lmplemen ta tion of poverty reduction strategies in the Eastern Mediterranean Region

I . k p ~ r r :of an @twwfl t ty m- aim. wt, lie-36; NQvernber 2wb

- i , b ~ 1,''' :,.world Health Organization

Regional Office for the Eastern Mediterranean

implementation of poverty reduction strategies in the Eastern Mediterranean

Region

Report of an intercountry meeting Cairo, Egypt, 14-16 November 2005

World Health Organization Reclonal Office for the Eastern Mediterranean

Calro 2006

4 World Health Or);at~i~,rtirlt~ ?UU6 A11 rights reserr,r.d. I'ljc designations rrnplrlytd 2nd thc prcst'ntalinn of t l ~ c ~l~;llr,ri,d in Ll~is publlratinll LIO nut irnpty thc ct.l>r,r++lrjlI 01 , u ~ y o y i i ~ i r ~ n \zhntsorvcr on the part LII thr. \.\!urhl Hedth Organlx,~tion cor~ccrning the lrgal ~ t ~ ~ t u s o f ,111y country, te~-rrtnry, cil) or ;~rt,a or (11 I ( $

.~rrthuritics, or cnnrzrnirlg t11+- Cl~xli[11itr7ti~>11 of it5 il.o11ticr5 t!r I ~ ~ ) I I I ~ L ~ ~ T I C S . Uott('d ~ I I I C S rln I I I , I ~ S 1-1 '~~res~ ' i l t appr\>\im.3ttb bordcr li~icq Inr wltict~ thure may not yet bt- full ,Igrccn~c.rIt. -l-ltc mcrltlun uf .;ppcific ~-nlnIx>i>Ics 111- ui certain ~nanufar tu~crs ' products dnrs not imply th,lt they ,Ire r!ndnrsrd rc t t in~ tric~ulc?d b~ t l ~ c Lt'orld IIcaltli Org,lnisnfir>~\ i11 prcfcrcncc lo othcrs r j l ,q >iri~iInr n.>tui-c that arc nt>t r~~cu t i c ) r l~d . Eri-clrs and on~~>>imn-. ckccptcd, tljc n,llncs o f pruprictary produrf .: ,lrc t l ~ ~ t i r l g ~ i i s l > ~ d bv i i n i t 131 ~ ~ l p ~ t . > l lcitt,rs I'lw M!orld Ilcalth Organizatinr~ rloc- not %warrant that [lie i n f t m ~ ~ t i o r r contained in tlii.: p~thlic.ntion is i~rrnpluir .3rlrl rr~rrcct and ~ 1 1 , ~ 1 1 rwt b ~ . li,itllc fur anv dantajir5 ~ n c u r r ~ ' ~ i AS il rcsult of its usr. Puhlicatiorls of the World 1 Tt.,~lth O r g , l ~ ~ i ~ a t i o n can bv nhl.>~z>cd t r u n ~ L ) ~ s t r ~ b ~ r t l o i ~ a n d S,~lr?<, \\'url~l Hcnltli O r y , , q ~ > ~ ~ . l t ~ , ~ n , l<c~lonn! (3ificc for the Lastr>rn h7ccIit~*1r;lnc,111, 1'0 But 7h08, V,~.qr Tit!., Lur r ) i2371, Egy[lr (tt.1. +?{I2 670 2535, fax: +202 hlrr 2.1~12; c m ~ i l : 1>St\(?i'cmru.rz.ho.inl). I < ~ ~ L I L - < ~ \ lor pcrnussion tn r rp r r l~ t~ r rc LVIjC) E.UKO p u b l ~ r ~ tic>ns. 111 p,ut or 1r1 ~ r h n l r , err to I r.>rrcl,ltt> t!lcm - wl\cthcr fur sale 0 1 ih r r ~ r ~ ~ ~ c o r > ~ r > > ~ ' r ~ i i l ( distribution - .;11ould l,t, ,~ddl-cssed tu th r I:r~ion.>l ,\diiscr, t l t . ;~lth ~ n d n ~ t ) n ~ ~ , t I ~ ~ , l l I r>tormat i~u~, at the ahnvc ,>rlclrc.:s (fax: +202 276 5400; crnt>il -!nr~ t i ho.inl)

Covt:r by Suhalh 111 4 s b ~ l i i 1'riiltc.d by I c,t~t[c oi l2rdb Stales Pr ints l~op

Document WIIO- EM!< H1/1152~03.06/5RO

Contents

Executive summary .......................... ....... .......................................... 1

1. Introduction .................................... . . . . . .............. .........5

TechnicaI presentations .......................................................... 9 2.1 Building linkages bctween second genera tion

poverty reduction strategies, Millennium Development Goals and cominuni ty -based

......................................................................... initiatil~es .g 2.2 Community-based strategy for poverty reduction .. 10 2.3 GIobaI lessons in health: imyIementation of

poverty reduction strategies ....................................... 12 2.4 Thc Social Dctcrminants of E Iealth and

Community -bawd lnitiativcs ...................................... 14 2.5 Health as thc priority intervention in community-

based initiative settings ................................................ 15 2.6 I'rotnuting healthy practices through community-

. . . . based inltlatlvils ............................................................. 17

2.7 Incomc generation and environmental pollution ....................................................................... challenges 18

2.8 Integration of TB DOTS in all BDN areas of the Region through proactive community

. . . ................................................................... p a r t i ~ ~ p a tmn 1 9

2.9 Str~ngthening routine inimuniz~ tion a t comrnu~~i ty lcvcl.. ............... ................

2.1 0 7l1c roIc of mothers in breaking thc cyclc of poverty ........................................................................... 22

2.1 1 CBI approaches: health and quality of life c l~~~llenges in sltim areas ............................................... 24

3 . Country experiences ........................................................... 27 3.1 Afghanistan c ~ l ~ d its dcvclopmcnt proccss ................ 27 3.2 I Iealthy ViiIdge prograinme in J u r ~ i a l ~ ...................... 28 3.3 Fxpcl-icnce o f AgriculturaI Crcdit Cuoperntiun on

pnvcrlv rcductim~ in Jordan and its linhage ith .................................................. HVP .......................... .. 29

3.4 Espcricnce of Morocco in cu~~~rnuni ty-based . . . . ~nltiat~ves ........................................................................ 29

3.5 Experience of I'akistan in t11e institutionalization of cornmui~itv-based initiatives and involv~i-nen t of civil societies in prugrarnme implemcntatim~ ........... 31

3.6 Experience of Azad Kashmir-Pakistan on yartncrshiy and resourcc rnuhiliza tiun for. po17cl.ty

.............. reduction and sustainability development 33 3.7 hy7cricncc of Saudi Arabia in the implementation

of t h ~ Healthy Cities programme ............................ 34 3.8 Establishment of cominui~ity infonilation centres

F in Sudan .......................................................................... 33 3.9 FIRDOS' exycricnces in povcrty ~qcduction ............... 37 3.10 Iraq experience .............................................................. 38 3.1 1 Using commu~~ity-based initiatives ds a yIatiorin

for poverty rcduction .................................................. 39

4 . Group work ............................................................................ 41

. . 5 Discussion ....................................,.............................. 42

............................................................................ 6 . Conclusions 48

................................................................ 7 . Recomrncndations 5 0

Annexes I . Agenda ..................................................................................... L54 2 . I'rogramr-ne .............................................................................. 55 3 . List uf participants .................................................................. 58 4 . Working group documer~tation ........................................... 65

txecutive summary

The intercountry meeting on the implrmentdiion of poverty reduction strategies in the Eastern Mediterranean Rcgion was Iielcl in Cairo, Egypt from 14 to 16 Novernbcr 20115 a1 the WHO Regional Office for the Eastern Mediterranean. The meeting was attended by focal points for community-based initiatives from 16 countries of the Region, as well as rcpresentalives from a number of internatio~~al organizations and WHO staff from headquarters, the Regional Office and country offices. Thc objectives of the meeting were to:

dcvclop an operational plan for enhancing the implementation of poverty reduction strategies; s l~are countries' experiences demonstrating governmel-I t owr~ership, community involvement, intersectoral collaboration and partnership in poverty reduction and sustainable development programmes in the Region; share vision, strategies and activities related to the Commission o n Social Determinants of Health and its 1 i nkages with Community-based Initiatives; re-emphasize health as a major component of the community-based initiatives.

Ihe meeting was organized into technical and country yrcscntations as well as discussions and group aimed at forming an operational plan for enhancing the implementation of povcrty reduction strategy and a set of recommendations.

Ai the end of the mctting, participants c o ~ ~ c l r ~ d e d that community-bnscd initiatives have been very succcssful in showir~g thc effectiveness of community-based approaches in health dcvcloprnent. Community-based initiatives have proven to bc particularly effective in corn mu nit^ mobili7ation and organization a11cl poverty rediictiun at micro level, and have shown that thcrc is further potential to drnslically improve I~ealth indicntol-s through nmpnwcring people to look aftcr their own healih. Cummunity- based initiatives from their inception have had a dual focus; making the y roccss sustainable with available cumrr~unity resources and attaining tangible health and quality of l i k

lrnplementat~on of poverty reductiorl strntegles in the Eastern Mediterranea~~ Hog~on

outcurnes. Furthcrmorc, community-based initiatives h n ~ ~ t . demonstr-ntcd thnt through c ~ ~ i i ~ ~ g as a 11ar-11~oiiizint:i verult. thcv h,~vc facilit~ted Ihc input '3nd coHaborc~tion ol ml11 tid imunsiui~al aclivitics.

Summary of recommendations

I . Cut111 tries should cieirelop ~lntional strategies for jnsiitutionalizing key components of community-based initiatives, i~~c lud ing advocacy, o r j c n t a t i o ~ ~ of: potential stakeholders and decision-makers, collaburntive in~plementation, networking, and monitorjng and evaluation.

2. Count rics should clevelop pI,~ns of action for implementing the regional strategies un povcrtv reduction for health, including the ncctlssary follow-up.

3. Countries should work closelv with all stakchold~rs to cnsurc that a gender perspective is incorporated into nat ionnl dcvclopn~eni plans, policics and activjtics.

4. \VI 10 should support national authorities in oricn tation 2nd training of 12-orkers in the health and other sectors and nongovcri~mental orjiC1ni~;l tioils and partners on using the community-bascd initintiires approach for I~ealth and dcvelopmen t (WI I 0 Represents Iives' offices, Regiondl Office, WHO headquarters).

5. Cott ntries should i~~coryorntc the communitv-based initiatives approad? into thc district health svstern, and should follorr up implementation and 1no17i tor progress.

6. Countries should cstnblisl~ a mechanism fur implcrncnting hcal th actititips nTithin thc community-bascd initia tivcs frarncrvork, with effective coordination ui i~~~iiol.rnal programmes a t all lr\rcls.

7. WHO should iieveluy a packngc of compruhcizsive hcalth guidciines for intrlgration of diffcrcnt health programmes in cumm~it~iiy -bawd iiiitintives areas (IN1 I 0 Ruprcsentiiti\~esr offices, Regional Officc).

FCVERTY QEULIC I ION 5TR:iTEGlF S !h THE EASTFRN MCCITCRRANEAN AECilON

8. S,l:HO shuc~lcl tldvocntc for ,~tid ~.nisc p~lblic. awarwiess uf thc corlccpts oi self ' care, domt~stic care, and cullectivc ~ n d cornr~~unity r31-c a 5 part of primdry hmlth cart. I A ~ t i ~ ) ~ ~ ~ sholild includc pl.uviding health educat io11 for the public on basic care activities ( \Y HO I<eyrcs t~ i~ t~ t j yesf ofi'iccs, l<egional Office, VVHO hei~dqua rtc1.s).

9. Mi11istl.i~~ of health should assumc a leadership role in

coc>i-dina ting the hedl th-reLitud inputs of o thcr sectors and in

identifyi~~g the roles and I-csponsibilitics of eac11 sector for health development, and sl~ould allocate adequate resources for orientation and crcatioi~ nf or.t~nership by other stakeholders.

I . Corrniries sl~ould strengthen and form~lize ilic. Community Insurance, Co~nmunity Development Fuiid and Social Welfare Fr111cl initiatives as pro-poor actions in national health policy and planning.

Countries should y reynrc an inventory of similar community-based programmes supported bv various cionor agencies and national nongox~ernmenlal organizations and work tu promote partnerships and build linkages betwcen such programmes. Countries sl~oulcl strengthen advocacy and ol-icnta tion for coi~~munity-based initiatives nnd MnGs a t the district and intermediate levels, and ratjonalizc the role of each scctor and progrdmme in this respcct.

12. WF 10 shoul~i prornute pro-poor health policies and facilitate linkages between conin~unilv-based initiatives, t11u work of the Cornmissic717 017 Social I letermindnts of I I c ~ l th 2nd the targets o f the MDCs.

13. WHO shuuld adopt and specificallv reflect III its documents and policies a clefinition uf povcrtv and its relationship n~it11 health.

I 4. \/$'I 1 0 ~17~7211d p r u ~ ~ i d e technical support to counlrirs to locus on communit~, involvement, in tcrsectol-al collnl~oration and partnership in elforts to~vnrds achieving the -MDGs (M'HO X<epresentatives' offices and Regional Office).

l~nplementation of poverty reduction strateg~es in the Eastern Mediterranean Region

15. Countries shouicl build capacity a t thc local level for the planning and implementation of povcrtv rcduc tion strategies.

16. Countries should develop a strategy for scaling up community-based in i tia lives tl~rough a phased approach. The first phase shoulci incl udc communj ty mobilization, organization and capacity-building, progressing to health development, life-skills develupment, social dcvelopm en t and eco~~omic development in subsequent phases. The strategy should be sufficiently flexible to allow each phase to be expanded according to the capacity and resources.

17. WHO should support countries in documcnting succcss

stories in an evidence-based manner and should use t h ~ m for further development of sustainable models of commuliity- based ini tiativcs (Regional Office).

18. WFIO should expand support for scaling up of community- based initiatives in countries. In this respect, t11e role of WHO should be clearly defined and be supportive of advocacy, training, information dcvdopment, exchange of experiences, resource mobilization and partnerships (WHO Representatives' offices, Ticgior~al Office).

19. Countries should take urgent action to address thc growth of urban slums as a priority health and development issue on the urban agenda. They should also request concerned sectors to highlight physical and social shortcomings of services in urban slums.

20. Countries shor~ld develop special straiegies to focus on health and clr~ality of life in slum areas as part of healthy city programmes.

21. WHO should initiate a strong advocacy carnpaigt~ at national and regional Icvcls to improve healill and quality of lifc in urban poor areas and slums as part of healthy city programmes. In this respcct it is rccomrnencied to initiate a BDN pilot project in the urban slums of each country in the ICegion (WHO Representativesf offices, Regional Office).

Implementation of poverty rsd~~ctiorl strateg~cs 111 the Eastern hledrterranea~i Regloo

1 . Introduction

The inter.country mccting 011 the implementation of yovcrtv rcduction strategies in the East~rn Meditcrl+anean Rcgio17 ~ V R S

I~eld in Cairo, l?gyi~t from 14 to 16 Novembcr 21105 a! thc WI I 0 Iicgional Office fur the Eastern Mcdi tcrrancan. The n i r e t i ~ ~ g rvas attended by focal points for community-hnscd initiatives from 16 countries of th r Rcgiol~, as wcll a s rcprcscn tdtives from a number of ii7terri;l tional organizations and WHO staff from l~eadquartcrs, thc Rcgional Office and uoun!ry offices. The objcctivcs of the mccting were to:

develop an operational plan fur enhancing thc implcrncntation of poverty reduction strategies; sharc cour~trics' experiences demonstrating government ownership, co~nmunity involvement, intcrscctoral collabol.dtion and partnership in poverty rcduction anct sustainable deveIuyment prngramm~s in thc liegion; share visior~, strategies and activities rcIated to the Com~nission on Social Tlctcrminanls of Health and its linkages with Commun i ty-based Initiatives; reiterate hcnltli as a ~najor component of the carnmuriit~- based initiatives.

The mccting was opened by Dr Moharned Abdi Jama, Ileputy Rcgional Jlircctcw, WHO/EMICO, who dclivcrccl a message fro111 Dr I-Iusscin A. Gezairy, WHO Rcgional Director for the Eastern Mcditerrancan. In his message, Dr Gczairy rcferred to hcaltti 3s a fundamental human right and a major social i~~vestment goal. \$'I I 0 and its hfemhcr States understood t l ~ t the rcasons for, and ~nccha~~isms lcadjr~g to, persisting incclualities in health wTcrc mainly the r c s ~ ~ l t of povcrty, limitation of rcsourccs, illiteracy, uverpopuln tion, poor sanitation and Iack of awareness regarding hcnlth a n d basic needs. This holistic \.iew provided a bronc1 s p r c l r ~ ~ m to collcctivcly aclciress all relevant issucs, determinants and factors. - 1 ' 1 ~ stratcgy of the Rcgional Off ice advocated for

lmplernentation of poverty reduct~on strategies In the Eastern Med~terranean Reg~on

human health and well-being as the u l t i ~ ~ ~ a t - c god of dcvclopment, with heaIth services no Iongcr. considered mcrely a complcx of solcl~r medical measures.

Dr Geztiiry rcfcrrcd to a meeting held in 2003 in Fcz, h4orocc0, in which reprcsen tatives from t l~c Ministries of Health, Finat~cc, Plai~ning and Budget had agreed upon fivc strategic dircctioits for a pro-poor strategy fur sustainable health development and poverty reduction fnr the Eastern Mcditurranean Region. These wcre later approvcd by the 50th Session of the Regional Committee for the Eastern Mediterranean in 2003. He cmphasized that thc ohjcctive of thc regionaI strategy was to improve the popt~lation's health, particularly the health of the poor and vulncrable. The strategy articulated broad Iincs of action for public authorities and stlggested the need to redress the cxisting in-tbalanccs between policy and allocation of public rcsourccs.

He stressed that WHO supported h~alth-relatcd interventions that could improve the health status of thc community, particularly the vulnerable, by narrowing widening disparities and dccreasing health inequalities. Such intervet~tions nccdcd to be strcngthcned and integrated in all arens implerncnting cornmur~ity-based initiativcs. Health-related programmes should utilize opportunities crca ted by cominuni t y-based initia tivcs and enl~ancc their implementation rate by defining a clear role for community ~nembers in support of their programmes.

Experiences from different countries in thc Region showed that organized and mobilized communities wcrc able to take active part in promotion, prevention and rnLlnngemcnt of communicable and nonco~~~rnunicable disedses resulting in reduction of morbidity and r-r~ortality. He noted that to sustain the community-based initiatives programme, g ~ \ ~ c r n n ~ c n t ownership and corn munity involveinen t in its management wcre essential. 111 addition, advocating for pclrtncrship and ge~~crating resources for programme expansion was crucial for the sustainability of community-based prugrarnmcs. Because of tl-le holistic approach, donors, U N ag~~ncics, nongovernrncntal organizations 2nd other relevant ministries

Implementation of poverty reduction strategies in the Eastern Mediterranean Reg~on

cotlld easily participate as partners in thc dcvclopmcnt process and improve harmonization and cfficicncy.

LIr C<czairv notcd that thc Millennium Dc\~cloprncnt Coals (MDGs) were focusecl on the reduction of poverty and rnalnutritiux~, pron~otion of gtlndcr equality and empowerment of women, universal primary education, inzprovcmcnt of maternal and child hcalth, reduction of the diseases of poverty, increasing access of families to water and sanitation and cnhnncing partnership in dcvclopmcnt. The Basic Dcvclopmcnt Nccds (BDK) approach was one tool for achieving the MDCls. Acl~ievil~g t11e MDGs should be iricluded in BDN prograrnlncs at country lcvcl for the ncxt fivc biennia tlirough the World Health Organixation Government Joint Programme Review and Planning Missions.

Dr Lezairy concIuc3ed by reiterating that the purpose of the meeting was to identify steps to operationaIize the regional pro-poor strategy for sustainable health deveIopment and yovcrty reduction in regionaI countries; WF-I0 ~7ould con tinuc to provide technical support for expansion of the con~munity- based yrogmmmc and its linkagcs with other development activities.

Mr M~lstafd Eid, I'rogramme Specialist, Islamic Educational Scientific and Cul turaI Organization (ISESCO), drcw attention to the strong cullaboration between the Regional Office for thc Eastern Mediterranean and ISESCO which began in 1989 with the signing of thc first agrccmcnt between the two organizations. ISESCO was keen to strcngtl~en countries' dcvclopmcnt in thc fields of cducation, science and culturc, especially for tliosc mcmbcrs of society who suffered through handicap o r bccausc of gcndcr discl.iminatior~ in both rural and poor city arcns. Assistance could take place through funding projects, such a recent regional workshop concerning career clcvcloyment that had been aimed at dccrcasil~g poverty "nd had taken place between UNESCO, ISESCO and the Go\~crnment of Morocco in July. ISESCO artd thc WHO Regional Office for the Eastern Mcditerrancan shared the samc goals, and building governments' capabilities woc~ld not bc possihlc to imp1c1nt.n t without joining srctorally in the field

Implementat~on of poverty reduct~on strateg~es In the Eastern Mediterranean Rey~on

of uconor~~ic, social and poIrtica1 nrvareiwss. The best way W ~ S

thlqough starting locaily with oificinls n r ~ d 11ongc~vcrr11nc11tnl organizations, t l~ercby ~iecrrasing povcrty and n c h i ~ v l n g thc godl of hettsr life and health insurc~nce for thosc mpmbcrs of socictv whc> W C ~ C I J I O S ~ in need.

Dr Mohammad Assai, Regional Adviser, Community-bdsccl Initiatives, W HOIEMIIO, briofcd the participants on thc aims of the n~ceting and what xvould bc C ' X ~ L ' C ~ C ~ from them. The l'oIlowing o~ttcumes were expected from thc discussioi-ts of the niccting:

thc outline of an operational I tor cnhancirlg irnl~lcmcri tation of poverty redudion stratvgy; shared countries experiences un guvernmen t ownership anti in~t i tu tionrllization 0 f country-based initiatives, in tcrsect ora l collaboration and cummunlty mvolvement; identified roIc of the community in selected health- rclated programmes and inturventions; shared visiuns and work of t h r Cnmmissioi~ on Social Dctcrn~inants of Health and its li11k;lgtl~ wi t11 CnT; t 1 7 ~ Member States informed 1 1 possibi1itit.s for coil~lbora tioti with ISESCO and the United Ndtions Industrid1 Ilcvclopmcnt Organization (UNIDO) in CBI settings; rccornmendations a i ~ d conclusio~~s to enhance the programme.

Kcy yrcser~tations were intcncled to hclp in dcvcloying a plan of' action for operationalizdtic>~~ of strategic directions for pro- 1-7oor 11caIdi policics by working groups. A cominittcc would he furrncd to draft thc recon~rncnclations and conclusions

Dr Omer Sulein~an (Sudan) was elected Chairperson, Dr Esmat hlnnsour (Egypt) was elected Vice-Chairpcrsun and Dr Snlah El Badnlvi (C3m;ln) was the Rapporteur. T11c agcnda, programme and full list of pa r t~c iy~~nts can bc found in Annrxcq 1, 2 ,lnd 3, resycctivcIv. Amwx 4 contains docuinents used ior group work.

lmolernentat~on of ~overtv reduction strateales In the Eastern Med~terranean Realon

2. Technical presentations

Bui tding linkages between second generation poverty reduction strategies, Millennium Development Goals and community-based initiatives Dr. M o / z n n ~ d A bdi /i~ma, Dcplrty Rqionnl Director, WHO Rqionnl Offiice~>for fht7 Fnstt7rlr Medilt~rmnrnl7

The co~~~munity-based initiatives approach is an integrated bo t tom-up development concept, based on community involvement and ir~tcrsectoral collaboration, which addresses the basic needs of communities, such as health, education and employment, through focusing on the poor. The MDGs also focus on the poor in a more holistic approach which calls for a dramatic reduction in povcrty, cquity in a11 facets of life, education for all, marked improvements in the health of thc poor, improved acccss to safc watcr and sanitation and finally an increase In harmonized partnership.

Poverty lieduction Strategy Papers were developed by low- income cuuntries in collaboration with the World Bank and other international agencies in order for them to describe their stratcgics regarding macroeconomic, structural and social policies and programmes to promote broad-based growtl~ and reduce povcrty, as M I ~ I I as additional cxtcrnal financial resources l~ccdcd for povcrty rcduction programmcs. Unforturicl telv, the first generation Poverty Reduction Strategy Papcrs lackcd a clcar financing mechanism and very littIc attpntion was giver1 to t l i? area of in tersectoraI collaboration in health. Today, the international conununity has reuogni~e~i the pitfdlls of the first generation I'overty Keduction Strategy Papers and has addrcsscd thcm in the second gcncration I'overtv Reduction Strategy Papers, attuning thc Papcl.s to thp

lrnplementatlon of poverty reduct~on strategies In the tastern Medtlerranean Reglon

ohjrctix7cs of thc MDGs, oricntlng the111 towards results, dncl ensuring tlwy arc bascd on consensus and are heaIth-centred.

Cummunitv-based initicltivcs, MDLs ;lid s ~ c o n d gcnrra tion I'ovcrtv Reciuctic~n Strategy Papers a l l l iavc common thcmcs ~ 1 7 d O ~ ~ C C ~ ~ T ' C ' S that addrcss the pour in 21 I~c>listi(- I I I ~ I I ~ C ~ .

lIowcvcr, this Iias not eliminated t l ~ c challcngcs, sc~ch as the nrcd tor ministries of hcalth to take a leadership role in interscctoral collaborations in order to address the brudd determinants of hcalth; participation of civil socictv in all de\~t.lopmcnt processes; cfficici~t use of resources and partnersl~ip dcvclopmcnt; political commitment and instability; anti strengthening social security, including efficient and ccluitnble heal t l ~ systcms.

Community-bclsed initiatives cd17 b~ a to01 for achieving both thc hlInCs and to operdtionalize second generation IJox~erty IXcduction Strategies. In community-basccl initiatives, the ap~roac11 11as been to focus on the poor dnci to irnprovc L ~ n ~ l sustain the quality of social c111d health services, intersectoral collaborci tion, coinmunity ownership, y artnerships, community self-st~fficicncl;, c rn~x~u~crrncnt of wornon and youth and tinally programme transparency through community leadership. Thus, bv i ~ ~ t ~ g r a t i n g the targets of thc MDGs RIXI sccond generation I'overty lieduction Slrcltegies i17

community-bascd initiatives we can keep the y rornisc of reducrng poverty and achieving healtli related MDGs bv 201 -5.

2.2 Community-based strategy for poverty reduction nr O~rrrl- S t~lr~imnlr, WHO Tr'mpot'i~~~j A~li?i~i>r , WHO r\t7giolznl Officr7 . . f o ~ . f l r c Cas/r7r-11 Ivl~~1Iit~~~r.nlrt'r7r I

The current strategies for povcrtv reduction, both global and national, arc. rnclinly vcrticnl and a r c ccn trcd around globnlizntiun and national govcrnmen~s . Thcsc stra tcgrrs arc engineered mainly by Intcrnationnl Mon~ta1.y ru17d (ThW) and World Rank {WII) and promoted thl-ough Ilic mccdia c u n f i l o ~ i ~ ~ ~ ' ~ ~ t ~ . The)! rotntc around prlvdtizdtivn and s t r ~ ~ c t ~ ~ r ; l l c~iIjusttncnt, prioritizt dcbt repayment an J refIect

lrnplementnt~on of povedy reductiori slraley~es In the Eastern Med~terranean Regton

the protectionist politics of indust rializeci countries. If thcsc policies are not rcspectcil by d countrv that country is declarcd at fault an d i t s dcbt is not rcstruuturcd. Invcstn~cnt in dcvelopmcnt or succcss in yovertv reduction dnrs r~ot savc defauItcrs from pcnali7a tion o r y unisl~n~ent. AIthoug11 tlic welfare statc 11elpecl in the ad~~~nc t r rncn t uf industricllizcd nations it i s now L~cilig denircl to the n~orld's dcvcloping countr-ics wliicli I ~ L I S ~ adopt the CVB policy that ccl~lsists of monct ary au tlwrity, fiscal authority, privatization anti finar-tcial Iibcraliza t ion. Such policies and stratcgics d o not assist tlic jmor. Today, across the world, 1.3 billin17 pcoplc live on lrss than L!S$ 1 per day, 1.3 billion hnvc no ncccss to clean u7atcr and 3 billion have no access to sanitaticn~~. One billion childr.en, aImost half of thc 2.2 billion children whu live in pnvertv lack shelter, safe ~ r a t c r and health. Almost 11 million childhood dcntl-ls per ypnr arc due to yovertv. Thc global priorities in thc wnrld n c ~ d US$ 40 billion whilc the world actuallv spends USS 780 billion on military action, US$ 10,5 billion 011 nlcol~olic drinks, and US$ 105 billion, in Europc alonc, on cigarcttcs.

Thc proposed community-bascd s trn tcgies can be implemcntecl as part o f CBI and primary health a r e . In tlic EDN area, besides fulfiln~cnt of fcIt needs and concerns, wants and clmbitioiis should also be addressed. Each BDN arcn shouId bc 21.rangc.d a p a c k ~ g e t11at should be the respoi~sibility of t l ~ c relevant sector. The health sector, bcing the initiator and pro~notcr of tllc programme, shuuld ensure 100141 covcrdge of t h ~ ' targctcd villrlgcs by health pnckage. Prim t ~ , p ~ ~ b l i c and cultural institutions should be reviewed and s t rcngthe~~ed. Thc programInc s11oulc-i be ared or district bascd rclthrr than targeting single isolateci villagcs. Spccinlizccl villagcs, for cxampIc those clepcncient on silk, milk products, etc. should bc developed in accordance with local skills and availability of ncltional resources. BDhT should targct the dc.vcloprnc.11t and quality uf pcople a17d tllcir attributes d i ~ ~ i S I ' L D L I ~ ~ be cxl-andrtl to inclcrde other nccds. Land orvnership, rrlnrkcting and scouting for intellcct and iru~ovations at l(>ral ICVCI dre also important al'rr?~ fo address.

lmplementatron of poverly reduct~on strategies in the Eastern Med~terranean Region

In the area of prin~ary hcalth care the dir-ertion should bc building care in a broad sense rdther than hcallh carp or~lv. Primary health care should be a t thrcc levels: sclf carr, cor~-lrn~~nity or collectivu car-c and institutions. Llomcst~c nursing, healthy lifestyle and emergency preparedness clncl response should be adcled to thc H compnncnts of primary health care. J'r~mary hcalth care units should bc supervised by a report to an intcrsectoral complex that addresses ~ 1 1 baslu development needs and brings all development sectors, nongovernmental organizatiorts and donors ulider one n~anagement entity that provides support to care in the broad scnse as well as to development. This complcx can bc called thc Health Development Complcx (HDC).

National anci globaI support is needed to build an alliancc in support of community-based poverty reduction and i11

lobbying to climinatc war and ensurc that war does nut tc3rgct innocent populations by aiming a t infrastructure, such as water supplies and leaving the people deprived, made hungrv, thirsty, irnyovcrished and open to disease.

2.3 Global lessons in health: implementation of poverty reduction strategies Dr Eugrnio Villnr, Coordinnfor, Pro-poor Hcnlth Polrci~s, WHO hmdqrinrters

Although poverty reduction strategies arc not being implemented in all the countries attending the mccting, their debate can enrich the discussivn of linking MDCs and community -based ini tia tivcs in the work of povcrty reduction in the Eastern Mediterranean Region.

Poverty reduction strategies (PRS) contained in the first generation Poverty Reduction Stratcgv . - Papers showed ldck 01

pro-poor focus, csyt.cially on fii~ancial barricrs affecting the poor and very limited participation of ministries of health d i ~ d communities; most were written by foreign consultants as a requirement for debt relicf approval.

lrnolernentation of oovertv reduction strateales In the Eastern Madlterranean Realon

IJliS in second gcrieration Povcrtv Reductiori Strategv Papers have shown:

greater linkages with hlDGs, bringit~g an outcorne- oriented focus, enjoying high political consensus and a lung-term framework that is rlsefid tu phase development efforts; the I ' I C C ~ for bcttcr costed strategies and adequate budgeting within a medium-term macroeconomic cxpenditurc framework, greater government and dn i~nr coordination, harr-r~onization and alignment aitd SWAps cxycriences; the ~nost criticai area where the Regional Office's CBI can bc u s c f ~ ~ l is probably the discussinn of liow their strong cornmunitv fvcus can properly fccd national health (or development) poIicics to ilnprovc thc health outcomes of the poor and, by so doing, contribute to povcrty reduction, fulfilment of basic human rights and economic growth.

As suocessful a s they arc, unlcss community exyericnccs h a w an impact in influcncing national policies CB1 ~ n d BDN ~ n a v miss a n opportunity tor scaling up at a natior~dl level and contribute to the lack of butt0111 up approach that is still n-lissing in I'RS.

The Regional Office with its rclevant experience in primary health care and commuriity development can play an important role in enriching poverty reduction discussions worldwide.

FragiIc states, so present in the Eastern Mediterranean liegion, nccd a diffcrct~t approach which focuses 011 political and institutional long-term approaches that n ~ o v e beyond relief. Health can, on the other hand, bc a key area for pn~moting peace ai-td national reconciliation due lo its high cunsensual and human character.

MUGS, especially Goal 8, bring a global approach to development, placii~g l1c~11th and poverty reduction a t the centre of devclopnient. We sl~oulci use tlwm as frar-r~cwurk

Implementation of poverty reduction strategies In the Eastern Med~terranean Reg~on

for placing community and national health efforts in upstrcam national and global political discussions.

2.4 The Social Determinants of Health and community-based Initiatives DY S n n ~ r r ? ~ Siddiqi, Kc:qinnal Adviscr, Iienlfll n ~ d Policy Di~veloyn~cnf, WHO R ~ ~ ~ i o n n l Officefor fht* Ensferr1 M~ditrrrnrr~nn

The Commission on the Social Determinants of Hcalth was launchcd in ChiIe in March 2005, in recognition of the 11ccd to establish health equity as a shared global goal, and on the understanding that acting 011 that goal denlands action on the underIyil~g causes of ill health, namely its social determinants. Of these, poverty is the most important.

The community-bascd initiatives programme and the wur k of the Commission sharc common elements: a broad definition of health; health as an essentiaI componci~t of social development; the value of collaboration and partnerships; ancl the nced for advocacy. Thcse inform our common concelqns for poverty and inequity, and the nccd fur action to solvc thcsc problems. FIowever, CBI and the Commission approach these shared concerns from different angles. CBI focuses on action, informed by policy, whereas the work of the Commission is more concerned with analysis, and the way this informs policy.

The Commission on Social Dctcrminants of Hcalth specifically contributes to the coIIcction and analysis of information for action, through knnwledgc networks. Tl~ese fucuscs For the organization of social deterrninan ts of health are: ear.1~ cl~ild development, priority pubIic health conditions, health systems, mensuremen t, emyloyn~en t conditions, globalization, urban settings, social exclusion, and gendcr and won~en's crr~powcrment. In the Eastern Mediterral~can Region these themcs are provisinnally identified to complcmcnt those at the globai level. These include: gender empowerment, child labour, social exclusion of migrant labour in c o c ~ n t r i ~ s nf the

Irnplemenlat~on of poverty reduct~on strategies in the Eastern Mediterranean Regloti

Gulf Cooperative Council, and feniale genital mutilation as lnar~ifested in gender dynamics.

CBI and thc Commission on Social Determinants of Health can work togcthcr to achieve common goals. In the Region urc face common problen~s; these include the great rangc between and w i d ~ l n countries in health and well-being; diffic~~ l ties in identifying anci accessing the most disadvantaged countries in cornpIcx emergencies and thc need for effective ways to monitor and evaluate programmes. The interests of the Region are complumcntary, and it is necessary to share information. Better indicators of process, outcorncs and lung-term impacts, and mcasure~nent tools to capture aggregate as well as distributional difference between the average and the disadvantaged are needed. The Commission nccds success starics horn CBI that document actions that work. CBI needs insights from thc Commission's knowledge networks to hcIp implement its programmcs.

Thus, a major link between thc two approaches is that the work of thc Commission providcs evidence that can be applied in CBT interventions. Together, CBI and the Commission on Social Determinants of IIcalth have the potcntiaI to alleviate poverty and social inequity, and to i~nprove the hcaIth of the disadvantaged. 111 order to achieve these objectives, action by Member Statcs is required to incorporate knowledge about social dc tcrminan ts 0 6 health dnd the CBI approach into nationaI poIicies that will result in better health outcomcs.

2.5 Health as the priority intervention in community-based initiative settings Dr A bdrllEnlr Assap'di, Assis fnn t Rl~gio?lnl Dil-cctor, WI 10 Regional OJicr for file Ensfr3rtl Modiferl-nutrcrn

WHO Rrgional Office for the Eastern Mediterranean started the cornmul~ity-based initiatives programmes aiming at a bcttcr quality of life and covering all the thrce dirncl~sio~~s of IieaIth: physicdI, social and spiritual. Health is the curnulativc

lmplerr~erllat~on of poverty reduct~on strategies In the Eastern Mediterranean Region

outcome uf Inany aspects of Iifc and thcrctc>re demai-tds close work with the related scclurs on tach of its predisposing factors. In partic~llar, since pcnvuriy i s t h e rilajol- causc of ill Ileal th i t is thc factor that recluircs special attention. Continuous monitoring of hcalth situations in all cultures and agc g r ~ u p ~ ~ i i d addressing emerging problems is recluircd since health risks take place throughout the human Iifcsyan. In the Eastern Meditcrrar~ean Region, wealthy countries face the highest burden of noncommunicable diseases which are increasing, and poor cnur~tries sutfcr most froin communicable discascs, whereas middle-income cou~~t r ics suffer from a combiriation of both situations.

The 1.cgiona1 stratcgic directions approved by thc Rcgional Comlnittcc in 2003 suggest pro-poor hcalth policies to:

combat the discascs of the poor; reduce the h n a ~ ~ c r a l burden of hcalth care on the poor; improve the impact/efficicncy of public health services; reallocate pctblic resources in favour of poorer countries and poorer gruups; incrcase the supply and effectiveness of non-personal pclblic hcrllth services.

In the light of these dircctior~s, the following 5 core strategies have been recommended for strengthening health devc.loyment in community-based initiative settings:

intrasectoral coordination among Ilea1 t17 programmcs; intc~.sc.ctornl collaborations betwrcn rclatcd sectors at 311

lcvel; partnerships with private sectors, nongovernmc~~tal organizc~ tions and agencies; comrnu~~i ty cmpowcrmont in pr~\~t .nt iun, folluw-up d11d health leadership; access tu a comprchcnsivc 11cal th package.

lrnplementat~on of poverty reduction strateg~es in the Eastern Med~terranean Reg~on

2.6 Promoting healthy practices through community-based initiatives U r Snycd Jnffirr J l~ / s sn l r~ , Mr7dicnl Officer, Hcnlfhy L$styl~ Pronzof io~~, WIIO R~);;iuimi ~ f f i i i c ~ -. for thr E n s f i w Mrditcr.mn~~ni~

The Millennium DeveIopmcnt Goals sct out an agenda for the atio ions of the world through which human development is a way to reduce povcrty. This has led to an overwhelming clcbate revolving around tl-te improvement in heal t11 indicators as proxy indicators for achieving the MDGs. With most of the gods relatcd to health directly and/or indirectly, WHO is in the furcfron t articulating with Member States vis-h-vis putting heaIth ccntral in all developmental agenda.

The CBI approach is an endeavour by thc Regional Office to han~ess efforts of different sectors providing a platform to the conirnunity to plan and implement interventions in a manner whereby they feel more cmpowered, create more ownership and thus bring morc benefits to the population by improving their health status and quality of life through attacking thc social, economic and cnvironmenta1 determinants of health. Thc underlying goals of the community-bascd initiatives approach are in line with the MDGs. Over a period of years, howcvcr, it has been seen that the focus of must of the community-based initiatives in thc Region has been on other issues (e.g. income generation) rather than on health. Whcre l~calth status of the population may have irnpIicitly or explicitly improved as a result of these interventions, a renewed focus nccds to bc placed on the health aspect making heaIth lead dcvclopment not the other way round.

Some of the existing best practices provide an opportunity for CBI to integrate with and also expand to replicate some of the best practices currently practised in CBI project areas. Unless hcalth leads all other aspects of development, community- bascd initiatives may not contribute the enormous benefits envisaged.

Implementatlon of poverty reduction strategies in the Eastern Mediterranean Region

2.7 Income generation and environmental pollution challenges ,141- L ~ 1 ~ l . f Kok, I I I L ~ ~ / . $ ~ I rnl nt~:c ) Ioy~ncu f Offiur~~,, , . IIr~rfrrl iVnftolls J t~d ir~ t r in l D(>i~r?l0p17~tlt O,;~nrr~:a tinn

The mnnda tc of the Unj ted A-n tio~is Industrial D P V C ~ T ) ~ ~ > I C I I ~ Org,c?rli~,z~ tion (UKIDO), to dcvelop industry, calls for n balance u i a ttcntion bctiveen ec'or~omy, c~ivironment and cmplovrneni S C ~ that i ~ ~ d u s t r v can play its role in achieving sustainability of societies. It is thercfortl ncccssarv to introd~lce r~spw7siiv~ness, fIcxibility and creativity in socictics, since in a globalized and compcti tivc setting individual sorictirs havc to respond to previously unknown challenges. It is clear that a cnp~city to idcntify and capitalize on previously untapped syncrgics, making the lullcst use of local knowIcdgc and strengths is important.

WHO and UKlDO havc a nu~nbcr of shared interests, among them income grncration and public IiraIth and cnvirunrnental pollution. Expcr in~cc with micro-credit i l l some places wl~crc public hetilth c<irc qystems are itnplcmentcd has shown that annual credit recovery ratcs hdve C U I ^ I S C ~ U ~ ~ ~ ~ ~ V increased, soinetimcs froin 6U'L to 95'%, ul-iderl~nin;: thr. dircct rcnnornic il-npct of heLll th srr\~icus. Tncome genera tion programmes could bcncfit from methods to assure that thc additional income gcr~crated is adequately investcd m hedlth systcins and/or heal tli ii~surance. U NIDO has devclopeci specific approaches to income genercltir7n, among others throi~gli ~dcntifving functioning value chains that link rural producers wit11 formal sector c l i e ~ ~ t inclustries as critical conditions for SU CCCSS.

UNIDO has set up a 11ctrrork of national cle,lnrr production ccr~trec as a channel for i n~p l cmc~~ t ing cleaner proct~dt~rcs and technulogics i l l enterprises and advising on national envirc7n111cr1tal yolicius. AII approdch ~ncompashirlg life-cvcic a11aIysis is gcncrally followed Icniiing, in additlon to ci~\~itor~rnental in~p~.ovcrncnts, to srgrufrc-=~nt finar7cial savings. Some of these wnircs have alrcadv lahcn up thc initiative to clral ivith p o l l ~ ~ t ~ o n caused by the hecllth scctor (Czech I<eyublic, Mcxico, Sri Lankd and Ugancla). ?hose initiatives havc ubtaincd or havc projcctcd in~portant r e s ~ ~ l t s in

lmolerr>er~tat~un of oovertv reduction strateales In the Eastern Med~terrancan Hca~on

en~i ronrnent~~l dnd financial savings. A lnrgc pol-tion of the hcalth sector budgct gocs ultlnia tcIv to enicrprises tllc1t supply g ~ u d s and scrvii-rs or tcchl~ology that affects cificicncc. in using basic inputs such CIS water and energy. Furthur, entcrpr~scs and speciali~eci technologies are re1c.vnnt to thc trclnsport, clisposa1 c~nd/or recycling o f imcdical was tc.

In conclusion, sornc considc~xtion will be givcn (311 110w ture cooperation alid joint programming couId further take place.

2.8 Integration of TB DOTS in all BDN areas of the Region through proactive community participation Dr Akihil-o Staift-r, Rrgionrrl Advisr>r, S f q ~ TB, WHO Rccgiflnnl O f ~ r r for flit.

Ens tc.vn Mrh tcrmrrt~nrr

I'ovcrt\: encourages severe Ileal th consequences, trapping the poor in a vicious cycle of sickness and hardship. High costs of hcdlth services impoverish people and creatc yovcl.ty traps that they are unable to escape. Povcrty also ncccntuatcs gender gaps. Puor women, caught in ;I web of ycrfc3rrning their multiplc roles 2s cliildbenrcrs, homemakers and wage earners, pay a high price f n ~ . health. Yet when irnpoverishcd famiIics irnprnvc their health and subse yuently productivity, they tci~d not to fa11 back intu poverty.

Evidence shnrvs that diseases have a negative cconomic impact and act as a major constraint to development. Dismse kt't 'pscl~ildren awciv from school and prevents adults from wrning a living. A family stricken bv malaria can s p c ~ ~ d over unc quarter of its income 017 t r e a t l n ~ ~ ~ t a l ~ d a person with tuberculosis loses, on average, 20141 to 3U'L uf the dnnual housul~old income because of r IInc~s.

Corn]-tlunity involvcmcnt is vital for raising the awareness of p c n p l ~ about tuberculosis ; I I I L ~ its subsequent trea tn~ent. It is also import;l t ~ t to relieve the stigma associatrd it.llh tuL~crcuIosis in thc community. Thc stigma nssnciatccl wi th tu bprcuIosis plays considerable rolc in thc h r a l th-seeking bchaviuur of tuberculosis pa tici-t ts. OI~- t . the integration of

lm~lementat~on of poverty reduction straten~es in the Eastern Mediterranean Region

dircctlv observed treatment, short cuursc (DOTS) care rs achieved in the organized and mobilized BDN area it cnnblcs wider access for tuberculosis patients and assists the Stop TR campaign in finding more patierits and providing treatment to them. 117 addition, health education through DDN community leaders w i l I improve peopk's knowledge tour~rd prevention and cure of tuberculosis. BDN can also give prrority tu tuberculosis patients arid thcir families and provide them with a wider package of care including f~ealth education, skills' dcvclopmcnt, income generation, nutrition etc.

Within BDN the cluster representatives selected by community members are entrusted by them and live in close proximity with them. ?'hey have major roles in promoting tubercuIosis DOTS by performing the following tasks:

Iiaise between the health facility and comil~unity cluster in respect to tuberculosis DOTS; raise awareness of families towards the discasc and its treatment through organization of regular ht. a1 th education sessions heId by rotations at the co~l~muni ty cluster households; identify suspected tuberculosis cases (cough for more than three weeks) and refer them to the nearest health facility; encourage and motivate confirmed cascs tn continue with the disease therapy and supervise their trca tment; ensure that all paticnts have adequate drugs available with their treatment supervisor and they are tdking them regularly; give poor and tuberculosis affected families high priority and support for skillsf training, yrovisioi~ of health- relatcd services, access to safc drinking-water and sanitation, ctc; make sure poor families with a tuberculosis affccted member are given priority to an income-generating project; make sure that a11 children of the family affectcd by tuberculosis are fully immunized, especially baciIIe Calmctte-Guerin (BCG);

lniplementation of poverty reduction strategies In the Easter11 Medlterrarlvar~ Hoglon

ensure that all schonl-agcd cl~ildrcr~ of tlw t~tberc.ulosis- affcctcd faniilv are act ~rnlly enrulIod ; ~ t their respecti\:e schools; coordinate between the viIlage dcveIopment cornlnittee and the national BDN programme for tl-arning of thc health worker at the BDN area in tuberculosis DOTS, equipping thc faciIitv/laboratc~r~ arid cnsuring thc 3vaiI;lbilitv of adequatc drugs.

2.9 Strengthening routine immunization at community level Llr. Snrd Snlnlr Yolr Ri~gioiurl Adz~iwr., I/nccirle Prrvcrr fn blc Disens~s lr mi Inrnrliniznt~o~z, WHO Rqr;lionol Officr' ,. . for t f 7 t ~ Enstr~rn Mrditrrm~~r~frrl

A routine immunization programme wiII never be strong without t11c fuII participa tiori of the community. Ll~erc. arc two conipol-ren ts for successf irl roc1 tine immuni~a tion: supply and demand.

The community must be provided with the scrviccs they nccd such as fixed health centres, outreach scrviccs, and mobile serl~ices. Demand must also bc created by cornmunitv awarcncss and social mobilization. Irrimur~ization coverage at co in r~~ur~ i ty lcvcl c ~ l n bc i~nproved through the "rcach every d~strict" (IIED) approach, which has five components:

planning and management of resources; re-establishment and outreach service; supportive sup~rvision; cumrnunity links with service delivcrv; monitoring and usc of data for action.

Involvcmcnt of the con~munity and distl.ict IeveIs is essential in tlie re-establisl~mcnt a13 J con tact with commcui~ity leclders and stakcI~(>lders, and obtaining understanding and cammi tmc~~t of the cu~nmunitv. 111 social rnobiIizativl~ a focal point for the cornmunits 11as to be identificd through the vil Iage develoymcnt committee, women's union, tlqibal leader =md religious leaders etc.

Implementation of poverty reduction strategies in the Eastern Mediterranean Reghon

The community should always bc given feecibask, s i ~ c h as whcthcr the incidence of diseasc is decreasing because of' immunii.ation services, the number of nc~rborns protected from neonatal tetanus, the number of c11ildrt.n fully immunized against diseases, immunization covcl.agc in percentage terms, how close the health facility is to rcading its immunization goals and any outbreaks of diseases riearbv against w h i d ~ they rieed to bc vigilant (as well as cncoriraging the population to get vaccinated).

Because of BDN activities, the in-ununization coverage is higher in BDN viIlages than in non RDN villages.

2.1 0 The role of mothers in breaking the cycle of poverty Ms Jonnnn Vocpel, Tcdrnicnl Offiic~u, Womt.n irz I - le~l fh n r ~ r i Dez~c~loy~rrr~ f , W O Rrcgionnl Officcfor the Easir7rn Mrditrr~fi~rcrrrl

Two variabIes arc crucial for the development of a productive community and to brcak the vicious cycIe o i poverty: education and health. Women, in their roles as r-r~others, arc placed in a unique position to either facilitate ur impede these variables in thcir families and thcrcfore the largcr community. Mothers not only manage the health of the farnily but arc also the driving force in child development. Thc capacity of mothers is dctcrmined by many factors including thc interaction that t17c mother has within socicty, the rcsourccs that are available for her use and the social roles that are expected of her. These factors form the background for her parenting abilities and influence the health of her family and thc outcomes of her d~ildren's dcvelopmcnt. When wuincn clo not have access to education or have coi~stricted mobility within society, thcir capacity as ~nothcrs d~mir~ishcs. Poor yupi~lations find then~selves i~nahle to x~avigatc into better socioeuonomic conditions due in part to unchangii~g grndcr inequities.

TIIF preventative side of health is a role carried to a large extent by mothers in society. Mothcrs maintain and promote the health of the family. For instance, it is the woman who is in

lmplementat~on of poverty reduction strategies In the Eastern Med~terranean Reg~on

control of thc selection and preparation of food for hcl- family. Shc is thc onc who ensures that her children develop hcalthy ~~ulri t innal habits. 'l'he woman aIsu takes the lending role in chiId irnm~~nization and it is the mother who trains her family in matters of personal hygiene and solid wastc. disposal. I,Vomen are often the first to provide first aid in accidents involving children and it is usually the woman who dccidcs whctl~cr shc or anynnc in hcr falllily nccds 11elp from l~ealth scrviccs. T l ~ c woman also undertakes thc managcmcnt of trcatmcnt i t 1 many cascs of silnplc illness and gives those who are ill in her family their medication.

In order to break the cycle of poverty, it is important for the youth of poor communities to have greater capacity than their parents, to secure jobs outside the informal sector, and to bring home a regular income that can supply above and bcyond basic minilnum needs. Parenting plays a critical role in determining the future capacity of children. Womcn, as mothers, influence the children's educational success and subsequent employment options. When ihe mother is uneducated and hcalth illiterate shc passes these vulnerabilities down to her children. Keeping in mind the role of mothers in preventative health and child development it is critical that women are educated and allowed access to resources and dedsion-making in order to successfully carry out thcsc rolcs.

The unit of Womcn in Health and l3eveloy1nent in the Regional Office works to facilitate greater participation of uromcn in thcir communities and works closeltr with the community-based initiatives programme. The community- based initiatives programme focuses on efforts to mobilize and crnpower cc7rnmunity members to establish their health priorities and to seek sustainable solutions to thcir health challenges. Wolnen are encouraged to bt. part o f thc assessment process and to help identlfy the constraints and challenges they face. Practical dcvcIopment interventions, S U C ~ I AS mcdical and 11 tcracy trr~ning a n d micro-financing ;Ire

also pr4ornoted. Mlcro-credlt programmes targct~cl to women arc cffcctivc interventions bccausc they foster independcncc anci sustainability. Skills training for women should includc

lmplernentat~on of poverty reducl~on strateg~es In the Eastern Med~terranean Reg~on

facts (711 n~ltr i t ioi~ and health, chilci d r v r l o p ~ ~ ~ c n t and L7rinciplc.s nf developing and maintaining n husincss, in addition to li tpracy classes.

Rcnlizing thc crucial rnlc of parcr~ting and specit'icdlly the role of mothers rn max~nlizinp, health and productivity oi families is an integral step in ensuring both hcalthv outconws and p o s ~ tivc cconomic growth for poor communities in the Eclstcrn Medl terrai~can Region.

2.1 1 Health and quality of life challenges in slum areas Mu Kniiin~nr-s Khosh Cllnslnii, Plarrrrltrg, ,Mo~i fn r i~ rg nlrd Ez~nliirrtlorr, WHO Rtyio~ril Of~c~.fur flre Enstrrrr Mrd~trrrcrnmr~

The s l ~ ~ m s prcsent one of the most formidable cl7aIlcngcs to human society today. The condition of urban slums is as urgent as clin~ate change. As the CN General Secretary Kofi Aiman has said, "Slums reprcscntcd the worst of urhan p o ~ ~ c r t ~ and inequality . Yet d ~ e world had the resources, know-how and pouer tu reach t11c target ~stablishrd i l l the Millenniti~n Declaration." At least one billion prnplc livc In sIums, with f l i ~ 11ighcst percentage uf them foc~ncl in Asia, Africa ant3 Latin America. Slurns present a serious thre;lt to human rights, social cohesion, hea I th, environment and social ivell-bcing of alIf wl-tetl~cr rrch or poor.

In an cco~~oinic sense, slums are synonymous with povertv, ~~ncinployment, menial jobs, casual cmployrll rn t, slavcrv and toll that devclopil~ent liter'lture politely rcfcrs to a s thc "inform,ll sector.". In social tcrms, gender (low status O F women), cthnicity and uducat io~~ (Iow health literacy) arc the domin~n t structural dcter+mi~~ants of health in slums.

The hcalth oi s l c~~n dwellers is adversely affccted bv puor Iivi~ig conditions; ~ n a d e q u ~ ~ t c housing, unsnfc water, poor ~ ~ 1 1 1 ta tlon, ove rc ru~ .d ing anti high dmsity, hazardous I O C ~ ~ I O I - I S , exposure to pollution c ~ l ~ d cxtrclncs of tcmpcrnturr. SociaIlv, res~dunts of slums carry stignm and are excludrd al-td labcllcd. Thev are exposed to socia1 vice, crime, vic)Iencc,

lrnplementat~on of poverty reduct~on strategies In the Easter11 Mediterranean Region

drugs and addiction. They lack access to quality hcalth services, and reasonable and safe transportation. Among slum dwcIlers, women, infants and diildren arc 3t the highest risk.

The growth of slums threatens global hcalth. Since population densitv is higher dnd contact within slums is more probable conditions do not induce health, so the slums provide hazardous conditions for thc spread of pandemics, such as HIVIAIDS, SARS, etc. Similarly, from a soda1 angle, slums are a threat through having a reservoir of poor, vulnerable to political. exploitation, extremism and social disruption.

The reason for the existence and growth of slums is a complex colIcction of demographic, economic, social, governance, development policy, cultural and historical causes. Rapid poptllation growth, poverty and urbanization rank as dominant causes for growth of slums. In 1950 onlv 86 cities had pupulations of over one million, now there are 386, in 2015 there will be approximately 550. The present urban population (3 billion) is larger than the total population of the world'in 1960. Rural yopuIation is expected to pcak to 3.3 billion in 2020 and then to decline. Cities wilI see almost all world population growth peaking at about 9 billion in 2050. The population of cities around the world is growing at the rate of about 180 000 a day. More than 90'% of the world's urban population growth by 2030 will be in Iess developed regions. Findings by the UN also revealed that sub-Saharan Africa had the highest rate of slum-dwellers with 72% of the urban population living il-I slums, followed by south central Asia with 59%) eastcn~ Asia with 36%, western Asia with 33%, and Latin America and the Caribbean with 32%.

Communi ty-based i ~ i i tia tives offer an effective approach to help pcoplc in slum areas to raise their health and quality of life standards. Community-based initiatives are flexible and location oriented, hencc they are compatible to work within the informal sector. Community-based initiatives have all the strategic attributes and ~ n e thodoIogiua1 responsiveness to help in cumrnunity organization, applied awareness raising and local level capacity building. Also, the institutional aspects and

Implementation ot poverty reductton strateg~es In the Eastern Mediterranean Reglon

input of formal sectors cocllcl be Inore finc-tuned and focuscd through commt~n i ty -basd initiatives.

I'ropose'd strategy for. countries is to publicize thc health artd socia1 consequerlce of sll~ins, docurncnt and develop baseline data, pwrticularlv fur ht.;llth ii-t slum ,Ireas uf countries of the 13egiun. Hcalth~? cities prugratnIncs should lead the advocacy, b y calling for a national meeting, followed bv mitiating a RDN approdch in slums. It is necessary to undertake, cncouragc research and studies and work closelv with housrng nncI urban development sectors

The proposed s t ra t~gy for WHO is to support countries in proinotion, indudc as part of the agenda of tltc Regional Cer+tificntion Cumm ission and Regional C:ommi t tcc, include in l~ealth system clevelopmcnt, urban primary hcaIth cnrc and promotr compatibility bettvecn the health system in slums and cumtnunity-based in i tia tivcs. hrHO may sponsor documentation, provide technical support and strengthen community-basrd initiatives to forcefully promote health in slums.

Irnplemer~tat~on of poverty reduct~ot~ strateg~es In t h e Eastern Mediterranean Heg~on

3. Country experiences

Afghanistan and its development process L3r AIdi ATzrrrt~rl Mo~rnri~r, Mrdicnl Offii-(.I-, WHO Alyhnri lstnn

Afghanistan is in transition and is shifting hum long-standing crisis to lasting pcace. Like any othcr country, povcrt~r in Afghanistan i s 3. complex and mu l tidir-r~ensional pl~cnumcnon. A high percentage. of the population Iivus in a state of deprivation of food, shcltcr, access to hcalth care and safe watcr. Povcrty in Afgl~anistan is linked with chaIIcngas in arcas such as peace and sccurity, souid n ~ e d and injustice, dcr-norracy and good governance, ~ L I I I I ~ I ~ T rights and the environincnt.

Afghanistan's war-ravagecl nation is struggling to stand 011 its feet and iree itscif from the blight of abjfrt poverty. Efforts towards achieving MDCs and the povcrty reduction strategies are connected to each otl~cr.

A short documentary film showed a review of thr hcalth sccior, the time frame of the dcvcIoyment process, thc poverty profile and the BDN prograrnn~c in Afghanistan. ?'he lattcr ~ V C highligl~ts of the snlicnt fcatures uf the overall developmcr~t in this war-ton7 country. It nlsu s11arec-l so111c of the main succcss arcas with respect to outcomes of the progra rnme in thc targeted populn tions. WHO Afghani stan 11opcs thdt Afghrl~~ist;ln will s1lC~rc and cnntribu tc to the rcgional efforts i l l CBl whir11 is a fundamental tool for poverty ~+ccluction and indecd in hclpil~g coinmunities attain hcalthicr l iv~s.

Implementation of poverty reduct~on strategies in the Eastern Med~terranean Reg~on

3.2 The Healthy Village programme in Jordan Dr Brrdir A/-Molln, Assistn~zt to tlre Dirccfor qf fhr Hrnlthy Villnxcs Pvoyl-nn~nre Mirr isfry . of . Hrwlfh, J u r d ~ n

The programme startcd in Jordan in 1996 in two villages and has now expanded to involve 30 villagcs w i t h a population coverage of 36 000. In March 2005 it was institutio~-lalizcd as =I

separate dircctoratc linked to the general sccrctary of ~~~~~~~y health care which supports the directorate with a well- established office, seven full time technical staff finnncc for programme implementation.

The general objectives of thc healthy village programme is to support the states efforts for developing rurCll areas to provide health for everyone, depending on the principle of sclf dependence of the community in the development proccss.

The programme clcmen ts include:

basic development requirements; community-based schools; a village data centre; models for a healthy life; child frici~dl y houscs; child friendly communities; women cmpowerment programmes; protectilig the environment; meeting basic needs of the community.

So far the programme has accomplished a grca t deal incluciing the formation of local councils; participation in many national and religious celcbratiot-IS; establishment of informatior1 centres; preparation of a training manual; training and capacity buiIding for the cor-r~munity and health staff; collaboration with Agricultural credi t Coopcra tion (ACC) (small income generating loans); ACC cooperati011 with UNICEF and UNDP. The future outlook of 1-hc programme is to extend to reach all villages in Jordan on a national level.

Irrll~lemsntat~on poverty reduct~on strateg~cs In the Eastern Med~terranean Reg~on

3.3 Poverty reduction in Jordan lrr,yirlr>rr Tniufirr I labnhnr~h, 131rrcfor-Grlnrrnl, A~rict~l tr l l 'nl U r ~ d i t Cooyemf io l~ , J ~ l l ' ~ i f l l 1

The Agricul turn1 Crcdi t Cooperation (ACC) was established in 1960 in ordcr tu sr~pport and d ~ v c l o p agriculture and increase productiun whilc improving i t both quantitatively and qualitatively by providing the required capital to fund agricultural projects. The ACC has opcratcd and developed spccializcd credit programmes targeting ccrtain groups of peoplc; the healthv village project is one of tl~ose programmes.

ACC concluded an agreement on 11 April 2002 with the Ministry of Health and WHO in relation to the healthy village project which aims a t enhancing princip1t.s uf primary health care for villagers and imyrovirig their social conditions. The project is expected to cover 30 villages in Jordan.

The objectiws of the healthy village projcct arc to improve the qualitv of life of citizens and hclp solve t h ~ problems of poverty and u~~crnyloyment by means uf funding small income gen~rat ing projects. The groups targeted are the local communitv mcinbcrs of villages covered by the project. There are 131 beneficiaries of this project and 91 157 Jordanian dinars have been spent. The percentage of borrowers is 70% women and 30% men \v.\.ith the average loan per borrower being approximately 700 Jordanian dinars. Ovcr 8414 of the projects are continuing and there has bccn 92% loan collection. Further details on the healthy village projccts in Jordan can be found in "Evaluation of the project".

3.4 Experience of Morocco in community-based initiatives Dr Kntrn-Enundrr Drrr-krrairi, Nr7tio) lo1 Coordtnntor of Conztlz i r u i t y - b n s r ~ i I n i / r a f z ~ ~ ~ s , M I F I ~ S ~ T I / of F-Tc7nlth, Mol.ocuo

111 Morocco the social policy and prever~tion of poverty revolvcs ,~rt>und the political yroccss of consolidation of the rnuciern state and ~.cforms and structuring projccts for thc generation of income and human dcvclop~ncnt. More thari

Implementation of poverty reductlor, strategies in the Eastern Med~terranean Reglon

15'Yn of the national expenditure is allocntcd to the social sector and there is multidimensional effort in arcas oi hcalth, education, training, social housing, rural dcvel opmcn t, soci a1 programmes uf assistance, social protection, and soIidarity artd support with associations. Even so there are persistent social deficits:

2% of the urban population are below the poverty line; the poverty rate is 19'%, of which 23'S live in the rural areas; 700 000 hoclsehoIds live in districts or sl.lcItcrs which are inadequate.

The NationaI lni tiative of Human DevcIoplllent ( N 1HD) was announced in a speech to the nation by H. M. King Mohammed VI of Morocco in May 2005. It offers additional financing to support human development and in particular through income-gcncrating activities, support for the access of basic equipmcn t (par titularly health equipment), support to cultural and hcalth activities and enhaiiccment of the governing and local capacities. Its target is 360 priority communities with an average community population of 10 500. In addition to thc usual budget there is financing o f 10 billion Moroccan dirhams aver a 5 year period. The mcthod ta be crnployed bv NIHD is integrated sucraI dcvelopmcnt through participative programmes and appropriate community integration within activities carried out by other sectors. Thus it can be seen that the implementation is adapted to that of the BDN programme.

In Morocco there are 27 demonstration experimental cities practicing BDN through use of guidelines. A pool of resource personnel and a partncrsliip at local arid nationcll level could be dcvcIoped. Howcvcr, despite this there is an absence of political support for a national strategy governmcn t project and difficulty in mobilizing and coordinating intt.rscctor;ll astion. Thc difficulties arc in how to ir~trgratc tht. RDN approach with NIHD to make it a nationaI stratcgy against poverty and towards health improvement and 11ow to enhance health actions to place thcin a t the centre of conccn~ for participants and spcakers on the programme.

Implementation ot poverty reduction strateg~es In the Eastern Med~terranean Region

A NIHD/BDN partnership has been launched in one province =lnd a forum is being organized for December 2005 under the slogan that BDK is under the service of the NIHD. The partn~rsliip is being consolidntcd and other partners are being integrated. rraining and supervising of a multidisciplinary pool of trainers in cac11 ared during 2006-2007 will bc carried nut with the support ar-td assistance of WHO.

3.5 Experience of Pakistan in the institutionalization of community-based initiatives and involvement of civil societies in programme implementation r ) r KI~tisJlnl Ktrnr~ Znmnn, Nntiounl Prqgrnnrnzr OSficcr, WHO Prrkisfnn

The l3DN programme is currently implemented in scven districts of Pakistan, covering a total population uf 1.3 rni1liol-r. The government of North West Frontier I'rovince (NWFP) has provided funcis to replicate the programme during 2005 to 2008 in five additional districts.

WHO has bccn coIIaborati~~g wit11 the Ministry of Hcalth's efforts to address the social determinants of health in a holistic and comprcl~cnsivc manner with the overall objective of improving health and the quality of life.

The BDN communities are implementing various social wcIfare projects like improving health, achieving universal priinarv education, cnl~ancing literacy, ensuring supplies of safc drinking-water and sanitation and gender mainstrcaming.

Incoinc gcncration schemes range frcrn agriculture, livestock and pot~ltrv and small business cntcrpriscs etc. and thesc are also implcrncnt~d through cummunih~ cost sharing. This lias brought about a tangible iinprovelncnt in health and other social and e c o ~ ~ o i ~ ~ i c sectors.

T l ~ c Ivlinistry of FIcalth in collaboration with the district govcrnmer~ts and WlIO has taken t l ~ c following stcps to institutinnalize the programme and invulvc civil society in an ef for t to improve inefficiencirs and maximize resources:

lrr~plemerltatron of poverty reduction strategies In the Eastern Mediterranean Reg~on

intcgratiii~; cc71nmunitp action in local devcloynient, transfcr~.ing capacity and tcchnolog~; involving t11e c~rnmunitv in decision-making, evolving shared vision and consensus on nccds nncl resource allocdtion at the grilss root Ievel; strcl~gtheniilg insti tu lions and organizations and interaction rvi thin the xis sting systems in support with thc district d~volution plan; devising mechanisms for attracting public s ~ c t o r funcling at district, provincial and national levels (thc district, provincial and national levels providing funds after examination uf BDN documents; forming mechanisms fi7r cu~rdinat ion and entering partnership with IocaI civiI society orgnni7,ations and often national and intcrnatiunai partners of UN dgencics under Unite J Nations Development Assistance F r a m e ~ ~ o r k ( U h DAF); integrating BDN prograrnmc activities with ongoing governmrn t dcvelop~nent programmes like RnI l Back Malaria, ?'B DOTS Conin~u~~it\;-based ladv health workers programme and Ci tizcns' Community Boards; linking with the long-term policy objectives of the Government of Pakistan-Poverty Reduction Strategy Papers and MDGs; building a national programme un BDN. (The government has allocated US$ 35 million to its develnpnien t programme (2(106-2010) and the project is presently being clocumentcd.)

lrnplementat~on of poverty reduction strateg~es in the Eastern Med~terranean Reg~on

Experience of Pakistan in partnership and resource mobilization for poverty reduction and sustainability development Ur KIi irsltnl K h n t ~ Znmnn, Nnfionnl Procpl-nnznze Offiicer, WHO Pnkistnr~

Partnerships arc rclationshiys between individuals, groups or organixations, characterized by mutual cooperation and responsibility for the achievement of shared goals. Thc basic development necds programmes in Azad Jarnmu and Kashmir are known for building ~ffcctive and strong partnerships, maximizing resources and adding value to the existing programme. Some of the strategies for buiIding partnerships arc as follorvs:

organization and mobiIization of thc community; capacity building of the comn-lunity in establishing development benchmarks and orientation on development issuts, project management and financial procedures of social mobilization; invulvement of community representatives in project implementation, supervision and monitoring; registration of the village dcvclopment committee as a civil society organization and establishing Iinkages with donors and development partners; information sharing and facilitation of visits of potential partners; joint plar111i~ig (participatory planning); signing of memorandas of understanding betwccn WHO, the community and partners; joint monitoring; joint evaluation.

Partners have been able to mobilize resources for programme expansinn and added to the capacities of the local committee. 'She excellent social and economic indicators achieved so f a r in the arca speak of the usefulness of the partnersl~ip.

lm~lementatron ot Dovertv reduction strateales In the Eastern Med~terranean Reaion

Experience of Saudi Arabia in the implementation of the Healthy Cities programme Dr. Hnrund AI-Slriorknrt, Coo~dirlntor of Al-Oln Hcrrltlty C i f y , Snrrdi ~ I r t ~ b i r r

In Saudi Arabia, thc Hcal thy Cities progrilnimc bcgan in 1995- 1999. Al-Dukavriah city in AI-Qdssirn rcgion was selected to be thc First city implementing the progra1mri~e follo\.\~ed by AI- Mandaq in AI-Baha region. During the seconci stage in 20(12, the programme extended to cover fix7c Inorc cities. By thc end of 2004, during the third stage, the programme i i ~ c l u d ~ c l another 16 cities. Thc. progrnmmc has expanded and in less t l~an two years the number of healthy cities has incrcascd from 7 tu 23 and a vcry dynamic and active programme. has emerged. Thc programme is serving about onc thirci of the total p~pulat ion. T11c activities of the hcalthv city prc>jcct in each citv a re extcnsivc and the programme has cvolved as unu of the most all-embracing and vigoroc~s in the Eastern Mediterranean Rcgion.

Thc c n ~ ~ ~ m u n i t y has bccn actively participating in !hc programn~e in all aspccts oi health dnd cnvironmcnt. However, thcrc is still a need for morc community involvcmcnt, csyccially by worncn, in the planr~ing and implcnientntio~~ of programme activities. Meanwhile, support from princes and governors cnsurcs that the achievcmcnts of the p ~ ~ o g r a m ~ n e are sustained. It is that sustdinabilitv which is thc cornerstone for the programme's movement and progress.

The l~ealthv city programme in Sdu~il Archin has a vcry actrve website ( W M ' W . ~ C ~ . ~ O V . S ~ ) . The fluw of information through thc welsrtt. is c011~t;lntl~ updated and it is thr.oug11 this rncans th,~t 1111portan t communication and currcspondcr~ce lakc placc. T11c pragranliiw has also been successfc~l in ducrunent~tlon and 11,~s produced a largc number of p~rb l i c~~ t~ons , booklets 2nd posters, both at the national coord rn;ltor.'s office as wclI as in dif fcrent health17 citios. Currently good qu,~lity wnl.ks arc being produceci, both as ~ I O C U ~ ~ I C I I ~ S as w ~ l l as mntcrral for the wrtlslte and the press.

Furtl-rcl-mnrr, the p~tblic relatrons and informati011 aspects of tlic prograrnrr~e are strol7g and exwllent contacts nncl

Implementatlon of poverty redudluri slralegies in the Eastern Medtterrancan Heglon

relationships have bccn maintamed wi tl7 a~tI7oritics at 11at10na1, rcgi011~11 and city IeveIs, inc lud~ng thc mrnistries, uovcrnors' offices and city Icadcrs. In this regard, particuhrly, 3

thc r Icnl thy Cities pr.ogramlnc has mobllizod co11siderilbIe resources from ~ i~ f fe ren t public a r ~ d civic sectors.

3.8 Establishment of community information centres in Sudan nu Y n h n Mohnrrrrd E l Mnr~zorrl, Nnfiorrnl Coordir~ntor, Cor~~rrzzir~ity-hnscd I~ritrntivt~s, Srrdnlr

B U h was introduced in Sudan in 2 inode1 areas in the late 1980s when the experience was new and implementation tools did not exist. It was revitalized in the 1990s after Regional implementation tooh wcrc dcvclopcd and adaytcd to thc country's situation. They were uscd to guide imylernentation in modc1 and cxyansion areas. These tools includud data coIlection in the form of baseline and follow up tiouselio1d surveys. The experience was cxpandcil as community-basccl initiatives including BDk and other initiatives.

A community-based information system is designed to collect data, analvsc, store and usc information for timcly dccision- making during all phases of CBI inanagcment starting by planning and ending by evaluation and re-planning .This i~ivolves ~ n a ~ i y steps: collection, cornpila tion, analysis, presentation, dissemination and use for decision making.

117 order to cleterminc community development status and potential prublcr-r~s, it is necessary to cvIIect reIevdnt information from families, compile and examine it to be interpreted and used as a basis for future actions.

Baseline data arc colIuctcd through:

houscl~old survcy qucstionnajres; village, communi tv level cluestionnaires; deveIc>prnen t of community profile; nee~ls yrioritizaiion.

lmplementatlon of poverly reduct~on strategies In the Eastern Mediterran~an Reglon

A baseline household survey is coi~ductcd on a ~OUSC-to- house basis. A survey is first compilcd on a cluster basis and then on ~ i l l ~ ~ g c basis. At the time of the survey, each fanlily in the village is dllnttccl a number to help in project planning, irnpleincntation and management. Every house is visited by a surveyor and information on every question is collected from familv rne~nbers or by observation according to the nature of thc question. The Village Devclopmcnt Committcu and BDN team supcrvisc the survey process; a project manager monitors the exercise and ensures its quality and reliability. Surveyors deposit the filIed forms to their supcrvisor who crosschccks the colIected information. The data arc compilcd by the surveyors and supervisors jointly, first on a cluster basis and then on the village level. The BDN team and project manager in consultation with the Village Dcvclopmcnt Committee make IocaI adjustments to ensure the success of the endeavour.

In addition to thc househoId surveys, general information is collected about the locality regarding thc facili tics for hcalth, education, civic amenities, socia1 set up etc. This information is valuable for priority setting and cicvcloping the villagc profile. It is helpful in monitoring the progress and evaluatirig the results of interventions.

Community information centres have been established in H5(X1 of thc 52 CBI areas in 8 states. The remaining areas are in the process of developing their centrcs. Community information centres are pIaces where information is prcscntcd in a simpIc format and accessiblc to communities.

Indicators generated includc:

basic infrastructure: (social institutions, schools health facilities e tc.); demographic: population size by age group and sex;

health: prevalent diseases including non communicable diseases, child and maternal deaths, scrvice u t iIizalion and coverage (antenatal care, attended deliveries, vaccination ctc.);

lmplernentat~on of povcrty reduct~on strategies rn the Eastern Mediterranearl Reg~on

social: education (literacy and cnrolment in basic education by sex), water and sanitation (access to improved suurces and quantity of watcr, sanitary disposal of solid and soft waste), social links and harmony; economic: i~~corne of family, livelihuocl and skills, household assets.

T l~e benefits are:

casytocollectandanalyseclataatcc~~~~rnu~~ityIcvcl; casy access to reliable sources of information; build co~nmunity trust and ownership to prioritized issues; facilitates bottom up evidence-based planning; facilitates evaluation and decision-making for re- planning.

The disadvantages are:

role of related sectors is not satisfactory in either analyscs or use of information; indicators are not regularly used by individual ministry uf health vertical yrogrammcs, e . . Expanded I'rogramme on Immunization, ctc. management capacities of cornmunitics to kccp records are weak in some areas. fillancia1 support to maintain centres is not always guaranteed.

3.9 Experiences in poverty reduction in the Syrian Arab Republic 174s Lmr-rnur Frnrrk, CI1rrfLxrcr1f1~1(~ Ofliccr, Fzrtzdfor Itztr~grntcd Rurnl Llrwloy i ! r r > l i t of S y n n

Tlte Fund for Integrated Rural Development of Syria (FllIDOS) was cslahlishcd in July 2001. It was the first nongovcrnmcntal orgnniza tion in the Syrian Arab 1Ccpublic working in tlic area of rural development. The challcngcs it faced wcre those of the Syrian Arab Republic's increasing

Implementation of poverly reduct~on strategies in the Eastern Med~terranean Region

population during the 1980s and 1990s; its thrcatcned environment, state of health, education, socioccononiic factors and urban migration; factors which have Ied to crowcied cities.

The organization's strategy is to proceed in accorcfance with the national rural situation in the aim of achieving sustainable development through basic development needs and cs tabiishing faciIities needed by the comrnuni ty, for examylc:

dental clinic, health cIinic, nurscry; education with university scholarships; information centre, mobiIc children's libraries, community school, baby friendly home.

FIRDOS encourages income generating and grants loans. Since the organization began it has become established in 10 governorates and 110 villages. It has 3346 beneficiaries and has spcnt 162 million Syrian pounds. There has been a 100'% return 01-1 a11 Ioans.

3.1 0 Iraq experience

Despite the short period of time that thc CB1 project has been running in Iraq remarkable achievcmcnts have been realized. The CBI project was adopted by the Ministry of HeaIth in January 2005 in coordination with WHO. In March 2005 a CBI workshop was carried out in Amman and a plan of action was prcparcd and agreed upon. Following the election of the transitionaI government 16 new ministers were briefcd i n order to assure their continuous support and the dclegation of their authority to their representativcs. A national technical ministerial committee was established and 6 BDN arras were selected according to the criteria of poverty and security. CBI committees were establishcd at governorate and district level with representatives of the line directorates.

Village dcvclopment con~mittees were clccted from among teachers, religious leaders and prornincnt women in the villages. BaseIine surveys were carried out in all of the 6 BDN

Implementation of poverty reduct~on strategies In the Eastern Mediterranean Reg~on

areas in which data were collected and for analysis at district level. This facilitated prioritization of community needs and they began to solve their problems in a bottom-up approach.

The ministries started to invest ii7 BDN areas according to the nccds of the community. Safe water projects were initiated in 3 BDN areas, Al-Dasem, Al-Michbis and Al-Intissar; mobile clinics, heaIth education sessions and EPI campaigns werc carried out in most of the BDN areas. A campaign to eradicate illiteracy was initiated in 3 BDN areas and secondary classes were established in Al-Dasem, Al-Sulaiman, and Al-Dahira to give the opportunity for defaulters, especiaIIy among females, to complete their education.

Iraq's experience was made real for participants at the meeting through a short film which movingly presented the background situation and events prcscntly occurring in Iraq.

3.1 1 Using community-based initiatives as a platform for poverty reduction Dr Molmmmad Assai, Regional Adviser, Commld nity-bnsed Inif intives, WHO R~gionnl Oflicrfor fht. Eastern Meditermnean

Using community-based initiatives as a platform for povcrty rcduction and health requires a number of measures. Tn order to peruse the core strategies for strengthening health development in community-based initiative settings, a programme has to follow five key practices to achieving better health outcomes, including: community organization; community needs assessment; capacity building and planning through social and economic development projects; community-based management and ownership; and institutionalization.

Tile regional strategic directions, approved in the 50th Session of the Regional Committee in 2003, should be implemented through cornmunity participation and nccds strong political commitment and invcstment. Combating diseases of the poor requires specific actions for prevention and early management

Implementatror~ uf poverty reductron strategies In the Easterrl Med~terranean Reg~on

of I-tealth problems I i ke tuberculosis, nialaria, HTV/AlDS, vaccine preventable diseases and other communicable diseases as well as noncommunicable diseases. It is possible to reduce the firiancial burden of health care on the poor through establishing a curnmunity-based health insurance scheme, a

system to support the poor, free preventive care for all, rcduced drug priccs and subsidi~ed treatment of those iclcntified as poor. Impact and efficiency of public hcalth scl*vices can be achieved through training hcalth care providers, good governance and community involvement in health system management, and standardized hcalth care adapted to spccific neecis of the poor. I'ublic resourccs can be reaIlocatcd in favour of poor and underprivileged areas, through Linkages wit11 national policv, with poverty reduction programnies and motivating health staff working in remote areas. Thc supply and cffectivcness of public health services can be possible through building awareness, development of a basic ~ L I bIic health services package, promcoting Ioca I p~rtnerships and cost-effective pruvision of public health scrviues.

I11 conclusion, [he community-hascd initiatives platform can be used to achieve poverty reduction for health through ii~stitutionalization, capacity-buil~ling, advocacy, rcsourcc gencra tion and partnership.

In~plementat~on of poverty reduction strategtes In the Eastern Med~terranean Reg~on

4. Group work

Group work took place in three different scssioris. Dr Mohamrncd Assai explained the aims artd method of working on each occasion and each piece of group work was prescntcd for discussion directly after it was completed. The aims of the group work were to:

examine the enabling factors, weaknesses and needs to enhance poverty reduction strategic directions to opcratiunaIize pro-poor policies; examinc the means uf strengthening health initiatives through CBI at different le\?eIs; outline plans of action for putting into practice poverty reduction strategies through CBI in the Eastern Mediterranean Region during 2006-2007.

Annex 4 contains documentation relatcd to group work.

Implementation of poverty reduct~on strategies ~ f l the Eastern Med~terranean Region

5. Discussion

During t l ~ c first day uf the meeting discussion focuscd on poverty and the definition of poverty. Essentially participants saw poverty as deprivation or a lack of purchasing power. It was feIt to be deprivation from cIcan water, sanitation, education, health and power. It was volunteered that poverty was not simply lack of income but lack of capabiIitics and the problem was how to rclcasc people from its fatiguing affect.

Thc poverty reduction issue was seen as important but it was seen to be duc to basic problems. Policies of prix~atizatinn of water and sanitation etc. were feIt to be unhelpful because although the rich could afford to pay when those facilities were privatized the poor could not, nor could they bc expected to contribute. The poor were often not seen but lived below the surface, they wcrc not part of what was the formal part of society and services (l~caltl~leducation etc.) missed them out.

It was mentioned that linkages between CRI and public health institutes and universities would facilitate the exposure of acLdemia to the field where the community is well-organi~ed and n~obilizcd for health action whilst facilitating more rcsedrch-oriented and scientific progrclmmes. It was thought nucessal-y to rxamincl programmes carefully to dccidr i f thcv should bc linked and whcrc.

Tnitia tivcs for poverty red~iction were i~nyortant but the governments' c o ~ ~ c e p t of dc~eloprnent and approach to dcvclopment needcd to be changed to suit the countrjes in the Region. The governmvnts' roIcs n ~ c d c d to be reconsidered with thought given to d~c~nt r~ i l i za t ion which was a coi~ccpt that seelncd to rxrork. Tt w a s thought that knuwIudgc of social d c t c r m t n a ~ ~ t s of heaIth was needcd a t micro lcvel to gain knowIccIge that would enlighten a t national level; pussibly

lnlplementat~on of poverty reduction strateg~es In the Eastern Mediterranean Heglorl

CJ31 couId supply dcficicnci~s a t micro Icvc.1 in helping with mid-term activities and indicators.

Thr cnmmcnt was rndiit. that people wcrc used to a vcrtical dpproach so trying to rethink mil educak t o ~ v ~ r d s a hori~ontal dpproclch was necessary. The authorities needed to be educated; some cou~~t r ics cvcn denied the situation so the work had to be clone on ground Icvcl. S t r ~ i c t ~ ~ r a l wcakncss could not be changed su concentration should be placed on what could be changed t l~ro t~gh enablement and a driving force. It was suggesteci that successes should brl asscsscd and the responsibility for success i o u ~ ~ d , whether it lay with voluntccr groups, ministries, initiatives or commu~-ritics and that the strengths and weaknesses of donors needed to be examined.

CHI began with villages and was therefore on a slnaII scalc but it was needed in urban s l u~ns whcrc so much poverty existed. Strategies directly related to achieving MnGs I I C C ~ C ~ to be developed. I'articipants pointed out that there wcrc cxainples of a participatory approach working with gover17mcnts and civil society and trying to build capacity using transparency and delnocracy but this couId delay action.

A point that was rcycatcd sevcral times was that without security there could be no Jcvclopmcnt, without a secure environment nothing could be implemcntcd and that hcaIt11 and deveIopment should be used as a bridge towards stability.

During the second day of the meeting the focus of disct~ssion lcant towards health with the comment that no one could deny the hugc impact made by poverty on health. Thc cost of drugs was prohibiting everywhere. Other problems perceived rvcre the lack of a safe water supply, brain drain due to poor working conditions, Ion' salaries and professional standing so the quest 1011 of heal t11 svstcms was brought illto the foregrounci and g c ~ ~ c r a l dissatisfaction with all health systems cxpressecl.

It was mentioned that BDN programmes needeci to focus ~ n o r c on health, placing heaIth at the centre as a basic aim of

Implementation of poverty reduct~on strategies in the Eastern Mediterranean Reg~on

each p r o j ~ c t b e c a u s ~ everyone recognized that health was the most important factor in a person's life and uItimatclv one would PA); everything to maintain health. The question of how to motivate health workers was also co~lsidered. It was argued that every sector thought ~ t s owrn arca of speciaItv was of foremost importance but that it was necessary tl>crcfc>~.e to consider carefully how each sector had a role to play and then could be guided forward. Cross-cutting mcasures were a means to intersectoral cooperation. I'hc comment was made that it was important to link the health system with programme prese~~tation so that the ministries of health could be shown how BDN could produce good health and that it was necessary to took at results from BDN showing liow peopIe whose health improved got back to being economically productive.

Participants fcIt that thcrc was a need for coherence and linkagc at national and regional level and that producing guideIines a11d tools was a key factor, that ernpowernlent was d strategy fur poverty reduction therefore governments should becor-r~e facilitators not planners and that in the newr paradigm a process shift was important so that people's capacity would be improved and poverty reduced. This meant that RDN should be furthcr strcngth~ned and each community examine where its priority lay. It was through community that a better quality of Iife could be achieved. In the past it was thought that primary health care, the heaIth sector and health meant, basically, health treatment but tha t now it had a wider meaning. There was a morc holistic view of health and CBI could be used as an entry point into I~ealth care. It was felt that people nccdcd to be e~~courngcd and motivated into using the facilities available, for cxarnpIe by giving free insurance i f the whole family w a s vaccinated.

It was stressed that peuyIesl actions should not be dictated but that they should be educated and empowered; e~nyowcrmcnt was seen as organizing and indicating what was necessary. The CBI programnle was a philosophy that sl~ould have priority writ11 thc ministries of health and it was necessary tu point this oti t to ministries.

lmplernentatlun uf poverly reduction strategies In the tastern Mediterranean Region

Prick in the ;~chrcvcinents of RIIN in tllr arcs ot hcnltli was exprcsscd and it was thought thili BDN could be uscd ds tlir basis uf pvlicv L1lld expanded illto the 11ation;ll luvel, Ihal the drvrlopmcnt o f guidelines dnd those already prepilred C U L I I ~ be i~sed for trilini~-tg and that countl-ics s110uId not wait but thai mublIe tecll-rzs to cvokc change in districts ,n7J commu12ity c ~ ~ ~ ~ i dis t r l~t invoIvement were t t~r kcy.

It was pointed uut that curnmon goals must be set for all sectors in ordcr to encourage uuoperation. It nJc~s thought that health must be part elf the focus of BDN and that it was unacceptable to see, fur examplc, a dcath from trtberculosis in a BDN area.

Llr Gczniry participated in discussions of the sccond dav ofthe ineetir~g during which hc strcssccl that i t was an area rvherc countrlcs, ministries of health drld 0 t h ~ ~ devt~loprmrt~t srrtors had not achicved enough, that i t was L>otll a process dnd an outcome and that ~t was a democratic process whereby peoplc should be brought to recognize their nueds and that WHO were not there tu teach but to cooperate. Thus it was i inpor ta~~t within primary health care that there was 11-1 tersectorsl coordination within thc region of hcalth aiid witliiti tlir Iicgional Of'ficc but thn t i t was not l-~npycning to the full extent possible. All intrrcstcd partics: t11c cornn~ur~itgr, ministrrcs of health, agriculture etc, needed to sit together a11d WHO 111ust influence governincnts and the cornint~nitv to act and give cummunities whd t thev wanted, asking comr~iunitjtls what they fclt to bc thcir priorities R I I C ~ reaIizing that rvhatcver the priority, whether it was water, roads, etc. ~bou1d ultirnatelv have a link to hedth. A dernucratic mechnnisn~ sl ' t~uld bc huiIt by which thc priority could bc identified, for cxamyic a qucstion~~nirc, nitd o l~cc thc qucstio~~n;lire had bccn nnswcr-cd it ~ ~ ) u l d be casy to nssoss whorc the con-ununity priorities Iny.

7'he ~ m p o w e ~ . n ? e ~ ~ t of ~ ~ o m c 1 2 was seen AS crucicll because wurrlcn iccrc at thc puIse uf the family; thcv ciiscussecl needs and ~nst l red action was takci~ in the best interests of their families and therefore their conlrr~unities.

Imulernentat~on o l povertv reduct~on strateqres rn the Eastern Mediterranean Region

It was agreed that through work within cum mu nit it.^ mutual trust was built which uvercamc poljticaI belief and diffcrcnccs.

Data were seen as ir~valuablc and although national survc3ys might be distrusted, data a t the cornmunit/ Irvel were acceptable since they were sccn to assist in programme planning and implementation. The usc of datclbases as part of strategy was ~ne~ltioncd.

I t was thought that the focus shouId be on dt.ccntralizatinn and that strengthening management at all Icvcls was a n a s p c t that had to be examined. The question of what cxartly was meant by community was asked and the lack of cornn~unity representatives at a national Icvcl was mentioned. Capacitv- buiIding of management at all lcvcls and of cnabIing people was also frcqucntly spoken of during discussion. Pcople should be used as a valuable resource.

It was felt necessary to have a concrete method of evaluation so that an rlndcrstanding of why something worked could bc reached and methods institutionalized. Tl~ird party evaluntinn would provide evidence fur what was trulv working and what was not.

On the third day discussions were mainly focused on two areas: achieving partnership and preventing slums which wcrc an cvcr-increasing factor in urban environments. I t was thought that the CBI approach should be packaged and made available. Again capacity building of ycoplc t v ~ s seen as important and it was suggested that ycoplc could bc sponsored and trained.

A lengthy discussion ensued about which sections oi society should hc involved in economic development and it was stressed that this could not be u~~dcr taken by social workers and goodwill alone but that private companies must bc brought to appreciate the important role t l~cv cot~ld play. I'rivatc compdnies sl~oulci be approached tu help and sho~lld be brought to see their responsibilities towards the rvorkfol-cc. and the cnvirorin~ent etc. It was tl~ought tha t BDN would work well in slum areas bccausc incv~tably thesc areas did not

lmplementat~un of poverty reduction stralegies In the Eastern Med~terranean Reg~on

f i t into t11c fi)rrl~al l'tctwork fur health sincc they wcre ~ i o ~ n r n t ~ ~ ~ i t i ~ ~ that ~ i i c l not go to primary ht>altl~ care facilities ,ind scllools etc. FlKUOS was congratu1att.d on having had such cl huge impact in thc four years during which they had been uyerating. I t was stressed that indayencience was thc aim and that a t the beginning of projects peoplc and curnmunitics nccdcd financial support but that dcveloplnent was thcir responstbility.

It was mc~~tioned again lhat the Rcgional Office had the tools and could adapt them and use thcm to promotc healthy lifestyle in urban arcas, Nongovernmental or.ganizations often operated in urban arcas but uTcrc not necessarily geared to working within thc community; thesc could be organi7ed and trained. Unitcd Nations agencics also had some urban projects but nut at community level. It was thought possibIc to l~nrrnonize the work of these different scctors and make use of tlw tools avclilabIe.

Dr Mohammed Assai reflected that thesc co~nmcnts all showed the need for ydrtnersllip and that nongover17mental organizations were taking part in training activities but that perhaps g o v c r i ~ m ~ n t s and colleagues should make a package with n~inistrics of hcalth and focal poitits to go beyond WHO and find their own agcnts for change. Jt was possible that WHO could pilot actlon, but that i t was governments that 17ccded to extend.

It was asked whether the poor had the capacity to develop and strengthen their political voice through initiatives; thcir legal status had to be recognized.

lrnplernentatlorl of poverty reduct~nn strategies rn the Eastern Med~terranean Region

6. Conclusions

The con~n~~~ni~y-L>d\ed initiatives that lidve bccn ~ntroduccd i l l

countl-ips ~i t h ~ Iiegion il l the p s t two dcc~des have had an advocacy role and dcrnonstration purpose and have bccn w r y s~rcccssful in shoiving thc cffcctivcness of communi ty-based apprcoaches in health dcvr lop~~lcnt . The CBI h v c proven to bc pdrticulnrly cffccti~c in comm~rnity ~nol-ulization and urgani~dtion and pot-crty rrduction at micro 1 c x ~ I and have shown that t l~crc i s further potential to drasticdlly improve 11ed t11 indlca tors tl-t rough empowering pcoplc tu look after thcir own hc,)lth. CRI from thcir inception have had a dual focus: making the process s~~stdinnbIe with a ~ a i l ~ ~ b l e corni~luni tt. resources and attaining tarigibIc health 2nd quality of litc outcorncs. Purthcrmorc, CHI have clumonstratcd thn t through acting as a hsrmo~~izing irtlnuc thcy have idcilitntccl the inyu t and cnllalwration of mu1 tidinlensional activities.

The implctner~tntiu~~ of UBI in dificrrnt cvuntrics 112s hcen primarily sl?(ronsored by ministl.il~s o f health through promoti~i11 dnd builclir~g of community Icadcrship and cr4cnting confidence among di ffcrcnt r;takcholdcrs rcspnnsiblc for lcxal c-lcvclopmciit; howcvcr in sume countl-ics there has not been adecluatc prmnotion, orientatiun m ~ d dinlogut. with other concer11c.d srrtors at national, pror~incia1 , ~ n d clistrict l~vc l s . Alsv, diffcl-cnf national hcalth progrnlnines su far have not utilizcd fhr tuIl pute~~tinls 0 6 C13I opportuliitics to strcamlinc tlivir lit'lil i-1itiviti~s. T.%'it11i17 t h ~ Regi01151 O f f i ~ ~ , strong collnt-mrn tion has ~ C C ' I I cstnhIis11~d wit11 othcr lira1 t11 programmes such as tubcrrulosis, ~nalal-i,~ control, healthy lifestvlcs, in~muniza tic311 n n c l school henltli, h u l tn11d1 murc cffort is rciluired a t counL1-v Ic\rPl to realizc thc conrilinated joint plc~~uning and inlcri~ction betn~ccil different heal tl7 1?S081';1T711IlCS.

lmplementat~on of poverty reduct~on strateg~es In the Eastern Med~terranean ReQlon

The CBI approach c~nphasizcs poverty reduction for health. Tvpically puvcrtv is associated with lack of financial resources and thcre is a need to rsdrfinc, encompassing social deprivnt~on and lack of choice in having access to the mi i~imum csscntial services and attributcs. Certain global economic policirs hrrvc ~qssulted in exclusion of poor sections of society from 11avi11g access to basic needs. ?he concept of community findncing scl~cmcs for pro-poor actions has been successfully tested in the model areas and this expcricnce has grcat potentla1 for further dcvclopment creating association with different stakeholders and groups supporting thc poor at local lcvels. Thc linkages between various programmes working to achievc MDGs also need to bc connected and properly harmonized.

The extensive application of CBL in the Region at the n-lode1 phasc calls for careful appraisal of the approach guided by thc experienccs of thc countries and evidence generated. Thc meeting acknowIedged the success uf all countries irnplemcnting CRI and npprcciatcd that the rcvisiting and updating of the approdch along with thc operational process, procedures and mechnnisn~s is required before cntcring larger scale application. The CBI approaches have bcen predomir~antly focused in the rural areas and hcnlthy citics activities for tn,~ in cities; however, the improven~en t of hcal th, environment and quality of life in thc slum areas has not been the subject of spcrial focus. The meeting aIso reemphasized the crucial role of womcn in sccuring the health of the family and the cornrnunity at large, noting that women's role needs to be strcamlir-trd and incorporated as a cross-cutting theme.

lmplementatlon of poverty reduction strategies rn the Eastern Mediterranean Reg~on

7. Recommendations

Institutionalization

I. Countries should dcvelop national str<i tcgies for institutionalizil7g key componrnts of community-based initiatives, including advocacy, orirn ta tion of potential stakrholdcrs and decision-makers, collaborative implementation, nc tworking, and monitoring 31id e v a l u LI t ' ion.

2. Cuuntries should d ~ v c l o p plans of action for imylcmenting the rcgronal stratefiles on povcrtv reduction for healtl~, including the necvssary foIIuw-up.

3. Countries should work closcly wit11 dl1 ~t~~keliulcicrs to cnsurc thd t d gendcr perspective is incnrpor;i teci into 112 ticma1 d ~ ~ ~ r l o p m e n t plans, policics ~ n d nctivi tirs.

4. Wf 10 shoulii support national au thori tics in orientation and tmining of workers in the hc31tli and 0t11rr sectors nnd nungovcrnrncntal organizations nncl pnrtncrs or1 using the community-bascd initr;ltivrs approach for tiec1lth and cl~i'elopmcnt (\VHO RcprPsrn tativcs' ut'ficcs, Rcgion;lI Office, WHO headquarters).

Strengthen~ng the health component

3. Cc)llr~tri~s SIIULIIC~ i n c o r p ~ r a tc t l ~ COIIIIIILIIII~Y-hrlsc~l il-tiliativrs dppruach into thc d is t r ic t hcilIth systcm, anti sho~11d folloiv up implen~er~tntion ~ n d monitor progress.

6. Cou~~t r ies s11o~1ld establish a mt.i.har~isn~ for implcn~enting hcnltl~ autivitics within tllr curnmunity-

Itnplernentat~or~ of poverly reduction strateyres In the Eastern Med~terranean Reg~on

based ini t i~t ives frnmcwork, with effcctivr coordinntron of national prugr~lrniilrs at a11 1t.vels.

7. WHO should cl~vclop a p'ickngr clf cornprel~cnsiv~ hralth guidelines tor integration of cliffcl-tint hcnlt11 pr~nsraniincs in community-bascci ii~itiati\~t.q c?l+cn5 (1VHO r\cprcscntatrvc.sl offices, Regiondl C)ffic.tx).

8. WHO s l ~ u u l d advocatc For and raise public awareness of the conccpts of self care, domestic care, and collcct~vc and C C ) ~ J I ~ ~ ~ U I ~ ~ ~ V care as part of primary hraltli carc. Actions shouid includc providing hcaith cducntion for thc public on basic care activities (WHO 12cprcsc11tatives' offices, I i c g i ~ n ~ ~ l Officc, WHO l~cac~c~u~l r tc rs ) .

Advocacy, resource mobilization and partnership for health

9. Ministrics of health should assume d Icadershrp role in

courdinat~r~g the I-rcalth-related inputs o f o t l~cr sectors dnd in ~Jcntifying the roles and rcsponsihilities of each sector for hcal th development, and should dllvcate acJcquatc resources for c>ricn!a tion nnci crcation of owl~crshiy bv other stakcholdcrs.

I[). Countries shuulci strengthen and formdlizc thc

Community Insurance, Community Developmcn t Fund and SociaI Wclfnrc Fund mitiativcs as pro-poor actions in 11atiunaI health policy and planning.

Harmonization and linkage with similar initiatives

11. Countries should prep~~r-e an invrntcxy of similar community-h2sc.d progrdrnlncs supported by various do11ol- agcl~cies and na tionnl nongovt.1-nmcntal or.ganizntiu~~s and bvork to promote partnerships m d build link,lgcs between such prugramtnes. C'ountrics should s t r ~ n g t h c n advocacy ' 3 r d orientation To14 cornmunitv-bilscd iriitiatives ,111d MDGs ; ~ t thc district

Implementation of poverty reduction strateq~es In the Eastern Med~terranean Healon

and intcl-mrdiate levels, and rationalize the role of each sector and programme in this respect.

12. WHO should protnote pro-poor hcnl t l~ policies and facilitate linkages bctwren community-b,~seci ii~itiativcs, the work of the Commission on Social Dctcl-m~nants of Health dnd thc targets of the MDGs. (WHO Rcprcsentatives' offices, RcgionaI Offirc and WHO hcndquarters).

13. WHO should adopt and specifically reflect in its documents and policies a definition of poverty and its relationship with hcalth (W HC7 Represen ta tivcs' offices, Reginna I Office, WHO headquarters).

14. WHO should provide technical support to countrics to focus on con~munity involvement, i~itcrscrtoraI rollaboratioti and partnership I efforts towards achieving the MDGs (WHO Reprcsent;ltiws' officcs a n d Regional Office).

Scaling up of community-based initiatives

15, Countries should build capacity at the local Iuvel ior the planning and i~nplementation of poverty reduction

strategies.

16. Countries shuuld develop a strategy for scaIing uy7

community-based initiativcs througl~ a pl ias~d ~ppruach . The first phase should incIudc comrnunitv niobili~ation, organization and cdpacitp-building, progressing to health d~vclopnient, life-skills development, social developinen t and economic dc~r~loprnen t in s~tbsequcn t p11ast.s. The stratcgy should be sufficicntlv flexible to allow each phnsc to bc expanded accol.ding to t l ~ c capacity and resources.

17. WHO should support corinlrics in dncumc17 tins succcss storks in a11 evidence-bascd manner ~ n d shuulci use

Implerr~enlat~on uf poverty reduct~or~ strateg~es In the Eastern Mediterranean Region

t h c ~ n for further Jrvclopincnt uf sustail-tablc rnodcIs of c o m r ~ ~ u n itv-bnsrtll i11i tiatives (IZcg iona f Ofhcc).

18. WIIO shorild cxl7a1id support o r scclli~i~; up of cumniunity-b,lscc3' initiatives in coul~tl-ips. 117 this respect, the role of WIJO should be c l ~ a r l v drfined c~rtd be s u ~ ~ m r t ~ v e of advocacy, tl-ainil~g, ir~furmation clevelopmcn t, exchange of cxpcricnces, resou rcc niobi1ization and partnersliiys (WHO Reprcsen ta tivcs' offices, IIcgional Ofiicc).

Slum areas in urban settings

19. Countries should take urgent action to addrcss the growth of urban slutt~s as a priority hcalth 2nd deveIoyment issue on the urban agenda. They should also request concerned sectors to highlight physical and social shortcomings of services in urban slums.

20. Countries should develop special strategies to focus on hcalth and quality of life in sIclrn arcas as part of hcalthy crty programmes.

21. WHO should initiatc a strong advocacy campaign a t

17ational a n d regional levels to improve health and quality of life in urban poor areas and slums as part of healthy city programmes. In tl~iq respect it is

recomtncnded to initiate n UDN pilot project in the tirban slums of each cour~tr-y in the Region (LVHC', Repre.scntntives' offices, Rcgional Officej.

lrnplernentat~on of poverty reduction strategres in the Eastern Mediterranean Reg~on

Annex 1

Agenda

Mcssage from the Regional Director Remarks from Islamic EduccltioilaI Scientific a11d CulturaI Organization (ISESCO) Building linkagcs bctween Second Gcncra tion Poverty Reduction Stra tegics, Millennium Development Coals and Community-based Ini tiativcs Objcctivcs and ~ncthodology of work Supportive s tratcgy for community-based poverty reduction CIobcll Icssons in health-puverty reduction strCltegy implemcn ta tion Introduction to the Commission on Social Determinants of Health and its linkagcs with CBI Enabling factors, weaknesses, and needs to enhance poverty reduction strategies tn attain MDGs HeaIth as the priority intervention in CBI settings Promoting healthy practices through CBI (c-g. JMCI, 1nenta1 health, nutrition, hcal th promo tion, reproductive health, environmental health and healthy schools) Integration of TB DOTS in all 13DN areas of the Region tlirough pro-active community participation Strengthening routine immunization at community lcvcl Strengthening hcaltl-t initiatives through CBI in different levels Women in EIcaIth and Development as a cross-cutting intervention in CRI areas Regional exycricnces (Afghanistan, Jordan, Pakistan, Saudi Arabia, Sudan, and Syrian Arab Republic) in ii~stitu tionalization of CBI, involvement of civil societies, govcrnmel~t ownership and partncrship development Health and quaIity of life d~allenges in slum arcas CBI partnership with UNIDO and Agriculture Creciit Cooperation Experience of FIRDOS in poverty reduction activities Enhancing operationalization of poverty reduction stratogics though CRI in tllc Eastern Mediterranean Region in 2006-2007 Concluding remarks, recommendations and closing of the meeting

Implementation of poverty reduction strateg~es In the Eastern Mediterranean Reglon

Annex 2

Programme

Monday, 14 November 2005

09:OO-09:IS Mcssagc from the Regional Director

09: 15-09:30 Islamic Educational Scientific and Cultural Organization (ISESCO) Iiclnarks by Mr Mustapha Eid, Programme Specialjs t, ISESCO

09:30-0950 Building linkages between Second Generation Poverty Reduction, MDGs and CBI/Dr Mnlzarn~d Abdi larrrn

09:50-10:lO Election of officers Introduction of participants Adoption of the programme

10:45-10:55 Objectives of thc meeting and methodology of work/ Dr Molzafrlrrlnd Assni

10:55-11:lO Supportive strategy for community-based povcrty

rcductionl Dr Ower Silleirrrnvr

11:lO-11:20 Global lessons in health-povcrty reduction strategies

implemerlta tion/ Dr Elrgcnio V i h r

11 :20-1 1:30 Introduction of Social Determinants of Health and its

linkages with CBI/ Dr Snrneen Sjddiqi

11:30-14:OO Panel discussion on:

Linkages between CBI, PRS and MDGs Country cxperiences on community participation in local development processes

14100-15:30 First group work -

What a rc thc enabling factors, u~cakncsscs, and needs to cnhancc povcrty reduction strategic directions to opera tionalizc pro-poor policies?

Implementat~ori of povec!, reduot~orl stratey~es I r l the tasterr~ Med~terranean Heq~on

15:30-17:00 Gro1117 p r e s ~ n ta !ions and discussion

Tuesday, 15 November 2005

08:3O-08:40 Flcal th 2s thc y rial-ity intcrvcntion in CBI scttingsl Dl. ilbdzillnlr As..;r-ru'di

08:40-08 :50 Proinotir~g l~ealthv practices through CBI (c.g. IMCI, mcntnl healtl-r, nutrition, health promotion, reproductive health,

environmental licaIt11 and henithy schools)/ Llr S m y ~ r i J17ffr7r

H I I S M ~ ~ I

08:SO-09:OO 117tcgrati011 of TB-DOTS in all I3DK arcas of the Rcgion through pro-active community participation/ D1- f k i l ~ i r n 5uitr.1

09:OO-09:lO Strengthening routine immunization at community levell DI. Smiri Smlnll Yorl.ssorrf'

10:2O-12:OO S e c o ~ ~ d group wurk --

Strengthening health initiatives through CBI at diffcrcnt Ieveis

12:OO-14:OO Group prcscntations and discussion

14:OO-14: 15 Women in HeaIth and Development as cross cutting intervention in CBI areas1 Ms Jonu~lrr Vogd

14:lS-14:30 Fscperiencr of S u ~ i a n in establishment of comrnunitv based ~ n f o r m a tiun c.t.ntrrsl Dl- Yohirr Molrn~lir~d El Mnrrzo111

14:30-14:45 Expci+iencc of Saudi Arabia in irnylcmc~ita tion of hecl1thy city prngrLlminc/ 1 > l . Hnmnd /Il-SI~i~)r>knll

14:45-15:15 Ekperiences of A f g h a n l ~ t ~ ~ n , I'akistan and Jordan in

institutionalization of CBI and involvcmcnt of crvll snrirties in programme implementation

Irnplernental~on of poverty reduction strateg~es in the Eastern Mediterranean Reg~on

Wednesday, 16 November 2005

08:3(7--05:40 CBI approaches: health and quality of life challenges in slum srca s l M r Kcriurrznrs KIz~~s lr C l ~ l ~ s h m

08:10-08:50 Experiel-uce of Agriculture Credit Cooperation (ACC) on poverty reduction in Jordan and ~ t s Iin kages with Healthy Villages Programme/ Lngilrrrr Tnnlfiq Hnt~nshntrh

OH:50-09:00 UNIDO and collaboration with WHO in incomc generation and environmental pollu tion challengeslMr Encr! Kok

09:OO-09:lO Experience of Azad Jarnmu and Kashmic of Pakistan on partnership and reso~~rce mobilization for poverty reduction and sustainable developmentlDr KIrzlslzal Kharl

Zarrrn~i

09:lO-09:20 F1RT)CIS' expericnccs in poverty reduction1 DT Awntcf Cho~r ra

09:20-10:40 Pancl discussion (Countries experiences to be shared)

10:40-10:50 Using CBI as platform for poverty reduction and health (institutionalizati~>n, capadty building, advocacy, rcsourcc

generation and partnership)/ Dr Molramrrlnd Assai

10:50-14:OO Third group work-

Outline plan of actions for operationaIization of poverty reduction strategies through CBI in the Region during 2 0 0 6 2007

14:OO-15:30 Group presentations and discussion

15:30-16:OO Concl~rding remarks, recommendations and closing session1 Llr MO~ILIU~PCI Abtii ]allin

Implementatlor1 of poverty reduct~on strategies In the Eastern Med~terranean Reglon

Annex 3

List of Participants

BAHRAIN Ms Nawd Abdallal-r Ynussouf Senior Social Rcscarcher in Health Ce17tr.e~ hlinistrv of Health Manama

Dr Hoda El-Mahrnoud Professor Faculty of Health Sciences Psychological and SociaI Sciences Department Manama

DJIBOUTI t3r Kassirn 1 ssak Osman Genera1 Inspector of Health Focal I'uint uf the Basic Development Nu'tlec-is (BDN) Programmu Djibouti

Mr Ismail Sougueh Coinmuni ty Supervisor Executive Secretariat Ministry uf Health Djibouti

EGYPT Dr- Esmat Mrlnso~ir Undcrsccretnry icjr Primarv Health Care Mrnistry uf Hedl th a r ~ d 1'opul;ltion Cairo

Dl- Schnrn 1 Iusscin U~iclctsrcrctary for Envlronmcntal Affair5 Ministl-v of H r L ~ l t h and Population Cairo

Irr~plemetitat~on uf poverty reduct~on strategies In the Eastern Med~terrccnean Reg~on

IRAQ Dr Mohmmed Salman h l i m PI-in~nry I Iealth Carc and JJuL>lic Health Department Mrn~s t~ .y of llcalth Baghdad

ISLAMIC REPUBLIC OF IRAN Dl. Moharnmad Reza Vaez Malidavi Dcputv Director in Social Affairs Management and Planning Organizaiion Ministry of N7elfare and Sucial Security Teheran

T)r Ali Asghar Farshad Director central Environrncntnl a11d Occuya tional Health Department Ministry of Health and Medical Education Teheran

JORDAN 1h- Badic El Mulla Assistant to tlic Director of the IIcalthy Villages I'rogramme Ministry of Health Amman

Dr Raghad Al Hadicii 1 Ggh HeaIth Council Amman

LEBANON 111. Mohamccl Ali Kanaan EP1 Manager Chief of the Social Heal tl-I Dcpartmci~t Ministry of I'ublic Health Beirut

lmplernentat~on of poverty reduction strategres In the Eastern Med~terranean Heg~on

LIBYAN ARAB JAMAT-IIRIYA Dr EI-Mukhtar Mohamcd Hadida EIcalt11 Plannir~g Authority Tripoli

MOROCCO Dr Katra-Ennada Darkaoui Head of Outpatient Care Department National Coordinator of Communi tv-Based Initiatives Directorate of Hospitals and Ocitpatient Care Ministry of Health Rabat

OMAN Dr Saeed Khamis A1 Mukhaini Medical Officer Department of Primary Health Carc Ministry of HcaIth Muscat

Dr Salah El Badawi Community-baed Initiatives Expcrt Department of Primary Health Carc Ministry of Health Muscat

SAUDI ARABIA nr Harnad AI-Sliwekan Coordinator of Al-Ola Healthy City Ministry of Health Riyadh

SOMALIA Dr Moliamed Hcrsi Uualc Permanent Secretary Ministrv of Health ~ o ~ a d i s h u

Implemental~on of poverty reduct~on strategies In the Eastern Mediterranean neglon

MI. IZhmccI Abdi Jnrna L>irtactor-Gc~icrd Ministrv of H c a l d ~ and Labour Hargeisa

SUDAN L3r l ' ; l l~i,l Mol i~mcd El Man~ou l Con~niu~i i ty -base Initiatives NdtiondI Coordindtor kcdernl M111ist1-y o f Health Khartoum

SYRIAN ARAB REPUBLIC Dr Mouhsen Kanaan Director o f the Healthy ViIIi~gcq I-'rngrnmnle Ministry of Hcalth Damascus

TUNISIA Dr Fathi Mansouri Doctor in I'ublic Hedlt1-1 M i ~ ~ i s t r v of I'ubjic Health Tunis

YEMEN Tlr Mnslch Al-Toali Dircctor Cencrnl of Planning

a lon Ministry ot I'ublic I Ical th and Popul t '

Sana'a

TEMYORARY ADVISERS

LJr Omcr Suleiman nircctor, 13cvclopmo11t Technology and Service Intcrnational K h , ~ r t o t i ~ n St'Ur-Zh

Implernentat~on ul pwvcrty reducl~on strateg~es ~n the Easterr) hludrterranear~ Reglon

DI- Ornerd Mubarak Amrn,tn JORDAN

OTHER ORGANIZA'TIONS

Agriculture Credit Cooperation (ACC) Enginecr Tawfik f IabasI~neh Director General Amman JORDAN

Fund for Integrated Rural Development in Syria (FIRDOS) Ms T.,aurcncc Frank Chicf Executive OfCicer DATJI ~ S C L L S

SYIIIAV ARAB RT7:PUBLIC

Dr Awatif Choura Field Mnnagcr. Micro Finance d17d E ~ i ~ ~ c a t i o ~ i Ddmascus S Y K I A h A I<AH ICEPUBLIC

Islamic Educational, Scientific and CulturaI Organization (ISESCO) Mr M u s t a f ~ Eid Prog~.aiiiinc 5pct-ialist Rabat MC3JII )C:I.'O

SociaI Devclop~nent Agcncy (ADS) hlr Kajib Cucdira Director Iinha t MOROCC:C)

Implementat~on of poverty reduct~on strateyes in the Eastern Mediterranean ReQlOn

United Nations Industrial Development Organization (UNIDO) Mr Evurt Kuk Industrial D~.veluyment Officer Tnd u strial Promotion and Technology Branch I'rogl-a mine Develop~ncn t and Technical Cooperation Division Vienna AU SI'lIIA

WHO SECRETARIAT

Dr Moharned Abdi Jarna, Deputy Regional Director, W HO/EMRO Dr Abdullah Assa'edi, Assistant Regional Director, WTF IO/EMRO Dr Zuhair HaIIaj, Director, Communicable Disease Control, WHO/EMRO Dr lIichcm Lafif, Director, Administrative and Finance, WHO/EMRO nr Rclgacrm Sabri, Dircctor, IIealth Systems and Services Dcvclopmcn t, WHOIEMRC) Dr Ibrahim Abdel Rahim, WHO Representative, Tunisia Llr Jnuuad Mahjour, W H O Kcprcscntative, Lebanon Ur Mubashar ria^ Sheikh, WHO 12cprcscnta tive, Islamic Republic of Iran Mr Kaiumars Khosh Chashm, Short-term Professional, Planning, Monitoring and Evaluation, WHOIEMRO Dr Akihiro Seita, Regional Adviser, Stop Tuberculosis, M7HOIEMRO Dr Sameen Siddicli, Regional Adviser, Health Policy and Planning, W HOlEMRO Dr Said Youssouf, Regional Adviser, Vaccinc I'rcventable Discases and Irnmuni~a tion, W HOlEMRO Ms Joanna Vogcl, Technical Officer, Women in Health and Dcvclopment, WHOlEMKO Dr Savcd Jaffar Hussain, Medics1 Officer, Hea 1 thy Lifestyle I'romo tion, WF IO/EMRO Dr Sr~san Watts, T~c1717icr71 Assistant, Hcal tll Polic-y and Planning, \YT IO/EMRO Dl. Et lgc~~io Kaul Villar, Coordinator Fro-Poor Hc,~lth I'olicics, MDGs Hei11 th and nrvelopn~t>nt Policy, WHO/HQ

lmalernentation of aovertv reduct~on strateales in the Eastern Mediterranean Realon

Dr Daher Aden, Medical Officer, Primary FIcalth Care, WRO/Somalic? Ms Kancia Ahmed, Basic Dcvclopmrnt Nerds Prcrgrnmmc Coordin~ tor, W ICC)/bgypt Dr Abdi Ahmed Mournin, Medical 0ftic.t.r I'rinldry Hc.alt11 Care, WRO/Afghanistan Dr Iman Sl~anklti, Technical Clfficcr, Community-based Initiatives, WIiO/Iray Dr Khushal Khan Taman, NationaI Programme Officer, WRO/i'akistan Dr Mohamrndd Assai, ICcgional Adviser, Community-tmscd Initiatives, WHO/EMRO Dr Mahlnood A f ~ a l , Short 'Term Consultant, WHOIEM IIC) Ms Tonia Rifaey, Short Term I'rofcssional, Community-based Initiatives, WHOlEMRO Ms Hala El Shazlv, Administrative Assistant, Office of the Assistant Rcgional Director, WHOIEMRC) Ms Noha Gamal, Sccrctary, Cnmmr~nity-based Init~ativcs, W HO/EMRO Ms Hala Urhan, Secretary, Women's Hcnlth and Ueveloprnent, WHOlEMRO

lrnplerr~entatron of poverty reduction strategies I r l the Eastern Medltcrranean Req~on

Annex 4

Working Group Documents

First working group: Analysis of enhancement of poverty reduction strategies at the country level

Thc following strntrgic directions for pro-poor I-teal th policies were adoptccl bv the Iitlgin~~cll Con~mittee, in 20n.3, in the prescnce of all i~~inistcrs of health:

1. ComLu t the diseases of the poor (tuberculosis, malaria, RIDS, lnalnutrition ctc)

2. Reducc thc financial burden of health carc on the poor 3. Improve thc irnpact/efficicncy of public hcalth ~cr-\~ices 4. Reallocate public resources in favour of poorer countries

and puorcr groups 5. Improve thc supplv and effectivt.17ess of nun-personal

public health services

PIcase discuss withr11 yuur wol-king group a) cnabling factors, b) weaknesses nncl c.) recluircd ~r~tcrventiuns r e l n t ~ ~ l to poverty recluction strategies in the countries of thc liegivr~ present ill

your group ancl trv to focus on factors related tu: a) policy formulatio17, b) planning stage, c) implemcntation and d) moni tnring proccsses.

enabling factors, c.g. strong politicaI commitment, priority given to tht. poor in th? nationaI ht.aIth policy, presence of functional I~ealth insurance systc-lm for the poor, high Ievcl of community awareness; weaknesses, e.g. 1 0 ~ access of the poor to quality h ~ a l t h carc srrvicrs, high bulden of communicable diseases, lorv socioeconc)mic st2 tus of the cntirc popc~lntion and luw humari clevelopmcnt index rating; interventions needed, c.g. awareness building througli serninars/rnnss r~~edia/yublic;l tiunsl excl~ange uf' cxpcri~nces, priority in resourcc allocntioi~ to t h ~ undcrpri\riIegcd arcas in national health poIicy.

Implementation of poverty reduction strategies in the Eastern Mediterranean Region

Kindly use the attached table to note the output of your discussions (analysis) this will facilitate easy prcscntation of the group disuussjons.

Analysis for enhancing poverty reduction strategic

Implementation of puverty reduct~on strategies In the Eastern Mediterranean Region

Second working group: Strengthening health initiatives through community-based initiatives at different levels

Hcalth status of the community can be improvecl through their active invoIvemcnt in the planning, implementation and monitoring processes. Rascd on the cliscussions wc had in the morning and in order to upscaIe the health status of the community, their roles and responsibilities need to be well identified. On the uthcr hand, different health related programmes nccd to cuordina tc and compliment their intervcntiuns. CRI has created an exccllcnt opportunity for the health sector, through organizing and mobilizing communities, to bc involved in their developmental process including health.

Co~widering the present status in different countries of the I<egion in your working group discus the: a) enabling factors, b) limitations and c) requircd interventions geared towards strengthening the h ~ a l th componcn t of CBI in the community, district and national levels.

Kindly use the attached table to note the output of disa~ssions (analysis) this will facilitate easy presentation of thc group discussions.

Strengthening health initiatives through community-based initiatives at different levels

Community

Enabling factors

Limitations

Required interventions/ actions

District/ provincial

National

lmplementat~on of poverly reduction strategies 111 the Eastern Mediterranean Reg~on

Third wurking group: outline pIans for operationalization of poverty reduction strategic directions through community- based initiatives in the Eastern Mediterranean Region (2006- 2007)

A s discussed i11 thc first working groups, the follo~ving strdtcgic dircctio~is for pro-p~)ur hedlth policies wcre approved L>v the R ~ g i o ~ i a l Committee in 2003:

1. Colnbat the diseases of the poor (tuberculosis, malaria, AIDS, malnutrition etc)

2. Rcducc thc fina~~cial burden of health care on the poor (insurance systrm)

3. Iinprovc thc i~np~~ct/efficicncy of pubIic I~calth services (quality of care)

4. Rrallocatc public rcsourccs in favour of poorer countries and poi)rer groups - s . Imyros~c t lv supply ,~nd effectivcncss of nun-personal public hcnltli serviccs

In order to make the approvrd strategic directions functinnnl; difiercnt activities arc expected to be ii-t~plcrnrr~tcd at thc national and Iocal Icvels. We have designcd a table for each policy and arc expecting thc working groups to discus and present thcir findings in thc attached tables. The plans for each policy may be broke11 down into: a) procducts, b) main nctivi ties, c) respunsibilities, d ) time frame and c ) rcqciireci rcsourccs for implementation of each individual pro-pour strntcgy.

lmplementat~on of poverty reduction strategies In the Eastern Med~terranean Reg~on

Outline plans for operationalization of poverty reduction strategic directions through community-based initiatives in the Eastern Mediterranean Region (2006-2007)

Outline pIans for operationalization of poverty reduction strategic directions through community-based initiatives in the Eastern Mediterranean Region (2006-2007)

"..

Combat the diseases of the poor (tuberculosis, maIaria, AIDS, malnutrition etc)

I Products

Outline plans for operationaliza tion of poverty reduction strategic directions through community-based initiatives in the Eastern Mediterranean Region (2006-2007)

Reduce the financial burden of health care on the poor

Improve the impactlefficiency of public health services

Main activities

Products

Who

Main activities

Products

When

Who

Main activities

Resources

-

When

Who

Resources

When Resources

- .-

Implementation of poverty reduction straleqles In the Eastern Mediterranean Region

Outline plans for operationaIiza tion of poverty reduction strategic directions through community-based initiatives in the Eastern Mediterranean Region (2006-2007)

Outline plans for operationalization of poverty reduction strategic directions through communi ty-based initiatives in the Eastern Mediterranean Region (2006-2007)

... , , ,- -- -

public resources in favour of poorer countries and poorer groups

Products

lmprove the supply and effectiveness of non-personal public health services

Who Main activities

,

products

.

When

Main activities

Resources

Who When Resources

Community 8md lnitiatim Unk World Health OrgonMon

Regional OfRce h r the Eastern Mediterranean RO. Box 7608 Nasr City

Cairo 11371, Egypt Tel: +2 (02) 670 2535

Fox: +2 (02) 670 2492/4