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W ELTGESUNDHEITSORGANISATION REGIONALBÜRO FÜR EUROPA WORLD H E A LTH O R G A N IZ A T IO N REGIONAL OFFICE FOR EUROPE ВС ЕМ И РН А Я О Р Г А Н И ЗА Ц И Я ЗД РА В О О Х РА Н Е Н И Я ЕВРОПЕЙСКОЕ РЕГИОНАЛЬНОЕ БЮРО O R G A N IS A TIO N M O N D IA L E DE LA SANTE BUREAU RÉGIONAL DF. L’EL'ROPE REGIONAL COMMITTEE FOR EUROPE REGIONALKOMITEE FÜR EUROPA COMITE REGIONAL DE L’EUROPE ЕВРО П ЕЙ СК И Й РЕ ГИ О Н А Л ЬН Ы Й КОМ ИТЕТ Thirty-fourth session EUR/RC34/14 Copenhagen, 24-29 September 1984 6765L 20 July 1984 Provisional agenda item 10 ORIGINAL: ENGLISH PROPOSED PLAN OF ACTION FOR THE IMPLEMENTATION OF THE REGIONAL STRATEGY FOR ATTAINING HEALTH FOR ALL BY THE YEAR 2000 At its thirty-third session in Madrid, the Regional Committee adopted resolution EUR/RC33/R4, requesting the Regional Director to submit a final version of the regional target document to the thirty-fourth session of the Regional Committee, together with a plan of action and a list of indicators for monitoring progress towards achieving the targets in the Region. In response to that request, this document presents a plan of action for implementation of the regional strategy for HFA2000 (EUR/RC30/8 Rev.2) and consequently for attainment of the regional targets set out in document EUR/RC34/7. In particular, it lists the different action to be taken by Member States, the Regional Committee and the Regional Office, respectively. The document recognizes that the action will mainly need to be taken by the countries themselves, while also stressing the responsibilities of the Regional Committee in monitoring the implementation of the regional strategy, evaluating the progress made in attaining the targets, and revising the course of action if necessary. It links the development and the endorsement of the European regional contribution to the WHO General Programme of Work and the biennial programme budget to the support needed for implementation of the regional strategy and attainment of the targets. Finally, it identifies the immediate action that the Regional Office should take to support countries and the Regional Committee in the execution of their share of the plan. The document was discussed by the Regional Health Development Advisory Council at its fourth meeting (24-26 April 1984) and by a meeting of a subcommittee of the Consultative Group on Programme Development (6-8 June 1984). In the light of this review, it was considered that the plan was logically linked to the regional strategy, the regional targets and the global plan of action. At the same time, it was suggested that the plan should not be too prescriptive and that it should allow all the necessary flexibility for countries to define their own priorities and strategies. EUR/RC34/14 6765L page 2 1. Introduction This plan of action is an operational continuation of the regional strategy and regional target documents in the sense that it shows who should exercise the main responsibility for taking each type of action and by what date. Its aim is threefold: first, to provide guidelines for countries to formulate their own plans of action for the development and implementation of their national HFA strategies; second, together with the list of indicators, to constitute a tool for the Regional Committee to monitor the implementation of the regional strategy and to evaluate the attainment of the regional targets; - third, to link, even more closely, the programme of work and the allocation of resources of the Regional Office to the support needed by Member States and the Regional Committee in carrying out their share of the plan. 2. Actors The plan addresses itself to the three actors who, within the context of this Organization, share the main responsibility for initiating activities for implementing the regional strategy and attaining the regional targets: (a) Member States, both individually and collectively through intercountry cooperation; (b) the Regional Committee and, through it, the consultative bodies for the European Region; and (c) the Regional Director and, through him, the entire secretariat of the Regional Office. 2.1 Member States It is strongly emphasized, in both the regional strategy and the regional target documents, that most of the action needed to achieve HFA in Europe falls, individually or collectively, within the responsibility of Member States. The plan stresses three types of action that may be undertaken by Member States, namely action (1) to determine, through the formulation of their own national HFA priorities, strategies and targets, the extent of their contribution to the attainment of the regional strategy in general and the regional targets in particular; (2) to review their national machinery for intervention in HFA priority areas and to revise it as necessary, so as to bring it more into line with, and make it more supportive of, their own national strategy; (3) to report at intervals to the Regional Committee on the progress made in implementing their own national strategy and reaching their own national targets. Ten major areas are identified in the plan. Their listing below reflects only the time sequence of their realization and not their relative importance in the target document: - managerial process and health information; - primary health care development; quality of care assurance and health technology assessment; health personnel; health research; policies affecting lifestyles; policies and mechanisms related to environmental health; health education; policies ensuring the prerequisites for health; support for social groups whose activities influence health. In May 1982, the Thirty-fifth World Health Assembly approved a global plan of action for implementing the global strategy for health for all (resolution WHA35.23). It was thereby envisaged that the regional committees would monitor the implementation of the regional strategy every two years from 1983, and evaluate the effectiveness of the strategy in reaching the targets every six years from 1985. EUR/RC34/14 6765L page 3 2.2 Regional Committee The main responsibilities of the Regional Committee are: first, based on the reports by Member States, to monitor the implementation of the regional strategy every two years and to evaluate its effectiveness in reaching the regional targets every six years; second, on this basis, to update as necessary the regional plan of action, strategy and targets, and list of indicators; third, to submit proposals on the European regional contribution to the General Programme of Work every six years and on the biennial programme budget every two years, which fully support the implementation of the strategies and the attainment of the targets at both national and regional levels. 2.3 Regional Office The main responsibility of the Regional Office is to give full support to Member States and the Regional Committee in carrying out their respective shares of the plan. In so doing, the four main roles given to WHO in the European Region for the Seventh General Programme of Work should be kept in mind: (1) to help make existing knowledge better known by identifying innovative and improved health care approaches in Member States; (2) to promote priority health research; (3) to act as a catalyst in promoting national health policy development towards HFA principles ; (4) to improve cooperation and coordination between international organizations active in the health field. This support is outlined in general terms in the European regional contribution to the General Programme of Work and, in more detail, in the biennial programme budget. The plan of action sets out only the major action to be taken by WHO to support Member States and the Regional Committee in their efforts to reach the regional HFA targets. 3. Future amendments of the plan of action The plan will have to be amended in the light of the progress that Member States make in their HFA development, which can be influenced by many factors. It would therefore seem logical to update the plan in accordance with the monitoring of the implementation of the regional strategy every two years and with the evaluation of the effectiveness of the strategy every six years. PLAN OF ACTION Member States Date Action for national Reporting to health development Regional Committee Regional Committee Regional Office 1984 September Thirty-fourth session to review and endorse; - regional target document - 1is t of indicators - plan of action - 1986-87 programme budge t by October Has distributed the agreed list of regional indicators and the common framework and format for evaluating HFA strategies 1985 by March Have submitted information on global and essential regional indicators as a base for evaluating the implementation of the global, regional and national HFA strategies Has launched a publicity campaign to make both the regional strategy and the target documents fully known to health authorities at all levels, health professionals and the general public by June Has developed and disseminated modules for forecasting health situations, as a tool for priority-set ting Has set up regional information bases to be used by Member States for international comparisons Has developed and published guidelines enabling decision­ makers to identify needs for information to support their managerial process relative to the regional HFA strategy and targets 'O O ' W0) ' - j <=: QQ O' pd (D 17* PÖ ОUO4> September Thirty-fifth session to; - evaluate the progress made since the adoption of the regional strategy in 1980 - update the plan net ion, as nece у Regional Director to submit a report on the result of the evaluation of the regional HFA situation and trends since the adoption of the regional strategy in 1980 member States Date Regional Committee Regional Office Action for national Reporting to health development Regional Committee 1985 (continued) by December Have reviewed the health information systems and adapted them, as necessary, so that they are fully supportive of the managerial process and cover at least the list of indicators agreed upon (36)a Have analysed the national health situation in the light of the HFA strategies and have identified major national health development priorities (35) The EACMR to submit an HFA regional research plan based on priorities related to the regional targets Has developed and issued guidelines for formulating the national HFA strategy with regard to certain critical European health policy issues Has developed and disseminated scenario methodology for formulating the HFA2000 strategies 1986 September by December Have analysed the national HFA policy and strategy, and revised them, as necessary, to ensure that they are in line with the regional HFA principles and contain clear national targets, supportive of the overall regional HFA targets (34) Have reviewed and revised, as necessary, the managerial process for HFA development, implementation, monitoring and evaluation,, while ensuring full community and m u l t isectora1 involvement (35) Thirty-sixth session to: - review and endorse the 1988-89 programme budget - review and endorse the HFA regional research plan - set policy for increased extraordinary support to regional HFA development Regional Director to submit a proposal for the regional HFA research plan, for the 1988-89 programme budget and for increased extrabudgetary financial support to regional H FA development Has developed and publicized the guidelines on functional criteria for selected PHC issues specific to the European context Has diffused information on effective organizational patterns of health service delivery existing throughout the Region and identified certain pitfalls to be avoided Has collected and disseminated particularly interesting national experiences of policies, mechanisms, methodologies and achievements with regard to quality of care and technology assessment a The number in parentheses refers to the target number to bo reached by the proposed action. EUR/RC34/14 6765L page 5 Date 1987 March by June September by December 1988 September X) o> W Member States &) -vj Cj _______________________________________ OQ On pa Regional Committee Regional Office ^ ^ Action for national Reporting to 0> О health development Regional Committee ^ Have submitted a monitoring report on the formulation and implementation of the national HFA strategy Have analysed the overall organizational pattern of health service delivery and prepared a comprehensive national plan, as necessary, for improvement of PHC (26-30) Have assessed and reviewed, as necessary, the policy on quality of care and health technology assessment (31,39) Thirty-seventh session to; - review a report on monitoring of the implementation of the regional strategy - revise the regional plan of action, as necessary Has diffused the regional HFA research plan and contacted national health research councils or equivalent authorities to convince them of the research needs for HFA development Regional Director to submit a report on monitoring of the implementation of the regional strategy Has developed and diffused сазе studies and guidelines on coordinated health manpower planning and on health manpower scenarios Has promoted the development of model projects on environ­ mental health improvements for industrialized areas Has provided guidelines and given assistance for the development of policies for health promotion, especially in relation to schools, workplaces, the family and the community Thirty-eighth session to; - endorse the regional contribution to the Eighth General Programme of Work - endorse the 1990-91 programme budget Submit proposals for the 1990-91 programme budget and the regional component of the Eighth General Programme of Work v.ember States Date 1988 (continued) by December 1989 by March September Regional Committee Regional Office Action for national Reporting to health development Regional Committee Have analysed health manpower development experience and adopted comprehensive plans for such development in line with the national HFA strategy (37,38) Have developed a national HFA2000 research plan that gives priority to major areas where knowledge is lacking, in order to reach the national HFA targets (32,33) Have reviewed public policies that affect lifestyle and revised them, as necessary, to make a healthy lifestyle the easier one to choose (13) Have reviewed environmental health policy as well as mechanisms for monitoring, assessing and controlling environmental hazards, and revised them, as necessary, so as to be fully supportive of the national strategy (18,19,24) Has disseminated basic principles and guidelines on public information through collaborating centres Has developed guidelines regarding critical HFA issues relative to sectors other than health Have submitted a monitoring report on implementation of the national strategy Thirty-ninth session to; - review the report on monitoring of the implementation of the regional strategy - revise the plan of action, as necessary Regional Director to report on the monitoring of the regional strategy XJ Cb OQ fD on m^ c o n pa Ln \ f pü о ы -p- Date 1989 (continued) by December 1990 by March September XJ СГ» rt Member States Çü sj d (W Regional Committee Regional Office ^ '“л Action for national Reporting to 00 О health development Regional Committee ^ Have analysed and revised, as necessary, public policies related to income security, employment, housing, food and education, so as to eliminate pockets of poverty and areas of deprivation and give preferential treatment and special support to the most needy and thereby provide equal opportunities for all to develop, maintain and make full use of their health potential (Chapter 1) Have reviewed health education programmes and revised them, as necessary, so as to reinforce basic aspects of the national strategy Has developed model projects in consumer-oriented health care and health policy Has provided guidelines for the special reporting on national progress with regard to; - the Expanded Programme on Immunizat ion - the International Drinking Water Supply and Sanitation Decade which is required in the light of the global target dates set for 1990 Have reported on the national progress in implementing programmes which have 1990 as their target date; - the Expanded Programme on Immunization - the International Drinking Water Supply and Sanitation Decade Regional Director to submit a report on regional progress in reaching the global targets related to; - the Expanded Programme on Immunizat ion - the International Drinking Water Supply and Sanitation Decade Fortieth session to; - review the reports on; - the Expanded Programme on Immunization - the International Drinking Water Supply and Sanitation Decade - approve the 1992-93 programme budget Date Action for national Reporting to health development Regional Committee Regional Committee Regional Office 1990 (continued) by December Have reviewed activities and practices with regard to social groups involved in lifestyle, environment and self-help issues and adopted policies and programmes, as necessary, to strengthen their impact in priority areas of the national strategy (14) 1991 by March Have submitted an evaluation report o n the effectiveness of the national strategy and the degree of attainment of the national targets September Forty-first session to; - review the evaluation report on the effective­ ness of the regional strategy and the degree of attainment of the regional targets Regional Director to submit an evaluation report on the effectiveness of the regional strategy and the degree of attainment of the regional targets