WORLD HEALTH ORGANIZATION
ORGANISATION MONDIALE DE LA SANTi
REGIONAL OFFICE FOR
THE WESTERN PACIFIC
BUREAU R~GIONAL DU PACIFIQUE OCCIDENTAL
REGIONAL
CO~~ITTEE
TECHNICAL DISCUSSIONS WPR/RC22/TD7 27 September 1971 ORIGINAL: ENGLISH
'l'went;,--second Session llJanila 21-29 September 19'71
REPORT OF THE TECHNICAL DISCUSSIONS ON "hEALTti ~IANPOWER IN THE DEVELOPING COUNTRIES: PROBLEMS AND NEEDS"
1.
Subject
The Regional Committee for the WHO Western Pacific Region under Resolution WPR/RC20.R2 selected "Health Manpower in the Developing Countries: Problems and Needs" as Technical Discussions subject for its Twenty-first Session in 1970. however, the floods which disrupted Manila during the Twenty-first Session resulted in the postponement of the Technical Discussions until the Twenty-seoond Session of the Regional Committee (Resolution WPR/RC21.R4i. The Technical Discussions finally took place on 24, 25 and 2'( September 1971. The following report summarizes the results and conclusions of the discussions. 2. Planning and preparation for the discussions
Advanced planning included preliminary correspondence in 1969 between the Chairman of the Twentieth Session of the Regional Committee and the Secretariat concerning the selection of the Technical Discussions Chairman. On the recommendation of the Regional Director and the concurrence of the incumbent Chairman, Dr Kung-pei Chen, Professor and Director of the Institute of Public Health, College of Medicine, National Taiwan 'Jniversi ty, Taipei, Taiwan, Republic of China, was designated as Chairman. A working paper on the subject was prepared by the Secretariat and distributed to the Representatives of Member countries and of the international organizations as well as to observers of non-governmental organizations attending the Regional Committee Meeting.
WPR/RC22/I'D7 page 2
With the deferment of the Technical Discussions to 1971, the formality of redesignating Dr Chen was undertaken through exchange of correspondence between the Regional Director and the Chairman of the Twent~'-f1rst Session of the Regional Committee. In addition to the working paper previously prepared by the Secretariat, Dr Chen prepared a second working paper entitled "Health Manpower Probliems in Developing I • Countries and Approaches to their Solution". other documents for the Technical Discussions included the technical discussions programme/procedures and techniques, guidelines for the discussion group memberships and an evaluation sheet. In addition, a report of the Regional Director to the Committee entitled "Report on the Inventory of National Health Manpower and Training in the Western Pacific Regiorl' {WPR/RC22/8 1 was used as a background document. A list of the working documents and background material prepared is given in Annex 1. ~.
-~
Organization of the Discussions The objectives of the Technical Discussions were: (1) To exchange information on the health manpower situation obtaining in the countries and territories of the Western PacifiC Region; To identify resources and means which can be employed in the study and development of health manpower; To consider feasible approaches that can helip establish a balance in health manpower supply and demand in the countries of the Region.
(2)
(:'1)
The sequence of the discussions was arranged as follows: (a) First Plenary Session, (b: Group Discussions, and (c) Second Plenary Session. The first plenary session concerned itself with an overview of the subject matter, including a summarization of the principles entailed in the assessment and planning of the health manpower resources. A break-up into three discussion groups of the Technical Discussions participants permitted a more detailed consideration of the subject within.the framework of the stated objectives of the discussions. Guidelines were prepared in advance to facilitate the group discussions. The second plenary session was designed to enable the participants as a body to review the consolidated group reports as presented in the Draft Report of the Technical Discussions. TI.e group discussions were structured to ensure involvement of all participants. .
WPR/RC22/TD7 page 3
In addition, the collaboration of some individuals was sought 1n the organization and conduct of the discussions. Dr K.P. Chen (China and Or C.N. Derek Taylor (New Zealand'; served, respectively,as Chairman and Rapporteun of tne Technical Discussions Group. Those collaborating in the capacity of Chairman and Rapporteur for the discussion groups were Dr H.r.,. Franklands (Australia) and Dr K.L. Thong United Kingdom', for Group A, Dr James King (United States of America) and Dr J.C. Thieme (Western Samoa\ for Group B, and Dr Truong-Minh-Cac (Viet-Nam) and Dr Tiao Jaisvasd Visouthiphongs (Laos) for Group C. The Technical Discussions Chairman was assisted by two resource persons with expertise in the health manpower field and who happened to be tn Manila serving as WHO 'Consultants in the Western Pacific Region, viz., Dr Krishnaswamy Rao and Or Rebecca Bergman. The Secretariat was represented by Dr A.A. Angara, Assistant Director of Health Services, who served as Secretary of the Technical Discussions. 4. First Plenary Session
The Chairman of the Technical Discussions opened the session with the observation that regardless of the stage of its socio-economic development, ever~' cOWltry in the world was atri ving increaaingly to provide better services for the health protection of its population. Accomplishment of this aim entailed the study, among others, of the health demands of the population as well as the resources that could be tapped to meet them. Resources meant manpower, materials and funda and in the context of health services delivery manpower constituted a most essential ingredient. The Chairman cited cc ~ain principles that apply in any health manpower resources stud and these were: (a) (b) (c) (d) the relationship between health planning and health manpower resources; the identification of the demands for health manpower and of the conditions that lead to these demands; consideration of the supply of available manpower; and balancing demand and supply and certain administrative considerations concerned with health manpower planning.
Commenting on the first three items (a, b and c), Dr Rao observed that even though some cOWltries did not have planning units, it could not be said that they had no health planning. Although these cOWltries had no formal written plans and did not employ the systematic methods, they satisfied nevertheless the fundamental principles involved in the planning process, viz., goal setting, plan formulation, implementation
WPR/RC22/TD7 page 4
and evaluation and revision. Every step in the formulatio~ of the plan and every activity in its implementation entailed the use Of manpower in the required numbers and types trained for the work they are to perform. Planning for health manpower on the other hand required information to meet present and future demands in order to 'develop and provide manpower in adequate numbers. Dependence of one on the other was evident and the two were linked throughout the whole planning proces·s to the extent that undertaking planning for one inevitably involved planning for the other. In a global sense, the study of health manpower extended also into the other sectors concertned in national development. For example, health manpower generally needed a basic education on the average higher than was required by most other sectors. because of the technical training required; where only a few met these minimum basic educational qualifications, competition with other sectors was keen for their recruitment. The demand for health manpower was simply a reflection of the demand for health services. This demand originated from two segm~nts of a country's population, viz., the public sector and the private sector. In some countries of the Region, particularly the small developing countries, only the public sector existed. In a few others, the services rendered by some categories of health workers were designed to satisfy the demand of both sectors. In the larger developing countries, on the other hand, public and private sectoral demands were distinct and identifiable. Efforts designed to meet current and future health demands of the population needed to include consideration of the country's health policy as this influenced the demand in both the public and private sectors. Health policies were in turn guided by the political, social and economic conditions of the count~J, and a full understanding of the situation obtaining was essential in any health manpower study. Additionally, the structure and functioning of the health services needed attention since current health service demands were not infrequently satisfied through changes in the structure of the services and improvements ~f individual manpower performance standards. Sooner or later consideration of the manpower supply base would come up for review because of the increasing population size and the developmental growth being experienced by all countries. The study of manpower supply invariably included certain specific factors. Of immediate relevance was the length and quality of basic ed~cation as well as the numbers available from which selection could be made for training of the various categories. Prospective potential 'for employment of health manpower could be forecast for at least a decade and a 'careful estimate of this potential is necessary. Facilities for technical manpower training, especially at professional and specialized levels, deserved priority attention both in countries with the resources to establish their own training facilities and in smaller countries whose only means was through arrangements with other countries.
WPR/RC22/TD( page 5
;)r Chen took up the approaches towards balancing supply and demand once the assessment of each had been completed. He cited two approaches which could be employed, viz., (a) increasing utilization and health manpower productivity and (bj reducing losses of health manpower. He pointed out that utilization meant the degree of effectiveness of health workers in relation to the functions of the categories to which they belonged and to the training they received. Productivity, on the other hand, meant the output of service within a time unit of a particular category of manpower. In general, increased utilization and productivity could be achieved throu~~ better supervision and other administrative arrangements such as by offering incentives in rural areas and by introducing automation in medical practice in more developed communities. Another recourse was the use of auxiliaries to relieve professional and highly skilled staff of routine tasks. Reducing m~npower loss involved two principal problems. One was emigration or "brain drain" which was now of grave concern to some countries in the Region; the other involved "inactive" manpower in the country. Factors underlying these two problems included the lack of economic and pr.ofessional incentives. The reasons for these would need detailed study before rational corrective measures could be proposed. When planning future developments in their health services countries should try to identify factors that might work against the proposed developments in order to avoid disruption of long-range plans once they have been put into operation. Dr Chen made further observations on certain requisites in planning for health manpower. One of these was the need to establish a health manpower planning unit. This could operate independently of, but should preferably be located within the structure of the health planning section of the national health agency. Improved collection of data on manpower was emphasized and this could be achieved in the main 0y establishing agencies for the registration and licensing of health manpower together with organized systems of recording and processing of data in hospitals and other health services. Another essential requirement was co-ordination among related agencies and particularly within the health and planning agencies (e.g., between the health and education ministries). Co-ordination prevented duplication of services and ensured the best use of specialized manpower. For example, in some countries such categories as demographer, statistician and social scientist who were useful in the initial assessment of health problems could be seconded from other agencies.
Dr Bergman's statement gave accent to the studies on nursing manpower and the experiences that could be drawn from them. In the past nursing studies "counted heads" (ratio of nurses to beds, population, dootors, etc.); then attention was paid to the time given by nurses to various
WPR/RC22/TD7 page 6
functions and categories of patients; later, to "activity studies" designed to determine the time spent by nursing personne~ at professional and non-professional levels of nursing in carrying out their various functions; and more recently, the trend had been to look at ~.patient needs" to determine what was needed rather than what was being done. The early orientation of the nursing profession to manpower research and planning had largely contributed to the rational development of nursing education and service. However, certain negative aspects had also been noted, viz., th~ studies tended to view nursing in isolation and the studies used as a baseline in other settings for continued work were unneces.sarily duplicated (e.g., activities of nurses in general hospital wards) • In the current view, nursing manpower was part of comprehensive national planning and consequently of health and manpower planning. As analysis of the problems revealed similarities and differences among areas or countries, results of studies with a common base (e.g., placement in rural areas) could be applied to other countries, but in the case of unique problems studies should be undertaken in specific contexts (e.g., health practices of the population). Study and planning should be realistic of the situation and be focussed on areas where the findings could find application and contribute to the improvement of patient care. An approach to a nursing manpower study was exemplified in the preparation of a master plan for nursing manpower in a developing country in the Region where the major steps taken included: (a) the preparation of a model adapted from the literature of another country to serve as the conceptual model; (b) contacting knowledgeable 'people closely involved with the problems being studied in order to learn the real needs and problems; (c) collecting all available data on problems which had been recognized, identifying problems that still needed to be studied, and considering the ethical/philosophical issues involved (e.g. education and over-supply of nurses, levels of personnel desirable); (d) describing the needed organizational ,framework (staff, budget, stage of development, etc.); and (e) setting priorities in the areas of study and planning for their implementation and evaluation.
Dr Bergman cited the studies being made of certain problems within the framework of the master plan for nursing manpower. These problems were: (a) a "brain drain" of major proportion, (b) the existence of two nursing education programmes (four-year graduate nurse apd a five-year baccalaureate nurse) in a situation where there was very little difference in the abilities and utilization of the two categories, and (c) the utilization and effectiveness of different resources for a particular health service. Solutions were being sought to curb the "brain drain" in order that enough nurses could be retained to meet local needs rather than be faced with the alternative of having none left to replace
WPR/RC22/TD7 page 7
retirements, let alone to fill new positions. On nursing education, the principle was brought out that the output in the work of the graduates must justify the difference in educational input otherwise one of the categories should be discontinued. In the study of the use of resources in the particular health service, the role of nurses and midwives in the particular area were being analyzed and such questions as adapting their education programmes to the existing situation and whether in the circumstances midwives should be trained in elementary medical care as a second level "of public health nurse were being considered. In conclusion, she stated that nursing was a basic component of all health care. Delivery of services to be effective should not be haphazard but needed to be analyzed and manpower-planned. It was also possible that as a partner w1thin the larger framework of health manpower planning, nursing would find some answers which would help solve problems of the other health professions. During this first plenary session, participants commented and expanded on the points brought out by the resource persons. After a stimulating discussion, they broke up into the three pre-determined groups so that more people would have an opportunity to take part.
5.
Group discussions
The group discussions were based on the four questions set out in the guidelines for the Technical Discussions. As was to be expected, discussion in all three groups reiterated in various ways the views and principles already expressed in the first plenary session and cited in the working documents. The following is a brief summary of the main points which emerged from the group discussions after consideration of the four questions referred to above. Q,uestion'l: "To what extent do national health administrations have up-to-date and reliable information, as well as assessments, on their health manpower resources?" It was evident that some countries Undertake periodic surveys to establish the number of professional and auxiliary personnel in the various categories. The general view was that most countries do have information on health manpower resources. I!owever, it was not possible to ascertain from the discussions whether such information as age, sex, domicile, educational qualifications, specialization, etc., was recorded in the surveys. There was variation in the ability of countries to obtain this type of information. Abnormal situations obtaining in some countries, such as war, added to the difficulty of acquiring needed health manpower data and of making a realistic assessment of health manpower requirements. From information available from partiCipants, emphasis appeared to There appeared to be difficulties in planning for the supply sufficiently and accurately to meet future demand. be given to future demand rather than to supply.
WPR/RC22/TD7 page 8
Question 2: "What means and resources are necessary in a country to allow the study and development of the health manpower?" The establishment of a health manpower cell in health planning units was suggested to permit the study of health manpower, but it was recognized that many countries had not yet developed the policy and machinery for health planning. All countries had registration requirements for certain categories of health manpower but there appeared to be few countries or territories within the Region with regulations providing for annual registration of all necessary categories of health manpower. It was generally agreed that annual registration of appropriate categories of health professionals was the best means of obtaining data on current health manpower, such as sex, age, educational background, place of practice or working placement, movement (including change of job), retirement, emigration and death. It was recognized that there are deficiencies in resources, including personnel, material and financial components to a varying extent in all countries. Although no country has fully developed a plan for systematic development of manpower resources, some countries do have plans in regard to certain categories of manpower. In some of the countries of the Region, the demand aspect of some categories of health manpower come under the jurisdiction of the Ministry of Health, whereas the training institutions in health and the policy in regard to educational qualifications and numbers for admission which relate to supply, fall under the jurisdiction of the Ministry of Education. There sometimes appeared to be problems of co-ordination between the two Ministries in regard to balancing demand and supply and on the standards to be set for the quality of he"alth manpower resources. Question 3: "From information obtained in 1 and 2 above, what action may countries take to estimate and meet their health manpower requirements?" The following points emerged from the group discussions: (1) A country should define the services it. wishes to provide and then produce the trained manpower necessary to provide this service. (2) Health care services should be reorganized, if necessary, to avoid duplication and competition for services, facilities and health manpower in neighbouring areas.
(3) Legislation should be introduced to regulate the supply and utilization of manpower and to make it possible to determine at any time what health manpower is currently available. The following were particularly stressed:
WPR/RC22/TI17 page
9
(a) (b)
registration of certain categories of health manpower; bonding health workers where governments have given economic support for education and training either at the basic or post-graduate levels.
(4) The importance of an appropriate organization for strict enforcement of the legislation proposed above. No health worker Subject to registration should be permitted to practise or to be employed in his professional capacity unless he is, in fact, currently registered.
(5) The need to develop a national co-ordinating body to advice on the production and utilization of health manpower. This body was all the more necessary in countries having private institutions and voluntary health agencies whose activities were not always known or reported regularly to the government. (6) The possibility of introducing incentives to health workers to encourage them to work in rural and less desirable locations. These incentives could include money, housing, educational opportunities and travel.
(7) The organization of study groups at the national level to investigate and report on better methods of utilization of manpower and on more effective ways or producing the various categories of health workers.
(8) The possibility of providing for social security and compu~sory insurance should be kept in mind as the socio-economic condition of a country improves through its development plans. The effect of this on the quality, quantity and categories of manpower is important as it constitutes a component of long-term planning. (9) The importance of basic research activities in health manpower. The following subjects particularly merited research activity: (i) studying the methodology of supply and demand projection, including development of criteria and norms based on local situations; determining the underlying factors which contribute to the "inactivity" of health professionals and the causes of their emigration; re-assessing the present structure of medical and health services through "activity studies" to determine whether other or new types of categories could take over some of the functions of health professionals.
(ii)
(iii)
WPR/RC22/TD7 page 10 ,
Q.uestion 4: "How can international agencies such as WHO, assist countries in developing their health manpower to meet national requirements?" Areas of international assistance to governments which could be extended upon ,request would include: (1) Consultant or advisory services in connection with government efforts to formulate and execute health manpower development programmes. (2) Fellowships for nationals who would have responsbility for formulating or administering national health manpower 'programmes. It was suggested that when considering fellowships governments should give priority to post-graduate rather than undegraduate studies and where feasible, to short-term rather than long-term fellowships. Experienced national personnel would berlefit the most in these studies and they were also likely to require less time for observation and to assimilate more from the fellowship opportunities. Some groups thought that a short-term fellowship was considered less likely to contribute to the "brain drain" now being experienced by some countries in the Region.
(3) Organization of group meetings on an inter-country and/or country basis. These may consist of training courses, seminars or workshops, to promote exchange of views and experiences and to introduce new concepts or processes in the development of health manpower programmes. These meetings should be held for various levels of health workers. (4) Sponsorship of regional training centres, such as those for teacher training in order to promote improvement in the quality of teachers and of specific categories of health manpower and assistance in the development of existing national training facilities which could be made available to other countries in the Region. (5) To provide technical information by issuing scientific publications and other literature in health manpower development. While international standards for classification of health personnel could be of value, it was felt that it would be largely an academic exercise and of little practical value. In the matter of reciprocity standards among countries, it was considered that this was a political question and could not be resolved in these Technical Discussions.
6.
Second Plenary Session
At the final plenary session, the Chairman introduced the draft report of the Technical Discussions and replied to requests from the floor for clarification on portions of the text of the report. The
WPR/RC22/TD'7 page 11/12
participants examined the ~~ept section by section and adopted the report. The draft text of the conclusions of the meeting presented by the Technical Discussions Rapporteur was also adopted by the participants. The conc~usions
fit."t
of the Technical Discussions were as follows:
(1) Health manpower development is necessarily connected with national health planning. Planning for the manpower required in health services would need the establishment of a health manpower cell which should preferably be within the organizational framework of the health planning unit in the Ministry or Department of Health. (2) Organizational features that can help in the study and improveme.nt of the health manpower situation include: (a) a more effective structuring of health services and clearer definition of the functions of the staff manning these services; establishing or strengthening a national health manpower co-ordination body to look into supply and demand in the public and private sectors as well as the training of manpower; and improving the collection and processing of health manpower data and creating national registration units for certain categories of health manpower.
(b)
(c)
(3) Among the measure~ that can be undertaken by countries to define and help solve their health manpower problems are: (a) (b) health legislation to regulate the supply and utilization of health manpower; provision of incentives that can promote professional growth and help retain manpower in the health services and in less attractive working areas; undertaking studies on health manpower such as more effective methods for projecting supply and demand on special problems being encountered.
(c)
(4) Making available international assistance to requesting countries. This would consist of adVisory/consultative services in health and manpower planning, awarding fellowships, sponsoring group educational activities at inter-country and national levels, monitoring, retrieving and disseminating new knowledge, and stimulating research in health manpower development.
WPR/RC22/I'D7 page 13/14 ANNElC 1
LIST OF WORKING PAPERS AND BACKGROUND MATERIALS
WPR/RC22/TDl
Health Manpower in the Developing Countries: Problems and Needs, by Dr A.A. Angara, Assistant Director of Health Services, WHO Regional Office for the Western Pacific Technical Discussions Programme Procedures and Techniques for the Technical Discussions Guidelines for the Technical Discussions Health Manpower Problems in Developing Countries and Approaches to their Solution, by Dr K.P. Chen, Professor and Director of the Institute of Public Health, College of Medicine, National Taiwan University, Taipei, Taiwan Discussion Group Memberships Report of the Technical Discussions Evaluation Questionnaire Training of National Health Personnel: Report on the Inventory of National Health Manpower and Training in the Western Pacific Region (Resolut10n WPR/RC2l.Rll)
WPR/RC22/'Im WPR/RC22/TD3 WPR/RC22/'I'D4 WPR,/RC22/TD5
WPR/RC22jTD6 Rev.l WPR/RC22/TD7 WPR/RC22/I'D8 WPR/RC22/8
WPR/RC22/l'D7 page
15
ANNEX 2
LIST OF OFFICERS AND MEMBERS TECHNICAL DISCUSSIONS WREAU ET ME%t1BRES DES DISCUSSIONS TECHNIQUES
GENERAL CHAIHMAN
Dr K.P. Chen
PRESIDENr
Director Institute of Public Health College of Medicine National Taiwan University
. China Chine
DISCUSSION GROUP A GROUPE DE DISCUSSION A CHAIJlttAN PllESlIElfl' Dr H.M. Frank1ands Deputy Director-General Department of Health Canberra Dr K.L. Thong
Australia Australie
.:if RAPPORTEUR
Principal Medical and Health Officer Medical and Health Department Government of Hong Kong
United Kingdom Royaume-uni
Dr C.H. Yen China Director-General Chine National Health Administration
Japan National Hospital Division Japon Medical Affairs Bureau Ministry of Health and Welfare Dr H. Kasuga
Japan Assistant Chief Liaison Officer Japon International Affairs Minister's Secretariat Ministry of Health and Welfare Dr Abdul Majid bin Tan
Mr K. Watanabe
Sri Abdul Aziz Deputy Director of Training Ministry of Uealth GENERAL RAPPORTEUR
Malaysia· Malaisie
Dr C.N. Derek Taylor New Zealand Deputy Director-General of Health (Public Health) Qepartmept _of _Health _ _
WPR/RC221rD7 page 16 MEMBERS
MEMBRES
Mr Onn bin Kayat Assistant Secretary (Administration) Ministry of Health
Malaysia Ma1a:iJsie
Dr T.A. Gomez Chief Office of Health Education and Personnel Training Department of Health Mr Sae Hoon Ahn Second Secretary and Consul Korean Embassy in the Philippines Mr F.S. Cruz Director of Public Health and Social Services Territory of Guam Mr Chau-Van-Muoi Secretaire particulier du Ministre de 1a Sante
Philippines
Republic of Korea Repub11que de Coree United States of America Etats-Unis D'Amerique Viet-Nam
_f
Dr Tran-Minh-Tung Ministre de 1a Sante Mrs L. Batista Board Member Catholic Nurses Guild of the Philippines
Viet-Nam . International Committee of Catholic Nurses Comite Internatlonale des Infirmieres et Assi;stantes Medicosociales Medical Women's International Association Association Internationale des Femmes Medecins
Dr r.Y. Za1amea National Corresponding Secretary Philippine Medical Women's Association DISCUSSION GROUP B GROUPE DE DISCUSSION B CHAIRMAN PRESIDENT
Dr James King Associate Director Office of Internationale Health Public Health Service Department of Health, Education and Welfare
United States of America Etats-Unis D'Amerique
WPR/RC22/l'D1 page 17 RAPPORTEUR Dr J.e. Thieme Director of Health Health Department Dr A. Tarutia Senior Specialist Medical Officer Papua and New Guinea Western Samoa Samoa-Occidental Australia Australie
Dato (Dr) Abdul Majid bin Ismail Malaysia Director of Planning and Research Malaisie Ministry of Health
Dr C.N. Derek Taylor Deputy Director-General of Healtn (Public Health) Department of Health. Dr C.S. Gatmaitan Undersecretary for Health and Medical Services Department of Health Dr V. SundararaJan Senior Registrar Ministry of Health Dr G.H. Choa Director of Medical and Health Services Government of Hong Kong !<Irs Luisa Alvarez Secretary and Member of the Board of Directors Health Education Association of the Philippines Dr J. Catindig Vice-President, Family Planning Organization of the Philippines Member, Regional Council of South-East Asia and Oceania, I.P.P.F.
New Zealand Nouvelle-Zelande
Philippines
Singapore Singapour United Kingdom Rc;>yaume-uni
International Union for Health Education Union Internationale D'Education pour la Sante International Planned Parenthood Federation Federation Internationale pour Ie Planning Familial
WPR/RC22jrm page 18 MEMBERS
MEMBRES
Dr E.T. Novales Member Philippine Medical Women's Association Dr E.T. Caparas President Philippine Medical Association
Medical Women's International Association Association Internationale des Femmes Medecins The World Medical Association, Inc. L'Association Medicale Mondlale, Inc. -
DISCUSSION GROUP C GROUPE DE DISCUSSION C CHAIRMAN Dr Truong-Minh-Cac Directeur general de la sante Dr Tiao Jaisvasd Visouthiphongs Directeur de l'Ecole de Sante publique Dr E.F. Thomson Secretary-General Australian Medical Association Dr So Satta Ministre de la Sante Publique Agrege des Centres HospitaloUniversitaires de France
.
Viet-Nam Laos
PRESIDENT RAPPORTEUR
MEMBERS MEMBRES
Australia Australie Khmer Republic Republique khmere
Dr Pruoch Vann Directeur general adjoint de la Sante Charge des Relations exterieures du Ministere de la Sante Publique Dr Phouy Phoutthasak Directeur general du Ministere de la Sante Publique
Khmer Republic Republique khmere
Laos
Dr Mechiel Chan Kin Chung Principal Medical Officer (Health) Sabah Dr D.H. Silva Ferreira Chief of Macau Health Services
Malaysia Malaisie
Portugal
WPR/RC22iI'D7 page 19 MEr-tBERS MEMBRES
Dr Nguyen-Xuan-Trinh Chef du Service de la Formation Ministere de la Sante
Viet-Nam
t'!rS M.R. Ordonez International President CICIAMS Division of Maternal and Child Health Manila Health Department
International Committee of Catholic Nurses Comite international Catholique des Infirmieres et Assistantes Medico-sociales
WORLD HEALTH ORGANIZATION
ORGANISATION MONDIALE DE LA SANT'
REGIONAL OFFICE FOR THE WESTERN PACIFIC BUREAU RfGIONAL DU PACIFIQUE OCCIDENTAL
REGIONAL COMMITTEE Twenty-second Session Manila 21-29 September 1971
TECHNICAL DISCUSSIONS WPR/RC22/TD7 Corr.l 28 September 1971 ORIGINAL: ENGLISH
REPORT OF THE TECHNICAL DISCUSSIONS ON "HEALTH MANPOWER IN THE DEVElOPING COUNTRIES: PROJ3LmIIS AND NEEDS" Corrigendum
Page 11/12, first line: Amend to read as -follows:
"participants examined the text section by section and adopted the report."
Page 15, Annex 2: j'
After GENERAL CHAIRMAN, add: GENERAL RAPPORTEUR Dr C.N. Derek Taylor Deputy Director-General o'f Health (Public Health) Department of Health New Zealand