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PAN AMERICAN WORLD 61-Oz)*2HEALTH HEALT __ \ /ORGANIZATION ORGANIZATION directing council regional committee PAN AMERICAN WORLD 61-oz)*2HEALTH HEALT __ \ /ORGANIZATION ORGANIZATION XXVII Meeting XXXII Meeting Washington, D.C. September-October 1980 Agenda Item 10 CD27/34.A (Eng.) PREFACE (Rev. 2) 2 October 1980 ORIGINAL: ENGLISH REGIONAL STRATEGIES OF HEALTH FOR ALL BY THE YEAR 2000 PREFACE 1. INTRODUCTION The attached Document CD27/34.A of 13 August 1980 represents the American Region's initial contribution to the task of the WHO Executive Board Program Committee, which is to formulate proposed Global Strategies for HFA/2000 and submit its proposals in the form of a report to the 67th session of the WHO Executive Board for review and report to the Thirty- fourth World Health Assembly. The Directing Council, at its XXVII Meeting, agreed to complement the strategies already developed by incorporating further contributions and constructive criticisms made by Member Governments during their re- view of this document. The Directing Council has directed that this Preface be used as the mechanism to advise the WHO Executive Board Program Committee of its intention to develop further strategies directed towards the achievement of national, bilateral, multilateral, subregional, regional and global cooperation for achievement of the goal of Health for All by the Year 2000. Accordingly, the Directing Council has established an Ad Hoc Work- ing Group to prepare a complementary document, to be submitted by no later than 15 November 1980, to the WHO Executive Board Program Committee for its consideration and incorporation into its report on global strategies. The complementary document, prepared by the Ad Hoc Working Group, should pay particular attention to the promotion of health in developing countries, with a view to reducing those disparities that detract from the achievement of the goal of Health for All by the Year 2000, in accordance wih the Alma-Ata Declaration and as an integral part of development and of the New International Economic Order (WHA33.24). -2- 2. STRUCTURE OF THE COMPLEMENTARY DOCUMENT 2.1 The purpose is to prepare additional strategies, goals and targets to elaborate and complement the strategies contained in the initial document (CD27/34.A) in order to contribute to the development of the health sector and the achievement of the following objectives: - The restructuring and expansion of the health services system to improve its equity, effectiveness and efficiency; - The promotion and improvement of intersectoral linkage and cooperation; - The further promotion and enhancement of regional and interregional cooperation. These three objectives are designed to address the specific contribution of the health sector in reducing social and economic inequalities. 2.2 The Ad Hoc Working Group is requested to pay particular attention to development of targets in the following priority areas; - Life expectancy - Infant mortality - Mortality in the age-group 1-4 years - Immunization coverage - Safe drinking water and waste disposal - Access of the population to health services These targets should establish the baseline to be achieved by every country in the Region. 2.3 Within this framework, the Ad Hoc Working Group will focus its deliberations on the contributions made by Member Governments during the debate of the XXVII Meeting of the Directing Council, as listed in section 2.4 and relate these to the framework established in Document CD27/34.A. 2.4 Complementary Strategies Monitoring and Evaluation-Guiding Principles - The complementary document is expected to include the following elements: -3- - The conduct of epidemiological assessments of the achievements and failures of the Ten-Year Health Plan for the Americas for 1971-1980, to establish baselines for evaluation; - On the basis of these analyses, the establishment of minimum, acceptable indicators of levels of health for the Region; - The review of the health status of the countries in the Region against the minimum acceptable indicators, and rank them in relation to their need for health improvement; - The development of mechanisms to set regional priorities, direct the resources of the Region to assist those countries that need help to reach the minimum acceptable level, and to avoid duplication of effort; - The evaluation of progress, the readjustment of the baseline upwards, and the repetition of the process. Health Needs of Island Communities - to reflect the unique problems asso- ciated with the delivery of effective and efficient Primary Health Care (PHC) in small island communities, with particular reference to the Caribbean. Realignment of Research to PHC - to effect the realignment of research within the Region of the Americas to effect speedier resolution of critical health problems by establishing improved means for the iden- tification of problems, their prioritization, their allocation to the research community and the allocation of resources for the research effort required. Industrial Development - to make health and environmental protection integral elements of major industrial development activities, such as the development of major hydroelectric projects or the development of heavy industries. Cost and Financing of Health Services - to encourage the development of new systems of financing and containing the cost of health services. Dental Health - to foster prevention of dental caries through the fluoridation of municipal water supplies, where needed. Methodologies and Standards of Health Care - to propose development of methodologies for the evaluation of health services and programs and for the normalization and accreditation of hospitals, clinics, and public health services, that would contribute to the development of national standards of health care. -4- Information Exchange - to foster the exchange of information within the Region (and between Regions) on recent advances and new modalities in Primary Health Care; and for the establishment of mechanisms for their evaluation as to their application in other countries so as to avoid needless duplication of effort in the development of effective PHC programs. Health Facilities - to rationalize the need for health care facilities (of all levels of complexity) within the emphasis on primary health care and for their construction, modernization, and maintenance. Coordination of External Aid - to reflect the necessity to bring about more effective coordination of external aid provided by multilateral agencies, private agencies, and through bilateral agreements; as well as the need to direct the resources available through external aid to areas of greatest need and national priority; and to coordinate the application of external aid between sectors of the national economy. Preventive Health - to articulate more forcefully strategies for the prevention of disease and disability, particularly in rural and marginal urban areas, and the island communities. Development of Human Resources - to promote development of human re- sources that would emphasize: - Health care administration; - Distribution of human resources in the health sector; - Bilateral, subregional, regional, and global cooperation in the education, training, and development of human resources for the health sector; - Recognition of emerging roles in the health sector including, for example, the use of nurse practitioners and dental thera- pists in PHC delivery; - Training and use of traditional health workers in Primary Health Care. Eradication of the vector of urban yellow fever Prevention of physical handicap - to propose activities relating to blindness, deafness, and other disabilities conditions that affect individual capacity to function normally; and programs for the rehabili- tation and assistance of handicapped individuals to reduce the need for their institutionalization; e - 5- Primary health care of the aged - to propose activities with particular reference to the special health needs of elderly women, directed towards the early recognition, treatment, and rehabilitation of physical and mental diseases to which this group is particularly prone. Chronic respiratory disease - to alert the public to the dangers of smoking and the inhalation of environmental contaminants, many of which are the products of industrial production (e.g., coal dust). Accident prevention - to educate the public in the prevention of acci- dents; and the introduction of regulations for the safety of the public (e.g., compulsory seat-belt legislation). 2.5 Further elaboration of priority components of coverage of health services program content in Document CD27/34.A, will include in particular: Maternal and child health - programs directed toward the growing phenomenon of teenage pregnancy and the physical and mental damage to the health of the mother and infant as a result of early pregnancy. Mental health - efforts directed to the growing phenomenon of teenage and young adult suicide. Cardiovascular and degenerative diseases and cancer - proposals for the reduction of hypertension; and health promotion activities to emphasize the positive aspects of lifestyle that can reduce or prevent the onset of cardiovascular diseases and cancer (e.g., diet, exercise), as well as the negative aspects of lifestyle that encourage chronic diseases (e.g., cigarette smoking, obesity, alcoholism). Food and Nutrition - establishment of goals for minimum acceptable protein and total calorie intake. The focus of external aid should be directed more towards the stimulation of local food production. Occupational diseases and industrial hygiene
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