REPORTOF THE DIRECTOR QUADRENNIAL 1978 1981 ANNUAL 1981 HEALTH FOR ALL BY THE YEAR 2000 In 1977, the World Health Assembly decided that the main social target of the governments and of WHO should be the attainment by all people of the world by theyear 2000 of a level of health that would permit them to lead a socially and economically productive liJe, that is, the goal popularly known as "health Jor all by theyear 2000." In 1978 the International Conference on Primary Health Care (Alma-Ata, USSR) declared that, as a centralJfunction of the national health system and an integral part of economic and social devel- opment, primary health care was the key to achieving that goal. Subsequently, the governments com- mitted themselves-at the global level at the World Health Assembly, and at the regional level at meetings of the PAHO Governing Bodies-to implement the resolutions adoptedfor attaininghealth Jor all. In the Americas the high point of these mandates was reached on 28 September 1981 when the Directing Council of PAHO approved the Plan of Action Jor implementing the regional strategiesJfor health Jor all by theyear 2000. These strategies had been approved by the Directing Council in 1980 (Resolution XX) and today constitute the basis of PAHO 's policy andprogramming, and represent in addition the contribution of the Region of the Americas to the global strategies of WHO. The Plan of Action approved by the Directing Council contains the minimum goals and regional objectives, as well as the actions governments of the Americas and the Organization must take in order to attain health Jfor all. The Plan, continental in nature, is essentially dynamic and is addressed not only to current problems but also to those likely to ariseJrom the application of the strategies and the Julfillment of regional goals and objectives. It also defines priority areas that will serve as a basis, in developing the program and the necessary in/rastructure, Jor national and international action. The exchange and dissemination of information constitutes one of the priority areas of the Plan of Action. PAHO's publication program-including periodicals, scientific publications, and oJficial documents-is designed as a means of promoting the ideas contained in the Plan by disseminating data on policies, strategies, internationalcooperation programs, and progress achieved in collaboration with countries of the Americas in the process of attaining health Jor all by theyear 2000. REPORT OF THE DIRECTOR QUADRENNIAL 1978-1981 ANNUAL 1981 Official Document No. 183 July 1982 PAN AMERICAN HEALTH ORGANIZATION Pan American Sanitary Bureau * Regional Office of the WORLD HEALTH ORGANIZATION 525 Twenty-third Street, N.W. Washington, D.C. 20037, U.S.A. ISBN 92 75 17183 1 © Pan American Health Organization, 1982 Publications of the Pan American Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. For rights of reproduction or translation of PAHO publications, in part or in toto, application should be made to the Office of Publications, Pan American Health Organization, Washington, D.C. The Pan American Health Or- ganization welcomes such applications. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the Pan American Health Organization concerning the legal status of any country, territory, city, or area of its authorities, or concerning the delimitation of its frontiers or boundaries. The mention of specific companies or of certain manufacturers' products does not imply that they are endorsed or recommended by the Pan American Health Organization in preference to others of a similar nature that are not mentioned. Contents INTRODUCTION vii Chapter 1: GENERAL DIRECTION OF THE ORGANIZATION 1 Evaluation of the Ten-Year Health Plan for the Americas (1971-80) 2 National and Regional Health for All Strategies 3 Plan of Action 4 Governing Bodies 5 Pan American Sanitary Conference 6 Directing Council 6 Executive Committee 10 Management 11 Administrative Services 16 Financial management 17 Personnel 20 Management and computer sciences 21 Conference and general services 22 Bibliographic and health information office 24 Information and Public Affairs 25 Women in Health and Development 26 Relations with Other Organizations 29 PAHO and the international cooperation system 30 PAHO and the inter-American system 33 Subregional groups 35 Bilateral agencies 36 Foundations 38 Chapter 2: HEALTH SERVICES 41 Medical Care Systems 43 Planning 49 Information Systems 52 Management Systems 53 Financing Health Services 54 Health Facilities Maintenance 55 Health Education and Community Participation 56 Rehabilitation Services 59 Maternal and Child Health and Family Planning 61 Nutrition 66 Health Service Research 75 Chapter3: DISEASE PREVENTION AND CONTROL 79 Communicable Diseases 80 Expanded Program on Immunization 80 Tuberculosis 89 Acute respiratory infections 93 Mycoses 95 Leprosy 96 Diarrheal diseases 97 Bacterial diseases 101 Sexually transmitted diseases 102 Rickettsial and viral diseases 104 Vector biology and control 108 Aedes aegypti eradication 109 Malaria 112 Other parasitic diseases 119 Hospital-Acquired Infections 123 Blindness Prevention 123 Noncommunicable Diseases 125 Cancer 125 Other noncommunicable diseases 131 Mental Health 132 Dental Health 134 Laboratory Services 137 Epidemiologic Surveillance 139 Biologicals 141 Vaccine control 141 Drug quality control 143 Blood banking 144 Radiation Health 145 Accident Prevention and Control 148 Chapter4: ENVIRONMENTAL HEALTH PROTECTION 151 Water Supply and Sanitation 153 Institutional and Manpower Development 166 Solid Waste Management 169 Control of Pollution and Other Environmental Health Hazards 172 Human Ecology and Health 176 Occupational Health 177 Food Protection 178 Chapter5: HUMAN RESOURCES AND RESEARCH 182 Manpower Development 183 Planning 184 Education and Training 185 Medicine 185 Public health and social medicine 186 Health care administration 187 iv Nursing 188 Mental health 189 Dentistry 190 Engineering and environmental sciences 191 Veterinary medicine 192 Continuing education 193 Technical and auxiliary personnel 194 Training in supervision of local health units 197 Fellowships 197 Technologic Resources 201 Regional Library of Medicine and the Health Sciences 202 Research Promotion and Coordination 202 Advisory Committee on Medical Research 203 National health research policies 204 Institutional development 204 Special Program for Research and Training in Tropical Diseases 205 Chapter 6: SPECIAL PROGRAMS 206 Animal Health 206 Emergency Preparedness and Disaster Relief Coordination 223 Statistical Services 232 Publications 234 Periodical publications 234 Scientific publications and official documents 235 Distribution and sales 237 Textbook program 238 Filmstrips 239 Audiovisual aids 240 Index 241 Acronyms 255 u HEALTH pROTECTION AND pROMOTION OF SPECIAL GROUPS Women and children (Photos: Dana Downie/PAHO) Introduction The years 1978 to 1981, and especially the last, were transitional ones in the history of the Pan American Health Organization. During its first three-quar- ters of a century PAHO slowly changed from an obscure international body without permanent staff whose sole interest lay in quarantinable diseases to a major international agency with representatives throughout the Western Hem- isphere executing dozens of important health programs. Despite its many accomplishments, however, PAHO shied away from clearly stating the logical ultimate goal of an organization of its kind: health for all. In the round its sometimes disjointed programs lacked that central focus and, in particular, its activities were not coordinated with those in sectors other than health. On the eve of the quadrennium which is the subject of this report new cur- rents became apparent in the thinking of health leaders in the Americas. Fore- most among them was a new willingness to accept that health for all must be PAHO's overriding objective. From that general premise they could then deduce those broad policies that would fulfill it: the urgent need to extend health serv- ices to the entire population, the predication of such services on primary care systems, the requirement that consumers be as involved as providers in health matters, the demand for technologies suited to local conditions, and more. Transforming the health-for-all goal and the general and specific policies underlying it into concrete realities was PAHO's quadrennial work. The first step was to analyze the successes and shortfalls of the Ten-Year Health Plan for the Americas which had occupied it and its member governments during the 1970s, for from the past come lessons for the future. That done-and the task was an arduous one-the countries then used those lessons to formulate strategies to provide their own citizens comprehensive health services by the end of the century and PAHO did likewise for the hemisphere as a whole. The result was a seminal document, Health for All by the Year 2000: Strategies, published at the end of 1980. Flowing from this publication was a still more specific Plan of Action drawn up during 1981 which fleshed out the Regional Strategies' broad precepts in careful detail. The quadrennium thus saw the construction of the framework within which PAHO's programs during the remainder of this century will be carried out. Its building required great thought