PROPOSED STRATEGIES FOR ATTAINING HEALTH FOR ALL BY THE YEAR Report of the Programme Committee of the Executive

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1 WORLD HEALTH ORGANIZATION ЕВбз/42 ORGANISATION MONDIALE DE LA SANTÉ 22 November 1978 EXECUTIVE BOARD INDEXED Sixty-third Session Supplementary agenda item 1 d О ^ PROPOSED STRATEGIES FOR ATTAINING HEALTH FOR ALL BY THE YEAR 2000 h t b U Report of the Programme Committee of the Executive Board 1. In examining this agenda item, in response to resolution EB61.R30,^ the Committee took the attached discussion paper entitled "Formulating strategies for attaining an acceptable level of health for all by the year 2000" (document EB63/PC/wp/6 Rev.l) as the basis for its review, 2. The Committee expressed its conviction that strategies and plans of action for attaining an acceptable level of health for all by the year 2000 should be formulated first and foremost in the Member States, and that regional and global strategies should be built up on the basis of national strategies and plans of action. 3. The Committee discussed the extent to which the Executive Board should suggest how national strategies and plans of action might be formulated and what they might include. It was agreed that the Committee would prepare for the Board 1 s consideration a draft of a document which the Board would invite Member States and regional committees to consider using as a basis for formulating national strategies and plans of action and regional strategies. On the basis of these, in turn, the Committee would formulate global strategies for review by the Board and ultimate adoption by the Health Assembly. 4. For this purpose, a first draft of the document would be prepared by the Secretariat for early December 1978 and circulated to members of the Committee to enable them to submit written comments if time permitted; the Committee would then hold a special session on 8 and 9 January 1979, immediately before the Board 1 s sixty-third session, to prepare a final version of the draft. The first draft would also be circulated to other members of the Board to give them an opportunity to study it in advance, but with a note to say that it would be reviewed, and no doubt amended, by the Programme Committee before formal submission to the Board 5. It was agreed that the draft document would be based on the material contained or referred to in paragraphs 6-19 of the discussion paper, together with the comments of members of the Committee during its discussion, which had been carefully noted by the Secretariat. 6. The Committee endorsed the discussion paper 1 s proposals regarding its own role (paragraphs 20-21), the function of the regional committees (paragraph 22) and the function of the Executive Board (paragraphs 23-24) in the formulation of strategies and plans of action. It was in agreement with the timetable suggested for this process (paragraph 25). 7. The Committee recognized the close relationship between action for primary health care and for attaining an acceptable level of health for all by the year Accordingly, it recommended that the Director-General f s report to the sixty-third session of the Board on the International Conference on Primary Health Care (Alma Ata, USSR, September 1978) should concern itself mainly with the presentation of the background and report of the Conference, together with the Director-General 1 s own comments and suggestions, keeping in mind that the action proposed to follow up the Conference would be outlined in the document mentioned in paragraphs 3-5 above. 1 WHO Official Records, No. 244, 1978, p. 20.

2 EB63/42 ANNEX EXECUTIVE BOARD EB63/PC/wp/6 Rev.l Sixty-third Session 30 October 1978 Programme Committee of the Executive Board Provisional agenda item 6 FORMULATING STRATEGIES FOR ATTAINING AN ACCEPTABLE LEVEL OF HEALTH FOR ALL BY THE YEAR 2000 Discussion paper This document is intended to provide a basis for the Programme Committee's discussion with a view to devising suitable ways of formulating strategies for attaining an acceptable level of health for all by the year CONTENTS Page Introduction 2 A basic concept 2 Blueprint for health for all 3 Strategies and plans of action 3 The role of WHO 5 Function of the Programme Committee of the Executive Board 5 Function of the regional committees 5 Function of the Executive Board 6 Timetable 6 Conclusion

3 ЕВбЗ/pc/wp/ó Rev.l page 2 Introduction 1. In 1977 the Thirtieth World Health Assembly decided, in resolution WHA30 o 43, that the main social target of governments and WHO in the coming decades should be "the attainment by all the citizens of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive lif 2. The Executive Board, when reviewing long-term health trends at its sixty-first session in January 1978, requested its Programme Committee to propose strategies for attaining an acceptable level of health for all by the year 2000, taking into account such trends (resolution EB61.R30).2 This request followed a discussion in which the need was stressed for a blueprint for future action aimed at reaching the target set for the year 2000, taking into account long-term political, social and economic trends as well as the latest progress in science, preventive aspects of health, and the organization of health systems. 3. The purpose of the present document is to provide a basis for discussion among members of the Programme Committee, with a view to arriving at the most suitable ways of formulating strategies for attaining an acceptable level of health for all by the year 2000 ; the Committee's proposals will then be considered by the Board. For reasons that will become apparent, the document is not about the detailed strategies themselves. 4. The joint WHO/UNICEF International Conference on Primary Health Care, held in September 1978, culminated in the adoption of the Declaration of Alma-Ata. This Declaration, which constitutes a strong political foundation for the development of primary health care, clearly states that such care is the key to attaining the target of health for all by the year 2000 as part of overall development and in the spirit of social justice. In the Declaration, the Conference called on all governments to formulate national policies, strategies and plans of action to launch and sustain primary health care as part of a comprehensive national health system and in coordination with other sectors. The Conference also called for urgent and effective international - in addition to national - action to develop and implement primary health care throughout the world, and particularly in developing countries. 5. In view of the above, and in keeping with the policy of basing international action on countries' real needs, it is proposed that strategies should be formulated first and foremost by countries themselves. Regional and global strategies should then be devised on the basis of these national strategies, as well as those derived from groupings of countries for particular purposes. This procedure is both politically desirable and technically feasible, and is preferable to any attempt by the Programme Committee and Executive Board to formulate detailed strategies centrally. A basic concept 6. The development of strategies for health for all by the year 2000 calls for an understanding of some of the basic concepts on which resolution WHA30.43 was based. The reference in that resolution to a socially and economically productive life implies that health development both contributes to and results from social and economic development. Such development takes place in individual countries, but international action is required to support it. International cooperation for health development, which is an essential part of WHO'S Constitution and philosophy, must reach far beyond the confines of the health sector, making itself felt in many other economic and social sectors. Such cooperation constitutes a vital contribution of health to the establishment and maintenance of a New International Economic Order. 1 2 WHO Official Records, No. 240, 1977, p e 25. WHO Official Records, No. 244, 1978, pp

4 EB63/PC/WP/6 page 3 Rev.l Blueprint for health for all 7. A blueprint for health for all was sketched by the Director-General in his addresses to the regional committees in ^ This blueprint outlined some important policy directions; key priority programmes; the processes and mechanisms involved in health development; and the kind of resources required to achieve the target. 8. In discussing policy directions, the blueprint recognizes the inevitability of variations in the content of national strategies for health development, taking into account social expectations, political realities and economic capacity, and points to the need for the preferential allocation of resources to the social periphery in order to ensure a more equitable distribution of health resources. 9. The blueprint emphasizes the formulation and implementation of programmes for health development, i.e., activities organized in such a way as to attain defined health objectives in communities and in the country as a whole, in contrast with the all too prevalent practice of creating medical institutions that provide services in an ad hoc manner. It is stressed that priority programmes have to be determined by each country in the light of its particular health problems and the needs of its population. These programmes must be delivered using technology that is appropriate, technically sound and socially acceptable. 10. Among the mechanisms for health development, prominence is given in the blueprint to country health programming, which involves defining and formulating priority programmes within a cyclical planning process. That process includes policy formulation; the definition of priorities and the preferential allocation of budgets to them; the preparation of programmes to give effect to these priorities; the integration of the different programmes within the overall health system; the monitoring and evaluation of programmes and of the services and institutions for delivering them; and, in the light of this evaluation, the modification of existing plans or the preparation of new plans in continuation of the cycle. Research aimed at generating new knowledge and at applying existing knowledge is an integral part of this process ; an appropriate balance must be struck between biomedical and health services research. 11. Other mechanisms mentioned in the blueprint are the strengthening of ministries of health to enhance their political, social, technical and managerial functions; the establishment of national health advisory councils; various regional mechanisms for programme development based on national human resources and institutions; and technical cooperation among developing countries as an instrument for mutual aid to make the best use of limited resources. Appropriate education both of the population at large and of health workers is an essential feature throughout. 12. The blueprint emphasizes the overriding importance of primary health care within the context of a broader health system, the other components of that system being organized in such a way as to give it maximum support. Strategies and plans of action 13. While it would be unwise to be too specific in attempting to define the differences between a strategy and a plan of action, it is useful to indicate what each might entail. A strategy should include a policy basis, coupled with a statement of goals and of the broad lines of action required to attain them. A plan of action, on the other hand, should be more specific in spelling out the details of the steps to be followed and the resources and time required. 14. In his address to the Thirty-first Health Assembly, in May 1978, the Director-General stressed that to translate the blueprint for health for all into universal action would require a combination of unprecedented worldwide social conviction, technical wisdom, 1 WHO Chronicle, 31: (1977).

5 ЕВбЗ/pc/wp/ó Rev.l page 4 managerial competence, economic imagination, and, above all, political determination. This political determination is supremely important within countries in order to formulate vigorous and viable strategies, and to convert them into practical plans of action. 15. Only on the basis of such national strategies and plans of action will it be possible to arrive at realistic regional and global strategies. By virtue of their regional and worldwide perspectives, and guided by WHO 1 s General Programme of Work and programme budget policy and strategy, as well as by the health doctrines built up in the Organization over the years, those will be much more than aggregates of national strategies and plans of action. Yet it should again be emphasized that action must both begin and end in Member States, with regional and global international activities being devoted to supporting national action. 16. It is suggested that national plans of action should include the political, social, economic and managerial dispositions required to reach the national health target as well as any necessary legislation, appropriate budgetary allocations and ways of financing them, together with a timetable for implementation. 17. The Director-General addressed the following questions to the International Conference on Primary Health Care: (a) Are you ready tc address yourselves seriously to the existing gap between the health "haves" and the health "have nots" and to adopt concrete measures to reduce it? (b) Are you ready to ensure the proper planning and implementation of primary health care in coordinated efforts with other relevant sectors, in order to promote health as an indispensable contribution to the improvement of the quality of life of every individual, family and community as part of overall socioeconomic development? (c) Are you ready to make preferential allocations of health resources to the social periphery as an absolute priority? (d) Are you ready to mobilize and enlighten individuals, families and communities in order to ensure their full identification with primary health care, their participation in its planning and management, and their contribution to its application? (e) Are you ready to introduce the reforms required to ensure the availability of relevant manpower and technology, sufficient to cover the whole country with primary health care within the next two decades at a cost you can afford? (f) Are you ready to introduce, if necessary, radical changes in the existing health delivery system so that it properly supports primary health care as the overriding health priority? (g) Are you ready to fight the political and technical battles required to overcome' any social and economic obstacles and professional resistance to the universal introduction of primary health care? (h) Are you ready to make unequivocal political commitments to adopt primary health care and to mobilize international solidarity to attain the objective of health for all by the year 2000? 18. The Conference responded in the affirmative when it adopted the Declaration of Alma-Ata. This positive response makes it clear that the issues involved are essential ingredients of any national strategies and plans of action for attaining an acceptable level of health for all. Other issues that have to be taken into consideration are the systematic identification and use of political entry points for ensuring health development; ways of ensuring the involvement 1 WHO Official Records, No. 248, 1978, pp (in press).

6 EB63/PC/wp/6 Rev.l page 5 of other sectors whose activities are important for health development; the orientation of research to stimulate health development and improve health management; the monitoring and evaluation of progress by practical measures, including as far as possible the setting of quantified targets and the use of indicators of survival, such as the infant mortality rate and life expectancy at birth, and more refined indicators of the quality of life; and technical cooperation among countries in formulating and implementing their strategies and plans of action. The role of WHO 19. As mentioned in paragraph 3, this discussion paper is concerned with possible ways of formulating strategies, first of all in countries and subsequently in groupings of countries and at regional and global levels. Emphasis has been laid on the preparation of national strategies and plans of action by countries themselves, but it is also necessary to indicate WHO 1 s general role of supporting their development and implementation. The Organization will clearly have to fulfil its coordinating role to the maximum to ensure the harmonious development of these strategies and plans of action. This will include the provision of sound information and the exchange of information among countries. WHO will also have an important catalytic role to play with respect to cooperation among Member States for the formulation and implementation of the national, regional and global strategies and plans of action. This will include the attraction of bilateral and multilateral aid in the spirit of resolution WHA29,32 on the Board 1 s organizational study on the planning for and impact of extrabudgetary resources on WHO'S programmes and policy.^ In addition, Member States will no doubt call on the Organization more than ever before to intensify its technical cooperation with them in accordance with resolutions WHA29.48^ and WHA30.30.^ In fulfilment of these complex roles, WHO will no doubt have to review the way in which its structures respond to the needs of Member States This issue is considered in the background paper prepared by the Director- General entitled "Study of WHO'S structures in the light of its functions" (document DGo/78.1), which is currently being examined by the regional committees. Function of the Programme Committee of the Executive Board 20. What, then, should be the function of the Programme Committee of the Executive Board in this process? It is suggested that it should first reach agreement on ways of ensuring national commitment to develop strategies and plans of action of the type mentioned above, and of providing practical guidance to governments on these matters. It is hoped that the basic concept referred to in this paper (paragraph 6), the blueprint for health for all (paragraphs 7-12), the Alma-Ata Declaration and recommendations, and the points mentioned in paragraphs for inclusion in strategies and plans of action, will form a basis for the Programme Committee 1 s task. 21. In the light of its discussions, the Programme Committee should be in a position to present material to the Board that would help it in encouraging Member States, and WHO as a whole, to develop and implement the necessary strategies and plans of action. An additional function of the Programme Committee would be to review the regional strategies and, on the basis of these and any further activities required, to formulate a global strategy for the Board 1 s consideration in accordance with resolution EB61.R3Û. Function of the regional committees 22. It is suggested that the regional committees should be requested to play a leading role by becoming fully involved in the development of regional strategies. This would entail both stimulating and supporting countries in developing national strategies and plans of action, 1 WHO Handbook of Resolutions and Decisions, Vol. II, 2nd ed., 1977, p WHO Handbook of Resolutions and Decisions, Vol. II, 2nd ed., 1977,p. 67. WHO Official Records, No. 240, 1977, pp

7 EB63/PC/WP/6 page 6 Rev.l which would then be submitted to the regional committees for review. In the light of this process and of any additional intercountry activities required, regional strategies would then be formulated. Such bodies as regional programme committees and regional advisory committees on medical research would have roles to play in each of these processes. The regional committees could also be effective in helping to attract bilateral and multilateral aid to programmes that deserve priority. Function of the Executive Board 23. The Executive Board has important functions to carry out in ensuring the formulation and implementation of strategies for attaining an acceptable level of health for all by the year It will have to be active, both corporately and through its members, in stimulating Member States individually and in the regional committees to launch and sustain appropriate strategies and plans of action to this end. In this context, reference is made to ways of strengthening the work of the Executive Board and the relationships between the regional committees, the Board and the Health Assembly in the background paper on the study of WHO 1 s structures in the light of its functions. The global Advisory Committee on Medical Research also has a useful role to play. 24. The Board might wish to ask the regional committees to assume the function suggested in paragraph 22. It will also have to take steps to support the Health Assembly in developing and updating a global strategy» Through its Programme Committee, it could then monitor the progress of the regional and global strategies. These would form one of the bases for the Seventh General Programme of Work covering a specific period, as well as for WHO 1 s contribution to the preparation for the Third United Nations Development Decade, which will no doubt again include targets for development. Timetable 25. The following timetable is suggested: STEP ACTION BY DATE Review of ways of formulating strategies Programme Committee of November 1978 Executive Board Review of preliminary proposals of Programme Committee, and requests to governments, regional committees and Health Assembly to formulate national, regional and global strategies and plans of action Commencement of development of national strategies and plans of action First review of progress towards development of national strategies and plans of action and ways of formulating regional strategies Executive Board January 1979 Member States March 1979 Regional committees August-October 1979 First review of reports from regional committees Programme Committee of November 1979 Executive Board Submission of reports on national and plans of action strategies Member States June 1980 Further review of progress and formulation of regional strategies Regional committees August-October 1980

8 EB63/Pc/wp/6 Rev.l page 7 STEP ACTION BY DATE Formulation of proposed global strategy Programme Committee Executive Board of November 1980 Executive Board January 1981 Review of report of Programme Committee Adoption of global strategy World Health Assembly May 1981

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