managerial process for national health development
TRANSCRIPT
WHO-EM/MG/7
MANAGERIAL PROCESS FOR NATIONAL
HEALTH DEVELOPMENT
Report of an lntercountry Workshop
Damascus, Syrian Arab Republic,
15 - 25 September 1984
\VORLD HEALTH ORGANIZATION
EASTERN MEDITERRANEAN REGION
1985
WHO-EM/MG/7
January 1985
MANAGERIAL PROCESS FOR NATIONAL HEALTH DE,n:LOPMENT
Report of an Intercountry Workshop
Damascus, Syrian Arab Republic, 15-25 September 1984
(Meeting reference: WHO-EM/INT.WKP.MPNHD/3)
EDITORIAL .aT!
The issue of this document does not conatltute fonaal publication.
The manullcdpt has only been modified to the extent necea1at"y for proper comprehension. The views expreued, however, do not necessarlly reflect the official policy.of the World Health Organizatlon.
the designations employed and the pruent.atlon of the material ln this document do not imply the expression of any oplnlon whatsoever on the part of the Secretarial of the Organization concerning the legal status of any country, territory, city or area or of its authorities, or concet'Jl,ing the delimitation of its frontiers or boundaries.
TABLE OF CONTENTS
'WHO-EM/MG/7 'WHO-EM/INT.WKP.MPN HD/3
1. INTRODUCTICltl •• , ••••••••••••••••••••• • ••••••••••• •....... • • • 1
2. OBJECTIVES OF THE WORKSHOP ••••••••••••••••••••••••••••••••• 2 3. ORG.A..�IZATICN OF THE WORKSHOP A."'ID THE METHOD OF WORK •• • • , • • • 3
4. PROGRAMME OF WORK AND WORKING SCHEDULE ••••••••••••••••••,•• 5
5. t'.AR.TICIP.AfrrS ••••••••••••••• · •••• , ••• , ••••••••••••••• � •• ,.... S
6. LANGUAGE OF THE WOF.KSHOP ••••••••••••••••••••••••••••••••••• 5
7. INAUGURAL CEREMONY (SESSION I) •••••• • ••• •. • •••• •. •... • • • • • • 5
8. INTRODUCTION TO MPNHD (SESSION II) ••••••••••••••••••••••••• 5
9. PROBLEM-BASED METHODOLOGY (SESSION II) ••••••••••••••••••••• 6
10. HEALTH POLICY FORMULATION (SESSION III) •••••••••••••••••••• 6 1 1. INFORMATION SUPPORT FOR MPN1ID (SESSION IV) ••••••••••••••••• 8
12. MECHANISMS FOR ENSURING CONTINUITY IN THE MANAGERIAL PROCESS (SESSION V) ••••••••••••••••••••••••••••• 10
13. INTRODUCTION TO BROAD HEALTH PROGRAMMING (SESSION VI)
14. PROGRAMME BUDGETING: ALLOCATION OF HEALTH RESOURCES . . . . . . 12
(SESSION VII) •.•...•••.••.•.••.•••.•.•. : , .••. • .•.•. • •• • •• ,. . 15
15. FORMULATION OF NATIONAL PLAN OF ACTION FOR HEALTH FOR ALL (SESSION VIII) .••.•••... · •••••••••••••••.••••••• •.. • • • • • • • • • 17
16. DETAILED PROGRAMMING (SESSION IX) •••••••••••••••••••••••••• 20
17. PROGRAMME IMPLEMENTATION: PROGRAMME OPERATION AND INTEGRATION {SESSION X) •••••••••••••••••••••••••••••••••••• 21
18. MONITORrnG AND EVALUATICN OF NATIONAL STRATEGIES FOR HEALTH FOR ALL (SESSION XI) •••••••••••••••••••••••••••••••• 22
19. NATIONAL ACTION TO STRENGTHEN MPNHD AND USE OF TCDC MECHANISMS IN SUPPORT OF THE APPLICATION OF MPNHD (SESSION XII) • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 23
20. WHO TECHNICAL COOPERATI0!-1 IN SUPPORT OF MPNHD •• •........... 25
21. EVALUATION EXERCISE •••••••••••••••••••••,•••••••••••••••••• 26
22. CLOSURE OF THE WORKSHOP •••·•••••••••••••••••••••••••••••••• 29
ANNEX l
ANNEX lI
ANUEX III
LIST OF PARTICIPANTS • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 31
PROGRAMME OF WORK ••••••••••••••••••••••••••••••••••• 35
QUESTIONNAIRE FOR EVALUATION OF THE WORKSHOP •••••• , • 40
1. INTRODUCTION
WHO-EM/MG/7 WHO-EM/INT. WKP .MPNHD/3 page l
The Intercountry Workshop on the Managerial Process for National Health
Development held in Damascus, Syrian Arab Republic, from 15 - 25 September 1984
was hosted by the Government of Syria in collaboration with the World Health
Organization, Region.al Office for the Eastern Mediterranean Region.
This Workshop was one of several that have been organized in this Region
over the last tlolO years for senior health officals from the countries of the
Region, in support of the formulation and implementation of national strategy
for Health For All. The Inaugural Session was attended by His Excellency the
Minister of Health of the Syrian Arab Republic and officials representing the
Ministry of Health, other ministries of the Government, Parliament, universities,
educational and research institutions •from Damascus.
The participants of this Workshop were addressed ·by His Excellency
Dr Ghasoub El Rifai, Minister of Health of the Syrian Arab Republic on behalf
of the Host Government and Dr c. Vukmanovic, Responsible Officer for the Manager
ial Process for National Health Development, WHO read the message on behalf of
Dr Hussein A. Gezairy, Regional Dir�ctor for the Eastern Mediterranean Region,
wishing all participants successful deliberations during this important Workshop.
Dr Nazmy Falouh. Assistant Minister of Health of the Syrian Arab Republic
was elected Chairman of the Workshop and Dr I. Al Khawashky. Regional Adviser,
Organization of Health Care Services. Eastern Mediterranean Region, as Rapporteur.
The Workshop.was attended by 21 participants from 7 countries of the Region
and WHO staff from the Eastern Mediterranean Region.
WHO-EM/MG/7 WHO-EM/INT.WKP.MPNHD/3 page 2
The aim of this Workshop was to collectively learn and exchange experiences
on the concepts, principles, method• and procedures of an integrated Managerial
Process for National Health Development and it1 IDB.in component parts, and to pro
mote further understanding and increase capability of the participants to identify,
understand and define social, political, e�onomic, 0rgani1ational, technical and administrative issues. problems and constraint■ when applying the proce■s to the
formulation and implementation of national strategies and plans of action for
Health For All.
It is expected that thi1 lntercountry Wotk1hop en the Managerial Proce■■ for
National Health Development will stimulate national action 10 that similar work
shops will be organized nationally,fOT national leadership for health development representing health and other sectors of government as well as interested group■
and conmJnities, as an entry point for furthtr developing and strengthening national
managerial capabilities in support of national health systems based on Primary
Health Care and for the 1cti9ns required to support n�tional etrategies and plans
of action for Health For All.
2. OBJECTIVES 01' THE WORKSHOP
2.1. General Objectives
The general objectives were to promote further development of an integrated
managerial process for national health developllll!nt and to exchange experiences on
its use in the participating countries, with a view to ensuring its proper applica
tion in support of the formulation and implementation of national strategies and
plans of action for Health For All by the Year 2000.
2.2. Specific Objectives of the Workshop
In the light of using MPNlID as a critical tool fot the formulition and i111Ple
mentation of national strategies for Health for All by the Year 2000, the specific
objectives of the Workshop weret
WHO-EM/MG/7 WHO-EM/INT�WKP.MPNHD/ 3 p�e 3
(a) To analyse the accumulated experience in MPNHD, the current developments
and accomplishments, and to share experiences about important social,
economic, political 1 technical, organizational and administrative issues,
problems and constraints pertaining to the process when used in support
of Health for All,
(b) To practice the application of MPNHD and its various components in support
of the formulation and implementation of strategies for Health For All.
(c) To review the current methodology in use for MPNHD and to promote the
development of national guidelines for the integrated managerial process
for national health development.
(d) To stimulate countries to produce operational plans for systematic monitor
ing and evaluation of national •trategies and plans of ·action for Health
for All as a part of the ·application of the managerial process.
{e) To identify ways of using Technical Cooperation between Developing countries (TCDC) mechanisms to strengthen countries' capacities for
applying the managerial process.
3. ORGANIZATION OF THE WORKSHOP AND THE METHOD OF WORK
The Workshop was organized in 12 sessions and 11 exercises reflecting all major
components of the Managerial Process for National Health Development and its use in
support of formulation and implementation of national strategies and plans of action
for Health For All.
The work proceeded in plenaries and working groups. There were no formal lec
tures during the Workshop. The organization of the Workshop was therefore planned
to allow maximum flexibility for group interactions. sharing experiences among parti
cipants on the important items under discussion and putting into practice the knowledge
acquired individually during preparation for various sessions and collectively in
group dynamics in working groups were held every morning and some afternoons with the grou? dynamics in workin� group■ and in plenaries. Sessions in the form of plenaries
and working group■ were held every morning and some afternoons with the purpose of
engaging all participants in collective work on the proposed sessions and it related
exercises.
WHO-EM/MG/ 7 WHO-EM/INT.WKP.MPNHD/3 page 4
For each new session, there was an initial plenary which was used by workshop
moderators for briefing working groups on the objectives of. that particular session
and exercises scheduled in response to the objectives, and to give participants a
sense of direction on the group work as well as to raise questions for clarification.
The work then proceeded in working group, heavily relying on active participation of
all participants and their contributions to the work of the groups, sharing their
experiences from their own countries. thus facilitating the process of learning from
each other, and making comparisons of the lessons learned. allowing for general obser
vations as a part of various country experience.
The outcome of working groups' discussions was reported in summing-up plenaries
for each session. A rapporteur frpm each working group, appointed in turn. supported by
the chairman of its working group. was requested to present -a group solution to the
assigned task of each group . Following the presentations from working groups 1 there
was general discussions in plenary. Finally. where appropriate, the moderator of the
session summarized the main outcome of the session: concepts. principles, methods,
techniques, processes, and solutions recommended during the discussion.
tn non-structured time some afternoons and in the evenings, participants were
assigned to reading the background documentation and preparing themselves for the
work of the following day.
The role of moderators was to structure discussions during plenary sessions and
-working groups and to keep the workshop proceedings within the framework of the accep
ted programme of work, ensuring that the objectives of the Workshop were achieved.
Each working group was also observed by the moderators and feedback was provided on
the various dimensions of the group dynamics. This was considered necessary to develop
sensitivity on the part of each participant on how to lead working groups in an effec
tive and efficient manner. The Chairman and the Rapporteur from the working groups were also provided hints on methods of making effective presentations. At the end
of the Workshop an evaluation of the outcome of the Workshop was conducted by all
participants. (Annex III).
4. PROGRAM'tE OF YORK AND tJORKING SCHEDULE
The detailed programme of work is provided in Annex II,
5. PARTICIPANTS
WHO-EM/MG/7 WHO-EM/INT.WKP.MPNHD/3 page 5
21 �articipants and S observers from the Ministry of Health of the Government
of the Syrian Arab Republic attended the Workshop. There were 14 participants from
seven countries from the Eastern Mediterrinean Region and 7 participants from the
Regional Office. WPCs and field staff, (Annex I)
6. LANGUAGE OF THE YORKSHOP
The working language of the Workshop was English. A concerted.effort was made
to allow, the host participants to speak in Arabic to facilitate their maxinum parti
cipation. Fellow Arabic-speaking participants then provided English translation to
the rest of the Group. The Regional Office has already extended the offe� to support
simultaneous translation; however, due to unavoidable circumstances, the host country
was unable to locate suitable resource persons.
7. nJAUGUF.AL CEREMONY (SESSION I)
The Inaugural Session took place in Al-cbam Hotel Damascus at 10.00 a.m.
On Saturday, 15 September 1984, the ·Opening Address was given by His Excellency
Dr Ghasoub El Rifai, Ministry of Health of the Syrian Arab Republic and
Dr C. Vukmanovic, Responsible Officer of the Managerial Process for National Health
Development, WHO Geneva read the Message to participants on behalf of
Dr Hussein A. Gezairy, Regional Director for the Eastern Mediterranean Region. The
Inaugural Session was followed by the Introduction o! participants, adoption of
Workshop objectives and Workshop procedures.
8. INTRODUCTION TO MPNRD (SESSICN II)
An overall introduction to the Managerial Process for National Health Develop
ment and its use for the formulation and implementation of national strategies for
Health For All was given followed by explanation of methodology and terminology in
use for the Managerial Process.
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9. PROBLEM-BASED METIIODOLOGY (SESSION II)
A brief overview was provided concerning the use of problem-based methodology
in training leaders and managers in the process of MPNHD. It was emphasized that
cases/problems relevant to country situations would be used to illustrate the applic
cation of concepts covered in the background readings during the plenary and working
groups.
10. HEALTH POLICY FORT-fULATION (SESSION III)
This session covered content, agents, processes and mechanil!lllls required to ensure
that the development and control of national health policies, strategies and plans of
action for Health For All are being formulated as integral parts of policy-making
mechanisms concerned with socio-economic d�velopment at the highest government level.
The three working groups were consequently asked to review and share experience
among participants on the important steps being taken in their own countries to
translate policies for Health For All into national reality. (See Exercise 1) .
There were nine specific issues addressed in working groups' exercises and the
synthesis of their findings were reflected in plenary discussion. The following
points were particularly raised in this discussion :
(1) It was stated that all countries represented in the Workshop have ascertained
initial political commitment to Health For All th_rough Government declaration
or announcement of this Policy by the Presidents of countries, It was however
realized that major efforts are required to translate their initial commitment
into reality.
(2) The need to produce specific legislative acts to enact National Policies for
Health For All and to ensure that Primary Health Care priorities are reflected
in these policies through appropriate intersectoral coordination and cooperation
was particularly emphasized.
(3) Systematic analysis and assessment of existing socio-economic policies and
health policies are required in all countries to ensure that health systems
are developed as an integral part of the overall social and economic develop
ment.
WHO-EM/MG/7 WHO-EM/INT.WKP.MPNHD/3 page 7
(4) While in all participating countries some forms of mechanisms for providing
political support to the development _and implementation of national strategy
for Health For All and coordination of activities within health sectors, with
other sectors and with comnrunities have been initiated, it was, however, em
phasized that these mechanisms have not yet fully acted as collective bodies on
a permanent basis. They meet occasionally and there are many problems rela
ted to sustaining membership, promoting secretarial and securing financial
support and developing adequate mechanisms for the monitoring and implementa
tion of their agreed actiona and recoannendations.
(5) It was for example stated that the systematic review and analysis of the
extent of existing coverage of Primary Health Care by health and health-related
sectors such as agriculture, education, industry, environment, housing, etc
are urgently needed to formulate more sound and realistic policies concerning
the scope, quantitative and qualitative coverage of population groups, progres
sively, as required.
(6) Reviewing various national experiences it was stated that for example in many
instances only few institutions outside the Ministry of Health were fully infor
med or have participated in reviewing policies for Health For All and Primary
Health Care. Many sectors in the Government are not being made fully part of
national action for HFA/2000 and Primary Health Care. Educational institutions
have not been properly engaged in Health For All and Primary Health Care acti
vities. Interested groups, people and CDllllllUnities are not sufficiently acting
as equal partners in National Health Development Processes.
The Workshop therefore strongly recommends that promotional activities at
national level for Health For All and Primary Health Care be intensified first and
foremost within the health -sector, among various kinds of health personnel, health
and health educational institutions. Intensive promotional activities are further
required at the highest policy levels in the government to help translate initial
political cot11111itment.for HFA/2000 into national -reality. Further promotion is also
required with the ministries of Planning, Budget, Education, Agriculture and other
WHO-EM/MG /7 WHO-EM/lNT.WKP.MPNHD/3 page 8
sectors related to Health. Massive promotional activities for obtaining total
commitment of people and communities for HFA/2000 and Primary Health Care are
required:
- The Workshop unanimously concluded that without ob�aining total politi
cal commitment for Health For All and commitment of various sectors,
interest ·groups and people and communities for national actions towards
HFA/2000 and Pdmary Health Care, plans attd programmes being formulated
through the application of MPNHD will remain on paper.
- Further, the Workshop recommended that in most of the countries, reorienta
tion of existing educational institutions and educational programmes are
required to match their national policies for Health For All.
- Policies to develop national health manpower plans to achieve the strategy
for Health For All are required in most of the countries.
- it was stated that in many countries, policies.for generation and alloca
tion of health resources to priorities being determined in the national
plans of action for Health For All, are required.
11. I�FOR.'-1ATION SUPPORT FOR MPNHD (SESSION IV)
This topic was discussed in plenary session (see'"Exercise 2). The discus
sion indicated various ways in which information support to Managerial Process
is being organized and obtained in countries. In some countries Health Informa
tion Support is generated from medical records and existing reports from health
centres, hospitals and other types of health care facilities, while in others
very often special surveys are conducted in addition to partial reporting from
health centres and health institutions.
Many problems were considered as being common to the majority of countries:
Partial coverage of data generation and collection; incomplete and poor data
registration. Numerous data that have been collected have never been processed
nor relevant information generated. In addition to inadequate coverage of infor
mation generation in terms of geographical areas and certain population groups,
mention was made of inadequate coverage concerning types of information collected.
"Problems of inadequate cotmnunication and dialogue between users of information and those
WO-EM/MG/7 WO-EM/INT.WKP.MPNHD/3 page 9
that produce the information were mentioned. In the ministries of health and
health administration at intermediate and local level analytical potentials for
making use of available information are limited. Many examples were cited in
the discussion of inadequate dialogue between various sectors of the government
and poor utilization of existing information in sectors other than Health for
health development planning purposes.
The Workshop concluded that radical measures for improvement of national
health information support to facilitate decision-making in all relevant components
of the Managerial Process for National Health Development are required. The
following recommendations were made:
t. A national colllllittee, group or similar mechanism on inter-sectoral and inter
disciplinary bases, representing both producers and users·of health informa
tion from Health, Education, Agriculture, Planning, Finance and other minis
tries of the government, should be formed. Representatives from institutes
of public health, medical schools or the schools of public health and the
management training institutions, research institutions, social insurance
authorities where they exist, representatives of interest groups and of non
governmental organizations and other kinds not mentioned above should be in
cluded in the work of the committee or the group. The task of the committee
or group should be that of designing a national health information support
system to the Managerial ·Process for National Health Development as a part of
health system design for the country.
2. The need for setting-up national councils for developing and/or strengthening
national health information support to decision-making process within MPNHD
was agreed upon.
3 . Guidelines for national health information support to MPNHD should provide
comnon national definition■, clas1ificationa, nomenclature, statistical
standarda and statistical methodology.
4. It was recommended that a national colllllittee group or similar body identi
fied under ( 1) above should be charged with the responsibility of formulating
national indicators for identifying changes in the health situations in the
'WHO-EM/MG/7 'WHO-EM/INT .WKP .MPNHD/3 page 10
country and therefore to support mnitoring and evaluation of the progress
made in implementing national strategy for Health For All. To facilitate
the task of formulating national indicators use should be made of WHO publi
cation entitled "Development of Indicators for Monitoring progress towards
Health For All by the Year 2000" (Health For All Series No. 3, Geneva, 1981) .
5. Need was identified to organize systematic trai�ing on a continuous basis,
both for producers and users of information on the subject of information
support to decision-making as a part of continuous training activities being
conducted within MPNHD.
12, MECHANISMS FOR ENSURING COOTtNUtTY IN THE MANAGERIAL PROCESS (SESSION V)
The Managerial Process for National Health Development should be a continuous
process, the continuity of which should be ensured and maintained through political,
legislative and technical support as well as intra- and inter-sectoral coordination
and collaboration of various national sectors providing health or health-related
services. The Community plays an important role in this respect through awareness
of its needs and understanding of its obligations towards health care services.
This topic was discussed in plenary session (See Exercise 3) after relevant
introductory remarks.
In discussing this topic, it became evident that lack in continuity in the
Managerial Process for National Health Development is one of the most alarming
colillllOn constraints for such development. Many factors were seen to hinder this conti
nuity. At national level, these include political instability; unpredicted econo
mic recessions; lack of follow-up mechanisms at national, intermediate, institu
tional and community levels; proper sense of accountability and means of its
assurance. At the level of health sectors, however, the main constraints lie in
the lack of or inadequate intra-sectoral co-ordination between different divisions
of health care provision; inadequate exchange of information within the same health
sector and between this sector and other national providers of health-related
services, professional rivalry and competition and the administrative and
technical indifference between planners, managers and implementation. monitoring,
controlling and supervising as well as evaluation bodies.
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The participants shared the ir specific experiences in this respect . A number
of problems were highlighted concerning barriers in buildin g the continuity at the
national, institutional and community levels. Based upon this discussion. the
following recommendations were made :
National Level :
( 1 ) Although national health councils with multi-sectoral membership have been
established in some participating countries, yet these bodies have limited
themselves mostly to perfunctory advisory roles, and on an irregular basis
when urgent needs arise. These bodies need to be legislatively and admini
stratively strengthened to ensure their continuous role in support to plan
n ing, follow-up and coordinating activities regarding formulation and implem
entation of national health policy and programmes at national, intermediate
and local levels .
(2) National councils should also assume the monitoring and evaluation role to
ensure continuity in the application of Managerial Process for National Health
Development.
Institutional Level :
( 1 ) A proper role for the national institutions (un ivers ities, professional
schools, medical and health associations and public bodies) wi�hin the context
of a particular social system needs to be developed. However, it is essential
that such institutions are involved in all levels of the HFA strategies. More
specifically, technical expertise should be tapped from professional institu
tions as advisers/consultants to the national council or similar body as well
as the ministries of health and other ministries . This will ensure their
positive role in implementation of plans of action of these strategies .
(2) Active multi-disciplinary technical groups or committees need to be estab
lished to develop programmes based on rrimary Health Care on an ongoin g basis ,
and they need to be connected with the national health council or similar
bodies. The role of these committees should also be to conduct research and
feasibility studies relevant- to Primary Health Care implementation in a
multi-sectoral capacity.
WHO-EM/MC/7 t.'HO-EM/ INT .WKP.MPNHD/3 page 12
Community Level :
( 1 ) ' In order to build continuity in the Managerial Process for National Health
Development. the role of the coumunity. through appropriately planned program
mes of health promotion and education, should be expanded from an advisory
capacity to a partnership in formulating and implementation of programmes
as welt as in monitoring and evaluation.
(2) A concerted effort is needed to prepare communities in differentiating real
needs versus ''wants" by the technical as well as political bodies.
1 3 , tNTROnUCTION T O BROAD HEALTH PROGRAMMING (SESSION VI)
Five sessions (2 plenaries and 3 working group exercises ) were organized to
provide the participants an opportunity to review and practise Broad Health Progam
ming for the formulation of national strategy for Health for A ll. Specific exerci
ses in the working groups covered situation analysis , problem definition and set
ting priorities . objective setting , strategy and programme formulation .
During the plenary session, a stage was set to help participants analyse
information on health problems and to determine health development strategies by
undertaking feasibility analysis of alternative courses of action . Following is
the summary of small group deliberations on this subject.
Situation Analysis
1 . Most of the participants agreed that the situation analysis in their countries
focusses on disease-oriented problems. Socio-economic problems still continue
to escape the scrutiny needed by health development planners in most of the
countries during the proces s of situation analysis :
2 . The actual process of situation analysis i s generally being carried out prima
rily by the minis tries of health with some support from the Ministry of Plan
ning and thus relying heavily on morbidity and mortality information and
health resources data . Representatives of the other ministries (Agriculture.
Industry , Education) are rarely involved in either providing information and
or in reviewing available data relevant to health development . Thus, a col
lective effort is needed to systematically analyse :
(a) Socio-economic and development policies
(b) Health policy
(c) Socio-economic situation
(d) Demographic situation
WHO-EM/MG/7 WHO-EM/INT.WKP.MPNHD/3 page 13
(e) Epidemiological situation and health status of the population
(f) Health resources situation
(g) Health services situation
(h) Situation of housing, food and nutrition
(e) Environmental situation
J. All the Groups agreed that very little is being done to formulate long-term
Plans of Action for Health for All and to anticipate (forecast) needs for
national health development . Such forecasting is needed to prepare for the
expected as well as unexpected events due to projected socio-economic growth
as well as to cope with turbulent national and global economics. Moat of the
countries are concentrating on short-term plaMing for national health develop
ment.
4. Most of the �articipants pointed out that a comprehensive data analysis requi
res trained manpower available to planning groups and committees charged with
the planning and management responsibilities for national health development .
Problem Definition
5. As regards the problem definition stage, there was a consensus that 111alnutri
tion, diarrhoeal diseases, malaria , and road accidents were the highest priori
ty problems in countries represented in this Workshop .
Following criteria were considered by all groups in identifying these priori
ties:
- loss of economic productivity
- social consequences
- mortality
- morbidity
- available resources
- projected health development services .
YHO-EM/MG/ 7 'WRO-EM/ INT.WKP ,MPNHD/3 page 14
Obj ectives and target setting
6 , Each Group provided specific statements of general objectives . targets, and
indicators for the problems selected above. It was, however . stressed that
special considerations are needed in defining health impTovement objectives.
These include the extent of coverage of population at risk on short-term and long-tenn bases , specia 1 attention to promotive and preventive aspects, poll t ical
and social acceptability as well as technical feasibility. From the examples cited above, it was clear that all the participants were able to formulate general and
specific objectives. targets and indicators. A need was felt to train and
inform others involved in planning groups as well as technical comnittees.
Strategy fonnulation
7. Strategy formulation for the obj ectives identified by the working groups
provided rich illustrations of the application of criteria listed in the
background reading materials (MPNHD 8 1. 3 , pp. 48-49).
8 . Effective strategy formulation is also contingent upon coordination within
the health sector as well as with other sectors. The working groups high
lighted the problems prevalent within the health sector about the lack of
coordination and stressed the need that the health sector has to demonstrate
first by real actions, how mechanisms of coordination have been effectively
displayed within health sector if we are to win the support of other sectors.
Programme formulation
During the progrannne planning phase , a number of observations, and suggestions
were presented by the working groups based on their individual experience from their
own countries. These included :
9. A d istinction to be made concerning the service programme and the development
programme in order to ensure appropriate allocation of resources. This would
enable the development of a strate gic approach in carrying out the overall
health improvement obj ectives for a particular problem.
10. Health programme planning and formulation must ensure both vertical and
horizontal coordination.
WHO-EM/MG/7 WHO-EM/ INT. YKP. MJmHl)/ 3 page 15
1 1. Lack of technical support in areas of health development continues to be a major
problem in the countries of the participants. Professionally competent manpower
is needed at all echelons of health and various sectors to carry out planning ,
implementation and evaluation of programmes being proposed - to support HFA stra
tegies ,
Preparation for Broad Programming:
1 2. Discussion had indicated that many countries have so far made limited and insuf
ficient efforts to undertake broad programming for the systematic fonnulation of
national strategies for Health for All , due to lack of clear terms of reference
from the highest decision-making establi1hment in the countries. It was strongly
reco111111ended that in assigning this task , attention should be paid to the fol
lowing :
Equal partnenhip in assuming responsibility among health and health-related
sectors ;
Involvement of decision-makers and political groups;
Time frame for completing the task ;
Criteria for monitoring and evaluation of the proposed work to support
HFA;
Clear indication of mechanisms required for reporting the outcome of the
proposed work .
14 . PR� BUDGETING: ALLOCATION OF HEALTH RESOURCES (SESSION VII)
The availability of resources could be the backbone for attaining any priority
health programme objectives. These resources should be clearly identified quantita
tively, functionally, and qualitatively for the achievement of each of these objec
tive separately , and should be considered in the light of the available information
and the present utilization of such resources in relation to stated objectives and
the extent of service delivered to the communities in question.
This topic was projected for discussion by the plenary after introducing the
most salient features to be regarded in connection with it (see Exercise 7) .
WHO-EM/MG/7 WHO-�/INT.WKP.MPNHD/3 page 16
It was stated during discussion that broad health programming and programme
budgeting are interlinked and part of the formul ation process of health strategy.
However , it was clearly revealed that there is an overall deficiency in the situa
tional analysis and programming capabilities in the health sector in most of the
partic ipating countries to implement health development strategies rather than to
develop vertical specialized services. Similarly, there seem to be equal deficien
cies in countries concerning their capabilities for the economic analysis of propo
sed strategies during broad prpgramming and the assessment of cost benef its . This
is of vital importance for proper allocations of financiai . manpower and other re
sources within the realities of availability and the possibility of readjustment
according to proposed objectives. The d iscussion had stressed the importance of
do ing thorough and comprehensive broad programming which might be the only method
of persuading politicians, decision-makers and finance providers of the feasibility
of health programmes and the practicality of attaining their objectives within
proposed durat ions. Alternative objectives should always be prepared for possible
achievement from the same suggested resources for the consideration of politicians
and decision-makers within the framework of the same health programme .
Specific experiences of the participants were presented and discussed. Problems
and constraints that hinder proper judgement of resources and consequent allocation
were highlighted , The synthesis of these and the possible means of solution were
the following :
1 . Decision-makers should have good feasible explanations about the preferred
pattern of allocations in terms of the expected outcome within a health prog
ra111111e. This necessitates proper programme analysis in both horizontal and
vertical directions, and reasonable comparison between costs and benefits.
2 . Resource allocation should seriously consider the available pol itical, social
and economic realities and should make space for possible unforeseen economic
and o ther constraints, and plan for re-orientat ion and re-adjustment according
to such potent ial circumstances.
WHO-EM/MG/7 WHO-EM/INT. WKP .MPNHD/3 page 17
3. Alternative objectives w ithin the same framework of the programme and the
availability of resources should be kept ready for consideration by
decision-makers .
4. Allocations of resources should be mainly d irected towards budgeting of
programmes in support of politically determined objectives of the entire
health system . rather than specific health services .
5. All types of national resources should be identified clearly and practically
to decis ion-makers . The means of generation and timely utilization and
poss ible adjustment towards their availability should also be clarified.
6. Discuss ion of the main constraints that hinder feasible allocations of re
sources and subsequent attainment of object ives revealed the following conclu
s ions that necessitate immediate attention :
- Deficiency of programming capabilit ies for efficient programme budget
projection at high ministerial level;
- Rigidity of systems of employment and resource readjustment at the level
of the ministries and lack of or improper understanding of the finance
controlling bod ies . or their interference in directions opposing the prog
r amme objectives.
- D ifficulty in attaining objectives of programmes within proposed durations
due to all above-mentioned reasons, and the resultant effect · on politicians
as to the feasibility of the whole health programme.
15. FORMUIATION OF NATIONAL PLAN OF ACTION FOR HEALTH FOR ALL (SESSION VIII)
A national master Plan of Action for Health for All should be the result
of broad programming and realistic priority health programme budgeting dependent on allocation of available as well as expected resources. This master plan which constitutes one of the components of the National Plan of socio-economic develop
ment and presumably formulated by health authorities in collaboration with national
planning bodies and sectors dealing with health-related problems should be cons i
dered as a working document to be proposed to Government for their consideration
and approval. Once accepted by the Government . this document is meant to provid�
long-term political guidance on countries ' priorities within a realistic framework
of economic feasibility and resources ' availability for the development of a coun
try health system based on primary heal th care.
WHO-EM/MG/7 WHO-EM/INT.'WKP.m'NHD/3 page 1 8
This master Plan o f Action i s subdivided into several medium-�erm programmes
where goals are translat ed into detailed objectives and specific targets. To
implement the mediu�-term programmes. short-term actions are taken (yearly plan) ,
these actions are directed towards the targets , and their effectiveness and quantifi
cation are measured by accepted indicators to ensure progress related to the medium
term progra11111e and in conformi ty with the master Plan of Action.
All these plans are not supposed to be static, as they might be subj ect to
changes or modifications governed by economic, political, technical and other consi
derations and circumstances and should be guided by frequent evaluat ion of activities
performed in terms of programmes.
There was a plenary discussion of this topic by the participants (see Exercise 8).
They all a�reed and understood during the d i scussion that for a nat ional Plan
of Action to be formulated, the following components have to be considered and
included :
- Policies to be followed
- Objectives and related targets to be attained
- Polit ical, social, economic . administrative and technological processes
required
- Priority health problems to be identified
- Main actions agreed by all concerned sec tors
- Manpower required
- Broad allocation of resources
- Organizational responsibilitie s for progra11111e implementation, monitoring
and successive evaluation .
Nevertheless, it was quite evident from discussions among participants tha t
prac tically none of their countries have properly formulat ed a national master Plan
of Action for Health for All . This was mainly attributed to the prevailing political
as well as economic uncertainty . However, medium-term (5-6 years) plans or program
mes have been formulated in this direction in most of the participating countries .
WHO-EM/HG/7 WHO-EM/ INT. WKP .MPNHD/3 page 1 9
Unfortunately, very often these medium-term plans and programmes fell short of the
achievement of their objectives and targets due to constraints related to the quan
titative and qualitative deficiencies in many of the afore-mentioned components of
plans of action. Such being the case, most of the activities within the available
health systems of the participating countries are directed on a yearly plan basis
governed by the allocated budgetary health allocations and mainly aimed at dealing
with any presently eminent health problem.
The participants showed great concern about this alarming situation. They
discussed possible avenues of solutions, the synthesis of which could be included
in the following :
1. Strengthening of the managerial capabilities within ministries of health at
the central level to ensure comprehensive formulation and coordination in the
implementation of the master Plan of Action for Health for All with all its
related components.
2 . Increase the managerial abilities of technical people concerned with the health
of the population in different sectors of the Government. Consequently, they
should act as catalysts to enable the achievement of targets and objectives of
any formulated plan of action at various levels ,
3. Plans of Actions for other health-related activities in miniatries other than
Ministry of Health should be formulated in synchronization and harmony with the
national master Plan of Action of Health for All.
4. Encouragement of the ••tabli1bment of health management institutions, at the
national or regional level through national actions and international collabora
tion. These institutions should be directed towards the development of high- as
well as mid-level health managers .
'WHO-V't/MG/7 WHO-EM/INT.WKP ,MPNHD/3 page 20
16, DETAILED PROG'RAMMING (SESSION IX)
Exerc is e 9
This process consis ts of the detailed fonnulation of a country-wide programme
that coincides with the obj ectives and targets of the national master Plan of Action
for the �l timate improvement of health care delivery systems. This deta iled programming is ideally undertaken at the regional or provincial level to enable the review
of the local implication of the programme activit ies and facilitate its implementa
tion .
The Working Group d iscussed the subj ect (Exercise 9) and the following observa
tions were made in thi s respect :
1 . I t was point ed out that none of the part icipat ing countries have to this
moment carried out detailed programming at the peripheral level. The maj or
reason cited was the la ck of trained personnel capable of undertaking this
task . It seems that mos t of the trained personnel , if ever available , are
concentrated at the central level . The need for detailed programming a t the
c entral level was perceived only when requested by political or technical in
ternational agencies and is usual ly conducted through their assistance.
2 . In order to ga in maximum benefi t of detai led programming at the peripheral
level , it was recommended that a manager with full-time responsibility be
d esignated , who must ensure the involvement of related technical and a dminis
trative sectors and community members. It was further recommended that clear
terms of reference be prepared and the team be enlightened through intensive
briefing and frequent interchange of information and experiences with the
c entral planning units.
3 . A further analysis o f the implication o f the national master Plan of Action
at the peripheral level enables planners to ensure the conformity of the
regional ac tivit ies with that of the plan. This may allow the planners
and implementers to tes t the feasibility of the programme and its pos s ible
adjus tment.
W.O-F.M/MG/7 WHO-EM/INT.l¥'KP.MPNHD/3 page ·. 21
4. Detailed programming at the peripheral level allows the setting of the local
obj ectives and targets to deal with the specific local health priorities .
Furthermore, the recognition of possible obstacles and cons traints, in re
source · availability and traditional barriers, could be mQre striking and a
more practical programme of activities can be de1ineated accordingly.
5. Detailed programming at the peripheral level allows for adaptation of pre
vailing or · existing health systems to the emerging socio-economic development,
within the available local resources .
17 . PROGRAMME . IMPLEMENTATION: PROGRAMME OPERATION ,AND INTEGRATION (SESSION X}
Exercise 10
Progra11111e implementation conducted whether centrally or peripherally requires
detailed programming which has been previously endorsed by the appropriate multi
sectoral authorities concerned . This allows the programme managers to make use of
the available resources for the benefit of the population to be served. There are
three essential phases for programme implementation, namely s tarting up procedures,
day- to-day operation of activities and services as well as monitoring .
Participants were challenged with this exercise (Exercise 1 0) to make comments
and observation on the unique attributes needed to provide the know-how and the
leadership needed to demystify implementation of programmes. Their recommendations
were as follows :
1 . Programme manager must attend to prevalent and proj ected population problems,
and should . be able to re-orient his team to the strategy of HFA/2000. He
must be able to adjust the operational details to the existing realities of
the community and its resource s, in a stimulating rather than reactive attitude.
2. Very few examples of genuine active community involvement in the implementa
tion of. PHC at the peripheral level were available among the participating
countries. It was recommended that, to be more effective, community involve
ment should start at the level of ·planning arid then continue up the implemen
tation as well as monitoring phases .
WHO-E�/MG/7 WHO-EM/INT.WKP.MPNHD/3 pa�e 2 2
3. To acquire better inter-programme and inter-sectoral co�ordination . i t
was emphasized that the current health manpower and logistic support has
to be re-orien�ed to perform a 111Ulti-purpose health development role �t
the peripheral community level.
4 . It was reiterated that the implementation of the PHC concept should never
be pursued as a vertical prograume. This would min imize duplication of
scarce resources. discourage bui lding of professional empires and provide
the consumer access to integrated health services.
5 . Management of resources during implementation (available funds, manpower .
constructions . etc. ) needs continuous manipulation according to availab ili·
ty.
6. Problems confronted during implementation could be in the form of l�ck of
motivation of personnel, lack of facil ities and, more cri t ical ly, lack of
orientation towards PHC strategy.
1 8 . MONITORING AND EVALUATION OF NATIONAL STRATE GIES FOR HEALTH FOR ALL (SESSION XI )
Exercise 11
Evaluation is the constructive systematic method of learning from experience
to improve current activities and promote better planning for future ac�ion accord
i ng l y . This comprises critical and sincerely real istic analys is of various aspects
of programme actiyities and the impact of its implementation on the overall socio
economic development in relat ion to its acceptability, cost-efficiency and effec
tiveness. Evaluation is not meant only for programmes and their activities. It
should reflect on the whole managerial process for nat ional health development.
This topic was reviewed among the working groups where discussions revealed
that most participating countries , if not all, have not yet developed an evaluation
mechanism as defined in the managerial process. Hence , they were unable to progress
in the proper and right d irection of formulating strategies and policies for HFA/2000 .
Most countries have a central ized system of feed-back from periphery to central
bodies which is not fully analysed nor utilized as it mainly originates from
hospitals and health centres without reflection of the real hea lth s tatus �f the
population.
WRO-EM/MG/7 WHO-EM/INT. lJXP ,Ml'NHD/3 page 23
The participants appear to be familiar with the evaluation components as
outlined in HFA Series No. 6 , However, application of these components seems
lacking in their national managerial system .
The parti cipants recommended the following :
1 . Indi cators for the evaluation process need to be developed 'during the pro
granming phase at central as well as peripheral level .
2 . Emphasis be laid on developing competent technical personnel to carry out
the evaluation process ,
3. Evaluation should be performed by national multi-sectoral - committees with
special terms of reference to systemati cally review every component of MPNHD ,
Sub-conmittees of the same composition should be established at. the periphery .
4 . Sincerity and facing o f realities have to be the guiding principles in the
evaluation process so that the evaluation ·results in the improvement of the
progral!lllles.
5. Mobilization ·of resources and collection of adequate information about the
availability of these resources, - their distribution and future development,
are essential . for effective evaluation.
6. Evaluation should be performed through the mechanisms of self-evaluation,
regional then central evaluation, multi-sectoral evaluation as well as
joint national-international review and evaluation mi ssions.
7. The WHO common framework and format for evaluation of HFA Strategy are recom
mended to be used and seriously considered aa guidelines for the participa
ting countries in their national process of evaluation.
19. NATIONAL ACTION TO STRENGTHEN MPNHD AND USE OF TCDC MECHANISMS IN SUPPORT OF THE APPLICATION OF MPNHD (SESSION XII)
The patticipants of the workshop reviewed the possible avenues for strenghten
i ng MPNHD on a national basis and the use of technical collaboration of developing
countries in that respect. This was di scussed i n a plenary session and the followi�g
was · recommended :
WHO-EM/MG/7 WHO-EM/INT. WKP. MPNHD/3 page 24
1 . Continuous and persistent efforts should be directed towards the national
policy-making bodies to whom the needs and requirements as regards the health
situation are clearly projected . This should be perfonned along with means
of concomitant translation of the national initial commitment to HFA strategy
into reality in the form of legislative enforcement, health infrastructure
development, strengthening of planning units and mechanisms of inter-- and
intra-sectoral co-ordination as a continuous process under the leadership of
a highly authorized and prestigious national body.
2 . Thorough assessment o f the existing managerial process and capabilities.
This should be followed by intensive efforts to build national managerial
capabilities in the right direction at various levels of health services
and health-related sectors , and other health-interested groups and coll'llllUnities.
This should include managerial staff support of technical ministries and
managerial re-orientation of their existing technical staff towards MPNHD.
3 . Ministries o f health should pursue a continuous dialogue and deploy inter
sectoral partnership with other ministries responsible for health•related
problems.
4 . Ministries o f health should study, then enforce the necessary administrative
and technical changes required in support of HFA strategy, possibly through
continuous briefing of all health personnel at all levels and dissemination
of information concerning national health pol icy, programmes and their objec
tives and targets, to health professionals as well as other officials and
pol iticians in the community to create coord ination and understanding and to
initiate a constructive dialogue between different sections within the Ministry
of Health and with other related sectors in that respect. A legislatively
supported multi-sectoral national council rather than a vertical department
within the Ministry of Health for PHC could be the answer to this question.
S . Training should be pursued at the national a s well as the regional level
for the strengthening of MPNHD. This should be directed towards 1
training of the trainers
- development of health development planners in all health-related sectors
WHO-EM/MG/7 WH07EM/ INT. WKP. MPNHD/ 3 page 2 5
orientation of representatives of .interested. groups and C"Dmmunii:ies
organization of provincial seminars and workshops in MPNHD invo'tving all
health and health-related sectors and communities
appropriate development of learning material through national experts and
by translating sets of WHO publications related to MP NHD into the national
language
establishment or s trengthening of national institutions for health d1velopment
and TCDC to develop critical masses of health development specialists. This
should be supported by national health research institutions and the continu
ous initiation of inter-reaction between all these institutions to ensure the
integrated reconstruction of existing health systems to achieve the goal
of HFA through the PHC concept, and to develop national guidelines for its
achievement
- organizing national multisectoral workshops on MPNHD .
6. Governments, and ministries of health should use the 1co11D110n framework and
format of WHO for evaluating the strategy for HFA/2000, as an entry point to
draw the attention of all national institutions and decision-makers to realize
the need for further strengthening of MPNHD.
20. WHO TECHNICAL COOPERATION IN SUPPORT OF MPNHD
The participants discussed the possible avenues of WHO technical coopera
tion in support of MPNHD in their countries . Their recommendations were as
follows:
1 . Establishment of a regional centre for the development of managerial capa
bilities in support of MP NHD
2. Assistance to countries in establishment of national institutions for train
ing in the managerial process at all levels.
3. Support national seminars for MPNHD and continue regional workshops in this
respect.
4 . WO should play a catalytic role in coordination between international and
bilateral agencies in support JJf HFA strategy and the development of national
managerial processes.
WHO-EM/?-'G/7 WHO-E�/INT. WKP. MPNHD/3 page 2 6
5 . WRCs in the countries o f the Region should be given more chance and be challenged
to play promotive and suppor�ive roles in the development of national managerial
process.
6. Supporting fellowships to develop health development specialists ,
7. WHO approach to HFA strategy should be concomitantly directed to other sectors
of national authorities concerned with health.
8 , Encouragement and support to visiting seminars and case studies , between countries
of the Region to exchange experiences a■ regards field application of the stra
tegy of HFA.
9 . More concentration should be given by WHO to the most common areas of weakness
in the Region as evidenced by the course of the evaluation process.
1 0. To ensure total country commitment for HFA strategy and PHC, the Regional Office
should include other government sectors dealing with health matters i n its
related activities .
1 1 . All political regional meetings and councils as well as existing political
and technical organ izations should be used to promote HFA strategy .
1 2 . The Regional O ffice might consider a meeting at highest level of government
sectors related to health problems, where the most important issues and problems
in pursuing HFA strategy are displayed before of all parties concerned for
collective and coordinated solution.
2 1 . EVALUATION EXERCISE
The evaluation of the Workshop entailed participants ascertaining their v iews
on the educational experiences provided during the workshop as well as on determining
future training needs for their respective countries in the Managerial Process for
National Heal th Development . O ut of 21 participants, 1 8 completed the questionnaire .
The analysis of their responses are as follows :
The maj ority of the participants strongly agreed that the objectives of the work
shop were adhered to and that they would strengthen their efforts to implement na
tional strategies for Health for All . Fourteen out of eighteen participants rated
their overall experience of this workshop as excellent. The participants considered
the orp,anizat i on and the methods used extremely useful in learning the concepts, principles
WO-!M/MC/7 WO-EM/INT .WKP .MPNHD/3 page 27
procedures and methodologies discussed during the workshop . Most of the partici
pants found the interchange in working groups and plenary very productive in terms
of learning from ·each others' experiences in the Region.
The following Table of selected items ·support the above.
Table 1 : Views about objectives and methodology (No. 18 }
Workshop Experiences
1 • Objectives supported efforts to implement national HFA stra-tegies
2. Objectives increased my capacity as planner/administrator
3 . Overall organization consistent with objectives
4 . Background reading useful
5. Plenary sessions helped crystalize issue
6 . Working groups allowed discussion and inter-change
7 . Tasks accomplished during the workshop
Strongly Agree Agree
1 5 3
1 0 8
1 0 7
1 4 2
1 2 6
9 8
5 1 1
Disagree Strongly No Disagree Opinion
-
Participants were asked to identify the components of MPNHD which were fairly
developed in their country as well as those which needed further development. Their
responses revealed that formulation of policies and broad progralll!ling have been fairly
wel l attended to but evaluation of development strategies and detailed progra111111ing
in some cases require immediate attention (See Tables 2 & 3) .
Table 2 : MPNHD Components fairly well developed in countries represented
Components Ranking
1. Formulation of National Health Policies 2
2. Broad Programming
3. Programme Budgeting 3
WHO-EM/MG/7 WHO-EM/INT.WKP.MPNHD/3 page 28
Table 2 (Cont 'd)
Components
4. Master Plan of Action
5 . Detailed programming
6. Implementation
7 . Evaluation
8 . Re-programming
9. Information support
( 1 m extremely well developed)
(6 � least developed)
Table 3: MPNHD components, which require immediate attention
1 • Formulation of National
2. Broad progralillll.ing
3 . Progra=e Budgeting
4. Master Plan of Action
s . Detailed Programming
6 . Implementation
7 . Evaluation
8 . Re-programming
9 . Information support
( 1 � immediate attention)
(5 = needed in the future)
Health Policies
Ranking
4
4
5
5
6
5
4
5
5
4
3
4
4
2
The participants selected the following 3 actions to support MPNHD in their
countries in order of priority:
1- Developing national guidelines for MPNHD
2- Organizing a national workshop on MPNHD with a multi-sectoral composition
3- Provided a briefing paper to higher policy-makers and decision-makers.
WHO-EM/MJ;/7 'WHO-EM/INT.w'KP.MPNHD/3 page 29
In terms of WHO support , the participants identified the following in
terms of priority :
1- Strengthening planning units within ministry of health
2- Mobilization of national institution to re-orient their programmes to HFA
strategies
3- Re-orienting national training institutions.
22. CLOSURE OF THE WORKSHOP
The Workshop was closed by Dr Nazmi Fallouh, Vice-Miniiter of Health of
the Syrian Arab Republic on behalf of H. E. The Minister of Health of the boat
country. He expressed his appreciation and satisfaction with the dynamics
developed through the Workshop and in its outcome. He also hoped that thia will
lead to initiation of similar activities at the national level of all participa
ting countries for the development and strengthening of MPNHD and its use in
support of strategy of HFA.
Dr c. Vukmanovic thanked the Government of Syria and H.E • . the Minister
of Health for providing all the necessary assistance to make this workshop
a success. He also thanked the participants for their efforts and collective
engagement in the activities of the Workshop which resulted in such an instruc
tive and informative outcome.
Several participants have also expressed their appreciation and thanks
to the Government of Syria and to WHO for organizing this Workshop and allowing
them accessibility to its collective learning on MPNHD.
ANNEX I
WO-EM/MG/7 WHO-EM/INT .WKP.Ml'NHD/3 page 31
LIST OF PARTICIPANTS
AFGHANISTAN
CYPRUS
DEMOCRATIC Y!MEM
nJtBOUrI
IRAN. ISLAMJC REPUBLIC OF
Dr Ali Ahmad Omar President of Cadre Department Ministry of Public Health Kabul
Dr Abdul Quadir Awa Vice-Pres ident . International
Relat ions Department Ministry of Public Health Kabul
Could not participate
Mr Jaffer Jooman Director-General Planning and Statistics Minis try of Public Health Aden
Mr Abdul Aziz Assakaf Director. Division of Medium
Level Health Cadres Ministry of Public Health �
Could not participate
Dr. Bij an Sadrizadeh Director-General Family Health Department Ministry of Health Teheran
Dr Ayoub Espander Health Specialist Ministry of Health Teheran
WHO-EM/MG/7 WHO-EM/INT .lJKP.MPNHD/3 page 32
LEBA.�ON
LI BYA.� ARAB JAMAHIRIYA
SOMALIA
SYRIA.� ARAB REPUBLIC
*
Mr Afif Ballouz Administrative Chief (Health Projects ) Ministry of Public Health Beirut
Mr Georges Maalouf Hospital Administration Ministry of Health and Social Affairs Beirut
Mr Habib Esmail Tamer Director-General of
Health Manpower Developm�nt Secretariat of Health Trip�
Mr Yassin Farah Ismail Director of Planning Department Min istry of Health Mogadishu
Dr Ahmed Sherif Abbas Responsible Off icer for Coordination
w ith International Agencies Ministry of Health Mogadishu
*
Dr Nazmy Falouh Assistant Min ister of Health Ministry of Health Damascus
Dr Mustafa Al Ba 'ath Assistant Minister of Health Ministry of Health Damascus
Dr Walid Al Haj Hussein Director Internat ional Relations Ministry of Health Damascus
Also Chainnan of National Preparatory Committee .
WHO-EM/MG/7 W'RO-EM/INT,WIQl ,MPNHD/3 page , 33
OBSERVERS FROM HOST COUNTRY
Dr Khaled Mardini Director pf MCH Centres Ministry of Health
Dr Hesham Burhani
Dr Asaad Iatewany
Dr M . Yass in Muft ah
Director , . School Health Ministry · of ' Education
Director of Planning Ministry of Health
Director of Prevent ive Services Ministry of Health
OBSERVER FROM AN INTERNATIONAL ORGANIZATION
Dr R. Nahas
WHO STAFF PAR'IICIPATING
Dr M. I. Al Khawashky
Dr M.A. Khalil
Dr H . R�jeb
Dr J . J irous
Dr A.M. Rahmani
Dr Chang Hua Chuang
Dr Sayed Ali Russe in
UNFPA Representative Syrian Arab Republic
Regional Adviser, Organization of Health Care Services
Regional Adviser , Occupationil Health
Regional Adviser, Nutrition
'WHO Representative and Programme Coordinator
'WHO Repre sentative and Programme Coordinator
'WHO Malariologist
UHO Medical Officer, Oral Health
Eastern Mediterranean Region
Eastern Mediterranean Region
Eastern Mediterranean Region
Kabul, Afghanistan
Be irut , 1'!banon
Riyad , Saudi Arabia
Damascus , Syrian Arab Republic
YHO.-EM/MG/1 W'HO-EM/INT.WKP.t(PNliD/3 page 34
Dr c. Vukmanovlc
Or Abdul Wahid Saj ld
Ms A.N. Hetata
Hiss Mona Zaki
WHO SECRETARIAT
Responsible Officer . WO, Geneva Managerial Process for National Heal th Development
�'HO Consultant Director, Office of Educa tional Development ,
University of Texas Medical BTanch , Galveston , Texas , USA.
Conference Off ice?" Easterq Mediterranean Region
Secret11ry t:astern Mediterranean Region
ANNEX II
WHO-EM/MG/7 WHO-EM/ INT • WKP .MPNHD/ 3 page 35
Intercountry Workshop �n Managerial Process for Nat ional Health Development Damascus, Syrian Arab Republic, 15-25 September 1984
Date/ Time
Saturdaz 1 579784
10 .00
1 1 .00
1 2.45
1 3.00
1 4.30
Afternoon
Type of Session
Plenary
Initial Plenary
Working Croups
PROGRAMME OF WORK
Subject
Session l - Opening of the Workshop
Pause
- Introduction of Participants Workshop Objectives and Workshop Procedures Session 2
Recommended Reading
Organization of the Workshop
- Inttodoctlon to MPNHD concepts , Principles , and Procedures. Main
Managerial Process for Methods National Health Development
( •BFA• Series No.S) Components of the Process
• Methodology in use for MPNHD _ Use of terminology within
MPNHD
- Problem-based learning in MPNHD
Session 3 Introduction to . Formulation of National Health Pol icies
Exercise l : Health Policy Formulat ion Process : Actors . Mechani sms, Content
Lunch
WHO/EMRO Technical Publication No. 5 : Introducing a Managerial Proces s for National Health Development Draft Glossary of terms used in •eFA• Serir.s , Nos. 1-8
Global · strategy for Health for All ( "HFA" Series , No . 3) PP • 31-49) MPNHD Guiding Principles ( �HrA· Series , No . 5 PP • 18-21)
Free for discussions and preparation for the following day
l-lHO-tH/�r./7 WHO-E�/INT.WKP.Ml"NHD/3 page 36
Date/ Time
Sunday
1 6/9/84
o.B . 30
09 . 45
10 . 30
10. 45
Type of Session
Summing-up plenary for Session 3
Plenary
Pause
Plenary
Subject
National Health Policies
Session 4 Introduction to Information support for MPNHD
Session 5 Mechanisms for ensuring continuity in the managerial process
Lunch
Recommended Readin
MPNHD Guiding Principles (HFA Series , No . S ,
pp . 57-60)
MPNHD Guiding principles (HFA Series No . 5 , pages 14-17 )
1 3 . 30
Afternoon Free for discuss ions and preparation for following day .
Monday
1 7 /9/84
08 . 30
09 .00
10. 30
Initial Pleoary
Working groups
Session 6
Introduction to Broad Health Programming
Exercise 4 : Situation Assessment , Problem definition and Setting Priorities
Visit to the National Health Institute followed by lunch given by the Ministry of Health
MPNHD Guiding Principles (HFA Series No . 5) Broad Programming as a part of MPNHD (MPNHD/81 . 3 )
idem
Afternoon ; Free for discussions and preparation for the following day .
Date/ Time
TUesda;(
18/9/84
08 . 30
10. 45
1 3 . 30
Afternoon
Wednesdar
19/9/84
08 . 30
10.30
10. 4 5
1 3 . 30
16.00
1 9 . 30
Type of Session
Working Groups
Working Groups
Subject
Session 6 (Con 't) Exercise 4 (Cont ' d)
Pause
Exercise · 5 ; Setting Health Objectives and strategy Selection
Lunch
'WHO-EM/MG/7 WHO�EM/INT.WKP.MPNHD/3 page 37 . .
Recommended reading
Broad programming as put of MPNHD (MPNHD/8 1 .3 )
A tour of Damascus organized by the Ministry of Health
Working Exercise 6 : Strategy iclem Groups selection and broad health
programme formulation
Pause
Summing-up Broad Health Programming Broad Programming as plenary for a part of KPNHD Session 6 (MPNHD/8 1 . 3 )
Lunch
Summing•up Broad Health Programming idem Plenary for Session 6 (cont 1 d)
dinner
WHO-E!-f/MG/7 WHO-FY/!NT .\..'KP.MPNHD/3 page 38
Date/ Type of Time Session
Thursday
20/9/84
08 . 30 Plenary
10. 30
10 . 45 Plenary
1 3 . 30
Subject
Session 7 : ~ Programme Budgeting, Allocation pf Health Resources
Pause
session 8 Introduction to National Master Plan of Action for Health for All
Lunch
Afternoon Vis it to Bosra Roman Amphitheatre
Friday
2 1/9/84
Saturday
22/9/84
08 . 30
8 . 45
10. 30
Initial plenary
Working Groups
Non-working day
session 9
Introduction to Detailed Programming
Exercise 9 : Detailed Programme Formulation
Pause
- Visit to Rural Health Centre
16 . 30
1 9 . 00
Working Groups
Session 10 : Programme Implementation
Closure
Recommended Reading
P�o9ramme Budgeting as a part Of MPNHD
(MNHHD/84 . 2 )
MPNHD Guiding Principles (HFA Series No . 5
p . p . 34-35
Detailed Programming as part of MPNHD (MPNHD/8 1 . 4 )
Programme Implementation as a part of MPNHP (MPNHD/8 1 . 5 )
Date/ Time
Sunday 23/9/84
OB.Jo
10. 30
l0.45
1 1 .00
1 3 . 30
16.00
19.00
Monday 24/9/84
08 . 30
10. 30
10 .45
1 2 .00
1 3 .00
14.00
1 5 .00
Type of Session
Summing-up Plenary for Sessions 9 & 10
Pause
Initial Plenary
Working groups
Lunch
Working groups (Con 'd}
Summing-up plenary for session 9
Pause
Plenary session
Plenary Session
Plenary Session
Plenary Session
WHO-EM/MG/7 YHO-EM/INT ,WKP .MPNH0/3 page 39
Subj ect
Detailed Programming and Progra.imne Implementation
Session 1 1 : Introduction to Monitoring and Evaluation of MPNHD and its use in Support of Health for All
Exercise 1 1 : Monitoring and Evaluation
Monitoring and Evaluation
Closure
Monitoring and Evaluation of MPNHD
Session 1 2 National Action t o Strengthen MPNHD and Use of TCDC Mechanism in support of the application of MPNHD
WHO Technical Cooperation in support of MPNHD
Evaluation of workshop
Consideration of Draft Report
Closing Session
Recommended Reading
idem
Health Programme Evaluation : Guiding Principle3 (HFA Series No. 6)
Health Programme Evaluation s Guiding Principles (HFA Series No . 6)
t;ITTO-EM/�r./7 wno-EM/lNT .llKP .MPNHD/3 page 40.
ANNEX III
Questionnaire for Evaluation of the Workshop
Directives
Please ( V
for each item
the appropriate column
1 . Objectives of the Workshop would
support my efforts as a member of
national health administration to
implement the Goal of HFA/2CX>O .
2 . Objectives were planned to increase
my capacity as national health
planner and public health
administrator .
3 . Obj ectives were realistic in stimula
ting an awareness for the need to
develop and implement in my country
the integrated Managerial Process
for National Health Development .
4 . The overall organization of the
Workshop was consistent with the
objective s .
5 . The background WHO publications were
useful in elucidating concepts ,
principles , methodologies and
process of MPNHD in support of
HFA strategies .
6 . Preparatory reading materials were
easy to follow in term of language
and style .
strongly Agree Disag?"ee Agree
Strongly , No Disagree opinion
7 . Plenary sessions triggered/stimuiated
active interaction among participant s
a . Plenary sessions helped crystalize
issues/problems pertinen:. to
applying an integrated MPNHD
9 . Plenary sessions allowed sharing
of experiences al!IOng the
participants
10 . Moderators facilitated discussion
and provided interventions
appropriately during the
plenary sessions
1 1 . working group format allowed
indepth discussion and exchange
of experiences on specific component
o f MPNHD.
12 . working group allowed me to
learn from others and to help
others to learn from me
1 3 . Feedback on the group process
within working groups by the
moderator helped increase task
productivity for assigned
exercises
1 4 . Tasks assigned to the working
group were adequately accomplished .
s
Strongly · Agree Agree
WHO-EM/MG/7 YHO-EM/INT.'WKP .MPNHD/3 page 41
Disagree Strongly No Disaqree opinion
I
I
I
WHO-EM/MG/7 WHO-EM/INT . WKP .MP�IBD/3 p age 42
1 5 . Circle the component ( s ) of MPNHD which is/are - fairly well developed
and applied within the health system of your country :
a . The formulation of 1'1-'.t tonal health policie s , comprising goals ,
priorities , and main directions towards priority goals , that are
suited to the social needs and economic conditions of the country and
form part of national social and economic development policies ;
b. Brean Proqrammin� - the translation of these policies , through
various stages o f planning , into strategies to achieve clearly
stated objectives and , wherever possible , specific targets ;
c . Proqral'lllle budgeting - the preferential allocation of health resources
for the implementation of these strategies ;
d . ThP. Master Plan of Action resulting from broad programming and
programme budgeting and indicating the strategies to be followed and
the main lines o f action to be taken in the health and other sectors
to implement the se strategies ;
e , Detailed programminq - the conversion of strategies and plans of
action into deta iled programmes that specify obj ectives and targets ,
and the technology , manpower , infrastructure , financial resources , and
time required for their implementation through a unified health system ;
f . Implementation - the translation of detailed programmes into action
so that they come into operation as integral parts of the health system;
the day-to-day management of programmes and the services and institutions
for delivering them, and the continuing follow-up of activities to ensure
that they are proceeding as planned and are on schedule .
g . Evaluation of developmental health strategies and operational programmes
for their implementation , in order progressively to improve their
effectiveness and impact and increase their e fficiency.
WHO EH/MC/7 WHO-EH/INT ,WKP,MPNHD/3 page .43
h. Reprogramming , a s necessary , with a view to improving the master
Plan of Action or some of its components , or prepru::ing new ones as
required, as part of a continuous managerial process for national
health development.
i , Support, in the form of relevant and sensitive information , for
all these components at all stages .
1 6 , Circle the component (&) o f MPNBD which is/are least developed and
require immediate attention :
a . Th e formulation o f natiqnal health policies , comprising goals ,
priorities , and main directions towards priority goals , that
are suited to the social needs and economic conditions of the
country and form part of national social and economic development
policies ,
b. Broad Programming - the translation of these policies , through
various stages of planning, into strategies to achieve clearly
stated objectives and, wherever possible , specific targets ,
c . Programme Budgeting - the preferential allocation o f health
resources for the implementation of these strategies ,
d , The master Plan of Action resulting from broad programming and
programme budgeting and indicating the strategies to be followed
and the main lines of action to be taken in the health and other
sectors . to implement these strategies i
e . Detailed programming - the conversion of strategies and plans
of action into detailed programmes that specify objectives and
targets and the technology, manpower, infrastructure , financial
resources , and ti.me required for their implementation through
a unified health system,
WHO-EM/MC:/7 WHO-EM/INT,WKI' .MPNHD/3 page 44
f . Implementation - the translation o f detailed programmes into action
so that they come into operation as integral parts of the health
system, the day-to-day management of programmes and the services and
institutions for delivering them, and the continuing follow-up of
activities to ensure that they are proceeding as planned and are on
schedule .
g . Evaluation of developmental health strategies an4 operational
programmes for their implementation , in order progressively to
improve their effectiveness and impact and increase their efficiency ,
h . Reprogramming, as necessary , with a view to improving the master
Plan of Action or some of its components , or preparing new ones as
required, as part of a continuous managerial process for national
health development;
1 . Support , in the form of relevant and sensitive information , for all
these components at all states .
1 7 . Based upon your participation in this Workshop , select future
action ( s ) needed to support the application of MPNHD and its use for
strategies for Health for All in your country . Please write your
order of prio rity ( 1 = highest priority - 2 = moderate priority -
3 = Low priority) in the right hand column.
a . Organizing a national workshop Conference
and or/seminar to discuss issues and problems
related to further promotion and application
of MPNHD in support of national strategy
for Health for All with multi-sectoral
par tic ipa tion .
b . Developing national guidelines for the
integrated Managerial Process for National
Health Development .
Priority Order
WO--EM/�/ 1,
WO-EM/lNT.WJCP,MPNHD/l page 4$
17, (Cont' d)
c. Provide a briefing paper to highet policy
and decision-making authorities on the need
for developing and · strengthening · national
managerial capabilities in support. of
national strategy for Health for All.
d. Seek suppox-t in my country and from WHO
to translate in my own national language
WHO publications on •MPNHD Guiding Principles•
e. Initiate a syistematic monitoring in M'f
country of the Managerial Process for
National Health Development and its use
in support of national strategy for
Health fo:I;' All ,
f. Others
Priority Order
1 B . Based upon your experiences in this Workshop , identify the
potential area of promotional , political and technical •upport
needed from WHO to implement MPNHO in your country. Please
wrimyour order of priority ( 1 • highest priority - 2 • moderate
priority - - 3 • low ·priority) in . the right Jland column,
a. A thorough assessment of the existing MPNHD
and its use for strategy for Health For All
b. Strengthening planning units within Ministry
of Health
c . Mobilizing national institutions to
reorient their programmes towards BFA
Strategy.
WHO-l'.M/MC/7 WHO-EM/INT .1JKP .MMnm/3 page 46
d. Reorient national training institutions
and organize training programmes to strengthen
the tec�nical competence of health system
based on Primary Health care .
e . Others
1 9 . Any overall comments 1
Priority Order
20. on a scale of l - 5 how would you rate your overall experience
within this Workshop
1 ____ .._ ___ 1,-___ +-__ _. ____ s poor excellent