(WPR/RC24/SR/7)
SUMMARY RECORD OF THE SEVENTH MEETING
Queen Margaret College, Wellington Monday, 3 September 1973 at 3.00 p.m. CHAIRMAN: Dr C.N. Derek Taylor (New Zealand)
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CONTENTS
Consideration of draft resolution ••••••••••••••••••••••••••• Selection of topic for the Technical Discussions during the twenty-fifth session of the Regional
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Committee...................................................
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Future sessions of the Regional Committee •.••••.•.••••.•••••
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REGIONAL COMMITI'EE:
TWENTY-FOURTH SESSION
Seventh Meeting Monday, 3 September 1973 at 3.00 p.m. PRESENT 1.
Representatives of Member States AUSTR;LIA CHINA Dr H.B. Franklands Dr Chen Hai-feng Mr Chou Shan-yen Professor Shih Cheng-hsin Dr Chang Kuang-hua Dr Tsao Yung-lin Dr D. Singh Dr J. Laigret Dr Teruhiko Saburi Dr Rintaro Okamoto Professeur Agrege Sok Heangsun Dr Kadeva Han Dr My Samedy Dr Phouy Phoutthasak Tan Sri Datuk (Dr) Abdul Majid bin Ismail Dr S.K. Mukherjee Mr Onn bin Kayat Dr Dr Dr Dr PHILIPPINES PORTUGAL REPUBLIC OF KOREA H.J.H. Hiddlestone C.N. Derek Taylor G. Blake-Palmer R. Dickie
FIJI FRANCE JAPAN KHMER REPUBLIC
LAOS MALAYSIA
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Dr A.N. Acosta Dr J.B. Duarte Finheira Dr Sung Hee Rhee Dr Sung Kyu Ahn Dr Kyong Shik Chang
StMttARY RECORD OF THE SEVENTH MEETING
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REPUBLIC OF VIET-NAM
Dr Truong-Minh-Cac Dr Pham-Van Dr Nhan-Trung-Son Dr Ho Guan Lim Dr J .L. Kilgour Dr G. Choa Dr Mr Dr Dr J.C. King F.S. Cruz M. Kumangai J. Nunn
SINGAPORE UNITED KINGDOM UNITED STATES OF AMERICA
WESTERN SAMOA
" II. Representative of Associate Member PAPUA NEW GUINEA
Honourable Seiu1i Taulafo Dr J.e. Thieme Mr FaapOituu1ao Atoa
Dr M. Wainetti
III. Representatives of the United Nations and Related Organizations UNITED NATIONS CHILDREN'S FUND IV. Mr A.H. Aslam
Representatives of Non-Governmental Organizations INTERNATIONAL DENTAL FEDERATION INTERNATIONAL COMMITTEE OF CATHOLIC NURSES Brigadier J. Ferris Fuller Miss P. Dudderidge Miss S. Burrell Dr R. Black Dr G.D.T. Harper
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INTERNATIONAL COUNCIL OF NURSES INTERNATIONAL PLANNED PARENTHOOD FEDERATION INTERNATIONAL SOCIETY OF RADIOLOGY V. WHO Secretariat SECRETARY
Dr Francisco J. Dy
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REGIONAL COMMITI'EE:
TWENTY-FOURrH SESSION
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CONSIDERATION OF DRAFT RESOLUTION The Committee considered the following resolution.
1.1
Drug dependence (Document WPR/RC24jWp!7 Rev.l) (continued from the sixth meeting, section 2.2)
Dr KILGOUR (United Kingdom) suggested that paragraph 5 (a) be amended to read: "to stimulate and develop activities in the field of the control of drug abuse and drug dependence" Decision: The draft resolution as amended was adopted (see resolution WPR/RC24.R8). 2 SELECTION OF TOPIC FOR THE TECHNICAL DISCUSSIONS DURING THE TWENTY-FIFTH SESSION OF THE REGIONAL COMMITl'EE: Item 19 of the Agenda (Document WPR/RC24/10)
Dr KING (United States of America) questioned the value of Technical Discussions at these meetings. A great deal of time was devoted to them by the representatives, some of whom might not feel qualif1ed to enter the discussions. The diversity of conditions in the Region made a worthwhile result very difficult. Dr HIDDLESTONE (New Zealand) observed that representatives had completed a qUestionnaire on the Technical Discussions and perhaps the result of these evaluations should be awaited before making a decision. Dr MAJID (Malaysia) considered that some subjects were beyond the experience of all representatives, but there was an opportunity to learn of many subjects in the field of health, picking up points that could benefit one's own country. Dr LAIGRET (France) considered that the Technical Discussions provided an enriching experience: on the one hand, the documents prepared provided basic data and stimulated thought; on the other, the group discussions offered an opportunity to express ideas and to dis~ cover the opinion of representatives from other countries. After a debate on budgetary questions, which was not always easy to follow for non-specialists, technical discussions brought in fresh air and appeared both resting and instructive. The REGIONAL DIRECTOR stated that the Executive Board at its eighth session had adopted a resolution inviting the regional committees to consider the advisability of holding Technical Discussions on matters of regional interest. This suggestion had been supported by the Committee at its third session when it decided in resolution WPR/RC3.R14 that
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"Technical Discussions be a part of the agenda in future sessions of the Regional Committee". The Regional Director pointed out that the Technical Discussions were not in fact a part of the Regional Committee agenda but were held in conjunction with the session. Dr FRANKLANDS (Australia) stated that he did not object to the holding of Technical Discussions as such, but thought that the subject matter might be modified. Although the ~opic for this year's Technical Discussions was a good one, it was one on which it was difficult to reach authoritative conclusions. He suggested a return to the type of subject used in the past, i.e., a topic of relatively limited scope which would allow exhaustive consideration to be given in the time allotted, for example, "Fluoridation of Water" or "Value of Nursing Aides in Hospitals or Public Health Work". Dr HO (Singapore) found the Technical Discussions interesting and a good interlude in the Committee's work-load, but he did not think they really justified the time allocated to them. He supported the modifications suggested by Australia or their abolition altogether. The CHAIRMAN thought that the general consensus seemed to be that the Technical Discussions should be continued but that two pOints should be taken into account in future: (1) The topic should be particularly relevant to the Region. This was of course, the responsibility of the Committee to determine. (2) The subject should be sufficiently restricted to enable ample time for discussion in the time allocated and for firm conclusions to be reached. The Committee then discussed the selection of a topic for the Technical Discussions in 1974. Dr MAJID (Malaysia) pointed out that Malaysia had submitted six topics but as there had been an outbreak of dengue fever recently in Malaysia he would like to support the one suggested by the Regional Office - 2.3 ., Control of Vector Mosquitos of Dengue Haemorrhagic Fever". This topic was particularly important not only to Malaysia but also to other countries in the Region more or less similarly exposed. Dr THIEME (Western Samoa) supported the Malaysian proposal. Dr PHOUTTHASAK (Laos) proposed that topic No. 1.5, "The Need for 'Generalists' rather than 'Specialists' in Medical Care Systems in Developing Countries", be selected as this would continue the discussion at this session and also dealt with manpower planning in developing countries. Dr LAIGRET (France) supported the selection of the item on the control of the dengue vector, since French Polynesia had experienced dengue outbreaks with a beginning of haemorrhagic signs.
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SESSION
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Dr ACOSTA (Philippines) gave his support to the topic 2.2 "The Use of the Medical Assistant in Health Services". This was very pertinent in the present stage of development of the health services in the Philippines where it was becoming increasingly realised that the lower levels of health workers were very important. He also recognised the importance of the topic proposed by l~alaysia and supported by France, but considered tllio: sllhject would be best considered in depth at a regional seminar. Dr SINGH (Fiji) stated that the topics proposed by the Representatives of Laos and the Philipptnes could be considered as a continuation of the subject matter studied this year. In his opinion, Topic 2.3 needed study in depth. He would support 2.2 in the first place, foJlowed by 1.5, second choice.
Dr PINHEIRA (Portugal' emphasized the fact that in developing countries the health personnel at the basic level had a very important role to play and therefore their training was particularly relevant to the proper development of health programmes. He gave his support to topic 1.6 "Postbasic Preparation of Trainers of Paramedical Health Workers" • Dr CHEN (China) said that he found all the topics important and but suggested that perhaps 1.5 and 2.2 could be combined one topi.c as they were simtlar in content.
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Dr WAINETTI (Papua New Guinea) supported the suggestion put forward by China that 1.5 and 2.2 be amalgamated. The training of speCialists was a costly business and what was really needed, especially in the rural areas, were general practitioners (generalists) who could handle practically all medical problems without having to refer their patients to specialists. Dr RHEE (Republic of Korea) stated that in the Republic of Korea, because of the shortage of professional staff, especially doctors, the use of auxiliary personnel was essential. As mentioned by the Regional Director in his Annual Report, the health services must be efficient at all levels to be effective. Although the question of health manpower had been discussed previously at meetings of the Regional Committee he felt further discussion was justified. He therefore s~p~orted topic 2.2. Dr KING (United States of America) pointed out that the question of health manpower had been discussed as recently as 1971. Dr TRUONG-MIlJ'r'!-CAC (Republic of Viet-Nam) supported the suggestion, made by Malaysia, to discuss the control of the vector of haemorrhagic dengue, a disease which existed in Viet-Nam and in other countries of
SUMMARY RECORD OF THE SEVENTH MEETING
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the Region. Othe !'Wise, he would favour the proposal made by the Representative of Laos. Dr MAJID (Malaysia) explained not envisaged that topic 1.5 could was his experience that many young whereas the Health Services of the that, when suggesting topics, he had be discussed together with 2.2. It doctors were desirous of specialising, Region needed "Generalists".
The REGIONAL DIRECTOR considered that topic 2.2 was of great importance. Reports received from countries in the Region and visits made by the WHO staff showed that there was an urgent need to train and utilize medical assistants. For this reason a project entitled "Conference on the Medioal Assistant" had been included in the List of Additional Projects (page 389 of document WPR/RC24/2). It was hoped that savings would permit this conference to be held as it would enable a full discussion to take place among the countries in the Region on this very important subject. In the Region at least 7($ of the people live in rural areas and many die without medical attention. The training of medical auxiliaries or assistants was therefore essential. The Regional Director said that he had been impressed with the first aide and emergency treatment given by the barefoot doctors in China. This did not mean, however, that other countries should follow this pattern. They should rather tailor the training and duties of medical auxiliaries to fit their own needs. Dr ACOSTA (Philippines) said that in view of the comments of the Regional Director he would wi tpdraw his support of the "Use of the Medical Assistant in Health Services". Dr KILGOUR (United Kingdom) said that his delegation supported the Malaysian suggestion for the control of the dengue vector mosquito. Dr LAIGRET (France) expressed the view that if the technical aspects of the dengue question were to be discussed in detail, a seminar would be necessary, but that it was possible to adopt a public health approach to the subject. It might be useful for example, to define the most effective way of including a dengue vector control project in a general health programme. Dr KING (United States of America) supported the suggestion of the United Kingdom as it was a narrower, more conCise, more clearly delineated and defined subject on which the Committee could concentrate in the time allowed. Dr CHEN (China) supported the statement of the Regional Director and withdrew his earlier suggestion that items 1.5 and 2.2 be combined. The CHAIRMAN called for a vote and then declared that the topic for the Technical Discussions in 1974 would be the "Control of Vector
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REGIONAL COMMITTEE:
TWENTY-FOURTH SESS:'"ON
r.1osquitos of Dengue Haemorrhagic Fever". (For consideration of draft resolution, see the eighth meeting, section 1.2.)
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FUTURE SESSIONS OF THE REGIONAL COr.1r.1ITI'EE: (Documen t WPR/RC24/11)
Item 20 of the Agenda
The REGIONAL DIRECTOR drew the attention of the Committee to the fact that document WPR/RC24/1l dealt with two separate aspects of future sessions of the Regional Committee: (1) the twenty-fifth session in 1974 and (2) the venue of the twenty-sixth session and the question of holding alternate sessions at Regional Headquarters. As far as the first aspect was concerned, last year the Committee had adopted resolution WPR/RC23.R22, in which it accepted the invitation of the Government of Malaysia to hold its twenty-fifth session (1974) in Kuala Lumpur. The sessions of the Regional Committee, when held in Manila, were covered by the Host Agreement for the Regional Office executed by the Government of the Republic of the Philippines and the Organization on 22 July 1951. Sessions held away from Manila were covered by an agreement between the Host Government and the Organization relating to the facilities and services and to the legal status afforded to the Organization on the occasion of holding the specific session of the Regional Committee on the territory of the Government; the agreements are normally written in terms of the Convention on Privileges and Immunities of the Specialized Agencies, including its Annex VII which specifically relates to the World Health Organization. Such agreements were executed with the Government of the United States of America for the session in Guam last year and with the Government of New Zealand for the current session of the Regional Committee. The holding of the twenty-fifth session of the Regional Committee in Kuala Lumpur would therefore be dependent on the conclusion of an agreement with the Government in terms of our normal practice in this, and the other regions. If such an agreement were not concluded, the meeting would have to be convened at Regional Headquarters. As to the second aspect of the agenda item, the 1972 session of the Regional Committee decided, in its resolution WPR/RC23.R23, to consider the question of the venue of the twenty-sixth session (1975) of the Regional Committee and of holding alternate sessions at Regional Headquarters at its twenty-fourth session. Document WPR/RC24~1 contained a reference to earlier resolutions of the Committee on future sessions of the Regional Committee, with indications as to where they could be found in the Handbook of Resolutions and Decisions of the Regional Committee for the Western Pacific.
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Annexed to the document were extracts from the summary records of the sixth and seventh meetings of the twenty-third session of the Regional Committee. Dr MAJID (Malaysia) referred to resolution WPR/RC23.R22 and said that the Government of Malaysia reaffirmed its invitation to hold the 1974 session of the Regional Committee in Kuala Lumpur. Dr Majid also advised that preliminary preparation hac commenced and that the agreement to hold the meeting would be signed as soon as the documents were received by the Malaysian Government. The CHAIRMAN invited comments from Representatives on the confirmed invitation. There being no objections or abstentions the Chairman accepted the invitation, and thanked the Malaysian delegation. The Chairman invited Representatives to comment on the venue for the 1975 session. Dr FRANKLANDS (Australia) said that Australia still believed that there were great advantages in having regular sessions at Regional Headquarters. Members should have regular opportunities to meet with the total staff at headquarters and therefore suggested that the 1975 session should be held in Manila and thereafter should be held there each alternate year. Dr KING (United States of America) supported the recommendation of the Australian delegation and said that it should result in considerable savings which could then be used to finance fellowships and other programmes which would be of immediate help to Member governments. Dr KILGOUR (United Kingdom) also supported the proposals of Australia and the United States of America. Dr Kilgour said that the holding of sessions away from headquarters every other year enabled members to get an idea of the problems in other states but it also allowed members the opportunity to meet the total staff of the Regional Office at least every two years. Dr LAIGRET (France) said that, in principle, his Government was not favourable to venues other than the Regional Headquarters; nevertheless, it accepted them if the host government assumed the extra cost involved. Dr SINGH (Fiji) asked for clarification on whether the location of the 1975 meeting was for the present Committee to decide or would the final decision be made at the 1974 session. The REGIONAL DIRECTOR advised that the present session would have to decide the venue for 1975 as stated in resolution WPR/RC23.R22 the Committee decided "to consider the question of the venue of the
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REGIONAL CCMMI'ITEE:
TWENTY-FOURI'H SESSION
twenty-sixth session (1975) of the Regional Committee and of holding alternate sessions at regional headquarters at its twenty-fourth session". The Regional Director pointed out further that if it were decided to hold the twenty-sixth session in a place other than in Manila it would be necessary to include in the budget the additional funds required should the host government not agree to meeting the additional cost. Dr SINGH (Fiji) drew attention to nule 4 - "The Committee shall flold at least one regular session a year. It shall determine at each regular session the time and place of its next regular session" and asked whether the Committee was not placing itself in an embarrass ing situation. The CHAIRMAN advised that this was not so and that at the 1974 session the arrangement would be confirmed, as the invitation of the Government of Malaysia had been at the present session. The Chairman then invited further comments on the 1975 session; there being none it was decided that the session in 1975 would be held at Regional Headquarters in Manila. The Chairman then asked the Rapporteurs to prepare resolutions: (a) on the venues for the 1974 and 1975 sessions of the Regional Commi ttee; and (b) in regard to the prinCiple being accepted that o,lternate sessions be held at headquarters in Manila. Dr KING (United States of America) stated that his Government would support the suggestion made by Dr Laigret that where sessions were held away from headquarters the host country meet the increased costs. The CHAIRMAN pointed out that there was already a resolution to the effect that countries be encouraged to pay. The topic had been debated previously and could be referred for debate at a future session if members so desired. (For consideration of draft resolution, see the eighth meeting, section 1.2.)
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The meeting rose at 5.05 p.m.