•
(WPR/RC30/SR/5)
SUMMARY RECORD OF THE FIFTH MEETING Mandarin Court, Singapore Thursday, 4 October 1979 at 9.00 a.m. CHAIRMAN: Dr A.G.K. Chew CONTENTS (Sing~pore)
1.
Consideration of draft resolutions •••••••••••••••••••••• Strategies for health for all by the year 2000: review of progress towards development of national strategies and plans of action (continued) ••••••••.•••••••••••••••• Seventh General Programme of Work covering a specific period (1984-1989): preliminary review of nature;'. objectives, structure and method of preparation ••••••.•• Contribution of health to the new international economic order
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167 169 172
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Correlation of the work of the World Health Assembly and the Regional Committees ................................. .
5.1 5.2
Consideration of the agenda of the sixty-fifth session of the Executive Board ••• ;......................... Consideration of resolutions of the Thirty-second World Health Assembly and the Executive Board at its sixty-third and sixty-fourth sessions ••••••••••••• ~
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172 175
6.
Country health programming •••...•••.••••....••.•••••..••
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REGIONAL COMMITTEE:
THIRTIETH SESSION
1.
CONSIDERATION OF DRAFT RESOLUTIONS The Committee considered the following draft resolutions:
1.1
Special Programme for Research and Training in Tropical Diseases: Joint Coordinating Board (Document WPR/RC30/Conf. PaperNo. 4) Decision: The draft resolution was adopted without comment (see resolution WPR/RC30.R5)
1.2
Technical Cooperation among Developing Countries (Document WPR/RC30/Conf. Paper No.5) Decision: The draft resolution was adopted without comment (see resolution WPR/RC30.R6)
1.3
Membership of the Sub-Committee on Technical Cooperation among Developing Countries (Document WPR/RC30/Conf. Paper No.6) Decision: The draft resolution was adopted without comment (see resolution WPR/RC30.R7)
1. 4
Sub-Committee on the Gene_ral Programme (Document WPR/RC30/Conf. Paper No. 7)
C?l... Work
Decision: The draft resolution was adopted without comment (see resolution WPR/RC30.R8) 1.5 Membershi (Document the General Pro ramme of Work 8)
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Dr ACOSTA (Philippines) suggested that operative paragraph 1 (1) might be amended to show the full composition of the Sub-Committee instead of the changes in membership. Dr HAN (Director, Programme Management) explained that the present wording had been chosen to show the rotation of membership, certain members being replaced each year. Decision: The draft resolution was adopted without further comment (see resolution WPR/RC30.R9) 1.6 Cost of travel of representatives (Document WPR/RC30/Conf. Paper No.9)
Dr FAAIUASO (Samoa), presenting this draft resolution at the request of the CHAIRMAN, said that its object was to help small independent countries that were unable, for financial reasons, to send a representative to the Regional Committee. He suggested that the words "if so requested", in the third line of the second operative paragraph, should appear immediately after the word "finance". Dr HOWELLS (Australia) said that he had spoken against the principle underlying the draft resolution, but would not oppose the adoption of the resolution if the majority .of representatives were in favour of it.
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Dr FISCHER (United States of America) wondered whether the draft resolution provided the Executive Board with enough flexibility to consider alternative methods of financing the travel of representatives. The present wording gave blanket authority to the Regional Director. but there was no knowing how that would be received by the Executive Board. There should be some indication that the Regional Director would be exercising judgement in deciding who needed such assistance. He therefore proposed that the draft resolution should be reworded accordingly. Dr CHRISTMAS (New Zealand) had some reservations about Dr FISCHER's suggestion. which would place the Secretariat in a difficult position. He proposed that "if so requested" should be deleted, since that qualification did not apply to delegates to the Health Assembly. The point was that the situation was the same for the Regional Committee as for the Health Assembly. If the draft resolution was amended so that countries had to apply for assistance. he could not support it. Dr NOORDIN (Malaysia) suggested that, in operative paragraph 2, "finance" should read "consider financing", so as to allow greater flexibility. Dr NICHOLSON (United Kingdom of Great Britain and Northern Ireland) supported Dr NOORDIN's suggestion. Dr FAAIUASO (Samoa) agreed with Dr CHRISTMAS that it would be better to delete "if so requested". He pointed out that persons from six of the Member States represented at the Regional Committee were members of the Executive Board and could therefore support the resolution when it came before the Board. There was therefore no need for the rewording proposed by Dr FISCHER. Dr FISCHER (United States of America) withdrew his suggestion in view of Dr NOORDIN's proposal, which' allowed for flexibility. He also agreed with the point made by Dr CHRISTMAS. His own point was that a radical change by all regional committees in the matter of travel costs might be seen as a political matter. The modification of "finance" to "consider financing" was a good suggestion. which he supported. Dr NOORDIN (Malaysia) said that the purpose of the draft resolution was to help Member States who were unable to send a representative to the Regional Committee for financial reasons. The words "if so requested" were necessary in order to place the onus on Member States to make a request. WHO would then consider if the request was fair. Dr CHRISTMAS (New Zealand) still thought that the Secretariat should not have to determine what countries should be assisted, and that countries should not be placed in the humiliating position of having to request help. Some might indeed prefer not to subject their representatives to such a condition. He therefore suggested the addition of "at least" to operative paragraph 2, before "finance". It should then be left to the Executive Board to decide on the principle involved. Dr ACOSTA (Philippines) said that the most valid argument for the draft resolution was that the Regional Committee had the same status as the Health Assembly in that it made policy decisions. The words "if so requested" should therefore be removed. It should be left to Member States to claim reimbursement of travel costs or not. as they wished, thereby eliminating the awkward situation where a particular country had to make a formal request.
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Dr FISCHER (United States of America) favoured the retention of "if so requested". On reflexion, he did not feel as strongly as other representatives about the ability of WHO to consider the criteria, since it already considered criteria for a great many technical cooperation activities. "If so requested" provided a desirable measure of flexibility. One option might be to devise a way of financing travel through country allocations, if that was recognized as a legitimate part of technical cooperation. It should be left to the Executive Board to consider the alternatives. Dr NICHOLSON (United Kingdom of Great Britain and Northern Ireland) thought that there was general sympathy with the newly independent states concerned. All agreed that there was a need for a suitable mechanism. The question was how to present the matter to the Executive Board in an acceptable way. The CHAIRMAN said that the REGIONAL DIRECTOR was in favour of setting up a working group, consisting of the representatives of Malaysia, New Zealand, the United Kingdom, the United States of America, and Samoa to redraft the text. Dr FAAIUASO (Samoa) proposed that, instead, the matter might be settled during the coffee break. It was so agreed. (For continuation of discussions, see the seventh meeting, section 1.11). 2. STRATEGIES FOR HEALTH FOR ALL BY THE YEAR 2000: REVIEW OF PROGRESS TOWARDS DEVELOPMENT OF NATIONAL STRATEGIES AND PLANS OF ACTION: Item 14 of the Agenda (Documents WPR/RC30/11 Part II and WPR/RC30/11 Part II Add.l to WPR/RC30/11 Part II Add.3) (continued from the fourth meeting, section 2)
The REGIONAL DIRECTOR said that he had held further discussions with the Director-General on the proposed international health funding group. The object of the group was to mobilize resources for the promotion of primary health care in developing countries in support of health for all by the year 2000. Several funding agencies were in favour of the establishment of such a body, which would complement, and not overlap with, the planned global health development advisory council. The involvement of developing countries and the WHO regions Ln the funding group was regarded as important, but as the group had not yet been definitely established there was no need at the present stage for the Regional Connnittee to appoint a member. The item could be considered again at the next session, including the question of the funding group. Meanwhile, a short briefin5 note on the group (document WPR/RC30/27) was being circulated to the Committee. In the absence of further comments, the CHAIRMAN asked the Rapporteurs to prepare a suitable draft resolution. (For consideration of the draft resolution, see the seventh meeting, section 1.1).
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3.
SEVENTH GENERAL PROGRAMME OF WORK COVERING A SPECIFIC PERIOD (19841989): PRELIMINARY REVIEW OF NATURE, OBJECTIVES, STRUCTURE AND METHOD OF PREPARATION: Supplementary Agenda item 1 (Document WPR/RC30/25)
The REGIONAL DIRECTOR said that, as early as April 1979, discussion had started, in Geneva and at the regional offices, on the nature, objectives, structure and method of presentation of the Seventh General Programme of Work. As a result, a discussion paper had been elaborated which was now before the Committee. The objectives of the Seventh General Programme of Work would focus on the long-term goal of health for all by the year 2000. It, should represent the needs of Member States to enable them to implement national strategies for attaining that goal. The classification structure of the Programme might therefore be quite different from that of the Sixth General Programme of Work, in that it would focus on priority issues for WHO action, divided into three broad categories of interrelated programmes - health systems programmes, health technology programmes and promotional and support programmes. Approaches as a means of attaining the objectives of the Seventh General Programme of Work would have two broad aspects: coordination, which would include the availability of valid information on health programmes and systems; and technical cooperation, which would include the use of valid information. An endeavour would be made to include, in the broad lines for WHO action, related action in sectors other than health, as far as WHO could influence them. The review that the Regional Committee was to make at the present session was a preliminary one, in preparation for the Programme Committee of the Executive Board to mak~ draft proposals for the nature, objectives, structure and method of preparation of the programme. Those proposals would be closely related to the Programme Committee's review of the Regional Committee's report on the item just discussed (Formulating strategies for health for all by the year 2000). Preliminary material for the Programme of Work would be prepared, in consultation with governments, during the 'first few months of 1980 and the Regional Committee would be asked to make a review of preliminary regional material at its next session. Dr COHEN (Office of the Director-General) observed that the preparation of WHO's general programmes of work was the responsibility of the Executive Boar1. For the first time, the regional committees were being asked to comment on the draft material before review by the Board, to ensure that they were involved from the beginning. The Seventh General Programme of Work was bound to differ from its predecessor because of the important policy decisions taken by the Health Assembly since the Sixth Programme had been prepared - resolution WHA29.48, the adoption of ,health for all by the year 2000 as countries' main social target, the Alma-Ata Conference, and resolution WHA32.30 asking countries to formulate strategies for health for all. The three Programmes covering the remaining 20 years should all reflect those decisions.
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The accent in the Seventh Programme would be on building up national health systems based on primary health care. In place of the fragmented structure of the past, the objective would be one single vertical system the health system itself - into which all other programmes would be fed. Three different types of programme would form the basis of the Seventh Programme: health systems programmes; health technology programmes, designed to define the most appropriate technology for the health system; and promotional and support programmes, designed to support the other programmes and including, for example, research and the Organization's governing bodies. The proposals now before the Committee, if accepted, would entail profound changes in ministries of health and in WHO at all levels, to reflect the integration of all existing vertical programmes into a single system sup~orted by all its parts. The findings of the current study of WHO's structures in the light of its functions would be relevant in that respect. Dr NOORDIN (Malaysia) pointed out that both the note at the end of paragraph 21, section A, on page 18 and the second subparagraph under "Health protection and promotion" in section B on page 19, referred to the health of specific population groups. ' Was he right in assuming that programmes under section A related to services, and those under section B to technology? Dr COHEN (Office of the Director-General) said that Dr Noordin was correct. Countries now had many services that were not part of a single system; for example, maternal and child health (MCH) care, workers' health and primary health care. Under the proposed system, it would be the responsibility of MCH workers to wo~k out a common approach within primary health care, since a single health worker would provide all care. Workers' health services too could be integrated into the single system, using the most appropriate technology., Dr NOORDIN (Malaysia) followed that reason~ng for section A of paragraph 21. For section B, however, he found the phrase "health technology programmes" confusing; would health technology come under those programmes? Dr COHEN (Office of the Director~General) illustrated his reply with a,further example. Countries often had separate malaria control and health services. The intention was to have one service only, with overall strategies worked out for the country as a whole and delivered at the appropriate service level. That would call for a much more effective dialogue than was now usual between the technical staff working on technologies and other staff working on the infrastructure. It had been to achieve a single viable health system of that kind that the Executive Board had asked the Director-General, in 1971, to change the thrust of WHO's programme~ That had been attempted, not very successfully, in the Fifth and Sixth General Programmes of Work, and a further attempt would be made in the Seventh. There being no further comments, the CHAIRMAN asked the Rapporteurs to prepare an appropriate draft resolution. (For consideration of the draft resolution, see the seventh meeting, section 1.2).
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CONTRIBUTION OF HEALTH TO THE NEW INTERNATIONAL ECONOMIC ORDER Item 16 of the Agenda (Document WPR/RC30/l4)
The REGIONAL DIRECTOR said that the Executive Board, at the sixty-second session, had decided that the subject for the technical discussions during the Thirty-third World Health Assembly in 1980 would be "The contribution of health to the New International Economic Order". Document WPR/RC30/l4 contained a discussion paper, prepared as a first step towards providing the background for the Technical Discussions. It described the formulation of the New International Economic Order itself and the associated International Development Strategy; the health aspects of the issues involved; and the interrelationships between the two. Finally, on page 27, it posed some fundamental questions for review by the Committee •
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Dr NICHOLSON (United Kingdom of Great Britain and Northern Ireland) thought that the discussion paper set out fairly well the contribution that health could make to the new international economic order. With regard to the first question suggested for discussion in paragraph 63, viz "Is it true that socioeconomic development is dependent upon human energy and that an acceptable level of health is required to generate this energy?", he certainly hoped that it was true and that it could be proved, because otherwise the health sector would be in an awkward position vis-a-vis the economists, who always demanded statistical evidence of the contribution of health to economic development. Dr ACOSTA (Philippines), referring to the figures quoted in paragraph 19 of the discussion paper, concerning the difference in infant mortality rates between developed and developing countries, said he would like again to stress the point he had made the previous day concerning the importance of developing indicators to guide governments in the formulation of their strategies for attaining health for all by the year 2000. Dr HSU SHOU-JEN (China) said that the new international economic order should eventually enable the developing countries to channel new resources into the improvement of their health services, but for that end to be achieved a great deal of effort would still be required. As stated in the document under discussion, the health systems of most countries remained outside the mainstream of social and economic development. If that situation was to be changed, the following points must be stressed: (1) health was concerned with the whole life span of every individual, and was therefore not just a technical but a social and economic problem; (2) effective health work protected the labour force and hence was of great importance ~n the development of the economy . If health services were to develop as they should, within the new international economic order, attention must be paid to the following aspects: (1) health development should be recognized as an integral part of national economic development and the necessary resources should be allocated for that purpose by the State; (2) the importance of primary health care in the development of rural economies should be recognized. In the development of primary health care, the specific political, economic, environmental and other conditions of the country concerned should be taken as a bas is . Primary heal th care mus t--aim to alleviate the economic burden of medical expenses for the people. Mass participation, without -
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which no health campaign could have lasting results, must also be stressed. The rural barefoot doctors and cooperative system serving China's 800 million workers was one example of such participation. Of course, alongside the foregoing points, stress had also to be laid on self-reliance and on population control. Only when all those conditions were fulfilled would it be possible to overcome a country's backwardness in the health sphere arid ensure the attainment of health for all by the year 2000. Dr FISCHER (United States of America) thought that the discussion paper outlined very well the issues facing health professionals throughout the world, in relation to the new international economic order, and agreed with its thesis that health could, if the opportunities were properly seized, be an important bridge between international and national efforts towards social and economic development. Referring to paragraph 30 of the paper, he observed that th~ debate on the relationship between health and the new economic order was just beginning: he believed it would be good for all concerned and would afford an opportunity for the health sector to playa more vital role in the development of the world's economieR. The health lluthoritieH of hiFi country looked furward to part it: i pat ing in it and to supporting the ro Ie of heal th not perhaps in "leading", as the paper termed it, to a genuine socioeconomic development order, but to providing models for other socioeconomic sectors. In an effort to stimulate more interest among other sectors of political leadership, both international and national, in the role that health could play in the development process, the United States delegation to the thirty-fourth session of the United Nations General Assembly would be submitting a draft resolution entitled "Health as an integral part of development". He had copies which he would distribute to any interested representatives and any support that their government representatives in the United Nations could give would be appreciated. Dr FAArUASO (Samoa) said that in his own small country the main , areas of economic development would be food and agriculture, industrialization and employment, including training for industry, improvement of the quantity and quality of exports, and strengthening of fiscal resources for the support of the first three areas. But the health sector realized that the growth of industry and agriculture would pose risks which would need monitoring and timely intervention. The population structure of most developing countries, with a high proportion of young people, made them particularly susceptible to such risks, and if development was rapid it was no easy task to maximize its benefits and minimize its adverse effects. Also development would require fitness and motivation; for that, health education would be necessary. Lastly, the quality and sophistication of health planning would need to be substantially increased to cope with the needs.
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Dr TALIB (Malaysia) said that, with regard to health planning, he could not help following the thinking of the economist, because in the last analysis the fundamental issue would be input and output. In that respect the health sector was in a weak position, because there were not enough indicators to demonstrate that output equalled input. As had been pointed out, most of the indicators at present available, such as reduction in infant or maternal mortality rates., were negative, the only positive one being longevity. That, together with the fact that other sectors such as nutrition and education also contributed, in ways difficult to evaluate, to health improvement, made it difficult for the health workers to put their case strongly to the economists. So an effort was required in the direction- of developing positive indicators. Dr COHEN (Office of the Director-General) said that the present review, in the Regional Committee, of the subject for the next technical discussions at the Health Assembly was part of the new approach that consisted in giving the Assembly information predigested at the country level. What had prompted the Board to select the subject was the feeling that, in the new international economic order, health was almost entirely ignored. There must be some way of getting through to the decision-makers and showing them that health was not just a service provided to consumers but a contributor to national productivity. In the controversy that had been going on for years with the economists, the counter-argument of the health workers had been to demand proof in turn that economic growth necessarily contributed to social advancement, and the discussion paper before the Committee contained some telling examples to the contrary. So there was no need for the health sector to be entirely on the defensive, though it was true, as the representative of Malaysia had pointed out, that better indicators were needed. What he had just said applied not only to WHO but to the health sector in general. He had recently attended the United Nations Conference on Science and Technology, held in Vienna, and one of the main issues discussed there had been the problems involved in the transfer of technology from developed to developing countries. In the health sector no such problems had arisen: developing countries had not had technologies forced upon them, nor withheld from them because of patent rights, and even in the pharmacological field, WHO had dared to stand up to the transnational companies in a way no other economic or social sector had done, with benefits that were already obvious in that the transnationals had recognized that changes must take place in the pattern of drug manufacture and distribution and that a confrontation was not inevitable. The United States representative had observed that the health sector could be a bridge between national and international economic development efforts. That was important because there was an almost universal fee1ing, for psychological reasons, that any social sector was only a sort of smokescreen for real, i.e., economic, development. HHO had to prove that that was not so and that its strategies for health for all were in themselves a contribution to economic development. If representatives agreed to the foregoing concepts, it was important that they should endeavour to prove the case not only at the technological but at the political level, so that the World Health Assembly could demonstrate to the world that health was not just a service to consumers but a contribution to development.
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... Dr FISCHER (United States of America) said that the discussion paper's merit, in showing the benefits of investment in health in terms of hard economic facts, deserved recognition. He, too, believed that health had its investment as well as its consumer aspects and that the former should be stressed. In doing so, however, it would be unwise to adopt the economist's view wQolesale or indeed to try to speak only in economic terminology. Ideas that gained political acceptance did so with no thanks to either economic or medical jargon alone. As the Chinese said, health was "people business". Now that "Health for all" required· a person to be "socially and economically prOductive" there could be no return to the "holier than thou" attitude common among medical personnel; health expenditure must be justified in realistic terms. On the other side of the issue, health levels could not be related too closely to gross national product (GNP). The United States of America, with one of the highest GNPs, had its own share of health problems and deficiencies. There being no further comment, the CHAIRMAN asked the Rapporteurs to prepare a draft resolution. (For consideration of the draft resolution, see the seventh meeting, Reetion 1.3). 5. CORRELATION OF THE WORK OF THE WORLD HEALTH ASSEMBLY AND THE REGIONAL COMMITTEES: Item 15 of the Agenda (Documents WPR/RC30/l2 and WPR/RC30/13) Consideration of the agenda of the sixty-fifth session of the Executive Board: Item 15.1 of the Agenda (Document WPR/RC30/l2)
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5.1
The REGIONAL DIRECTOR said it had been clear for some time that efforts should be made to synchronize the agenda of the World Health Assembly, the Executive Board and the Regional Committees. This was the first year a formal attempt had been made to do so. Document WPR/RC30/l2 set out the main items of the provisional agenda of the January 1980 session of the Executive Board. As could be seen, there were a number of items on the agenda of the Committee that would also be discussed by the Exec-utive Board. A record of the Committee's deliberations would be transmitted to the Director-General and taken into account by him in preparing the documentation for the Executive Board. In the absence of comments, the CHAIRMAN asked the Rapporteurs to consider whether they would prepare a draft resolution. (For consideration of the draft resolution, see the seventh meeting, section 1.4). 5.2 Consideration of resolutions of the Thir~second World Hqalth Assembly and the Executive Board at its sixty-third and Sixt,fourth sessions: Item 15.2 of the Agenda (Document WPR/RC30 13) Development of the mental health programme (resolution WHA32.l3)
5.2.1
The REGIONAL DIRECTOR drew attention to operative paragraphs 1 and 2.
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In reply to a question by Dr ACOSTA (Philippines), the REGIONAL DIRECTOR confirmed that the Special Account referred to in operative paragraph 4 would be similar to those for smallpox eradication and for the malaria programme. 5.2.2 Workers' health programme (resolution WHA32.l4)
The REGIONAL DIRECTOR drew attention to operative paragraphs 3 and 4. 5.2.3 Development and coordination of biomedical and health services research (resolution WHA32.l5)
The REGIONAL DIRECTOR drew attention to operative paragraphs 1 and 2. He noted that a report on progress in research in the Region would be discussed under item 19 of the agenda of the Regional Committee's current session. 5.2.4 Review of the medium-term programme for the promotion of environmental health (resolution WHA32.3l)
The REGIONAL DIRECTOR drew attention to operative paragraphs 3 and 4. 5.2.5 Smallpox eradication (resolutions WHA32.32 and EB63.R5)
The REGIONAL DIRECTOR drew attention to operative paragraph 4 of resolution EB63.R5. The Committee noted the four above-mentioned resolutions without comment. 5.2.6 Respiratory diseases (resolution WHA32.33) The REGIONAL DIRECTOR drew attention to operative paragraph 3. He noted that "Acute respiratory diseases" was the subject of the Technical Presentation to be made on Friday, 5 October. Dr FAAIUASO (Samoa) asked about the state of research on those diseases in the Region, and particularly pneumonia.
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Dr HAN (Director, Programme Management) said that, pending a detailed account of such work during the Technical Presentation, he could report that research was going ahead at the Institute of Medical Research in Goroka, Papua New Guinea on pneumonia and the development of pneumonia vaccine. It was also proposed to establish a surveillance unit in the Region not only for the collection of epidemiological data but also for research on respiratory diseases •
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5.2.7
Leprosy (resolution WHA32.39) The REGIONAL DIRECTOR drew attention to operative paragraph 1.
5.2.8
Development of the WHO programme on alcohol-related problems (resolution WHA32.40) The REGIONAL DIRECTOR drew attention to operative paragraph 2.
5.Z.9
Action programme on essential drugs (resolutions WHA3Z.4l and EB63.RZO)
The REGIONAL DIRECTOR drew attention to operative paragraph 4 of resolution WHA3Z.41. 5.Z.l0 WHO long-term programme for maternal and child health (resolution WHA32.42)
The REGIONAL DIRECTOR drew attention to operative paragraph 1. 5.2.11 Pr0.E0sec!...EE.9 ..1t;:.~mme_!>~dg~_t__ (?r.. _J:..l:l..e.__t~~s_i~~.!_ ..P_e..:r.io<;Ll9~9-1!.~_: programme review: t_raditional medicine programme (resolution EB63.R4)
The Committee noted the five above-mentioned resolutions without comment.
The REGIONAL DIRECTOR drew attention to operative paragraph 2. In reply to a question by Dr FAAIUASO (Samoa), the REGIONAL DIRECTOR explained that, as distinct from the regular budget financed by Members' contributions, WHO's Voluntary Fund for Health Promotion received the voluntary contributions of governments, organizations and individuals to the work of the Organization, sometimes in the form of support to specific programmes or activities. Donors in the Western Pacific Region included the Governments of Australia, Japan and New Zealand and the Japan Shipbuilding Industry Foundation. 5.2.13 Action in respect of international conventions on narcotic and psychotropic substances (resolution EB63.R29)
The REGIONAL DIRECTOR drew attention to operative paragraph 1. Dr CRUZ (United States of America) said that drug abuse and its social consequences had become a major problem in many countries. His Government was glad to see increased attention in WHO to efforts to combat illicit use of narcotic and psychotropic substances, in particular the development of a programme of research in the epidemiology of drug abuse; but he wished to urge stronger measures by the governments of other countries to reduce drug abuse, especially in the medical uses, and if possible in curbing illicit traffic.
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• The REGIONAL DIRECTOR said thatT-lHO' s mental health programme included treatment and preventive aspects, as well as epidemio+ogical research in drug abuse and that those aspects were being given increased attention. WHO was cooperating with the United Nations Division of Narcotic Drugs, UNFDAC and USAID in that respect. 5.2.14 WHO's human health and environment programme - evaluation of the effects of chemicals on health (resolution EB63.R19)
Dr FAAIUASO (Samoa) said that his country endorsed the content of that resolution, and expressed gratitude to WHO for its cooperation in evaluating environmental health problems, particularly the work of a WHO expert in Samoa. There being no further comments, the CHAIRMAN asked the Rapporteurs to prepare a draft resolution. (For consideration of the draft resolution, see the seventh meeting, section 1. 5). 6. COUNTRY HEALTH PROGRAMMING: Item 17 of the Agenda (Document WPR/RC30/l5)
The REGIONAL DIRECTOR referred to the last session of the Regional Committee, when the reprCRentative of New Zealand had rightly pointed to country health progrann1l1ng as a fundamental process in the planning of national health services. As a result of his comments, the subject had been placed on the agenda of the present session, so that representatives would have the chance to exchange comments on experiences and problems encountered 'in introducing or carrying out the process. Document WPR/RC30/l5 described programming, the principles and the WHO in the Western Pacific Region. programming as a tool for technical for its support. the policy basis for country health procedures, and the past efforts of It also referred to country health cooperation and described mechanisms
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Mr TUNOA (United States of America) noted the significantly rapid growth of countries' commitments to country health programming, as shown in Annex 4 to the document. American Samoa was fully committed, and, since 1969, when an agency for overall health planning had been created, it had fulfilled the requirements mentioned in section 7 and 8 of the document which referred to the development of a network of centres and supportive care groups to ensure an institutionalized, on-going capability, rather than one-shot planning exercises. An advisory council had been appointed, representing the community, legislature, chiefs, orators, farmers and providers of health services; the "consumers" of those services could thus express their views on health problems. The country health programming agency provided technical expertise. American Samoa had had a long-range health programme since 1974 which was reviewed and revised annually. No medical facility or equipment. could be installed without its necessity being certified by the Health Coordinating Council. Before the establishment of the agency and the Council, planning and direction of programmes had been the responsibility of the Director of Health for the Territory •
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He further referred to the organization of workshops on country health progranuning, and pledged the support of the United States of America and American Samoa for WHO's. eff()rts. There being no further comments, the CHAIRMAN asked the Rapporteur to prepare a draft resolution. (For consideration of the "draft resolution, see the seventh meeting,. section 1.6).
The meeting rose at 12.00 noon.
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