· 2
I.
NATURE OF PROGRAMME "
L
The objectives of the Seventh General Programme of Work
will focus on the long-term goal of the attainment by all the citizens of the wor.1d by the year 2000 of a level of health that will permit them to lead a socially and economic.lly productive life. The Seventh General Programme of Work will
be the first of three General Programmes of Work of WHO until the target date of the year 2000. The targets for the
Seventh General Programme of Work will therefore be intermediate targets for the period 1984 to 1989 in relation to the longterm targets for the year 2000. The Programme will constitute
WHO's support to the national, regional and global strategies for attaining health for all by the year 2000. It will
therefore represent the Organization's response to the individual and collective needs of its Member Stat·es, in connection with the implementation of the strategies for health for all.
2.
The Programme will thus consist cif priority. issues for
WHO action, and the broad lines for su·ch action, iothe health sector, as well as in other sectors concerned as far as WHO can have an influence anthem,. to promote, coordi:nate and support efforts by the countries of the world individually and collectively to attain the goal of health for all. It will therefore
aim at supporting countries individually and collectively to refine and implement their strategies for health for all and to evaluate progress towards the attainment of this goal. To
this end objectives and targets will be defined for .each of the priority issues included in the Programme. Particular emphasis
will be laid on supporting developing countries, but the needs of developed countries will also be taken fully into account.
... II• STRUCTURE OF PROGRAMMB
IklO/79.1 Page :3
3.
The Declaration of AlIDa Ataclearly stated thatpr1JDary 1
,
health care, based on appropriate technology', is th!3 key to attaining the1;arget of health for all by the year 2000. The Declaration calls on all governments to launch and sustain primary health care as part of a comprehensive national 2 ' health system and in coordination with other sectors. The Seventh General Programme of Work will theJ'efore' be structured in such a way as to support the strengthening of health'systems for the delivery of health programmes that make use of' " appropriate technology.
"Technology" and "Appropriate Health Technology" are used in the sense ascribed to them in the Alma Ata Report on Primary Health Care, namely: "Technology - an association of methods, techniques and equipment together with the people using them; . Appropriate Health Technology - technology that is scienfically sound, adapted to local needs, acceptable to those who apply it and to those for whom it is used, and can be maintained by the people themselves in keeping with the principle of self-reliance, with resources the community and the country can afford." A Health System implies ,services, institutions and ~ctivities in the health and other relevant seCtors and th:e people planning, operating and using them, interacting to deliver health programmes .at various levels. The first of these levels is'the point of contact between individuals and the system, where primary health care is delivered. The various intermediate levels as. well as .', the central level provide support, and special ized servioes which become. more complex as .they become more central. (Based on the Alma,Ata Report and document A32/8 "Formulating Strategies for Health for All by the Year 2000"). 2
1
-
.
000/79.1 Page 4 4. Three broad categories of interrelated programmes will
form. the budy of the Programme, namely health systems programmes, heal th technology programmes and promotional an.d support programmes. Health systems programmes will deal with the
absorption and application of appropriate technologies within health systems, with the establishment and progressive strengthening of these systems, and with the related health systems research. Health technology programmes will deal with These
technologies for delivery by the health system.
programmes will thus concentrate on identifying technologies that are already appropriate for delivery by the health system, with the research required to adapt or develop technologies that are not yet appropriate for delivery, and with the transfer of appropriate technologies. Appropriate technology for health
will thus be an integral part of every programme, including the health' systems programmes, and will not appear as a separate programme. Promotional and support programmes will deal with
..
political, social,. scientific, technical, managerial, informational, financial and administrative promotion of and sU'P'Port to strategies for health for all.
5.
Further details concerning these three categories of
programme are to be found in Section V of this paper .
.... 6, The Sixth General Programme of Work defines an approach as a means expressed in broad terms for attaining an objective. Two broad aspects of such. approaches by WHO will be emphasized in the Seventh, namely coordination, including ensuring the availability of valid. information on health programmes and systems; and technical cooperation with countries individually and collectively, including ensuring the use of valid information.
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The mutual support of these two aspects will be indicated for every programme wherever applicable.
7.
The Seventh Programme will lead to the building up of
global programmes as national and regional variations on universal themes. This implies intercountry and regional
programmes that reflect countries' priority needs, interregional programmes that reflect the collective priority needs of a number of Regions, and global promotion and coordi-
..
nation of these regional and interregional programmes. "top to bottom" and "bottom to top" approaches will be combined.
The
Thus, global policies and principles will promote These will give
regional and national programme developments.
rise to programme activities at national and regional levels, and will in turn influence the global policies and principles.
DGO/79, Pa~e 6
1
. Const1tutio~,
III.
METHOD OF PREPARATION OF PROGRAMME
8.
It is recalled that, by Article 28 of the
it is the function of the Executive Board to submit the General Programme of Work to the World Health Assembly for consideration and approval. objectives, structure and First, the nature, general of preparation of the
met~od
Programme will be decided by the Executive Board, following proposals made to it by its Programme Committee.
9.
Consultations will take place with Member States as part
of a continuing process of consultation with respect to the strategies for health for all, the Seventh General Programme of Work, the development of medium-term programmes, the prosramme budseting of WHO's resources at the country level, particularly for the biennium 1982/83, and the study of WHO's structures in the light of its functions. This is in keeping
with the new programme budgeting process of arriving at general indications of priorities well before the operational period, more precise decisions about activities being taken at the start of the operational period. Countries will be
encouraged to undertake and sustain a ,well-balanced national health development proce~s
to promote and support such develop('~anagerial
ment in accordance with Resolution WHA31.43
Processes for Health Development") and as part of the formulation of strategies for health for all. Such a process will, inter
alia" generate information on the priC!lrity needs of the country. This information will be used for all WHO's programme development processes, including the preparation of the Seventh General Programme of Work.
fist"". Page 7 10.
1
The reorientation ot strategies to attain health for all,
and of WHO's support to these strategies, will require above all total COllmi'tment and supreme motivation on the part of WHO and its Member States. To enlist this commitment dialogues will To generate
take place at the highest policy-making level.
the motivation, seminars and workshops will be organized for national and WHO staff at the operational levels to acquaint them with the strategies and with the action to be pursued to develop, implement, and support them.
-
11.
Draft material prepared in the light of the needs of
Member States with respect to national and regional strategies for health for all, will be submitted by the Regional Committees to the Programme Committee of the Executive Board, following whose proposals the .Board will prepare the draft Programme and wi 11 submit i t to the World Health Assembly. This draft
Programme 't?O will be prepared in the light of the global strategy for health for all. In all these activities the governing
bodies will be closely supported by the Secretariat at the appropriate level - Programme Coordinators in countries" Regional Programme Committees, the Headquarters Programme COIIimittee and the Global Programme Committee, making use of the recently established Programme Development Working Group as necessary. 12. Annex 1 provides further details of ,the timetable for the
.preparation of the Seventh General Programme of Work and shows its relationShip with the timetable for formulating strategies for health for all.
DGO/79.l Page 8
..
IV.
STBUCTURE OF DOCUMENT
13.
The $tructureof the Sixth General Progl"lmIIIe of Work
document will be retained as far as poss.ible to ensure continuity and acceptance. but will be mo.ified as necessary in :the light of developments subsequent to the preparation of that Programme.
Chapter 1:
Introdu.c t ion t~)It.
This will consist of, the usUal
ef illtrotluction for
a General PrograDDDe of Work, citing the censt1tutional and other policy bases.
Chapter 2:
Progress review of implementation of Sixth General Programme" of .W~rk
-
This will consist of abroad assessment of progress made with the implementation of the Sixth General Programme of Work, the way and .extent to which governments are usial it, and the lessons to be drawn for the Seventh.
Chapter 3:
Strateliesforhealth for all
This chapter will pravide a summary of the global strategy for health for all. chapters as follows: 3:1
It w111 be
sub-div.~ed , ';e
into three sub-
----------
!o!.l~ !!.e!.l!h_s!'t~a!.i2.n_i!!!.ela!i2.n_t2. !.o!.l~ ~o.£i~ economic situation;
This sub-chapter,w111 be. based on the Sixth World
-
Health Situation Report, but it can already be stated that in addition to the material that it will be possible to glean from this report, there will be a nee4 for a succinct analysis relating the world health situatien to the world socia1 and economic situation.
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This sub-chapter will consist of a description of the philosophy underlying the goal of health for all by the year 2000 and review of the targets and approaches being adopted to give effect to this philosophy.
This sub-chapter win indicate the nature of the .health reforms required to attain health for all by the
-
year 2000.
Chapter 4:
Priority issues for the Seventh General Programme of Work
This chapter will indicate the priority issues and the general targets for WHO for the period 1984:~9 inclusive, in support of the implementation of the strategies for health for alL It will stress ways of ensuring that the health reforms
inciuded in sub-chapter 3.3 are, in fact, introduced.
Chapter 5:
Rolesjfunctions, processes and structures of WHO rol~s
This chapter will start by stressing the particular
and functions of WHO during the period 1984-1989 in support of national, regional and global strategies for health for all. The analysis of this chapter should lead to the identificatton for each programme at each policy and operational level of the approaches to be employed in fulfilment of WHO's coordinating and technical cooperation roles, as weil as their mutually supportive infiuence. The chapter will also indicate the implications of the
...
implementation of the Seventh General Programme of Work for the way in which WHO will have to work, namely the processes it applies, its structures, the nature of these structures and
000/79.1 Page 10
. This part of the
the interrelationships between them.
chapter will 'be based on the results of the study of WHO's structures in the light of its functions.
ChapterS :
General Programme framework
These will be based on chapter S of the Sixth General Programme of Work, with the additions necessary to incorporate the concept of WHO's support to strategies for health for all.
...
The criteria
included in chapter 8 of the Sixth
General Programme of Work will be updated in the light of the, programme budget policy and strategy adopted following resolution WHA29.48 and the newer requirements in connection with the stra tegles for health for all. It will thus be
necessary to add criteria relating to such matters as social relevance, the promotion of country-wide health programmes, preference to the underserved, and TCDC. as well as criteria relating to the. quality of life.
..
The approaches included in chapter 7 of the Sixth General Programme of Work remain valid. However, many
add it 16nal WHO approaches, that have since been adopted or pr:oposed would have to be added. These include inter-
national political action for health, support to technical cooppration among developing countries, the ~timulation
of
action by other social arid economic sectors, coordination of the channelling and use ot external resources for health, support to national health advisory councils, regional and global health development advisory councils, greater employment of nationals in 1he work of WHO within their
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000/79.1
P¥e, .11
Q~
countries
aq~
at regional and global levels,
EJt;'j;ijblishment Cif regional networks of national centres for health development, broadening the scope of advisory panels to include relevant areas outside the health
sector such as the mass media, making more use of nongovernmental organizations, ensuring the availability of ~
information on heal th technolocy and systems·,
and fostering the proper use of such information.
,..
6.4
This will consist ofa list of programmes, classified under th.e three broad categories of health systems pr~graimnes. health teehnologyprogrammes and promotional and support programmes. These catecories of programmes will have the broad functions outlined above. under Section II "Structure of Programme" , paragraph 4.·
For each programme, targets will either be listed, if these can aiready be defined 1n the light of the strategies for he.alth for all, or ways of arriving at them will be indicated, starting from countries and working through regional and global levels, or by dir.ect political decision of the Regional Committees or Health Assembly. The appropriate mutually supportive coordinating and technical cooperation approaches will be indicated. detailed. activities will not be included; deferred to the m~dium-tet'1D
More
they will be
programmes based on the
Seventh General Programme of Work.
In Section V of this paper further details are provided of the proposed classified list of programmes. It is stressed that governments Should use their own health development programme structures that best respond to their particular situations and should in no way feelobiUced
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.. At the same
to introduce WHO's programme structure.
time, WHO's programme structure should be derived from the substance of the programmes to be delivered, and this substance should be derived from national needs for health development. WHO's programme structure should
thus reflect the priority needs of the vast majority
~, t~. ~'.be~ st~1'~' Chapter 7: Monitoring, control and evaluation I
WHO's provisional guidelines for health programme evaluation will be the basis for evaluating the Seventh Gent:lral Programme. These guidelines will be adapted as necessary for the evaluation of the strategies for health for all, including appropriate health and related socio-economic indicators. The evaluation
of the attainment of stated objectives will include an assessment of the incorpOration of appropr.iate technology in technology programmes and the integratic.n of these prograJUles into health systems programmes.
Chapter 8: Appendix 1:
Appendices The Programme Classificat.ion Structurr:-
. of the Organization's
This will be used for all aspects
activities, including supPort to strategies for health for all, general progra~e
of work, medium-term programmes, programme
budgets and the related planning and evaluation processes and information support. The Programme ClaSsification Structure will
ultiJiuitely be derived from the substance of the programme to be delivered, and these in turn will be derived from national needs for health development. .
The first classified list of programmes ,
wi). I, thus evolve in a flexible manner into a final Programme Classification Structure· in the light of progressive reviews of drafts of the proposed Seventh. General Programme of Work in the Regional Committees, Executive Board and Health Assembly. Appendix 2.: 1 .
Glossary of TermR
Document HPC/oPE/7S.1
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DGO/79.1 Page 13
V.
CLASSIFIED LIST OF PROGRAMMES
14.
Objectives, tentative targets
and approaches will be
i>resented for each of the programmes in the General Programme tlf Work. These programmes will be classified within a However, the whole
Programme ClaSSification Structure.
eoncept of grouping a. variety of programmes under major programmes may have to be reconsidered. Such sub-divisions
may be forcing countries unduly to think in terms of groupings of programmes that are more convenient for WHO Headquarters than for them. Countries probably have to think more in
terms of the development of their comprehensive health system and the integration of technical programmes into it. This implies the need for much greater flexibility, starting with the smaller building blocks of programmes rathl"!r than major programmes grouping a number of programmes under them.
15.
In order to provide sound support to countries it is
necessary to appreciate how health systems are df!veloped. The most valid available information on health status and on existing provisions tor health care has to be marshalled. Account has to be taken of the influence of health policies on shaping health systems. The translation of policies into
programmes, for example through country health programming, taking into account relevant factors from sectors other than the health sector, also shapes the health system. Likewise,
various types of legislation, as well as economic factors and the methods of financing the health service, will have-their effect. So will other social and administrative factors,
such as the distribution of responsibility for the delivery
D(JO /19. I
Page 14
.. ~ystems,
of health care between the government, social security
industrial enterprises, public, and in some countries private institutions, whether for the purpose of profit-making or not;
16.
One of the greatest impediments to the develoPment of
comprehensive health systems is the implementation of various programmes as separate entities. It is socially, technically
•
and economically unsound to attempt to deliver health programmes in isolation from one another. For effective delivery, these ."
programmes have to be integrated into the health system at various levels, and through various institutions, some of which in some countries are run by different administrations. But before attempting to integrate these programmes into the general health system there is a need to decide for each one of them what technologies are really usefUl and can be afforded, and how best to apply th0m. Likewise, it is necessary to
decide what technologies ar0 requirf'r1 but are in ne0d of further development before they are applied.
... 17. In addition to dealing with the policy, legislativ~.
social, economic and administrative factors mentioned above, a useful process for developing a comprehensive health system in a country is to analyze information on the state of health of the population, on the human environment, and on available provisions for health care. This helps to decide on The next
priority programmes with specified objectives.
steps are to gather information from each of these programmes on technologies that ought to be delivered by the general health system, and then to organize those technologies that are acceptable within the different levels of the health system infrastructure as required. This infrastructure is
-
..
...
DG0/79.1 Page 15
buU t up progressively from primary health care, training the most·appropriate personnelaccordlngly. timet ... the proce~s,
At the same'
includes identifyinC
technologies~hat
are not yet suitable for application, and either adapting them in collaboration with the proiramme personnelcQn~erned
il~tl1 ilheyare s~it,Dl~j ot indicating the need for new technologies and setting in .motion the research required. to ' develop them.
18.
The detailed planning and .ana.eaent of' the~heal th ..
system thus consists of defining the technical bases for the system as outlined above, updating the .introductton .of more appropriate technologies as' they become available and feaSible, health manpower planning and. training of, staf,! as necessary, establishing the necessary physioal facilities, ensuring. the financial resources required, and org.hiz~ng
the whole into a viable technioaland managerial system. This includes the dettni tion of the levels of the systelD and its oontent at eaoh level, and ..the estabUshmen.t of the. mechanisms required at the looal, intermediate and central levels to ensure coordination between the various institu.tions and the various levels involved, as social and economic sectors. ~ll
as with other related
19.
WHO's general programme
o~ w~rkshould be of use'to
countries in Support of the develop!llent by them of their health systems, whether through a process, sUohas that outlined above. which should be inherent in the country health programming
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process. or through some other'process havinC a similar purpose.
It is in this perspective that the progralllBes in This classified 11st.is·
the classf·ied list should be seen.
not in 1.tgelf an expression of absolute priorities for the Organiza tion . It is su• •ted that the priority 8ctivi ties of the'
OrpnizationwiU result from careful ,analysis with coun.tries of their 'needs in supplrt ofthei!, strategies ,for health for aU by 'the year 2000, translating these needs into WHO's respona:e Jnder each of the WHO
presr_s
cOncerned;
and
fromcareful\definition of the approaches to be· used for each procrammet with a view to ensuring that all. programmes do in fact support· the progressive development of comp.rehensive health sys'tems by countries, lIWlking use of "the .list of approachestha"t fol'll part oftbe Seventh General Programme of Work. (See chapter 7 of the Sixth General Prog~
of Work
and sub-chapter 6 .3 of the proposed outline for the Seventh). The pro~r
application of the criteria that form partof.the
Programme (See chapter 8 of the Sixth Ge.neral Progra.me of Work and sub-cbapter 6.2 of theproplsed outline for the Seventb) should go far to detel'lline the ulti. .te priority activities of the Organizatbm, particul.arly du-ring the .~
...
. prog~ing
sequential:!y linked .processes of 1IIedium-term programme budgeting.
and
20.
'!'he foUowtncfraaework for the 11.t·of progJ:aIRleS
reflects a .1fe,neralized model of public healthsysteWls, organized in such a way as to support the development of
COWIPrehensive health systems in the manner outlined in paragt:aphs 14 to 19 above:
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21.
Framework for classified list of pro,ramllies
A.
HEALTH SVSTEMSPROGRAMMES
Heal th systems programmes will deal with the absorption and application of appropriate technologies within health systems. wi th the establ ishmEmt and prolressi ve strengthening of these systems. and with the related health systems research. They aim at establishing comprehensive health systems based
...
on primary health oare and the related political and social reforms.
Development of comprehensive
hea~th
systems will comprise:
- Health situation and trend analysis, epidemiological surveillance of both communicable and non-communicable diseases and of environmental hazards, and the related statistical and other informational support. - Primary health care and related 'social and.economic development - The supPort of the rest of the health system tor primary hEilllthcare. and in particular support by
the immediate
referral levels, including instttlitional development - Strengthening of national capabilities to build up health systems based on primary health care, through the application of the national health development process , including health manpower planning based on health systems needs and potenti8.1 manpower availability, and the related operational aspects of traininK health workers. .. ' I
1 defined in Resol~tion WHA31.43, namely country health programming, nationalhe~ll th prOKralllilebudgeting, health programme evalUation and information support,
As
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- Definition of poUefes corteerning the types of heal th manpower, their interrelationships and their training requirements, career structures, labour relationships and ",ages in the health system. the prevention of the brain-drain and educational processes as applied to hea;l.th manpower training - Multisectoral·support to health development, comprising policy definition in the health and relevant socioeconomic and environmental sectors and the associated legislation, and·the fostering of the social, economic and administrative factors that contribute to health development, - Health systems research, which will relate to the process of integrating appropriate technology into health systems; and to the efficient organization of such systems
~:
These programaes w111 include the develot:aent of .el'vice. required tOI' specifiC population grflUpS, such a. pregnant
women and young mothers, infants and children, They wi~l
workers in certain occupations, the handicapped, and the also include the. lOKi sties ot drug and
vaccine supplies,
-' 11. HEALTH TECHNOLOGY PROGRAMMES
Heal th ~echnology programmes wi 11 deal with identifying tecnnologies that are already appropriate for delivery by the health system, with the research required to adapt or develop techoohlf!:ies that are not yet appropriate for delivery, and with the trans!!;'r of appropriate technologies
000/79,1 Page 19
Health protection and promotion ' will comprise:
- General health protection and promotion through such mechanisms as health edueatic)n and health information o'f the public, nutrition, promotion of oral heaith, and prevention of accidents. - Protection and promotion of, the health of specific popUlation groups, such as maternal
and
child health, including human
reproduction and the health of school children and adolescents, workers' health,and health of the apd - Protection against communicable diseases immunization and disease vector control - Promotion of mental health through ~mproving
through
the psycho-
social environment, Pl'eventing or reducing psycbiatric, neurological and' psychosocial problems, inclUding those related to alcohol and drug dependence, and ensuring the mental health rehabilitation of the physically sick and of the handicapped - Promotion of environmental health, including community .ater stit;Ply
~r1d
satiJ taticiri. envi tonmenta 1 health aSpects , .. ','
of rural and urban'd'evelaiSil'lent schemes and housinltt cOilttOl
'---,
of environmental health hazards, and food safety.
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Diai2ostic, therapeutic consist of:
an~
rehabilitative technology will
Clinical technology for primary health care and its immediate referral levels, and laboratory and radioloiical technology in support of primary health care; medicine; tation; tradi tional
physical, mental and related social rehabiliand drug policies, including essential dru«s and
...
drug quality, safety and efficacy.'
Control of specific diseases will deal with:
- the develop.ent and transfer of appropriate technologies for the control 01
diseases of widespread major public parasl tic, bacte'rial,
health importance, such as malaria;
viral and mycotic diseases, including zoonoses; diarrhoeal diseases; cancer; and cardiovascular diseases
- Particular attention will be devoted to tropir.al dil:;ease research.
...
C.
PROMOTIONAL AND SUPPORT PROGRAMMES
Promotional and support programmes will deal with political, SOCial, SCientific,. technical, managerial, informational, financial, and administrative promotion and support.
-
Genera,l promotion and 'support will include:
- the activities of the World Health Assembly, Executive Board ~dRegional
Committees' to ensure political, SOCial,
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000/79.1 Page 21
managerial, technical and financial support to Member States individually and collectively in connection with national, regional and global strategies for health for all.
Research promotion and development wi 11 deal with: - the development of national health research capabili,ties; biomedical and health syst ••• research methodology; heal th research management, inch.idinr;ethical· aspects; .research information support; and national and inter·
national health research de"elopment mechanisms.
WHO's general programme development,. management, coordination and support will consist of: - WUO's programme development process, including the preparation of the General Programme of Work, mediUm-term programming, programme budgeting, programme evaluation and information systems support i external coordination for
health and social development. including health aspects of emergency reI iefopera tions; heal th information support,
including WHO publications and health literature services; and gener-al services and support programmes, including staff development and training.
VI.
ILLUSTRATIVE EXAMPLES OF INTERACTION BETWEEN HEALTH SYSTEMS AND HEALTH TECHNOLOGY PROGRAMMES
~g lQ
<D~ I'-'
0
22.
The following examples - of the Programme of Immunization against the major infectious
1'-':0
....
diseases of children and the Programme of Mental Health - are provided to illustrate some of the ways and some of the areas in which interaction between health techn~logy programmes 1 and health systems programmes will take place. This interaction if of fundamental importance l.ut is difficul t to portray on paper; the presentation of each of these
programmes in parallel columns is a poor attempt to do so.
Health Technology ProgramiDes
Health Systems Programmes
The Ultimate selection of appropriate technology for inclUsion in health systems is a two-way process, involving both categories of programme. The criteria
for appropriateness are scientific soundness, effectiveness, adaptability to local needs, social acceptability, and feasibility in terms of manpower, training requirements and costs.
( «
( c, t,
I(
(
(
These programmes will deal With ways of ensuring balanced and coordinated integration of health technologies into health systems functioning within finite resources. This
balance is particularly relevant to health manpower development-in the light of health syste.JU Deed.
23.
Prosr....
of
r ..unization
Development of comprehensive Health Systems
The programme will provide or upda·te guidelines for the planning of immunization programmes in countries. These will include,
These programmes will deal with the organization of the provision of immunizations in coordination with the other functions of primary health care and its referral instit\,ltions; the i.ntroduc.tion of immunizations into
to give a few examples, such matters as guidance on diseases to be covered and in consequence on different combinations of vaccines; ways
primary health care in conformi ty. wi th schedules for different combinations of vaccines;
:CD, 8 ...;J 1\,)(0
~l:I
of phasing the introduction of immunization 1.
w
....
'fbese ways and areas have been extracted irom the current activities of the Expanded .Programme on Immunization and the Programme of Mental Health.
~;
Programme of Immunization (Cont'd)
Devel0e!l'ent of Comprehensive Health Systems (Cont'd)
18 ID--..... I>.)
cD ~
~
against these diseases;
immunization schedules the
the planning for programme coverage of the total child population; the organization the design of
~.
in different epidemiological situations; types of vaccines required as well as the
of community participation;
equipment to store, transport and administer them; the types of personnel required to plan
schedules fOT immunization sessions to ensure the appearance of infants and children at the appropriate facility at the right time; organization of technical, managerial and logistic support and guidance from the referral levels of the health system~.
and control the programJIIEI, to administer the vaccines and to guide and supervise those who administer them; requirements. estimates of financial
the
The programme will identify those vaccines and the equipment that are appropriate for use, and will promote research to develop more stable, more potent and less reactogenic vaccines for the diseases concerned. It will also deal with
The programme will ensure constant review of purchasing and logistiC practices to ensure the immediate use by the health system of those vaccines and that equipment which have been found appropriate.
the development and testing of suitable cold
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23.
Programme of Immunization (Cont'd)
Development of Comprehensive Heaillllt Systems (Cont'd)' .
chain equipment wi th a view to establishing. prototypes of refrigerators, cold boxes, vaccine· carriers and cold packs that can be manufactured at the country or regional levels.
The programme will ensure the transfer of technology that has been found appropriate, through the organization of seminars and workshops, the provision of fellowships, publ ications and other means of communication.
The programme wi 11 deal wi th 'training in the organization of schedules forimmunization sessions and the presentation and administration of different types of vaccine a's part of the general training of health personnel, particularly at the primary health care level, but also at intermedtate referral levels. "t:Itl
Joint health services research will be undertaken to improve operational strategies for the administration of immunizations.
(1) _______ :; 8 --l
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.....
23.
Programme of Immunization (Gont'd)
l)evelopmentof Comprehensive Health Slst-ems (Cont'd)
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Health services research will be undertaken to ensure proper coordin61tion between the administration of immunizations and the other functions of primary health care and immediate referral levels.
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....
The programme will promote regional and self-reliance in vaccine production, including the establishment of quality control centres.
The programme will develop specific ways of monitoring itself and of evaluating its effectiveness 'in reducing the incidence of the diseases concerned. This will be based on
The programmes will evaluate in particular accessibility of immunization facilities to children. and coverage of the child population with immunizations against the diseases concerned.
WHO's provisional guideline.s for health programme evaluation and will include evaluation indicators and criteria.
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24.
!»r0lr.DUDe of Mental Health
Development of Comprehensive Health Systems
The programme will assess and provide information on world trends in mental health and their implications for health development in-countries and .t regional and global levels. The programme will deal with all aspects of mental health policy and the associated enlightened mental health legislation. The programmes will deal with the incorporatio.n of mental health policy into general health policy and with the harmonizin~
of mental health legislation
with other health legislation. The programme will foster and support men t.a 1 heal th strategy fo.rmulation in consonance witl'\ mental health policy, emphasizing the integration of such strategy into overall health development and in particular primary health care.
The national health development process will indicate ways of synthesizing mental health strategy with other specific programme st~ategies
in evolving the overall
health development programme.
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Measures will be developed for ensuring close collaboration with. at-her sectors that are
...
24.
Programme of Mental Health (Cont'd)
Development of Comprehensive Health Systems (Cont'd)
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.......... -.)
relevant to the promotion and maintenance of mental h",alth, foJ::. example social welf .... education, justice., include fosteri~g
....
These measures will
an understanding of the
mental health methods that are applicable. Community enlightenement in primary health care programmes will include the creation of awareness of those psychosocial.factors that may either foster mental health or lead to itB deterioration.
Measures will be developed to prevent psychological disorders and distress that may accompany social change, and to promote safeguards against mental 111 health through such measures as protective social, networks, environmental modifications and promotion of behavioural patterns. which increase the resistance of indiv.iduals and communities to stress and strain. The programme wi'll analyze and provide mental health information which can be used to promote health care, e.g. on community attitudes concerning the acceptance or rejection of different types of health care.
The knowledge of these psychological attitudes wl1l be applied to foster community health care. involve~ent
in primary
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24. Programme of Mental'Health(Cont'd)
Development of Comprehensive Health Systems (Cont'd)
Existing methods for mental health care will be assessed with respect to their appropriatness in terms of effectiveness, social and cultural acceptability, associated manpower and training requirements, and costs; and
In the development of primary health care and the supporting referral levels, full account" will be taken of the results of this assessment, and only those methods that are appropriate will be included.
information will be provided concerning the selection o"f appropriate methods in different socio-econollic contexts.
Research will be undertaken aimed at developing further appropriate methods for improvio~
The progra. .es will . . . 1 . . th the prompt introduction to the ~eneral
health
psychosocial development: as well as
system of the fruits of this research.
effective technologies for the assessment, prevention, treatment and rehabilitation of psychiatric, psychosocial and neurological disorders, particularly at primary health care level.
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....
24.
PTogra~me
of Mental Health (Cant'd)
Development of CompreJlensive He.lth ... Syst~J!!s· (Conttd) . . . ..
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Joint operational research will be undertaken 'to improve ihe integration of mental health services. tnto ttw general ~e!llth
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system. Health services resear~h
will pe he~lth
unqertaken to ensure proper coordination between the provision of mental Care an~
the other components of
pri~ary
health Call! iit.nd its referral services! Specific eval~ation
methods,
ind~eatQrs
TI1e eval1,lliHon Qf primary health care and its s4Pporting services will in c 11,lde the assessment of the accessibility of mental health care to communities and indlv1d1,lals, as wpll as of coverage of the popu 1a tion in need.
and criteria Wi 11 Pe deyelpped f<l,l' assessing the the
effecqve11.ess of "lental hea\th programmes. w~ll
These lI\ethoq!'\
he based 011 WHO's p:ro~ramme
t:lr~wtsional
guidelines for health
evaluation.
25.
~:
The level or levels at Which various I.\ctivitie s will pe canied ().W1: by will Pe qete~ined ~y
e~ch
of
the above cb~~t~r
pragra~e~
the application of the. SeVenth
~rite:ria incl"~ed, ~n ~~~~
6.2 of
t"'~ ~rp~Q~!id cn~qin~
at
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(i~ner~~ PrQ~r~Qe
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000/79.1
Page 31
VII.
IMPLICATIONS OF PROGRAMME
S1'Rottoia:· F'em
ORGANIZATIONAL
STRUCTURE
26.
It is realized tha t changes in the functions of various
~~ogrammes
as compared with their present functions could
live rise to the need for organizational changes In the Sec.retariat. No less, the implementation of the Seventh
~eneral Programme of Work in the manner outlined' above may
lead many countries to consider it necessary to introduce erganizational changes into their Ministri 05 of Health. Also, ways will have to be found of identifying clearly in the Programme Budget the resources to be attributed to the ~arious
programmes involved in interacting activities.
27.
It is too early to predict the exact nature of theSe
ehanges since they would only emerge as attempts are made to reorient programmes according to their new functions in the Seventh General Programme of Work. It may be necessary to
take into consideration new patterns of management at the various policy and operational levels. These may give· rise
to difficul ties of both a pra:ctical and a psychological nature. and, if introduced, may lead toatroubled transitional period until the Secretariat readjusts toa rnodifiedorganizational structure. At the sallie time, if programmes do hav·e to be re-
oriented in order to make them more relevant to the establish.1 • on primary ment of comprehensive national health systems . based
health care for the. delivery of programmes that make use of
....
appropriate technlogy, as well as to make theRl'more interactive, it has to be recognized that structure must follow function rather than function following structure.
As 1n
all new ventures, the benefitg and the risks have to be weighed against each other.
\
\i ,
TIMETABLE FOR PREPARATION OF THE SEVENTH GENERAL PROGRAMME OF WORK AND FOR FORMULATING STRATEGIES FOR HEALTH FOR ALL
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Seventh General ProgralDlile of Work Review of nature, objectives, structure and method of preparation ............. . Secretariat proposals for nature, objectives,structure and method of preparation ....... .
Strategies for health for all
RPes, HPC
April 1979
GPe
May 1979 May 1979 June 1979
32 WHA
Review of document A32!S Review of detailed timetable for formulating strategies Start of consultation with countries on continuing basis
EB 60.1 RDs
Preliminary rpview of nature, objeeii~es; ~tructurp and mithod of prpparati6n ....... . Draft proposals for nature, objectives, structure and method of preparation ....... .
Res
Sept, !Oct 1979
Res
First review o£ progress
PC/EB
Nov. 1979
PC 'ED
First review of reports from Reltional Committees
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Seventh General Programme of Work Adoption of nature, obje~tives, st rurture and method of preparation . ;' ... '...... '.. ".' .... .
Strategies for health for all
ED
.Jan. 1980
ED
Progress review
Provision of guidance to Secretariat 'on preparation of material ....... GPe Consultation with countries on contInuing basis Prepars,tion Of preliminary mate:'ial Consolidation of preliminary materia 1 ••••.....•..........•..• Review of prelimina'ry regional material ........................ Review ofprelilllinary material
Jan. 1980 Feb. 19~Oi .' I
GPe
Progress review
RDs RPCs, HPC
June 1981 Feb. 15180/ June 1980 RPCs Preparation of material for r:egional strategies
PDWG
July 1980 Sept 'Oct. 1980 Nov. 1980 Formulation of regional strategies Formulation of proposed global strategy -
RCs PC/EB'
Res PC/EB
..
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i~ WIC (j,) . ' ,
"00
...
~
Seventh. General' Programme of Work Start of preparation of draft re~ional and central contributions ................ .
Strate~ies
:for health for all
;I>
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RPCs,
.....
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HPC
Dec. 1980 Jan. 1981 EB Review of PafB's proposals and pre~on of'global strategy Adoption of,!1jfobal strategy
May 1981 End of preparation of draf: regional and central ~ofltributions
WHA
RPCs, HPC
June 1981 Sept, Oct. 1981
Finalization of regional contribu tions Preparation of draft material for Programme .... "....•............ Finalization of draft Programme proposals ................... . Final ization of draft Programme'. Approval of Programme NB:
Res
POW'}
Oct. 1981
PC/ES ER
Nov. 1981 Jan. 1982 May 1982
WHA
This timetable does not take into account the work of the various Sub-Comniittees of the Regional Committees
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