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-An Executive Summary of the WHO's
Draft Policy Health for All (HFA) in the 21st Century
aims to help realize the vision of Health for All,
launched at the Alma-Ata Conference in 1978. It sets out,
for the first two decades of the 21st century, global
priorities and targets which will create the conditions
for people worldwide to reach and maintain the highest
attainable level of health throughout their lives.
Health for All in the 21st Century is a continuation of
the HFA process. It builds on past achievements, guides
action and policy for health at all levels
(international, regional, national and local). Most of
all, it takes account of the dramatic global changes of
the past 20 years. It is the result of an extensive and
inclusive process of consultation with and within
countries - a process essential to creating ownership of
the policy, and thereby helping ensure its implementation
by all partners.
Over the past two decades primary health care (PHC), as
the cornerstone of Health for All, has provided impetus
and energy to progress towards HFA. Despite gains,
however, progress has been hampered for several reasons,
including insufficient political commitment to the
implementation of Health for All, slow socioeconomic
development, difficulty in achieving intersectoral action
for health, insufficient funding for health, rapid
demographic and epidemiological changes, and natural and
man-made disasters. Further, poverty has increased
worldwide. Health has suffered most where countries have
been unable to secure adequate income levels for all.
Although the 21st century faces new threats, new
opportunities and approaches to overcome them are
becoming available. Globalization of trade, travel,
technology and communication could yield substantial
benefits, provided serious potential adverse effects are
addressed. Global environmental hazards require urgent
attention. New technologies could transform health
systems and improve health. Stronger partnerships for
health between private and public sectors and civil
society could lead to stronger joint action in support of
HFA.
NEW TRENDS
INFLUENCING HEALTH IN THE 21ST CENTURY
- Widespread
absolute and relative poverty.
- Demographic
changes: aging and the growth of cities.
- Epidemiological
changes: continuing high incidence of
infectious diseases; increasing incidence
of noncommunicable diseases, injuries and
violence.
- Global
environmental threats to human survival.
- New
technologies: information and
telemedicine services.
- Advances in
biotechnology.
- Evolving
partnerships for health that include the
private and public sectors and civil
society.
- Globalization
of trade, travel and the spread of values
and ideas.
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The
realization of the goals of HFA depends of bolstering
commitment to key values through: provision of the
highest attainable standard of health as a fundamental
right; continued and strengthened application of
ethics to health policy, research and service provision,
implementation of equity-oriented policies and strategies
that emphasize solidarity; and incorporation of a gender
perspective into health policies and strategies.
The values are strongly linked, each serving to underpin
the execution of policy and strategies.
Goals and targets help define the vision of HFA. The
goals of HFA are to achieve an increase in life
expectancy and in the quality of life for all; to improve
equity in health between and within countries; and to
ensure access for all to sustainable health systems and
services. Targets are defined to spur action and to set
priorities for resource allocation. The global targets in
support of Health for All reflect earlier HFA targets and
are in line with those agreed at recent world
conferences. Targets related to health policies and
systems need to be met if action on the determinants of
health is to lead to improved health outcomes and access
to care. Achieving these targets will ensure that the
goals of HFA are met.
An initial set of targets will guide the implementation
of the HFA policy and define priorities for action for
the first two decades of the next century. Specific
indicators of progress will be developed for the global
health targets. Regional and national targets will be
developed within the framework of the global policy, and
will reflect the diversity of needs and priorities. They
should be measurable, time- bound, and feasible, and will
need to be supported by adequate resources. All targets
should be reviewed periodically. Indicators will be used
to assess the degree of progress being made towards the
attainment of the goals and targets, as indispensable
aids to effective monitoring and evaluation of
programmes.
GOALS AND TARGETS
OF HFA
Goals and targets
help define the vision of HFA. Indicators assess
the degree of progress. The goals of HFA are:
- an increase
in life expectancy and improvement in the
quality of life for all;
- improved
equity in health between and within
countries;
- access for
all to sustainable health systems and
services.
Health
Outcomes
By 2005, health equity indices will be
used within and between countries as a basis for
promoting and monitoring equity in health.
Initially, equity will be assessed on the basis
of a measure of child growth: the percentage of
children under five years who are stunted, should
be less than 20% in all countries and in all
specific subgroups within countries by the year
2020.
Maternal mortality rates (MMR), under-five or
child mortality rates (CMR) and life expectancy
will be met (i.e. MMR less than 100 per 100000
births; CMR - less than 45 per 1000 live births,
life expectancy at birth - over 70 years for all
countries). Chagas disease will be eradi cated by
2010 and measles by 2020; neonatal tetanus and
leprosy will be eliminated by 2010, and trachoma
by 2020. In addition, vitamin A and iodine
deficiencies will be eliminated before 2020.
By 2020, the worldwide burden of disease will be
substantially decreased. This will be achieved by
implementation of sound disease-control
programmes aimed at reversing the current trends
of increasing incidence and disability caused by
tuberculosis, HIV/AIDS, malaria, tobacco- related
diseases and violence/trauma.
Intersectoral
Action on the Determinants of Health
By 2020, all countries, through
intersectoral action, will have made major
progress in making available safe drinking-water,
adequate sanitation, food and shelter in
sufficient quantity and quality. By 2020, all
countries will have introduced, and be actively
managing and monitoring, strategies that
strengthen health-enhancing lifestyles and weaken
health-damaging ones, through a combination of
regulatory, economic, educational, organizational
and community based programmes.
By 2005, all Member States will have developed,
and will be implementing and monitoring, policies
that are consistent with this HFA policy. By
2010, all people will have access throughout
their lives to high-quality, comprehensive
essential health care. By 2010, global and
national surveillance and alert systems,
supported by the use of communications
technology, will permit rapid and wide
dissemination of information about current and
impending transnational threats to health.
By 2010, all countries will have established a
health information system that enables them to
monitor and evaluate their health situation, the
performance of their health services and the
impact of their policies. By 2010, research
policies and institutional mechanisms (including
ethical review processes) that support
capacity-building, innovation in research,
partnerships between stakeholders and
science-based decision-making will be operational
at regional and country levels.
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Actions by
all Member States. To realize the goals of Health for All
states need to be guided by two policy objectives: making
health central to human development, and developing
sustainable health systems to meet the needs of people.
In implementing the former objective, it is acknowledged
that good health is both a resource for, and an aim of,
development. Further, the health of people, particularly
the most vulnerable, is an indicator of the soundness of
development policies. Lines of action that address the
determinants of health aim to combat poverty, promote
health in all settings, align sectoral policies of health
and ensure that health is included in sustainable
development planning.
Health systems must be able to respond to the health and
social needs of people over their life span. To do this,
sustainable health systems will be developed that
guarantee equity of access to essential health functions.
These functions include making quality care available
across the life span; preventing and controlling disease,
and protecting health, promoting legislation and
regulations in support of health systems; developing
health information systems and ensuring active
surveillance; fostering the use of, and innovation in,
health-related science and technology; building and
maintaining human resources for health; and securing
adequate and sustainable financing. A socially sensitive
health system will take into account the economic,
sociocultural and spiritual values and needs of
individuals.
The roles of WHO and governments will be decisive in
ensuring that the policy leads to substantial
improvements in health. Governments will need to develop
and implement policies coherent with HFA values. As the
world’s health conscience, WHO will provide
leadership for the attainment of Health for All. WHO will
promote international collective action for health by
developing global ethical and scientific norms and
standards; international instruments that promote global
health; facilitating technical cooperation among
countries; strengthening decision-making developing
appropriate health information systems; establishing
active surveillance systems; strengthening global
research capacity; providing leadership for the
eradication, elimination and control of selected
diseases; and providing technical support to prevention
of public health emergencies and helping post-emergency
rehabilitation.
NEW APPROACHES TO
DEVELOPMENT
These news
approaches have been evolved from eight World
Conferences, in which WHO participated actively,
convened between 1990 and 1996 to address some of
the world’s most pressing problems. These
meetings have achieved a global consensus on the
priorities for a new future development agenda,
including explicit support to the attainment of
Health for All as a priority:
- Development
should be centred on human beings.
- Central goals
of development include the eradication of
poverty, the fulfillment of the basic
needs of all people and the protection of
human rights.
- Investments
in health, education and training are
critical to the development of human
resources.
- The
improvement of the status of women,
including their empowerment, is central
to all efforts to reach sustainable
development in all of its economic,
social and environmental dimensions.
- Diversion of
resources away from social priorities
should be avoided.
- An open and
equitable framework for trade, investment
and technology transfer is critical for
the promotion of sustained economic
growth.
- While the
private sector isvital for economic
development, governments should take an
active part in formulating, regulating
and monitoring health, social and
environmental policies.
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Progress from
policy to action requires dynamic leadership, public
participation and support, a clear sense of purpose and
adequate resources. To support the process of change,
specific attention will be given to strengthening
policy-making capacity; developing systems of good
governance; setting priorities at various levels;
strengthening and broadening partnerships for health; and
implementing evaluation and monitoring systems.
Jamkhed Institute of
Training and Research in Community-Based Health
and Population
DIPLOMA
IN COMMUNITY-BASED HEALTH AND DEVELOPMENT
Duration : 3
months 7th September 1998 to 6th December
1998
Place : Jamkhed
Eligibility : Doctors (Allopathy,
Homeopathy etc.), Nurses, Social Workers or
Basic Graduate degree holders involved in
community health. Ability to communicate in
English is essential.
Unique Features of the Course :
Active participation of trainees, community
involvement in teaching, academic back-up, field
experience with "on hand" training.
Doctors
committed to rural work are eligible for
scholarships
Apply
for prospectus to :
Director, Comprehensive Rural Health Project
Jamkhed 413 201, Dist. Ahmednagar, Maharashtra
Fax: (02421) 21034 • Ph.: (02421) 21322,
21323
u Comprehensive Rural Health Project is
affiliated with Pune University for Research.
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HELP LAUNCHES
PRESCRIPTION FOR INFORMATION CAMPAIGN
Patient education
is becoming an increasingly important part of
medical practice worldwide. But busy doctors
simply do not have time. In order to help doctors
to ‘prescribe information, HELP - Health
Education Library for People - has started a
Prescription for Information Campaign in India.
HELP has printed Information Prescription pads
which are available free to doctors on request.
HELP has also made entry for all doctors and
patients free.
In the past patients in India had difficulty
getting reliable information about their medical
problem in everyday language. This is now easily
available at HELP, Om Chambers, Kemps Corner,
Bombay 400 036, India’s first Health
Education Resource Centre. HELP has access to
information on every health and medical topic
under the sun - explained in a layman’s
language. HELP has an Internet connection at http://www.healthlibrary.com providing information on
the latest medical research from all over the
world. "Health for the Millions" is
also available at this website.
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