W O R L D
H E A L T H
REGIONAL OFFICE FOR SOUTH-EAST ASIA
ORGANIZATION
REGIONAL COMMITTEE 1 I
ProvisionalAgenda lem 11 SEAIRCSl I7 3 July 1998
RENEWING HFA STRATEGIES
Health for All is a continuing, valid and timeless aspirational goal. While considerable health gains have been made globally, as also in the countries of the Region, in pursuance of health for all by the year 2000, much remains to be done. The unfinished agenda has been compounded by socioeconomic, environmental, demographic and epidemiological changes under way. Hence the rationale for renewing commitment to the social goal for health for all and defining a new policy and strategy to achieve it in the 21S' century, keeping in view the new challenges and opportunities. The global health policy - Health for all in the twenty-first centuly Global Health Declaration - and the Regional Health Declaration are milestones in that direction. Appropriate action has been initiated for implementation of the principles and policy guidance of the Regional Health Declaration, as decided by the fiftieth session of the WHO Regional Committee for South East Asia. The Regional Committee may make a note of the developments in this behalf and provide further guidance for coordinated and accelerated implementation of the Regional Health Declaration.
1.
INTRODUCTION AND BACKGROUND
It is widely accepted today that the real objective of development is to widen the choices of the people. These choices, inter alia, encompass decent education, good health, community participation and environmental security. Increase in GNP with equity and social justice is a means towards this end. This was realized two decades ago when the World Health Assembly, in 1977, gave the call for Health for All by the Year 2000. The International Conference on Primary Health Care, held in 1978 in Alma-Ata, declared that PHC was the key approach to attaining HFA. It emphasized that health development was essential for socioeconomic development. The stage for social development was thus set. HFA by the year 2000 captured the imagination of the entire world. The global health situation, including in the countries of the WHO South-East Asia Region, has improved significantly since 1977. Life expectancy has increased. Infant mortality rates have declined. Access to health services has improved. Dreaded diseases, such as leprosy, poliomyelitis, neonatal tetanus and guineaworm are on the verge of elimination or eradication. Yet, despite these and other gains, the unfinished agenda is enormous. HFA by the year 2000 is not universally attainable. Besides, profound political, socioeconomic, environmental, demographic and epidemiological changes are under-way. Poverty, illiteracy, malnutrition and gender bias are still widespread in many parts of the world; these are particularly pronounced in SEAR countries. Population explosion and urbanization is leading to environmental degradation. Very importantly, the inequalities and inequities in health and economic levels, between and within countries, are too striking to be overlooked. These constitute the basis for elaborating the new HFA strategy and revisiting PHC as the approach to HFA Accordingly, the World Health Assembly, in 1995, recognizing the continuing validity of HFA, resolved (WHA 48.16) to renew the HFA strategy, based on equity and solidarity. The Regional Committee for South-East Asia, at its forty-eighth session in 1995, also resolved (SEAlRC4811) to do so by placing human health at the centre of development. The Regional Committee, at its forty-ninth session, also underlined the linkage between the third evaluation of the HFA strategies and their renewal. 2.
THE GLOBAL HEALTH POLICY - HEALTH FOR ALL IN THE TWENTY-FIRST CENTURY
The global health policy has been developed through a series of meetings and wide-ranging consultations at global, regional and country levels, involving all stakeholders. The Fifty-first World Health Assembly, in May 1998, recognized the report "Health-for-all in the twenty-first century" and adopted the World Health Declaration (WHA 51.7). Health for All (HFA) in the twenty-first century aims to help realize the vision of Health for All, launched at the Alma-Ata Conference in 1978. It sets out, for the first two decades of
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the 21"' century, global priorities and targets which will create the conditions for people worldwide to reach and maintain the highest level of health throughout their lives. Health for All in the twenty-first century is a continuation of the HFA process. Over the past two decades, primary health care (PHC), has provided impetus and energy to progress towards HFA. Despite gains, however, progress has been hampered for several reasons, including insufficient political commitment to the implementation of Health for All, slow socioeconomic development, difficulty in achieving intersectoral action for health, insufficient funding for health, rapid demographic and epidemiological changes, and natural and man-made disasters. Further, poverty has increased worldwide. Although the twenty-first century brings new threats, new opportunities and approaches to overcome them are becoming available. Globalization of trade, travel, technology and communication could yield substantial benefits provided serious potential adverse effects are addressed. Global environmental hazards require urgent attention. New technologies could transform health systems and improve health. Stronger partnerships for health between private and public sectors and civil society could lead to stronger joint action in support of HFA. HFA is a vision that recognizes the oneness of humanity and therefore the need to promote health and to alleviate ill-health and suffering universally and in a spirit of solidarity. The realization of the goals of HFA depends on upholding commitment to its key values: human rights, equity, ethics and gender sensitivity. These values are strongly interlinked, each serving to underpin the execution of policy and strategies. The goals of HFA are to achieve an increase in life expectancy and in the quality of life for all; to improve equity in health between and within countries; and to ensure access for all to sustainable health systems and services. Targets are defined to spur action and to set priorities for resource allocation. Actions by all Member States to realize the goals of Health for All need to be guided by two policy objectives: making health central to human development, and developing sustainable health systems to meet the needs of people. The roles of WHO and governments will be decisive in ensuring that the policy leads to substantial improvements in health. Governments will need to develop and implement policies coherent with HFA values. In doing so, they recognize that investments in health will contribute to improvements in health outcomes and will enhance achievement of sustainable human development goals. As the world's health advocate, WHO will provide global leadership for the attainment of Health for All. WHO will promote international collective action for health. Progress from policy to action requires dynamic leadership, public participation and support, a clear sense of purpose and adequate resources. To support the process of change, specific attention will be given to strengthening policy-making capacity; developing systems of good governance; setting priorities at various levels; strengthening and broadening partnerships for health; and implementing evaluation and monitoring systems. Committed action at all levels - global, regional, national and local - will be crucial to transforming the Health-for-Allvision into a practical and sustainable public health reality.
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3.
WORLD HEALTH DECLARATION
The World Health Declaration, developed against the backdrop of the global health policy summarized above, consists of the following articles relating to rights and principles and actions and responsibilities toward Health for All in the twenty-first century. Rights and Principles Reaffirmation of commitment to the principle that enjoyment of the highest standard of health is one of the fundamental human rights. Improvement of the health and well being of the people is the ultimate aim of socioeconomic development. Commitment to the ethical concepts of equity, solidarity and social justice and gender perspective and their incorporation in HFA policies and strategies. Actions and Responsibilities Commitment to strengthening health systems, including essential public health functions, for ensuring universal access to health services. = Recognition of interdependence of nations, communities, families and individuals all working together to meet common threats to health and promote universal wellbeing.
4.
Resolution The Member States of WHO, by adopting this Declaration, have resolved to promote and support the above rights and principles and actions and responsibilities, full participation and partnerships, calling on all peoples and institutions to share the vision of Health for All in the twenty-first century, and to endeavour in common to realize it.
DECLARTION ON HEALTH DEVLEOPEMNT IN THE SOUTH-EAST ASIA REGION IN THE 21STCENTURY
4.1 Overview After adoption of the resolution on Renewing the Health For All Strategy by the World Health Assembly in 1995,the Regional Office took a lead by organizing an Informal Consultation on Renewing the Health For All Strategy in August 1995. The meetings of CCPDM, Regional Committee, Health Ministers, Health Secretaries, Parliamentarians and an intercountry meeting have since then discussed the subject. Following a Consultative Meeting on Health Development in the South East Asia Region in the 2 1 ' ' Century in March 1997, an Intersectoral Regional Conference on Health Development in South-East Asia Region: A New Vision for a New Century, was held in June 1997. A Draft Declaration on Health Development in SEAR in the 21'' century was finalized at this Conference. At the fifteenth Meeting of Ministers of Health, held in Bangkok in August 1997, the Declaration on Health Development in the South-East Asia Region in the 2 1 ' ' Century (Regional Health Declaration) was adopted. The Regional Health Declaration - our contribution to the global health policy - is a statement of commitment on health development. It is a pledge to ensure Health For All by mobilizing All for Health. It is a resolve to strengthen national capacity and regional solidarity to further this aim.
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The Regional Health Declaration is founded on principles, inter alia, of human rights, equity and social justice and gender equity and centrality of health to sustainable development. It identifies the challenges of inequities in health, creation of enabling environment for health, ensuring basic health services to all, particularly the poor, women and other vulnerable groups, etc.. and enunciates policy actions to meet the same. The Regional Health Declaration was endorsed by the WHO Regional Committee for South-East Asia at its fiftieth session in September 1997.The Committee urged the Member States to further adapt and integrate the policy guidance of the Regional Health Declaration in their national health policies and plans. It also requested the Regional Director to support Member States in their efforts in this behalf. 4.2
Actions taken for Implementation of The Regional Health Declaration: RHD has been widely distributed to all concerned.
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A working group for coordinating the development of an action plan for supporting the implementation of RHD has been established in the Regional Office. A Regional Consultation on Implementation of the Regional Health Declaration was held in Colombo, Sri Lanka, from 9-1 1 February 1998. The Health Secretaries of SEAR Countries, at their third meeting held in Bangkok, Thailand, from 25-27 February 1998, reviewed, inter alia, the actions taken for implementation of RHD. On the basis of the recommendations of the Regional Consultation and Health Secretaries, a plan of action for implementing the Regional Health Declaration was considered and endorsed by the 33d meeting of CCPDM.
5.
SUMMARY AND CONCLUSIONS
Health for All is a continuing, valid and timeless aspirational goal. While considerable health gains have been made globally, as also in the countries of the Region, in pursuance of health for all by the year 2000, much remains to be done. The unfinished agenda has been compounded by socioeconomic, environmental, demographic and epidemiological changes under way. Hence the rationale for renewing commitment to the social goal for health for all and defining a new policy and strategy to achieve it in the 21S'century, keeping in view the new challenges and opportunities. The global health policy -Health for all in the twenty-first century - the Global Health Declaration, and the Regional Health Declaration are milestones in that direction. Appropriate action has been initiated for implementation of the principles and policy guidance of the Regional Health Declaration, as decided by the fiftieth session of the WHO Regional Committee of for South East Asia. The Regional Committee may make a note of the above developments and provide further guidance for coordinated and accelerated implementation of the Regional Health Declaration.