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Provisional summary record of the fourteenth meeting, WHO headquarters, Geneva, Thursday, 16 January 1986, at 9h30.
[Unpublished] 1986 Jan 16. 20 p. (EB77/SR/14)This document provides a progress and evaluation report of the Expanded Program on Immunization (EPI), a summary record of the 14th Meeting, held in Geneva, Switzerland during January 1986. Dr. Uthai Sudsukh began by saying that the Program Committee had undertaken a review and evaluation of immunization against the major infectious diseases in relation to the goal of health for all and primary health care. This was the second in a series of evaluations and reviews of World Health Organization (WHO) programs corresponding to the essential elements of primary health care. The Program Committee had requested the Secretariat to revise the progress and evaluation report in light of its observations as well as those of the EPI Global Advisory Group. The revised report was before members in document EB77/27, which contained a draft resolution proposed for submission to the 39th World Health Assembly in May 1986. Dr. Hyzler indicated that the revised report provided an excellent picture of the present situation, and he supported the recommendations of the EPI Global Advisory Committee and the draft resolution proposed for submission to the Health Assembly. The underlying concern that was expressed in the report was that EPI might become isolated as a vertical program at the expense of encouraging infrastructure development. Consequently, it was important to ensure that rapid increases in EPI coverage were sustained through mechanisms that also strengthened the delivery of other primary health care interventions. The efficiency of EPI was linked closely to the efficacy of maternal and child health services. The real commitment to the success of immunization that was needed was that of the health workers providing day-to-day care to mothers and children and their families. Those countries that had realized the most progress in immunization had done so because of a very strong maternal and child health component in their national health services. Dr. Otoo made the point that 1 of the major constraints in EPI programming was the shortage of managerial skills and that more effort must be made to improve managerial capabilities. Comments of other participants in the 14th Meeting are included in this summary document.
Washington, D.C., World Bank, Population, Health and Nutrition Dept., 1986 Dec 31. 124 p.In the current environment of general budget stringency in developing countries, it is unrealistic to push for more public spending for health services. The answer to this health crisis is to relieve government of much of the responsibility for financing those kinds of health services for which the benefits to society as a whole (as opposed to direct benefits to the users of the service) are low, freeing public resources to finance those services for which benefits are high. The intent is to relieve government of the burden of spending on health care for the rich, freeing public resources for more spending for the poor. Individuals with sufficient income should pay for their curative care. The financing and provision of these "private" health services should be shifted to a combination of the nongovernment sector and a public sector reorganized to be more financially self-sufficient. A shift such as this would increase the public resources available for those types of health services which are "public goods" and currently are underfunded "public" health programs, such as immunization, vector control, some prenatal and maternal care, sanitary waste disposal, and health education. Also such a shift would increase the public resources available for simple curative care and referral for the poor who now only have limited access to low quality services of this nature. Government efforts to cover the full costs of health care for everyone from general public revenues have contributed to 3 sets of problems in the health systems of many countries: an allocation problem -- insufficient spending on cost-effective health activities; an internal efficiency problem -- inefficient public programs; and an equity problem -- inequitable distribution of benefits from health services. 4 policies for health financing are proposed to raise revenues for important health programs, increase the efficiency of public health services, and make the system better serve the poor. These are: charging users of public health facilities; providing insurance or other risk coverage; strengthening nongovernmental health activities; and decentralizing government health services. A table summarizes the effects of each of the 4 options for reform in alleviating health sector problems.
Washington, D.C., Academy for Educational Development, 1986 Dec. 14 p. (25th Anniversary Seminar Series)This paper, delivered as part of the Academy for Educational Development's 25th Anniversary Seminar Series, outlines the World Health Organization (WHO) view of acquired immunodeficiency syndrome (AIDS) as a public health problem of paramount international importance. AIDS is transmitted sexually, through blood, and from mother to child. The combination of sexual and perinatal transmission allows identification of sexually active, pregnant women as a group at potential risk. There are currently about 36,000 reported cases of AIDS throughout the world, of which 30,000 are from the Americas. Overall, the AIDS cases come from 78 countries representing all continents. A major question for the future concerns the situation in Asia, where there are currently a small number of cases. The only strategy for preventing AIDS is monogamous sex with single partners over long periods of time, without prostitution and intravenous drug abuse. AIDS particularly threatens the health gains that have been achieved in the developing world and its control must be anchored in the context of primary health care. WHO is aggressively pursuing the function on coordinating the international exchange of information on AIDS. WHO is, in addition, helping countries to organize their own national AIDS prevention and control programs. The solution to the AIDS crisis will be a blend of technological and social advances, and the cutting edge will be education. WHO projects that US$1.5 billion/year will be required to conduct the WHO component of the global campaign against AIDS.
HEALTH POLICY AND PLANNING. 1986 Mar; 1(1):37-47.This economic analysis assesses the probable costs of implementing various activities of the World Health Organization's (WHO's) global strategy of "health for all by the year 2000" and the likelihood that developing countries will be able to afford these costs, either on their own or with the assistance of developed countries. If this policy is to be transformed into concrete results, there must be a plan complete with budgetary requirements, planned activities, and expected results specified in adequate detail. The overall costs of the activities proposed by the global strategy would amount to approximately 5% of the gross national product of most developing countries, with water supplies and primary health care comprising the most expensive activities. Although there is a good match between estimated resource requirements and planned activities, the desired outcomes are often unlikely to result from the activities proposed. At present, all 25 industrial market and nonmarket industrial developed countries have already achieved the outcome goals of the global strategy; however, these countries account for only 25% of the world's population. Of the 63 middle-income countries, 54 have already achieved a gross national product per capita of over US$500, but only 22 have an infant mortality rate better than 50/1000. Very few low-income countries are close to reaching their targets for income, infant mortality, life expectancy, or literacy. On the basis of current trends, 25-33% of countries are considered unlikely to achieve the outcome goals by the year 2000. In general, it appears that expenditure targets are too low to cover the needed health services activities. Further research on the costs of health promoting activities such as immunization and primary health care should be given high priority.
Lancet. 1986 Jan 25; 1(8474):223.This article summarizes the conclusions and recommendations of a joint UNICEF/WHO consultation on primary health care in urban areas. The meeting, which was held in Guayaquil, Ecuador, in October 1984, was attended by representatives from 9 countries: Brazil, Colombia, Ecuador, Ethiopia, Guatemala, India, Philippines, Republic of Korea, and Peru. 5 priorities were emphasized: the need for comprehensive rather than partial coverage, the use of simple 1st-line remedies such as oral rehydration, the reallocation of resources, intersectoral and interinstitutional collaboration, and the supporting responsibility of governments and international agencies. Community participation is an essential component of primary health care. Once the process of community development is launched, the balance within the existing health care system must be adjusted to prepare for the explosive tempo of urbanization. Cities, regions, and countries must move with sustained determination toward full primary health care coverage for the urban poor. Ongoing close collaboration between UNICEF and WHO is of great importance to the future of primary health care. Specifically, the consultation recommended: 1) consciousness raising activities to make governments, the world public, international organizations, and nongovernmental organizations aware of the scale of the need; 2) continuing support to projects and the informal network of people dedicated to the development of primary health care and the subsequent transformation of health systems; and 3) help with scaling up the health care system.
International Journal of Health Services. 1986; 16(1):121-39.This article analyzes the patterns of health sector aid to India since 1947, summarizing criticisms such as the extension of dependency relationships, inappropriate use of techniques and models (maintenance costs of large projects are often too high for poor undeveloped countries), and Malthusianism in population programs. The major source of foreign assistance has been the US, amounting to US$107 million from 1950-1973; this figure is broken down to detail which foundations and agencies provided assistance, and how much, over this time period. Foreign assistance for family planning is also discussed. Most health policies adopted in India today predate independence and were present in plans established by the British. New patterns in health aid are described, such as funding made available in local currency to be spent on primary care and especially maternal and child health. The focus of foreign aid has been preventive in emphasis and oriented towards the primary care sector. In some periods it has contributed a substantial share of total public sector expenditures, and in some spheres, it has played a major role, particularly the control of communicable diseases. However, the impact of less substantial sums going to prestige medical colleges or to population control programs should not be ignored. Several aid categories have been of dubious origin (PL-480 counterpart funds and US food surpluses as the prime examples). However, the new health aid programs do not deserve the ready dismissal they have received in some quarters.