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Global Health in Transition: A Synthesis: Perspectives from International Organizations Ninth General Programme of Work, 1996–2001 and Intensified Cooperation with Countries in Greatest Need Ninth General Programme of Work, 1996–2001 World Health Organization. 1994. Ninth General Programme of Work: Covering the Period 1996–2001 (Health for All Series, No. 11). Geneva: World Health Organization. This is the third of three General Programmes of Work since the resolution on Health for All was adopted by the World Health Assembly in 1977. It has two functions. First, in the context of the Health for All strategy, it defines the policy framework for world action during the period 1996–2001. Second, it sets the framework for program development and management for WHO itself during that period. Both frameworks take into consideration progress made during the Seventh and Eighth General Programmes of Work in development, trends in health status, and changing health system needs. OBJECTIVES To reaffirm WHO's commitment to the principles of health for all. To set global targets for major health-related problems. To identify the major policy issues for the world and for the WHO. CONCLUSIONS Inequities in health status and access to health care persist between and within countries, and their reduction is essential. One of the most important global trends has been democratiza
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Global Health in Transition: A Synthesis: Perspectives from International Organizations tion of political systems and a greater participation of people in determining their own future. Growing concern is expressed about the adverse health effects of environmental degradation, pollution, diminishing natural resources, and global climatic change. Gains in health status and coverage are notable worldwide. Still, although the disparities between developed and developing countries are narrower, those between developing and least-developed countries have widened. The increasing costs of health care, coinciding with global economic problems, have prompted many countries to explore new financing mechanisms. RECOMMENDATIONS FOR POLICY AND ACTION Collaborative efforts must be intensified if disease elimination and control targets for the year 1995 (neonatal tetanus) and targets for the year 2000 (poliomyelitis, dracunculiasis, leprosy, and measles) are to be met. Three types of more specific regional and national disease control targets for the most common health problems will need to be set within the framework of the Ninth General Programme of Work: health status targets for reducing mortality, morbidity, disability, and health risks; health services targets for good-quality care and services; and policy targets for all countries for adopting policies and strategies and implementing action plans in areas that also act as health determinants: living and environmental conditions, behavior favoring health, and health systems. Sustained world action is called for if the following four aspects of policy are to be realized: integrating health and human development; ensuring equitable access to good-quality health care; promoting and protecting health; and preventing and controlling specific health problems.
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Global Health in Transition: A Synthesis: Perspectives from International Organizations Intensified Cooperation with Countries in Greatest Need Division of Intensified Cooperation with Countries (ICO). 1995. Report on Activities 1990–1994. Geneva: World Health Organization. In 1989, the WHO, its governing bodies, and its secretariat decided to take urgent action with respect to the growing worldwide inequities in health status and access to health care. This commitment was then translated into an initiative called Intensified Cooperation with Countries in Greatest Need. The WHO Director General created a special division dedicated to this initiative, with the necessary institutional authority and management capacity. That division is now involved in 28 of the least-developed countries. OBJECTIVES To formulate and implement policies and plans for health development reform, to correct inequities, and to lead to sustainable health development for the most needy groups. To improve financing and management of health systems at all levels, with emphasis on the most disadvantaged groups, peripheral areas, and universal access to basic health services. To more effectively mobilize, coordinate, and manage external resources. CONCLUSIONS As the program of Intensified Cooperation with Countries in Greatest Need has evolved, it has taken a “horizontal” and nonmedical approach, in contrast to a “vertical,” disease-specific approach. It is also a demand-oriented initiative based on the particular needs of each country, in contrast to WHO's global programs and its major involvement at the central and regional levels. Thus far, the initiative has placed primary emphasis on strengthening the health sectors in the poorest countries. It has become increasingly evident, however, that halting and reversing the decline in health status requires as a complement a strong and highly focused attack on poverty and its health consequences.
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Global Health in Transition: A Synthesis: Perspectives from International Organizations RECOMMENDATIONS FOR POLICY AND ACTION The next phase of the initiative will require a more comprehensive approach based on ensuring that the poorest, most vulnerable groups have access to primary health care through expansion of basic health services and more emphasis on community involvement, so that they can take action on their own behalf; protecting the poorest from risks to health that are beyond their control by using multisectoral strategies; and promoting a strong commitment on the part of leaders in the poorest countries to the health of their populations, including assumption of responsibility for monitoring reductions in health inequities. Experiences with this initiative in specific countries will provide the basis for promoting a policy for health development in the neediest countries, toward three broad objectives: to provide technical information and insight to policy makers and development experts; to communicate to the general public the nature and seriousness of the health consequences of poverty, as well as the sorts of policies and actions required to address them; and to emphasize the solidarity required for ensuring greater attention to health in overall human development, as well as the political commitment required to reverse the downward trend in donor funding allocations. COMMENTARY These two WHO documents bring to this Synthesis two critically important emphases: A global approach to assessment of health-related matters, target setting for improving health and health services, and establishment of norms or standards for provision of health care services, such that they are equitable and efficient and involve people in their provision and evaluation. A country-specific approach to building the capacities required to set and implement policies appropriate to health development, particularly for countries in greatest need.
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Global Health in Transition: A Synthesis: Perspectives from International Organizations A relatively new initiative, Intensified Cooperation with Countries in Greatest Need rests on the principles that there are no universal prescriptions and that development is the product of local capacities. The one principle that is universal, however, is that poverty is the most fundamental obstacle to health and overall development and is a permanent menace to world peace. This brings WHO closer to the United Nations Children's Fund triad of poverty, population growth, and environmental degradation as humankind's greatest challenges. The Ninth General Programme of Work sets directions for global health policies in normative and country-specific terms. The 1995 World Health Assembly approved a conceptual framework and time-table for developing a New Global Health Policy based on equity and solidarity as the pivotal process for renewing WHO's Health for All strategy. In 1995 the World Health Assembly proposed the development of a New Global Health Policy, with the intent of achieving high-level political endorsement of a global health charter at the World Health Assembly in 1998. Based on equity and solidarity, the new policy would be pivotal in renewing WHO's Health for All strategy. WHO is inviting widespread contributions, from its member states, international organizations, and all interested parties, to the formulation of this Global Health Policy. Given WHO's mandate for coordinating global approaches to health development, this process could be critical in bringing greater coherence and consolidation to the health-related commitments of the international community.
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