Apri l 1930

REPORT ON SUB-REGIONAL MEETING ON HWLLTH FOR ALL BY THE YEAR 2000

Kuwait, 14 - 17 Apr i l 1980

INTRODUCTION

A . l ForewoM

1.1 The meaning of IiFA,';lOOO

1.2 Preparat ion of plans f o r ~ ~ A / 2 0 0 0

A.2 Objectives of t h e m e t i n g

A . 3 Method of conduct o f the meetlng

B.l Policy

1.1 D e f i n i t i o n of pollo:,

1.2 Major pol icy i s s u e s re levan t t o HFA/2000

1.3 Po1ic.v gaps and remedles

B.2 S t r a t e g i e s

2.1 Defiri i t lon uf s t r a t ~ = & y

2.2 D t r a t c & i c x fa:: fi17A!"I:i)(,i)

2.3 MethodoloKy oi' s t r a t e m s e l e c t i o n

B.3 Plan of a c t i o n

3.1 Def in i t ion of plan of a c t i o n

3.2 Main d i f fe rences between planning f o r IiFA/2000 and ~ r a ~ m l . short-term plannine;

3.5 Changes i n planning methods requlred t o ensure HFA/2000 is e f f e c t i v e

3 . 4 L l n k l w HFA/2OOO plarrs wl rn oL!irr (iizni

3.5 Regional planning f'ar W A , ;'(!i.!; i ri Lhc G ' i l i 4 re-.

B.'I S u m r y and conclusions

Annex I - LIST OF PART 11:ii'lAN" '3

Annex I1 - OPENING ADDRE,.Sr? DY i1.F. THE MINISTk?? I,?? PW,IC HEA1,Tii. KUWAIT

Annex I11 - MESSAGE BY Wi k.b:. 1 IF%, LJJL~~(T(IW, WHO EAbTERN MEDITEJlREANEAN REGION

Annex I V - ACENDA

A ~ u i a ~ V - SUGGESTED ;I,ULfiGINIL 8 l l H 'I'M; J iJNE 1930 UZPmlINE

A sub - reg iona l Meeting was held i n K t t w a i t f rom 14 t o 17 Apr i l 1980, i n

pursuance of t he o b j e c t i v e s of r e s o l u t i o n EIl/RC29A/11.7 o f t h e Regional Conunittee

fcr t h e Eas t e rn Medi ter ranean on forrnul.?tina S t r a t e g i e s f o r Heal th for A l l hy

t h e Year 2000 (llFA/2000).

P a r t i c i p a n t s had been t~ominated by M~nistries of I l e n l t h , n ~ i n i s t r t e s

responsible for pl;lxlnirig, and otlker m i n i s t r i e s i n t e r e s t e d i n t h e s u b j e c t .

Tl~cb l i s t of p a r t i c i p a n t s i s g jven i n Anrtex I .

The mecting was opened by H.1:. Lhe Min i s t e r of P u b l i c Hea l th , Kuwait,

D r . Ahdul Rehman A1 Awadi (Annex J I ) .

I n h i s message, D r . A.H. Taba , Regional D i r e c t o r , WHO E a s t e r n Medi ter ranean

Regional O f f i c e (Annex T ? I ) , r. irnu.=,,~.-;i i,: - tie:,; :I ;.i;.:.i. Fir tiic s u c c e s s oF the

meeting and expressed h i s g r d t i t - h . . . . .:o ,: ,:

D r . Nouri A1 Kazemi, D i r ~ c t < ~ r PI>',: i . . Eii?si t h ,lad Flann ing ,

Min i s t ry of P u b l i c Hea l th , K I I I I ~ I ; ~ , : . I ? . t i 3 and D r . S m ~ r T s l nm,

Tecilr.tico1 Adv i se r , O f f i c e o!. r!i- \"i.:i s t a r r. '' He*,: th, Riyad, Vice-(;hainsan,

The meet ing c e n t r e d ~rour~t l pr$b; i r r : is acid ot:hr<r s u b j e c t s o f par t ; ic i l fa r

i n t e r e s t t o t h e Gulf S t a t e s t h a t & t i e n d e n .

The agenda oT tile meeting i s g i v t : ~ n Annex. 1 i'.

WHO EHRO

A . l YORrnrnD

1.1 The meaning of WA12000

The tern "~A/2000" was f i r s t used i n a public forum i n 1977, when the

World Health Assembly adopted a resolution caanitting WHO and member countries t o

" ... the attainment by a l l the people of the world by the year 2000

of a level of health that vill permit them t o lead a s o c i d l y and

economically productive l ife".

It i s o m of the moat Ltaportant resolutions i n WHO's history. I ts

impact has already been large. It has led t o the Alma Ata Declaration of 1978,

i n ublch representatives of most governments i n the world re-rtated the i r

c a i t w n t t o liFA/2000, and affirmed that primary health care i s the key t o

attaining it.

In essence, WA/2000 means freedom from avoidable pain, d isabi l i ty , or

death for a11 people by the year 2000. HFA/2000 mans doing the beat possible.

within resource and technology constraints, t o eliminate unnecessary suffering.

liFA/2000 implies equitabil i ty. Health for a l l meana hcalth care for a l l ,

no matter how r i ch or poor, how young or old, irrespective of geographical

location, social otatus, sex, race or religion. What i s done i n one place for

one group of people must be done for everyone who needs It throughout the country.

Accesr t o baaic health services, whose degree of eophistication will vary according

t o ehe resources of each country, should be made possible for a l l people, and

part icularly for the more deprived l iving i n the rura l areas.

Is it po8sible to attain health for all by the year 20001 The answer

is yes, if there is cranitmsnt, and if the right tools are used. Conrmifmcnt ia

in term8 of believing that health is a right, and health care should be provided

according to need, and not according to any other criterion.

The tools include application of the principle8 of primnq health care.

Of them, the moat important are community participation, lorcoat and simple

technology, prevention including environmental sanitation, and interaectoral

coordination.

C-nity participation ie esaeatial in meat countriae. Thcfc are I

insufficient profeaaional resources to cover the whole country, and self help

1 s a new aource of resources which must be tapped.

L w c o a t and simple technology are also crucial. High technology

illustrsted by phyaiciana and hoapitals is acnrce, and can only be provided

to an urban minority. The cost of, say, providing open heart surgery to prolong

the life of a single person i8 very high. If that money had been apent on.

say, immunizations or oral rehydration fluids, it might have naved the lives

of a hundred or mnrr children in rural stens

Preventive health care is important because it is cost/effective.

In other words, $ 1 apent on~prevention will avoid far more illneaa than

$ 1 spent on curative health care. Where money is acarce, it has to be uaed

where it w i l l do most good - i n provision of safe water, i n inmunization

p r o g r m e r , i n nu t r i t i on caupaigne, and so on.

In te rsec tora l coordination i s important because heal th i s affected

by what i s done i n sectors other than health. I n f ac t , i n l e a s developed

countr ies , a c t i v i t i e s i n the education, agr icu l ture , and publ ic works sec tors

may be a s important t o hea l th a s a c t i v i t i e s i n the heal th sector i t e e l f .

The sec tors must col laborate . For example, agr icu l tura l extenaion must be

used a s a tool t o a t t a i n b e t t e r hea l th through b e t t e r nu t r i t i ona l s t a tu s ,

and care muat be taken t o avoid heal th hazards r e su l t i ng from non-health

sector a c t i v i t i e s , such a s the spread of malaria and schistosomiasis due

t o new i r r i g a t i o n pro jec t s

If there i s co-iuuent, and L h r rigi lL too ls a re used, even the l e a a t

developed country can a t t a i n hea l th for a l l by the year 2000. For example,

i t might ensure t h a t hea l th services a re accessible i n remote r u r a l a reas ,

a s well a s i n the towns. That would he a good indicator of HFA/2000 attainment.

The rervices might be simple and low-cost, but everyone would be benefi t ing,

The simple and e f f ec t i ve hea l th a c t i v i t i e s can, i n f ac t , d r a s t i c a l l y reduce

in fan t mor ta l i ty r a t e s and increase l i f e expectancy.

1.2 Preparation of plans fo r HFA12000

Nearly every c o u n t y i n the world rill have t o change iLs paLtern of hea l th

care, i f it vants t o a t t a i n hea l th for a l l by the year 2000. Planning i s a way

of changlng d i rec t ion , and waking sure t h a t we proceed i n the r i g h t d i rec t ion .

WHO Em0

Thua, countries hare agreed t v prepare ~ A / 2 0 0 0 plans, and WHU i6 prepsred t o

col laborate where required.

I n the Eastern Mediterranean Region, WHO has organised t h r ee meetings

t o discuss HFA/2000 plan preparat ion. This repor t concerns the meeting held i n

Kuwait; attended by pa r t i c i pan t s from 5 countries+of the Region. One meeting

has already been held i n Somalia i n February 1980, and another i n Syria i n

March 1980.

It i s hoped t h a t count r ies w i l l have completed t h e l r nat ional HFA/2000

p l ans - a t l e a s t , i n broad ou t l i ne - by June 1980. These country p lans wi l l

then be examined by the WHO Eastern Mediterranean Regional Off ice , and used

a s a b a s i s f o r preparing a WHO regional s t ra tegy t o be submitted t o the

Regional Comi t t e e Meeting i n October 1980.

The purpose of a WHO regional s t ra tegy f o r HFA/2000 i s t o specify

a c t i v i t i e s i n which WHO might co l labora te technical ly wfth individual count r ies

o r groups of count r ies i n t he Region, t o support na t iona l WA12000 plans.

It w i l l a l s o serve t he purpnar of achedu1i.w a c t i v i t i e s in which tro o r more

count r ies can col laborate , i n accordance with the s t r a t egy of increasing

technical coopcraciun between developing count r ies (TCDC). I n essence, t he

r o l e of WHO w i l l be t o f a c i l i t a t e the use c % exte rna l resources i n t he i n t e r e s t

of attainment of na t iona l goals .

* Throughout t h e r epo r t reference has bt?*n made t o the Gulf S t a t e s a s the c o l l e c t i v i t y of countrien represented a t t n a meeting.

WHO E M 0

Planr prepared and agreed at WHO xegional level will be submitted to

WHO Central Office, Geneva, nnd assist the preparation of a global strategy.

Thia will serve the purpose of scheduling global activities in rupport of regional

and national plan.. The l j iubai strategy will be submitted to the World Health

Asssmbly for consideration in May 1981.

A.2 OBJBa'IVSS OP THE WETIWG

Resolution W K A 30.43, adopted by the World Health Assembly of 1977,

specified that "... the main social target of governments and WHO should be

the attainment by all the citizens of the world by the year 2000 of a level

of health thatwillpermit them to lead a socially and economically produotive

life."

An Executive Board study (document A32181 was prepared and presented

to the World Health Assembly of 1979. Inter alia, it specified a timetable

for preparation of HFA/200O plena, inelr~ding "submission of reports on national

strategies and plans of action to Regional Committees" by June 1980. Thia

repvrL warn endorsed by the Assembly in resolution WHA 32.30.

HFA/2000 waa discussed by the Regi-onal Cnnnittee for the Eastern

Mediterranean, at the meeting in Qatar in October 1979. The Regional Cwmittee

iaaued resolution W/Rc29A/~7 , which urged member states to formulate country

plans and assist preparation of a regional strategy, to be submitted to the

Thirtieth Session of the Regional Committee in October 1980. This resolution

WHO Elm0

alro requested VHO/EFRO to provide technical support to countries Eor the

purpose of plan preparation.

In accordance with this resolution, WHOIEIRO invited 6 countries to

attend a subregional meting in Kuwait from 14 to 17 April 1980. *

The objectives of the meeting were decided as followa:

- to increase understanding of the goala of HPA12000:

- to increare understanding of what kinds of plana were needed:

- to increaae understanding of methodologies of plan preparation: and

- to increaae understanding of what kinds of policies, strategies and

activities might be required so that HF~/2000 goals m i g h t be attainod~

Greater t~ndsrstanding would be achieved by a process ut structured

dfmcuseions among representatives of similar countries, asdated as required

by WRO technical mtaff. I h a outputs of the meting would ca~$riae participants'

own notes, reports of group discussions distributed during the meeting, and an

official surary report (thi.1 document).

* The Libyan Arab Jmnahiriya did not attend

WHO EMRO

A . 3 -OD OF C o r n s OF THE NEETING

The subject of HFA/2000 planning was divided i n t o th ree technical top ics

and one procedural top ic a s follows:

- po l i c i e s t o support HFA/20M

- -- s t r a t . o r relevance t o the attainment of ~ A / Z O O O goa ls

- cha rac t e r i s t i c s of s i o n a l plans of ac t ion leading t o IiFA/2000, and

- follow-up act ion concerning preparat ion of nat ional plans of act ion

by June 1980.

Each top ic consumed approximately one day of t he four-day meeting.

or earh nf thr rhvrr main technical tap lcr (I?rr' i io ius , s t r a t eg i e s . and

plans of ac t ion) , discussion wan i n i t i a t e d by an introductory presen ta t ion by one

of the WHO s t a f f . Thereaf ter , pa r r ic lpan tv rltn~rlhurrrl L l ~ r m n r l v c ~ muray, Lww

groups t o discuss pa r t i cu l a r aspects i n g rea te r depth. Tkrr groups m r e arranged

so t h a t every country was represented i n each i e x c c p t i n ~ .lordan, which was

represented i n only one of the Too groups). Reports of small g r m p diacuaaions

were presented t o plenary discusslorr sessions, and addi t iona l ly d i s t r i bu t ed i n

wri t ing.

The procedural top ic of follo*ruu act ion was discussed i n a plenary session.

a s reported i n Section B5 of thi a document.

Preliminary statements ir~npared by cwrt c o u n t r i ~ ~ represented a t the Pleetillp

were discussed i n d e t a i l a t an informal resaion.

WHO E M 0

B . l POLICY

1.1 Detini t iop of p o l i c ~

The meeting agreed tn arlnpt +he fr7llarfng definition of pulicy;

"Policy i s a statement of what our object ive i a , why we think i t i s

important, a id trow muclt we a r e C m l C t e d t o achieve it."

I n t he introductory prescntat i rm by D r . G. RifLa ( W H O I E ~ O ) , it was

pointed out by examples t ha t po l i c i e s have t he following addi t iona l cha r ac t e r i s t i c s :

- a pol icy statement gives u s continual guidance i n our da i l y work;

- it contains p r i nc ip l e s and r u l e s which help us t o make conaletent decisions:

- it c r ea t e s a t t i t u d e s which help t o ensure t h a t everything we do i s i n

l i n e with our o b j e c t ~ v e s .

Moreover, through selected examples i V was shorn t h a t var ious pol icy

statements,

i n t e r a l i a :

- may make it c l e a r who i s being c--3 trpld.

- do not g ive prec i se d e t a i l s :

- can be made a t a l l l eve l s .

F ina l ly , with a view t o riari , !r ing rl-e m a p r differences between a pol icy,

a s t ra tegy aad a plan of ac t inn , it waa pointed out tha t :

- a pol icy does not s t a t e & the ob j e s t i a e i s to be achieved: A statement

of method would he :. Itcaregg;

WHO EHRO

- a pol icy does nor give d e t a i l s of what i s t o be done, by whom and when.

Deta i l s of t h i s kind go i n t o a plan of ac t ion .

1.2 Malor policy i s sue s re levant t o HFA/2000

The following po in t s were made during t he dissuasion ;

While recognizing t h a t pol icy statements and indeed t he range of po l icy

i s sue s would vary from countrv t o country, a general measure of consensus on a

ntrmber of pa in t s w a s arhirvcd

There was a discussion on the d i f f e r e n t l a t i o n between p o l i c i e s and s t ra teg iea .

On t he one hand t he pr inc ipa l d i f fe rence w u l d be one of d e t a i l - p o l i c i e s a r e

e aaen t i a l l y broad statements and r e l a t i v e l y unspecif ic , whereas s t r a t e g i e s

develop pol icy decis ions i n a more spec i f i c manner. On the o ther hand,

it was suggested chat the main d i f fe rence i s i n respect t o cornaitment aa

npposed t o expediency - p o l i c i e s express comi tmet~ t , whereas s t r a t e g i e s

imply choice (of a tool which may o r may not be used, depending on t h e co s t /

e f fec t iveness analyses).

The WHO de f in i t i on of hea l t h was considered apprnprinte, bu t i t wan

important t o note t h a t hea l th i s not merely absence of i l l n e s s , bu t a l s o a

s t a t e of mental and aocia: w e l l - l r r k o g . IVluv yrrllclex t o support HFA/ZOW

EM/PHC/II EM/SW-REG.HTG.HFA.ZOW/~ (K~u) page 10

WHO FHRO

must take i n t o account more than j u s t avoidance of d i sease , physical d i s a b i l i t y ,

or premature death.

1.2.2 w"r p r i n c i p l e s

I) Every tndrvidual has bhe r i g h t t o h e a l t h and a l l members of the coolnunity

should be p-ovided with the opportunity t o a t t a i n adequate h e a l t h s t a t u s .

I ) P r i o r i t y should be given t b those persons i n the cormunity who have been

under-provided with oppsrturxitiea and ca re i n respec t of h e a l m . Under-

served members of the cawmunity a r e l i k e l y t o include those i n remote r u r a l

a reas , low income migrants t o urban areas , the handicapped, and el.derly Per-

eons ( p a r t i c u l a r l y i n view of the t rends towards reduct ion of the

inf luence of the extended family).

111) PrwnoLive and prevenrlve care sh011ld he given f l r a t p r i o r i t y aunmg the

range and scope of hea l th a c t i v i t i e s

IV) The Government should exerc i se 5 resplirisibi1ic.p :';r a l l t i-aith a c t i v i t i e s ,

although t h i s do-e not imply Chat eSir privnCe health sector should LWL Lr

encouraged. The o v e r a l l r espona ib i l ' ty f o r h e a l t h may be mainly devolved

on cne Kinistry of Health

V) The Fovcrmaent, probably bv wav of the n i n i # r w of Benlth, shmtld rnswrn

coordinat ion o f the planning and ilapl.cmentation of h e a l t h a c t i v i t i e s .

Coordination i a nerels - r y w e , '' ale and $overmenT agencies , between

EY/PHC/IL EM/SUB-REG .mc. HFA. zo00/7 (KW) page 11

government sec tors , and between the component p a r t s of the government hea l th

sec tor .

VI) The pr inc ip les of modern, ~ c i e n t i f i c hea l th planning should be applied.

Pa r t i cu l a r l y , planning should be dynamic - subject t o review and updating

through monitoring and evaluat ion, t o meet changed needs and opportuni t iea ,

based on a r o l l i ng horizon wong other considerations.

VII) Every e f f o r t should be made t o ensure t h a t t he cos t of a t t a i n ing an adequate

hea l th s t a t u s i s not a b a r r i e r , cons t ra in t , o r discouraging fac tor . It may

be advisable i n sane cowntnes t o l i s t pa r t i cu l a r types of hea l th a c t i v i t i e s

which a r e t o be f r e e oE charge.

VIII) Waste of resources through gnder -u t i l i za t ion o r excessive demands of hea l th

f a c i l i t i e s , overprescr ipt ion of drugs, and s im i l a r nccurrences should be

avoided. Without prejudice t o the above, some a c t i v i t i e s might requ i re a

nominal charge t o be made, t o r a t i ona l i z e u t i l i z a t i o n ,

IX) P r i o r i t y should be given t o primary hea l th care a c t i v i t i e s , a s defined

i n the Alma-Ata Declaration, t ha t is:

- hea l th education

- n u t r i t i o n

- water suppl ies and bas ic ssnite?%o.o

- materna l and child cnre, .!nrkr."ding f m i l y p l ann3q

- l rnmunl zationc

EM/PHc/II EK/SUB-REC.MTG.HFA. 200QI1 IKW' page 12

- prevention end control. of ! ncal'ijr endemic dise:ln~a

- treatment of conwon disear?er and i n ju r i e s , and

- provision of e s s en t i a l drruqs

I t was suggested t h a t ~ p e c l a l cona idera t io~l should moreover be given

t o emergency care , espec ia l ly i n the context of accidents, den ta l heal th

care and possibly mental hea l th .

C d n i t y part!cipati.on should be an e s s en t i a l element En respec t of

hea l th ca re del ivery. 1x1 pa r t i cu l a r , the coaanunity should be encouraged

t o d a r t i c i p a t e i n hea l th ca re provis ion, including pro tec t ion of l e a

own hea l th .

Every opportunity should be taken t o promote and u t i l i z e interi-orxn?ry

coaperation and co l labora t ion . Thls might include sharing o r exchawp

of resources , coordinated act ion against d i seases whish arons p ? r " .?. '

boundaries, and o ther a c r i v i t i c a .

Wphasis should be given t o the t rn in ing and il~sigluaent o"pri.!?;,r . i t c o i t h

care workers - t h a t i s , heal!:l. worker^ wlw are thi* f ::il"rct nT i:nrrtact

of t he conmnrnity with the iiralti: crre system Ctirrlrtrla ai~rpuld be i l+?alsrnr8d

t o meet the needa of ~iFA.l'21~7;, with emphasis or: preventhe c a r e , e~vJ.r.c+m~im~, :i.

san i ta t ion , hea l th educalinrz and rrr <,,n.

) The Government should enenur age ~ ' " i c i en t acquis i t ion , d i strihn4.iorl i.nr1

use of druga.

WHO Em0 EM/PHC/?I EM/SUB-REC.MC . l W A . 2 M 0 / 7 ( K I P ) page 13

1.3 POLICY GAPS AND REMEDIES

1.3.1 The following gaps in existing policies were identified:

Complete abacnce of exnlicit hea l th p o l i c y o tn tamsnt , e ;

- Health policy mtatements which are not clear, or comprehensive

enough;

- Confusion betwen policy making and strategy determination;

- Health policy statements biased in favour of curative medicine,

with little or no reference to fact finding or research, to

cormunity involvement, to problem identification, etc;

- Divorce between health policy statements and healttr manpower training

policies (particularly of medical personnel);

- Diverging or conflicting policies hetween different departments

responsible for various aspects of the health seruices and of

health related activities (workers' healrh, envttonmental health,

fwily planning, water pupply and sanitarl~n etc.l :

- Policy setting based on prc-.conceived ideas (overemphasis on

borrowed models, on anjahict-i.cated approaches, on "more money by

itself equals better he!aIthv,rtc . ) or on a too detailed approach

leaving little or ns room f o r definition of alternative strategies;

- Obsolete policies, lack of flexibility in existing policies.

WHO Ern0

1.3.2 Among the cause* identified for these gaps were:

- Overcentralized policy making;

- inadequate information of the policy makers;

- Lack of suitable mechanisms for policy making or reviaion, which

cnr*lrl ens.rre i .a. participation of the con.-era and mltidfssip-

linary representation in the policy makillg process; lack of

flexibility in the policy making mechanimn;

- Health planners unaware of the value of health policy stateaantr:

- Policy makers not convinced oi the multi~~ctoral nature of haalth

and of its contributory role to development;

- l'reponderant influence ot a non-public-health oriented medical

profession, vested interests of the medical profesafon; uvsr-

reliance on expatriate expertise;

- P o l i c i e s which are uot bnard s m groper basellne infornaticn (no

data; wrong or poor data; d a t a not accepted or not properly utilized)

- Administrative patterns or policies (centralization, decentralization,

civil service regulst lana, etr.) that hinder the formulation of

adequate health policies;

1 . . 3 . 3 In addition to the possible sol~ttione which may derive f r m

the identificarion of the causes indicated above the following

. .

WHO EMRO EM/PHC/I~ FM/SllB-REG. btTC. RFA. 2000/7 (KIXJ) page 15

were a l s o recognised:

- Ensure proper access t o and o r i e n t a t i o n of pol icy decis ion

mokcra at all levels with reanrd to health snd hcolth-related

i s sues , removing a t t i t u d i n a l b a r r i e r s , undue inf luences , e t c ;

- Strengthen o r e s t a b l i s h information and c o m n i c a t i o n systems

concentrating on key issues for na t iona l development;

- Increase in te rna t iona l methodological inpu ts i n hea l th s t a t i s t l c s

and information, i n appropria te h e a l t h technology i n Basic Health

~erv ices /Pr imary Health Care, operat ional research, e t c ;

- Encourage in tegra ted pol icy making and i n t e r s e c t o r a l plannim

with the p a r t i c i p a t i o n of t h o ~ e responsible for the financing

of hea l th se rv ices (higher hea l th council or i n t a r - m i n i s t e r i a l

board) ;

- Policy making should not h~ tvnd~ily I ? t l u r v c e d by p a r t i c u l a r pressure

groups;

- WHO should provide rn.7y.r i :~ i i ~ r m a t i o n on experiences i n planning

rrimary Health Care an3 re!ared a c t i v i t i e s i n d r t f c r c n t count r ies

( both success and f a i l u r e stories?, comparison of s t r a t e g i e s ,

policy settiry i;n I,,,ir:-i.tril t:a?is. e t c .

In addition to the abovc tbc qcnvp irished tc. 1-ccnuliic:~rl that a tuacLLog uL

high l e v e l pol icy makers i n h e a l t h and heal th-re1 nted a c t i v i t i e s (of the type

EM/PHC/I 1 sn / su~-rc~c .mc .w~~ . 200017 ( o I . ~ ?

pane 16

WHO EMRO

of the Inter-Ministerial Consoltatinn on Health Services and Manpower Development

held in Teheran, February 1978) should be called in the Gulf area to evaluate

existing policies for HFAIZOOO. Such a meeting could be convened bv the Gulf

Health Secretariat with WHO and UNICEF natticipation. The meeting should be

preceded by an evaluation of existing country policies, their components and the

achievements reached so far.

2.1 Definition of strategy

The meeting discussed and adopted the Eotlowing definition 61: strategy:

"A strategy is a statement of where we want to go, and how we can best

ensure we get there. It explains the general direction in which we should

proceed, in order to reach our objectives".

In the introductory session presentrr' by :'r U. Hi.ndl.t! CWWOfEMROY

a number of examples were given of s t r s t r w ebabnrntior and stateruents,

leading to specific considerat.ioni;. Irra'l ..:he popular ttndcrstanding of

the meaning of strategy as veil art i+rs .irl.entific meaniirp, contain the following

main elements:

- it is more concerned w i t h g m ~ r t ? . i d r l o ilr .&a(. tu do, than with details;

- it i e more concerned wit:!? wha? uze d l t dn river a long period, than with what

we might do tbday or tmorrnw,

- it is concerned with methods of doing things, rather than just apecieing

WHO EHRO E M I P H C I ~ 1 EM/SUB-RFZ.HTG.HPA. 2nnol7 (KIM) page 17

- it is concerned with listing alternatives, and then analyzing them to

determine which i n best.

Furthermore, strategy was compared with plans of action:

- while plans of action give specific indication of what is to be done and who

will do it, when and with what resources, a atrategy does not contain such

details. Particularly, a strategy does not state a precise timetable, or a

definite target as to how much will be achieved by a certain date.

- Just as strategies follow on logically from policies, so plans of action

follow on logically from atrategy selection. Thus the process moves from the

general to the detailed. Plans of action must contain the detail after the

best atrategiea have been selected.

Finally, illustrated examplee, attention of the participants vrra

brought to a possible confusing sitnation, when noliciea in one plan enn

be considered as strategy issues in a hroader p lan . Ch tile uthes hand, s

situation may also exist when a partlcj~iar srrhject <:nn :...: .it,* object of

both policy and strategy s ta tements

The groups then discussed d i f f - r e o r s f i g ~ r n relevant: to C'W concepr of

strategy.

EM/PHC/~ 1 EHISUB-XEG.~C.BFA. 2 ~ ) 0 / 7 b

page I8

WHO EMRO

STRATEGIES FOR HFA/2000 2.2

2.2.1. A selecteci number of .'deal poTiries t o support HE~/2000 were discussed,

(see 1 . 2 Major Policy i 3 4 t 1 ~ - ~ ~ I P V I E P ~ ? t n HPA/ZOOO) assuming Chat any strategy

defined worlld be conditioned hy pre-existine; pol icy decis ions and based on

cuncerlxing I r a appl~cnbilit:r under loca l circumstances. Alternat ive

S t ra teg ies should a l so be considered t o the extent possible.

2.2.2. Examining the po l i c i e s I i sted under Nos. 1 .2 .2 . (111) ipromotive and

p r ~ v r n t r v e errre . h z , s r l A he in-,r First p r i o r 1 . t ~ ) CI?) (priority assistance

should be given to the underi:~*vidrd? and I (every individual hns the

r i g h t t o healch) Ir was polnted out t h a t these po l i c i e s have a l re ldy

been la rge ly accepted and are t d n t implemented by t h e Gulf Stater ; .

The relevant s t ra teg ies , , however, need t o he S?m-z?atad taking inco

account each country's socio-economic al tuat inn,and present and future

p o s s i b l i t i e s .

2.2.3. S t ra teg ies should he Crc~:.!?:qre;( ?%?*her .ic* t h a t Co:e,.,-n~~!:r"s tr;;"., . .:n -21

equi tab le bani s, provide cmrebor ,* i?w PxCrnal-v " ' z . w ' ~ * ) Care i W C ) F P L Y ~ C ~ . ~

t o the whola popnlati-q, !?> . . r i r ~ , n . i:r r r s ? V : rirr.:l iif!~+s b a s i c se rv ices

( l i t e r acy , social services , roads et!..'? as ragkit h e oruvttied for by other

i n t e r s ec to r a l o r sectotdl ' a : i rr -I?? .rvrru! i e f fo r t t a ) p r m o t e I.iving

condi t ions of the people

I) Planning sEf=y

- The group tcor.,'i.",.:---i . - t 41 i n - i : r qr- i:r "PC 2 r P g i : i m r s had r s c .

chance r r i a i l - , -nc , r:i .c*l ri ,, : - , -: ,' . ?s:' f, -!e,; rFrai:~?p:r^.e For planning

anc fmp.eme:?t:i :hil

WHO Em0

page 19

- Developing planning policies entails the building up of an

adequate information system and the development of health services

research. These should underline the preparation of medium and long

tern rnoprehenaive health plana including targets, projacte, progra~nes

described in a way which would pennit meaauring and monitoring of

progrers on the baals ul neltctad social and I ~ r m l L h lrldLca~urs.

Evaluation and monitoring in turn should lead to plan revision and

adaptation eccording to experience and developments. It was stressed

that a good plan require6 good plannera and administrators, trained

for the purpose.

- The YHC: strategy should in fact be baeed on a comprehensive

national health plan which, itself, should be an integral part of

the countries' socio-economic development plan. This entailed

translating the broad objectives of the overall plan into inter-

sectorally coordinated targets and action proposals. Such work

could be performed through inter-ministerial planning conmittees

or boards. National Health Gnmcils could also play 4n important

role in ensuring thn establishment of a national health davelop-

ment network to ensure the coordination and integration of intsr-

aectoral actlvitlra at. d i r t r r e u t l s v e l a cvztlluclva Lu tl~e lilplewn-

tatinn of health and health-related strategies for HPA12000. Such

e health council could he supported by executive cmmittees, which,

if established on a regional basis, cou ld considerably Ftrengthen the

programme.

EM/PHC/~ 1 EM/SUB-RFI: urc.n~~.2wo/7 w t u t ! page 20

WHO E r a 0

- It was considered e s sen t i a l Chat the representatives of inerharlism

o r mechanisms establ ished far planning. and evaluation should r~a've

d i r e c t access t o the decis ion makers an d l1 a s t o those responsible

fo r execution so a s t o avoid working i n a vacuum, producing docmen-

t a t i o n which remained la rge ly unut i l i red .

11) Strategy for PHC

- Undar the aegis cE the G u l f Health Secreteriat coneiderable

agreement hag already been reached i n regard t o a common

de f in i t i on of PBC servlcea, t i l a i r scope, the composition of the

bas ic se rv ices team, and terms of reference for i t s var ious

members. F a c i l i t i e s have been designed and l i s t s of equipment,

suppl ies , t ranspor t d r a m up.

- The Gulf s t ra tegy may thsretore he ::urrni.?crp.d as cmexirir; ,:ie

e igh t CnapOnentS of PHr nf tt* ;'!ma I t a i::s.claraZion t n W ~ I ~ C ? ; ,..riatit::

be added emergency c a r e , dent::; heal tl: c w r ; .mil possibly roer..).al.

heal th , (see 1.2.2 Crx?

The basic H e a l l l s Sr rv1r : rs i l S ~ S > tern: wor.1.d n c w a l l v be cqcrrrd 01.

one o r more physicians, ptit i l l - health nurses , nursing s t a f f ,

, . laboratorv ~eshni.cj.ai: -; . . . I : s 1. s tat is l l .c ians, ariminlrt,ra,L.ive

support s t a f f . Tn ce:rni?x c s t e s dentall a s s i s t a n t s may a l so be

members of the team T1.e Cnm ~ t q r . s i c la.% say, however, vary

~ p e ~ l R I . t ~ y - l : , s f . all:: :!I rrljrnhfi, - : dapenlinp; an tlle population served and

l 0 ~ 8 . 1 clrcurnst.anctr,p, i;hii ; , i n i r i r \ n s , h<.:.*ever, remining the same for

811 Bttli/PH(: units

WHO EMRO EFI/PWC/I : EMISWR-RFG T r S s . HFA. 2000/7 (KI%J) page ' I

- I n addi t ion, community heal t l r wurhrrli a ~ r l v r in the village uC

o r ig in may be employed ir! small set t lements o r remote a reas , although

t he process of' upgradin8 tl?ese outaosts is underway. Active super-

visi.,i., il~,~:i continued t - a ~ n i n p of suck, stsf:' ! s considered an essen t ia l

element of' the pr~ugramme.

- The Gulf PRC srraregy maker full provision for the inccgrar ion of

cura t ive and preventive hea l th servicen (including UCH) a t t he

d i f f e r e n t l eve l s . In pa r t i cu l a r , r e f e r r a l of acute o r emergency

cases t o P syetem o i Liospitalization cen t res , with the pcovision of

adequate t ransport f a c i l i t i e s i s planned. A s p a r t d the regional

s t ra tegy being developed by smre count r ies i t i s foreseen t h a t PHC

centre8 (or un i t s ) w i l l . respond admini s t r a t i v e l g ~ t o the neares t

hosp i ta l (including provis ions £or tbu r o t a t i o n o r exchnnge

of medical staff) t o prevent r e e l a t i on and fos ter two-way col laborat ion,

w i x i l c i n other crkaea auclr x r l a t i u i k v l r i p could be S i r a i t e d Lo suprrvJ.sion

and technical support being provided by the nearest cura t ive cen t r e .

A s p a r t of the former schme I F i e foreseen i i ta t thrc network of 50-to

100-bed c n m ~ n i t v hosp i ra i s t:o be es tab l i shed would a! so become the focal

cen t res fo r preventive a ~ t i v i ' . i @ ~ . The g r ~ u p s t ressed t h a t i n

developing a s t ra tegy , l ink ing d o s e l y I ! n ~ o i t a l s and PHC cent res , care

should be exercised I.;: . ~ v r . i . ~ i c ~ r a t i v e ~ e r v i c e s dominating preventive

se rv ices - a problem ~&ir?i a,crriiri be solved through an aopropriate

managerial and 6xganizatinnal approncb. The rural oonununlty hospi ta l

would become n d r s i r a2 mi-c'r: , % ; - cnrmarehenail;re PBC and i n e t i t u t i o n a l

c a r e i n r r ~ r e l a rena ,

WHO EMRO E M / P H C / ~ ~ EX/SITB;REG. MY;,HPA. 2800/7 (KUW) page 22

- Where acccssibl1ILy Lu PHC centreg represents a problem i . s rn

out lying and mountainous a reas , provision should be made ini tke uea of

mobile hea l th c l i n i c s attached t o the PHC system, and when neceb-sary

f o r a f lying hea l th service, which should perform the functions r~orepally

undertaken by s t a t i c PHC un i t s .

- Nomads (whose number i s decreasing rapidly i n most Gulf

countr ies) may requi re special s t r a t e g i e s on a s e l ec t i ve baa i s , such ax

the t r a i n ing of community hea l th w r k e r s drawn from the d i f f e r e n t

t r i b e s , t he establishment of hea l th service un i t 8 a t fixed partaage or

gathering po in t s and t he use of mobile hea l th un i t s . I n f a c t the

provis ion of fixed hea l th se rv ices t e contr ibutory t o a Inw range

pol icy for t he set t lement of nomads.

1117 Manpowr d e v e l o p i n s requires s t r a t e g i e s eliraely l inked , ; , .rcrps~r;,!l i .

and c o n c r a t e l ~ , to tltc typaa and narrrra of t.he LWG snargic*?n P 3 19rp

provided t o the population,

Three a reas of act ion were recognized:

- bas ic train* : nr ra teg ies nhould be dcvc?.oped by a l l iiulf

countries t o increase the number o f na t i ona l s t r a i ned for mans-lrr

i n the d i f f e r e n t clrLeqnrLes nt heal t t? personnel t o reduce thil

present dependency on expatr'utaa i n the gears t o c m e , T(lougb

t h i s could be m e t i n p a r t by Increasing t he number of tra3d.rbe

i n a t l t u t f n n s a: d i f f e r e n t ?vpen, the moat important aspect was

WHO EMRO FMI.PI:C/I 3. F:H::I;IB- REC: :eG. HFA. 2000/7 (KUW)

the necessi ty t o c lose ly ntin,-' : ' a - nature of t r a i n ing and the

relevant cur r icu la Po *.he ;v ' , * -:< ?he country and the s t r a t e g i e s

chosen for the deveiopment; * * : !:'+!: services. Recruitment of candidates

fo r middle l eve l r : .: constitrxtes a problem and among the

s t r a t e g i e s r e cmended rverr: establishment of a career ladder;

the possibi . l i ty of top cnwrdir~~tea acceding t o un ivers i ty t r a i n ing ;

rec ru i t ing t ra inees Frrrrn the .i r-st day of study d i r e c t l y i n t o t he

eervice as f u l l rnemkrars, idf" h l i s a l a r y and sen ior i ty rights.

I n undergraduate medr. , . r e '!'!R greater emphasis needs t o be

given t o taaching I? ,?eaIZn and cnnrmnlcy medicine.

The a v a i l a b i l i t y of nde-vint-e .runbers i i ~ d qual i ty of teaching s t a f f

I n these d i s c ip l i ne s i 3 c ,* i l i ? pier-ious cons t ra in t , and ~ t r a t e g i e s

need t o be developed t:rr unanr* ? bench i~g of t r a i n e r s f o r the

d i f f e r en t ca tegor ies n ' ',.,.i: "7 A 1 8 ~ ~ ~ r i t y basi 8.

- &?%r~&~-~~.5~?!k~&. rnrticill.er.Ly Important where

la rge numbers of expati r s * r. .: w: i? iii 'i.,*reni- personal and

professional baclrgrnunA 7 ,. : >... . 7, . 4 :P;' i s ; number of years

t o come. Similar nppl'sr t'.t a a t l o r . , l r re turning

a f t e r t r a i n ing i n C->reir .. i . .

- Continuing,~d:8.iraii~.:,: r . - ! . intcrfirrrl component nf PHC

e f f o r t fo r a l l leveli: . . ,> !:-ired . n p e . ~ i a1 indrtccments

o r con t ro l l ing re.g,ri * + ' : I :-i a h e adopted tb ensure pa r t i c i pa t i on

of the s t a f r i m ri!lrr rtCon programmes.

i9,..rhhemrrre a regional urnatem could effcct ivalw be de.reiopad to

e s t ab l i sh 8 b ~ b l i c Health Traini:>g and Research la5titrr"i t o c<cjr'~-a

apecia l i s t : ; eE different r q t e ~ o r i s e i n the f i e l d of pubI<.r heair!: M.:~: I

part ic i r lar regard t o the planning, organizat ion and adartnistrarion of

I3ralt)i services , and t o c a r q out p ~ i b l i r hea l th research on nubles:Ln

o f ccmnoun i n t e r e s t to caunt r ies i n the Region.

IV) Pft.;ani:rj~l ,nf_ !ma= ,=w~me~e,s~ sad. c o n m u m u part_tigeaLr_Op

.- Strateg-~n should be de,relcped t o ensure the? i n t e g r a f t ~ ~ n c!.! i:a a l t t

e~locat ion i n a l l esvecte nf i%RII ser-vices.

- RealCh education programna shnuld become an i n t eg ra l par t uf ~ e n c r a l

education prograumer covering t he pr inc ipa l elements of tiaaLtR;

n u t r i t i o n and san i ta t ion , includi.ng such aspects as the controi of

~ . ~ r n i . c u b i e diseases, chi: grcrertt ion of road a d h m u x : - i r l e n ? z

- A long range s t r a t r gv :?hotlld he :rwtabi i e i a d to %+frnu; :i-i. -**.*

proaoote canmunity motivatr on utrrl purticip.nt,? .,>I n heats.% prog: iilMe&.

'Thirr sl~ould irrclkzJe t).r ..4ii . ., ',*. .... w ,. ,:.+ , ;:7. 4. p s.:mn,.!.~ig w

i:uplementaa:icn and aye?, .i:t -; r . ;,e a e t r i c b s p-iz-7 d r :

V) i?i.~ancinc of heal&b~ apr.~~:-c;.ew

- Though the present 2 i i r . . . a - . ,,,: xirtak : r f tnr ~ G ~ i i f rotk:,%rxes

d i d not,, ol ptesrri t , ~ r r r s r i t 2 ,,. 9 i . e :A !arri.utkc, c:.rrP?ralrt To *he

developtoerr; o i PHC urrur1cry ~p the c m l n p yenrs,, t h e $ro:lyP fa?.r. th.rb

n a t . . : .ikr : v orvda ,:!or exmuple, ai i

d r . , l e t i ~ , ~ , t ! f ~ t ~ t a ac:,:~ ir,

WHO E M 0

page 25

- While in principle the financing of PHC services is and should

remain a government responsibility, other resources might also be

harnessed to contribute to them either directly (through lndlvidual

t.,;kk+n payments for certain aspects as for example hospitalization)^^

indirectly (contributory social insurance, etc.). In certain cases

governments had chosen to subsidize private care clinics and

hospitals as an additional option open to citizens seeking medical

treatment. This strategy had the added advantage of permitting

governmental control over private hospitals and practice, including

price setting anrl mnntrnl of the qunl i ty of aarvi c e a offered.

2.3.1 The discussion focussed on methods of identification and formulation of

potentially uaeful strategies, analysis of alternatives, and deeisior making

in the selection of the strategy r n i x The intention vro to concanttJEu an

the main weaknesses of the process leading to strategy selection, and to

suggest ways of overcoming the weaknesses with emphasis on m A / 2 w

planning.

2.3.2. Many procedural and methodological issues were discussed, and illustrated

by oxamplca of recent expericncee in thk Gulf States. The followinfi ate the

main points on which there was general agreement:

1 ) Efforts should be made to generate a wide range of possible strategies.

The purpose of planning is to consider innovative approaches which

EM/PHC/~ 1 e~ / su~-aec .m~ .WFA, 200017 [ h ? ~ i

page 26

might laad t o i ~ ~ ~ p r o v e m e ~ ~ m ! !lei1 th c a w progr-armea, and the ntust

appropriate time for considerat ion of new ideas i s during i n i t i a l

s tages of s t ra tegy se lec t ion .

11) As wid. a range of v i c v a a* p u s a i b l e . l r r , ~ l d Lr aooylrt, f o r zhe purpose

of g e n e r a t i w new approaches. f ieal th wor%rrr 8 a8 a l l l eve l s should be

encouraged t o submit ideas and suggestions.

111) Ful l use s'rouid he made r r l ~ e p o r t s and prtblisations concerning s t r a t e g i e s

used i n other countr ies Mowever, s t r a t ~ g i e s do not necessar i ly

apply i n the same way ! n 4Iffer.rvt r n l r ~ t r Jes I n a s much a s nat ional

s t a f f have a h e t t e r appreci #ti,>: oi t h e i r counr.rien' environment

(including the crrl t u r a l cantext i f .~r heai t h , major aim should be t o

develop rhe nat iona l c a p a b i l i t y fur inrravatiort.

I V ) Special atten~rcr. . ,d q r l 4 + ok . I . . r . ' ! r 16,. 2 ~ : I:?' r : ; i t i p ~ ~ : - ~ : ; : ~ i .

I ntararct,oral

and intrasectara!

boundaries run n i:ip.*- 7 I > : , . , .. >,~. , ..(,; , ., :gnr.::i:d;parti cularLy

if different ~dminiairrtii.t..i * r e L. , - ' -~l~wi as I: , ~ 1 . r rRse of water

supply ptopreomeb! r r r d r,?r. i r.%>zsc !t,:i

V ) The r o l e of reserrck 1- and au~a lys i s was

discussed a t Iertpth. - . !her* t r i s rbi'c>r't:sge of nki l lcd

and experieacrb ;~RI: . ,x ;I ,*- r : r l ; )I*rbeuer .. 22.- irr,r:.r i,npontsnt

problem r a a : r~ .. :':e quakity of

WHO EMRO E M / P H C / ~ ~ EM/SI~-RE~.M(:.WFA.~~OO/~ (Y.UJ) page 27

research, ra ther than quant i ty .

For example, too much emphasis may be given t o c l i n i c a l research,

a t the expense of hea l th se rv ices and operat ions research. There

may be a des i re t o produce publ icat ions, end c l i n i c a l reeearch

papers a r e general ly e a s i e r t o produce than hea l th aervices research

pepera . Researchers may a l so tend t o be more concerned with applying

techniques than i n 5~ i rv ing rea l problems. D i f f i c u l t i e s a l so r e s u l t f r w

overspecial izat ion, i n a s much a s research workers tend t o deal

with narrow aspects of a problem ra ther than with the whole problem

vhich of ten requi res a mul t id i sc ip l inary approach.

VI) There are pressures to r e s t r i c t analysis t o rpcci f i c s t r a t e g i e s already

selected. Sometimes decis ion making precedes analysis , and planners

a r e expected ro j u s t i f y decis ions, t a rhe r rnan parcrclpare r n

o r contr ibute t o decis ion making process i t s e l f ,

VII) The da ta base for s t ra tegy sekeccdon i s o f ten inadeauete. Strengthening

of the routine data collect.ion opstern (that % c , the hoolth inEo.miatlon

system i n general) i a an important long term a c t i v i t y <&rich w i l l

contr ibute t o b e t t e r strategy ana ly s i s . Survey deslgn, condcrct

of experiments and p i l o t t e s t a , development of b e t t e r mathematical

modelling s k i l l s , and cor rec t use of ava i lab le da ta ( f o r example, by

recognition of t h e i r uncer+ainty o r unre l iab i i . i tv ) a r e a l l rleserving of

improvement.

WHO EM70

VIII) Great rttcntion should be paid t o se lec t ion o f meaaures of performance

(that i s , indicators) t o be used t o indicate the re la t ive merits

of al ternative wtrategies. I n some cases, s trategies are compared

only on the baais of costs, and l i t t l e attention i s paid t o comparison

of output8 or impacts. Those concerned vi th budgeting and finance

tend t o think mostly of established budget oeilings and costs

rather than of financial requirements for new strategy selections.

IX) It i s essential t o analyse several al ternatives, rather than simply

concentrating on amplification of a singla ~ t r a t e g y . In t h i s regard,

decision nukers rhwld be prerented with the al ternatives rather than

v i th a single strategy proposal.

X) Decision makers may need t o be advised on how they can make best

u8a of planners and researchers, and of thei r reports. Caod aiialysee

are not useful i f decision makers m r r not receptive t o them,

X I ) Attention should be paid to characteriat t~ta ~ u c h aa f lexibi l i ty

and robustness of al ternat l wv straregies. Other things being equal,

preference ahould be given t o strategies which are rabuat (that i s ,

useful i n a wide range of cil-cumstances) and flexible (capable of

being modified i n remponse t o change8 i n needs or the environmentl.

Strategies which involve construction of large, special-purpose

buildings (for example) are not l ike ly t o be e i ther robust or

flexible.

WHO Ern0 E H / P R C / ~ ~ EH/SUB-REC.~EC.HFA. 200017 (KW) page 29

XII) Consideration should be given to developing mechanisms for coordi-

nation and prmotion of continuing development and research atudtrs

It was pointed out that decision makers and senior administrators

often have a routine workload such that they have little opportuntty

to consider alternative strategies and possible changes. A network

for health development activities (in WHO terminology, a National

Health Development Netvork) might be created as an ongoing source

of ideas, research, planning, and encouragement of change.

3.1 Definition of plan of action

The meeting agreed to accept the following as a definition of a plan of

action:

"A plan of action is a document containing detalls ol what in to be done, w;len,

by whom and with what resources, for the ourpose of attainjng s m e stated objectives."

In an introductory presentation by Dr. A.M. Mochf , iWk'fl C o n s u l t e n t ) , it was

pointed out that plans of action should

- be based on prior consideration of policies and stretealev melevant. to the plan's

objectives;

- contain a set of decisions made by responsible persons;

- specify the monitoring and evaluation activities which will be conducted, to

measure progress and take corrective action where necessary and;

- group activities into ~rojzcts and p r o g r m e s for the sake of logistical and

conceptual convenience

wwn ~ m o

The methods of plan preparat ion were discussed. These included administra-

t i v e and organizat ional aspects , such as formation a f planning t e a m s represen ta t ive

of conamerr , hea l th workers, technical exper t i se , and management. They a l so

insludrd ana ly t ica l methods, such as cos t /e I fec t ivencss , computations. p r o j e c t i o n

and forecar t tng, operat ions research and experimentation, and p r i o r i t y setting

tachniqua.

3.2 blain d i f fe rences between p l a n n i n ~ f=-JA/2000 and ueual ahort term planning

Ef for ta towards a t t a i n ing HFA/2000 imply long term planning while

ex in t i n s p1anni.w processes mainly cover medium o r shor t periods, o f ten

conatrained aa they a re , by nat ional budgetary a l loca t ions , which a r e

made mortly Qn annual bas i s .

3.2.1 Continuity and st4billtL; The proviaion of cont inui ty and s t a b i l i r y over

a long plan period i n respect of the planning process i t s e l f aa voll a s of ltiv

implementation and of the subsequent changes which may be required, were

eonriderad t o be t he main d i f fe rences between long-term and short-term planqing.

The rams considerat ions equally apply t o adequate planning for the

required manpower. This i s a long-term p r v c r s a .

Experience has furthermore shorn that thrarlgi* the absence of cmmiment

Ca long term objec t ives short-term p lans may besate rrubject t o d r a s t i c

. ~ n d P r n t r o r even t o cance l la t ion depending on loca l continge&ies.

3.2 .1 . Projec t ions and t h e i r relationship with formulatEon: Changes of d i f f e r e n t

p a r m e t e r s d i r e c t l y o r indirectly r e l a t ed CS- hea l th , such a s morbidity, spec i f i c

WHO EMRO

page 31

mortal i ty , demographic, aocial , economic, technvlugical, and other re levant

ind ica tors , a r e d i f f i c u l t t o p red ic t over a long period of time with any prec i s ion .

Such changes may happen f a r t e r than an t ic ipa ted a t a c e r t a i n po in t i n time.

I t was therefore considered t h a t preparat ion of a de ta i led long term plan,

including ref ined object ives , quant i f ied target., f ixed method., exact human

and mater ia l resources would not be feaa ib le nor j u s t i f i e d , a s compared t o

medium and short term plans. However, the format of the long-term plan should

r e t a i n , i n general terms. a l l the required formal cha r ac t e r i s t i c s of a proper

plan of act ion.

3 .2 .3 . Scope and depth: I t i s im p l i c i t t h a t a long-term plan w i l l be wider i n

scope and ahould provide more room for f l e x i b i l i t y while shor te r term plans w i l l

have t o be developed i n depth so a s t o take care of a l l e s s e n t i a l d e t a i l s inherent

i n en act ion plan.

3.2.4. Monitoring, evaluat ion, research: I n order tn ensure timely and adequate

amendments, o r wore elaborate reformulations of the plan which c h a q e s i n

parameters may require , long-term planning w l l l have ti. r e l y more on proper

monitoring and evaluat ion mechanims sa are11 a s on pe r t i nen t research than i s

t h e rare fn+ shorter tern planning. Plowever, t h i s should be underetood ae a

problem of g radua l i ty r a t he r than a baaic departure from c m o n methods.

3.3. Changas i n planning m e t h o d ~ : ~ ~ i ~ d _ .tu-ezaure t h a t HFA/2000 iseffe*.

3.3 .l. .Strengtheniw of ~lannlnnoar&alli.zation: Notvl thstandiw the f a c t t h a t moat

countr ies of the Gulf area have es tab l i shed planning c e l l s , o r even more e labora te

organimations e i t h e r a t the cen t r a l l e v e l .%lone or vlrll tlrc invoivemnt o r

E M / P H C / I ~ EM/SUB- REG .HTG.HFA .2000/7 (KW) page 32

WHO Em0

regional/provincial facilitiee, the &coup Ielt that the overall netirmal planning

network6 require fur ther strengthening i n terms of qua l i f i ed manpower, and in

che appl ica t ion of su i t ab l e planning oethodology.

While the deciaion makers a r e normally not expected t o be familiar with the

d e t a i l s pf the planning process, they must be kept constantly informed by the

technical people of the progress made.

3.3.2. I n t e r s ec to r a l coordination: Because of the expected speed of change

r e su l t i ng from a c t i v i t i e a generated i n sec tors other ehan hea l th , one must

overcome the continuing weaknesses and gaps i n inLersectora1 coordinat ion, both

i n planning and implementation. I n c e r t a i n s i t ua t i ona where ac t ion t o t h i s end

haa not already been taken by t he Ministry of Planning o r o ther responsible

authori ty a t the highest l eve l of Government, the Ministry of Health should be

prepared t o take the i n i t i a t i v e .

3.3.3. information system: I t was conaidered t h a t , i n senera l , the ava5.l abi l X t y

of da ta exceeds the present capacity For u t r l i z s t i o n . The c t s s a i c e l infarrmation

system covers qu i t e a range of da ta t h a t i s r t u r i a l fox decis ion making and

adaptation t o change. Some of it, hu t not a l l , 19 spec4 f ~ c fo r planning and

management processes. Even so, i n t u i t i o n and pooled jrrdpmentn a r e ~ n g g ~ s h e d

fo r add i t iona l information, not obtainable i n a formal way (Delphi and other

ncthods). In certain i n n t a n ~ t a , hir;li prai.? ris,n I r. ~ l c t required i n lung-rsm

planning.

Personnel deal ing with informatioq systems, a t vasiorts aperat tonal i eve l s

i n the f ie ld , should be made aware of the imprrrtattce and proper u t i l i z a t i o n of

WHO E r n 0 E W I P H C I ~ ~ EH/SUB-REG.MG.HFA .2000/7 (KW) page 33

the da ta they co l l e c t .

The group was a l s o concerned about t he underu t i l i za t ion of the ava i lab le

heal th and heal th-related information from nat ional and in te rna t iona l aourcem.

Final ly , firm functional l i nks should be establ ished between planning,

information and rerearch.

3.3.4. Development of manpower: L o w term planning o f hea l th manpower Is of

c ruc ia l importance i n view of the d i s t a n t time horizon. At t he a m time, long-

term planning gives broader ecope for u t i l i z a t i o n of na t iona l resources,

a problem of special concern t o the Gulf S ta tes .

3.3.5. The re la t ionsh ip between longlterm and medium/short-term plans: While the

expected changes over a longer period of time, a6 i n the oase o f iiFA/2000, necess i ta te

presentat ion of the plan i n a broad (but no t loore) framewrk, the required

prec i s ion and quant i f i ca t ions can be achieved through preparat ion of medium-tern

plans, within the above framework, of 5 years ' o r shor te r durat ion.

3.4. Linking ~ ~ A I 2 0 0 0 plans with o ther p l ans -

3.4.1. It was recognized t h a t i n many count r ies there was a need t o reconc i le

newly es tab l i shed ~ A 1 2 0 0 0 po l i c l e s and s t r a t e g i e s with ex i s t i ng socio-economic

development and sec tora l hea l th p lans , taking i d t o account t he long-term planning

nature of HFA/~OOO.

I n pa r t i cu l a r there may be a need t o ensure t he in tegra t ion of planned

h e a l t h a r t t v i t j c s and changes in the h e a l t h services and LnTraatructura wlth

nat ional long-term pro jec t ions ,and plana such an for example t he 15-"ear

manpower plans ex i s t i ng i n c e r t a i n countr ies .

T h m G t 1 1 f Wralrh Mini . trr . ' h o . > r * . . i l hsa accepted a re--endation t!l:tt'

each hea l th min i s t ry should have a plar~nlng u n i t . Such u n i t s shunid be rblr to

u b t r l n frun t h e cen t ra l plannlng raintarry or departrnpn;: Sss!c Intotwatlor. r,f

the governments' Long-term develofn~e...t o b f e c t i v e s , nnd of economic, demoaraphic,

institutional pro jec t ions , e t c . required 'or r e n l l s t i r , i n t e r s e c t o r a l p l a n n i w .

In l a r g e r coun t r i es t h e e r t a h l i a h m e n ~ of rep;ionaL/provincial planning ceLl.9 may

be of advdntuge.

3 . 4 . 2 . l l schsnim f o r -. i n , c ~ ~ . t P ~ . J .

An example of a ; o ~ a i b l e t . h r ~ r - l c red approach t o ensure in tegra ted planning

and execution of hea l th a c t i v i t i e e , Including PHC programtea wan gi.;cn xn

follows:

Efiniaterial 1 eve1 hea l th cnun<:l l polf cy and l e g i s i a t i v * hodv

(with cabinet funct ions)

Haal th b e c u t i v e Coma* t t e e ~:onsul t sr i v r !:II*!:.,' I ; ~ n , .,.:..u r

(chaired hg Mlninrrr. O F Wealth) L!X* PU r ~ i s t + , ? ' i ea~ . t l . ,!, 8 . 9 !L.: L , .tr,,l

rxc&: lat l"r :trnctien I t 1 regard t o the

nrryra:rc:

Regi onal /Provincia l Health Cm.nr tIeeR reaponsib! t tor I r rnlmentat ion.

(or council 8 ) c ~ a ! o a t i o n ~ n d repor t ing on the

P ' . ' i T r M n w

Crmporition o f these bodlea a* rnr +hr*e l v v c l a should !nvolvc .a! 1

~ O V S I T M ~ ~ B ~ departments with hea l th nnd %real th-re1 ated rcsponefb i l i t i p a

C a n u n i t y p a r t i c i p a t i o n shm114 " A *nsured at. ReqIona?. Pravinci a1 C m s j t t e e

l e v e l and a t higher lev,' r * rnir-ear-t . c v * u oC *he I)=:.: *nal/Ptovineiai Conmirteea

a t tending meting8 of the Heal' : e t .~-<rmctrtr

WHO EMRO EMIPHC I 1 1 EH/SUB-REG .P(IG. HFA. 200017 (KW) page 35

3.5. Regional Planning for rnA/2000 in the Gulf A r e e ,

3.5.1. It was urged that the Gulf Health Secretariat should recamend to the

Council of Health Hinisters of the Gulf the setting up of a permanent technical

Committee on Health Planning to coordinate efforts in Planning for HFA/2000.

3.5.2. The Gulf Secretariat should be invited to attend technical meetings of

wnu and UNLCLY on planning and HFA/2000 organized in the Kegion and conversely

repre8entatives of these two organizations could profit from attendance at

Gulf Secretariat meetings dealing wlth health problems.

3.5.3. It ves also tea-cndcd that the Rcgional Public Hcolth Institute, whoma

establisbent is being conaidered in the Gulf area, should deal vith planning

methodology and training and give particular attention to HFA12000 progrrmrme

aspects. It was noted in this respect that the Arab Planning Institute in

Kuwait has opgmizad courses for health planners in cooperation with the

Johns Hopkins School of Public Health. Furthermore existing national

institutes of public administration could make valuable contributions by

organizing training progrrmrmes in adrntnis*.rn.tion 3r.d mariauement addressed

specifically to staff of the health qervi-rs

E W / P H C / ~ ~ FX/SUB-REG.~G.HPA. 2000/7 (KW? page 36

Trends i n hea l th i n the-?ulf S t a t e s 4.1.

I n recent years , there haa bean a remarkable improvement i n provision

of hea l th se rv ices i n the countr ies q a r t i r i p a t i n p i n the meeting. T h i s

has been complemented by p a r a l l e l improvements i n other s ec to r s afEecting

hea l th - r e t e r supply and basic sanitation, aducationn, ouLrltlon, soc ia l

welfare, cooraunications, and the economy i n general.

Advances i n heal th and health-promoting se rv ices have been so rapid

t ha t improvements i n heal th s t a t u s have not always kept pace. One reason

for t h i s i s t h a t some of the older generation a r e r e a t r i c t e d by t h e i r cul ture .

t r ad i t i ons , and behavioural pa t t e rn s from making f u l l and proper use of tha

service. provided. The younger generat ions w i l l be lesa l i k e l y t o be thus

constrained. Therefore, it i a only a mat ter of time before hea l th statu*

ind ica tors r e f l e c t the improvements i n the se rv ices and f a c j l i t i r r , and

hcfntc the Culf States a t t a i n the best aohIev~blc. lcvel of health.

I n consequence, the pa r t i c i pa t i ng count r ies have gard reason t o be

ea t i a f i ed with progreaa t o da te , and to be op t imis t ic abo~it fur ther progress i n

the next few years . HFAl2000 i s thus. a r e a l i s t i c goal.

4.2. Strengthening t he trend5

However, none of the p a r t i r i p a r k t ~ xo? cmplacen t . Concern was expressed

over many aspects of hea l th and hea l th cnrt8. For example, there has been

a rapid growth i n the kinds of ill hea l th associated with aff luence - road

accidents , c a rd iovascu l a~ d i seanas, and act on, There i s community pressure

WHO EMRO

fo r sophis t icated curat ive se rv ices which i n many cases a r e l e s s cosc le f fec t ive

than simpler preventive and promotive services .

Some of the concern arose from the f a c t t h a t the Gulf S t a t e s a r e facing

circumstances which are without p a r a l l e l i n the r e s t of the world, and

perhaps withorit p a r a l l e l i n h i s to ry . I n consequence, development of hea l th

care i s complicated by the h i s t o r i c a l gap i n experience i n r e l a t i on t o the

unique combination of circumstances and opportuni t ies present ly ex i s t i ng .

4.3. need for planning

Changes a r e taking place with g rea t r ap id i t y i n the Gulf S t a t e s . The

r a t e of change w i l l , i f anything, increase i n t he foreseeable fut,ure,

Because planning i s a weapon for encouraging, con t ro l l ing , and or ien t ing

change i n the r i g h t d i rec t ions , pa r t i c i pan t s were unanimous i n t h e i r

~onvictione that it m a t be used fully and effectively.

4.4. ~FA/2000 a s the preferred object iye

The Gulf S t a t e s already have much experience with h e a l t h plan. bt j t

these are mostly shor t -or medlvm-tern. The value o f :ong-tern, planning i s ,

however, now fu l l y recognized.

Thus the national political commitments to 1 ~ . 4 / 2 0 0 0 were reiterated on

technical grounds by the pa r t i c i pan t s . The HFA/20M) concept was accepted a s

a pa r t i cu l a r l y useful form of long-term hea l th planning, fo r t he following

reaaon.9:

- I t s in te rna t iona l support i r c i i i t a t i n g coi iahorat ion between coimtr ies

and the exchsngi O F experiences-

EM/PHC/IL EUISUB-REG.mG.HFA. 2OOO1' page 38

WHO EMRO

- the a t t rnc t fveness of the Irhrzse. which. i s ealai.l,y remembered and

mo t iva t i ona i :~ stimlllsf' n8

- the 20-year durat ion treat@$ Y! l u s i t a l extensinn nF the sequence

of one-year and five-year olnns:

- the wide p o l i t i c a l support 11 h s r already received; and

- the c o q r e h e ~ ~ s i v e n r s s o f I t r messnee, which w i l l encourage the

in te rsec tora l breadth whici- i s so ?bviouslv e s sen t i a l t o fu ture ac t ions .

The d i f f i c u l t i e s **F 21?-gi.:%r p! -.inin? vcrc stressed on several

occasions. For example, it- was pi-inter1 el i t chat the re a r e l i ke ly t o be

rad ica l changes In sacral and cultirt-al pa t te rns , i n the dmograpbj

and employment s t r uc tu r e , arid so or* by t h e ?;.ear 2000'. Consequentle.

the environment within which heal t t ; <:ate r t o be prcrvider! i:anno\r be prerii.ialy

fo recas t ,

It was a l so agreed,txowever, t ' irnc nap?, oi the eperi.ai pr-i:blems r,l :IL,V~ \,,Lf

Sta t e s (such a s the current reilansi.? :$I a / : r ; . na t ; : r r r : ! i f:?r nar th : f t?.*i.r

manpower requirements) cannot i:e ei .4 re4 1% -! 'GT? - t .ev-,i, r?':x. ?: ': 4 . TILLIS, ,.. ;.,e

term planning i s rssent.lal, and the . ! i :!ir. i : .?r . . con $ 7 crvcrtrnnre i f r i ,c 1 ie! ,r

techniques a r e used.

Iu pa r l i cu l a r , l K was ergrs~d + " ' a + an L1F4'%CW rl:n t.'frtW 'r and rhn;:!:! n o t

contain d e t a i l s of timing, rear-arrcr i l s . . , -.-* no ml PJonetheless, li: can serve

a s a general framework for ?xi .*. , ,- t t ~ :rrc a: ti-, 5:. a:rd nredilnnrerm p lan&.

The liFAI2000 plan worrld serve 3 s :A p . : ? e f : more uttailes t sc t i ca l . plantiin& f r m

time t o time, and w r ~ l d be *uF. jec tr i -.r. ou"ir~ati.;,n .ma prrir.!l.c i~pdilting i n

response t o new inf *mer+ ense

WHO Emu

4 . 5 . ! ? r e d act*o-?xfor ~ A , / Z ~ ~ _ E L a ? ~ ~ ; e p a r ~ ~ i ~ ~

T ~ z p 3 r ~ i 3 L p B ~ t d agreed i n p r inc ip le t h a t TWA '21100 planning wolrld be

a feas ib le and worthwhile a c f i v i t y . Note was caken o f W H O ' S request <Ln

response t o the 1979 Reeional G m l t t e e Reeolutirm) t h a t member count r ies

should submit ou t l i ne s of nat ional plans by June 1980.

Indeed, acme r:iluntries have already made s i gn i f i c an t progress i n preparing

such statements. Two impressive nat ional documents from Gulf S t a t e s were

discussed i n d e r a i l .

I t was not possible t o disrrasri courses of ac t ion for plan preparat ion

which would be ides i for a l l the aai-tlclp~atine countr ies . There a r e

d i f fe rences i n needs and condi t ions, i n addi t ion t o the d i f fe rences i n mount

of preparation already done prdol to the meeting. Dut r t w s a s v l d c r ~ t L l t a t ruvaL

countr ies w i l l wish t o consider the following s t ~ p s . i f not already taken.

4 . 5 . 1 . ~ e p o r t i n g t o o_e~.r~-stsrf_f-cn. the out~we .o!. r i ? ~ . ~ ? c ~ i n ~ . A short, informal, nnt iamal un+kahnp can RWb )?:!r:i'. m i ~ h t r * -onaidered.

Alte rna t ive ly a wr i t t en r epo r t might be prepared, cnnciirr:lr;a national i q l i c r l t i o n s

of HPA/ZOW. A major ob je r r lve !rf nra<:h rcp@rr:ri): mxti ir ba ti, oFr.aiir

approval i n p r i nc ip l e fo r HFA/ZO(K: p l a n x r i a ~ (or, i n *mme casea, "'lr its

continuatfon) .

4 . 5 . 2 . Preparetion of a _preta;-01. ~- r . o r . ~ ? - .:-i ~lk,?~!~~.-e;,=~ec.e=?

I t may be necessary to preparet n i.i .n\ i . '<ai cuncerq i r~ : the plan preparat ion.

I t would eaver the ob jec t ive , me:.ilad 6 r i $'!.an v-aparation, s t a f f t o be

involved, o ther resour r r ~-r:lul.i.rtmenc.t~ ' ,-.e:r?.inrv Int:Irrd?n~ ass i s tance

f r m WHO, IJNICEF o r ot!?er B - P T , 3 , ~ ' t ;in,( : , ? i ~ n e t a b l e .

EH/PHC/~~ E H / S U B - R E C . ~ C .WA. 200017 , page 40

The planning team should be colnst:r:iCed i n su!:h a usy as t o ensure t ha t

t he views of the whoi e of the M T ~ r . i . s * ' )r r*+ '~cr i .? . l .+ i :.!re whole o f the hea l th

vorkers, and views o f other be.rl !:h-pn mat : ; s ~ wrtoor .I u, ! X ?*,r taken i n to

account. This may require creat ion r f i r r t r .aarc?c,ra! or J nter'aecto1 s?

coordinating ccnanitte.ei.s, or other coordinai inn mechanisms.

I n addition,, shr ivntinrnl migkrt spec,! E r how the cmunlty's views will be

consulted, perhapa hy way of n hody sur.h a r a Natiorral Wealth Ad-vlsory Council.

Final ly , the prtrrc;rimr -. . : ' d n r r P r J f v .r&:l r.11 hod, 1 l take the dec i s fnns

regarding plan approar, :*>*re mi&, . -.ii. ?tr y.it:L. n Rqdy i n ex? stPnce,

for example, an i n t e r -n i r i sr.?r.ial ronnoi ?re* or 7. r sb i t l p t s u b - c m i ! t e a

an hea l th . I f no t , i t may be occeshAry Lo re?~mnoer"rcnti:z!? of a h??y

which represen ts a l l r ec tors w h a s ~ i ~ ~ ~ . r . ~ ~ ! v m e ~ ? i ) r c.?nsidezril e ~ e e n t d h l tr

plan implementation.

4.5.3, Decision t o prr0_"1!:ej! , f i :: : ,p4,a091n8,

The Minister :.f Be.?:!,!, ie. col'!r'.:!i;' .. . L P ,. ,.. , " I i s st-1.,

he asked t o approve the proti.cirl and r ,.T?P ,. ,- ,,a * . , , ,G . . , X : , . , ,

required resources ,

4.5.4. Commencement of P18nr!it;;;.

I.£ work has not nlrcarl:j! , mo-.r: - . ":v-~-. a s

possible a f t e r t h i s meet5 ,;p,. k t ; .:,i,!**tt , I ,n,,-* : ,$

discuss the protocol and .eVCse sr e u r . . e ~ .,;: :,e:f. m ~ , . Ypec.iTis task*

might be al located t o i r s laemborn :, cca~e?~2 e O E , > e e ? j * a q , y . q r ~ - > -..a f i r ~ ~ 3 . i x w <

EN/PHc/ i 1 EM/SWB-REG. MCG.HFA 2000/7 (KW) page 41

4 . 5 . 5 . Spec i f ic p&-nning tasks

T h ~ a r are diarurard i n d e t a i l i n e a r l i e r sec t ions of t h i s repor t

The followinp; are some of the main tasks of immediate relevance t o HFAIZOOO

plan preparat lun.

I ) HPA/ZOM) goals should be specif ied i n concrete and measurable

t e rn s . I n o ther words, the ob jec t ives should be spec i f ied a s an

ind ica tor (or set oL indicators): t h i s w i l l halp ensure t h a t HIIA/2000

i s adequately underetood, and can be monitored and evaluated l a t e r .

The ind ica tors should be appropriate co each country's am needs,

condi t ions, and resources.

11) In conjuction with ( I ) above, the pol icy base needs t o be examined

and defined a s necessary. This i s r e l a t ed t o the task of ensuring

p o l i t i c a l c m i t m e n t s , and carmitment of a l l o thers whose he?p ..a

needed i n ca rnr lna ou t the plan. High l eve l po l i c i e s s r e e s sen t i a l i y

statements of nat ional commitlaent, and t he p lan w i l l heve no relevance

unless there i s a c l e a r l y expressed i n t en t i on t o 'arry it out .

111) Many s t r a t eg i ea w i l l need to be considered. The most important of these

a r e primary hea l t h care a t ra teg len , and specially thuaa mub-atrateglca

d i rec ted a t environmental s an i t a t i on and o ther preventive measures.

IV) Papers should be prepared o r ex is t ing documents used i n order t o Drovjde

o r i en t a t i on f o r members of the planning tean, hea l t h advisory councile,

t he in te r -min is te r ia l conmittee, t he i n t e r s ec to r a l coordination committees

end o ther groups wiiose aasiatance is required. The aims of these documents

should be t o t r an s f e r i n f a m e t i o n ac.d ~ t i m u l a t r and maintain motivation.

EU/PHC/I P ~/SUB-RK.~C.HFA.~OOO/~ IKW) page 42

WHO E m 0

V) Assistance will probably be needed in respect of analytical and report

preparation tasks. Help might be sought frw national sources such as

universities, or from international agenciea if necessary,

VI) Of the analytical tasks, careful attention must be paid to economic

aspects, including estimation of cost/effectiveneas of alternative

strategies, resource analysis, and nerds fnr increased budg-tory provtaion.

VIE) HFAI2000 planning must be related to other plans such as national development

plans. Peroons invvlved i n those plans ahould also be involved in

~FA/2000 planning.

VIII) The plan should state any requirements for enabling legislation and draw

attention to existing policies and legislation which might act against

the interest of HFA/2000.

IK) Because of the high degree of similarity between the countries of the Gulf

and the already high level of collaboration in health and other matters. .

there may be a desire to arrange for collaboration in rerpert a? prcparntfon

of national HFA/2000 statements. This might be by way of an interccuntry

workshop, or by short periods of staff exchanges, or fry uthsr appropriate

means.

4 . 5 . 6 . Submission of the national st~tements to W H O I E 3

There is too littla t i m e tn conrplete a d~tsatled plan by June 1980. But

it is feasible to submit an outline statement by that date. The plan format (1)

distributed by the Secretariat during the meeting might be used a8 a basir.

WHO EMRO EM/P!IC/II EMISm-RE.HTG.HFA.2000/7 (KIM) page 43

The meeting noted that the national statements will be used as a basis

tor a Regional Statement to be submitted to the Regional Comnittee meeting

in October 1980. The participants agreed that such a Regional Statement would

be of value in enhancing the level of cooperation and collaboration between

countries, including the supporting of intercountry collaboration among

the Gulf States. The lamer has produced many benefits in the past.

For example, m c h has already been achieved through the medium of the

Secretariat General of Health for the Gulf States. Collaboration among

the Gulf States was generally viewed to be of extremely high relevence

to the theme of this meeting - that is, attainment of HFA/~OOO.

WHO EMRO

A N N E X I --

T [ST OF PARTICIPANTS - - - -- - - -- D l . A . F d ~ d l r A . L a l . i t Abu Z a i d

Di re r to r G e n e m i o f Cura t ive M e d i r i n r

M i n i s t r y o f H e a l t h Manama

k D r . Nazar ~ l s h a h a n d e r ' P r e s i d e n t

E s t a b l i s h m e n t of H e a l t h E d u c a t i o n and T r a i n i n g

Baghdad

Dr. Shawqi S n b r i Morkas A s s i s t a n t D i r e c t o r G e n e r a l ,

P revenLive Medicine M i n i s t r y o f H e a l t h Baghdad

D r . N i i j l u i r l d i r l A . I . A l a n i S e n i o r Expert , Pepar tment f c r P l a n n i n g of

Housing, Cons t ruc t - ion and S e r v i c e s M i n i s t r y of P l a n n i n g Baghdad --

Dr. N c i i l r i A 1 Kazemi nirer,tcnr nf nepar-tment of Public

H e a l t h and P l a n n i n g M i n i s t r y of P~i i , ' l i c Heal ti, Kuwait -.

M r . 1 A : M:ri;sa A s s i s t a n t U n d e r S e r r e t n r y

f i i r P l a n n i n g M i r i i s t r y <,f F l n n n i n g Kuwni t --

~ ~ i d n o t a t t e n d

:',l*l!?HC,; 1 i !<Pfi SU8-- REG. MTG. HFA, 200017 (KUW) ANNElf T . . {'a;?'? '1

Dr. Silln, ?. A;,*: X,b , (I! 1 i,. . i.i N:r! Lorial H e a l t h P l a n n i n g M i n i - f , ,. ,! -,, i l l i r . IHeslrlr

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Dr. Mi,;:. r ;? i a !'?l?irirrdn *,j i:; ; ~; i i. , < - . , I ;ill,

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!Ir. 6. Ri fka

: j r . A.M. Mochi

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~ r . M. Husain

WHO l<,MRO i . ? P l i C / l l ~>?iil!~i-~li(3.MTG.HFA.2000/7 (LLIli) ,\\IN!.X 1 . . .

I id#? l l l

!;AIlIlI A R A B I A D r . Samer Is lam Technical Adviser , O f f i c e of t h e

t l i n i s t e r of Heal rh Riyad

M r . Moham~nad Saleh Sharaf n i r e r r o r . Planning. B u d e e r i n ~ and

Toll ow-t~p M i n i s t r y of Heal th Riyad - Mr. Mohammed Kahrani P lann ing , Rudgeting and Follow-up M i n i s t r y of Heal th Riyad -

i ' ,vl ' rm ARAB E M I R A T ~ S *

KllPYESENTATIVES PROM OTHER UNITED NATIONS BODIES ~ -

UNIIF M r . Khnl i l I s s a Othman Resident Represen ta t ive U n i L r d Narious Development

Programme Kuwait - or. U.L. Fa r rag

UNICEF Gulf Area R e p r e s e n t a t i v e Abu Dhabi

WHO SECRETARIAT -

D i r e c t o r , S t reng then ing o f WHO O f f i c e f o r t h e &:istiicl. Hea l th S e r v i c e s ( S e c r e t a r y Mediterranean, Alexaridm-i:; of t h e Meeting)

Consu l tan t WHO O f f i c e f o r t he s ' . s i t e r n Medi te r ranean , AI.ew:~~id r i 3

Consu l tan t WHO O f f i c e f o r t h e E a s t e r n Mediterranean. Alexandria

Sen ior Systems Analyst WHO O f f i c e f o r t h e F : l ~ t e r n Medi te r ranean , Alexaidr ia .

P u b l i c Hea l th Adviser/WHO Riyad, Saudi Arabia Programme Coord ina tor

~i ,. M. Soliman ~ s s l s t & t Conference 0Tfii:er WHO O f f i c e f o r t h e E a s t e r n Medi te r ranean , Alexandr ia

Y~rs. D. Youakim- S e c r e t a r y WHO O f f i c e f o r t h e E a s t e r n Barsoum Medi te r ranean , Alexandr ia

Did n o t a t t e n d

WliO EMRO

IM,' l lHC L 1 EM/SUB-HEG.M?':;. HFA. 20C~0/7(KlJW) Arinex I 1 page I.

Address by H.E ,-D_r_-l\,:R. Al-Awa* -.

Minister of Health

a t the inaugurals~sslorr o f the sub- Rrg10na>-

m u o n Health fo r a l l by the Year 2MX) -

It i s my pleasure t o pa r t i c i pa t e with you today i n the inaugural ceremony

of the Sub-camit tee Meeting on Health fo r a l l by the Year 2MX) which i s held

i n col laborat ion with the WHO Regional Office f o r the Eastern Mediterranean.

I a l so take pleasure i n welcwing our dis t inguished guests , who are taking

part i n t h i s Hccting, and w i s h e h m a happy s t ay i n their s e e m 4 C o l l n F r y K r m a i r .

I a l so hope t ha t the Almighty w i l l bestow success upon the ac t iv i t i . e s of t h i s

Conference.

Dear Brothers and S i s t e r s ,

This heal th conference i s convened a t the end of the celebrat ions &ich 1 ? ; n

held on the occasion of the ''WHO Day" and the "Health Week" i n K I I W R ~ . ~ . i n

confinnati.on of such WHO noble object ives as the provision of henitit and welfare

t o every individuai in the Y t r r l d , W"' conntitufinr. ?>an airlc:erelp ~ r i iected

these object ives by providing : h a t :tes!th is n Eundimeartal r i gh t of every human

and o global ~ o c i a l obja.ztd,i- r h e * < ' . r i r l x l ha :*ttaina.i by a l l pr-1- vi thont

d i s t i nc t i on o r discrimi.nation.

It was i n the l i g h t of WtIO bri.: .'": 1 :, ' " .. hincanlrarian mttislon, L ~ U C . :be

T h i r t i e t h World Health Assembly i.n N.w 197: adop!:sd its reso lu t ion which provides

t ha t the pr inc ipa l s o c i a l ob jec t ive st€ a l l Govemaenru and cxl- (r'orid Health

Organization during the next. 211 year? ,m?hotrLr! be the attairreco - by a l l c i t i z ens

of the World of a hea l th l o - d - ~ ! t.hrrC , : i ~ r r i t R t-her tc lead a productive l i f e .

EM/'llltC,/ 11 I:~M./:;UD.HEG.MTG.HFA.ZU~:I! ' ~ ? ( ? . ' $ A :

Ann<,x 11 pap! i i

Y 110 LUHV

I n r ea l l7 , a t i nn o f t h i s o h j p r f i v ~ . t he Almn-Ata Conference.which was

he ld i n sunmer 1978, i s sued a h i s t o r i c a l d e c l a r a t i o n c l e a r l y indicating

char primary h e a l ~ t s care is uur a n l y w a y L U a t c a i t t the ubjrr . t iue 01 I ~ e a l t h

f o r a l l by the y e a r 2000. N a t u r a l l y , both t he concept of t h i s o b j e c t i v e

and method of i t s r e a l i z a t i o n will varv from one count ry t o ano the r . However,

t he ho ld ing of r eg iona l meet ings - t h i s meeting be ing one of them- t o

exchange opin ion and e x p e r t i s e and d i s c u s s our h e a l t h problems w i l l undoubtedly

lead t o a s i m i l a r i t y of p o i n t s of vtew i n o rde r t o ach ieve a c l e a r under-

s t and ing of the concept o f t h i s o b j e c t ~ v e . We a l l hope t h a t t h e world w i l l

reach comparable s t r a t e g i e s t o a t t a i n t he o b j e c t i v e of h e a l t h f o r a lL by t h e

y e a r 2 0 0 0 , which we - who a r e r e s p o n s i b l e f o r p u b l i c h e a l t h - a r e determined

Dear Bro the r s and S i s t e r s ,

Out of b e l i e t i n t h e importance nt prov id ing h e a l t h and w e l t a r e t o every

c i t i z e n , and i n conformity w i t h t h e p r o v i s i o n s of i t s C o n s t i t u t i o n and t h e

d i r e c t i v e s and c a r e g iven by H.R.H. t h e P r ince o f Kuwait and H . R . H . . t h ~ C z r ~ w . .

Pr ince , ou r Country s p a r e s no e f f o r t towardfi t h e p r o v i s i o n o f t h e b e s t h e a l t h

serv i ,ces t o c i t i z e n s , and g i v e s s p e c i a l a t t ~ n t i - o n t o t h e p r o v i s i o n o f primary

h e a l t h c a r e t o a l l ci t17ens and e x p a t r i a t e s a l i k e s i n c e t h e s e s e r v i c e s a r e

rendered by ou r var io t i s h o s p i t a l s anti h e a l t h c e n t r e s f r e e of charge .

AS a Mgmher of tha W n r l r l U a a l + ) i 0 - p a n i v q t i n n , Ktgwpir wnrt ld h r p l ea sed i f

c l o s e coope ra t ion would he es t ,i Lta!ied r:i rli t he c o u n t r i e s of t h e world i n g e n e r a l

and wl fh chose of cnts Reglon ;I :,:Lrrl1491ar Tar Lrle ac ra lmenr : of che WHO

o b j e c t i v e o f h e a l t h f o r a l l by thp y e r r 2Ot'U.

S ~ n c e January 1979, we have s t a r ' pd t h e f < , r m n r a t i o n of a h e a l t h p l an

f o r Kuwait u n t i l t h e gear 2 0 0 0 wr1F1- the c o m p r e h e n s ~ v ~ sorio-economic

development p l an of t h e ci!iilit:rp, 1x1 rhe plat- , riii' r :nns idnrnr~on i s g ~ v o n t o

developing and s t r e n g t h e n i n g r B nr ;~y P ~ e a l t h ro;e s e r v i c e s progrananes, t o

i n t e g r a t i n g p reven t ive , c u r a t i v e ;nil r e h a b i l i r . y t i v e s e r v i c e s , t o developing

W H O IMRO

Annex 11 p*pe 1 1 I

h e a l t h a d m i n i s t r a t i v e systems and t o suppor t ing h e a l t h s e r v i c e s s t u d i e s

and r e sea rch . For t h i s purpose , a Supreme Healrh Planning Comnitree tras

been formed o u t of r e p r e s e n t a t i v e s of t he M i n i s t r y of Heal th and the

a u t h o r i t i e s concerned wi th p lanning and medica l educa t ion . Sub-committees

have a l s o been formed t o p repa re t he s t u d i e s and r e sea rch work r e q u i r e d

f o r t h e p lan . We hope Lo f i n a l i z e t he h e a l t h p l an i n t h e n e a r f u t u r e .

Dear Bro the r s and S i s t e r s ,

I would l i k e t o welcome you once more i n your second count ry Kuwait,

and hope rhat the A l m i g h t y wi1.l bestow succes s upon your Meeting and

w i l l r e a l i z e t he hope o f t he World Heal th Organ iza t ion f o r t h e a t t a inmen t

of h e a l r h and w e l f a r e by r v a l y Ltrdividval i n this World by the ycsr 2000 .

A&X I11 page i

ANNEX I11

MESSAGE BY DR A . H . TABA

DIRECTOR

WHO EASTERN MEDITERRANEAN REGION

TO THE

SUB-REGIONAL MEETING ON HEALTH FOR ALL

BY THE YEAR 2000 Kuwait, 14 - 17 April 1980

Excellency, Colleagues and Friends,

I t is n pleasure for me to send a message to this important meeting.

I would ha-r very much liked to he present personally to share my views with

y o 1 1 . However, because of other commitments, it has not been possible for

me to have the pleasure of attending.

At the outset, 1 would like to express our gratitude to the Government

of Kuwait, represented here by His Excellency Dr. Abdul Rahman A1 Awadi,

Minister of Health, for having kindly agreed to host this meeting and for the

excellent arrangements made to ensure its success. I would also like to extend my

sincere thanks to all the Governments represented in this meeting. Your participation

testifies tile willingncos and enthusiasm cl' y o u r ci?~mtri.es to collaborate,

,~utionally as well as collectively, in achieving health for all by the year 2000.

Indeed, this is a unique opportunity for the countries represented to determine

tor themselves, with WHO collaboration as requested, how to achieve this goal.

Our main endeavour at this meeting is to exchanipviews and translace

concepts into meaningful and practical tasks, in compliance with the Resolution

adopted by the Regional Committee (Sub-Committee A) in October 1979. I understand

that copies of Lllr ResuluLion (No. PIMII:I:LYAiK. 1 ) have been distributed to you for

easy reference.

T i c goal of health Lur all iriljiiies sac.Lnfying the baslc needs of the

communities and thus improving the quality of life. This goal requires active

involvement and coordinated effort not only of the health sector hnt also of

the other social and economic sectors. In this context I am pleased to note the

ANNEX 111 pnge ii

p a r t i c i p a t i o n of s e c t o r s o t h e r than h e a l t h i n t h i s meet ing , p a r t i c u l a r l y t h o s e

u r p l a l ~ n i r l g and f inance . I am e q u a l l y happy t o r e f e r To t h e c l o s e c o l l a b o r a t i n n

which has been developed wi th UNDP, UNICEF and o t h e r i n t e r e s t e d o r g a n i z a t i o n s ,

i n t h e s e c o l l e c t i v e endeavours.

Encouraging developments a r e now t a k i n g p l ace i n i n d i v i d u a l c o u n t r i e s

towards ach iev ing h e a l t h f o r a l l , i n keeping wi th t h e ~ r i n c i p l e t h a t r o l t n t r i ~ s

n a i u r a l l y s e t t h e i r own goa l s and dec ide how t o u t i l i z e t h e i r r e sou rces i n the

l i g h t o f e s t a b l i s h e d p r i o r i t y needs. In t h i s whole p r o c e s s , WHO i s p leased t o

c o l l a b o r a t e w i th i t s Member S t a t e s i n a t t a i n i n g t h e o b j e c t i v e s i n t h e con tex t of

t h e pr imary h e a l t h c a r e approach. This suppor t i s d i r e c t e d i n p a r t i c u l a r t n

c o u n t r i e s where t h e r e i s no adequate h e a l t h coverage, coupled w i t h i n n u f f i c i e n t

nu~ribers of t r a i n e d personnel and l i m i t e d budgetary r e s o u r c e s .

It i s f u l l y r e a l i z e d t h a t under takinp t h e t a s k of p r ~ p a r i n c n a t i o n a l

p o l i c i e s , s t r a t e g i e s and p l ans of a c t i o n w i l l r e q u i r e a c t i v e follow-up nf t h i s

vorkshop. WHO i s prepared t o respond t o any r e q u e s t s which might h e Eorthromiog

from governments t o c o l l a b o r a t e i n t h i s e x e r c i s e . Consu l t an t s and WHO s t a f f

w 1 1 l be a v a i l a b l e t o v i s i t c o u n t r i e s r e q u e s t i n g ou r c o l l a b o r a t i o n , and work wi th

you a t t he n a t i o n a l I p ~ r e l .

As you a r e aware, two s i m i l a r meetings have been he ld i n t h e p a s t two

months, one i n Somalia and t h e n t h ~ r i n n m a s c u < . h important rea.qou fox l l u l d i l ~ ~

t h e i e t h r e e meet ings i s t o fo rmula t e regional s t r a t e g i e s t o he present t -d t o the

Kcgional Committee nex t October, and which w i l l he based on n a t i o n a l s t r a t e g i e s

produced by t h e i n d i v i d u a l c o u n t r i e s .

Zt i s s i n c e r e l y hoped t h a t a t t h e end o f t h i s meet ing , you w i l l be i n a

b e t t e r p o s i t i o n t o s t i m u l a t e a p p r o p r i a t e p o l i c y f o n u l a t i o n and t o h e l p develop

~ d e q u a t e n a t i o n a l s t r a t e g i e s f o r ach iev ing t h e goal of h e a l t h f o r a l l by t h e

v e x 2000 T h i s goa l should bc ach ievab le by v i ~ ~ u r or che f u l l co lLabora t lnn of

the Member S t a t e s . We have t h e technology, and, most impor t an t , t h e w i l l t o

.lr h? eve t h e g o a l .

Wishing you a most s u c c e s s f u l meet ing .

WHO Em0

1. Opening Session

2 . Adoption of the Agenda

3. Election of Officers

4 . Introduction of the programne

5 . "POLICY" - Towards achieving health for a l l by the year 2000

6. "STRATEGY" - Towards achieving health for a l l by the year 2000

7. "pUNS OF ACIION" - Towards achieving health for a l l by the year 2000

8 . Summary reports, conclusions and recomnendatione

9 . Cloeing session.

ANNEX V

1. National policy basis and background for HFA/ZWO; decisions taken and thaae

outstanding; relat ion of the HPAlZOOO ef fo r t t o existing health plans and t o

national socio-econwic plans.

2. S-ry of moat relevant baaaline information relevant to~HPA/2000 planning

( inc lud iq soneideration of Einancial rseourcem availablm).

3. Outline of steps undertaken andlor contemplated for plan preparation; for

monitoring and evsluation: £or intrarectoral and intersectoral coordination.

4. Time f r u and phasing of the WA/ZMX) plan.

5 . Main accepted objectives and strategies of WA/ZWO (1ncludiq main trmsfeciir-

mationr of existing services, new aervices requlred ond the i r functions;

epecial approaches for trainin$, c-nity pnrticipatiora, atc.).

6. Looeatirl p rogrp lc prapoaalm eard raanrurce reguironontr (rlat1ecz.l and ar t ra-

budgetary) for HPA/2000, and t h s i r distr ibution i n time.

7 . Requirements for WRO and UNTLFF a8nistrmcr for the planning process m d / ~ r

the implementation of W P X ~ ~ ~ progaawacs Irarludlng rseoslandaticne for

activities which should becme par t of a regLortaP strategy.