Beyond any considerations for improving the health of the world must be the recognition that the growing world population will strain to the limit the ability of social, political, environmental and health infrastructures to cope. Health infrastructure - buildings and equipment, the staff, the drugs, the vehicles - is central to good health care. Services must be integrated, cost-effective and provided as close as possible to the people who need them.
With health resources unlikely to be greatly increased but with ever growing demands for services, because of expanding populations and the advances of science which make more conditions treatable, the debate about the rationing of health care, with the attendant ethical problems, is likely to become intense. Hard choices will have to be made - and greatly enhanced mechanisms found for listening to the voice of the health consume
WHO‘s contributions to world health
Within the framework of the organization s constitution and the guidance given in the periodic general programmes of work, all WHO activities are geared to respond to the priority problems of the age groups referred to in this summary. The full extent of WHO‘s work at national, regional and global levels cannot be reflected here, but examples are given of different types of action.
Child and adolescent health
WHO encourages self-reliance of countries in conducting immunization through basic health services. It cooperates with UNICEF in its initiative of supplying vaccines to over 100 countries. Major priorities are to at least sustain the accomplishments of previous years and to continue to strive for achievement of the 1992 World Summit for Children goal of immunization against the six vaccine-preventable diseases (diphtheria, pertussis, tetanus, measles, poliomyelitis, tuberculosis).
In an effort to make the best use of limited resources to eliminate neonatal tetanus, WHO has given priority to countries that account for 80% of total cases and have an estimated mortality of 5 or more per 1 000 live births. WHO initiated a series of measures to arrest the spread of diphtheria in eastern Europe, including the formulation of a plan of action and the establishment of a European task force. In 1993 progress towards the poliomyelitis eradication goal was heartening. Efforts are being made to develop a more heat-stable poliovirus vaccine that can be delivered with a less rigorously maintained cold chain. Large donations for poliomyelitis eradication were coordinated with different organizations. In 1994 the region of the Americas committed itself to eliminating measles by the year 2000, and incidence is now at the lowest level ever. If the momentum is sustained the Americas may well lead the way towards global elimination of this major killer of children.
By the end of 1994 virtually all developing countries had implemented plans of action against diarrhoeal diseases in children. Nearly 42% of health staff in the countries had been trained in supervisory skills using materials developed by WHO, and almost 30% of doctors and other health workers had been trained in diarrhoea case management, many of them in the more than 420 diarrhoea training units established in over 90 countries. It is estimated that nearly 85% of the population of the countries had access to oral rehydration salts at the end of 1994.
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