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W O R L D H E A L T H O R G A N I Z A T I O N

R E G I O N A L O F F I C E

F O R

T H E E A S T E R N M E D I T E R R A N E A N

P R O P O S E D PROGRAMME BUDGET FOR THE BIENNIUM

1980 - 1981

A L E X A N D R I A , J U L Y 2978

The R e g i o n a l D i r e c t o r h a s t h e h o n o u r

t o p r e s e n t t o t h e R e g i o n 8 1 C o m m i t t e e t h e

programme b u d g e t p r o p o s a l s f o r t h e E a s t e r n

M e d i t e r r a n e a n R e g i o n f o r t h e 1980-1981

B i e n n i u m .

TABLE OF CONTENTS

EXPLWATKIRY NOTES

REGIONAL DIRECTOR'S PROGRAMME STATBMEHT

S-ES lum, TABLES:

Estimated Obligations by Source of Funds

Slsfmm-ry by Major P r a ~ / P m g r a ~ m d SmUFw 0.9 Flaas

&rauy by Wsr 9rOg.m and 0ag.aismttomal-

Errtinwtes 1980-1981 by Appropriate Section w i t h

t e n t a t i v e project ions f o r 1982-,1983

MdJOR PROGRAMME AND PROGILAllME ANALYSES

1.3 Regional Committees

2 -1 Executive Uanagement

2.2 General Pmgramae Development and Masugmmrt

2.3 External Coordination f o r Health .end ~ c % & & + ~

Develeprent

RBSBB-M:~ Proleotion and Development

R e - 1 M ~ e c t o r 's Development Prggmamm

Health Services ' Development

Family Health

Mental Health

Prophylactic, Diagnostic and Therapeutic Suhstmmes

Col~aunicabXe Disease Prevent ion and Control

Noncommunicable Disease Prevention and Contml

Promotion of Environmental Health

Health M-er Development

liealth Information

8.1 General Services and Support Prograarrrss

Page

l NFORMATI ON ANNEXES

RF(;I~JNAI, OFFICE - NARRATIVE AND TABLE

C(XINTRY PROGRAMME STATEMENTS AND TABLES :

Summary o f s e r v i c e s and a s s i s t a n c e t o Governments

Afghanistan

Bahrain

Cyprus

Domoo ra t i c Yemen

D.11 bout i

E R Y P ~

I ran

1 raq

I s r a e l

Jordan

Kuwai t

Lebanon

Libyan Arab Jamahiri ya

Oman

Pakis tan

Qatar

Saudi Arabia

Somalia

Sudan

Syr ian Arab Republic

T u n i s i a

United Arab Emirates

Yemen Arab Republic

Regional Advi sers - Narrat ive

I nter-Country Programme

PROPOSED PROGWIME BUDGET

EASTERN MEDITERRWEiN REGION 1080/1981

E X P L A N A T O R Y N O T E S

Form of p re sen ta t ion

1. This Proposed Programme Budget Presenta t ion r e f l e c t s a depar ture from previous

procedure i n t h a t both progrdmme and budget f o r 1980-1981 cover two f u l l y in t eg ra t ed

years i n one biennium. This is In accordance wi th t h e World Health Assembly dec i s ion

t h a t " the programme budget of W H D s h a l l cover a two-year period beginning wi th t h e

biennium 1980-1981 and s h a l l be reviewed and approved by the Health Assembly on a two-

year b ~ s i s " (WHA30.20). The revised cs t imatcs fo r t h e yt.drs 1978 a d 1977 have a l s o

been combined i n t o onc s i n g l e blcmnlum for purpose of compdrison.

2. The Programme Budget f o r 1980-1981 has been developed, a s f a r a s poss ib l e , i n

accordance with the new approved procedures "emphasizing t h e need f o r c l o s e col labora-

t i o n between W H O and Member S t a t e s i n the development of well-defined country h e a l t h

programmes w i t h ln whl c:h individual p r o j e c t s dnd d c t i v i tles can subsequently be pl annod

i n de td l l dnd ~r\iplcmcntc?d i n r c l a t i o n t o o v e r ~ i l l p r o g r m e - o b j e c t i v e s In c l o s e r hclrmohy

wi th n a t i o n a l hea l th programmes processes(WHt~30.23). The new procedures t h e r e f o r e

r e s u l t i n t h e d e f e r r a l of d e t a i l e d p r o j e c t planning u n t i l c l o s e r t o t h e a c t u a l opera-

t i n g period, i n c l o s e r harmony wi th na t iona l h e a l t h programming processes.

3. The c l a s s i f l c a t r o n of programmes is based upon t h e S ix th General Programme of

Work covering the s p e c i f i c period 1978-1983. The progranrme c l a s s & f i c a t i o n s t r u c t u r e ,

however, r e f l e c t s some minor changes from t h a t applied t o previous programme budgets.

1978-1979 c ~ m p a r a t i v e budget da t a have been re-arranged t o accommodate t h e new c l a s s i -

f i c a t i o n s t r u c t u r e .

4. Country programme t a b l e s provide budgetary provis ions t o t h e programme l e v e l only

and no t , a s i n t h e p a s t , t o t h e p r o j e c t and project-component l eve l s . To compensate

p a r t i a l l y f o r l o s s of t he accustomed p ro jec t - l eve l d e t a i l , t h e a c t i v i t i e s r e l a t i n g t o

each programme have been described and a r e shown i n parentheses immediately below each

programme descr ip t ion .

In t h e Case, however, of Inter-Country prOgrmUES, some d e t a i l has been ret i t ined

and is r e f l e c t e d i n t h e tdbles .

5. An analytical statellent applyi- to the Region aa a whole forms a p u t of the

presentation for each major programe and its related subordinate programmes. These programe statements attempt to define clearly the objectives of each progr., to

assess past progress i n meeting these objectives and t o met forth the anticipated con-

tribution of the budget proposal towards achieving thm.

The programe proposals to be financed undsr the Regular Budget are b u d upoa 8

tentative alxocation of US $ 39 650 000 for the1980-1981 biennium period. This gigure represents an increase of US $ 7 265 000 or 22.4% over the 1978-1979 biennium, of which

US $ 2 857 500 or 8.8% represents growth i n real term8 and US $ 4 407 500 or 13 .6

the amount required t o offset the anticipated increase dbe to inflation. Stated in a

more f uiliar "per annum" context the budget proposals ref lec t an increase of 10.7%

per uurm of which 4.2% per annum represents growth i n real term8 while 6.5% per anzum

represtmts campansotion for inflation.

I t is worth noting that World Health Assembly resolution WHA.31.23 r e s ~ c t s a

m h i n real terms Sar the entire organization to 2% per annum for the 1980-1981 bion-

aim ofrer the preceding biennium. The higher r a t io of 4.2% per annum growth in real

teru for this Region, a8 referred t o above, is attributable t o the s h i f t i n resource8

from Headquarters, global and inter-regional ac t iv i t ies t o the repiom, in the s p i r i t of

resq&ut&m WHA39.48 which aims a t 60% of regular krdget resources being devoted to

tecbnioal oooperaticm and provision of servicer.

The table on page 28 provid68 a projection of the estimates into the 1982-1983

bi.nniam.

7. Other laurce8

Where ac t iv i t ies rra financed part ial ly o r completely from saarces other than Rogulu

madget the fund8 antioipated are ahom on table8 i n the 001- headed " O t h e r Sou~ces".

These other source8 of fund8 a m a8 follar8:

(a) United Natiaru D o v e l p m t P r o p r (DP)

The United Nation8 Dmvelopart P r o g r m (WDP), through i t 8 Governing Couaoil,

establishes oeiling8 on a five-year bruis for the ao8t of technical cooperation it i 8

abl. to provide for eaeh oountrp. I t is within th0.e .nwal ceilings, te~ed~'1ndioatitn

Pluming: Pigums" (IPF), that cauntriea can plrn and sub8qumtly request UWDP f-d

u.i8tulOe.

The proposed budget ref lects the availability of funds under th is category based

upon information available a t the time of its preparation. I t should be noted, hwever,

that there all be an increase i n funds from t h i s source as more information becores

available approaching the actual period of progrcrrme Implementation.

(b) United Nations Fund for Population Activities (FP)

The abbreviation "FP" shown i n the tables column headed " O t h e r Sources" indioates

those ac t iv i t ies part ial ly or completely financed by the United Nations Fund for Poplla-

tion Activities (UNFPA). A t this stage, UNFPA assistance is not known i n rosf ccues

beyond 1979 and therefore is not ful ly reflected i n the Proposed P r o g r m Budget for

1980-1981.

(c) Voluntary Fund for Health ProPlotion

Activities financed by voluntary contributions from M e m b e r States of the Region

f a l l und8r this category and are classified as follows:

"VA" - Assistance to the Least Developed Among Developing Countries.

"mu - Malaria

"VI" - Expanded Programme on Immunization

"M" - Miscellaneous Designated Contributions.

(d) Funds-in-Trust (ET)

Funds-inlPrust,indioated by the symbol "ET", represents those ac t iv i t ies requested

and paid for on a reimbursable basis by the cotmtriea aoncerned.

REGIONAL DIRECTOR'S PROGRANME STATEb1ENT

In accordance with the continuing evolution i n the ways i n which W H O collaborates

with its M e m b e r countries, there a re a number of s ignif icant changes i n the format

i n which the Proposed Programme Budget for 1980/81 is presented. T h i s represents a

logical next s t e p i n the continuum of our move, a s instructed by our Governing Bodies,

towards giving increasing emphasis on technical co-operation i n the r ea l sense, a s

opposed t o technical assistance.

I take pleasure i n proposing t o Member countries a programe which, developed i n

close consultation w i t h t h e m , sets out a series of ac t i v i t i e s , under the various

appropriation sections, which r e f l ec t the needs of the countries. The programmes

a re described i n a standard way, t he i r objectives being set out a s c lear ly a s possible,

followed by the steps which i t is proposed t o take i n order t o implement them i n col-

laboration with Member countries.

A s was done for the previous biennium, continuing attempts have been made t o i m -

prove the statement of objectives and to describe the nature of the proposed collabora-

t ion with and among countries i n a way which r e f l e c t s how the p r o g r a m has been re-

oriented t o increase relevance and benefit t o the countries of the Region.

* * * I t w i l l be noted that there a r e cer ta in themes running throughout the proposed

programme for the two years.

One of these is a c lear re f lec t ion of the greater involvement of the nationals of

our M e m b e r countries i n the carrying out of the proposed programmes, with a concomitant

diminution i n the expenditure upon WSUl s ta f f whether i n the Regional Office o r i n the

f ie ld .

There i s also, throughout the programre, an emphasis upon what might be cal led

a research and development approach, which r e f l e c t s the increasing respons ib i l i t i es

of the Regional Office i n a l l aspects of biomedical researuh and, i n ~ r t i c u l a r , the

need to approach the most v i t a l problems facing our Region i n such a way a s t o pro-

vide every possible co-operation with Member countries i n achieving the goal of health

for a l l by the year 2000.

I n t h i s connection i t w i l l immediately be noted tha t by f a r the highest proportion

of the budget i s devoted t o the development of comprehensive health services and the

key and closely related area of health manpower development. The largest s ingle

section of the budget, i n c lear response to the repeated guidance of our M e m b e r coun-

tries, goes t o health ranpower development, and the cab ined budget for health services

and manpower development taken together r ep resen t s 50% of t h e expenditure proposed.

A s WHO'S own systems o f programme development improve and become more responsive

t o the needs o f t he Member coun t r i e s , so i s i t t h e case t h a t t he Proposed Programme

Budget f o r t h i s p a r t i c u l a r biennium is c lose ly baaed on t h e o v e r a l l o b j e c t i v e s of t he

S i x t h General Progranme o f Work covering the period 1978/83, and t o t h e Medium-Term

Programmes which have been prepared i n s e l ec t ed sub jec t s .

* * * A s i s w e l l known, ou r Region has been inc reas ing ly cha rac t e r i aed i n r ecen t yea r s

by eve r more in t ima te and productive t echn ica l co l l abo ra t ion between ou r Nember

coun t r i e s , as wel l a s by the cont inuing generous support provided t o t h e less well-off

among them, by those economically more for tunate .

I t w i l l r e a d i l y be seen that by f a r t he highest propor t ion of tb budget is pro-

posed t o be devoted t o t h e needs o f t h e l e a s t well-off count r ies . Those f i v e

coun t r i e s i n our Region which are def ined by the United Nations as amongst t h e l e a s t

developed among developing coun t r i e s , account f o r no l e e s than 54 per c e n t o f t h e

expendi tures proposed i n c o m t r i e s .

Conversely i t w i l l be noted t h a t t h e moat a f f l u e n t among t h e c o u n t r i e s have aga in

w i l l i n g l y agreed t o reduce their demands upon t h e WHO budget i n t h e interests o f o t h e r

c o u n t r i e s and, a s i n t h e previous biennium, a t t e n t i o n $8 d r a m t o the generous volun-

t a r y con t r ibu t ions t o supplement the WHD programme which have been made by amueral

c o u n t r i e s inc luding Egypt, I r an , I r a q , Kuwait, Libya, Q a t a r , Saudi Arabia and United

Arab Emirates.

I n accordance wi th t h e d e f i n i t i o n s a r r ived a t by t h e World Health Assembly,

90.80 per cen t o f t h e t o t a l budget w i l l be devoted t o direct t echn ica l cooporat ion

wi th coun t r i e s , a f i gu re , i t w i l l be noted, which a l r eady exceeds the target o f 80 per

cen t e s t ab l i shed by the World Health Assembly Resolut ion WHA 29.48 t o be achieved by

1980 i n the world a s a whole.

I n this connection i t an11 be p a r t i c u l a r l y noted that expendi tures on such i t e m s

as pol icy organs, general programme development, management and co-ordination and

non-technical support programmes, which r ep resen t 9.40 pe r cen t o f t he t o t a l , cont inue

the long t r a d i t i o n o f t h i s Region o f providing s e r v i c e i n Nember c o u n t r i e s a t the

minimum overhead cos t .

A s i s w e l l known, WHD i n t h i s Region has always c a r r i e d o u t a l l o f its func t ions ,

whether advisory o r educational o r developmental, a t the l e a s t cos t to i t s Member

countr ies and this philosophy w i l l be maintained.

I n accordance wnth the recommendations of the Governing Bodies concerned, i t

w i l l be seen tha t specia l emphasis i s given t o the following subjects:

- The need not only t o increase the quant i ty and t o improve the qua l i ty of heal th

personnel, but a l s o t o increase the relevance of the t r a in ing of a l l hea l th

personnel t o the needs of the heal th services and t h e populations a s a whole;

- the need still t o make dramatic improvements i n the q u a l i t y of information upon

which heal th ac t ions a r e determined;

- the need to cont inueto explore, implement and evaluate e f f e c t i v e primary heal th

ca re services and t o t r a i n the manpower, a s well a s t o improve the s impl i f ied

technologies, which a r e appropriate for t h e m ;

- the need t o pay due a t t e n t i o n t o the overwhelming problems faced by the l a r g e s t

s ing le age group i n our population, chi ldren under the age of f i v e years;

- the need t o take, and the f e a s i b i l i t y of taking, urgent s t eps t o improve the

q u a l i t y of protection of the population, and i n p a r t i c u l a r the ch i ld population,

agains t those main d i seases f o r which we have, through immunization, a protect ive

mechanism readi 1 y a t hand ;

- the need, i n the l i g h t of the increas ingly rapid i n d u s t r i a l i z a t i o n of a l l M e m b e r

countries, t o promote and expand e f f o r t s p e c i f i c a l l y d i rec ted t o the hea l th of

working populations, t o the control of occupational hea l th r i s k s and t o the pro-

motion of the humanization of working condit ions;

- the need t o continue t o make pa r t i cu la r e f f o r t s t o control c e r t a i n d i seases whch ,

desp i t e a l l pas t e f f o r t s , a r e still espec ia l ly c h a r a c t e r i s t i c t o the countr ies of

the Region, notably the e n t e r i c in fec t ions , schistosomiasis , malaria, tuberculos is

and blindness;

- the need t o in tens i fy e f f o r t s i n a l l aspects of the promotion of environlnental

heal th , n t h specia l emphasis on opera t ional research, appropriate technology

t r a n s f e r and expanded t r a i n i n g e f f o r t s ;

- the need t o improve a number of very bas ic se rv ices on which e f f e c t i v e hea l th

se rv ices depend, such a s the laboratory se rv ices a s a whole, and the paramount

i s sue of the repa i r and maintenance of a l l forms of medical equipment.

For severa l years there has been continuing concern throughout the Region a s a

whole with the extent of ~ ~ m u n i c a t i o n and col laborat ion between those responsible

f o r the t r a i n i n g of the manpower needed for the heal th services and those responsible

f o r running the heal th se rv ices themselves.

Following the landmark Minis ter ia l Consultat&on on Health Services and Manpower

Development held i n Teheran i n 1978, with the pa r t i c ipa t ion a t the highest l eve l of

Ministers of Health and of Education, and of educational and heal th service leaders

from a l l over the Region, a p a r t i c u l a r l y strong e f f o r t w i l l be made, i n col laborat ion

with countr ies , s t e a d i l y t o improve upon the present s t a t e of a f f a i r s .

Likewise there w i l l be continuing e f f o r t s on the p a r t of the Organization i t s e l f

t o a s s i s t countr ies to improve the ex ten t t o which developments i n heal th a r e l inked

t o developments i n o ther sec to r s , notably i n agr icu l tu re , the economy, education and

comuni t y development.

Pa r t i cu la r p r i o r i t y w i l l be given t o the t r a in ing of teachers of a l l l e v e l s of

heal th personnel and the re w i l l be continuing emphasis a t the country l e v e l i n carry-

ing through the Regional Teacher Training Programe, with strong emphasis on eduua-

t iona l planning and technology, which has been i n operation i n the Region s ince 1972.

The Region has a long and honourable t r a d i t i o n i n medical education a s such.

I n recent years medical schools have expanded rapidly , and t h e i r output of doctors

has mul t ip l ied accordingly. Indeed i t can be argued, and is so argued by many

leaders i n the f i e l d , t h a t , a t l e a s t i n some countr ies , we a r e approaching sa tu ra t ion

point i n regard t o the numbers of doctors avai lable . A t the same time few people,

whether i n the profession i t s e l f , i n the Government a u t h o r i t i e s o r amongst the general

public, seem s a t i s f i e d with what those doctors do. A s elsewhere i n the world a

completely new look i s being taken a t medical education i n almost every country of

the Eastern Mediterranean Region, i n which WHO is proud to play i t s part . Many of

our a c t i v i t i e s i n medical education a s such w i l l be d i rec ted a t a continuous attempt

t o evaluate its product i n the l i g h t of the r e a l needs of the peoples' hea l th services.

A t the same t i m e , and r e f l e c t i n g the needs of a l l , and the experience i n recent

years of those who have experimented s o successful ly along such l i n e s , the re w i l l be

a much g rea te r e f f o r t than i n the pas t d i rec ted towards the planning, production and

e f fec t ive u t i l i z a t i o n of a l l o the r ca tegor ies of heal th workers.

I f the re a r e some who would question the point of view t h a t the Region i s reach-

ing near t o sa tu ra t ion point a s regards i t s production of doctors , o r a t any r a t e of

doctors a s present ly t ra ined, there a r e none who question the need t o t r a i n more, and

be t t e r , a l l i e d heal th workers of a l l kinds; a u x i l i a r i e s of a l l kinds; primary heal th

care workers t o meet the s p e c i f i c defined needs of the l a rge underserved population

of almost a l l countr ies , and heal th professionals o the r than doctors.

The heal th manpower stock of our countr ies i s i n danger of becoming not l e s s ,

but more, ou t of balance with need. Immense shorteges continue t o e x i s t among almost

a l l middle l e v e l and aux i l i a ry personnel, however the word "shortage" i s defined.

Cooperative ac t ion be t t e r t o def ine overa l l hea l th service needs, to f ind b e t t e r ways

of predic t ing manpower need and demand, t o design re levant t r a in ing programmes, t o

ca r ry ou t such programmes i n the most e f f e c t i v e and e f f i c i e n t way, and t o monitor

the use t o which t h e r e s u l t a n t manpower i s put, w i l l be high among the p r i o r i t i e s of

1980 and 1981.

Not l e a s t important among the heal th workers of the Region, t o whom specia l

a t t e n t i o n w i l l be devoted, a r e nursing personnel, denta l professionals and aux i l i a r i e s ,

and the manpower needed f o r the environmental hea l th services. Each of these groups

remains in shor t supply and in each the re is a need fo r much careful thought as to

the design of t r a i n i n g programmes. There has been, i n these areas , a s i n medicine

i t s e l f , too much emphasis over the years on supposedly high, yet largely i r r e levan t ,

s tandards of so-called academic excellence divorced from r e a l i t y . Given the deter-

mination of Member countr ies t o co r rec t t h i s s t a t e of a f f a i r s , W H D ' s programme is

ready t o provide co-operative help.

Renewed e f f o r t s w i l l be made, i n col laborat ion with those countr ies which have

rea l i zed the urgent need, t o develop organiced nat ional systems f o r continuing

education of hea l th personnel. I n a s imi lar connection col laborat ion w i l l be ex-

tended t o c e r t a i n countr ies of the Region, who, continuing t o be dependent t o a l a rge

extent on hea l th personnel imported from other countr ies , a r e i n s t i t u t i n g spec ia l

r eo r ien ta t ion programmes f o r such personnel.

A s reconmended by the Minis ter ia l Consultat ion on Health Services and Manpower

Development, the World Health Organization w i l l , i n p a r t i c u l a r , d i r e c t its e f f o r t s

i n these sub jec t s towards:

- Promotion of a c t i v i t i e s a t country a s w e l l a s Regional l e v e l t h a t enhance the

acceptance and implementation of an in tegra ted approach t o hea l th se rv ices and

manpower development.

- Collaboration with member countr ies i n conducting s t u d i e s on heal th needs and man-

power requirements, a s a bas i s f o r plans of ac t ion f o r an in tegra ted approach t o

hea l th services and manpower development. Such s t u d i e s may be i n the form of

country heal th programme exercises.

- Promotion and support of evaluat ive research on hea l th se rv ices and manpower

developanent, including research i n t o appropriate hea l th technologies, and d i s -

semination 02 information on the r e s u l t s of such research.

- Provision of information t o countr ies on a l t e r n a t i v e approaches to , and p rac t i ces

i n hea l th services and manpower development both within the Region and elsewhere.

- Emphasis, i n i t s t r a i n i n g progralmne, on the development of nat ional competencies

i n manpower planning and management, a s well a s i n the development of task-based

community-oriented cur r i cu la f o r the t r a in ing of a l l ca tegor ies of h e a l t h personneL

- Provision of technical advice, through appropriate consultancies, missions, work-

shops and task forbes, on s p e c i f i c a reas where co-ordination may be planned and

implemented.

- Continuous review of the progress made, a s well a s of the obs tac les t o progress.

A steady expansion of W H O ' S work i n occupational hea l th is proposed, and ex-

penditures i n t h i s programme area a r e proposed t o be doubled.

The funds avai lable , though small, w i l l be used i n a c a t a l y t i c fashion, i n co-

operation with o the r agencies concerned including IID, t o promote the expanding

e f f o r t s of Member countr ies themselves t o improve working condit ions, t o study needs

i n the subject , and t o formulate o r r ev i se standards and prepare guidel ines f o r pro-

t ec t ion aga ins t occupational hazards, including the improvement of occupational

hea l th l eg i s l a t ion . Provision i s made f o r ca re fu l ly designed fel lowships t o augment

the st i l l scarce heal th manpower spec ia l i z ing i n occupational heal th , with p a r t i c u l a r

emphasis on the t r a in ing of occupational hygienis ts and o the r middle-level personnel.

The huge proportion of nat ional heal th budgets which i s devoted t o the purchase

of drugs continues t o be a source of concern t o a l l M e m b e r s t a t e s and t o the Organiza-

t ion. Above a l l the re i s a need f o r improved r a t i o n a l i t y i n the use and production

of drugs of a l l kinds and i n a l l countries. This w i l l c a l l f o r continuing e f f o r t s

i n the t r a i n i n g of doctors and pharmacists and f o r subs tan t i a l programes of continu-

ing education and re-education of those whose ac t ions do i n f a c t determine both the

pa t t e rns and t h e cos t of prescribing. There is a continuing need, and provision w i l l

be made, f o r applied research i n t o the pa t t e rns of u t i l i z a t i o n of drugs, e s p e c i a l l y

by new categor ies of heal th workers i n t o whose hands expensive and powerful t o o l s a r e

being increasingly placed.

WHO w i l l co l laborate wi th Member countr ies i n the much needed strengthening of

regulatory a u t h o r i t i e s e spec ia l ly i n the f i e l d s of drug l icensing and inspection of

manufacture and d i s t r ibu t ion .

I n the p r o g r a m s r e l a t e d t o Disease Control i t w i l l be noted t h a t , desp i t e the

rapid advances made by and i n a majori ty of our M e m b e r countr ies , there is sti l l an

expressed need f o r subs tan t i a l WHO ac t iv i ty . There w i l l be continuing and expanding

emphasis on se lec ted aspec t s of communicable d i sease control . Three components of

this programe a r e of outstanding importance. I n budgetary terms the l a r g e s t item

i s fo r continuing a c t i v i t i e s d i rec ted towards the control of malaria and o the r

p a r a s i t i c diseases, of which those a f fec t ing the l a r g e s t populations a r e malaria

i t s e l f , and schistosomiasis.

Of equal importance, however, and with very promising po ten t i a l f o r fu tu re e f fec t -

iveness, a r e the proposed a c t i v i t i e s t o develop and improve the capacity of the

nat ional epidemiological services , with pa r t i cu la r regard t o t h e i r Capacity t o under-

take e f f e c t i v e survei l lance of communicable diseases.

A t t he same time, continuing the upsurge of a c t i v i t y t h a t has been notable s ince

1976,there w i l l be a s t rong d r ive , i n col laborat ion with the world-wide W H D Expanded

Progralme on Iarmunization, t o make immunization aga ins t d iphther ia , pe r tuss i s ,

tetanus, measles, pol iomyel i t i s and tuberculos is ,access ible t o more and more of the

chi ldren of the Region. A s i s well known the goal is t o make ths v i t a l and

e f f e c t i v e protect ion ava i l ab le t o every ch i ld by 1990. This i s one of the pro-

grammes i n which WHO is working i n c lose associa t ion with many d i f f e r e n t partners.

While the governmnts of t h e countr ies i n which the programme is a c t i v e a r e the most

e s s e n t i a l of these par tners , f o r without t h e m nothing can be achieved, w e look for-

ward t o continuing generous ass i s t ance from individual coun t r i e s t o the Voluntary

Fund f o r Health Promotion, a s w e l l a s t o continuing f r u i t f u l col laborat ion with

UNICEF and UNDP.

The Expanded Prograinme on Immunization provides r e a l i s t i c hope of r e l i e f ,

through the appl ica t ion of wel l - t r ied immunitation procedures t o vas t populations

h i t h e r t o deprived of them, from the s i x d iseases concerned, a s w e l l a s from a l l the

su f fe r ing and l o s s of l i f e they have represented over the h i s t o r y of mankind.

The e n t e r i c i n f e c t i o n s , i nc lud ing a l l forms of d ia r rhoea1 d i s e a s e , ranging from

cholera which causes s o much pub l i c anxie ty , but l i t t l e grave publ ic danger, t o t he

neglected d i a r rhoeas o f in fancy which q u i e t l y k i l l an es t imated th ree q u a r t e r s of

a mi l l i on ch i ld ren i n ou r Region every year , w i l l cont inue t o be a major focus o f

ou r work i n connnunicable d i s e a s e c o n t r o l and i n maternal and c h i l d hea l th . These

d i s e a s e s take a huge t o l l o f l i f e i n our Region. Thei r con t ro l depends t o a l a r g e

e x t e n t upon simple c l a s s i c pub l i c h e a l t h measures and the a v a i l a b i l i t y of r e l a t i v e l y

cheap and simple c u r a t i v e t o o l s , inc luding rehydra t ion ma te r i a l s .

I t i s a source of shame t h a t t h e d i a r rhoea l d i s e a s e s cont inue t o plague our

people a t a l l , and t h e i r c o n t r o l c a l l s f o r huge and gustained e f f o r t on tile p a r t o f

everyone involved i n pub l i c h e a l t h throughout the Region.

Within t h e programme a r e a of Family Heal th t h e r e w i l l be cont inuing emphasis, i n

an expanded form, on the important a c t i v i t i e s o f Maternal and Chl ld Heal th, N u t r i t i o n

and Heal th Education.

The pre-eminent importance of ch l ld ren under f i v e y e a r s o f age i n every count ry

of t h e Region i s inc reas ing ly w e l l recognized, a s i s t h e e x t e n t t o which l o s s of l i f e

among them, almost e n t i r e l y from d i s e a s e s whose prevent ion is understood, r e p r e s e n t s

perhaps t h e b igges t of a l l cha l l enges f ac ing ou r h e a l t h s e rv i ce s .

The i n t e r l o c k i n g e f f e c t s of uncont ro l led family s i z e , loadequate n u t r i t i o n and

i n f e c t i o u s d i s e a s e s , e s p e c i a l l y t h e e n t e r i c i n f e c t i o n s , i s very well underqtood.

Despi te cont inuing e f f o r t s over many years , t he propor t ion o f i l l n e s s and dea th

occu r r ing among i n f a n t s and ch i ld ren under f i v e cont inues t o be a dramat ic and t r a g i c

f e a t u r e of t h e g r e a t ma jo r i t y of our Member count r ies .

I n co l l abo ra t ion n t h UNICEF and UNFPA f u r t h e r e f f o r t s w i l l be maintained and

expanded, a doubling of Regular budget funds i n t h i s programme a rea i s proposed, and

s p e c i a l emphasis, c l o s e l y co-ordinated with t h e a c t i v i t i e s o f t h e Expanded Programme

on Immunization, w i l l be d i r e c t e d towards t h e r e s o l u t i o n of t he se problems.

There is still an urgent need f o r more e f f e c t i v e na t iona l food and n u t r i t i o n

p o l i c i e s , a s t h e r e i s f o r t r a i n e d personnel a t t h e p ro fe s s iona l and middle l e v e l s i n

n u t r i t i o n and i n h e a l t h educa t ion , and funds w i l l be made a v a i l a b l e f o r t r a i n i n g i n

t he se a r ea s .

The new and expanding r e sou rces of the WHO Global S p e c i a l Programme f o r Research-

and Tra in ing i n Tropica l Diseases w i l l be tapped, and merged wi th our own r eg iona l

programme, wherever t h e s i x d i s e a s e s malar ia , s ch l s to somias i s , f i l a r i a s i s ,

trypanosomiasi s, leishmaniasis and leprosy - with which i t is especia l ly , concerned

a r e of importance t o the Countries of the Eastern Mediterranean Region.

Should a l l forecas ts being made a t the time of wri t ing prove accurate, the years

1980 and 1981 should see t h e l a s t s tages of completion of the c e r t i f i c a t i o n of the

eradicat ion of smallpox from a l l countr ies of the Region.

I n so f a r a s the prevention and control of non-comunicable diseases i s con-

cerned, the highest emphasis w i l l be given t o e f f o r t s t o control chncer, t o improve

the capaci t ies of Member countr ies i n control l ing and handling the mounting t o l l

from the cardiovascular d iseases and t o measure the extent of mental disorder and t o

contain i ts spread and a i d i ts victims. I n the case of mental health, though the

programme remains a r e l a t i v e l y small one, the f a c t t h a t i t has doubled a s a per-

c e ~ t a g e of the proposed budget i s a recognition of the mounting importance being

attached t o t h i s all-pervading problem i n the countr ies of the Region. I t is a l s o

worthy of note t o r e a l i z e t h a t qu i t e a high proportion of the funds spent i n heel th

services development, and of those spent i n the promotion of t ra ining, do i n f a c t go

towards t h e preparation of men and measures t o deal with the non-communicable

diseases. The time is f a s t coming, of course, i f indeed i t is not upon us, when

the diseases of the more a f f l u e n t and advanced s o c i e t i e s become those of g rea tes t

s ignif ic iance i n our Region. There i s a tremendous need f o r improved quan t i f i ca t ion

of t h e i r prevalence and impact, and increasing e f f o r t s w i l l be made, through research

and otherwise, t o apply the basic pr inciples of epidemiology, the fundaaental science

of public health, t o the study of these diseases.

I n mental heal th work par t i cu la r ly , but i n many o ther f i e l d s a s w e l l , such a s

the study of heal th service needs and demands, and i n the development of up-to-date

guidance on t ra in ing programmes, the Organization expects t o be making more and more

use i n its own work, and t o see g rea t ly increased use made by M e m b e r countr ies , of

the h i the r to too much neglected contributions of the soc ia l and behavioural science8.

Biomedical Research, including applied research i n t o the effect iveness and

aoverage ~f heal th services, has now been a regional r espons ib i l i ty fo r three years;

and i n the coming biennium a c t i v i t i e s i n t h i s area a r e expected t o become even more

prominent. The Eastern Mediterranean Advisory C o m i t t e e on Biomedical Research

(EM ACMR) and its annual meetings, f o r which continuing provision is made, have become

cornerstones of our work. Emphatic p r i o r i t y has been l a i d d m regarding the over-

r id ing importance of applied research, and of support t o research a c t i v i t i e s re la ted

t o the disease problems of g rea tes t sever i ty i n the M e m b e r countries. There w i l l

be an expansion of t h e WHO Col labora t ing Cent res i n the Region, and of s p e c i f i c

agreements w i th s e l e c t e d c e n t r e s of exce l lence which a r e ca r ry ing ou t r e sea rch work

wi th in t he p r i o r i t i e s l a i d down by the EM ACMR. An i n t e r l o c k i n g s e r i e s of Advisory

Panels supplements t he work of t he EM ACMR i n f i e l d s such a s Canaer, Mental Heal th,

primary f iea l th- ta re and Nursing and, a s p a r t i c u l a r a r e a s of r e sea rch a c t i v i t y open

up, provis ion w i l l be made t o convene small S c i e n t i f i c Working Groups both t o adv i se

W I U on t h e best ways i n which i t can con t r ibu t e , and t o review s p e c i f i c r e sea rch

proposals .

An important new panel , set up i n 1978, is t h a t on Heal th Se rv i ce s and Manpower

Development,whose members w i l l be c a l l e d upon t o p lay an a c t i v e p a r t i n our programmes,

no t l e a s t i n Research i n t he se sub jec t s .

A s t h e o v e r a l l reg ional r e sea rch programme expands, s p e c i f i c r eques t s an11 be

made f o r Voluntary Funds t o supplement those made a v a i l a b l e i n t he Regular Budget,

and from the Regional D i r e c t o r ' s Development Programme.

The e f f e c t s o f environmental p o l l u t i o n on h e a l t h remain among the s e r i o u s pub l i c

h e a l t h problems of t he Region,and t h e i r con t ro l i s t h e cont inuing r e s p o n s i b i l i t y of

n a t i o n a l h e a l t h a u t h o r i t i e s and o f W H O , d e s p i t e t h e growth i n r ecen t yea r s of o t h e r

na t iona l and i n t e r n a t i o n a l agencies wi th environmental c o n t r o l func t ions . I n re-

sponse t o need i t is proposed t o provide a s i z e a b l e i nc rease i n t he propor t ion of

t he budget devoted t o t h e promotion of environmental h e a l t h i n the coming biennium,

These a c t i v i t i e s w i l l account f o r about 7% o f t h e t o t a l budget.

Basic s a n i t a r y measures, wi th s p e c i a l emphasis on the improvement o f food s a f e t y

and hygiene,are v i t a l i n an a r e a wi th the socio-economic and c l i m a t i c cond i t i ons o f

t h e Eas te rn Mediterranean Region. The bas i c problem of the provis ion of s a f e and

e f f e c t i v e exc re t a d i sposa l and t h e c o n t r o l of usage of f a e c a l l y contaminated waste

waters f o r food crop i r r i g a t i o n w i l l cont inue t o be tackled i n c o l l a b o r a t i o n wi th

na t iona l a u t h o r i t i e s . The p rov i s ion of a s a f e water supply i n adequate q u a n t i t i e s

w i l l a l s o be of high p r i o r i t y and i n t h i s WIQO w i l l cont inue t o work c l o s e l y w i th a l l

concerned.

A s i n o t h e r a c t i v i t i e s i t i s c l e a r t h a t progress i n environmental h e a l t h c o n t r o l

cont inues t o be hampered a t a l l l e v e l s , and i n almost a l l c o u n t r i e s , by an in -

s u f f i c i e n c y o f proper ly t r a i n e d manpower.

Within t h e environmental h e a l t h programme, a c t i v i t i e s t o promote t h e product ion

o f more, and more r e l e v a n t , manpower w i l l have p r i o r i t y . This w i l l c a l l e s p e c i a l l y

f o r the development of t r a i n i n g capac i t i e s f o r producing l a r g e numbers of middle

l eve l technical personnel t o complement and extend the e f f e c t i v e range of the pro-

fess ional l e v e l workers.

The protection and conservation of the f i n i t e supply of the world's water re-

sources i s of specia l importance i n the Eastern Mediterranean Region where f resh

water resources a r e generally l imi ted and the re is heavy dependence on the desaliniza-

t ion of marine waters. The W H D Global Environmental Monitoring system, i n collabora-

t ion with UNEP, which dea l s with both a i r pol lu t ion and water pol lu t ion,wi l l be

subs tan t i a l ly expanded i n the Region t o the point where i t is ant ic ipated t h a t a t

l e a s t 12 countr ies w i l l partake i n the network deal ing with the measurement of a i r

qua l i ty , and 11 countr ies w i l l have monitoring s t a t i o n s and/or col laborat ing

l abora to r i e s contributing t o the monitoring of water qual i ty . WHO w i l l he lp t o

f o s t e r the in ter regional col laborat ion required t o deal with marine pol lu t ion pro-

blems i n the Mediterranean.

A s a core contr ibut ion t o the i n t e n s i f i c a t i o n of e f f o r t s i n a l l aspects of

environmental health, the establishment of an Eastern Mediterranean Centre f o r Environ-

mental Health A c t i v i t i e s i s contemplated. Such a cen t re would address i t s e l f t o

research and t r a in ing , t o the i d e n t i f i c a t i o n and c l a s s i f i c a t i o n of environmental pro-

blems and t o the fu r the r development of a coordinated network of nat ional i n s t i t u t i o n s .

The World Health Organization i n t h i s Region has always enjoyed very f r i end ly

and f r u i t f u l col laborat ion with i ts s i s t e r United Nations Agencies and it is a n t i -

cipated t h a t these re la t ionsh ips w i l l become c lose r and more intimate. Amongst the

o the r agencies of the United Nations system which a r e most a c t i v e l y involved and

whose programne focus, l i k e W H D ' s , i s s t rongly upon the prcrmotion of heal th , UNDP

and UNICEF, UNFPA and UNEP a r e the most c ruc ia l .

There w i l l a l so be a continuation of f inanc ia l support from UNFPA and, i n those

a c t i v i t i e s i n which they a r e primarily concerned, wi th FAO, UNESCO, I m ' a n d the

Economic Commissions. An expansion is ant ic ipated i n the use of UN Volunteers i n

a va r ie ty of p ro jec t s , p a r t i c u l a r l y i n the l e a s t developed countries.

The continuing expanding involvement of the World Bank (IBRD) i n hea l th mat ters

w i l l be more and more c losely re la ted with W H D and i t i s an t i c ipa ted that W H D w i l l

continue t o a c t a s the executive agency for p ro jec t s financed by them i n the hea l th

area.

W H O ' S c o n s t i t u t i o n a l r o l e a s t he d i r e c t i n g and co-ordinat ing a u t h o r i t y on i n t e r -

na t iona l h e a l t h work i n t he world, has been inc reas ing ly r e a l i z e d i n r ecen t years

and, i n t he Eastern Mediterranean Region i n p a r t i c u l a r , t h i s type of work w i l l be

expanded and improved upon i n 1980/81. We welcome t h e way i n which those c o u n t r i e s

which a r e i n a p o s i t i o n t o provide b i l a t e r a l a i d t o t h e i r less f o r t u n a t e f r i e n d s ,

whether t he se be coun t r i e s w i th ln our Region o r from o u t s i d e , a r e i nc reas ing ly con-

s u l t i n g t h e Regional Of f i ce on t h e development of t h e i r own programmes. WHO has a

weal th of knowledge and understanding of t he h i s t o r y o f i n t e r n a t i o n a l h e a l t h develop-

ment throughout t he Middle Eas t . Our experience is r e a d i l y put a t t h e d i sposa l of

those who a r e newer t o t he f i e l d . We expect t o cont inue t o en joy cons t ruc t ive co-

o p e r a t i v e r e l a t i o n s h i p s w l t h t he I s lamic Development Bank and t h e Council o f Heal th

Min i s t e r s of t h e Arab League.

A s WHO'S po l i cy t o encourage the u t i l i z a t i o n of n a t i o n a l s t o work on W H O

a c t i v i t i e s i n t h e i r own c o u n t r i e s g a i n s momentum, i t i s a n t i c i p a t e d t h a t t h e r e w i l l

be a cont inuing t rend towards t h e provis ion o f funds t o enable governments and

educa t iona l i n s t i t u t i o n s t o undertake d i r e c t recru i tment of h e a l t h workers who might

no t o therwise be a v a i l a b l e t o them, but who a r e no t i n a d i r e c t employer/employee

r e l a t i o n s h i p wi th WHO i t s e l f .

No expansion i s a n t i c i p a t e d i n t h e number of Wm Programme Co-ordinators and

where no such pos t e x i s t s , s u i t a b l e arrangements m l l be made f o r co-ordinat ion of

W H O programme.

A s a l r eady mentioned i n connect ion wi th t h e Regional Research Programme, i n -

c r ea s ing use w i l l be made o f an interlocking s e r i e s of advisory panels , i n a v a r i e t y

of f i e l d s , drawn from t h e e x p e r t i s e which is s o r a p i d l y expanding among Member

count r ies .

The e x t e n t t o w h c h t h e s en io r h e a l t h o f f i c a l s of Member c o u n t r i e s a r e a c t i v e l y

involved i n pol icy p repa ra t ion and programme des ign is expected t o i n c r e a s e and the

work o f a committee s e t up f o r t h i s purpose by the Regional Committee a t i t s Twenty-

seventh s e s s ion I n 1977 w i l l become an inc reas ing ly important l i n k between our

Governing Body and t h e S e c r e t a r i a t . I n t he s p i r i t o f co-operat ion which has i n -

c r ea s ing ly cha rac t e r i zed the working relationship between WHO and the Member coun t r i e s

i n r ecen t yea r s , i t i s a n t i c i p a t e d t h a t t he re w i l l be more and more o p p o r t u n i t i e s f o r

exchange o f views and a c t i v e involvement of n a t i o n a l s a t every l eve l .

The World Health Organization has now been providing service t o the countr ies

of the Eastern Mediterranean Region over the pas t 29 years. I have reason t o believe

t h a t our Member countries take r e a l pr ide i n how we work together and i n what we have

achieved. Our Region i s one of extraordinary d ive r s i ty . Although its population is

not a l l that large , i t contains some of the r i c h e s t countr ies i n the world and some

of the poorest. I t i s i n many ways a cornerstone of the world, and i t has not been,

f o r many years, f r e e of the s t r i f e t h a t a t every point i n the h is tory of mankind has

characterized an area of constant and rapid change and d i v e r s i t y of r e l i g i o u s and

p o l i t i c a l bel iefs .

Not l e a s t among the sources of our g r a t i f i c a t i o n i n our work l i e s the f a c t that,

i n the face of every d i f f i c u l t y , WHO has remained a t the service of a l l , regardless

of p o l i t i c a l events, without in te r rup t ion s ince the inception of the Eastern Mediter-

ranean Regional Office i n 1949. I firmly believe t h a t our record w i l l be maintained.

I t is a source of continuing s a s t i s f a c t i o n t o observe the extent t o which heal th

concerns do i n f a c t override p o l i t i c a l consideration& and it w i l l be our continuing

e f f o r t t o ensure t h a t they do so more and more.

I submit t h i s Programme Budget for the years 1980/81 f o r the consideration of

Member countr ies , i n the knowledge t h a t i t has been b u i l t up i n the c l o s e s t collabora-

t ion and consultat ion with them, a s w e l l a s i n the confidence that, adapted and

adjusted a s needs may be, time passes, and circumstances change, i t w i l l play i ts

appropriate modest pa r t i n moving, with our Member countr ies , one s t e p f u r t h e r along

the road t o the defined goal which a l l countr ies of the world have set, of hea l th

f o r a l l by the year 2000.

SUMMARY OF REGIONAL IIEALTH IJRCC~RAhlME --- -- ------ LSTIhlATED OALI GATIONS BY SOURCF OF FUNDS

V r r i tchd h'at~orls Dt~vc~lopment Programme

IJnl ted Nati nns Fund f o r Population A c t i v i t i e s

Funds In Trust

Voluntarv Fund f o r Health Promotion

Total o t h e r sources

GRAND TOTAL

Figure based on information p r e s e n t l y a v a ~ l a b l e and w i l l be adjus ted when fur ther information becomes a v a i l a b l e ,

Programme

Nuinbci

1.3

2.1

2.2

2.3

2.4

2.5

SUMMARY BY

Majcr Progmune/p:-0gram.c

REG1 ONAL COIW I TTEES

EXECUTIVE MANAGEMENT

GENERAL PROGRMtE DEVELOPMENT AND MANAGEMENT

2.2.1 General Programme Development

2.2.2 Country Healthprogramming 2.2.3 Information Systems

Programme

EXTERNAL COORDINATION FOR HEALTH AND SOCIO-ECONOMIC DEVELOPMENT

2.3.2 Collaboration with hlulti lateral and Bilateral Programmes

RESEARCH PROMOTION AND DEVELOPMENT

REGIONAL DIRECTOR 'S DEVElXlPMENT PROGRAMME

MAJOR PROCRAMME/PROGMfME AND SOIlRCE

Biennium 1978 - 1979

Ofher Reylcr Sources Total

US$ US$ US$

50 000 50 OOO - .

223 300 223 300

205 200 205 200

1 583 200 433 900 2 017 100 51 500 51 500

1 839 900 433 900 2 273 800

623 200 623 200

694 700 200 000 894 700

200 ooo 200 OOO

OF FTWDS

Biavliurn 1980 - 1981

W e r %war ao~mt?s Total US$ m US$

56 000 56 000

264 10 0 264 100

204 600 204 600

1 768 600 790800 2559400 240 400 240 400

2 213 600 790 800 3 004 400

664 800 664 800

507 200 300 000 807 200

800 000 1 000 000 1 800 000

1

P 01

Programme

Nuinbcz

HEALTH SERVI CES * DEVELOPMENT

3.1.0 Programme P l a n n i n g and Genera l A c t i v i ties

3.1.1 H e a l t h S e r v i c e s 9 Planning and Management

3.1.2 Pr imary H e a l t h Care 3.1.3 Workers * H e a l t h 3.1.4 Care of t h e Aged,

D i s a b i l i t y P r e v e n t i o n and R e h a b i l i t a t i o n

3.1.5 A p p r o p r i a t e Technology f o r H e a l t h

3.1.6 H e a l t h S e r v i c e s ' Research

FAM I LY HEALTH

3.2.1 Mate rna l and C h i l d Hea l th 3.2.2 N u t r i t i o n 3.2.4 H e a l t h Educa t ion

MENTAL HEALTH

Y MAJOR PROGRAMMEDROGRAMME AND SOURCE OF FUNDS

Biennium I Biemim 1978 - 1979 1980 - 1981

1

* F i g u r e based on i n f o r m a t i o n p r e s e n t l y a v a i l a b l e and w i l l be a d j u s t e d when f u r t h e r i n f o r m a t i o n becomes a v a i l a b l e .

Other Rcylcr Sources Total US$ US$ US$

Otlier Regular Sourceri n t a l US$ US$ US$

Programme I Majcr proSnmme/p:agramme Nuinb~~.

/ PROPHYLACTIC, DIA(NOST1C AND / TIfERAPEUTIC SUBSTANCES

1 3.4.0 P r o g r a m Planning end General Activities 1 3.4.1 Drug Pol ic ies end Management

3.4.2 Pharmaceuticals and , Biologicals

COMMUNICABLE DISEASE PREYENTION AND CONTROL

P r o g r a m Planning and General Act iv i t i es

Epidemiological Surveillance

Malaria end Other Parasi t i c Diseases

Bacterial , Viral end My cotic Diseases

Smallpox Eradication Expended Progrmm on

Imunisat ion Prevention of Blindness Vector Biology and

Control

* Figure bared on infomation presen

Y MAJOR PROCRAMME/PROGRAMME AND SOURCE OF FUNDS

Bicnnium Biemium 1978 - 1979 1980 - 1981

Ofher Oftier Rcy lrr Sourcaa Total Regular source^ Tots1 US$ us9 US$ US$ vsS US$

I

y available uni rill he adjusted rhon further information becaaes available.

Programme

Nu.nbci

- SUMMARY

NONC~~UNI CABLE DI SEASE PREVENTION AND CONTROL

4.2.1 Cancer 4.2.2 C a r d i o v a s c u l a r Diseases 4.2.3 O r a l H e a l t h 4.2.4 O t h e r Noncommunicable

D i s e a s e s 4.2.5 Immunology

PROMOTI ON OF ENVIRONMENTAL HEALTH

5.1.0 Programme P l a ~ i n g and Genera l A c t i v i t i e s

5.1.1 Environmental H e a l t h P l a n n i n g and Management

5.1.2 B a s i c S a n i t a r v Measures 5.1.3 Recogni t ion and C o n t r o l of

Environmental Hazards

3Y MAJOR PROGRAMME/PROGRAMME AND SOURCE OF FUNDS . .

Other Otlier Rcgulcr Sources T w l hg~lu Soum?a Total I US$ US$ US$ US$ US$ US$

* F i g u r e based on i n f o r m a t i o n p r e s e n t l y a v a i l a b l e and w i l l be a d j u s t e d when f u r t h e r rn fonna t ion becomes a v a i l a b l e .

Programme

Nuiibc..

6.1

7.1

.

t

Pigum

SUMMARY

Majcr. P m g r a z ~ / p . ~ m m c

HEALTH MANPOllER DEVEUIPMENT

6.1.0 Programme Planning and General A c t i v i t i e s

6.1.1 Health Manpower Planning and Management

6.1.2 Promotion of Tra in ing 6.1.3 Educational Development

and Support

HEALTH INFORMATION

7.1.0 Progranune Planning and General A c t i v i t i e s

7 . 1 Health S t a t i s t i c s 7.1.2 WHO Pub l i ca t ions and

Documents 7.1.4 Health L i t e r a t u r e

Se rv ices 7.1.5 Health f n f o n a t i o n of

the Pub l i c

based on information p resen t ly

BY MAJOR PROC;RAMME/PROGR~IE AND SOURCE


Ofher R c y l c r Sou- Total US$ US$ US$

571 500 571 500

203 000 203 000

7 310 900 1 535 MI0 8 846 800 692 900 692 900

8 778 300 1 535 900 10 314 200

105 000 105 000

401 400 240 100 641 500 383 100 383 100

92 4CX) 92 400

122 900 122 900

1 1 0 4 800 240 100 1 344 900

a v a i l a b l e and rill be adjus ted .hen

OF FUNDS

Biemiurn 1980 - 1981

Otbier Regular souzceo T~tal US$ us$ US$

663 500 663 500

633 700 633 700

8 363 900 1 216 WO* 9 580 800 1 084 600 100000 1 1 8 4 600

10 745 700 1 316 900 12 062 600

122 700 122 700

437 100 372 900 810 000 442 800 442 800

110 300 110 300

110 000 110 000

1 222 900 372 900 1 595 800

f u r t h e r i n f o m a t i o n b~cole8 avai lable .

hl tu

h) 0

Programme

Nuinbci

--

8.1

SUMMARY BY MAJOR PROGRAMME/PROGRAMME AND SOURCE OF FUNDS

T O T A L

2 203 600 2 203 600 2 545 900 2 545 900

I

32 385 600 18 809 900 51 195 500 39 650 000 16 764 500 56 414 500

.........................................

Bieanium 1980 - 1981

Oflier wi%lm Souroeu Total US$ us US$

Majci Progra2~e/p.-ogramnu?

Bionnium 1978 - 1979

Of lier Regukr Souram Total

US$ US$ US$

GENERAL SERVICES AND SUPPORT PROQtAMMES

8.1.0 Programne Planning and General A c t i v i t i e s

8.1.2 Pe r some 1 8.1.3 Suppl ies 8.1.4 Conference, O f f i c e and

Building Se rv ices 8.1.5 Budget 8.1.6 Finance and Accounts

122 300 122 300

248 000 248 000 223 600 223 600

1 165 700 1 165 700

131 500 131 500 312 $00 312 500

141 100 141 100

246 200 246 200 267 800 267 800

1 413 400 1 413 400

123 400 123 400 354 000 354 OoO

C

Progmmme Nuinbci

1 . 3

2.1

2 .2

2 .3

2.4

2.5

SUUMARY

Majcr P ~ r & 7 ~ / p i ~ ~ ~ e

RMiIONAL CONWZTEES

EXECUTI YE MANAGEWT

Regional

GENERAL PROGRAMME DEVELOPMENT AND MANAGEMENT

Regional Country Inter-Coun t r y

EXTERNAL COORDINATI ON FOR HEALTH AND SOCIO-ECONOMIC DEVELOPMENT

I n ter-Country

RESEARCH PROMOTION AND DEVELOF'MmT

I n t e r C o u n t r y

REGIONAL DIRECTOR'S DEVELOPMENT PROGRAMME

Inter-Country

IQ P

BY IWOR PROGRAMME AND ORGANIWTfONAL


(Xfher Rey lcr Sources TOW US$ US$ US$

50 000 50 000

223 300 223 300

205 200 205 200 1 583 200 433 900 2 017 100

51 500 51 500

1 839 900 433 900 2 273 800

623 200 623 200

694 700 200 000 894 700

200 000 200 000

LEVEL

Bimium 1980 - 1981

Wlier m l a r Sounceu 'Dotal US$ vs$ US$

56 000 56 000

264 100 264 100 -

204 600 204 600 1 768 600 790 800 2 559 400

240 400 240 400

2 213 600 790 800 3 004 400

664 800 664 800

507 200 300 000 807 200

800 000 1 000 000 1 800 000

Programme Nuinbc~'

HEALTH SSERVICES' DEVELOPMENT

C o u n t r y I n t e r - C o u n t r y

FAMILY HEALTH


MENTAL HEALTH


PROPHYLACTIC, DIAGNOSTIC AND THERAPEUTIC SUBSTANCES


Y BY MAJOR PROGR;\hLr\lE AND ORGANIZATIONAL LEVEL

Bicnnium Bimium 1978 - 1979 1980 - 1981

COMMUNICABLE DISEZSE PREVJNTION 1 4.1 1 M m C O N r n O L

I Programme

1 Nu.nbci

_ 6 3-

I I c o u n t r y

Majc~ Programme/p;*ogrammc?

I n t e r - C o u n t r y

NONCOMhKlNI CABLE DI SEASE PREVENTION AND CONTROL


PROMOTI ON OF ID VI RON MENTA L HEALTH


HEALTH W P O W E R DEVELOPMENT


Y BY W O R PROGRAMME AND ORGAhIZATIONAL LEVEL


atlier R c y k r Sourcas Total

US$ US$ US$

B i d u m 1980 - 1981 I

Othier Regular So- Total US$ us$ US$

PRO(;RAMME AND BUDGET ESTIMATES FOR THE BIENNIUM 1980 - 1981 BY APPROPRIATION SECTION WITH A TENTATIVE

PROJECTION FOR THE BIENNIUM 1982 - 1983

A j ~ r o p r i a t i o n S e c t i o n Es t imated O b l i ~ a t i o n s T e n t a t i v e Pro. iect ion

Bienni urn B l e ~ i u m Biennium

1978 - 1979 1980 - 1981 1982 - 1983 US$ USS US$

1 P o l l c v Organs 50 000 56 000 60000

2 Fencra l Programme 3 581 100 4 449 700 Development , Management and Coord ina t ion

3 Development of 7 491 400 9 279 100 Comprehensive Hea l th S e r v i c e s

4 Disease Preven t ion 7 898 800 8 699 400 and C o n t r o l

5 Promation of 1 277 600 2 651 300 Envi ronmental H e a l t h

6 H e a l t h Manpower 8 778 300 10 745 700 Development

7 Hea l th In format ion 1 104 800 1 222 !300 1 497 000

8 General S e r v i c e s and 2 203 600 2 545 900 2 939 000 Support Programmes

Major Programme

REGIONAL COAllYlI TTEES 1.3 - The Regional Conunittee is a const i tu t ional organ of the Regional Organization.

Thus, i U s an inter-governmental organ corpssed of regweeentati*es.of t h e L ~ 8 8 ; p

S t a t e s (current ly 23 f u l l Members i n the Eastern Mediterranean Region). The Regional

Director i s ex-officio Secretary of the Regional Copnittee.

The Regional Committee is responsible for formulating po l ic ies governing matters

of exclusively regional character, and a l s o f o r supervising the a c t i v i t i e s of WHO i n

the Region. Through i ts annual meetings, the Regional Coltmaittee provides advice and

guidance t o the Regional Director on planning and implementation of the Rerrional Pro-

gramme. Further, it can tender advice through the Regional Director and the Director-

General t o the Organitation on in ternat ional hea l th matters which have wider than

regional significance.

The estimates provide f o r an annual meeting of Sub-cornittees A and B of the

Regional Colmnittee f o r the Eastern Mediterranean Region.

Major Programme

EXECUTf VE MANAGEMENT - --- -----

The Regional Director is the technical and administrative head of the Regional

Organization. In this capacity, he supervises the work of the WHD Secretar ia t i n

the Regional Office o r attached to country and interoountry programmes.

Within the overall policy of work, a s established by the World Health Assemblies,

and i n consultation with the Regional Conmittee, he is responsible for the execution

of the WHO programme i n h i s Region. I n t h i s connexion he establ ishes d i rec t contact

with the governments of the Region and consults the au thor i t i es e i ther d i rec t ly o r

through h i s s t a f f with regard t o the WH) a c t i v i t i e s i n t he i r respective countries.

He maintains contacts with appropriate professional groups i q the Region. H e a l so

co-ordinates health progrannnes assis ted by other international organizations within

the Regi~n.

The RegLonal Director formulates the Proposed Programe Budget for submission t o

the Regional Committee.

Major Programe

GEKERAL PROGRAMME DEVEUPlldWT AND MANAGEMENT

Objectives:

- t o col laborate with M e m b e r Countries i n the development of nat ional heal th plans

and programmes a s an i n t e g r a l pa r t of t h e i r overa l l socio-economic development systems

and through improved programme concepts t o enhance W H D ' s own c a p a b i l i t i e s t o respond

t o countr ies ' needs i n a coherent manner;

- t o col laborate i n the strengthening of countr ies ' c a p a b i l i t i e s f o r planning and

management of t h e i r heal th se rv ices through provision of necessary technical and

adminis t ra t ive support and l e g a l reforms wherever necessary;

- t o improve the u t i l i z a t i o n and e f f i c i ency of the ava i l ab le technical and f inanc ia l

resources of WHO, United Nations and o the r mul t i l a t e ra l and b i l a t e r a l agencies, f o r

heal th purposes through better coordination and mobil ization of these resources.

Co-operation with and among countr ies

During the l a s t t h i r t y years, almost a l l countr ies of the Region have developed

and improved organization f o r the planning, management and del ivery of hea l th services.

WHO has in general collaborated i n t h i s development with s p e c i f i c support t o planning,

management and technical aspects of t h e i r heal th se rv ices and t r a in ing of personnel.

A r eo r ien ta t ion of the heal th programes t o meet the pressing needs of the whole

population is required a s the present approaches t o planning, organization, f inancing

and management i n most of the countr ies a r e inadequate. Yoreover, there a r e many

gaps i n hea l th information i n technical development which would require f u r t h e r

support t o the countries. The proposed programoe envisages ass i s t ance t o various

a c t i v i t i e s planned under general programme development, country hea l th programming

and information systems development.

Programme

General Programme Development

Objectives:

- t o col laborate with M e m b e r S t a t e s i n providing by the year 2000 a l e v e l of hea l th

t h a t w i l l permit t h e i r populations t o lead a s o c i a l l y and economically productive

life;

- t o develop medium-term programmes covering three spans of two-year progralmne

budgetary cycles within the framework of the Organization's General Programme of Work

to meet the pr ior i ty needs of the countries i n the implementation of the i r plans;

- t o collaborate i n strengthening of countries' capacities for planning and manage-

ment of conprehensive national health services within the i r intersectoral endeavours

for socio-economic development,

- to foster a network of ins t i tu t iona l infrastructures and services able to cope,

through appropriate preventive and curative health, sanitary and social measures, with

the ident i f ied health needs of urban and rural communities;

- to develop a valid system of health progralrme evaluation, with a range of quanti-

t a t i ve and qual i ta t ive indicators, a s an integral component of health a ~ t i ~ i t i e s a t

a l l levels i n the Region;

- t o d i rec t and coordinate the a c t i v i t i e s of the technical un i t s of the Regional

Office;

- t o extend technical support t o the WHO Progall) CO-ordinators and f i e l d s t a f f

i n t he i r country and project ac t i v i t i e s , including the application of norms and stand-

ards for technical procedures and practices adopted by the Regional Office;

- t o provide consultative services i n various f i e ld s of health a t the request of

governments;

- t o maintain l i a i son with agencies interested i n health and related a c t i v i t i e s a s

w e l l a s those contributing funds for WHO-assisted projects.

Co-operation wlth and among countries

This p r o g r a covers the supervisory and co-ordinating s e rv ims provided by the

Director of P r o g r a m Nanagement and h i s immediate s t a f f i n planning, programming,

evaluation of the country and inter-country p r o g r a m s , and providing technical support

t o the countries on the instruct ion of the Regional Director.

I n the i r attempts t o reach the above objectives, a l l countries of the Region have

progressed during the l a s t three decades and many of them have developed national health

plans of various duration. The p8ce of progress has differed acmrding t o tkm ami l a -

b i l i t y of financial and manpower resources and some countries have a longer way than

others t o go t o provide adequate health services t o t he i r en t i r e population.

I n 1S80/81, W H ) rill continue t o cooperate with countries i n strengthening the i r

ccrp8city for planning and mnagelent of t he i r heal th progr-s.

The response t o coun t r i e s ' r eques t s w i l l be more f l e x i b l e and adapted t o s u i t s p e c i f i c

s i t u a t i o n s . Technical co l l abo ra t ion w i l l be provided through country and in t e rcoun t ry

s p e c i f i c p r o j e c t s o r programmes, t he W H O Programme Co-ordinators and Regional O f f i c e

s t a f f .

One o f the mechanisms through which W H O cooperates wi th coun t r i e s i n t h e i r en-

deavour t o provide a more comprehensive, coordinated and t echn ica l ly capable h e a l t h

s e rv i ce t o t h e e n t i r e population, i s medium-term programming. I t r ep resen t s , a t t h e

na t iona l and regional leve ls , t he t r a n s l a t i o n i n t o a c t i v i t i e s of the W H O General Pro-

gramme of Work concerning a s p e c i f i c period (now the S i x t h General Programme of Work

and period 1978-1983). S t a r t i n g from the a n a l y s i s of coun t r i e s ' needs and coun t r i e s*

priorities and ob jec t ives , medium-term programmes w i l l be formulated i n c l o s e consul-

t a t i o n and a s soc ia t ion wi th the na t iona l hea l th a u t h o r i t i e s ; thxs would al low WHO t o

respond more e f f e c t i v e l y t o t he needs o f t he coun t r i e s , through two-year programme

budget cyc le s , and t o make an eva lua t ion aimed a t programme improvement.

Exerc ises i n medium-term programming have been and a r e being c a r r i e d o u t i n the

a r e a s o f Health Manpower Development, Environmental Health, Comprehensive Health

Services. Other main a r e a s of the S i x t h General Programme o f Work w i l l be covered

dur ing the next biennium s t a r t i n g wi th Disease Prevention and Control .

The b a s i s o f the eva lua t ion o f h e a l t h programmes i s a comparison between planned

and a c t u a l achievements. To t h i s end, eva lua t ion must be continuous dur ing t h e i m -

plementation of a programme and, i n t h e d e f i n i t i o n of o b j e c t i v e s and formulat ion o f pro-

grammes, due regard must be paid t o t he measurabi l i ty cif r e s u l t s both from t h e quant i -

t a t i v e and q u a l i t a t i v e po in t s of view and, whenever poss ib l e , t a r g e t s must be de t e r -

mined i n s p e c i f i c terms. Recent and f u t u r e developments i n t he way WHO a s s i s t s and

w i l l a s s i s t coun t r i e s i n t h i s s e n s i t i v e a rea of h e a l t h programme development is re-

l evan t t o t h e Information Systems Programe (2.2.3)

Country Health Programming

Object ives:

- t o p a r t i c i p a t e , wi th planning bodies, m i n i s t r i e s o f h e a l t h and o the r related

m i n i s t r i e s o r organiza t ions , i n t h e promotion, review, adap ta t ion and improvement o f

i n t e r s e c t o r a l planning, progral~lming and management procedures and p r a c t i c e s f o r h e a l t h

s e rv i ces ;

- t o inc ream the productivity of heal th services systems by promoting technical ,

administrat ive and l ega l changes where necessary through s tud ies and research;

- t o ensure programme support by introducing advanced methods of assessment,

management, administrat ion and supervision i n the heal th services;

- t o improve the methods of formulation, implementation, monitoring and evaluation

of heal th programmes;

- t o plan fo r provision of heal th services su i t ed t o the needs of the communities,

a t an acceptable cost under prevai l ing socia l and economic conditions.


Member S t a t e s have continued during the pas t biennium t o increase the capac i t i e s

of t h e i r hea l th services i n order t o r a i s e them t o a sa t i s fac to ry l eve l of ef fect ive-

ness and efficiency. WHO has helped them through various contributions i n t h e f i e l d

of planning/prograPning, a w n s t r a t i o n and management.

The country heal th programming approach t o heal th planning deserves specia l

a t tent ion. I t is a process designed t o iden t i fy p r i o r i t y heal th problems of prime

concern t o countries i n the context of t h e i r development plan and t o formulate appro-

p r i a t e programmes t o cope with them. I t r e s u l t s from a nat ional commitment and is

a national responsibi l i ty . I t i s an in te r sec to ra l continuous process through a cycle

of programmes formulation, implementation, evaluation and reprogramming. I t reqrures

the s e t t i n g o f a permanent mechanism within the National Health Planning system. WHO

helps in te res ted countr ies i n adapting this f lex ib le method t o nat ional s p e c i f i c con-

dit ions. A c r i t i c a l mass of national personnel, not only i n public heal th se rv ices

but a l s o i n other re la ted f i e l d s of socio-economic development, has t o be t ra ined a t

national l eve l , with the pa r t i c ipa t ion of W H O s t a f f a s necessary. The nat ional s t a f f

with knowledge and experience of the country hea l th programming process can, and w i l l ,

then, pa r t i c ipa te i n s imilar exercises i n other countr ies of the Region, thus concretely

contr ibut ing t o the e f f o r t towards technical cooperation among developing countries.

The country heal th programming approach has been used i n Afghanistan, Democratic

Yemen, I raq , Pakistan, Sudan and Yemen Arab Republic. Yore countr ies w i l l c e r t a i n l y

take benef i t of i t i n the coming years, and W H D w i l l contr ibute t o national e f f o r t s i n

t h i s respect by coming, on request , i n t o any point of en t ry of t h i s continuing, r o l l i n g

process. Courses and workshops w i l l a l s o be held, a s required, t o fu r the r the trans-

f e r of the country heal th programming process and methodology and to exchange experience

among the countr ies of the Region. The process i t s e l f and country experience of i t

w i l l be kept under review t o ensure i t s proper development, appl ica t ion and evaluation.

The programme includes the WHO programme coordination a t country.leve1. The

system of WHO Programme Co-ordinators ( W H D Representatives) countinues t o be an i m -

portant element i n the s t r u c t u r e and function of the Organization i n r e l a t i o n t o

technical col laborat ion a t the country level .

Among the main functions of the W H O Programme Co-ordinators a r e the following:

- t o e s t a b l i s h d i r e c t and continuous col laborat ion with the nat ional heal th

author1 t i e s ;

- t o col laborate with the Government i n the development of methods f o r country

hea l th programming, p ro jec t formulation and management;

- t o a s s i s t i n the assessment of country hea l th needs and resources and i n planning,

implementation and evaluation of nat ional heal th programmes;

- t o ensure e f f i c i e n t planning and del ivery of WHD's col laborat ion i n r e l a t i o n t o

these programmes;

- t o a s s i s t , a s may be appropriate, the Regional Off ice and Headquarters with i n t e r -

country and inter-regional p ro jec t s respect ively; and

- t o coordinate ac t ion and cooperate with country o f f i c e s o r representa t ives of

o the r organizations and agencies, p a r t i c u l a r l y those of the United Nations system.

I n 1980/81, W H D Programme Co-ordinators a r e foreseen i n Afghanistan, Democratic

Yemen, I r aq , Libya, Oman, Pakistan, Q a t a r , Saudi Arabia, Somalia, Sudan and Yemen.

Those i n I raq , Libya, Qa ta r and Saudi Arabia a r e expected t o be f u l l y financed by the

host Governments under funds-in-trust arrangements.

Programme

Informa t ion Systems Programme 2.2.3

Objectives:

- t o develop a heal th information system and t o disseminate re levant information

on Health S ta tus and Health Progrannne Development,

- t o develop a W H O information system f o r programme management, f o r the regional

and in te rna t iona l exchange of heal th and heal th r e la ted information;

- t o cooperate with countr ies of the Region i n the development of National Health

Information Systems providing re levant information on t h e i r hea l th s t a t u s , hea l th

se rv ices 9 .d development;

- t o ensure tha t WHO and the national heal th information systems be mutually

supportive and, whenever possible, compatible.


Health progranvPe development, implementation and evaluation require r e l i a b l e

heal th information.

WHO is developing and w i l l continue t o develop during the next biennium an In-

formation System a t Country, Regional and Global l eve l s , the aim of which is not only

t o meet the need of the Organization f o r heal th information but to i n t e r a c t with the

National Health Information Services, i n order t o serve the Organi%ation's programmes

of technical collaboration with countr ies and the in te rna t iona l exchange of heal th

and health-related information.

I t w i l l a l s o promote the development o f , and d i r e c t support t o the national hea l th

information systems. I t w i l l cooperate with nat ional s t a f f on the f e a s i b i l i t y , design,

implementation and evaluation of the systems and w i l l 88sist i n the t ra in ing of

nat ionals i n systems development.

The memory component of the Information System i s bosed on the "prof i le concept"

a t each echelon of heal th a c t i v i t i e s (project , p r o g r a m , country ,regional programe,

global programme). The p r o f i l e provides information f o r s i t u a t i o n analys is , which

is se lec t ive and user-oriented a t nat ional and in te rna t iona l levels . I t is i n t e r -

linked with medium-term programming and country heal th programming (2.2.1 and 2.2.2).

Emphasis w i l l be given during the next biennium, i n c lose associa t ion with national

heal th a u t h o r i t i e s , t o the preparation of country progrrmne p r o f i l e s covering in-

formation on a l l national hea l th programnes, whether a s s i s t e d o r not by WHO and/or

o the r sources of technical cooperation.

The information system is useful i n heal th progranme evaluation (2.2.1). Pro-

g r a w e p r o f i l e s have an in tegrated element of evaluation which enables progralmes'

ef fect iveness and eff ic iency t o be determined. Conwlidated within country p rof i l e s ,

i t w i l l enable progress and d i f f i c u l t i e s i n countries ' hea l th p r o g r a m development

t o be ident i f ied .

Major Programme

EXTERNAL COORDINATION FOR HEALTH AND SOCIO-ECONOMIC DEWPMENT 2 3 - Programme

Collaboration with the United Nations System and other Organizations 2.3.1 - dbjectives:

- To a s s i s t i n the Organization's par t ic ipat ion i n the overall development pro-

gramme of the United Nations and i n par t icular t o promote a t the country level co-

ordinatxon with other organizations within the United Nations system especially with

UNICEF, FAO, WFP, UNESCO and the Region's Commissions;

- t o par t ic ipate i n the development of cooperative a c t i v i t i e s within the context

of the programmes of UNDP and the United Nations Capital Development Fund, and i n

Technical Co-operation among Developing Countries (TCDC).

Co-operation with and among countries

Close collaboration is maintained with UNDP, UNICEF, FAO, WFP, UNEP, UNFPA,

UNESCO and other Unxted Nations Agencxes a t country and Regional Office leve ls i n

order t o develop a coordinated development programe most suited t o countries' needs.

WHO provides technical support t o or a c t s a s Executing Agency for the other specia-

lirred agencies and UNDP. Jo in t projects have been in i t i a t ed with UNEP i n the con-

t r o l of pollution i n the Mediterranean and Red Seas, and i n countries of the Kuwait

Action Plan Region. Technical support is a l so provided t o UNICEF which has an ex-

tensive progranrme i n some countries of the Region i n maternal and chi ld health, -

primary health care, the Expanded Programme on Irmnuni%ation, nu t r i t ion and training.

The World Food Programe is ass i s t ing i n the development of large projects i n the

Region and technical support is provided t o the health aspects of these projects.

The development of family planning and population a c t i v i t i e s i n the context of

maternal and child health programmes is being undertaken i n collaboration with UNPPA

a t country and regional levels.

Close collaboration is maintained with UNDP. A t country level , consultations

between the UNDP Resident Representatives and WHO Programme Co-ordinators and/or with

the Regional Office ensures the best possible co-ordination of the United Nations

inputs t o serve the socio-economic development process i n member countries. For th i8

purpose jo in t programming between UM)P and W H D w i l l be encouraged and concerted with

the national planning and programming cycle.

s o f n t collaborative propammes w i l l continue t o serve the most deprived sectors

of t h sdmmunity, by means par t icular ly of the t ra ining of middle-/and lower-level

heal th workers, the provision of r u r a l water suppl ies and peripheral heal th services.

Special consideration i s given t o the i d e n t i f i c a t i o n of countries ' po ten t i a l f o r

WDC and the promotion of new and e x i s t i n g TCDC a c t i v i t i e s and programme.

Continuous e f f o r t s w i l l be made t o secure UNDP resources f o r the development of

regional heal th p ro jec t s t h a t benef i t a number of countr ies o r have a po ten t i a l multi-

p l i e r e f f e c t i n the form of stronger national i n s t i t u t i o n s o r new national programmes

i n p r i o r i t y hea l th areas.

Programme

Collaboration with Mul t i l a t e ra l and B i l a t e r a l Programmes

Objectives

To co-ordinate the regional programme with mul t i l a t e ra l development programmes,

funds and organizations within the United Nations system, and t o promote, enhance and

co-ordinate co-operation with m u l t i l a t e r a l and b i l a t e r a l sources of support f o r heal th

work i n the countr ies of the Region.


A co-ordination u n i t has been set up i n the Regional Of f i ce a s an inter-country /

a c t i v i t y t o a c t a s a focal point f o r UNDP-assisted programes and p ro jec t s , a s s i s t i n g

the Regional Director i n guiding and co-ordinating heal th-re la ted a c t i v i t i e s executed

under the United Nations Development Programme. I n accordance wi th its cons t i tu t iona l

mandate, W H O a c t s a s the d i r e c t i n g and co-ordinating ah thor i ty of in te rna t iona l heal th ,

and an increas ing port ion of the functions of the technical advisory s t a f f of WHO is

di rected towards such co-ordination a c t i v i t i e s with the United Nations bodies, and

m u l t i l a t e r a l and b i l a t e r a l technical co-operation programmes. The co-ordinating u n i t

w i l l be s t a f fed , from 1980, by a senior adminis t ra t ive a s s i s t a n t and a secre tary .

This programme a l s o covers the technical d i r e c t i o n and support provided by WHO

t o the hea l th programme of the United Nations Rel ief and Works Agency f o r Pa les t ine

Refugees i n the Near East (UNRWA). I n accordance with an agreement reached between

W H O and UNRWA, which was f i r s t r a t i f i e d i n 1950, W H O provides the se rv ices of the

~ g e n c y ' s Director of Health and four o the r heal th s p e c i a l i s t s on a non-reimbursable

loan basis .

Countries' socio-economic development programmes a r e being supported by a number

of m u l t i l a t e r a l and b i l a t e r a l agencies including the World Bank, the Regional Develop-

ment Banks, the Islamic Development Bank, SIDA, DANIDA and USAID. Some Arab S t a t e s

such a s Saudi Arabia, Kuwait, UAE and Qatar are providing financial support through

WHO o r through special development funds such a s the Saudi Fund for Development, the

Abu Dhabi Fund for Arab Economic Development, and the Kuwait Fund for Economic Develop-

ment. WHO has collaborated with these Organieations i n Sector studies, f ea s ib i l i t y

studies, and ident i f icat ion of projects; and for some pro je t t s , WHO has been designtatbcl

a s Executing Agency. WHO is a l so collaborating with the sub-regional organizations

such a s the Council of Arab Ministers of Health and the Secretariat-General of Health

for Arab Countries of the Gulf Area.

These a c t i v i t i e s w i l l be further developed and strengthened during the next

Mennium.

Major Programme

RESEARCH PROKITION AND DEVELOPNIENT

- To promote t h e development of t h e c a p a b i l i t y i n Member coun t r i e s t o undertake

biomedical research i n a l l its aspec t s ;

- t o support research a c t i v i t i e s i n p r i o r i t y a r e a s e s p e c i a l l y i n the f i e l d o f

h e a l t h s e r v i c e s research, inc luding research i n h e a l t h manpower development;

- t o i n i t i a t e , conduct and co-ordinate co l l abora t ive r e sea rch work of r eg iona l

importance e s p e c i a l l y i n a r e a s which a r e not being adequately supported;

- t o promote the d i f f u s i o n o f new s c i e n t i f i c knowledge and r e sea rch methods i n t h e

coun t r i e s of t h e Region;

- t o co l l abora t e i n the app l i ca t ion o f r e sea rch f ind ings i n t he development o f com-

prehensive na t ional h e a l t h serv ices .

Co-opera t i o n wi th and among c o u n t r i e s

Even though promotion of research has always been a component o f t h e a c t i v i t i e s

of t he Region, i t has acquired a new dimension, i n t he l a s t three yea r s , i n pursuance

o f Assembly r e s o l u t i o n s WHA 27.61, WHA 28.70 and W H A 29.64. An a c t i v e Regional

Research programme has been b u l l t up and w i l l be continued and expanded.

The Eas tern Mediterranean Advisory Cormnittee on Medical Research (EM ACMR), con-

s t i t u t e d i n 1976, has s i n c e m e t annual ly and has i d e n t i f i e d the re sea rch p r i o r i t i e s

of t h e Region and recommended an o v e r a l l plan o f work. Provis ion is made f o r annual

meetings i n 1980 and 1981. I n accordance wi th t h e recomaendations of t h e Cormittee,

three teams of expe r t s v i s i t e d seven c o u n t r i e s t o survey t h e r e sea rch p o t e n t i a l i n the

Region. A d i r e c t o r y o f r e sea rch i n s t i t u t i o n s has been compiled wi th d e t a i l e d p r o f i l e s

of t h e most a c t i v e i n s t i t u t i o n s and i t w i l l be maintained on an up-dated basis.

S c i e n t i f i c working gmup meetings took place i n 1977 on Heal th Se rv ices Research

and on S o c i a l and Behavioural Sc iences i n Health Se rv ices and Heal th Manpower Develop-

ment. They provided a conceptual framework f o r t he r e sea rch and pointed t o t h e stra-

t e g i e s f o r s t rengtheniqg c a p a b i l i t y w i th in t h e Region f o r t hese r e sea rch a c t i v i t i e s .

WHO Col labora t ing Centres have been designated i n c e r t a i n c o u n t r i e s t o c a r r y o u t re-

sea rch i n s p e c i f i c f i e l d s of enquzry, and co l l abora t ion wi th these w i l l be continued

and expanded.

In the biennium 1980/81, W H D w i l l continue t o operate a research programme geared

t o the health needs of the Region, i n an e f f o r t t o prorote the continuing involvemant

and act ive participation of Nember c o u n t ~ i e s i n identifying the i r problems and managing

national research programmes.

The overriding p r i o r i t i e s of research i n health services and manpower development

la id down by the EM ACMR w i l l be respected and implemented, and the mechanisms set

down by the 1977 meeting of the coxmuittee regarding the award of Research Contracts,

Research Grants and Research Training Awards wall be followed. In addition t o health

services research, continuing collaboration i n selected pr ior i ty areas, including com-

municable disease research,and research i n a variety of aspects of pharmacology and

therapeutics, rill be extended.

Major Programme

REGIONAL DIRECTOR'S DEVELOPMENT PROGRAMME

This programme w i l l be used i n a s f l e x i b l e a manner a s possible t o promote and

support technical co-operation a c t i v i t i e s . Sums an11 be released a s and when

pa r t i cu la r technical co-operation programmes evolve and require funds t o launch and

support them o r t o a t t r a c t extrabudgetary recources.

Among the a c t i v i t i e s w b c h a r e l i k e l y t o benef i t from t h i s programme a r e co-

operation between the countr ies of the Region i n heal th research and development.

Likewise, i t w i l l be used, a s required, t o develop fu r the r a c t i v i t i e s i n such f i e l d s

a s educational technology, programmes re la ted t o primary heal th ca re and overa l l

heal th development, communicable d isease control , technical co-operation i n non-com-

municable d isease control , na t ional drug po l i c i es and management, basic san i t a ry

services and pre-investment planning. This programme w i l l a l s o be used t o meet some

of the needs i n emergency s i t u a t i o n s , thereby responding t o Regional C o w i t t e e recom-

mendations f o r the establishment of such an emergency fund. An amount of $ 800 000

has been t e n t a t i v e l y set as ide from the Regular Budget f o r the biennium 1980/81 f o r

the Regional Director ' s Development Progrannne.

Voluntary contr ibut ions a r e s o l i c i t e d from Member S t a t e s of the Region t o supple-

ment t h i s programme.

Major Programe

HEALTH SERVICES DEVELOPMENT

Objectives:

- t o promote the strengthening of countries' capaci t ies for the planniw anQ manage-

ment of comprehensive national health services ;

- t o promote the development of primary health care;

- t o promote workers' health;

- t o promote the development of standard health technologies;

- t o promote a more rat ional production, d i s t r ibu t ion and u t i l i t a t i o n of r f e ,

effect ive and economic prophylactic, diagnostic and therapeutic substances,


In 1980/81, WHO w i l l continue t o cooperate v!ith countries t o strengthen the i r

capacity for the planning and management of t h e e eomprBhen'aive health serviaqa *<.the

various administrative levels , a s has been done i n previous years, notably, i n

Afghanistan, Democratic Yemen, I raq, Pakistan, Somalia, Sudan and the Yemen Arab

Republic.

Country health programming w i l l receive par t icular attention. WHO w i l l continue

to support national endeavours i n t h i s domain. Anotlrer area of collaborrtion wilJ

be medium-term programming (1928/83), an exercise which requires the closeat consulta-

t ion with countries. In addition, WHO w i l l a s s i s t whenever neoesa8ry i n the pro-

vision of emergency r e l i e f services t o meet the health needs of displaced persons,

a s requested.

The Regional Advisory Committee on Emergency Medical Services w i l l i n tens i fy i ts

e f f o r t s i n advising the Regional Director on ths development of these services i n the

countries interested. Collaboration i n the expansion of rehabi l i t a t ion services w i l l

a l so grow further.

The nature and scope of cooperation i n hospital services w i l l be guided to $0-

extent by the outcome of the study conducted by WHO i n 1976. P r io r i t y w i l l be

given t o t ra ining of non-medical hospital s ta f f .

Pr i lury health care w i l l oontinue t o receive p r io r i t y i n ths Context of technical

cooperation with and among, countries. This i s i n l i n e r i t h a Oe.olution (-5khZ.15)

adopted by the Regional Sub-committee A i n 1975 which "...INVITES Member S t a t e s to

continue t o cooperate i n exploring new ways of ensuring maximum coverage of t h e i r

populations by hea l th services..." Follow-up a c t i v i t i e s a r e under planning f o r the

period succeeding the 1978 Internat ional Conference on Primary Health Care (Alma Ata,

USSR) .

I n Appropriate Technology f o r Health, i t is envisaged tha t W H O col laborat ion w i l l

expand i n the biennium 1980/81 and w i l l involve designation of collaborating centres

i n the Region.

Under the same heading, (ATH), W H D w i l l support countr ies t o extend the scope of

t h e i r public heal th laboratory services t o the periphery. Co-operation w i l l a l s o

take place t o help countr ies t o design and improve nat ional l abora to r i e s f o r the

production and control of b iologicals , including vaccines.

The sub-programme i n Maintenance and Repair of Medical and Hospital Equipment is

expanding s teadi ly . I n 1980/81, WHO col laborat ion w i l l cover twelve countr ies and

w i l l include, i n addi t ion, support f o r two Regional Training Centres i n Cyprus and

I raq .

Many countr ies a r e expressing growing i n t e r e s t i n workers' health. W H O w i l l

co l laborate with Goverrunents and with o ther United Nations agencies ( e spec ia l ly L I B )

i n promoting the development of occupational heal th se rv ices with specia l emphasis on

t r a in ing of personnel including occupational hygienists .

Continuing support w i l l be given t o heal th se rv ices research geared pr imar i ly to

the tension of heal th coverage t o underserved communities.

Programme

Health Services Planning and Management

Objectives ;

- t o p a r t i c i p a t e with planning bodies and Minis t r ies of Health, i n the promotion,

review, adaptation and improvement of planning programming, and management procedures

and p rac t i ces f o r heal th services ;

- to increase the product iv i ty of hea l th se rv ices systems by promoting technical ,

adminis t ra t ive and l ega l changes where necessary, through s t u d i e s and research;

- t o extend the heal th i n f r a s t r u c t u r e , i n s t i t u t i o n s and se rv ices t o give access t o

hea l th care t o a s large a proportion a s possible of the population, urban and r u r a l ,

with pa r t i cu la r a t t en t ion t o the most remote and underprivileged people;

- t o provrde heal th se rv ices sui ted t o the needs of communities, a t an acceptable

c o s t under prevai l ing soc ia l and economic condrtions;

- t o give l o g i s t i c support t o hea l th programmes, with regard t o supplies, equipment,

pharmaceutical substances and t h e i r production, maintenance, etc. ;

- t o promote heal th information systems and disseminate the information on com-

prehensiue heal th services.


Member S ta tes , with WHO co-operatron, have continued t o increase the capac i t i e s

of t h e i r heal th services and t h e i r ef fec t iveness and eff ic iency. WHO c o n t ~ ~ b u t i o n s

a r e i n planning/programming, administrat ion and management, hospi ta l and donucil iary

care se rv ices , primary heal th ca re , appropriate heal th technology, t r a in ing of a l l

ca tegor ies of personnel, and heal th information.

The country heal th programming approach t o heal th planning deserves spec ia l a t ten-

t ion. I t IS a process designed t o iden t r fy p r i o r i t y hea l th problems of prime concern

t o countr ies i n the context of t h e i r development plans and t o formulate appropriate

programmes t o implement them. I t r e s u l t s from a nat ional commitment and is a nat ional

r e spons ib r l i ty , I t is an in te r - sec to ra l contrnuous process through a cycle of pro-

gramme formulation, rmplementatron, evaluation and reprogramming. I t r equ i res the

s e t t i n g of a permanent mechanism within the National Health Planning system. WHO

col laborates with In te res ted countr ies i n adapting t h i s f l e x i b l e method t o s p e c i f i c

nat ional conditions, and i n t r a i n i n g a c r i t i c a l mass of nat ional personnel, not only

i n public heal th services but i n o the r r e l a ted f i e l d s of socio-econonlc development.

National s t a f f t ra ined and experienced i n country hea l th programming then, p a r t i c i p a t e

i n s rmilar exerc ises i n o the r countr ies of the Region, thus contr ibut ing concrete ly t o

Technical Cooperation among Developing Countries.

The country heal th programming approach, which i s being already used i n Afghanistan,

Democratic Yemen, I r aq , Pakistan, Sudan and the Yemen Arab Republic, w i l l be taken up

by more countr ies i n the new brennium,and W H D w i l l contr ibute , on request , t o nat ional

e f f o r t s a t various s t ages of t h i s continuous process.

Another mechanism through which WHO is prepared t o cooperate with countr ies i n

providing more comprehensive, coordinated and technical ly sound heal th services , is

medium-term programming. I t represents , a t the nat ional and regional l eve l s , the

translat.. -; i n t o a c t i v i t i e s of the WHO General Programme of Work concerning a Spec i f i c

Period (now the Sixth General Programe of Work fo r the period 1978-1983). S ta r t ing

from the analys is ~f countries ' needs, p r i o r i t i e s and object ives , medium-term pro-

grammes a r e formulated Ln c lose consul t a t ion and association wr th national heal th

au thor i t i e s ; t h i s allows WHO t o be t t e r respOnd t o the needs of countries, through

two-year prograarpe budgets, and to make an evalua$ion amed a t p r o g r a m improvement.

Exercises i n medium-term programing, wNch began with health manpoyer development,

environmental heal th , and comprehensive health services w i l l be extended during the

next biennium t o the other main a reas of the Sixth General Programme of Work.

Health progrfmme developlpent, implementation and evaluation require, f i r s t , r e l i a b l e

heal th information. W H O is developing and rill continue Qurlng the next bienniur an

information system a t regional and global l eve l s , the aim of which is not only t o

meet the need 99 WHO fo r heal th information but t o i n t e r a c t with and develop national

hea l th information services , I n order t o serve p r o g r a l e s o f technical w l l r b o r a t i o n

with countr ies and the in tornat ional exchange of heal th and health-related in f~rmat ion .

The memory component of the information system is based on the "prof i le oarrrrept" a t

each echelon of heal th a c t i v i t i e s . Emphasis w i l l be put by W H O i n tbe next biennium,

i n c lose associa t ion with national hea l th au thor i t i e s , on the preparation of country

p r o g r a m p r o f i l e s covering information on a l l national hea l th progranmer, whether

ass i s t ed o r not by WW) and/or o the r sources of technical cooperatAon,

Hoapi t a l Administration h .

Objectives:

To cooperate with the countr ies of t h e Region i n developing in tegrated and

e f f i c i e n t hospi ta l se rv ices by:

- improvement of hospi ta l service planning;

- in tegra t ion of horpit.1 re rv ices i n tbe hea l th a r e de l ive ry sp~ tem;

- applicatkon of mderq managerial methods and development of managerial @ k i l l s ;

- appl icat ion of -ern hospi ta l a rch i t ec tu re and design;

- procuring su i t ab le hospi ta l equippent; and

- trainAng of hospi ta l s t a f f


A s countr ies of the Region spend a major p a r t of t h e i r heal th budgets on hospi ta l

services , these must be planned t o meet best medical care needs. I n pa r t i cu la r

tendency t o build specia l ized hosp i t a l s needs t o be curbed i n favour of general

hospi ta ls , which a r e considered bes t sui ted t o community needs, p a r t i c u l a r l y i n

developing countries. WHO cooperation is ava i l ab le i n hosp i t a l planning, i n stand-

a rd ia ing and procuring hospi ta l equipment, and i n r a i s i n g the q u a l i t y of hosp i t a l

management by the t ra in ing, p a r t i c u l a r l y of hosp i t a l administrators.

Consultant services w i l l be made ava i l ab le t o Djibouti t o study the hosp i t a l

services and advise on hosp i t a l planning and organization. Hospital equipment

needed t o improve the se rv ices w i l l be procured, and fellowships w i l l be ava i l ab le

e spec ia l ly f o r hospi ta l administrators.

I n Lebanon the organization of hospi ta l se rv ices w i l l be required. The necessary

equipment w i l l be provided a s w e l l a s fellowships i n hospi ta l management.

The Hospital Administration (UNDP) pro jec t i n Syr ia , s t a r t i n g i n 1978, w i l l

support the establishment of a hosp i t a l administrat ion u n i t i n the Ministry of Health,

the management of Al-Mojtahed Hospital i n Damascus; and the t r a i n i n g of hosp i t a l

personnel. I n addi t ion, WHO w i l l cooperate i n organizing and developing the capacity

of hosp i t a l s t o provide emergency medical care, including in tens ive care.

Emer~encv Medical Services

Objectives:

To a s s i s t the countr ies of the Region i n es tab l i sh ing e f f i c i e n t emergency medical

se rv ices a s in tegra l p a r t s of hea l th c a r e del ivery systems through co-operation in:

- making epidemiological s t u d i e s of the medical emergency condit ions, t o a s sess

the s i z e of the problem;

r planning and organizing emergency medical services ;

- standardizing equipment; and

- planning and Implementing t r a i n i n g p r o g r a m s f o r emergenay m ~ ~ I l a a l technia ians

(EMT's) and o the r personnel working i n these services .


Cr i t i c a l medical and surgical conditions resul t ing from cardiovascular diseses,

t r a f f i c and industr ia l accidents, intoxication and other conditions a r e increasing

rapidly i n almost a l l countries of the Region. Nany pat ients d i e because health

care systems a r e not equipped to deal with t h e m eff ic ient ly . Medical technology nor

makes i t possible t o provide emergency care i n time i f properly trained personnel a r e

available.

In Jordan, WHO rill provide consultant advice on the organisation 02 emergency

medical services, fellowships t o t r a in nationals preferably instructors rho rill then

t r a i n more national s ta f f . Equipment wi l l a l so be provfided.

Cooperation w i l l eentinue with the Government of Tunisia i n developing erergencg

services, by the provision of consultants, equipment and fellowships.

A seminar on emergency lnedical services w i l l be held i n 1981.

Primary H e a l t h Care

Objectives:

Principal objective

to promote the development of primary health care

Detailed objective

t o p r m t e , within a comprehensive national heal th system appropriate t o the

conditions and needs of each country, the provision of prirrrry health care to the

whole population, ensuring tha t populations that a r e nor underserved, and high-risk

and vulnerable groups, a r e properly served.

Co-operation r i t h and among countries

A s outlined i n the Sixth General Program9 of Work, the t a rge ts sbould be t o

ensure that an adequate quantity and qua l i ty of health -re is made m i l a b l e to a11

members of a community o r a l l inhabitants of a country, as w e l l a s m a x i m coverage

of underserved populations and high-risk and vulnerable groups, by p r i r r y heal th care.

I t is hoped t h a t by 1981 addi t ional countr ies w i l l have adopted the primary hea l th ca re

approach a s nat ional policy, including possibly Afghanistan, Democratic Yemen, Pakistan

and the Libyan Arab Jamahiriya.

WH) w i l l co l laborate in :

- promotion of primary heal th ca re i n countr ies by means of regional and nat ional

seminars, and through dissemination of information;

- es tab l i sh ing p i l o t p ro jec t s fo r h i t h e r t o unserved communities, with the a c t i v e

pa r t i c ipa t ion of the communities involved;

- evaluation and research a c t i v i t i e s per ta in ing t o PHC developments;

- arranging v i s i t s by WH) s ta f f / consu l t an t s i n the s p i r i t of technical cooperation.

Educational programmes or iented t o primary heal th ca re w i l l be es tabl ished and/or

improved i n countr ies where primary hea l th care i s delivered by heal th professionals.

I n t h i s connection WHO'S r o l e w i l l include:

- col laborat ion i n t r a i n i n g na t iona l s i n methods of organizing continuing education;

and

- col laborat ion i n the organization of continuing and in-service educataon.

The t h r u s t of the Regional Off ice is thus t o promote nat ional ac t ion i n primary

hea l th ca re a s an expression of technical cooperation. The Organization w i l l a o i n t a i n

its c a t a l y t i c r o l e t o support the development of primary heal th ca re a t the country

level .

Programme

Workers' Health 3.1.3

Objectives:

t o promote the hea l th of working populations, t o con t ro l occupational hea l th

r i s k s , and t o p r o m t e the humanitation of work.


A l m s t a l l countr ies i n the Region would be considered t o be i n a developing

s tage a s f a r a s workers* h e a l t h is concerned. Rapid urbanisation and i n d u s t r i a l i -

za t ion have given impetus t o the development of occupational hea l th se rv ices and have

st imulated Governments t o seek in te rna t iona l col laborat ion i n this important f i e l d .

T'he scopl of occupational hea l th se rv ices has widened and is aimed a t not only pre-

venting upational hazards but a l s o promoting workers' hea l th i n general. These

s e r v i c e s go beyond i n d u s t r i a l workers and embrace a l l ca t egor i e s of workers inc luding

of f ice-aorkers , a g r i c u l t u r a l workers and o thers . The bas i c problems of workers'

h e a l t h a r e somewhat s i m l a r i n t he var ious coun t r i e s of t he Region, but p r a c t i c a l

s o l u t i o n s may d i f f e r depending l a r g e l y on the development of genera l publ ic h e a l t h

s e r v i c e s i n each country.

A s ou t l ined i n the S i x t h General Programme of Work, W H O , i n co l l abo ra t ion with

ILO i n a r e a s of common i n t e r e s t , w i l l formulate o r r e v i s e s tandards and prepare guide-

l i n e s f o r p ro t ec t ion a g a i n s t occupational hazards and w i l l promote co-ordinat ion of

a c t i v i t i e s f o r s t rengthening t h e l e g a l , adminis t ra t ive and occupational framework t o

ensure h e a l t h and s a f e t y i n work places.

I t should be r eca l l ed t h a t a t t h e regional l e v e l , WHD has the mandate t o col labo-

r a t e with Member S t a t e s i n t he f u r t h e r development o f occupational h e a l t h s e rv i ces ,

a s expressed i n a number of Resolu t ions adopted by t h e Regional Committee i n 1950, 1966

and 1971. The Resolut ion (EM/RC21A/R,12) adopted by Sub-Committee A i n 1971 " ...... Requested the Regional Direc tor t o cont inue t o a s s i s t Governments i n co l l abora t ion

with o the r United Nations agencies concerned i n planning and developing t h e i r occupa-

t i o n a l hea l th a c t i v i t i e s wi th in the framework of publ ic h e a l t h s e r v i c e s , . . . . . . . . . " W H O w i l l co l l abo ra t e wi th coun t r i e s i n developing comprehensive occupational

h e a l t h programmes and s e r v i c e s t h a t a r e co-ordinated, and p re fe rab ly in t eg ra t ed wi th

the general publ ic h e a l t h serv ices .

WHO w i l l promote the development o f methods fo r t he e a r l y de t ec t ion of h e a l t h

impairment of workers; the c o l l e c t i o n and dissemination of information on s p e c i f i c

occupational h e a l t h problems and t h e i r so lu t ion , and on occupational hazards; and

w i l l coordina te and s t imu la t e research.

Col labora t ion i n the f i e l d of occupational h e a l t h w i l l continue t o expand. The

planned expenditure i n t he biennium 1980/81 amounts t o a sum of approximately $ 570 000

compared wi th about $ 200 000 expended i n the preceding biennium.

Programme

Care o f t h e Aged, D i s a b i l i t y Prevention and Rehab i l i t a t i on

Objec t ives :

To a s s i s t the coun t r i e s o f t h e Region i n e s t a b l i s h i n g and developing r e h a b i l i t a t i o n -- s e r v i c e s wi th spec ia l emphasis on prevention of d i s a b i l i t i e s through 'co-operation in :

assessment o f the d i s a b i l i t y problem;

- planning of su i t ab le rehab i l i t a t ion p r o g r a r e s ;

- in tegra t ion of the rehab i l i t a t ion p r o g r a m s i n the heal th eare hel ivery system;

- designing and Oquipping r e h b i l i t 8 t i o n aentrea; and

- pla&ng training;,progral~mes in the d i i f e r e n t aspects. o f rehabilitation;.


Public demand i s increasing f o r the care of d i s a b i l i i i e s resu l t ing from war

i n j u r i e s , t r a f f i c and other accidents; and neurologioal, psychiatric, cardiovascular

and chest diseaseg. Countries a r e therefore es tab l i sh ing and developing rehab i l i t a -

t i o n services i n t h e i r hea l th care systems.

WHO w i l l continue its co-operation with the Governments of Afghanistan, Djibouti ,

Jordan, Lebanon, Saudi Arabia, Somalia, Sudan and Syria, i n the developrent of t h e i r

r ehab i l i t a t ion services, by the provision of consultant and advisory services , fellow-

ships, supplies and equipment, and by ass is tance with the recruitment of s t a f f a s

requested.

The Internat ional I n s t i t u t e of Rehabi l i ta t ion fo r the Developing Countries, an

I ran Government-UNDP project , is expected t o begin functioning i n 1980/81, and WHO

w i l l continue its col laborat ion with t h i s project .

Appropriate Technology f o r Health

Objectives:

General object ive

To col laborate with countr ies i n the development and adaptation of simple, low-

cos t and e f fec t ive technologies i n spec i f i c areas.

Spec i f i c object ive

To support, by means of appropriate technology f o r heal th , the e f f o r t s of the

countr ies of the Eastern Mediterranean Region t o develop t h e i r heal th services with

pa r t i cu la r reference t o primary heal th care.

Co-omration with and among countr ies

The following regional t a r g e t s f o r the period including the biennium were set by

a Working Group on Appropriate Technology fo r Health which m e t i n the Regional Office.

i n November 1977:

- The improvement and adapta t ion of e x i s i t i n g technologies and the development

of new technologies.

- The development of systems and p r a c t i c e s f o r e f f e c t i v e and wide a p p l i c a t i o ~ l of

appropr ia te techniques and methods.

- The establ ishment and development of management systems f o r the la rge-sca le

app l i ca t ion of e x i s t i n g and improved techniques.

The problem of d iar rhoea1 d i s e a s e s is i d e n t i f i e d a s one w h c h should r ece ive

major emphasis.

Following prel iminary surveys of needs and p r i o r i t i e s i n appropr ia te technology

f o r hea l th , WHO w i l l c o l l a b o r a t e i n :

- t h e formulation of p l ans f o r technological r e sea rch and developme~lt ( inc luding

con tac t s , f i nanc ia l support , e tc . . . ) ;

- incorpora t ing r ecen t techniques and methods i n the t r a i n i n g o f primary h e a l t h

workers and o t h e r h e a l t h c a r e personnel ;

- the dissemination of information;

- in -serv ice t r a i n i n g o f h e a l t h p r a c t i t i o n e r s i n o r d e r t o p r o m o t e t h e r e f i n e m e n t o f

technologies; and

- the i d e n t i f i c a t i o n of and support t o co l l abora t ing c e n t r e s i n ATH.

I n the s p i r i t of t echn ica l cooperat ion, WHO w i l l co l l abo ra t e t o set up a Regional

network of i n s t i t u t i o n s involved i n the app l i ca t ion of app ropr i a t e technology i n

support of primary h e a l t h care , s o t h a t coun t r i e s w i l l a cqu i r e a c a p a b i l i t y i n the

choice, adapta t ion and a p p l i c a t i o n of technology f o r heal th.

Radiat ion Technology

Object ives:

- To in t roduce the concept o f bas i c r ad io log ica l s e r v i c e s i n t h e coun t r i e s of the

Eas tern Mediterranean Region.

- t o s t rengthen departments of rad io therapy, nuclear medicine and r a d i a t i o n pro-

t e c t i o n i n t he coun t r i e s of t he Eas tern Mediterranean Region.


I n t h i s f i e l d only two very small p ro jec t s a r e st i l l maintained %n the Programme

and Budget f o r the biennium 1980/81.

One d e a l s with the t r a i n i n g of radiographers i n Yemen Arab Republic and another

with the improvement of r ad ia t ion protect ion i n Saudi Arabia.

The concern of the Regional Off ice with the implementation of basic radiological

se rv ices and with the e f f i c i ency and eff icacy of r ad ia t ion medicine techniques,

although not expressed i n budgetary terms, w i l l be strengthened i n order t o prepare f o r

a more s u b s t a n a a l programme i n rad ia t ion technology f o r the 1982/83 biennium.

Maintenance and repa i r of medical and hospi ta l equipment

Objectives:

- To develop a network of workshops f o r the maintenance and repa i r of medical

equipment s t a r t i n g from the cen t ra l l e v e l and going towards the periphery;

- t o strengthen the Regional Training Centres f o r the Naintenance and Repair-of

Medical Equipment and t o d i v e r s i f y t h e i r t r a in ing a c t i v i t i e s .


This programme i s growing continuously - twelve country and two inter-country

p ro jec t s being included i n the Progranrne Budget fo r the biennium 1980/81.

With the development of the two Regional Training Centres i n Cyprus and I r a q and

the co-operation with twelve countr ies of the Region i n developing a network of rork-

shops f o r maintenance and repair of medical and hosp i t a l equipment, it is expected t h a t

some of the needs of programmes such a s the Expanded Programme on Immunisation, Publ ic

-81th Laboratories, and Radiologic Techniques w i l l be covered.

The experience p i n e d i n maintaining and repa i r ing medical and hosp i t a l equipment

w i l l be used f o r the assessment of the type of equipment which is the most s u i t a b l e

f o r countr ies i n t h i s Region i n such terms a s s impl ic i ty of operation, technical per-

formances, r e l i a b i l i t y , a v a i l a b i l i t y of spare p a r t s , and cost .

Laboratory Technology

Objectives:

- To increase the scope of work of the public heal th laboratory services i n the

countr ies of the Region and expand to the periphery by organizing o r reorganizing

the services ;

- t o augment epidemiological surveil lance a c t i v i t i e s ;

- t o improve the qua l i ty and increase the quant i ty of vaccines and sera produced;

- to t r a i n personnel a t d i f f e r e n t l eve l s , t o man d i f f e r e n t d i sc ip l ines of laboratory

services;

- to r a i s e the technical performance of l abora to r i e s by the establishment of qual i ty-

control methodology j

- t o col laborate with countr ies i n the development and adaptation of simple low-

cos t technologies i n s p e c i f i c areas.


Co-operation w i l l continue with almost every country i n the Region i n es tab l i sh -

ing o r modernizing t h e i r laboratory services. The general aim is the organization

o r reorganization of l abora to r i e s , increasing the quant i ty and improving the q u a l i t y

of vaccines and se ra products a s well a s of o ther b iologiaal material , and es tab l i sh -

ing departments t o apply the necessary methodology and bias-free controls. The

q u a l i t y of work and performance i n the laboratory an11 be emphasized and i n t e r n a l

mechanisms f o r the quali ty-control of more laboratory se rv lces w i l l be introduced.

Regional and national courses i n specia l laboratory techniques such a s have been

held throughout the Region i n recent years w i l l continue under t h i s programme a s the

need a r i ses .

I n the s p i r i t of TCDC, i t i s expected t h a t the donation of vaccines e.g. cholera,

TAB, r a b i e s and BCG, by some countr ies i n the Region t o o the r s w i l l continue.

P ro jec t s which have been successful ly completed i n Egypt and Sudan have increased

the capab i l i ty of the Region t o develop laboratory services.

The f i r s t phase of a four-year UNDP-financed project i n Tunisia has paved the way

f o r the development of four provincial l abora to r i e s during the biennium.

Co-operation w i l l continue a l s o i n developing Blood bank services and i n in t ro -

ducing the associated new techniques ~f p lasmphores is and application of component

therapy.

I n Lebanon a project document has been formulated f o r a lRJDP financed project

f o r the establishment of public hea l th laboratory services a t the cen t ra l public hea l th

laboratory i n Beirut and a t s i x provincial public heal th laboratories.

Progranane

Health Services Research

Objective :

To develop the capab i l i ty of Member Countries t o undertake operational research

with a view t o improving the design and management of t h e i r heal th services.

Co-opera t ion with and among countr ies

A S c i e n t i f i c Working Group on Health Services Research i n 1977, defined the

conceptual framework and the c h a r a c t e r i s t i c s of hea l th Services research. I t specif ied

c r i t e r i a f o r the designation of i n s t i t u t i o n s a s W H O Collaborating Centres f o r heal th

services research, a s w e l l a s the c r i t e r i a fo r the se lec t ion of research proposals f o r

WHO support. Also i t reviewed and approved research proposals which w i l l be imple-

mented during the period of the biennium.

The promotion of heal th services research w i l l continue, geared primarily t o

extending basic heal th services t o the a s yet unserved populations.

l a jo r Programme

FAMILY HEALTH

Objectives:

I n the context of the development programnes of the countr ies of the Region fo r

Comprehensive Health Services par t$cular ly f o r the populations l i v i n g i n r u r a l and

peripheral areas , and expecia l ly i n r e l a t i o n t o the vulnerrble groups of chi ldren and

women i n reproduotive l i f e , the main object ives of the family hea l th programe are:

- t o reduce morbidity and morta l i ty amongst in fan t s , chi ldren and mothers, and,

ul t imately, families and conmunities, from the c losely re la ted fac to r s of a l n u t r i t i o n ,

infect ion, unregulated f e r t i l i t y end lack of i n f o r m t i o n regarding health;

- t o develop and strengthen the family heal th component of heal th se rv ices part icu-

l a r l y a s p a r t of primary hea l th ca re and other developmental a c t i v i t i e s a f f e c t i n g the

l i v e s of famil ies and poople;

- t o promote a coordinated i n t e r s e c t o r a l approach t o improving the hea l th and

soc ia l welfare of the family a s a un i t ;

- to promote knowledge and appropriate technology f o r the p romt ion of human re-

production, the sound physioal growth and psychosoci+l development of the young, and

tho well-being of the family am a whole, through education, t r a i n i n g and research.

Co-operation with and among countriem

Between 42 and 50 per cent of the population i n countriem of the Region a r e under

the age of 15 years. Some 11 mil l ion chi ldren a r e born each year. An unacceptably

high proportion of t h 8 m d i e before reaching the age of f ive . Accompanyin@ t h i s

excessive morta l i ty is the high morbidity whlch represent8 much pain and almo mubmequont

permnent d i s a b i l i t y i n row ins tances t o the ch i ld and anguish t o the prentm. There

is a need t o i d e n t i f y mre c l e a r l y the problems and needm of the f a n i l y a s a whole i n

countr ies of the Region a s w e l l a s t o improve and re-orient hea l th ca re on the b a s i s

of the family a s a u n i t of care. Family heal th ca re u l t ima te ly depends upon the

education of family members about t h e i r remponsibil i ty f o r t h e i r own heal th care , and

of heal th workers who must see beyond the individual t o the family and the community.

I n giving p r i o r i t y t o a c t i v i t i e s i n maternal md c h i l d heal th , human reproduction,

n u t r i t i o n and heal th educzation, and working towards the development of canprehensive

hea l th services , hea l th manpower development and comunicable d isease con t ro l , WHO w i l l

co l laborate with governments in :

a ) improving the administrat ion and management of se rv ices f o r providing integra ted

maternal and chi ld heal th , n u t r i t i o n and f e r t i l i t y regula t ion ca re by:

- the development and adaptation of methods fo r improved del ivery of heal th ca re i n

the preconceptional, prenata l , na ta l and postnatal periods, i n infancy and i n child-

hood ;

- revised and appropriate t r a in ing f o r adminis t ra tors and senior teachers i n maternal

and chi ld heal th care , the t r a i n i n g of primary hea l th workers i n n u t r i t i o n and heal th

education, and the building and strengthening of nat ional c a p a b i l i t i e s f o r t r a i n i n g

i n specia l techniques fo r f e r t i l i t y management and maternity care;

- f e a s i b i l i t y t r i a l s on the del ivery of n u t r i t i o n and f e r t i l i t y r e g u l a t ~ a n service

a s an i n t e g r a l pa r t of primary heal th care ; and

- par t i c ipa t ion i n the WHO Expanded Programme on Immunization and i n spec ia l

ac t i v i t i e s f o r the improved management of diarrhoea1 d i seases i n c h l d r e n ;

b) improving information and technology development f o r family heal th in :

- the prevention and management of d isorders of pregnancy and c h i l d b i r t h e.g.

toxaemia of pregnancy;

- f e r t i l i t y regula t ion by means of s tud ies on the hea l th r a t iona le f o r family

planning; assessment, improvement and development of methods f o r f e r t i l i t y regula t ion;

epidemiological research on i n f e r t i l i t y ; and the strengthening of nat ional resources

f o r research i n human reproduction;

- the promotion o f , preparation f o r , establishment and protect ion of breast-feedings;

- the promotion of physical growth and psychosocial development of the young;

s t u d i e s on the epidemiology, prevention and soc ia l implications of low b i r t h weight;

improved ch i ld n u t r i t i o n i n the weaning and preschool periods;

- prevention and management of in fec t ions i n mothers and i n young chrldren;

c ) promoting the heal th o f the family a s a whole by the development of low-cost

educational methods f o r hea l th education of f ami l i e s i n family heal th ; and i n

d ) strengthening the i n t e r s e c t o r a l approach f o r improving the hea l th of the family

and cornunity a s a whole through support t o the development of food and n u t r i t i o n

p o l i c i e s , and assessment of the ex ten t and control of def ic iency diseases , i n collabora-

t i o n with FA0 and UNICEF.

Pronramme

Maternal and Child Health

O b ~ e c t i v e s :

The long- term ~ b j e ~ t l ~ t ? ~ of the programme are :

- t o a s s i s t governments i n t h e i r e f f o r t s t o reduce maternal, pe r ina ta l , i n fan t

and childhood mortal i ty and morbidity;

- to st imulate and f a c i l i t a t e the systematic and expanded appl ica t ion of preventive,

cura t ive and r e h a b i l i t a t i v e measures i n maternal and c N l d ca re through the provision

of heal th and other socia l services , i n order t o promote the optimum physical growth

and psychosocial development of the ch i ld , improve reproductive health, and enhance

the qua l i ty of human l i f e ;

- t o col laborate with countr ies i n the development and strengthening of nat ional

capac i t i e s f o r provision of maternal and ch i ld care, including family planning, a s

pa r t of heal th and re la ted soc ia l services.

The medium-term object ives are:

- t o col laborate with the countr ies i n MCH redevelopment programmes whlch aim a t

defining the problems, the resources, present coverage and p r i o r i t i e s , evaluat ing new

approaches, a s s i s t i n g with t r a in ing and f a c i l i t a t i n g expansion of improved MCH care;

- t o col laborate with the countr ies i n s p e c i f i c a reas of emphasis including ex-

pansion on immunization, the prevention and treatment of dehydration i n acute diarrhoea1

disease of e a r l y ahildhood, and the promotion of breast-feeding.


The Organization w i l l continue t o col laborate with countr ies i n respect of

fu r the r development of t h e i r MCH se rv ices I n general . The B6ja project i n Tunisia

has been useful i n introducing a number of appropriate new techniques and methods.

I n Somalia the programme f o r the improvement and expansion of MCH se rv ices funded

by UNFPA with WHO a s Executing Agency is being implemented. Co-operation w i l l

continue with the Governments of Syr ia and I r a q and the United Nations Relief and

Works Agency f o r Pales t ine Refugees i n the Near East, i n the general development of

t h e i r MCH services.

The Technical Discussions on the Present S t a t e of Child Health i n the Region,

a t the Regional Committee i n 1978, and the i n t e r e s t aroused by the designation of 1979

a s In te rna t iona l Year of the Child, a r e l i k e l y t o r e s u l t i n increased a c t i v i t y t o

reduce morta l i ty and morbidity i n infancy and e a r l y childhood, during the biennium.

I n regard t o the second medium-term object ive , the r e s u l t s of o r a l rehydration

t r i a l s i n I r an and Egypt i n 1977-78 and i n Somalia i n 1978, w i l l be applied throughout

the Region during t h e biennium. Large q u a n t i t i e s of the WHO guidel ines on the pre-

vention and treatment of dehydration have been d i s t r i b u t e d i n English and i n Arabic.

Oral rehydration s a l t s a r e being produced i n Egypt and Syria. Research t o evaluate

various approaches towards popularising o r a l rehydration e a r l y i n the course of

d iar rhoeal a t t a c k s i n i n f a n t s and young chxldren has been approved a s high p r i o r i t y

by the Regional Advisory Cormnittee on Biomedical Research. The MCH and Nutr i t ion ex-

p e r t i s e i s pa r t of a new group formed a t the Regional Off ice t o a s s i s t the countr ies

t o formulate and implement programmes of control of e n t e r i c in fec t ions , one of whose

main t a r g e t s w i l l be subs tan t i a l reduction of the unbearably high morta l i ty and mor-

b i d i t y i n chi ldren under three years from acute d iar rhoeal diseases.

Programme

Nutr i t ion

Objectives:

- To a s s i s t the Governments i n reducing the incidence of a l l forms of malnutri t ion

and i n promoting b e t t e r n u t r i t i o n of a l l individuals;

- t o col laborate i n developing the heal th component of mul t isectora l food and

n u t r i t i o n p o l i c i e s and programmes;

- t o promote and f a c i l i t a t e the control of s p e c i f i c n u t r i t i o n a l def ic iencies ;

- t o promote the development of nu t r i t iona l - s t a tus survei l lance systems.


The approaches taken by the countr ies i n col laborat ion with Wig) i n the period of

the S ix th General Programne of Work include assessment of t h e magnitude of n u t r i t i o n

problems; planning and implementing n u t r i t i o n progralaes i n the heal th se rv ices ;

opera t ional research t o i d e n t i f y and evaluate lost appropriate methods of resolving

n u t r i t i o n a l problems; t r a i n i n g i n n u t r i t i o n , with col laborat ion of FAO and UNICEF where

appropriate; and taking s t e p s towards the formulation of nat ional food and n u t r i t i o n

p o l i c i e s .

The experience gained i n national n u t r i t i o n surveys i n Tunisia and Egypt w i l l

be applied i n s imi lar surveys i n o ther countries. I n respect of Pales t ine refugees

an endeavour w i l l be made to construct a simple n u t r i t i o n a l survei l lance system based

on MCH records. Likewise the National Nutri t ion I n s t i t u t e of I r a n , with WHO consul-

t a n t ass is tance , has planned t o undertake a p i l o t n u t r i t ~ o n a l s t a t u s survol l lance

system based on the records of a primary heal th care programme north of Teheran.

S t i l l i n the a rea of assessment, but i n t h i s case i n respect of Vitamin A deficiency

and xerophthalmia, the preliminary appra i sa l s which a WHO consultant ophthalmologist

has carr ied out i n a number of c o r n t r i e s w i l l be repeated i n o ther countries; where

these appra i sa l s ind ica te the need, WHO w i l l a l s o col laborate i n nation-wide o r

province-wide Vitamin A-deficiency surveys t o provide baseline data f o r ac t ion pro-

grammes t o solve the problem.

The findings of operational research p ro jec t s t o evaluate home-made weaning foods,

i n the Sudan, and to f ind p rac t i ca l ways of including n u t r i t i o n i n primary heal th care ,

i n Somalia, w i l l influence programmes i n the biennium, a s w i l l t he outcome of t r i a l s

i n the Region on the appl ica t ion, a t v i l l age l e v e l , of o r a l rehydration f o r chi ldren

with diarrhoea1 diseases.

The Regional Food and Nutr i t ion Training project i n which W H O collaborated with

UNICEF, FA0 and UNESCO, and which ended i n 1978, w i l l be followed up by nat ional

t r a in ing programmes. Regional courses can still take place i n whatever sub jec t s the

need i s apparent. Collaboration between the agencies a t regional level w i l l be

maintained by the Inter-Agency Co-ordinating Committee on Food and Nutr i t ion which

held i t s f i r s t meeting i n April 1978.

In regard t o nat ional food and n u t r i t i o n policy, one of the d i f f i c u l t i e s facing

governments i s sometimes t h a t of iden t i fy ing the sources of re levant da ta , making some

in te rp re ta t ion of them, and iden t i fy ing the po ten t i a l resources within the government

min i s t r i e s and agencies a s a whole f o r formulating and implementing such a policy.

I n t h i s respect , j o i n t FAO/WHD/UNICEF missions such a s took place i n Somalia i n 1976

and the Sudan i n 1978 can be helpful , e spec ia l ly i f they can suggest some thoughts a l s o

on the machinery of formulation and implementation. Impl ic i t o r e x p l i c i t food policy

has exis ted i n almost every nat ion-s ta te s ince the e a r l i e s t recorded history. I n our

Region, the building-up of famine reserve stocks i n ancient Egypt i s a very widely

known example, I t remains t o be seen t o what extent i n any one s t a t e the mult i tude

of impl ic i t and e x p l i c i t food policy ac t ions can be r a t i o n a l i ~ e d and made mutually

supportive i n the shape of a formal food and n u t r i t i o n policy.

Programme

Special Programme o f Research, Development and Research Training i n 3.2.3 Human Reproduction

Objectives:

- To improve the hea l th of mothers and children and ul t imate ly of famil ies and

comunities, through reduction of hea l th r i s k s i n human reproduction, encouragement

of responsible parenthood, and promotion of growth and development of children and

youths;

- t o col laborate with countr ies on t h e i r request , i n improving maternal and ch i ld

heal th services , with specia l a t t e n t i o n t o prenatal care , midwifery services both

i n s t i t u t i o n a l and donucil iary, postnatal care of mothers, care of i n f a n t s and chi ldren,

and f e r t i l i t y regula t ion including treatment of i n f e r t i l i t y ;

- t o col laborate i n the development and improvement of o b s t e t r i c , gynaecological

and paed ia t r i c services i n r e l a t e d i n s t i t u t i o n s , and i n the t r a in ing of required

categor ies and numbers of hea l th personnel fo r these services ;

- t o help t o c l a r i f y the re la t ionsh ips between heal th , human reproduction, popula-

t i o n dynamics and family plannang;

- t o undertake, support and guide appropriate research i n human reproduction.

Co-operation with and amonP countr ies

A c t i v i t i e s under t h i s programme a r e c losely r e l a t e d t o those described under the

NCH programme, but with added emphasis on maternity care and midwifery services , and

re la ted research i n human reproduction. Family planning a c t i v i t i e s a r e o r i en ted t o

hea l th object ives , 1.e. primarily r e l a t e d t o the hea l th of mothers, chi ldren and

families. Moreover, the problems of s u b - f e r t i l i t y and i n f e r t i l i t y , deserve equal

a t t e n t i o n with those of high f e r t i l i t y .

Programmes and p ro jec t s of in tegra ted MCH and family planning a c t i v i t i e s with

hea l th ob jec t ives have been es tabl ished i n col laborat ion with UNFPA i n Afghanistan,

Democratic Yemen, Jordan, Somalia, Sudan, Syria and Yemen. The main purpose of these

p ro jec t s is t o improve the q u a l i t y and coverage of MCH care se rv ices , through w e l l -

planned expansion of the i n f r a s t r u c t u r e of urban and r u r a l MCH Centres. Such improve-

ment depends, apa r t from physical f a c i l i t i e s on e f f e c t i v e t r a i n i n g and s t a f f i n g pa t t e rns ;

on good co-ordination with, and support to , primary heal th care; and on s imi la r

e f f e c t i v e co-ordination with and support from specia l ized medical cen t res and maternity

hosp i t a l s ,

During the biennium (1980-81),an inter-country project on socia l and preventive

o b s t e t r i c s w i l l begin under the WHO regular budget, I t i s intended t o supplement

and strengthen tho a c t i v i t i e s already carr ied out under a UNFPA-supported inter-country

project i n Family liealth, and t o give specia l a t t e n t i o n t o problems of pe r ina ta l and

maternal morta l i ty , low birth-weight and cervical cancer, Other s ign i f i can t heal th

problems re la ted t o o b s t e t r i c s and midwifery, e.g. abort ions, breast-feeding, f e r t i l i t y /

i n f e r t i l i t y w i l l a l s o be looked in to . The matter of t r a in ing and u t i l i z a t i o n of

t r a d i t i o n a l b i r t h a t tendants , and su i t ab le involvement and pa r t i c ipa t ion of the com-

munity i n this regard, w i l l continue t o be emphasized through meetings, courses and

exchange of v r s i t s among s imi lar and in te res ted countr ies of the Region.

The needs of in te res ted countr ies i n research i n human reproduction a r e being

responded t o through coordination from WHO Headquarters and the Regional Off ice ,

through technical advisory ass i s t ance (Tunisia) , establishment of Collaborating Centres

of C l in ica l Research (Egypt, Pakistan and possibly I r a n ) and pa r t i c ipa t ion of se lec ted

nat ionals i n specia l ised meetings and f i e l d s tudies . These a c t i v i t i e s w i l l be

strengthened i n accordance with needs and accomplishments.

Programme

Health Education

Objectives:

- To col laborate with member s t a t e s i n the development of s u i t a b l e heal th education

programmes and a c t i v i t i e s , with main emphasis being l a i d on individual and community

involvement i n the ac t ion programmes;

- t o a s s i s t the general publ ic , both urban and r u r a l , i n t h e i r understanding o f ,

and s e l f-education i n , heal th matters, s o tha t they may assume more respons ib i l i ty

i n the promotion of individual , family and community health;

- t o encourage the expansion of hea l th education a s an important and e s s e n t i a l

component of ex i s t ing and developing heal th se rv ices i n member s t a t es .

- to help in tegra te heal th education i n t o the overa l l heal th and welfare services.


Guidance on the promotion of hea l th education has been derived from the Regional

Sub-committee A Resolution (No.EM/RC27A/R.B) of 1977, which s t a t e s i n t e r a l i a t h a t ,

"programmes i n primary heal th ca re w i l l not be successful without adequate heal th

education based on the needs and wants of the communities", and t h a t Member S t a t e s

should "strengthen t h e i r hea l th education services ... "; and from Regional meetings

on Health Education Aspects of Family Health, i n 1977; on the Expanded Programme on

Immunization, i n 1977; and on Primary Health Care, i n 1978.

During the b i e ~ i u m (1980-81) WHO w i l l promote hea l th education a c t i v i t i e s i n sup-

por t of primary heal th care ; family heal th , with Special a t t e n t i o n t o maternal and ch i ld

heal th , immunization and n u t r i t i o n ; and the control of diarrhoea1 diseases p a r t i c u l a r l y

among children. I n addi t ion, specif i c programmes t o improve midwifery services , e.g.

t r a i n i n g and use of t r a d i t i o n a l b i r t h a t tendants , w i l l be promoted. Research and

f i e l d s t u d i e s a r e needed on socio-cul tura l pa t t e rns and the "needs and wants of the

communities", and it i s proposed t o carry out a t l e a s t one f i e l d study i n a s u i t a b l e

country during the biennium, More such s tud ies w i l l be promoted. Such s t u d i e s and

research could be carr ied out i n f i e l d t r a in ing a reas of heal th personnel t r a i n i n g

i n s t i t u t i o n s .

WH) w i l l continue t o col laborate with a l l countr ies of the Region, on request ,

i n the promotion of heal th education.

Major Programme

MENTAL HEALTH

Objectives :

- to promote mental health ac t i v i t i e s through bet ter planning and a more effect ive

organizational framework6

- to prevent o r reduce mental and neurological morbidity and i ts consequences;

- t o strengthen mental health services, improve the quality of care and provide

training f a c i l i t i e s for the development of manpower resources ;

- t o increase awareness of the mental health implications of socio-economic changes

and establ ish preventive measures,;

- to promote national p i l o t projects for the developept of bet ter preventive,

therapeutio and rehabi l i ta t ion measures i n drug dependence;

Cooporation with and among countries :

The t ! r n s t of the programme w i l l be directed into the following major areas a t

Regional and country levels:

A. REGIONAL

(a ) Planning, organization and management in mental health care

The important targets t o be achieved are:

- developent of competent national administrative bodies for proper planning and

e f fec t ive prograaming;

- integration of mental health care with the general health system and co-ordination

of a c t i v i t i e s with related social services;

- developent of relevant psychiatric f a c i l i t i e s more responsive t o ooplpp~nity needs

with due emphasis on extension of services to the periphery;

- up-dating mental health regulatiomand laws;

- development of an appropriate model for mental heplth information systems.

(b) Developpent of mental health workers and promotion of psychiatric t ra ining

programmes

Along with the promotion of psychiatric t ra ining i n general, special emphasis w i l l

be given to the developent of psychiatric nurse teachers i n the Region, This is

considered a major ac t iv i ty for strenthening the mental health t ra ining programme for

general health workers as well as for psychiatric personnel.

Other camponensof the proposed programme w i l l focus on mental health t ra ining i n

schools of public health and on the promotion of postgraduate s tudies i n psychological

medicine.

(c) Programme ac t iv i t i e s for dealing with specif ic problems o r issues:

- prevention and treatment of drug dependence and alcoholism;

- promotion of child psycho-soc~al development and mental health care;

- c a r e o f long-termpsychiatricpatients,

B. COUNTRY

Development of country mental health programme

- i n i t i a t i o n of mental health programmes i n cer ta in countries where no such a c t i v i t i e s

have been previously available, as i n Yemen Arab Republic ;

- supporting exis t ing rudimentaiy programmes, as i n Afghanistan, Somalia and Sudan

(Southern Region) ;

- i n i t i a t i n g t ra ining and promoting the developnent of professional mental health

workers ;

- collaborating with national au thor i t i es t o move mental health care from hosptial-

based services t o community-oriented f a c i l i t i e s , e.g. the Libya project.;

- developent of rura l psychiatry - new models a r e under way i n Sudan and Egypt;

Major Programme

PROPHYLICTIC, DIAGNOSTIC AND THERAPEUTIC SUBSTANCES 3.4 - Objectives :

- t o provide ass is tance i n the establishment and promotion of pharmaceutical

production and drug-supply se rv ices ;

- t o formulate in te rna t iona l spec i f i ca t ions f o r t h e qua l i ty of drugs, guidelines f o r

good manufacturing pract ices , and in te rna t iona l non-proprietary names fo r pharmaceut-

i c a l substances ;

- t o promote the exchange of information by nat ional regulatory au thor i t i e s on the

s c i e n t i f i c evaluation of drugs f o r sa fe ty and eff icacy, on drug r e g i s t r a t i o n and on

data t h a t form the bas is fo r decisions t o withdraw drugs from the market ;

- t o promote the monitoring of drug utilization and assessment of ef f icacy i n

medical pract ice , and the assessment of drug requirements with spec ia l reference t o

primary heal th ca re and r u r a l areas , and thereby give guidance on the se lec t ion of

e s s e n t i a l d rugs ;

- t o a s s i s t member countr ies i n the development of capab i l i ty t o formulate and

implement r e a l i s t i c drug p o l i c i e s ;

Cooperation with and among countr ies

For e f f e c t i v e and economic prophylaxis and therapy of d iseases an appropriate

supply of drugs is required. Governments have requested t h e col laborat ion of W H O i n

the establishment and fu r the r development of t h e i r drug supply and control organiza-

t ions f o r the period 1980/81 a s i n previous years.

A s e f f i c i e n t heal th ca re se rv ice r e l i e s on the cor rec t choice and use of drugs,

W H O has been requested t o strengthen nat ional e f f o r t s t o improve t h e r a t i o n a l i t y of

drug u t i l i z a t i o n .

I n countr ies where it is intended t o extend the heal th services , heal th planning

must include a r e l i a b l e fo recas t of the kinds and cos t of drugs t o be supplied t o

newly es tabl ished heal th care services , especia l ly i n t h e r u r a l and prlmary hea l th

ca re area. The WHO publ ica t ion "The Select ion of Essent ia l Drugs" (Technical r epor t

series 615, 1977), provides a valuable reference.

Drug u t i l i z a t i o n s tud ies can contr ibute necessary data and should be included

i n planned programmes. In c a n t r i e s where ecoi~omic conditrons permit medical ca re

free of charge for everyone rho needs it, priority is allocated to improvements of the

existing services and strengthening of their efficiency. In such countries, the drug

utilization study is one of several tools to approach optimal drug therapy. Precise

information on e.g. irrational prescribing, abuse of drugs or insufficient information

to patients on the use of drugs, provides the basis for corrective action. This

Wm activity requires the interdisciplinary collaboration of technical units respon-

sible for prophylactic and therapeutic substances, developaent of health manpower and

primary health care; it has opened a new area of operational research. The import-

ance of keeping drug costs as low as is consistent with reliability is self-evident.

The application of a realistic purchasing policy particularly in the case of imported

drugs presents some substantial difficulties. In this respect evidence of manufac-

turers* standards of operations provides a better safeguard than a c e r t i f i c ~ ~ ~ of

analysis relating to an individual batch or consignment.

The importance of these two factors is underlined by the fact that pvrchase of

drugs consumes about 15 to 20 percent of total health budgets, and that miscalculations

in drug supply and utilization threaten the functioning of otherwise well-planned

projects at the root. Drug utilization studies are under way in two countries:

Democratic Yemen and Sudan, in an endeavour to assess drug needs in the oontext bf

primary health care.

Wm will continue to collaborate by providing fellowships for the training of

various professional categories of personnel; organizing regional seminars and train-

Ing courses on subjects relating to drug regulation and surveillance; providing

consultants to advise on and train in drug procurement control, utilization and

surveillance; supplying information on drug specifications and warning of any adverse

reactions to drugs in use; and supplying materials and equipment for quality control.

Drug policies and management

Objectives :

- to collaborate with Member States in the development and improvement of national

services responsible for drug legislation and administration ;

- to strengthen the potential of Member States to secure m adequate supply of

the most suitable and useful drugs at reasonable cost to the public and private sectors

of health services ;

- to assist in the asressnent~of countries* needs for ph'annaceutical products in

the light national health goals ;

Cooperation with and among countries

For effective planning and management of pharmaceutical services, government

agencies must be adequately staffed with specialists in the relevant branches of

medicine (0.g. clinical pharmacology) and pharmacy (e.g. pharmaceutics, biopharmacy).

Sons, countries have sent nationals abroad for specialized training; others plan to do

so. Consultants advise on structural improvements of drug administrative services.

They facilitate modernizing of drug legislation and the updating of National Formularies.

Evaluation of drugs for efficacy, safety, economy and their compliance with the health

needs of the country, is promoted by WHO'S drug information services, and by training

of professionals. Continuingoomparisonof drug demands with substantiated drug require-

ments has been and will continue to be organized at the national and intercountry levels

in collaboration with WHO. Countries participating in these activities are Democratic

Yemen, Egypt, Iran, Iraq, Libyan Arab Jamahiria, Pakistan, Sudan and Tunisia.

WHO will continue to collaborate by providing consultants, advisory services and

fellowships, and arranging for the exchange of ideas and experience by means of group

meetings and consultations .

Phannaceutioals & Biologicals 3.4.2 - Objective :

To collaborate with Member States in the development and improvement of drug

production, standardisation, storage, distribution and in all aspects of control of

quality of drugs produced in Member Countries and/or wving in international commerce.


The quality of pharmaceutical preparation is ensured by proper product developnent

including stability studies, establishment of a product specification, observance of

a code of good practice3 and quality control in manufacture, and, finally, by storage

under appropriate conditions during all stages of the distribution chain. Government

regulatory organizations contribute to the assurance of quality by inspection of

facilities and operations in all stages of production and distribution and by planned

sampling programmes for the laboratory testing of drugs. They may also give technical

guidance regarding quality assurance, and publicise matters such as the WHO code of

Good Manufacturing Practices. Collaboration in this field involves assistance in the

establishment or upgrading of pharmaceutical inspection services and quality control

laboratories especially by training personnel. This collaboration will continue during

1980/81. Special emphasis w i l l be placed on effect ive inspection of pharmaceutical plan

and operations for adherence t o good manufacturing practices, t h i s being potent ia l ly

the most economically beneficial aspect of the work of a regulatory authority.

I t is recognized that there is a need for substant ia l quant i t ies of standard

reference substances for use i n governmental and commercial quality-control laboratories

of the Region. I t is intended therefore t o explore the poss ib i l i ty of developing

the potential of one o r more national laboratories t o prepare, ca l ib ra te and d i s t r i bu t e

standard reference materials. The aim would be tha t such laboratories would be

designated by WHO as suppliers of Regional Reference Standards.

WHO w i l l continue t o collaborate by the provision of long- and short-term consul-

tants , advisory services, fellowships, reference literature, standard reference materials

and equipment necessary for WHO-supported projects.

Major Programme

00MMUNICABLE DISEASE PREVmION AND CONTROL 4.1 - O b j e ~ t i ~ o S :

- t o strengthen national and international epidemiological surveillance of commun-

icable diseases of major public health importance;

- t o collaborate with countries i n evolving programmes for the control of commun-

icable diseases, in particular: malaria, schistosomiasis, f i l a r i a l infections, trypano-

somiasis, communicable diseases of the respiratorygstem, tuberculosis, en te r ic

infections, leprosy, sexually transmitted diseases, zoonoses and other communicable

diseases of major public health importance; and t o provide prompt and effect ive

assistance i n emergencies;

- t o complete and maintain smallpox eradication i n the Region;

- t o expand the use of immunization, through the health services, i n the control

of those diseases for which effect ive inmunizing agents and methods ex is t ;

- t o promote research on e f fec t ive and economical measures for the prevention and

control of the communicable diseases i n close association and aollaboration with the

Global Promamme for Reseach and Training i n Tropical Diseases.


Communicable diseases continue t o be one of the most important health problems

i n the Region i n s p i t e of the considerable change which has occurred in patterns of

morbidity and mortality and the progress achieved i n t he i r ~0ntN3l . The problems posed by these diseases c a l l fo r a f lex ib le approach and theiwiaptation

of preventive and control measures t o national circumstances and poss ib i l i t i es .

WHO is continuing collaboration with governments i n the control and eradication

of specif ic communicabl3 diseases through organized campaigns, manpower training,

fellowships, supplies and equipment. Special a t tent ion w i l l be given t o strengthening

surveillance reporting and recording systems. The main thrusts w i l l be through the

Expanded Programme on Immunization (EPI), the control of vector-borne and water-

associated diseases, the prevention of blindness and the programme for diarrhoea1 d i s -

eases including cholera. Appropriate measures for the maintenance of smallpox eradica-

t ion w i l l be continued.

Contributions to the Voluntary Fund for Health Promotion, for EPI, have been

made by Saudi Arabia, Kuwait, Iran and the United Arab Ehirates; and W H ) with UNICEF

is collaborating with national EPI projects throughout the Region, and i n an inter-

regional UNDP-supported project concerned with vaccine production, quality control,

c o l d chains for presgrvation of vaccine and logis t ic support.

The regional plan for the control of diarrhoea1 diseases and the prevention of

cholera,fomulated by the Regional Meeting on Cholera and Diarrhoea1 Mseases,will be

pursued during the biennium with WH) collaboration.

The "border" meetings w i l l be continued to enhanoe necessary oooperation among

neighbouring countries i n malaria eradication and control.

Similar "border" meetings involving Syria, Jordan, Lebanon and possibl- *&ey

are thought advisable for schistosomiasis control. In th i s respect also, provision

w i l l be made a t the pre-planning stages of new irr igat ion schemes and water develop-

ment peojects to minimize the i r potential health hasards.

The plan of action prepared by the Cor~lnittee t o study the prevention of blindness

i n the Region established by the Regional Sub-Committee "A" w i l l be follarnd Qlting the

biennium.

Prograume

Programme planning and general ac t iv i t ies

Objective:

TO prepare a medium-term programe for conmanicable disease control.


The W H 3 Collaborative Medium-Term Prograring Working Group, including Headquarters

and Regional Office participants, is scheduled to m e e t during the f i r s t w . d r of October

1978 (tentatively in E3HRO), to prepare for the draring-up of regional mediur-ten

p r o g r a e s on w-icable diseases.

I t is therefore anticipated that, following t h i s meeting, a medium-term program8

on unmunicable diseases prevention and control i n the Region for 1978/83 w i l l be

formulated.

Consultations with Governments i n the Region wi l l take place for th i s purpose

as necessary.

Programme

Epidemiological surveillance

Objectives:

- t o a s s i s t countries i n planning and develop&ng national epidemiological service& and

coordinate regional ~ ~ r ~ e i l l a n ~ e of comunicable diseabar;

- t o a s s i s t i n studying development, implementation and evaluation of cop.uniqable

disease control prograamer including @valur$ion of Imunization prograaraes;

- t o promote and a s s i s t with Seminars, conferences, technical meetings and t ra ining

courses i n the broad f i e ld of epidemiology and other more spec i f ic f ie lds ;


The epidemiological services have not developed equally i n the oountriee of the

Region and there a re considerable gaps i n knowledge of geographical dis t r ibut ion of

most communicable diseases, of populations a t r isk, of what degree of p r ior i ty cummun-

icable diseases should receive among health problems, and on the f ea s ib i l i t y of control.

Epidemics of new diseases have occurred with considerable loss of l i f e . In the

absence of adequate epidemiological services and laboratories, assistance is provided

a t government request for emergenay services and/or the ident i f icat ion of aet iological

agents. Mssernination of information is also undertaken.

To achieve the objectives of t h i s programe, oountries must es tabl ish oontral

epidemiological intell igence un i t s supported by a network of no t i f ica t ion agents

reaching the most remote areas. Such surveillance mechanlsns ex i s t i n many oountries

of the Region as part of former mass campaigns, but a re not fu l l y uti l ized. Simple

screening mechanisns su i tab le for use by primary health care workers can be of great

value i n defining t h e geographical dis t r ibut ion of disease and for ear ly warning of

impending epidemics.

W K ) w i l l oontinue its collaboration with the countries of the Region in establish-

ing ep idg~io logioa l services end t ra ining epidemiologists and other s ta f f by providihg

consultants and advisory services and supplies and equiprent when nmeesary.

Governments are nor w e l l aware of the importance of inter-wuntry ooordiaation, in

part icular i n the control of qlrarantinable dieeases. The oorron policy rhioh emerged

from meetings held during the 1977 Session of the Regional Cornittee and of the Arab

League, concerning measures t o prevent the importation and spread of cholera i n the

Region, w i l l be pursued with WHO collaboration during the biennium, as w i l l the

regional plan for en te r ic diseases control formulated by a technical group of experts

from countries of the Region.

Similar inter-country coordination w i l l be promoted i n respect of R i f t Valley

Fever and brucellosis as well as other areas of epidemiological studies.

Programme

Malaria and other pa ra s i t i c diseases

Objectives:

- t o collaborate with Governments i n assessing malaria s i tua t ions and programmes

and i n the planning of anti-malaria programmes as par t of overal l health plans;

- t o cooperate with Governments towards the eradxcation of malaria when t h i s

is feasible, o r reduction of i ts incidence where i t is not feasible i n the near

future; t o a s s i s t countries i n the development of their basic health services, to

enable them t o es tabl ish anti-malaria operations a t peripheral level and eventually

undertake sat isfactory vigilance against the re-introduction of malaria;

- t o conduct epidemiological surveys of other paras i t i c diseases, par t icular ly

schistosomiasis, for determination of t h e i r nature, character is t ics and geographical

dis t r ibut ion;

- t o collaborate with countries i n evolving programmes for the control of other

paras i t i c diseases, par t icular ly schistosomiasis, with the ult imate aim of eradicating

them ;

- t o develop control a c t i v i t i e s for preventing the spread of schistosomiasis and for

t reat ing and curing infected cases;

- t o promote t ra ining of natxonal manpower;

- t o develop health education for the information of the public;

- t o apply environmental measures t o avoid introduction of diseases i n i r r iga ted

areas ;

- to etrengthen programme coordination and cooperation amongst neighbouring countries.


Assessment of malaria s i tuat ions and programmes carried out with national o f f icers

show tha t , i n Spite of set-backs and administrative and technical d i f f i cu l t i e s , most

countries have been able t o maintain t he i r achievements by means of a f lexible approach,

aimed a t a t ta ining predetermined targets . WHD w i l l maintain i ts cooperation with

countries i n t h i s approach. In cer ta in countries,however, a serious s i tuat ion ex is t s

and the Regional Office is providing a l l possible administrative support and technical

cooperation t o improve it. Training of national s ta f f receives the highest p r ior i ty

and technical self-rel iance has been s teadi ly increasing in the Region.

The integration of malaria a c t i v i t i e s into the general health services w i l l be

stimulated whenever practicable by promoting the trend towards a multi-purpose

u t i l i z a t i on of malaria personnel for the control of communicable diseases other than

malaria, and a more consistent participation of the general health services i n the

control of communicable diseases.

Cooperation among neighbouring countries w i l l be continued as signified by

border meetings and by the continued assistance offered by the r icher countries t o

others.

Of par t icular importance is the plan for a medium-term coordinated malaria

programme i n the Arabia Peninsula.

In schistosomiasis, collaboration with countries of the Region is focussed on:

- undertaking studies (epidemiological and malacological) to assess the public

health importance of schistosomiasis control;

- organizing programes for the control of schistosomiasis;

- the follow-up of schistosomiasis programmes and the i r progress;

- the evaluation of control programmes.

The importance of national administrative support and self-rel iance for the

implementation of schistosomiasis control programmes cannot be over-eolphasized. In

view of the success achieved i n Bulinus control by the use of the molluscicide

niclosamide, under re la t ive ly economical conditions, i t w i l l be suf f ic ien t i n the future

t o maintain the vigilance of breeding s i t e s a t its present level and to react t o any

re-infestation of waters by Bulinus, and to obtain the expected r e su l t s through system-

a t i c treatment of infected persons.

The t h r u s t of the programme w i l l be d i rec ted pa r t ly towards malntaxning and

strengthening the pos i t ive r e s u l t s so f a r achieved i n some countries, and p a r t l y a s

i n Jordan where no Bulinus nor Biomphalariasnaiis could be traced, towards ensuring

the permanent absence of these vectors from the country by the survei l lance of water

bodies, and the search f o r human cases and t h e i r treatment.

The improvement of san i t a ry standards, pa r t i cu la r ly s a f e water supplies and the

provision of su i t ab le l a t r i n e s a s well a s heal th education, w i l l be promoted i n

schistosomiasis control programmes; spec ia l emphasis w i l l be given t o protect ive en-

gineering measures i n i r r i g a t i o n schemes.

The col laborat ion of WHO i n schistosomiasis control p ro jec t s I n Somalia, Syr ia ,

the Yemen Arab Republic, Democratic Yemen, Jordan, Sudan and Tunlsia w i l l be extended

t o o ther countr ies during the next biennium.

A s a r e s u l t of the development of nat ional manpower and exper t i se , the tendency

t o provide countries more and more with consultant services , suppl ies and equipment,

and fellowships, r a the r than longrterm exper ts , w i l l be continued.

Apart from d i r e c t involvement WHO w i l l follow closely the development of na t iona l

programmes and w i l l co l laborate a s required. I n t h i s respect , schistosomiasis con t ro l

a c t i v i t i e s i n Egypt, where t h e d lsease is considered the most important public heal th

problem and where the nature of its l r r i g a t i o n system (from basin t o perennial) , together

with the high r a t e of ~ n f e c t i o n , provide f o r various aspects of schistosomiasis research,

s tud ies and control .

I n Upper Egypt, where a s a r e s u l t of the Aswan Dam, l a rge areas were converted

from basin t o perennial i r r i g a t i o n , the prevalence of S. haematobium in fec t ion is

s t a t e d t o have increased i n some such a reas from 5 per cent t o 33 per cent wi th in two

years a f t e r conversion. Moreover, S. haematobium occurs very commonly among t h e

Lake Nasser fishermen(approximate1y 60 per cent). The na t iona l control programme

a t Lake Nasser is l inked with t h e I R UNDP/WHD Project i n Research on the Epidemiology

and Methodology of Control of Schistosomiasis i n Man-Made Lakes (Ghana and Egypt),

where t h e main a c t i v i t i e s a r e concentrated i n Accra around Lake Volta . I t is expected t h a t

the activi*eson the Egyptian s ide of the project , which have so f a r been l imited,

w i l l be developed during the biennium. Other national a c t i v i t i e s of importance a re

undertaken a t the National Research Centre, Dokki, Cairo; the Bilharzia Research

I n s t i t u t e , Faculty of Medicine, Cairo University; and the I n s t i t u t e of Research fo r

Tropical Medicine, Cairo, i n addit ion t o t ropioal medical departments i n a number

of un ivers i t i ee i n Egypt.

In I raq, s tudies and controJ a c t i v i t i e s a r e being undertaken a t the I n s t i t u t e

of Endemic DiSeaSeS, which cover communicable and p a r a s i t i c diseases including schisto-

somiasis; and, i n I ran, important s tudies covering a l l aspects of schistosomiasis

prevention and control a re being undertaken a t the Bi lharzias is Research and Control

Project a t Dezful, Khuzestan as well a$ a t the I n s t i t u t e of Public Health Research

i n Teheran.

Cutaneous leishmaniasis is present i n most countries of the Region. Recent

s tudies i n Afghanistan and Saudi Arabia showed t h a t cutaneous leishmaniasis follows

a focal pa t t e rn of d i s t r ibu t ion i n both countries. I t was suggested t h a t , i n view

of the resources avai lable t o t h e i r malaria control services , cutaneous l e i s b a n i a s i s

control should be entrusted t o the already established network of those services

i n these two countries; however, a cen t ra l u n i t responsible f o r cutaneous l e i s b a n i a s i s

control should be es tabl ished as pa r t of the cen t ra l malaria organization, t o be

responsible f o r t r a in ing of s t a f f i n case-finding and treatment. W I D collaboration

w i l l continue a s required i n t h i s f ie ld . WW> collaboration with the Government of

I raq w i l l be maintained a l so i n respect of the control of v i sce ra l leishmaniasis

(Kala-azar 1.

The problem of Tryponosomiasls i n the Region is l i m i t e d t o Southern Sudan where

i t is a po ten t i a l ba r r i e r t o socio-economic development. A review of the s i t u a t i o n

by a consultant , following an increase i n the number of regis tered cases i n the

Yambio area, and deta i led epidemiological s tud ies t o demonstrate t h e existence of an

ac t ive focus has been followed by control measures using t h e l o c a l resources. W K )

w i l l continue t o col laborate as required i n these measures and i n t h e t r a in ing of

loca l mioroscopists.

A bilateral agreement has been signed between the Governments of Sudan and Belgium

for the setting up and implementation of a programme for survey, treatment and control

of human trypanosomiasxs. WHO will continue collaboration in this field as required.

Programme

Cholera and enteric infectims 4.1.3 - Objectives:

- to establish a system of notification, reporting, storage,retrieval and analysis

of information on cholera and enteric infections at national and regional levels;

- to disseminate knowledge on the most appropriate techniques of epidemiological

surveillance, laboratory testing, treatment of infections and rehydration;

- to provide emergency assistance in case of epidemics.


The control of enteric infections depends on knowledge of the environmental factors

responsible for the completion of the cycle of transmission. The chain can be inter-

rupted through the progressive long-term provision of safe water supplies, appropriate

sewage disposal and health education of the public . As a first step towards thislong-

term~target , W H D will cooperate in the establishment of adequate surveillance,.mechan-

isms, the introduction of suitable methods of treatment, in particular, rehydration,

the development of laboratory diagnostic services and epidemic control measures. The

regional plan formulated by a regional group of experts to achieve the short-term objec-

tives provides for oral rehydration to reduce mortality from gastroenteritis particular-

ly among the youngest age groups, and at the most remote village level, as well as

the rapid notification of all forms of gastroenteritis. It provides also for contin-

uous surveillance of food, water and sewage, for the early detection of enteropathogens,

and the prevention of food and water-borne infections.

W H D collaboration in the biennium will be by means of advisory services on a

short and long-term basis (epidemiologists), the training of staff in epidemiology

and laboratory techniques and research, and material support to establish and implemt

oral rehydration. Inter-country coordination of activities is expected to be further

enhanced. Agreenlent is being sopght from all countries concerned on a common policy

for international travel and trade.

Tuberculosis

Objectives:

The long-term object ive is t o reduce the d isease by u t i l i z i n g modern control

techniques, inexpensive and adapted t o the loca l and f inancia l p o s s i b i l i t i e s , u n t i l a

s t age of t o t a l eradication is reached.

The medium-term object ives a r e prevention of the d isease through BCG vaccination;

ea r ly diagnosis; ambulatory treatment with the most e f f e c t i v e and inexpensive drugs;

establishment of a r e t r i e v a l system f o r de fau l t e r s ; education of the population; w n t r o l programmes against bovine tuberculosis where necessary; t ra in ing of personnel

f o r the in tegra t ion of tuberculos is w n t r o l i n t o the basic heal th services , and the

organization of r e f resher courses, seminars and workshops a t cen t ra l and provincial

levels .


Tuberculosis i s a major public heal th problem i n the Region. There a r e nat ional

tuberculosis control programmes i n a l l countries of the Region, with var iable degrees

of success.

The t h r u s t of the WHO col laborat ive programme is on the in tegra t ion of tuberculos is

w n t r o l a c t i v i t i e s i n t o the general heal th servzces. Importance is given t o the

t r a i n i n g of nat ional heal th workers so t h a t they can play an e f f e c t i v e r o l e i n integra-

t ion.

The inclus ion of BCG vaccination i n the Expanded Programme on Illmunization is

expected t o play a major p a r t i n protect ing the population agains t tuberculosis once

the EPI bui lds up momentum i n an increasing number of countries.

In t h i s connection W H 3 w i l l continue t o cooperate i n procuring BCG vaccine f o r

countr ies with mass BCr,-itaccination campaigns. Pa r t i cu la r a t t e n t i o n w i l l be d i rec ted

a t qua l i ty control of BCG vaccine, i n accordance with the guidelines which have been

s e t ou t t o meet the requirements f o r dr ied BCO vaccine i n t h e context of the WH)-

sponsored in te rna t iona l qua l i ty control system.

I t is expected t h a t , a s government support of control measures inareases , t h e

problems such a s breakdown i n drug provision systems, lack of e f f e c t i v e supervision

and weakness of r u r a l heal th laboratory f a c i l i t i e s , w i l l be c l e a r l y i d e n t i f i e d and

solved by the countries. The improved coverage of r u r a l communities by hea l th se rv ices

which is expected during the biennium should be a major factor in establishing

comprehensive national tuberculosis control programmes.

WHO collaboration through long-term projects with the Governments of Afghanistan,

Democratic Yemen, Libya, Pakistan, Somalia and Yemen Arab Republic, by mg- of

technical expertise to support the national programmes, fellowships, supplies and

equipment will continue as necessary.

The marked decline in incidence among children in Libya is expected to be

maintained.

WI13 collaboration will continue in Pakistan where expansion of the pmgraPPlPe

to more districts will be continued; and,in Oman, where the outcome of a review

of the tuberculosis control programme carried out by a consultant in 1977 will be

followed through during the biennium.

Leprosy

Objectives:

The long-term objective is to prevent and control leprosy, using the recognized,

effective and economically suitable methods so that the disease is brought gradually

under control and ceases to be a medical, social and economical problem.

The medium-term objectives are the collection and analysis of epidemiolog!loal

data in various areas through surveys, the training of personnel, the development

of health education, the integration of control methods in basic health services, and

the development of a rehabilitation system for leprosy patients.


Although the number of leprosy cases is not known and cannot be estinated with

great precision, it is thought that there are at least 178 601 cases in the Eastern

Mediterranean Region.

The prob2em is very limited in Bahrain, Cyprus, Israel, Jordan, Lebanon, Libya,

Syria, Tunisia and the United Arab Bairates. It is of public health importance in

Democratic Yemen, Egypt, Iraq, Saudi Arabia and Yemen Arab Republic where cases number

between a few hundred and 10 000 to 20 000; and in Iran, Pakistan, Somalia and Sudan

where there is a relatively higher endemicity in some parts of their territories.

Despite the efforts of governments and the cooperation of private international

institutiqns, the problem has not been substantially reduced during the lastBn years.

The approaches t o meet the objectives are based on the collection of epidemiological

data, case-finding focussed on school children and other high-risk groups, and t rea t -

ment systems adjusted t o local s i tuat ions. Also recommended are the demonstration and

u t i l i z a t i on of simple methods t o combat d i s ab i l i t i e s , the development of health educa-

t ion programmes, the gradual integration of ac t i v i t i e s in to the basic health services,

the granting of fellowships t o key s t a f f for training abroad, and the organization of

short seminars and workshops t o inform and t ra in health workers.

Direct WHD cooperation by means of supplies and equipment t o the leprosy control

projects i n Pakistan and Sudan, w i l l be followed up by the assignment of a W H D lepro-

l og i s t to the new leprosy control centre a t Wau i n Sudan. The German Leprosy Relief

Association, which has collaborated extensively with the Government i n the construction

of the Wail centre, w i l l finance the provision of the leprologist .

Bi la te ra l assistanoe t o the leprosy programme i n general has been p r~v ided by the

Sasakawa Memorial Health Foundation of Japan, which has granted $ 17 000 to WHO fo r

the provision of advisory services and fellowships.

Veterinary public health

Objectives:

- t o promote the development of and coordinate veterinary services a t the appropriate

minis ter ia l levels as w e l l a s the regional level for those aspects relevant t o the

protection of human health;

- t o develop a system of surveillance and control of zoonoses including food-borne

infections ;

- t o stimulate exchange of knowledge and information and promote inter-country

coordination.


The health problems connected with zoonoses i n the Region a re as yet t o be

thoroughly investigated and there is a growing awareness of such problems. A s the need

for regional centres for dissemination of information has become obvious some countries

have agreed to t he i r establishment. National epidemiological services are not yet

developed t o a p o i n t which could ensure tha t zoonoses problems a re fu l ly evaluated.

Furthermore, collaboration among veterinary services and health services leaves much

row for improvement.

Some zoonoses have assumed epidemic proportions before the health services could

be made aware of it. Coordination of e f fo r t s a t country and inter-country levels is

the main need.

The main emphasis of WHO collaboration w i l l be on the improveanent and dissemina-

t ion of knowledge on zoonoses and the para l le l and coordinated expansion of e p i m i o -

logical surveillance i n human and animal health services.

This w i l l be achieved through the establishment of regional and inter-regional

centres for the collection and dissemination of information and training of medical

and veterinary s t a f f .

The Inter-Regional Zoonoses Centre i n Athens for the countries of the Mediterran-

ean area (supported by UNDP) is expected to be operational by 1979 and the possibi l i ty

has been raised of the establishment of similar centres for the Arab countries of the

Gulf area.

A technical meeting on brucellosis for 1979 i n collaboration with W H O Headquarters

and the FAO/WHO Centre i n Berlin for Research and Training i n Veterinary Public Health

is expected t o indicate a sound approach to the control of the disease.

An inventory of regional wsources i n the veterinary public health f i e l d is also

being undertaken as a s tep towards greater xnvolvement of the available technical

expertise and f a c i l i t i e s i n a regional programme.

Surveillance measures to monitor and prevent the spread of R i f t Valley Fever

w i l l be maintained i n accordance with the recolmnendations of a seminar on the subject

i n Egypt i n 1978.

Smallpox eradication

Objectives:

- t o complete cer t i f ica t ion of eradication of smallpox from a l l countries of the

Region ;

- t o maintain an ef f eat ive surveillance system;

- t o vaccinate where appropriate and according to circumstances;

- t o consolidate r-esults achieved and par t ic ipate i n the col lect ion and prompt

exchange of information.

Cooperation with and among w u n t r i e s

With the apparent in terrupt ion of transmission of the disease on a global basis,

a c t i v i t i e s a r e now directed towards c e r t i f i c a t i o n and au thor i t a t ive endorsement of

eradication.

I f no new case of sanllpox is detected, a l l countries of the Region w i l l have been

c e r t i f i e d before the beginning of the biennium. I n t h i s case, surveil lance w i l l con-

t inue as pa r t of the overa l l survei l lance of communicable diseases.

Programme

Expanded programme on Immunization

Objectives:

The long-term objectives are:

- t o make immunization agains t diphtheria, pe r tuss i s , tetanus, measles, poliomyeli t is

and tuberculosis accessible t o every chi ld i n the Region by 1990, and as a consequence

t o reduce morbidity and morta l i ty from these diseases.

- t o reduce morbidity and morta l i ty s imilar ly f o r o ther se lected diseases of public

heal th importance f o r which s a f e and e f fec t ive vaccines become available.

- t o f a c i l i t a t e regional se l f - re l i ance , pa r t i cu la r ly i n mat ters of vaccine production

and qual i ty control.


The considerable upsurge of a c t i v i t y tha t hasoccur red in t h i s programme r e f l e c t s

the considerable degree of cooperation which e x i s t s between w u n t r i e s f o the Region.

Saudi Arabia, Kuwait, I r an and t h e United Arab Rnirates contributed through t h e WH)

Voluntary Fund fo r Health Promotion t o finance expanded immunization programmes i n

countries with low per cap i ta GNF. Much support a l so comes from UNICEF which is i n

e f f e c t WHO'S steady partner i n t h i s programme. Inter-country cooperation (TCDC) i n

vaccine production and qual i ty control takes the form of a UNDP supported project i n

whkch I ran, Egypt, Tunisia, Jordan, I raq and Pakistan a r e a l l par t ic ipants .

With WHO and o f ten UNICEF collaboration the Governments have formulated Plans of

Operations and/or Plans of Action fo r Expanded Programmes on Imuniza t ion i n Afghanistan,

Democratic Yemen, Egypt, Pakistan, Somalia, the Sudan, Syr ia and the Yemen Arab

Republic. I n most oases the supplies and equipment specif ied i n these plans have been

delivered and operations have begun. WHO collaboration has taken the form of assignment

of s t a f f i n most of those countries, consultant services and planning missions by

Regional Off i ce or W m / m s t a f f .

Training which began with a Regional Seminar i n December 1977 for the Programme

Directors, National Operations Officers and WH3 country s t a f f assigned t o EP1,is

being continued by intensive national courses i n EPI management (Pakistan i n September

1978 and probably Egypt for early 1979) and w i l l continue t o be supported by WHD i n

1980/81.

The great tasks which remain i n EPI to be undertaken during the bienniumaretomove

from p i lo t phases t o country-wide implementation where applicable; t o sustain momentum

and inter-country and WH3 collaboration a f t e r the periods covered by the present

plans(most1y f ive years); and to develop information systems as the essent ia l tool of

management they must be. In addition, research i n appropriate technology i n respect

of cold chain and other operational aspects such as sa fe and speedy injections,and

research i n public motivation is planned and have t o be developed. Finally, many

lessons are to b& learned and applied from the experiences of t h i s Programme i n its

f i r s t few years.

Programme

Special programme for research and training i n t ropical diseases 4.1.6 - Objective :

This programme aims a t promoting and assis t ing the developnent and coordination

of biomedical research in the Region, par t icular ly i n major paras i t i c diseases.


The Regional Office w i l l collaborate closely with governments and WH) Headquarters

within the overal l global programme of Research and Training i n Tropical Diseases.

An adviser t o be assigned a t the Regional Office for the General WH3 Research Prograrmne,

w i l l a lso coordinate with governments and WHO Headquarters, prograrmnes for Research

and Training i n Tropical Diseases within the context of overal l biomedical researah

i n the Region.

The Eastern Mediterranean Advisory Connni t tee on Bionedical Research, a t its th i rd

meeting which took place i n Alexandria i n March 1978, showed par t icular i n t e r e s t i n

the Research and Training i n Tropical Diseases Programme, and r-dedthatthe Region-

a l Ofdbe continue the iden t i f ica t ionof research in s t i t u t i ons available fo r project8 i

in the field. It also emphasized the importance of strengthening Research Institutions,

particularly by the training of research workers in TDR, in harmony with the global

programme.

Budgetary provision is available for fellowships to research workers in the Region

in the field of Tropical Diseases. The Government of Iran has paedged a special

contribution of US $ 500 000 for the Progrannne for Research and Training in Tropical

Diseases in the Eastern Mediterranean Region, for the specific purpose of establishing

a Regional Centre, for Research and Training in Tropical Diseases with the suggestion

that the site of this centre be in Iran in view of the availability of technical and

financial capacities and resources in the country.

Programme

Prevention of Blindness - 4.1.7

Objectives:

- to strengthen and expand the ophthalmological services, in particular towards the

more peripheral rural areas, for the early treatment of blindness producing affections,

such as trachoma, ~nchocerciasis, cataract and glauwma.

- to support mass preventive measures aiming at reducing the incidence, particularly

among young age groups, of trachoma and xerophthalmia.


The Eastern Mediterranean Regional Committee (Sub-Committee A) has established a

Committee to study Prevention of Blindness in the Region, wmposed of the Ministers of

Health of Kuwait, Saudi Arabia, Bahrain, Egypt and Iran, the Regional Dir-tor and a

representative of the International Agency for the Prevention of Blindness. At its

request, WHO convened a meeting of experts to draw up a plan of action for the prevention

of blindness in the Region and to study the feasibility of a proposal to establish a

regional ophthalmological centre for training and research. WHO will continue its

collaborative role in implementing the plan during the biennium. The group is expected

to continue to meet regularly to follow up and evaluate the implementation of the plan.

Wm, in collaborataon with the Regional Countries, envisages strengthening of some of the already existing centres for control, treatment and research on eye diseases and is

also studying the creation of one or more Regional Centres for prevention of blindness.

The main emphasis i s being placed on the expansion of services t o populations

l iv ing i n the most remote areas, where lack of curative ophthalmologiaal services and

consequent delays i n treatment lead t o blindness. The second, equally important, thrust

is towards mass chemoprophylaxis and chemotherapy of trachoma, and Vitamin A t o prevent

xerophthalmia, where conditions permit reasonable benefit against the kosts .invglved.

Onchocerciasis, which is a problem i n Sudan and the Yemen Arab Republic, iswrecoqlplex, and appropriate control methodolo&es have not yet been devised. The main emphasis

a t present is on the use of drugs, intermittently and a t reduced non-toxYc dosages, t o

reduce microfilaraemxa and the r i s k of blindness. No large-scale operations are encou-

raged against the vector, un t i l r e l i ab l e methodologies have been developed by the ad hoc study xn West Africa. -

The programme provides for consultant services for country projects, i n par t icular

i n trachoma control and onchocerciasis, and for evaluation. There is provision also

fo r essen t ia l supplies and equipment within the l i m x t s of available resources, and for

t ra ining through fellowships.

Programme

Vector biology and control

Objectives:

To cooperate m t h the countries of the Regxon towards:

- the assessment of vector-borne diseases and programmes;

- the planning of vector control i n vector-borne diseases as par t of an overal l

health plan;

- the establishment, within the exis t ing resources, of f lex ib le and dynamic programmes

adapted t o diversified biological, ecological and chemical vector control, taking in to

consideration the socio-economic s i tua t ions ;

- the promotion within each country of intra-sector ia l and inter-sector ia l cooperation

so tha t exis t ing resources can be u t i l i z ed i n the most economical and e f f i c i en t ways;

- the promotion of control and prevention of vector-borne diseases i n the water re-

sources developulent projects through engineering methods;

- the promotion of sa fe use of pest ic ides and provision of regulatory measures for

t h i s purpose;

- the ts aining of nationals; and

- the cprrying out of applied research.


The p r i o r l t y of prevention and control of vector-borne diseases is f u l l y recognized

among the communicable diseases and heal th problems i n the Region.

The most important vector-borne diseases i n the Region a r e malarxa, schistosomiasis,

leishmaniasis, trypanosomiasis, f i l a r i a s i s , onchocerciasis, some of the arbovirus

diseases and plague foc i ( s i l v a t i c ) . Vector control is one of the major components

of campaigns f o r prevention and control of these diseases.

Vector control measures (including control of intermediate hos t s and rodents

reservoirs of the diseases) a r e applied for:

- malarxa (mosquito control ) I n f i f t e e n countries of t h e Region;

- schistosomiasis ( sna i l control ) In s i x countries;

- leishmaniasis (sand f l y control ) i n two countries; and

- rodent borne diseases (rodent control ) i n SIX countries.

The Regional Office w i l l continue t o provide administrat ive and technical wopera-

t i o n i n the promotion of the s a f e use of pesticldes.

.d te rna t ive methods of vector control a re being introduced i n order t o reduce t h e

t o t a l re l iance on chemical control . Biological control of vectors, and environmental

managenent, especia l ly i n water resources developnent projects , w i l l be speoia l ly

promoted . Training of nat ional s t a f f w i l l continue t o receive high p r i o r i t y , m order t o

promote technical se l f - re l iance. A plan f o r establishing a Regional Training and Re-

search Centre i n I raq is being formulated.

Applled research on different aspects oP vector control w i l l continue i n coopera-

t i o n with the countries of the Region. Thls research includes t e s t s of new insec t i c ides

and spraying equipnent and experiments on biological control of vectors of malaria,

u t i l i z i n g larvivorous f xsh.

A t a Seminar on t h e Prevention and Control of Vector-Borne Diseases i n Water

Resources Development Projects , i n Ilexandria and Khartoum m 1978, s c i e n t i s t s and

heal th workers formulated plans for control . Including measures against the spread of

schistosomiasis vectors, which w i l l pursued during the biennium. A s a follow-up of

t h i s Seminar, a project is already being envisaged for the control of water-associated

diseases i n Sudan (Jezi ra and Rahat I r r i g a t i o n Areas) with collaboration of UNEP

and b i l a t e r a l agencies. ii preliminary Plan of Operation fo r t h i s project is under

negotiat ion with the Government of Sudan. The programme, which is scheduled t o cover

a period of ten years, has for i t s objectives the improvement of i r r i g a t i o n i n the

agr icu l tu ra l and economic areas of Sudan and the control of some of the water-borne

diseases of t h e area such as malaria and schistosomiasis.

Inter-agency cooperation and coordination, with FhO, UNDP and DANIDA vector control

d l 1 be continued.

Major Programme

NON-COWUUNICABLE D l SEASE PRGVENTION AND CONTROL

Principal objoc t i v e

- to prevent and cont r o l non-communicable diseases.

Detailed object ives .%.

- to promote cancer prevention and control , including coordinated cancer research;

- t a promote the prevention asd control of d iseases of the cardiovascular system;

- t o promote and develop programmes f o r the control of o the r non-communicable

d iseases of public heal th importance, a i t h due regard f o r the c r i t e r i a f o r determining

p r i o r i t i e s ;

- t o promote the development of p o l i c i e s and programes f o r o r a l health.

Co-operation with pnd among countr ies

Reorientat ion of the cancer programme has been taking place with increas ing zea l ,

i n col laborat ion with the Governments of the Region. I n t h s context , cancer is be-

coming incrcas ingly recognized a s an important public hea l th problem. W H O technical

co-operation i s expected t o reach a peak i n 19W/lll through consultant se rv ices , fellow-

sh ips and suppl ies and equipment. Meetings w i l l be organized t o exchange s c i e n t i f i c

information. Cancer r e g i s t r a t i o n and cancer epidemiology w i l l head the list of prio-

r i t y a reas f o r collaboratioq.

Of cardiovascular d isease , rheumatic heart d isease , hypertension and ischaemic

hea r t d isease a r e among the common causes of morbidity and morta l i ty i n the coun t r i e s

of the Regian. W H D w i l l continue i t s co-operation with countr ies i n epidem&ological

s t u d i e s and i n improving the standard and qua l i ty of care , including in tens ive care.

I t ~s expected t h a t col laborat ion with countr ies i n e s t a b l i s h n g and developing

o r a l heal th se rv ices w i l l grow fur ther . A major object of co-operation w l r l be to

determine the magnitude of the problem of dental i l l - h e a l t h espec ia l ly den ta l caries.

Training of denta l a u x i l i a r i e s w i l l a l s o receive spec ia l a t t e n t i o n e.g. i n Sudan.

WHO w i l l increase its support f o r the fu r the r development of immunology se rv ices

and f a c i l i t i e s by organizing courses, fos te r ing research, sponsoring s c i e n t i f i c

meetings and awarding $ellowships.

I n human genet ics , dissemination of i n f o r m t i o n , promotion of research, and

technical guidance on request , w i l l be m j o r f a c e t s f o r WW co-operatioa with coyntries.

Programme

Cancer

Objectives:

- To continue the implementation of the Regional Cancer Programme;

- t o strengthen cancer a c t i v i t i e s a t country l e v e l , iden t i fy ing the principa4 causes

hindering cancer detect ion, diagnosis, treatment, r e h a b i l i t a t i o n and prevention and

f inding adequate solut ions;

- t o co-operate with countr ies i n improving t r a i n i n g of medical personnel and the

heal th education of the public i n the f i e l d of cancer;

- t o promote cg-operation within the Region and a t in te rna t iona l l eve l i n cancer

epidemiology, cancer detect ion, diagnosis and treatment, increas ing the r o l e of Regional

Reference Centres f o r various cancer sites and of the Regional Advisory Panel i n t h i s

d i rec t ion.


Continuing the e f f o r t s i n cancer control , nine country pro jec t s and -*en i n t e r -

country p ro jec t s a r e included i n the Programme Budget f o r 1980/81.

I r a q , Kuwait and Sudan have undertaken t o S t a r t a p i l o t p ro jec t on strengthening

cancer a c t i v i t i e s a t country level . The major f a e t o r s which a r e hindering canoer de-

t ec t ion , diagnosis, treatment and prevention have been reviewed i n the three countr ies ,

and recommendations h v e been made f o r improving the s i tua t ion . These a r e t o be fo l -

lowed up and a l t e r n a t i v e opt ions w i l l be promoted i n order t o obta in a r e a l improvement

of the s i tuat ion. The pro jec t could then be extended t o o ther countries.

A new country p ro jec t i n cancer is s t a r t i n g i n Saudi- Arabia.

The courses on cancer epidemiology and on cancer r e g i s t r y w i l l be repeated, and a

Seminar aimed a t improving undergradute and postgraduate teaching i n cancer is a l s o

planned.

Programme

Cardiovascular Diseases

Objec t ives :

- To a s s i s t i n making epidemiological s t u d i e s t o a s s e s s t he card iovascular d i s ease

problem i n c o u n t r i e s of t h e Region,

- t o he lp i n c o n t r o l l i n g these d i s e a s e s by developing medical s e r v i c e s and p a r t i -

c u l a r l y emergency medical s e rv i ce s ,

- t o t r a i n c l i n i c a l and pub l i c h e a l t h workers i n card iovascular d i s ease con t ro l .

Co-operation wi th and among c o u n t r i e s

Cardiovascular d l s ea scs , mainly rheumatic hea r t d i s e a s e , hypertension and

ischaemic hea r t d i s ease , a r e among t h e common causes o f morbidi ty and m o r t a l i t y i n

t h e Region.

WHO a c t i v i t i e s i n t h i s a r e a w i l l d ea l with:

- t h e prevent ive a s p e c t , which w i l l focus on epidemrological s t u d i e s t o assess the

card iovascular d i s ease problem, and

- the c u r a t i v e a s p e c t , i n which WHO w i l l promote h igher s t anda rds of c a r e of cardio-

vascular d$seases, w i th t h e focus mainly on i n t e n s i v e c a r e s e r v i c e s , i nc lud ing coronary

care .

WHO w i l l cont inue i t s co-operat ion with Egypt t o develop and expand i t s i n t e n s i v e

c a r e s e r v i c e s inc luding coronary c a r e u n i t s i n u n i v e r s i t y h o s p i t a l s by suppor t t o

t r a i n i n g and i n t he es tab l i shment of f a c i l i t i e s . Advisory s e r v i c e s , equipment and

supp l i e s , and fe l lowships w i l l be provided.

To he lp f u r t h e r improve Lebanon's c a p a b i l i t i e s i n c o n t r o l l i n g card iovascular

d i s e a s e s WHO w i l l provxdo s u p p l i e s and equipment, and consu l t an t s e r v i c e s t o eva lua t e

and adv i se on the count ry ' s programmes.

A Regional Seminar on Epidemiological S t u d i e s i n Cardiovascular Diseases w i l l be

he ld t o p lan s c i e n t i f i c s t u d i e s a s a b a s i s f o r prevent ive measures i n c o n t r o l l i n g

card iovascular d i s eases .

Programme

O r a l Health

Object ives:

To a s s i s t the coun t r i e s of t he Region i n e s t ab l i shzng and developing o r a l h e a l t h

s e rv i ces , both preventive and cu ra t ive , through:

- co-operation i n undertaking epidemiological s t u d i e s t o i d e n t i f y o r a l d i s e a s e and

a s s e s s the e x t e n t of the o r a l h e a l t h problem;

- promotion o f prevent ive s e r v i c e s f o r o r a l and den ta l d i seases ;

- promotion of water f l u o r i d a t i o n , and co-operation i n such p ro jec t s ; acd

- t r a i n i n g of o r a l h e a l t h personnel.


Dental c a r i e s , e s p e c i a l l y among school ch i ld ren , is an important and inc reas ing

o r a l h e a l t h problem i n the Region. I t s ex ten t has t o be determined and o r a l h e a l t h

s e rv i ces , p a r t i c u l a r l y preventive measures, have t o be developed.

Co-operation i n o r a l h e a l t h w i l l continue. I n I r a q the preventive o r a l h e a l t h

s e r v i c e s w i l l be evaluated wi th the he lp of consul tan ts . I n t h e Sudan t h e training

of o r a l a s s i s t a n t s w i l l r ece ive p r i o r i t y . Other c o u n t r i e s a r e l i k e l y t o r eques t 00-

opera t ion and support f o r t h e i r o r a l h e a l t h serv ices .

A s p a r t of t he Regional Ora l Health Programme, WHO w i l l hold a Seminar on Ora l

Health i n 1980, t o review the o r a l h e a l t h s t a t u s i n the c o u n t r i e s of t he Region and

exchange i d e a s on the subjec t .

Programme

0 t h e r Non-Conmunicable Diseases

Genet ics

Object ives:

- To c o l l e c t , ana lyse and d isseminate information on human gene t i c s ;

- to promote research on s p e c i f i c f a c t o r s t h a t may cause i n h e r i t e d d i seases , through

changes i n t he s t r u c t u r e o f genes, i n t he mechanism o f t h e i r a c t i o n , o r i n t h e com-

pos i t i on o f t h e i r products , and through changes i n chromosome s t r u c t u r e and mechanisms;

- t o provide t echn ica l guidance and advice on human g e n e t i c s t o na t iona l p rog rames

concernec' with the s tudy o f t h e pub l i c h e a l t h imp l i ca t ions o f i n h e r i t e d d i seases ; and

- t o co l l abo ra t e wi th d r f f e r e n t c e n t r e s f o r the development of r e sea rch i n t h e i r

s p e c i f i c f i e l d s of competence.


Two g e n e t i c counse l l ing p r o j e c t s have been planned: one, i n Egypt, due t o s t a r t

i n 1978 and the o t h e r i n Cyprus, o r i g i n a l l y planned f o r 1975 bu t , owing t o t h e pre-

v a i l i n g s i t u a t i o n a t the t i m e , kep t i n abeyance.

A course on l abo ra to ry diagnosis i n haematology dea l ing mainly wkth anaemiasis

and haemoglobinopathies he ld i n Thailand i n 1978 was a t tended by p a r t i c i p a n t s from

Sudan, Pakis tan , I r aq and Egypt.

A course is proposed on haemoglobinopathies and o t h e r r e l a t e d d i s o r d e r s i n 1980

and another on cy togene t i c s and katyotyping i n 1981.

Programme

Immunology

Objec t ives :

Long-term o b j e c t i v e s

- t o f o s t e r the development o f immunology on a l l i ts a s p e c t s i n developing c o u n t r i e s ,

e s p e c i a l l y resoarch i n t o t he immunology of d i s e a s e s posing pub l i c h e a l t h problems,

w i th s p e c i a l emphasis on t r a i n i n g conducted m those c o u n t r i e s , i n order t o speed t h e

development o f t h e i r own e x p e r t i s e ;

- t o encourage t h e i n t roduc t ion of e s t a b l i s h e d immunology techniques i n t o p a t i e n t

c a r e , and t o s t anda rd i ze r eagen t s and methodology;

- t o develop and i d e n t i f y new knowledge on immunology wi th p o t e n t i a l a p p l i c a t i o n t o

d i s e a s e s of pub l i c hea l t h importance;

- t o co-ord ina te r e sea rch on a l l branches o f immunology;

- t o s tandard ize t h e nomenclature of immunological terms.

Medium and short- term o b j e c t i v e s

- Organizat ion of courses ;

- t o support r e sea rch i n t h e immunopathology and immunology;

- t o pub l i sh r e p o r t s on s u b j e c t s o f publ ic h e a l t h importance.


Courses are being proposed, for 1980, on immunological methods ( t o promote re-

search i n immunology), and on the immunopathology of sohistosoma and f i l a r i a s i s , and,

for 1981, on the immunology o f v ira l and r icketts ia1 diseases, and on immunogenetics

including its practical and theoretical aspects.

w o r Programme

PROMOTION OF ENYI RONMENTAL HEALTH

Programme

l$nvironnental Health Planning and Management

- To provide tuchnacal con$ultation i q the development o f both p e g i ~ n a l and national

envaronincntal heal t b a c t i v l t i e s ,

- t o promote and develop environmental heal th policqes, panagement and financing

of services , ins ta tu t ions and programmes;

- t o encourage ac t ivc and aystcmatlc parcicigataon of the hea l th sector i n the for-

mulation and exeoution of socio-economic devslopment plans;

- t o promote the development of innovative and apprspr ia te technology f o r environ-

mental control that wall be within the f inancra l c a p a b i l i t i e s of the area; and,

- to a s s i s t i n planning, project formul t a t ion , management and evaluation of t r a in -

ang programmes fo r various ca tegor ies of envrronnwntsl heal th workers an the w n t e x t

of need and avai lable resources.

CQ-oneration with an6 among c o u n t r i ,

Baseline data on environmental heal th needs and ava i l ab le reseurces for a t t ack ing

both e x i s t i n g and emerging environmental problems w i l l bq? marntained on a current Pas i s

i n col laborat ion with nat ional a u t h o r i t i e s i n order to a s s $ s t planr)&n&, as tab l i sh ing

act ion p r i o r i t i e s , allowing f o r evaluation of r e s u l t s and providing the input necessary

fo r e f f e c t i v e qccisionwmaking.

Moro comprohensive data r e l a t i n g to spec1 f ac problems w i l l be provided a s needed

by consul tants on survey missions t o a ssess s i t u a t i o n s $or fens ibJe means of ac t ion

wrthin current ly gvailable resot+rces. Emphasas w i l l be ggven t o the development of ln-

novative and appropraate tachnoLogy through operational rssvarch focused on regional

and national problems. Wide dissemination of such dcvelopmcnts i s r e q u i s i t e to pro-

gramme ~mplemuqtntion.

Jntensaf ica t lon gf e f f o r t s to a s s i s t the Menrbar S t n t a s i n dcqling with those severe

bas ic cnvirorunttntal heal th problems yet remaining a s wel4 a s t o f a c i l i t a t e the a t t ack

s n emerging and cQmplex now environmental problcms r e s u l t i n g from population growth,

rapid &ndus t r i a l i za t ion , the trend toward urbanazat~on and also Current socio-econvmrc

devgloplncnts,can best be promoted by the establishment o i an Eagtern Mediterranean

Centre far Enviroru~ental A c t i v i t i e s (CENA) . This Centre w i l l address i t s e l f rn tens i vely

t o developing e f f e c t i v e means of deal ing with environmental and ecological prablegls,

t~ environmental research, t o strenthening national and regional environmental pro-

gra-s, t o developing a comprehensive and in tegra ted educational and t r a in ing capa-

b i l i t y , t o e s tab l i sh ing a co-orbinated network of nat ional i n s t i t u t i o n s working &-

l e c t i v e l y on environmental problems and t o providing f o r Wady technology and iqforma-

t ion t r ans fe r .

The r e l a t i v e p r i o r i t i e s assignable t o e n v r r ~ m e n t a l heal th problems may vary from

country t o country depending upon l o c a l s i t u a t i o n s and largely influenced by s t ages

of development, lndust r ia lxzat ion and urbanization. Inadequacy of basic sanatary

measures still remains a major concern i n much of the Region so t h a t emphasis i s still

being given t o provision of sa fe water supply and e f f e c t i v e excre ta d i s p o s A , Food

san i t a t ion problems a l s o reaain a s a high p r i o r i t y i t e m .

Prevention of environmental pol lu t ion is more economical than correct ive measure$.

For this reason a s w e l E a s f o r the public heal th benef i t s t o be gained, e f f o r t s t o

encourage e a r l y a t t e n t i o n t o newly'emerging problems a r e being made. Since such a c t i -

v i t i e s cannot be e f fec t ive ly undertaken without a properly organized in f ras t ruc tu fe ,

equal a t t e n t i o n must be given t o strengthening environmental heal th se rv ices and in-

s t i t u t i o n s . Training must therefore be provided i f the qua l i f i ed manper needed t o

s t a f f these services i s t o be avai lable . An a rea o i g rea t need i s i n t h e development

of t r a in ing c a p a b i l i t i e s f o r producing large numbers of middle-level technician per-

sonnel who can complement and extend the e f f e c t i v e range of highly t ra ined profess ional

personnel .

Basic Sani tarv Measures

Objectives:

- To promote and col laborate i n nat ional planning of se rv ices and i n i n s t i t u t i o n -

building fo? the provision and survei l lance of drinking-water suppl ies and wastes d i s -

posal ;

- t o a s s i sk c a u n t r i e i I n the formulation and implewntat ion of comuni ty water supply,

mate disp~sal and r u r a l scmitat ion p ro jec t s , and t o col laborate with nat ional and

multi-national agsncies concerned with a view t o mobiliasing nat ional and/or in terne-

t iorml rebources fo r the impleimentation of these projects ;

- to provide technical cooperative se rv ices t o supple-nt the technical c a p 8 M l i t y

of ~ t i m L eater supply and s a n i t a t i o n agencies a s and when required.

Co-operation wi th and among coun t r i e s

WHO i s co l l abo ra t ing wlth coun t r i e s i n ca r ry ing o u t assessment of t he water supply

and sanitation situation, i n improving d a t a collection precedures, and i n formulat ing

long-, medium- and short- term water supply and s a n i t a t i o n programnes. h a t e r supply

and s a n i t a t i o n agencies a r c being strengthened through t r a i n i n g of na t i o n a l personnel

and the provis ion of technica l s e r v i c e s t o supplement na t iona l s t a f f and t o adv i se on

improved o rgan iza t iona l , admin i s t r a t i ve and managerial procedures. Programmes f o r

su rve i l l ance of drinking water q u a l i t y and waste d i sposa l networks a r e being e s t ab l i shed .

The Organization co-operates a l s o i n preparing pre-investment p r o j e c t s , i n car ry-

i n g ou t master p lan and f e a s i b l l l t y s t u d i e s , and i n ob t a in ing f inanc ing from b i l a t e r a l

and i n t e r n a t i o n a l sources.

Consultancy se rv i ce s a r e provided In spec i a l i zed a r e a s a s requi red and t o i n t e r -

p r e t new developments of environmental concern a s w e l l a s f o r t h e prepara t ion o f

po l icy recommendations.

Subsequent t o t h e dec i s ion of the United Nations Water Conference t o dcs lgna t e

1981-1990 a s tho I n t e r n a t i o n a l Drinking Water Supply and S a n i t a t i o n Decade, cons ide rab l e

e f f o r t i s being made t o c o l l a b o r a t e wi th Member governments i n t he preparacion f o r t h e

Decade. Ons a c t i o n has been t h e rdpid assessment of water supply and s a n i t a t i o n

programmes and of t h e e x t e n t t o which these might be u se fu l ly expanded t o meet t h e

o b ~ e c t i v e s recommended by the Unlted Nations Water Conference, i.e., water and s a n i t a t i o n

f o r a l l by 1990. With W X I c o l l b o r a t i o n , t h i s e x e r c i s e was c a r r i e d o u t i n about ten

c o u n t r i e s of t he Region.

The development of na t iona l p l ans f o r water supply and s a n i t a t i o n is being given

p r i o r i t y i n c o u n t r i e s of t he Region and thc p r o j e c t s under way i n t he se f i e l d s w i l l be

continued. Consultant s e r v i c e s a r e being made a v a i l a b l e t o Somalia f o r t h e e s t a b l i s h -

ment of a water q u a l i t y su rve i l l ance programme.

The management and d i sposa l of s o l i d wastes a r e becoming a problem i n s eve ra l

c o u n t r i e s of t he Region. Counsultancy s e r v i c e s w i l l cont inue t o bo provided a t the

r eques t of governments.

Technical advice i s being provided t o s eve ra l Count r ies of t he Reglon on s p e c i f i c

problems such as the high concent ra t ion of n i t r a t e s i n water , p o t e n t i a l carcrnogenic

ch lo r ina t ed o rgan ic s An d r ink ing water a s a r e s u l t of water c h l o r i n a t i o n , excess ive

f l u o r i d e s i n water and de f luo r ida t ion . Technical information on s t a b i l r z a t i o n ponds

has been disseminated to a l l Member s t a t e s of the Region and t h e i r use f o r the t r e a t -

ment of waste water promoted.

Programme

Recognition and Control of Environmental Hazards

Objectives:

- To promote the development and implementation of progralqmes fo r the e a r l y de-

t ec t ion and control of pol lu t ion i n the environment (chemical, physical and b io log ica l ) ;

- t o evaluate the e f f e c t s of environmental f a c t o r s on heal th ;

- t o promote and co-ordinate re levant research; and t o f o s t e r the p rac t i ca l ap-

p l i ca t ion of research findings; and,

- t o promote environmental san i t a t ion , e spec ia l ly a s r e la ted t o urban and r u r a l

development and primary heal th ca re , t h a t contr ibutes t o the prevention of communicable

disease.

Co-operatson with and among countr ies

Increased a c t i v i t i e s aimed a t developing sus ta inable c a p a b r l i t i e s i n the a reas

of pol lu t ion monitoring and control i n a i r , water and s o i l a r e planned f o r the biennium.

These w i l l involve environmental impact assessments i n order t o determine the magnitude

of the problem and t o p r i o r i t i z e a c t i o n programmes, Development of basic p o l i c i e s ,

c r i t e r i a and standards, regula t ions and l e g i s l a t i o n w i l l be needed, S ta f f a c t i v i t i e s

supplemented by consultant surveys, assessments and recommendations ar r ived a t through

ac t ive co-ordination with nat ional input of needs and c a p a b i l i t i e s w i l l be a c t i v e l y

pursued. Workshops, seminars, t r a i n i n g courses and academic placements w i l l be used

t o produce a steady supply of the r e q u i s i t e specia l ized personnel a t a l l l e v e l s of

operation within the nat ional in f ras t ruc tu re ,

The WHO Global Environmental Monitoring System has been expanding i t s operations

by increas ing ex i s t ing monitoring cen t res and ac t ive ly promoting the c rea t iop of new

networks, The major t h r u s t of t h i s programme i n concept is t o i n t e g r a t e and i n t e r -

d i g i t a t e a l l data- measuring l e v e l s of toxic mater ia ls i n various media leading t o

degradation of the environment.

The bas ic aims of these programmes a r e f i r s t l y t o assl ist Member s t a t e s i n develop-

ing anr$/or strengthening nat ional c a p a b i l i t i e s i n manpowed and i n r t i t u t i o n s f o r i m -

plementing programmes i n these f i e lds . Secondly, they become p a r t of a g l ~ b a l network

which feeds data concerning pol lu t ion to a centra l computer f a c i l i t y f o r ana lys i s ,

s torage and r e t r i e v a l . Such baseline data on a global bas i s w i l l allow f o r demonstra-

t ion of pol lu t lonal l eve l s and trends a s an a id t o the dsci$$on-meking processes in-

volved an a t t a i n i n g improvement of environmental condit ionsr

For the measurcmnt of a i r q u a l i t y , four countr ies i n the Region - Egypt, I r a n ,

I r a q and Pakistah - have been added t o the network which already included I s r a e l .

A c t i v i t i e s a r c under 'way t o add seven additronal countr ies t o the network a t t h e i r

governments' request. These a r e Kuwait, Lebanon, Libyan Arab Jamahiriya, Saudi Arabia,

Sudan, Syria and Tunisla.

For the protection and conservation of the f l n i t e supply of the world's water re-

sources, @ global monitoring programme fo r water qua l i ty i s being established. I n

the Eastern Mediterranean Region t h i s assumes an important place since the Region's

fresh-water reqources a re generally q u i t e l imited and many must depend upon desalina-

t i o n of marine waters fo r potable, domestic, i n d u s t r i a l and a$r icu l tu ra l supplies.

Establishment of monitoring citations and se lec t ion of colXaborcting l abora to r i e s is

underway ,$n eleven countr ies - Egypt, I r an , I r aq , I s r a e l , Kuwait, Libyan Arab

Jamahiriya, Pakistan, Sauda Arabia, Sudan, Syria and Tunisla.

Inter-regional, programmes dealing wlth marine pol lu t ion problems i n the Mediter- 1

ranean have addressed the problem of inventoryang land-based sources ~f po l lu tan t s

and t h a t of mQnitoring the qua l i ty of coas ta l r ec rea t iona l and seafood growing waters,

s ince Mediterranean tourism has a great economic impact on the Region. A c t i v i t i e s

a r e cantinrung. i n Cyprus, Eqypt, I s r a e l , Lebanon, Libyan Arab Ja~ahiriya, Gyr- and

Tunisia, Designation of col laborat ing l abora to r i e s and comencemeqt of sampling

which has begun i n $$ypt, I s r a e l and Lebanon, w i l l be extended t o o ther countries.

Two o the r closed sea programmes a r e being developed f o r rapid implementation

a l o ~ g l i n e s s imi lar to those developed i n the Mediterranean Action Plan* The f i r s t

involves the following e igh t countries: Bahrain, I r an , I r a q , Kuwa~t, Oman, Q a t a r ,

Saudi Arabia and the Ungted Arab Emirates. An extensive programme with contr ibutory

funding has beqn approved f o r t h i s a c t i v i t y f o r the area of the Kuwait Action Plan

Region (KGPR). A l a rge por t ion of the planned programme i s involved with human hea l th

e f f e c t s 04 pol iu t ional burdens while the remainder dea l s with marine ecological e f f e c t s

l a rge ly i n f l u e n ~ e d by o i l contamination. The second involves e igh t c ~ u n t r i e s of t k

Region bordering the Red Sea qnd the Gulf of Aden. These &re Demcratkc Yemen,

Djabouti, Egypt, Jordan, Saudi Arabia, Somalia, Sudan qnd Yemen Arab Republic. This

programme w i l l a l s o be developed around two major components: human hea l th e f f e c t s

and marine ecological concerns. Since the Red Sea/Gulf of Aden L$ l inked with the

Mediterranean through the Suez Canal, in tegra t ion of f indings on both ends of the Canal

w i l l provide valuable data.

A c t i v i t i e s i n b iological monitoring for determination of t o t a l b?dy l e v e l s and

heal th e f f e c t s of toxic mater ia ls contaminating more than one medium, such a s lead,

mercury, cadmium and chlorinated hydrocarbons, a r e commencing i n a n e f f o r t t o a s sess

t o t a l heal th impact a s a guide t o more re levant standards and c r i t e r i a f o r auch sub-

s tances i n a l l meidia i n which they occur. I n i t i a l e f f o r t s a r e under way i n I r a n and

I s r a e l on this programme with o ther countr ies t o be added l a t e r .

Promotion of Food Safe ty

Objectives:

- To promote the deQelopmnt of programmes t o ensure food s a f e t y and to supply in-

formation f o r planning and implementation;

- t o promote reduction i n human i l l n e s s and economic losses caused by microbial ,

chemical and physical contamination of food products; and

- t o a s s i s t i n e s tab l i sh ing c r i t e r i a and standards f o r tood handling, production

and preservation t h a t w i l l ensure the protection of the consumer.


The improvement of food sa fe ty and hygiene is of utmost codcefn i n a Regron where

the t o l l among chi ldren under f i v e from acute diarrhoea1 disease s t f l k dons t i tu tes

a grave public heal th problem. Repeated outbreaks of cholera have been t raced t'o

f aeca l ly contaminated foodstuffs r a t h e r than t o water supplies.

S ta f f e f f o r t s i n collaboration with nat ional input w i l l be i n t e n s i f i e d on a l l re-

levant f r o n t s t o ameliorate this pr~blem. Additional input from consul tants tb corn-.

plement and expand these e f f o r t s w i l l be obtained. I n s t i t u t i o n strengthening bbtki a s

t o manpower t ra ined f o r meeting the problems and a s t o laboratory c & p a b l l i t i e s f o r per-

forming the necessary sampling and t e s t r n g wall be emphasized,

Public education campaigns w i l l be encouraged and a s s i s t e d an order t o provide

bas ic personal hygiene and sa fe ty i n food-handling i n the home. Such e f f o r t s can be

focused a s an i n t e g r a l pa r t of primary heal th care a c t i v i t i e s . he bas ic problems of

provision of s a f e and e f f e c t i v e excre ta disposal a s well a$ control of usage of f aeca l ly

contaminated waste waters fo r food crop i r r i g a t i o n w i l l continue t o be emphasized a s

w i l l the ready a v a i l a b i l i t y of adequate supplies of water f o r domestic use.

Collaboration continues with nat ional governments and with in te rna t iona l organizo-

t i o n s such a s FA0 a s well a s with the Arab Organization fo r Standardization and hletro-

logy (ASMO) on mutual i n t e r e s t s i n improving food control and hygiene a c t i v i t i e s .

Collaborating laborator ies f o r food sa fe ty programmes have been designated i n Egypt

and I r a n with o the r s t o be added gradually.

Training e f f o r t s on an in te rna t iona l bas is a s well a s strengthening t r a i n i n g

c a p a b i l i t i e s f o r food control and inspectional a c t i v i t i e s have resu l t ed i n adding t o

the manpowor pool fo r these programmes. Such i n s t i t u t e s have been a s s i s t e d i n

Democratic Yemen, Jordan, Libyan Arab Jamahiriya, Pakistan, Saudi Arabia, Tunisia and

Yemen Arab Republic.

The Organization i s co-operating with various countr ies i n strengthening food

san i t a t ion services , and i n programes t o e s t a b l i s h a s u i t a b l e and e f f e c t i v e in f ras -

t ruc tu re fo r implementing municipal, provincial and nat ional s t r a t eg ies .

Major Programme

Programme

Programme planning and general ac t i v i t i e s 6.1.0

Objectives:

Within the context of the Sixth General Programme of Work, and the Medium Tern

Progranune on Health Manpower Development for the period 1978-1983 approved by the

Regional Committee a t its Twenty-Seventh Session i n October 1977, the broad objectives

w i l l be:

(a) t o promote the development of appropriate health personnel t o meet the needs of

en t i r e populations;

(b) t o promote the development and application of relevant processes for basic and

continuing education.


A s i n previous years the programme area of Health Manpower Development is the

largest s ingle component i n the Programme Budget. I t should also be noted tha t , as i n

the past, i n addition t o the substant ia l a c t i v i t i e s and expenditure under t h i s specif ic

heading very substantial t ra ining e f fo r t s are a lso proposed within a l l other programme

areas.

The high pr ior i ty devoted t o the Health Manpower Development Programme by the

Member Countries of t he Region continues t o be a source of g ra t i f ica t ion ; the Organiza-

t ion w i l l continue t o play an act ive ro le as regards the t ra ining of a l l categories of

health manpower and the sensi t izat ion of governments t o the need for the reorientation

of t ra ining programmes to meet health services needs. Indeed, the overriding considera-

t ion which w i l l govern the programme i n 1980-81 w i l l be the need not only t o increase

the numbers and improve the qual i ty of health personnel but a lso t o make t h e i r t ra ining

more relevant t o the needs of populations. Accordingly, a research and development

approach t o health services and manpower development w i l l be increasingly emphasized.

The prograrmne w i l l continue t o be characterized by constant exchange of views and

consultation with Mmber countries. I t w i l l be based on the perspective t ha t health

manpower development is only one factor, a lbe i t a key one, i n developing health services

t o meet the needs of en t i re populations.

Tho Eastern llediterranean Region was one of the f i r s t t o support Medium-Term

PrograPmneforIIealth hlanpower Development, and, i n the programme developed for tine period

up t o 1983, ovory e f fo r t has been made to s t a t e objectives as clear ly as possible so

tha t the programme can be monitored, evaluated and ~0nt inuously adjusted as required.

There w i l l be a steadily increasing thrust t o take collaboration with Member

Countries beyond consultation and exchange of views, which have long characterized the

way of working, t o the development of programmes i n which national personnel w i l l be

more and more fu l ly involved i n planning and execution.

The ~ rgan iza t ion ' s collaboration with Member Countries does not moan collaboration

w i t h health authori t ies alone, but a lso with those governmental agencies whioh have the

responsibili ty for the training of health personnel, frequently the Ministries of

Education, and invariably the national planning authorit ies.

A s has long been recognized, and i n recent years expl ioi t ly s ta ted, the balance of

t h e health manpower stock of the Region needs correction as muah as do actual shortages;

par t icular emphagis w i l l accordingly be la id on correction of the imbalance which exists.

~ h r s w i l l include e f fo r t s t o increase the stock of well-trained in temedla te and auxiliary

personnel, while a t the same t i m e the thrust of recent years towards improving education

and t ra ining a t the profession41 and primary health care levels w i l l be continued.

he programme i n 1960-81 w ~ l l continue t o r e f l ec t the reoomme~dations of the 1978

Ministerial Consultation on Health Services and Manpower Development.

The programme has three components:

- health manpower planning and management;

- promotion of training;

- educational development and Support.

While major a c t i v i t i e s and a high proportion of the regular budget wl l l continue to

ae mostly devoted t o the d i rec t promotion of t raming, there w i l l a lso be an increased

e f fo r t t o promote heagth manpower planning and reforms i n the management of health man-

power. These a re areas whLM are i n great need of development i n most Member Countries.

I t 1s i n these areas a l s o t h a t there w i l l be a pa r t i cu la r th rus t towards improving

the capacity to predic t manpower needs.

Under Educationcrl 1)evelopment a d Support, high p r i o r i t y w i l l be given t o meeting

the needs of the Region f o r heal th learning mater ia ls , a s w e l l a s t o increasing the

capacity of countries f o r e f f e c t i v e educational planning. These represent an e s s e n t i a l

underpinning of. the whole heal th manpower development movement.

P r o g r m e

Health manpower planning and management 6.1.1

Objectives:

- to promote the concept of in tegra ted health services and manpower development

(HSIJID) and its acceptance by Member Countries, and provide information on a l t e r n a t i v e

approaches to the establishment of permanent mechanisms f o r its implementation ;

- t o promote and col laborate with in te res ted Member Countries i n the development

of s u i t a b l e permanent HShlD mechanlsmS,adapted t o the requirements of- ihdividual

countries, and evaluate t h e i r impact on the pa t t e rn of heal th profeSsiona1 t r a i n i n g i n

r e l a t i o n t o the health services needs; and

- t o promote nat ional capac i t i e s f o r , and opera t ional research i n , pldnning, manage-

ment and evaluation of heal th services and manpower development.

Cooperation with a d among countr ies

The programme 1s formulated t o ensure dialogue among a l l s e c t o r s concerned i n

HSMD within countr ies , and t o involve nat ional groups i n s tud ies on coordination

between heal th services and educational systems. Countries must have expressed i n t e r e s t

i n and a commitment t o developing HSMD mechanisms and operat ional research i n HSMD.

Guidelines on heal th manpower planning w i l l have been t e s t e d i n a t l e a s t one country,

on the bas i s of which they w i l l be revised and d i s t r ibu ted t o a l l countries. hietho-

dologies f o r manpower s tud ies w i l l have been developed i n severa l countr ies and t h e i r

impact on the qua l i ty of country heal th programming w i l l be assessed. The t r a i n i n g

of nat ionals i n country heal th programming w i l l be continued. A s e r i e s of regional

and na t iona l workshops on management and planning of hea l th se rv ices w i l l ensure t h i t

a s countr ies become increasingly s e l f - r e l i a n t i n these f i e l d s t h e i r experiences w i l l be

made ava i l ab le t o the Region a s a whole. Guidelines f o r the planning and implementation

of continuing education f o r heal th personnel, including primary ca re workers, w i l l be

t e s t e d i n .it ledst one country i n 1980; rn inter-country workshop on t h e i r use w i l l be

he ld l r l 1981, and the ~ o l l ~ r b o r ' r t i n g country w i l l b e supported i n dcvcloping continuin;:

cducdtzon yrogr~unmes. Fellow.si~ips w i l l be provided f o r nationcrl coordan.ltors of

continuing educatio.: progrunmos.

ObjCCtlVeS:

- t o promote,in coll.lbordtion with governments, t h e planned tr.i ining of h e a l t h

personnel , a t all l e v e l s , requi red f o r t h e hea l th s e r v i c e s with s p e c i a l omph.isis on

middle-level and primdry hed l th workers;

- t o promote, i n coun t r i e s of t he Region, the planned development of bas i c programmes

f o r t r a i n i n g the numbers md ca tcgor i c s of requi red h e a l t h personnel , a s determined

through country hea l th p r o g r m l n g o r o t h e r hea l th manpower s t i d i e s ;

- t o promote dnd c o l l a l ~ o r d t e with governments i n tho deveLopment of po:;tgrcrduate,

post-basic and continuing educ,ltlon programmes f o r a11 ca t egor i e s of h e a l t h personnel ,

a t n a t i o n a l m d regzondl l eve l s .

Cooperation w i t l l and among c ~ u n t r l e s

Increas ing emphasis w i l l be given t o c o l l ~ t b o r ~ t i o n wi th Member Countries i n t h e

development of educat ional i n s t i t u t i o n s f o r in termedia te , a u x i l i a r y and primary c u e

workers; and i n the development of t , ~ s k and cor,u:luni t y o r i e n t e d mul t ip ro fe s s iona l t r a i n -

rng p r o g r m e s f o r a l l cd t egor i e s of hedltll pCrSOnncl and s p e a i f i c a l l y f o r d e n t a l and

environmental h e a l t h workers.

,is p a r t of t h e e f f o r t t o improve t h c q u ~ l l t y and use ol: tho Itcgional ur rec tory of

Education a d Trdining Programmc?s f o r Health Personnel, WtIO w l l l utrclertake, i n c o l l ~ b o r a -

t i o n with Member Count r ics , a s tudy on t h e utilization of tho 'D l rcc to ry , whlch w i l l s e rve

a s J. basas f o r i ts revis ion . The c o l l e c t i o n of information on inn6v.itive educat ional

programmes w i k l be continued .is wel l a s t he promotion of information exchange on such

progrvmaes among Mcmbcr Countr ies .

Col labora t ion w l l l continue wi th Member Countr ies i n t h e planning and development o f

new h e a l t h t r a i n i n g i n s t i t u t i o n s rnd i n promoting the reform o f e x i s t i n g ones, f o r a l l

c a t e g o r i e s of h e a l t h p r s o n n c l . I n add i t i on t o fe l lowships , workshops and t ra in ing-cbus-

s e s t o promote i n s t i t u t i o n a l development, WHO w i l l c o l l a b o r a t e i n f i e l d - t e s t i n g case-

s t u d i e s on non-tradit ional types of t r a in ing programmes f o r heal th professionals and

a u x i l i a r i e s , and prepare guidelines on a l t e r n a t i v e approaches t o strengthening dnd

innovating the t r a in ing of health personnel.

The fellowship progrnmme, which COntinu~s t o receive the strong support of a l l

countries, w i l l continue a s a key core ac t iv i ty . I t s procedures are more e f fec t ive ly

s t r e m l i n e d each year, and i t focusses more and more in tens ively on e f fec t ive e d u ~ ~ l t i o n -

experiences fo r the fellows. Intlmdte day-to-day collaboration with Member Coantries

w i l l be maintained a t its present high l eve l ; provision i s made f o r the usual biennldl

meeting of nat lonal fellowships o f f i c e r s which has been dn important f ea tu re i n ensuring

the ef fect iveness of the Programme f o r severa l years past . There w i l l be wnt inu ing

e f f o r t s t o define more e f fec t ive ly the educational object ives of individual fellowships

and t o monitor and evaluate the ef fect iveness of the programme,

Nursing t r a in ing and services have not advanced i n the Region at the same r a t e

a s medical educatron and some other professional t r a in ing activities, and the whole

question of nursing, including the r o l e of the nurse i n the heal th team, requires

much more a t t en t ion than has been given i n the past.

Based on a review of the ex i s t ing pat terns of nursing ca re i n the Region, specidl

e f f o r t s w i l l be made i n col laborat ion with Member Covntsies, t o develop t r a in ing areas

t o demonstrate s a f e and e f f e c t i v e nursing care. Support w i l l a l s o be given t o the

development of job descr ip t ions and procedure manuals t o guide the t r a i n i n g and p rac t i ce

of middle-level nurses. WHO w i l l promote the use of nursing personnel i n the t r a i n i n g

and supervision of t r a d i t i o n a l b i r t h at tendants and o the r t r a d i t i o n a l heal th workers

with pa r t i cu la r reference t o primary heal th care.

k survey of pa t t e rns of nursing ca re i n countr ies of the Region w i l l be conducted

with the aim of ident i fy ing methods f o r improving and con t ro l l ing the qua l i ty of

nursing care. This w i l l be a col laborat ive a c t i v i t y between nursing and o the r heal th

personnel and w i l l concentrate initially on a c t i v i t i e s i n hospi ta l , but the f indings

and methods of control w i l l have equal relevance f o r community care.

The pressing need f ~ r teachers of midwifery continues t o be met i n severa l ways,

including the WIfOAJY+IICEF-supported Regional Midwifery Teacher Training Programme;

thks programme i s being expanded t o support new developments i n midwifery cars.

The Organization.wil1 continue i t s collaboration with Member Countries i n the devel-

opment of sound t ra in lng programmes f o r o ther categories of auxi l iary and primary heal th

workers . I n postgraduate medical education WHO w i l l col laborate with medical schools i n

defining the object ives of t h e l r programmes In r e l a t i o n t o heal th ca re needs, and pre-

paring competency-based task-oriented cur r i cu la t o meet them.

Continuing education of doctors and of o ther heal th profess ionals w i l l be fu r the r

promoted and e f f o r t s w i l l be made t o encourage Member Countries t o develop systematically

nat ional programmes of continuing education. Where a subs tan t i a l proportion of hea l th

manpower is sti l l imported from o ther countries, pa r t i cu la r e f f o r t s w i l l be di rected

towards continuing education programmes, re-or ienta t ion courses, and other mechanisms

t o ensure t h a t the imported professional manpower has a t r u e understanding of t h e needs

of the country fo r which they a r e working.

I n postgraduate education i n public heal th , the Organization w i l l continue to col la-

borate i n reforming educational programmes t o meet the needs of heal th se rv ices and

communities, and w i l l promote t r a in ing t n heal th services research. A meeting o f

Directors of Schools of Public Health i n Africa and Asia is due t o be held i n t h e African

Region i n 1981 and the pa r t i c ipa t ion of d i rec to rs of schools of public heal th and heads

of departments providing postgraduate t r a in ing i n public heal th , from the Eastern

Mediterranean Region, w i l l be supported a s i n t h e past.

Programme

Educational development and support

Objectives:

- t o e s t a b l i s h a regional network f o r t h e t r a in ing of teachers and educational l eaders

i n educational planning;

- t o promote the systematic design of educational programmes, a s f a r a s poss ible

problem-oriented and competency-based; and t o ensure the a v a i l a b i l i t y of na t iona l

s t a f f s k i l l e d i n educational process and management;

- t o e s t a b l i s h t h e evaluation of educational programmes arld i n s t i t u t i o n s as a means

of increasing t h e i r impact, and t o assess t h e i r relevance t o systematically defined

hea l th needs;

- t o ensure that properly designed and tested teaching/ leming materials are pro-

duced, and t o support research into communication problems;

- t o collaborate With Member S ta tes i n establishing and developing a regxonal l ibsary

system comprxsing a network of regional and sub-regional l ib ra r ies , w i t h inter- l ibrary

cooperation.

Cooperation with and among countrxes

This programme deals with educational planning and technology i n the health sciences;

health learning materials; and health l i t e r a t u r e services, resources and personnel.

I t represents a fundamental infrastructure upon which the e f fec t ive promotion of t ra in?

ing programmes themselves can be developed.

Main thrusts and p r io r i t i e s i n educational planning and technology continue t o be

i n the systematic trqining of teachers of health personnel. Par t icular a t tent ion rill

be given to teachers of middle-level, auxiliary and primary health care personnel. The

needs of ins t i tu t ions and minis t r ies w i l l be ref lected i n workshops and spec i f ic fellow-

ships i n overal l educational planning, curricuhm developleqt, inst ruct ional methods

and materials, evaluation of students and of educational prograrmpes, and educational

managemen t . Close collaboration w i l l continue with the WK) Regional Teacher Trauling Centre,

Department of Medical Education, Faculty of Medicine, Pahlavi University, Shiraz, Iran,

whose a c t i v i t i e s w i l l be expanded and reoriented increasingly towards teacher t ra ining

a c t i v i t i e s for health personnel other than physicians. The centres which have been

established under the leadership of the Regional Teacher Training Centre i n other coun-

t r i e s of the Region w i l l assume increasing responsibili ty for t ra ining fellows of t h e i r

own and other countries.

Support w a l l be provided on request t o the developnent of t ra inipg technology for

community health workers and the t ra ining of natronal s t a f f i n the methodology.

Act ivi t ies w i l l foaus on re la t ing education and t ra ining programmes t o health needs

and the tasks of health personnel.

Main ezfor ts w i l l focus f i r s t l y on completing the surveys of countries of the Region

begun i n 1977, which form the basis of future action. The surveys w i l l be carr ied out

a s f a r as poss ible by-joint teams of na t iona l and Wm-recruited s t a f r ; and secondly

on the o s t d o l ~ s ~ l m e n t w d development of nat ional panels of ;ruthors/contributors who

can design, prcydre ~ i l l t l t e s t basic heal th learning mater ia ls t o meet l o c a l needs. WHO

w i l l co l laborate w i tn p ~ t r t l c i p . t l n g countr ies and UNICEF i n planning a sy2tem t o produce

health-learning mater ia ls and uls t r i . , i l to thcm t o o the r countries. An in ter im programme

evaluation working group w i l l convened.

The WHD regional medlcal l i b r a r y system es tabl ished i n 1978 whereby the Pahlnvi

Medical Library of the Imperlal Medical Library of I r a was designated a s a Wm Regional

Medical Library w i l l be fu r the r developed and i ts services expanded i n l i n e with the

recommendatlolls of a meetlng of col laborat ing countr ies i n 1979. I t is ant ic ipated t h a t

In th ree o r four countr ies appropriate l l n k s w i l l be es tabl ished t o the MEDLINE terminal

i n Teheran.

The t r a i n i n g of a l l l e v e l s of heal th sciences l i b r a r i a n s w i l l be supported, with

spec ia l a t t e n t i o n t o a s s i s t a n t and aux i l i a ry l eve l s , based on t h e 1977 regional workshop

and using the t r a in ing manual issued i n 1978.

Continuing education on heal th sciences l ib ra r i ansh ip w i l l be promoted by the develop-

ment of guidel ines , the establishment of new programmes and t h e support of e x i s t i n g pro-

grammes.

Guidelines w i l l be developed f o r bas ic source lists f o r heal th professions l i b r a r i e s

o the r than medical, using an adapted model of t h e 1977 medical bas ic sciences list.

Major Programme

HEALTH INFORnL'rTION

Progr m e

Health s t a t i s t i c s

Objectives:

( a ) t o col laborate with Member S t a t e s i n the development, improvement and adequate

r eor ien ta t ion of t h e i r heal th information systems m d services , a s an i n t e g r a l com-

ponent of t h e i r general heal th services , with a view to:

- the i d e n t i f i c a t i o n , provision and proper use of t h e information necessary f o r

the e f f i c i e n t planning and management of heal th services ;

- the establishment and promotion of mechanisms t o ensure the permanent flow of

such infonaatzon i n t o the decision-making process;

- the development of manpower resources f o r the management of such hea l th information

services and f o r the u t i l i z a t i o n of information;

- the establishment of c e n t r a l heal th s t a t i s t i c a l u n i t s and the gradual and pro-

gress ive development of sub-national u n i t s as and when t ra ined heal th s t a t i s t i c a l

personnel become available.

(b) t o advise on education and t r a i n i n g f o r various ca tegor ies of heal th s t a t i s -

t i c a l personnel;

( c ) t o c o l l e c t , analyse and promote the exchange and disseminataon of heal th and

heal th-re la ted information, from Member S t a t e s and other sources, and t o serve a s

a foca l point f o r on-request feedback of such information t o Member Countries a s

well a s t o o t h e r u n i t s i n the Regional Off ice o r i n WHO/Headquarters;

(d) t o provide support se rv ices t o o the r programmes i n the Region as regards both

information and s t a t i s t i c a l methodology i n the s t ages of design, co l l ec t ion ,ana lys i s

and/or in te rp re ta t ion of datd;

(e) t o promote the use of t h e In te rna t iona l C lass l f i cd t ion of Diseases, s o t h a t

s t a t i s t i c s emanating from a va r i e ty of sources can be compared with reasonable

confidence.

( f ) t o col laborate i n the development of the W H O Information System.


Ef f i c i en t nat ional heal th information se rv ices and systems, capable of making

avai lable timely, medningful and up-to-date information, a r e rqcognized a s pre-requis i te

t o sound plgnning, ddministrntion, management and cvaludtion of heal th seyvaces. A s many

hlember S t a t e s have poorly developed and poorly s t a f f e d hea l th s t a t i s t i c a l services ,

they can carry ou t only i so la ted s t a t i s t i c a l a c t i v i t i e s , producing data f o r non-specified

c l i e n t s , without focussing on the s p e c i f i c requirements of decision-makers i n t h e heal th

administrat ion. k few countr ies , on the o ther hmd, t r y t 6 adopt heal th*informat ion

systems of devcloped countr ies , without adpating them t o l o c a l circumstances. hiore

important is t h a t , i n e i t h e r case, whatever s t a t i s t i c s a r e being produced a r e not being

properly u t i l i z e d .

Technical cooperati011 with Member Countries i n the development, improvement and

reor ien ta t ion of hegrlth s t a t i s t i c d l system r e t a i n s a h i g h , p r i o r i t y i n WHO'S programme.

Such coopcr,ctlon is achieved e i t h e r through country p ro jec t s spec i f j ca lay (or with compo-

nenls ln heal th s t d t i s t i c s , o r through intercountry p ro jec t s and the se rv ices of the

Regional Adviser. I n a l l cases , c lose r cooperation with JIcmber S t a t e s i n promoting a

d i r e c t l i n k between the users and producers of infonnatipn is peomoted, thus permitt ing

i d e n t i f i c a t i o n of information needs and of the gaps between exzs t lng and required in-

formation, and seeking appropriate remedies. Collaboratron with natxonal institutions

is being promoted, through establishing col laborat ing centres , and through con t rac t s

f o r technical services , to deal with development of appropriate methods and procedures

of common i n t e r e s t t o Member Sta tes . Supplies and equipment w i l l be provided when

necessary f o r the development of nat ional heal th information services. Trazning

a c t i v i t i e s form m e s s e n t i a l component of the p r o g r m e , through provision of fellow-

sh ips , col laborat ion i n na t iona l teaching and t r a i n i n g a c t i v i t i e s , o r pa r t i c ipa t ion i n

regional seminars and workshops.

Requests from Member S t a t e s f o r hea l th s t a t i s t i c c l l information i n s p e c i f i c f i e l d s

a r e frequently received. hloreover, W H O i t s e l f , so ds t o be ab le t o plan and execute

e f f i c i e n t l y i t s programme o i col labordt ion with hlember S t a t e s , necds re levant informa-

t ion. Therefore, the co l l ec t ion and disscminatlon of information from and t o countr ies ,

In a meaningful and useful mmncr, r cqu i rcs concerted e i f o r t by the Organization and

countries.

Programme

WHO publications and documents

This programme provides budgetary provision f o r the issuance of WHO publications,

whether of a technical nature o r otherwise, including the RegiOnol Office t r ans la t ion

s t a f f and services , a s well as the se rv ices of the Reports Off ice a t the Regional

o f f i ce .

Programme

Health l i t e r a t u r e se rv ices

The Regional Off ice Library is included under t h i s programme the purpose of which

is t o provide a referelice and d~cumentation se rv ice on medical and public hea l th sub-

j e c t s t o W H D s t a f f i n the Regional Off ice and i n the f i e l d , and on raquemt, t o o the r

persons and i n s t i t u t i o n s .

The programme al$o eovers technicdl cooperation with Member S t a t e s I n developing

nat ional heal th l i b r a r y se rv ices and promoting regional l i b r a r y services.

Programme

Health information o i the public

The Regional In fomat ion Off ice is included under t h i s prograarme the purpose 00

which is t o help the creat ion of an informed opinion on public heal th mat ters and t o

e n l i s t publ ic suppQrt f o r heal th ac t ion, pa r t i cu la r ly i n relrrqion t o WH3-supported

Major Programme

GENER.& SERVICES AND SUPPORT PROGRMhIES

his major programme provides the f u l l range of non- tochn~cal support se rv ices to

the o the r programmes, i n the Regional Off ice and the f i e l d . Assistance is given

t o the technical u n i t s i n the planning and development of regional programmes. The

programme a l s o contributes t o the elaboration of regional policy on the administrat ive

aspects oi p r o g r m e plannlng and execution.

The major prograqune is divided i n t o t h e following programmes:

Programme

Planning and general a c t i v i t i e s 8.1.0 - This programme comprises the Of f i ce of the Director, Support Programme, who is the

p r inc ipa l ddviser t o the Regional Director on a l l adminis t ra t ive , f inanc ia l , budgetary

and l e g a l matters clnd d i r e c t s the adminis t ra t ive se rv ices provided t o the Regional

Off ice shown i n the support programmes l i s t e d below.

Personnel 8.1.2

This programme covers the a c t i v i t i e s of the personnel u n i t with its respons ib i l i ty

f o r personnel recruitment and assignment, post c l a s s i f r c a t i o n and sa la ry systems, per-

formance appraisa l system, s t a f f r u l e s and personnel procedures/policies, s t a f f r e l a t i o n s ,

personnel records and f i l e s and s t a f f t r a in ing and development.

Supplies 8.1.3

This progrcunme covers the medical supply u n i t which is responsible f o r the procure-

ment of suppl ies and equipment f o r the opera t ing programmes and f o r purchases f o r

Member Countries.

Progrcuame

Conference, Off ice and Building Services

This programme covers the conference and general services , conference arrangements

and records, buildlng management, p r in t ing services , adminis t ra t ive suppl ies and equip-

'ment, communications and mai l , t ranspor ta t ion, inventory records and common services.

Programme

Budget 8.1.5 - This programme covers the budget unit wath its responslbll ity for budget devel-

opment and executipn.

Programme

Finance arid accounts 8 .1 .6 7

This programme csvers the f inancial servkces of the Regional OPfipe w i t h their

responsibil ity f ~ r implomenti~g financial and auqountlog pQlic ies , rules and procedures

as w e l l 4s dlsburolng and reporting On the funds of the Orgmxzation.

INM3RMATION ANNEXES

REGIONAL OFF1 CE

Personnel : A s i n the previous biennium every e f fo r t has been made t o hold Regional

Office expenditure a t a minimum level. In accordance with t h i s policy the following

professional posts have been eliminitated and replaced by posts of the general service

category resul t ing i n a saving of U S $ 64 500 for the 1980-1981 biennium.

Deletions:

2.2.1 GiNERAL PROGRAMME DEVEWPMENT - The post of Administrative Officer (Pl) has beem

deleted, effecltive 1980, substituted by a general service category post a t the

QM level.

7.1.5 HEALTH INFORMATION OF THE PUBLIC - The post of Information Officer(P4) has been

deleted,effective 1981, and replaced by a general service category post a t the M level.

Taking in to consideration the above changes, posts a t the Regional Office dl1

be as follows for the 1980-1981 biennium:

2.1 EXECUTIVE MANAGEMDTC - (Office of the Regional Director )- The Regional Director

(UG), an administrative of f icer (P2) and an administrative assis tant (IM8).

2.2.1 GBNERAL PROGRAMME DEVEIDFWEWT - The Director, Programe Management (D2), an

administrative assis tant (RAX), a junior administrative ass i s tan t (W), a secretary

(M6) and a clerk-stenographer(a5);

7.2.1 Wf13 PUBLICATIONS AND DOCUMENTS - (Reports and Documents and Translation)- a reports

of f icer (P3), a secretary (M6), two clerks (At51 and a clerk typist(B14), three trans-

l a to r s (two P4 and one P3), two clerks (m6) and one clerk-stenographer (m5);

7.1.4 HEALTH LITERATURE SERVICES - a l ib rar ian (W), an assis tant l ibrarian(=?),

and a l ibrary olerk (M4);

7.1.5 HEALTH INFORMATION OF THE PUBLIC - an information of f icer (P4) to be abolished

i n 1981 and replaced by an administrative assistant(E1Qo and a secretary (g16);

8.1 GmERAL SERVICES AND SUPPORT PROGRAMMES

8.1.0 Programme Planning and General Act ivi t ies - the Director, Support Progra8me(Dl),

a junior administrative ass i s tan t (W7) and a clerk-stenographer ( a 5 ) ;

8.1.2 Personnel - a personnel of f icer (P4), an administrative a s s i s t a n t ( M ) , a j ~ n i 0 r

administrative assis tant(m7), a secretary (M6), a nurse clerk(m6) and four clerk-

stenographers (M5 ) ;

8.1.3 Supplies - two supply officers(0ne P3 and one P l ) , an administrative ass i s tan t

(mix), two clerk-stenographers (EMS), two clerks (EV5), three clerk t v p i s t s (F.4);

8.1.4 CONFERENCE, OFFICE AND BUILDING SERVICES

Conference Services - a conference of f icer (P2) and a clerk-stenographer(W5);

General Services Unit - a general services officer(P41, a regis t ry ass i s tan t

(Ehd8), a general services ass i s tan t (M), two t rave l c lerks (one Qb7 and one m5) ,

four regis t ry clerks (one EN6 , two W5 and one EM4), two general services c le rks

(one EM6 and one m5), a clerk-stenographer (m5),a telephonist (W5), two clerk

typ is t s (W4) and one clerk (W3).

Liaison of f ice i n Cairo - one administrative o f f i ce r (Pl)

8.1.5 Budget - an administrative ass i s tan t (=), a junior administrative ass i s tan t

(m), a budget ass i s tan t (EM6), a budget acwunt c lerk (EY6), a budget c l e r k ( a 6 ) and

a c lerk typ is t (Rd4) ;

8.1.6 Finance and Accounts - a budget and f ~ n a n c e o f f i ce r (P4), a finance officer(P3),

an administrative ass i s tan t (QdX), a cashier (EM8), three a s s i s t an t accountants(one EM8

and two =6), a secretary (M6), an accounts clerk(m5), an acwunts/budget clerk(gl5)

and a clerk-stenographer (M5);

To summarise, provision is made i n 1980 for the post of the Regional Director,

sixteen posts i n the professional category and sixty-five posts i n the general services

category; i n 1981 for the post of the Regional Director, f i f t e en posts i n the profession-

a l category and sixty-six posts i n the general services category.

In addition, provision of US $ 180 000 is made t o w v e r twenty-two custodial

s t a f f and US $ 73 000 t o cover the cost of temporary s t a f f fo r the biennium.

Provision has been made for duty t ravel amounting to US $ 45 200 in 1980 and

US $ 50 700 i n 1981 t o enable the Regional Director and his senior of f icers t o v i s i t

countries of the Region t o consult with governments on questions of policy and programe

support, t o discuss the development and execution of' projects with health administrations

and f i e ld s t a f f , t o attend o f f i c i a l meetings, to co l lec t public infomation material ,

t o maintain press and radio contacts and to v i s i t Headquarters fo r discussion of policy

and other matters.

The common services provisions amount to US$ 320 000 i n 1980 and US $ 350 000

i n 1981 while library books and materials provisions are estimated a t US $ 19 000 and

US $ 20 900 md public information material and supplies provisions are US $ 8 000

and US $ 8 500.

In t o t a l , Regional Off ice costs w i l l amount t o US $ 3 667 700 for the biennium.

Regular Budget

REGliONAL 0mCE

2.1 EXECUTIVE MANAGEMENT

Off ice o f t h e Regional D i r e c t o r

2.2 GENERAL PROCRAMME DEVEMlWENT AND MANAGEMENT

2.2.1 General Programme Deve lopmen t

O f f i c e of t h e D i r e c t o r , Programme Management

7 . 1 ' HW LTH I NM.)RMATI ON

7.1.2 WHO P u b l i c a t i o n s and Documentat i o n s

Repor t s and Documents T r a n s l a t i o n

7. I . 4 r i ea l th L i t e r a t u r e S e r v i c e s

L i b r a r y Books and m a t e r i a l

7.1.5 H e a l t h In format ion of t h e P u b l i c

P u b l i c i n f o r m a t i o n S u p p l i e s and m a t e r i a l s

Bienluum 1978

-/Man Ye.- 1978 1979 - -

3 3 - _--

5 5 - --

5 5 6 6 --

11 11 - --

3 3

-- 3 3 --

2 2

-- 2 2 -- - .

- 1979 Biennium

1978 - 1979 US$

223 300 --I_

205 200 .-----

LOR 700 274 400

383 100

49 600 32 ROO ,

82 400

107 300 1 5 600 -

122 900

W l a r Budget

1980 -

1980 1981 - - -

3 3 --

5 5 --

5 5 -- 6 6

11 11 --

3 3 --

3 3 - - -

2 2

-- 2 2 - - .

Biennium 1981

Btenn~um 1980 - 1981 u s

264 100

204 600

123 700 319 100

442 800

60 400 3 9 900

100 300

93 500 1 6 500

110 000

Regular Budget

REGXONAL OFFICB)

8.1 GENERAL SERVICES AND SUPPORT PROGRAMMES

8.1.0 Programme P l u m i n g and General A c t i v i t i e s

8.1.2 Personnel

8.1.3 Suppl ies

8.1.4 Conference, Of f i ce and Building Services

Conference General Serv ices Unit Lia ison Off ice , Cai ro Temporary S t a f f Cus todia l S t a f f C o m n Se rv ices

8.1.5 Budget

8.1.6 Finance and Accounts

TOTAL - REGIONAL OFFICE !

B i d u m 1978 -

-/Man Yeam 1978 1979 - 7

3 3 --

10 9 - - .

10 10 --

2 2 16 16 1 1

-- 19 19 --

6 6 --

11 11 --

83 82

=PI== ==PI==

1

1979 Biennium

1978 - 1979 US$

122 300

248 000

223 600

72 200 315 300

63 300 57 000

167 000 490 !mO

1 165 700

131 500

312 500

3 220 500

P====f==s====

Reguler Budget

1980 - 5.

1980 1981 -

3 3 - - ,

9 9 - - v

10 10 P - 8

-42 2 1 6 16 1 1

- - . 19 19 --

6 6 --

11 11 - - .

82 02

=PP3= PI===

Biennium 1981,

Blennium 1980 - 1981

USE

141 100

246 200

267 800

*€m 900 331 600

74 900 73 000

180 000 670 000

1 413 400

123 400

354 000

, 3667 'WlO

C = I P = U E = l l f PDII

COUNTRY PROc,RM E STATEMENTS

AND T A B l d S

StlMMARY OF SERVICES AND ASSISTANCE TO GOVERNMENTS

REGULAR BUDGET

ESTIMATED OBLIGATIONS

OTHER SOURCES

ESTIMATED OBLI CATIONS BI ENNI UM BI ENN I UM BIENNIUM BIENNIUM

1978 - 1979 1980 - 1981 1978 - 1979 1980 - 1981 us S us s US$ US$

AFGHANI STAN 3 145 900 3 451 600 1 344 600 1 183 900

BAHRAIN 94 000 119 800 170 000 186 400

CYPRUS 372 000 435 400 - - DEMOCRAT1 C YIMEN 1 976 700 2 602 900 1 223 800 780 400

WI BOUT1 80 000 340 100 - 18 400

EGYPT 1 223 400 1 503 100 266 000 1 023 000

I RAN 329 500 364 500 479 800 - 1 RAQ 751 800 602 300 275 000 299 800

ISRAEL 311 000 386 600 - - JORDAN 760 700 938 000 599 500 - KUWA I T 80 000 97 600 30 800 110 800

LEBANON 596 400 944 600 2 681 000 806 000

LI BYAN ARAB JAMAHI RI YA 228 000 100 000 1 010 300 1 464 300

OMAN 588 600 695 600 164 500 345 600

PAK I STAN 2 107 3~10 2 317 300 1 020 700 650 000

QATAR 103 590 58 800 64 600 231 000

SAUDI ARABIA 131 000 151 600 2 163 500 2 598 400

SOMALI A 2 353 200 3 223 200 639 700 466 100

SUDAN 2 094 600 2 447 400 1 555 400 1 081 000

SYRIAN ARAB REPUBLIC 1 132 700 1 375 300 466 800 13 800

TUNISIA 1 276 500 1 388 800 1009 200 219 500

UNITED ARAB EMIRATES 38 500 50 700 100 500 61 300

YEMEN 1 990 500 2 463 700 2 546 800 2 519 100

SUB-TOTAL 21 765 800 26 058 900 17 812 500 14 058 800

INTER-COUNTRY PROGRAMME

GRAND TOTAL

C O W R Y PROGRAYYE STATENF3lT

AFGHANISTAN

NATIONAL HEALTH DEVELOPMENT STRATEGY

The national health strategy has been expressed through the Afghan Seven-Year

Health Programme, AH 1355-61 (1976-1982) dram up in the context ~f the first Republican

Social and Economic Developrsnt Plan.

Tbe ~overmnt's health objectives fall under three main headings:(.) to build up

health infrastructure, i.e. health facilities and installations, health manpower and

water resources; (b) to control specific diseases and groups of diseases by appropriate

health technologies; (c) to establish and develop central support systems for health,

with special reference to administration and management of health services, supplies

and distribution of pharmaceuticals, diagnostic and therapeutic services.

Ten major programmes have been dram up to fulfil these objectives, dealing respect-

ively with hospitals, basic health services (including priury health care),environmntal

health, health manpower development, malaria and leishmaniasis, tuberculosis and leprosy,

imunioation, drugs and biologicals, technical support services, administration and

planning.

Country health progrcring began in AH 1355, (1976) and the first annual revision

of the National Health Programme, within the seven-year perspective, took place late in

AH 1356 (1977). This seven-year Health Prograne, includes the sector-specific provis-

ions (mainly for construction of health installations, training units 8nd wawr supplies)

of tho seven-year Social and Economic Development Plan, but in addition outlirw8 the

operational programmes and development81 efforts in each of the major component8 of the

national health services.

The oollaboratign of external agencies is being increasingly brought into line with . the priority provisions of the progrmw. WHO collaboration is expected to cover only

selected aspects of the seven-year Health Programme.

TBCHNICAL COOPERATION PROGRAMMES FOR HEALTH

Health planning, progr..~ina and project formulation

The preparation of tho Afghan National Health Progr- ud the seven-year Health

Progrlrre led to a recognition th8t(a) planning ud progr8uing require a continuous or

cyclic process based on-the monitoring of results ud pe r f o ~ n c e in the light of

123

changing circumstances, and(b1 development projects o r service improvements have a

much b e t t e r chance of success and of a t t r a c t i n g external support when properly formulated.

Therefore one important aspect of technical cooperation with WHO w i l l cons i s t of

j o i n t programming of a c t i v i t i e s leading t o programme budgeting; programme evaluation,

and e laborat ion of f e a s i b i l i t y analyses and a c t i v i t y formulation a s a bas is f o r both

nat ional ac t ion and external support.

Health services and primary heal th care development

There is 8 major e f f o r t t o extend the heal th services network. The key e l e e n t is

the all-purpose basic heal th centre a t d i s t r i c t level , and thus the major t h r u s t is i n

t h e d i rec t ion of commissioning more such centres, but a t t e n t i o n is a l s o being paid t o

extensions of services t o bring them closer t o the sca t t e red r u r a l communities, and t o

the strengthening of more specia l ized r e f e r r a l centres.

Several external sources a r e col laborat ing with the Government i n t h i s domain.

WHO col laborat ion i s required only f o r two s p e c i f i c components:

- strengthening of comprehensive community services espec ia l ly a t the r u r a l periphery

and with emphasis on reaching women and children. WHO w i l l support the t r a i n i n g

and supervision of community heal th workers i n both regular and extension services

espec ia l ly f o r family heal th care. There is a need a l s o t o develop aspects of

personal and community care which h i t h e r t o have had a low pr io r i ty , but which c a l l

f o r more a t t e n t i o n as the pa t t e rn of i l l - h e a l t h changes. WHO w i l l co l laborate i n

such e f f o r t s - e.g. i n building up a mental heal th component of the general hea l th

services.

- strengthening of support systems required f o r the proper functioning of heal th

services. While i n some respects the Government benef i ts from col laborat ion with

o ther sources, WHO is expected t o contr ibute technical ly by arranging f o r add i t iona l

t r a in ing and by the piovision of supplies and equipment.

Drug pol ic ies and managpment

The Government proposes t o deal systematically with i s sues re la ted t o drugs,

vaccines and re la ted therapeut ic o r prophylactic agents. The Government has inv i t ed

WHO par t i c ipa t ion i n es tab l i sh ing a drug qual i ty-control capabi l i ty . This implies a

comprehensive policy on drugs and biologicals . The expanded programme w j l l cover a l l

aspects of t h i s comprehensive policy f o r drugs and pharmaceuticals, with s p e c i a l emphasis

on formulation (based on sound and f e a s i b l e p r inc ip les ) and its application. Sound

manufacturing and processing practices and quality-control of local and imported prsducts

required for the control of common conditions will be promoted. Another component will

be tho study and large-scale application of herbs and plants traditionally employed in

folk medicine.

Communicable disease prevention and control

Control programmes for specific diseases will be intensified by technologies of

mass application, Special field forces engaged in specific disease control activities

will broaden and diversify the scope of their work, and serve to link more effectively

the community and its health workers with the network services installations.

Malaria control will show a progressive shift to more cost-effective methods, and

more insistence on community rusponsibility in reduction of vector breeding etc, Never-

theless, as malaria will continue to be associated with surface water its ultimate

control will depend largely on change in irrigation practices. Control of other vector-

borne diseases, notably leishmaniasis, is already being associated with malaria control.

The extended immunization programme is expected to have become established as a

permanent component of community health services.

In the case of tuberculosis and leprosy, special control measures will largely be

absorbed by regular services; only selected control and referral functions will be

carried out by specialist units.

Until safe water supplies and excreta disposal can be universally ensured, diarrhoea1

disease control will largely depend on prompt treatment and prevention of severe dehydra-

tion. There will be a major expansion in the production and use of oral rehydration

mixtures through health services and extension workers.

WHO participation will promote mastery of appropriate technology and a shift towards

full national responsibility and control.

Promotion of environmental health

Recognizing that judicious exploitatton of water resources lies at the very root of

general development in this country, and also represents the most important single factor

in reducing disease, both the Government and external agencies are spurring the develop-

ment of water supplies for domestic use. The next few years will see a marked increase

in WHO participation in this domain mainly by making available a study and design group

to analyse the feasibility of, and design, large-scale schemes calculated to provide

considerable numbers of r u r a l inhabi tants with water suppl ies with low maintenance cos ts .

Management of water resources w i l l assume an increasingly important r o l e i n the

control of malaria and of po l lu t ion from sources o ther than animal excreta. A t the same

time, WHO w i l l be associated with nat ional e f f o r t s t o overcome other s a n i t a t i o n problems,

including the d isposal of wastes and excreta, not only by engineering methods, but a l s o

and espec ia l ly by behavioural approaches.

Health manpower development

The Government is keenly aware of the d e s i r a b i l i t y of proceeding f u r t h e r and f a s t e r

with "double integration" i n t h i s domain - i.e. of t r a i n i n g d i f f e r e n t members of the

heal th team together, and of bringing t r a in ing and continuing education more c losely i n t o

l i n e with service needs.

WHO col laborat ion has been ca l l ed f o r i n order t o cover some of the c r i t i c a l gaps

caused by the rapid extension and expansion of hea l th services : f u l l advantage w i l l be

taken of the provisions of the regional medium-terra programme f o r heal th manpower develop-

ment including pa r t i cu la r ly those elements deal ing with a more object ive appraisa l of

se rv ice requirements a s a bas is f o r both manpower and educational planning, development

of teaching a i d s and learning mater ia ls , curriculum revis ion and teacher t ra in ing. W h i l e

t r a d i t i o n a l domains, such a s continuing o r advanced education abroad, w i l l a l s o remain an

important p a r t of WHO'S contr ibut ion, the new t rend i n manpower development is expected

t o r e s u l t i n WHO collaborating, not with separa te i n s t i t u t i o n s , b u t by deploying its

resources a s t o make them ava i l ab le t o a l l groups and schools concerned with education,

t r a i n i n g and management of manpower.

RoaLth i n f o n u t i o n

The Government has r ecen t ly made a s izeable input towards strengthening of t h e i r

hea l th information services. These se rv ices were reorganimd, and a t r a ined un ive rs i ty

graduate was appointed t o head the service. In col laborat ion with WHO, an ad hoc survey

f o r i n f a n t and e a r l y childhood morta l i ty has been ca r r i ed out i n Greater Kabul a rea and

the repor t , containing very useful r e s u l t s , has now come out.

WHO col laborat ion w i l l continue towards f u r t h e r strengthening of the heal th inform-

a t i o n services , and extension of the ad hoc survey t o o the r p a r t s of the country, par t -

i c u l a r l y r u r a l areas.

WHO col laborat ion w i l l a l s o continue towards making ava i l ab le necessary medical

l i t e r a t u r e t o the medical schools and other teaching i n s t i t u t i o n s .

Regular Budget

A F G I W I STAN

.

Plajor programme/programme

2.2 GENERAL PROGKAF*IME DEVEMWENT AND \!ANACEMENT

2.2.2 Country Health Programming (WHO Programme Coordinator)

3.1 HEALTH SERVICES ' DEVELOPMENT

3.1.1 Health Services' Planning and Management (School of Radiography; Maintenance and repair of medical equipment; Hospital administration)

3.1.2 Primary Health Care (Development of basic health services)

3.1.4 Care of the Aged, Disability Prevention and Rehabilitation (Rehabilitation services)

3.1.5 Appropriate Technology for Health ( Institute of Pathology, Kabul; Health laboratory services)

3.2 FA,,! I LY HEALTH

3.2.1 bfaternal and Child Health (Family health services development)

3.2.4 Health Education (Health education)

Estimated - Biennium

1978 - 1979 US$

174 300

252 800

183000

93 100

Y

Obligations


US$

200 300

56 300

213CjO

5.1 200

101 000

15 900

Source

of

FP

Othcr Sourcee

Estimated

Biennium 1978- 1979

US$

189 600

Obligations

Blennium 1980-1981

US$

28 000

Regular Budget

Estimated Obligations

Bienn urn Blenn urn 1978 - 1979 1980 - 1981 .F

AFGHAN I STAN ( c t ' d )

Major Prouraume/programae

3.3 MENTAL HEALTH

(Development of mental h e a l t h s e r v i c e s and t r a i n i n g :

3.4 PROPHYLACTIC, DIAGNOSTIC AND THERAPEUTIC SUBSTANCES

3.4.1 Drug P o l i c i e s and Management (Drug p o l i c i e s and management)

4.1 COMMUNICABLE DISEASE PREVENTION AND CONTROL

4.1.1 Epidemiological S u r v e i l l a n c e ( I n s t i t u t e of P u b l i c Hea l th , Kabul)

4.1.2 Malar ia and O the r P a r a s i t i c Diseases (Ma la r i a c o n t r o l prograame; Le ishmanias i s c o n t r o l )

4.1.3 B a c t e r i a l , Viral and Mycotic Diseases (Na t i ona l t u b e r c u l o s i s programme)

4.1.5 Expanded Programme on Ilmnuni z a t i o n (Expanded pMgramIe o f immunization)

5.1 PR(MOTION OF ENVIRONMENTAL HEALTH

5.1.2 Bas i c S a n i t a r y Measures (Environmental h e a l t h )

59 500

1 6 1 7 0 0

1 364 600

137 700

89 100

8 1 100

182 200

2 8 9 1 0 0

961 300

212 600

310 900

J

Sourcc

ai

DP

DP

Other Sources

Estimated

Blenn~um 1978 - 1979

US$

995 000

160 000

Obliiationa

Biennium 1980 - 1981 US$

990 000

38000

COUNTRY PROGRAMME STATmENT

BAHRAIN

NATIONAL HEALTH DEVEWPMENT STRATW

Health services have developed i n the context of long-term health plan fo r the per-

iod 1969-1986, and under which appreciable progress has been made i n the control of ccnn-

municable diseases and i n making health services readily accessible t o the en t i r e popula-

tion. Major thrusts now are towards providing high-quality family primary care through

a network of recently constructed health centres, and developing environmental health

and workers' health services t o deal with the problems associated w ~ t h the very rapid

economic and industr ia l development of the muntry and the associated inf lux of immigrPrt

workers.

Bahrain sti l l depends t o some extent on expatr ia te professional s t a f f fo r its

services ; W H ) w i l l collaborate par t icular ly i n the pr ior i ty area of health man-

power development, which has implications for Bahrain and a l so neighbouring s ta tes , i n

the control of environmental pollution problems, the develoment of workers' health

services, and i n organizing the health information system.

TECHNICAL COOPERATIm PBOGWMMES FaR HEALTH

Health services development - Workers' health (occupational health)

In addition t o the petroleum refinery, during the l a s t ten years,ship-repairing

yards, an aluminium smelter and a large number of small indus t r ia l concerns have been

developed, and the Government is concerned about the protection of the health of the

workers. WH) w i l l continue t o collaborate i n developing the occupational heal th laws,

the introduction of occupation health services, the establishment of regular health

screening and services for expatr ia te workers par t icular ly i n respect of theUtroduot ion

of communicable diseases, and developing t ra ining programmes on occupational health for

phsysicians and nurses employed i n health services, and for inspectors and hygienists.

Promotion of environmental heal th

High pr ior i ty is being given t o the development of a modem sewage system i n

Manama, where 43% of the t o t a l population lives. A plan has been d ram up by a firm

of sub-contractors and WH3 has collaborated i n its review and evaluation.

Bahrain is actively involved i n the plans fo r Qontrol of environmental pollution

and of the de le te r ious ez fec t s of coas ta l polLution within the countries of the Gulf

area. W H O w i l l co l iaborate i n the deve lopen t of wa$te d isposal and other environ-

mental heal th programmes. In addi t ion, ass is tance w i l l be provided together with UNEP

i n the regronal coas ta l pol lu t ion control programes fo r the protect ion and d e v e l o p e n t

of the marine environment and coas ta l areas.

Health manpowor deve lopen t - Nat$onals a r e being t ra ined abroad and a t home t o man the services ; meanwhile

t ~ l e r o a r e t raaning progrE)mmes t o o r i e n t expe t r i a t e s t o the hea l th problems of the

country. WHO has oollaboreted i n the development of the College of Health Sciences

and the School of Nursing and i n o t h r r t r a in ing a c t i v t i e s f o r various ca tegor ies

of technicians, and w i l l cont%nue t o provide technical support f o r continued education

of the heal th professional s t a f f i n the country.

Health information

With tho growth of heal th se rv ices the need f o r heal th information f o r the manage-

ment and monitoring of hea l th se rv ices has been recognized.

WHO w i l l continue t o w l l a b o r a t e i n technical guidance and t r a in ing of personnel

f o r medical records and heal th s t a t i s t i c s .

COUNTRY PROGRAMm STATEMENT

CYPRUS


The long-term objective of the Government is t o a t t a i n a high standard of health

services so a s t o offer the best possible medical care and at tent ion to a l l c i t i zens

and t o implement an effect ive programme of preventive medicine and hygiene.

I t ig proposed t o increase the number and improve the qual i ty of health manpower,

t o expand hospi ta l services, t o improve the health information system, and t o move

towards a national health service.

TECHNICAL COOPERATION PROGRAMMES FOR HEALTH

Health services development

The Government is determined t o make health care f a c i l i t i e s available and access-

i b l e t o the population a t large with pat icular a t tent ion t o rura l communities. In this

context the health centres and hospital networks a re being expanded and the qual i ty of

t he i r services improved. Attention is a l so being given t o expansion of laboratories

and strengthening of medical rehabi l i t a t ion services through the e~tabl ishment of add-

i t i ona l physiotherapy centres.

WHO w i l l continue t o collaborate closely with the Government i n the development of

the Regional Centre fo r the t ra ining of p e r s o m l i n the mainteWmnae and repair of medical

equipment. The Centre received i ts f i r s t group of t ra inees i n 1978.

WHO w i l l continue a s necessary i ts cooperation with UNHCR i n ass i s t ing the health

au thor i t i es i n the northern and southern sectors t o meet the health needs of the

population . WHO w i l l collaborate also, i n the organization and delivery of health care, care

of the Aged, and hospital administration, the fur ther development of basic heal th

services, medical rehabi l i ta t ion, and maintenance and repair of medical equipment, i n

r e l i e f and rehabi l i t a t ion a c t i v i t i e s and i n the promotion of Publich Health Laboratories.

Disease Prevention and control

There are no quarantinable diseases in Cyprus, and most infectious diseases are

under control. However, echinococcosis is of some concern and a recently initiated

control programme will be continued. Among the non-coauuunicable diseases there is an

increase in cardiovascular diseases, diabetes and cancer. Road accidents constitute

the leading cause of death in the age group 15 - 49 years.

Thalassaemia is a major problem; about 14 per cent of the population carry the

trait, and one child in 200 is reportedly born with the disease. Possible control

measures will be explored.

WHO will assist the Government in the field of non-communicable diseases as

required.


The Government intends to establish and maintain the best possible environmental

control manures and facilities, taking also into account the needs of displaced persons.

Surveillance will be continued to maintain the status of malaria eradication.

WHO will cooperate by providing consultant services in environmental health.

Emphasis will be on problems of Mediterranean pollution and solid wastes disposal.


The health manpower situation is improving steadily. The WHO fellowship programme

will continue to be used for the improvement of the manpower situation.

COUNTRY PROGRAMME STATEMENT

DEHOCRATI C YEMEN


The cu r ren t na t iona l h e a l t h development s t r a t e g y is formulated wi th in t h e con-

t e x t o f t h e Five-Year Development Plan f o r 1979-1983 and programed i n a country

h e a l t h programming e x e r c i s e c a r r i e d o u t i n 1978 i n co l l abora t ion wi th WHO. The

major programme a r e a s i d e n t i f i e d a s p r i o r i t i e s a r e communicable d i sease c o n t r o l , i n -

c luding malar ia , schis tosomias is , t ube rcu los i s , com~lunicable eye d i s e a s e s and collPon

childhood i n f e c t i o n s ; primary h e a l t h care ; maternal and c h i l d h e a l t h and family

planning; t h e provis ion o f p o l y c l i n i c s i n urban a reas ; h e a l t h adminis t ra t ion; and

h e a l t h manpower development.

TECHNICAL CO-OPERATION P R O G W S lWR HEALTH

Health s e r v i c e s development

The Government p l ans t o e s t a b l i s h p o l y c l i n i c s i n c i t i e s f o r f i r s t - p o i n t con tac t

wi th the h e a l t h s e r v i c e s and wi th r e f e r r a l f a c i l i t i e s f o r s p e c i a l i s t serv ices . The

h e a l t h information s e r v i c e , n a t i o n a l h e a l t h l abo ra to ry s e r v i c e , the pharmaceutical

s e r v i c e s and the s e r v i c e f o r t h e maintenance and repair o f medlcal equipment w i l l be

f u r t h e r developed wi th WHO co l l abora t ion .

I n o rde r t o implement t h e r a p i d l y expanding h e a l t h s e r v i c e s t he Government

proposes t o s t rengthen t h e c e n t r a l h e a l t h admin i s t r a t ion and t o set up s t r o n g de-

c e n t r a l i z e d admin i s t r a t ive u n i t s i n governorates, provinces and d i a t r i a t s .

Primary h e a l t h c a r e

This programme i s a major component of t he h e a l t h c a r e system. I t is designed

t o ensure increased coverage o f t h e r u r a l populat ion through a network o f primary

h e a l t h c a r e u n i t s a t v i l l a g e l e v e l , s t a f f e d by workers s e l e c t e d by the community and

t r a i n e d l o c a l l y . Community p a r t i c i p a t i o n is s t r e s s e d a t a l l l e v e l s o f supervis ion ,

implementation, motivat ion and evalua t ion .

Some p r i o r i t y con t ro l programmes i n communicable d i s e a s e s and ma lnu t r i t i on a s

w e l l as a s p e c t s of maternal and c h i l d h e a l t h a r e incorpora ted i n t he primary h e a l t h

c a r e programme.

The a s p e c t s of t h e programme on which WHO co-operation is l i k e l y t o focus a r e

i ts t r a i n i n g component and t h e t r a n s f e r o f t he information and experience gained i n

s i m i l a r p rog rames elsewhere.

Family hea l th

A comprehensive approach t o Family heal th is to be developed so a s t o include

elements of maternal and ch i ld heal th , the expanded programme on immunization, the

control of diarrhoea1 d i seases of children, and nu t r i t ion . WHO w i l l co l laborate

p a r t i c u l a r l y i n regard t o the t r a in ing of manpower f o r ch i ld heal th services , and

the supervision of the MCH component of primary heal th care.

Disease prevention and control

Malaria, tuberculos is , comunicable eye diseases and schzstosomiasis a r e major

hea l th problems t o the control of which the Government has assigned high p r i o r i t y

and s p e c i f i c t a r g e t s f o r the end of the 1979-1983 Development Plan. W H D w i l l be

associated with these control progralunes a s well a s with the Expanded Programe on

Immunization which aims a t 80% coverage of e l i g i b l e age-groups of children, and 80%

coverage of pregnant women with te tanus toxoid. With regard t o sohistosomiasis, a

study is t o be made of i ts epidemiological, malacological and environmental aspects

before designing a control programme. Epidemiological se rv ices an11 be fu r the r

strengthened.

Promotion of environmental hea l th

The Government i s sys temat ica l ly developing cornunity water supply systems as a

high p r i o r i t y i n environmental heal th ; waste d isposal and food hygiene a r e a l s o

given p r io r i ty . Community pa r t i c ipa t ion is being fos tered i n the improvement of

environmental conditions. W H D col laborat ion w i l l continue i n the form of s t a f f ,

dissemination of information, co-operation i n f e a s i b i l i t y s t u d i e s and i n the mobiliza-

t i o n of addi t ional investment and extra-budgetary resources,


This programme i s incorporated i n the a c t i v i t i e s of a l l the o the r programmes.

The manpower requirements and t r a i n i n g fo r the p r i o r i t y heal th programmes necess i ta te

the expansion and extension of the t r a in ing f a c i l i t i e s a t the c a p i t a l and the o the r

governorates. Though nat ional c a p a b i l i t i e s have a l ready been g r e a t l y enhanced,

in te rna t iona l co-operation i n providing teaching s t a f f w i l l be required t o meet the

addi t ional demand f o r t r a ined hea l th manpower. W H D w i l l co l laborate i n the pre-

para t ion of teachers and the development of i n s t i t u t i o n s and cur r i cu la t o meet the

increased manpower needs.

Health information

A c e n t r a l heal th s t a t i s t i c a l u n i t has been i n exis tence fo r some years. A

number of nat ional s t a f f have been t ra ined, and professional expa t r i a t e s have been

jo ining i n the service through b i l a t e r a l and in te rna t iona l arrangements. There i s

sti l l need t o fu r the r strengthen the heal th s t a t i s t i c a l services , pa r t iou la r ly i n

the provinces, and t o t r a i n nat ional heal th s t a t i o t i c a l personnel. WHD col laborat ion

w i l l continue through advisory se rv ices i n t h i s area.

DEMOCRATIC YEMEN

Major Programme/programme

2.2 GENERAL PROGRAMME DEVELOPMENT AND WAGEMENT


3.1 HEALTH SERVICES' DEVELOPMPI'I

3.1.1 Health Services' Planning and Management (Public heal th advisory services ; Maintenance and repa i r of medical equipment)

3.1.2 Primary Health Care (Primary heal th ca re )

3.1.3 Workers' Health (Occupational heal th )

3.1.5 Appropriate Technology f o r Health (National heal th laboratory:

3.2 FAMI LY HEALTH

3.2.1 Maternal and Child Hea 1 t h (Maternity centred family planning programme; Child hea l th )

3.4 PROPHYLACTIC , DIAGNOSTIC AND THERAPEUTIC SUBSTANCES

3.4.1 Drug Pol ic ies and Management (Pharmaceutical services )

Regsrr Budpet Soun?e

aZ

FP

Othcr S o m e

EBtimated


US$

143 100

235 400

79 000

128 100

20 500

Estimated Biennium

1978- 1979 US$

497 600

Obligation8


US$

153 800

266 200

77 800

55 900

181 300

268 500

76 000

. Obligation8

Biennium 1980-1981

US$

DEMOCRATIC YEMEN ( c t ' d )

4.1 COMMUNICABLE DISEASE F'REVENTION AND CONTROL

4 .1.1 Epidemiological Survei l lance (Epidemiological s e r v i c e s )

4.1.2 hlalaria and Other P a r a s i t i c Diseases (Malaria control programme; Schistosomiasis contro l )

4.1.3 Bacter ia l , Viral and Mycotic Diseases (Tuberculosis con t ro l ; Leprosy control 1

4.2 NONCOMMUNICABLE DISEASE PREVENTION AND CONTROL

4.2.1 Cancer (Cancer control )

5 .1 PROMOTI ON OF ENVIRONMENTAL HEALTH

5.1.2 Basic Sani tary Measures (Community water supply and environmental hea l th se rv ices 1

5.1.3 Recognition and Control of Environmental Hazards (Environmental hea l th po l lu t iona l problems)

6.1 HEALTH MANPOWER DEVELOPMENT

6.1.2 Promotion of Training (Nursing Education, Mukalla School; Medical education; I n s t i t u t e of Health Manpower Development Aden, Phase I I ; Post-gradua t e t r a i n i n g i n publ ic hea l th ; Fellowships )

m Budget Source

of

finds

VA

VA

VA

DP

Othcr Sourcee

Estimated


US$

168 700

219 500

80 100

49 500

163 400

585 100

EBtimated Biem~um

1978- 1979 US$

192 500

533 700

Obligations


US$

134 300

504 400

103 100

200 400

21 400

541 800

Obligations

' Biennium 1980-1981 US$

90 000

240 000

40 000

410 400

DJIBOUTI

INTRODUCTION

Djibouti gained its independence oilly recently i n June 1977,, and joined WHO member-

ship i n March 1978. I t is a small country, with a surface area of 22 000 sq. km, but

with population estimates widely varying between 110 000 and 350 000. Three quarters

of the population l i v e i n the capi ta l c i t y (DjiboutP) and the four provincial capitals3

the remainder l i v e i n rura l areas, mostly nomads.

TECHNICAL COOPERATION PROORAWYeS FOR HEALTH

Health services dsveloa~lent

Communicable diseases const i tute major problem. The diseases most frequently

not i f ied i n 1975 were: influensa, tuberculosis and sexually-transmitted diaeaae$,but

such diseases a s whooping cough, neasles, mumps and infectious hepa t i t i s a re very comon.

Administratively, the country is divided into four provinces. There were ( i n 1975) one

general hospital with 822 beds, and 10 medical centres with about 200 bed.. Out-patient

f a c i l i t i e s , prenatal and chi ld health centres, s ~ h o o l health uni ts and dental health

un i t s provide additional services.

WHO w i l l collaborate i n the reorganisation and development of health services a t

various levels. Hospital services development and rehabi l i t a t ion services a r e add-

i t i o n a l venues fo r collaboration.


Malaria does not seem t o be endemic i n Djibouti, but l imited outbreaks a r i s e i n

vulnerable areas due t o the introduction both of A. nambiae and gamatocyte oarriers

along the roads followed by nomadic population. Thus 191 cases w e n , reported during

1973-76 (with 96 cases i n 1975 alone); similar outbreaks occurred e a r l i e r during 1963-65.

WHO collaboration w i l l be i n i t i a l l y directed towards assessment of the present

s i tua t ion and developing m t i o n a l aapabi l i t ies .


The Oovernmnt is appreciative of the need fo r the development of its environmental

health progrulmae.Thoughthe oountry is occasionally confronted with floods and droughts,

the ahronic problems a re those of environmental pollution.

Apart from Djibouti (c i ty) , no dis infect ion is carr ied out i n public water supplies

i n urban and ru ra l areas. Water supply is mostly through bore holes, unprotected shallow

dug w e l l s or surface sources. Sewerage systems are ra ther limited, end so l id wastes

disposal i s uncontrolled, offer ing breeding grounds for f l i e s and rodents. Red Sea

pollution is a l so a problem.

WHO rill continue ~0118b0t8tion i n these areas, with q strqng element of 0 r g - e

t i on and a t ra ining progrolanns of nationals.

Health manwwer development

Djibouti relie@ mainly on expatr ia tes fo r health personnel. In 1975, of the 52

physicians, 6 dent i s t s and 6 pharmacists, 141 p r o f e 8 8 i o ~ l nurser and r idr iver , 102

ass i s tan t nurses and 193 nursing auxi l iar ies , dental, phuuceu t ioa l , laboratory and

radAology teehnlcirnr, the majority were expatriates. Changes i n ava i lab i l i ty a f t e r

independence is qui te l ikely. WHO collaboration rill be through providing advisory

mrvices i n health manpower developlent .ad i n t ra ining rurtional personnel.

Health information

The ava i lab i l i ty of timely, re l iable , reuringful and up-to-date i n f o r u t i o n is

recognised a s a prerequisite t o sound planning, adr inir t ra t ion, management and evaluation

of health services. WHO w i l l collaborate towards the es t ab l i8bon t of a nation8Z health

information system and t ra ining nation81 s ta f f .


EGYPT


The Fourth Five-Year National Development Plan, 1978-1982, incorporates a strategy

of decentralization based on autonomous regional development areas. It provides for

preventive health services, primary health care, curative and specialized health services

and the production of all required pharmaceuticals and vaccines. There is emphasis on

people's participation in the planning and administration of the services, delegation of

authority, strengthening the central planning machinery in the Ministry of Health,

raising the quality of care, continuing education of a11 health personnel, co-ordinating

medical education and research with health services, the control of environmental

pollution, developing information services to support planning and evaluati.?, and

health-services research particularly in health economics and information.

There is considerable bilateral and multilateral technical cooperation and WHO

collaboration is available for the various components of the Governments' programe.



Egypt has a well developed network of rural and urban health facilities and services.

A referral system is being developed through urban policlinics designed to serve 100 000

to 200 000 inhabitants. District and general hospitals with specialized units are being

upgraded.

One of the problems in the management of these facilities is the maintenance and

repair of medical equipment, and WHO is collaborating in the training of technicians for

this purpose.

As a result of the increase in population, traffic and industrial development, a

serious problem of environmental pollution has arisen. In the rural areas the luge

quantities of fertilizers and pesticides being used to promote agricultural production

are contaminating the environment and soil to an unknown extent. The Government has

established an environmental and occupational health centre to study chemioal and

bacteriological contami~tion of air, water and food and to conduct toxicological

studies; to study fresh and canned food with a view to determine the effects w the8 of

heavy letals, additives, preservatives, pesticides and bacteria; to determine quantities

of heavy metals in drinking water; to examine and determine the effects of contaminants

and chemicals on the health of the working population in industries; and to find

possible solutions to the problems studied.

WHO and UNEP are aollaborating in the ertablishment of the centre in developing

a system for early identification of health problems associated with pollution and the

general environment of work, and in developing guidetines and criteria adapted to

~ 0 n d i t i 0 ~ in egypt.

, Shigella and Salmonella infections are major cases of gastro-enteritis particularly

in children. WHO is collaborating in studies for identification and typing of SNgella

and Salmone3la.

In order to develop a comprehonsive immunization progrsume, the Government intends

to produce DPT as well as BCG vaacines for the Expanded Programe in I~munination and

to achieve self-sufficiency in vaccine production. WHO and UNDP are aollaborating in

this development and in quality control procedures.

A large phrrrmaceutical industry h8s grown and is being further exp8nded to achieve

self-sufficiency in ph8~ceutical products. WHO is collaborating in developing drug

policies, in improving pharmaceutical production practises, and ph8rm8eeutical quality

control, through the provision of consultants, fellowships and supplies and equiprent.

Disease rev en ti on and control

The Oovernaent plans to set up a surveillanae system for the rapid diagnosis and

early notifimtion of unusual corunicable disease. which soretires appear as sudden

epidemias ud to establish oo~rdination uongat veterinary 8nd publia health authorities

at administrative and teahniaal levels. WHO will collaborate through the provision of

consultants, supplies and equipwmt.

Anti-ularia aotivities are plumed and executed as p8rt of the general health

activities through the malaria control service of the Yinistry of Health and Malaria

Control Units distributed all over tho aountry. The risk of amlaria is now restriated

to limited areas. WHO collaboration will continue through limited provision for supplies

and by cooperating in teahniaal aspects of the progr-, including the training of

mtiomlr.

The Government h8s embarked upon 8n extensive progrusre of developing further the

intensive care, emergency services and other specialized units already available in

larger hospital., in collaboration with WHO , USAID, and bilateral agencies. WHO will

cooperate particularly in the establishment of national training centres.

An increasing number of genetic health problems, especially haemo-globinopathies

and neural disorders, are being recognized, and studies are being undertaken with WHO

collaboration to assess their extent and to provide a basis for establishing genetic

counselling services.

The large textile and sugar industries are responsible for respiratory diseases

from cotton and bagasse dust. WHO will collaborate in developing programmes for the

control of such allergic diseases and in strengthening the institutions responsible for

these programmes.


Egypt is participating in the inter-regional programme for the control of pollution

in the Mediterranean. A complete inventory has been made of land-based sources of

pollutants and a programme has been established to monitor pollution in recreational

waters and shell-fish beds. A collaborating centre has been designated and laboratory

analyses are being made.

The air-pollution monitoring system established in Cairo is being expanded and

extended to the provinces.

Solid waste collection and disposal systems are being strengthened.

WHO is collaborating through the provision of consultants, fellowships, supplies

and equipment to programmes for air quality, water quality, the monitoring and control

of pollution in the Mediterranean and Red Seas, and solid wastes disposal.


The programme of health personnel training continues to be an active one involving

large numbers of trainees in various categories. In the case of health personnel

trained under the Ministry of Education e.g. physicians, dentists, pharmacists,

professional nurses, this has called for greater collaboration with the Ministry of

Health in the utilization of health care facilities other than University hospitals for

training purposes.

In medical education, as a result of the emphasis given in previous years to train-

ing teachers in educational planning and technology, the programme has reached a stage

where those responsible are re-examining the relevance of training to health-service

requirements and are aware of the need for changes in ways of organizing curricula,

instructional methods and m8terial8, and evaluation. Accordingly, more emphasis is

being given to the support of new medical or health-sciences education units/departmnts

or centres.

In addition to the staff of medical schools, training in educational planning

and technology has included teachers in nursing, public health, dentistry and Ministry

of Health staff. Those in nursing are mainly teachers from W Hi~har.bstitutes--d.

Nursing, and they are expected to play an important role in improving nursing education

programmes in their om institutions as well as in other nursing institutions in the

country.

As the Seaoaduy Nurm Technia81 Sahools Programs which are nor graduating large

nurbers,became established, emphasis rill be given to post-bsic nursing and midwifery

education.

Progress is being made also in training and utilizing traditional birth attendants

within YCH progr-8.

The Centre for Educational Technology in Health Sciences, Cairo, whoso major funa-

Uonis develomnt of learning MterialS, is gradually overcoming the difficulties of its

earlier stages of development and a significant increase in its activities is 8nticip.t.d.

WHO will eontinru to collaborate in developing the above training activities in the

different institutes.

Health information

Iaforrut%on is rvquind for pla~ing, unageoent and monitoring of health, social

w l f a n and enviromntal health progr...es. The Authority for Yobiliution and

8t.ti.tics is responsible for tho collection and processing of national statistics. The

Ninistry of Health collocts and pr-sses information on disoasea, serviaes, and other

factor. related to the managememt of health services. In addition, the Institute of

Statistical Studies and Research, Cairo, and the High Institute of Public Health,

Alexandria, h a m progrrno. for training, teaching and research in health statistics.

WHO is continuing its collaboration with a11 these organitations and institutions,

partiaularly in developing data-processing capabilities at various administrative and

or#8niqational levels and the training of personnel.

E G Y P T

~- Ma.ior Programme/progr~~lle


3.1.1 Health Serv ices ' Planning and Management (Medical emergency cent re ; Maintenance and r e p a i r Of

medical equipment)

3.1.3 Workers ' Health (Occupational hea l th )

3.1.5 Appropriate Technology f o r Health (Sh ige l l a and Salmonella Survey; Laboratory se rv i ces ; Production of b a c t e r i a l vaccine and con t ro l )


3.4.1 Drug p o l i c i e s and Management (Drug p o l i c i e s and management)

4.1 COMMUNICABLE DISEASE PREVENTION AND COElTROL

4.1.1 Epidemiological Su rve i l l ance (Epidemiological s e rv i ces )

4.1.2 Malaria and Other P a r a s i t i c Diseases (Malaria con t ro l programme; F i l a r i a s i s survey)

Regular Budget , ,/-


~iennium Biennlum USI- 1978 - 1979 1980 - 1981

Sourcc

of

Funds

DP

Other Sources

121 500

26 000

5 4 0 0 0

81 000

&timated

B~enn~um 1978- 1979

US$

226 OOO

82 100

81 200

19 100

1 1 0 6 0 0

38 400

122 200

Obligations

B~ennium 1980-1981 US$

733 000

Regular Budget

E G Y P T

(ct 'd)

Ma.lor Pro~ramme/pro~rararne

4.2 NONCOWUNICABLE DISEASE PREVENT1 ON AND CONTROL

4.2.2 Cardiovascular Diseases (Intensive care units - University Hospitals)

4.2.4 Other Noncommunicable Diseases (Genetic counselling)

4.2.5 Immunology (Allergic diseases)

5.1 PROMOTI ON OF ENVIRONMENTAL HEALTH

5.1.3 Recognition and Control of Environmental Hazards (Environmental health pollutional problems)

6.1 HEALTH MANPWER DEVEUlPMENT

6.1.2 Promotion of Training (Health professionals education; High Institute of Public Health, University of Alexandria; Post-basic nursing educatton; Fellowships)

6.1.3 Educational Development and Support (Centre for educational technology in the health sciences; Health education)

7.1 HEALTH INFORMATI ON

7.1.1 Health S t a t i s t i c s (Strengthening of basic health statistical services)

TOTAL - EGYPT

Estimated

T u m 1978 - 1979

US$

87 000

38 500

451 500

313900

50 000

1 223 400

l l l D P U P I t L l

- Obligations


US$

132 400

40 600

73 700

588 800

164000

50 000

1 503 100

I P I P I D S P I P I

Source

or

DP

DP

Othcr Souree~

Egtimated B~ennium

1978 - 1979 US$

40000

266 000

P t l e = l P P f P 0

Obligatione


uss

190 000

100 000

1 023 000

PPt lP IPPDI3

COUNTRY PROGRAMLlE STATElYIENT

I RAN - NATIONAL HEALTH DEVEMPMENI' STRATEGY

In the past decade Iran has experienced an extremely fast economic growth and has

had one of the most rapidly rising Gross National Products in the world.

This economic growth has been accompanied by many social changes, not least in the

field of public health and welfare. The rapid development of an integrated approach to

health and welfare, with decentralization on a regional basis, has taken place in close

conjunction with a wide variety of other social reforms including land reform, workers

profit sharing schemes, the establishment of an educational corps and a health corps,

compulsory social security, nutritional programmes and a wide range of preventive

medicine activities.

The current national health development strategy was formulated in the context of

the Sixth National Development Plan (1978-19831, which envisages a substantial increase

in annual per capita expenditure on health.

Particular efforts are being taken by the Government in the field of health man-

power development, where the authorities are taking steps to ensure that all training

programmes for health workers are as closely as possible integrated with those for

the development of health services.

High priority is given to the establishment of health and welfare networks, and

the development of primary health care.

Primary health care is seen in a broad context which encompasses the prevention

and control of communicable diseases, including ipp~unisation, maternal and child health,

and the promotion of environmental health.


Primary health care

The development of frontline health care delivery and the promotion of the concept

of health services development as an integral part of overall comnunity develop~ent has

received Government approbation as a result of the outcome of research and developlent

projects in primary health care in various regions of the country. WHO will continue

to be associated with the primary health care programw mainly in relation to its

periodic evaluation and to making its experience available to other countries in the

Region, including a s a spec i f i c f e a t ~ r e the co l lec t ion and t rans fe r of information on

appropriate technology f o r health. Research i n heal th services development is a part-

i c u l a r concern of the Government, and WHO w i l l col laborate c losely i n t h i s respect.


The heal th author i t ieg propose t o exploi t the opportunity which I ran presents f o r

c e r t a i n aspects of cancer epidemiology and control ; WHO w i l l cooperate i n this a c t i v i t y

by providing consultant services and t rans fe r r ing information on epidemiological find-

gngs t o other countries.

The Government is concerned a l s o t o formulate new drug p o l i c i e s and t o introduce

e f fec t ive management of the preparation, d i s t r i b u t i o n and use of drugs.

Promotion of environwntal heal th

The main t h r u s t of WHO collaboration i n t h i s respect w i l l be i n r e l a t i o n t o the

monitoring and control of a i r and water qual i ty , t o marine pol lu t ion control i n the

Kuwait Action Plan Region (Urn), and t o environmental improvement projects.


WHO'S r o l e w i l l be t o col laborate with the Government a s required i n c a t a l y t i c

a c t i v i t i e s , based t o the extent possible on a research and d e v e l o p e n t approach, t o

fu r the r the Government's expressed in ten t ion of c rea t ing an e f f e c t i v e in tegrated hea l th

service and manpower development programme.

Specif ic input w i l l be made, a s requested, t o a number of experimental i n s t i t u t i o n s

including Bu A l i Sina University, Hamadan, the University of Retaiyeh, West Azerbaidjua

and Fassa University i n Fars Province a s w e l l a s o the r i n s t i t u t i o n s where new approaches

t o t r a in ing a r e being developed.

Continuing c lose col laborat ion i n a l l aspects of educational planning and

technology, under the overa l l leadership of the Department of Medical Education Pahlavi

University, Shiraz (WHO Regional Teacher Training Centre) i s anticipated.

Continuing col laborat ion i n i n s t i t u t i o n a l development with the School of Public

Health, I n s t i t u t e of Public Health Research, University of Teheran, w i l l be extended.

There rill be continuing col laborat ion with t r a in ing programmes i n c e r t a i n s p e c i f i c

f i e l d s including nursing and medical l ibrar ianship .

Wcr Sourcee Sourcc

Estimated Obl~gatione I R A N of

Biennium Biennium 1978 - 1979 1980 - 1981 - US$ US$

3.1 HEALTH SERVICES* DEVELOPMENT

3.1.1 Health Services' 40 000 DP Planning and Management (Maintenance and repair of medical equipment; Basic health services)

3.1.5 Appropriate Technology for Health (Public health laboratory services)

3.1.6 Health Services ' 100 000 DP Research (Health services development research)

3.2 FAM I LY HEALTH

3.2.1 Maternal and Child 76 000 FP Health (Support to population programme)

3.3 MENTAL HEALTH 48 800 DP

(Psychotropic subetances)

3.4 PROPHYLACTIC , DI AWOSTI C AND THERAPEUTIC SUBSTANCES

3.4.1 Drug policies and management (Drug policies and management )


4.2.1 Cancer (Cancer control)

Regular Budget

I R A N

( c t 'd)

Major Pro~rarmne/pro~ramme

5.1 PROMOTION OF ENVIRONMENTAL HEALTH

5.1.3 Recogni t ion and C o n t r o l of Environmental Hazards ( A i r p o l l u t i o n c o n t r o l ; I n d u s t r i a l domest ic and a g r i c u l t u r e p o l l u t i o n survey ; Environmental h e a l t h p o l l u t i o n a l problems)


6.1.2 Promotion of T r a i n i n g (High I n s t i t u t e o f Nursing; Hea l th p r o f e s s i o n a l e d u c a t i o n ; School o f P u b l i c Hea l th , Teheran; Fel lowships:

TOTAL - IRAN

Estimated


US$

8 500

287 000

329 500

---------- ----------

7

Obligations


US$

35 900

295 600

364 500

---------- ----------

Source

of

Funds

DP

DP

,Ww- &urm Estimated

B~ennium 1978- 1979

US$

160 000

55 000

479 800

----------- -----------

Obligations

Biennium 198Q-1981

US$

----------- -----------

COUNTRY PROGRAMME STATEMWT

lKig - NATJONAL HEALTH DEVEIPPMENT STRATEGY

The main emphasis is on fur ther well-balanced development of health manpowerinolud-

ing the rec t i f ica t ion of the imbalance between the various categories and the improve-

ment of the geographical distributzon of health workers; the gradual extension of

aomprehensive rura l health services as well as of the health insurance scrheme aiming

a t t o t a l population coverage; increased e f f o r t s towards the preventron and control

of diseases, with pr ior i ty on communicable diseases, inuluding bet ter immunization

coverages, and an overal l improvement of environmental conditions.

The complet$on of a detai led national health plan for the period 1976/1980, was

postponed due t o delay i n completing the overall National Developsnt Plan for the

same period.

The National pevelopent Plan for the period 1981/1985 is under preparation and

there are etudies i n progress towards abng-term plan t o the year 2 000.

Country health programming was carried out i n 1978.


Comprehensive health services

The provision of aomprehensive health services t o the ru ra l population by 1980will

continue through an expansion of s t a f f i ng gf the main health centre*, sub-centres and

mobile rura l health unrts. Village-level s ta t ions, below sub-centres, a r e being

expanded.

Improvement of medical care implies increasing the r a t i o of 2.0 beds per 1 0 0 0

inhabitants i n 1977 t o 2.3 i n 1980.

MCH services are being expanded so tha t the number of centres w i l l have increased

from 100 i n 1975 to LBO i n 1980.

The National Nutrit ion I n s t i t u t e w i l l be strengthened and attempts w i l l be made

t o integrate the national nu t r i t ion policy i n to the general health services.

Continuous emphasis w i l l be l s i d on health education.

A Regional Training Centre i n Maintenanae and Repair of Medical Equipment estab- l ished i n 1978 w i l l recerve continuing support.

Hospital services administration is being adapted and modernized in consonance

with new developments.

The Directorate of Public Health Laboratory Services aims at co-ordinating the

laboratories, improving training and standardizing equipment and methodology.

More personnel will be trained for the National Rehabilitation Institute.

There will be an increased use of locally produced drugs, and WHO will collaborate

in advising on drug policies and management.

Within the entire context of comprehensive health services, technical cooperation

with WHO will be centered around the Regional Training Centre for Maintenance and

Repair of Medical Equipment and hospital services administration. As and when required,

in the other specified areas, WHO collaboration is available in respect of information

transfer, consultant services, co-ordination functions and fellowships.


The main trends and objectives will be to promote epidemiological surveillance,

the expanded immunization programme with its gradual integration into the general health

services, strengthening of the staffing pattern, modernization of equipment, and to

support administrative decisions, payment of financial incentives to health workers,

as well as the purchase of modern equipment and additional transport. It is estimated

that the transmission of malaria may be controlled by the end of 1980. The Endemic

Diseases Institute in Baghdad will be strengthened A Malaria Training Research Centre

is being established in Baghdad to train malaria personnel from the Arab Countries.

The Ministry of Health wishes to continue technical cooperation with WHO in

epidemiological surveillance, aiming at further assessment of communicable diseases,

training of the national staff and in obtaining advice for future planning.

The Malaria Eradication Programme may require technical co-operation on a rather

broad basis through 1gCf2,

On a lesser scale, technical cooperation will continue in visceral leishmaniasis

control as well as in communicable diseases control and prevention of visual impairment.

&le disease reve en ti on and - - control

A new National Cancer Institute will be constructed and the National Cancer

Register will extend beyond the boundaries of Baghdad city.

The national oral health survey is expected to be completed by the end of 1980.

Other non-communicable diseases will receive due attention through the Institutes

concerned.

Technical co-operation with WHO, through consultants, fellowships and inforution

transfer, will continue in cancer control and preventive oral health services.


The Directorate-General of Humon Environment was established in 1975, under the

Ministry of Health. It now includes also the Directorate of Occupational Health, At

the national level, plans and activities related to the human environment as a whole

are coordinated through the Supreme Council of Human Environment in which 18 ministries

are represented. Coordination of matters related to environmental health will contin-

through the Council and that will include applied research, air pollution monitoring

and control, food safety and occupational health, among other subjects.

Technical cooperation with WHO, UNDP and ILO will continue in building the required

infrastructure for large environmental programmes, including occupational health.

Health manpower develomnt

The health problems of the country are rather well defined. The required tasks of

health workers are being elaborated by a study on job descriptions. In order to keep

pace with the growth of the health services and the increasing population, three n e w

medical colleges were established: A1 Nustansariyah, in Baghdad, (1975) at Sulaiun-

iyah in 1977; and at Kufa (Kerbala Province) in 1978.

The national authorities are fully aware of the amfavourable ratio between medical

and other health personnel. Increasing attention must be given to training the "medium

level" and auxiliary personnel, if the desired balance is to be attained.

Technical co-operation with WHO will continue in medical and nursing education

through consultantships, provision of teaching and training aids, meetings, workshops,

exohange of visiting professors and fellowships.

Regular Budget


Biennium ' Biennium

us$ F 1978 - 1979 1980 - 1981

Other Sourcee Sourec

Ebtmated Obl~gatione I R A Q

of B~ennlum Biennium

9 000

198 300

4 500

15 000

10 000

246 000

- 751 800

P I I P = P I I I P P -

(ct 'd) - Major Progranune/prograrmne


4.1.1 Epidemiological Surveillance (~pidemiological~urveillanc~

4.1.2 Malaria and Other Paras1 tic Diseases (Malaria eradication programme; Visceral leishmaniasis control)

4.1.7 Prevention of Blindness (Prevention of blindness)



4.2.3 Oral Health (Preventive oral health services)


5.1.1 Environmental Health Planning and Management (Environmental health)


6.1 HEALTH MANPOIlER DEVELORnENT

6.1.2 Promotion of Training (College of Nursing, Baghdad; Medical education; Fellowships)

TOTAL - IRAQ

17 800

141 500

5 300

24 600

5 300

35 000

230 300

602 300 PI==P=tt l=a

1978 - 1979 US$

275 000

275 000

1980-1981 US$

45800

21 600

299 &00

DP

FT

, I


ISRAEL - NATIONAL HEALTH DEVELOPMENT STRATEGY

I t i s the policy of the Government of I s rae l to make high-quality primary medical

care available t o the en t i r e population withln the framework of a national health in-

surance system, and with ready interact ion between the primary, secondary and t e r t i a ry

aare sectors. The integration of curative and preventive services is seen a high prior-

i t y i n order t o avoid overlapping and t o f a c i l i t a t e continuity i n health care. Anumber

of groups, based on the exis t ing health insurance system, Ministry of Health services

and medical schools, have been developing different approaches t o the implementation of

t h i s policy, and much empirical knowledge has been gained about the feas ib i l i ty , c o s t ,

advantages and disadvantages of d i f fe ren t approaches. There i a a growing movement to

establ ish family medicine as the focus of primary medical care, which aims a t wmprehens-

i ve and continuing care for the family unit .

Disease patterns i n I s r ae l a re mainly those of industr ia l ized soc ie t ies and in-

areasing at tent ion is being given therefore t o the control of non-comunicable diseases

and of environmantal hazards associated w i t h industry and urbanization.

TECIHI CAL COOPERATION PROGRAMMES FOR HEALTH

Non-communxcable disease prevention and control

WHO collaboration, i n the form of fellowships and conaultants, w i l l focus mainly

on cancer control, which is the object of a very act ive voluntary organization conaerned

par t icular ly with prevention and ear ly detection.


WW collaboration i n environmental health w i l l r e l a t e mainly t o the monitoring

and oantrol of a i r and r r t % r quality, t o marine pollution i n the Mediterranean and Red

Seas, and t o environmental improvement.


Continuing collaboration w i l l be extended i n the carefully designed W H D Fellow-

ships programme which is constructively used by the Government and Universities, p r e

dominantly for short periods of t ra ining abroad for potent ia l ly key individuals i n

selected f ie lds .

Collaboration will be specifically targeted upon nursing education, and upon s u p

port and continuing evaluation and monitoring of the programmes of the Centre for Health

Sciences of the Ben Gurion University of the Negev. A t the latter University and other

universities having health professional schools, particular mphaais will be laid on the

training of key teachers and on training in appropriate aspects of community medicine.

w@= Budget

I S R A E L

~a j o r Prog~amme/programme

3.1 HEALTH SERVICEB' DEVELOPMENT

3 .l. 5 Appropriate Technology f o r Health (Radiation p ro t ec t ion )

4.2 NONCOMNRMICABLE DI SEASE PREVENTION AND CONTROL

4.2.1 Cancer (Cancer con t ro l

5 .1 PROMOTION OF ENVIRONMENTAL HEALTH

5.1.3 Recognl t i on and Control of Environmental Hazards (Air po l lu t ion con t ro l ; Environmental h e a l t h p o l l u t i o n a l problems)

6.1 HEALTH W W E R DEVELOPMENT

6.1.2 Promotion o f Tra in ing (Nursing education; Medical educat ion; Fellowships )

WTAL - ISRAEL

Estimated


US$

18 500

6 500

286 000

311 000

==========

Obligations


US$

9000

15 300

62 900

299 400

386 600

==========

Source

' d

Othor Sources

-ted

Biennium 1978- 1979

US$

Obligations

Biennium 1980-1981 US$

COUNTRY PROGRAlldh(E STATEMENT

JORDAN


Medium-term socio-economic development plans are periodically prepared by the

Jordan Development Board and resources a re allocated fo r the development of the health

sector, i n addition t o provisions for health a c t i v i t i e s i n other sectoral p r o g r m s .

The principal health service problems are: the poor d i s t r ibu t ion and variable

qual i ty of health services i n rura l and desert areas; a shortage of professional and

auxi l iary health manpower; overlapping of curative services and limited coordination

between the public and private sectors; inadequate control of drugs; need fo r mre

modern methods of managing health ins t i tu t ions , and lack of proper educjtron of the

public i n the best way t o u t i l i z e medical services.



A s par t of the development plan, the Yinistry of Health w i l l be strengthened,

and improved administrative practices introduced. A comprehensive long-term plan fo r

the development of the health services w i l l be developed. Health leg is la t ion rill be

up-dated t o define the respons ib i l i t i es and coordinating ro l e of the Ministry of Health,

and s t a t i s t i c a l and information services w x l l be improved. Attention w i l l k given to

the administration and management of hospital services and t o co-ordinating t h n with

other health services. The health insurance scheme wi l l be fur ther developed. Part-

icu la r a t ten t ion w i l l be given t o improving the maternal and chi ld health serviaes.

WHO w i l l continue t o collaborate with the Government i n various aspects of public

health, i n primary health care a s a pr ior i ty , i n esfabl ishing a network of workshops

f o r the maintenance and repair of medical equipment, i n medical rehabi l i ta t ion, and i n

the emergency medical services, and i n public heal th laboratory services Par t icular ly

i n the improvement of the Vaccine Ins t i tu te , and the establ ishrent of an adequcrte

v i rus section.

Family health/maternal and chi ld health

I t is envisaged that the collaboration of internat ional agencies with the Govern-

ment wi l l continue i n maternal and chi ld h e a l t h / f u i l y health.


The importation of malaria from neighbouring countries continues to be a threat

to the eradication programe. WHO cooperation is directed towards technical support

and a minimum amount of supplies as required, the coordination of activities between

Jordan and neighbouring countries through the promotion of malaria border meetings,

and fellowships.

A national programme is being developed as part of inter-country plan for the

control of enteric infections. WHO will provide consultant services, fellowships,

local training of staff, supplies and equipment.


WHO will collaborate by providing consultant services for problems of Red Sea

pollution, strengthening of environmental control programmes, and solid wastes disposal.

Fellowships will be awarded for developing manpower capabilities for the monitoring and

control of marine environment pollution and for environmental health pollution problems.


In health manpower development, WHO will continue to promote the training of

national teachers for medical and nursing education, the further strengthening of the

Faculty of Medicine and Pharmacy of the University of Amman, the strengthening of nurs-

ing services and the development of professional and auxiliary nursing education pro-

grammes. Preparation of graduate nurses as midwives has been receiving considerable

attention.


KUWAIT

NATIONAL HEALTH DEVEU)PhlENT STRATEGY

The Health services i n Kuwait have developed a t a f a s t pace during the l a s t three

decades. In 1974 there were 11 hospi ta ls with 3 500 beds; ten polyclinics and 34

cl inics . The budget i n 1977 was US$ 184 million (K.D. 54 million). The per capi ta

health expenditure being US$ 167 (K.D. 49 per annum). The t o t a l number of s t a f f em-

ployed by the Ministry of Health is between 16 to 17 000 which is increasing by more

than 15% per year. There a re fur ther plans t o expand the services during the next few

years and i n 1976 a medical college s ta r ted functioning.

The Government is committed t o the welfare of the people and therefore it is con-

cerned about the effectiveness and efficiency of health services and is anxious t o i m -

prove it so that Kuwait should develop one of the best health care systems i n the world.

Availabili ty of financial resources has not been the l imit ing factor. However, the

health services depend upon expatr ia te manpower and expertise which is being drawn from

other friendly countries. There is a great variation i n the qual i ty of professional

and middle level personnel.- The Government has made a great e f f o r t t o bring the health

care as near t o people i n t he i r homes as posssible, with the r e su l t tha t Kuwait has a

re la t ive ly greater level of coverage by medical care than other countries i n the Region.

I t is expected tha t i n the next few years, a l l homes w i l l be within ten minutes' driving

distance from a f i r s t quality hospistal.


Health services planning and management

In view of these developments and plans, the Government is concerned about defini-

t ion of agreed goals, objectives and pr ior i t i es . Wm and other organizations have

collaborated i n developing the capacities for planning and strengthening of the planning

process.

WID would continue to collaborate i n strengthening the planning process, develop-

ment of t ra ining of personnel, improvement of management and reorganization of health

structure, development of information systems, aol lect ion and re t re iva l of data.

Non-communicable disease prevention and control

Cancer (Comprehensive programme a t community leve l )

Cancer ac t i v i t i e s i n Kuwait s ta r ted i n the late '60s with the new Radiotherapy . ... Department a t A 1 Sabah Hospital. In 1971 a Cancer Registry was organized which pro-

vides information on cancer dis t r ibut ion by site, age, sex and population arlgin.

Cancer c l i n i c s have been introduced during the l a s t few years and preventive measures

i n terms of decreasing population exposure t o environmental carcinogens i n the occupa-

t ional area are being gradually undertaken.

W m would collaborate i n developing a Comprehensive National Cancer Programme which

is envisaged t o strengthen ear ly detection, public and professional education, improved

follow-up, rehabi l i ta t ion and primary prevention addressed t o the general population

(control of smoking, eating, chewing and other habi ts re la ted with carcinogenesis).


Recognition and control of environmental hazards (Environmental health pollution

problems)

Kuwait,on account of its geographical s i tua t ion and climate,depends on desalination

of water. The 0x1 industry has created a number of environmental health problems and

therefore the Government is concerned about the pollution of the environment. Kuwait

is also signatory t o the convention for the control of environmental pollution and the

deleterious e f fec t s of the ooastal developent within the Gulf. WH) would collaborate

with the Government and UNEP i n the developent of manpower capabi l i t i es i n a i r qual i ty

control, marine pollution problems of the Gulf and environmental improvement a c t i v i t i e s

i n the country.

Health manpower developent

Promotion of t ra in ina (Fellowships)

Manpower development is especially important for health services i n view of t h e i r

labour intensive nature. Importation of expatriates is only a temporary solution.

Eventually nationals would have to be trained for the various professional and middle

level positions. WH) would collaborate i n the t ra ining of national teachers, re-

or ientat ion of expatr ia te s t a f f t o prepare them t o meet the needs of the country and t o

t r a i n and reorient the nursing s t a f f through establishment of new nursing teaching pro-

g r m e s and in-service training.

Regular Budget - Mimated Obligations

K U W A I T

-

Othcr Sourccs

Estimated Blennium

1978 - 1979 US$

30 800

30 800

======I====

- - -

Major Progrannne/pro~ramme

3.1 HEALTH SERVICES ' DEVELOFMENT

3.1.1 Hea l th S e r v i c e s 1 P l a n n i n g and Management ( N a t i o n a l h e a l t h p lann ing)


4.2.1 Cancer (Comprehensive c a n c e r programme a t community l eve l :


5.1.3 Recogni t ion and C o n t r o l of Environmental Hazards (Environmental h e a l t h p o l l u t i o n a l problems)

6.1 HEALTH MANPOWER DEVELOEWMT

6.1.2 Promotion of T r a i n i n g (Fe l lowships )

TOTAL - KUWAIT

80 000

80 000

==========

1 7 600

80 000

97 600

53====2===

Source Obligatione

S~ennium 1980 - 1981 US$

24 100

4 7 1 0 0

3 9 600

110 800

==E===3===

- - -

or

-

FT

FT

FT

-- -

COUNTRY P R O C ~ STATEWT

LEBANON

NATIONAL HEALTH DEVEYAPMENT STRATEGY

The events of 1975 and 1976 have deeply disturbed the nat ional heal th planning

machinery, a s i n the o the r nat ional sectors , and the re was delay i n developing the

subaequest Five-Year Health Plan, taking i n t o account the changed manpower and heal th

se rv ices parameters.

However, the broad object ives of the Government a r e to:

- reorganize and strengthen the Ministry of Health, and i n pa r t i cu la r , t o e s t a b l i s h

a hea l th planning u n i t a s well a s t o revive and expand the c e n t r a l hea l th o t a t i s -

t i c a l u n i t ;

- reorganize the basic hea l th se rv ices and improve the hosp i t a l se rv ices administra-

t ion;

- s t e p up t r a in ing of personnel and gear the t r a in ing towards nat ional hea l th require-

ments;

- continue prevention and control of communicable d iseases and explore deeper the

epidemiology of the main non-communicable d iseases ; and

- implement a national environmental heal th programme with emphasis on water supply,

sewerage and disposal of s o l i d wastes.

TECHNICAL CO-OPERATION PRO- mR HEALTH

Health 8ervice development

A t the cen t ra l l eve l , a study group has made recomendations on the reorganisa-

t i o n and strengthening of the Ministry of Health. A nat ional heal th planning group

has been established.

Primary heal th care is del ivered through r u r a l and peri-urban dispensaries. Of

more than 300 dispensar ies a small proportion f a l l s under the j u r i s d i c t i o n of the

Ministry of Health; by and l a rge dispensar ies a r e or iented towards cura t ive medicine.

A ser ious reshaping of bas ic heal th se rv ices i s a f e l t need with a view t o improving

the overa l l coordination between the Ministry of Health, various groups and non-

governmental national agencies, t o design a proper s t a f f i n g pa t t e rn and a geographical

d i s t r i b u t i o n of bas ic u n i t s which w i l l ensure f a i r population coverage.

Of 143 hospi ta ls , 20 belong t o the Government and contain 1400 of the t o t a l of

11 370 beds. Logis t ics problems a r e recognized and the Government intends t o ex-

plore the def ic iencies i n the administrat ion of t h e i r hospi ta l services.

Maternal and chi ld heal th a r e beingstrengthened a s ex i s t ing f a c i l i t i e s , both

governmental and pr ivate , a r e inadequate t o meet growing demands.

Epidemiological s tud ies of mental i l l n e s s e s t o provide a bas is a r e required f o r

the improvement of the national mental heal th services i n accordance with recognized

in ternat ional standards.

The Government project fo r the advancement of pharmaceutical administrat ion i n

the Ministry of Health, includrng l eg i s la t ion , regulation, qua l i ty con t re l and drug

procurement and storage a s w e l l a s the establishment of drug information services

has been revived and w i l l continue i n 1980-1981.

Along with th strengthening of the Central Public Health Laboratory i n Beirut ,

plans a r e under way t o s e t up public heal th l abora to r ies i n the provinces and thus

t o develop a national public hea l th laboratory service. This w i l l back up the con-

t r o l of the major, pa r t i cu la r ly the communicable diseases and the reduction of en-

vironmental hazards.

WE?,) w i l l be ac t ive ly involved, i n a l l these a c t i v i t i e s , through 1980-1981.


The higher ranking communicable diseases a r e typhoid and paratyphoid fevers,

r e sp i ra to ry tuberculosis, schistosomiasis, v i r a l hepatitis and poliomyelitis. The

extent of p a r a s i t i c d iseases i s not known. I n absolute f igures i t can be s t a t e d

t h a t the global problem of comunicable diseases does not represent a cause of major

public hea l th concern. However, s t r i c t epidemiological vigilanoe w i l l be maintained

and an expanded immunization programme i s being implemented. The n o t i f i c a t i o n

system is being revived.

I n 1980/1981 WHO w i l l continue t o col laborate c lose ly i n the f i e l d of epidemio-

log ica l surveil lance.

b n g the non-comunicalbe diseases, the Government w i l l g ive more emphasis t o

the epidemiology and control of cancer and the cardiovascular diseases. These a r e

the two spec i f i c f i e l d 6 i n wMch WHO w i l l be ac t ive ly involved i n 1980/1981.

Prolaotion o f environmental hea l th

The major th rus t w i l l be towards the provision of s a f e water, d isposal of used

and r a i n waters, co l l ec t ion and disposal of s o l i d wastes, prevention of coas ta l water

pol lu t ion and control of o the r environmental hazards. A s the e n t i r e undertaking is

complex, expensive and time-consuming, the Government is counting on ipnu t s freni

various sources i n support of the nat ional e f f o r t .

I n 1980/1981 WHO w i l l be c lose ly col laborat ing i n the National Waste Management

Plan.


Both the r a t i o s and the geographical d i s t r i b u t i o n of personnel need improvement,

and f o r t h i s , heal th manpower planning and management require strengthening. The

current Five-Year National Plan, provides the bas i s f o r the e f f o r t i n t h i s d i rec t ion.

I n medical education the main tasks w i l l be t o evaluate the undergraduate curriculum

i n r e l a t i o n t o the hea l th needs of the country and t o review coordination between

t r a in ing i n s t i t u t i o n s . The redevelopment of the Government Nursing School w i l l

continue and its curriculum w i l l be revised.

I n 1980/1981, W H O w i l l co l laborate i n the above described process.

Health information

The revival and strengthening of Health S t a t i s t i c s se rv ices w i l l continue. The

Ministry of Health is f u l l y aware that data co l l ec t ion , processing and ana lys i s a r e

the beckbone of planning, implementation and evaluation. The major a r e a s t h a t w i l l

receive c lose a t t e n t i o n a re :

- the establishment of a c e n t r a l s t a t i s t i c a l department a t the Ministry of Health,

and

- the establishment of recording and repor t ing a t a l l l e v e l s including the t r a i n i n g

of personnel.

W I I ) i n 1980/1981 w i l l co l laborate c losely i n the a c t i v i t i e s enumerated.


LIBYAN ARAB JAMAH1 RI YA


Provision of curative and preventive health services on an integrated and decen-

t ra l ized basis, f ree of charge t o a l l c i t izens, has been the essence of the national

health policy since 1969. The main objectives s e t for th t o implement t h i s policy a re

(a) eradication of endemic and epidemic diseases, (b) expansion and decentralization

of health f a c i l i t i e s and services, (c) t ra ining of health personnel of a l l categories,

and (d) a t ta ining eventual self-sufficiency i n the production of cer ta in therapeutic

substances.

The above objectives a re amply ref lected i n the s t ra teg ies adopted for health

development ac t i v i t i e s tha t are integrated into the current five-year (1976-80)

National Development Plan,

The Jamahiriya has made rapid s t r i de s i n developing i ts health services. Overall

phys lc lhea l th f a c i l i t i e s (such as hospitals, polyclinics, health centres) have been

nearly doubled, the budgetary resources have been t r ip led and the health s t a f f of variom

categories has increased fourfold.

The f i e l d s t o which the Government has given pr ior i ty and i n which WHO technical

collaboration is anticipated i n 1980-81, are (a ) health manpower development, (b) prim-

ary health care, (c ) health administration and management, (d) ra t ional production

and dis t r ibut ion of pharmaceuticals, and (e ) promotion of applied research on health

problems of importance t o developing countries.

TECHNICAL COOPERATION PROGRAMMES FOR HElZLTH

Prmary health care and health services development

The decentralization of health services received a strong impetus with the creation

of health directorates (Murakbat E l Saha) for each municipality. New hospi ta ls and

health un i t s have extended coverage t o previously under-served communities. The crea-

t ion of peoples' Health C o m m i t t e s , an element of the new po l i t i c a l s t ructure , has

f a c i l i t a t e d increased community participation i n health services. The Government,

with the collaboration of WHD, has made an evaluation of the mpact of basic health

services with a view to further strengthening them, par t icular ly front-l ine health care.

WH) w i l l continue, i n 1980-81, i ts cooperation with the Government i n the evaluation

of its programmes of immunization, disease control, health education, water supplies

and sani ta t ion, a l l of which a re components of community development. W H D technical

collaboration is also planned to strengthen supportive services such as nationalhealth

information systems, and health administration and management.


The control programmes for tuberculosis and trachoma have been highly successful.

The compulsory immunization programme though requiring further improvements, has

brought about a declining prevalence of some infectious diseases. The Government . while recognizing the need t o continue these e f for t s , proposes t o organize control

programmes for other health problems, including non-communicable diseases. I t is

planned accordingly to enlarge the present endemic diseases un i t in to an endemic and

non-communicable disease unit . WH) w i l l work closely with t h i s uni t and i n 1980-81

w i l l be involved i n periodical evaluation of the prograrmmes with a view to the i r

integration into basic health services, and i n the development of epidemiological

s tudies and preventive measures against problems such as rheumatic and other cardio-

vascular diseases, diabetes, cancer, v i ra l diseases, bi lharziasis , cutaneous leishma-

n ias i s and especially rodent plague which is posing a threat t o communities i n sca t t -

ered areas. The country w i l l take advantage of the Organizatim's programmes of

technical cooperation i n the qual i ty control and production of drugs and biologicals

locally o r regionally and of support t o national seminars for the dissemination of

drug information and the concept of essent ia l drugs t o ra t ional ize drug use and

expenditures incurred on them. WH) w i l l continue t o collaborate i n t h e reorganization

of mental health services and the development of preventive ophthalmological sorvices.


Considerable investments are being channelled through the Secretar ia ts of

Municipalities and Housing for the provision of sa fe water and sani ta t ion programmes.

The Secretar ia t of Health continues t o s e t up standards, promulgate necessary legis la-

t ion and generally coordinate ac t i v i t i e s i n t h i s f ie ld . Systems of water supply and

sewage disposal are constantly being upgraded to meet the needs of growlng c i t i e s and

towns. Increasing at tent ion is being given to t h e disposal of industr ia l wastes,

and coastal water monitoring and pollution control. Other environmental hazards

including t r a f f i c accidents have been a source of concern and the Government proposes

to invest igate these problems with a view t o organizing programmes of prevention.

WHO w i l l continue to collaQorate i n these e f f o r t s through i n f ~ r m a t i o n t r ans fe r , provi-

s ion of appropriate technology, study and survei l lance of environmental heal th problems,

t r a in ing of personnel and promotion of san i t a ry measures with emphasis on the needs

o l r u r a l areas.

:leal t h manpower development

The T;ovornment is giving t h i s a c ~ i v i t y high p r io r i ty . The t o t a l heal th s t a f f

increased fourfold between 1971 and 1978. While the immediate s t a f f i n g needs of

a l l heal th establishments a r e being met by d i r e c t recruitment o r on the bas is of b i l a t -

e r a l technical cooperation w i t h f r iendly countries, utmost ihrportance is being given

t o the development of nat ional manpower i n a l l hcal th f i e l d s . The new schools fo r

a s s i s t a n t nurses a r e t o be strengthened s t ead i ly and new t ra in ing programmes a r e being

i n i t i a t e d . WHO w i l l continue t o col laborate with nat ional medical and heal th t r a in ing

i n s t i t u t i o n s i n curriculum development, evaluation of t r a i n i n g programmes, introduction

of modern teaching techniques, and provision of teachers, teaching a ids and l i t e r a t u r e .

Special a t t en t ion w i l l be given through the fellowships programme to the t r a in ing of

personnel i n p r i o r i t y areas such a s primary heal th care, heal th administrat ion and

management,and heal th se rv ices research.

Health information

Advisory services to review the health s t a t i s t i c a l a c t i v i t i e s were provided i n

1976, and a plan f o r t h e i r strengthening followed. A na t iona l is presently following

postgraduate s tud ies t o head on re tu rn the heal th s t a t i s t i c a l services , and a number

of nat ionals a r e being t r a ined a s middle l eve l personnel. WHO col laborat ion w i l l

continue t o fu r the r develop the heal th s t a t i s t i c a l i n f r a s t r u c t u r e and expansion of

a c t i v i t i e s .

Regular Burnt

LI BYAN ARAB JAMAHIRI YA

(ct 'd) - Major Proaramme/~ro~ramme

4.1 CmMUNICABLE DISEASE PREVENTION AND CONTROL

4.1.1 Epidemiological Surveillance (Epidemiological services)

4.1.3 Bacterial, Viral and Mycotic Diseases (Tuberculosis control ; Epidemiology and control of viral diseases especially viral hepatitis)

4.1.5 Expanded Programme on Immunization (Expanded programme of immunization)


4.2 NONCOMMUNICABLE DI S W E PREYENTION AND CWTROL


4.2.2 Cardiovascular Diseases (Epidemiology and control of cardiovascular diseases)

5.1 PROMOTION OF ENVIROMaENTAL HEALTH

5.1.1 Environmental H.alth Planning and Management (Environnental heplth services)

5.1.3 Recognition and Control of Envirornmental Hazards (Control of environmental hazards - and occupational diseases; Environmental health pollutional problems)

EWmated

1978 - 1979 US$

25 500

9000

- Obligatio118

1980 - 1981 US$

Sourco

or

PT

FT

FT

FT

FT

FT

FT

FT

Othcr Sourcee

EWmated Biennium

1978 - 1979 US$

293 200

108 600

5 100

29 100

29 100

9 700

137 700

29 100

Obligatiw


315 800

SOB00

6000

30 200

24200

12000.

156 700

77 300

Regular Budget

Estimated


US$

70 000

228 OOO

O=PPPI=P=IP

Sourco

of

Funds

FT

FT

LIBYAN ARAB JAMAHIRIYA

( c t 'd)

Ma lor Programme/programm

6.1 HEALTH MANPOslER DEVELOPHENT

6.1.2 Proaot ion of Tra in ing (High I n s t i t u t e , Benghazi; Medical education; Health I n s t i t u t e , Misurata - Health Manpower Development; Fellowships)

7.1 HEALTH INFORMATI ON

7.1.1 Health S t a t i s t i c s (Advisory s e r v i c e s on v i t a l and h e a l t h statistics

TOTAL - LIBYAN ARAB JAMAHIRIYA

Obligations

Biennium ' 1980 - 1981

US$

100 000

100 000

I P = P h t = = D

Othcr Sources

EWawted Biennium

1978 - 1979 US$

113 200

86 400

1 010 300

=====a======

Obligatians


249 400

98 100

1 464 300

P I = I = I P P P I

COUNTRY PROGRAlYME STATBdSJT

o x NATIONAL HEALTH DEVEU)PIIIFNT STRATEGY

The f i r s t Five-Year Developent Plan was formulated for the period 1976-80 by the

Developent Council, the interminis ter ial body responsible for national sooie-io

developent planning.

One of the resolutions of the Council defines a s a primary target of the plan: " t o narrow the gap i n the standards of l iving i n different regions with special

emphasis on the l ea s t developed regions".

Other resolutions deal specif ical ly w i t h the hgalth f ie ld: "to impro*r rmtr i t ional

and public health conditions" and "providing for sc ien t i fc studies i n relat ion to water

resources and ways of preserving and increasing its supply".

The capi ta l expenditure component of the health developlent budget fo r the biennium

1980-81 remains, a s for previous years, a t approximately 18 million dol lars per year.

Recurrent expenditure which for 1978 was 33 million dollars, is expected to inoreaae i n

l i n e with the expansion of health services.

Country health programming is tentatively scheduled fo r 1979.

The stage of developolent of the country, where foma l education has begun only very

recently, obliges the health sector t o rely heavily on the services of expatr ia te s ta f f .

However, as more nationals with basic education became available fo r training, the pro-

portion of Omani personnel in the health services w i l l inereme rapidly.

W H ) cooperation has s ignif icant ly expanded over recent years and the Organization's

services a r e being well u t i l i zed by the Government.

TECHJICAL COOPERATICN PROGRAMhlES FOR HEALTH

General programne develoment, management and co-ordination

The WK) Programme Coordinator w i l l continue to part ic ipate i n the developnent of

country health programming i n the context of the national 8ooio-economic developeet

plans, and w i l l ensure a t country level, --ordination with the United Nations p r o g r m s

related t o the health field.

Development of wmprehensive health services

The development of an integrated approach to the delivery of health care remains a'"

major pre-occupation of the Ministry of Health. Against a background of division and

and separate ac t i v i t i e s of the curative and preventive departments, the advocated

policy of the Government for the future is an integrated approach to comprehensive

health care for the en t i r e population. This w i l l require a change i n the orientation

and qual i ty of s ta f f which w i l l be pursued progressively i n the coming years.

Physical health f a c i l i t i e s a re expected t o be suf f ic ien t i n the biennium to

provide adequate coverage to the population. To achieve the objective of affording

comprehensive health care t o the en t i r e population, additional s ta f f w i l l have t o be

recruited, and others w i l l have t o be replaced o r re-trained.

Pr ior i ty w i l l be accorded, i n the context of an integrated approach to health care

delivery, t o an accelerated development of maternal and chi ld health services so tha t

they can be available t o the en t i r e rura l population by the end of the biennium.

Simultaneously, studies on the nu t r i t iona l s ta tus of the young w i l l lead to the

development of a national nu t r i t ion policy.

To promote the achievement of the proposed goals, the recently established na-

t ional health. education committee w i l l be concerned with the strengthening of the

Health Education Section.

The s ignif icant improvement which has taken place i n the health s t a t i s t i c a l system

w i l l be reinforced.

WHO cooperation is expected i n the planning and implementation of this policy.


Malaria const i tutes a major problem. During the biennium, the Malaria Control

Programme w i l l cover the e n t i r e national t e r r i to ry , on the basis of the par t ic ipat ion

of a l l the health services and the communities themselves.

WK) w i l l continue t o afford technical co-operation par t icular ly i n the f i e ld s of

t ra ining personnel and planning. UNDP rill remain a par t ic ipant i n t h i s programme.

The Ikpanded Programmeon I~ll~unizationlaunchedon a country-wide basis a t the end

of 1977, w i l l continue to be implemented by the bait health services on a t o t a l

coverage basis.

The programme on the prevention of blindness w i l l be strengthened with progressive

expansion to a l l vulnerable segments of the population and wi l l include vector control

and hygiene measures besides drug administration.

The o ra l health programme w i l l be developed to include pre-school children besides

those already attending school.

WH3 w i l l par t ic ipate i n a l l these programmes through the provision of wnsul tant-

ships, t ra ining and basic supplies and equipment.


The inadequacy of sa fe water supply and S a n i t a t i ~ n systems account predominantly

for causes of diseases and deaths, par t icular ly with infants and children of ru ra l

communities.

Responding t o the appeal of the populations involved and i n concomitance w i t h the

launchingo-fthe International Drinking Water and Sanitation Deoades, the Government w i l l

endeavour t o provide t o the ru ra l population water supply f a c i l i t i e s based on simple

and r e l i ab l e systems. The Government w i l l concurrently s t r i v e t o improve human wastes

disposal systems in a l l areas.

W H ) w i l l be requested t o par t ic ipa te fu l ly i n these undertakings by providing

technical operational personnel and co-operating i n the t ra in ing of s ta f f and education

of the communities.


While the need for a large number of expatr ia te medical and para-medical personnel

t o s t a f f the health services w i l l continue, with the increasing ava i lab i l i ty of educated

nationals t ra ining programmes i n the various health f i e l d s will be of paramount impor-

tance. The overall training programme w i l l have t o be oriented to provide qualified

s t a f f t o carry out functions according to t he new pol ic ies of the Government. Physical

f a c i l i t i e s allowing the conduot of national multidisciplinary health training programmes

basis w i l l have been provided before t h e s t a r t of the biennium.

Health information

The Government is keen about strengthening the health s t a t i s t i c a l services,

being fu l ly aware tha t proper health data are the backbone of planning,im@lea~entation

and evaluation of health services.

WH) contributed i n the assessment of needs and i n preparing a plan fo r developent

of the health s t a t i s t i c a l services.

WH: 111 continue collaboration through provision of advisory services and t ra in ing

of natic---a1 s t a f f .

Regular Budget

O M A N

Major Pro~ramme/pro~ramme

2.2 GENERAL PROGRAMME DEVELOFWENT AND MANAGEMENT

2.2.2 Country Hea l th Programming (WHO Programme Coord ina tor )


3.1.1 Hea l th S e r v i c e s ' P lann ing and Management ( H o s p i t a l a d m i n i s t r a t i o n ; Maintenance and r e p a i r o f medica l equipment)

3.1.2 Primary Hea l th Care (Development of b a s i c h e a l t h s e r v i c e s )

3.2 FAM I LY HEALTH

3.2.1 Mate rna l and C h i l d H e a l t h (Maternal and c h i l d h e a l t h )


4.1.2 M a l a r i a and Other P a r a s i t i c Diseases (Mala r ia c o n t r o l programme; Malaco log ica l su rvey)

4.1.3 B a c t e r i a l , V i r a l and Mycotic D i s e a s e s ( T u b e r c u l o s i s c o n t r o l )

4.1.5 Expanded Programme on Immunization (Expanded programme of i m u n i z a t i o n )

4.1.7 P r e v e n t i o n of Bl indness ( P r e v e n t i o n of b l i n d n e s s )

Estimated - Biennium

1978 - 1979 US$

165 400

3 1 900

12 000

82 000

4 500

4 500

Obligations


US$

215 700

7 1 300

10 600

1 5 XI0

12 600

8 300

17 800

Othcr Source?

Estimated

Biennium 1978- 1979

US$

160 000

Obligations

Biennium 1980-1981

US$

284 40(

48 00(

Regular Budget

O M A N ( c t ' d )

4 .2 NONCOMMUE~I CABLE DISEASE PREVENTION AND CONTROL

4 . 2 . 3 O r a l H e a l t h (Ora l h e a l t h s e r v i c e s )

5 .1 PROMOTION OF ENVIRONWTAL HEALTH

5.1.2 Bas ic S a n i t a r y Measures ( P o r t s a n i t a t i o n ; P r o v i s i o n of b a s i c s a n i t a r y measures )

5 . 1 . 3 Recogni t ion and Cont ro l o f Environmental Hazards (Environmental h e a l t h p o l l u t i o n a l problems)

6 .1 HEALTH MANPOWER DEVELOPMENT

6.1.2 Promotion of T r a i n i n g (Fe l lowships )

7 .1 HEALTH INFORMATION

7 .1 .1 H e a l t h Statistics (Advisory s e r v i c e s on v i t a l and h e a l t h s t a t i s t i c s )

TOTAL - OMAN

Estimated


US$

8 000

135 800

120 000

24 500

588 600

---------- ----------

- Obligations

Bienniium 1980 - 1981

US$

177 300

18 800

120 000

27 300

695 600

-------- --------L ==

Source

of

DP

FT

Othor source^

Estimated

Blennlum 1978 - 1979

US$

4 500

164 500

- - - - - - - - - - - -----------

Obligations


1 3 200

345 600

- - - - - - - - - - ----------


PAKI STAN


The na t iona l h e a l t h development s t r a t e g y has been formulated wi th in the frame-

work of t he hea l th pol icy promulgated i n 1976 and programmed i n a country h e a l t h

programing exerc ise . The h e a l t h p lan a i m s a t a coverage of 50% of the populat ion

wi th bas i c hea l th c a r e by 1981.

The p r inc ipa l pol icy o b j e c t i v e s o f the p lan are t o move from a predominantly

medical s e rv i ce t o a t h r e e - t i e r system manned by phys ic ians , h e a l t h a u x i l i a r i e s and

community h e a l t h workers, wi th a major expansion o f bas i c h e a l t h s e r v i c e s i n r u r a l

a r eas ; t o progress ive ly i n t e g r a t e s p e c i a l h e a l t h and hea l th - r e l a t ed programmes wi th

the bas i c h e a l t h s e rv i ces ; and t o s h f t the emphasis from c u r a t i v e t o prevent ive

measures. Targets have been set f o r populat ion coverage by h e a l t h s e rv i ces , f o r

malaria con t ro l , f o r thecont ro l o f communicable d i s e a s e s o f ch i ldren , and f o r environ-

mental h e a l t h serv ices .

The preventive programme, i n which community h e a l t h workers w i l l be a c t i v e , w i l l

be implemented through the Expanded Programme on Immunization and the improvement o f

environmental s an i ta t ion .

TECHNICAL COOPERATION PROGRAMMES FOR HEALH


The provision o f f ron t - l i ne h e a l t h c a r e t o remote and underaerved communities,

which has been a f e a t u r e of h e a l t h s e r v i c e s development i n Pakis tan f o r s e v e r a l years,

w i l l be extended and r e in fo rced wi th emphasis on community p r t i c i p a t i o n and o v e r a l l

c o m u n i t y development. The na t iona l h e a l t h p lan provides f o r t h e continued develop-

ment of basic h e a l t h r a r v i c e s p a r t i c u l a r l y i n r u r a l a r eas . WHD w i l l co l l abo ra t e by

providing s t a f f and advisory s e r v i c e s f o r t he improvement o f family h e a l t h and w i l l

a l s o g ive s p e c i a l a t t e n t i o n t o t h e development of c o m u n i t y h e a l t h workers.

WHD w i l l a l s o cooperate i n t h e development o f t he na t iona l h e a l t h l abo ra to ry

s e r v i c e , i n workers' h e a l t h and i n r e in fo rc ing the h e a l t h educat ion programme.

A l a r g e pharmaceutical i ndus t ry has grown i n the country and WHD is co l l abora t -

i n g i n developing drug p o l i c i e s and q u a l i t y c o n t r o l o f pharmaceuticals.

Disease p reven t ion and c o n t r o l

There is a n o v e r a l l f a l l i n t h e i n c i d e n c e o f m a l a r i a and t h e c o n t r o l programme

is being g r a d u a l l y i n t e g r a t e d w i t h t h e c o n t r o l o f connnunicable d i s e a s e s i n g e n e r a l .

W H O c o l l a u o r a t i o n w i l l c o n t i n u e i n t h e form o f c o n s u l t a n t s e r v i c e s , t h e ass ignment

of n a t i o n a l s t a f f , f e l l o w s h i p s , and s u p p l i e s and equipment.

W H O w i l l be a s s o c i a t e d s u b s t a n t i a l l y through t h e Expanded Programme on Immun-

i z a t i o n w i t h t h e c o n t r o l o f t h e communicable d i s e a s e s o f c h i l d r e n .

A comprehensive cancer c o n t r o l programme i s be ing developed - a cancer r e g i s t r y

was e s t a b l i s h e d i n 1978 and W H O c o l l a b o r a t i o n i n t h i s f i e l d w i l l con t inue .

Promotion o f environmental h e a l t h

The a r e a s i n which WHO c o l l a b o r a t i o n w i l l c o n t i n u e i n 1980-1981 a r e t h e p lann ing

and managment o f environmental h e a l t h s e r v i c e s , wa te r supp ly systems and t h e c o n t r o l

o f environmental hazards .

Hea l th manpower development

The c r u c i a l r o l e o f h e a l t h manpower development f o r t h e promotion o f h e a l t h

s e r v i c e s i s mani fes ted by t h e p r i o r i t y r o l e accorded t o i t by t h e n a t i o n a l a u t h o r i -

ties. The implementation o f t h e new t h r e e - t i e r system o f h e a l t h s e r v i c e s depends

on a s u b s t a n t i a l i n c r e a s e i n t h e amount and q u a l i t y o f t r a i n i n g programmes f o r h e a l t h

a u x i l i a r i e s and pr imary h e a l t h c a r e workers , w h i l e a t t h e same t i m e a n o r i e n t a t i o n

o f p r o f e s s i o n a l e d u c a t i o n towards community s e r v i c e s must be emphasized. T h i s c a l l s

f o r much more communication between t h e h e a l t h - s e r v i c e and e d u c a t i o n sys tems a s w e l l

a s f o r t h e a v a i l a b i l i t y o f s k i l l e d e d u c a t i o n a l a d m i n i s t r a t o r s and t e a c h e r s . WHO is

c o n t i n u i n g i ts c o l l a b o r a t i o n , i n t h e c o n t e x t o f t h e medium-term programme i n h e a l t h

manpower development, i n v a r i o u s a s p e c t s of h e a l t h s e r v i c e s and manpower development.

H e a l t h i n f o r m a t i o n

The problem is n o t s o much t h e u n a v a i l a b i l i t y o f t r a i n e d h e a l t h s t a t i s t i c a l

pe rsonne l . Ra ther t h e r e i s need f o r s t r e n g t h e n i n g of t h e p r o v i n c i a l h e a l t h s t a -

t ist ical s e r v i c e s , and an o v e r a l l r e o r g a n i z a t i o n o f t h e n a t i o n a l h e a l t h s t a t i s t i c a l

s e r v i c e s t o e n s u r e t h e a v a i l a b i l i t y o f t ime1 y, r e l i a b l e and u s a b l e i n f o r m a t i o n , and

t h e f r e e f low o f t h a t i n f o r m a t i o n between t h e p r o v i n c i a l and c e n t r a l l e v e l s . W H O

c o l l a b o r a t i o n w i l l c o n t i n u e i n t h i s a r e a .

Regular Budget

P A K I S T A N

(ct 'dl - Major Prouramme/programme

5.1.2 Basic Sanitary Measures (Peshawar water supply)


6.1 HEALTH MANPOWER DEVEmRHENT

6.1.2 Promotion of Training (Health professional education; Institute of Hygiene and Preventive Medicine, Lahore; Post-basic nursing education; Training of auxiliary health personne 1; Fellowships)

7.1 HEALTH I NFORMATI ON

7.1.1 Health Statistics (Reorganization of health statistical services)

TOTAL - PAKISTAN

Estimated


us9

680 000

43 000

2 107 300

----------- -----------

Obligations


US$

56 200

840 800

20 600

2 317 300

---------- ----------

Sourcc

of

-

DP

Other Sources

Estimated

Blenn~um 1978 - 1979

US$

22 000

1 020 700

----------- -----------

Obligations

Blennium 1980 - 1981 US$

650 000

----------- -----------

COUNTRY PROGRAYYE STATEMENT

NATIONAL HEALTH DEVELOPME?iT STRATEGY

The nat ional heal th development s t r a t egy is formulated i n a nat ional hea l th plan

prepared by the Government i n 1978 with the col laborat ion of W H D and other i n t e r -

national and mul t i l a t e ra l agencies.

The p r i o r i t i e s spec i f i ed i n the plan a r e ( a ) primary hea l th care , (b) hea l th

manpower development, ( c ) the upgrading of hosp i t a l s and c l i n i c s , (d ) the commission-

ing of a new 660-bed general hosp i t a l , ( e l the in t roduct ion of new medical spec ia l i -

ties t o reduce t r ave l l ing abroad f o r treatment, ( f ) the upgrading and strengthening

of preventive heal th se rv ices by the creat ion of specia l ized u n i t s and an increased

a l loca t ion of resources.

The plan envisages the strengthening of t h e organizat ional and managerial s t r U C -

t u r e of the Ministry of Health and of the adminis t ra t ive i n f r a s t r u c t u r e i n general ,

a s well a s the reinforcement of technical cadres.

TECHNICAL CO-OPERATION PROGRAMMES FOR HEALTH

Primary heal th ca re

The Government is committed t o a primary care system based on hea l th c e n t r e s

and in tegra ted with the hosp i t a l se rv ices t o meet the needs of the whole population.

The service depends on e x p a t r i a t e s t a f f .

Health se rv ices development and disease control

The new organization of the Ministry of Health has provided f o r a wide range of new

a c t i v i t i e s i n the Department of Preventive Medicine, including p a r t i c u l a r l y hea l th

education, v i t a l and hea l th s t a t i s t i c s , and i n d u s t r i a l health.

WHO w i l l co l laborate i n the heal th education programme and i n aspects of com-

municable d isease control , p a r t i c u l a r l y the immunization of chi ldren, por t heal th ,

and food and water control .

Promotion of environmental hea l th

I n view of t h e rapid i n d u s t r i a l i z a t i o n of the country the Government is concerned

with problems of environmental pol lu t ion. WHD w i l l co l l abora te i n t h i s r e spec t by

t h e provision of consul tants and fellowships.


Health manpower of a l l ca tegor ies is almost exclusively foreign and is l i k e l y t o

remain so f o r some time. E f f o r t s a r e being made t o a t t r a c t nat ionals t o the hea l th

professions and to be t ra ined a t the Health Training I n s t i t u t e of the country.

WHO is collaborating i n the promotion of nat ional t r a in ing programmes by i ts

associa t ion with the Health Training I n s t i t u t e and the provision of fellowships.

Regular Budget

Q A T A R

- Major Pro~.rame/programme

3.1 HEALTH SERVI CES ' DEVELOPMENT

3.1.1 Health Services ' Planning and Management (Publ ic heal thadminis t ra t ion

3.1.2 Primary Health Care (Primary hea l th care)

3.2 FAM I LY HEALTH

3.2.4 Health education (Health education)


5.1.3 Recognition and Control of Enviror~sental Hazards (Environmental heal th po l lu t iona l problems)

6.1 HEALTH MANKMF.R DEVELDIMENT

6.1.2 Promotion of Training (Health manpower d e v e l o m n t ; Fel larships)

'I JTAL - QATAR

Estimated


US$

45 500

58 000

103 500

I=PP=P=PDI

Obligations


US$

18 800

40000

58 800

===I==*=-

Sourcc

oi

Funds

PF

PT

PF

FT

FT

Other Sourcee

%timated


us$

64 600

64 600

--- - - - l l t t = t t P

Obligations


140000

3 6 2 0 0

12 100

13 200

29 300

231 000

P P I I P P I I I I l

COUNTRY PROORAMaE STATEWT

SAUDI ARABIA


me national wealth of Saudi Arabia is being applied to socio-economic develop-

ment of which health i s considered an integral par t . During the National Develop-

ment Plan period ending i n 1980 high pr ior i ty has been given t o comprehensive health

services. The National Development Plan's objectives i n the heal th sector were to :

a ) provide and develop a chain of integrated heal th un i t s fo r delivery of com-

prehensive health care t o a l l segments of the population;

b) control communicable disease;

C) reduce infant mortali ty from 152 to 110 per thousand;

d) increase t o t a l hospital beds from 1.1 : 1000 t o 2.5 : 1000 of tho population ;

e ) develop and strengthen the administrative in f ras t ruc ture with a v ie r t o

regionalitation and decentralization;

f ) develop an adequate health information system; and

g) develop health manpower to meet the c r i t i c a l shortages i n s ta f f ing of heal th

services.

Country health progrpmming has not been undertaken. Several min is t r ies besides

the Ministry of Health provide heal th inputs t o the National Development Plan and

thus make i t d i f f i c u l t t o ident i fy agreed indicators of social relevance f o r eva-

luat ing health programmes.

The Ministry of Health's development programme ta rge ts a r e a s follows:

a ) development of integrated, comprehensive heal th care delivery system both

a t the periphery and i n urban areas;

b) balanced development of health manpower responsive t o the country's needs;

c ) a t tent ion to basic sani tary and environmental health measures ( in co-ordina-

t ion with the Ministry of Municipal and Rural Affairs) ;

d) control of communicable diseases and development of e f fec t ive categorical

programmes with a view to t h e i r ult imate integrat ion i n the overa l l heal th

services; and

e ) promo tion of intercoun t r y coordination i n the health f ie ld .

The o b j e c t i v e s and t a r g e t s conform broadly wi th WHD programme o b j e c t i v e s and

c l a s s i f i c a t i o n contained i n t h e S i x t h General Programme o f Work f o r 1978-83.

The Minis t ry o f Health has a l s o begun t o r eo rgan i t e , r eg iona l i ze and decen t r a l i ze

t h e serv ices . The t r a i n l n g Of n a t i o n a l s is being cons tant ly expanded i n o rde r to

s t a f f t h e developing h e a l t h s e rv i ces . A s t a r t has been made on coordina t ing h i t h e r t o

independent h e a l t h a c t i v i t i e s . National coordina t ing bodies and t echn ica l cornmitees

a t supervisory and execut ive l e v e l s have been e s t ab l i shed f o r environmental h e a l t h and

h e a l t h manpower d e v e l o p e n t . A High Health Advisory Board is being c o n s i d ~ r e d f o r t h e

o v e r a l l coordina t ion of h e a l t h pol icy and implementation.


WH3 t echn ica l cooperat ion w i l l cont inue while t h e Government w i l l assume most

f i n a n c i a l commitments i n accordance wi th present agreements.

Development o f comprehensive h e a l t h s e r v i c e s

The t rend towards i n t e g r a t e d , comprehensive h e a l t h care i s growing wi th t h e w m -

p l e t i o n o f t h e i n i t i a l h o s p i t a l bui ld ing programme; i n t e g r a t e d pe r iphe ra l h e a l t h u n i t s

wi th a well-defined r e f e r r a l system a r e being provided. Most new urban developments

have new h o s p i t a l s ; t h e emphasis i s now on consol ida t ing e x i s t i n g f a c i l i t i e s r a t h e r

than on the cons t ruc t ion of more new f a c i l i t i e s . The primary h e a l t h c a r e concept is

ga in ing ground and a p i l o t p r o j e c t is contemplated. The need f o r comprehensive

country h e a l t h programing is a l s o apprec ia ted .

WHO w i l l w n t i n u e i t s cooperat ion i n t h e promotion, planning and implementation

of i n t e g r a t e d h e a l t h s e rv i ces , i n t h e eva lua t ion o f c u r r e n t p lan r e s u l t s and i n f u t u r e

h e a l t h planning e s p e c i a l l y i n respect of hea l th economics and h e a l t h information.

Communicable d i s e a s e prevention and con t ro l

A h e a l t h informat o? system is t o be developed. The primary h e a l t h care pro-

gramme w i l l provide a b a s i s f o r d a t a co l l ec t ion . The Government i s l ay ing Spec ia l

emphasis on t h e Expanded Programme on Immunization. The malar ia c o n t r o l programme

is being strengthened by a d d i t i o n a l malaria u n l t s f o r a r e a s h i t h e r t o unserved; i n t e r -

country coordinat ion of malaria c o n t r o l i n t he e n t i r e Arabian peninsula i s being

a c t i v e l y pursued. Schis tosomias is con t ro l is rece iv ing i n c r e a s i n g a t t e n t i o n because

of t h e hazards r e s u l t i n g from a g r i c u l t u r a l and water development p ro j ec t s .

WHO w i l l continue its cooperat ion when requi red , f o r d i sease prevention and

con t ro l gene ra l ly and f o r t h e Haj period i n p a r t i c u l a r ; and a s requested by the

Government w i l l co l l abo ra t e i n implementing and eva lua t ing a permanent expanded

immunization programme.

Advisory se rv l ces f o r t h e Malaria Control Programme w i l l continue i n o rde r t o

s t rengthen the country 's own malar ia con t ro l measures and t o assist i n coordina t ion

wi th neighbouring count r ies .

Non-communicable d i sease prevention and con t ro l

The Government proposes t o set up con t ro l programmes f o r cancer , card iovascular ,

mental and i n d u s t r i a l d i s e a s e s a s soc ia t ed wi th urbaniza t ion and i n d u s t r i a l i z a t i o n .

WHO w i l l be a s soc ia t ed wi th these programmes a s required.

Promotion of environmental h e a l t h

The numerous development programmes, r u r a l and urban, t h e cons t ruc t ion o f new

townships, i n d u s t r i a l i z a t i o n and changing demographic p a t t e r n s have added t o the

complexit ies of environmental h e a l t h problems. The Minis t ry o f Municipal and Rural

A f f a i r s has a major r e s p o n s i b i l i t y i n t h i s f i e l d , p a r t i c u l a r l y f o r s a n i t a t i o n , water

s u p p l i e s and building. UNDP and W m a r e co l l abora t ing mainly i n providing consul-

t a n t s f o r pre-investment and f e a s i b i l i t y s t u d i e s o f var ious pro jec ts .


The High Connnittee f o r Health Manpower Development and i ts subordina te t e c h m c a l

committee (wi th r ep resen ta t ion a t app ropr i a t e l e v e l s from M i n i s t r i e s o f Health, Higher

Education, Planning and Finance) has ind ica t ed i t s commitment t o a balanced and rea-

l i s t ic development o f h e a l t h manpower through an i n t e g r a t e d mechanism f o r h e a l t h

s e r v i c e s and manpower development. A r eappra i sa l o f t h e o v e r a l l t r a i n i n g programmes,

i d e n t i f i c a t i o n of p r - o r i t i e s and r e s t r u c t u r i n g of c u r r i c u l a t o make them responsive

t o needs and requirements of t he h e a l t h s e rv i ces , was begun i n 1978 i n accordance wi th

the o b j e c t i v e s of the Regional Medium Term Programme on Health Manpower Development.

WHO co l l abora t ion w i l l be mainly i n manpower planning and management and the

implementation of balanced, coordinated, t r a i n i n g programmes.

WHO fe l lowships w i l l be u t i l i z e d main1 y t o develop f u r t h e r teacher t r a i n i n g

p o t e n t i a l .

Regular Budget

Estimated

Biennium 1978- 1979

US$

70 000

131 000

---------- ----------

Other Sources Source

Btimated Obligationa SAUDI ARABIA of

Biennium Biennium

I

Obligations

Biennium 1980- 1981

US$

33 900

70 000

151 600

----------- -----------

(ct 'd)

Major Programme/~roffranune


5.1.1 Environmental Health Planning and Management (Promotion of Environmental health)



6.1.2 Promotion of Training ( Health manpower development, Fellowships)

VITAL - SAUDI ARABIA

1978- 1979

973 600

34 200

2 163 500

----------- -----------a

1980-1981

1 068 500

38 200

36 200

2 598 400

------- -------==PI

FT

FT

FT

COUNTRY PROGRAMME STATWWT

SOMALIA

NATIONAL HEALTH DEVEWPMENT STRATEGY

The current national health developent strategy is based on a Government policy

of increasing as rapidly as possible the health manpower stock of the country and re-

forming the administration of health services, i n order t o deal more effectively with

the problem of communicable diseases as pr ior i ty , and to develop environmental health

services and primary health care. Systematic health planning, including health nhn-

power planning, began i n 1978 and WHO has cooperated i n country health programing.

I t is o f f i c i a l policy t o cu l t iva te i n the people an awareness of the burden of

preventable disease and of measures t o reduce it. Similarly, other government

authori t ies are being oriented t o the need to develop community preventive services

a s well as hospital f a c i l i t i e s . '

TECHNICAL CWPEIWTIW PROGRAMMES FOR HEALTH

Health services developent

Primary health care is the major focus of collaboration with WHO i n the area and

the programme w i l l be reinforced by the Government's e f f o r t t o a t t a i n self-sufficiency

i n the production of drugs, i n i ts measures to control drug production and use, and i n

the developent of a r e f e r r a l system which w i l l make the best use of the other levels of

the health services inoluding the growing spec ia l i s t services. Mental health services

w i l l a lso be developed.

I n the area of Family Health, MCH services a re t o be developed both i n coverage and

quality. The f i r s t phase of the programme would cover Mogadishu and the Shibe l l i Region

where technical advisory services as well as material assistance i n the building and

improvement of physical f a c i l i t i e s w i l l be provided. In nu t r i t ion , WID w i l l collaborate

i n t ra ining and providing advisory services par t icular ly for the assessment of nu t r i t ion

s t a tu s of vulnerable groups.

A oentre for the repair and maintenance of medical equipuent w i l l continue t o re-

ceive the support of WHO and the public health laboratory services w i l l be fur ther

developed. An e f f o r t is being made to develop rehabi l i t a t ion services.


The main emphasls w i l l be on developing epidemiological services and on the con-

trol of schlstosomiasrs whrch is widespread i n the two major r iver basins of the coun-

try. Trachoma w i l l continue t o reoeive attention. W H O w i l l collaborate i n these

a c t i v i t i e s as well as i n the Expanded Programme on Immunization against the leading

communicable diseases of childhood. WHO w i l l also collaborate In s t a r t i ng a pro-

gramme for the prevention of Blindness.

Promotxon of environmental health

While there has been some progress in providing a s a f e water supply and sani ta t ion

services there is need for much development i n these f ie lds . Unfavourable environ-

mental aonditlons a re s t i l l among the leading causes of diseases i n the country. WHO

w i l l contlnue its collaboration i n these f i e ld s by the provision of s ta f f and consul-

t an ts and a t Government request w i l l provide pre-investment services for basic

sanitary measures and the mobilization of additional investments from the internat ional

and b i l a t e r a l agencies.


The intake of t ra inee intermediate and auxiliary health workers has increased

almost fourfold i n recent years and t ra ining f a c i l i t i e s a re being expanded accordingly.

The need to strengthen the t ra ining of publlc health s t a f f is par t icular ly realized.

Nursing t ra ining is being raised t o degree level i n order t o a t t r a c t good qual i ty

entrants. Speaial a t tent ion is being glven to the t ra ining of laboratory and X-ray

technicians, sani tar ians and pharmacists. The production of physicians is being

increased so that , with a redis t r ibut ion of exis t ing physicians, each d i s t r i c t w i l l

have a t l e a s t one physician. Opportunities fo r contlnuing in-service education are

being increased. An attempt is being made to make health careers more a t t r ac t i ve

professionally and f-.nancially.

WHO technical cooperation i n health manpower development w i l l be mainly i n

developing the educational capabilities of teachers and ins t i tu t ions , and, through the

fellowshlp programme, i n ra i s ing the level of health services administration.

Health information

The Government 1s eager t o strengthen i ts health s t a t i s t i c a l services. They a re

i n great need of timely, re l iab le , meaningful and up-to-date information for the sound

planning, adminxstration, management and evaluation of the health services.

W W w i l l continue its collaboratron for the development of national health s t a t l s -

t i c a l services and t ra inlng of national s t a f f .

Budget

S O M A L I A

Major Programme/programme_

2.2 GENE3AL PROGRAMME DEVEUIPMFNT AND MANAGEMENT



3.1.1 Health Serv ices ' Planning and Management (Centre f o r t he r e p a i r and maintenance of medical equipment )

3.1.2 Primary Health Care (Basic h e a l t h s e rv i ces / Primary h e a l t h c a r e )

3.1 .4 Care of t he Aged, D i s a b i l i t y Prevention and Rehab i l i t a t i on (Rehab i l i t a t i on s e r v i c e s )

3.1.5 Appropriate Technology f o r Health (Publ ic h e a l t h labora tory s e r v i c e s )

3.2 FAMILY HEALTH

3.2.1 Maternal and Child Health (Maternal, c h i l d and family h e a l t h )

3.2.2 Nu t r i t i on (Applied n u t r i t i o n programme

3.3 MENTAL HEALTH

(Development of mental hea l t h programme 1

Estimated


US$

155 200

109 100

257 000

18 500

135 500

112 700

Obligations


US$

229 100

133 000

353 300

101 200

175 500

164 500

56 100

Soum

of

FP

Othcr Sowee

Estimated Blennium

1978 - 1979 US$

225 700

)

Obligation6


144 300

Regulrrr Budget

S O M A L I A (ct'd) -


4.1.1 Epidemiological Surveillance (Epidemiological services)

4.1.2 Malaria and Other Parasitic Diseases (Malaria pre-eradication programme; Schistosomiasis control )

4.1.3 Bacterial, Viral and Mycotic Diseases (Tuberculosis control; Venereal disease control)

4.1.4 Smallpox Eradication (Smallpox eradication)

4.1 .5 Expanded Programme on Immunization (Expanded programme of immunization 1



5.1.2 Basic Sanitary Measures (Community water supply; Municipal environmental sanitation advisory services)


Estimated

Btennium 1978 - 1979

US$

106 300

393 000

39 000

24 000

161 700

Obligations

B i d u m 1980 - 1981

202 700

479 300

9 300

23 600

214 000

32 000

&wco

oi

VM

DP

VI

DP

Other Sources

Ebtbted B~ennium

1978 - 1979 US$

150 000

200 000

64 000

Obligations


' US$

121 800

200 000

WWW

S O M A L I A ( e t ' d ) -

6 . 1 HEALTH AQINWWFJI' DEVELOPMENT

6 . 1 . 2 Promotion of Training (Health manpower development; Nursing education: Fe l lowships )

7 .1 HEAL2H INFORMATION

7 . 1 . 1 Health S t a t i s t i c s (Advisory s e r v i c e s on v i t a l and h e a l t h s t a t i s t i c s )

TOTAL - SOMALIA

Estimated


US$

744 100

97 100

2 353 200 ----------- -----------

Obligations


US$

891 800

157 800

3 223 200

----------

Source

or

,-

Othcr Source~

Estimated Biennium

1978 - 1979 US$

639 700

---------- ----------

Obliationa


466 100

---------- ----------

COUNTRY PROGRANME STATENENT

SUDAN - NATIONAL HEALTH DEVEJIOPMEN'I' STRATEGY

The phased programme f o r ac t ion f o r socio-economic development formulated by the

Sudanese S o c i a l i s t Union prescribed t h e following p r i o r i t i e s f o r the heal th sector :

( a ) preventive and w c i a l medicine espec ia l ly i n the control of environmental hea l th

problems, maternal and ch i ld health, and school heal th ; (b) strengthening of r u r a l

heal th care f a c i l i t i e s t o ensure complete coverage and f a i r d i s t r i b u t i o n of bas ic

heal th care t o the e n t i r e population; ( c ) t r a i n i n g f o r 811 l e v e l s of professional ,

technical and aux i l i a ry hea l th manpower; (d) consolidation of ex i s t ing cura t ive

heal th care f a c i l i t i e s t o provide better services f o r the population and allow f o r

some expansion of f a d l i t i e s i n the less developed areas ; and (e) d i r e c t pedical re-

search on heal th problems according t o t h e i r p r i o r i t i e s .

A National Health Programme f o r 1977/78-1983/84 was formulated i n 1974 a s a pa r t

of the socio-economic plan and was approved by the Cabinet a s well a s the Sudanese

S o c i a l i s t Union i n Yay 1975. I t covers Sudan's e igh t main heal th problems, some of

which a r e i n t e r s e c t o r a l - e.g., man-made malaria and the provision of primary hea l th

ca re t o r u r a l and nomadic populations. These e igh t problems a r e given p r i o r i t y f o r

the a l loca t ion of f inanc ia l resources.

Some of the main programme a reas - nationwide malaria; man-made malaria; primary

hea l th care ; schisfosomiasis control i n i r r i g a t e d areas ; sa fe water supply; environ-

mental heal th ; food supply (mainly m i l l e t ) i n c e r t a i n regions; and onchocerciasis - have been considered a s hea l th development programmes, o the r s a s i n t e r s e c t o r a l develop-

ment programmes. Primary heal th ca re covers not only the heal th se rv ices per se , but

a l s o g a s t r o e n t e r i t i s i n chi ldren, immuniration, tuberculosis , publ ic hea l th information,

and hygiene. A s regarxis communicable diseases, such a s man-made malaria and schis to-

somiasis, the heal th f a c t o r s have been considered together with the economic and socio-

p o l i t i c a l fac tors . This app l i e s a l s o t o onchocerciasis, which i s causing considerable

economic l o s s due t o blindness, mainly i n the Southern Region but a l s o i n c e r t a i n parts

of the Northern provinces.

TECHNICAL COOPERATION PROGRAhWES FOR HEALTH

Primary hea l th ca re

Of the e i g h t programmes comprising the Sudanese nat ional hea l th programme, primary

heal th ca re has been singled out a s the most important f i e l d f o r governmental ac t ion

during the development plan period July 1977 - June 1984. The main objective of the

primary health care programme may be summed up as maximum coverage of the rura l and

nomadic populations by 1984. The programme w i l l require the t ra ining of approxxmately

4 000 persons. This w i l l necessi ta te the construction and equipment of community t ra in?

ing centres attached to rura l dispensaries so tha t trainees may learn i n an environment

similar t o tha t i n which they w i l l subsequently work. Specially modified t ra ining

schemes a re t o be evolved for nomadic community health workers. W H D w i l l be actively

involved i n 1980-81 i n the development of basic health' uni ts , and w i l l cooperate i n

innnunization programmes, malaria control, family health, health education, nu t r i t ion

and rural water supplies. The national health authori t ies w i l l be engaged i n technical

cooperation w i t h a number of countries i n the Region, with WHD providing consultant and

coordination functions.


Communicable endemo-epidemic diseases are highly prevalent i n the Sudan and a f fec t

par t icular ly the child population. In general,,diseases resul t ing from poor environ-

mental sani ta t ion const i tute the bulk of the health problems with which the Sudanese

Government has t o deal. Furthermore. some of the economic progress which has been

accomplished during the l a s t decade i n agriculture developent has aggravated cer ta in

disease problems, such as malaria and schiotosomiasis; t h i s r e su l t s i n a decrease of

the expected economic output of the projects. A project is being planned by the

Government i n collaboration with WHD for the prevention and control of vector-borne

diseases associated with water. The project which is long-tern is being planned with

the anticipated collaboration of other United Nations Agencies such as UNEP and FA0

as w e l l a s b i l a t e r a l contributors. WflD w i l l be associated during 1980-81 with malaria

control, expanded immunization against measles and other leading communicable diseases

of childhood, the control of onchocerciasis, t r ypanomias i s , leishmaniasis and leprosy.

WflD w i l l a lso collabo-ate i n a comprehensive cancer programme a t co~munity level.


The demand for sa fe water supply and proper sewage disposal system is increasing.

As a resu l t , an overal l control of water and envimmumtal pollution is of the utmost

importance. Industr ia l waste is an added problem w i t h n w l y created industr ies i n big

c i t i e s where water supply is a l so inadequate. The extensive agricul tural and industr ia l

developent plans launched by the Government w i l l involve employment of a large number

of workers who w i l l be exposed t o occupational hazards, both from the environment i n

which they work .and from the endemic diseases t o which they might be e x p o d .

Personnel trained i n sanitary engineering and occupational health w i l l be required

t o meet the situation. WH3 w i l l provide supplies and equipment, and fellowships, t o

support the environmental health programme.


To m e e t the objectives of the national health plan, the Government is making

intensive e f f fo r t s i n the t ra ining and u t i l i z a t i on of intermediate and auxiliary

health cadres. There a re nineteen training programmes for professional and sub-

professional categories, and s i x postgraduate courses fo r various special is ts .

special is tsand ins t i tu t ions i n the Sudan a re being u t i l i z ed by HM3 for t ra ining

of auxiliary p e r s o ~ e l from neighbouring countries i n the Region.

WH3 w i l l continue t o collaborate i n health manpower developnent by providing

consultants i n medical and dental education to the Faculty of Medicine a t Khartoum

and Wad Medani as well as advisers i n nursing and sani ta t ion and fellowhsips;

supplies and equipment.

Regular Budget

Estimated


US$

239 500

244 900

114 000

Other Sources Source

Ekkimated Obligktione S U D A N

of Blenn~urn B~ennium

' -

Obligations


US$

316 400

264 500

30 600

70 600

MaJor Programme/programmn

2 .2 GENERAL PROGRAMME DEVELOPMENT AND MANAGEMENT


3.1 HEALTH SERVICES ' DEVELOPMEXT

3.1.1 Health Serv ices ' Planning and Management (Publ ic h e a l t h advisory se rv i ces , Southern Region; Maintenance and r e p a i r of medical equipment ; Advisory se rv i ces / programme development and suppor t )

3.1.2 Primary Health Care (Primary h e a l t h c a r e na t iona l programme )

3.1.3 Workers' Health (Occupational h e a l t h )

3.1.4 Care of the Aged, D i s a b i l i t y Prevention and Rehab i l i t a t i on (Rehab1 li t a t i on s e r v i c e s )

3.1.5 Appropriate Technology f o r Health (National h e a l t h l abo ra to ry s e r v i c e s )

3.2 FAMI LY HEALTH

3.2.1 Maternal and Chi ld Health (Materni ty centered family planning)

1978- 1979

224 300

248 400

239 900

1980-1981

2 3 5 1 0 0

37 200

Funds

VA

DP

FP

Source

oi

fin&

DP

VM

V I

S U D A N ( c t ' d )

3.2.2 Nu t r i t i on (Maternal and c h i l d hea l th , n u t r i t i o n programme)

3.4 PROPHYLACTIC , DIAGNOSTIC AND THERAPEUTIC SUBSTANCES

3.4.1 Drug P o l i c i e s and Management (Drug p o l i c i e s and management )

3.4.2 Pharmaceuticals and Biologica ls (Training courses i n pharmaceutical chemists)

4 .1 COMMUNICABLE DISEASE PREVENTION AND CONTROL

4.1.2 Malaria and Other P a r a s i t i c Diseases (Malaria con t ro l programme; Schistosomiasis con t ro l ; Onchocerciasis con t ro l ; Trypanosomiasis con t ro l , Southern Sudan; Leishmaniasis con t ro l )

4.1.3 Bac te r i a l , Viral and ~ y c o t i c Diseases (Cerebro-spinal meningi t i s con t ro l p i l o t s t u d i e s ; Tuberculosis con t ro l ; Leprosy con t ro l )

4.1.5 Expanded Programme on Inrmuniza t i o n (Expanded programme o f immunization)

4.1.7 Prevention of Blindness (Prevention of bl indness)

Other Sourcee Regular Budget

E&bated Biennium

1978 - 1979 US$

16 000

457 000

355 300

EWmated


US$ 'i '

33 000

21 000

682 000

137 200

135 500

Obligstiwe Biennium

1980-1981 ,US$

457 000

259 200

- Obligations


US$

41 400

693 400

66 200

121 200

34 600

Regular Budget

S U D A N ( c t ' d )

4.1.8 Vector Biology and Control (Control of water a s s i s t e d vector-borne d iseases)

4 .2 NONCOMMUNICABLE DISEASE PREVENT1 ON AND CONTROL

4.2.1 Cancer (Comprehensive cancer programme a t community l e v e l )

4.2.3 Ora l Health (Dental a s s i s t a n t s )

5 .1 PROMOTION OF WVIRONMENTAL HEALTH

5.1.1 Environmental Heal th Planning and Management (San i t a ry engineer ing course, Univers i ty of Khartoum)

5.1.2 Basic S a n i t a r y Measures (Rural water supply)

5.1-3 Recognition and Control of Environmental Hazards (Environmental h e a l t h p o l l u t i o n a l problems)

6 . 1 HEALTH MANWWER DEVELOPMENT

6.1.2 Promotion of Tra in ing (Medical and d e n t a l educa t ion; Fel lowships)

7 .1 HEALTH INFORMATI ON

7.1.1 Heal th S t a t i s t i c s (Ad-hoc i n f a n t and e a r l y childhood m o r t a l i t y survey)

TOTAL - SUDAN

Estimated


US$

44 000

52 500

391 000

2 094 600

---------- ----------

Obligations


US$

200 000

20 600

24 300

48 800

514 800

2 447 400

---------- ----------

Source

of

DP

FP

Othor Sources

Eotimated B~enn~um

1978 - 1979 US$

14 500

1 555 400

----------- -----------

Obligatione

B~ennium 1980 - 1981 US$

92 500

1 081 000

----------

00-Y PROGRAIIQIE STAT-

SYRIAN ARAB REHlBLIC

NATIONAL HEALTH DEVEZIDPIYIMT STRATEXY

The Government had drawn up an out l ine of planned development targets fo r the per-

iod 1971/1985. The health sector of the fourth Five-Year Plan prepared by the Planning

Office of the Ministry of Health foresees.coverage of the entkro population w i t h a f u l l

range of preventive and curative health services.

The Ministry intends to concentrate on the development of basic health services i n

two o r three provinces each year, with the ultimate objective of providing an acceptable

standard of health serviae for the e n t i r e population. The Health Plan a a l l s fo r the

establishment of 47 n w health centres, the construction of f i ve n.r provinoial hospitals,

increasing the to t a l number of beds t o 10 118, upgrading of exis t ing provincial and

d i s t r i c t hospitals, and i n i t i a t i o n of a country-wide health education.campaign.

TEW1CA.L COOPERATION PMG- POR HEALTH

Health serviaes dovelopent

The Fourth Fivo-Year Plan aims a t coverage of the e n t i r e population with preventive

and curative health servioee. W H l w i l l continue to aollaborate with the Government i n

a t ta in ing t h i s goal, Support w i l l be given for the further development of hospi ta l

administration serviaes and for the strengthening of emergency medical care, including

intensive care. Likewise, WHD w i l l continue its cooperation with the Government i n the

expansion of medical rehabi l i ta t ion services t o dewlop a network of rehabi l i t a t ion

f a c i l i t i e s i n the country.

Public health laboratory services w i l l be expanded t o cover more population i n the

provinces as well as i n &he peri@ery, and VH) w i l l collaborate i n achieving this goal.

Maternal and chi ld health/fanily health m H

The f i r s t phase of the MCWFH projeat, funded by UNPPA, came t o an end i n 1978/79;

the seaond phase which w i l l oontinue through 1981, is e x p e a t d to see the extension of

integrated YCH and family planning services t o a l l usban areas. WH) w i l l continueto.

aollaborate i n this plan.


The programme of surveillance of communicable diseases w i l l be concerned mainly

with en te r ic infections, zoonoses and food-borne infections but w i l l include also the

evaluation of the immunization programme and the expansion of surveillance a t prlmary

level.

WHO collaboration w i l l be focussed on control of en te r ic infections, including the

prevention of introduction of cholera and the diffusion of the pract ice of o r a l rehydra-

tion.

Programme expansion of schistosomiasis control w i l l continue. More bordermeetings

w i l l take place between Syria, Jordan, Lebanon and possibly Turkey.

The number of discovered indigenous cases of malaria has been s teadi ly increasing

due mainly t o operational and administrative d i f f i cu l t i e s . WHO w i l l continue to co-

operate i n assessing the progress of the programme and i n the planning of ac tzv i t ies

adapted t o the divers i f ied epidemiological and socio-economic s i tua t ions of the various

provinces. Provisions for supplies, fellowships and d i r ec t par t ic ipat ion i n t ra ining

of national s ta f f are a lso par t of WHO support t o the Government's effor ts .


WHO w i l l provide consultant services i n programes for a i r quality, water quality,

marine pollution, environmental improvement and food sanitation. Fellorrshipa w i l l

a lso be provided t o develop manpower capabi l i t i es i n a i r qual i ty control, water qual i ty

rutvei l lance and food sanitation. In addition, l imited amountrdsuppl ies and equip-

ment relevant to needs w i l l be provided.

Health manpower develop~ent

In medical and dental education WHO collaboration w i l l continue i n the fur ther

development and imprcvement of the qual i ty of teachers and ins t ruc tors i n medicine and

dentistry. Speaial a t tent ion w i l l be given to the promotion of postgraduate medical

education and the development of the dental school.

There a r e eleven nursing schools i n the country preparing nurses and midwives.

Their major needs are t o develop curricula re la ted t o job descriptions, and t o improve

teaching through t ra ining i n education methods. WH3 w i l l continue to help i n preparing

qual i f ied faculty members by provision of fellowships and through strengthening f i e l d

t ra ining areas.

Regular Budget

SYRIAN ARAB REPUBLIC

( c t 'd)

4 . 1 COMMUNICABLE DISEASE PREVENTION AND CONTROL

4.1.1 Epidemiological S u r v e i l l a n c e (Advisory s e r v i c e s i n epidemiology)

4 .1 .2 Malar ia and Other P a r a s i t i c Diseases (Malar ia e r a d i c a t i o n programme; Schiso tosomias i s c o n t r o l )

4.1 .5 Expanded Programme on Immunization (Expanded programme of immunization)

4 .1 .7 Prevent ion of Bl indness (Communicable eye d i s e a s e c o n t r o l )


4 .2 .3 Ora l Heaath (Facul ty o f Dental Medicine ]

5 .1 PROhIOTI ON OF ENVIRONMENTAL HEALTH

5.1.3 Recogni t ion and Cont ro l of Environmental Hazards (Environmental h e a l t h p o l l u t i o n a l problems )

6 . 1 HEAL'lW MANPOWER DEVEU)PMENT

6.1.2 Promo t i o n of T ra in ing (Nursing educa t ion , Damascus; Technical Hea l t h I n s t i t u t e ; Medical educa t i on ; Fe l lowships )

TOTAL - SYRIAN ARAB REPUBLIC

Estimated


US$

23 500

208 900

11 400

366 500

1 132 700

----------- -----------

- Obligations


US$

51 200

336 000

118 600

64 500

373 000

1 375 300

----------- -----------

Source

of

Funds

DP

DP

Othor Sources

&timated

B~ennium 1978 - 1979

US$

87 700

50 400

466 800

----- ---- - ----------

Obliiatione

Biemium 1980 - 1981

US$

1 3 800

---------- ----------

COUNTRY P R O G ~ STATEMENT

TUNISIA


The main heal th problems of Tunisia are:

- communicable diseases, of which the most important a r e i n t e 8 t i n a l infect ions

due t o inadequate san i t a t ion , p a r a s i t i c diseases, rabies ;

- chronic diseases, especia l ly anaemia and haemglobinopathy, lymphoma of the

diges t ive t r a c t , cancer of the u te r ine cervix and cavi ty , and of the breas t ;

- malnutri t ion, e spec ia l ly i n r u r a l areas;

- a r a t e of in fan t morta l i ty which reaches 120 per thousand i n r u r a l areas ; and

- inadequate health-care coverage of the r u r a l population.

The current national hea l th s t ra tegy is incorporated i n a National Health

Development Plan. Major goals of the Government a r e the improvement of r u r a l hea l th

ca re coverage, the control of comunicable diseases and canaer, the prevention of

environmental pollution, and the development of heal th planning capab i l i t i e s .

A p r i o r i t y programme a rea i n which WHO has a major input is hea l th manpower

development.

TECHNICAL COOPERATION PROGRALlldES H)R HEALTH


A considerable extension of bas ic heal th services is proposed, which envisages

the construction of heal th service u n i t s d i s t r ibu ted throughout the country u n t i l

a11 c o m u n i t i e s have ready access t o primary hea l th a a r e d i rec ted toward8 the manage-

ment and control of prevalent diseaaes. WHD col laborat ion w i l l be mainly by means

of advisory services re la ted t o hea l th planning and management, the development of

medical emergenay services , and the expansion of the public heal th laboratory service

including radia t ion pr\jtuction. A 8 well , WHD w i l l cooperate i n developing a

national heal th information system.


The programme f o r the eradicat ion of malaria and the control of sohisto.oria8is

which have been very sucaessful w i l l be pursued, and WHD w i l l continue col laborat ion

as necessary u n t i l both diseases have disappeard. Of the chronic d imases , cancer

receives much a t t en t ion , and WHD collaboration with the National Cancer I n s t i t u t e ,

Tunis, which i s a W H D Regional Reference Centre, w i l l continue.


The Government is pursuing a long-term progralame f o r construction of sewerage

systems and treatment p lants , and the maintenance of the q u a l i t y of drinking water.

The "Organisation Nationale de 1 'Assainissement" is responsible f o r the planning,

execution and operation of waste management projects . WHO collaboration w i l l con-

t inue by means of consultant services and fellowships.


A high proportion of W H ) ' s co l laborat ive e f f o r t w i l l be devoted t o the correct ion

of continuxng severe shortages i n c e r t a i n ca teaor ies of Health Manpower p a r t i c u l a r l y

a t the middle and lower l eve l s , and specia l e f f o r t s w i l l be devoted t o the t r a in ing

of teachers of a l l categories. There w i l l be continuing col laborat ion i n the ex-

tens ive medical education project with a l l th ree medical f a c u l t i e s a t the Uruvers i t les

of Tunis, Sousse, and Sfax, i n accordance with a five-year plan fo r development with

pa r t i cu la r emphasis on teacher t r a in ing and re-or ienta t ion of the curriculum towards

the preparation of doctors who w i l l serve the heal th needs of the Tunisian community.

I n col laborat ion with UNDP there w i l l be continuing e f f o r t s t o promote the work

of a nat ional centre f o r the development of heal th personnel teachers. I n the

s p e c i f i c case of t h e Medical Faculty of the Universi ty of Tunis, a nat ional cen t re fo r

teacher t r a i n i n g i n medicine i t s e l f is envisaged. I n the area of educational develop-

ment and support, s p e c i f i c emphasis w i l l continue t o be given t o the development of a

nat ional biomedical information system, strengthening o f hea l th service l i b r a r i e s ,

and i n i t i a l s t eps towards the creat ion of a nat ional documentation centre.

The general fel lowship a l l o c a t i o n f o r Tunisia rill increas ingly be used t o com-

plement these a c t i v i t i e s and w i l l be s p e c i f i c a l l y related t o the o ther co l l abora t ive

programes of W H O , with a diminishing emphasis on the use of WZr) fellowships f o r

c l i n i c a l t r a i n i n g cP physicians.

mWU Budget

T U N I S I A

- Major ProRramme/~roRramme

2.2 GENERAL PROORAMME DEVELOPMENT AND MANAGEMENT


3.1 HEALTH SERVICES ' DEVEU)PMMST

3.1.1 Health Services ' Planning and Management (Advisory services; Medical emergency services)

3.1.5 Appropriate Technology for Health (National public health laboratory services; Radiation protection)

4.1 COMMUNICABLE DISEASE PREVENTION m CONTROL

4.1.2 Malaria and Other Parasitic Diseases (Malaria eradication programme; Schistosomiasis control)

P. 2 NONCaMMUNI CABLE DISEASE PREVENTION AND CWTROL


5.1 PROMWION OF ENVIRUWENTAL HEALTH

5.1.3 Recognition and Control of Environmental Hazards (Environmental health pollutional probrlems)

Estimated

B i d um 1978 - 1979

US6

77 800

51 !JOo

15 000

137 000

32 500

Obligations


US$

173 000

207 100

38 600

52 900

Source

of

DP

Ckhcr Sources

Ebtbted

Biennium 1978- 1979

US$

399 000

Obligatione

Bienniunl 1980-1981 US$

43 700

COUNTRY PRDCZUMW STATmPNT

UNITED ARAB =RATES

WATIWAL HEALTH D E V W m STRATEGY

The fledera1 f in is try of health of the United Arab m i r a t e s is responsible for

providing health services t o the seven federated emirates. Provision of health

f a c i l i t i e s during the l a s t ten years has greatly increased. A t present 2 423 beds i n

twenty-five hospitals and eigthy-three general and specialired clinioa a re avallable

i n the country. In addition, about twenty-four hospitals and cl inica are under eon-

atmotion which wi l l provide about 4 000 more hosptial beds for treatment.

The health services a re expanding a t a very f a s t paoe and therefore the quality

of services being provided varies from one emirate t o another. In addition, a number

of other government departments and organizations a re providing health servfces.

The Ministry of Health was established i n 1972 and its administrative s t ructure

and process a re st i l l being developed. The budget of the Ministry of Health i n 1978

was 818 million dirhams (approximately US $ 212 500 000).

TECIWICAL COOPHZATION PROORAMlldES FOR IBALTH

Health services developont

WR3 is collaborating w i t h the Federal Government i n restructuring the administration

and the organization of health services w i t h a v ie r to improve the planning, propmming

and u t i l i s a t i an of the available resources and the quality of services being provided.

The recorendations of WID mission consisting of a pharmacist, public health adminimtra-

tor, and management oonsultant, which vis i ted the country i n 1978, w i l l be taken into

-count-in the WID Technical Cooperation Programme for the biennium.


The Malaria Control Progr-e, i n progress i n the Bnirates,will be continued and

its coordination with the programmes of the neighbouring Arab Sta tes w i l l be promoted . Prowtion of environmental health

Because of the rapid Urbanization and industr ia l izat ion i n the country, partioular-

l y the growth of the o i l industry,the probleu of environmental hazards and pollution

of the s o i l a r e assuming greater importance.

Tne Fede ra t i on is a l s o s l gnd to ry t o t h e convention f o r t h e c o n t r o l of environmental

pollution m d t h e d e l c t c r i o u s e r f e c t s of t h e c o a s t a l deve lopnen t (Kuw~i t ..ction P lan 3e-

gioi l ) . \,I30 ! w i l l c o l l a ' J c rd t e w i th t h e Government and CXCP i n t h e development o f manpower

c a p a b i l i t i e s and i n t h e implementation of programmes f o r a l r q u a l i t y c o n t r o l , marine

p o l l u t i o n c o n t r o l and enviroxunental xmprovement a c t r v i t i e s i n t h e vclrlous c o u n t r i e s

involved.

The Government depends l < l r g e l y upon e x p a t r i a t e p r o f e s s i o n a l s , middle- level m d

a u x i l l d r y personne l f o r i ts h e a l t h s e r v i c e s . E f f o r t s a r e being made t o t r a r n n a t i o n a l s

t o assume p r o l e s s l o n a l r e s p o n s i b i l i t ~ e s f o r running ti-re s e r v i c e s a s we l l ds t o give

r e o r i e n t a t i o n courses f o r t h e expatriate p r o f e s s i o n a l s and middle - leve l workers t o

meet t h e requirements of h e d l t h s e r v i c e s of t h e country.

Heal th in format ion

S t a t i s t i c s a r e be ing c o l l e c t e d i n va r i ous h o s p i t a l s and h e a l t h o rgan i za t i ons .

There is a need t o c o l l a t e and coordinate i n f o r . ~ d t i o n . \VIO w r l l c o l l d b o r a t e i n

s t r e n g t h e n i n g t h e h e a l t h i n f o r n a t i o n i n f r a s t r u c t u r e o f t h e h l rn i s t ry of Hedlth.

Regular Budget

UNITED ARAB EMIRATES

major Programme/programme

2.2 GENERAL PROGRAMME DEVELOPMENT AND MANAGEMPlT


4 .1 COMMUNICABLE DI SEASE PREVENTION AND CONTROL

4.1.2 Malaria and Other Paras i t i c Diseases (Malaria survey)

4.1.7 Prevention of Blindness (Prevention of b l indness)

5.1 PROMOTION OF WVIRONlYENTAL HEALTH

5 .l. 3 Recognition and Control o f Environmental Hazards (Environmental hea l th p o l l u t i o n a l problems

6 .1 HEALTH MANPOWER DEVELDPMENT

6.1.2 Promo t i o n of Tra in ing (Fellowships )


7.1.1 Health S t a t i s tics (Advisory s e r v i c e s on v i t a l and h e a l t h s t a t i s t i c s )

TOTAL - UNITED ARAB EMIRATES

Estimated


US$ L

8 5 0 0

30000

38 500 = ========a

Obligations


US$

20 700

30 000

50 700 ==========

Othor Sourceg

EWmated

B~enn~um 1978- 1979

US$

100 500

Source Obligations

Biennium 1980-1981

US$

12 100

13 200

36 000

61 300

or

FT

FT

FT

FT


YEMEN ARAB REPUBLIC

NATIONAL HEALTH DEVEWFWENT STRATEGY

The Five-Year National Socio-economic Development Plan covers the period 1976/77-

1980/81, and inc ludes a plan f o r t he h e a l t h s ec to r . About YR 420 mi l l i on has been

provided f o r hea l th . P r i o r i t y a r e a s inc lude development of bas i c h e a l t h s e rv i ces /

primary h e a l t h ca re ; s t rengthening of h e a l t h admin i s t r a t ion ; s trengthening of

h o s p i t a l s e rv i ces : h e a l t h manpower development; con t ro l of communicable d i s e a s e s

e s p e c i a l l y tuberculos is , malar ia and ur inary schis tosomias is ; and hea l th educat ion.

TECHNICAL CO-OPERATION PROGRAMMES BUR HEALTH


The country h e a l t h programming exe rc i se c a r r i e d o u t i n t he context of t h e h e a l t h

p lan f o r 1976/77-1980/81 provides f o r a primary h e a l t h c a r e programe (PHC) which is

t o be developed along wi th b a s i c h e a l t h s e r v i c e s (BHS). I t i s envisaged t h a t the

BHS/PHC programme w i l l see the es tab l i shment by 1981 o f a network of h e a l t h c e n t r e s

and sub-centres together wi th nea r ly 300 primary h e a l t h care un i t s . Voluntary

o rgan iza t ions w i l l continue t o support maternal and c h i l d h e a l t h , immunization and

mobile c l i n i c serv ices .

The development o f b a s i c h e a l t h s e r v i c e s and primary h e a l t h c a r e w i l l be re-

inforced by cont inuing o rgan iza t iona l development a t t h e Minis t ry of Health where,

p a r t i c u l a r l y , t he epidemiology, h e a l t h s t a t i s t i c s and h e a l t h educat ion s e c t i o n s w i l l

be strengthened. Technical support w i l l be provided by t h e s t rengthening of the

pub l i c h e a l t h l abo ra to ry s e r v i c e and t h e p r o j e c t f o r t h e maintenance and repair o f

medical equipment a s w e l l as development of mental h e a l t h serv ices . I n a l l o f t hese

a c t i v i t i e s WHO w i l l c o l l a b o r a t e by making a v a i l a b l e advisory se rv i ces , fe l lowships ,

s u p p l i e s and equipment.

Conmiunicable d i s e a s e prevention and con t ro l

The major t h r u s t s of communicable d i s e a s e con t ro l -11 cont inue t o be i n r e l a t i o n

t o ~ n a l a r i a , t ube rcu los i s , s ch i s to somias i s and d iar rhoea1 d iseases . WHO w i l l cont inue

i t s co l l abora t ion i n these f i e l d s , and w i l l p l ay a 8 a j o r r o l e i n t he expanded pro-

gramme on i m u n i x a t i o n and i n the f u r t h e r s t rengthening o f epidemiological s e rv i ces .


The Government assigns high p r io r i t y to thm provision of a u f e water supply, and

there ha8 been considerable progress i n a o n s t r u c t i ~ rrter aupply s y s t e u i n Samoa

and weid . a s w e l l a s i n sore rural areas. WiKl rill continua t o collaborate i n

developing environmental health 8ervice8 and water supply and -werage s y s t e u ; and

as executing agency for UNDP, i n strengthening the Rural Water Supply Departnent of

the Ministry of Public Health.

The inarea& r a t e of development of health urpower t o net the needs of t b ~

Governmmntos pr ior i ty health program86 is to be maintained through 1981. A oonsider-

able proportion of the required manpower is expected t o be trained by 1981. The

implementation of the p r i n r y hoalth atre p r o g r a m rill call for special a t ten t ion

to the t ra ining of front-l ine workers.

WHD rill aontinue i n its ro l e of executing agenoy for the UNDP-fimnoed Health

Manpower I n s t i t u t e project i n Suraoa, and rill co-owrate a1.o i n nursing education

and the t ra ining of primary health care workers. Fellowships rill continue t o be a

n j o r component of WHD collaboration i n health manpower developlent.

Regular Budget - Estimated Obligations

Biennium Biennium 1978 - 1979 1980 - 1981 F

YEMEN ARAB REPU5LIC

- !a~~rPr_o_gra_"1m_e_/~r?gr_a_m.me

2 . 2 G E N r n L PRoGWhZ!lE DEVELOPMEKT AID hWAGE1lENT

2 . 2 . 2 Coun t ry H e a l t h Programming (WHO Programme C o o r d i n a t o r )

3 . 1 HEALM SERVICES ' DEVEMPhlENT

3 . 1 . 1 H e a l t h S e r v i c e s ' P l a n n l n g and hlarlagement (Loca l h e a l t h s e r v i c e s , T a l z , Loca l h e a l t h s e r v i c e s , Hode ida ; P u b l i c h e a l t h a d m l n i s t r a t i o n ; hla in tenance and r e p a i r o f m e d i c a l e q u i p m e n t )

3 .1 .2 P r imary H e a l t h C a r e (P r imary h e a l t h c a r e )

3 . l . 5 A p p r o p r i a t e Technology f o r H e a l t h ( N a t i o n a l p u b l i c h e a l t h l a b o r a t o r y )

3 . 2 FAMILY HUL'IH

3 . 2 . 1 M a t e r n a l and C h i l d H e a l t h ( M a t e r n a l and c h i l d h e a l t h and f a m i l y h e a l t h )

3 . 3 MENTAL HEALTH

(Menta l h e a l t h )

4 .1 COhMJNICABLE DISEASE PREVENTION AND CONTROL

4 . 1 . 1 E p i d e m i o l o g i c a l S u r v e i l l a n c e ( E p i d e m i o l o g i c a l s e r v i c e s )

184 300

638 800

272 900

192 700

330 300

156 200

198 600

389 100

44 1 0 0

171 000

Sourcc

of

VA

VA

VA

FP

VA

Other source^

Estrmated

B~enn~um 1978- 1979

US$

400 000

224 500

255 200

1 7 3 000

Obligatlom

H~ennium 1980-1981 US$

400 000

1 2 0 000

4 3 3 2 0 0

1 4 1 6 0 0

YEMEN ARAB REPUBLIC

(c t ' d )

4.1.2 Malaria and Other P a r a s i t i c Diseaseo (Schistosomiasir control ; Malaria control programme)

4.1.3 Bacter ia l , Viral and Mycotic Diseases (Rtberculosis control )

4.1.4 Smallpox Eradication (Smallpox eradicat ion )

4.1.5 Expanded Programme on Immunization (Expanded programme of immunization )

4.1.7 Prevention of Blindness (Prevention of blindness )


5.1.2 & s i c Sanitary Measures (Environmental heal t h se rv ices and community r a t e l supply; Water supply and sewerage system f o r Sana'a and Hodeida)

5.1.3 Recognition and Control of Environmental Haoards (Environmental heal th po l lu t iona l problems )

4

6.1.2 Promo t ion of Training (Fellowahips )

TOTAL - YEMEN ARAB REPUBLIC

Othor Sourcee b Source

EWuted Obligatione ' or

Biennium Biennium 1978- 1979 1980-1981

549 400 789 300 VA

484 700 215 000 VA

460 000 420 000 VA

2 546 800 2 519 100

=====x==== ====a=====

N.B. UNDP ass i s t ed programmes a m present ly under reformulation and review and a r e therefore not r e f l ec ted i n the above table .

REGIONAL ADVISERS

'personnel : Provision is made under the Regular Budget f o r 26 posts i n the profession-

a l category and 35 posts i n the general services Category during t h e biennium, Under

UNFPA , provision is a l so made f o r one post i n the professional category and one i n

the general services category.

The following addit ions and o f f s e t t i n g dele t ions of posts a r e re f l ec ted i n the

proposed Programme Budget:

(1) One MCH Adviser (P4) and one Clerk-Stenographer (m5) have been added t o Maternal

and Child Health (3.2.1), whlle one Health Education Adviser (P4) and one Clerk-

Stenographer (Rd5) have been deleted from Health Education (3.2.4).

( 2 ) One Health Economies Adviser(P4) and one Clerk-Stenographer (lB15) have been added

t o Health Services Development, i n Programme Planning and General Ac t iv i t es (3. l o o ) ,

while one Adviser (P4) and one Clerk-Stenographer (EM5)have been deleted from Cardio-

vascular Diseases. (4.2.2).

(3) The post of Public Iiealth Administrator (P5) under t h e Programme "Collaboration w i t h

m u l t i l a t e r a l and b i l a t e r a l programme" (2.3.2) has been deleted and replaced by an

Administrative Assistant (EXiX) post.

The establishment of Regional Advisers fo r t h e 1980-1981 biennium is a s follows:

2.3.2 Collaboration with m u l t i l a t e r a l and b i l a t e r a l programme - one, administrat ive

a s s i s t a n t (EW() and one clerk-stenographer (mfXIG).

3.1 HEALTH SERVICES DEVELOPMENT

3.1.0 Programme Ranning and General Act ivi t ies (two Dl) th ree P5 and one P4 a s froln

1981; two m7 and one addltronal W S a s f r o m 1981,

3.1.3 Workers' Health - (one P4, one 3325).

3.1.5 Appropriate Bchnology f o r Health - (two PJ and two Rd5).

3.2 FAMILY HEALTH

3.2.1 Maternal and Child Health - (two P4 and two Rd5 of which one professional and

one general services post financed from UNFPA).

3.2.2 Nutr i t ion - (one P5 and one M5)

3.3 MENTAL HEALTH - (one P5 and one m16).

3.4.0 Prophylactic, Diagnostic and Therapeutic Substances - programme planning and

general ac t iv i t i e s (one P4).

4.1 COSlQmMICABLE DISEASE PREVENTION AND CONTROL

4.1.0 Programme Planning and General Act ivi t ies - (one D l and one M7).

4.1.1 Epidemiological Surveillance - (one P5 and one m5).

4.1.2 Malaria and Other Paras i t ic Diseases - (one P5, one P4 and two M5).

4.1.8 Vector Biology and Control - (one P4 and one m5).

4.2 NON-COMMUNICABLE bISEASE -ION AND CUNTROL

4.2.2 Cardiovascular Disease - (one P4 and one EN15 i n 1980 ohly).

5.1 PROWION OF WIRONMENTAL HEALTH

5.1.0 Programme Planning and General Act ivi t ies - (three P5 and two m5).

6.1 HEALTH MANPOWER DEVEXDPIIIENT

6.1.0 P r o g r m e Planning and General Act ivi t ies t one D l , one P5 and t w o P4, one

IWC, one m, two M7, one EY6, s i x EM5 and two QL4).

7 • HEALTH 1WK)RMATION

7.1.0 Programe Planning and General Act ivi t ies - (one P5 and one g15).

Estimated obligations for Regional Advisers under the Regular Bugdet of US $

3 368 900includeprovision for duty t ravel of US $ 250 700 t o enable Regional Adviaera

t o advise f i e l d s t a f f , to a s s i s t i n the planning, implementation and evaluation of f i e l d

projects and to consult health authori t ies i n the countries of the Region.

Estimated obligations fo r UNFPA Regional Advisers of US $ 121 000 include provision

for duty t ravel of US $ 9 200.

Regular Budget



2 .2 GENERAL PROGRAIlhiE DEVELOPMENT AND MANAGEMENT

2.2.3 In format ion Systems Pro gramme

ISP 001 - In format ion system development

ISP 002 - Nat iona l h e a l t h in format ion s e r v i c e s

2 . 3 EXTERNAL COORDINATION FOR HEALTH AND SOCIO-ECONOMI C DEVELOPMENT

2.3.2 C o l l a b o r a t i o n w i t h M u l t i l a t e r a l and B i l a t e r a l Programmes

CWO 001 - UNDP c o o r d i n a t i n g s e r v i c e s

CMB 001 - UNR\VA p u b l i c h e a l t h personne l

2 .4 RESEARCH PROMOTION AND DEVELOPMENT

RPD 001 - Promotion and development of p u b l i c h e a l t h r e s e a r c h

RPD 002 - Biomedical r e s e a r c h

2 .5 REGIONAL DIRECTOR ' s DEVELOPMEN T PROGRAMME

DCP 001 - Regional D i r e c t o r ' s Development Programme

Estimated

Biennium 1978 -, 1979

US8

51 500

107 OOO

516 200

348 000

346 700

200 000

-- -

- Obligations


US$

240 400

68 700

596 100

507 200

800 000

Sourco

of

Funds

VA

VA

Othcr Sources

Estimated Bienn~um

1978 - 1979 US$

200 000

Obligations


300 000

1000 000

Regular Budget


Biennium Biennium 1978 - 1979 1980 - 1981 1


( c t ' d ) - Major Programme/programme

3.1 HEALTH SERVICES ' DEVEMPMENT

3 .1 .0 Programme Planning and General A c t i v i t i e s

PPS 100 - Regional Advisers

HSP 001 - Advisory s e r v i c e s

HSD 004 - Strengthening of t h e h o s p i t a l adminis t r a t i o r t r a i n i n g programme

HSD 005 - Working group on modern concepts o f the management of h o s p i t a l used f o r teaching purposes

HSD 006 - National h e a l t h programme development

HSP 002 - Seminar on emergency medical s e r v i c e s

3.1.2 Primary Health Care

PHC 001 - Seminar on primary h e a l t h c a r e

PHC 002 - Regional c e n t r e f o r bas i c h e a l t h s e r v i c e s development atad research

PHC 003 - Primary h e a l t h c a r e

PHC 004 - Meeting of Regiona: Advisory Panel on Primary Health Care

PHC 005 - Meeting of chairmen of medical a s soc ia t ions on primary hea l th c a r e

3.1.3 Workers ' Health

WKH 001 - Training course on occupational h e a l t h

WKH 100 - Regional Adviser

561 700

272 000

38 500

1 9 900

160 000

25 000

45 500

205 000

45 800

103 500

665 500

339 200

25 600

16 300

16 300

50 900

121 000

Sourcc

ai

Funds

FT

Othor Sourcee

Ebtbated

Biennium 1978- 1979

US$

Obligations

Biennium 1940-1981

US$

10 600

m Budget

INTER-COUNTRY P R O G R A W

( c t ' d ) ~- Major Programme/programme

3.2.2 Nu t r i t i on

NUT 004 - Regional food and n u t r i t i o n t r a i n i n g programme

NUT 005 - Prevention of n u t r i t i o n a l d e f i c i e n c i e s

NUT 100 - Regional Adviser

3.2.4 Health Education

HED 002 - Health educat ion a c t i v i t i e s

HED 100 - Regional Adviser

3.3 WTAL HEALTH

MNH 007 - I n t e r reg ional Training of Psych ia t r i c Nurse Teachers

MNH 009 - Group meeting f o r planning organiza t ion and management of mental h e a l t h c a r e

MNH 010 - Prevention and treatment of drug abuse and alchoholism

MNH 011 - Care of t h e mental chronics

MNH 012 - Child mental h e a l t h c a r e

MNH 100 - Regional Adviser



PPT 100 - Regional Adviser

Estimated


US$

47 600

103 500

103 500

30000

103 500

91 400

Obligations


US$

52 800

123 000

61 200

67 800

17 600

20 300

13 000

25 600

121 000

107 800

Source

at

Other Sources

Estimated B~ennium

1978- 1979 US$

Obligations

Biennium 1980-1981

'US$

k l a r Budget


( c t ' d )

,-


3.4.1 Drug P o l i c i e s and Management

DPM 004 - Symposium on drug evalua t ion and drug con t ro l

DPM 005 - Research development i n drug u t i l i z a t i o n

DPM 006 - Working group on e s s e n t i a l s of n a t i o n a l drug p o l i c l e s and management

4 .1 COMMUNICABLE DISEASE PREVENT1 ON AND CONTROL


PPC 100 - Regional Adviser

4.1.1 Epidemiological Su rve i l l ance

ESD 001 - Epidemiological s e r v i c e s

ESD 100 - Regional Adviser

4.1.2 Malaria and Other P a r a s i t i c Diseases

MPD 001 - Malaria co-ordinat ion meetings

MPD 003 - Seminar on s c h i s tosomiasis i n t h e EMRO and of r ecen t development i n con t ro l and prevention

MPD 004 - Training i n malar ia

MPD 005 - Coordination o f an t i -malar ia programmes i n the Arabian Peninsula

Estimated

Bicndum 1978 - 1979

US$

16 000

27 000

50 000

107 000

25 500

105 300

12 000

Obligations


US$

38 900

14 000

124 800

31 800

123 400

20 000

30 300

81 800

Sourca

d

VA

WI

Othcr Sources

Estimated

Blennium 1978 - 1979

US$

200 000

Obl~gatione

'Biennium 1980 - 1981 US$

600 000

135 900

war Budget

INTER-COUNTRY PROGRAMNIE

( c t ' d )

% J O ~ Pm~ramme/programme

4.1.2 Malar ia and Other Paras1 t i c Diseases

MPD 006 - Tra in ing i n ma l a r i a and vector-borne d i s e a s e s

MPD C07 - Fellowships i n t r o p i c a l d i s e a s e s

MPD 100 - Regional Advisers

4 .1 .3 B a c t e r i a l , V i r a l and Mycotic Diseases

BV?d 001 - Regional r e s ea r ch and t r a i n i n g f o r rodent c o n t r o l

BVM 002 - Advisory s e r v i c e s on v e t e r i n a r y p u b l i c h e a l t h

4 .1 .5 Expanded Programme on Immunization

SPI 003 - Expanded programme of immunization

4.1.7 Prevent ion of Bl indness

PBL 002 - Prevent ion of b l i ndnes s

4 .1 .8 Vector Biology and Cont ro l

VBC 001 - Vector and p e s t c o n t r o l

VBC 100 - Regional Adviser


4 .2 .1 Cancer

CAN 003 - Regional Advisory pane l on cancer

CAN 004 - Regional t r a i n i n g course on cancer r e g i s t r y

Mimated


US$

65 000

70 000

214 500

40 000

47 000

275 000

50 000

31 500

103 500

22 500

29 000

Obligations

Biennium 1980 - 1981'

US$

250 300

42 400

50 400

121 000

14 800

Source

of

Othcr Sources

Estimated Biennium

1978 - 1979 US$

Obligations


US$

Regular Budget


( c t ' d ) - Major Programme/programme

CAN 005 - Regional re ference con tres f o r bladder, head and neck cancers

CAN 006 - Regional re ference c e n t r e on lymphoma and oesophageal

CAN 007 - Regional re ference c e n t r e f o r b reas t and u t e r i n e ce rv ix cancer

CAN 008 - Seminar on improving teaching o f cancer i n Eastern Mediterranean Region

CAN 009 - Second Regional course on epidemiology of chronic d i seases with s p e c i a l emphasis on cancer

( i n co l l abora t ion wi th IARC:

4.2.2 Cardiovascular Diseases

C M 001 - Epidemiological s t u d i e s on card iovascular d i seases

CVD 100 - Regional Adviser

4 .2 .3 Oral Health

ORH 002 - Advisory s e r v i c e s i n d e n t a l h e a l t h

ORH 003 - Seminar on o r a l h e a l t h



PPE 100 - Regional Advisers

5.1.1 Environmental Heal th Planning and Management

EHP 001 - F e a s i b i l i t y s tudy f o r Regional Centre f o r environmental h e a l t h

Estimated


US$

37 200

23 500

43 000

103 500

68 000

287 400

II

- Obligations


US$

24 600

12 600

33 600

16 800

22 000

72 OW

59 100

31 800

25 600

336 100

100 000

Sourco

of

Othcr Sourcee

EWmated

B~ennium 1978 - 1979

US$

Obligations


Regular Budget

INTER-COUNTRY PROGRAMNlE

( c t ' d )


5.1.2 Bas ic San i t a ry Measures

BSM 002 - Development of na t iona l water supply and s a n i t a t i o n information systems

BSM 004 - Training of p l a n t ope ra to r s (Training and s w a g e treatment 1

BSM 005 - Seminar on waste s t a b i l i z a t i o n ponds-design on opera t ion

PIP 001 - Formulation of pre-investment p r o j e c t s f o r b a s i c s a n i t a r y s e r v i c e s

6 .1 HEALTH MANPOWER DEVEMPMENT


PPM 100 - Regional Advisers

6.1 .1 Health Manpower Planning and Management

HHM 001 - Development of h e a l t h i n s ti t u t i o n s

HHM 002 - Regional v i s i t i n g s c i e n t i s t s programme

HHM 003 - Meeting o f d i r e c t o r s of schools of pub1 i c hea l th

H W 004 - Health s e r v i c e s and manpower development

HHM 005 - Development of manpower planning and management capabi 1 i t y

HHM 006 - Continuing education of hea l t h personnel

HMD 030 - Working group meeting on education f o r change

Estimated


US$

100 000

571 500

42 000

60 000

6000

75 000

20 000

- Obligations


US$

31 800

97 600

51 200

663 500

46 000

80 000

18 300

278 100

130 100

81 200

Soum of

0-r Sourceg

EMmated B~enn~um

1978 - 1979 US$

Obligations


' US$

234

INTER-COUNTRY PROGUIWE


6.1.2 Promotion of Training

HMT 001 (A) - Regional Training Centre on maintenance and r e p a i r of medical equipment, Higher Technical I n s t i t u t e , Nicosia (CYPRUS)

H#r 001 (B) - Regional Training Centre on maintenance and r e p a i r of medical equipment, Baghdad (IRAQ )

002 - Regional nursing/ midri f e ry developen t

HNT 003 - Part ic ipat ion i n educational meetings

HYT 004 - Health manpower deve lopnent

HMT 005 - Meeting of nat ional f ellowships o f f i c e r s

HMT 006 - Developnent and support of post-graduate educeition i n public himlth

HYT 007 - Development of environmental heal th

W T 008 - Development of o r a l hea l th

HMT 009 - Support t o develop ment of t r a in ing progrrraaes , task-based, coa~runity or iented including PHC support

6.1.3 Educational Development and Support

HUE 001 - Regional Programhe i n d u c a t i o n a l planning and techno logy

- Regional Health ture Services

Regular Budget

Estimated


US$

20 000

75 000

105 000

33 500

7 349 300

===========

Othcr Source9 Sourcc

Ektbated Obligatione INTER-COUN'IRY PROGRAMblE

- Obligations


US$

23 000

148 600

122 700

18 100

9 867 400

===========

( c t ' d )

.-


HME 003 - Regional Research Development i n Educational Technology

HME 004 - Health l ea rn ing m a t e r i a l s



PPI 100 - Regional Adviser

7 .l. 1 Heal th S t a t i s t i c s

ICD 001 - Train ing f o r t h e Ninth Revision o f t he I n t e r n a t i o n a l C l a s s i f i ca - t i o n o f Diseases

HST 001 - Health s t a t i s t i c s f o r monitoring

TOTAL - INTER-COUNTRY PROGRAMME 997 400

----------- ----------- 2 705 700

----------- -----------

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