The Work of WHO in the Eastern Mediterranean Region Annual Report of the Regional Director 1 January–31 December 2004 World Health Organization Regional Office for the Eastern Mediterranean 1 Cairo 2005 WHO Library Cataloguing in Publication Data WHO Regional Office for the Eastern Mediterranean The work of WHO in the Eastern Mediterranean Region: annual report of the Regional Director, 1 January–31 December 2004/WHO Regional Office for the Eastern Mediterranean p. ISBN 97-892-9021-452-6 ISSN 1020-9166 1. Regional Health Planning I. Title [NLM Classification: WA 540] Photographic acknowledgements: Tonia Rifaey, Kaveh Kazemi, Reuters, WHO Representative’s Offices of the Islamic Republic of Iran, Jordan, Lebanon, Morocco, Oman, Pakistan, Sudan, Regional Office photographic archive The full text of this publication can also be found on www.emro.who.int © World Health Organization 2005 All rights reserved. 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Printed by FAME Network, Egypt–700 2005 Contents Contents Abbreviations vi Introduction ix Executive summary xiii Governing bodies 1 1.1 World Health Assembly 2 1.2 Executive Board 2 1.3 Regional Committee 2 1.4 Regional Consultative Committee 3 Health policy and management 7 2.1 General programme development and management 7 2.2 Public policy and health 13 2.3 National health policies and programme development and management 21 2.4 Biomedical and health information and trends 26 Health systems and services development 33 3.1 Organization and management of health systems based on primary health care 33 3.2 Human resources for health 41 3.3 National drug policies based on essential drugs, and traditional medicine 48 3.4 Quality of care and health technology 50 Promotion and protection of health 51 4.1 Reproductive, family and community health and population issues 51 4.2 Healthy behaviour and mental health 59 4.3 Nutrition, food security and safety 76 4.4 Environmental health 79 Integrated control of disease 87 5.1 Eradication/elimination of specific communicable diseases 87 5.2 Control of other communicable diseases 100 5.3 Control of noncommunicable diseases 116 Administrative services 123 6.1 Personnel 123 6.2 General administration 124 6.3 Budget and finance 125 Country statistical profiles 127 1. Demographic indicators 128 2. Socioeconomic indicators 129 iv Annual report of the Regional Director, 2004 3. Health expenditure indicators 131 4. Human and physical resources indicators 132 5. Indicators of coverage with primary health care 133 6. Health status indicators 135 7. Selected morbidity indicators 136 Annexes 1. Organizational structure of the WHO Regional Office for the Eastern Mediterranean 138 2. Professional staff in the Eastern Mediterranean Region 141 3. WHO/EMRO meetings held in the Eastern Mediterranean Region, 2004 143 4. New publications and documents issued by WHO/EMRO in 2004 149 5. WHO collaborating centres in the Eastern Mediterranean Region 155 Tables 2.1 Procurement of supplies and equipment 2003–2004 by source of funds 23 2.2 Summary of sales of publications in 2004 30 3.1 Number of fellowship applications received and fellowships awarded 42 by country of origin, Eastern Mediterranean Region, 2004 4.1 Percentage of DALYs due to different diseases attributable to lack of 69 physical activity in the Eastern Mediterranean Region 4.2 Pedestrian deaths as percentage of all road traffic deaths in selected countries 74 of the Eastern Mediterranean Region 5.1 Planned measles campaigns in 2005 in Eastern Mediterranean Region 99 5.2 Status of tuberculosis control in the countries of the Region 105 5.3 Number of parasitologically confirmed cases in countries with no or sporadic 115 transmission and countries with low-moderate malaria endemicity (Group 3) 5.4 Number of recorded and estimated cases of malaria in countries with a severe 115 malaria problem (Group 4) 6.1 Professional posts as at 31 December 2004 (all sources of funds) 123 6.2 Distribution of recruited temporary professional staff by programme area, 2004 124 Figures 2.1 Projects accepted for funding by the Small Grants Scheme in 2004 18 2.2 Number of disastrous events in the Region and total population affected, 2004 23 3.1 Distribution of fellowships by major area of study, 2004 43 3.2 Distribution of fellowships awarded in 2004 by region by placement 43 3.3 Status of health professions education accreditation initiatives in 45 the Region, 2004 Contents v 4.1 Physical in activity in the Eastern Mediterranean Region 69 4.2 Deaths per 100 000 population in countries of the Eastern Mediterranean 73 Region compared to the United Kingdom 5.1 Estimated measles deaths in the Region, 1999–2005 98 5.2 Main international partners in tuberculosis control in the countries of the Region 104 vi Annual report of the Regional Director, 2004 Abbreviations AFP Acute flaccid paralysis AFRO WHO Regional Office for Africa AGFUND Arab Gulf Programme for United Nations Development Organizations AIDS Acquired immunodeficiency syndrome BDN Basic development needs CDC Centers for Disease Control and Prevention, Atlanta, USA CEHA Regional Centre for Environmental Health Activities DOTS Directly observed treatment, short course DPT Diphtheria, pertussis and tetanus EM/ACHR Eastern Mediterranean Advisory Committee on Health Research EMRO WHO Regional Office for the Eastern Mediterranean ESCWA Economic and Social Commission for Western Asia EPI Expanded Programme on Immunization FAO Food and Agriculture Organization of the United Nations FCTC Framework Convention on Tobacco Control GAVI Global Alliance for Vaccines and Immunization GCC Gulf Cooperation Council GFATM Global Fund to Fight AIDS, Tuberculosis and Malaria GTZ Deutsche Gesellschaft für Technische Zusammenarbeit HIV Human immunodeficiency virus IDD Iodine deficiency disorders ILO International Labour Organisation IMCI Integrated management of child health IOM International Organization for Migration IOMS Islamic Organization for Medical Sciences ISESCO Islamic, Educational, Scientific and Cultural Organization JPRM Joint programme review and planning mission MDT Multidrug therapy NID National immunization day OPV Oral poliovaccine PAPFAM Pan Arab Project for Family Health RBM Roll Back Malaria SEARO WHO Regional Office for South-East Asia STD Sexually transmitted diseases Abbreviations vii TB Tuberculosis TDR UNDP/WHO/World Bank Special Programme for Research and Training in Tropical Diseases TT Tetanus toxoid UN United Nations UNAIDS Joint United Nations Programme on HIV/AIDS UNDP United Nations Development Programme UNEP United Nations Environment Programme UNESCO United Nations Educational, Scientific and Cultural Organization UNFPA United Nations Population Fund UNHCR United Nations High Commission for Refugees UNICEF United Nations Children’s Fund UNIDO United Nations Industrial Development Organization UNODC United Nations Office on Drugs and Crime UNRWA United Nations Relief and Works Agency for Palestinian Refugees in the Near East USAID United States Agency for International Development WFP World Food Programme WPRO WHO Regional Office for the Western Pacific WTO World Trade Organization Introduction Introduction Since I entered office as Regional Director in 1982, a constant theme of my strategy to address health issues in the Region, and a concern close to my heart, has been to look not just at the diseases themselves but at the underlying causes of disease, especially poverty. During the 1980s and early 1990s, the Eastern Mediterranean was one of just a few WHO regions focusing on such issues. Through the basic development needs approach, we already had well established community-led poverty reduction strategies and programmes in 12 countries by the time the Millennium Development Goals were set by the United Nations in 2000. Now, as more and more emphasis is placed on the need to identify the social determinants of health and to develop strategies for poverty reduction that take them into account, I see that the groundwork we carried out is a good basis from which to build. Now we must scale up. Most countries of the Region have good models—villages and districts that have proved that poverty reduction and health improvement go hand in hand and are achievable, but models is all they will remain unless we have the political and social commitment to expand the experience we have gained. Above all, we must work in partnership with others: at ground level with other sectors and nongovernmental organizations, and at strategic level with sister agencies and global funding partners, under the umbrella of and in full coordination with national health authorities. The Millennium Development Goals will prove a testing ground for all of us, I am sure. Last year I spoke of the high numbers of maternal deaths that still occur in some parts of the Region, and of the impact this has on families and societies.