WHO Regional Committee for South-East Asia
final Report nnd Minutes
Fortieth Session, Pyongyang, DPR Korea 15-21 Sep~ember1987
WORLD HEALTH 0RG.t-NEZATION Regional Offic; for South-East Asia New Delhi, No ember 1985 -. WHO Regional Committee for South-East Asia
Final Report and Minutes
Fortieth Session, Pyongyang, DPR Korea 15-21 September 1987
WORLD HEALTH ORGANIZATION Regional Office for South-East Asia New Delhi, November 1987 CONTENTS
Page
SECTION I - REPORT OF THE REGIONAL COMMITTEE
INTRODUCTION
PART I - RESOLUTIONS SEA/RC~O/RL Prevention and Control of AIDS in the South-East Asia Region SEA/RC~O/R~ Management of WHO'S Resources SEA/RC~O/R~ Information and Education for Health in Support of Health for All by the Year 2000
SEA/RC~~/R~Targeting for Reorientation of Medical Education for Health Manpower Development in the Context of Achieving Health for All by the Year 2000 sEA/Rc~O/R~ Intensification of PHC Through District Health Systems Towards Achieving Health for All by the Year 2000
SEA/RC~O/R~Method of Appointment of the Regional Director sEA/Rc~O/R~Thirty-ninth Annual Report of the Regional Director
sEA/Rc~O/RB Selection of a Topic for Technical Discussions a. SEA/RCLO/R~ Resolution of Thanks
sEA/R~40/R10 Time and Place of Forty-first and Forty-second Sessions s~A/RC40/Rll Detailed Programme Budget for 1988-1989 and Report of the Sub-Committee on Programme Budget Page v PART I1 - DISCUSSION ON THE THIRTY-NINTH AlRmAL REPORT OF THE REGIONAL DIRECTOR
PART I11 - EXAMINATION OF THE DETAILED PROGR4KME BUDGET FOR 1988-1989 PART IV - DISCUSSION ON OTHER MATTERS Item
1. Review of the Draft Provisional Agenda of the Eighty-first Session of the Executive Board and of the Forty-first World Health Assembly
2. Method of Appointment of the Regional Director 3. Technical Discussions
4. Review of the Director-General's Introduction to the Proposed Programme Budget for 1988-1989 and the Comments of the World Health Assembly Thereon 24
5. WHO'S Public Image 24
6. AIDS
7. Drug Abuse
8. Intensification of the District Primary Health Care Action Plan 26 9. Special Programme for Research and Training in Tropical Diseases: Report on the Joint Coordinating Board 10. Special Programme of Research, Development and Research Training in Human Reproduction - Membership of the Policy and Coordination Advisory Committee 26
11. Consideration of Resolutions of Regional Interest Adopted by the World Health Assembly and i the Executive Board 27
12. Time and Place of Forthcoming Sessions of the Regional Committee 13. Selection of a Subject for the Technical Discussions to be held during the Forty-first Session 2 8 1. List of Participants
2. Agenda
3. Report of the Sub-Committee on Programme Budget
4. Recommendations Arising out of the Technical Discussions on Information and Education for Health in Support of Health for All by the Year 2000
5. Report of the Twelfth Meeting of the Consultative Committee for Programme Development and Management
6. List of Official Documents of the Fortieth Session
SECTION I1 - MINUTES OF THE SESSION 1. First Meeting, 15 September 1987, 9.00 a.m.
2. Second Meeting, 15 September 1987, 2.30 p.m.
3. Third Meeting, 16 September 1987, 9.00 a.m.
4. Fourth Meeting, 16 September 1987, 2.30 p.m.
5. Fifth Meeting, 18 September 1987, 9.00 a.m.
6. Sixth Meeting, 18 September 1987, 2.30 p.m.
7. Seventh Meeting, 21 September 1987, 9.00 a.m. SECTION I REPORT OF THE REGIONAL COMMITTEE'
'originally issued as "Draft Final Report of the Fortieth Session of the WHO Regional Committee for South-East Asia", document SEA/RC40/23, on 20 September 1987. INTRODUCTION
The Fortieth Session of the Regional Committee for South-East Asia was held in Pyongyang, Democratic People-s Republic of Korea, from 15 to 21 September 1987. The inaugural session, which was attended by representatives from ten Member States of :he Region, the United Nations Development Programme and UNICEF, as well as three nongovernmental organizations having official relations with WHO, was held at the People-s Cultural Palace. The subsequent plenary sessions were held at the Koryo Hotel.
The session was declared open by Dr Uthai Sudsukh, Chairman of the Thirty-ninth Session, and was then addressed by Mr Li Jong Ryul, Minister of Public Health, DPR Korea; Dr H. Mahler, Director-General of WHO; and Dr U KO KO, Regional Director for South-East Asia Region, WHO. Mr Chong Jun Gi, Vice-Premier of the Democratic People's Republic of Korea, inaugurated the meeting.
A Sub-committee on Credentials, consisting of representatives from Bangladesh, Mongolia and Nepal was appointed. The representative from Mongolia, Dr Sh. Jigjidsuren, was elected Chairman of the Sub- committee, whlch held two meetings and presented its reports (SEA/RC40/20 and Add. I), based on which the Regional Committee recognized the validity of the credentials presented by all the representatives.
The Regional Committee elected the following office-bearers:
Chairman ... Dr Kim Yong Ik (DPR Korea) Vice-chairman .. . Or R. Hapsara (Indonesia)
The Committee reviewed the draft provisional agenda of the Eighty- first Session of the Executive Board and of the Forty-first World Health Assembly (SEA/RC40/6), and then adopted its own provisional agenda and supplementary agenda (SEA/RC40/1 Rev.1). It established a Sub-committee on Programme Budget consisting of representatives from all Member States present, and adopted its terms of reference (SEA/RC40/4). Under the chairmanship of Dr Joe Fernando (Sri Lanka), the Sub-committee held three meetings and submitted a report (SEA/RC40/21), which was endorsed by the Regional Committee (resolution SEA/RC40/RIl). 2 REPORT OF THE REGIONAL COMMITTEE
The Committee elected Dr J. Norbhu (Bhutan) as Chairman of the technical discussions on Information and Education for Health in Support of Nealth For All by the Year 2000, and adopted the agenda for these discussions (SEA/RC40/5 and Add.1). The conclusions and recommendations arising out of these discussions (SEA/RC40/22), which were held on 17 September, were later presented to the Regional Committee, which endorsed the recommendations and adopted a resolution (SEAIRCLOIR3).
The Committee decided to hold technical discussions on the subject of development of district health systems during its Forty-first Session.
A sub-committee consisting of representatives from Bangladesh, DPR Korea, India, Maldives, Nepal and Thailand was formed to draft resolutions.
In the course of seven plenary meetings, the Regional Committee adopted eleven resolutions, which have been issued separately in Pert I of this report.
The Committee nominated Sri Lanka to the Policy and Coordinstion Advisory Committee of the Special Programme of Research, Development and Research Training in Human Reproduction.
The Committee decided to hoId its Forty-first Session at the Regional Office in New Delhi, India, and noted with appreciation the invitation of the Government of Indonesia to host the Forty-second Session in 1989.
Parts 11, I11 and IV of this report are devoted to summaries of the Committeess discussions on important matters. REPORT OF THE REGIONAL COMMITTEE 3
PART I
The following eleven resolutions were adopted by the Regional Committee (the references to the 'Handbook' are to the Handbook of Resolutions and Decisions of the WHO Regional Committee for South-East Asia, seventeenth edition, 1948-1975, and its supplements):
SEA/RCIU)/RI PPgWrrION AND UMTROL OF AIDS IN TBg SOUIREAST ASIA =ION
The Regional Committee,
Considering the global problem of AIDS, which has assumed pandemic proportions, and taking note of World Health Assembly resolution WHA40.26,
Realizing that AIDS is no respecter of political or geographical boundaries,
Recognizing that the low prevalence of AIDS in the countries of the South-East Asia Region is a favourable condition for containing the spread of the infection,
Emphasizing that information and education on the prevention of AIDS and epidemiological surveillance of the population at risk are the most important activities to be undertaken by the countries of this region,
Understanding the potential risk of transmission of AIDS through the use of non-sterile syringes and needles, blood and blood products, and
Noting that mandatory screening of international travellers, migrant labourers and emigrants can only marginally help prevent the spread of the infection,
1. APPROVES the Regional Plan of Action for Prevention and Control of AIDS, which is in conformity with the WHO global strategy for the prevention and control of AIDS;
2. RECORDS its appreciation of the efforts made by the Regional Director since 1985 for active collaboration with Member States in the prevention and control of AIDS despite financial constraints; 4 REPORT OF THE REGIONAL COMMITTEE
3. URGES Member States:
(a) to formulate and/or implement national plans of action for facilitating the implementation of the Regional Plan of Action in the context of WHO global strategy for the prevention and control of AIDS; and
(b) to share information on AIDS with the Organization as well as with Member States; and
4. REQUESTS the Regional Director:
(a) to extend technical cooperation in the formulation and implementation of national plans for the prevention and control of AIDS;
(b) to continue to liaise with other agencies for obtaining extrabudgetary resources for intensifying the activities of national programmes on AIDS, within the frame of the WHO Global Programme on AIDS; and
(c) to promote and support research studies on the risk behaviour of populations, laboratory technology, counselling on AIDS, information and education for health (IEH) and social awareness and action.
Handbook 5.1.6 Seventh Meeting, 21 September 1987 Page 35 SEA/RC40/Min.7
The Regional Commit tee,
Reaffirming its commitment to the Health for All goal and strategies, and the value system implicit therein,
Noting the progress made and obstacles to be overcome in attaining the goal of Health for All,
Reviewing the issues and options presented in the Regional Committee document on 'Management of WHO'S Resources' and the practical implications thereof, and
Taking into account the deliberations of this Committee on this subject,
1. RE-EMPHASIZES the important role of regional arrangements as provided in the WHO Constitution, which should be further strengthened; REPORT OF THe REGIONAL COMMITTEE 5
2. AFFIRnS that the present structure and functions of WHO at country and regional levels are generally compatible with its role of technical collaboration and coordination, and that the present system of appointment of country staff, particularly WHO Representatives, by a process of consultation among the Regional Directors, Member States, and the Director-General need not be changed;
3. URGES the Director-General to pursue the development of a long-term staffing policy for the Organization in close consultation with the Regions;
4. URGES Member States:
(a) to implement the recommendations contained in Appendix 3, Annex 5 to the report of this Committee;
(b) to make full and effective use of the Regional Programme Budget Policy as well as the joint GovernmentlWHO managerial mechanism in the formulation and implementation of WHO-s collaborative programmes, notably in the selective use of WHO'S resources in accordance with the national Health for All strategies as well as in the orderly and efficient implementation of biennial programme budgets;
(c) to further promote and strengthen the research and development required to facilitate the implementation of the national policies and strategies for Health for All ;
(d) to monitor and review the management of WHO-s resources at the country level; and
(e) to keep the members of the Executive Board from South- East Asia and the delegations to future World Health Assemblies informed of the deliberations and the viewpoints of the Regional Committee on the subject of Management of WHO'S Resources; and
5. REQUESTS the Regional Director:
(a) to transmit to the Director-General the report of the discussions of the Regional Committee on the doculwnt -Management of WHO'S Resources' (SEA/RC40/14) for onward transmission to the Executive Board;
(b) to review the structure of the Regional Office to ensure its responsiveness to the needs of the countries, and to ensure that it is best organized to fulfil meaningfully WHO'S technical collaboration in 6 REPORT OF THE REGIONAL COMMITTEE
accordance with the Regional Programme Budget Policy, and in pursuance of the national and regional Health for All goals and strategies; and
(c) to submit a report to the Forty-first Session of the Regional Committee in 1988 on further developments on the subject of Management of WHO'S Resources.
Handbook 2.2.4 Seventh Meeting, September Page I4 SEA/RC40/Min. 7
SEAIRC40lR3 INFORHATION MD EDUCATION FOR BWTH IN SUPPORT OF UTH FOR ALL BY TBE YEAR 2000
The Regional Committee,
Recognizing the vital role of information and education for health in promoting a healthy life-style through primary health care,
Noting the need to ensure coordinated action between various health and health-related sectors and to encourage active community involvement,
Emphasizing the importance of advocacy of health at various levels to make people self-reliant in health care, and
Having considered the report of the technical discussions held during the session,
I. ENDORSES the recommendations made in the report of the technical discussions (document SEA/RC40/22);
2. URGES Member States to make appropriate changes in respect of policies, strategies, approaches and resource allocation to strengthen IEH to provide effective support to HFA12000; and
3. REQUESTS the Regional Director:
(a) to support the training of health professionals in interpersonal relationship and communication skills;
(b) to encourage a better understanding of health development by media personnel;
(c) to provide technical support to improve capability in the IEH programme and IEH related-research, and
(d) to support national efforts in integrating IEH in all elements of the primary health care programme.
Handbook 4.3 Seventh Meeting, 21 September 1987 Page 29 sEA/RC40/Min.7 REPORT OF THE REGIONAL COMMITTEE 7
SXA/RC*OIR4 TAWZTlW FOR BIWBJlCUTAIIOU OF MEDICAL EDUCATION HIR IiEALlU lWlPWMt DEVEIDPMEhT IU axlrw OF ACBIWIIK ~~~RAILIIY~YEAI~~OOO
The Regional Committee,
Appreciating the active role that WHO continues to play in the development of medical education in the Member States,
Reaffirming World Health Assembly resolution WHA29.72, and its own resolution SEA/RC29/R9 on Medical Education,
Being concerned that notwithstanding successes and the high technical quality that have been achieved in medical care, reorientation of medical education requires further intensification to provide the essential infrastructure to comprehensive health system based on primary health care, and
Being aware that the medical manpower development system to support people's health should be based on the principles of equity and social justice,
1. URGES Member States:
(a) to undertake, on a priority basis, the strengthening of their health manpower policies and systems, so as to make them consistent with HFA strategies, and
(b) to continue their coordinated efforts towards developing national targets for reorientating their medical education systems; and
2. REQUESTS the Regional Director:
(a) to assist the countries in strengthening their health manpower development system consistent with HFA strategies;
(b) to assist the countries of the Region in formulating realistic programmes with targets for the reorientation of medical education systems up to the year 2000 to support the development of their comprehensive health systems based on PHC;
(c) to constitute a regional task force to assist and support reorientation of medical education in the countries of the Region; and 8 REPORT OF THE REGIONAL COKMITTEE
(d) to report on progress to the Regional Committee in a subsequent session.
Handbook 7 Seventh Meeting, 21 September 1987 Page 42 SEAlRC401Min.7
SenlnCbolBs ~IPTcar1onOF Pac llmwGn DIsniIcr muLm snsm TIRdeDS ACUIEVIIG HgaGT% FOR ALL BY IBB YEAR 2000 The Regional Committee,
Recalling the World Health Assembly resolution (WHA39.7) to support Member States in particular in establishing or strengthening district health systems based on primary health care, and
Endorsing the approach of intensification of national sction programmes for primary health care to the target of Health for All, with special attention to the vulnerable and underserved sections of the population,
1. URGES Member States:
(a) to intensify action programmes starting with priority elements of primary health care within the national plans and strategies for primary health care; and
(b) to mobilize resources and develop national capabilities so that the experience gained in the intensification of the primary health care programme in selected districts be further extended to the remaining districts so as to accomplish the goal of Health for All by the Year 2000; and
2. REQUESTS the Regional Director to provide necessary support to Member States in their efforts to implement, monitor and evaluate the intensification programme in the selected districts and in the mobilization of resources for achieving the goal of Health for All.
Handbook 4.1 Seventh Meeting, 21 September 1987 Page 26 SEA/RC40/Min. 7
The Regional Committee,
Being aware that important issues which have a far-reaching impact on the structure of the Organization and the nature of its functions are under discussion by the Executive Board, REPORT OF THE REGIONAL COMMITTEE 9
Recalling its resolutions SEA/RC32/R7, SEAlRC331R5 and SEA/RC34/R6 on the organizational structure and the efforts that had been undertaken by the Director-General and the Regional Office to realign the Organization's structure in the light of its functions with a view to ensuring that activities at all levels promote integrated actions,
Recalling also its resolution SEA/RCIO/R3 wherein the Regional Committee had recommended that there should be no change in the existing procedures for the appointment of Regional Directors, and
Emphasizing the Constitutional provisions for regional arrangements;
1. RECOGNIZES the advantages of greater involvement by the Director- General in the selection of Regional Directors, and therefore recommends that a suitable method of consultation be evolved;
2. REITERATES that there should be no major deviation from the current accepted practices and procedures which take into cognisance the requirements and responsibilities of the Member States in the context of regional arrangements as provided in the WHO Constitution;
3. REQUESTS the Regional Director to report to the Director-General for onward transmission to the Executive Board the deliberations and the views of the Regional Committee concerning the appointment of the Regional Director; and
4. URGES the Executive Board to give serious consideration to the views of the Regional Committee on this important topic.
Handbook 2.1.1 Seventh Meeting, 21 September 1987 Page 9 SEAlRC40lMin.7
The Regional Committee,
Having considered and discussed the Thirty-ninth Annual Report of the Regional Director to the Regional Committee (document SEAlRC4012 and Corwhich covers the activities of WHO in the South-East Asia Region during the period 1 July 1986 to 30 June 1987, and
Appreciating the efforts of the Consultative Committee for Programme Development and Management in critically reviewing the Thirty-ninth Annual Report of the Regional Director,
1. NOTES with satisfaction the progress made during the period in implementing WHO-s programme of collaborative activities in the South- East Asia Region; and 10 REPORT OF THE REGIONAL COWITTEE
2. CONGRATULATES the Regional Director and his staff on a clear and comprehensive report.
Handbook 9 Seventh Meeting, 21 September 1987 Page 46 SEA/RC40/Min.7
The Regional Committee,
I. DECIDES to hold technical discussions during the Forty-first Session in 1988 on the subject of Development of District Health Systems; and
2. REQUESTS the Regional Director to take appropriate steps to arrange for these discussions and to place this item on the agenda of the Forty-first Session.
Handbook 1.2.2 Seventh Meeting, 21 September 1987 Page 5 SEA/RC40/Min.7
The Regional Committee,
Having brought its Fortieth Session to a successful conclusion,
1. WISHES to convey its sincere thanks to His Excellency the Great Leader, President Kim I1 Sung, and to His Excellency the Dear Leader, Mr Kim Jong 11, rendered warm care in bringing to a successful conclusion this important meeting in Pyongyang. It further offers its deep thanks to the Government of the Democratic People's Republic of Korea, through the Ministry of Public Health, for having made excellent . arrangements for the meeting and for having extended such warm and generous hospitality to the participants of the session; and
2. EXPRESSES its sincere thanks to the Regional Director for his effective contribution, and to all members of his staff for their efforts towards the smooth conduct of the session.
Handbook 1.2.3(2) Seventh Meeting, 21 September 1987 Page 7 SEA/RC40/Min.7 REPORT OF THE REGIONAL COMMITTEE 11
!SEA/RC40/110 TIUB )31D PLACE OF FORTY-FIBST dw PORTY-SEWHD SBSSIWS
The Regional Committee,
1. NOTING that the Royal Government of Bhutan had requested an alternative venue for the Forty-first Session of the Regional Committee;
2. DECIDES that the Forty-first Session will be hosted by the Regional Office in New Delhi, India in September 1988, unless a Member State issues an invitation; and
3. NOTES with appreciation the offer of the Government of Indonesia to host the Forty-second Session of the Regional Committee in 1989.
Handbook 1.2.1 Seventh Meeting, 21 September 1987 Page 3 SEA/RC40/Min.7
SEA/RC40/RIl DETAILKLI PPOCBIWQ BnogCr FOR 1988-1989 AND WORT OF lBll Sm-uxmIn'Ku 08 PRoGUma7 BmBT
The Regional Committee,
Having considered the report of the Sub-committee on Programme Budget (document SEAlRC40121) and the Detailed Programme Budget for 1988-1989 (document SEA/RC40/3),
I. APPROVES the report of the Sub-committee on Programme Budget;
2. NOTES:
(a) that the relevant report and recommendations of the Consultative Committee for Programme Development and Management (document SEA/PDM/Meet.l2/8) were considered in the deliberations of the Sub-committee on Programme Budget ;
(b) the 1988-1989 detailed programme budget (document SEAlRC4013) with an elaboration of activities and changes within the programmes, as explained in the Regional Director's Programme Statement;
(c) the three options for reduction in the 1988-1989 programme implementation andlor programme budget, as referred to in the report of the Sub-committee on Programme Budget; and 12 REPORT OF THE REGIONAL COWITTEE
(dl the Regional Medium-Term Programme for the period 1990- 1995, which, in addition to the Regional Programme Budget policy, should guide the preparation of the 1990-1991 programme budget;
3. REQUESTS the Regional Director to implement the 1988-1989 programme contained in document SEA/RC40/3 (within the constraints of the proposed options for reduction of the budget and/or progrannne implementation) in accordance with the policies laid down in the Regional Programme Budget Policy, guidelines provided by the World Health Assembly and in cooperation with Member States; and
4. REQUESTS Member States:
(a) to initiate now the preliminary steps for timely implementation of the 1988-1989 progranune; and
(b) to forward to the Regional Office, by November 1988, a detailed plan of implementation for the second year of the biennium.
Handbook 3.3 Seventh Meeting, 21 September 1987 Page 24 SEA/RC40/Min.7 REPORT OF THE REGIONAL COMMITTEE 12
DISCUSSION ON lIIB WBTY-NIUTR AHItDa BEPOET OF TBg BgC1O)lbl DIRECI
The Thirty-ninth Annual Report of the Regional Director was introduced by the Director, Programme Management, on behalf of the Regional Director. He said that the Member States made determined and concerted efforts towards Health for All by the Year 2000, despite various social and political problems that confronted them. Health ministries were assuming a leadership role in health and health-related socio-economic development. The governments had pursued vigorously their efforts towards health development within the framework of the new managerial process for optimum utilization of WHO'S resources and implementation of the Regional Programme Budget Policy. Joint government/WHO mechanisms had been established for the planning, implementation, monitoring and evaluation of WHO-s resources.
The most important achievement during the year had been the successful completion of the first evaluation of Health for All strategies by the Member States.
WHO had supported the countries in developing programmes on health manpower information systems. The countries, too, had recognized the need for reorientation of medical education in the context of the rapidly changing concept of health care.
The regional research programme had progressed further with countries undertaking projects themselves or in coordination with WHO and other agencies. WHO-s efforts, including resources from global programmes of TDR and HRP, were being used more effectively to develop national capabilities and as its catalytic base for development.
Realizing the importance of health services research, the South-East Asia Advisory Committee on Health Research (SEAIACHR) had identified priority areas for research in support of Health for All strategies and provided guidelines for research development through WHO collaborative efforts.
In the field of maternal and child health including family planning, WHO had collaborated with UNICEF, UNFPA and other international 14 REPORT OF THE REGIONAL COMMITTEE agencies in strengthening promotive and preventive health measures for mothers and children. Several studies were being supported by WHO for evolving appropriate strategies for the effective delivery of maternal and child health and family planning services.
WHO'S nutrition programme had aimed at strengthening, developing and reinforcing national capabilities for reducing malnutrition. It was gratifying that a measurable reduction in protein-calorie malnutrition had occurred in a few countries, and that some impact had been made on iodine-deficiency diseases.
WHO'S major thrust in the area of environmental health had been on involving the community in improving drinking water supply and sanitation. Although countries had been developing these facilities, the coverage had not been adequate. WHO collaboration in this field encompassed institutional strengthening, manpower development, water quality surveillance, development of research capabilities and resource mobilization. Efforts were also needed to reduce health hazards emanating from environmental pollution due to rapid industrialization.
Considering that irrational prescription and overuse of drugs had resulted in serious public health problems, WHO had laid emphasis on the development of appropriate drug policies to ensure the supply of essential drugs and promote their rational use. Almost all Member States had now established a national list of essential drugs.
Communicable diseases had continued to take a heavy toll of life despite the countries spending large proportions of their health budgets on the prevention, control and treatment of such diseases. The Expanded Programme of Immunization had registered an impressive progress in managerial, operational and technical aspects of the programme in all countries. WHO support in this field had been mainly through training courses and seminars in EPI management.
Malaria continued to be a major public health problem in most Member States. The overall situation in the Region with regard to malaria control Was satisfactory judging from registered positive cases, but there had been no improvement in terms of potential difficulties due to insecticide-resistant mosquitoes and drug-resistant parasites. There was thus a need to pursue important strategies, such as community participation, intersectoral collaboration and mobilization of internal and external resources.
Diarrhoea1 diseases and acute respiratory infections (ARI) contributed to high mortality among children. WHO thrust in this area had been directed to training and development of regional self- sufficiency in the production of oral rehydration salt. In regard to ARI, the emphasis had continued to be on the training of primary health workers and district and other medical personnel as an integrated package programme development, epidemiological studies and training. REPORT OF THE REGIONAL COMMITTEE 15
WHO-s collaborative efforts on tuberculosis and leprosy continued to emphasize multidrug treatment regimens, intensification of epidemiological surveillance, strengthening of laboratory services, training of health manpower and promotion of research.
WHO collaborative activities in the field of prevention of blindness had been intensified in all the countries, with the main thrust directed to building up and strengthening the infrastructure for essential eye care through the primary health care approach.
Noncommunicable diseases, such as cancer, cardiovascular disorders and mental disease, were being recognized as important causes of morbidity and mortality in several countries of the Region. WHO had been supporting countries in the training of personnel in diagnosis, radiotherapy and chemotherapy. Health education and community involvement played a major role in the control of these diseases.
In the recent past, AIDS had become a matter of great concern to the Member States. Although a few countries had reported AIDS cases, none of them was of indigenous origin. Member Statea had constituted national committees or task forces to prevent the occurrence of AIDS. WHO had established a Special Programme on AIDS, and, at the regional level, developed a regional plan for the surveillance and control of AIDS.
In conclusion, the Director, Programme Management, expressed his satisfaction that despite multifarious social and political problems and financial constraints, Member States had forged ahead in their march towards the goal of Health for All by the Year 2000. He hoped that the Regional Committee, through its collective wisdom, would provide guidance and directions on future health activities in WHO'S collaborative efforts.
As usual, the recommendations of the CCPDM were taken into consideration while discussing the relevant chapters of the Annual Report. In its discussion on the Annual Report, the Regional Committee brought out the following salient points.
At the regional level, special attention needed to be paid to technical collaboration in managerial processes, research, and mobilization of resources.
The Committee observed that the concept of primary health care was expanding in all countries. The Committee noted with satisfaction the intensification of primary health care action programmes, development of primary health care network, intersectoral actions for health, referral support for primary health care, operations research for the district health system and urban primary health care.
The establishment of country support teams was considered as an important effort by the Regional Office to improve its support to the 16 REPORT OF THE REGIONAL COMMITTEE
countries. The meetings of the Ministers of Health in this Region greatly helped Member States in enhancing awareness of the importance of policies in the field of public health.
The world economic crisis had aggravated the economic problems faced by developing countries, stretching their limited resources in health and social welfare. While efforts could be made to find additional resources for health development, it was also necessary to devise measures to use the available resources more effectively. This called for improved management of country resources and WHO resources.
The progreas made by the Region in the face of ever-rising inflation and financial constraints was no mean achievement.
Notwithstanding the progreas made by some of the Member States, countries were resorting to technology imports on a large scale, and they were becoming more and more dependent in the fields of diagnostic, therapeutic and rehabilitative aids and appliances. There was a need to develop within the Region appropriate technology baaed on the knowledge gathered in health development and health administration. Attempts should also be made to adapt and develop further the transferred technology.
The Cornittee, while noting the progress made in the development of the information system, emphasized the need for further strengthening the system in the Member States so that appropriate managerial processes can be fntroduced in the development of health policies, strategies, implementation monitoring and evaluation of their collaborative programmes.
The Committee stressed the need for further development of leadership in HFA so as to stimulate larger intersectoral coordination, financing of health care, health economics, cornunity participation, rational use of drugs, development of appropriate technology, etc.
In order to achieve better intersectoral coordination, Member States should use a separate mechanism for bringing about intersectoral coordination in matters relating to the entire health and social sectors involving other ministries and agencies.
The Committee was of the view that the Regional director'^ Development Fund should be enhanced substantially in order to promote new innovative activities and also to meet the emergent situations in the Member States.
The importance of national epidemiological surveillance system was emphasized. The Common Framework and Format at the country level should be such that it would serve the internal management of the country as well as the needs of WHO for the transfer of information. REPORT OF THE REGIONAL COMMITTEE 17
Health systems research should be emphasized, and since it has to be country-based, it was agreed that Member States would lay more emphasis on it and, in this respect, would aim at strengthening of the district health system geared towards primary health care.
There was in-depth discussion on the subject of health manpower development. The Committee noted that there were gross imbalances in health manpower in the countries, not only quantitatively, but qualitatively too, and much was desired to be done to raise the level of knowledge and skill of the health professionals. Towards this end, reorientation of medical education was being aimed at in the countries. It was emphasized that health policy requirements for medical education should be community- and need-based, so that the health professionals could deliver the required assistance at the PHC level. WHO would discuss with countries ways and means of developing the regional collaborative programme on medical education.
The Committee especially noted the poor implementation of the fellowship programme. Further efforts should be made to improve both national and WHO mechanisms towards speedier implementation of the fellowship programme.
The Committee appreciated the importance of public information and education for health and noted that rapport with media specialists, health education specialists and programme managers needed to be improved.
The Committee took note of the progress made in research promotion and development in the Region which was aimed at putting greater thrust to research programmes for institutional strengthening, strengthening of research promotion and coordination mechanisms, and transfer of technologies. Emphasis was laid on the integratlon of health systems research, health behaviour research and health economic research.
The Committee noted the mounting morbidity and mortality as a result of traffic accidents and, in this regard, suggested that health authorities should take the initiative to create proper health education and training material and programmes for the prevention of all types of accidents - including domestic, fire and household - in addition to preventive measures for the main causative factors.
There was considerable discussion on maternal and child health programmes within the countries. The Committee noted the outcome of the discussioos held in Nairobi earlier this year and the World Health Assembly resolutions on maternal and child health, particularly on safe motherhood. It was emphasized that efforts should now be directed to training and research, to ensure safe motherhood.
Drug abuse and alcohol-related health problems, together with mental health, were the emerging problems within the Region. The Committee noted that each Member State should pay attention to the strengthening 18 REPORT OF THE REGIONAL COMMITTEE of their efforts in tackling drug and alcohol problems by establishing appropriate mechanisms, not only for the treatment and rehabilitation of persons afflicted with these problems, but also to take effective preventive measures so as to prevent the production and import of drugs. Information systems pertaining to these issues should also be strengthened.
Environmental pollution was emerging as a problem in urban and semi- urban areas. Strict safety measures in chemical and related industries causing environmental pollution should be undertaken by Member States.
In regard to the health care of the elderly, the Codttee noted that since the demographic pattern in countries of the Region was changing, and the number of elderly people was increasing. collaborative efforts in this programme area should be stepped up in the countries as well as in the Region, aimed at identifying the problem of the aged, and promoting health programmes for the aged to be suitably integrated in the primary health care strategies.
In regard to nutrition, it was considered that although the problem was medical, its solution lay in the non-medical domain of socio- economic development. The subject would be taken up by the SEA/ACHR at its next meeting in Colombo in April 1988. The countries of the Region were deeply involved in the control of iodine deficiency-related disorders, in collaboration with UNICEF, and ICCIDD.
WHO'S collaboration with Member States continued in the field of traditional medicine, and was appreciated, but the Committee stressed the need for concerted action on this subject with effective utilization of traditional systems of medicine and for further collaboration amongst the Member States in the development of traditional medicine. Efforts should be made to further strengthen traditional medicine institutions and promote the establishment of more WHO collaborating centres in traditional medicine.
Communicable diseases continued to be a major problem in the Region.
Currently, AIDS was not a major problem in the South-East Asia Region in terms of magnitude; however, there was a potential risk of , the disease spreading, on a large scale, in the South-East Asia Region. Information and education on the prevention of AIDS, and epidemiological surveillance of the population at risk, were important activities. The WHO Special Programme on AIDS (SPA) had been formed in February 1987. Active technical collaboration between the Organization and national task forces was essential for the effective implementation of the Regional Plan of Action which had been formulated.
The Committee appreciated the progress made in the coverage of EPI activities, but stressed the importance of an integrated approach conceived as a long-term perspective. REPORT OF THE REGIONAL COMMITTEE 19
The Committee noted that the malaria control programme was beset with serious problems such as insecticide-resistant vectors, drug resistance of P.falciparum, and shortage of resources. The Committee felt that greater efforts should be made towards intercountry and international cooperation, so as to achieve more effective and efficient malaria control.
Vector-borne diseases, dengue haemorrhagic fever and Japanese encephalitis continued to be problems in some countries of the Region. The Committee felt that emphasis should be laid on rapid diagnosis, case management, and vector control.
The Committee, while noting the progress made in the field of leprosy control, felt that vigorous efforts should be continued in the eradication of the disease.
Prevention of blindness and the tackling of the problem of deafness also needed continuous support. With the changing human ecological status and demographic patterns in the Region, degenerative diseases - particularly those affecting the heart and the brain - and the problem of cancer, would need appropriate actions for assessing their total impact and to strengthen programmes for the control of these diseases.
The Committee also noted with satisfaction the progress made in the creation of the HELLIS network and its linkages, and suggested that the functioning of the network must be strengthened at the national level. Translation of essential publications into local languages should be undertaken for appropriate dissemination of health information.
The Regional Committee adopted a resolution approving the Annual Report (SEA/RC40/R7). 20 REPORT OF THE REGIONAL COHMITTEE
BWINATIOII OF TEE DETAILBD PROGBIWIE BUTGET FOR 1988-1989
The Sub-committee on Programme Budget, comprising representatives from ten countries, met on 15 and 17 September and submitted its report (SEA/RC40/21) to the Regional Committee.
In accordance with its terms of reference, the Sub-committee reviewed the implementation of programmes during the first eighteen months of the 1986-1987 biennium, examined the detailed programme budget for 1988-1989, reviewed the contingency plan for reduced implementation during 1988-1989 and noted the MediunrTerm Program for the Eighth General Programme of Work covering the period 1990-1995.
The Sub-committee discussed the low rate of implementation during 1986-1987 and also the programme budget implementation reductions that had been imposed during that biennium. Endorsing the observations and recommendations contained in the relevant sections of the report of the twelfth meeting of the CCPDM (SEA/PDM/Meet. l2/8), the Sub-committee felt that there was a need to promote a more creative/catalytic form of WHO collaboration and that greater use of health services research should be made towards this end. It also felt that further quantification of the targets and objects of the Medium-Term Programme could be attempted when subsequent revisions were initiated.
In resolution SEA/RCW)/Rll, the Regional Committee approved the report of the Sub-committee on Programme Budget and requested (1) the Regional Director to implement the 1988-1989 programme, and (2) the Member States to take preliminary steps soon in order to facilitate timely implementation of the programme. REPORT OF THE REGIONAL COFU4ITTEE 21
PART IV
DISCIlSSION ON ort!ER UArreBS
Item 1 REVIEW OF TUE DRAPT PROVISIONAL bGKPlDA OF TUE EIm-FIRST SESSION OF TBB EXBCDTIVB BOARD AND OF ZBE POBTY-FIRST WBLD WTBAsSlMBLY
The Regional Committee took note of the draft provisional agendas of the Eighty-first Session of the Executive Board and of the Forty-first World Health Assembly, and also of the subject of technical discussions at the Forty-first World Health Assembly, entitled Leadership Development for Health for All.
Item 2 mmD OF MPOINRlgWT OF TUE REGIONAL DIBgCTOB The Regional Committee considered this subject to be of far-reaching importance and affirmed that:
(a) candidate(s) for the post of Regional Director should be from a Member State of the Region and possess the desired qualities of experience, knowledge of health problems of the Region, integrity, loyalty and leadership;
(b) the countries of the Region should take primary responsibility for his selection and nomination;
(c) the process of nomination and appointment should be as short as possible; and
(d) recognizing the advantages of greater involvement by the Director-General in the selection of the Regional Director, a suitable method of consultation be evolved. 22 REPORT OF THE REGIONAL COWITTEE
The Regional Committee agreed that the existing procedures should remain in effect and that the process of consultation should be strengthened to ensure that the aspirations of the regions, as well as those at the global level, are adequately reflected (resolution SEA/RC40/R6).
Item 3 TBCHEICAL DI~SSIONS
Technical discussions were held on the subject of Information and Education for Health in Support of Health for All by the Year 2000. The discussions, among other aspects, assessed the existing situation of Information and Education for Health (IEH) programmes in the Member States of the South-East Asia Region and identified issues, constraints, resources and infrastructure for IEH activities. The main policies and approaches to IEH in support of HFA 2000 were also reviewed. The following recommendations arising out of the discussions (document SEA/RC40/22) were endorsed by the Committee:
(a) Suitable reorientation and strengthening of IEH is needed in respect of policies, strategies, approaches and resource allocation to provide adequate support to achieve the goal of HFA/2000.
(b) The existing academic and in-service training programmes for health professionals should be reviewed, based upon Health for All strategies and their implied value, and be strengthened in respect of information, education and communication sciences. Teaching should be participatory and field-oriented. Similarly, the training of media personnel should include health orientation with close interaction between media specialists and content specialists.
(c) (I) Health workers at the grassroot level must be equipped with skills to use appropriate IEH technology. involve individuals, families and communities to identify their felt needs, participate in their own health affairs for self-reliance and promote healthy life style.
(2) While it is important for policy-makers to be aware of health issues, it is equally important for health- related workers to become orientated in the dissemination of health information and to facilitate interaction between the community and health systems. REPORT OF THE REGIONAL COMMITTEE 23
(d) In order to obtain media support for the advocacy of HFA and PHC,
(I) the health sector must develop a partnership with departments of information and broadcasting so that the communities have easy access to the right kind of information concerning their health situation, and plan self-help programmes. This would help to counter any misinformation generated by the mass media;
(2) linkages should be established between various health-related sectors to get the maximum benefit from IEH programmes. Mechanisms should be developed for intersectoral coordination. Efforts should be made to involve fully nongovernmental organizations, including women-s and other groups in IEH activities, and
(3) the possibility of adopting a multi-media approach and social marketing techniques using corporate resources might be explored.
(e) (1) Research in IEH should aim at developing/improving policies, strategies and methods of planning, management and evaluation of IEH programmes. It must be culture-specific, people-oriented and should result in community involvement in its own health care system. Results of such research must be made available to training institutes, programme officers and health workers to be utilized in programme implementation.
(2) Comparative effectiveness of various methods, such as person-to-person communication, community organization and traditional and modern media might be tested in respect of health issues.
(3) Case studies and success stories relating to IEH should be documented from the Member States and disseminated by the WHO Regional Office in order to be utilized in training and programme development.
(f) WHO should examine the feasibility of setting up a clearing house mechanism to facilitate the exchange of IEH-related information among the Member States.
A resolution (SEA/RC40/R3) was adopted in support of these recommendations. 24 REPORT OF THE REGIONAL COMMITTEE
Item 4 BEVIEW OF TEE DI1IBCrOR~'S ImOWmIoN TO TBB PBOWSW PROGBAM(B BUDGET FOR 1988-1989 ABD CceMlmTS OP TBB VOm ImALln ~~Y mBEMl
The Regional Committee reviewed the working paper prepared by the Director-General and also took note of the discussions on this subject that emanated from the twelfth meeting of the CCPDM, which studied the report of the Consultative meeting convened by the Regional Director on 24-25 August 1987.
The Committee accepted a number of action points at both country and regional levels in relation to the eleven main issues identified in the Director-General's working paper. It strongly affirmed the Organization's value system to which all Member States continued to give their fullest support. It agreed that the main issue was how to implement better, the WHO collaborative programme, while recognizing that an approach would be necessary which took into consideration the varied environmental, social, political, cultural and economic conditions of each country, which, in turn, affected the kind of management system or style adopted.
The Committee, while affirming the need for improved management of the Organization's technical collaboration, felt that actions to effect such improvements should be consistent with the Organization's policy of decentralization, with which the Committee was in full agreement. The Committee felt that monitoring and evaluation should be intensified with the full involvement of the country support teams. It agreed on the need to preserve the use of country planning figures and their full budgeting. The Committee favoured continuance of the existing procedures and mechanism for the appointment of staff, while agreeing on the need for a longer-range staffing policy for the Organization. It particularly emphasized that the selection of WHO Representatives should continue to involve consultations among the Member States, Regional Director and the Director-General.
The Committee resolved that the Regional Director transmit to the Director-General the report of the discussions of the Regional Committee on this item for forwarding to the Executive Board (resolution SEAIRC4OIRZ).
The full text of the actions recommended at country and regional levels may be found in Appendix 3 to Annex 5 to this report.
Item 5 mo-s PUBLIC DIKE While discussing the agenda item on WHO-s Public Image through its Health Development Work, the Regional Committee was of the opinion that REPORT OP THE REGIONAL COMMITTEE 25
the Organization already enjoyed high credibility due to its technical support in health development activities in the Member States. WHO had many accomplishments to its credit and there was a need to project this aspect,not to bolster WHO'S image perse,but to provide momentum to the national health development and strengthen collaborative activities with the Member States.
The Committee also endorsed the action-based programme on promoting WHO'S public image through its health development work.
During discussions on the fortieth anniversary of the Organization, the Committee had no doubt that the Member States would take suitable measures, using guidelines from the Regional Plan, to celebrate the event in a befitting manner.
The Committee nominated India to address the special WHO fortieth anniversary celebrations at the Forty-first World Health Assembly in May 1988. Indonesia was nominated to represent the Region at the Round Table Discussions to be held during the Assembly to commemorate the tenth anniversary of the Alma-Ata Declaration.
Item 6 AIDS
The - Regional Committee discussed document SEA/RC40/15, on AIDS (Supplementary Agenda item l), submitted by the Government of Bangladesh, along with Chapter 13 of the Annual Report, Disease Prevention and Control, and noted that AIDS, although not yet a public health problem, was an emerging one in the Region. There was a potential risk through the use of blood and blood products and non- sterile practices. The Committee urged Member States to be alert, and emphasized selective epidemiological surveillance and health education on the mode of transmission of the disease. The Committee approved the Regional Plan of Action and urged the Member States to implement the programme in collaboration with WHO (SEAIRCLOIRl).
Item 7 DBDG MUSE
The Committee discussed document SEA/RC40/16 on Drug Abuse, submitted by the Government of Bangladesh along with Chapter 10 of the Annual Report. It noted that the magnitude of the problem of drug abuse, including alcoholism and drug addiction in the Region was increasing, and there was a need to assess the magnitude of the problem. Numerous conventions had been held, but there was a need for concerted action as a follow-up to be initiated towards treatment, rehabilitation and 26 REPORT OF THE REGIONAL COMMITTEE control measures, along with preventive and enforcement measures from non-health sectors, including legislation relating to drug trafficking. National health authorities might promote action and involve themselves closely in national drug abuse control programmes.
Item 8 I~SIPICATIONOF TEE DISTRICI PRWYBBbLI7l CAW ACIIOiV PLAU
The Regional Committee discussed document SEA/RC40/17 submitted by the Government of Bangladesh along with Chapter 4 of the Annual Report. It endorsed the approach of intensification of national action programmes on primary health care aimed at achieving the target of Health for All by the Year 2000, with special attention to vulnerable and underserved sections of the population. It requested WHO to provide the required support to Member States for their efforts to implement, monitor and evaluate the PHC action plan in selected districts in the countries of the Region and further expand the activity into a nationwide programme (SEA/RC40/R5).
Item 9 SPECIAL PROfXMNE POIl BBSEARCE AND TRAINING IN TROPICAL DISEASES: REPORT ON TEE JOINT COORDINATILK; BOW
On behalf of India and Sri Lanka, who are the two current members from the Region on the Joint Coordinating Board, and who attended its tenth meeting, the representative of India informed the Committee on the meeting and highlighted the issues pertaining to the progress and management of the TDR programme. Mefloquine had already been synthesized and was now available for use in malaria control programmes. Progress in the development of candidate vaccines against malaria was also substantial, although it would take more time before a really effective vaccine was identified. Multidrug therapy in the control of leprosy had already produced spectacular results.
One of the significant changes in the approach to developmental strategy was the decision to support more institutional strengthening, rather than research projects or programmes. In this context, Member States were requested to produce suitable, technically sound proposals and expedite administrative clearances at the national level.
Item 10 SPECIAL PRoGlUHNE OF RESEARCB. DEWLO= AND RESIfAECE TRAINING m -0. - WgWgeSBIP OF TBB POLICY ABD COOPDINATIW ADVISORY COMKITlTE
The Regional Committee was informed that the Special Programme of Research, Development and Research Training in Human Reproduction had REPORT OF THE REGIONAL COMMITTEE 27 established the Policy and Coordination Advisory Committee (PCAC), an advisory body to the Director-General, to make recommendations on matters related to the policies, strategies, financing, overall organization, management and impact of the Programme.
The Committee's attention was drawn to the status of the membership. Under category (b), out of the three members from the Region, Nepal would complete its tenure at the end of the year necessitating nomination of a suitable member for representing the Region for three years starting from January 1988. The names of Sri Lanka and India were considered. Since India would be entitled to membership under category (a) by virtue of its being a substantial contributor to the Programme, Sri Lanka was nominated to this Advisory Committee.
Item 11 CONSIDERAIION OF RgSOLOTIONS OF BBGIONAL. INTEBBST BY TUB VOBLD BBdLTB ASSKHBLY AND TEE mmvE llom Fifteen resolutions of regional interest adopted by the Fortieth World Health Assembly and eight by the Seventy-ninth session of the Executive Board were brought to the attention of and noted by the Regional Committee.
(I) Promotion of Balanced Health Manpower Development (WHA40.14 and EB79.Rl6)
(2) Management of WHO-s Resources (WHA40.15 and EB79.R7)
(3) Collaboration with Nongovernmental Organizations: Principles Governing Relations between WHO and Nongovernmental Organizations (WHA40.25 and EB79.R22)
(4) Global Strategy for the Prevention and Control of Aids (WHA40.26)
(5) Maternal Health and Safe Motherhood (WHA40.27)
(6) Health of the Working Population (WHA40.28)
(7) Research on Aging (WHA40.29)
(8) Use of Alcohol in Medicines (WHA40.32 and EB79.Rl7)
(9) Diarrhoea1 Diseases Control (WHA40.34 and EB79.RB)
(10) Towards the Elimination of Leprosy (WA40.35)
(11) Fortieth Anniversary of WHO (WHA40.36) 28 REPORT OF THE REGIONAL COMMITTEE
(12) Recruitment of International Staff in WHO: Participa- tion of Women in the Work of WHO (WHA40.9 and EB79.Rl3)
(13) Development of Guiding Principles for Human Organ Transplants (WHA40.13)
(14) Economic Support for National Health For All Strategies (WHA40.30)
(15) Eighth General Programme of Work Covering a Specific Period (1990-1995 inclusive) [WHA40.31 AND EB79.R18]
(16) Cooperation in Programme Budgeting (EB79.R9)
Item 12 TIWB ARD PLACE OF POKTFICCUIAG SESSIOUS OF TBB REGIONAL CMIITTEE
The representative of Bhutan conveyed his Government's inability to hold the Forty-first Session in his country due to certain unavoidable developments. In the light of this situation, the Regional Committee decided to hold the Forty-first Session in the Regional Office unless a Member State issued an invitation, and noted with appreciation the invitation of the Government of Indonesia to hold the Forty-second Session in Indonesia.
Item 13 SELBCCION OF A SLIBJECl' FOR TBg HCBNICAL DISCUSSIONS TO BE HELD MlRIBG TEE POP.=-FIRST SBSSIOB
The Regional Committee decided to hold technical discussions on the subject of Development of District Health Systems during its Forty- first Session in 1988 (SEA/RC4O/RB). REPORT OF THE REGIONAL COHMITTEE 29
Annex 1
1. Representatives. Alternates and Mdsers
Representative : Mr Kazi Golam Rahman Joint Secretary Ministry of Health and Family Planning Dhaka
Alternate : Dr Md. Shamsul Islam Deputy Director (ITHC) Directorate General of Health Services Dhaka
Representative : Dr J. Norbhu Director Department of Health Services Ministry of Social Services Thimphu
Alternate : Dr (Mrs) H.M. Norbhu Senior Gynaecologist Thimphu General Hospital Thimphu
DEUOCRATIC PEOPLE'S REPUBLIC OF KOREA
Representative : Dr Kim Yong Ik Vice Minister of Public Health Ministry of Public Health Pyongyang
)originally issued as SEAIRCLOIL9 Rev.1, on 19 September 1987 30 REPORT OF THE REGIONAL COMMITTEE
DWOCRATIC PEOPLE'S BEPUBLIC OF KOREA (cont'd)
Alternates : Mr Chon Su Ok Director Department of External Affairs Ministry of Public Health Pyongyang Dr Song Pi1 Jun Director Institute of Health Administration Research Pyongyang Dr Kang Yong Jun Chief Institute of Evaluation and Introduction of New Technology Ministry of Public Health Pyongyang Dr Kim Won Ho Section Chief Institute of Health Administration Research Pyongyang Mr Kwon Sung Yon Officer Department of External Affairs Ministry of Public Health Pyongyang Mr Li Tae Hwan Researcher Institute of Health Administration Research Pyongyang
Representative : Mr R.K. Ahooja Joint Secretary Ministry of Health and Family Welfare New Delhi
Alternate : Mr Atul Pandit First Secretary Embassy of India Pyongyang REPORT OF THE REGIONAL COMMITTEE ? 1
Representative : Dr R. Hapsara Special Adviser to the Minister of Health on Medical Technology Jakarta
Alternate : Mr R.H. Moertolo Counsellor Embassy of the Republic of Indonesia in DPR Korea Pyongyang
Adviser : Dr Ida Bagus Mantra Head Centre for Health Education Department of Health Jakarta
Representative : Dr Abdul Samad Abdullah Director-General of Health Services Ministry of Health Male
Alternate : Mr Mohamed Rasheed Assistant Director of Planning and Coordination Ministry of Health Male
MONGOLIA
Representative : Dr Sh. Jigjidsuren First Deputy Minister Ministry of Public Health Ulan Bator
Alternate : Dr 2. Jadamba Chief International Relations Department Ministry of Public Health Ulan Bator 32 REPORT OF THE REGIONAL COMMITTEE
Representative : Dr D.N. Regmi Chief, Public Health Division Ministry of Health Kathmandu
Alternate : Dr Y.M.S. Pradhan Chief, Planning Division Ministry of Health Kathmandu
Representative : Dr Joe Fernando Director-General of Health Services Ministry of Health Colombo
Representative : Dr Uthai Sudsukh Deputy Permanent Secretary Ministry of Public Health Bangkok
Alternates : Dr Damrong Boonyoen Director, Health Planning Division Office of the Permanent Secretary Ministry of Public Health Bangkok
: Dr Somkhuan Shampeung Director, Health Education Division Office of the Permanent Secretary Ministry of Public Health Bangkok
Adviser : Dr Somsak Chunharas Chief Office for Technical Cooperation and Health Manpower Development Office of the Permanent Secretary Ministry of Public Health Bangkok REPORT OF THE REGIONAL COMMITTEE 33
2. Representatives of the United Nations and Specialized Agencies
United Nations : Mr Carl-Erik Wiberg Development Resident Representative Programme : Pyongyang
: Mr E.V. Melder Deputy Resident Representative Pyongyang
United Nations : Dr M. Adhyatma Children's Fund Regional Adviser for Primary Health Care Regional Office for East Asia and Pakistan Bangkok
3. Representatives of Nongovernmntal Organizations
Christian : Dr Zhang Bao-Kang Medical Deenabandhu Medical Mission of General Surgery Commission First Affiliated Hospital to Nanjing Medical College 300 Kwangchow Road Nanjing, People-s Republic of China
International : Dr Michel F. Lechat Leprosy President Association International Leprosy Association Ecole de Sante publique ~niversit& catholique de Louvair Clos Chapelle aux Champs 30 B - 1200 Brussels, Belgium
International : Dr Suchitra Prasansuk Federation of Department of Otorhino-Laryngology Oto-rhino- Faculty of Medicine laryngological Siriraj Hospital Societies Mahidol University Bangkok 10700, Thailand 34 REPORT OF THE REGIONAL COMMITTEE
1. Opening of the session
2. Sub-cornittee on Credentials
2.1 Appointment of the Sub-committee 2.2 Approval of the report of the Sub-committee SEA/RC40/20 and Add. 1
3. Election of Chairman and Vice-Chairman
4. Adoption of the Provisional Agenda and SEA/RC40/ 1 Supplementary Agenda Rev. 1
5. Appointment of the Sub-committee on Programme Budget and adoption of its terms of reference
6. Adoption of Agenda and election of Chairman SEA/RC40/5 for the Technical Discussions and Add. 1
7. Review of the Draft Provisional Agenda of the eighty-first session of the Executive Board and of the Forty-first World Health Assembly
8. Address by the Director-General, WHO
9. Thirty-ninth Annual Report of the SEA/RC40/2 and Regional Dl rector SE~/RC40/1nf.l
10. Technical Discussions on Information and Education for Health in Support of Health for All by the Year 2000
11. Review of the Director-General's Introduction to Proposed Programme Budget for 1988-1989 and the comments of the World Health Assembly thereon
loriginally issued as document SEA/RC40/1 Rev.1, on 17 September 1987 REPORT OF THE REGIONAL COMMITTEE 35
12. Review of the Programme Budget for 1988-1989
12.1 Consideration of the report of the Sub-committee on Programme Budget
13. Consideration of the recomendations arising out of the Technical Discussions
14. WHO'S public image through its health development work
15. Special Programme for Research and Training in Tropical Diseases 15.1 Joint Coordinating Board (JCB) - Report on the JCB session
16. Special Programme of Research, Development and Research Training in Human Reproduction - Membership of the Policy and Coordination Advisory Committee in place of Nepal whose term expires on 31 December 1987
17. Consideration of resolutions of regional interest adopted by the World Health Assembly and the Executive Board
18. Time and place of forthcoming sessions of the Regional Committee
19. Selection of a subject for the Technical Discussions at the forty-first session of the Regional Committee
20. Adoption of the final report of the fortieth session of the Regional Committee
21. Adjournment
Supplemzntary Agenda
1. AIDS SEA/RC40/15 2. Drug abuse SEA/RC40/16 3. Intensification of district PHC action plan SEA/RC40/17 4. Method of appointment of the Regional Director SEA/RC40/18 36 REPORT OF THE REGIONAL COMMITTEE
Item 1 IrnrnION
The Sub-committee on Programme Budget held a preliminary meeting on 15 September 1987 in the Small Talking Room of the Koryo Hotel, Pyongyang. Dr Joe Fernando of Sri Lanka was unanimously elected as Chairman. The Sub-committee reviewed its terms of reference (SEAlRC4014) and the working papers (SEAlRC4013 and SEAIRC4OIPBIWPl to 4) as well as the information documents relating to the implementation of the programme for the first eighteen months of the 1986-1987 biennium, the detailed Programme Budget for 1988-1989, the funding situation for the financial period 1988-1989 and the regional medium- term programme for the Eighth General Programme of Work, covering the period 1990-1995. The Sub-committee met twice again on 17 September 1987 to carry out its work and to finalize its report. The meetings were attended by:
Mr Kazi Golam Rahman Bangladesh Dr (Mrs) H.M. Norbhu Bhutan Mr Kwon Sung Yon DPR Korea Dr Kim Won Ho DPR Korea Mr R.K. Ahooja India Dr R. Hapsara Indonesia Mr Mohamed Rasheed Maldives Dr Sh.Jigjidsuren Mongolia Dr Z. Jadamba Mongolia Dr D.N.Regmi Nepal Dr Y.M.S.Pradhan Nepal Dr Joe Fernando Sri Lanka Dr Damrong Boonyoen Thailand Dr Somsak Chunharas Thailand loriginally issued as document SEA/RC40/21, on 17 September 1987 REPORT OF THE REGIONAL COMMITTEE 37
Item 2 REVIEW OF lllg IW-ATION OF PROGlUllMlS DURING THE FIRST EIWlEEB lRNnaS OF lllg BIEttUILM 1986-1987
The Sub-committee reviewed the working paper SEA/PDM/Meet.l2/6 and the conclusions of the twelfth meeting of the Consultative Committee for Programme Development and Management (CCPDM) as contained in Section I11 of its report (document No.SEA/PDM/Meet.l2/8). The Sub-committee was informed that the implementation rate of the Organization-s collaborative programmes in the Member States during the first eighteen months of the biennium 1986-1987, at 62 per cent in financial terms under the Regular Budget, was nearly identical to that of the 1984-1985 biennium, a period which had attracted adverse audit comments on late implementation and large scale reprogramming towards the end.
The Committee was also informed that in view of the drop in the exchange value of the US Dollar against the Swiss Franc, the Director- General had recently imposed global budgetary implementation reductions and that, regretably, the South-East Asia Region had attracted a cut in view of its low rate of implementation and high proportion of unobligated funds as on 31 March 1987. This cut was in addition to the previously imposed pro-rata reduction in programme implementation as a result of the shortfall in the receipt of assessed contributions for the biennium.
The Committee noted that the implementation rate would need to be accelerated and endorsed the recommendations contained in Section I11 of the CCPDM report while emphasizing the importance of improving the delivery of fellowship and local cost subsidy components as well as the need for providing documented justification for programme changes.
The Committee was informed that an increased emphasis on local cost subsidy and fellowship components, with a corresponding decrease in long-term staff, had resulted in an increased complexity of the total programme to be implemented. The main reasons for difficulty in programme implementation could thus be best identified through an analysis of the difficulties in implementing the fellowships component.
The Committee also felt that the CCPDM could assume a more active role in programme analysis by making use of the result of CST and other programme reviews or audits.
The Committee also felt that there was a need to review the entire process of planning, implementation and evaluation of WHO'S collaborative programmes at District, National and Regional levels so as to promote a more creative/catalytic form of WHO collaboration. Increased use of the health services research and development programme at the country level as described in the Eighth GPW could be used towards this end. 38 REPORT OF THE REGIONAL COHHITTEE
Item 3 BEVIEW OF TEE WTAJXKD BUDGET FOR 1988-1989 .is-a-vis PA- OF llTILIZAIIOLI OF TEE BBGmdR MlXKr IN TERlS OF MCE DURING 1984-1985 dRD 19861987
The Sub-committee reviewed document SEA/RC40/3 and the working paper SEA/RC40/PB/WPZ, which set out the pattern of utilization of assistance in respect of each component during the 1984-1985, 1986-1987 and 1988- 1989 biennia. The Sub-committee was informed that as desired by the Thirty-ninth Session of the Regional Committee, the detailed programme budget for 1988-1989 was prepared with an emphasis on details for the first year, while the second year would be further refined towards the end of 1988. This document was different from the previous budget documents inasmuch as it contained further details of components, i.e. long-term staff, short-term consultants, fellowships, etc., for 1988 and in some cases even for 1989.
It was recognized that provision of these details, at least for the first year of the biennium, should improve the implementation. The Sub- committee also noted that there had been a reduction of $300 000 in staff costs for the Region, and as such the Detailed Programme proposals have now been developed for a total budget of $76 703 900, as against $77 003 900 noted by the Thirty-ninth Session of the Regional Committee. This reduction was purely a recosting and did not affect the programme.
The Sub-committee noted that the shifts in resources reflected in the Detailed Programme Budget for 1988-1989 were within the established budgetary ceiling and that the activities described therein were consistent with the Seventh General Programme of Work, and reflected the firm commitment and fundamental desire of the Member States to intensify their efforts to implement strategies and plans for achieving the social goal of Health for All and All for Health.
The Sub-committee recommended the adoption of an appropriate resolution requesting the Regional Director to implement the 1988-1989 programme and the Member States to begin taking preliminary steps now to ensure a timely implementatiozl of this programme.
Item 4 PrmDIWG SIrOATION - FIN&NCIAL PmIOD 1988-1989 The Sub-committee reviewed the information provided in the working paper SEA/RC40/PB/WP3 relating to the funding situation during the biennium 1988-1989, and noted the three scenarios provided by the Director-General in order to cope with currently envisaged financial constrainta. The Member States would be kept informed of further developments as and when more information became available. REPORT OF THE REGIONAL COMMITTEE 39
Item 5 RI(GIO~~I~-TEP~ PBOG- mu m EIG~amra PBOG~~~ OF WIRK (COVBBIBG THE PERIOD 1990-1995)
The Sub-committee noted that the Regional Medium-Term Programmes (MTP) had been developed by the Regional Office after detailed consultations with Member States and that the objectives, targets, approaches and activities enumerated in the working paper would form the basis for the Organization's collaboration with the Member States during the period of the Eighth General Programme of Work, covering the period 1990-1995, and that the biennial budget for 1990-1991 would be prepared within this context.
The Sub-committee noted that the regional MTPs had been developed in accordance with the classified list of programmes for the eighth GPW, which had been approved by the World Health Assembly in May 1987. It also felt that increased efforts should be directed towards complete quantification of targets and objectives, and recommended that this guidance be kept in mind when subsequent revisions to the MTP were initiated. The Sub-committee endorsed the recommendations made by the twelfth meeting of the CCPDM (in Section IV of its report, SFA/PDM/Meet. 1218). 40 REPORT OF THE REGIONAL COMMITTEE
BECOHMENDATIONS ARISING OOT OF TEE TECHNICAL DISCUSSIONS ON I~TIOUAHD EDUCATIOB FOR BWTB IU SUPPORT OP BWTB FUR ALL BY TEE YEAR 20001
Item 1 INnODUCcIWI
Under the chairmanship of Dr J. Norbhu, Director, Department of Health Services, Ministry of Social Service, Bhutan, technical discussions were held on "Information and Education for Health in Support of Health for All by the Year 2000" on 17 September 1987. Dr Y.M.S. Pradhan, Chief, Policy Planning, Monitoring and Supervision Division, Ministry of Health, Nepal, was elected Rapporteur. The annotated agenda, as approved by the Fortieth Session of the Regional Committee was the basis of discussion, which was planned as follows:
Annotated Agenda
1. Concept, scope and objectives of Information and Education for Health (IEH) - conventional approach; concentration on information dissemination; obsession with motivation; campaigns; IEH in the context of PHC.
2. Current status of IEH in the South-East Asia Region
2.1 General constraints to projection of the visibility of the IEH programme
2.2 Structure - existing models in Member States
2.3 Manpower development; teaching programmes in academic institutions; deficiencies in skill development programmes
2.4 Community involvement - existing pattern of community involvement in Member States; utilization of peripheral organization and the role of leaders loriginally issued as document SEA/RC40/22, on 18 September 1987 REPORT OF THE REGIONAL COMMI'CTEE 41
2.5 Mass media - newspapers, television, radio; printed material and traditional media in the dissemination of health information
2.6 Research - present status of IEH research; research methods; utilization of research findings.
3. New policies and approaches in IEH
New policies in harmony with the policies and strategies of PHC, development of human resources; appropriate educational technology; multisectoral approach; monitoring and evaluation.
4. Implications of new IEH policies in achieving the goal of HFA12000 4.1 Reorientation of the IEH structure - to act as a permanent operational arm of PHC
4.2 Training at the professional level in IEH in support of PHC; teaching in medical schools and departments of community medicine; orientation of media personnel in health development; training of workers in health- related sectors and training of health education specialists
4.3 Community involvement - healthy life-style; self-help groups; strengthening of peripheral institutions; HFA leadership; training of health workers; interface between the community and the health systems
4.4 Media strategies- - partnership with mass media: multi- media approach; coordination with programme imp1ementation;WHO-s collaboration in advocacy for HFA; intersectoral coordination 4.5 IEN-related research - new guidelines for IEH-related research; research methods; utilization of IEH-related research findings.
5. Recommendations
The discussions were aimed at assessing the existing status of IEH Programmes in the Member States of the WHO South-East Asia Region, and identifying issues, constraints, resources and infrastructure for IEH activities. The new policies and approaches to IEH were reviewed, the operational feasibility examined and recommendations made for consideration by national authorities to strengthen existing IEH Programmes to support HFA/2000. 42 REPORT OF THE REGIONAL COMMITTEE
Item 2 OPERIllG ADDPBSS BY IRE cEUWAIl
The Chairman thanked the delegates for electing him to chair the technical discussions. In his opening address he outlined the general framework of the discussions on the basis of the agenda. He said that WHO'S policy of Health for All by the Year 2000 demanded a reassessment of information and education strategies and their organization. To achieve this goal, IEH will have to take on the role of an agent of social change. He also emphasized the role of health and health-related workers in educating the community directly as a part of their preventive and curative services. Health education must also adopt a positive approach to help families recognize health as a positive value. IEH should become an integral part of the process of socialization and the families and the communities should be competent to carry it out.
In order to achieve the goal of HFAI2000, and to ensure integration of IEH in all the elements of PHC, a reorientation of the IEH structure was essential. A satisfactory blend of appropriate technology, proper mix of information and education, community involvement, strengthening of manpower development and intersectoral coordination was necessary. He then invited the delegates to formulate practical suggestions that could facilitate IEH activities to support HFAI2000.
Item 3 CONCEPT, SCOPE AND OBJECTIWG3 OF IF37
IEH was considered as a basic precondition for any successful health care delivery system. The Declaration of Alma-Ata was a landmark in the history of health education to which it gave a place of prime importance in promoting individual and community self-reliance and developing people's ability to become full partners in health promotion and care. To achieve the goals set at Alma-Ate, there was a need to specify measures that could be taken by the individuals, families, communities and the health services at the primary and supporting levels. These measures should reflect new approaches in health education as well as health care which required a multi-sectoral approach. In the context of PHC the objective of IEH was to foster public information and education for health in order to motivate people to want to be healthy, to seek help when needed and to do what they can individually and collectively to maintain and promote health in a dynamic interaction and partnership with health services. As such, IEH called for a balanced mix and mutually supportive use of mass media, community organizational efforts and interpersonal approach to generate a level of social awareness that would involve people and enhance their ability to participate in their own health care system. REPORT OF THE REGIONAL COMMITTEE 43
Item 4 aRlKKT STAmS OF IEB IN SOllIEBAST ASIA
Item 4.1 General Constraints
While adopting the policy of HFA/2000 through PHC and to encourage people to participate in health development, IEH was accepted by the Member States as an essential element of primary health care. However, this did not affect the IEH organizational structure significantly. The main emphasis was on =ism. In some countries there were separate IEH related organizations with different names, like information education comunication; programme support comunication; information, motivation and education, etc. that were being used according to the needs of those programmes. In many countries IEH was still largely associated with instructional efforts and sporadic audio-visual and media activities. Its key role in helping individuals, families and communities to become self-reliant was rarely perceived. There was scarcity of resources and its importance in integrating PHC was still to be stressed.
Item 4.2 Structure
The group recognized that in the countries of South-East Asia there was a formal structure of health education specialists and IEH was also integrated into other professional activities. This compromise model had shown certain limitations: one had been the concentration of efforts to produce specialists at the national level with low priority to train others in this subject. Another drawback had been the gap between the activities of specialists and those of others. In practice, this meant that some countries had a well-structured health education service at the upper levels, but inadequate manpower to carry it out in the field.
Item 4.3 lknpaer ~cvelop~nt
There was a scarcity of high level information and health education professionale to provide technical leadership in information and education for health activities. Health education specialists, where available, were not always utilized to assist health workers in health education at field level, to train them for education, and to provide other forms of technical assistance thereafter. The problem with IEH manpower development was that even when specialization in IEH was available, only certain professions made use of it. There was also reluctance to accept IEH as a separate discipline within the existing curriculum of the educational institutions for the different 44 REPORT OF THE REGIONAL COMMITTEE
professions involved. Before any attempt was made to persuade a medical faculty or school of public health to allocate a substantial amount of time to IEH in the existing curriculum, there must be certainty that the proposed subject matter was of an academic standard and relevant to primary health care.
Moreover, there was need to develop a well-defined career structure within the system to attract good quality of people.
Since every health worker should also function as a health educator, the training of health workers should be in tune with the health syatem based on primary health care, which entailed social equity, community participation, intersectoral action and use of appropriate technology.
There was need to revolutionize the very concept of IEH, organizing informal self-help groups from the vulnerable and disadvantaged sections of population, such as pregnant mothers, economically handicapped, etc. Specific messages needed to be developed and delivered to reach the target audience/group.
Problem-oriented teaching programmes on health should be introduced in the primary and secondary schools and teachers' training programmes. Innovative approaches to attract students for a healthy life style might also be considered.
Item 4.4 Collnity Iovolve~nt- Existing Pattern Community involvement was given prime importance in developing countries to accelerate rural development or community development programmes. From the very beginning it was concerned with working with communities to change behaviour by imparting new skills and knowledge. Although health was one of the components of the programme, it was normally focussed on community development with preference on agriculture extension, cooperatives, etc. The participation was often relegated to a contribution by the community in terms of money, time or labour. Involvement of the community in the development process from the early stages was rare. In many places, providing audio-visual material was considered as health education. There were very few opportunities to initiate a dialogue between the communities and health workers in the decision-making process.
Item 4.5 Hass Media
Communication through mass media was attractive, but its effectiveness was, however, limited. Experience in using mass media to change people's behaviour is yet to be proved. Mass media helped in REPORT OF THE REGIONAL COlMITTEE 45
reinforcing existing beliefs and opinions rather than in changing and converting them. In many countries the mass media, except radio, were limited to the urban population and did not control undesirable advertising which often conflicted with health education. The contacts between health workers and media personnel were very limited and the contribution of media to health development was insignificant. The messages were expert-oriented and sometimes beyond the comprehension of common people. They lacked clarity and simplicity, and did not create any interest among the general public. A further disadvantage of the mass media in some countries was that the primary target groups did not have access to the mass media. Traditional media was utilized rarely; traditional healers and health workers were the source of information on health-related subjects in the villages.
Item 4.6 Status of IKH-related Research
The importance of research in health behaviour services, IEH and community participation was well recognized. There was paucity of information about the numerous researches conducted by the universities and very few health education bureaux in the Region had research units. Most research related to IEH was being carried out by professional researchers in the teaching institutes. Methodologies also needed close scrutiny. Almost all research protocols relied exclusively on a single behavioural science data gathering technique, 1.e. survey research. Researchers mostly overlooked the techniques of participant observation, depth and open-ended interviews, case studies and other behavioural science research methods. Research findings were also not properly utilized in programme implementation.
Item 5 NBY POLICIES lUlD APPRMCEKS IN IKH
The WHO Constitution specially called for "active co-operation" of people in the health field, and the declaration of Alma-Ata listed , "education concerning prevailing health problems and the methods of preventing and controlling them" as the first of the eight elements of primary health care. Certainly, the goal of HFA/2000 could not be achieved without the fullest co-operation of an informed and educated public, willing to become involved and self-reliant in the matter of health.
Public information and education for health should be considered two sidea of the same coin. It should focus essentially on advocacy aimed at convincing policy-makers, administrators and professional groups that investment in health was sound economics, a political asaet with popular appeal and a social imperative; developing and strengthening organized community groups for their active involvement in health 46 REPORT OF THE REGIONAL COMMITTEE development; and informing the public and enlisting people's participation in specific health programmes, while, at the same time, promoting healthy living. Doing this required intersectoral collaboration, particularly in strengthening health education of the school-age child, and in mobilizing all available community resources.
Item 6 IWPLICATIOUS OP NIW IRE POLICIES IN ACBIEVIUG TEE GOAL OF HFA/2000
Item 6.1 Reorientation of IRE Structures
A possible solution in respect of the IEH structure might be to provide support to the further development of the existing organization. It might provide for specialization in IEH to satisfy the needs of IEH services in the ministry of health as well as integration of IEH subject matter into the basic and postgraduate training of other professionals which had an important role in IEH activities.
Orientation was also needed to create a new image of IEH as an operational arm of primary health care, developing a positive concept of health, innovative educational approaches and technologies. The pressure had to be geared towards community involvement with multisectoral and multidisciplinary approaches. IEH had to develop new strategies at various levels of action, 1.e. national, legislative, district, health centre and community. It must also take cognizance of social and environmental sectors that affect health.
Item 6.2 Training at the Professional Level Effective IEH services require integration of IEH subject matter at an undergraduate level in all medical and nursing schools, as well as in teachers training colleges, schools of mass media and journalism; specialization in IEH should also be offered in postgraduate medical and nursing schools, as well as in faculties of medicine.
In training, the major focus should be on the preparation of community-based health and health-related workers to assume an active role in community health education with emphasis on team work, social mobilization and on enlisting the support of other development workers.
Item 6.3 Counitp Involvemnt in Primry Eealth Can
Community involvement is the key factor in the implementation of the PHC concept, and IEH is considered to be the cornerstone of the PHC REPORT OF THE REGIONAL COMHITTEE 67
approach. To establish better communication with the community, health workers should develop the skills to identify religious and opinion leaders, representatives of voluntary organizations and respected community figures, help them in identifying the specific needs of the community and participate in improving the health of the people by developing partnership with the health care system. Religious institutions and associations should be mobilized to support IEH and promote healthy living among their adherents - women's support must be specially enlisted. Considering that the seeds of good health are sown early, it was essential to focus on children and young adults. Through the educational channel the message of health should be taken to the households.
Item 6.4 Iledia Strategies
Over the past 20 years there had been a substantial increase in the spread of modern communication media in some of the Member States. In others, its presence was insignificant. The issue of one-way versus two-way communication between the health services and the community was raised. The use of traditional network in message transmission was discussed. The group felt that at macro and mezo levels, the modern mass media may be effective in creating necessary awareness about health, but at the grassroots level it might not be able to provide health information through modern media except radio. Thus, health and health-related workers had to be trained in the technique of effectively disseminating the required information through the existing network and social institutions. They also had to support the community in the decision-making process. Where feasible, village newspapers and village radio broadcasts may be tried.
Item 6.5 Social Harketing
It was desirable to explore marketing techniques to advance health , development. However, care would need to be taken not to substitute it for health service and to make sure that the infrastructure existed to cater to the demand generated for services.
Item 6.6 Research Develop~nt
To encourage and improve IEH-related, community-based research there was a need to develop manpower and research capability of health education bureaux. Even at the periphery, simple, problem-orientated research may be designed and conducted, focusing on local health 48 REPORT OF THE REGIONAL COWITTEE problems. The behavioural and social scientists needed to be encouraged to take required interest in it. A variety of methods should be used from the discipline that contributed to the knowledge of IEH, and research findings should be utilized to support the programmes leading to achievement of the goals of HFAl2000. There was need to develop case studies and IEH-related success stories to be utilized in the training institutes to improve health programmes.
Item 7 RECfHlEtDATIONS
1. Suitable reorientation and strengthening of IEH is needed in respect of policies, strategies, approaches and resource allocation to provide adequate support to achieve the goal of HFAl2000.
2. The existing academic and in-service training programmes for health professionals should be reviewed, based upon health-for-all strategies and its implied value, and strengthened in respect of information, education and communication sciences. The teaching should be participatory and field-oriented. Similarly, training of media personnel should include 'Health Orientation', with close interaction between media specialists and content specialists.
3. (a) Health workers at the grassroots level must be equipped with skills to use appropriate IEH technology, involve individuals, families and communities to identify their felt needs, participate in their own health affairs for self-reliance and promote healthy life style.
(b) While it is important for policy-makers to be aware of health issues, it is equally important for health- related workers to get oriented in dissemination of health information and to facilitate interaction between the community and health system.
4. In order to obtain media support for advocacy for HFA and PHC:
(a) The health sector must develop a partnership with the departments of information and broadcasting so that the communities have easy access to the right kind of information concerning their health situation and plan self-help programmes. This would help to counter any misinformation generated by the mass media.
(b) Linkages should be established between various health- related sectors to get the maximum benefit of IEH programmes. Mechanisms should be developed for intersectoral coordination. Efforts should be made to REPORT OF THE REGIONAL COMMITTEE 49
involve fully NGOs, including women's and other groups in IEH activities.
(c) The possibility of adopting a multi-media approach and social marketing techniques using corporate resources might be explored.
5. (a) Research in lEH should aim at developinglimproving policies, strategies and methods of planning, management and evaluation of IEH programmes. It must be culture-specific, people-oriented and should result in community involvement in its own health care system. Results of such research must be made available to the training institutes, programme officers and health workers to be utilized in programme implementation.
(b) Comparative effectiveness of various methods like person-to-person communication and cornunity organization; traditional and modern media might be tested in respect of health issues.
(c) Case studies and success stories relating to IEH should be documented from the Member States and disseminated by WHO Regional Office in order to be utilized in training and programme development.
6. WHO should examine the feasibility of setting up a clearing house mechanism to facilitate exchange of IEH related information among the Member States. 52 REPORT OF THE REGIONAL COMMITTEE "
year of the biennium - and the importance of the financial audit in policy and programme terms in monitoring the use of this policy.
2. Renewed emphasis on the improvement of WHO'S information system was needed to support the managerial process for WHO programme development.
3. In the Health for All Leadership Development, though the current focus was directed towards motivating the political leadership to the goal of HFA, other aspects should also receive increased emphasis in the regional plan for the Health for All Leadership Development programme, especially those related to intersectoral coordination, financing of health care, health economics, community participation, rational use of drugs, development of appropriate technology, etc. In this the role of local leadership was of paramount importance.
4. A specific forum should be developed simultaneously with general approaches to develop HFA leaders. It was also necessary to develop intersectoral coordination before going to the grass-roots level, and the Annual Report might summarize country achievements in these areas.
5. WHO should play a more leading and active role in the implementation of health activities funded by other international agencies, especially in view of their increasing interest in health development activities, such as UNICEF in the expanded programme of immunization (EPI) and the nutrition programme. The flexibility inherent in the WHO partnership with the Member States was an important factor favouring the enhanced role of the Organization.
6. It might be advantageous for the Member States to have a separate mechanism for intersectoral coordination of mattera relating to health sector, involving other ministrieslagencies.
7. As the funds earmarked for the intercountry programme were very limited, the question of increasing the allocation for the Regional Director-s Development Programme, in order to provide more assistance to Member States in cases of emergencies, should be considered by the Committee while reviewing the broad regional/intercountry program proposals for 1990-1991.
Chapter 3 HEbLTE SYSm DBVBU)RIBBT
Progress had been made by Member States in the field of health situation and trend assessment by developing their respective national health information system in collaboration with the Organization. The REPORT OF THE REGIONAL COMMITTEE 53
first evaluation of HFA strategies had been completed successfully and the second round of monitoring of progress on the implementation of the HFA strategies, using the common framework and format, was due by March 1988. In the field of managerial process for national health development, there was a change in the Organization policy to seek suitable entry points for its involvement, rather than concentrate on a few selected countries to develop the managerial process.
The following points were recommended for consideration by the Regional Comud ttee:
1. The strengthening of the national epidemiological surveillance system, emphasizing prompt reporting of any outbreak or spread of communicable diseases, and immediate dissemination of information to declsion-makers to enable them to take urgent and appropriate action, were essential, and in this context the Organization should assist Member States to develop a suitable system.
2. The Common Framework and Format should take Into consideration the information available, as well as the requirements of the countries. Therefore while revising the Format, the information needs of the country should be incorporated so as to serve as an internal management tool.
3. As information is a crucial input for successful management, linkages should be established at all levels emphasizing the important relationship with the Health Situation and Trend Assessment (HSATA) programme.
4. Effective interaction, for successful development of health systems in countries where planning had been decentralized, should be pro- moted between the health administrators, health services, and those concerned with the processing of health information. Sensitivity in reacting to reported trends should also be developed.
5. WHO should assist the Member States to make use of available resources under other programmes, such as the intensification of action programme on Primary Health Care (PHC) to strengthen this interaction.
6. As regards health systems research, more emphasis should be placed on increasing the awareness and strengthening of health systems research policies, as well as on better utilization of available resources.
Chapter 4 OrlGAuIzArIOR OP UEALm SYSW(S WED OEl PPlWBY BgdLTB CAE33
The Member States had taken steps to intensify the PHC programme at the district level, strengthening the training of middle level health 54 REPORT OF THE REGIONAL COMMITTEE workers and the referral system - especially the medical institutions serving as the first referral unit. In spite of problems such as lack of transport, communication, etc, efforts were being made by governments to develop an effective referral system for the provision of PHC at the district level with the involvement of the local community. Innovative approaches, such as the introduction of a pilot project for community-based self-financing of PHC expansion activities, were being adopted by some Member States.
The following point was recommended for consideration by the Regional Commit tee :
WHO'S assistance would be required to support countries' efforts to intensify PHC action programme at the district level. * * *
Chapter 5 miALm Ehuwuim Health manpower planning had assumed greater importance since the acquisition of skills and expertise in the health sector at present appeared to be lopsided and imbalanced. Many countries had a large reservoir of health manpower available; perspective planning for the development of health manpower had been undertaken by some countries, including reorient'ation of national policy on medical education, inclusion of health education as part of general education and promotion of intersectoral coordination. An intercountry consultation on 'Reorientation of Medical Education' was held in the Regional Office to discuss undergraduate medical education.
Concerning teacher training, the Organization was supporting two teacher training centres in the Region for the training of teachers both from within the Region and outside. The teachers thus trained would form a critical mass for providing training to people coming from different institutions. The Organization was supporting this activity, and also the development of health learning materials for use in Member States, such as self-instructional packages for English language, training courses, etc.
The fellowship programme was the weakest, as far as implementation was concerned in comparison with other components. At an earlier CCPDM meeting, a series of steps was recommended for action by the Member States and the Regional Office for improving the delivery of fellowship programme. The main reasons for poor implementation of fellowships were the delay in nomination of candidates for fellowships, delay in securing placement in host institutions, lack of adequate English language skills, etc. REPORT OF THE REGIONAL COMMITTEE 55
The following points were recommended for consideration by the Regional Committee:
1. Reorientation of medical education was not a one-time activity but a continuing one, so that emerging issues and problems in the health field could be tackled appropriately. Health policy requirements for medical education should be community- and need-based and, in this context, the identification of community health requirements was of paramount importance.
2, One of the thrusts of the WHO programme should be to encourage the countries to adopt an appropriate health manpower development policy, which currently did not sufficiently reflect rational integration among demand, supply and utilization.
3. With regard to the numbers of auxiliary and paramedical personnel in training, the nurses:doctor ratio was very low and needed to be improved. 4. In addition to the strengthening of inservice training in maternal and child health (MCH), the training of nursing personnel, midwifery personnel, etc., should also be strengthened and WHO should also assist the countries in the identification of training requirements for these categories.
5. More intensive utilization should be made of available facilities for training within the Region and through nongovernmental organizations (NGOs).
6. An evaluative study of the fellowship programme, encompassing the reasons for poor implementation and lapse of fellowships, should be undertaken by the Organization with a view to identifying the problem areas specific to the Region and applying remedial measures.
7. Efforts should be made to improve the representation of women for the award of fellowships.
Chapter 6 PUBLIC IWOQUATION AND ELIUCATION FOR BgALTE
The following point was recommended for consideration by the Regional Committee:
1. The rapport between the media specialists, the health education specialists, and programme managers needed to be improved in order to ensure a high quality media coverage which would help solve 56 REPORT OF THE REGIONAL COMMITTEE
priority health problems or change the behaviour and life style of the people in such a way that health risks could be avoided. This would have an impact on awareness of priority health problems, attitudes and behavioural change of the people which would ultimately lead to community participation in implementation of HPA and PHC strategy.
Chapter 7 BBSBbaCB rnrnI0N m DBPEUlRlBHT Good progress had been made by the Member States in undertaking research promotion and development for achieving the goal of HFA. The main thrusts of the Organization's research programme were aimed at institutional strengthening for research, strengthening of research promotion and coordination mechanism in the Member States, and the transfer of technology. Strengthening and integration of Health Systems Research (HSR) , Health Behaviour Research (HBR) and Heatlh Economy Research (HER) was recommended by the Advisory Committee on Health Research (ACHR). The following points were recomended for consideration by the Regional Committee:
1. Research activities should be designed to solve health problems at the country level. 2. Utilization of research results should be promoted at the country level. 3.Collaborating centres should be encouraged to make use of information available from similar centres in other regions.
Chapter 8 GENEBAL EEALm PBrncTION m PrlamTION The South-East Asia Region had a large share of global malnutrition in terms of people affected. The Organization's collaboration with the countries in this programme had greatly contributed to reducing the incidence of protein-energy malnutrition, vitamin A deficiency, iodine- deficiency disorders and nutritional anaemia. The main focus of the Organization's regional nutrition programme, therefore, aimed at REPORT OF THE REGIONAL COMMITTEE 57 strengthening the national capabilities for dealing with nutritional problems in the Member States. Besides supporting country-specific nutrition projects, the Organization had also developed regional programmes for controlling iodine-deficiency disorders and xerophthalmia. In the field of accident prevention, though there was no clear cut policy, many countries had developed their national programme to prevent accidents from traffic, domestic and occupational hazards, and a regional strategy had also been formulated.
The following points were recommended for consideration by the Regional Committee:
1. Health education was an important aspect of the nutrition programme on which the Organization should concentrate its efforts, and that it should be integrated with primary health care activities.
2. It was imperative for the national authorities to implement effectively their national programmes on prevention of traffic accidents by doing further epidemiological research studies, etc. It was also essential to prepare a position paper on what was being done by Member States in this field.
3. The national authorities should adopt a multisectoral approach for prevention of traffic accidents and in this the health authorities could take the initiative in view of the increasing number of fatalities arising out of such accidents.
4. Domestic fire and other household accidents - which were on the increase - could be prevented by better health education, which needed to receive the attention of the countries.
5. WHO should also designate a collaborating centre within the Region for prevention of accidents and, if such a suitable centre was not found within the Region, an appropriate centre in other regions should be identified.
Chapter 9 PPrnCrION AND PROIIOTION OF OF SPECIFIC POPULATION GROWS
Member States had taken steps for improving the quality of services provided in the maternal and child health programme. Many states had programmes in this area supported by WHO as well as by other international organizations. One of the constraints encountered related to the difficulty in recruiting long-term experts, as a result of which not only the programme implementation suffered, but also the funding agencies tended to withdraw their support. In a project requiring more than one consultant during the biennium, even when the first short-term 58 REPORT OF THE REGIONAL COMMITTEE consultant had been recruited, suitable arrangements should be made to enaure the recruitment of another consultant before the expiry of his assignment.
Reproductive health in adolescents formed a separate programme in the Eighth General Programme of Work, in view of the developmental, health and social problems facing this group. Increasing importance was being given by the Member States to the promotion of activities related to the programme on health of the elderly.
The following point was recommended for consideration by the Regional Committee:
The Organization should take effective steps to improve the situation with regard to making timely recruitment of staff.
Chapter 10 ROTECTION AND PB01(OTION OF IIBRTU. HEALTB In the field of protection and promotion of mental health, drug abuse and alcohol-related health problems caused great concern in the countries of the region. Preventive measures had been taken by the countries to cope with the problem, as well as for treatment of addicted persons.
The following points were recommended for consideration by the Regional Committee:
1. Member States should think in terms of strengthening their efforts in tackling alcoholism and drug abuse by establishing appropriate mechanisms for the treatment and rehabilitation of persons afflicted with these problems.
2. There was a need to take effective preventive measures against the import and production of drugs, in accordance with international conventions.
3. Information systems should be strengthened with a view to obtaining the latest data on the extent of the problems, surveillance and monitoring of drug abuse and alcoholism for the countries to initiate preventive measures. WHO should also obtain information on these problems from other countries where they are endemic, and disseminate it to the Member States in the Region to help them manage the problems. REPORT OF THE REGIONAL COMMITTEE 59
Chapter 11 PBOLWIION OF KNvI80rnATAL. &Burn
The focus on collaborative activities under the programme for the promotion of environmental health continued to be directed towards improving the community water supply and sanitation in the context of International Decade for Drinking Water Supply and Sanitation (IDDWSS). Housing in urban and rural areas was also being given increased attention in most countries of the region. Increasing numbers of motor vehicles and industrialization were among chief factors responsible for environmental health hazards. Further, food safety is emerging as a problem.
The following points were recommended for consideration by the Regional Committee:
1. In order to prevent environmental pollution due to the emission of smoke, chemicals, etc., Member States should enforce strict safety measures for chemical and related industries causing environmental pollution.
2. Greater involvement of WHO was essential in the international movement of food exposed to radiation contamination. A regional initiative with WHO support might be necessary for developing a protocol on food safety standards, perhaps in collaboration with FA0 and UNDP.
3. An appropriate technology for the Region should be developed for identification - with least delay - of food contamination, and through formulation of appropriate legislation, the countries should take effective steps to tackle the problem.
4. A multisectoral approach was essential in dealing with the food safety problem with full involvement of the community.
Chapter 12 DUGNOSTIC, lUBBbPEDTIC AND BEBMILITATIVE TECEN0U)GP
A number of activities had been undertaken in the Member States with the collaboration of WHO in developing departments of immunology, provision of basic radiological services and management and quality control of essential drugs and vaccines. Many countries had developed an essential drugs list, as well as a standard drug regimen for use in particular diseases. In the field of traditional medicine, attention was focussed on how the traditional medicine practitioners could be used effectively in PHC with appropriate training. 60 REPORT OF THE REGIONAL COMMITTEE
The following points were recommended for consideration by the Regional Committee:
1. Member States should become self-reliant in the production and maintenance of diagnostic, therapeutic and rehabilitative equipment, especially for the development of basic radiological services, and WHO collaboration would be needed to enable the countries to establish contact with appropriate technology centres for local production of basic radiological equipment.
2. In addition to the development of an essential drugs list, it was also essential to formulate, with WHO collaboration, an appropriate policy and mechanisms for the rational use of drugs.
3. Dissemination of information on essential drugs was important for health professionals as well as for community health workers and the manual on essential drugs for health workers, which was now under print, should be distributed by the Organization as soon as it was ready.
4. WHO should support the Member States in undertaking research as well as quality control of traditional medicines, with particular emphasis on how the traditional medicine could be used in PHC not only for curative, but also for preventive, care. In addition, WHO should assist Member States to resort to a complete cycle of development in traditional medicine, starting from the cultivation of medicinal plants, to a wider application and acceptance of these medicines.
Chapter 13 DISEASE PBBVgRTIOR AUD CONlXOL
Considerable progress had been made by the countries of the Region in the prevention and control of communicable and noncommunicable diseases. The universal coverage of immunization by 1990 received the major attention of the governments to ensure that a reduction in the incidence of EPI target diseases was achieved. The malaria problem continued unabated in many countries, while tuberculosis and leprosy control activities continued to receive major support. AIDS was another emerging problem, and Member States had taken appropriate measures to prevent and control the spread of this disease. In the area of noncommunicable diseases, cancer and cardiovascular diseases received support from the Organization. REPORT OF THE MGIONAL COMMITTEE 6 1
The following points were recommended for consideration by the Regional Committee:
1. Though coverage of EPI was quite good in many countries, the incidence of EPI target diseases, particularly tuberculosis, did not yet show substantial reduction. Coordination is essential at the national level for achieving maximum benefit in the EPI programme through a mechanism where agencies concerned, such as WHO and UNICEF, collaborate in providing technical assistance to Member States.
2. Since immunization against hepatitis B is quite expensive, WHO should collaborate with Member States in promoting the indigenous production of low cost vaccines, and the transfer of the appropriate technology.
3. WHO might promote collaboration between neighbouring countries in the tackling of the malaria problem in view of the difficult terrain and inaccessibility.
4. WHO-s assistance would be required in restratification of malaria control through undertaking epidemiological and entomological studies of malarious areas, as well as in the introduction of effective and rapid diagnosis and treatment of malaria cases.
5. There was a need to create an awareness among doctors on the problem posed by dengue haemorrhagic fever (DHF), and WHO support might be needed in the improvement of diagnostic techniques. . ~ management of cases, and application of appropriate control measures to help reduce the incidence of DHF in countries where it is endemic.
6. Japanese encephalitis (JE) was posing a maior problem in some co;ntries. WHO support is esseniial ;o assist the countries in epidemiological research and the production of JE vaccine.
7. Integration of acute respiratory infections (ARI) with control of diarrhoea1 diseases, as had been recommended by WHO Headquarters, should be left to the discretion of the Member States, as such an approach had proved difficult in some countries.
8. WHO should support Member States in strengthening their national programmes in the prevention and control of acute respiratory infections.
9. Prevention of blindness should be made a part of health education in schools to promote awareness among school children about the causes of visual impairment and how these could be prevented. 62 REPORT OF THE REGIONAL COMMITTEE
10. Early detection and treatment of cancer should be promoted, and WHO should encourage the countries to adopt fiscal policies against smoking and other factors responsible for spread of this scourge.
Chapter 14 EbUTB ~TIOUSOPPORT
The following points were recommended for consideration by the Regional Committee:
1. Further support should be provided for strengthening the health information support through use of the HELLIS network and its linkages, and the country budget should be utilized for the purchase of WHO documents and publications.
2. WHO assistance might be required for the translation of essential publications into local languages for wider dissemination in the countries.
The Committee noted resolution WHA40.15, adopted by the Fortieth World Health Assembly, calling upon the Regional Committees to review the Director-General-s Introduction to the Proposed Programme Budget for the Financial Period 1988-1989, and his assessment of WHO'S programme budget during the period of the Seventh General Programme of Work, as well as his reflections for 1988-1989 and beyond, and report on the outcome of their deliberations to the Executive Board at its eighty- first session in January 1988. Pursuant to this directive, the Director-General had prepared a paper on 'Management of WHO'S Resources' analyzing these documents and the comments of the Executive Board and the Assembly. It also noted that a consultation meeting, convened by the Regional Director in August 1987, had undertaken an in- depth review of the issues and options for action proposed in the Director-General's paper with a view to facilitating the discussions on this subject at the CCPDM and Regional Committee meetings.
The Committee felt that the main issue was how optimal utilization of the Organization's resources could be made in direct support of the Member States' efforts to implement their national Health for All strategies through improved delivery of WHO'S collaborative activities REPORT OF THE REGIONAL COMHITTEE 6'4
at the country level, and how the managerial process could be improved to achieve this objective.
The following points emerged from the discussions:
I. Most countries in the Region were at different stages of health system development, but all of them required better strategic management of programme delivery, which naturally could not be isolated from the prevailing socio-economic, political, and cultural conditions in each country.
2. While reaffirming the commitment of the Member States to the Organization's value system, the Committee Felt that this value system had already been incorporated into national health policies. However, more vigorous efforts should be made to translate those policies into action by involving national leadership in various sectors.
3. More positive and practical efforts in intersectoral coordination must be made in order to promote the policy of HFA.
4. While the Organization-s collaborative programmes in the Member States could be reviewed by joint coordination mechanisms, Member States may not always agree to their national programmes or those carried out in collaboration with other agencies to be subjected to any such review.
5. The Common Framework and Format for monitoring and evaluating the HFA strategies needed to be simplified to take into account the information base of the countries.
6. There were certain contradictions in the document Management of WHO-s Resources, such as on the one hand decentralization of authority to implement the collaborative activities was envisaged at the country level, whilst on the other there was further central control proposed over the utilization of the Organizationrs resources.
7. The CST mechanism has been established for all countries of the region, and should now be fully activated to support the Member States as envisaged in the Regional Programme Budget Policy and the new Managerial Framework. CSTs should be given more prominence in interaction between the Regional Office, the WHO Representative (WR) and the Member States.
8. In order for countries to undertake proper planning for the utilization of the Organization's catalytic resources, the Country Planning Figure (CPF) must be intimated to them.
9. In view of the various stages of development of the managerial process in the Member States, implementation of the collaborative 64 REPORT OF THE REGIONAL COMMITTEE
programme could certainly be improved; however, this ahould not be construed as the country's inability to utilize the resources, thus qualifying for its withdrawal by the Organization.
10. The Regional Office should be strengthened further to have better interaction with the countries and Headquarters in providing a coordinated backstopping support to the Member Statea as well as to instil efficiency and promote a better image of the Organization.
11. All global programmes should be closely coordinated with the regional offices in order to avoid confusion and ensure a uniformity of approach.
12. While the current decentralized staffing system ahould continue in the recruitment of staff for the Organization, emphasis ahould also be given to the managerial skills of candidates.
The Committee reviewed in detail the steps suggested by the consultation meeting for ensuring better management of the Organization's resources and recommended that the suggestions, as modified by it, be presented to the Regional Committee for its consideration (Appendix 3).
The Committee also endorsed the recommendation of the consultation meeting that, in view of the importance of the subject matter under consideration by the governing bodies of the Organization, the embers of the Executive Board from the South-East Asia Region be requested to keep in view the conclusions that might be reached at the Regional Committee on this subject while attending the Executive Board session in January 1988 and request the Board to refer any other important and related matters to the Regional Committee sessions in 1988. The delegates from the Member States attending the forty-first World Health Assembly in May 1988 ahould also be fully briefed on the trend of discussions at the Regional Committee so that they could express their views and sentiments as appropriate, since the outcome from the World Health Assembly on this subject might well become the Organizationride policy.
Section 3
REVIEW OF TBB IWLEXENTATION OF TBE UBO'S COlLMOIIATIVB PWQWMES IN TEE MiHBER STATES FOR THB FIRST EIGKTKKU noms OF TBB BI~~AIM1986-1987. 1 JANUARY 1986 lU 30 JUNE 1987
The Committee noted that the working paper (document SEA/PDH/ Meet.1216). on the implementation of the Organization'a collaborative REPORT OF THE REGIONAL COMMITTEE 65
programmes in the Member States during the first eighteen months of the biennium 1986-1987, reflected a delivery rate of 624 in financial terms under the Regular Budget and that even, after taking into consideration the activities which were under processing, the total delivery as of 30 June 1987 was only 79%. This presented a rather unsatisfactory picture of implementation of the Organization's collaborative programmes, especially in view of the fact that the Director-General had been iorced to resort to budgetary reductions in programme implementation during the current biennium due to expected shortfalls in the collection of assessed contributions from certain Member States. The Committee was also informed that in view of the unprecedented drop in the exchange value of the US Dollar against the Swiss Franc, the Director-General had to impose additional budgetary reductions on the regional/country programmes and, regrettably, the South-East Asia Region had attracted a larger share of this additional cut in view of its low rate of implementation and high proportion of unobligated balances as on 31 March 1987.
The Committee also noted that in pursuance of a recommendation by it, at its eleventh meeting, an evaluative analysis of programme implementation in the Member States had been included in the working paper. The Committee was informed that, at the end of August 1987, the overall programme delivery had reached only 69%, after taking into consideration mandated reductions in programme budget implementation.
The following points emerged from the discussions:
1. Five countries of the region and the intercountry programme accounted for 84% of the remaining unobligated funds. By programme, Health System Development, Organization of Health Systems based on PHC, Health Manpower and Disease Prevention and Control showed slow implementation, while, by component, fellowships and local cost subsidy accounted for 61% of the unobligated funds.
2. Roughly about 36% of the budget remained to be obligated during the last six months of the biennium - a situation very similar to that obtaining during the 1984-1985 biennium, which had invited adverse comments of the external auditors about the low rate of implementation resulting in large scale reprogramming.
3. SEAR had attracted a larger share of additional reductions in programme implementation owing to its low rate of delivery and higher proportion of unobligated funds as on 31 March 1987, which was one of the criteria considered by the Director-General in establishing each region-s share of additional cuts.
4. As implementation of fellowship programmes always presented problems, some countries had identified their needs for utilization of the Organization's fellowship programme for developing their health manpower - which would facilitate speedier implementation of this component. 66 REPORT OF THE REGIONAL COMMI'ITEE
5. Some countries utilized funds under the local cost subsidy (LCS) component at the district level for training activities, and this bad posed certain problems in accounting due to cumbersome procedures involved. It was clarified that the accounts submitted by the local administration through government channels would be acceptable to the Organization for further release of funds under the LCS component.
6. Although WHO Headquarters had provided guidelines for the preparation of regional programme budget policies, the South-East Asia Region had developed its policy in consonance with the views and requirements of its Member States. In order to avoid reversion of unobligated funds to Headquarters, the SEAR policy provided for advance implementation of activities planned in the following biennium.
The Codttee made the following recommendations with regard to improving the delivery rate of the Organization's collaborative programmes in the Member States:
1. It should be recognized that a purely audit view could not be taken regarding the pace of expenditure, and that a certain amount of concentration of expenditure was inevitable towards the latter part of the biennium. A mechanism, therefore, needs to be devised in order to help clear the relatively larger number of proposals which tend to come into the pipeline during the second year of the biennium.
2. Countries should speed up the implementation of activities during the remaining months of the current biennium, even by advancing implementation of activities planned during the 1988-1989 biennium, in order not to risk attracting further reductions in their budget, which was a distinct possibility due to the continuing financial crisis of the Organization.
3. In case of reprogramming of the unspent funds in their respective country programmes, the countries should properly document such reprogramming, showing the relationship of the new activities to the planned objectives of the programmelproject and the effect of such reprogramming on the objective/activities of the programme1 project from which funds were diverted.
4. The suggestions made by the Committee, at its tenth meeting, with reaard to plannina detailed budgets to facilitate early and smooth implementation of- collaborative activities should be followed by the countries for implementation of the 1988-1989 programme.
5. Country support teams should, as recommended by the Committee in its earlier meeting, collaborate with the Member States in their periodic review of implementation of the Organization's programme REPORT OF THE REGIONAL COMMITTEE 67
to enable them to implement the planned activities according to schedule.
6. There should be much closer collaboration hetween the countries, the WR, and the Regional Office in the processing of pipeline activities and there should be a regular feedback from the Regional Office to the countries on the extent of processing of the pipeline activities.
7. WHO should provide to countries a list of potential candidates available for short-term assignments in order to enable them to select suitable persons to assist them in their country programme.
8. Proper and timely utilization of extrabudgetary funds should be made in order to attract more resources from this source, especially in view of the shrinking resources under the Regular Budget.
9. Timely submission of accounts for use of local cost subsidies would facilitate the continuing ability of the Organization to advance funds for undertaking national level activities under this component.
10. The Organization would do its utmost to help the Member States in the timely implementation of its collaborative activities and, in turn, the countries should also support in the appropriate fora the Organization's efforts in this direction.
Section 4
REVIEW OF THE HEDIM-TERM PROGRAMMES FOR TEE EIGEITH GENERAL PROGRAlMB OF WORK (COVERING TEE PERIOD 1990-1995 INCLUSIVE)
The Committee noted that the Regional Medium-Term Programmes (MTP) had been developed by the Regional Office after detailrd consultations with the Member States, as decided by the Committee at its eleventh meeting held in April 1987, and that the objectives, targets, approaches and activities enumerated in the working paper would form the basis for the Organization's collaboration with the Member States during the period of the Eighth General Programme of Work, covering the period 1990-1995. The Committee was informed that the regional MTPs had been developed in the classified list of programmes for the Eighth General Programe of Work, which had been approved by the World Health Assembly in May 1987. 68 REPORT OF THE REGIONAL COMMITTEE
While agreeing in general to the regional MTPs, as presented in the working paper (document SEA/PDM/Meet.l2/7), the Committee made the following observations:
1. The target dates provided in the various programmes appeared to be either too late or too early, depending upon the level of implementation of activities, as well as the developmental plans of the respective countries and, therefore, they should be considered as general guidelines for WHO'S collaborative programmes, which were in support of the national programmes.
2. The regional HTPs under programme area 3.7.0 on Research Promotion and Development should stress the concept of institutional development at national and regional levels for designation as WHO Collaborating Centres, which should be orientated towards the goal of HFA, and should clearly spell out its linkages with similar centres in other regions.
3. Prevention and control of alcohol and drug abuse involved intersectoral coordination and could not be the responsibility of the health sector alone. This fact should be reflected appropriately in programme area 3.10.2 on Prevention and Control of Alcohol and Drug Abuse.
4. Under programme area 3.12.1 (Clinical, laboratory and radiological technology for health systems based on PHC), reference should be made for the promotion of regional capacity in the production of basic radiological equipment in order to make the countries self- sufficient in this area. The Organizationas research programme could be made use of by the countries to identify the type of equipment which could be produced locally - possibly under a Technical Cooperation among Developing Countries (TCDC) arrangement.
5. The programme area 4.13.4 on Parasitic Diseases should reflect the problem faced by Thailand by the spread of liver fluke, which had affected over seven million people in that country. REPORT OF THE REGIONAL COMMITTEE 69
Appendix 1
LIST OF PARTICIPANTS
BANGLADESH
Mr Kazi Golam Rahman Joint Secretary Ministry of Health and Family Planning Dhaka
Dr Md. Shamsul Islam Deputy Director (ITHC) Directorate-General of Health Services Dhaka
BHUTAN
Dr J. Norbhu Director Department of Health Services Thimphu
DEMOCRATIC PEOPLE-S REPUBLIC OF KOREA
Mr Chon Su Ok Director Department of External Affairs Ministry of Public Health Pyongyang
Dr Song Pi1 Jun Director Institute of Health Administration Research Pyongyang
Dr Kang Yong Jun Chief Institute of Evaluation and Introduction of New Technology Ministry of Public Health Pyongyang
Mr Kwon Sung Yon Officer, Department of External Affairs Ministry of Public Health Pyongyang 70 REPORT OP THE REGIONAL COHPIITTEE
INDIA
Mr R.K. Ahooja Joint Secretary Ministry of Health and Family Welfare New Delhi
MALDIVES
Mr Mohamed Rasheed Assistant Director of Planning and Coordination Ministry of Health Male
MONGOLIA
H.E. Dr Sh.Jigjidsuren First Deputy Minister Ministry of Public Health Ulan Bator
Dr 2. Jadamba Chief External Relations Department Ministry of Public Health Ulan Bator
NEPAL
Dr Y.M.S. Pradhan Chief Policy, Planning, Monitoring, and Supervision Division Ministry of Health Kathmandu
SRI LANKA
Dr Joe Fernando Director-General of Health Services Ministry of Health Colombo
THAILAND
Dr Damrong Boonyoen Director Health Planning Division Office of the Permanent Secretary Ministry of Public Health Bangkok REPORT OF THE REGIONAL COMMITTEE 7 1
WBO Secretariat
Dr Chaiyan K. Sanyakorn Director, Programme Management
Mr R. Helmholz Director, Support Programme
Dr D.B. Bisht Director, Health System Infrastructure
Mr M. Pelling Reports and Documents Officer
Mr J. Mittar Budget and Finance Officer
Mr N. Raman Special Assistant to Director, Programme Management
Mr S. Vedanarayanan Senior Administrative Assistant
Mr S.K. Varma Senior Administrative Assistant 7 2 REPORT OF THE REGIONAL COMMITTEE
Appendix 2
SCEEHA FOB CONSIDERATION OF TBIBTY-NINTE ANPRIM, REPORT OF TEE PBGIOlUL DIBBCTOR (PROVISIONAL AGENDA ITEM 9) (Document sE~/~C40/2)
SECTION I - DIRECTION. COORDINATION AND IIARAGEHlHT
Chapter 1 GOVERNING BODIES (pp.1-5)
Chapter 2 WHO-S GENERAL PROGRAMME DEVELOPMENT AND MANAGEMENT (pp.6-27)
2.1 Managerial Process for WHO'S Programme Development 2.2 WHO'S Infarmation System 2.3 Health for All Leadership Development 2.4 Staff Development and Training 2.5 Coordination 2.6 Emergency Relief Operations
SECTION I1 - BWTH SYSTPIl INFRASTRUCTURE
Chapter 3 HEALTH SYSTEM DEVELOPMENT (pp.29-45)
3.1 Health Situation and Trend Assessment (HSATA) 3.2 Managerial Process for National Health Development (MPNHD) 3.3 Health Systems Research 3.4 Health Legislation
Chapter 4 ORGANIZATION OF HEALTH SYSTEMS BASED ON PRIMARY HEALTH CARE (pp.46-60)
4.1 Research Promotion and Development 4.2 Activities at Country Level REPORT OF THE REGIONAL COMMITTEE 71
Chapter 5 HEALTH MANPOWER DEVELOPMENT (including health manpower development activities in other programmes) (pp.61-92)
Managerial Process for Health Manpower Development Health Manpower Development Research Medical Education Nursing Education and Services Training of Other Categories of Health Personnel Teacher Training Health Learning Materials Manpower Activities in Other Programmes Fellowships Group Educational Activities
Chapter 6 PUBLIC INFORMATION AND EDUCATION FOR HEALTH (pp.93-97)
SECTION 111 - BWTE SCIENCE AND 'IECBPIOm - tIEALTU PROHOTION ANDCARE
Chapter 7 RESEARCH PROMOTION AND DEVELOPMENT (pp.99-106)
Chapter 8 GENERAL HEALTH PROTECTION AND PROMOTION (pp.107-122)
8.1 Nutrition 8.2 Oral Health 8.3 Accident Prevention
Chapter 9 PROTECTION AND PROMOTION OF HEALTH OF SPECIFIC POPULATION GROUPS (pp. 123-135)
9.1 Maternal and Child Health, including Family Planning 9.2 Human Reproduction Research 9.3 Workers- Health 9.4 Health Care of the Elderly 9.5 Women, Health and Development
Chapter 10 PROTECTION AND PROMOTION OF MENTAL HEALTH (pp.136-139)
10.1 Psychosocial Factors in the Promotion of Health and Human Development 10.2 Prevention and Control of Alcohol and Drug Abuse 10.3 Prevention and Treatment of Mental and Neurological Disorders 74 REPORT OF THE REGIONAL COMMITTEE
Chapter 11 PROMOTION OF ENVIRONMENTAL HEALTH (pp.140-152)
11.1 Community Water Supply and Sanitation 11.2 Environmental Health in Rural and Urban Development 11.3 Control of Environmental Health Hazards 11.4 Food Safety
Chapter 12 DIAGNOSTIC, THERAPEUTIC AND REHABILITATIVE TECHNOLOGY (pp.153-169)
12.1 Clinical Laboratory and Radiological Technology for Health Systems Based on Primary Health Care 12.2 Essential Drugs and Vaccines 12.3 Drug and Vaccine Quality, Safety and Efficacy 12.4 Traditional Medicine 12.5 Rehabilitation of the Disabled
SECTION IV - HEALTH SCIENCE AND TECHNOLOGY - DISEASE PREVENTION AND CONTROL
Chapter 13 DISEASE PREVENTION AND CONTROL (pp.171-255)
13.1 Immunization 13.2 Disease Vector Control 13.3 Malaria 13.4 Parasitic Diseases 13.5 Tropical Diseases Research
13.6 Diarrhoea1 Diseases 13.7 Acute Respiratory Infections 13.8 Tuberculosis 13.9 Leprosy 13.10 Zoonoses 13.11 Sexually Transmitted Diseases 13.12 Smallpox Eradication Surveillance 13.13 Other Communicable Diseases
13.14 Blindness 13.15 Cancer Control 13.16 Cardiovascular Diseases 13.17 Other Noncommunicsble Diseases REPORT OF THE REGIONAL COMMITTEE 75
SECTION V - PR- SOPPORT
Chapter 14 HEALTH INFORMATION SUPPORT (pp.257-262)
14.1 Health Literature and Library Services (including HeLLIS) 14.2 Publications and Documents
Chapter 15 SUPPORT SERVICES (pp.263-267)
15.1 General 15.2 Personnel 15.3 Budget and Finance 15.4 Equipment and Supplies 15.5 General Services 76 REPORT OF THE REGIONAL COMMITTEE
Appendix 3 SUGGESTED ACTIONS FOR CONSIDERATIOB OF BEGIMAL KUlIT1BB ON THE ISSWS AND OPTIONS PBOPOSKD Jll THE DIBBCTOR- GENERAL'S PAPEX OA '- OF YBO'S BESOWCBS'
ktion at Country level Action at Regional hvel
1. WHO'S SYSTPll OF VALUES. mLIm AND STRATEGY FOB WA
(Para 53, also paras 23-25 of EB81/PC/WP2)
1. Action to develop HFA I. The Regional Committee should leadership in line with reaffirm its commitment to the the DG's initiative WHO value system for HFA, which should be pursued to is a synthesis of Member States- translate the commitment commitment to HFA Goal. into practical action. and maintain a high 2. Regional Office should provide level of commitment both technical cooperation to develop within and outside the institutional activities and health sector. networks, teaching and learning materials, etc., for HFA leadership development. 2. Countries should take steps to disseminate information and its implied value to different groups of people to mobilize political, financial management, technical and popular support to HFA goal.
3. Conduct HSR on solving problems related to implementation of HFA strategy. REPORT OF THE REGIONAL COMMITTEE 77
Action at Country level Action at Regional le-I
2. BBSHMSIBILITIBS OF MEMBER STAlXS AHD RKGIOUAL arOl1ms W AGREED upon IN BBSM.UTIMIS VBh33.17 AND uan34.24
(Para 54, also paras 10-12 of EBBl/PC/WPZ)
1. Countries should strive 1. The Regional Committee will and adhere to these two collectively monitor and review far reaching resolutions. individual country programmes in the Regional Committee itself. Practical method would consist of revising the terms of reference of the CCPDM, as indicated against item No.6.
2. The Regional Committee, in addition to deepening its analysis of the implications of the Health Assembly and the Executive Board resolutions, should also appropriately inform the Executive Board and the Health Assembly of regional priorities and concerns, thus improving the two-way flow of information among the various levels of the organization.
3. MOUITOBING dRD WALUATIOU OF EATIOtL4L STRATEGIES FOR BWTE FOP ALL
(Para 55 of EBBl/PC/WPZ)
I. Countries should undertake 1. The Regional Office should strengthening of their maintain comprehensive country health information systems. programme information, including WHO'S collaboration and national 2. They should incorporate health programmes. the indicators and points contained in CFH into 2. The Regional Office should their own national and support fully the improvement monitoring evaluation. of M6E system l.n the countries. 78 REPORT OF THE REGIONAL COMMITTEE
Action at Country Level Action at Regional Level
3. The process for monitoring 3. The Regional Office should take be linked to the planning up with WHO Headquarters the cycles, e.g. mid-term question of simplifying the CFF reviews, etc., and to take into account the infor- incorporated into the mation base of the countries. national managerial process.
4. Countries should maintain updated health situation and trend analysis profiles.
4. DECENTRALIZATION AWANGJMWTS
(Para 56, also paras 13-16 of EB81/PC/WP2)
1. The decentralization 1. Delegation to WRs/countries should be both of powers of necessary authorities and and functions in terms of functions should be implemented delegated authorities to on a time-bound frame and be countries and WRs. The new based on the changing needs of managerial arrangements for the countries. Towards this end, optimal use of resources preparatory actions to train should be introduced quickly. WRs should be taken.
2. The procedures of work of the joint Government/WHO mechanisms need review and clear definition. It must be forward looking and it should undertake work of develop- mental nature as part of decentralization arrangements.
5. RXGIONAL. PPolXAME BrmcBT POLICIES
(Paras 57 6 58, also paras 26-30 of EB81/PC/WP2)
I. The provisions of the 1. The Regional Office will provide Regional Programme Budget technical support through the Policy shall be implemented country support teams (CST) for during 1988-1989 programme the formulation of 1990-1991 budget period. Programme Budget in accordance with the Regional Programme Budget Policy. REPORT OF THE REGIONAL COMMITTEE 79
------Action at Country Level Action at Regional Level
2. The Regional priorities and administrative guidelines will be taken into account in formulating the 1990-1991 programme budget in countries.
3 Detailed scheduling of implementation of Fellowship Programme at least for the first year of the biennium should be completed before the start of the biennium. This should apply from 1988- 1989 programme itself.
4. The provisions under Fellowship component should be justified, spelling out the subject, speciality, skills and knowledge, and the relationship with the programme objectives. To the extent possible, they should be in line with the national health manpower development policies.
5. The main criteria for supplies and equipment should be its relevance to programme objec- tiveslactivities. This compo- nent should be carefully planned and itemized. Establishment of ceiling figure for supplies and equipment for each programme could be considered, without in any way constraining the programme objectives. Reprogramming for purpose of additional supplies should be avoided unless it has specific relevance to the programme objective or is 80 REPORT OF THE REGIONAL COMMITTEE
Action at &ontry Level Action at Regional Level
in response to unforeseen, but unavoidable emergencies. It is considered unrealistic to develop lists of either appropriate or inappropriate equipment to serve as a guideline. It is also unrealistic for the Regional Director to report on all items of supplies purchased.
6. REVIEW OF YBO'S ACTION IN INDIVIDUAL mJ5B STATES
(Para 59, also paras 27-30 of EB81/PC/WP2)
1. The importance of periodic 1. The Regional Committee will reviews and making them evolve a mechanism to determine more effective needs to be the use of WHO'S resources in stressed, particularly to countries towards objective of ensure that allocations are health for all and for institut- fully and properly utilized. ing regional audits in policy Therefore, in addition to and programme terms. The terms on-going reviews of of reference will be worked out individual programmes by by the CCPDM. The actual reviews the WRs, countries should will benefit from the inputs undertake periodic review from the joint WHO/country in which the Regional reviews. Office should be involved. Such reviews may also include national programmes and to the extent possible use the 'protocols' for WHO audit in policy and programme terms. Such reviews may occur at least three times in a biennium by a joint WHO/country review team. REPORT OF THE REGIONAL COMMITTEE 81
- - Action at Country Level Action at Regions1 level
2. In addition to the above, specific reviews of programmest like EPI, CDD, etc., may continue.
3. The content of the reviews will include interactive and advisory process from Regional Office to Member States, discussion of adherence to agreed policies, provision of information support needed for reprogramming/programme development, and should be to the extent possible action and future-oriented. The WR should be actively involved in the whole process.
7. COmY PWIUG FIGURES
(Para 60, also para 28 of EBBI/PC/WPZ)
1. Article 60 of the regional I. The current practice of programme budget policy informing countries of planning providing for advance figures (CPF) for purpose of implementation and approved broad programming by WHO should activities of the next continue. The entire CPF should biennium should be given be budgeted and no percentage effect for utilizing of this amount should be with- available savings. held by the Regional Office. Without such clear indication of the CPF there can be no proper planning.
2. Withdrawal of country allocation or diversion thereof, in situations where countries are unable to implement within the prescribed time framework, because of weak managerial 82 REPORT OF THE REGIONAL COMMITl'EE
Action at Cumtry level Action at Regional Level
structures, does not seem appropriate in view of the announced policies of WHO to support countries in strengthening management.
3. The mechanisms suggested in item 6 will improve delivery of programmes.
8. ENSURING TIMELY IMPLEMENTATION AtUl DISPOSAL. OF INOBLIGATED PrnS (Para 61, also paras 28 and 30 of EB81lPCIWP2)
1. The introduction of the I. CSTs should be made fully reviews indicated in item effective and operational. They No.6 above will ensure that should support countries in implementation takes place programme formulation, reviews on a timely basis. and assist in implementation.
2. Countries should set up 2. CSTs should support countries focal points as an in detailed scheduling of integral part of the joint activities before the start country/WHO mechanism to of the biennium to ensure prompt accelerate implementation start of implementation and, of WHO collaborative later, during the biennium for programmes. comprehensive review and reprograming.
9. F~CTIONSOF YBs, TBB PEGIONAL OFFICES AND EQ
(Para 62, also paras 37 and 41 of EB81/PC/WP2)
1. WRs should discharge the 1. HQ can and should provide functions as defined in the support to the Region in the new managerial framework form of sound technical back- (DG0183.1) and further stopping to meet the request specified in the Regional emanating from Member States Programme Budget Policy. and the Regional Office. REPORT OF THE REGIONAL COMMITTEE 83
Action at Country Level Action at Regional Lael
To do so, WRs and their 2. HQ staff should also support offices will need to be implementation of programmes by strengthened in the performing substantive work following ways: along with the Regional staff in countries. Funds should be (a) using available national made available both from HQ and expertise in the form of the Region. HQ and Regional special task force, advi- staff should work as a team. sory group, contractual service agreement, etc; 3. Headquarters* programme initia- tives in countries should be (b) receiving administrative undertaken in close consultation support from the Regional with the Regional Office to Office depending on the ensure effective coordination. need of each country; 4. The flow of m~lnagerialand (c) receiving technical and technical information between information support from different levc!ls of the the Regional Office and Organization should be free HQs as needed; and and uninterrupted to enhance the functioning of the staff. (d) receiving training and development, as needed, of WRs and nationals.
10. STRUCTWB OF TBE REGIONAL OFFICE
(Para 63, also paras 9-12, 31 and 36 of EB81/PC/WP2)
1. The structure gf the regional offices should be reviewed to ensure that they are best organized to flrlfil their designated Functions.
2. The Regional structure must continue to provide for good management of technical cooperation with the Member States, as well as credible technical expertise. 84 REPORT OF THE REGIONAL COMMITTEE
Action at Country level Action at Regional Level
I I. PRESEII'C SrSIRl OF STAFF= OF URO SECRETARIAT
(Paras 64 and 65 of EBRI/PC/WPZ)
1. The present system of staff recruitment operates under the general guidance and control of HQ, with authority delegated to the Regional Director for appointments up to P5. WRs are appointed after close consul- tation involving the Director- General, the Regional Director and the country concerned.
2. The current decentralized staffing system should continue, with emphasis given to the managerial skills of the candidates, in the recruitment of staff for the Organization.
3. The interest and willingness of individual staff members to serve in the particular country of the Region is also an important factor. And this specially applies in regard to WRs. While technical qualification is essential, effectiveness of staff in the Region and country often demands practical experience and familiarity with the needs and conditions of the Region/countries. Cultural affinity and empathy are also useful assets. In regard to recruitment of country-based staff, acceptance by the country concerned remains a predominant factor. REPORT OF THE REGIONAL COMMITTEE 85
Action at Country Level Action at Regional Level
4. The proposal to recruit younger people to WHO - as contradistinct from the scheme of associate professionals - for training and returning them to their cuuntries after specified years and re- recruiting them eventually as long-term career staff may appear, on the f.lce of it, to be attractive. However, there arc many practical difElculties uf implementing this, &, (1) difficulties in absorbing them in countries after WHO service; (ii) unwillingness to return to the country; and (iii) assuring their availability to WHO.
5. The central roster of potential candidates f recruitment to WHO, as mainlained in HQ, should be made more comprehensive and up to date. While reference to this raster will be useful far recruitment to Region/countries, it should not constrain the search and recruitment from outside the roster, if needed.
6. The predominant requirement is a well-conceived and well- formulated long-term staffing policy and plan prepared in consultation with the Region and countries. 86 REPORT OF THE REGIONAL COHHITTEE --
Annex 6
LIST OF OFFICIAL WclMENTS OF THE FORTIETO SESSION^
SEAIRC~OIIRev. 1 Agenda
SEAIRCLOIZ and Thirty-ninth Annual Report of the Regional Corr. 1 Director
SEA/RC40/ 3 and Detailed Programme Budget for 1988-1989 Corr. 1
SEA/ ~~4014 Suggested terms of reference of the Suh-committee on Programme Budget
SEA/RC4O/PB/WPl Report of the twelfth meeting of the Consultative Committee for Programme Development and Management (SEA/PDM/Meet.12/8): Section I11 - Review of the implementation of WHO'S collaborative programmes in the Member States For the first eighteen months of the biennium 1986-1987, i.e., I January 1986 to 30 June 1987
SEA/RC40/PB/WP2 Review of the Detailed Programme Budget for 1988- 1989 vis-a-vis pattern of utilization of the Regular Budget in terms of each component during 1984-1985 and 1986-1987 SEA/RC40/PB/WP3 Funding situation - Financial period 1988-1989 SEA/RC4O/PB/WP4 Keport of the twelfth meeting of the Consultative Committee for Programme Development and Management (SEA/PDM/Meet.l2/8): Section IV - Review of the Medium-term Programmes for the Eighth General Programme of Work (covering the period 1990-1995 inclusive)
Information and education for health in support of Health for All by the Year 2000 - Agenda for the technical discussions
SEA/RC40/5 Add.1 Information and education for health in support of Health for All by the Year 2000 - Annotated agenda for the technical discussions toriginally issued as document SEA/RC40/24, on 5 October 1987 - REPORT OF THE REGIONAL COMMITTEE 8 7
Review of the draft provisional Agenda of the Eighty-first session of the Executive Board and of the Forty-first World Health Assembly
Information and education for health in support or Health for All by the Year 2000 - Working paper for the technical discussions
WHO-s public image through its health development work
Special Programme for Research and Training in Tropical Diseases - Joint Coordinating Board (JCB) - Report on the JCB session
Special Programme of Research, Development and Research Training in Human Reproduction - Membership of the Policy and Coordination Advisory Committee
Time and place of forthcoming sessions of the Regional Committee
Consideration of resolutions of regional interest adopted by the World Health Assembly and the Executive Board
Selection of a subject For the Technical Discussions at the Forty-first Session of the Regional Committee
SEA/RC40/14 and Review of the Director-General-s Introduction to Corr. 1 the Proposed Programme Budget Fur 1988-1989 and the comments of the World Health Assembly thereon
AIDS in Bangladesh perspective
Drug abuse
Action plan for strengthening of district PHC
Method of appointment of the Ref,lonal Director
SEA/RC40/19 Rev. 1 List of Participants
SEA/RCPO/ZO and Report of the Sub-committee on Credentials Add. l
Report of the Sub-committee on I'rogramme Rtrdget 88 REPORT OF THE REGIONAL COMNITTEE
SEA/RC40/22 Recommendations arising out of the technical discussions on information and education for health in support of Health for All by the Year 2000
SEA/ RC40123 Draft final report of the Fortieth Session of the Regional Committee for South-East Asia
SEAIRC40124 List of official documents of the Fortieth Session
Information Documents
SEA/RC40/Inf. 1 List of technical reports issued and meetings and courses organized during the period 1 July 1986 to 30 June 1987.
SEA/RC40/Inf .2 Special Programme of Research, Development and Research Training in Human Reproduction
SEA/RC40/ Inf .3 Special Programme for Research and Training in Tropical Diseases
SEA/RC40/Inf.4 Information and education for health in support of Health for All by the Year 2000
SEA/ RC40/Inf. 5 WHOISEAR work plan for the fortieth anniversary of WHO, 1988
SEA/RC40/Inf .6 Prevention and control of acquired immunodeficiency syndrome (AIDS), with particular reference to the South-East Asia Region
SEAIRC40IInf .7 Case definition of AIDS for surveillance purposes
SEA/RC40/Inf.8 Provisional WHO clinical case definition of AIDS
Kinutes
SEA/RC40/Min. l First Meeting, 15 September 1987, 9.00 a.m.
SEA/RC40/Min.2 Second Meeting, 15 September 1987. 2.30 p.m.
~EA/RC40/%in.3 Third Meeting, 16 September 1987, 9.00 a.m.
SEA/RC40/Min.4 Fourth Meeting, 16 September 1987, 2.30 p.m.
sEA/RC40/Min. 5 Fifth Meeting, 18 September 1987, 9.00 a.m. -, REPORT OF THE REGIONAL C0MMI':TEE 89
SEA/RC40/Min.6 Sixth Meeting, 18 September 1987, 2.30 p.m.
SEA/RC40/Minutes Corrigendum to Minutes, 18 September 1987 Corr. 1
SEA/RC40/Min.7 Seventh Meeting, 21 September 1987, 9.00 a.m.
Resolutions
SEAIRC4OIRl Prevention and control of AIDS in rhe South-East Asia Region
SEA/RC4O/RZ Management of WHO'S resources
SEA/RCLOIR3 Information and education for health in support oE Health for All by the Year 2000
- SEAIRC40IR4 Targeting for reorientation OF medical education for health manpower development in the context of achieving Health for All by the Year 2000
SEA/ RC40/R5 Intensification of PHC through district health systems towards achieving Health for All by the Year 2000
SEA/RCLO/ R6 Method of appointment of the Regional Director
SEA/RC40/R7 Thirty-ninth Annual Report of the Regional Director
SEAIRC40IRB Selection of a topic for technical discussions
SEA/RC40/R9 Resolution of thanks
SEA/RC40/RIO Time and place of Forty-first and Forty-second Sessions
SEAIRCLOIR11 Detailed Programme Rudget For 19RH-1989 and Kcport of the Sub-committee on Programme Budget SECTION II
MINUTES OF THE SESSION SmQUBY n1ms1
Pirst Meeting. 15 September 1987. 9-00 a.m.
AGENDA
Item
1. Opening of the Session
2. Address by the Minister of Public Health, DPR Korea
- 3. Address by the Director-General, WHO
4. Address by the Regional Director
5. Address by the Vice-Premier, DPR Korea
6. Appointment of the Sub-committee on Credentials
7. Approval of the Report of the Sub-committee on Credentials
8. Election of Chairman and Vice-Chairman
9. Statement by the Representative of UNDP
10. Statement by the Representative of UNICEF
11. Adoption of Provisional Agenda and Supplementary Agenda # 12. Appointment of the Sub-committee on Programme Budget and Adoption of its Terms of Reference
13. Adoption of Agenda and Election of Chairman for the Technical Discussions
14. Adjournment
10rginally issued as document SEA/RC40/Min.l, on 15 September 1987 92 MINUTES OF THE FIRST MEETING - Item p.ge
Annexes
1. Address by the Chairman of the Thirty-ninth Session 103
2. Address by the Minister of Public Health 106
3. Address by the Regional Director 108
4. Address by the Vice-premier. Democratic People's 112 Republic of Korea MINUTES OF THE FIRST HEETING 93
Item 1 0mWG OF 1BE SESSION RC Provisional Agenda item I
The Fortieth Session of the Regional Committee was opened by DR UTHAI SUDSUKH, Chairman of the Thirty-ninth session. Welcoming all those present, he said that it was a great honour and privilege to welcome especially the Vice-Premier and the Minister of Public Health of the Democratic People-s Republic of Korea, who had evinced great interest in the work of WHO. Their presence symbolized their firm support and commitment for regional collaboration in health development. He paid tributes to the Director-General of WHO and thanked him for his constant guidance and encouragement, despite financial constraints and other problems. He also thanked the Regional Director for his able guidance and assistance to the Member States in health development programmes.
Dr Uthai expressed great appreciation and gratitude to the Government of the Democratic People-s Republic of Korea for their whole-hearted hospitality and kindness and for their excellent arrangements to make the stay of the delegates a memorable one.
He pointed out that the Organization was facing a very unfavourable international atmosphere due, mainly, to the financial crisis resulting from shortfalls in the assessed contributions from Member States, and from the significant decline in the exchange rate of the major currency in use in the Organization. At the same time, the commitmnt to attain the goal of Health for All was approaching its targetted year of 2000. There was, therefore, a need to concentrate all efforts towards Health for All during the remaining thirteen years, despite the many problems. He referred to the emerging problem of AIDS and said that it was a challenge to developing countries, whose limited resources would need to be utilized to combat this dreadful dfsease. He was, however, confident that with proper utilization of resources it would be possible to make a significant contribution to health development of the countries. In conclusion, he urged the representatives to share their opinions and experiences during the discussion to make the session successful and fruitful (see Annex 1 for the full text).
Item 2 ADDRESS BY TXB MINISTER OF PUBLIC UEALm, DPR MBBa
Welcoming the delegates to the Fortieth Session of the WHO Regional Committee for South-East Asia, H.E. MR LI JONG RYUL, Minister of Public 94 MINUTES OF THE FIRST MEETING
Health, Democratic People's Republic of Korea, stated that the current session would assess the results achieved by the countries in the implementation of the strategies for Health for All by the Year 2000, with a view to pooling the valuable experiences gained by the Member States for further development of activities in the health field. WHO had been making sincere efforts to attain its cherished goal of providing an independent and creative life in good health to the whole of mankind and had achieved significant results in this direction, such as the eradication of smallpox. The Member States, on their part, appreciated and extended their whole-hearted support to the Organization's efforts in implementing the strategies for Health for All, which, was a common task to be undertaken in all countries. Referring to the short period available for realizing the goal, he said the current session of the Regional Committee assumed great importance in that it would afford an opportunity for the countries and the Organization to identify important issues confronting the countries in the implementation of Health for All activities at the country level, and to devise new strategies for achieving this goal through mobilization of national and international support (see Annex 2 for the full text ).
Item 3 ADDFSSS BY DIRECMB-CXNKUL. VBO
DR MAHLER, Director-General, WHO, said that the world was living in a difficult period with the East and the West engaging themselves in a nuclear encounter which could result in the possible annihilation of the human species. What needed to be tackled more urgently was the fundamental injustice between the North and the South; two-thirds of the population of the South were underprivileged, and if preventive measures were not taken to set right the basic economic and social injustice, the 'spaceship' earth would explode. WHO had formulated ideas to remove this injustice in accordance with its Constitution and the value system of Health for All in the context of the Alma-Ata Declaration, emphasizing the primary health care approach.
One of the major differences between WHO and other organizations was that the Member States were willing to set specific goals for * themselves and for the Organization. The achievement of global eradication of smallpox within a short span of ten years was one such example; the other one was the progress made in regard to immunization coverage. According to a decision of the World Health Assembly, all children in the world should be immunized against common diseases of childhood by the year 1990. Whereas ten years ago the coverage was just five per cent, it now stood at fifty per cent. This was truly remarkable, and he was confident that the target set by the World Health Assembly would be achieved within a few years. This distinctive feature of Member States in WHO in their North-South, East-West MINUTES OF THE FIRST MEETING 95
dialogue had been responsible in bringing ideals and goals closer. It was for this reason that even though the world looked gloomy, the Organization still fought for a better future.
Referring to the prime interest of countries with economic development that existed in the world today, Dr Mahler said that this was a most dangerous trend. He reiterated that all developments meant human development and, in this context, recalled the definition of Health for All which envisaged every one leading an economically, politically and socially productive life. Thus, social priorities were a prerequisite for any economic activity.
Citing the example of the Democratic People's Republic of Korea, Dr Mahler said that under the guidance of its Great Leader, H.E. President Kim I1 Sung, the country had shown the importance of social productivity going hand in hand with economic productivity. He hoped that the delegates would have an opportunity to see for themselves later the excellent harmony that existed between social and economic developments. -- Expressing his gratitude to the Government of DPR Korea for hosting the session of the Regional Committee, he said that the country thereby demonstrated symbolically the best possible use of the Organization.
Item 4 ADlRlESS BY TEE RBGIOWbl DIRBIXOR
DR U KO KO, the Regional Director, welcomed the representatives of the Member States, representatives of UN agencies and others. Describing Pyongyang as a beautiful city, he said that the presence of high digni- taries on the occasion symbolized their concern for the health and well-being of their people, as well as an appreciation of WHO-s colla- borative efforts with the countries in their resolve to achieve HFA 2000. He conveyed his thanks to His Excellency President Kim I1 Sung, the Government, and the people of the Democratic People's Republic of Korea for hosting the session in their picturesque country and for the excellent arrangements.
DPR Korea, he said, was as a jewel among the nations of the world. Under the dynamic leadership of Comrade Marshal Kim I1 Sung and Comrade Kim Jong 11, the country had achieved great progress and prosperity and had attained an enviable standard of living, and had incorporated all the elements of primary health care for effective implementation of health care activities. The introduction of the 'section doctor' system throughout the country had enabled people to get medical care within a distance of 1-2 kms from their homes. A sanitary system involving community participation had been evolved. Effective combinations of strategies had resulted in increased life expectancy 96 MINUTES OF THE FIRST MEETING and reduced infant mortality, and had brought about a marked change in the morbidity and mortality pattern. Health formed the cornerstone of social development and the Government of DPR Korea was deeply committed to achieving HFA 2000.
Referring to health development in the Region, the Regional Director stated that a decade had passed since the World Health Assembly had decided on the goal of Health For All by the Year 2000. Primary health care had been accepted universally as the key approach to bring health to the doors of the people. Health for All strategies had been evaluated to assess their impact on health development. Mechanisms for planning, implementation, monitoring and evaluation of health activities had been strengthened. Many countries had evolved innovative approaches to associate people in their health development within the framework of total development.
These steps had led to a perceptible improvement in health indicators and economic parameters in most countries of the Region. There had been a decline in the child dependency ratio, crude death rate and infant mortality rate. A declining trend in childhood mortality was discernible; life expectancy at birth had increased significantly, though it was still below the level obtaining in more advanced countries. Indicators of socio-economic development, such as per capita GNP or the level of food output, showed promislng trends in several countries of the Region,
Describing the endorsement by the Regional Committee of the Regional Programme Budget Policy as an important landmark in the collaborative functions of WHO and the countries, the Regional Director said that this policy would enable Member Countries to use WHO-s resources optimally. The detailed programme budget for 1988-1989 had been prepared in accordance with this policy which would also be used for the formulation of the broad programme budget for the first biennium (1990-1991) of the Eighth General Programme of Work.
The world was facing a serious economic and political crisis. The developing countries had yet to overcome the global recession of 1980- 1983. The problem of high cost of servicing past debts and the rising world interest rates and the resultant devaluation of currencies had accentuated poverty in such countries. This had resulted in reduced . financial outlay on health, seriously affecting health development.
An evaluation of Health for All strategies by Member Countries had clearly brought out the need to provide a massive influx of funds for strengthening health infrastructures, developing capabilities for health management and the adoption of sound and appropriate technologies. Realizing this, the Thirty-ninth World Health Assembly had urged Member States to develop further their national strategies.
He said that WHO'S resources could play a crucial catalytic role in health development, but the Organization's financial situation caused MINUTES OF THE FIRST MEETING 9 7
serious concern. It had to reduce its budget for 1986-1987 by about six per cent. The Fortieth World Health Assembly had requested the regional committees to take necessary action to secure the best possible use of WHO'S limited resources, in keeping with the letter and spirit of the relevant resolutions of the World Health Assembly and the Executive Board. The regional committees were also requested to report on the outcome of their deliberations to the next meeting of the Executive Board in January 1988. This important subject would be dealt with under Agenda item I1 of the Regional Committee.
The South-East Asia Region had become fully involved in the development of policies and programmes for WHO collaboration in a spirit of active partnership. The interest shown by the Ministers of Health in their annual meetings to discuss common problems and provide directions for health development was proof of the high degree of political commitment to such a collaborative endeavour. Such a commitment, coupled with a motivated leadership and determination to usher in a new era of health and development, would greatly help the countries in their march towards the cherished goal. WHO had a moral and technical responsibility for catalyzing the process of such a .. development. He expressed the hope that the Regional Committee would analyse the situation and provide policy and programme guidance (see Annex 3 for the full text).
Item 5 ADDRBSS BY TtlR VICE-PEIX1F.R. DPR KOWA
MR CHONG JUN GI, Vice-Premier of the Democratic People's Republic of Korea, extended a warm welcome to the Director-General of WHO, Dr Halfdan Mahler, the Regional Director of the WHO'S South-East Asia Region, Dr U KO KO, and the delegates from the Member States, and representatives of the various UN agencies and international organizations.
He said that the current session of the Regional Committee posed a great challenge of evaluating the successes and experiences of the Member States in order to set up joint objectives for more active regional cooperation, and he was convinced that with the concerted efforts of the Member States, the meeting would be conducive to substantial health development in the countries of the Region.
Health was an essential requirement for man to lead an independent and creative life, and only a healthy man could display creativity and make active and worth-while contributions to his country and the world.
WHO has a mission to attain a satisfactory level of health for all by promoting cooperation and research in the field of public health in 98 MINUTES OF THE FIRST MEETING
the Member States. For this purpose, it initiated the strategy for achieving Health For All by the Year 2000. This reflected the unanimous desire and aspirations of the peoples of the world to exercise their basic right to a happy life, with good health, free from any disease. In order to attain the goal of Health For All, the WHO South-East Asia Region had urged the Member States to fulfil their comitment to the promotion of people's health, giving particular emphasis to cooperation amongst them and to the optimum utilization of their resources. Considerable progress had already been made in the Member States in this regard, leading to reduction or eradication of various diseases, and in lowering the rate of mortality, but a lot had still to be done.
Priority needed to be given to the preventive measures which could be carried out only by active participation of the Member States, and it was necessary to take various governmental and social actions while giving preference to mobilization of the people towards hygienic activities.
People's lives and health could be protected and their desire for good health and longevity accomplished only by bringing about an improvement in the medical services. For this purpose, hospitals and clinics should be rationally distributed on the primary health care pattern, and their function and role increased steadily. Medical services should be well-organized and their quality enhanced so that people could have easy access to them.
He stressed the need for promotion of health work in each Member State in order to implement properly the WHO-s collaborative programme. The countries of the region could solve many of their problems by developing their latent skills and by collaborating among themselves. The Regional Office should play the role of a coordinator, organizer and inspirer to achieve the common goal in the countries of the region. In particular, emphasis should be placed on the rational use of the experiences, technical equipment, materials, funds and other resources needed for primary health care.
The experience of health development in DPR Korea showed that all countries were capable of achieving rapid development in the field of health research and medical services if they formulated Juche-oriented health policy. His country had established a policy to give priority to y health work.
His country had also established a well-regulated health care system, both in the capital city of Pyongyang and in the remote villages, with the introduction of the 'section doctor- system. His country had also laid solid foundations for a sound public health service system.
He hoped that the participants would be able to witness during their stay the successes and achievements of the people of DPR Korea, based MINUTES OF THE FIRST MEETING 99 on the Juche idea. He assured the delegates that the people of his country would do their best to promote the friendship and cooperation with the South-East Asian countries and would sincerely implement their commitment to develop cooperation with WHO. He wished the meeting every success.
Item 6 APPOIN7MENT OF TBB SUB-a)lWTTEE ON CREDENTIALS RC Provisional Agenda item 2.1
The Regional Committee agreed that the representatives of Bangladesh, Mongolia and Nepal should constitute the Sub-committee on Credentials.
The meeting was then temporarily adjourned.
Item 7 APPROVAL OF TEE REPORT OF TBB SUB--ITTEE ON CREDENTIALS RC Provisional Agenda item 2.2
On resumption of the meeting, the representative of Mongolia, who had been elected Chairman of the Sub-committee on Credentials, read out the report of the Sub-committee (SEA/RC40/20) recommending recognition of the validity of the credentials presented by the representatives of Bangladesh, Bhutan, DPR Korea, India, Indonesia, Maldives, Mongolia, Nepal, Sri Lanka and Thailand. The Sub-committee also noted that the credentials of one of the members of the delegation of Indonesia were awaited and recommended that he be permitted to take part in the work of the Regional Committee pending the receipt of his credentials.
The report of the Sub-committee was approved.
Item 8 eLBcnON OP CnAIW AnD VICE-CUAIW RC Provisional Agenda item 3
On the proposal of Dr Jigjidsuren (Mongolia), seconded by Dr Abdullah (Maldives), Dr Kim Yong Ik (DPR Korea) was elected Chairman.
On the proposal of Dr Uthai Sudsukh (Thailand), seconded by Mr Rahman (Bangladesh). Dr Hapsara (Indonesia) was elected Vice-Chairman.
On taking the chair, DR KIM YONG IK thanked the members for electing him the Chairman. 100 MINUTES OF THE FIRST MEETING
Item 9 STATDIWC BY IY REPRBPBBSEI7TATIVE OF OWDP
MR E.V. HELDER, Deputy Resident Representative, UNDP, Pyongyang, conveyed the greetings of the UNDP Administrator. In view of its close relations with WHO, even before UNDP established its relations, it was but appropriate that the current session was being held in the capital of OPR Korea. DPR Korea had accorded highest priority to health care standards, especially in maternal and child health. WHO's support to national efforts in health development was very encouraging.
UNDP had supported WHO's efforts in providing a better quality of life for the people of DPR Korea, through environmental pollution control, by establishing a monitoring mechanism for air, water and food pollution and in taking appropriate corrective action.
UNDP and WHO had also jointly collaborated in providing assistance to governments of the South-East Asia Region, supplementing WHO'S own efforts to provide better health standards. He considered the topic 'Information and Education on Health in support of Health for All By the Year 2000- as relevant for deliberations in conjunction with the current session.
He was confident that WHO, with the help of Member States, would be able to challenge the social afflictions, such as drug abuse and AIDS as proposed by Bangladesh for discussions, and wished the deliberations all success.
Item 10 STA~NIBY m REPBBSEllTATIVE OP mCKP
DR M. ADHYAZUA congratulated the Chairman and the Vice-Chairman on their election. He thanked Dr Mahler, the Director-General, and Dr U KO KO, the Regional Director, for the invitation to attend the current session. He recognized the importance of the current meeting since it formulated policies concerning regional activities.
Dr Adhyatma said that UNICEF, as a funding agency, was particularly ". concerned with child welfare by providing supplies and training. In carrying out its activities it collaborated with other UN specialized agencies, such as WHO, ILO and UNESCO. UNICEF, however, did not duplicate efforts of other specialized agencies, but followed the technical advice of the responsible agencies. UNICEF greatly regarded WHO-s standards, especially in child health. The Joint Committee on Health Policy consisting of WHO and UNICEF experts was another example of UNICEF collaboration with WHO. Also, UNICEF collaborated with WHO in conducting reviews on EPI and CDD in various countries. He hoped that still closer cooperation could be developed between the two MINUTES OF THE FIRST MEETING 10 1
agencies at the country level, benefiting Member States, and wished the session success.
Item I1 ADOFTION OF PROVISIONAL AGgllDA AULI SUPPL.EUKUIARY AGENDA RC Provisional agenda item 4 and RgVIBV OF lUE maPr PROVISIONAL AGEBM OF TEE EIGBn-PIRST SESSIOR OF EXECUTIVE W AKl OF TBE FORTY-FIRST WRY) tlEAL.TE ASSElIBLY RC Provisional agenda item 7
The REGIONAL DIRECTOR referred to the provisional agenda (item 4) (document SEAIRC4OIl) which had been developed in consultation with the Chairman of the Thirty-ninth Session of the Committee, the Director- General of WHO and the Member States. Three more items had been subsequently proposed by Bangladesh: (1) AIDS, (2) Drug Abuse, and (3) Intensification of District PHC Action Plan. Sri Lanka had proposed the item of -Methods of Appointment of the Regional Director'. All these items had been included in the supplementary agenda (document SEA/RClrO/l Add.1 Rev.1). While considering the provisional agenda and the supplementary agenda, it would be useful for the Committee to consider also agenda item 7, 'Review of the draft provisional agenda of the Eighty-first Session of the Executive Board and of the Forty-first World Health Assembly' (document SEA/RC40/6), as this would enable the Committee to correlate the items on its agenda with those of the Eighty-first Session of the Executive Board and the Forty-first World Health Assembly.
A review of these agenda items would serve as a briefing to those who would attend the ensuing sessions of the Executive Board and the World Health Assembly, and help develop joint approaches to common problems facing the countries of the Region, considering that there were six items of common interest.
He also drew the attention of the Committee to the technical discussions to be held during the World Health Assembly in May 1988, for which the subject of -Leadership Development for Health for All' had been selected. The discussions were expected to contribute to the capacity of 'leaders' to influence, develop and implement their national policies and strategies for Health for All. The technical discussions in 1988 would focus on clarifying the leadership functions required in initiating changes within national situations in respect to the challenge of HFA and in dealing with crucial implementation issues for the HFA strategy, besides exploring the process of leadership development within the national and international contexts.
The provisional agenda and the supplementary agenda were then adopted, after taking note of the draft provisional agendas of the 102 MINUTES OF THE FIRST MEETING - Eighty-first Session of the Executive Board and the Forty-first World Health Assembly.
Item 12 APPOIWR(BRT OF TEE SUB-COnaTl'EB ON PROGB*IPIE BUDGEI ADOPTION OF ITS TBBllS OF BBFEEKNQ RC Provisional Agenda item 5
Introducing the subject, the REGIONAL DIRECTOR mentioned the past practice of the Consultative Committee for Programme Development and Management (CCPDM) in reviewing the programme budget. CCPDM had submitted its report for consideration by the Sub-committee on Programme Budget.
Regarding the membership of the Sub-committee, he suggested that one representative from each country might participate in the Sub-committee meetings. Members who had attended the meeting of CCPDM held just before the session of the Regional Committee could attend the meetings of the Sub-committee in view of their experience with the subject, since this had been discussed in CCPDM. The countries which could not participate in the meeting of CCPDM might nominate a member to the Sub- committee. Though the Sub-committee was scheduled to meet at the same time as the technical discussions group, he hoped that it would be possible for most of the countries to be represented at both the discussions.
The terms of reference (document SEA/RC40/4) were adopted and the composition of the Sub-committee, as proposed by the Regional Director, was approved.
Item 13 ADOPTION OF AGENDA ANLI ELBCIION OF CBdZPllMl FOR llll?IECIiUIW DISCIlSSIONS RC Provisional Agenda item 6
On the proposal of Mr Ahooja (India), seconded by Dr Abdul Samad Abdullah (Maldives), Dr J. Norbhu, Representative from Bhutan, was ' elected Chairman for the technical discussions. The proposed agenda and the annotated agenda for the technical discussions (documents SEA/RC40/5 and SEA/RC40/5 Add. 1) were adopted.
Item 14
The meting was then adjourned. MINUTES OF THE FIRST MEETING 103
Annex 1
ADDilBSS BY THE CMIW OF TUE THIRTY-NIRIB SESSION
It is my great honour and privilege for me as Chairman of the Thirty- ninth Session of the Regional Committee to be given the opportunity to declare open the meeting of the Fortieth Session of the Regional Committee for South-East Asia Region.
In my capacity as Chairman of the Thirty-ninth Session of the Regional Committee, may I be permitted to extend our gratitude to Their Excellencies the Deputy Premier and the Minister of Public Health of the Democratic People's Republic of Korea, for the high honour they have bestowed to this meeting through their presence in spite of their busy schedule. Indeed Their Excellencies' presence today and their subsequent address reflect firm support and commitment for regional collaboration in health development. It is our distinct honour to welcome your Excellencies on behalf of all delegations.
In our Organization, WHO, there is a distinguished personality whom I shall take the liberty to address as an eminent and inspiring HFA leader, who has not only initiated the concept but also demonstrated his genuine technical and managerial capabilities, as well as his unique social and political know-how to make our Organization's high progress and reputation survive despite of financial constraints and other problems facing us now-a-days. No one would imagine a Regional Committee meeting existing and encouraging without him. He is with us here, Dr H. Mahler, our Director-General. We thank you, Dr H. Mahler, for your presence.
There is still another eminent personality whom I have a great privilege to address, as our most constructive regional leader in health development - without him and his kind support, our Regional Committee meeting would never be convened. We thank you, Dr U KO KO, for your presence here, and also for your constant guidance and assistance to the health development programmes in the countries of this region.
I believe all the delegations share with me that in Pyongyang, the hospitality most characterising the South-East Asian socio-cultural life has been nicely demonstrated by our host since our arrival to this beautiful city. It is thus my great privilege on behalf of all delegations and on my own delegation to thank the Government of the Democratic People's Republic of Korea in general and H.E. the Deputy Premier and H.E. the Health Minister, in particular, and the people of DPR Korea as well as the organizers of this meeting for providing us 101 MINUTES OF THE FIRST MEETING the most convenient facilities and arrangements for this meeting which make our stay in Pyongyang such a remarkable and memorable one, and of course, truly facilitate the highest level of deliberations of this Regional Committee Meeting.
It is also my great pleasure to extend the warmest welcome and greetings, to all the distinguished representatives, their alternates and advisers as well as representatives of UN agencies, multilateral, bilateral and nongovernmental organizations for attending this meeting. I do appreciate your willingness and time to travel from neighbouring and from distant countries. I always admire your fruitful contributions during our deliberation.
Last, but not least, the presence of all distinguished guests is most precious and really make this meeting the most auspicious and memorable one.
During the previous session of the Committee, attention was paid to several important issues of regional interest, and I would like to express gratitude to the members of the Committee, without whose contribution and support, we would not have been able to come up with the resolutions which you must all have been well aware of. Today, we are starting our Fortieth Session of the Committee and even though men at the age of forty years are considered as their life is just at its beginning stage, on the contrary, our Organization has made several significant contributions during this period, in helping mankind in attaining its ultimate stage of health. But, we may also realize that the actual struggle in life has just started in our Organization, because on this occasion of our coming Fortieth Anniversary and also the time of one decade after Alma-Ata Declaration, WHO ie facing a severe, unjustly blow, from this very unfavourable international atmosphere. As we are all well aware of, one of the crises we are facing is the financial one, which is mainly a result of the shortcoming of the assessed contributions from Member States and the huge decline in exchange rate of the major currencies in use in our Organization. At the same time, our agreement upon attaining the goal of Health for All is approaching its targetted year of 2000, even though progress has been made during the past decade, we will have to be more careful in the remaining 13 years when money is falling short, but in many instances, problems are on the increase both in terms of quantity and severity. We have the emerging problem of AIDS which is a challenge to developing countries like ours. We need also to adapt the way we have been utilizating our limited resources, both national and international, ones in order to achieve the most out of it.
As a member of our Organization, I am confident that we all feel the impact and agree that there are changes to be made, change in planning for maximal efficiency, in best managing the available resources and in generating technologies appropriate for countries' specific situations. Financial resources from our WHO is rather small compared to those from MINUTES OF THE FIRST MEETING 105 other sources, but proper use of its resources, either in monetary, manpower or technical form, can make a lot of significant contributions to our countries' health development. I am sure this very Fortieth Session of our Regional Committee will be one of the important sessions. Several essential topics are waiting for our enthusiastic and genuine sharing of opinions and experiences and I will not delay it any longer, but to wish this session a very fruitful one and tremendous contributions to health development in all Member States within our region. 106 MINUTES OF THE FIRST MEETING -
Annex 2
ADDRESS IIY TEE IIIRISTEX OF PUBLIC BWTH
Today, in Pyongyang, we hold the Fortieth Session of the WHO Regional Committee for South-East Asia with great interest of the people in the health field in the South-East Asia Region.
Present at the current session are distinguished representatives from ten Member States and several figures from WHO. In particular, the presence of Dr Mahler, Director-General of WHO, gives more significance to this session.
On behalf of the Government of the Democratic People's Republic of Korea, I have great pleasure to accord a warm welcome to Dr Mahler, a distinguished guest to our country, who is devoting himself to the work of eradication of diseases and promotion of people's health, and to the representatives, Dr U KO KO, and prominent figures from international organizations who are present at the meeting with a desire to contribute to attaining the lofty aim of Health for All.
At the current session, we shall appreciate learning about the results and experiences achieved during the last year by the countries of South-East Asia in the course of implementing the strategies for Health for All by the Year 2000, which was proposed by WHO and endorsed by all Member States, and pool the valuable experiences and devise ways and means for further activities in the health field.
Everyone has a full right to enjoy health and it is a unanimous desire of all.
The World Health Organization has set the global goal to accompish within this century the cherished desire of mankind to lead an independent and creative life in good health, and has been making w efforts to attain this goal. In this course, WHO has recorded significant achievements, such as eradication of smallpox from the planet. For such successes, WHO and the Regional Office for South-East Asia get due appreciation from many governments of the world. And the people of the world extend a whole-hearted support to the strategy of the Organization.
The strategy for Health for All by the Year 2000 is a common task to be accomplished in each country as well as in each region and throughout the world. It is not long before the year 2000. MINUTES OF THE FIRST MEETING 107
The accomplishment of the centuries-old desire of mankind within only thirteen years, which is a short period as against the human history on the planet, needs correct judgement in the situation and timely solution. For this end, it is one of the most important issues that we should find new ways on the basis of results and experiences gained in every country in different conditio~~sand of scientific analysis and assessment of the present situation.
Therefore, the governments and the peoples Ln the region attach great importance to the annual session of the Regional Committee and hope that the session would meet the desire and aspirations of the times.
Thanks to the responsible activities of the Regional Office and Member States, technical exchange and collaboration in health field have become more active.
If we creatively mobilize the internal possibilities and potentialities under the support of, and collaboration with, WHO, we shall bring a new favourable phase in our work.
Aware that by sincere and active efforts of all delegates present here, this session will serve as a successful booster to health work in Member States to attain the strategic goal of WHO and also a significant meeting to strengthen further the links of friendship, cohesion and cooperation between the countries in the Region, I wish great success to the current session. I08 MINUTES OF THE FIRST MEETING
Annex 3 ADDRESS BY BEGIORAL DIRECTOR
On behalf of the World Health Organization, its Regional Office for South-East Asia, distinguished delegates from Member countries, and on my own behalf I have great pleasure to extend to you, Your Excellencies, our cordial greetings and warm welcome to this historic occasion of the 40th session of the Regional Committee. Your very presence here symbolizes your affection for your people and their well being and health as well as your appreciation of WHO'a collaborative work with the Governments of this Region in their resolve ro forge ahead to achieve Health For All by the Year 2000. SI , Your Excellency, the Vice-Premier, may I also take this opportunity to convey through you to His Excellency President Kim I1 Sung, the Government and the people of Democratic People's Republic of Korea our sincere thanks for inviting us to hold this meeting in your picturesque country and for the excellent arrangements made and for the warmth of your reception.
I also wish to extend a cordial welcome to the distinguished delegates from the Member States of South-East Asia Region, representatives of international agencies and NGOs and to all the esteemed guests who have assembled here.
DPR Korea is one of the jewels among the nations of the world and particularly of Asia situated on the cultural confluence of the East and the West with an age old history and traditions, endowed with scenic beauty and rich natural resources. Its valiant people have made supreme sacrifices throughout its revolutionary history to maintain their dignity, honour and integrity. They have forged ahead with incredible momentum in their march towards progress and prosperity under the dynamic leadership of Comrade Marshal Kim I1 Sung. The Great Leader, Comrade Marshal Kim I1 Sung, and the beloved leader Comrade Kim Jong I1 have shown you the way and evolved for you the philosophy * based on -Juche principles, through which you have attained high level of socio-economic achievements and an enviable standard of living.
DPR Korea recognizes health as a fundamental human right and guarantees free medical service to every citizen highlighting the needs for the most vulnerable groups comprising of women and children. This country has made applicable all the elements of primary health care, fully involving communities and eliciting intersectoral coordination for effective implementation of health care activities. With the *section doctor' system throughout the country the service distance is MINUTES OF THE FIRST MEE:TING 109
just within a kilometer or two enabling individuals and families a close contact with their physicians in their homes and work places. Through effective strategies for prevention and control of communicable diseases, equitable distribution of resources and notable success in socio-economic development, the life expectancy at birth has increased to 74 years; infant mortality has reduced to below 10 per 1 000 live births; and morbidity and mortality pattern shows a distinct change comparable to developed councries. Thus, health forms the cornerstone of social development in DPR Korea and the Government is deeply committed to achieve Health For All by the Year 2000.
Let me now say a few words on the health development in our Region. We have already completed one decade since we collectively decided in the World Health Assembly in 1977 to achieve Health for All by the Year 2000. During this decade, primary health care has been universally accepted in countries of South-East Asia, as the key approach for bringing health to the doorsteps of the people. Countries have taken bold steps to evaluate health for all strategies and identified problems and constraints in their implementation. In addition, several key health programmes have also been evaluated with a view to assessing their impact on health development in the context of HFA objectives. Mechanisms for planning, implementation, monitoring and evaluation of health activities have been strengthened. Many countries have evolved innovative approaches for involving people in their health development within the framework of total development.
All these have resulted in a perceptible improvement in health indicators and economic parameters in most countries of this Region. Although population has increased at approximately 2.05 per cent during 1983-1984, child dependency racio has definitely fallen due to a decline in fertility. There is a steady decline in the crude death rate. For example, in Bangladesh, India, and Indonesia, the crude death rates have fallen from around 22 in 1962-1965 to 13-15 range in 1980- 1985. Infant mortality rate has also been substsntially reduced to the level below 50 per 1000 live births in Burma, DPR Korea, Sri Lanka and Thailand. Childhood mortality, which reflects more accurately the socio-economic and health development, has also shown trends towards decline in all countries for which data is available. In some councries like DPR Korea and Thailand, it has become one-third of what it was in 1965. The life expectancy at birth has shown a marked increase, although in most countries it is still below that in developed countries. The parameters of socio-economic development, such as per capita GNP, or index of food production, etc., show promising trends in several countries of this Region.
One of the important landmarks in the collaborative functions of WHO and the countries was the endorsement by the Thirty-ninth Session of the Regional Committee of the Regional Programme Budget Policy for South-East Asia Region, a policy which would in the spirit of partnership enable Member States to use optimally WHO-s technical and 110 MINUTES OF THE FIRST MEETING
financial resources for catalyzing their health development in the critical areas. The policy has already been applied in the preparation of the detailed programme budget for 1988-1989 and will be used in the formulation of the programme budget for 1990-1991 which is the first biennium of the Eighth General Programme of Work, to commence the decade ending in the year 2000 A.D. for achieving Health For All.
Today, the world is passing through a serious economic and political crisis. The global recession of 1980-1983 had more serious consequences for the developing countries which have yet to come out of the economic recession. Their growth rate has not regained the original momentum. Prohlems of acute imbalance of payment, high cost of servicing past accumulated foreign debts, coupled with rising world interest rates and consequential devaluation of national currencies have led to poverty in those countries. The share of public expenditure on health in absolute terms tended to go down and this would, therefore, seriously affect health development.
Evaluation of Health For All strategies by Member countries has brought out clearly how urgent it is to provide massive influx of funds for strengthening health infrastructure, developing capabilities for health management and adoption of sound and appropriate technologies. We must emphasize that the goal of Health For All by the Year 2000 will contribute to a genuine social change and improvement in economic productivity.
Aware of this situation, the Thirty-ninth World Health Assembly, vide resolution WHA39.15 urged Member States, inter alia, to develop further their national strategies for Health For All by the Year 2000 by producing whenever feasible, costed plans focussing on primary health care in the most realistic way within the resources expected to he available.
In this context, WHO would play a very crucial catalytic role in health development, there is serious concern about WHO'S financial future at this critical juncture. WHO, as other international organizations, is now gripped with unprecedented fiscal crisis. WHO had to slash about 6 per cent of its budget in 1986-1987 and the prospects for 1988-1989 are not much brighter. Drastic contingency plans had to be prepared for reducing implementation of the programme budget for - 1988-1989. - The Fortieth World Health Assembly reviewed, in May 1987, the Director-General's Introduction to the Proposed Programme Budget for the Financial Period 1988-1989, and his assessment of WHO'S programme budget during the period of the Seventh General Programme of Work, as well as his reflections for 1988-1989. In this connection, the Assembly requested the Regional Committees, vide its resolution WHA40.15, to review the situation assessments and reflections of the Director- General, and take necessary action to secure the best possible use of MINUTES OF THE FIRST MEETING 111
WHO'S limited resources in keeping with the letter and spirit of all relevant resolutions of the World Health Assembly and the Executive Board. The Regional Committees were also requested to report on the outcome of their deliberation to the Executive Board at its eighty- first session in January 1988. This important subject will be dealt with under agenda item I1 of the Regional Committee.
In South-East Asia, the Organization has successfully developed an intimate dialogue with the Governments of the Member Countries in pursuing such a mandate. In this Region, the Regional Committee has become fully involved in the development of policy and programme for WHO collaboration in the spirit of active partnership. The high degree of political commitment for such a collaborative endeavour is evident from the interest and enthusiasm displayed by the Health Ministers, who meet every year to discuss common problems and provide directions towards the development of health for all in this Region. WHO has moral and technical responsibility for catalyzing the process of such a development. The Regional Committee, on the other hand, has to take more active part in analyzing the situation and providing policy and programme guidance.
With the high degree of political will and commitment, motivated leadership and strong determination to usher in the new era of health and social development, 1 have no doubt that we will continue our march more effectively with accelerated momentum towards our cherished goal. I am looking forward to purposeful and successful deliberations in this session of the Regional Committee for future guidelines of collaborating actions, surmounting the problems md difficulties WHO is facing at present.
Before I conclude, may I once again wish to express my sincere gratitude to Your Excellencies and the Government oE the Democratic Penpleps Republic of Korea for hosting the Fortieth Session of the WHO Regional Committee for South-East Asia and the Seventh Meeting of the Health Ministers of the Member States in these picturesque and hospitable surroundings. 112 MINUTES OF THE FIRST MEETING
Annex 4
ADDReSS BY TEE VICE-PREMIER, DEMOCRATIC PEOPLE'S REPUBLIC OF KOREA
Today, the Fortieth Session of WHO Regional Committee for South-East Asia begins in Pyongyang, the capital OF our country.
On behalf of the Government of the Democratic People-s Republic of Korea, I have great pleasure to offer a warm welcome to you, the delegates to this session from various countries and international organizations.
The current session of WHO South-East Asia Regional Committee poses a heavy, yet honourable, task to evaluate the successes and experiences gained in health work of the countries in the region to elaborate means and ways of setting joint objectives for more active regional cooperation in this field.
I am convinced that, with your concerted efforts, the session will be a significant meeting substantially conducive to the health development in the countries of the region.
Health is an essential requirement of a man to lead an independent and creative life.
Only a healthy man can highly display chajusong and creativity and make active contribution to the worthwhile work for the country and the nation. Therefore, the protection of people's health represents a noble undertaking for the progress of society and mankind. WHO regards it as its mission to attain satisfactory level of health for all through the activities to promote cooperation and medical science researches in the field of public health on a world-wide scale.
Proceeding From such a mission, WHO initiated the strategy for a. Health For All by the Year 2000 and is striving for its implementation.
The strategic task reflects the unanimous desire and aspiration of the world people to exercise their basic right to a happy life in good health free from diseases. In order to attain the goal of Health For All by the Year 2000, WHO South-East Asia Regional Office brought each Government to fulfil its commitment to the promotion of people's health, giving particular emphasis to cooperation among the countries and utilization of resources in the region. MINUTES OF THE FIRST MEETING 113
In the course of implementation of WHO'S strategic goal of Health For All, considerable progress has been made in the Region in regard to the promotion of peopless health reducing or eradicating various diseases with low rate of mortality.
But the people of the South-East Asia Region have still more things to do in the future than with they have already done.
In order to progress in health work priority should be given to prevention work. It insures people against various diseases and guarantees an independent and creative life of the masses of people. It is a work for broad masses and, consequently, it can be successfully carried out only by the active participation of the people themselves.
To effectively push ahead with preventive wcrk, it is necessary to take various governmental and social measures while placing sanitary propaganda before other work to mobilize broad masses to this scheme.
Medical service work should be steadily improved to promote health work. It is an important work for providing people with complete medical benefit. Only when it is done well, can people-s lives and health be protected and their desire for health and longevity accomplished.
In order to Improve the work, hospitals and clinics, on the lines of PHC, should be rationally distributed and their function and role increased steadily. And mecial service should bt? well organized to be brought close access to inhabitants and its level of quality enhanced.
Thus, on-the-spot treatment, out-patient treatment and first-aid treatment should be done more satisfactorily on a high level.
It is of great significance for the promotion of health work in each Member State to implement properly the collaborative programme of WHO.
The countries in the South-East Asia Region can solve many probelms with their own efforts if they develop all the latent possibilities, collaborating with one another in such a way that those with experience in health assist with experiences and those with specialists through - specialists.
The Regional Office should enhance its function and role as a coordinator, organizer and inspirer to achieve the common goal in the countries of the Region and thus should strengthen ties of friendship, cooperation and solidarity between them and further promote health work on the principle of individual and collective self-reliance.
In particular, emphasis should be placed on the rational use of the experiences, technical equipment, materials, funds and resources needed for the implementation of primary health care. 114 MINUTES OF THE FIRST MEETING
The technical cooperation daily expanding between our country and the South-East Asian countries will be helpful to the health work, not only of our country, but of other countries of the Region.
I would like to express my expectation that the current session will take useful and practical measures by exploring earnestly new ways and forms of expanding cooperation and enhancing its effectiveness in health field in the Region.
The historical experience in health development of our country shows that the countries which were once colonies of the imperialists are capable of achieving rapid development of health work and medical science and techniques if they formulate =-oriented health policy attaching a great importance to health work.
In our country, we established a policy of giving priority to health work and have been directing great efforts to it since the first days of building a new society under the brilliant leadership of the great leader, Comrade Kim I1 Sung.
Consequently, we have put into effect the complete, universal free medical care and it enables us to protect and promote people's health while adhering to the policy of preventive medicine.
Today, under the vigorous guidance of the dear leader, Comrade Kim Jong 11, our people have established a well-regulated health care system in the capital and in remote villages as well, introducing an advanced sectiondoctor system.
Our people have also laid material and technical foundations for public health service solid enough as to manage health work satisfactorily by themselves, by establishing general hospitals, specialized hospitals and other modern therapeutic and prophylactic institutions, juche-oriented medical science research base, independent pharmaceutical and medical appliances industry.
We are convinced that our health work would advance more rapidly along with the general development of the national economy and the growth of the country's might.
Today, we see a fresh upswing in the socialist construction in our T~ country. Our people are working new miracles and innovations in all fields of socialist construction to carry out successfully the task of the first year of the 3rd seven-year plan.
During your stay in our country you will witness our people's whole- hearted support to, and trust in, the Government of the Republic, the might emanating from our entire people's unity and solidarity based on the juche idea and the successes achieved in socialist construction under the leadership of our Party. MINUTES OF THE FIRST MEETING 115
Our people will do their best in the future too to promote the friendship and cooperation with the people of the South-East Asian countries and to implement sincerely their commitment to developing cooperation with WHO.
You are not only the delegates to the Regional Committee session, but also distinguished guests of our country.
You will feel warmly the fraternal sentiments of our people towards the people of the South-East Asian countries during your stay here.
I sincerely wish you pleasant and beneficial days during your sojourn in the country and greater success in the Regional Committee session. SUMMARY MINUTES^
Second Meeting. 15 September 1987. 2.30 p.m.
AGENDA
I tem Page
I. Thirty-ninth Annual Report of the Regional Director 118
2. Approval of the Second Report of the Sub-committee on Credentials
3. Thirty-ninth Annual Report of the Regional Director (contd.) 124
4. Address by the Director-General 129
5. Adjournment 131
Annexes
1. Text of the Regional director*^ Address Introducing His Annual Report for 1986-87
2. Closing the Ranks for Health for All - Address by Dr H. Mahler
y~riginallyissued as document SEA/RC40/Min.2, on i6 September 1987 Item 1 THIRI'Y-NIWTB ANNUAL REPORT OF TEE REGIONAL DIRECrOP RC Agenda item 9
DR CHAIYAN K. SANYAKORN, Director, Programme Management, speaking on behalf of the Regional Director, introduced the Annual Report for the period 1 July 1986 to 30 June 1987 (document SEA/RC40/2 and Corr.1) and highlighted the salient features of health development activities undertaken by the Member States with WHO collaboration.
He said that Member States made determined and concerted efforts towards Health for All by the Year 2000, despite various social and political problems that confronted them. Health ministries were assuming a leadership role in health and health-related socio-economic development. The governments had pursued vigorously their efforts towards health development within the framework of the new managerial process for optimum utilization of WHO'S resources and implementation of the Regional Programme Rudget Policy. Joint GovernmentIWHO mechanisms had been established for the planning, implementation, monitoring and evaluation of WHO'S resources. The Regional Programme Rudget Policy, endorsed by the Regional Committee, would enable the countries to use WHO-s resources optimally.
The most important achievement during the year was the successful completion of the first evaluation of Health for All strategies by the Member States who were in the process of collecting information for the second round of monitoring and implementation of those strategies. Although the health infrastructure had expanded and provided wider coverage in several countries, it had not yet reached the underserved and unserved populations. Therefore, the focus of efforts was on the development of an operational framework for progressive intensification at the district level.
WHO had supported the countries in developing programmes on health manpower information systems. The countries also recognized the need for reorientation of medical education in the context of the rapidly changing concept of health care.
Realizing the importance of health services research, the South-East Asia Advisory Committee on Health Research (SEA/ACHR) had identified priority areas for research in support of Health for All strategies and provided guidelines for research development through WHO collaborative efforts.
In the field of maternal and child health, WHO had collaborated with UNICEF, UNFPA and other international agencies in strengthening MINUTES OF THE SECOUD IDETING 119
promotive and preventive health measures for mothers and children. Several studies were being supported by WHO for evolving appropriate strategies for the effective delivery of maternal and child health and family planning services. WHO-s nutrition programme aimed at strengthening, developing and reinforcing national capabilities for reducing malnutrition. It was gratifying that a measurable reduction in protein-calorie malnutrition had occurred in a few countries, and that some impact had been made on iodine-deficiency diseases.
He said that WH0.s major thrust in the area of environmental health had been on involving the community in improving drinking water supply and sanitation. While countries had been developing these facilities. the coverage had not been adequate. WHO-s collaboration in this field encompassed institutional strengthening, manpower development, water quality surveillance, development of research capabilities and resource mobilization. Efforts were also needed to reduce health hazards emanating from environmental pollution due to rapid industrialization.
Considering that irrational prescription and overuse of drugs had resulted in serious public health problems, WHO had laid emphasis on the development of appropriate drug policies to ensure the supply of essential drugs and promote their rational use. Almost all Member States had now established a national list of essential drugs.
Communicable diseases continued to take a heavy toll of life despite the countries spending large proportions of their health budgets on the prevention, control and treatment of those diseases. WHO'S collaborative efforts in this area were directed towards the reduction of mortality and morbidity due to these diseases. The Expanded Programme of Imunization had registered an impressive progress in managerial, operational and technical aspects of the programme in all countries and there was definite evidence of reduction in the EPI target diseases in some countries. It was gratifying that several countries were committed to the achievement of Universal Child Immunization by 1990. WHO support in this field had been mainly through training courses and seminars in EPI management.
Malaria continued to dominate the health scenario of most Member States for several decades. Despite a decrease in the total number of malaria cases, the overall situation in the Region was quite alarming due to some formidable technical problems. There was thus a need to pursue important strategies, such as community participation, intersectoral collaboration and mobilization of internal and external resources for malaria control and operation.
Diarrhoea1 diseases and acute respiratory infections continued to contribute to high mortality among children, despite the availability of a simple and cost-effective technology for their treatment. WHO-s thrust in this area was directed to assisting the countries in the training of clinical and managerial staff and in developing national or 120 HINOTES OF THE SECOND METING - regional self-sufficiency in the production of oral rehydration salt (ORS). In regard to ARI, the emphasis continued to be on programme development, epidemiological studies and training.
WHO-s collaborative efforts in the fields of tuberculosis and leprosy focused on the employment of multidrug treatment regimens, intensification of epidemiological surveillance, strengthening of laboratory services, provision of adequate quantities of essential drugs, training of health manpower and promotion of research. However, much more effort was needed to integrate these programmes into general health services.
He continued that, in the recent past, AIDS had become a matter of great concern to the Member States. Although a few countries had reported AIDS cases, none of them was of indigenous origin. Member States had constituted national committees or task forces to prevent the occurrence of AIDS. WHO had established a Special Programme on AIDS, and, at the regional level, developed a regional plan for the surveillance and control of AIDS. It was hoped that with improved surveillance and development of technical manpower, it would be possible to restrict the spread of this infection in this region.
WHO'S collaborative activities in the field of prevention of blindness were intensified in all countries with the main thrust directed to building up and strengthening the infrastructure for essential eye care through the primary health care approach. Several countries had developed programmes for the treatment of cataract and provision of low-cost spectacles. Attention had to be paid to the strengthening of referral facilities in order for the programme to make a real impact.
Noncommunicable diseases, such as cancer, cardiovascular disorders and mental diseases, were being recognized as important causes of morbidity and mortality in several countries of the Region. While primary prevention through intensified health education programmes would be ideal, WHO had been supporting countries in the training of personnel in the early diagnosis and providing training facilities for radiotherapy or chemotherapy. Health education and community involvement played a major role in the control of these diseases, some of which were directly related to, and the result of, changing life- - styles.
Several countries introduced innovative approaches in national health development, such as decentralization of authority, targeting at the district level, drug cooperatives and technical cooperation among districts. It was necessary to involve nongovernmental organizations in health care activities. WHO continued to collaborate with UN and bilateral agencies, as well as nongovernmental organizations, in carrying out effectively their activities to achieve the goal of HFA. In conclusion, he expressed satisfaction that, despite multifarious social and political problem^ and financial constraints, the Member States had forged ahead in their march towards the goal of Health for All by the Year 2000. He was confident that the citizens, with better health facilities and improved quality of life, would in turn be able to contribute effectively to social, technical, financial and spiritual development of their countries. He hoped that the Regional Committee, through its collective wisdom, would provide guidance and directions on future health activities in WHO'S collaborative efforts (see Annex 1 for the full text).
The CHAIRMAN invited Dr Chaiyan K. Sanyakorn, Director, Programme Management, to make his observations on the mechanism for discussion of the Annual Report of the Regional Director.
DR CHAIYAN recalled that the Thirty-ninth Session of the Regional Committee had decided upon the procedure for discussing the Regional Director-s Annual Report. He said that, to begin with, country representatives were expected to make oral presentations of a general nature, after which the report would be discussed by major programmes or groups of programmes. The Chairman of, or a member designated by, the CCPDM would offer his observations on that portion after which it would be discussed by the Regional Committee.
The CHAIRMAN invited comments of the representatives, observing that they be precise and brief in their presentations, in view of the rather heavy agenda before the Committee. Representatives of nongovernmental organizations in official relations with WHO could make statements of an expository nature. Representatives of nongovernmental organizations not affiliated to WHO or voluntary agencies were welcome to attend the proceedings of the Regional Committee as observers, according to the Rules of Procedure of the Regional Committee.
DR HAPSARA (Indonesia) thanked the delegates for electing him Vice- Chairman and hoped that he would be able to accomplish the task with their full support.
Expressing the appreciation of the Indonesian delegation on the , comprehensive report of the Regional Director, he said that it was - important to take stock of the health programmes and the constraints to their development. The report reflected the thinking on these aspects. Despite the enormous socio-economic problems, countries of the Region had forged ahead towards the goal of HFA. He said that WHO had 8~le'i~t~ened.tt.8 ca'ialytic .tole is health ieuelopment. ~=t,while irs first constitutional function of directing and coordinating international effort in health was effective, i.ts role in technical cooperation was rather limited. The Director-General had stated that that would depend on interlinked actions by all Member States. He felt that the Regional Committee should try to analyse ways to strengthen cooperation in this region. The Global Programme Budget policy needed to be brought to bear on the Regional Programme Bcrdget policy. The world economic crisis had aggravated the economic problems faced by developing countries, stretching their limited resources in health and social welfare. While efforts could be made to find additional resources for health development, it was also necessary to devise measures to use the available resources more effectively. This called for improved management of country and WHO resources. The relevant points mentioned in the guidelines for preparing the regional programme budget policy would have to be kept in mind for evolving a managerial framework for the optimal use of WHO'S resources in direct support to Member States. The process of decision-making could be accelerated and made more consistent.
At the regional level, special attention needed to be paid to at least four aspects: elaboration or improvement of regional planning, monitoring and evaluation; enhancing cooperation with individual Member States for strengthening of management capacity and ensuring the availability of relevant health information; further promoting and supporting research developments, especially in health development, and concerted and intensive activity to mobilize financial resources.
DR ABDULLAH (Maldives) conveyed the felicitations of his delegation to the Chairman on his election. He also congratulated Dr Hapsara on his electlon as Vice-Chairman, and other office bearers. He complimented the Regional Director and his staff on the comprehensive report which, he said, reflected developments in the Region as regards endeavours towards Health for All by the Year 2000.
MR AHOOJA (India) congratulated the Chairman on his election and was confideflt that under his able guidance the deliberations of the Regional Committee would be purposeful. He congratulated Dr Hapsara on his election as Vice-Chairman and said that he had ably represented the interests of the Region at the Executive Board. Despite resource constraints, WHO'S collaborative programme had, in no way, diminished in the Region. At the same time, it was evident that there was no hope of any addition to these resources in the foreseeable future. It was, therefore, essential that the resources were used most optimally, and this required detailed discussion at the Regional Committee.
Many countries had, in recent times, established strong health infrastructures and these resources, too, needed to be utilized to the optlml~m and WHO'S role in ensurlng this needed to be examined. The commitment to the goal of HFA 2000 needed- to be reaffirmed. There was a need for intersectoral cooperation in the field of health. WHO could play an effective role in this regard so that the goal of Health for - All - and All for Health - could be achieved.
DR UTHAI (Thailand) congratulated the Chairman and the Vice-Chairman on their election. He also felicitated Dr Norbhu on hia election as Chairman for the technical discussions. He complimented Or Chaiyan on his very informative presentation, and the Regional Director for his MINUTES OF TBE SECOND MEETING 123
comprehensive Annual Report. He extended his felicitations to all countries in the Region which had made significant strides towards HFA in the face of economic difEiculties.
The concept of primary health care was expanding in all countries. Bhutan was training village health workers to cover inaccessible and difficult areas. Burma was mobilizing all possible resources for a more effective use through primary health care programme supported by WHO, UNICEF and US AID. Maldives was approaching health as a multi- disciplinary programme with a strong political commitment and support from the highest level. Nepal was persevering with its integrated community health development project. Mongolia had successfully introduced health awareness and commitment among the leaders and community and was expanding the benefits of 3uch project to other areas. The record of DPR Korea in this sphere was equally impressive, with its comprehensive 'section doctor system'. Such efforts and experiences were encouraging for all countries and some could be found useful by other countries as well. Thailand had implemented a traditional medicine programme in the country with WHO and UNDP support.
The establishment of country support teams wa:; an indication of the support that the Regional Office was trying to provide to the countries. Regional meetings and other mechanisms had helped initiate intersectoral action in health at the country level. The Regional Committee served as a platform to harmonize the efforts of different countries. The meetings of the Health Ministers in this Region greatly helped Member States in spreading awareness of the importance of policies in the field of public health. WHO had been successful in providing clear guidelines on important health issues. Members from the Region participating in the Executive Board had made important contributions at the global level. Referring to the introduction of the decentralized management system in Thailand for managing WHO'S resources for optimal use, he said that his country had benefited from this experience. He hoped that the able leadership of the Director- General and the Regional Director would provide further inspiration and encouragement to Thailand in its march towards Health for All.
DR REGMI (Nepal) congratulated the Chairman and Dr Hapsara on their election. He conveyed his appreciation to the Regional Director and the staff of the Regional Office for the comprehensive annual report. The progress made by the Region in the face of ever-rising inflation and financial constraints was no mean achievement. He hoped that with new and innovative ideas, proper planning and guidance from WHO, the countries of the Region would be able to do very useful work. Nepal had introduced some innovative concepts, such as training of community health leaders, and drug abuse control scheme, where collaboration with nongovernmental organizations had been useful. Recently, Nepal had introduced decentralization of health projects which, he hoped, would be useful for future work. 124 MINUTES OF Tlis SECOND IIBETING
DR FERNANDO (Sri Lanka) congratulated the Chairman and the Vice- Chairman on their election, and the Regional Director for his Annual Report. He observed that, despite financial constraints, collaborative programmes were progressing satisfactorily and hoped that, in the Eighth General Programme of Work, it would be possible to make further progress with support from the Member States.
Item 2 APPROVAL OF TME SECOND BBPOBT OF TEE SUB-CWITTEP. ON CREDENTIALS RC Agenda item 2.2
The Representative of Mongolia, Chairman of the Sub-committee on Credentials, read out the second report of the Sub-committee (SEA/RC40/20, Add.1) recommending that the validity of the credentials presented by the representative of Indonesia be recognized. The report was approved by the Regional Committee.
Item 3 TEIRTY-NINTA ANNUAL REPORT OF TEE REGIONAL DIRRCrOR (contd.) RC Agenda item 9
MR KAZI GOLAM RAHMAN (Bangladesh) congratulated the Chairman and the Vice-Chairman on their election. He said that the report produced by the Regional Director was comprehensive as it explained all the activities carried out by the WHO Regional Office, and the future directions that the Regional Office and its Member States would like to follow. The gains in the health field in this region during the past few years had been very impressive. These gains courd not have been achieved by the Member States without the active support of the WHO Regional Office for South-East Asia and the Organization as a whole. His country would like WHO to be more actively involved in the future in the control of communicable diseases, such as malaria, especially where it necessitated active participation of two or more Member States. In spite of the good progress made by Member States, countries of the Region were becoming increasingly dependent on technology import and that this was more prominent in the field of diagnostic, m therapeutic and rehabilitative areas. He stressed the need to develop indigenous appropriate technology based on the knowledge gathered and capabilities attained so far. For this purpose, he called upon the Regional Office to assume leadership in collaboration with the Appropriate Technology Centre and UNIDO.
Member States were becoming increasingly dependent on the import of drugs and medicine. Bangladesh was following a pragmatic policy in this area and was the only country in the Region that had reduced its dependence on the import of drugs. In financial terms, its imports of UIBUTES OF THE SECOND WTINC 175
essential drugs were the same as they were five years ago, but in material terms his country had been able to reduce the quantity of drugs, He felt that WHO should spearhead moves to reduce dependence on the import of essential drugs in the Region. Bangladesh was willing to share its experiences in this field. In conclusion, he thanked the Regional Office and other international agencies, particularly UNICEF and UNDP, for their valuable assistance.
DR NORBHU, (Bhutan) congratulated the Chairman on his election. He expressed the hope that under his able guidance the Regional Committee would have fruitful deliberations. He thanked the Regional Director for his very lucid and comprehensive report.
Bhutan had made some major strides for the achievement of the social goal of Health For All by the Year 2000. The programme on essential drugs had taken a concrete shape and the processes for training of health workers in -rational prescribing' and drug quantification were being devised. A national Formulary had been pre-tested and would be distributed to all districts by December 1987. The health information system had been strengthened and the first National Bulletin on Health Statistics was due to be printed by end-September 1987.
A national Workshop on Intensification of Primary Health Care was held in July 1987 and, as of November 1987, specific activities would be undertaken in two districts of Bhutan. EffcBrts to identify the optimal health service delivery system and modalities at Mongar District in Bhutan had started giving considerable information and some models were being adapted and replicated in other districts.
He thanked WHO for its support, both technical and financial, which had played a vital catalytic and supportive role. The establishment of a country support team in the Regional Office had also helped in facilitating implementation of various health programmes in his country. Given Bhutan-s severe constraints both in manpower and finance, WHO-s collaborative support must have a degree of flexibility in order to enable the country to achieve the goals in the health development.
DR JADAMRA (Mongolia), speaking on behalf of the Representative, congratulated the Chairman and the Vice-Chairman on their election. His delegation was grateful to the Minifiter of Public Health, and the Government of the Democratic People's Republic of Korea, for hosting the session in the beautiful city of Pyongyang. He also thanked the Regional Director for his excellent and informative report on the work of WHO for the year 1986-87.
He had gone through the Regional Director-s Annual Report in depth during the meeting of the CCPDM in the last few days. Despite many constraints and difficulties facing Member States, the people of our region were able to benefit a lot from the good work done in the health 126 MINUTES OF TKE SECOND I&ETING
field. His country would complete its seventh Five Year Plan by the year 1990, by which time they would be able to fulfil a number of targets set by WHO. Dr Jadamba complimented the Regional Director for having prepared an excellent annual report.
MR CHON SU OK (UPR Korea) felicitated the Chairman and the Vice- Chairman on their election. He thanked the Regional Director for the good work done in the field of health development and For presenting an excellent report to the Regional Committee.
The report amply illustrates the useful steps taken by the WHO Regional Office and by the Member States for health development. Through the coordinating role of the WHO Regional Office, the strategy for Health for All by the Year 2000 had been implemented, resulting in the enhancement of quality of primary health care in the countries. His government had taken several measures during the last year, which included strengthening the role and functions of general and specialized hospitals, adopting measures to build up material and technical foundations of city hospitals, county people's hospitals, factory hospitals, ri hospitals, and clinics in order to enhance the level of their management. The -section doctor' system was also further strengthened.
According to some major health indices, as of 1986, the crude death rate was 5.0 per 1 000 population, the natural population increase was 17.9, and the infant mortality rate was 9.8 per l 000 live births. The average life expectancy at birth had reached 74.3 years, and the number of doctors and health workers of secondary grade per 10 000 population was 27 and 43.2 respectively. The ratio for hospital beds per 10 000 population had reached 135.9.
His country was making vigorous efforts to further enhance the level of disease prevention and treatment by improving their specialized medical services. They were encountering problems connected with aging of population, and of reducing morbidity, cardiovascular diseases, cancer and metaholism.
DPR Korea was deeply interested in TCDC programmes in the field of health development and hoped that the efforts of WHO'S Regional Office would lead to the strengthening of South-South cooperation. Exchange -. of information and technology in the field of traditional medicine was also included in the Plan of Action.
Introduction (page ix-xlii)
At the request of the Chairman, MR AHOOJA, Chairman of the CCPDM, said that the Committee discussed the report of the Regional Director in detail, and made certain recommendations and points for consideration by the Regional Committee. These points and recommendations were in MINUTES OF TBE SECOND NEBTING 127
document SEA/PDM/Meet.l2/8. He suggested that as per the schema for consideration of the Thirty-ninth Annual Report of the Regional Director (Annex 2 of SEA/PDM/Meet.lZ/B), the Committee might wish to consider the recommendations made by CCPDM. He particularly invited attention to Section I of the report, and the rc!commendations related to this section. He read out the recommendations on this section and suggested that it might be appropriate for the Regional Committee to discuss these points.
DR HAPSARA (Indonesia) sought clarification on item 2, and wanted to know whether any specific line of thinking was envisaged to improve the WHO-s information system. Secondly, he asked how far the review of the specific planning of the region for the health development as a totality would cover.
The Chairman of CCPDM explained that the question of information systems was discussed in detail in the meeting: of CCPDM from two viewpoints: firstly, the use of the information management system to assist the Member States to have right type of policies in the health sectors for the achievement of Health for All goal and, secondly, the availability of information and flow of information from Member States to WHO in order to monitor and evaluate the direct assistance in collaborative programmes.
DR ABDULLAH (Maldives), referring to recommendation 7 on page 4, sought clarification whether the suggested increase in the allocation for the Regional Director's Development Fund was proposed to be made by reprogramming the existing regional budget, or had the CCPDM identified potential additional sources of funding. He also wished clarification on recommendation 6, which suggested a separate mechanism for intersectocal coordination on matters relating to the health sector.
The Chairman of CCPDM said that the recommendation to enhance the allocation was made to strengthen the hands of the Regional Director to respond quickly to emergency requests without having to seek funds from Headquarters or other sources, since most of the countries in the Region were prone to emergencies. Any unutilized funds on this account could be diverted to other collaborative programmes in the last quarter of the biennium. No definite views had, however, been expressed on the magnitude of the funds to be made available.
As regards recommendation 6, he said that the countries had various mechanisms for intersectoral coordination. It was to lay emphasis on the fact that health was not a matter pertaining to the health ministries alone, and that everyone should contribute to the goal of Health for All, that the establishment of a stronger mechanism of intersectoral coordination had been recommended.
On the request of the Chairman, MR HELMHOLZ, Director of Support Programme, clarified that any increase in funds for the Regional 128 MINUTES OF TBE SECOND UEETING
Director's Development Fund would have to be made by reorganization of priorities within the intercountry programme. It had been suggested during the CCPDM meeting that priorities in the intercountry programme could be reviewed while the budget for the 1990-91 biennium was being considered.
DR UTHAI (Thailand) appreciated the work done by the CCPDM on direction, coordination and management. He fully endorsed recommendation 4 and emphasized that its actual implementation was very crucial. Thailand experienced difficulty in bringing the various sectors together. He wished to exchange views and feelings with other countries.
DR CHAIYAN, Director of Programme Management, responding to the observations made by the representative from Indonesia, said that the WHO Programme Management Information (PMI) study, consisting of two phases and involving all WHO regions including SEARO, had continued during the year under review. The study was coordinated by WHO headquarters. Phase I of the study involved the information requirements at the WHO Representatives- level to support the national strategies for health for all. The WR framework of information requirements was finalized by the Programme Development Working Group in Geneva during March 1987. The second phase related to the study deals with the information requirement of various WHO programmes at regional and headquarters levels. SEAHO's programme for informatics development at the regional and country level had been initiated. The Informatics Support Committee had reviewed and revised the plan recently and the plan had been submitted to the WHO Representatives.
Health Systems Lkvelopwnt (pp.29-45) and Organization of Bealth System Based on Primary Bealth Care (pp. 46-60)
The CHAIRMAN suggested that Supplementary Agenda item 3, Intensification of District PHC Action Plan (document SEA/RC40/17), also be considered with the section on Health System Development. He invited the Representative from Bangladesh to present document SEA/RC40/17 prepared by the Government of Bangladesh.
MR RAHMAN (Bangladesh) said that his country had proposed the topic in order to stimulate discussion on the subject. Some of the countries in the Region, such as Indonesia and Thailand, made significant progress in the development of health services infrastructure by intensifying primary health care at the district level. Bangladesh, along with others, had been the beneficiary of this experiment in other countries. His country had started the development and intensification in the two districts of Tangail and Gazipur. Simultaneous experiments were also being done with the involvement of local and religious leaders and also the ministries and departments actively involved in the health field and in other nation-building activities. The paper also listed the constraints in the health services approach and attempted to discuss the subject and enable everyone to gain from the experience of other countries in realizing the goals of health for all at a minimum cost, both in terms of finance and human resources. Under this effort, flexibility for responding to local needs, development of mechanisms for community participation and intersectoral collaboration at the field level, involvement of health personnel in other health sectors affecting health and nutrition and all other relevant matters were taken care of.
Bangladesh was encouraged in introducing this, from the experience of other countries as well as their own, while undertaking the Expanded Programme on Immunization. It was observed that the EPI and many other activities were not thrust upon the people, but the community welcomed the activities. The people were interested in the programme, were keen on lightening the burden of the government physically, financially and mataerially.
The introduction of the upazila (sub-district) system with health as a subject transferred to it had made the situatian ideal for involving the local leadership. Keeping this in view, he called for a discussion on a number of related issues and sharing of experience with the Member States. He requested the Regional Office to mobilize national and international resources for the district health action plan as an operational approach for achieving HFA 2000.
The CHAIRMAN suggested that further discussion on the subject be temporarily suspended to enable Dr Mahler address the session.
Item 4 ADDRESS BY rBB DIBBCTOR-GENEBAL RC Agenda item 8
DR MAHLER, Director-General of WHO, referred to 'he financial crisis that the Organization was facing which, he said, was mainly due to the level of receipt of assessed contributions and laxity in using WHO'S resources most effectively. Consequently, programme activities to the tune of USS45 million had to be curtailed in the course of the year. Although the bulk of this burden had been on headquarters, the regions too had had to suffer the consequences. He urged the Member States to use their collective resources wisely and improve the management of cooperative activities in order to make regional technical cooperation meaningful. This aspect had attracted serious attention of the Executive Board at its session early this year. It was essential to carry out the health policies already enunciated, without deviating from them, even if inadequate resources necessitated their implementation at a slower pace than had been envisaged originally. Resources should be put to the maximum use in implementing those policies. The current financial uncertainty would disappear soon leading to stability in the budgetary situation, which should be exploited fully in order to reach the goal of Health for All by the Year 2000 and sustain it afterwards.
Emphasizing the need to use national resources consistently to carry out socially just health policies, Dr Mahler said the health value system decided on collectively in WHO could have a major political influence. The strategy for Health for All based on primary health care, with its emphasis on a single infrastructure to deliver many targeted programmes, was still the least expensive by any standards. No doubt, it cost far more than most developing countries were now spending on health, and much less than most industrialized countries were spending. Thus the developing countries had to fight for more resources for health, while developing and industrialized countries had to fight for more rational use of resources. WHO was ready to support the Member States in this process.
In regard to the management of WHO-s resources, he reiterated his unshakeable belief in decentralized management of WHO-s technical cooperation activities as long as these were in line with the policies of the Organization. The Member States had at their disposal all the managerial instruments required to run their Organization as a responsible democracy: adequate policy directions for attaining Health for All, a comprehensive strategy to give effect to these directives, a general programme of work, regional programme budget policy guidelines, a clear programme budgeting process and managerial arrangements in harmony with all these. These precious instruments should be used properly. One of the instruments suggested at the Thirty-third World Health Assembly was the review of WH0.s action in individual Member States in the Region. He believed that the countries would derive much benefit by analysing together in the Regional Committee the way each and every one of them was progressing towards Health for All and using WHO-s resources to that end.
Countries of this region, he said, had succeeded remarkably in dealing with political, economic, social and health problems. Many of them were self-sufficient in food production and had dealt with their financial problems skilfully. Their basic economic situation should not be a deterrent to the implementation of their strategies for Health for All. This region had been a pioneer in trying out new processes, be it country health programming as part of the managerial process for national health development or applying research and development methods to build up district health systems. Thus, the passing financial crisis should not lead to the Member States abandoning the paths they had embarked upon but should impel them to continue along MINUTES OF THE SECOND MEETING 131
those paths. He was confident that Member States could make significant progress by pursuing a collective policy and adapting it to local needs.
Referring to the large-scale assistance provided by many voluntary and other organizations for health activities in the Member States, he said that this was in the nature of a -quick action- programme which left little impact. A correct policy, even if carried out at a slower pace for financial reasons, would yield greater- benefits in the long run than incorrect policies carried out rapidly. He, therefore, urged the Member States to ensure that their own resources and all external resources for health were used in an enlightened way to reflect WHO'S collective policies. On a more positive note, he said that a number of important bilateral agencies had become more involved through WHO in helping developing countries to build up permanent health infrastructures based on primary health care, in order to attain Health for All. On his part, he had attempted to secure extrabudgetary funds for the purpose.
He urged the Member States to celebrate next year WHO'S fortieth anniversary and ten years since the Declaration of Alma-Ata, not as a one-time explosion of synthetic euphoria, but as a year-long expression of determined action to achieve the goal that had already been set. By acting out in their countries the policies, programmes and strategies of WHO, they would be the best advocates of what: Health for All stood for. In that way, they and the people they represented would support one another in living out the great health and development adventure and convert financial weaknesses into substantive strengths. In order to achieve success in this respect, everyone must display outstanding, consistent international solidarity for the health of people everywhere. They must close their ranks in their resolute march towards Health for All by the Year 2000 and beyond (see Annex 2 for the full text).
The CHAIRMAN thanked Dr Mahler for his address, and said that his observations and suggestions would provide the Member States appropriate guidance in tackling the various health problems that the countries faced.
Item 5 ADJ-
The meeting was then adjourned. Annex 1 TEXT OF THE REGIONAL DIRECTOR'S ADDRESS INTRODUCING HIS ANNUAL REPORT FOR THE YEAR 1986-87
I have great pleasure to present to you the Regional Director's Annual Report for the period 1 July 1986 to 30 June 1987, as contained in the document SEA/RC40/2. While this document provides details of collaborative activities of WHO with Member States during the period under review, I wish to highlight the salient features of the collaborative programme vis-a-vis health development in Member Countries.
In spite of multifarious social and political problems faced by the developing countries, the Member Countries of the South-East Asia Region have made determined and concerted efforts towards Health for All by the Year 2000. Health ministries are assuming leadership role in health and health-related socio-economic developments. WHO and the Member Countries, together as partners in health development, have vigorously pursued their efforts towards health development within the framework of new managerial processes for the optimum utilization of WHO-s resources and implementation of regional programme budget policies. Joint Government/WHO mechanisms have been established for the planning, implementation, monitoring and evaluation of WHO'S resources and these have been further strengthened in several countries. The Regional Programme Budget Policy for South-East Asia has been endorsed by the Regional Committee. This policy would, in the spirit of partnership, enable countries to use WHO-s resources optimally.
The most significant development during the year is the successful completion of the first evaluation of Health for All strategies in all countries of this region. The countries are now in the process of gathering information for the second round of monltoring and implementation of these strategies. Based on the information available in the countries, the regional volume of the Seventh Report of the World Health Situation has been compiled. In spite of all these .. efforts, it is now realized that management processes and systems have generally remained inadequate, and therefore, weakens planning and implementation of policies and Health for All strategies.
Although the health infrastructure has expanded and provided wider coverage of the populations in several countries, it is yet to reach the unserved and underserved population. There has been an emphasis, no doubt, on primary health care delivery, but it needs to be pointed out that primary health care has no longer remained as a single entity, but should be considered as a package. WHO and country efforts are now MINUTES OF THE SECOND MEETING 133
being focused on the development of an operational framework for progressive intensification at the district level.
It has been stressed time and again that health manpower development needs more vigorous WHO collaboration to strengthen the health infrastructure. The Organization has also supported countries to develop programme on health manpower information systems in order to improve decision-making regarding priorities in planning, production and utilization of manpower. In view of the changed emphasis in health development, the need for reorientation of medical education in tune with the rapidly changing concept of health care has been recognized by most countries.
I need hardly emphasize that in view of the rapidly changing scenario of technological development and the emerging scientific knowledge, research in all its aspects should form the backbone of the health development process. As you are fully aware, research activities under the aegis of the Organization have been guided by the South-East Asia Advisory Committee for Health Research. This Committee has already identified priority areas for research in support of HFA strategies and provided guidelines for research development, through WHO collaborative efforts with the countries. The Advisory Committee on Health Research rightly emphasized institutional strengthening and a judicious balance between human resource development and material development.
Mr Chairman, in spite of national and international efforts for health development, the two most important health indicators, viz. the birth rate and infant mortality, continue to be alarming high in this region. It is well nigh impossible to achieve HFA objectives unless we continue to strengthen promotive and preventive health measures and initiate a great deal of health activity for the vulnerable groups of the population, namely, mothers and children. WHO, in collaboration with UNICEF and UNFPA and other international agencies, has therefore collaborated with countries in maternal and child health, including family planning, with major emphasis on wider service coverage and improvement in the quality of services. The Organization has laid stress on specific initiatives aimed at achieving more effective integration of maternal and child health and family planning services. Several strategies for effective delivery of mate~naland child health and family planning services, such as studies on low birth-weight, causes of infant mortality, field-testing of techniques for monitoring ~hysicalgrowth and psychosocial development of the child.
The governments of the countries of this region are aware of the magnitude of the problem of malnutrition in our region. The nutritional status of the most vulnerable population, namely, children below the age of five, is made critical because of widespread prevalence of infectious diseases. WHO-s nutrition programme, working in close collaboration with other UN agencies such as UNICEF, is aimed at 134 WIWTES OF THE SECOND IIEETIK:
strengthening, developing and reinforcing national capabilities for reducing or controlling malnutrition. It is gratifying to note that evidence has begun to accumulate indicating that a measurable reduction in protein calorie malnutrition has occurred in a few countries and some real impact has been made on iodine-deficiency diseases.
In the area of environmental health, WHO'S major thrust has been to involve the community in improving drinking water supply and sanitation. While several countries have been developing these facilities, as indicated by the mid-term review of the progress of the International Drinking Water Supply and Sanitation Decade, the programme coverage is not quite adequate. WHO'S collaborative activities involve instituti~nalstrengthening, manpower development, water quality surveillance, development of research capabilities and resource mobilization. There would be a need for great deal of efforts to reduce health hazards due to environment pollutants if we have to be forewarned from the experiences of developed countries.
Although almost all countries have established a national list of essential drues.-, manv non-essential drues- are still marketed in most countries, thereby expending valuable resources allocated for health development. Another serious problem is of irrational prescribing, resulting in overuse of drugs often rising to menacing proportions. Irrational use of drugs, such as antibiotics, has not only resulted in iatrogenic diseases, but have posed some serious public health problems, such as emergence of resistant strains of micro-organisms. WHO has therefore laid emphasis on the development of appropriate drug policies to ensure supply of essential drugs and promote their rational use.
Mr Chairman, communicable disease still continue to take a heavy toll of life in several countries of our Region. We are still far from the acceptable levels of morbidity due to infectious diseases, particularly in infants and children. Most of our countries continue to spend large proportions of their health budget on the prevention, control and treatment of communicable diseases. Countries' and WHO'S collaborative efforts are therefore directed towards substantial reduction in mortality and morbidity due to these diseases.
The Expanded Programme of Immunization has registered an impressive progress in managerial, operational and technical aspects in all countries of the Region. There has been a very high level of political commitment to this programme and several countries are committed to the achievement of Universal Child Immunization by 1990. The important strategy to achieve this goal has been to integrate the programme with primary health care and promote greater social mobilization and community involvement. WHO support has mainly been in the field of training courses and seminars in EPI management, cold chain logistics; EPI programme reviews and evaluation, and developing complete, efficient and timely reporting system, and making available vaccines of assured quality. Malaria has always dominated the health 3cenario of most Member Countries for the last several decades. Although some countries have reported a decrease in the total number of malaria cases, the overall malaria situation in the Region is quite alarming, because of some formidable technical problems, such as vector resistance to insecticides, parasite resistance to drugs, large-scale population movements, refractory behaviour of some pri~lcipal malaria vectors, and, above all, the non-involvement of communities in accepting anti- malarial measures. While technical challenges can possibly be overcome through appropriate use of drug combinations or employment of newer insecticides or adoption of integrated vector control methodology, important strategies which need to be seriously thought of and vigorously pursued are community participation, intersectoral collaboration and mobilization of internal and external resources for malaria control and operation.
Diarrhoea1 diseases and acute respiratory infections still continue to be the leading causes of mortality in children in spite of the availability of a simple and cost-effective technology for their treatment. WHO programme for the control of diarrhoea1 diseases has therefore focused on this target group with the goal of substantial reduction in mortality due to diarrhoea. WHO thrust in this programme is to assist countries in training of clinical and managerial staff, strengthening of clinical training in medical schools, assisting in developing national or regional self-sufficiency in the production of ORS and emphasizing on breastfeeding and weaning practices, improved hygiene and sanitation and health education. ARI programme also follows a similar approach though the present emphasis is still on programme development, epidemiological studies and training.
Tuberculosis and leprosy control continue to receive high priority in a number of countries of this Region. In spite of active tuberculosis control programme operating in several countries for a number of years, the prevalence of infective cases continues to be high. WHO-s collaborative efforts in the field of these mycobacterial diseases involve the employment of multidrug treatment regimen, intensification of epidemiological surveillance, strengthening of laboratory services, provision of adequate quantities of essential drugs, training of health manpower and promotion of research. However, a great deal of efforts would be needed to integrate this programme into general health services and undertake intensive health education to develop social consciousness and communit:~ involvement in the prevention and control of such diseases.
During the recent past, AIDS has become a matter of great concern to the Member Countries. Although a few countries have reported AIDS cases, none of them proved to be of indigenous origin. However, all countries have constituted task forces or national committees to prevent the occurrence of this dreadful disease. WHO has taken the challenge through the establishment of a Special Programme on AIDS and 136 UINUTES OF TBE SECOND MEETING we, at the regional and global level, have prepared a regional plan for the surveillance and control of AIDS and provided technical assistance and disseminated information on the global situation to Member Countries. We are hoping that with improved surveillance and technical manpower development, we should be able to restrict the spread of this infection in the countries of our Region.
Mr Chairman, since blindness is one of the priority health problems in this Region, WHO collaborative activities for the prevention of blindness were intensified in all countries. The main thrust of the WHO programme in this area is to build up and strengthen the infrastructure for essential eye care, through the primary health care approach. Since 50 per cent of the total blindness is due to cataract, several countries have developed programmes for the treatment of cataract and provision of low-cost spectacles. It should be emphasized that while the primary health care approach would serve to take early measures for the prevention of blindness, a great deal of attention would have to be paid to the strengthening of referral facilities to make a real impact of the programme on prevention of blindness.
While countries have been using their limited resources to fight the menace of communicable diseases, some of the noncommunicable diseases, such as cancer, cardiovascular disorders, mental disease, etc., are now being recognized as important causes of morbidity and mortality in several countries of this Region. It is expected that demographic trends of ageing, changing life-styles and increased environmental risk factors are likely to contribute to the higher incidence of cancer in our Region. While primary prevention would be ideal through intensified health education programmes, WHO has been supporting countries in training of personnel in early diagnosis and providing training facilities for radiotherapy or chemotherapy in the countries. WHO-s collaborative activities in regard to all such noncommunicable diseases relate to supporting epidemiological surveillance, training manpower in planning, monitoring, evaluation and control. Health education and community involvement have to play a major role in the control of these diseases, particularly since some of them are directly related to, and the result of, changing life styles.
Several countries have introduced innovative approaches in the national health development, such as decentralization of authority, targeting at the district level in support of primary health care, model primary health care project, section doctor systems, drug cooperatives and technical cooperation between districts. Realizing that in these gigantic efforts towards achievement of health for all, there is a need to involve everyone in the health development, several countries have now felt it necessary to involve nongovernmental organizations in health care activities. WHO, in collaboration with UN and agencies like UNDP, UNICEF, UNFPA and bilateral and nongovernmental organizations, has been effectively collaborating with the countries to achieve the goal of health for all. MINUTES OF TBB SECOND MEETING 137
Mr Chairman and distinguished delegates, I have presented to you a bird-s eye view of health development activities during the period under review, in which WHO has played a catalytic role. I must emphasize that, in spite of multifarious social and political problems, deteriorating financial situation and several constraints on resources, both financial and human, through sheer determination, commitment and concerted efforts, the Member States are forging ahead in their march towards HFA goal and striving to provide better health facilities to their people, with the ultimate aim of improving their quality of life so that they, as citizens of the sovereign countries, could contribute effectively to social, technical, financial and spiritual development of their countries.
Finally, Mr Chairman and distinguished delegates, I have no doubt that the Regional Committee, through its collective wisdom, would provide guidance and directions on future health activities in our . collaborative efforts. Annex 2
CLOSING lUE RANKS FOR tlEALTtl POR ALL
Address by Dr 8. Ilahler. Mrector-General. WO
As always, I am happy to be with you again. This year I should like to let you know how I feel about your Organization's situation thirteen years before the year 2000. Since we met last year the full impact of your Organization-s financial crisis has hit us all. We have been running faster to try and prevent disaster overtaking us, but I am afraid we have only partially succeeded in doing that. Disaster there may not be, but the financial situation is very grave indeed. Paradoxically, we have been able to avoid outright disaster by starting to run more slowly - not in terms of our policy, which runs steadily, but in terms of our financial capacity to support you in carrying out your health programmes based on that policy. There is no way out of the simple equation: funds that do not come in cannot go out. And there is no point in going over the detailed reasons for our financial crisis; they are known to all of you. I should just like to comment briefly on the two main factors that gave rise to it. One is the low level of receipt of assessed contributions; the other is laxity in using WHO-s resources in the most effective and efficient way. The effects of the two are interrelated.
It does not help to cry over missing contributions. We have to face that reality. We just have to fight for more and make do with less. That is why I had to cut out activities to the tune of US $35 million this year based on the calculated hope that that would keep your Organization solvent. Even that proved to be too small a sacrifice, so I had to make an additional US $10 million reduction a few months ago. To do that I placed the bulk of the burden on headquarters, not least by postponing all recruitment from the regular budget of external candidates to the Geneva office until next year. You have unfortunately had to suffer the consequences, some directly, some indirectly. I have heard some cynics saying that this freeze has had no " measurable adverse consequences. Well, if you merely use your collective resources as additional pocket money, I would agree that the difference might be the same. But if you use your collective resources wisely, to reinforce the policy to which you, your governments and your people are committed, if you do that the difference could be very great indeed.
Over the past three years I have been stating in front of all of you here, and in front of all other regional committees, that if the management of our cooperative activities does not improve, the MINUTES OF THE SECOND HEEYING 139
technical cooperation component of our regional budget might be criticized out of existence. I added that this could lead to serious reservations about our constitutional regional arrangements, if not to an end to them. I know that some of you were thinking: "'let the old man talk. He is under some pressure here and there so he is letting off steam with us". Well, those of you who were present at this January's meeting of the Executive Board would have seen things differently.
Of course, you can retort that if I had not brought to light the need to improve the management of our resources the whole matter might have gone unnoticed. I am afraid not. Quite apart from the need for any organization to maintain the transparency of its actions, not least a worldwide organization with the highly sensitive constitutional role of directing and coordinating authority on international health work, quite apart from that, too many external reports and critical sentiments - yes, sentiments cannot be ignored either - too many of these made it clear that the storm was quickly :athering and was bound to burst one day. Well, it did and we are in the midst of it. Fortunately, as always we were the first to reveal our weaknesses, not in order to condone them or weep over them, but in order to convert them to strengths. Had we not done that the storm would have been a tornado, not a mere tempest as it is today, and rre would have been in a situation of abject defence, whereas now we can at least deal with the matter with dignity.
Honourable representatives, you are no doubt aware that Board members, as well as delegates to this year-s Health Assembly, took great pains to tell us that the crisis is merely a financial one, not a crisis of confidence. I am sure they meant what they said, but at the same time I cannot help feeling like the patient who believes he has a life-threatening cancer and has gnawing, unspoken doubts about his physician-s reassuring statements. Now, it is all too easy to commiserate with one another that we are innocent bystanders in an outburst of lack of faith in development, or that we are victims of internationally imbalanced macro-economics. But laying blame will help nobody. Finding appropriate solutions will help everybody.
I am afraid I have no magic panaceas, but I believe that alleviating remedies do exist if we want to use them. There is nothing new about the remedies in 1987, nine years after the Declaration of Alma-Ata. Yet they are nevertheless revolutionary. They consist in carrying out our revolutionary health policies without deviating from them, even if inadequate resources make it necessary to carry them out at a slower pace than we had originally anticipated. And the remedies also consist in making sure that whatever resources we have are squeezed to the maximum in carrying out our pre-determined and fully determined policies. Before trying to indicate how these remedies might profitably be applied, I should like to add a note of optimism, guarded optimism, but, nevertheless, realistic optimism. Uncertainty about the future is one of the greatest impediments to any rational kind of management. We are all only human, and when we are not sure about tomorrow we think only of enjoying today, even at the expense of eating up what little resources we have. After all, people argue, if there will be no tomorrow why worry about? Honourable representatives, there -will be a tomorrow; it is within our grasp. It is therefore worth the extra effort. The fog of financial uncertainty is clearing; when it disappears the certainty will become apparent. It will be a substantially reduced certainty over the coming years, but nevertheless a highly tangible certainty that can be exploited to the full, that must be exploited to the full, if we are to reach our goal of Health for All by the Year 2000 and keep it up afterwards.
So even if others may have lost faith in us, we must preserve our faith by demonstrating that it is well founded, by always keeping in front of us our health value system, by persevering in our policy and strategy for health for all and by using collective resources to make sure that national resources are indeed consistently used to carry out socially just health policies. For it is precisely when adjustments to existing policies have to be considered - and that applies to social policies no less than to economic ones - it is precisely under those circumstances that social justice is more important than ever. It would be all too easy to make economies in health systems at the expense of the weaker segments of society - the underprivileged periphery who may not yet have grasped the full significance of their voting power, or who may have none in reality. That is where reference to the value system decided on collectively in WHO can have major political influence. We in the health sector obviously cannot dictate economic adjustment policies to governments hard pressed by foreign debts and by the insistent policies of external creditors. But we certainly can use WHO-s collective conscience to bring forcefully to the attention of governments that social productivity is an essential prerequisite for economic productivity. Those countries that have ignored that fact have done so at their peril, as example upon example of social unrest demolishing economic policies have shown.
But let me be a devil-s advocate for a moment and postulate the reintroduction of the kind of system that prevailed before WHO-s new health paradigm hit the surface, and I am sorry to say still prevails in too many countries. Would it cost less and relieve national health budgets, as well as WHO'S budget in support of these? Not at all; to the contrary. The Strategy for Health for All based on primary health care, with its emphasis on a single infrastructure to deliver many targeted programmes, is low cost by any standards. That does not mean that it costs next to nothing. It costs far more than most developing countries are spending on health today, and much less than most industrialized countries are spending on health. So developing countries have to fight for more resources for health, and both developing and industrialized countries have to fight for more rational use of resources. In all cases your Organization stands ready to MINUTES OF TEE SECOND UEETING 141
support you in the fight. To do that, remembering that charity begins at home, your Organization has to demonstrate in practice that it is using its resources as befits wise action in the midst of a financial weatherstorm.
Honourable representatives, the management of WHO-s resources is a most important item on your agenda this year. I am sure you will debate the issues with the same openness and intensity with which I have presented them to you in the background document. I should just like to single out a few points that appear to me to be of particular importance. First I should like to restate my personal, unshakeable belief in decentralized management of our technical cooperation activities, as long as these are carried out in line with the policies you have decided on collectively in your World Health Organization. If that takes place we will rightly be proud that we are displaying responsible democracy. ,If it does not take place, we shall have to face the shame of manifesting irresponsible anarchy; and responsible governments will not support that, nor will responsible people condone it.
You have at your disposal all the managerial irkstruments required to run your Organization as a responsible democracy. You have adequate policy directions for attaining health for 1111, a comprehensive strategy to give effect to these directives, a general programme of work that enables each and every one of you to define the scope and content of your cooperation with WHO, regional programme budget policy guidelines, a clear programme budgeting process and managerial arrangements in harmony with all of these. So I could sum up the remedy in a few words. Use the instruments we have, and use them properly; they are precious instruments indeed.
One of the instruments you as a regional committee were urged to use by the Thirty-third World Health Assembly, and I am afraid you are hardly using, is to review WHO-s action in individual Member States in the Region. I really do believe you will all derj.ve much benefit from analysing together in the Regional Committee the way each and every one of your countries is progressing towards health for all and using WHO'S resources to that end. I know that at first sight the idea of looking at one another-s strengths and weaknesses may seem to be going very far, but I am convinced that within a very short time you will realize how useful that mutual trust can be and you will look forward to the experience. For it can help to minimize your weaknesses and strengthen your strengths.
"Yes," I can hear you thinking, "the old man is dreaming again." And yet how often do we have to remind ourselves that without dreams humankind would never have dreamed up today's values and tomorrow's achievements. Recent history in WHO is ample proof of this, in spite of the international financial climate. "But what of today's sordid realities?" you may rightly exclaim. Well, let us Look at them and see what they really are and what can possibly be done to make them brighter. Forgive me, if I try to analyse your realities from a possibly distant perspective, but I can assure you a no less empathetic one for all the distance. I shall weave my dreams into my perceived realities and try to illustrate how to convert weaknesses into strengths.
Nearly forty years ago, when WHO was born, it had only four Member States in this region. Today, you are eleven in number. Surely the addition of independent states within the region to those that existed in 1948 is a cause for rejoicing. It is too easy to take political developments like these for granted. Of course you have your problems, serious internal and external ones, political, economic and social problems, and certainly health problems, but by comparison with many other parts of the world you have succeeded in dealing with these problems in a remarkably positive way. Many of you who were dependent on others for food supplements in the past are now self-sufficient in food production. While that in itself is no guarantee of proper nutrition for all, it is certainly a highly important step in that direction.
And you have also been skilful in handling your financial problems in such a way as to minimize the negative effects of foreign debts. Some of you, I admit, have had to reduce your investments in health because oi a fall in the prices of your exports, particularly oil prices, but on the whole I believe your basic economic situation should not constitute too heavy a brake on the implementation of your strategies for health for all. What is more, you have the power of choice, and from my perspective that is the key that can enable you to alleviate your health and related development problems. Through your WNO you have given rise to a vast array of health development options from which to choose the ones most suited to your social preferences and your pockets.
I should like to congratulate those of you who have been quick to try out the new processes for arriving at rational choices that your Organization has worked out with you. This region has indeed been a pioneer in these areas, whether in trying out country health programming as part of the managerial process for national health development nearly fifteen years ago, or applying research and - development methods to build up district health systems in more recently years. So I believe that, certainly in this region, the passing financial crisis in WHO should in no way be a reason for abandoning the paths you have embarked upon, but rather an even more impelling reason for continuing along these paths, at whatever pace your economic situation permits.If you follow the right direction you will eventually reach your desired destination; if you follow other directions you will never reach it. So I firmly maintain that you can make very significant progress by sticking doggedly to our collective policy, adapting it to local needs, but not deforming it in the process. I realize that you are exposed to terrible temptations when other Organizations, or other Member States for that matter, offer to pour large sums into health activities in your countries. All too often, I am sorry to say, they have not learned the lessons of developmental history. Their assistance is too often paternalistic in nature, with foreign health parachutists descending on you to perform quick fixes that leave little or nothing behind when they leave. When they do that, they are wasting their and your resources. Correct policy, even if carried out at a slower pace for financial reasons, will reap infinitely greater benefits in the long run than incorrect policies carried out more quickly. It is your responsibility to make sure that your own resources and external resources for health are used in a sufficiently enlightened way to reflect WHO-s collective policies; and it is the responsibility of your most intimate external partner in health - WHO - to support you in achieving that.
On a more positive note, there are signs that a number of important bilateral agencies have really begun to grasp what we mean in WHO when we refer to enlightened bilateral support to developing countries. They are realizing the value of investing their resources in such a way as to bring WHO'S collective policies to life. Until recently they may have been more attracted by the special research programmes. But I can sense a desire to become more involved through WHO in helping developing countries to build-up permanent health inErastructure based on primary health care, in order to attain health for all. For my part, in my desire to compensate for the difficult regular budget situation, I have stretched my moral conscience to the limit in attempts to secure extrabudgetary funds for that purpose. I now appeal to you to stretch your imagination to the limit to make health infrastructures like these a sustained reality and an attraction to external partners at the same time. The benefits of such partnership, I believe, will extend far beyond their health consequences. They will show the way to a new kind of enlightened North-South dialogue, not shackled by hard-nosed economics, but open to human values that in the long run will also have important positive social and economic consequences for all partners.
As you can see, the picture may not be rosy, but it is certainly not dismal. Far from it. There are remedies. And I am confident that they , will be applied, some earliK some later, but all in time to achieve our common goal. That is why I believe you can celebrate our fortieth anniversary next year, not as a one time explosion of synthetic euphoria, but as a year-long expression of determined action to achieve the goal we have set ourselves. I would beg of you therefore, as I suggested at this year's World Health Assembly, I would beg of you to -act out in your countries next year a double celebration of forty years of WHO and ten years since the Declaration of Alma-Ata. And I emphasize -act out these anniversaries, and not merely pay lip service to them. Mr Chairman, honourable representatives, by acting out in your country the values, the policies, the strategies and the programes 144 PIINUTES OF RIE SECOND llBETING you have defined worldwide in your Organization, you will be the best advocates of what health for all stands for in dreams and in reality. And I should add that if you make sure that 1988 is only one of many future years, what you act out will become permanent features of your health systems. In this way, you and the people you represent will support one another in living out this great health and development adventure that you have taken upon yourselves through your WHO. By that kind of action, you can convert financial weaknesses into substantive strengths. To succeed in that, all of you, all of us, must display outstanding, consistent, international solidarity for the health of people everywhere. We must close our ranks - all Member States throughout the world, across regional boundaries and political barriers, North and South, East and West, together with the secretariat - we must close our ranks in the resolute march towards health for all by the year 2000 and beyond. SUUUARY UIWOTES~
Third Ueetfng, 16 September 1987. 9.00 a.m. AGENDA
Item Page
1. Thirty-ninth Annual Report of the Regional Director 146 (cont'd)
2. Adjournment 160
10riginally issued as document SEA/RC40/Min.3, on li September 1987 Item 1 TBIRTY-NINTH ANNUAL RBPORT OF TBB IIKCIOIIU DIBBCmE (cant-d) RC Agenda item 9
Health System Developlent (pp.29-45) and Organization of Health System6 Based on Primary Health Care (pp.46-60) (cont-d)
The CHAIRMAN requested the Chairman of the CCPDM to report on the discussions at the CCPDM.
The CHAIRMAN, CCPDM, said that Member States had made considerable progress in developing health information systems, although there was still scope for improvement. With the emergence of AIDS, epidemiological surveillance in the countries needed to be strengthened. The collaborative approach in respect of managerial processes for national health development had changed, and this had enabled the formulation of policies at one end and evaluation of procedures at the other. Health systems research and health legislation were also considered. He then read out the reconnuendations of the CCPDM relating to Health System Development.
In respect of health systems based on primary health care, the CCPDM had reviewed intensification of primary health care action programmes, development of PHC network, intersectoral actions for health, referral support for primary health care, operations research for the district health system and urban primary health care. The Committee had stressed the need for WHO support to countries to intensify PHC action programmes at the district level.
DR SONG PIL JUN (OPR Korea) acknowledged the support provided by WHO and said that DPR Korea had made good progress in the development of health systems based on primary health care. Attention was paid to strengthen city (district) hospitals at the first referral level, county hospitals in rural areas, and hospitals in factories and enterprises. Medical institutions had been integrated at the PHC level to strengthen specialization at that level. In order to improve the quality of service, specialized hospitals and dispensaries had been established.
A mass movement had been launched for collective action in sanitation and in the prevention of diseases in each county and city. Emphasis was now being laid on providing modern equipment at each health facility; improving sanitary facilities to reach the required standards of sanitation; eradicating communicable diseases to reduce MINUTES OF TEE THIRD neeTINC 147
morbidity and mortality levels, and improving the quality of services to advanced levels.
Standards and targets had been set for each c,>unty and district and the Ministry of Public Health assessed their progress in accordance with the main principles of the movement. Three counties had been designated -model* public health counties to encourage other counties too to work hard to receive the title. This was a very effective way of strengthening PHC. Thus, the Government of DPR Korea would be launching national movements to improve sanitation and eradication of diseases through mobilization of the community itself.
DR HAPSARA (Indonesia) suggested that recommendation 4 under Chapter 3 of the report of the CCPDM be considered in relation to the managerial process for national health development. Particular attention needed to be paid to planning at country as well as regional levels. This, he said, would improve the sensitivity in reacting to reports. He urged consideration of the first four points of the report under Chapter 3 along with the first two points under Chapter 2.
DR NORBHU (Bhutan) said that in his country besides intensification, extension of PHC was also being tried in a project area, since all elements of PHC were not available in all the districts. It had been possible to establish an information network and the first national information bulletin was under preparation.
DR JADAMBA (Mongolia) said that health services to childcen and adults, which were separate at the district level, had been integrated and all members of the family were listed in the health card. Preventive aspects of health received attention. For example, family health services had been initiated in district hospitals where the health of the family as a whole was cared for. Multisectoral collaboration was being accelerated through consultation with other ministries. The media would be used progressively for improving the level of health of the people. As regards rural health services, lessons learnt from the Huvsgul aimak project, supported by WHO, would be borne in mind in extending the services to other aimaks of , Mongolia.
DR REGMI (Nepal) said that, following the enactment recently of legislation on decentralization, his country had fully reorganized the health system from the village level upwards. All vertical projects had been integrated and carried out through the district office. Planning was being initiated at the village Level and consolidated at district, regional and central levels. The central government monitored the progress and provided feedback. Construction of health posts had been started and each village would have a sub-health post. The village would have nine wards, each having a volunteer. Intensification of PHC was being carried out at the ward level, in addition to the village panchayat level. One teacher in each village would he trained in PHC. DR DAMRONG (Thailand) said that in Thailand increasing attention was being paid to collaboration in health system development. He felt that there was need to develop linkages amongst information, epidemiological surveillance, health services research, monitoring and evaluation, manpower development and the forecasting of morbidity and mortality profiles up to the year 2000. This would enable projection of the future scenario in planning. He requested WHO support in promoting TCDC in this regard, especially in the exchange of experiences and information.
DR ABDULLAH (Maldives) said that his government had given priority to providing essential services to each island with a view to making it self-reliant. Other services were not provided, not due to financial constraints alone, but also because some of them could be redundant in view of the small populations of the islands. The policy of decentralization in the health sector had enabled his country to achieve important goals of PHC in individual islands. A new policy had recently been adopted under which several centres of development had been created. Emphasis was laid on decentralization not only in atoll health and essential services, but also in the management of each individual island and atoll.
A pilot project in one southern atoll had been planned with WHO and UNDP support. It aimed at providing essential health services to the atoll with full participation from all the sectors concerned, and the community as well. If successful, similar projects would be undertaken in other atolls too. Health was considered to be the responsibility of the Ministry of Health as well as other sectors and NGOs, and the community in general. The government held a number of meetings to promote intersectoral collaboration. As regards training, workshops and seminars were organized periodically with the participation of the Ministry of Health for island and atoll chiefs. Similar workshops were held for community leaders also in their respective atolls. Thus, with the limited resources and manpower, his country had been able to mobilize community leaders to deliver the message of primary health care and HFA to each individual and contribute to the achievement of the global objective.
DR HAPSARA (Indonesia) endorsed the views expressed by the a Representative from Bangladesh concerning the action plan on primary health care although, he said, past experience indicated that some difficulties were bound to be encountered. In regard to the strengthening of district health services in his country, he said that the national health policy and programme planning followed the long- term and five-year socio-economic planning. In this process, attention was paid to human resources, and all aspects of health manpower development were taken into account. Another significant development related to the strengthening of community involvement and decentralization of planning of the health systems. The other priority programme was health information development. His government was convinced that health development was one of the most important elements for social change; it was :herefore important to plan, monitor and evaluate the health programme systematically and comprehensively with the active involvement of the community, and with the support of WHO and other UN agencies. The strengthening of district health services should form part of the total development of health services.
MR AHOOJA (India) said that his country had a very strong primary health care system. Efforts relating to the ir>tensification of this programme revolved round providing comprehensive health care in addition to the provision of curative service to the community. His government had a programme for the development of HFA leadership at the primary health care level. ile strongly supporte~l the proposal of the Representative from Bangladesh for an exchange of experiences at the regional level and said that WHO could play an 2mportant role in this area. He agreed with the views of the Representative from Indonesia that sensitiveness to react to information should also be developed. WHO collaboration in this field would be of utmost importance.
The volume and variety of information flow was becoming too heavy and it was essential to process this information quickly and present it in a form that was convenient and easy for decision-making and managerial action. A programme for the deployment of computers in this field had been undertaken in his country. WHO could collaborate usefully in this area in order to respond to the needs of decision- makers in the Member States.
DR ADHYATUA (UNICEF) said that many countries were now taking steps to intensify primary health care programmes at cgmmunity, village and district levels. More resources would be required to extend this approach to cover the whole country. UNICEF was interested in developing PHC programmes at the community Level and had been supporting PHC development through country prcgramming. Meanwhile, other bilateral and international agencies had begun to evince interest in developing and supporting the PHC approach at various levels. He therefore urged the Member States to coordinate and utilize the , external resources as effectively as possible by pooling them all for the development of PHC programmes in their respective countries.
The REGIONAL DIRECTOR said that it was gratifying that there were no differences of opinion on how the PHC programme was being organized in the countries of this region. He pointed out that primary health care was the key programme for achieving the goal of Health for All within the framework of national health development, which was part of the national development programme. He said that the promotion by WHO of Health for All strategies was considered different from the process of development of national health plans, but this was not correct. Health for All strategies in fact constituted part of t.he overall national development programme. He was particularly gratified to note the interest of the countries in the intensification of district health services. He said that what was being contemplated now was different from the pilot projects that were initiated earlier. These projects did not have much impact since they could not be replicated. Some exemplary work was called for to accelerate the progress of primary health care programmes. External resources, when they became available, should be mobilized to support the district health system so that this formed part of the whole national health plan.
Health Uanpwer Development (~~.61-92) and Information and Education for Health (pp.93-97)
The CHAIRMAN, CCPDM, reported on the discussion on the subject. He said that the Committee considered the health manpower development programme to be lopsided, and this required correction. While reviewing the various aspects of health manpower development and the role of WHO, it was noted that the fellowship programme was the weakest as far as implementation was concerned. In the past year, a series of steps had been recommended for improving the fellowships programme. The CCPDM had enumerated the main reasons for the poor implementation as delay in receipt of nominations of candidates for fellowships, delay in securing placement and lack of adequate language skills. He then read out the recommendations of the CCPDM on these two chapters.
It was agreed that Chapter 6, Information and Education for Health, be taken up for discussion in greater detail during the technical discussions.
MR KAHMAN (Bangladesh), referring to the observations of the CCPUM that the health manpower development programme was lopsided, said that there was a gap in approach since the emphasis now was on the development of doctors, nurses and paramedical personnel. Under the primary health care programme, health manpower development should take into consideration not only doctors and paramedical workers, but also health workers who were actively working at the community level. There should he linkages with community workers who were also health workers and constituted the bulk of health manpower. It was therefore important - to include this group as an integral part of health manpower in future health manpower development programmes.
Similar gaps existed in the area of Information and Education for Health. It was the responsibility of the Regional Committee to fill these gaps and give a concerted development policy for the Region.
DR SOMSAK CHUNHARAS (Thailand) agreed that reorientation of medical education had to be a continuing process. Thailand had held two national conferences on medical education over the last seven years, MINUTES OF THE THIRD HEETING 151 which had helped focus attention on reorientatbn of medical education towards Health for All and quality of life. The second conference held in 1986 had established a monitoring committee which was playing a catalytic and promotive role in reporting issues from the conference and implementing them in a coordinated manner. His country had accepted health manpower policies and planning ,is important aspects of health manpower development activity and was trying to improve health services for the rural people through better use of available manpower rather than trying to increase the number of doctors.
More health personnel, such as nurses, were being assigned to work at the health centre level, supervised by doctors from the district level. He suggested that the WHO Regional Office might consider monitoring the situation in Member States to maintain a balance between health manpower and providing technical support for studies necessary to understand hetter the country situations in this respect.
DR FERNANDO (Sri Lanka) said that the subject of health manpower development was important, particularly for the countries of the Region. Proper development of health manpower was important if the goal of HFA was to be achieved. Sri Lanka had made efforts to improve health manpower development, paying equal attention to the development of different cadres, ranging from the grassraots-level workers to secondary and tertiary level workers. A National Institute of Health Sciences had recently been set up in the country to train health manpower. He appreciated the assistance provided by WHO and US AID for the development of this institute which, he said, could also serve the other countries of the Region in developing different categories of manpower.
Sri Lanka was also making every effort to reorient new medical students to the needs of the country. Steps had been taken to educate the public through seminars for different media personnel, where important subjects, such as primary health care, were discussed. Government officials and the Minister of Health participated in such seminars, the discussions at which helped to improve the knowledge of the public on health matters.
PROF PRAWASE WAS1 (Chairman, ACHR) felt that the inappropriate practices of doctors produced by universities was causing a lot of social and economic damage to the country. In Thailand alone, the annual economic loss resulting from this was no less than 20 000 million bahts. What the doctors were taught was not real knowledge, hut something peculiar which was not really critically examined or created for the needs of the country. There was emphasis on improved pedagogic teaching, but the drawback lay in the inability of educators to critically examine knowledge or to create knowledge. Moreover, reorienting medical education was not easy unless a proper strategy to fulfil this need was evolved. He suggested that WHO consider offering not only technical guidance, but also closely collaborating with medical schools in developing a new strategy. Such a partnership would provide political leverage to those who favoured a change. In this context, he recalled the exhortation of the WHO Director-General to use WHO as a partner in development.
He said that health systems research had not progressed very far in the last decade, and this fact had been highlighted by the Director- General at the last meeting of the Global ACHR. In order to achieve real headway in health systems research, a coordinated approach was necessary, involving epidemiologists, social scientists, biomedical scientists and health economics researchers, who would work in coordination with policy makers and administrators. Such a multi- dimensional approach to health manpower training was crucial. Individuals who were experts in all these fields could be called *Health for All* experts and many such experts were needed for health systems research to be successful.
DR REGMI (Nepal) stated that Nepal had evolved an appropriate manpower development policy, with WHO collaboration, ten years ago. The country had been training doctors with health orientation, not simply doctors who were suitable for hospitals only. The real need was for community physicians oriented towards epidemiology, health planning, health statistics, etc. These called for new institutions since it was difficult to incorporate new ideas into the old medical curriculum. He felt that WHO could play a useful role in this sphere by providing information for the whole region. One or two institutions in the Region could develop a system for imparting medical education, epidemiology, health statistics, public health, etc.
DR HAPSARA (Indonesia) expressed his full agreement with the views of Dr Prawase Wasi as regards medical education. The role of WHO in actively supporting country efforts in improving medical education was crucial. It was natural to expect strong resistance to any innovative approach; but such resistance needed to be tackled and this would require time. Referring to the Chapter on Health Manpower Development in the Regional Director's Annual Report, he agreed that emphasis had been laid on health manpower utilization as a matter of considerable urgency. The career development of health professionals was equally important and he wished to know WH0.s thinking on this aspect, both on conceptual and practical aspects.
DR KIM WON HO (DPR Korea) stressed the need to intensify education in the field of improving health manpower training, including identification of health manpower needs and planning. Training of health manpower was important in solving health problems. DPR Korea had laid emphasis on training of health workers and had re-educated 3 500 doctors in 1986. A six-month training course was also conducted through the education network to train cadres, including administrative and management personnel, in health education so as to improve their political and administrative work ability at management level. DR NORHHU (Bhutan) mentioned that Bhutan had made concerted efforts to provide training to different categories of health workers. They were quite successful with the training for para-professionals most of whom were being trained in the country itself. However, there existed a large gap between the need and availability due to lack of training facilities for post-graduate and similar higher education. He suggested that WHO should actively assist countries ljke Bhutan, Nepal and Maldives, where training facilities for higher medical education were very limited.
His country was in the process of entering into a memorandum of understanding with the Thai Government for trainjng of district medical officers for post-graduate studies. He suggested that other countries in the region should provide special facilities for admission into some of their institutions of excellence, through the mechanism of TCDC. WHO could play a major role in making arrangements fcr placements.
DR AHDULLAH (Maldives) said that in Maldives, just as in Bhutan, they were faced with the problem of the training of doctors, nurses and other public health workers. Maldives was too small a country to have medical colleges of its own. However, they were about to initiate training programmes for nurses and other paramedical workers. In the meanwhile, his country was dependent on other countries in the Region for meeting their medical education needs.
Although it would be easier to send doctor5 from his country to Europe and to developed countries, it was his government*^ policy that as far as possible, doctors should not be sent outside the region for initial training. WHO had played an important role in providing fellowships to his country for undergraduate medical education, but they werc finding it extremely difficult to get jplacements for them in various countries due to a number of reasons, mainly the language problem. He sought assistance in this regard from countries of the Region.
He was grateful to Bhutan for providing training to nurses even though Bhutan itself was a small country. Negotiations with Sri Lanka for training of paramedical5 was being pursued and it was hoped that, in the near future, the project would succeed.
He supported the suggestion made by the Repr?sentative from Nepal regarding the establishment of regional training centres. However, instead of having full-time courses for medical education and establishing a centre for this purpose, some of the existing centres in the countries of the region could initiat,? specially planned post-graduate courses in community medicine for the doctors for the Region. The whole programme of medical education in the countries of the Region needed reorientation in order to achieve the goal of Health for All by the Year 2000. Moreover, medical education was being viewed increasingly as an investment for making money. A change in thinking therefore became imperative. WHO should take the initiative to mitigate the problems of the countries in this field. He suggested holding of a meeting of people concerned from medical schools, such as professors, with the objective of assisting the countries to reorient their training programmes in medical education. The meeting could make a good assessment of the situation prevailing in the region and recommend ways and means to bring about improvement in the field of medical education,
DR JADAMBA (Mongolia) said that he was in agreement with Professor Prawase Wasi that, although this subject had been discussed a number of times in various Eora, nothing substantial had come out of it. The Fortieth World Health Assembly adopted a resolution on the important aspect of health manpower development, and all the countries were expected to take necessary steps to implement the resolution in the next few years. In Mongolia, health manpower development was carried out in a planned manner. Preference was given in admissions to medical school students mostly from the rural areas, and, after graduation, they were deployed in the countryside. Thirty per cent of the students were paramedical workers, and about eighty per cent of the medical students in Mongolia are sent to work in aimaks and somons.
Mongolia had taken a number of steps to reorient the post-graduate training to the needs of somon health services. A number of measures had been taken to mitigate the difficulties of doctors who worked in somons, and these measures were working successfully.
DR PRAWASE WAS1 (Chairman, ACHR) agreed with the suggestions made by the Representatives of Bhutan and Maldives on setting up of regional training centres in community medicine, and said that this could be done without high financial costs. In Thailand, during the last ten years, the country was fortunate in retaining doctors who were dedicated to their profession and, were employed at the district hospitals. After 3-4 years of services, these dedicated doctors are sent to Belgium or the Netherlands for one year where they follow courses in community medicine. They return orientated and refreshed and continue to be employed in the district hospitals, and they provide a better quality of work. . But all district doctors could not be sent for training due to financial constraints. If regional training centres in community medicine could be established, it would help in improving considerably the quality of health care at district level. WHO could act as a catalyst, coordinating assistance from agencies such as SIDA, IDRC, etc, andsupport the establishment of regional training centres.
MR AHOOJA (India) said that his country had a very large reservoir of trained medical manpower. In fact, it was actually exporting trained MINUTES OF THE THIRD MEETING 155
medical manpower, and a large number of Indian doctors were working in Europe and the Americas. Rut medical education in India was somewhat lopsided and corrective steps were being initiated. His government had started a national education policy and was in the process of evolving a national medical education policy.
During the previous three years, efforts had been made to reorient medical education to make it more community- and need-based. It was a matter for satisfaction that initiatives had been taken recently by the premier institute of the country, the All-India Institute of Medical Education, to identify the needs of the community in order to reorient medical education.
As part of his country's TCDC programme, India had been offering, to the extent possible, a number of places to students from the Region in its medical colleges. Recently, two places were offered to Maldives. However, in the context of the requirements of his country, the number of medical schools was not being increased. Although there were 13,000 places in the medical colleges, the competition for those seats was very intense. He said that WHO might consider some kind of initiative so that the requirements of the countries in the Region could be assessed and coordinated with the facilities available.
MR RAHMAN (Bangladesh) stated that as a consequence of legislative action taken to transfer the subject of health to the upazila level, the health manpower development policies plannin,: and programming, as well as the curricula for medical education had to be readjusted. The government had also set up a special committee of parliamentarians to look into the various aspects the of countryes manpower needs in the health sector, including training and curricula, keeping in view the PHC approach, and this committee had visited several countries, both within and outside the region, to observe health manpower development in these areas.
With a view to making effective utilization cf the 0rganization.s fellowships programme, the Committee had identified the areas in which WHO fellowships would be needed to meet the requirements of the country. Bangladesh had a number of institutions with facilities for providing training in various fields, and MI Rahman hoped the Organization would take advantage of these facilities by arranging placement for fellows from countries within the Region.
The REGIONAL DIRECTOR, referring t.o the detailed discussions that had taken place at the CCPOM and the Regional Committee on this subject, said that some distinction should be drawn between community orientation and training in skills. Orientation started from early childhood and required dedication, while training in skills could be imparted at the highest level, not necessarily of the district or provincial level. Concerning the suggestion made f'3r WHO collaboration for establishing regional training centres to meet the health manpower 156 UIRUTES OF THE THIRD MEETIh'G
needs in community health, he said that if past experience of WHO in collaborating with similar centres was any guide, they were not successful - mainly owing to the lack of adequate resources to sustain the continuance of such centres, and, more importantly, the subjects to be dealt with were country-specific, requiring provision of training at the country level.
He felt that while there should be regional collaboration in developing a network of three to four centres, which could provide general guidelines and philosophy of approaches, the actual training of field workers should be undertaken at the country level, while the Regional Office would discuss with the countries ways and means of developing a regional collaborative programme in manpower development for community health.
As regards the training requirements of some countries, he said that while, on the one hand, the receiving countries had problems of meeting their own manpower needs, on the other hand the Organization had also encountered certain difficulties in finding placements due to various reasons. He felt that though some progress had definitely been made during the past decade by the countries in meeting their manpower requirements, the whole situation required a careful study, and suggested that this subject might be discussed further under TCDC at the meetings of the Advisers and the Ministers, which would follow the current session of the Regional Committee.
Turning to the Organization's fellowships programme, the REGIONAL DIRECTOR said that it was the joint responsibility of the Member States and WHO to ensure its effective implementation, and he referred, as an example, to the fact that at the moment the Organization was still receiving applications for utilizing 1987 fellowships, while in fact action should have been taken to nominate candidates for fellowships planned for the 1988-1989 biennium.
While the Organization would take necessary action to improve its budgetary and administrative procedures to facilitate speedier implementation of fellowships, the countries on their part should improve their national mechanisms for processing fellowship nominations, etc, as well as ensure that the selected candidates possessed basic educational qualifications required by the receiving - institutions, and necessary language proficiency to secure placement.
He further stated that in pursuance of the Executive Board resolution, the Organization would be undertaking a study of its fellowship programme in order to prepare a report for submission to the Executive Board in 1989 and, in this connection, the Regional Office would be convening a meeting some time in late 1988 to afford an opportunity to the countries and the Regional Office to see how the delivery of the fellowship programme could be improved in the context of the manpower requirements of the countries. Research Promtion and Developaent (pp.99-106)
In his introductory remarks, the REGIONAL DIRECTOR stated that the regional research promotion and development programme had commenced in 1976 and, during its twelve years of existence, had achieved significant progress in promoting research activities to meet the needs of the countries. The major thrust of the programme was directed towards promoting research and development in the context of implementing the strategies for Health for All, with primary health care as the key approach.
The Organization was also providing support: to countries in the fields of research in human reproduction and tropical diseases through its global programmes, while at the regional level the Advisory Committee on Health Research had contributed significantly to the development of the regional research programme.
DR PRAYASE WAS1 (Chairman, ACHR), in his presentation, stated that at the thirteenth session of the Advisory Committee, held in Mongolia in July/August 1987, three new research items were given importance, viz (1) research related to information and education for health, (ii) self care: emerging research challenge for PHC in developing countries, and (iii) family life in a changing social and technological environment and its implication for healthy human development, which involved behavioural researches, stressing the importance of social sciences.
While the Advisory Committee had initially dealt with a disease- oriented approach of conditions prevalent in tie countries, such as malnutrition, malaria, dengue haemorrhagic fever, etc, of late, the Committee-s emphasis was on health systems research, health behaviour research and health economics research, and it would be necessary for the Member States to develop a mechanism to promote health economics research and training.
He then briefly referred to the discussions of the Advisory Committee on the subject of self care and family life and said that these areas represented important inputs to the research related to .. information and education for health. He stated that at the next session of the Advisory Committee, which would be held in Sri Lanka, research on nutrition and clinical research would receive main attention. He said that the Advisory Committee at its last session had made three main recommendations, viz: promotion and support of health systems research, institutional strengthening and support for the establishment of national coordination mechanisms for health research in the Member States.
He presented his concept on the Measurement-Information-Decision- Implementation (MIDI) cycle in health development, and referring to it he said there was need for coordination of research in epidemiology, 158 UIhlJTES OF THR THIRD MEETING *
social sciences, health economics and clinical/biomedical research in order for the health development loop to flow around effectively. This was problem area which would require the full involvement of the policy makers and health administrators, who were too busy to pay attention to this health development loop. If the goal of HFA was, however, to become a reality, it was imperative that this MIDI loop be activated fully.
The Regional Office was convening a meeting of task forces on institutional strengthening and HSR shortly and he hoped that this would provide an opportunity for the countries to pool their experiences together and devise ways and means of strengthening the research capabilities of their institutions.
The CHAIRMAN, CCPDM, said that Dr Prawase Wasi had dealt with the subject extensively, and drew the attention of the Regional Committee to the three points recommended by CCPDM for its consideration.
DR SOMSAK (Thailand) said that the Regional Director's Annual Report reflected very well the basic nature of research activities which cut across various programmes in health. The main emphasis of the programme in building up the capability of institutions in research studies was therefore highly relevant. He commended the interest shown by the Regional ACHR in various disciplines essential for complementing the conventional health- and medical-oriented research.
Thailand had been working on health economics and health behaviour research. As already referred to by the Chairman of the ACHR, health economics research in Thailand started in the previous year. A batch of district hospital doctors underwent the first training course held early in June. It was observed thst they had shown significant interest in this. The studies covered different aspects, such as a better understanding of the way people were spending money for their health, the role of the private sector in the overall national health services system, the way government doctors allocated their limited resources for health, etc. He hoped the results would help the government to take corrective steps in order to progress effectively towards the goal of health for all which would not be possible without paying proper attention to such economic issues relevant to the situation in the country. - Health behaviour research would start soon and Thailand expected it to provide a better knowledge of people's behaviour related to their health, and assist to deal more specifically with the communities in involving them in health development activities through the concept of community participation and self-reliance. This would also help in the formulation of proper strategies for health promotion and disease prevention. Another important aspect with regard to research promotion and development was the promotion of information-seeking behaviour among the high level policy-makers. The lack of interest from the MINUTES OF THE TtiIRD MEETING 159
higher level administrators regarding research seemed to be well recognized in almost all countries. Experiences in different countries might be worth sharing and this could be mentioned in future Annual Reports. Also, it would be worthwhile to organize workshops or seminars to sensitize high level administrators.
DR HAPSARA (Indonesia) sought clarification whether the ACHR intended to give priorities to research on economics, finance, revenue, and expenditure in the community in the field of health, and whether any country had experience to share with others on health economic research. Referring to the MIDI mentioned by Dr Prawase Wasi, he wondered if any specific steps, long-term or short-term, had been envisaged to improve this.
DR REGMI (Nepal) said that Nepal was conducting regularly health methodology courses, in collaboration with WHO, with participation from doctors and other health personnel. He sought clarification whether any research had been carried out as to how to overcome difficulties faced by countries in carrying out primary health care activities suffering a shortage of manpower, resources, etc.
DR PRAWASE WAS1 (Chairman, ACHR), responding tc~the points raised by Dr Hapsara, said that when the ACHR had taken up the health economic research during previous year-s session in New Delhi, priority areas on research had been discussed, but not in detail. In Thailand, a seminar was organized with about seventeen economists from universities and these participants had gone into the details of this research and had identified priorities.
As to the query raised by Dr Regmi, he agreed that it represented a very important aspect of health research in support of PHC. The Regional Office brought out publications on the concept and the methodology of health services research and the managerial aspects to support PHC. But he felt that more needed to be done. This subject could be taken up at the task force meeting scheduled to be held in November this year.
The REGIONAL DIRECTOR said that since Dr Prawase Wasi had presented - the subject comprehensively, he would make a brief intervention on the utilization of research. The Regional Office was preparing abstracts of the research activities undertaken by countries with WHO collaboration. The first volume had already been brought out and the second one was expected to be published soon. He hoped these abstracts would help the Member States to keep themselves informed of the research activities and their findings.
On the utilization of research findings on health economics, health behaviour, or health services, it was very important that health administrators, health planners and high level. decision-makers be partners in such activities. Very often, these activities were 160 MINUTES OF THE THIRD MEETING
undertaken by high level university academicians in isolation without involving persons from the field of health. Consequently, very little follow up action resulted from such findings.
He reminded the Regional Committee that Dr Prawase Wasi, who had been associated with the ACHR for the previous five years, would be completing his term as Chairman of the ACHR. The countries of the Region had benefited much under his chairmanship. He complimented Dr Prawase Wasi for his invaluable contribution, and hoped he would continue his association with WHO and the ACHR.
Item 2 ADJOuRNnENr
The meeting was then adjourned. S~YMIWUTES~
Fourth Meeting, 16 September 1987, 2.30 p.m.
AGENDA
Item Page
1. Thirty-ninth Annual Report of the Regional Director (cont -d)
2. Appointment of a Sub-committee to Draft Resol~~tions
3. Adjournment
loriginally issued as document SEA/RC40/Min.4, on 17 September 1987 162 HINIITBS OF THE FOURTH IIEETIUG
In the absence of the Chairman, the Vice-Chairman took the chair.
Item 1 THIRTY-NIm ANNUAL R6PORT OF THE REGIONAL DIBBCCOE (cont-d) RC Agenda item 9
General Health Protection and Promotion (pp.107-122) Protection and Proaotion of Health of Specific Population Croups (pp.123-135) and Protection and Promotion of Mental Health (pp.136-139)
Drug Abuse KC Supplementary Agenda item 2
The RECIONAL DIRECTOR suggested that along with these chapters, the following resolutions of the World Health Assembly and the Executive Board of roeional interest (document SEA/RC40/12) be also considered:
- Mnternnl ltedlth and Safe Motherhood (WHA40.27); - Health of the Working Popolatjon (WHA40.28); - Research on Aging (WHA40.29); and - L'sc of Alcohol in Medicines (WHA40.32 and EB79.RI7)
The subjecc oi Drug Abuse could be taken up while discussing Chapter In.
The CIIAJRMAN, CCPDM, then highlighted the discussions on Chapter 8. He said that the CCPDM had cnnsidered the problems of malnutrition and noted that, besides supporting country-specific nutrition projects, the Organization had also developed regional programmes for controlling iodine deficiency disorders and xerophthalmia. Although many countrles had developed national programmes on traffic, domestic and occupational hazards, there was no clear-cut policy on accident prevention. It was, therefore, necessary to evolve such a policy. He then read out the - recommendations of the CCPDM on this chapter.
Under Chapter 9, the CCPDM had noted the steps taken by Member States for improving the quality of MCH services. It had also noted that reproductive health in adolescents would form a separate programme in the Eighth General Programme of Work. The recommendations of the CCPDM on this chapter as well as on Chapter 10 were then read out.
The VICE-CHAIRMAN then invited the Representative from Bangladesh to Introduce Supplementary Agenda item 2, Drug Abuse (document SEAIRC40116). Introducing the item, MR RAHMAN (Bangladesh) explained that this subject had been proposed by the Government of Bangladesh as it was felt that it had not been adequately reported in the previous Annual Report. The deliberations of the International Conference on Drug Abuse and Illicit Trafficking, held recently in Vienna, and the lack of emphasis on this subject in the Regional Director-s current Annual Report had also prompted his government to propose the item.
He said that prevention and control of drug abuse were the responsibility of the enforcement ministry and not of the Ministry of Health, which should be concerned with rehabilitation, both psychological and physical, of victims of drug abuse to make them socially and economically productive.
In the past, numerous conventions had been held on the prevention and control of drug abuse, but no activities had been initiated for the treatment and rehabilitation of victims. He suggested that consideration be given to the drawing up of a blueprint for coordinated action by Member States covering various aspects.
DR KANG YONG JUN (DPR Korea) referred to Section 9.4, Health Care of the Elderly, and said that the average life expectancy in DPR Korea was 74.3. Hospitals undertook treatment of the aged while there was also a centre for treating diseases of the aging people. Research on prevention of aging, with particular emphasis on the avoidance of medicine and on preventive measures, was being undertaken. The effect of drinking water, which was believed to cause aging, was being studied. Activities on intensifying research on cardiovascular diseases, and quick ways of recovering from diseases such as pneumonia, were also being undertaken. Modern technology was being applied and the results of modern research would be followed to improve research standards.
In 1981, his country had joined the International Society for Aging People and since then had continued as its active member. Research activities had been carried out jointly with the Soviet Union. A proposal had been submitted for establishing a WHO collaborating centre on the subject and the Government looked forward to positive support to . research on geriatrics at the current session. MR AHOOJA (India) referred to the problem of iodine deficiency, and said that his country had a programme which would ensure that by 1992 only iodized salt was used in the entire country.
In regard to drug abuse, he said that the magnitude of the problem in his country was not known. Certain drugs were being misused and there was a need to study the extent of the problem. While alcohol, tobacco and opium were being misused, the use of psychotropic substances was not very extensive. Legislation had been enacted to prevent drug abuse. The problem might not be severe at present, but 164 MINUTES OF TEE FOURTH KEETING
could assume a serious proportion later. Perhaps a survey could be undertaken to investigate whether drug abuse was more related to a particular group of population, and a suitable rehabilitation programme could be formulated.
MR KAHMAN (Bangladesh) highlighted the actions being taken by his country in regard to Vitamin A deficiency, iodine deficiency disorders and smoking. It had been decided that only iodized salt would be marketed. To this end, iodization of salt was proposed to be done through a collaborative programme involving WHO and UNICEF. Legislation was expected to be enacted in the forthcoming session of Parliament. His country had been facing problems in regard to Vitamin A deficiency dnd protein-energy malnutrition with the ,result that the nutrition standard in the rural areas had not improved. Efforts were being made to vitaminize imported wheat.
In regard to smoklng, he said that the Parliament was expected to enact a legislation whereby it would be obligatory for the manufact~irers to include a warning on cigarette packets that smoking was injurious. Besides, a wide campaign against smoking had been launched.
DR FERNANDO (Sri Lanka) said that malnutrition was one of the major prohlems faced by the Member States. It had affected the vulnerable group, especially the pre-school children under five years of age, as well as expectant and lactating mothers. Member States should pay greater attention to this problem because more than the lack of food, malnutrition was the result of lack of knowledge about suitable food. Malnourishment also resulted in the birth of babies with low birth- weight, besides causing maternal mortality. It was therefore essential for all the countries of this region to make earnest efforts to tackle the problem of malnutrition.
He said that drug abuse was an emerging problem in most countries. In Sri Lanka, there were 26 000 known drug addicts, and efforts were under way to solve this problem. He urged that greater attention be paid to this problem since it was common to all the countries.
DR JADAMRA (Mongolia) said that in his country maternal and child health care programme had been elaborated with the assistance of r experts from the USSR. This programme included preventive measures against infectious diseases affecting children. Health institutes and rest homes for expectant mothers in aimak centres were established where pregnant women could stay until delivery.
A rehabilitation centre had been established in Ulan Bator to provide necessary services to the aged. There were institutions where people suffering from diseases of occupational etiology were treated free of charge, thus relieving factories and similar establishments of the responsibility of looking after the health of their own workers. MINUTES OF THE FOURTR MEETING 165
This innovative approach to the health problem was expected to improve the health situation.
DR REGMI (Nepal), referring to the problem of drug abuse, said that while there were only 5 000 cases of drug addicts in Kathmandu three years ago, the number had increased to 12 000 in the past year and to more than 13 000 in the current year. He pointed out that this problem concerned not only the Ministry of Health but ott,er ministries as well. Other countries of the Region were also faced with this problem. He suggested the establishment of a mechanism or surveillance system to check drug abuse and drug trafficking. He wished the Member States to share their experiences whenever new developments occurred in regard to drugs so that preventive measures could be taken well in time.
DR ABDULLAH (Maldives) said that alcohol and drug abuse posed no problem in his country. However, because of the increasing tourist trade there was a danger of this problem arising. The country had therefore taken adequate steps to minimize the negative effects of tourism. In this context, he said that new guest houses were not normally allowed to be opened in Male, thus confining the tourists to other island resorts. This minimized their contact with the local population. The Government also imposed strict penalties forpossession and use of drugs. This indicated the Government-s serious concern about this problem.
Health education was one of the most essential areas that required attention if Health for All by the Year 2000 was to be achieved. This subject was receiving priority attention in his country. Several important activities had been undertaken jointly with the Ministry of Education. A programme was being worked out whereby school children would be provided health education. It was planned to include in the school health curriculum a programme for increasing health awareness. The Government had appointed a multisectoral national committee with the Minister of Health as the Chairman with a view to increasing health awareness. This committee cooperated with various sectors and nongovernmental organizations and conducted workshops where materials were disseminated to the participants. Televisiorl and radio were being utilized extensively to disseminate health education. The Government was also using the forum of public gatherings to promote health awareness.
As regards the promotion of health of specific population groups, emphasis was being laid on the promotion of the health of mothers and children. The immunization programme in the country had achieved an impressive coverage of around 90 per cent through mobile teams.
DR SOMSAK CHUNHARAS (Thailand) highlighted tb.e problems that his country might face before the year 2000. In regard to oral health, Thailand was faced with the problem of shortage of qualified dentists, the ratio of dentist to the population being 1:20 000. The cost of 166 MINUTES OF THE FOURTB MEETING curative or rehabilitative dental care was disproportionately high compared to the economic status of the people. Oral health targets for the year 2000 had been defined and indicators established. Dental health services at different levels used different types of health personnel, such as dental auxiliaries and village volunteers. His country would be glad to share its experience with other Member States in the Region.
Aging was sure to become a major problem in Thailand before the turn of the century. The aged had been accounting for most of the national health expenditure, for different reasons. Research on aging and services for the elderly, based on health promotion or disease prevention, was highly important. An intersectoral approach to this problem seemed most rational. The Regional Office could play an effective role in facilitating an exchange among Member States of information on innovative and affordable approaches suitable for dealing with such a problem in a developing country such as Thailand.
A countrywide campaign against smoking had been launched recently, with the doctors and health personnel stimulating the population by setting personal examples. With a view to inculcating the non-smoking habit, it was planned to organize countrywide walks through mohillzation of doctors from rural areas from each region and meeting in Bangkok at the end of the week.
The REGIONAL DIRECTOR said that the Regional Office had, in the past, collaborated with countries in such programme areas as maternal and child health, adolescence, oral health and health of the elderly, and assured that this collaboration would be continued. An inter- agency conference on safe motherhood had been held in Nairobi earlier in the year in which UNFPA, the World Rank and UNICEF had also participated. This meeting had adopted a resolution that was subsequently endorsed by the World Health Assembly. WHO was in the process of ascertaining the extent of funding available to this programme and how the various countries could interact. Three countries in this region, viz, Bangladesh, Bhutan and Nepal, had been identified for collaboration on maternal mortality under the Assembly resolution, and preparatory action was in hand.
As regards malnutrition, he said that though the problem was " medical, its solution lay in the non-medical domain of socio-economic development. The Advisory Committee on Health Research was seized of this problem and had directed the Regional Office to look into it. This subject would be taken up at its next meeting in Colombo in 1988. WHO had recently brought out a publication entitled 'Nutrition: Problems and Programmes in South-East Asia-, which discussed in detail the different aspects of the problem and possible solutions to them. Copies of this publication had been forwarded to the Governments in the Region. The Representatives would be sent copies of this publication in due course. The South-East Asia Region was estimated to have about 100 million cases of iodine deficiency-related disorders. A major joint effort with UNICEF had been launched about two years ago and a situation analysis and future workplan developed. Follow-up work was in progress and a regional consultation was expected to be held in 1989. The technological solution to this problem - iodization of salt - sounded very simple but the problem lay in securing its acceptance by the people, which was related to socio-economic aspects,behaviour of the people and technical monitoring of programme.
He thanked Bangladesh for proposing the agenda item on drug-abuse control. He said that inter-agency drug abuse control programmes were in operation in several countries of the Region, including Burma and Thailand, while WHO was marginally involved in the programme in Nepal and Sri Lanka. In India, an agreement on drug abuse control had been signed recently between the Government and UNFDAC. He invited the countries to utilize the collaborative services of WHO in this sphere, considering that there was a major health component in this programme.
Dr BAO-KANG ZHANG (Christian Medical Association) stated that the United Nations had recently celebrated the birth of the five billionth child of the world. Ninety per cent of the increase in population was taking place in developing countries whose present population constituted three-fourths of the total world population. The largest numbers of newborns were concentrated in areas with a poor economy and low living standards. Rapid increase in the population retarded economic growth and slowed down improvement of living standards. The United Nations had predicted that the world population would reach 6.5 billion by the year 2000. China had been practising family planning since 1970 and the annual population growth dropped from 25.86 per 1 000 to 11.28 per 1 000 in 1985. The activities comprised several elements, including extensive education work with emphasis on rural areas which accounted for RO per cent of its population, economic rewards and disincentives, advocacy of delayed marriages and one-child families, free contraceptives and guidance on the choice of family planning methods, running nurseries and old people-s homes, and the principle of equal pay for equal work so that people would not seek a second child. .
Promotion of Environmental Bealth (pp.140-152)
The CHAIRMAN, CCPDM, stated that the Committee had taken note of the work being done in the context of the International Decade for Drinking Water Supply and Sanitation and of the increased attention being paid to rural and urban housing in most countries of the region.
He then read out the recommendations of the CCPDM. Diagnostic, Therapeutic and Rehabilitative Technology (pp.153-169)
The CHAIRMAN, CCPDM, said that following the discussion on this chapter, the CCPDM had made four recommendations for consideration by the Regional Committee. These recommendations were read out.
MR RAHMAN (Bangladesh) recalled the apprehensions expressed earlier by his delegation regarding the increasing dependence of the Region on imported technology and medicine. He suggested that the countries of South-East Asia as well as other regions, collaborate with other organizations, such as UNIDO, through WHO, in the matter of production facilities and essential instruments. The Appropriate Technology Centre might be contacted with a view to building up capabilities for the production of essential medical appliances already created. With regard to drugs, his Government had adopted a comprehensive policy and resisted pressures from multinational groups. Bangladesh would like to share its experiences with other countries of the Region as well as with other regions. In the field of traditional medicine, bilateral collaborative programmes with other countries had been successful. Programmes on Unani and Ayurvedic medicines were being carried out with WHO collaboration. Formularies were under preparation in conformity with WHO and national policies. He was confident that the traditional medicine programme would be fostered in his country.
DR SONG PIL JUN (DPR Korea) said that the policy of his government was to promote the development of traditional Korean medicine combined with Western medicine. Under this system, Western techniques were applied for diagnosis and traditional approaches for therapeutics. Faculties of traditional medicine existed at medical universities and schools. Colleges of traditional Korean herbal medicine, integrated into Western medicine, had been estahl ished where clinical, diagnostic and therapeutic systems were scientifically based. In view of its curing potential, proven research and standardization in production, traditional medicine could be scientifically based. The integration of traditional and Western medicines contributed truly to primary health care and development of new therapeutics and remedies. He suggested the establishment of a WHO Collaborating Centre for Traditional Medicine in DPR Korea. This would enable the introduction of acupuncture and traditional therapeutics in primary health care, quality control and standardization of traditional medicine, exchange - of information, training of traditional health workers and research. He further suggested that a regional exhibition on traditional herbal medicine be organized in 1988 to commemorate the fortieth anniversary of WHO.
In the field of essential drugs, his country had developed a national list of 265 essential drugs. Large-sized factories producing drugs, antibiotics and biologicals at the central level had either been established or expanded. Medium-sized production was organized at the county level. Thus, drugs would be available for primary health care as MINUTES OF THE POURTE METING 169
well as for export. The production of vaccines enabled the countries to carry out immunization against measles, olio and Japanese B encephalitis. Drug quality control had heen organized through the publication of a pharmacopoeia and the establishment of institutions in counties and cities. His country looked forward to WHO assistance in training specialists in drug quality control, including immunoassay, supplies and equipment, and quality control of biologicals. Guidelines or manuals had been prepared for more than 300 traditional medicine preparations. He suggested that WHO disst!minate the available information to other countries of the Region.
DR NORBHU (Bhutan) said that his country had made constant progress at all levels of the essential drugs programme during the past two years. A number of training courses had been organized and a national formulary prepared, which would be put to use in the country by December 1987.
The REGIONAL DIRECTOR, referring to the point raised by the Bangladesh Representative, to conceive the programme of essential drugs as a regional collaborative effort, said tbat earlier the drugs programme was deliberately left out of the purview of TCDC programme due to a number of complexities which were not only economical and technological, hut even political in nature. The Regional Office had developed some way of collaborating in consultation with Member States. He suggested that Health Ministers of the countries of the Region may examine this area under TCDC and agree in principle for collaboration in this field. He mentioned the example of ASEAN, where the Regional Office was working in collaboration with UNDP and ASEAN authorities to draw up a suitable programme.
The Regional Director then referred to another important point raised regarding the transfer of technology and said that the Advisory Committee on Health Research was looking into it. There were problems not only in transfer of technologies, but also for the transferors and the transferees.
Disease Prevention and Control (pp. 171-255)
AIDS RC Supplementary Agenda item 1
The VICE-CHAIRMAN suggested consideration of tht! following resolutions while discussing this chapter: - Diarrhoea1 diseases (WHA40.34 and EB79.R8) - Towards the Elimination of Leprosy (WHA40.35) - Global Strategy for the Preventlon and Control of AIDS (WHA40.26) The CHAIRMAN, CCPDM, said that the CCPDM made a number of points for consideration by the Regional Committee and read out the relevant points.
The VICE-CHAIRMAN then invited the representative from Bangladesh to introduce the Supplementary Agenda item 1, AIDS (document SEAlRC40115).
MR RAHMAN (Bangladesh) at the outset made it clear that his Government's proposal to introduce the subjects of AIDS and drug abuse as supplementary agenda did not mean that there was high incidence of these diseases in his country. In fact, his country was least affected by these two scourges. At the time of proposing these subjects, his country did not know that the Regional Office would be circulating so many papers at the session. The reasons for AIDS were well-known and countries like Bangladesh had to be very careful in this regard.
His country was concerned about the lack of adequate intercountry collaboration in malaria control activities. It is felt that transmission occurred from areas across his country-s borders and consequently the control programme in Bangladesh was affected.
Bangladesh was also concerned about the incidence of dengue haemorrhagic fever and Japanese encephalitis. Although the country did not have these diseases, WHO'S involvement would be appreciated if control measures were taken in the countries where the diseases were endemic.
He said that a high degree of awareness existed in his country about diarrhoea1 diseases and its preliminary treatment: oral therapy, and oral salt, and the credit for this went to two organizations - ICDDR.B, and the Bangladesh Rural Advancement Centre (BRAC) which was a nongovernmental organization. He said that Bangladesh would welcome the Member States to take advantage of their expertise in the field of dissemination of information and research, and would be glad to receive fellows from other countries at 1CDDR.B.
DR CHAIYAN (Director, Programme Management) then mentioned briefly the background to AIDS which was caused by human immunodeficiency virus (HIV). He referred to the information documents already circulated that included SEA/RC40/InE.6, 7 and 8. The disease was a grave threat to the achievement of Health for All goal. Although it was widely prevalent in Africa, the Americas and Europe, fortunately, South-East Asia region was the least affected by it. But it was being viewed as an emerging potential problem.
The cases so far reported in the Region were all imported ones, and included those of the natives who contracted the disease abroad. To combat this problem, high-level multidisciplinary task forces or committees had been set up and national capabilities were being developed For HIV screening. Epidemiological approach to surveillance and educational activities were started in many Member States, along with screening of migratory labourers and foreign students, and adoption of legislative measures. The countries had started implementing the global plan of action for the prevention and control of AIDS through existing health infrastructure.
AIDS and other manifestations of HIV infections were recognized as major public health concern at the seventy-seventh session of the Executive Board which adopted a resolution approving of WHO-s efforts for the control and prevention of the disease. The seventy-ninth session of the Executive Board endorsed the Director-General-s proposal to establish a Special Programme on AIDS (SPA), which was formally set up on I February 1987. SPAns major tasks included: (1) to support and strengthen national AIDS programmes through the world, and (2) to provide global leadership, help ensure international collaboration, and pursue global activities of general value and importance. The Fortieth World Health Assembly requested the Director-General to ensure that the strategy formulated to control AIDS was effectively implemented at all levels.
The modus operandi of SPA was through exchange of information, preparation and distribution of guidelines, advice on international travel, collaboration on supply of test kits and reagents, advice regarding utilization, and quality control of blood and blood products, coordination of research activities in Member States, etc.
The Thirty-eighth Session of the Regional Committee recommended in 1985 the development of a programme for the surveillance of AIDS in South-East Asia Region. Consequently, the Regional Office convened three intercountry consultations on AIDS. The last consultation, held in August 1987, reviewed the situation in the Member States and further developed the Regional Plan of Action. An intarcountry workshop on laboratory diagnosis of AIDS was supported, and support was given for a national workshop on AIDS epidemiology and diagnosis in India. Member States had been provided with materials on AIDS produced by WHO headquarters, ELISA test kits and other reagents for Western Blot assays, and reporting forms on AIDS. WHO Rel~resentatives in the countries had been briefed on the epidemiology, surveillance and control of AIDS. There are two WHO collaborating centres on AIDS, one each in India and Thailand, for the purposes of ii) training nationals in the diagnosis of AIDS, (ii) carrying out confirmatory tests, and (iii) monitoring the situation by confirming ELiSA-positives referred to by Member States.
A team of SPA staff from WHO headquarters and short-term consultants visited Mongolia, Nepal, Sri Lanka and Thailand, in JulyIAugust 1987, to collaborate in planning activities for the prevention and control of AIDS. Proposals for training of clinicians and scientists from the Member States, were being actively pursued with WHO headquarters. A centrally-managed and well-coordinated global programme on AIDS with regional ramifications had finally been decided upon to combat this problem, and UNDP had proposed to allocate US$ 1.4 million for the establishment of an umbrella project on AIDS. Active technical collaboration between the Organization and the national task forces was essential for effective implementation of the Regional Plan of Action.
DR UTHAI (Thailand) thanked the Regional Office for the report presented on the subject. A majority of the eleven cases detected in Thailand were foreigners and while eight patients had already died, the remaining three active cases were under close surveillance. He sought the support of WHO in intensification of the Special Programme on AIDS, particularly the regional plan of action for the prevention and control of AIDS, through making available reagents for screening of HIV antibodies through ELISA and Western Blot tests as well as provision of test kits at low cost. He also requested stepping up of exchange of information. There were already two collaborating centres - one in India and one in Thailand - and it would be appropriate to set up a collaborating centre in each country.
DR ABDULLAH (Maldives) said that AIDS was posing a major threat to the achievement of HFA goal and the panic created by its negative publicity might force political leadership and opinion leaders to embark on a vertical programme, cornering a major portion of scarce resources which could otherwise be usefully utilized. He felt, therefore, instead of starting a vertical programme of AIDS, the activities should be integrated with existing programmes of primary health care. He suggested a cautious approach as to mass screening since screening might not only be ineffective in detecting suspected cases, but turn out to be counterproductive. Fully aware of the possibility of importation of cases into the country, the Government set up a national multisectoral committee to advise on the formulation of a national programme for the prevention and control of AIDS to which, he hoped, WHO would provide necessary technical support.
DR REGMI (Nepal) said that though no case of AIDS had been reported so far in his country, the government had already constituted a national steering committee. WHO had provided the services of two experts to review the situation and formulate a plan of action, and its assistance would be necessary in obtaining test kits. Nepal received a , large number of foreign visitors. In this connection, he wondered whether WHO would take the initiative to undertake research for developing curative medicine in other systems of medicine such as ayurveda, in collaboration with leading ayurvedic institutions in the Region. He regretted that the Regional Director-s Annual Report did not make a mention of the problem of deafness though a suggestion was made by him at the last session. Malaria posed a major problem in his country and, with the production of DDT being stopped by many countries and the high cost of malathion and development of resistance, WHO should assist the countries in devising alternative strategies to deal with this prohlem. MINUTES OF TBB E'OWnt MEETING 173
DR KANG YONG JUN (Democratic People-s Republic of Korea) stated that though no cases of AIDS had been detected so far in his country, a system of surveillance for early detection of AIIIS had been established in view of the increasing threat posed by this disease. The government had taken several measures to cope with this prohlem such as training of its specialists in the management of AIDS cases in research institutes and hospitals and techno-methodolo~ical aspects of AIDS control. He hoped that WHO would collaborate with the countries through provision of material, technical and financial support in the prevention and control of AIDS. In the control of diarrhoea1 diseases programme, marked results had been achieved by the Region to acquire self-sufficiency in the production of ORS and extensive introduction of ORT for case management. He was grateful to WHO for providing the services of a consultant in parasitology and supply of reagents and equipment for strengthening research efforts.
The national programme on control of diarrhoea1 diseases was quite advanced and DPRK was expected to achieve self-sufficiency in the production of ORS shortly. In view of DPRK's epidemiological situation, WHO support would be required in the training of specialists in the field of protozoal diarrhoeas, including amiobiasis, as well as to strengthen their research capability in protozoal diarrhoeas by developing the Centre for Protozoal Diarrhoeas, which could support the country in achieving self-sufficiency in the production of entamoeba antigen.
DR ISLAM (Bangladesh) said that the incidence of P.falciparum was high in the north-eastern part of his country and the parasite had developed resistance to 4-aminoquinoline. The efficacy of insecticide spraying, besides being expensive, was also doubtful now and the cumulative effect of spraying for more than 20 years on the human being was also not known. WHO should take initiatives to develop alternative strategies for the control of malaria.
DR JADAMBA (Mongolia), referring to the meeting of health ministers of the socialist countries held recently in Moscow to discuss the problem of AIDS, said that though the number of detected cases of AIDS was not high in the Region, in view of the danger posed by the disease, .. an intersectoral committee, headed by the Chairman of the Council of Ministers, had been established in his country. Suitable legislative action was also being taken to guard against the problem. Though WHO had provided assistance in the form of consultancy services and Mongolia had participated in the regional seminar on AIDS organized by the Regional Office, further assistance would be required from WHO in establishing laboratory diagnostic centres in Mongolia and in the provision of reagents for laboratory diagnosis of AIDS. He sought the support of the Regional Office in providing information related to management of AIDS and prophylactic measures taken in the countries of South-East Asia as well as in other regions. His country also would like to participate in the proposed health ministers conference on AIDS to be held in London next year. DR AHOOJA (India) said that 19 cases of AIDS had been detected in his country. These were largely non-indigenous cases. Action was under way to screen 75 000 persons among the high-risk group to ensure that cases were detected quickly. Twelve diagnostic centres had been established, and 17 more were being set up. A national task force on AIDS had been formed. Considerable effort and research had been done in the past three years in the investigation of the disease.
However, there were many other diseases which were of greater interest to the country and more time should have been given to the diseases which were of urgent concern. EPI with the target set for 1990, was geared primarily to the production of vaccines. Malaria, leprosy, blindness were some of the other problems that engaged the country's immediate attenti0n.A~ regards leprosy, it was expected that 60 per cent of the cases would be covered by 1990 and total coverage achieved by the year 2000. The target set for blindness was to reduce the incidence from 1.4 to 0.3 per cent by the year 2000.
DR HAPSARA (Indonesia) wished to be apprised of the latest advancements in the application of science and technology in relation to disease control that might have already been monitored by SEAR0 or headquarters.
DR LECHAT (International Leprosy Association), said as pointed out in the Annual Report, this region had nearly half of the world's leprosy cases. The countries in the Region had launched large-scale control activities in line with the recommendations of WHO for implementation of multidrug therapy through primary health care. Despite this, the fact that expertise, infrastructure and political will existed to tackle the problem, the problemof drug supply remained. This called for mobilization of external financial resources, and nongovernmental organizations could play a crucial role in this respect. Close cooperation already existed among governments. WHO and nongovernmental organizations for securing supplies of drugs. In line with resolution WHA40.35 of the World Health Assembly, "Towards the Elimination of Leprosy", expanding and strengthening of the collaboration would contribute greatly to making leprosy control a success. He assured the fullest cooperation of ILA to foster such collaboration. - He mentioned that the Thirtieth International Leprosy Congress would be held in the Hague, the Netherlands, in September 1988, under the joint sponsorship of ILA and WHO. This would provide an opportunity to Member States of the Region to report and compare their experiences and to prepare for the final onslaught against leprosy.
DR SUCHITRA PRASANSUK (International Federation of Otorhino- laryngological Societies) mentioned in detail the objectives of the Federation and the work being carried out by it. The Federation stood for improving the quality of oto-rhino-laryngological care. With MINUTES OF TEE F'OURTR MEETING 175
special attention on prevention and control of deafness, the three otological centres established under the Committee of Worldwide Prevention of Hearing Impairment, will soon be converted into an International Ear Care Agency. Some of the activities undertaken by each regional centre of the organization included spreading knowledge on ear care, conducting courses to improve oto--audiological capability of ENT doctors as well as of personnel engaged in the field, acting as referral centres, building up a data-base on the nature and extent of auditory disorders, formulating prescription screening programmes, managing patients with auditory disorders and advising governments on programmes for the prevention of auditory disability. Special attention was paid to the promotion of preventive measures, easy detection and easy management of reversible hearing disorders, especially among children.
DR ADHYATMA (UNICEF), said that he found from the discussions on AIDS that the emphasis was more on clinical cases, rather than on sero positives. If twenty sero positive cases were identified, the number of actual cases should in fact be higher by 50 to 100 times. Another aspect that was being neglected was the use of unsterilized needles in some countries as this might be one mode of transmission of the disease. With the increased EPI coverage in the context of the target of 1990, more unsterilized needles would be used with resultant increased danger of AIDS.
He also suggested inclusion in the Annual Report information on sterilization of vaccination equipment.
DR CHAIYAN (Director, Programme Management) said that the screening of travellers, particularly migratory labourers and foreign students, had so far been of limited value, but it depended on the policy of the individual country. On the point raised by Dr Adhyatma, he agreed that transmission through unsterilized needle was possible and hence sterilization of vaccination equipment before immunization should be ensured.
The REGIONAL DIRECTOR agreed with the observations of the Committee that in rushing for AIDS control activities other priorities in . communicable diseases should not be overlooked. No doubt AIDS was a serious problem and a grave concern, but there was no need to get panicky.
He was glad that the Committee had noted the seriousness of the malaria problem. The situation was not alarming at present since for the current year less than four million cases were diagnosed and recorded as against an all-time high of eight million cases reported in the earlier years. However, it should not be forgotten that the control programme was beset with a number of problems, such as insecticide resistance of vectors, drug resistance of parasites, operational problems, financial and resource inadequacies. In the light of these developments, the countries should be very alert. As regards vector-borne diseases, such as Japanese encephalitis and dengue haemorrhagic fever, stress should be on vector control rather than on development of vaccines which would bevery costly and difficult to apply. He mentioned that the diarrhoea1 diseases programme was entering the second phase covering etiological study; control and prevention through mortality prevention with ORT was still stressed in many countries.
He was happy at the progress made by Member States on Expanded Programme on Immunization in the context of the target of 1990 to achieve Universal Child Immunization. He suggested that countries should plan for activities of EPI to be carried on beyond 1990 since once the target of UCI was achieved, it did not mean that EPI activities should he abandoned or the tempo reduced. The aim should be an integrated approach to be adopted in tackling EPI target diseases. The district health system mentioned earlier could be a useful vehicle to implement integrated EPI. Communicable Diseases Programme was one area where efforts to secure extrabudgetary resources could be made.
Noncommunicable diseases were emerging problems, particularly in countries like DPR Korea, Mongolia, Thailand and Sri Lanka. A reglonal programme on deafness would start from the biennium 1990-1991. Similar to the blindness programme, it was possible that inputs should be available from nongovernmental and professional organizations, with whom WHO was having fruitful collaboration.
As regards the forthcoming meeting of health ministers on AIDS to be held in London in the last week of January 1988, countries of the Region had been invited to this meeting and they should respond positively.
The VICE-CHAIRMAN suggested that a resolution adopting the Annual Report be submitted to the Regional Committee in due course.
Item 2 APPOINlWBNT OF A SUB-CUMMITIZE TO DRAFT BBSOLUTIOUS
He then proposed the constitution of a sub-committee consisting of representatives of Bangladesh, DPR Korea, India, Maldives, Nepal and Thailand to draft this resolution as well as resolutions on other important subjects, which would be considered by the Regional Committee on 21 September 1987. He said that if other Members were also interested to participate in the work of this sub-committee, they were welcome to do so.
Item 3 ADJOuuNmWT
The meeting was then adjourned. SOlMARY UI~S1
Fifth Meeting, 18 September 1987. 9.00 a.m.
AGENDA
Item Page
1. WHO-s Public Image Through its Health Development Work 178
2. Review of the Director-Generalns Introduction to the 183 Proposed Programme Budget, and Comments of the World Health Assembly Thereon
3. Method of Appointment of the Regional Direclor
4. Special Programme for Research and Training in Tropical Diseases
5. Adjournment
10riginally issued as document SEAfRC40fMin.5, on 19 September 1987 In the absence of the Chairman, the Vice-Chairman took the chair. He welcomed Mr Carl Erik Wiberg, Resident Representative of UNDP to DPR Korea.
Item I WBO'S PUBLIC IHAGE TBRWGB ITS HBhlTU DEVEWPMENT WORK RC Agenda item 14
The VICE-CHAIRMAN invited the Regional Director to introduce the subject.
The REGIONAL DIRECTOR said that this agenda item had an important implication not only for the Organization but also for health development in general. Since its inception, WHO had been a partner with Member States in their health development efforts. Several innovative measures had been initiated by the Organization to promote health and prevent diseases, and these had brought about significant changes in health development throughout the world. The eradication of smallpox and the movement of Health for All by the Year 2000 were regarded as important initiatives which had further strengthened the working relationship between WHO and its Member States. WHO had provided strong leadership and was considered a technical agency dedicated to the development of public health. It was thus appropriate that the work of the Organization was further promoted with a view to achieving its envisaged goal. He however cautioned against any attempt to publicize the Organization; rather an awareness about the activities of WHO should be created. In this context, he said that a workplan had been drawn up by the Regional Office, which formed part of the background document, and that the comments and suggestions made by the representatives should help to further refine it.
The VICE-CHARIMAN invited comments from the representatives and drew their attention, in particular, to the workplan annexed to the background document (SEA/RC40/8).
DR KIM YONG 1K (DPR Korea), referring to the fortieth anniversary of WHO, said that the current discussion had significance in evaluating the work of WHO and its role in international health development. The Organization had a number of achievements to its credit. He quoted, as examples, WHO's vital collaborative role in the global eradication of smallpox and implementation of the HFA strategies, with primary health care as the key approach. He said that WHO's proposal to promote its public image through health development work had the full support of his delegation. This would be given appropriate shape in his country on the occasion of the fortieth anniversary of WHO, in 1988, through propoganda, publishing papers and magazines and televising material about primary health care. This publicity would cover all activities and achievements of WHO. Efforts would be made, as a part of the celebrations, to accelerate and further promote primary health care activities and create model units in the name of WHO to boost the Organization's image. He proposed that WHO take up the Jang Dok county in South Pyongyang Province of DPR Korea for the intensification of primary health care activities.
MR AHOOJA (India) supported the idea that the programmes, policies and strategies of WHO needed to be further publicized in order to secure better support, but cautioned against the use of sophisticated media for the purpose. While he agreed that WHO-s programmes and activities, as well as its achievements, should receive the widest publicity through mass media and other communication channels in order to create awareness of its role and functions among the population, he felt that the use of sophisticated media, such as TV slots, for this purpose might be expensive. He said that emphasis should be on less expensive methods of publicity and that the current use of normal channels would be quite effective to create greater awareness among the people.
MR RAHMAN (Bangladesh) complimented WHO on creating a profound effect on the health policy of each country. Tnis was considered a remarkable achievement for an international organization, such as WHO. The change in WHO-s approach from technical asslstance to technical collaboration was quite pertinent, more so in the context of the Alma- Ata Declaration when the emphasis shifted to primary health care. Despite these outstanding achievements, it was unfortunate that WHO did not have the image that it deserved.
Referring to the strategies and approaches set out in the workplan, he asked whether the existing structure of the Organization was in conformity with the changed approach from technical assistance to technical collaboration, and from curative-oriented health policies to preventive and promotive orientation. With regard to the media approach, which appeared to be expensive, he cited the example of UNICEF which, by virtue of its multisectoral and collaborative programmes, had succeeded in promoting its image. Its greeting cards programme not only served to boost its image, but also helped to raise funds. He further pointed out that although health was regarded as a multisectoral activity, yet very little had been done to promote this concept, and suggested that the Organization emulate UNICEF in implementing its collaborative programme. Although a vast amount of resources might be needed, WHO should continue to collaborate with Member States in promoting the multisectoral concept. He complimented the Regional Office for preparing this document and presenting it for discussion. The VICE-CHAIRMAN suggested that document SEA/RC40/Inf.5, WHOISEAR Workplan for the Fortieth Anniversary of WHO, 1988, also be taken into consideration in order to enlarge the scope of the deliberations.
DR IDA BAGUS MANTRA (Indonesia) congratulated the Organization on preparing the workplan for promoting the image of WHO, and said that interaction with national counterparts was very important. In its absence, people did not have a proper understanding of the work and role of WHO, which they considered merely a funding agency. Secondly, the attitude of the national staff needed to be changed while increasing their capabilities. In providing technical assistance to the Member States, WHO should ensure the transfer of technology to the staff. Besldes, it had to play a coordinating role in the utilization of financial assistance flowing from various international agencies to the countries.
In regard to the fortieth anniversary, he assured the Organization that his country would support whole-heartedly the celebrations, and added that this workplan would be integrated with the national ZEH programme so as Co improve WHO'S immage.
DR FERNANDO (Sri Lanka) said that WHO had been one of the outstanding ageocies in the United Nations system and that it had contributed to che improvement of the health of the people living in developing countries. Highlighting its achievements during the forty years of its history, he said that the Organization had been making sincere efforts, in collaboration with Member States, to improve the health OF the people. He cornended the workplan drawn up by WHO and said that it would be a good tribute to the Organization if each country took up a particular activity for implementation during a specified period. This would no doubt accelerate the progress towards the goal of HFA. His country had set a target to reduce maternal mortality rate from 0.6 to 0.5 per cent by 1988.
DR NORBHU (Bhutan) said that WHO was regarded as one of the leaders among several agencies, and it was looked to for guidance in matters of health. There was thus no need for any special effort to boost its image through publicity. As for the fortieth anniversary celebrations, it would be appropriate simply to assess its work. He agreed that staff -, development could increase the level of technical competence of the Organization.
DR REGMI (Nepal) commended WHO'S role in the eradication of smallpox, control of malaria, the Alma-Ata Declaration on primary health care and its plan to immunize all children of the world by 1990. In view of its contribution to health development, it did not need any ~ublicity. What needed to be publicized was the fact that WHO was not a funding agency, but an international technical agency. It would be inappropriate to celebrate the fortieth anniversary by glamourizing the Organization. DR JADAMBA (Mongolia) recalled WHO'S achievements in the past and suggested implementation of resolution WHA40.06 to celebrate the fortieth anniversary. He confirmed that there had been no erosion of public image of WHO and stressed the need to inform the public of the strategies and approaches to HFA and the active involvement of the people. He suggested the issuance of commemorativ~stamps and postcards on the occasion of the fortieth anniversary, and distribution of booklets in local languages to educate the masses about WHO'S work. His delegation fully supported the proposed workplan and had reflected the country-level activities to be undertaken during the fortieth anniversary in the national workplan.
DR RASHEED (Maldives) observed that WHO had become a household name and that there was no doubt about its image. The current financial crisis should not be a factor necessitating boosting of its image. Instead, the Organization-s activities should be intensified during the fortieth anniversary celebrations. His delegation fully supported the proposed workplan. He said that the impression that WHO was a funding agency should be corrected by transferring knowledge and technology to national counterparts for improving further the health services.
The VICE-CHAIRMAN, speaking as the representative of Indonesia and as a member of the WHO Executive Board, referred to information, education and communication (IEC) and activities at the global, regional and country levels. He observed that activities at the global level had been accelerated during the past 2-3 years. There was need to strengthen many significant aspects at the regional level. The conntry-level activities depended more on the needs, aspirations and problems of individual countries. As related to WHO-s public image, the IEC programme needed to be strengthened. He observed that despite achievements sometimes the image was not enhanced and this was the case with WHO. Having served as Chairman of the WHO/UNICEF Joint Committee on Health Policy in the past year, he perceived the need to work together with UNICEF. Learning from an internal evaluation, he emphasized the need to accelerate the IEC programme in order to improve implementation of the national programmes. He requested the representative from UNICEF to give his views on WHOIUNICEF cooperation.
DR ADHYATMA (UNICEF) observed that UNICEF, as a funding agency, could not be compared with WHO, which was a technical agency. By working together, particularly at the country level, the image of both the agencies could be improved. UNICEF provided funds to other sectors, such as public works, social welfare and education, in addition to health. However, in carrying out its programmes, it benefited from WHO'S technical advice since UNICEF employed programme officers and not technical officers. He therefore underlined the need for closer cooperation between WHO and UNICEF at the country level.
The VICE-CHAIRMAN invited the Regional Director to comment on the feasibility of the programme in the next five years. 182 MINUTES OF TEE FIFTH IIBETING
The REGIONAL DIRECTOR was glad to note the encouragement and support extended by the representatives. He said that the activities proposed for image building were 'action-based' and aimed at improving health development work at the national level within the framework of planned activities for achieving the goal of Health for All by the Year 2000, and had been chosen carefully. The caution advocated by the representative from India in regard to the use of sophisticated media had been well taken and that it would be taken note of. As most of the activities were to be carried out at the country level, he looked forward to cooperation from the ministries of health and the WHO Representatives.
Although WHO did not function as a multisectoral agency, its relations extended beyond health ministries, for example, with foreign ministries on matters of policy, and with health ministries on operational matters. In addition, WHO dealt with other ministries on other matters, such as agriculture, housing, science and technology, social welfare, education, etc. It however did not operate as focal contact with planning ministries or prime ministers- offices as it was basically a health organization. It had been making conscious effort to raise the importance of health ministries, which were considered by many as weak ministries in the national context, by strengthening them.
The Regional Director reiterated that WHO extended technical collaboration to the national authorities and that it should not be treated as a donor agency. With regard to the development of WHO staff (item I of the 'strategies' included in the document SEA/RC40/8), he suggested that this item be linked to the proposal on WHO-s public image to enable it to improve its performance. The subject had also been included as an item in the document on management of WHO'S resources. Currently, national personnel, who were well qualified and had attained a level of competence in their own countries, were developed by further training. WHO staff were trained in managerial or technical aspects depending on their needs, but postgraduate training was no longer given. He assured that the documentation on these subjects prepared for the Regional Committee would be reviewed further taking into consideration the advice of the Regional Committee and actions would be taken by the Regional Office; but, the real actions lay at the country level.
In this context, the Regional Director referred to two important events, scheduled to take place in 1988. As part of the fortieth anniversary celebrations, a special session of the World Health Assembly was proposed to be held in Geneva on 4 May 1988, which would be addressed, among others, by the Chairman of the Executive Board, representatives of staff associations, the Director-General, and representatives of the six WHO regions. Secondly, on 6 May 1988, as part of the World Health Assembly, a function was proposed to be organized to commemorate the tenth anniversary of Declaration of Alma- MINUTES OF TEE FIFTH HEETING IR?
Ata. This function would comprise a round table discussion wherein the Executive Director of UNICEF, the Director-General of WHO, and one representative from each of the six WHO regions would participate. The Director-General had suggested that the regional committees nominate representatives from two countries, one to participate in the fortieth anniversary celebrations and the other to represent the Region at the round-table discussion. He proposed that the representatives discuss amongst themselves and arrive at some consensus regarding the two countries to be selected.
The VICE-CHAIRMAN accepted the Regional Director-s suggestion and indicated that countries would be willing to organize the programmes for the fortieth anniversary of WHO in such a manner that the occasion would be very fruitful for real health development of the people of the Region.
Item 2 REVIEW OF TEE DIRECI'OP-GRNEXAJ.'S INTRODUCTION lU TEE PROPOSED PROGRlWlE BmK;ET AND C-NTS OF TBE YOBLD llEALTEl ASSENBLY TBBBBON RC Agenda item 11
Introducing the subject, the REGIONAL DIRECTOR recalled that the Fortieth World Health Assembly had reviewed the Director-General-s Introduction to the Proposed Programme Budget for the financial period 1988-1989 and, in particular, his assessment of the WHO-s programme budget during the period of the Seventh General Programme of Work, as well as his reflections for 1988-1989 and beyond. The comments of the seventy-ninth session of the Executive Board, held in January 1987, had also been considered. The Assembly had requested the regional committees, vide its resolution WHA40.15, to review these documents and the comments of the Assembly thereon. The exercise was aimed at securing the best possible use of WHO-s limited resources in keeping with the spirit of all relevant resolutions of the World Health Assembly and the Executive Board. The resolution Further requested the regional committees to report on the outcome of their deliberations to the Executive Board at its eighty-first session in January 1988.
In pursuance of the above resolution, the Director-General had prepared a document entitled "Management of WHO-s Resources" (document EBBl/PC/WP/2). The Regional Committee had been requested to pay particular attention to two important sections of this document: viz. issues for review (paragraphs 21-41), and options for action (paragraphs 32-65). Individual issues had been identified and presented in the background document (SEA/RC40/14).
He mentioned that, in order to facilitate a review and discussion by the Regional Committee, an ad hoc consultation meeting had been held 184 nIHUTES OF TEE FIPTB lIEETIRG
%*. in the Regional Office on 14-15 August 1987. The observations and comments of that consultation had been submitted to.the twelfth meeting of the CCPDM whose views were contained in Section 2 of document SEA/PDM/Meet.l2/8. The outcome of the discussions on this subject in the current session would be reported to the Executive Board in January 1988.
The CHAIRMAN, CCPDM, said that discussions at the ad. hot consultation, as well as in the CCPDM, had started on the that there was a need for the optimal use of WHO resources. He then highlighted the two important issues considered by the CCPDM. First, there was no questioning the value system of WHO, since all countries had accepted it and were adhering to it. It was felt that a standardized single approach could not be insisted upon to achieve the goal of HFA, but that the matter had to be viewed in the light of prevailing socio-economic, political and cultural conditions of each country. Withholding a part of the budget or reallocating resources was not likely to meet the requirements. It would be necessary to indicate the planning figures to the Member States, but that the existing system could continue. Secondly, while there was emphasis on decentralization, some suggested actions were likely to lead to greater centralization. Thus, there was contradiction between certain policy goals and the actions suggested for achieving them. Both the comittee and the CCPDM had felt that monitoring and evaluation of the WHO collaborative programme needed to be intensified and a new mechanism had been suggested for this purpose, including greater role for the country support teams functioning at the Regional Office. The CCPDM was of the view that the present decentralized staffing system should continue for the success of WHO programmes.
The VICE-CHAIRMAN said that substantial information on this important topic was available to the representatives, and he suggested that the Committee might consider taking up one issue at a time so that the discussions would be fruitful.
The REGIONAL DIRECTOR stated that the document SEA/RC40/14 identified points for consideration while the document prepared by the CCPDM highlighted the issues that the Committee might wish to discuss. The two were inter-related and the discussion would be simpler if the Committee examined the document SEA/RC40/14, point by point, and * concentrated on the recommendations of the CCPDM on relevant points which reflected the views of the participants.
The VICE-CHAIRMAN invited comments on item 1 of Suggested actions, 'WHO-s system of values, policy and strategy for HFA'.
DR ISLAM (Bangladesh) said that the subject had been thoroughly discuseed at the CCPDM and almost all the participants, except Indonesia, had expressed their views. The Vice-Chairman, speaking as the representative of Indonesia, stated that his delegation fully endorsed the views of the other participants. XIROTBS OF TBE FIPTB MEETING 185
DR UTHAI (Thailand) expressed his happiness over the fact that the CCPDM had thoroughly reviewed the issues and options proposed in the Director-General-s paper on -Management of WHO'S Resources- and made recommendations on various points for consideration by the Regional Committee. While supporting the recommendations made in the CCPDM report (document SEA/PDM/Meet.lZ/B), he referred to some major points which needed further clarification and elaboration.
Point 7 on page 14 was highly relevant. The mechanism of country support teams would be a good linkage, along with WHO Representatives, as it envisaged a closer coordination with the countries in accordance with the Regional Programme Budget Policy which catered to the need for close collaboration between WHO and the countries at every step of the collaborative programme, viz, planning and implementation, and national health development. He proposed enlarging the terms of reference of the country support teams to enable them to review the country health development policies and strategies in order to identify appropriate WHO collaborative programmes to support effectively HFA strategies; to review periodically the progress in the implementation of country programme and make recommendations for remedial actions; to seek and mobilize technical and other support from the Regional Office; and to undertake a review of the collaborative programmes of the countries, along with some related national development programmes in the context of agreed policies.
The use of nationals to supplement the work of WRs (point I, page 20) needed elaboration. He wanted this point to be reviewed along with point 4 on page 22, regarding the recruitment of younger people in WHO and said that in his opinion, younger people, if recruited, would have better understanding and commitment to WHO'S value system, policies and strategies as they would be involved on a continuous basis for a certain period of time.
He strongly supported the principle and concept of delegation of authority for the implementation of the country programme budget at the country level. However, instead of setting a ceiling on country planning figure for delegation to the countries, it would be more fruitful and beneficial for effective management of WHO-s resources to select certain programmes in each country in which full delegation from the regional level could be implemented.
He fully supported point 3 on page 20 for action at the regional level and such a coordination could be developed through better and effective information exchange system by the use of microcomputers. In the context of Thailand, for example, it was difficult to know the exact situation at any point of time.
Regarding point 1 on page 15, he said that che Regional Committee should endorse WHO-s system of values, policy and strategy for HFA as these were very crucial for HFA strategies, a!; well as for better quality of life to the people in the Region. 186 HINUTBS OF THE FIFTE llBETING
The REGIONAL DIRECTOR was happy at the comments of Dr Uthai which showed his close involvement with WHO and of his knowledge and experience. However, for easy reference, he suggested that the Committee take up action points one by one.
Referring to some of the points raised by Dr Uthai, the CHAIRMAN, CCPDM, said that the CCPDM had discussed the role of the country support teams and the terms of reference in great depth. Fears were expressed that the CST should not be given terms of reference that would make it another level of contact between the Member States and the Regional Office. A situation should not be created in which all programmes had to be referred to the CST, resulting in further delays, instead of expediting programme implementation. A periodic review of the programmes with the CST would present a mechanism in which closer interaction would take place between the Regional Office and the Member States, If the reviews were to take place thrice during a biennium, it would bring out deficiencies in the implementation of the programmes which could be rectified.
He said that the point regarding recruitment of staff at a younger age was gone through very thoroughly by the CCPDM which did not consider it feasible as the proposal was beset with practical difficulties for the reasons stated on page 22 of the report.
The REGIONAL DIRECTOR said that Dr Uthai touched upon a number of points. After Mr Ahooja-s intervention, he still thought that the Committee should deliberate on the point regarding CST. He felt that Dr Uthai's observations on the methods should appropriately relate to the section on the role of WRs and to the use of nationals by the countries which formed part of other sections (9 on page 20). Recruitment of younger staff which came under section 11 on page 22, was different.
The VICE-CHAIRMAN proposed that the Committee consider the suggested actions, item by item.
There were no observations on points 1 and 3. With respect to point 4, the REGIONAL DIRECTOR pointed out that the earlier remarks of Dr Uthai regarding the role of WHO Representatives were relevant to this item. Referring to point 5, he said that Dr Uthai suggested earlier enlargement of the terms of reference of the country support teams. The CCPDM did not consider it desirable to make CSTs as an additional level between the country and the Regional Office and that the terms of reference should not be too elaborate.
DR NORBHU (Bhutan) said that the item of CSTs was discussed in depth by the CCPDM and since this was a new mechanism and the delegates did not have enough experience about its working to be able to form firm views, the CCPDM was cautious and did not want this mechanism to delay the implementation of the programmes. IIIHUT%S OF TBE FIFTH HEETING 187
DR UTHAI (Thailand) agreed with the views expressed by the Chairman, CCPDM, and the representative from Bhutan. He did not propose to create another type of mechanism in order to delay the process of planning or budgeting, but said that the CST should have some terms of reference to work on in scrutinizing programmes and also integrate support from various divisions of the Regional Office. He therefore suggested that the subject be discussed either by the Committee or by the CCPDM at its next meeting.
The REGIONAL DIRECTOR said that the existing terms of reference were more on technical cooperation and support so that the CST could work jointly with the national teams and the WR. This method could strengthen the decision-making process of the national authorities. The terms of reference of CSTs could be studied by the next CCPDM.
The Committee was in agreement with item 6, Review of WHO'S Action in Individual Member States.
With regard to item 7, Country Planning Figures, DR UTHAI (Thailand) clarified that the country planning figures (CPF) would help the countries to start their planning process. Documerlt DGO83.1 on the New Managerial Framework for Optimum Utilization of WHO-s Resources suggested its optimal use by the Member States. The CPFs were needed to work on formulating planning and detailed programing.
He suggested trying out decentralized management of a particular major programme in a few countries. The programmes areas could be identified by the countries, based on a country's specific needs. Thailand could opt for the PHC programme, for example, and another country might decide upon the malaria programme. No doubt, the programme would be collectively based upon the policies and strategies of HFA using PHC as the key approach.
The VICE-CHAIRMAN said that the Regional Office had introduced many innovative aspects in recent years on policy programme, programme planning, etc. in order to improve the planning process. On the one hand the shortage of financial resources was being discussed, and on the other, the expectations of the Member States were increasing. The . need of the hour therefore was to reappraise priority settings and make the best of the available resources. This was the right time to strengthen the planning process which, in this light, should be reviewed from the district level to the WHO-s regional collaboration level. This would improve the planning process and thereby improve the planning figures.
The REGIONAL DIRECTOR agreed that the planning process at the country level was inadequate and efforts should be made to strengthen the planning process, mechanisms, and the infrastructure. This was the purpose of the MPNHD. The observation made by the Vice-Chairman could be reflected appropriately, perhaps as observation 1 on 'Action at 188 MINUTES OF RIE PIFTE UEETING
Regional Level* against item 7, Country Planning Figures. Para 60 of EBBl/PC/WPZ suggested the abandonment of CPFs and that the country allocations might be determined based on actual deliveries. He feIt that Dr Uthai-s suggestion on 'decentralized management' went in another direction, but this could be more appropriately incorporated as observation 4 -Decentralized arrangernents- under -Action at Country Level*.
DR UTHAI (Thailand) agreed with the suggestion made by the Regional Director.
With regard to item 8, -Ensuring Timely Implementation and Disposal of Unobligated Funds', DR FERNANDO (Sri Lanka) said that this item was discussed at length both at the CCPDM and in the Sub-committee on Programme Budget. It had been suggested that if two-thirds of the allocation of the country had not been utilized by the end of the second quarter of the second year of the biennium, the unobligated amount would be diverted for use by other countries. He hoped that such a situation would not arise because the implementation rate was around 62 per cent for the first 18 months. Secondly, a number of recommendations had been made to improve the delivery rate. It was also hoped that the use of CSTs would accelerate delivery in the countries. The observations of the CCPDM under item 6, Review of WHO'S Action in Individual Member States, will also obviate the need to resort to diversion of funds.
In regard to item 9, Functions of WRs, the Regional Offices and HQ, the VICE-CHAIRMAN said that the functions of management cooperation was considered to be weak and limited in many regions. Hence, stress needed to be laid on the strengthening of management, and this was not only a practical, but also a strategic measure. Hence management of cooperation should be strengthened at regional and higher levels for better collaboration with other agencies.
The REGIONAL DIRECTOR suggested that this could be incorporated against item 5 on 'Action at Regional Level-. The main idea was to strengthen management of cooperation at the regional level and to develop it further in collaboration with other agencies, and thereby improve the Organization's leadership in the health sector.
Item 10, Structure of the Regional Office, needed further study in the light of the needs of the countries and in the context of the financial situation.
DR FERNANDO (Sri Lanka) said that as far as item 11, Present System of Staffing of WHO Secretariat, was concerned, he was somewhat per- turbed to observe the remarks on the recruitment of WHO Representatives through a central roster. WRs would have to have close liaison and rapport with the national authorities, the ministry and the government. Therefore if a person not acceptable to the receiving country was MINUTES OF TtLP: PIPRl MEETING 189
appointed, it would result in an unsatisfactory arrangement both for the country and the WR. He felt confident that the countries of the Region would be concerned if WRs who were not in tune with the needs and aspirations of the country were to be assigned. Therefore the appointment of WRs should be made only after close consultation with the recipient countries.
MR AHOOJA (India), agreeing with the vi~?ws expressed by the Representative of Sri Lanka, said that the current procedures in the appointment of WHO Representatives should continue.
DR JADAMBA (Mongolia) supported the point made by the Representative from India that the present system of close consoltations between the Director-General, the Regional Director and the country should continue in the appointment of WHO Representatives.
DR UTHAI (Thailand) said that decentralization of powers and functions to the country level with regard to implementation of Organization's collaborative programmes should include delegation of authority to the countries and the Regional Office not only for the formulation of policies and strategies, but also for the recruitment of personnel. He therefore felt that close consultation between Headquarters, the Regional Office and the Member States should continue in the matter of selection of WHO Representatives.
DR REGMI (Nepal) expressed his full support to the views expressed by earlier speakers on the subject.
The REGIONAL DIRECTOR stated that even though the Regional Office, at present, had the delegated authority to recruit staff upto P5 level, there were certain procedures established by Headquarters and these points needed to be taken into consideration while processing recruitment. In the case of recruitment of staff at levels higher than P5, such as that of WHO Representative, consultattons with Headquarters and final approval by the Senior Staff Selection Committee was necessary. He noted that the delegates were not happy about the statement in the Director-General's paper that the WHO Representative should be appointed through a centralized system of recruitment, and that the democratic process hitherto followed, i.e., close consultation * between the Government, the Regional Director and the Director-General, should continue. The views of the Committee would be reflected in the final submission to Headquarters.
The VICE-CHAIRMAN, referring to point 6 on page 22 relating to long- term staffing policy, said that such a policy sho~~ldpay attention to educational aspects too.
MR AHOOJA (India), while favouring the evolution of a balanced recruitment policy, said that a time-frame should be fixed for the development of the long-term staffing policy. The REGIONAL DIRECTOR said that Headquarters was at present involved in looking at the long-term recruitment policy of the Organization globally in all its aspects, such as programme needs, and staff recruitment, development, training, etc. and hence the Executive Board had requested the Regional Committees for their views on this matter so that they could be considered by the Board while developing its policy paper. Some studies had recently been conducted by two or three study groups. The current financial situation was a constraint to this process though the thinking about the future staffing pattern indicated a trend towards recruitment of a core group of public health generalists, to be called health development specialists, while a number of short-term consultants would be provided in specialized fields. However, finalization of the long-term staffing policy would take some more time since the plan would depend on the funding situation.
Item 3 WeMOD OF APPOINlMWT OF THE ERGIONAL DIBECTOB RC Supplementary Agenda item 4
DR FERNANDO (Sri Lanka), introducing the paper on the agenda item (SEA/RC40/18), said that the subject, which had been discussed by the Executive Board in January 1987 without reaching any consensus, was quite important to the Member States as it had put forward certain suggestions in respect of the method of appointment of the Regional Director, such as submission by the Director-General of a list of names to the Regional Committee for selection of one of them or that the Regional Committee submit three names to the Executive Board in order of priority for selection by the Board.
Referring to the constitutional basis for the appointment of the Regional Director, as set out in Article 52 of the WHO Constitution, he said that the selection process had been carried out in the past at the level of the Regional Committee, which submitted the name of one candidate, for appointment by the Executive Board, as the Regional Director. The different suggestions considered by the Board, in his opinion, were not acceptable since the countries in the Region made a thorough assessment of the candidate nominated for the post of the Regional Director and had close consultations with each other in his nomination, with whom they hoped to work for a minimum period of five years. Enumerating the qualities which a candidate for the post of Regional Director must possess, such as, integrity, experience, thorough knowledge of health problems of the Region, loyalty to the value system of WHO, as well to the Organization as a whole, he said that the views of his government in the matter of selection of Regional Director were that the candidate for the post of the Regional Director must necessarily be from among the Member Countries in the Region, should possess the qualities referred to earlier, and that the Regional Committee should nominate the candidate and the Executive Board confirm the nomination.
DR REGMI (Nepal) said that as the Regional Director had to serve the Member countries of the Region, the selection of the candidate should be made by the Regional Committee, in consultation with the Director- General, and therefore the existing procedures should continue.
MR RAHMAN (Bangladesh), while congratulating the Government of Sri Lanka for its timely and thought-provoking paper on the subject, stated that the Government of Bangladesh had considered the matter in great detail and was of the view that, in order to ensure continuity and appropriate development of the Region, no changes should be effected in the existing method of appointment of the Regional Director.
The VICE-CHAIRMAN, while agreeing with the view that the present practice of selection of the Regional Director should continue, said that there could be some improvement in strengthening the process of consultations between the Regional Committee and the Director-General in the matter.
MR AHOOJA (India) felt that the candidate selected for the post of Regional Director must belong to the Region since only such a person could appreciate the health developmental activities of the Region and take appropriate decisions for the successful jmplementation of the Organization-s collaborative programmes. Though the selection of the Regional Director was the prerogative of the Member States of the Region, he saw no harm in improving the consultation process between the Regional Office and the Director-General in order to ensure that the latter's advice was available to the Regional Committee.
DR JADAMBA (Mongolia) agreed that the present system of selection of Regional Director should continue.
The VICE-CHAIRMAN, summing up the discussions on the subject, said that the consensus of the Committee was that the current practice of selection of Regional Director by the Regional Committee and approval by the Executive Board should continue and that the consultation process with the Director-General should be strengthened in such a way . as to reflect the aspirations of the Member States of the Region as well as the global concern.
Item 4 SPECIAL PROGBlUME FOR BESBABCB lum TRAINING IN TROPICAL DISEASES RC Agenda item 15
The REGIONAL DIRECTOR, introducing the document on the subject (SEA/RC40/9), referred to the twin objectives of the Special Programme for Research and Training in Tropical Diseases (TDR), viz. promotion of research for the development of new and improved tools to control malaria, filariasis, schistosomiasis, trypanosomiasis, leishmaniasis and leprosy and strengthening of research capabilities of the tropical countries affected by these diseases. The TDR Programme was being managed by a Joint Coordinating Board (JCB), which had a membership of 30, including two, India and Sri Lanka, from the South-East Asia Region. The Regional Committee decided, in 1981, that representatives who attend the JCB sessions be requested to make a report to the Committee.
MR AHOOJA (India), giving the highlights of the tenth session of the JCR, held in Geneva in June 1987, said that some of the major achievements reported at the session related to the synthesis of mefloquine, its availability for malaria control programmes in several countries, agreement with the pharmaceutical industry to keep the price as low as possible as well as production of kits for measuring drug resistance malaria. Referring to the support provided by the TDR for research in malaria vaccine development and the heavy investment made by several agencies and pharmaceutical firms, he said that candidate vaccines would soon be ready for clinical evaluation and it was necessary to carefully plan and control malaria vaccine trials, since the results of different trials should be directly comparable for selecting the vaccine for malaria control programmes. TDR would continue to fund vaccine research and coordinate the development of candidate vaccines.
The multidrug regimen had shortened the therapy for leprosy patients and fixed combined regimens appeared to be cost-effective as compared to life-long dapsone treatment. Although vaccines were a powerful tool for prevention, their effectiveness and precise role in disease control had to be determined and, therefore, trials would have to be undertaken in non-endemic and endemic areas with a view to determining their safety and acceptability and their potentially protective immunogenicity. With the increasing demands for more disease control programmes emerging from research laboratories and scientific research, the TDR would have to pay more attention to the strengthening of field research capabilities in the countries. The meeting approved a budget of $59.3 millions for the biennium 1988-1989, of which 25 per cent had been earmarked for the strengthening of research capabilities. Further, a new component, called Programme Development Fund, had been established to meet the recommendations made by the Scientific and Technical Advisory Committee, which was the most important committee of TDR and which reviewed from scientific and technical angles the expenditure, scope and dimension of the TDR and recommended priority areas for its support. The JCB session also reviewed the progress made since the previous year in regard to external evaluation of the Programme and research in tropical diseases in specific relation to AIDS had also been brought under its purview. DR FERNANDO (Sri Lanka) reported that considerable discussions on malaria had taken place at the JCB session. He said that the Board was aware that no country had yet developed a satisfactory vaccine, though trials were underway in Sri Lanka with promising results.
Although the Director-General advocated the integration of acute respiratory infections programmes with the existing diarrhoea1 diseases programmes, JCB felt that the countries should be free to decide whether to have integrated programmes or separate ones.
The REGIONAL DIRECTOR informed the delegates that the South-East Asia Region was receiving technical and financial support and collaboration from the TDR. With the new approach from the current year, there would be more support for research strengthening activities based on institutions, and therefore Member States should attempt to produce technically sound, manageable and feasible proposals to attract more funds, and simplify internal clearing procedures.
Item 5 AlMOOPHlBWT
The meeting was then adjourned. SmY111ms1
Sixth keting, 18 September 1987, 2.30 p.m. AGENDA
Item Page
1. Consideration of the Report of the Sub-committee on 196 Programme Budget
2. Consideration of the Recommendations Arising nut of the Technical Discussions
3. Special Programme of Research, Development and Research Training in Human Reproduction - Membership of the Policy and Coordination Advisory Committee
4. Consideration of Resolutions of Regional Interest Adopted by the World Health Assembly and the Executivc! Board
5. Selection of a Subject for the Technical Discussions at the Forty-first Session of the Regional Commit.tee
6. Time and Place of Forthcoming Sessions of the Regional Commi t tee
7. Consideration of Draft Resolutions
, 8. Adjournment
loriginally issued as document SEA/RC40/Min.6, on 19 September 1987 Item 1 CDUSIDEIUTION OF TBE REPORT OF TUB S-TlXE ON PROGUMHE BUDGET RC Agenda item 12.1
The VICE-CHAIRMAN invited Dr Fernando, Chairman of the Sub-committee on Programme Budget, to present the report.
DR FERNANDO said that the Sub-committee on Programme Budget consisted of representatives from all countries of the Region, except Burma, and its terms of reference appeared in document SEAlRC4014 covering four main areas. The first area related to review the implementation of programmes during the first 18 months of the 1986- 1987 biennium; the second concerned examination of the detailed programme budget for the biennium 1988-1989, with particular reference to the pattern of utilization of assistance in respect of each component, namely, long-term staff, short-term consultants, supplies and equipment, subsidies, grants and group educational activities, during the preceding and ongoing biennia; the third related to review of the contingency plan for reduced implementation during the 1988-1989 biennium, while the fourth area related to any other issues on which the Sub-committee wished to make a reference or recommendation to the Regional Committee.
He said that the'sub-committee held three meetings to carry out the assigned task and finalize its report. He read out the recommendations contained in the report of the Sub-committee (SEA/RC40/21).
The VICE-CHAIRMAN, thanked Dr Fernando for his presentation and said that the Sub-committee which comprised representatives of all Member States, had produced a report which had been circulated to all the representatives. As the Sub-committee had gone through the issues thoroughly, it would perhaps be advisable for the representatives to restrict their observations to the policy issues and principles at this stage. However, any additional comments would be welcome.
DR UTHAI (Thailand), supporting whole-heartedly the recommendations of the Sub-committee, said that it was gratifying that representatives ~. were involved in the formulation of the programme budget as well as the Regional Programme Budget Policy which contained criteria for prioritization of programme areas. He expressed his appreciation of the Organization-s ability and efforts to seek extrabudgetary resources in order to bridge the gaps created by the reduction in WHO regular budget. It was important to note that the extrabudgetary resources had gone over $21 million, as shown in document SEAlRC4013, from the $16 million noted at the last session. This was all due to the Organization-s sincere efforts to offset the pruned regular budget in order to continue its collaborative programme uninterruptedly. MR AHOOJA, referring to the views of the audit that 75 per cent of the funds should be obligated by the third quarter of the year, said that it would be more realistic to plan the programmes properly. To insist on utilization of 25 per cent of the programme in each quarter would not be realistic. As a natural phenomena?, there would always be greater concentration of expenditure during the last quarter, and this should be accepted as a realistic attitude to programme implementation.
The REGIONAL DIRECTOR agreed with the views expressed by the Representative from India that the expectations of the auditors were high. He said that it would however be better t:o improve delivery at the country level and avoid genuine delays. It would be pertinent for the Committee to know that when the matter of management of WHO-s resources came up for discussion at the governing bodies of WHO, it became difficult to explain the delays in the implementation of the envisaged programme. The action taken at the country level and directed by the Region was being controlled by HQ who had a mandate from the Assembly. It was thus incumbent on the part of the countries as well as the Regional Office to improve the implementation of the collaborative programme.
DR UTHAI sought clarification on the three scenarios mentioned under Item 4 of the Sub-committeees Report. He also enquired when the Medium- Term Programme mentioned in item 5 of the same document would be finalized and made available to the Member States in the preparation of detailed programming for the 1990-1991 biennium.
Replying to the queries raised by the Representative from Thailand, the REGIONAL DIRECTOR said that the three scenarios, described in the document SEA/RC40/PB/WP3, were designed to meet the financial situation arising out of delays in the receipt of contributions by the Member States. In regard to the Medium-Term Programme (MTP), this was based on the Eighth General Programme of Work (8th GPW) which had been approved by the World Health Assembly in May 1987. As this Programme would begin from 1990, the MTP would cover 1990-1995. During the next two years, that is the 1988-1989 biennium, the focus would be on the Seventh General Programme of Work. However, since there existed a . general frame in the Eighth General Programme of Work for such programmes as blindness and deafness to start in 1990, a beginning could now be made in these fields to provide some coverage.
MR HELMHOLZ (Director, Support Programme), complementing the Regional Director-s statement, said that the preparation of the programme budget for 1990-1991 would commence shortly. It would perhaps be appropriate to prepare the budget within the context of MTP. Copies of the relevant documents would be sent to Member States before long.
DR FERNANDO (Chairman, Sub-committee on Programme Budget) thanked all members of the Sub-cornittee and of the CCPDM, and the secretariat for their assistance in finalizing the report of the Sub-committee. The VICE-CHAIRMAN requested the secretariat to draft an appropriate resolution for adoption by the Regional Committee.
Item 2 CONSIOERATIOII OF TBe RE-ATIONS ARISING OUT OF TEE TECEINICAL DISCUSSIONS RC Agenda item 13
DR NORBHU (Chairman, Technical Discussions Group) acknowledged the support of the secretariat in preparing the report on the technical discussions and said that the programme on IEH was reviewed from many angles: concept, scope and objectives of IEH, structure of the programme, manpower development, community involvement, mass media and research. He then read out the recommendations arising out of the technical discussions.
DR ABDULLAH (Maldives) suggested modification of items 1 and 2 of the recommendations. He said that the phrase 'emerging health care system- in item 1 was rather vague and that the existing structure was not effective enough to attain the objective of IEH. In regard to item 2, he suggested replacing "health development" by "health orientation".
DR MANTRA (Indonesia) said that in his country the organizational structure had undergone a change only recently. He therefore suggested that the recommendation be modified to read "organizational structure in some countries may be changed as to fulfil the mission of IEH".
MR RAHMAN (Bangladesh) referred to item 4 (b) of the recommendations and said that the terminology "communication sectors" was not clear. He suggested substituting it by "health related ministries".
MR AHOOJA (India) referred to item 4.5 concerning mass media and suggested that the possibility of disseminating health information through teachers and school-going children be incorporated. He also suggested that item 4 (b) of the recommendations concerning linkages be amplified. -i Responding to the observations made by the Representative from India, DR NORBHU confirmed that the point raised by him had been considered at the discussions. It was agreed that school health education component, wherever effective, be used.
The REGIONAL DIRECTOR, referring to item 1 of the recommendations said that a change in the organizational structure could upset the planned pattern of the country structure. He therefore suggested that the staff be given proper orientation. At the request of the Regional Director, Dr Bisht (Director, Health System Infrastructure) read out the proposed revised wording. DR ABDULLAH (Maldives) thought that it would perhaps meet the purpose if the word 'organizational- were deleted, since, under item 4.2, the report referred to *structure' without specifying *organizational'. Alternatively, the Committee could emphasize 'structure needing reorientation', in the sense of concentration of specialists at the national level not serving any useful purpose.
The VICE-CHAIRMAN said that the word *changes- could be substituted by 'strengthening- or *reorientation* and th,! sentence rephrased suitably.
DR MANTRA (Indonesia) said that Indonesia had taken an important step in this direction by developing a mutually beneficial partnership with the press association of the country. This had encouraged working with groups that had potential for health education, such as women-s associations, religious groups, etc., in the present situation when resources were limited. He wished this situation to be reflected in the report.
DR NORBHU mentioned that though the group had tried to incorporate these aspects in the report, it could not be more specific. The first point raised by Dr Mantra relating to multi-media and social marketing had been covered under recommendation 4(b), while the second had been covered in the text of the report, though it had not been included in the recommendations.
DR JADAMBA (Mongolia) was of the view that the reference to mass media, as contained in the report, might not be acceptable to some countries. Mongolia's experience in using mass media for health information and education had not been disappointing. The wording of item 4.5 needed to be changed in this context.
MR RAHMAN (Bangladesh) stated that in his country, nongovernmental organizations had played a very important role in developing the IEH sector. This had led to increased awareness of health problems, such as diarrhoea1 diseases and EPI.
The REGIONAL DIRECTOR suggested that the reco~nmendations could be -_modified suitably to reflect the views expressed by the representatives.
The VICE-CHAIRMAN then invited the Chairman of the technical discussions to read out the revised version of the recommendations.
DR NORBHU read out the revised recommendatron 1. Suitable re- orientation and strengthening of IEH is needed in respect of policies, strategies, approaches and adequate research allocation to provide support to the goal of Health for All by the Year 2000.'. The revised item 4(b) read as: -Linkages should be established between various health-related sectors to get the maximum benefit of IEH programmes. Mechanisms should be developed for intersectoral coordination. Efforts 200 MINUTES OF THE SIXTI3 MEETING - should be made to involve fully NGOs, including women's and other organizations in IEH activities.-
DR DAMRONG (Thailand) felt that recommendation 2 should be more precise to cover temporary and foreseeable issues concerning academic and in-service training of professionals who were the key to the strengthening of IEH programmes. He suggested that this recommendation might be reworded to read: -The existing academic and in-service training programmes for health professionals should be reviewed, based upon health for all strategies and its implied value, and strengthened in respect of information, education, and communication sciences. The teaching should be participatory and field-oriented. Similarly, training of media personnel should include 'Health Orientation' and close interaction between media specialists and content specialists should always be brought into focus.'
XR AHOOJA (India) reminded that he had suggested that children could be used in reaching the parents. He wondered if this was included.
The REGIONAL DIRECTOR suggested that Mr Ahooja-s remarks could be incorporated in the text of the report.
Item 3 SPECIAL PROGRAMHE OF RESBILRCB. DEVEU)P1IEM AND RESEARCH TRAINING IN EllUAN REPRODUCTION - llEWERSBIP OF POLICY AN0 COORDINATION ADVISORY -1lTEB IN PLACE OF NEPAL WHOSE TEUU WIRES ON 31 DECEHBER 1987 RC Agenda item 16
Introducing the item, the REGIONAL DIRECTOR said that this Programme was established in 1972 to promote, coordinate and develop technology relating to human reproduction and family planning. The Policy and Coordination Advisory Committee (PCAC) acted as the main advisory body to this Programme. Explaining the status of membership under category (b), he said that out of three members from the Region, Nepal would complete its tenure at the end of the year. Hence the Committee might wish to nominate a suitable member for representing the Region for three years starting from January 1988. Thailand and Indonesia had been invited to serve.in category (c) for a three-year period from 1 January -' 1988. These could not be considered for election.
DR RAHMAN (Bangladesh) wondered if either Sri Lanka or India would accept a nomination.
MR AHOOJA (India) said that since India was a substantial contributor to this Programme, it might be entitled to membership under category (a). A nominee from another country would therefore increase the strength of the Region's participation in the Programme.
DR FERNANDO (Sri Lanka) agreed to Sri Lanka being nominated. u1msOF TEE SIW mInG 20 1
Item 4 COUSIDlBAIItXl OF RESOLUTIONS OF REGIONAL IUTBREST MlOPTED BY m Hlm BBblra ASSglIBLY AAD TEE KXBrnIvE Born RC Agenda item 17
Introducing the item, the REGIONAL DIRECTOR said that the document contained 23 resolutions of regional interest. Out of those, sixteen resolutions had already been considered along with the Annual Report of the Regional Director and other agenda items. He would therefore wish to bring to the attention of the Committee the remaining following seven resolutions.
Recruitment of International Staff in WHO: Participation of Women in the work of WHO (WHA40.9 and EB79.Rl3)
Development of Guiding Principles for Human Organ Transplants (WHA40.13)
Economic Support for National Health for All Strategies (WHA40.30)
Eighth General Programe of Work Covering a Specific Period (1990-1995inclusive) (WHA40.31 and EB79.Rl8)
Cooperation in Programme Budgeting (EB79.R9)
MR AHOOJA (India) referring to the resolution on -Recruitment of Staff in WHO: Participation of Women in the Work of WHO; said that while the CCPDM was reviewing the Regional Director-s Annual Report, it had been observed that the percentage of women who had been awarded fellowships fell below the 30% mark. This was a matter which the Member States should note and take appropriate remedial measures.
The VICE-CHAIRMAN referred to the resolution 011 Economic Support for National Health for All Strategies, and said that this was the result of the technical discussions in an earlier World Health Assembly. This resolution was in line with the many efforts that were being made in the Region to mobilize additional resources and also to have proper financial planning. Prompt attention should be paid to this subject. 2 This topic had come up during the discussions on the Regional Director's Annual Report and other agenda items.
The REGIONAL DIRECTOR said that the first point made by the Repre- sentative of India had been noted. Some time ago a lady consultant had been recruited to review the situation on women. One of the recommen- dations made by her was that efforts to remedy the imbalance should start in the administrative machinery of the countries themselves.
With regard to the point raised by the Vice-Chairman, he agreed that this resolution had arisen out of the technical discussions in the World Health Assembly. There were other documents available on this subject, and he would be happy to provide them to the representatives.
The 8th GPW had already been discussed in the meeting earlier. The MP was based on 8th GPW which had been adopted by the Executive Board and the World Health Assembly, and the regional MTP had been developed within that framework. The World Health Assembly wished to see that WHO'S programme in the future was based on progrsmm budgeting and also that the Member States discharged their financial obligations punctually.
The Regional Committee noted the resolutions brought to its attention.
Item 5 SELECTIOR OF A S-CT QOR THE TECHNICAL DISCUSSIORS AT TlIX WRR-FIRST SESSION OF TBB REGIONAL COMIITTKE RC Agenda item 19
The REGIONAL DIRECTOR introduced the agenda item drawing attention of the Committee to the working document (sEA/RC40/13) listing subjects discussed since 1978, and giving four subjects for possible discuf~sions at the Forty-first Session of the Regional Committee. He said that the repre- sentatives might feel free to propose any other topic, if they so wished.
DR UTHAI (Thailand), proposed the subject, 'Development of district health systems'. Though this subject was superficially referred to by the Director-General two years ago in the World Health Assembly, no concrete policies, strategies and programmes at various levels, both in the countries and in the Organization, were available.
The VICE-CHAIRMAN agreed with Dr Uthai and said that it was the first time that mention was made to the subject of district health system in a proper manner.
DR REGMI (Nepal) suggested the topic, 'Strengthening of strategies for the development of water supply and sanitation for achieving the goal of Health for All by the Year 2000' as a first choice and 'Development of district health systems' as the alternate subject.
DR NORBHU (Bhutan) supported the proposal of Or Uthai.
DR FERNANDO (Sri Lanka) also preferred the subject of development of district health systems.
OR ABDULLAH (Maldives) supported the proposal made by Dr Regmi.
MR AHOOJA (India) and DR CHON SU OK (OPR Korea) also supported the topic of development of district health systems. In view of the preference of the majority of the countries, the VICE-CHAIRMAN announced that the topic for technical discussions at the Forty-first Session of the Regional Committee would be 'Development of District Health Systems-.
Item 6 TmAND PLACE OF FORTECCUING SESSIONS OF TBE REGIONAL CMMITTEE RC Agenda item 18
Introducing the item, the REGIONAL DIRECTOR said that it was customary to hold alternate sessions of the Committee in the Regional Office, unless there was an invitation from a country. The Regional Committee had received invitations to hold the Forty-first Session in Bhutan in 1988 from the Royal Government of Bhutan and for the Forty-second Session in 1989 from the Government of Indonesia. Representatives from these countries might wish to confirm the invitations.
DR NORBHU (Bhutan) said that regrettably it was not possible to host the session of the Committee in 1988, but his government would however like to host it in some other year.
The REGIONAL DIRECTOR said that in view of the situation, the Forty- first Session of the Regional Committee could be held in the Regional Office, unless an invitation is received from any Member State.
The VICE-CHAIRMAN suggested that the Committee agsee with the proposal made by the Regional Director to hold the Forty-first Session in the Regional Office, unless some invitation comes from any country.
DR MANTRA (Indonesia) renewed the invitation of his Government to host the Forty-second Session in Indonesia. The exact place and time would be decided later.
Item 7 - CONSIDEUATION OF DRAFT RESOLUTIONS A preliminary review was made of the draft resolutions prepared by the sub-committee on drafting resolutions.
Item 8 ADJOURIWFXF
The meeting was then adjourned. SIWURY MINDTES~
Seventh Meeting, 21 September 1987. 9.00 a.m.
AGENDA
Item Page
I. Consideration of Draft Resolutions 206
2. Fortieth Anniversary of WHO and Tenth Anniversary of the 209 Declaration of Alma-Ata
3. Adoption of the Final Report 209
4. Adoption of Resolutions
5. Closure of Session
loriginally issued as document SEA/RC40/Min.7, on 15 October 1987 In the absence of the Chairman, the Vice-Chairman took the chair.
Item 1 CONSIDERATIOR OF DEAFT RBSOLVTIORS
The VICE-CHAIRMAN proposed that the Committee begin its discussions with the draft resolutions. Resolutions numbered 3-11 had been discussed in the earlier session and agreed upon by the representatives. Draft resolutions Nos.1 and 2 required some further elaboration and discussion. Draft resolution No.1 on Prevention and Control of AIDS in the South-East Asia Region was taken up for consideration.
DR UTHAI (Thailand) drew the attention of the Committee to operative paragraph 3 of the Resolution, sub-paragraph (a) of which urged Member States *to participate actively in the implementation of the Regional Plan of Action in the context of the WHO global strategy for the prevention and control of AIDS'. He proposed that the text be changed to read: '(a) to formulate national plans of action for facilitating the implementation of the Regional Plan of Action in the context of the WHO global strategy...'.
MR AHOOJA (India) was of the view that most of the Member States of the Region had already formulated their national plans of action and the question now was of implementation of the Regional plan of action. The main purpose of this resolution was to emphasize the importance that the Regional Committee attached to the question of AIDS. He felt that the resolution, as it stood, might serve the purpose, as the Member States were fully aware of the importance of the problem.
The REGIONAL DIRECTOR suggested -formulation' be replaced by *to formulate and/or implement...'. The VICE-CHAIRMAN was of the opinion that if the Regional Director's * proposed phrase was acceptable to the representatives, then that would cover the suggestions made by the representatives of Thailand and India.
MR RAHMAN (Bangladesh) felt that the suggested revision appeared to be repetitive and required editing.
The VICE-CHAIRMAN clarified that 'Regional Plan- and *National Plan' were two separate entities and deserved to be mentioned separately.
The REGIONAL DIRECTOR proposed a revision of the paragraph, to read: 'to formulate and/or implement national plans of action for facilitating the implementation of the Regional Plan of Action in the context of the WHO global strategy for the prevention and control of AIDS'. This was agreed to.
He drew attention to the revised draft resolutions 2 and 8 and solicited the views of the representatives.
DR MANTRA (Indonesia) suggested amendments to paragraph 4 of the draft resolution 2. He felt that it was appropriate that the importance of research, which had been discussed many times during the meeting, be reflected in this resolution. He suggested rewording para 4(c), to read: 'to monitor and review the management of WHO-s resources at the country level and to promote and support research and development required to facilitate the implementation of the national policies and strategies for achieving HFA/2000-.
The VICE-CHAIRMAN proposed further modification of the paragraph, urging Member States -to further promote and strengthen the research and development required to facilitate implementation of the national policies and strategies', to be included as sub-paragraph (c) in paragraph 4.
The REGIONAL DIRECTOR suggested that, since the substance of the resolution had been agreed upon by the Committee, this sub-paragraph could be included as item (c) and the remaining items in this paragraph could be renumbered accordingly. There being no other comments, the revision was approved.
The VICE-CHAIRMAN, speaking as the Representative of Indonesia, drew attention to paragraph 5 of the draft resolution which dealt with procedural aspects and which were important. He recalled that the discussions at the World Health Assembly and the Executive Board had stressed the implementation of the decisions by Regional Offices. In this context, he suggested the addition of two sub-paragraphs. He proposed the following as sub-paragraph (b): *to review the entire process of planning, implementation and evaluation of WHO-s collaborative programme at district, national and regional levels so as to promote a more creative catalytic form of WHO collaboration'. This subject had been discussed in the Committee, but putting it in its proper context would be more appropriate Ln the process of implementation.
His second proposal was to incorporate a new sub-paragraph (c): 'to further enhance the relevant technical cooperation with individual Member States for the strengthening of national health development, ensuring that valid information to prepare, implement and evaluate national strategies for Health for All is available'.
DR UTHAI (Thailand) supported the suggestion of Dr Hapsara and said that the two items could be inserted as sub-jtems (b) and (c), renumbering the items that followed. The REGIONAL DIRECTOR suggested modifications to the proposed new paragraphs (b) and (c).
The VICE-CHAIRMAN said that he was of the opinion that a lot of attention would be focused on strengthening of the district aspects of health care, involving special measures on planning, strengthening and evaluation of such services. Practically all the Member States were trying hard to review and strengthen the district health systems. This was the reason for his delegation proposing the inclusion of districts in the health system.
DR UTHAI (Thailand) agreed with the views of the Vice-Chairman and suggested insertion of the following operative paragraph between 5 (a) and (b) on page 3: *to review the process of planning, implementation and evaluation of WHO collaborative programmes at the national, and particularly at the district level, and at the regional level, so as to promote a creative and catalytic WHO country collaboration-.
DR JADAMBA (Mongolia) felt that since planning, implementation and evaluation of national plans were the responsibility of the respective governments, WH0.s support should be limited to evaluation at the national level.
MR AHOOJA (India) said that since the subject had been considered by the CCPDM, whose report had been approved by the Regional Committee, and had been incorporated in the draft final report with action at the regional level indicated therein, it might not be necessary to enlarge the resolution.
The REGIONAL DIRECTOR left the choice to the Committee whether to include the reference in the draft resolution on detailed programme budget or as a part of the present resolution.
DR ABDULLAH (Maldives) felt that a reference to the district level might not be necessary.
The VICE-CHAIRMAN agreed to omitting the reference to district level support and suggested rewording of the resolution accordingly.
DR NORBHU (Bhutan) felt that if a reference could be made to discussions at the CCPDM as originally envisaged, then the inclusion of the proposed paragraph would not be necessary.
DR JADAMBA (Mongolia), DR ABDULLAH (~aldives), DR REGMI (~epal) and MR RAHMAN (Bangladesh) agreed to the suggestion.
In the light of the views expressed by the representatives, the REGIONAL DIRECTOR suggested dropping the proposed addition to the operative paragraph and revising the existing preambulary paragraph to MINUTES 09 RIB SEVENTH MEETING 209 read: 'Reviewing the issues and options presented in the Regional Committee document on "Management of WHO'S Resources" (SEA/RC40/14), and the practical implications thereof, and also the deliberations of the Regional Committee:
This proposal was agreed to.
Item 2 POBTIEln IVWImNIy OF YBO AWD TENTEl AIwImmY OF TBE DKCWPlVIOR OF W-ATA
The REGIONAL DIRECTOR said that there would be two celebrations at the World Health Assembly in May 1988: (1) the celebration of the fortieth anniversary of WHO, at which one representative from each Region would be required to address the Assembly and (2) the celebration of the tenth anniversary of the Declaration of Alma-Ata, for which one member from each Region would participate in a round-table conference. In view of -across-the-table' discussions involved in the round-table conference, the nominated delegate should be conversant with one official language, not necessarily English, .and should have had considerable experience in the implementation of HFA activities.
The VICE-CHAIRMAN requested nomination of two members to represent the Region at the two celebrations.
DR UTHAI (Thailand), seconded by DR ABDllLLAH (Maldives) and DR MANTRA (Indonesia), proposed India to represent the Region in the fortieth anniversary celebration of WHO, and Indonesia to attend the round-table discussion at the tenth anniversary of Alma Ata. The two nominations were approved by the Regional Committr!e.
The REGIONAL DIRECTOR comended the unified approach of members of the Regional Committee. He suggested that the speech to be delivered at the fortieth anniversary of WHO be well prepared. The Regional Office would be willing to provide background documents.
Item 3 MNIPTIMI OF RIB FINAL. REPORT RC Agenda item 20
The VICE-CHAIRMAN drew the attention of the representatives to the draft final report (SEA/RC40/23) which had been circulated, and suggested consideration of the document part by part; in case of Part IV, individual items would be considered separately.
MR RAHMAN (Bangladesh), referring to para 4 on page 6 of Part I1 of the report, said that mention should be made of the need for more intensified intercountry and international cooperation in the field of malaria control, in the context of the discussions at the Regional Committee and the Health Ministers' meeting.
DR DAMRONG (Thailand), referring to the same paragraph, suggested rephrasing of the last sentence as follows: 'There was thus a need to start more cost-effective control measures and to pursue important strategies, such as community participation, intersectoral collaboration and mobilization of external resources.'
The REGIONAL DIRECTOR clarified that pages 5, 6 and the first three paras on page 7 gave a summary of the introduction of the Annual Report by the Director, Programme Management, and that the suggestions made by the representatives from Bangladesh and Thailand would be reflected suitably in para 3 on page 10 relating to the discussion on malaria.
The VICE-CHAIRMAN suggested the addition of 'technical collaboration in' before the words 'managerial process' in para 4 on page 7.
DR JADAMBA (Mongolia) stated that the first sentence in para 6 on page 7 should be reworded as follows: -The establishment of country support teams was considered an important effort by the Regional Office to improve its support to the countries.'
MR RAHMAN (Bangladesh) suggested that, in para 9 of page 7, mention should be made of the need for the countries to develop indigenous capability and also to adopt appropriately transferred technology.
MR AHOOJA (India), referring to para 6 on page 8 relating to health manpower, stated that the Committee discussed this subject in the context of reorientation of medical education with a view to improving the skills of health professionals qualitatively in the context of delivering the required assistance at the PHC level, which should be made clear in the report.
MR RAHMAN (Bangladesh), while agreeing with the point made by the Representative from India, said that the question of explaining health education in macro terms, so as not to remain confined to the medical colleges, should also be reflected in the report.
The REGIONAL DIRECTOR said that the final version of the report would be revised taking into account the regional collaborative efforts as well as the health education aspects.
DR JADAMBA (Mongolia) said that some stress should be laid in para 6 on page 9 on further collaboration between the Member States in the field of development of traditional medicine.
DR ABDULLAH (Maldives) stated that the Committee's appreciation to the Regional Office for providing assistance to the countries in the prevention and control of AIDS should be suitably reflected in the last para on page 9.
DR JADAMBA (Mongolia) said the first sentence of last para on page 9 should be modified suitably to reflect the potential risks posed by AIDS.
MR AHOOJA (India) said that suitable mention should be made on page 10 of the report, of the importance of leprosy control programme and the need for its continuance.
The REGIONAL DIRECTOR said that the points made by the Representatives concerning the importance of the leprosy control programme leading eventually to its eradication, and the danger posed by AIDS, as well as the points made by CCPDM, would be suitably included in the report.
PART I11 - Agreed.
PART IV - Discussion on Other Matters was then taken up for consideration item by item.
P(R AHOOJA (India), referring to point (c), of item 2 on the Method of Appointment of the Regional Director, stated that there was a need for further clarification of the consultation process with the Director-General. He suggested that the operative para 1 of draft resolution No. 6 on the subject be included in the report.
The REGIONAL DIRECTOR, while agreeing with the point made by the Representative from India, said that operative para 1 of draft resolution 6 could be included in the proceedings as para (dl, and mention in para (c) and the last para to 'consultation process' be deleted. The revised paras would then read as follows:
'(c) the process of nomination and appointment should be as short as possible, and i '(d) recognizing the advantages of greater involvement by the ~irector-General in the selection of the Regional Director, a suitable method of consultation be evolved.
'The Regional Committee agreed that the existing procedures should remain in effect, and that the process of consultation should be strengthened to ensure that the aspirations of the regions as well as those at the global level are adequately reflected:
DR MANTRA (Indonesia), referring to point (c)(2) of item 3, desired that the sentence be rephrased to read -It is important for policy- * makers and workers in health-related sectors to become aware of health issues to be orientated in the dissemination of... health systems.'
DR NORBHU (Bhutan) pointed out that since the recommendations on technical discussions and a resolution on the subject have already been agreed by the Regional Committee, changes should now be made only if they were really necessary.
After some discussion, it was agreed not to make any changes to the existing text.
On item 4, DR JADAMBA (Mongolia) suggested that the word, 'support- in line 6, para 3, be substituted by the word 'involvement'. Also, the last sentence of the same para be revised to read, '... continue to involve consultations among the Member States, the Regional Director and the Director-General'. The suggestion was agreed to.
On item 5, the VICE-CHAIRMAN indicated that since the Committee had already nominated India and Indonesia to represent the Region in the WHO fortieth anniversary celebrations at the Forty-first World Health Assembly, and at the round-table discussions to be held during the Assembly respectively, the nominations would be incorporated.
On item 6, DR FERNANDO (Sri Lanka) said that the words, -without becoming panicky' in line 7, be deleted. The suggestion was agreed to.
On item 7, Drug Abuse, MR AHOOJA (India) suggested inclusion of a reference to the need to assess the magnitude of the drug problem.
Referring to item 11, DR JADAMBA (Mongolia) proposed listing of the resolutions of the World Health Assembly and of the Executive Board together, instead of the present practice of differentiating what were discussed with the Annual Report of the Regional Director and which were noted.
The REGIONAL DIRECTOR felt that it was a matter of format and if the Committee so desired, he would do so.
DR NORBHU (Bhutan) referred to item 12, line I, and proposed deletion of the phrase 'regret for its'. ., The draft Final Report, as amended, was adopted by the Committee.
Item 4 AWPTION OF BBSOLOTIORS
The Committee adopted the following 11 resolutions the drafts of which had been circulated to the representatives earlier: MINUTES OF THE SEWNTH MEETING 21)
I. Prevention and Control of AIDS in the Sc,uth-East Asitr Region (sEA/RC~~/RI)
2. Management of WH0.s Kesources (SEA/RC40/1<2)
3. Information and Education for Health in Supl)ort of Health for All by the Year 2000 (Sk:A/KC4(l/H?)
4. Targeting for Reorientation of Medical Education lor Health Manpower Development in the Context of Achieving Health for All by the Year 2000 (SEA/RC4(1/R4)
5. Intensification of PHC Through District Health Systems Towards Achieving Health for All hy the Ypar 2000 (SEA/RC40/R5)
6. Method of Appointment of the l 7. Thirty-ninth Annual Report of the Repional Dl rector (SEA/RCLOIR7) 8. SelectLon of a Topic lor Technical i)iscussions (SEAIRC40IKR) 9. Resolution of Thanks (SEA/KC40/R9) LO. Time and Place of Forty-first and Forty-second scssions (SEAIRC4OIRIO) 11. Detailed Programme Hudgat for 1988-1989 and Report of the Sub-committee on Programme Rudget (SEA/KC40/RII) Item 5 CLOSURE OF SESSION - At this point the Chairman presided. MR AHOOJA (India) said that the Regional Committee had had successful discussions, as was reflected by the important resolutions that it had adopted. It was clear during the discussions of various agenda items that the concern of the Member States relating to health problems transcended their boundaries and comrnon concern had been reflected for the whole Region as one entity. The Committee had felt that health was an important input for improving the standards of living as well as productivity of the people, and for their welfare. He hoped that the commonality of interest, ideas, and views that had been reflected, would translate themselves into all-round improvement in the standards of health in the whole Region. On behalf of his delegation he thanked the Chairman for his able guidance and the businesslike manner in which he had steered the proceedings, as well as for his own contributions to the discussions. He also complimented the Vice-Chairman for his contribution and for shouldering the responsibility of the Chairman in his absence. The fact that Dr Mahler had found time to attend the session and address the Committee not only indicated his concern for the health of the people of this region, but also reflected his interest in the Region, and the contribution that it could make at the global level. He thanked the Regional Director for his hard work, continuing interest and devotion to the task of achieving HFA/2000. He expressed his gratitude to the Director, Programme Management, and the Director, Support Programme, and other staff of the Regional Office for their efforts towards the smooth conclusion of the session. He also thanked the Government of DPR Korea for the excellent arrangements made for the meeting and for their warm hospitality without which, he said, the success of the meeting would not have been possible. MR RAHMAN (Bangladesh) recalled the observation made by the Regional Director earlier that the Committee had completed its business with a sense of team participation and togetherness. His delegation felt proud to be a part of this session. He appreciated the productivity and constructivity that had been in evidence not only in the Regional Committee, but also in the Regional Office under the able leadership of Dr U KO KO who had set the pace of health development. He wished to place on record his country-s appreciation for the excellent arrangements made by the Government of DPR Korea for the meeting under the leadership of the Vice-Minister of Public Health. During his stay in the country, he had had the opportunity to learn a lot which reaffirmed his faith that investment in health was a wise investment. DR FERNANDO (Sri Lanka) said that he was confident that the decisions arrived at during the session would have far-reaching implications for the health of the people of South-East Asia. The deliberations, which had been conducted in a cordial manner, were fruitful. He paid special tributes to the Regional Director and the secretariat for their commendable efforts to make the session successful. He thanked the Government of DPR Korea and the members of the delegation for the impeccable arrangements that had been made for the conduct of the meeting. He said that the Chairman and the Vice- * Chairman deserved special compliments for the excellent manner in which they conducted the proceedings of the meeting, and also for their own personal contributions. He expressed the hope that the representatives would carry pleasant memories of their stay in DPR Korea. DR JADAMBA (Mongolia), speaking on behalf of the Representative, expressed his government's sincere thanks to the Government of DPR Korea for hosting the Fortieth Session and for the excellent arrangements. It was very encouraging to witness the tremendous advances that the people of DPR Korea had made in all spheres of social and economic development, including health. During this vislt, his IIIWJTES OF TEE SEVEFTB MEETING 21 5 delegation had had the opportunity to discuss with the Minister of Health their plan of cooperation for the next two years. He conveyed his sincere thanks to the Regional Director and the secretariat for their able technical guidance and unstinted cooperation. He also appreciated the efforts of the staff from the Regional Office and the nationals who worked behind scenes untiringly to bring the meeting to a successful conclusion. DR REGMI (Nepal) said that the session had proved very fruitful. There was consensus of opinion among the representatives on each topic. Shortcomings had been reviewed and efforts made to formulate plans for the future despite the financial crisis. He conveyed his government's thanks to the Government of DPR Korea for hosting the session in the historic and beautiful city of Pyongyang and to the staff of both the Regional Office and the host government for rendering all assistance to make the session a success. His country had been enriched by the learned guidance of Dr U ,KO KO, the Regional Director. On its part, Nepal would endeavour to attain the cherished goal of Health for All. He complimented the Chairman and the Vice-Chairman on their smooth conduct of the meeting, and conveyed his special thanks to the staff working behind scenes for their untiring efforts towards the success of the meeting. DR NORBHU (Bhutan) said that the session had been particularly memorable in that the Member States had taken a strong and unanimous stand on matters of importance to the Region. Among these was the decision that the Regional Committee would choose its own Regional Director. He conveyed his own gratitude and that of his delegation to the Government and the people of DPR Korea for their efforts to ensure the success of the meeting which was held in a spirit of friendship and cooperation. He thanked the Chairman and Vice-Chairman for their able conduct of the deliberations, and the Regional Director and his staff for the manner in which they had collaborated ill the success of the programme. DR DAMRONG (Thailand), sharing the sentiments of the previous speakers, and on behalf of the Thai delegation, expressed his country's sincere thanks to the Government of DPR Korea for hosting the meeting. He complimented the Chairman and the Vice-Chairman for their guidance and able conduct of the meeting, and the national staff for their excellent arrangements without which the session would not have concluded successfully. He also thanked the Regional Director for his helpful guidance and all those who had worked behind scenes. He said that the benefits derived from the discussions would help them to strive towards the goal of Health for All. On behalf of the Indonesian delegation and on his own behalf, DR MANTRA (Indonesia) thanked the Government of DPR Korea for hosting the session and for the hospitality extended to the representatives, which made their stay in the country most enjoyable. He also expressed 216 MINUTES OP THE SEVEllTll MEETING his thanks to the Regional Director for his wise guidance, and to the staff of the Regional Office for their able support which made the meeting a success. He thanked the Chairman and the Vice-chairman for providing nhle leadership during the Committee's deliberations. He expressed his apprectation to the representatives for their cooperation in the smooth conduct of the meeting and hoped that the outcome of the current session would hecome a strong basfs to accelerate national efforts towards the achievement of the HFA goals. He looked forward to seeing the representatives in New Delhi in 1988, and in his country in 1989. DR ABDULLAH (Maldives) joined the previous speakers in thanking the Government of DPR Korea for hosting the current session and the warm hospitality and kindness extended to the representatives. The visits to general and maternity hospitals of the country had been quite educative and the cultural prok:rammes enjoyable. He expressed his gratitude to the guides and interpreters provided by the,Government which helped to make their stay in the country pleasant and succenaful. He also expressed his gratitude to the Regional Director and the staff of the Regional Office for their valuable efforts to bring the meeting to a successful conclt~sion. The representatives from the Member States also deserved to he thanked for the cordial and businesslike manner in which the discussions were held. The Chairman, the Vice-Chairman of the session and the Chairmen of the technical discussions group and of the Programme Budget Sub-committee also deserved words of appreciation for the able manner in which they conducted the deliberations. DR SONG PIL JUN (DPR Korea) expressed his happiness that the Fortieth Session of the Regional Committee had been held in the capital of DPR Korea. He thanked the delegates for their appreciation of the work done by his country, and thanked the Regional Director and the staff of the Regional Office for the excellent support provided by them. The secretariat had worked hard to provide excellent documentation for the meeting. He also expressed his thanks to the Vice-chairman, the Chairman of the technical discussions, the Chairman of the CCPDM, and the Chairman of the Sub-committee on Programme Budget for their excellent work. He expressed his thanks to the representatives of nongovernmental organizations and United Nations agencies. He said that thanks were also due to the Indonesian delegation for agreeing to host the Forty-second Session of the * Regional Committee in their country. The current session had successfully evaluated the achievements in the field of health and discussed problems and difficulties faced, and tried to find solutions to them. He assured the Committee that his government would implement the decisions and resolutions adopted by the Regional Committee. In conclusion, he wished the representatives a pleasant stay in DPR Korea, success in their work, and a happy journey home. DR ADHYATHA (UNICEF) expressed his sincere thanks to the Government of DPR Korea for the excellent arrangements and warm hospitality. He MINUTES OF TEE SEWWRl KEETING 717 had been immensely impressed by what he had learnt and seen during his stay in the country. The current session had indeed achieved its objectives towards improving the health of the people in the Region. He expressed his thanks to the Chairman and the Vice-Chairman for ably guiding the deliberations of the meeting and to the secretariat of the Regional Office for their splendid support. MRS SUCHITRA, speaking on behalf of the nongovernmental organizations, expressed her most sincere gratitude to the Government of DPR Korea for the warm welcome and hospitality extended to the representatives. She enjoyed her stay in the country and had been much impressed by the work of the Great Leader, President Kim I1 Sung. She had learnt a great deal during the past few days. She congratulated the Regional Director and his staff for successfully guiding the meeting. The REGIONAL DIRECTOR said that he was overwhelmed by the kind sentiments expressed by the representatives. He was confident that with the same support the Organization would be able to reach the goal of HFA 2000. The Chairman, the Vice-Chairman, and the representatives all deserved credit for the successful conclusion of the meeting. It was significant that the Committee had been able to discuss each agenda item thoroughly and arrive at a consensus on them. It would be the endeavour of the Regional Office to ensure that all the eleven resolutions adopted were implemented, as desired by the Regional Committee. In regard to such items as district health care systems, drug abuse, AIDS, and management of WHO-s resources, the Regional Office would submit a report to the Director-General, the WHO Executive Board and the World Health Assembly, for further action. Ic may be necessary for the Executive Board members from this Region to follow up these items in the Assembly. The Regional Committee was becoming more and more important among the governing bodies and he was glad to see that the Committee had done very effective and productive work during the session. He was appreciative of the quality of discussions that had taken place. This was entirely due to the wisdom, thoroughness and restraint of the representatives whose interventions had been objective and productive. ,-. This had been the best Regional Committee session during recent years. He expressed his happiness and appreciation for the able guidance provided by the Chairman. The Vice-Chairman, too, had conducted the proceedings very effectively. He commended the role of the Chairmen of the CCPDM, the technical discussions group, and the Programme Budget Sub-committee, without whose guidance the session could not have concluded successfully. The participation of the UN agencies and nongovernmental organizations had been very useful and he looked forward to greater collaboration with them. '5 The Regional Director was glad that the representatives enjoyed their stay in DPR Korea. He said that the Juche principles, which broadly meant self-reliance and self-determination, and the Chongsanri principle, which meant -one for all, all for one-, were quite relevant to the Health for All principles. The Committee had expressed wholehearted supported to these principles. He expressed his appreciation to the officials of the Ministry of Public Health, and the supporting staff which ensured the smooth conduct of the session. He said that he was expressing the collective feeling of the Regional Committee in conveying admiration and gratitude to the Great Leader, President Kim I1 Sung, and the Dear Leader, Comrade Kim Jong 11, under whose guidance the country had developed sound principles in health work in DPR Korea. In conclusion, he wished the representatives a nafe return home and said he hoped to meet them again in New Delhi next year. The CHAIRMAN expressed his thanks to the Regional Director, the Vice-Chairman and the Chairmen of the sub-committees, with whose concerted efforts the current session of the Regional Committee had come to a successful conclusion. During the session the representatives had learnt of the efforts being made by the countries of the Region to attain the goal of Health for All with WHO collaboration. Experiences and information regarding practical measures had been exchanged. The session had brought about consensus on many subjects which showed the determination of the countries to achieve the goal of Health for All. The resolutions adopted were expected to give an impetus to the health of the people of the Region and promote interchange and cooperation between the countries. He expressed satisfaction at the success of the session and thanked the members of the secretariat and the supporting staff for their excellent work. Provision of health for all was a difficult and complex task, but that it may be possible to provide appropriate levels of health by the end of the century. The goal of Health for All could be achieved if the Member States marched towards it along the guidelines adopted jointly and with a spirit of individual and collective self-reliance. He wished the delegates a pleasant stay in Pyongyang and a safe journey home. In conclusion, he expressed his firm conviction that the subjects discussed and agreed upon at the session would be successfully carried out by all the Member States. He then declared the session of the Regional Committee closed.