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WORLD HEALTH ORGANIZATION
REGIONAL OFFICE FOR THE WESTERN PACIFIC BUREAU RiG'ONAl DU PACIFIQUE OCCIDENTAL
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ORGANISATION MQNDIALE • DE LA SANTE
REGIONAL COMMITTEE Thirty-first session Manila 9-1S September 1980 Provisional agenda item 19
WPR/RC31/18 Add.1 10 July 1980 ORIGINAL: ENGLISH
GENERAL ASSESSMENT OF THE IMPLEMENTATION OF THE SIXTH GENERAL PROGRAMME OF WOR!
This document (nGO/80.S) consists of a gener~l assessment, prepared at global level, of the implementati~n of the Sixth General Programme of Work covering a specific period (1982-83 inclusive). It analyses the extent to which the Programme has laid the basis for the Organization's activitie8 since 1978, with problems that have arisen in implementing the Procramme, and draws lessons therefrom for the preparation of the Seventh General Programme of Work. It is therefore su~itted to the Regional Committee for review and comment and for consideration in making its commertts on the proposed nature and prograDDDe structure of the Seventh General Programme of work.
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DGOIBO.5 page 2
1. Before embarking on the formulation of the Seventh General Programme of Work it is useful to assess the implementation of the Sixth.
The Sixth General Programme of Work consists of a conceptual preamble that defines poliey, followed by a description of programme activities to be undertaken in the light of that policy. An analysis of the world health situation gives rise to the health challenges to be expected for the period 1978-1983. A short review of the evolution and evaluation of WHO programmes lepds to the definition ~f the role and functions of WHO during that period. ImpHcatipns for WflO's progra~e for the period are also derived from a brief analysis ot long:-term health tttonds up to the end of the century. General principle. are provided, undertinins that the progr~mnes of WHO should be oriented towards 'defined goab and target.. Criteria for the selec~ion of programme •• re .ho ~pelled out, th, basic criterion of giving priority to the problem. of developing countr~es being e~phasized. 2.
3. The gen.rat prog~amme framework that follows describes the objectives of the Sixth Ge~eT.l 'pl1OIt:'8I1II1le of Work .. grouped under six sec tions, corre.p,anding:\ ~o the six .ajor areati of concern of the Organization for 1978-1983. . Theae are: :~ev~lopment of C~r..h.n8iv. He,lth Services; Disease Prevention and Control; }-romotioo of Envbonmeotal Health; Health Manpower Development; Promotion and Development of Biomedical and Health Services aesearch; and Progra~e Development and Support. The PFogratnme'j objectiv" come.as a logical sequence of it. poHcy balis. These objectives, however, are not set in any order of .global priority, aince priQfities vary by country and by region.
4. ,01' each principal objective the Sixth General Programme of Work describes detailed objectives, t.rget.~ approaches and activities and, sometimes, output indic~tors. D~apite this, the World Health Assembly, in adopting the Proaramme by ie'olution ~9.20, considered that it provided "an appropriate policy fU:lDework for the: fOnIN1,tion of medium-term prosr~es.n4 programme bu4seta ~itbin the perio~. cover.a". It therefore became neceslary to translcte the P~osr4mme in~o mor~ det.~led medium-term programmes for implementation thTough prQ.r~e bu~.~t'.
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The need to teet the methodology for medium-term programming led to the
prolr~88ive development of the medium-term programmes corresponding to the Sixth General Prog~.mme of Work, the order of their development being determined pra8m~tically. First to be elaborated in 1977 were the medium-term programmes
for Mental He.lth and Health Manpower Development, followed in 1978 by the mediulIl:-term progra_ fol' the Promotion of EnvironUlental Health. In 1979 ' the medium-t~r'm pl'ogramme for Comprehensive Health Services was put together. comprising Health Services Development, Family Health, Mental Health and Prophylactic. Diagnostic and Therapeutic Substances. Finally, in 1980, the medium-term programmes for Diseases Prevention and Control, the Promotion and Development Qf Biomedical and Heal th Services Research and Programme Development Consequently, by the end of 1980, all the and Support are being finalized. major areas of concern of the Programme will have been converted into Uledium-urm programmes, In the liaht of this schedule, it was possible to use some mediumterm programmes for the formulation of the 1980/81 programme budget and many for the formulation of the 1982/83 programme budget.
DGO/80.S page 3
Although it is too early at this stage to evaluate in detail the results of of the Sixth General Programme of Work through medium-term pro,'rammin~ and subsequent programme budgeting, what has been achieved until now, and what is planned can be compared with the original policy bases, objectives, and targets, to assess whether the Programme has been used as a guide for the activities of the Organization during the period concerned. th~,implementation
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An analysis of the medium-term programmes shows that the Organization's 7. activities since 1978 have generally reflected both the preambular part and the specific objectives of the Sixth General Programme of Work. In some cases, particularly in the ~ase of medium-term programmes that were elaborated first, the policy changes brought about by the A1ma-Ata Conference on Primary Health Car•• and the adoption of resolutions WHA30.43 on the goal of health for all by they.ar 2000, and W8A32.30 on formulating strategies to attain this goal, ,nee.uitated substantial revisions of the medium-term programmes. For example, in 1979 it was neces.ary to update both the programmes of Mental Health and Health Manpower Development in view of the new policy developments, in order ,to lay more elllphallie on primary health care and related activities. In another case, it was found necessary to narrow down the p~iority objectives of the programme for the Promotion of Environmental Health in view of the emphasis to be put on the International Drinking Water Supply and Sanitation Decade.
8. DUe to the proximity of the dates of preparation of the Sixth General Prolramme of Work and the 1980/1981 programme budget, and to the fact that ~ost medium-term programmes were formulated after that programme budget had been prepared, it is too early to assess the extent to which the Sixth General Prolramme of Work has been reflected in the Organization's Programme Budget. This will be possible for the 1982/83 biennium. 9. H've the criteria for prosramme selection been used? In general, it can be .aid that the most important determining criterion, namely priority to ct.:"eloplng courttries, has been respected, even if the other criteria have not 'been;ty.temadcally applied. In particular, it appears that the criteria ti"l.adu to the determination of the organizational level or levels for itnpf'"entation ofprograllllle activities were inadequately taken into consideration ethen pro-Sramming. io;~e.sixth General ~rogramme of Work's prosramme classification proved to be .. seribu8 obstacl~ to integrated programming. The Programme had originally ,Ildvocilted It" coordinated approach to the implementation of its six lIIajor areas of concern. but 'these included such heterogeneous objectives that coordination. both between the areas of concern and among the constituent programmes of each of them, proved to be very difficult to attain.
11. The second major obstacle encountered was that the approaches described in th~ Sixth General Programme did not make it sufficiently clear which programmes should deal with infrastructure and which with technical substance, or in other words 'Which programmes should deal with the health delivery system and which with the health system's content. This occurred in pllrticular with respect to the major area of concern of Comprehensive Health Services, which comprises programmes both of a technical nature and of a health infrastructure nature. As • result, during medium-term programming there was an overwhelming influence of technical programmes, many of them engaged in devplopinp, their own delivery system.
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DOO/80.S page 4 The lesson to be learned from this for ~he Seventh General Programme of 12. Work is that there is a need to distinguish clearly between. on the one hand. activities dealing with the infrastructure for the delivery of health programmes. and on the other hand those dealing with the technical content that is to be delivered. The former would include the planning and organization of health sy~tem8 based on primary health care, manpower, and the relationships between health and other socioeconomic sectors; the latter would include the content of the health system, i.e. the technology to be used. 8cientific endeavours to arrive at this technology. and the social control of technology so that it i8 really appropriate in the senee of the Declaration of Alma-Ata. The above-mentioned problems were increased to some extent by the different 13. timing of the development of the medium-term programmes. Although this waf nece8sary in order to test the methodology of medium-term programming, it made coordination between the major areas of concern even more difficult. The lesson to be learned for the Seventh General Programme of Work is that there is a need to formulate medium-term programmes simultaneously. possibly together with the preparation of the first programme budget for the period of the Seventh General Programme. i.e. the programme budget for 1984/85. 14. With these reservations, it can be said that the Sixth General Programme of Work has proved a useful basis for formulating the Organization's programmes. Its flexibility proved valuable at all organizational levels, the room left for initiative being ample in relation to the varying needs of countries and regions. The involvement of the Regional Committees, the Executive Board (in particular through it. Programme Committe.), and the World Health Assembly, proved a great as~et in guiding and monitoring the implementation of the Programme. 15. The Sixth General Programme of Work is being implemented during a transitional period marked by great policy changes throughout the world with with respect to health and development and the role of WHO in promoting this. The implementation of the Programme has consequently often been overshadowed by the dramatic launching of new health policies that will greatly influence WHO's activities in the 1980s and 1990s. Some of these policy changes were foreseen in the Sixth Programme, particularly in its preamble. But the extent to which cOllntries have been inspired by the Alma-Ata Conference on Primary Health Care, and in consequence their decision to develop strategies for health for all both individually and collectively, could not have been foreseen. The real success of the Sixth General Programme of Work will have to be judged in the final analysis by the degree to which it has prepared WHO to collaborate better with its Member States in the development and implementation of' strategies for health for all by the year 2000.
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