Всемирная организация здравоохранения (ВОЗ / WHO) · Technical Documents

Preparation of a fifth Regional programme of work for a specific period (1978-1983 inclusive)

31 декабря 1976 г. Всемирная организация здравоохранения

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'WORLD HEALTH ORGANIZATION

ORGANISATION MONDIALE DE LA SANT~

REGIONAL OFFICE FOR

THE WESTERN PACIFIC

BUREAU R~GIONAL DU PACIFIQUE OCCIDENTAL

REGIONAL COMMITTEE Twenty-seventh session Manila 6-11 September 1976 Provisional agenda item 16

WPR/RC27/1O 9 June 1976 ORIGINAL: ENGLISH

PREPARATION OF A FIFTH REGIONAL PROGRAMME OF WORK FOR A SPECIFIC PERIOD (1978-1983 INCLUSIVE) The Regional Committee, at its twenty-sixth session, adopted resolution WPR/RC26.R12 which: (a) accorded to each principal Sixth General Programme of (1978-1983 inclusive), and the orders of priority for objective proposed for the Work covering a specific period the detailed objectives therein, the Western Pacific Region;

(b)

requested the Regional Director to transmit the list of objectives showing the orders of priority accorded for~he Western Pacific Region to the Director-General for . consideration in preparing the draft Sixth General Programme of Work; and decided to consider, at its twenty-seventh session, whether it would be advantageous to prepare a fifth regional programme of work derived from the Sixth General Programme of Work, as had been done in the past, or whether the Sixth General Programme of Work would be a sufficient guide for the Region.

(c)

'-'

The draft Sixth General Programme of Work, incorporating the programme priorities accorded by all the Regional Committees of the Organization, was submitted by the Executive Board to the World Health Assembly which adopted it at its twenty-ninth session. 1 A copy of the final document is attached as Annex 1. While the Sixth General Programme of Work retains the flexibility of the Fifth, a modern management approach has been utilized in the formulation of its objectives, which are presented in much more detail. The Programme also attempts, wherever feasible, to define approaches,

Resolution WHA29.20, 1976.

I..,

WPR/RC27/l0 page 2 targets and output indicators. It lays down innovative approaches in developing and elaborating the future programme of WHO, and places increased emphasis on the relationship between health and socioeconomic development, and the interaction of health services, other social services and other sectors. It identifies two groups of programme objectives, additional to those contained in the Fifth General Programme of Work: (i) promotion and development of biomedical and health services research; and (ii) programme development and support. In accordance with resolution WPR/RC26.Rl2 the Regional Director invites the Committee to consider whether the elaboration of a separate regional programme of work, as has been done in the past, will serve any significant purpose, since it appears that sufficient details are already contained in the Sixth General Programme of Work to guide the delivery of the WHO programmes in the Region from 1978 to 1983 and Member States will be encouraged to develop their own country health programming by using the programme objectives set out in the Sixth General Programme of Work. Most of the draft principal and detailed objectives of the Sixth General Programme of Work to which the twenty-sixth session of the Regional Committee accorded priorities and which were transmitted to the Director-General in document WPR/RC26/ll, Annex 2, Revision 1 were retained in the final Programme, although in some cases reworded, amplified or rearranged. Annex 3 shows the final list of objectives, a cross reference to the draft objective in document WPR/RC26/ll, Annex 2, Revision 1, (attached as Annex 2) and the priorities accorded by the Committee at its twentysixth session, which it is felt, in most instances remain valid. The following four objectives, extracted from Annex 3 for clarity, are entirely new. The Committee may wish to indicate, in the same way as it did for the others at its twenty-sixth session, their relative priorities within the programme of the Region.

3.1

To reduce maternal, perinatal, infant and childhood mortality and morbidity, and to promote reproductive health and the physical and psycho-social development of the child and adolescent within the family context. To collaborate with countries in the development and strengthening of the family health component of health services, including family planning and welfare. concerned with health promotion and to integrate them into a single system where appropriate.

3.2

7.1 To promote closer cooperation between all services

1.6

To develop and apply chemical, biological, genetic and other means of control, of disease vectors, intermediate hosts and reservoirs of pathogenic agents, with due regard to safety for man and the environment.

ANNEX 1

• 1. 2. 3. 4.

WORLD HEALTH ORGANIZATION ORGANISATION MONDIALE DE LA SANT£ 19 March 1976

TWENTY-NINTH WORLD HEALTH ASSEMBLY Provisional agenda item 2.3

SIXTH GENERAL PROGRAMME OF WORK COVElUNG A SPECIFIC PERIOD 1978-1983 INCLUSIVE

CONTENTS

Introduc tion • •

. .. . . . . . . . . . . . . .. . . . . . . . . . .. . . . . •••••••••••••

2 3 10

The evolution of the world health situation and h.a1th challenges for 1978-1983 The evolution and evaluation of WHO's programmes • • • • • • • • • • • • • • • • • • The role and functions of WHO during the period 1978-1983

13 16 19

5. 6. 7• 8~

Medium-term implications of long-term trends for WHO's programme

.... .... .

Programme principles • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • ••

A p p r o a c h e s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Programme criteria • • • • • • • • • • • • • • • • , • • • • • • • • • • • • • • •• General programme framework 21

. . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 10. Development of comprehensive health services . . . . . . . . . . . . . . . . . . . . Disease prevention and control • • · . . . . . . . . . . . . . . . . . . . . . . . . 38 12. Promotion of environmental health · . . . . . . . . . . . . . . . . . . . . . . . . 13. Health manpower development . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14. Promotion and development of biomedical and health services research . . . . . . . . 15. Programme development and support · . . . . . . . . . . . . . . . . . . . . . . . . 16. Evaluation • • . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Annex - Glossary of terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 9. 27

11.

A29/6 page 2 SIXTH GENERAL PROGRAMME OF WORK COVERING A SPECIFIC PERIOD 1978-1983 INCLUSIVE 1. INTRODUCTION

Article 28 (g) of the Constitution of the World Health Organization requires its Executive Board "to submit to the World Health Assembly for consideration and appruval a general programme of work covering a specific period". The World Health Assembly has thus far approved five general programmes of work, respectively for the periods 1952-1956, 1957-1961, 1962-1966, 1967-1972 and 1973-1977 inclusive. These programmes were [ormulated by the Executive Board, approved by the World Health Assembly and subsequently adaptpd to regional needs by the Regional Committees. The first four general programmes of work were developed in very broad terms and could be interpreted in such a way as to permit any health activity to be undertaken by the Organization. The Fifth General Programme of Work was somewhat more explicit. It iJent.fi~d four principal programme objectives and outlined how they were to be attained. Th~~e objectives consist of the strengthening of health services, the development of health manpvw~r, disease prevention and control and the promotion of environmental health. At its fifty-fifth session the Board considered a review of the Fifth General Programme of Work submitted to it by the Director-General, and decided to take into account the conclusions of this review, as well as its deliberations on the revi~w, in formulating the Sixth General Programme of Work. 1 The Board recognized that, despite the very general nature of the Fifth General Programme of Work and the absence of specific priorities it has proved to be a useful guide for defining and programming the Organization's activities. It has left great flexibility to those executing the programme, thus enabling them to adapt the Organization's activities to the particular requirements of the regions and the countries and also to certain developments which had not been foreseen or had been underestimated. With this proviso it is being faithfully implemented on the whole, although within its framework many additional procedures have been adopted for formulating the Organization's 4etailed programmes, particularly with regaro to the establishment of more specific objectives and priorities. Likewise, the Board decided to take into account in its preparation of the Sixth General Programme of Work the conclusions and recommendations of its organizational study on the interrelationships between the central technical services of WHO and programmes of direct assistance to Member States. 2 In addition it decided to take into account the report of the Joint Inspection Unit on medium-term planning in the United Nations System, and the comments thereon of the Administrative Committee on Coordination. 3 To draw up the Sixth General Programme of Work, an Executive Board Working Group was set up as well as a Secretariat Working Group to support it. Proposals made by individual countries and experts, as well as recommendations of the Regional Committees were taken into account. The Sixth General Programme of Work retains the flexibility of the Fifth. It includes two additional groups of programme objectives, namely: the promotion and development of biomedical and health services research and programme development and support. Increasing emphasis is laid on the relationship between health and socio-economic development, and on the interaction of health, other social services and other sectors. The Sixth Programme presents its objectives in a much more detailed manner than the Fifth.

1 Resolution EB55.R25, 1975. 2 Resolution EB55.R26, 1975. 3 Resolution EB55.R66, 1975.

A29/6 page 3

As regards the period of time to be covered by the Sixth General Programme of Work, at the Fifty-fifth session of the Executive Board it was stressed that this should corresponc as far as possible to the period adopted throughout the United Nations system.

2. 2.1

EVOLUTION OF mE WORLD HEALTIi SIWATION AND HEALTH CHALLENGES FOR 1978-1983

!he evolution of the world health situation

Since the World Health Organization was founded, profound changes have taken place throughout the ,,,,orld. Many new sovereign States have emerged and on accession to inderer:dence have assumed new responsibilities. Important changes have taken place in relationships between countries, strengthening the spirit of cooperation among them. rnprecedented advances have been made in science, and health and education have become the birthrigh: 0f ever-increasing proportions of the world population. During the same period, man's environment has changed more than ever before and the global ramifications are only gradually becoming 3p~arent.

Health has to be attained in this emergent framework of political, economic, social, cultural, scientific, technological and psychological systems, superimposed on the geophysical envi~onment. Public health continues to be involved in each of those systems, and being a part of the total matrix, influences it by its own dynamics. In the past quarter of a century its ca~abilities have been expressed through intensive and extensive research. The new means available include, among many others, chemical and Lmmunological agents, genetical and biological technique. of disease vector control, new drugs, improved phYSical methods and the by-products of nuclear fission for diagnosis and therapy, electronic monitoring apparatus, automated laboratory techniques, computers, and improved communication. systems and analytical methods. Public health services themselves continue to evolve in answer to existing and emerging problems. The pace has differed in different countries, but everywhere progress is evident. Developing countries have had to face the most difficult problems with the least resources. To counter these problems they have frequently used modern scientific methods and tools, for which their young health service infrastructures were not always sufficiently developed and which caused an unnecessary drain on scarce resources. In spite of severe shortages of health manpower, a dearth of training facilities and inadequacy of available financial resources, vigorous application of public health measures has resulted in the saving of millions of lives. Thus, these already inadequate health structures must now meet the demands of growing populations with an increased life expectancy. As a result population dynamics and its influence on health demand increased attention in many countries. Health care has become more easily accessible for increasing numbers of people, and there has been a concomitant increase in expectancy of and demand for ever-higher standards of care as science and technology advance and as social progress is made. Notwithstanding, there is an uneven distribution of health care in many countries, rural populations being particularly underprivileged. The profile of morbidity continues to change. a number of countries, improvements in living conditions and the proviSion of extensive and intensive care have led to the survival of people who would previously have succumbed to their illness, thus creating a higher proportion of elderly persons in the population and a concomitant rise in the prevalence of chronic diseases. All this is highlighting the necessity of gauging priorities of community health needs and of the immediate relief of individual suffering and pain. As costs soar in many countries, it is becoming increaSingly evident that finite resources may limit the possible application of technological advances for all who require them, pOinting to the necessity of seeking out new ways of making health care universally available. The economic and social advantages of industrialization and urbanization have been accompanied by factors detrimental to health, such as the introduction of harmful pollutants into the environment, the increase in road accidents and the stress of city life.

Increasing numbers of countries are including in their constitutions or statutes the principle of health as a fundamental human right, as mentioned in WHO's Constitution. At

A29/6 page 4 the same time a growing demand for health care and rapid population growth in some countries are placing severe strains on existing health facilities. Governments are becoming increasingly involved in planning for economic and social development, and are creating general policy frameworks within which health planning must become accommodated. Man's health has come to be regarded as a prerequisite for optimal socio-economic development as well as one of the most important goals of such development. Public health services are no longer considered merely as a complex of solely medical measures. They are being increasingly recognized as an important component of socio-economic systems, combining all the economic, social, political, preventive, therapeutic andothermeasures which human society, in any country and at any stage in its development, is using to protect and constantly improve the health of every individual and of society as a whole. In recent decades many health problems previously considered local in character have proved to have regional and global implications. Speedy and increasingly frequent and voluminous international travel has converted certain seemingly national health problems into international health problems, and classical quarantine practices have given way to more positive measures of control through international collaboration in epidemiological surveillance. National and regional environmental problems have become global problems and international collaboration must again form the keystone of their control. It has become increasingly evident that individual national efforts alone are not sufficient to deal adequately with such diverse questions as biomedical and health services research, the control of the production, distribution and use of drugs and biological substances, the development of comprehensive national health services and of health manpower in developing countries and nutrition and population dynamics in relation to the future of human society. Thus, national, regional and global health systems are closely interwoven, and the modern world must be viewed in terms of these interrelationships. However, experience has shown that the determining factor in the development of national health services is effective national effort. External aid can only temporarily alleviate the consequences of disproportionately low allocations for health needs in national plans and budgets, and can never fully replace the shortage of local resources and manpower. As a component part of a country's socio-economic infrastructure, health services have to develop in keeping with the rates of its population increase and social, cultural and economic progress. 2.2 Some indicators of the world health situation

Most of the material that follows is drawn from the Fifth Report on the World Health The figures are based on the analysis of the most reliable available Situation, 1969-1972. 1 data provided by countries concerning the demographic situation, mortality and morbidity. Regional and central consolidation of information are rendered difficult by the uneven availability of data, so that the most that can be proffered at this stage are rather general statements. The world population continues to increase, but the growth rate varies greatly from country to country and from region to region. The main causes of this are high birth rate, reduction in infant mortality and increased life expectancy. The impact of population growth on the age structure of populations is revealed by an analysis of crude mortality rates. In the least developed countries the crude mortality rate, where it is known, is still high (above 18-20 per thousand). In the developed countries, where . f t d child mortality rates are low, the general rate is about 10 per thousand because of 1n an an . f f' the growing number of people over 65. For ~he world as a.whole three ma1n ra~ges 0 .1 gures can be discerned in the percentage distribut10n of populat10ns.by crude m~rta11ty rate, the first at 6-9 per thousand, corresponding to countries with ~ h1gh proport1~n of young people, the second at 14-17 per thousand for many developing countr1es, and the t~1rd at 2:-25 per thousand for other developing countries. The rates for developed countr1es are s1tuated between the first two ranges. ,

1 WHO Official Records, No. 225, 1975.

A29/6 page 5 There is wide variation among countries in life expectancy at birth. The countries of the regions of the Americas and Europe have the highest life expectancy, with a main range of figures for the percentage distribution of life expectancy between 70 and 75 years. In the Americas there is an earlier secondary important range for the percentage distribution between 60 and 65 years, for the developing countries of Central and South America. The Eastern Mediterranean and Western Pacific regions are similar to each other with a main range of figures between 50 and 55 years; however, the former has an earlier, secondary important range between 35 and 40 years for its least developed countries. There is a later, secondary important range between 70 and 75 years in the Western Pacific region corresponding to the most developed countries. Africa constitutes a third category, with the lowest life expectancy, the main range of figures being between 35 and 40 years, with secondary important range, between 40 and 45 and between 45 and 50 years. There is a main range of figures between 45 and 50 years for South-East Asia, but this has to be interpreted with caution as it is based on a sample of only 27.5%. . The percentage distribution of demographic growth rates in the WHO regions also shows wide variations. In Africa the main range is between 2.0% and 2.5%, with an important secondary range between 2.5% and 3.0%. In the Americas there are two main ranges, between 1.0% and 1.5% and between 3.0% and 3.5%, with an additional secondary range between 3.5% and 4.0%. In South-East Asia the main range is between 2.5% and 3.0%. In Europe it is between 1.0% and 1.5% with a secondary range between 0.5% and 1.0% In the Eastern Mediterranean the main range is between 2.0% and 2.5% with a secondary range between 2.5% and 3.0%. In the Western Pacific the main range is between 1.5% and 2.0%. Mortality rates by cause of death are known precisely only in countries with wellorganized registration services and where a high proportion of deaths are established by physicians. For this reason only fragmentary information can be provided, based on the ranking order of leading causes of death in the WHO regions. It is estimated that in those countries in which the expectation of life at birth is under 55 years, over half of all deaths are at ages under 15 and are caused by diseases typical of infancy and childhood, in particular intestinal and respiratory infectious diseases and specific factors of perinatal mortality. Although the exact numerical importance of malnutrition as a cause of death is nct known, special studies have revealed that in young children under five years of age nutritional deficiency was the underlying or associated cause of death in at least one third of the deaths.

Infant mortality rates cannot be estimated with much accuracy in many countries, and hence regional and global estimates are difficult to compute. The following rates were estimated by the United Nations Secretariat and WHO for the year 1965 and refer to continents and not WHO regions: Africa - 146 per 1000 live births; Americas - 100; Asia - 115; Oceania - 50; Europe - 32. 1 Since then some countries have reached rates as low as 11 to 15 per 1000 births. Cardiovascular diseases are responsible for more deaths than any other reported cause in the "regions of the Americas and Europe, occupying second place in the Eastern Mediterranean and third place in the South-East Asia and Western Pacific regions. Malignant neoplasms take second place in the Americas and Europe. Tuberculosis, influenza and other respiratory infections occupy a high position on the list of main causes of death. Other communicable diseases have not been taken into account among the most important causes. The reason for this is that the lists communicated by governments rarely mention the common infectious diseases as causes of death, since the underlying cause is not often given. Accidents and diseases of the newborn and early infancy rank also high among principal causes of death. Finally, the shortcomings of notifications of causes of death are illustrated by the fact that the diagnosis "symptoms and ill-defined conditions" occupies first place in three regions. In Europe it occupies seventh place.

1 Mortality in Infancy and Childhood.

UN and WHO ESA/P/WP/47.

1973.

A29/6 page 6 General morbidity statistics are either very incomplete or non-existent in many countries. The morbidity statistics for hospital patients vary in value. They are fairly satisfactory when diagnosis is made on the patient's discharge, less reliable when the diagnosis is made on admission; they usually ignore the out-patient services and private sector reflecting only morbidity that has led to admission to a public hospital bed, not general morbidity. There are differences between countries in the lists of diseases subject to compulsory notification, and the following information is based on data from less than half of the Member States. The information is t~erefore even more fragmentary than for mortality, is restricted to communicable diseases and is again based on the ranking order of those causes of morbidity in the WHO regions which are considered by governments as public health problems. Tuberculosis, and other respiratory infections, diarrhoeal diseases, measles, virus hepatitis and venereal diseases occupy high positions in all the regions. Malaria and other par:lsitic diseases (e.g. schistosomiasis, filariasis, onchocerciasis and intestinal par3sitoses) and leprosy were the most often mentioned in governments' reports in Africa, Central and South America, Asia and Eastern Mediterranean regions. There are many deficiencies in the notification of diseases that are universal, such as influenza, measles or meningococcal infections, none of which has been reported from certain countries. Children's diseases preventable by immunizatlon such as diphtheria, measles, whooping cough and poliomyelitis are still a serious problem in Africa and some other regions and tetanuS should be added to this list because of its high mortality.

2.3

Health challenges for 1978-1983

In many countries economic growth is being accomp~nied by social development. In order to sustain this trend it is becoming increasingly important to emphasize the contribution of health to social development, of which economic development is only a part. The contribution of health programmes to socio-economic development, and the integration of health planning with socio-economic planning, were dealt with at some length during the technical discussions on these matters at the Twenty-fifth World Health Assembly in 1972. If health development is an integral part of social development, it would seem reasonable to provide health care in close association with the provision of other social services. This approach has already been adopted in a number of countries and these experiments deserve close examination for possible introduction by other countries after suitable adaptation. For example, the provision of health care to children, pregnant women and mothers breastfeeding their infants, as well as to the aged, would be futile without ensuring that at the same time, through national and international efforts, they receive appropriate and adequate food. It has become clear that for health development, as for all other endeavours for social development, it is necessary to evolve and to apply realistic yet flexible planning . processes, commencing with the establishment of policies, and continuing with the translation of these policies into developmental strategies, with the formulation of operational programmes for the application of the strategies and with the proper management of these programmes to ensure that their objectives are attained. In this planning process, account has to be taken of very many factors of an epidemiological, environmental, social, political, economic, scientific and technical nature, as well as the actual and potential availability of resources and the utilization of existing resources. Based on available data, health trends have to be analysed. It is important to integrate and organize properly the information and resources with a view to reaching feasible health goals. For proper planning and operation of health programmes heavy reliance therefore has to be placed on health information in its broadest sense. The information has to be sufficiently concise to be manageable, and sufficiently relevant and sensitive for evaluation that will lead to improved policy making and programme formulation and implementation. Health programme development, implementation and evaluation require adequate information support. The type of information required includes vital and health statistics; geographical, social, economic, political and financial information; information relating to the implementation of health programmes and the utilization of health services; as well as

A29/6 page 7 scientific and technical information contained in the literature and in unpublished reports. The information has to be organized in a system that facilitates its generation, processing, storage and retrieval, analysis and dissemination as required. In addition, it is often necessary to create appropriate services within specific programme areas to ensure the adequate generation and use of the information concerned. It is essential that these services be integrated into the overall information system in the interests of efficiency and economy. Health administrators are thus faced with' the necessity of strengthening their functions for planning and long-term development in addition to their executive powers. In a number of countries elaborate health administrations have been developed in conformity with these newer concepts. In certain countries long-term forecasts, even until the end of the twentieth century, are being prepared. The reduction of the gap between health needs and the resources available for satisfying them is an important challenge. While resources for health development cannot always be made easily available, much more could be achieved in certain countries with existing resources if they were always devoted to those health problems that deserve priority attention and if they were applied in such a manner as to yield maximal social benefit for the investment concerned. The promotion of health, however, involves much more than the development of health services and is dependent in large measure on other social and economic programmes, such as rural development, urban development, the proper distribution of wealth and food, general education and appropriate demographic policy. The ultimate instrument for the delivery of health care is a comprehensive national health system or service. In the final analysis such a service can be conceived of as having three basic tasks: comprehensive individual and community measures of prevention of diseases, with special emphasis on the protection of the health of the new generation and on environmental health; provision to the entire population of timely diagnosis of diseases, when they occur, and of their adequate treatment and rehabilitation; and medical research and accumulation of medical and biological knowledge as the only possible basis for all complex measures aimed at protection and promotion of human health. In each society, various public and private resources may be used in different proportions and may be concentrated on solving different problems, but world experience has shown that there are a number of basic principles, as enunciated in resolution WHA23.61, observance of which can ensure optimal development of national health systems. These include the recognition of the responsibility of the State and society for the protection of the health of the population, the organization of rational training of national health personnel at all levels, the development of the preventive approach both for the community and for the individual, the setting up of an appropriate system of easily accessible preventive, curative and rehabilitative services, the extensive application of the results of progress in world medical research and public health practice, as well as the health education of the public and community involvement. Few countries have reached the stage at which they can feel satisfied with the coverage and depth of their health service. The development of such a service is a highly complex process for which full use has to be made of the methods mentioned above for planning, programme formulation and programme and service management. The complexity derives from the multiple facets of the service required for health promotion and protection, disease prevention, early detection, treatment and rehabilitation; from the need to take into account different aee and geographical distributions of people and their uneven educational and cultural backgrounds; from the difficulty of reaching a balance between the needs of the individual, the family, various types and sizes of communities and the nation as a whole; from the large number and bewildering variety of social and technical disciplines required to create and operate health services; and from the huge financial investments and organizational efforts required to dev~lop a nation-wide network of health services. In many countries health services have been built up from the centre through institutions based on the pattern of more affluent societies, and have reached the periphery only in a most desultory and primitive way. This has led to the proviSion of expensive services for a privileged few rather than to a minimally adequate service for the people as a whole. Other countries have attained a more equitable social distribution of less expensive health services,

A29/6 page

and lessons have to be learned from them for adaptation and wider application. Renewed attention is therefore being paid to primary health care at the community level, as has been stressed in a number of recent World Health Assembly resolutions. l ,2,3 In resolution WHA28.88 primary health care was regarded as the point of entry for the individual to thpnational health system, where it should be an integral part of that system related closely to the life patterns and needs of the community it serves and be fully integrated with the other sectors involved in community development. It is particularly important in rural areas of developing countries, in order to provide the largest possible population coverage, as well as to the contribution of such health policies and programmes to rural development. Health technology is an important element of any health system and has to be made available as far as possible to those in need. It continues to develop rapidly, giving rise to increasingly sophisticated diagnostic and therapeutic measures. As a result, the cost of applying these measures is increasing rapidly, and a growing need is felt, especially in developing countries, but also in the most affluent countries, for adapting and simplifying these technologies, making them available at a reasonable cost and ensuring that they are properly utilized. The continual enlargement of the armamentarium of pharmaceutical preparations, many of which are highly potent and may have harmful side effects, is creating ever increasing technical, financial and ethical problems for the health services. There is also a maldistribution of drugs within and between countries. All these factors make it tmperative for governments to review their policies and programmes in this vast area, and to collaborate in formulating appropriate national and international policies and programmes ensuring the adequate provision of essential drugs in all countries. In the midst of preoccupations with the establisbment of health policies and the formulation of health programmes, sight can never be lost of the fact that health cannot be imposed; it can only be attained. For individuals and communities to attain their deSired level of health they have to be enlightened. However, the dissemination of health information will not by itself improve the health status of a population. Such information has to be accompanied by the necessary motivation to apply it, and in order to stimulate this motivation, relevant social, cultural, economic and religious factors have to be taken into account. It appears mandatory to seek improved ways of gaining individual and public confidence and of encouraging greater community participation in the promotion of its own health, through integrated approaches to individual health education and mass information of the public on health matters. In no field more than in disease control is community participation an important element for success. It is necessary to apply disease control measures through their integration into the general health services, and in particular by means of preventive measures and health education, as well as through the promotion of environmental health, including measures that extend beyond the responsibilities of the health sector. Proper attention has to be paid to many varied matters, these include immunization and vector control measures for the prevention and control of certain communicable diseases. They also include individual behaviour and life style for the prevention and control of a number of paraSitic diseases, some cancers and certain cardiovascular diseases and for the promotion of mental and dental health, which are affected by so many factors within the individual and within the environment. The problems of the environment have been present since the beginning of history, and man's evolution has been shaped in large measures by his capacity to adapt to a changing environment. The apparent newness of the situation in recent years stems both from the degree to which man himself has contributed to the increase in environmental hazards and from The old environmental hazards a growing world conscience concerning the environment. presented by poor community sanitation is still all too prevalent in many places, especially in developing countries, both in rural and urban areas. To these hazards have to be added, in almost all countries of the world, environmental pollution by chemical and physical

1 2

Resolution WHA26.35, 1973. Resolution WHA27.44, 1974. Resolution WHA28.88 , 1975.

A29/6 page 9 agents, as well as rapid changes in the psycho-social environment, which sometimes affect health adversely. All these environmental factors affect the health of communities and of working populations, whether through their contribution to the generation or spread of disease, their inducement of accidents, their adulteration and contacination of food or their adverse effects on mental health. While health policies and programmes alone cannot ensure a safe environment, health aspects have to be given a prominent place in all c0~sid~rations of the environment. This implies a closer interrelationship than ever De for", ';e:".·!ee ali concerned with the control and improvement of the environment, whatever the basl~ disCl?line in which they have been trained.

Biomedical and health services research is essential to the accumulation of the knowledge required to devise appropriate measures for improving human health. All policies and programmes, whether for the control of disease, for the development of community health services or for the promotion of environmental health, are constantly evolving. This is both the result of and the rationale for the continual development of biomedical research in its widest sense. A proper balance has to be reached, however, between research and service, and between the development of new knowledge and the application of existing knowledge. To reach and maintain this balance, the social function of biomedical research related to its practical application must always be kept in the forefront. Only by so doing, will it be possible to rationalize the allocation of resources to biomedical research and the distribution of these resources to its various components. The most crucial factor for the improvement of the world health situation outlined in such broad terms above, is undoubtedly the development of health manpower that is properly attuned to the health problems of the people, and that is suitably trained to respond to health programme and service needs. Education for the health professions must take into account not only the local health situation, but also the local factors that have given rise to this situation as well as general educational, social and economic factors. All this implies a vast challenge, which has only partially been taken up as yet, for the education and training and subsequent optimal use of professional and auxiliary health personnel, and of other personnel who can contribute directly or indirectly to the promotion of health. In response to this challenge, in 1971 the World Health Assembly in resolution WHA24.S9 stressed the importance of current and long-term planning of the training of national health personnel in accordance with each country's objective needs and social and economic resources. It also stressed the importance of the top priority development and strengthening of State and other educational institutions as an integral part of public health and educational systems and of the development of a flexible system for the training of health personnel, that takes into account the contemporary achievements of science and technology as well as the most recent methods for organizing'the teaching process. An increasing number and growing diversity of profeSSions working together in teams are required for health promotion and maintenance. These include such diverse types as epidemiologists for both communicable and noncommunicable disease control; laboratory scientists, technicians and administrators; scientists and technical manpower for drug production; environmental engineers and auxiliary environmental health personnel; food control technologists and auxiliaries; medical, nursing, other professional personnel and auxiliary personnel, with appropriate skills ~nd attitudes for various functions within the general health services and in particular for the provision of primary health care; various clinical specialists and technicians; mental health personnel; a wide variety of scientific personnel for biomedical research; and specialists in the planning, management and eval~a tion of health services. It will therefore be necessary to intensify the study of health teams, including such aspects as their composition in various national and local contexts, their basic and continuing training, the promotion of collaborative teamwork between different types of health personnel of different educational levels and the implications for career structures. It is important to formulate programmes for the basic and continuing education of all types of health personnel in a coordinated manner, using appropriate educational processes, even if the subject matter to be learned varies Widely from profession to profession. Methods of financing health programmes and services, as well as the health promoting activities of other sectors vary from country to country. The ability to absorb the cost of health technologies depends on the economic capacity of any given country, and this

..,

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reemph asizes the import ance of adapti ng health techno logies so that they can be applie d in differ ent social and econom ic contex ts. While countr ies can learn from one anothe r with respec t to method s of financ ing health programmes and servic es, suitab le adapta tions have t~ ~e.m~de to. accommodate nation al patter ns concer ning such matter s as govern mental respon s1b1ll t1es, flscal alloca tions for health , social securi ty system s, paymen ts by indivi duals and the use of philan thropi c agenci es and volunt eers.

THE EVOLUTION AND EVALUATION OF WHO'S PROGRAMMES

The Execu tive Board 's organi zation al study on the interr elatio nships betwee n the centra l techni cal servic es of WHO and programmes of direct assista nce to countr ies includ ed a broad assessm ent of the evolut ion of WHO's program mes. l It laid down inter alia import ant princi ples concer ning interr elatio nships betwee n countr y, region al and headqu arters activi ties for the planni ng, implem entatio n and evalua tion of the programme. In noting the recommendation s of this study, the Twent y-eigh th World Health Assemb ly stress ed the necess ity of an integr ated approa ch to the develo pment of the program me, all programme activi ties at all levels being mutua lly suppor tive and parts of a whole. 2 3.1 Programme develo pments

WHO's programmes have been contin ually adapte d in an attemp t to respon d to changi ng world health needs. In the first stage of its develo pment WHO based its program me on certai n health priori ties determ ined centra lly. These includ ed malari a, matern al and child health , tuberc ulosis , venere al diseas es, nutrit ion and enviro nmenta l sanita tion. This system of determ ining priori ties was soon found to be unsuit ed to the widely divers e health needs of the countr ies of the world, and was in due course replac ed by a more flexib le mechan ism that was more respon sive to the reques ts of Member States for help, and that made allowa nce for the partic ular problem s of each countr y. The progre ssively streng thenin g region al organi zation foster ed a better apprec iation of the distin ctiven ess of nation al situat ions, thus enhanc ing the proces s of determ ining nation al and region al priori ties within the contex t of global polici es. These polici es are establ ished on the basis of the WHO Const itution , and on decisi ons of the World Health Assemb ly and Execut ive Board, which. over the years, have been a determ inant factor in giving direct ion to the whole programme of the Organ ization . Major policy decisi ons were the launch ing of the worldw ide campai gns for the eradic ation of malari a in 1955 and for the eradic ation of smallp ox in 1958. After brilli ant initia l gains, a number of constr aints hamper ed the progre ss of the time-l tmited malari a eradic ation programme, such as the lack of health servic e infras tructu res and inadeq uate govern mental suppor t. The strate gy was subseq uently revise d by the World Health Assem bly, leadin g to a renewe d empha sis on contro l programmes as and where needed . From 1958, the World Health Assemb ly gave active attent ion to the worldw ide eradic ation of smallp ox. making it one of the major object ives of the Organ ization . In 1967 this programme was intens ified and coordi nated effort s of an unprec edente d nature began on a worldwide scale. The attainm ent of smallp ox eradic ation is well within sight and this programme will no doubt be acclaim ed in the future as a histor ical event in man's· fight agains t diseas e. Once the diseas e has been eltmin ated, _it will be necess ary t0 sustai n adequa te vigila nce in order to mainta in smallp ox eradic ation throug hout the world. 3 The experi ence acquir ed in this programme will be used for the contro l 6f other commu nicable diseas es. The charac ter of countr y projec ts gradua lly develo ped from single servic es of Itmite d scope to broade r projec ts. Action to meet local emerge ncies, of which there are notabl e examp les, became the except ion, being replac ed by program mes planne d in advanc e for a number of years. More empha sis was laid on the organi zation of basic health servic es, design ed ultima tely to incorp orate specif ic health program mes. This was follow ed by a grOWing realiz ation of the import ance of primar y health care for the promot ion of nation al health 1 WHO Offici al Record s, No. 223, 1975, Annex 7.

2 3

Resolu tion WHA28.30, 1975. Resolu tion WHA28.52, 1975.

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services, as manifested, for example, by specific resolutions of the Executive Board and World Health Assembly.l,2 Communicable diseases began to be viewed in the broader perspective of coordination of their control. The concept of environmental sanitation gave way to that of environmental health. Concern grew for the control of non-communicable diseases, including mental disease, as they increased in importance as public health problems. The education and training of health personnel has been replaced by the broader concept of health manpower development, including health manpower planning and the efficient use of health personnel. The growing body of scientific knowledge related to health and disease reawakened interest and activity in the biomedical sciences and stimulated the Organization to develop its programme of assistance to biomedical and public health practice research. The programme for the promotion of research has been making steady progress since its inception in 1958. The Twenty-fifth World Health Assembly considered it "necessary to intensify WHO activities in the field of biomedical research, particularly in regard to the development of its long term programmes".3 The Twenty-seventh World Health Assembly endorsed the proposals submitted for WHO activities in biomedical research with particular Attention to increased international cooperation and coordination, exchange of research information and promotion and initiation of research in developing countries, particularly with respect to disease pToblems of importance to the area such as paraSitic infections and other endemic diseases. The implementation of this resolution is already gathering momentum and has been strengthened by more recent resolut!ons on long·term planning for the development and coordination of biomedical research and in particular of research on tropical disease~ and cancer. 6 3.2 Mechanisms for programme development

WHO's programme is conceived and implemented at a number of organizational levels, leading to a combination in varying proportions of direct collaboration with individual countries, intercountry and regional activities, and interregional and global activities. These global activities include the establishment of international standards, for example in relation to drugs and biological substances for prophylactic or therapeutic use. They also include the international statistical classification of diseases. injuries and causes of death, as well as the international health regulations. These activities, previously considered as exclusively normative, are now recognized as being of direct importance to health development at the country and regional levels. The scientific and technical bases of the programme were built up through wide consultation. both formal and informal, with experts in individual fields from allover the world. The outcomes of the formal consultations have been published in the WHO Technical Report Series which, although they may not represent the official views of the Organization, represent a rather unique sum of knowledge. The quality of much of the information for health development programmes has been widely recognized and has significantly guided the technical work of the Organization. The increasing importance of WHO's international coordinative role has been recognized. Programme coordination is also being intensified with the United Nations and with the other specialized agencies in the United Nations System, as well as with bilateral agencies. Details appear in the Executive Board's organizational study on coordination with the United Nations and the specialized agencies,1 and subsequent documents. A few examples of such coordination are the long standing activity of the Joint UNICEF/WHO Committee on Health Policy, WHO's involvement in the overall orientation of the United Nations Development Programme and as executing agency to a number of specific projects within this Programme, the joint efforts of WHO and the International Bank for Reconstruction and Development in Resolution EB55.R16, 1975. 2 Resolution WHA28.88 , 1975. 3 Resolution WHA25.60, 1972. 4 Resolution WHA28.70. 1975. 5 Resolution WHA26.7l. 1975. 6 Resolution WHA28.85 , 1975. 1

1 ~

WHO Official Records, No. 181, 1970, Annex 4.

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pre-investment planning for basic sanitary aervices, and cooperation with the United Nations Fund for Population Activities and with the United Nations Environment Programme as well as with regional economic commissions. In accordance with resolution EB55.R54,l collaboration with nongovernmental organizations having official relations with WHO is being improved and extended. While recognizing the independent character of these organizations, WHO is intensifying its efforts to involve them more actively in its programmes, particularly in areas where the resources of the Organization are limited or where scientific and other expertise in the nongovernmental organizations concerned could make an important impact on the development of WHO's programme. A number of current trends can be discerned in programming and programme management aimed at improving the Organization's efforts. Strong emphasis has been Laid on country health programming, which is understood as the systematic process of assessing a country's health problems in their socioeconomic context, of identifying areas susceptible to change and of formulating priority programmes to induce such change. It is stressed that country health programming is a national responsibility, WHO's role being to develop methodology, stimulate interest and collaborate with countries on request. Country health programming, however, has not yet become sufficiently widespread for WHO to determine its programmes over the medium-term in response to well-defined countries' needs. Also, the general programmes of work of the Organization covering a specific period have not been specific enough to determine the Organization's detailed programmes. It has therefore been necessary to introduce a process for formulating more detailed programmes based on the general programme of work and covering the same period as it. Only by progressing simultaneously within countries and within WHO in a coordinated manner can it be hoped to establish the required degree of consistency between country health programming and WHO's medium-term programming and to exploit to the full the complementary resources they offer. Successful programming, laudable in itself, has to be judged in the final analysis by the degree to which programmes are implemented and by the effect they have in improving the health situation. Considerable efforts are now being made to improve programme delivery and to evaluate the efficiency and effectiveness of programmes. In spite of the formidable problems of evaluating the effect of international health work, continuing efforts have been made by the Organization for the evaluation of its programmes. These efforts have resulted in the presentation of valuable reports on selected subjects to Regional Committees, to the Executive Board and World Health Assembly, and in the inclusion of an evaluation element in reports on activities undertaken at all levels. Success has not been achieved, however, in providing WHO with an instrument for asseSSing the value of its programme as a whole and its usefulness in solving country health problems. A renewed approach is now being developed for the systematic assessment of the delivery of the programme and of its ulttmate impact on the health situations of the countries. In accordance with this approach, evaluation is becoming an integral part of programme planning and delivery at all levels, based on sound programme information. Intensive and extensive activities are taking place to develop a rational information system for the Organization. At this stage particular emphasis has been laid on the development of the system for the support of programme formulation, implementation and evaluation. The system being developed is based on having information available where it can best be used. Programme profiles are in the process of being established at country, regional and central levels. The Organization's reporting system too is being completely restructured. -

1 WHO Official Records, No. 223, 1975.

A29/6 page 13 4. 4.1 THE ROLE AND FUNCTIONS OF WHO DURING THE PERIOD 1978-1983 Policy basis

The Organization's role and functions are firmly rooted in its Constitution. It is evident from its Constitution that WHO is much more than just another international organization or funding agency. It clearly has a leadership role to play in international health. It can best maintain this role by consistent stimulation to thought and action in the fields of health, by pioneering in relation to difficult health problems and by daring to innovate even in the face of conventional wisdom. Different emphases have to be given to the Organization's role and functions at different periods in the Organization's history in response to the world health situation at that time. Thus, during the period 1978-1983 incluSive, priority attention will be paid to the theme5 and approaches that follow. The Constitution states the objective of the Organization as follows: "The objective of the World Health Organization (hereinafter called the Organization) shall be the attainment by all peoples of the highest possible level of health". This is obviously a long-term objective. The Organization's medium-term objectives are means for attaining this ultimate objective. The first mentioned function in the Constitution is that of "the directing and coordinating authority on international health work". This function is unequivocal; whereas technical collaboration with countries is conditional upon the request or the acceptance of governments. Important functions of WHO are also based on many resolutions of the World Health Assembly and in particular on resolution WHA23.59, as follows: "(a) analysis and evaluation of information on the state of health of the world population and on environmental health (the preservation and improvement of which are vital to the health and life of the present generation· and of future generations) with a view to identifying general trends in the world health situation and to evolving a strategy in regard to the most promising ways of developing health services and medical science"; neb) study of the methodology of the planning, organization and socio-economic analysis of different health systems and services of different countries and the preparation of realistic recommendations on the best ways in which they might develop, taking into account the importance of the development and use of cost-effectiveness and cost-benefit analyses in the field of health"; _ "(c) preparation of international agreements, conventions and regulations on the most important health problems, including questions of environmental health, the importance and implications of which go beyond individual countries or groups of countries and have a direct bearing on the protection and promotion of health in all the countries of the world"; fled) formulation of recommendations on the establishment of standardS, norms, uniform technical specifications and nomenclatures for chemical, physical, Unmunological and other substances, compounds and preparations used in international and national health programmes"; n(e) coordination of research on the most urgent and important problems of biology, medicine and public health being carried on by national and international scientific institutions, with a view to making that research as effective as possible"; "(f) identification of the most rational and effective ways of helping Member States to develop their own health systems and first and forem t to train national health personnel at all levels, pro~ision of such as:~s~ance within the organizational and financial framework of the Organization and its Constitution, and partiCipation in the coordination of such assistance from all sources."

A29/6 page 14 4.2

Coordinating role

The pride of place given in the Constitution to WHO's coordinating role makes it essential to explain clearly what is meant by coordination. Coordination implies, essentially, leadership aimed at bringing to bear the right solution on the right problem with the right amount and quality of resources at the right time and place. In selecting the right problems for WHO's involvement emphasis should naturally be given to the health problems of those peoples throughout the world who are least capable of finding solutions of their own. In many developing countries there is a dire lack of human, material and financial resources to Cope with their burning health problems. Recent policy governing collaboration with developing countries which has been adoptrd hy the World Health Assembly should therefore be applied with renewed vigour. It is legitimate for the Organization to enter into dialogues with governments with a view to identifying jointly countries' high priority health needs. Such dialogues should help to ensure that governments' requests for collaboration with ~10 relate to problems the solution of which could have an important effect on improving the country health situation. The Organization can have no different set of priorities from those of its Member States, on condition that these priorities have been determined in response to the most important needs. A most important aspect of the Organization's coordinating role is to ensure the complementarity of priority national health programmes and of the Organization's programme resulting from its general programmes of work and from the resolutions of the Executive Board and the World Health Assembly. Appropriate solutions to similar problems may vary widely according to local circumstances and cultures. There is a natural tendency to apply to health problems in the developing world solutions that have taken root in the industrialized countries. WHO's guiding prinCiple in this respect should be "Don't adopt - adapt". Whenever possible attempts should be made to devise simple yet effective health technologies that can be applied by auxiliary health personnel for people who have either no access to or need for more sophisticated health services. Adaptation from one set of conditions to another is not a one-way process. There are outstanding examples in the Organization's history of health technologies which, having proved efficacious and economical in deve10ping countries, were later widely applied in developed countries. The Organization is rich in expertise, being able to draw on experts from allover the world. It is the Organization's duty to make sure that the requisite expertise from whatever number and variety of disciplines required is brought to bear conjointly on health problems. The resources to be used should be first and foremost those of the country concerned, and the choice of solution for the problem concerned should therefore be largely determined by existing and potential national resources. This emphasizes the paramount importance of training national health personnel in order to make countries largely self-reliant as quickly as possible for the implementation of health programmes. No country can afford to waste its health manpower. TIlis implies that skills have to be developed in accordance with tasks to be performed for the solution of health problems rather than solutions sought in accordance with existing skills. Since it is most unlikely that developing countries will have adequately trained professional health manpower in sufficient numbers within a reasonable period of time, initially other solutions may have to be adopted by them, such as the training and use of auxiliary health personnel and traditional healers and midwives. WHO's resources are meant to develop national resources, not to supplant then. They should therefore be used at the national level, primarily for collaborative analysis to promote the harnessing of national resources and in particular for education and training. On the other hand, for many years to come many governments will have to seek external aid, be it bilateral or multilateral. Such aid can make extremely valuable contributions to health development, but care has to be taken. Often capital investment in institutions, which was not followed up by the training of the requisite personnel or by adequate grants to cover current expenditure in subsequent years, has left an indifferent situation behind it, and in 1 li",,¥

Pv .. ~."f'

'1f'f'

Resolutions WHA28.48" 28.75" 28.76" 28.78 and 28.79" 1975.

A29/6 page 15 some instances it has had a detrimental effect. WHO should be increasingly involved in fncussing international attention on priority health problems and in assisting Member States to o~tain and use external assistance that will help them solve these problems. The time horizon to be considered when formulating WHO's programme should be anticipatory rather than retrospective. Care must be taken not to continue dealing with a problem that can now be dealt with by national health authorities or by other international organizations, even if the Organization played a pioneering role in providing the solution. As soon as solutions have been found to current health problems the knowledge should be transferred as quickly as possible for application at national level. A constant watch has to be kept for newly emerging health problems that will require WHO's 'attention, and attempts should be made to anticipate them and propose trial solutions. The prompt application of research findings should be promoted no less than further biomedical research. By properly adapting and applying the known findings of biomedical and health practice research great improvements could be made in the health of peoples throughout the world. When planning health programmes too, adequate attention must be paid to the future, taking into account the lengthy periods of time that must inevitably elapse between planning and implementation. It is easier to plan in relation to current situations and even easier in relation to past situations, but both the necessity and the difficulty of planning in relation to future situations constitute precisely the kind of challenge that is meet for WHO's coordinating role. As for the right place for WHO's activities, the primacy of activities within countries is unequivocal. In relation to activities conducted at any other level, sight should never be lost of the supporting role of these activities for improving health situations within countries, whether directly or indirectly. The Organization's Member States are not only the main foci of its activities; they also represent its highest constitutional authorities. 4.3 Programme formulation

Technical collaboration appears to have taken precedence over coordination in the evolution of the Organization's programme. It is now necessary to mo1erate this trend, first by emphasizing programme rather than project, then by graduating from ~maller to larger scale projects. This should be followed by phasing out WHO's project implementation role along with the phasing in of the acceptance of national responsibility for current programme management as a successor to project implementation, and by the concomitant gathering of momentum of WHO's coordinating role. Among the reasons for emphasizing small projects in the past are that, being discrete entities, they are more easily identifiable for international assistance, and are easier to formulate and manage than programmes. These attributes have carried the disadvantage of leading to WHO collaboration with countries being often provided through fragmented, unrelated efforts that are sometimes marginal to the solution of high priority health problems. In recent years, in a number of countries, the systems analysis approach has led to a type of development project that emphasizes the production of an impact on the solution of priority health problems, instead of merely detailing the resources that are to be invested. On the other hand, many programmes and services, at national and other levels, appear to have no clear purpose in terms of their impact on solving clearly discernible health problems. It is now mandatory to extend the analytical approach to programmes. At country level this trend should lead, in the first instance, to the definition of national health poliCies, and then to programmes aimed at solving the country's most important health problems through the formulation of strategies that, when implemented, are likely to have a significant impact on the solution of the health problems concerned. These might include major development projects where they are required and nationally acceptable. This demands very careful programme formulation and very good management. At regional and central levels, the systematic analysis of programmes should lead to the formulation of programmes that have clearly defined, realistic purposes, whether for the support of individual national programmes or for the solution of priority regional or global health problems. This is where the Organization's technical collaborative role and coordinating role must meet, programmes of technical collaboration conforming to the principle of coordination outlined above. The promotion of health is inextricably linked to the promotion of social and economic development in general. WHO has to become more prepared than ever to work together with all

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the other organizations of the United Nations System which are concerned with social and economic development, as well as with other agencies of a bilateral or multilateral nature that wish to be involved in programmes of common concern. All this is a long-term process, but in the course of time, as the process advances, conflicts that have arisen as a result of the divergently attracting forces of technical collaboration on the one hand, and coordination on the other hand, should progressively diminish until they finally disappear. The speed of achievement cannot be forced on countries. Even if WHO succeeds in developing its own rapid rate of progress along the above lines, and although it is legitimate for it to attempt to accelerate health development throughout its Member States, this acceleration will have to be adapted to a pace that countries can accept. In view of the long period of time that must elapse between the conception of any complex plan and its ultimate realization, a start has to be made now. It is evident that, for the fulfilment of the above role, a great deal of innovation will be required. Innovation, however, does not necessarily imply the pursuit of new programmes. It can also manifest itself as a new approach to existing programmes.

MEDIUM-TERM IMPLICATIONS OF LONG-TERM TRENDS FOR WHO'S PROGRAMME

Plans for the medium-term must take into account not only the successes and failures of the past, but also possible alternative trends in the world health situation and WHO's response to this situation until the year 2000. In view of the long period required between the conception of a health programme and its widespread implementation, too short a planning time horizon carries the risk of leading to the formulation of programmes that cannot keep pace with events. It is therefore necessary to analyse the implications for WHO's future programme of national long-term health plans, wherever these exist, and of trends and prospective developments in health technology and in the health and related socio-economic situation in the various regions of the World. As a specialized agency of the United Nations system, WHO is responsible in the first place for forecasts in the field of public health. As long ago as 1970 the World Health Assembly acknowledged the need to begin to develop long-term plans and forecasts of WHO activities, taking into account socio-economic predictions and forecasts of the development of research and of public health in different countries. 1 WHO's coordinating role should be increasingly expanded with respect to the international exchange of health and health-related information. This information should be much broader in scope than mortality and morbidity statistics and will include the experiences of a growing number of countries concerning the definition of health policies and the formulation, implementation and evaluation of health programmes and services. Countries will be able to rely on WHO for collaboration in the use of this information for dealing with national health probla~s. This will be a more useful approach than attempting to provide stereotypic solutions for groups of countries at similar levels of social and economic development. Since the compilation of socio-economic forecasts is outside WHO's terms of reference, the Organization takes into account the most reliable forecasts in this domain throughout the world. On the basis of these forecasts, WHO takes into account the effect on the development of the health services of the social changes taking place in the world. WHO will have to increase its activities with respect to social and economic development at the international level, including those areas in which health is not the central theme but the impact on health is important. The purpose of WHO's intervention will be to ensure that health considerations are properly taken into account, for example by economic and other planning authorities in programmes for agricultural, industrial and educational development. Current projections of demographic developments are adequate for planning over the medium-term, but not beyond it. In most developing countries, during the period under consideration WHO will have to give precedence to the health problems of children and young 1 Resolution WHA23.59, 1970.

A29/6 page 17 adults over those of the aged. WHO will give increased attention to the development of family planning measures as one of the functions of the public health services and to intensive work on fundamental aspects of the physiology of reproduction. The development of the concept of "family health", which is new to the health services. of many countrie~ of ~he. world is a direct result of an analysis of the long-term demograph~c prospects carr~ed out ~y WHO. ' In a number of countries closer attention will have to be paid to ageing populations, and WHO's programme should concern itself with the exchange of experience~ between these countries, particularly with respect to the integration of health and soc~al serv~ces. Experience in many countries has shown that the reaction to the emerging problems of the aged is often too slow and it will therefore be one of the d~ties of WHO to keep all governments aware of this rising concern and of measures to deal with it.

In view of the high prevalence of malnutrition in many countries, its known importance as a direct or associated cause of disease and death, particularly in children, and uncertainty concerning the situation in the decades to come, increased attention should be paid to this problem. Population growth at a rate which is greater than agricultural production is aggravating the problem in many countries. The Organization can be instrumental in leading to the most efficient use of existing sources of food and in promoting better distribution. Its activities in these fields should be conducted in collaboration with FAO. The Organization should intensify its studies on unconventional sources of protein and should stimulate research on nutritional requirements that take into account the growing variety of occupations throughout the world, as well as geographical and climatic conditions, habitat and places of work. Changes in the human environment and the trends noted in most countries of the world towards a further growth in industrialization, urbanization and the use of chemicals in agriculture and everyday life will doubtless continue for the next few decades. To prevent the unfavourable effects on the environment which we are now witnessing, WHO is planning to concentrate its efforts on the key public health aspects of this extremely complex problem, such as preventing pollution. providing mankind with good-quality drinking water and improving methods of disposal of waste. In these areas WHO should concentrate on the development of an adequate range of basic health criteria that could be applied in different countries and situations in order to support the monitoring of environmental influences on health. The Organization should develop its programme for the prevention of accidents, whether in the homes and factories or on the roads. It should also strengthen its programmes with respect to all environmental problems related to urbanization. Tendencies towards change in the nature and types of pathology are directly linked with the effect of socio-economic and demographic factors, with the probable appearance in the future of new means of control or eradication of individual diseases, and also with the manifestation of biological phenomena, e.g. the cumulation of pathological genes, changes in the properties of pathogens such as vectors and the appearance of new disease agents and vectors. In developing countries, communicable diseases will continue to predominate throughout the period under consideration. WHO should intensify its attack on these diseases by the promotion of the use of every available means. Particular attention should be given to the application of immunization, wherever applicable. The Organization should make greater efforts towards the integration of disease control programmes into the general health services and should promote the development of these services by their incremental use for disease control. It should present a realistic picture of the interdependence of disease control and general economic and social development with respect to such communicable diseases as malaria. The Organization's programmes for non-communicable diseases should continue to develop community control measures, particular attention being paid to preventive aspects. By means of health education these programmes should make the most of existing knowledge concerning the influence of life style, such as food habits, exercise and cigarette smoking. The Organization should be more active in demonstrating practical measures for controlling non-communicable diseases and promoting mental health through the development of general health services.

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The socio-econo:Tlic forecasts mentioned above along with those in t.he field of the biomedical sciences l.;i11 in'ovide a general indication of the most appropriate ways of develop~ng public health services in different regions and countries of the world. Fundamental pr~nciples for the eifective development of public health were laid down by the Assembly ir. 1970. 1 A pyramidal structure of health services for successive referral should be maintained as a model, and the Organization should be active in demonstrating various ways of developing such health service systems. WHO's programmes should emphasize the required socialization of the health services in the se~se of responding to community needs and of providing wide population coverage. As mer,t:'o:,ec; with respect to disease control, WHO should be active in promoting conjoint progra~~es tor health service development, disease control and mental health. Particular attention should be paid to the development of health services for the under-privileged such as rural populations. In order to achieve wide coverage, it will be necessary to increase the use of auxiliary he~lth personnel, and this emphasizes still more the need for standardizing health technologies. The Organization should develop a strong programme in this area. In the light of WHO's long-term objectives in regard to the provisions of medical services of a universal quality, the development of primary health care, to which considerable attention is now being paid, must be regarded as one essential element in providing the peoples of the whole world with medical care. Pharmaceuticals constitute one of the most costly elements in any health service, and WHO should intensify its programme with a view to making essential drugs available at This programme should include the promotion or production of these drugs a reasonable cost. in developing countries. The predicted rapid increase in the production of new pharmacological and biological prepa:.ations will present WHO with the task of developing further a system for effective standardization and control. In the long run the problem will arise of the adoption by the Assembly of more demanding recommendations concerning standards for the international distribution and utilization of medicinal, biological and other agents used in medicine and public health. Success in providing the population with sufficient health personnel will depend primarily on extending the existing facilities or creating new ones if necessary in the countries concerned for training public health staff. The Organization should make sure that its programme for health manpower development is fully supportive of the development of general health services. This implies adapting educational objectives to health needs. The Organization should thus be more active in making education for the health professions in the developing countries more relevant to the health needs of these countries. In doing so, it will have to take account of two separate time streams. On the one hand, full weight will have to be given to long-term considerations concerning health service needs, because the outcomes of the programme may take 10-20 years to become apparent. On the other hand, the short-term requirements for providing appropriate health manpower for existing health services cannot be neglected. WHO should continue to promote the training of health auxiliaries and the provision of adequate career structures for them. The coordinating role of WHO in research calls for the development of a system for the exchange of scientific information and the enlistment of the collaboration of groups of scientists and research workers in vario~s areas for solving key problems and for the development of methods for most effectively combining their efforts. Another important WHO f~nction, arising biomedical sciences and the potential danger detriment of health, is continuous vigilance always used only for the good of mankind and from the forecasts of rapid development of the of the use of certain discoveries to the to ensure that the achievements of medicine are never for its harm.

;.. ResolL~ior. ·~23.61, 1970.

A29/6 page 19 In strengthening its coordinating activities with respect should also take into account the long-term frame required for During the period under consideration, WHO should increase its countries that are interested in health research and that have to research the Organization the promotion of research. collaboration with those not been active in this field.

The Organization should strengthen its programme of applying the basic sciences to practical health problems. It should extend the efficient application of the behavioural sciences to health research. It should increase its vigilance in promoting the rapidity and effectiveness of the application of existing research findings within health services. The promotion of exchange of experience between countries concerning the application of research findings will occupy an increasingly important place in WHO programmes. Rapid development of scientific research on the organization of public health services may be anticipated. This implies the development of operational research methods and the application of such tools as systems analysis, and in particular the adaptation of the experience of countries that have had success with these methods. In the coming years, economic considerations will increasingly influence the scope and content of health programmes in all countries. The obstacles to "the attainment by all peoples of the highest possible level of health" will depend more on economic than on technical factors. WHO should alert the world to this fact and should at the same time encourage more economic attitudes towards the development of health programmes and utilization of health services. It should thus cooperate with the developing countries in devising health programmes that are geared to their own needs and resources and that depend on innovations applied to secure maximum economy. Further consideration should be given to non-conventional methods of paying for health services. WHO could be used to a greater degree than hitherto as a neutral platform for countries to exchange views and experiences on all economic aspects of health. It should certainly be active in coordinating the channelling of bilateral and multilateral aid for health into priority health programmes, so that the most efficient use is made of available resources. The development of promiSing trends revealed by public health forecasts will call for specific activities on the part of WHO in line with the requirements of the various regions and countries of the world, which differ both in disease pattern and in the level of development of public health services. Work on public health forecasting in WHO, began comparatively recently, will be carried out on a permanent basis so that it becomes part of the Organization's everyday activities. The possibilities of arriving at forecasts in WHO depend directly on the availability of reliable national forecasts and plans regarding their long-term developments in public health. For this reason, WHO's assistance to countries in preparing long-term forecasts and plans must form an essential part of its preparation of worldwide public health forecasts.

PROGRAMME PRINCIPLES

Taking into account the evolution of the health situation and health concepts in the world as described above, as well as the evolution and evaluation of WHO's own experience, the Sixth General Programme of Work Covering a Specific Period is intended to define major fields and directions for WHO programme activities in the period 1978-1983. These will be a blend of country, inter-country, regional, inter-regional and worldwide activities, which would derive both from the unique position and role of WHO in the development of world health as well as from its statutory, financial and other possibilities. The programmes of WHO should be oriented towards defined goals and tasks during this period, and should include those major fields of activity which experience has shown to be most successful and productive. These programmes should be sufficiently flexible in order to integrate global priorities with regional characteristics and individual country needs. They should, finally, take into consideration all other possible international and national efforts and resources in the field of health. Therefore, the various programmes, activities, services and functions developed by the Organization within the Sixth General Programme of Work Covering a Specific Period should comply with the following principles:

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(1) they should correspond to the major functions of the Organization as defined by Article 2 of the Constitution and in particular by the Twenty-third World Health Assembly in its resolution WHA23.59; (2) they should meet defined criteria in regard to quality of planning and management as expressed in previo~s decisions of the Executive Board and the World Health Assembly, and as reflected in the growing experience of the Organization; and specifically in regard to the rationale for selecting programme areas for WHO's involvement, programme approaches for attaining the objectives of these programme areas, the organizational level or levels for implementation of programme activities and the type of resource to be deployed; (3) they should concentrate on those problems or fields of activities which have been identified as objectives on a global or on a regional basis; (4) they should, to the extent possible, have quantified characteristics and targets against which their progress could be assessed by the regional committees, the Executive Board and the Assembly.

APPROACHES

An approach is understood in this Programme as a means, expressed in broad terms, for attaining an objective. There are various means for attaining the same objective, and ideally each of them should be considered separately and in conjunction with others in order to arrive at what appears to be the best combination at the lowest cost. Some approaches for attaining health objectives lie outside the health sector, for example, housing or development schemes which sweep away the ecological factors creating disease situations. Within the health sector very many approaches are available. WHO, in view of its international nature and limited resources, is unable to apply all of them, but it is attempting to broaden its conceptual armamentarium and its technical and managerial repertoire for reaching its ends. International health coordination is of primordial importance. The broad approaches used, or being developed, by WHO include the provision of direct service to countries as well as the creation of regional health institutions for training, research and development. The international exchange of information, the formulation of standards and the development, adaptation, application and transfer of methods and techniques related to health are all time-honoured approaches applied by the Organization. Among other approaches that continue to be used by WHO are the development of health concepts, the promotion of international understanding of these concepts to provide policy makers with a wide choice for deciSion, participation in the formulation of international policies for health and social development, and collaboration with other organizations and institutions for this purpose. Studies and surveys, consultations with governments and health experts, as well as collaboration in research and the application of its findings are all approaches widely employed for developing the Organization's programme. The following are illus~rations

of approaches that might be used at country level.

One of the fundamental prerequisites for promoting health is the formulation of national health policies. Methodological support might have to be strengthened in relation to such matters as methods for projecting and forecasting health problems and needs and the introduction of country health planning and programming processes. Particular attention might be given by WHO to collaborating with countries in relation to intersectoral studies for development planning in which health plays a part. The proposal of solutions for problems before these problems have been properly identified is a common phenomenon. For the correct identification of problems situation analysis, epidemiologicaland statistical surveys, and pre-investment analysis might be used to greater advantage. Legislation is often required for the implementation of national health policies. Fostering of community participation in the development and control of health programmes is often crucial for the successful implementation of these programmes. Popular information on

A29/6 page 21 health is essential for stimulating the public's interest in the promotion of its health and for leading to political interest in solving health problems. Such popular information is often inaccurate and sensational. WHO might be more active in helping ministries of health to provide accurate yet stimulating information on health to the mass information media. The provision of fellowships continues to be an important approach for training national health personnel. To be effective it should conform to a coherent plan for health manpower development. As countries' own health institutions develop, additional emphasis might be laid on the provision of fellowships within the country. The role of external consultation has changed. The method of attempting to solve specific problems for countries by means of WHO staff or consultants from other countries has to be modified in most instances in conformity with this new role. Whenever external consultation is required it should take the form of collaborative review with the national health administration or institution concerned. Technical support might still be needed for such diverse activities as the introduction of laboratory techniques, quality control of drugs, environmental monitoring and the design of health facilities. Scientific support might grow in importance as countries' health research activities gather momentum, for example with respect to such matters as the setting up of medical research councils or by sending experienced research workers from other countries to work together for a year or two with local research workers until the latter gain sufficient experience and confidence. In view of the importance of reducing the time lag between scientific and discoveries and their practical application, WHOlnight make special efforts to knowledge of scientific and technological advances that is accumulating in the becomes widely known at national level for possibl~ application. At the same health authorities and institutions might be more widely consulted in order to research requirements. technological ensure that the Organization time, national identify

Operational collaboration, such as the provision of health personnel or other types of assistance for a defined period of time has been used in a number .of instances and might have t·o be developed further in certain countries. The importance of collaboration at the country level with other organizations and institutions is becoming increasingly recognized, in addition to its. iJDportance at regional and central levels. Such local collaboration should fac11i"tate the channelling of the attention and resources of these organizations into priority health programmes at national levels.

PROGRAMME CRITERIA

One of the programme principles included in chapter.5 above states that the Programme should meet defined criteria and specifies the types of criteria to be used. The criteria that follow are to be used as guides for application by countries, Regional Committees, the Secretariat, the Executive Board and the World Health Assembly. It is not intended that all of these criteria must be applicable simultaneously. They represent the main types of criteria necessary for arriving rationally at decisions. It is understood that country and inter-country activities will be undertaken following requests from governments. The basic criterion giving priority to problems of developing countries is emphasized. (i) (a) (b) Criteria for selection of programme areas for WHO involvement The problem with whicb the programme area is ~oncerned is clearly identified. The underlying problem is of major importance in terms of public health, in view of its incidence, prevalence, distribution and severity; or in terms of its related adverse socio-cultural and economic implications.

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page 22 (c) There is a demonstrable potential for making progress towards the solution of the problem. There is a strong rationale for WHO's involvement because the programme area is specifically mentioned in the Constitution, General Programme of Work, resolutions of the World Health Assembly, Executive Board and Regional Committees; the problem requires international collaboration for its solution; WHO's involvement could have a significant impact in the promotion of health; WHO's involvement will promote self-sustaining programme growth at national level; or WHO's status as a specialized agency of the United Nations system requires collaboration with other agencies of the system for the solution of the problem. WHO's non-involvement would have serious adverse health repercussions. Resource criteria The programme area may be successfully developed and its activities maintained by Member States, after the termination of WHO's collaboration. The programme area is likely to attract extra-budgetary funding whether to countries or to WHO and from bilateral, multilateral, or non-governmental sources. Criteria for determining organizational level or levels for implementation of programme activities

Cd)

(e) (ii) (a)

(b)

(iii)

The following criteria are aimed at helping to determine at which organizational level or levels programme activities should take place. (a) Country activities:

Should aim at solving problems of major public health importance in the country concerned, particularly those concerning underserved populations, and should result from a rational process of identifying countries' priority needs by such means as country health programming. (b) Inter-country and other regional activities:

Similar needs have been identified in a number of countries in the same region following a rational process of programming; the pursuit of the activity as a collaborative effort of a number of countries in the same region is likely to contribute Significantly to attaining the programme objective; for reasons of economy the inter-country framework is useful for pooling selected resources, e.g. for the provision of highly skilled technical services to countries; the activity should be useful for eventual practical application at the country level; the activity encompasses regional planning, implementation and evaluation or is required for regional coordination; or the activity is an essential regional compor,;!nt of an inter-regional or global activity. (c) Inter-regional and Headquarters activities:

Similar requirements have been identified in a number of regions following a rational process of programming; the pursuit of the activity as a collaborative effort of a number of regions is likely to contribute significantly to attaining the programme objectives; for reasons of economy the inter-regional framework is useful for pooling selected resources, e.g. for the provision of very highly skilled advisory services to regions; the activity encompasses global planning, management and evaluation; the activity is required for global health coordination and for central coordination with other international agencies; or the activity consists of technical support to regions and/or between regions and is intended to stimulate further regional activity in the programme area concerned.

GENERAL PROGRAMME FRAMEWORK

The principal objectives of the Sixth General Programme of Work have been grouped under six sections corresponding to the major areas of concern of the Organization throughout

A29/6 page 23 1978-1983. These 18 principal objectives and their accompanying detailed objectives will form the basis of the Organization's programme structure throughout the period of the Programme. They are a logical consequence of the evolution of the world health situation and health challenges for 1978-1983, and of the evolution and evaluation of ~ID's programmes and its role and functions as presented in Sections 2, 3 and!.. They have not been set ouL in ailj order of priority. The order in which objectives and detailed objectives have been arranged therefore represents a functional classification. Priority programme areas and activities relating to these objectives will vary from country to country and from region to region, a3 well as centrally. The application of the programme selection criteria presented in Chapter 8 will help to define these priorities more accurately at the different levels. '.

The progrannne structure does not necessarily fo llow the existing orzanizati,ona 1 structure, since the attainment of progrannne objectives so often requires interlinking activilies from different fields of public health. Thus, for example, the use of health statistics and the international exchange of health information are approaches so extensively applied that they could be included under most detailed objectives. These objectives will later serve as a basis for formulating medium-term programmes in which various groups, at all organizational levels, will plan activities in more detail and on a more technical basis along the guidelines given by the Sixth General Programme of Work. This will give rise to a network of activities, representing local, regional and central variations on global themes. It is understood that most activities will be carried out as a cooperative effort of headquarters and the regions and, above all, in close collaboration with countries. In order to stress the need for a coordinated approach, the education and training of the different types of health personnel has not been dealt with separately under the approaches for attaining the various programme objectives. It is understood that the principles, approaches and activities described in section 13 refer to all categories of health personnel. An attempt has been made to define the targets, approaches and activities and, where reasonable, the output indicators for each objective. However, it did not prove possible at this stage to quantify targets for the world as a whole. Although it may sometimes be relatively easy to define the target of an activity or objective for a country or even a region, it is difficult to arrive at quantified targets for the Organization as a whole. For this reason, the following text will present general, non-quantified targets, permitting regions and countries to adapt and quantify them at their own level particularly when medium-term programmes are being prepared on the basis of the Sixth General Programme of Work. National health authorities will have an important role in defining the targets for each programme relevant to their country. WHO will therefore encourage countries to define their own particular targets and, where necessary. will collaborate in this work. In the same way, the approaches set out in the text cannot be applied universally without reference to country or region. Countries and regions will therefore have the opportunity later on of adapting and selecting these approaches in the light of their needs. The comments on targets apply equally to output indicators, since the results of most activities can be quantified only at the country level or in detailed programmes or projects. Some indicators have been presented in more definite terms than others, taking into account the feasibility of applying them. During the formulation of more detailed medium-term programmes, efforts will be made to improve these indicators and make them more specific, and this should facilitate the evaluation process described in section 10. The following are the principal objectives of the programme:

A. 1.

DEVELOPMENT OF COMPREHENSIVE HEALTH SERVICES To promote the strengthening of countries' capacities for the planning and management of comprehensive national health services

1.1 To encourage the strengthening of national capacities for planning and management of comprehensive national health services, including the necessary technical, administrative and legal reforms, as well as logistic support. 1.2 To promote national capacities for the development of the various components of health services and their integration in a balanced manner as appropriate to the needs of each country.

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page 24 2, To promote the development of primary"health care

2.1 To promote. within a comprehensive national health system appropriate to the conditions and needs of each country. the provision of primary health care to the whole population. ensuring that underserved populations and high-risk and vulnerable aroupa.are properly served. 3. To promote family health, particularly maternal and child health

3.1 To reduce maternal, perinatal, infant and childhood mortality and morbidity, and to promote reproductive health and the physical and psycho-social development of the child and adolescent within the family context.

3.2 To collaborate with countries in'the development and strengthening of the family health component of health services, including family planning and welfare. 4. To reduce the incidence of all forms of malnutrition and promote better nutrition of all individuals

4.1 To collaborate in developing the health component of multi-sectoral food and nutrition policies and programmes.

4.2 5.

To promote the control of specific nutritional deficiencies. To promote mental health

5.1 To promote mental health, including the prevention of mental diseases, alcoholism and drug abuse. 6. To promote Worker's health

6.1 To promote the health of working populations, to control occupational health risks and to promote the humanization of work. 7. To promote closer cooperation of health services with all other sectors concerned with health promotion, including social welfare services

7.1 To promote clos~r cooperation be~een all services concerned with health promotion and to integrate them into a single system where appropriate. 7.2 To collaborate with countries with a view to, improving the care of the aged, preventing accidents of all types, preventing disability and ensuring the rehabilitation of the disabled. 7.3 To promote health education and information of the public with particular emphasis on the responsibility of the individual and active community involvement. 8.

To promote the development of standard health technologies To promote and support the development of standardized health technologies.

8.1

8.2 To collaborate with countries in the development and adaptation of simple, low-cost and effective technologies in specific areas. 8.3 To promote the development of public health laboratory services.

A29/6 page 25 9. To promote a more rational production, distribution and utilization of safe, effective and economical prophylactic, diagnostic and therapeutic substances

9.1 To establish and improve international requirements and standards for the quality, safety and efficacy of prophylactic, diagnostic and therapeutic substances. 9.2 To collaborate with countries in developing and executing national drug policies and programmes based on such policies. 9.3 To promote the production and availability of essential drugs.

B. 1.

DISEASE PREVENTION AND CONTROL To prevent and control communicable diseases

1.1 To strengthen national and international epidemiological surveillance of communicable diseases of major public health importance. 1.2 To collaborate with countries in evolving programmes for the control of communicable diseases,· in particular: malaria, schistosomias~s, filarial infections, trypanosomiasis, communicable diseases of the respiratory system, tuberculosis, enteric infections, leprosy, sexually transmitted diseases, zoonoses and other communicable diseases of major public health importance and provide prompt and effective assistance in emergencies.

1.3

To complete, if necessary, and maintain worldwide smallpox eradication.

1.4

To expand the use of immunization, through the health services, in the control of those diseases for which effective immunizing agents and methods exist.

1.5 To promote and coordinate the development of research on effective and economical measures for the prevention and control of the communicable diseases, particularly the development of chemoprophylactic, chemotherapeutic and immunizing agents where these do not yet exist. 1.6 To develop and apply chemical, biological, genetic and other means of control, of disease vectors, intermediate hosts and reservoirs of pathogenic agents, with due regard to safety for man and the environment. 2. To prevent and control non-communicable diseases To promote cancer prevention and control, including coordinated cancer research. To promote the prevention and control of diseases of the cardiovascular system.

2.1' 2.2

2.3 To promote and develop programmes for the control of other non-communicable diseases of public health importance, with due regard for the criteria for determining priorities. 2.4 To promote the development of policies and programmes for oral health.

c. 1.

PROKlTION OF ENVIRONMENTAL HEALTH

To promote and develop environmental health policies and programmes

1.1 To collaborate in the planning and development of environmental health policies and programmes associated with national economic development policies, plans and projects.

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1.2 To promote and collaborate in national planning of services for the provision of community water supplies and for disposal of waste. 2. To promote recognition, evaluation and control of environmental conditions and hazarda which may affect human health

2.1 To promote the development and implementation of programmes for the early detection and control of pollution in the environment (chemical, physical and biological). 2.2 To evaluate the effects of environmental factors on health. to promote and coordinate relevant research, and to foster the practical application of research findinss. 2.3 To promote environmental sanitation, related to urban and rural development, that contributes to the prevention of communicable diseases. 2.4 To promote the development of programmes to ensure food safety and the supply of information for their planning and implementation. 2.5 To improve health conditions in human settlements and housing. HEAL TIl MANPOWER DEVELOPMENT

D. 1.

To promote the development of appropriate health personnel, to meet the needs of entire populations

1.1 To promote the planning for and training of the various types of health personnel comprising "health teams", with the proper knowledge, skills and attitudes for the execution of national health plans and programmes, including personnel with appropriate levels of skills for the provision of primary health care, as well as environmental health personnel. 1.2 To promote the integration of health manpower planning, production and utilization within the context of national health plans and socioeconomic development, in collaboration with the general educational system. 1.3 2. To promote optimum utilization and to reduce undesirable migration of trained manpower. To promote the development and application of relevant processes for basic and continuing education

2.1 To promote planning, curriculum development, methodology and evaluation of basic and continuing educational processes for all categories of health personnel. 2.2 To promote the development of national teaching staff and educational technologists able to apply a systematic approach to educational processes.

PRCMOTION AND DEVELOPMENT OF BIOMEDICAL AND HEALTH SERVICES RESEARCH

To promote and collaborate in the development and coordination of biomedical research, including health services research

1.1 To identify research priorities, strengthen national research capabilities and promote international coordination of research, especially with respect to problems of major importance to WHO. 1.2 To promote the application and proper transfer of existing and new scientific knowledge and research methods to serve as the basis for the development of comprehensive national health services.

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page 27 F. PROGRAMME DEVELOPMEr-.'T AND Sl;PPORT

To promote, within the context of overall socioeconomic development, support of health promoting activities

1.1 To collaborate in the preparation, execution and evaluation of health plans, programmes and development effort~ in accordance with periodically revised or confirmed health policy. 1.2 To promote the development and application of efficient managerial, information and evaluation systems for the planning and operation of health programmes including the financing of health activities.

1. 3 To promote the integrat lon of appropriate health components into socioeconomic development plans and current social and ~conomic activities, with a view to reducing health hazards and increasing health benefits. To increase UN and other international, multilateral and bilateral collaboration, in solving priority health problems or other socioeconomic problems with Significant health implications

2.1 To increase ir.ternational collaboration and the amount of external assistance available for health programmes, for the health component of development programmes, and for development programmes with identifLable effects on health, including community water supply and disposal of wastes, particularly in developing countries. 2.2 To plan for and provide an adequate and appropriate response to emergency situations, resulting in particular from natural disasters.

10. 10.1

DEVELOPMENT OF COMPREHENSIVE HEALTH SERVICES To promote the strengthening of countries' capacities for the planning and management of comprehensive national health services

10. LITo encourage the strengthening of national capacities for planning and management of comprehensive national health services, including the necessary technical, administrative and legal reforms, as well as logistic support. Approaches and activities In collabor~tion with planning bodies and ministries of health, the Organization will participate in the promotion, review, adaptation and completion of planning and management procedures and practices for health services, with particular attention to extending the coverage of populations by planned programmes. (An output indicator could be the number of countries that have collaborated with WHO in the planning of their health services.)

In collaboration with national executive bodies, the Organization will participate in developing various sytems for the provision of health services suited to the needs of communities and will collect and disseminate information on the subject, taking into account the particular needs of the countries concerned and the experience acquired by the Organizati, The Organization will collaborate with countries in planning and organizing health services adapted to the country or region, and in cases where such services already exist will collaborate in strengthening their capacity with the personnel, equipment and complementary services they require. The Organization will encourage the development of easily applicable managerial and evaluation methods related to various levels of health service, includi'ng, where necessary, the use of operations research and data processing techniques.

A29/6 page 28 (The impact of this activity could be measured by the degree to which the methods developed are made use of at peripheral, intermediate and central levels.) At Regional level, increase of the productivity of health services systems will be encouraged by technical, administrative and legal reforms where necessary. (The output indicator could be the number of countries that have ~ntroduced

such reforms.)

The Organization will give guidance on logistic support to health programmes and services with regard to practical problems such as supplies, equipment. pharmaceutical substances and their production, purchasing, storage, costing and measurement of depreciation, and maintenance. As far as pOSSible, the solutions proposed will be examined at national, regional and local level and by health institutions, and efforts will be made to comply with or develop standards. Exchange of information on logistic support and on the means of identifying areas in need of support will be encouraged. (Output indicators could be as follows: requests from countries, number of programmes, services and institutions having received logistic guidance, information and assistance from the World Health Organization in identifying areas in need of support.) 10.1.2 To promote national capacities for the development of the various components of health services and their integration in a balanced manner as appropriate to the needs of each country. r

. Approaches and activities The Organization will promote the dissemination of information on balanced health services. (An output indicator could be the quality and quantity of information circulated.) The Organization will encourage the planning, implementation and evaluation of health services that secure a proper balance between research, prevention, treatment and rehabilitation. The Organization will contribute to the development of regionalization and to the assignment of responsibility to integrated services at the local (health centres), regional (health institutions), and central (overall programmes) levels. 10.2 To promote the development of primary health care

10.2.1 To promote, within a comprehensive national health system appropriate to the conditions and needs of each country. the provision of primary health care to the whole population, ensuring that under served populations and high-risk and vulnerable groups are properly served. The targets should be to ensure that an adequate quantity and quality of health care is made available to all members of a community or all inhabitants of a country, as well as maximum coverage of underserved populations and high-risk and vulnerable groups by primary health care. Approaches and activities The Organization will promote the establishment of a primary health care system as part of a comprehensive health service. This system will comply with the following general principles: - Primary health care must be tailored tp the customs of the communities concerned and must meet their actual needs; It should be fully integrated into the national health service or find support at other levels for the work of peripheral units, in areas such as technical backing, supplies, supervision and reception of patients requiring special care;

A29/6 page 29 In the countries concerned, primary health care activities should also be properly integrated with other areas of community development such as agriculture, education, public works, housing and communications; Most medical and health activities within the primary health care context should, as far as possible, be carried out at the most peripheral level of the health service by the staff best trained for the purpose. (The output indicator will be the increase in the number of people covered by care of a given quality.) As far as developing countries are concerned, the Organization will appeal for and coordinate technical and financial assistance for the development of primary health care and for the training of first-line health personnel. The Organization will participate in the collection, interpretation and dissemination of data for identifying health needs and priorities relevant to primary health care and for evaluating primary health care services. The Organization will promote the active participation of the population concerned in the planning and implementation of health activities to ensure that such activities are properly adapted to local needs and priorities, and that any decisions on action to be undertaken should result from a continuing dialogue between the population and the officials of the various services. Primary health care services will be used, in particular, for the implementation of the Organization's expanded programme of immunization. The Organization will deflne particularly vulnerable and high-risk groups and will identify their particular problems with a view to formulating policies for making primary health care available to such groups. Specific programmes will be developed. The World Health Organization will continue, in collaboration with the United Nations Children's Fund, to seek and promote national solutions which could possibly be used in other countries and are applicable to primary health care, and which develop various measures for meeting the fundamental health needs of the populations of developing countries. -~

The Organization will identify groups with inadequate access to health care, with a view to giving them opportunities for access to the same level of care as the rest of the population. The Organization will promote the introduction of special primary health care services for vulnerable and high-risk groups. 10.3 To promote family health. particularly maternal and child health

10.3.1 To reduce maternal, perinatal, infant and childhood mortality and morbidity, and to promote reproductive health and the physical and psycho-social development of the child and the adolescent within the family context. The targets should be the reduction of maternal, perinatal, infant, childhood and adolescent mortality and morbidity by a given percentage in each country, promotion of the health of women of child-bearing age and the physical and psycho-social development of the child within the family context. Approaches and activities

The Organization will develop methods and formulate guidelines for specific intervention activities in family health, particularly with regard to maternal and child care. Emphasis will be given to primary health care and to simplified technology relevant to the control of diseases specific to maternity, childhood and adolescence, including suitable forms of school health services.

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page 30 The Organization will collaborate with countries in implementing programmes to solve local or regional problems related to the preconceptional, prenatal and postnatal periods and to childhood and adolescence. The Organization will further develop research on human reproduction, contraceptive methods and sterility, in particular by expanding its network of collaborating centres for research and through special working groups. Operations research on the application of research results will be encouraged. The Organization will also encourage research and promotion in the following fields: physical and psycho-social development of the child and the adolescent, promotion of nutrition, and prevention and early detection of exogenous hazards to healthy growth and development. 10.3.2 To collaborate with countries in the development and strengthening of the family health component of health services, including family planning and welfare. The target will be to ensure total coverage of MeH care during pregnancy, childbirth and chil dho(',d in the maximum number of countries. Approaches and activities WHO will collaborate with governments in the development of an information service. as part of their total information system, for the purpose of disseminating information on family health services, particularly maternal and child health serVices, and on manpower needs. The Organization will collaborate with countries in the planning, management and evaluation of sectoral and inter-sectoral family health and maternal and child health programmes as part of the general health services and the social welfare services, with particular emphaSis on the provision of primary maternal and child health care and on underserved populations. The Organization will collaborate with other agenCies and organizations interested in the care of mothers and children and family welfare, and will playa coordinating role in the development of inter-sectoral policies and programmes relevant to maternal and child health care, family planning and family welfare. The Organization will collaborate with countries in the development and strengthening of the family planning component of their health services, particularly as part of maternal and child care, by helping to formulate programmes on fertility regulation and sterility. The Organization will pay particular attention to the promotion of community participation in the development and implementation of maternal and child health programmes. WHO will encourage countries to utilize establishments and services not directly concerned in health care, such as mothercraft centres, nursery homes and day care centres, as a channel for the delivery of maternal and child health care and family planning. The Organization will promote and conduct research directed towards improving the operational capacity of maternal and child health care services, in particular by identifying high-risk factors that deserve priority attention. (The output indicator could be the number of countries with a significant increase in the coverage of HeH care.) 10.4 To reduce the incidence of all forms of malnutrition and promote better nutrition of all individuals

ie.i..: To collaborate in developing the health component of multi-sectoral food and nutrition policies and programmes. The target will be clearly formulated and implemented food and nutrition policies in the largest possible number of countries.

A29/6 page 31 Approaches and activities Emphasis will be given to basic nutritional problems in developing areas, to dietetic services and collective feeding in more developed and industrialized countries, and to the adoption of multi-sectoral policies and programmes. The Organization will collaborate in the definition of principles and in the development of methods for the formulation and implementation of food and nutrition policies. This support will extend to the analysis preceding the implementation of national projects where nutritional components are required and to the evaluation of nutrition interventions.

To identify the nutritional needs of countries and individuals (according to age and type of work), the Organization will promote studies to determine essential foods and to identify the different categories suited to each country, due concern being given to deleterious food habits. WHO will encourage the collection, analysis and dissemination of information on the approaches adopted by different countries; health education with regard to nutrition, such as by encouraging breast feeding as opposed to other systems of infant feeding; the creation, where necessary, of regional or national nutrition centres capable of training personnel and the introduction at all levels of the educational system of courses on the public health aspects of nutrition. The Organization will collaborate with the Food and Agriculture Organization of the United Nations and other international organizations concerned as well as with countries to develop policies and programmes to provide given population groups with essential foods, enriched where necessary, as in the case of weaning foods. 10.4.2 To promote the control of specific nutritional deficiencies.

The targets could be, according to the situation in the countries concerned, reduction in the prevalence of nutritional deficiencies such as those caused by inadequate protein, vitamin or calcium intake or reduction of the rate of increase in prevalence of diseases associated with overweight, such as cardiovascular diseases and diabetes. Approaches and activities The Organization will collaborate with countries in identifying risk groups for malnutrition and nutritional deficiencies. It will also collaborate with countries in establishing a permanent surveillance system that will facilitate the development of a variety of intervention programmes in health and other sectors, including programaes for the early detection and prevention of nutritional disorders. The relevant indices for this surveillance system could be based on clinical, ecological and social factors of likely premonitory importance. The Organization will collaborate with countries in selecting, designing or modifying measures for the control of specific nutritional deficiencies such as protein or calorie deficiencies, and in setting up logistic support, including operations research, for their use. The Organization will encourage the search for protein-rich foods, including acceptability studies, and will encourage research on non-conventional sources. In collaboration with the Food and Agriculture Organization of the United Nations and the United Nations Children's Fund, the Organization will encourage applied research on the composition, quality control, production and acceptability of basic or supplementary foods. WHO will encourage research on nutritional deficiency diseases and their treatment. 10.5 To promote mental health

10.5.1 To promote mental health, including the prevention of mental diseases, alcoholism and drug abuse.

A29/6 page 32 The targets will be tbe integration of Omental health activities within the general health services and the promotion of mental bealth in different communities and cultures. Approaches and activities In order to stimulate tbe control of mental diseases and to promote normal mental function in different communities and cultures, the Organization will pay attention to the epidemiological study of mental morbidity, including morbidity due to alcobolism and drug dependence, so as to design methods for its prevention or reduction; the development of methods for identifying and disseminating information on tbe nature, the frequency, and the changes over time of mental bealth problems witbin specified population groups; a. well as the testing, application and adaptation of effective low-cost strategies and methods for the prevention and treatment of specific mental disorders, including alcoholism and drug abpse. The Organization will collaborate with countries in developing general mental health policies, stressing the prevention of mental diseases, tbe treatment of mental patients within the community, and the integration of mental health action within the activities of the general health services. One feature of these programmes will be the strengthening of the mental health services within health ministries and the setting-up of such services where they do not exist. Special attention will be given to the formulation and implementation of programmes for promoting mental health in certain high-risk groups (e.g. mental health programme for children and adolescents, suicide prevention services, promotion of mental health education for special groups). The Organization will stimulate the development of services for the control of alcoholism and drug dependence, either as part of the general health serviceR or in close cooperation with these services, depending on the situation in the country concerned. It will strengthen its collaboration with the United Nations Fund for Drug Abuse Control and with other UN agencies. WHO will collaborate with countries in the design and implementation of programmes for orienting health and social workers and other types of personnel with respect to mental health problems. Within the context of the integration of mental health services within the general health services, stress will be laid, especially in the developing countries, on the establishment of mental health community centres in large conurbations; on the formulation of appropriate methods. The Organization will collaborate with countries with a view to providing information to those responsible for socioeconomic and health policies on the influence of psychosocial factors on health and the health services and the actual or potential mental health impact of various social, economic and health measures and activities. Metabolic, genetic and biological research will be encouraged, together with studies on psychosocial factors.

10.6

To promote worker's health

10.6.1 To promote the health of working populations, to control occupational health risks and to promote the humanization of work. The target could be a reduction in mortality, disability and morbidity among workers generally and espeCially due to diseases caused by working conditions.

A29/6 page 33 Approaches and activities In collaboration with ILO in areas of common interest, the Organization will formulate or revise standards and prepare guidelines for protection against occupational risk and will promote coordination of activities for strengthening the legal, administrative and occupational framework to ensure health and safety in workplaces. It will also prepare guidelines for the routine medical examination of workers. WHO will collaborate with countries, even during the early stages of industrialization, in developing comprehensive occupational health programmes and services that are coordinated, and preferably integrated, with the general public health services. The Organization will assist countries in monitoring the working environment, including preventive measures and the establishment of clinics and laboratories. (The output indicator for this activity could be the number of countries that have adopted programmes or general measures for the protection of workers exposed to occupational hazards.) WHO will promote the development of methods for the early detection of health impairment of workers and the collection, and dissemination of information on specific occupational health problems and their solution, and on occupational hazards. This will include criteria for placement medical examinations taking account of work exposure and human capacities. WHO will coordinate and stimulate research to cover gaps in knowledge of problems between work and health, including the study of occupational exposures, stressful work conditions and the adaptation of measures to prevent the effects of combined hazards. 10.7 To promote closer coeperation of health services with all other sectors concerned with health promotion, including social welfare services

10.7.1 To promote closer cooperation between all services concerned with health promotion and to integrate them into a single system where appropriate. The target could be the joint development of health and social welfare services within a single system and closer collaboration between these services. Approaches and activities The Organization will identify problems that are common to health services, to social welfare services and other social services, and to a number of fields such as the environment and the economic sectors, having a bearing on health problems. (The output indicator could be the number of countries having drawn up this list of common problems.) The Organization will collaborate with countries in developing common approaches and solutions to problems of common concern to the health, economic and other social sectors. The Organization will encourage the introduction of national legislation concerning health and social welfare with a view to the integration of such services where this is considered possible and necessary.

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In order to accomplish these activities , encouragement will be given to planning joint training programmes for health service, social welfare service, and other public service personnel.

The Organization will collaborate where necessary with other agencies and international organizations that have an interest in the activities defined above.

10.7.2 To collaborate with countries with a view to improving the care of the aged, preventing accidents of all types, preventing disability and ensuring the rehabilitation of the disabled.

The respective targets will be the formulation of policies and implementation of programmes for the care of the aged and the development of policies and programmes for the prevention of accidents of all types in as many countries as possible, and the introduction in the maximum number of countries of services aimed at reducing disability in as large a proportion of the population as possible. Approaches and activities The Organization will promote and coordinate the formulation of policies and programmes for the care of the aged as part of general social welfare and health plans and programmes, with particular emphasis on services within the community. (The output indicator could be the number of countries that have integrated the problems of the aged into their general social welfare and health programmes.) The Organization will collaborate with governmental, nongovernmental or specialized national institutions in the conduct of epidemiological and socio-cultural studies, to identify the problems of the aged and to find solutions for these problems, such as the development of specialized institutions, long-term care, geriatric services in hospitals and the social welfare and health facilities required to look after the aged in the community. WHO will collaborate with countries in defining the relative importance of accidents in terms of morbidity and mortality and in asseSSing their social and economic consequences and will draw attention to the mUltiple nature of accident causes and of the need for collaboration between various ministries such as the ministries of health, labour, transport and education. It will collaborate with countries in epidemiological studies on the human and medical factors involved in accidents, particularly on the social and economic cost of accidents and on the influence of alcohol and psychotropic drugs" and will promote the improvement of the assistance given to accident victims by the ~edical and public health services. (The output indicator for thiS activity could be the number of countries that have established national programmes for the control of accidents.) WHO will encourage the regular publication of information on accidents and their prevention, and for this it will be necessary to formulate standards for the collection, analySiS and presentation of data. It will exchange information with international agencies and nongovernmental organizations on accident prevention programmes and on the legislation that should be introduced in this field. Programme activities with respect to disability and rehabilitation will be centred on physical and mental disability and will be closely coordinated with work being carried out in related programmes such as care of the aged. Such activities will, as far as possible, be integrated into public health programmes, primary he~th care services and social welfare programmes.

A29/6 page 35 The Organization will encourage the implementation of measures aimed at individual patients, such as preventive and curative therapy for disabling diseases and remedial exercises; as well as community measures such as preventive legislation, the inducement of changes in any possible negative attitude to the disabled on the part of the general public and provision of educational facilities. The organization will endeavour, through regional and national projects and/or interregional and inter-institutional programmes to encourage effective local action directed to the early prevention of disability rather than to the correction of disability at a later stage; to set up a system of care at community level; to support studies and research to evaluate the problems of disablement and find methods of proved efficiency and effectiveness for their solution; and to strengthen coordination and cooperation between United Nations agencies and governmental, intergovernmental and private bodies, with emphasis on planning at. national and local level, community participation, and funding. The Organization will emphasize the use of multi-skill personnel for the provision of rehabilitative care in primary health care services as well as in higher level health services to which cases may be referred. 10.7.3 To promote health education and information of the public with particular emphasis on the responsibility of the individual and active community involvement. The target could be the systematic introduction in all the Organization's programmes, at all relevant levelS, of a health education and information component for the general publiC and the active involvement of the population. Approaches and activities On the internal level, a systematic analysis will be made within each of the Organization's programmes to determine the degree to which appropriate information of the public would assist in solving the problems tackled by such programmes.

(Output indicator: number and size of the public health education/information components in the Organizat,ion's various programmes.) The Organization will encourage countries to impart to the individual and the population at large a sense of responsibility for personal, family, community and mental health and to promote the active involvement of communities in improving their own health. (An output indicator could be the number of countries that have introduced health education and information programmes. However, a programme quality and range factor should also be introduced. ) The Organization will prepare easily asstmilable health education and information material adapted to various age and social groups. Depending on the country, emphasis will be placed on techniques and material designed to reach people: - where they meet as members of particular age or social groups; - as members of groups exposed to the same hazard or requiring the same type of health education (communities, workplaces). (Output indicators: finished material such as films and pamphlets, implemented projects such as number of health-education hours given in various places such as factories or universities.: The Organization will encourage countries to define and/or improve their health education policies. To ensure the development of such policies in some countries, the World Health Organization will encourage the establishment and consolidation of health education units in general health administrations. Such an approach should also attract the political support required to influence the general public and gain their participation.

A29/6 page 36 Studies will be organized to determine the behaviour of human communities on health matters so as to give greater emphasis subsequently to the health education component in the training of workers in all industrial and social sectors. 10.8 10.8.1 To promote the development of standard health technologies To promote and support the development of standardized health technologies.

The targets could be the availability to countries of a range of standardized health techniques so that prevention, diagnosis, therapy and rehabilitation may be carried out by internationally recognized instruments and methods. Approaches and activities The Organization will promote international collaboration, including collaboration with internatfonal institutions and nongovernmental organizations, for the purpose of defining a limited number of standards for health technologies such as radiology, methods, techniques, equipment and instruments. (The output indicator for this activity could be the number of defined standards made available to users.) To attain this objective, the Organization will stimulate the public and private industrial sectors to implement and test technologies as required, and to this end, will promote international recognitfon of the need for standardization, emphasizing the impact of the latter on costs, maintenance and personnel training and hence its general interest for all countries, particularly developing ones. 10.8.2 To collaborate with countries in the development and adaptation of simple, low-cost and effective technologies in specific areas. Approaches and activities Where necessary, the Organization will collaborate with countries in developing technologies through the adaptation or adoption of international standards, particularly in such fields as epidemiology and statistics; nutrition; the environment; therapy; public health administration and health information and education. 10.8.3 To promote the development of public health laboratory services.

The target will be the establishment, in as large a number of countri.es ~s pO$sible, of public health laboratory services ferming an integral part of the national health services.

Approaches and activities The Organization will encourage the development of programmes for the introduction of health laboratory systems and blood banks. Such laboratories will support public health programmes for medical purposes or for veterinary purposes related to human health and for ~erforming the tests required under hygiene and food and drug control programmes. The equipment, maintenance and management of these laboratories will be standardized in accordance with methods established by the Organization. (The output indicators for this activity could be: the nu~be~ of cou~tcies that have defined or adopted standards for equipment, personnel and laboratory operation, and the number and size of laboratories.) The Organization will promote the development and rational administration of laboratory services adapted to the countries concerned a~d integrated into their general health services at a central or decentralized level depending on the duties assigned them a~d the com?lexity of the equipment in use.

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10.9

To romote a more rational roduction distribution and uti:ization of safe and economical prophylactiC, diagnostic and therapeutic substances

~ffective

10.9.1 To establish and improve international requirements and standards for the quality, safety and efficacy of prophyla'ctic, diagnostic and therapeutic substances. The targets will be the development of new and revised require~ents and standards for drugs and the availability of up-to-date information on the safety and efficacy of dru~s. Approaches and activities Studies will be carried out to establish international standards and potency units for biological substances. The Organization will issue standards and guidelines for formulation and publication of requirements and specifications for quality control of pharmaceutical preparations and biological substances and for drug evaluation and registration. Further development of WHO collaborating centres for new international biological standards and chemical reference substances for the quality control and verification of drugs will generate information for dissemination. These centres will be invited to include in their programme the establishment of international biological standards and new international reference substances for distribution to national control laboratories. The Organization will select and publish' international nonproprietary names for new substances. (The output indicator for this activity could be the number of new international nonproprietary names established.) Formulation or rev~s~on of international codes for production, quality control and certification of drugs in international trade will be carried out by WHO, which will collaborate with countries in evaluating the safety and efficacy of drugs, including monitoring of adverse effects. The Organization will serve as a focal point for the exchange of information on the efficacy, availability and use of drugs of natural origin (e.g. medicinal plants).

10.9.2

To collaborate with countries in developing and executing national drug policies and programmes based on such policies. The target will be the establishment of mechanisms to ensure that essential and effective drugs reach those in need of them.

Approaches and activities The Organization will assist Member States in the development of national drug policies to solve such problems as the production or procurement and the distribution o£ d%ugs c t 1 of nomenclature, registration of quality and distribution. The latter will include ~heon ro management of drug storage and the regulation of purchase with or without ~ prescription. (The output indicator for this activity could be the number of countries collaborating with the Organization in developing all or some of such policies.) ~ountr~:s.for gover~ental regul~tory

Organization will provide countries with infbTmation on the methods used in other control of drugs and will collaborate with countries 1~ prov1d1ng the med1cal profess10n, auxiliary personnel and the general public with i f t~on on drugs. n orma T~e

(The output indicator for this activity cou ld b e t h e di f ferent types of information provided in relation to national drug policies.) . The Organiza~ion will encourage surveillanc~ of drug utilization and will continue to ass 1St cou~tries ~n drug monitoring. For this purpose, comparative international studies on the eff1cacy, safety and economy of alternative therapeutic substances will be performed by

A29/6 page 38 the Organization. In some countries, either a single drug control service or an effective coordination body capable of implementing national drug policies ranging from research to regulatory control will be established or strengthened. (The output indicator for this activity could be the quantity and quality of information on safety, efficacy, economy and accaptability of drugs in use.) 10.9.3 To promote the production and availability of essential drugs.

Approaches and activities The Organization will identify and quantify imbalances and inequity in the production and distribution of essential drugs. The Organization will collaborate with countries in developing financial and other arrangements to make essential drugs available, particularly those required for implementation of priority health programmes. For this purpose, the Organization will collaborate with countries in planning, programming and organizing the production or procurement of drugs and their distribution. Such activities will include advice on management of drug storage, distribution and establishment of lists of essential drugs. Activities related to production and distribution will be conducted in collaboration with the United Nations Industrial Development Organization, and such other organizations and bodies which might make a positive contribution to research on and production of essential drugs. (The output indicator for these activities could be the availability of a range of drugs corresponding to the needs of the principal health programmes in each country and to the needs of the general public, particularly in the context of primary health care prosr...es.)

11. 11.1

DISEASE PREVENTION AND CONTROL To prevent and control communicable diseases

11.1.1 To strengthen national and international epidemiological surveillance of communicable diseases of major public health importance. The target will be to ensure world coverage of epidemiological surveillance of communicable diseases of major public health importance. Approaches and activities The Organization will encourage the development of epidemiological surveillance services in the countries, supported where appropriate by WHO surveillance centres covering specific areas and promoting: - the development of national information services on the incidence of communicable diseases and on the morbidity and mortality they cause; - the collection, analYSiS, interpretation and dissemination of data at the regional and worldwide levels; - action at the national, regional or worldwide levels arising out of the data thus collected and interpreted. 11.1.2 To collaborate with countries in evolving programmes for the control of communicable diseases, in particular: malaria, schistosomiasis, filarial infections, trypanosomiasis, communicable diseases of the respiratory system, tuberculosis, enteric infections, leprosy, sexually transmitted diseases, zoonoses and other communicable diseases of major public health importance, and provide prompt and effective assistance in emergencies.

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The targets could be the determination, in the countries concerned, of the nature, eharaeteristics and geographical distribution of the endemic and epidemic communicable diseases that most severely affect the communities and the definition, within the framework of the national health plan, of a medium-term programme for the control of these diseases, and collaboration with countries in the implementation of this programme. J

Approaches and activities For all communicable diseases under consideration in a given country, the Organization will participate in: - establishing the profile of the epidemiological situation and determining the health and socioeconomic parameters that justify priority action; - determining the possibility of preventing or controlling the diseases concerned, using the most effective and economically most suitable methods; - ensuring that the basic health services are fully utilized and, where this infrastructure is still inadequate, that whatever intervention measures of its own may be considered necessary are implemented; '-

- making proper use of national epidemiological surveillance services and laboratory services; - providing an adequate supply of diagnostic, prophylactic and therapeutic substances of recognized quality, safety and efficacy. Within their overall programmes, the Organization may provide countries with special assistance for each of the diseases concerned. The extent of its involvement will depend on the priorities fixed at the national, regional and worldwide levels. The Organization will endeavour to develop further the approaches and means for providing immediate as8i8tance in emergencies in order to idaDtify the cause, to assess the nature and extent, of the problem to determine the necessary measures and to collabo~ate with countries in their implementation. ,The Organization will not exclude from its own activities a priori any communicable disease that repr,esents a problem for any country whatsoever. With this reservation, and not forgetting or underestimating the possible role of a particular disease in a given national situation, the Organization will concentrate its efforts and resources on the control of the follOWing diseases, which unquestionably command priority at the worldwide level. Parasitic 'diseases For malaria, the Organization, in accordance with resolution WHA22.39, will develop flexible programmes~ using epidemiological and socioeconomic criteria, emphasizing insectic14•• and antimalarial drugs, but not neglecting other ,methods of vector control. For this purpose i t will:

participate in evaluating situations and national programmes; - help to determine, for each country, the antimalaria programme suited to the situation and realistic plans of action for implementing it; - arouse a firm resolve on the part of the governments concerned, particularly with regard to the allocation of resources, and the support of informed public opinion; - stimulate research on new forms of action and improved methods; - draw up and implement, in collaboration with the manufacturing institutions and industries. a plan ensuring the aVailability of malaria drugs and insecticides i adequate quantities and at prices the customer can afford. n

•

arouse the interest of multilateral or bilateral international institutions and their medium-term and long-term support in the form of equipment, subsidies or loans;

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- encourage cooperation between countries in the same ecological and epidemiological region. particularly in border areas. With regard to schistosomiasis, priority action will be concerned with tbe epidemiological .tudy of the various etiological forms of the disease. particularly in relation to water resources development; the formulation of action plans in which measures to control parasitic infestation of man are combined with control measures directed against the host; the eacouragement of research; and the strengthening of international support for national control programmes. Within the framework of strengthened action against the filarial infections. onchocerciasis control will continue, particularly through the Control Programme in the Volta basin which will permit the economic exploitation of areas freed from the disease. On the I model of this Programme, taking into account the lessons learned from it, the campaian will gradually be extended to other areas where the disease is rife, particularly in Africa. Trypanosomiasis (African trypanosomiasis and Chagas' disease) will a180 be give~.hilh priority, both in research and in· prevention and control activities. Bacterial and virus disaasea The programme will be extended from the control of tuberculoSis to the control of communicable diseases of the respiratory system, which as a group form one of the principal causes of morbidity and mortality in many countries. This programme should include the chronic noncommunicable lung diseases. Leprosy will be the subject of an increased research effort under a special international programme for tropical diseases as well as under national control programmes in which the Organization will cODperate. The impetus given to cholera control should be extended, through prophylactic, therapeutic and environmental health measures - to the entire range of acute infections of the intestinal tract, Which also represent a major cause of morbidity and mortality, severely affect young children, and require a multidisciplinary approach. The Organization will promote awareness on the part of the community and the responsible authorities, in the health and social sectors, of the importance of the sexually transmitted diseases, and will encourage the adoption of measures to limit their spread. Veterinary public health, particularly the control of zoonoses, will retain its place among the Organization's activities, particularly in the various regions and according to the health and economic problems specific to each region. The Organization will exercise constant vigilance to detect the appearance or follow the development of diseases with high epidemic potential, current examples of which are cerebrospinal meningitis, influenza and haemorrhaaic dengue fever; it will also keep watch Oft the enzootic reservoirs of diseases communicable to man, such as plague, yellow fever and rabies. In addition, the Organization will pay particular attention to those diseases that can be prevented by immunization, notably diphtheria, tetanus,.hooping-cough, poliomzelitis and measles, not to mention smallpox and tuberculosis. Although baSically concerned with the communicable diseases that impose a heavy burden on the developing countries in tropical regions, the Organization will devote equal attention to the hazards to which the industrialized countries are exposed through the persistence of diseases such as tuberculosis, respiratory diseases, sexually transmitted diseases, interhospital and intrahospital infections, the spread of Salmonella infections, resistance to antibiotiCS, or imported cases of tropical diseases such as malaria. These activities will take into account the evolution of the International Health Regulations.

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11.1.3

To complete, if necessary, and maintain worldwide smallpox eradication.

The ~arget will be the total eradication of the disease throughout the world. Approaches and activities Until smallpox eradication can be regarded as complete, the Organization will endeavour to consolidate the results achieved and will participate in the collection and prompt exch~ge of information. 'ld up and mal.'ntain an international stockpile of smallpox vaccine Organization will bUl. in case of need. ~be

The Organization will prepare a registry of laboratories working on the .mallpox virus and will draw up safety standards for preventing the possible spread of the virus. (The output indicator will be the absence of cases of smallpox' throughout the world.) The Organization will summarize and describe in a major publication the experience ofsmallpox eradication throughout the world and will use the experience acquired in this probl. . for the control of other communicable diseases. Even if smallpox eradication is an established fact by the end of the Fifth General Programme of Work, it will still be necessary to continue surveillance, particularly for animal pox virus infections and for exanthematous infections in man, and studies on pox virus.

11.1.4

To expand the use of immunization, through the health services, in the control of those diseases for which effective immunizing agents and methods exist. The expanded programme of immunization will mainly be concerned with the following six diseases: diphtheria, whooping-cough, tetanus, poliomyelitis, tuberculosis and measles.

The .tar3etl will· be·-to eliminate . . or to reduce in size or number of the epidaaic. of whooping-cough, poliomyelitis and measles; to keep diphtheria morbidity al.a law. level; to reduce the morbidity level of tetanus and tuberculosis in young children; and to increase the p~QPQrtion of effectively immunized children -in group. at high risk becauee of ~ 3eographical situation or social status. Approaches and activities -The Organization will collaborate with the countries in planning and implementing immun1zatiQu.programmes for certain communicable diseases recognized to be of ~jor importance for_tne health of the community, and particularly for child health. In th. developing countries these progr_eewill be designed. as part of a primary health care policy. Specific attention will be devoted to the development of immunization schedules to facilitate the proper planning and management of immunization activities within the general health services. In every country, whatever its level of development, WHO will provide assistance with immunization programmes for population groups, whether children or adults, that are exposed to special risk because of the epidemiological situation, the environment, or the conditions of work.

Within the framework of the development of these programmes, the major efforts at country level will consist of: - promoting the basic immunization of children and where necessary of the mother, through the maternal and child health services; - strengthening the services for the supply and transport of vaccines, staff training, the management. supervision and evaluation of activities related to immunization Within the basic health services;

-..

- streng~hening ~r where necessary establishing epidemiological surveillance for the six commun1cable dl.seases concerned and for other communicable diseases of local epidemiological importance and for which immunization is applicable;

A29/6 page 42 - strengthening, where economically desirable. the national production and control of vaccines; - disseminating appropriate information, including textbooks and manuals. , - promo.ting puhlic ,J;ecognition of the benefits of the vaccination of children and encouraging the public to demand such benefits. (The output indicator will be the number of countries with which WHO is collaborating for the impicentat:l.on'·of ~he" ~xpanded progr&1llllle of immunization.) 11.1.5 To promote and coordinate the development of research on effective and economical measures for the pr~vention and control of the communicable diseases, particularly the development of chemoprophylactic, chemotherapeutic and immunizing agents where these do not yet exist. The targets will be the intenSification of research and development of effective vaccines against diseases for which they are not yet aVailable and the systematic development of new drugs for the control of communicable diseases of major importance, espeCially parasitic ~seases.

Approaches and activities The Organization will make efforts inter alia through its special progr&1llllle for research and tr.ining in tropical diseases: - to encourage and assist research on the biology of the agents of the major communicable diseas~s, particularly the paraSitic di ....e., and on the immunology and immunopathology of these diseases; - to increase the number of diseases that can be prevented by vaccination, and to reduce operational costs and problems by encouraging practical studies and research through national and international efforts; - to encourage improvement of the potency and stability of antigens. The Organization will also make efforts to coordinate research on the development and evaluation of new drugs and vaccines with the pharmaceutical industry, the scientific bodies concerned, and the national administrations of countries where the paraSitic diseases are endemiC. The Organization, in cooperation with Member States and with scientific institution., will set up a network of research centres for basic research on parasite biology and on the immunology and pathogenesis of the parasitiC diseases, including the strengthening of a certain number of medical institutions in the areas where these disea.e. are endemic. It will encourage the development of research in clinical pharmacology and the testing of new drugs and new vaccines by methods that permit international comparison of re.ult•• 11.1.6 To develop and apply chemical. biological, genetic and other means of control of disease vectors, intermediate hosts and reservoirs of pathogenic agents, with due regard to safety for man and the environment. The target could be the reduction of vector popula&iona and reaervoirs of pathogenic agents to a point where the continued transmission of the disease is unlikely. Approaches and activities The Organization will continue to promote: _ research on the development of improved and new pesticides; _ the development of improved techniques for their utilization against animals, reservoirs of pathogeniC agents, vectors, and other intermediaries of the agenta of huaan

A29/6 page 43 infection. Special stress will be laid on equipment and methods that have a specific effect on the target organisms, but are safe for man and have the least possible effect on non-target organisms and on the environment; - the development of specifications for pesticides and of methods and equipment for their application, so as to standardize their utilization in national vector control programmes; the establishment t in collaboration with national toxicology centres, of standard methods for measuring the effect of pesticides on man. The Organization will undertake research on biological methods of vector contrOl, studying the possible use of parasites, predators and pathogenic agents against specific vectors. The safety of non-target organisms, including man, will be regarded as a cardinal factor in the development of these agents. The Organization will continue its studies on the genetic manipulation of vectors in order to determine the effectiveness of this method for the control of vector populations and the possibility of incorporating it in integrated control programmes. Where there is insufficient information to serve as a base for drawing up control programmes for vectors and reservoirs of pathogenic agents, the Organization will develop and carry out studies on the ecology of vector species and reservoirs of pathogenic agents. This activity will be conducted in close collaboration with field research centres and with the national administrations concerned so as to give them the opportunity to continue such studies themselves. The Organization will devote particular attention to: - the development of methods of disseminating information so as to enable governments to apply effective and economical measures and methods of vector control, particularly for specific diseases; - the development of information systems according to the specific needs of national research and of vector control programmes. 11.2 11.2.1 To prevent and control noncommunicable diseases To promote cancer prevention and contrOl, including coordinated cancer research.

The target could be the development of methods and the coordination of programmes for the prevention and control of cancer with a view to increasing population coverage. Approaches and activities The Organization will continue its efforts to formulate and review WHO standardized nomenclatures, methodologies and reagents and to encourage their widest possible use, and to disseminate information on the latest advances in prevention, detection, diagnOSis, treatment and rehabilitation for common forms of cancer. (An output indicator could be the number of data disseminated and their utilization by the countries.)

The Organization will help countries to mobilize resources for setting up national cancer control programmes within the general health services, based on the above-mentioned standards and on the methods of detection, diagnosis, treatment and rehabilitation. In most regions, prevention will concentrate on programmes for educating the population about known preventive

measures, such as programmes to combat smoking. placed on particular groups such as children.

In some regions, emphasis will be

The standardization by the Organization of systems for the recording, notification and evaluation of the results of the treatment of cancer cases, and the application of the

A29/6 page 44 standardized systems in the countries, will lead to an improvement in national programmes as a result of international comparability. (One of the output indicators for such activities could be the number of countries or institutions that have implemented a standardized system for the recording and notification of cancer cases.) The Organization, partly through the International Agency for Research on Cancer, will continue to develop its long-term plan for international coordination of oncological research including studies of environmental. chemical, biological and other factors of carcinogenesis. A review of the different sectors of such research will make it possible to formulate the tasks that still have to be carried out and to determine the possibilities of applying the basic knowledge for clinical purposes. The network of WHO collaborating centres will be enlarged for this purpose and cooperation with relevant lovernaental and nongovernmental organizations will be strengthened. The Organization will develop an appropriate information system to facilitate international cooperation in cancer research. WHO will also conduct adequate epidemiological research on tbe basis of national registries of cancer morbidity. This research will have specific national objectives. pa~ticularly in countries that have only limited experience of cancer epidemiology. 11.2.2 To promote the prevention and control of diseases of the cardiovascular system.

The target will be the development of methods and coordination of activities leading to the establishment of comprehensive cardiovascular control programmes integrated in the general health care systems in communities.

Approaches and activities The Organization will collaborate with countries in the search for and the application and evaluation of methods for controlling the major cardiovascular diseases; as far as possible these activities should be integrated in the existing general health services. The Organization will promote the international coordination of such programmes. (The results of this activity could partly be measured by the number of countries collaborating with the Organization in these matters.) Information on cardiovascular disease control undertaken by WHO and other agencies will be collected and disseminated routinely. The Organization will also undertake: - to promote the utilization throughout the world of the WHO standardized nomenclatures, methods and criteria; - to coordinate the introduction of information services on control programmes. on trials conducted on new control programme models in the various countries. and on the management of cooperative projects; - to prepare guidelines and manuals for community-oriented programmes for the control of cardiovascular diseases; - to promote public information that gives great prominence to prevention. (The output indicators for this activity could be based on the quality, if measurable, and the quantity of information supplied to the countries.) 11.2.3 To promote and develop programmes for the control of other noncommunicable diseases of public health importance, with due regard for the criteria for determining priorities. The target could be the development of community-based programmes for the prevention and control of chronic noncommunicable diseases. ~

A29/6 page 45 11.2.4

To promote the development of policies and programmes for oral health.

The target could be the development of methods and the coordination of programmes for the promotion of oral health with a view to increasing population coverage. Approaches and activities The Organization will collaborate with countries in studies on the design, planning, administration and evaluation of national and local oral health services. The dissemination of information on the most recent experience in preventive oral health activities will make it possible to include preventive components in these programmes, including the fluoridation of water when possible, and dietary means for dental caries prevention. (Output indicators could be the number of countries collaborating with the Organization in these activities and the number and quality, if possible, of data disseminated on prevention.) The Organization will encourage and participate in the preparation of manuals and guides on the planning, replanning and evaluation of oral health services, including aspects of manpower, supplies and equipment. The Organization will keep up to date an epidemiological information system on the prevalence of and trends in the oral diseases and on research findings ~nd their application. The Organization will encourage the developn,ent of community health education programmes in oral health. The Organization will encourage research programmes whose aims include: - developing simplified equipment and instruments so as to reduce the cost and increase the productivity of oral health services; - establishing the acceptability and applicability of fluoridation. Approaches and activities The Organization will collaborate with countries in developing methods for early detection, diagnosis, timely treatment and research with respect to chronic diseases of public health importance, special attention being devoted in some regions to diabetes, chronic lung diseases. disorders of the nervous system and the sensory organs, rheumatoid arthritis and chronic diseases of the kidneys and the liver. The Organization will encourage countries within the planning and operation of the general health services to integrate action against these diseases and risk factors leading to them including tobacco and alcohol. The Organization will encourage epidemiological surveys so as to obtain a~equate knowledge of the problems with a view to incorporating the chronic diseases within the general programmes of epidemiological surveillance. The Organization will promote research that is primarily aimed at the p~evention of the diseases concerned; the formulation of standardized diagnostic criteria and survey methods; community studies; and operational research aimed at the prevention and control of the diseases concerned. 12. 12.1 PROMOTION OF ENVIRONMENTAL HEALTH

To promote and develop environmental health policies and programmes

12.1.1 To collaborate in the planning and development of enviro~ental health policies and programmes associated with national economic development policies, plan and projects.

A29/6 page 46 The targets could be the definition of national environmental health policies and the introduction of environmental health programmes into national socioeconomic plans in the largest possible number of countries, as well as the esta~iishGlent of international policies at the regional or worldwide level in collaboration with other agencies and sectors which are engaged in the environmental health field. Approaches and activities The Organization will strengthen its coordinating role at the international level with regard to the health aspects of the human environment. For this purpose WHO will maintain contacts and collaborate with the many international bodies that are involved and take an active part in the control of environmental pollution, and "ill promote the incorporation of environmental health criteria in the projects assi~ted by other international agencies. Collection, analysis, synthesis and dissemination of information on environmental health policies and services and on methodologies for environmental impact assessment will be conducted at all levels of the Organization. This information will be used for reviewing requirements periodically, for setting up or confirming priorities, for evaluation purposes and, in general, for assisting in decision-making. The Organization will collaborate on request in the interministerial planning of environmental health programmes and services with direct repercussions on public health. It will collaborate with countries in formulating basic policies and legislation for the control of air, water and soil pollution and will formulate national and regional pollution control plans, coordinated with national development programmes. (An output indicator for this activity could be the number of countries having such policies at the end of the period of the Sixth General Proaramme of Work.)

In countries where the Health Ministry does not yet include provision for Sanitary Engineering. WHO will offer the services of Sanitary Engineers to assess the public health impact of development policies and projects. Where such departments are not yet fully established, it will make efforts to strengthen them. (Output indicators for this activity could be the number of countries that have received the services of WHO sanitary engineers and the number of countries which, following WHO intervention, have developed adequate structures within the health ministry.) The Organization will also encourage studies on the health aspects of the pace of life, congestion, routine and other aspects of life in an urban environment. the evaluation of the harmful effects of noise on human health and well-being, and the long-term effects on public health of the trends towards industrialization and urbanization. The effects of these factors on physical and mental health will be assessed for their implications for the Organization's programmes with a view to devising preventive and corrective measures. 12.1.2 Tb promote and collaborate in national planning of services for the provision of community water supplies and for disposal of waste. Approaches and activities The Organization will endeavour to achieve better recognition of the importance and priority character of sanitation for human health. WHO will collaborate with countries as required in formulating policies and legislation and in setting up infrastructures for the surveillance of waste disposal networks and of drinking-water quality, and particularly for the detection of a number of deleterious substances. It will encourage the simultaneous development of adequate administrative and legal structures. Collaborative undertaking of national sector studies for community water supplies and waste disposal will lead to the definition and formulation of priority projects integrated within national development plans or compatible with them. This activity will receive special attention in planning for rural development.

A29/6 page 47 The Organization will collaborate with the national and multinational agencies concerned, with a view to mobilizing national and/or international resources for the implementation of sanitation programmes. WHO will maintain its international coordinating role with regard to the health aspects of technical assistance programmes, such as the application of health norms and criteria. WHO will promote national surveys and the strengthening of techniques of data collection for planning purposes. Guidelines will be offered on policies, programmes, institutions and legislation for water supplies and waste disposal. The Organization will formulate and execute preinvestment feasibility studies. This activity will often be linked with the previous activities for obtaining domestic and foreign finance. In view of the increase in travel and tourism, the Organization will provide advice on the solution of sanitation problems associated with international travel. The Organization will participate in or encourage the production, at regional and world. wide level, of guidelines, codes and manuals that stress low-cost and readily adaptable techniques. 12.2 To promote recognition, evaluation and control of environmental conditions and hazards that may affect human health

12.2.1 To promote the development and implementation of programmes for the early detection and control of pollution in the environment (chemical, physical and biological). The target could be the existence in most countries, at the end of the Sixth General Programme of Work, of programmes for the control of environmental pollution and hazards. Approaches and activities The Organization will promote the development of methods and techniques for measuring environmental hazards and the effects of pollution and for assessing their influence on human health. It will also undertake to develop guidelines for the application of methods of early detection, prevention or reduction of air, water and soil pollution and other environmental hazards to the population, whether of biological origin (excreta), chemical origin (industrial wastes), or physical origin (noise, radiation, heat), with due regard to social and economic conSiderations. The Organization will collaborate with countries in developing national and international programmes for pollution control, based on criteria to be determined by it. (The output indicator could be the number of COUntries that have developed programmes for the control of environmental pollution and hazards.) The Organization will collect and disseminate information on all relevant aspects of environmental pollution, early detection and control. It will encourage the development of relevant information services in the countries. It will also supply information on management techniques and technological problems. 12.2.2 To evaluate the effects of environmental factors on health, to promote and coordinate relevant research, and to foster the practical application of research findings. Approaches and activities The Organization will develop a programme on criteria for environmental health, consisting in particular of the following activities: - review and dissemination, in collaboration with national centres, of scientific information on the effects of environmental factors on human health, and preparation of documents setting out the criteria to be ~pplied; - development of information services and mechanisms for collaboration between WHO, national scientific institutions ~nd other agencies;

A29/6 page 48

- using epidemiological and toxicological techniques, the promotion and coordination of research, par~icularly on harmful immediate and long-term effects, including combined effects, and on indices for measuring adverse effects of pollution on public health in general and on the health of high-risk groups; promotion of and cooperation with other agencies concerned in the conduct of studies on the long distance spread and chemical transformation of pollutants in the environment and on the combined effects of multiple pollutants; - formulation, testing and publication of recommendations on maximum permissible limits. The Organization will encourage and support technical research on environmental health stressing in particular the adaptation of existing techniques to the needs of developing countries.

p~oblems,

12.2.3 To promote environmental sanitation. related to urban and rural development. that contributes to the prevention of communicable diseases. The target might be the reduction of biological hazards which could lead to an increase in the spread of communicable diseases. particularly in relation .to ecological changes due to urban and rural development • Approaches and activities In collaboration with Member States and with the international organizations and institutions concerned. the Organization will encourage the study and analysis of situations in which ecological changes. particularly due to urban and rural development, might &ive rise to biological hazards that could lead to the transmission of communicable di....... For this purpose it will promote the study and analysis of, and the collection of information on types of ecological changes that might create such hazards; research on the prevention of communicable diseases that ar.e apread by deficient sanitation and that are as.oeiated with rural and urban development; coordination at national. regional and worldwide levels of ....ures for the control of biological hazards; improvement of the knowledge of biological health haaards among development project experts and the participation of health experts in the planning of rural and urban programmes in order to make the control of such biological hazarda an integral part of the implementation of such plans.

,-r'.

12.2.4 To promote the development of programmes to ensure food safety and the .upply of information for their planning and implementation. The targets could be the reduction of morbi~ty due to contamination and chemical or biological adulteration of food, the establishment of international regulations on food hY&ieDe and adoption of national legislation; and the existence in the largest possible number of countries, by the end of the period of the Sixth General Programme of Work. of standarda for quality control of foods compatible with the international standards. Approaches and activities The Organization will develop internationally acceptable standards on food safety. including standards that would facilitate the movement of food products between countries. These standards will be periodically reconsidered and updated. Within the framework of the Codex Alimentarius CommiSSion, the Organization will collaborate with the other organizations involved and with the countries concerned in asseSSing needs. in particular of developing countries. Moreover, it will collaborate with countries to establish food safety standards adapted to specific national needs and to develop programmes for ensuring the gradual acceptance and application of these standards. (The output indicator for this activity could be the number of standards issued by WHO and the ~umber of countries that have accepted them.) WHO will develop strategies and methods for detecting and controlling food hazards, taking into account the diversity of physiological, social and economic needs. ~

A29/6 page 49 In order to reduce human illness and economic losses caused by the microbial contamination and the chemical or physical adulteration of foodstuffs, WHO will stimulate the establishment and development of national food safety policies, programmes and services so as to make food compatible with the international standards and to prevent the national and international spread of food-borne diseases. The Organization will promote the establishment of a food contamination and foo~-bor~e diseases information and monitoring programme to provide the necessary information for determining priorities and assessing the effectiveness of food monitoring activities. It will prepare codes, guidelines and manuals on food safety and related matters, including techniques for the preparation of various products and standards with respect to their r~lated utensils. WHO will participate in activities for the evaluation of food safety such as t~e determination of food additives, pesticide residues and biological and chemical contaminants. It will also endeavour to promote the evaluation and development of safe methods of food preservation, packaging, storage and transportation. To stimulate awareness of the importance of food quality for the health of the consumer, WHO will promote health education programmes for the general public and for executives and other personnel in the food industry. These programmes will emphasize the need for strict observance of the rules of hygiene in food factories, warehouses, marke~s, shops, restaurants and houses and for accurate labelling of package~ foodstuffs. WHO will promote and coordinate research where necessary to improve the interpretation of the results of toxicological tests, on methods for identification and enumeration of microorganisms and other biological disease-producing agents in foods and on related publiC health problems. Particular attention will be given to combined and long-term effects.

12.2.5

To improve health conditions in human settlements and housing.

The target will be the systematic introduction of health factors into the development of human settlements and housing. Approaches and activities In collaborat.ion with the other international agencies and nongovernmental organizat:ions and/or with their financial assistanc~ WHO will establish environmental health criteria fer housing and human settlements, taking into account the different climatic and sociocultural conditions met throughout the world. This activity will be supplemented by the establishment of WHO collaborating centres for·health problems related to housing. The Organization will encourage the development of intersectoral collaboration policies on the planning and organization of the various types of human settlement, from the small village to the large conurbation. The Organization will promote the health and psychosocial aspects of town and country planning and urban development, laying down principles and standards. Studies will also be encouraged on the health conditions of industrial development, the development of industrial or residential areas. and problems associated with urbanization.

In its endeavours to contribute to the development of human settlements and housing that respond to countries' needs, the Organization will pay particular attention to such aspects as human factors (e.g. size of houses) j environmental f.actors (e.g. ventilation, thermal protection. rodent control, baSic sanitation and accident prevention); and the social organiZation of the community (e.g. entertainment, distribution of health care services). Particular attention will be paid to these factors with respect to the design of low cost housing in developing countries.

13.

HEALTH MANPOWER DEVELOPMENT

13.1

To promote the development of appropriate health personnel, to meet the needs of entire populations

A29/6 page 50 13.1.1 To promote the planning for and training of the various types of health personnel comprising "health teams", with the proper knowledge, skills and attitudes for the execution of national health plans and programmes, including personnel with appropriate levels of skills for the provision of primary health care, as well as environmental health personnel. The target could be the development in the various countries of appropriate programmes for the training of adequate health personnel for comprehensive national health services. Approaches and activities The Organization will promote the integration of the planning. production and management of health manpower, including environmental health staff, within a coherent system responsive to national needs, as well as the evaluation of this system. WHO will promote the training of teams for community-oriented health work based on complementarity of the roles and functions of the various health workers and the members of the community and wherever necessary placing the responsibility for primary contact with patients on auxiliaries able to carry out well-defined activities after a minimum of training. The Organization will participate in the development. trial and dissemination of information on suitable methods for determining health team requirements. including the definition of distribution of duties within them. The Organization will participate in defining balanced staffing patterns for health services at all levels, including patterns for health teams. In each country the requirements of clinical, administrative and support staff will be determined in accordance with the socioeconomic context so as to increase the productivity of the health personnel, who will if necessary be formed into teams. An effort will be made to satisfy the health personnel needs of primary health care services with a view to providing total population coverage. WHO will participate in establishing criteria for improving the quality and the quantity of the training of health personnel in existing establishments and for setting up new establishments. (An output indicator could be the number of persons trained for various types of health personnel according to the criteria established in collaboration with WHO.) WHO will prepare guidelines on the analysis and formulation of health manpower policies, health manpower planning and the control of implementation of plans, the definition of tasks on a team basis and systems for developing health manpower so as to meet health needs. The Organization will expand considerably its internal programme of staff development and training, paying particular attention to training in the planning, management and evaluation of health programmes as well as to training in specific technical areas in which there is a lack of suitably trained personnel. The Organization will act in collaboration with other international organizations. especially 110, in order to improve the international classification of health manpower. To promote the integration of health manpower planning, production and utilization 13.1. 2 11 b i within the context of national health plans and socioeconomic development, in co a orat on with the general education system. The target will be the development of a permanent mechanism to ensure the integration of health manpower development within the framework of health services on the one hand, and of the educational services and the more general framework of socioeconomic development on the other hand. Approaches and activities . f health manpower planning into the The Organization will encourage the integratLon 0 overall process of socioeconomic development planning. r

A29/6 page 51 (One output indicator for this activity could be the number of national economic and social ..lcvelopment plans that include a health manpower planning component.) WHO will pr~~nte collaboration and closer rela'inns between those responsible for the training of health personnel and those responsible r0r the health services. The Organization will encourage better coordination of the efforts of health and education ministries, and mere generally of all concerned with education, to solve health ~anpower problems.

13.1.3

To pr.11uote optimum utilization and reduce undesirable migration of trained manpower.

The target will be the development by interested Member States of methods and the formulation of an appropriate management system aimed at preventing health personnel from leaving their profession or the geographical location in which they are required. Approaches and activities WHO will encourage countries to apply a policy for attracting and retaining health manpower in deprived areas. (The output indicator for this activity could be the improvement of indices for distribution of staff, retention of staff, and wastage due to departure or to inappropriate utilization.) WHO will promote the development of selection policies and of the tapping of new sources of manpower within the community. WHO will promote the introduction of career development and of continuing education for all categories of health personnel in order to improve their performance through education relevant to community health needs. WHO will promote the strengthening of the manpower component of health information systems in order to maintain ongoing surveillance of the number and distribution of health personnel. WHO will stimulate research in order to develop better understanding of the motivation, satisfaction, morale and sense of social responsibility of health workers, particularly Ln rural areas, so as to appreciate their aspirations better and provide them with suitable career development plans and conditions of work. To reduce or regulate the migration of trained manpower, the Organization will, as far as poSSible, encourage the public authorities to take adequate measures at the national level to combat undesirable international migration of health manpower.

13.2

To promote the development and application of relevant processes for basic and continuing education

13.2.1 To promote planning, curriculum development, methodology and evaluation of basic and continuing educational processes for all categories of health personnel. The targets should be to reach a situation by the end of the Sixth General Programme of Work in which interested Member States should, in collaboration with WHO: have developed the learning objectives applicable to the basic training and continuing education of all categories of health personnel; have prepared suitable curricula supported by adequate communication systems; have produced a specified quantity of teaching materials for basic or continuing education; and have developed mechanisms for the evaluation of the relevance of their educational processes to the needs of the health services and the population. Approaches and activities The Organization will encourage and participate in the preparation of practical guidelines on the development of learning objectives based on task analysis and guidelines on

A29/6 page 52

methods of curricula preparation, and in the development of teaching programmes and methods appropriate to the learning objectives based on the immediate and long-term needs of the population. The Organization will encourage the preparation by teaching staff, in consultation with staff of the health and related agencies, of standard curricula for the basic and continuing education of the various professional and auxiliary categories of health manpowerj it will promote the preparation of international criteria to assess educational objectives. The Organization will assist in the development of training systems with a wide range of methodology, including the use of self-instruction, small group learning and simulation methods, in order to create and reinforce problem-solving and decision-making skills within the health team. WHO will promote the development of a coordinated programme for the production, adaptation, and dissemination of low-cost learning materials, including self-instruction materials, for all categories of health personnel and their teachers. A central network will facilitate the design of these methods and training systems and their adaptation to local conditions. (The output indicator for these activities will be the number of countries having a sufficient quantity of learning materials, including self-instruction and simulation devices.) The Organization will promote the development, adaptation and application of valid short-term, medium-term and long-term evaluation mechanisms for all types of educational activity so as to measure the degree of achievement of the educational objectives by the learners (individuals and health teams). The relevance of the objectives, programmes, and evaluation tools themselves to the health needs and demands of the population will be evaluated, as will health personnel performance in relation to community needs. (The output indicator for this activity should be the number of countries where valid and reliable evaluation mechanisms are being used.) Practical guidelines for the evaluation of training activities and processes and for the utilization of educational methods and media will be prepared. (The output indicator for this activity should be the availability of tested practical guidelines and their utilization by countries#) 13.2.2 To promote the development of national teaching staff and educational technologists able to apply a systematic approach to educational processes. Approaehes and activities The Organization will collaborate with interested Member States in the development of their own training process and of research and training centres for the teachers of health personnel. The Organization will encourage and participate in the preparation of comprehensive educational packages for teachers; it will promote research on local factors and problems that favour or impede the preparation or implementation of educational plans. The Organization will encourage the development and strengthening of regional and national institutions able to provide the necessary resources for teacher training, advisory services, technical support and educational research. The Organization will encourage the development of training activities designed to familiarize multi-professional groups of teachers and educational managers with educational planning methods, with teaching processes and with the management of educational systems, including mechanisms for the evaluation of teachers. (The output indicator for this activity could be the number of persons, by COU;~L! Y trained in national research and training centres for teachers of health personnel.) The Organization will participate in the collection and dissemination of relevant dao that may be needed for decision-making and for the preparation of training programmes.

A29/6 page 53 14. 14.1

PROMOTION AND DEVELOPMENT OF BIOMEDICAL AND HEALTH SERVICES RESEARCH To promote and collaborate in the development and coordination of biomedical including health services research re~~arch,

14.1.1 To identify research priorities, strengthen nationa: research capabilities and promote international coordination of research, especially with respect to problems of major importance to WHO. In accordance with Resolution WHA27.61 the Organization is committed to promote and initiate research in developing countries and to strengthen research and training centres in these countries, particularly with respect to disease problems of importance to the area. To do so, it has to ensure the close cooperation and support of those countries which have an adequate reserve of biomedical research workers and to channel their activities, including the application of basic scientific disciplines such as genetics, immunology and biochemistry, into problems of developing countries. At the same time it has to exercise its coordinating role with a view to expanding knowledge for the world as a whole, for example in relation to such questions as cancer, cardiovascular diseases and environmental health, and to mobilize all the research capacities of the world without unduly burdening its own limited budget. The targets will be the pursuit of the humanitarian aims of biomedical research to strengthen the scientific basis needed for the development and maintenance of comprehensive national health services and international health programmes, as well as the international coordination of research with respect to the priority areas outlined in the Sixth General Programme of Work in such a manner as to maintain a proper balance, between research and service. Approaches and activities To this end, the Organization will, with the assistance of the Advisory Committee on Medical Research, regional research advisory committees, members of expert advisory panels, national medical research councils and WHO collaborating centres: _ identify priority areas for research and promote collaboration between countries for conduct of such research. This will include review and periodical updating of priority research areas in order to give continuing support to such research. _ foster the creation or further development of regional health research advisory committees and national health research councils or analogous groups. - develop the exchange of appropriate information to facilitate international research coordination and channelling of resources. -,

- stimulate collaboration between countries for the conduct of research on problems of common interest. - pay particular attention to the health research needs of developing'countries and to the promotion and conduct of research in priority areas which are not being adequately supported. _ develop its research programme through a variety of mechanisms including networks of collaborating research centres and research task forces. (An output indicator for this activity could be the number of research projects stimulated by WHO's programmes.) 14.1.2 To promote the application and proper transfer of eXisting and new scientific knowledge and research meLhods to serve as the basis for the development of comprehensive national health services.

A29/6 page 54

The target will be to shorten the time elapsing between scientific discoveries and their practical application. Approaches and activities The Organization will, in both the biomedical and public health research fields: - promote the rapid transfer of information on research findings through the use of appropriate information systems; - foster close contact and collaboration between national health research organizations, institutions and health administrators with a view to accelerating the application of advances and discoveries; - assist in the development of methods for adapting such research findings to meet the needs of various regions.

15. 15.1 15.1.1

PROGRAMME DEVELOPMENT AND SUPPORT To promote, within the context of overall socioecQnomic development, support of health promoting activities

To collaborate in the preparation, execution and evaluation of health plana, and develo~ent efforts in accordance with periodic'ally revised or confirmed health policy. progrlUDlle~

The target could be the formulation and bDplementation until the end of 1983, in the maximum number of countries, of national health policies, corresponding ~trategies and the mechanisms required for their timely Feview and adjustment •. ' " ., ,'. ,J'

Approaches and activities WHO will collaborate with countries in studies and analyses of their health policies and policy making and will encourage collaboration between academic institutions and government authorities for the development of research leading to methods for translating policy into strategy. In collaboration with other multilateral or', where applicable, bilateral assistance agencies, the Organization will participate in the process of country health programming (or equivalent process) leading to the formulation and/or execution of health development programmes or projects. National findings will be used for periodic review and bDprovement of the relevant theory and practice. Information on these processes will be widely disseminated. (An output indicator for these activities could be the number of countries that have introduced country health programming or developed a project formulation process.)

The priorities seiected in country health programming and requests made for WHO assistance may form an bDportant basis for the Seventh General Programme of Work. (An output indicator for this activity will be the number of countries whose country health programming results have been taken into account in the Seventh General Programme of Work.)

With the aim of integrating health planning into the overall framework of national socioeconomic development planning, the Organization will where necessary promote effective intersectoral communication in collaboration with other multilateral and bilateral assistance agenCies. 15.1.2 To promote the development and application of efficient managerial, information and evaluation systems for the planning and operation of health programmes, including the financing of health activities.

A29/6 page 55 The targets could be the elaboration and dissemination of guidelines on managerial techniques for planning and operating health programmes and the creation of permanent mechanisms for health management, information and development in as many countries as possible. Approaches and activities WHO will assist countries on request in creating permanent mechanisms for health planning, programming and evaluation. (An output indicator for this activity could be the number of countries collaborating with the Organization in creating such mechanisms and the number of countries having introduced them.) The Organization will improve its programme management system. It will further develop an information system to promote the generation, processing, analysis and appropriate dissemination of information to provide support f~ planning, programming, programme implementation and evaluation at all levels. It will build up this system from information derived from the various programmes. It will also develop further an evaluation system for analysing the results and effectiveness of these programmes at all levels, particularly at country level. Like the information system, this system will be devel~ped in coordination with other United Nations planning, information and evaluation activities.

WHO will advise countries on the management of national development programmes related to health. This will include adapting to national contexts such principles as planning and managerial techniques, evaluation procedures and information systems developed by the WHO programme management system, including where applicable, the use of dynamic models of health systems. Where necessary, the Organization will pay particular attention to improving the quality of coverage and the updating of vital and health statistics. It will emphasize the incorporation of health statistics, including statistics on health expenditure and finance, into more extensive health information systems on the one hand and into social and economic statistics on the other. Some regions will give special attention to the rational use of computers in national health systems. The Organization will encourage the introduction and review of health legislation and regulations relating to health programme planning and management. The Organization will provide information and collaborate with countries in developing and introducing improved methods for financing health activities. .This will include the development and improvement of methods of costing health development activities. The Organization will encourage countries to base their decisions on health services development on such criteria as results and cost. With a view to achieving a more equal distribution of care, it will encourage the development and application of research methods for the study of different systems of financing health activities. It will encourage the identification, rationalization and use of all potential sources to finance. country health programmes and health related activities.

15.1.3 To promote the integration of appropriate health components into socioeconomic development plans and current social and economic activities, with a view to reducing health hazards and increasing health benefits. The targets could be the promotion of the understanding of the relationships between the various sectors and health, and the establishment of intersectoral programmes, services or activities. Approaches and activities The Organization will examine whether levels of health could be enhanced by socioeconomic development activities in a number of specific areas by giving wide dissemination of relevant information to social, health and health related sectors.

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The Organization will collaborate with countries in analysing and reviewing national development plans and programmes to derive the maximum health benefit from national socioeconomic policies and economic activities and ministries of health will be provided with support on request to strengthen their active participation in national development activities such as urban planning, housing, agricultural development, industrial development, educational planning and social welfare with a view to improving national health conditions. (Output indicators could be the number of socioeconomic plans reviewed and/or modified to include a health component or to take health effects into account and the number of requests for consultations addressed to the ministry of health by other ministries or by other bodies in other sectors.) The Organization will assess, promote and support, through appropriate health programmes, general socioeconomic development measures responding to the priorities of socioeconomic development plans of benefit to health or reducing health hazards to a minimum. (An output indicator for this activity could be the number of socioeconomic development projects containing a fully defined health component with proved positive health effects or corrective and complementary measures suitable for maximizing health effects.) 15.2 To increase United Nations and other international, multilateral and bilateral collaboration in solving priority health problems or other socioeconomic problems with significant health implications

15.2.1 To increase international collaboration and the amount of external assistance available for health programmes, for the health component of development programmes, and for development programmes with identifiable effects on health, including community water supply and disposal of wastes, particularly in devel9ping countries. The targets could be the efficient use of assistance offered to supplement available national resources for solving national health problems and the increase in the extrabudgetary resources of the WHO programme as a result of collaboration with other organizations in the context of health programme development. Approaches and activities The Organization will collaborate with the United Nations and other organizations of the United Nations system, as well as with multilateral or bilateral agencies, in international action and studies aimed at promoting and supporting national and regional socioeconomic programmes. It will develop mechanisms for the coordination of international efforts and of the investment of resources from several sources into high priority national or international health programmes. In so doing it will actively seek the synchronization of country health programming with other country programming activities throughout the United Nations system and with national development planning. (An output indicator for this activity could be the number of organizations with which WHO collaborates and which collaborate with WHO, and the increase in their contribution to WHO's programmes, with particular reference to the priority programmes of the Sixth General Programme of Work.) The Organization will collaborate with countries on request in formulating concrete proposals which will attract external financial support for the solution of identified problems in a country or group of countries, including the formulation of project documents. For this purpose, the Organization will develop a mechanism for the provision of information on national and international needs and on the specific interests and capabilities of bilateral and multilateral agencies. It will endeavour to implement the recommendations contained in the Executive Board organizational study on the planning for and impact of extrabudgetary resources on WHO's programme and policy. It will accept external funds only if they relate to programmes that are technically sound, whose.obj~ct~ves cOinclide whit~ WHO's policies and the administration of which conforms to the OrganLzatLon s contro mec anLsms.

A29/6 page 57 WHO will emphasize in particular that all resources from whatever sources of funds that the Organization handles or which it has been instrumental in attracting for country and intercountry programmes, should be devoted to the integrated international health programme of WHO and its Member States as defined in the General Programme of Work and formulated in subsequent programme budgets. (The output indicator for this activity could be the number of requests for assistance made by countries and the response received in the way of external financial support.) 15.2.2 To plan for and provide an adequate and appropriate response to emergency situations, resulting in particular from natural disasters. The target could be an adequate response in as short a time as possible to any emergency situation with health implications. Approaches and activities WHO wi~l assist in the coordination of health plans and actions related to emergency situations, in collaboration with the League of Red Cross Societies and the United Nations Disaster Relief Office. The Organization will collaborate in establishing facilities (focal point) in each country to take decisions and action to solve the health problems arising in emergency situations. It will also collaborate in developing, both centrally and locally, preventive action mechanisms to deal with foreseeable events which may lead to catastrophic conditions. This will include establishment of national and inter-country warning systems for disasters or other emergencies. (Output indicators for this activity could be the speed of response to natural disasters and other emergencies and the extent to which emergency needs are met by outside assistance.) WHO will encourage and support the introduction of appropriate means for the mobilization and distribution of relief resources in emergencies. In particular, it will assist in the preparation of an inventory of relief requirements. (Output indicators could be: qualitative and quantitative matching between supplies and requirements; balance of distribution of emergency supplies to populations in need; and proportion of emergency supplies reaching the point of application.) 16. EVALUATION

Evaluation will be an integral component of WHO's activities at all levels. To develop a valid system of health programme evaluation, the range of quantitative and qualitative indicators used for evaluating programmes and projects will have to be extended and systematically improved. In the planning of activities strict account has to be taken of the possibility of evaluating the degree of implementation of a given set of actions and the results obtained. In the definition of objectives and formulation of programmes due regard should therefore be paid to the meas~rability ~f results from both the quantitative and qualitative point of view, and wherever possible targets should be determined in specific terms. Evaluation should be applied on a continuing basis during the implementation of a programme, so that it can provide a reliable basis for adjusting the approaches and methods of work adopted.

In most cases regional and global targets have been difficult to define for the Sixth General Programme of Work, depending as they do on national targets. An important activity during the period of the Sixth General Programme of Work will therefore be to determine national needs and priorities and to define national targets for each of the programmes concerned, as well as regional and global targets. This is of extreme importance for the planning and evaluation of health programmes and services themselves. In addition, it will facilitate the aggregation of national priorities into regional and global priorities for WHO in subsequent programmes of work.

A29/6 page 58 In conformity with the above principles WHO is developing a new system of evaluation as an integral part of programme planning a~d delivery at all organizational levels, based on sound programme informatio~. This system will be used for the evaluation of the Sixth General Programme of Work. It is based in large measure on a new reporting system, which is in the process of being developed. Reports will now focus on progress made in implementing activities and on the assessment of the effect these activities are making on attaining the objectives of the programme area concerned. This system will be introduced for reporting from projects in countries in which WHO is collaborating, from WHO representatives, from Regional Offices and from headquarters programmes. The programme presented in sections 10-15 contains details of the objectives, and wherever possible targets and ~utput indicators, of the Sixth General Programme. The basis of the evaluation of this Frogrwmme will be the subsequent comparison between planned attainments and actual achievements. In addition to periodic reporting it is intended to cond~ct specific evaluative reviews of WHO's programmes in countries in close collaboration with the national health authorities concerned. The evaluation of specific programmes will also be conducted in Regional Committees, the Executive Board and the World Health Assembly, particularl-T in the course of the review of the Organization's biennial programme budgets for the years 1978/1979, 1980/1981 and 1982/1983, which will be formulated within the framework of the S;~th General Programme. Finally, the progress of the Sixth General Programme as a whole will be reviewed by the Executive Board at appropriate intervals and in particular before the Board embarks on the formulation of the Seventh General Programme of Work Covering a Specific Period.

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ANNEX

GLOSSARY OF TERMS 1. OBJECTIVE A desired aim or end, for example "the improvement of child health".

DETAILED OBJECTIVES The breakdown of an objective into subsidiary objectives: For example, for the objective "improvement of child health" some detailed objectives .might be the reduction of perinatal mortality, the reduction of infant mortality, the improvement of child growth and development, the prevention of childhood infections and the prevention of accidents among children.

TARGET An objective or detailed objectives, or group of detailed objectives that have been made For example, the reduction more specific in quantified terms and or in terms of time. of the infant mortality rate to 30 per 1000 live births by 1980.

'4.

APPROACH A means, expressed in broad terms, for attaining an objective: For example, surveys for assessing the infant mortality rate with a view to facilitating and monitoring the attainment of red~ction in the infant mortality rate; or the publication of popularized information on infant care with a view to reducing the infant mortality rate. Some approaches can be considered as intermediate objectives; for example, the promotion of community participation, the attainment of which will help to reduce infant mortality but requires a special effort in itself.

TYPE OF ACTIVITY The practical interpretation of an approach in methodological and/or technical and/or logistical terms: For example, a repeated cluster sample survey of a number of communities for assessing the infant mortality rate and for monitoring its reduction, or the formation of a community mother club for promoting community participation in activities designed to reduce infant mortality.

OUTPUT INDICATOR Variable for estimating the outcomes of programme or project activities. For example, the percentage of births attended by physicians, nurses, midwives or auxiliary nurse midwives as an indicator of the outcome of a programme for improving obstetric care. Ideally relevant base line information should exist or be created at the beginning of the determined period in order to measure differences at the end of the period. However the measurement of indicators requires an effort in itself and is often costly; therefore the cost/benefit of the measurement has to be considered. Wherever possible at a reasonable cost, ways of arriving at the indicators should form an integral part of the programme.

IMPACT INDICATOR Variable for estimating the change in health or socioeconomic situation brought about by the programme or project activities. For example, the maternal and perinatal mortality rates as indicators of the effectiveness of a scheme for improving obstetric care or the diminution of absenteeism rate as the consequence of a programme of occupational health.

A29/6 page 60· Annex

A scheme of action for bringing about change in a specific period of time. This scheme should outline the objectives of the plan and the approaches and types of activity required to attain these objectives. 9.

PROGRAMME An organized aggregate of services, activities and development projects directed towards the attainment of defined objectives. A programme should ideally include the precise objectives, targets, methods, manpower, physical facilities, financial resources, time and their interrelationships required for the implementation of each service, activity and development project and for the aggregate of these services, activities and projects of which the programme is constituted, as well as output indicators for the evaluation of efficiency and effectiveness. For example, programmes for maternal and child health, the promotion of mental health and cancer control.

10.

DEVELOPMENT PROJECT An aggregate of activities that have ~ definite time limitation and a predetermined amount of resources and that are directed towards the attainment of precisely defined quantified objectives'. For example, the development of a specific number of :,ealth centres, the construction of a sewage disposal plant or the building, equipping, staffing and commissioning of a hospital.

11.

COUNTRY HEALTH PROGRAMME The totality of the health programme is a country.

12.

COUNTRY HEALTH PROGRAMMING The systematic identification of priority health problems in a country, the specification of operational objectives for the solution of these problems and the formulation of programmes consisting of interrelated methods, activities, resources, time and organization required for the attainment of these objectives.

13.

LONG-TERM Anything from 10 to 20 years and above depending upon the nature of the plan.

14.

MEDIUM-TERM A period of time that coincides with the time frame of a WHO general programme of work, at present six years.

1 The interpretation current in the United Nations system. In a number of countries the term "plan" means a precise definition of objectives to be attained, thf" determination of the resources to be deployed and the time taken for attaining them, and the allocation of responsibility for implementation.

Основные сведения

Организация Всемирная организация здравоохранения (ВОЗ / WHO)

Тип документа Technical Documents

Дата принятия 31 декабря 1976 г.

Источник Всемирная организация здравоохранения