10 February 1989 ORIGINAL: ENGLISH
REPORT TECHNICAL DISCUSSIONS ON TECHNOLOGY TRANSFER IN THE HEALTH FIELD
Convened by the REGIONAL OFFICE FOR THE WESTERN PACIFIC OF THE WORLD HEALTH ORGANIZATION Manila, Philippines 16 September 1988
Not for sale Printed and Uistributed by the Regional Office for the Western Pacific of the World Health Organization Manila, Philippines Februar y 1989
..ri/'T n
,w m>n T.mRARl :tn l'lril.,.,.l'li1'111't
2 2 SEP 1989
NOTE
The views expressed in this report are those of the participants in the Technical Discussions on Technology Transfer in the Health Field and do not necessarily reflect the policies of the Organization.
This report has been prepared by the Regional Office for the Western Pacific of the World Health Organization for the governments of Member States in the Region and for participants in the Technical Discussions on Technology Transfer in the Health Field, which was held in Manila, Philippines, on 16 September 1988.
CONTENTS
1.
INTRODUCTION • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • PRESENTATIONS • • • • . • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • GROUP DISCUSSIONS • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • CONCLUSIONS • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • ANNEX 1 - AGENDA • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • ANNEX 2 - OVERVIEW BY DR A. ROMUALDEZ •••••••••••• ANNEX 3 - REPORT BY DR A. SHIRAI •• 0 •• 0 • 0 •••• 0 ••
1 1 3 6 7 9 13
.'
2. 3. 4.
ANNEX 4 - REACTION OP A USER COUNTRY BY HR M. TAGUIWALO
... ................. •••• 0 ••• 0 •• 0 • 0 •
15
ANNEX 5 - REACTION OP A PROVIDER COUNTRY BY DR K. l'UJISAKI 0 •• 0 ••
19
1.
INTRODUCTION
Pursuant to Resolution WPR/RC38 .Rl8, "Technology transfer in the health field" was selected as the subject for the technical discussions to be held in conjunction with the Thirty-Nint h Session of the WHO Regional Committee for the Western Pacific. The discussions were held on 16 Septem ber 1988 from 1430 to 1700 hours . The agenda is shown i n Annex 1 . The objective of t he Technical Discussions was twofold: (1) to disc uss the modalities of the t r a nsfe r of tec hnology; and (2) to discuss the role of W H O in t he development of innovative approaches to technology transfer , including its leadership and coordinating roles in the ma nagement of the tec hnology transfer processes . Dr S . Tapa, ~inis te r of H ealth, Tonga, was selected as the moderator of t he session . In hi s opening statement, he remarked how privil eged he was to have been a participant in some of t he pa s t conferences and meet i ngs dealing with technol ogy t rans fer . He stressed t he major, perha ps critical, importance of the topic in t he field of health development, and agr eed with the statement of t he Secretary of Health of the Philippines, Dr A.R.A. Bengzon, who said during the Regional Committee meet ing: "The Region might show an example to other WHO regions as to how the obstacle of social i nequ ity could be addressed by ... the shar i ng and transfer of knowledge, re-sources , and t echnology ." The ~od erator proposed that an Overvi ew and Report should be presented to provide a framework for t he discussions, followed by react.ions from the so-called user a nd provider countries . For the op~n forum , the participants were encouraged to ex press t he ir perceptions of technology transfer in health, focusi ng on processes appropriat.e t o th~ir
count r y situations .
2. 2 .1
PRESENTATIONS
Overview (Dr A. Romualdez, Jr . , WHO ) (Annex 2)
A new concept of technology t ransfe r had evolved which followed discuss ions at various meetings spo nsored by t he WHO Regional Office for the Western Pacif ic and whic h could be adopted as the framework withi n which to strengthen tec hn ical cooperat i on. This framework would e nsure that the process of technology transfer did not increase the dependence of users on providers but rather pave t he way towards a relationship of interdependence and partnership. Such a relat i ons hi p may be achieved if the process emphasizes provi sions to enable user countries to modify, adopt and otherwise engage in the conti nuing deve lopment of the technology concerned . 2.2 Report (Dr A. Shirai, W HO) (Annex 3)
The Special Programme for Research and Training i n Tropical Diseases (TOR) had established a new programme, "TOR Initiative for Biotechnology I mplementation" to effect a real t rans fer of relevant biomedical technologies to the disease endemic countries (DEC). The
- 2 -
new initiative was designed to satisfy the increasing need for various biological reagents, developed as a vesult of TOR-funded research, to be produced in sufficient quantities and to be used in a simple, cost- effective manner in DECs . A limited number of selfsufficient facilities would be established in the DEC. In the process of strengthening such institutions, local scientists would be trained in various biotechnology-related disciplines and the indigenous production would be encouraged . About half of more than 40 products which had been developed under TOR auspices and which were currently in operational use were being produced exclusively in developing countries. For example, the Malaria Control Service Unit in the Department of Health, in the Phil ippines, produced the simple microtest kit for the testing of malaria parasites for drug sensitivity and the portable, low-cost, battery-operated field incubator . Member States within this Region had been requested to identify national focal points for the promotion of technology transfer, and 15 had responded thus far . 2.3 Reaction of a user country (Mr M. Taguiwalo, Philippines) (Annex 4)
The Philippines used a framework which considered technology transf er in two parts: (l) defining what was wanted from t he technology ; and (2) acquiring , developing a nd using t he technology . He described exper iences in four particular areas which had met with varied success . The examples showed Lhe r .. c.:LvL~ Lh"l detel·mined the efficiency and the effectiveness of technology transfer: (l) the l eadership in the user country, not only from the heal th authorities but also from other governmental and nongovernmental bodies; (2) the institutional f r amework , including the state of readiness, willingness and abilities of receiving i ns titutions ; (3) the flexibility of the provider country in making its technology available when the per iod of exchange needed to be longer than a year or two; (4) the strength, the logic, the soundness and the clar ity of the poli cy of the programme framework ; and (5) the awareness of the t i me needed before t he benefits could be seen. WHO could assist the user country in two ways: (l) in clarifying the issues to be decided and the preparations to be made for successful transfer; and (2) in planning the process of technology transfer , with the right combination of hardware, software and manpower interventions. 2.4 Reaction of a provider country (Dr K. Pujisaki , Japan) (Annex 5)
The framework of technology transfer was composed of the framework of technology development itself and the mechanisms for transferring that technology . The development of technology was undertaken independently of its trans fer . There were two mechanisms for transfer: multilateral and bi lateral cooperation.
'
- 3 -
Some concern about the effectiveness or the method of implementing t he cooperation had been expressed. Regarding multilateral cooperation, there was concern about the capability of t he user countries in the area of resource mobilization . As for bilateral cooperation , Japan was uncertain about the quality or
success of its many projects in the developing countries, owing to lack of information on the situation concerning technology development in these countries . There were three points which should be considered in technology transfer . In the case of priority setting, the requests from the user countries should be well thought out, and the technology should be used for the benefit of the people. Secondly, proper technological infrastructure must be present for successful transfer. Also, self -reliance of the user country was necessary to sustain the effort of technology transfer . Finally, there must be an assessment of the outcome. A provider country must be concerned about the appropriateness
of the technology . It may require some external organization like WHO to provide guidance. WHO could help to develop technologies that were appropriate for countries with limited resources,
infrastructure and health manpower. WHO could also cooperate with the provider countries by identifying the area of technology transfer , by assessing the feasibility of the cooperation programme, and by ~valuating the outcome of t he transfer .
1
r.ROHI' llT !;r.HSS TONS
Dr Tapa commented t hat the two working papers presented by the user and the provider countries served as an excellent background f or th~
group discussions.
Dr Dai Zhicheng (China) said that technology transfer in the health field was essential for achieving the goal of health for all by the year 2000 . It would not only raise the level of primary health care but save money and other resources. While the economic and scientific technology in China was still developing, China must keep abreast with the new technologies and t he managerial experience of other countries . One successful achievement was in the research and manufacture of plasma-derived Hepatitis B vaccine, for which WHO provided technical collaboration in conjunction with Japan and the Netherlands. Hepat itis B vaccine was now manufactured in China , and more than 2 million babies in China were protected every year from the virus. At the moment, technology transfer was still very much from developed to developing countries. However, it could be a two- way process with the developed also learning from the developing. For instance, t he manufacture of Chinese pharmaceutical products, biotechnical products, diagnostic equipment and traditional medicine could be transferred to other countries, including the developed ones .
- 4 -
Dr T. Maoate (Cook Islands) mentioned that the provider countries should be sincere in their offers of collaboration. When a technology was transferred, the infrastructure and whatever else was needed to maintain the transfer and use that technology should be affordable. Instances were cited of equipments being donated that was already obsolete, with spare parts that were either very expensive or no longer available . Therefore, serious consideration must be given to the cost of establishing the infrastructure and obtaining the equipment so that the transfer could be implemented and maintained and provide long-term benefits to both parties. A similar problem had been experienced in Papua New Guinea, said Dr Q. Riley, where a boat was donated for health work. The electrical fittings were a few years old, so maintenance was unavailable both in the country of origin and in Papua New Guinea. Recently, Papua New Guinea had had an outbreak of typhoid fever , symptoms of which were quite similar to those found in malaria . For differential diagnosis , a Widal slide test for typhoid fever was used, at a cost of only 20- 30 cents a test . Clearly, many of the technological advances which could be utilized in the developing countries were very simple. Another important factor which must be considered was the maintenance of medical equipment received by the user countries. Many countries did not have good maintenance systems. Also, the maintenance procedures varied for the same type of equipment produced in different provider countries. Therefore, it was essential for the provider countries to send their experts in order to make the donated equipment operational and to assist in its maintenance . maintenance. In addition, technicians from the user countries
should be trained in the provider countries in medical equipment Dr Sharifah (Malaysia) mentioned that in planning the transfer, it was important to assess the needs and set the priorities through negotiation and consultation between both the provider and the user. As for the transfer mechanism itself, there should be flexibility in the process . The user country should be able to sustain, develop and adapt the transferred technology so that it would become more acceptable in its own context - its infrastructure, its financial resources and its human resources. In that way, the concept of partnership sought in technology transfer could be attained . Dr K. Poutasi (New Zealand) commented that advances in technology did not necessarily mean savings . A computer-based information system, for example, could provide data but not information if the database was poor and incomplete. Professor Vannareth Rajpho (Lao People's Democratic Republic) highlighted the two main problems of technology transfer: (1) training staff to manage and maintain the technology; and (2) standardizing the equipment. Standardizing the brand of the equipment would facilitate the maintenance of equipment in the different parts of the country with the availability of spare parts .
- 5 -
Dr 'I. Taitai (Kiribati) mentioned that most of the points t hat. had been discussed are quite relevant to Kiribati as well, but two problem areas prevalent in the country were emphasized . Donated equipment often did not withstand t he environmental conditions in some island countries like Kiribati which had large amounts of dust., salt, humidity and the like . There was also a lack of proper airconditioning. Provider countries should take those situations into consideration so that the transfer of technology would serve its purpose. The other problem was the lack of competent manpower to ma i ntain sophisticated equipment . The collaboratio n of WHO in devising a system of maintenance would go a long way towards the success of technology tra nsfer. Dr M . Kumangai (USA ) described the difficulties in maintaining the hard disc of the microcomputer in Palau . After sending it four or five times to Hawaii (5000 miles away) for repair, it was put on the shelf and a new one was bought . He recalled that several years ago, WHO had conducted a two-year training programme on the repair of biomedical equipment, and wondered whether a similar activity could be arranged for the maintenance of microcomputers . Mr N. Taguiwalo (Philippines) expressed his opinion on t he principle of appropriateness and how to determine what was appropriate for one country . Appropriateness m eant economic feasibility , which meant sustainability and s uitability f or all conditions - physical , fina ncial and social. In the present world system, the principal method of signalling appr opriateness was the market system: if an item was bought and people paid for it and continued to pay for it, it was said to be appropriate . Nobody cared whether it was good or bad . But in t he health field , there was another model, which was the technical. A group of experts could get together and define ha llmarks of appropriateness and make recommendations accordingly . The question was how to make competent, effective , expert technical models that would exactly determine appropriateness. The biggest part of technology transfer was not the goods given by one country to another but in the goods one country purchased from another. That was where the real technology transfer occurred. He felt that the sooner attention was focused on the way the market determined what type of technology was appropriate the more quickly technology transfer could become a sustainable and widespread process . Dr I. Welch mentioned that in Austra l ia, sophisticated medica l equipment had been passed on to some of t he South Pacific Island countries whenever they were replaced by more sophisticated models. If people accepted it , it must to some extent be appropr iate . But the obvious problem was maintenance . Pr om the provider side, how much support should the count r y give to well-meaning people who arranged to send equipment since la rge costs were involved in
freight charges , etc . even if the equipment was sent as gifts .
- 6 -
Dr Q. Reilly (Papua New Guinea) said he welcomed the basic mechanical type of equipment, such as hospital beds, which were easily maintained. However, in the case of biomedical equipment, like old incubators, they would like to receive the same standard brands which exist in the country for the ease of maintenance. They did not want other brands. He urged the donating agencies to work through the pharmaceutical services to make certain that standard types of equipment were obtained. Otherwise, it was costly and frustrating for everyone. Dr K. Fujisaki (Japan) fully concurred with Mr Taguiwalo's assessment, in which he had initially attempted to define appropriate technology and then proceeded to the question of acceptance of foreign technology. Dr Fujisaki commended the courage of the Philippines in declining some assistance from abroad. He felt that the provider country should in its turn have the courage to develop flexible assistance programmes . If the technologies developed in Japan were not useful in the Philippines, what other assistance could they offer? It was time for countries like Japan to consider seriously the possibility of developing a more appropriate technology .
Dr Haji Hussain Daud (Brunei Darussalam) said he too was acutely aware of the problem of maintenance of biomedical equipment. The Ministry of Health tried to provide the various hospital-based services with up-to-date and expensive equipment to meet the needs of the specialists, with the intention of providing first class clinical services . They relied heavily on contracts for the maintenance of such sophisticated equipment and that seemed to be an unending and expensive exercise. This was because they had no biomedical engineering team capable of providing their own maintenance service. Until they were more or less self-sufficient, they must continue to depend on outsiders for maintenance services at prices which were beyond their control. 4.
CONCLUSIONS
The participants generally agreed that the technologies to be transferred should be appropriate and affordable. Thus, there should be a dialogue between the provider and user countries to assess the needs. The principal problem among the users was the lack of trained individuals to manage and maintain the technology.
- 7/8 -
ANNEX 1
AGENDA FOR THE TECHNICAL DISCUSSIONS ON TECHNOLOGY TRANSFER 1430 1430-1440 1440-1500 1500-1515 1515-1530 1530-1545 1545-1645 1645-1700 1700
Opening of Meeting Moderator•s Opening Remarks Overview and Report User Reaccion Provider Reac tion Coffee Break General Discussion Concl usions and Moderator's Closing Remarks Closing of Meeting
- 9 -
ANNEX 2
REGIONAL COMMITfEE Thirty-ninth session Manila 12-16 September 1988
WPR!RC39{fechnical Discussions/2 23 August 1988
ORIGINAL: ENGLISH
TECHNOLOGY TRANSFER IN T HE HEALTH FIELD Technical Discussions
The rapid development of technology over the last 25 years makes it imperative to review the entire technology transfer process. This must be based on the interaction between health and technology and take into acco unt diffe rences in social, cultural, political and economic conditions. The transfer process must ensure the timely application of technologies where they are most needed while giving due consideration to such matters as equity, self-reliance, use at the appropriate level, affordability and effectiveness. Regional interest in the promotion of the development, use and transfer of technology is reflected in resolution WPR/RC38.R 18. adopted by the Regional Committee for the Western Pacillc at its thirty-eighth session in 1987. which decided that "Technology Transfer in the Health Field" should be the topic for the Technical Discussions to be held in conjunction with the thirty-ninth session.
- 10 -
WPRIRC39{fechnical Discussions/2
!. INTRODUCf!ON AND BACKGROUND
In the course of implementing strategies to achieve health-for-all goals, there was a growing realization that the current concept of technical cooperation was not broad enough to include the whole range of activities involved in making full use of technology in dealing with health problems, particularly in the Third World.
An effort has been made by the WHO Regional Office for the Western Pacific to develop the strategy for health technology transfer through meetings such as the following: a) b) The Western Pacific Advisory Committee on Health Research (WPACHR), since 1976; A joint WHO South-East A~ia Region and Western Pacific Region meeting of directors of health research councils and analogous bodies, 1984; A working group on international cooperation in technology transfer in the health field, 1985; and A bi-regional conference on technology transfer in the health lleld. 1987.
c)
d)
From all these discussions, a new concept of technology transfer has evolved, which could be adopted as the framework within which to strengthen technical cooperation. Some <>f the recommendations were adopted as guidelines for technology transfer in the Western Pacific Region in !988. 2. TECHNOLOGY TRANSFER AND PRIMARY HEALTH CARE The emergence of primary health care as the major strategy to achieve health for <oil h:1s made it essential that existing appropriate technologies should be immediately incmp~>ratc<.l in health programmes. Since WHO has been the leading proponent of both the goal and the strategy, it must become deeply involved in the application of technology to the solution of health problems. The rapid advances in health technology, resulting from radically new concepts in the biological and physical sciences, will require increasing emphasis on the active management of technology transfer processes. 3. GUIDING PRINCIPLES FOR TECHNOLOGY TRANSFER 3.1 The availability of appropriate technological support is a vital component of the primaryhealth-care strategy. A prime consideration is that such support should conform to the principle of equity between nations, communities and individuals. 3.2 The capacity of a country to absorb health technology is determined to a great extent by its ability to share in the development itself of the technology. Thus an adequate national science and technology infrastructure will ensure not only that the technology selected is appropriate but also that its application can be continually updated, thereby contributing to self-reliance.
- lt -
WPRJRC39ffechnical Discussions/2
3.3 There must be thorough systematic planning, based on a good understanding of tr ansfer processes. before health technology is applied at every level. This is true of all countries, but especially of the user countries of the Third World. 3.4 In an increasingly interdependent world of rapid technological advances and almost instantaneous communication, well-thought-out programmes of international cooperatio n in health technology will be a prerequisite for productive partnership among nations and institutions. The present concept of technical cooperation is too narrow to accommodate such rapid changes, and agencies such as WHO will therefore have to broaden their vision to encompass integrated approaches to technology transfer. 4. COMPONENTS AND PROCESSES OF TECHNOLOGY TRANSFER
4.1 The compone nts and processes based o n the guiding principles are illustrated in the diagram below.
ursrRF.AM
St'IF.,.,t'F. ANO TECH~Ot.OG Y
BASIC A N ! ) - -- + MOO!FI<.'A1'l()fi:A:0:0AOAPTA~
/ll~ \
INF'R.AS!1UK"I'\JRE
APPLIED Rt;SEARQI
OEVEC.OPME~"T AND PROOUcnol'\
1
i
TECHNOLOGY _ _.... HEAI..'nt
~
~
IITlUZAnos
PROBLEMS
Ot!.VEU)PM ~N't
- - -+
A(..'OVISmQS
----+
A1'1'\,.I('A1 1V~
He31th techno logy: an :t.$.SOCiation o( methods. techniques and equtpmf:nt whic-h togt:ther whh tbe people using them t.an contribute significantly to sotving a heallh problem. (sor1ware. hardware. manpowtt)
- 12 -
WPR/RC39{fechnical Discussions/2
4.2 The transfer process can be illustrated by using examples from the fields of vaccination and informatics. There are three stages of transfer: development, acquisition and application. In the case of the expanded programme on immuniution, apart from vae<:ine development itself. application w;" mainly a matter of providing an adequate cold chain system, wupled with the training of field personnel, after an initial trial process of development and acquisition. The main activities involved in establishing informatics programmes are the acquisit ion of hardware and software and their adaptation for application in certain situations with national staff training. Tonga provides a good example of this. A complete transfer of technology wou ld also include a well developed science and technology infrastructure capable of modifying and ad apting existing technologies as well as developing and producing new ones.
5. IMPLICATIONS OF THE TECH NO LOGY TRANSFER STRATEGY 5.1 The adoption of this concept as a reference point for its action will have implications l(>r WHO's strategic direction as the 21st century approaches. A strategy aimed at restoring the balance between policy advocacy and the provision of technical inputs by WHO will help to maintain the Organization's leadership in international health, and enhance its ability to deal with health problems effectively. 5.2 Initially. strategy should he based on the guiding principles of technology transfer for health '"part of a specific problem -oriented programme developed within the context of health for all. In addition. this wncept recognizes the value of equity and self-reliance. The programme must ensure that iippropriate means and methods ure availahle l(>r the solution of health problems. Succes.~ful examples already exist in the Western Pacillc Region. One or these is the process hy which WHO. in collaboration with the Japanese Government, initiated a project in China on Hepatitis B vaccine production. China is now ahlc to produce the vaccine for almost its entire domestic needs.
53 It is recognized that the international donor community will continue to play a major role in the transfer of health technology. New initiatives in this field will generate more opportun itic.' for international cooperation.
- 13 -
ANNEX REPORT by Dr A. Shirai
3
In response to the need for effectin~ a real transfer of relevant biomedical technologies to the disease endemic countries (DEC), the Special Programme for Research and Training in Tropical Diseases (TOR) has intensified its activities in this area with the establishment of a new programme termed "The TDR Initiative for Biotechnology Implementation" (TDR/181). As most of you are aware, one of the objectives of TDR is to strengthen - through training and support to institutions - the capability of developing countries to undertake research required to develop these new diseases control strategies. This new programme will attempt to establish a limited number of unique, technology-driven partnerships between some of t hese TOR- strengthened institutes and those in the developed countries. The new initiative is designed to satisfy the increasing need for a variety of biological reagents, which have been developed as a result of TDR- funded research, to be produced in sufficient quantities and to be used in a simple and cost-effective manner in disease endemic countries. These reagents, including monoclonal antibodi es and nucleic acid probes, are to be used for improving patient diagnosis, parasite i dentif ication and characterization, as adjuncts to evaluating candidate vaccines, and for a variety of epidemiological studies related to disease transmission and vector control .
It is hoped that a wise selection of both the projects and the collaborating institutions will result in the establishme nt of a limited number of self-sufficient facilities for scaled-up production in the disease endemic countries. Examples of projects under consideration are the following : the large scale production of recombinant ~ leprae-derived proteins for testing as potential vaccine candidates or diagnostic tools; the production of sporozoite-specific monoclonal antibody-based test kits for use i n vector biology control programmes; and the production of test kits for malaria diagnosis, based on recently developed DNA probe techniques. The process of strengthening t he appropriate institutions in these countries will provide the opportunity for training local scientists in the various biotechnology-related disciplines (e.g. Immunology, Molecular Biology), which are required for the successful implementation of the biotechnology transfer process. These scientists will be trained locally without the usua l loss of productivity f or the country that usually occurs when scientists go abroad for several years to study. An additional result of this programme will be to strengthen the indigenous production of products in t he countries where they will be used . This initiative is thus designed more along the lines of applied contract-production of specific reagents rather than the promotion of investigational research, and it is expected that the reagents to be produced will be used for large-scale field trials and adapted to the needs of disease control programmes . However, large-scale production for control, marketing and possible commercialization of the products are not an integral part of this programme.
- 14 Annex 3
The other objective of TDR is to develop new methods of preventing, diagnosing and treating selected tropical diseases, methods that would be applicable, acceptable and affordable by developing countries, require minimal skills or supervision and be readily integrated into the health services of these countries. In relation to this, the last few years have seen the emergence of the first products whose development was facilitated by !DR. More than 40 such products are now ready for or are now undergoing fieldtesting . About half of the products, now in operational use, are being produced exclusively in developing countries. A prime example of this is the Malaria Control Service Unit in the Department of Health, Philippines, which produces the simple microtest kits for the testing of malaria parasites for drug sensitivi ty, as well as a port ablQ, low- cost battery-operated field incubator. The production
has continued on a self- sustaining basis, with t he i tems being sold on a non-profit basis . And finally, in relation to the Resolution, WPR/RC38.R7, adopted by the Regional Committee last year on Technology Transfer, the Member States within this Region had been requested to identify national foca l points for the promotion of technology transfer, and thus far, 15 have responded. This hopefully would lead to the development of a regional network in which WHO can play a vital and l~ading role in the promotion and coordination of technology transfer, such as the dissemination of information on new and improved methods for disease control.
- 15 -
ANNEX 4
REACTION OF A USER COUNTRY by Mr M. Tagui~alo
I will be talking about technol ogy transfer from a user country perspective. Let me first make a distinction about the term ~· There are two uses of the term user; one is in drug abuse where a "drug user" is an addict. It talks about the user as a victim. I hope we are not talking about that in this session. But in computer language, a user, as in .. user- friendly" or USer-driven" denotes the supremacy of the user over the technology. I certainly be l ieve that we should be talking about the user- country in those terms. 11
I
shall be
talk~ng
of our experience in the Philippines as a user
country. I shall use a framework ~hich considers technology transf er in two parts. The first part consists of defi ning what you want from the technology in the first place. The second part is acquiring, utilizing and developing the technology. So far, most of the discussions on technology transfer has been about the second part meaning to say acquiring, developing and ut i l i zi ng technol ogy. We would like to say, however, that the f irst part ( i .e., t~e def i nition of the problem and the definition of the framewor k of a solution within which the technology is a component) is a cr i tical issue for the user country.
I will speak of our experience in the examples provided by four particular areas. One exampl e is our experience in the area of research and training in tropica l medicine at the Research Institute for Tropi cal Medic ine (RITM). Th l $ E<xamplP. i s on~ nf tl"c hnnlngy transfer in partnership with the Japanese Government . Our experience has been very good . We bel ieve this result came about because the problem has been well identified, the modes of intervention so well articulated, and the role of the research institute was clearly defined . In addition, the process of technology transfer was done professionally and efficiently . Right now, we are principally focusing on diffusing the results of our efforts better for utilization by the periphery. The second example is our partnership, again with the Japanese Government, on food and drug regulation. Although the assistance of the Japanese Government for food and drug laboratories came many years ago, the recent enunciation of our government of a national drug policy puts the technology t hat is the subject of this exchange in the centre of an issue that can yield much greater benefit to our country. This is an example where policy developments made the technology transfer even more rational and beneficial. The third example is our experience in vaccine production. Since the 1950s we had engaged in some form of vacci ne Production via the Alabang Vaccine Laboratory. But because our policy and programme was not clear enough, we allowed our capabil i ties to deteriorate. At the moment we are revi vi ng our ini t i at i ves in vaccine production in the context of our expanded programme on immunization.
- 16 -
Annex 4
The last example that I will cite is our experience in the production of information, education and communication (IEC} materials. As of now, various efforts from various donor countries have allowed us to develop and disseminate l arge quantities of 1EC material. We believe t.hat it is now timely to marry both the technology and t he policy towards better use. These examples provide us wi th some issues from the stand point of what determines the efficiency and effectiveness of technology transfer . The first issue i nvolves the matter of leadership in the user country . There has to be a clear sign in the user country that the technology transfer is a critical and important iss ue in the life of the country, cri tical and important enough to be linked to ~ visible leadership. Normally, in the health field, the leadership by t he health authorities is a principal concern, but we also have to cite t he leadership provided i n support of such actions by foreign ministries, by economic planning ministries and includi ng the participation of non-government organizations . The second issue is the institutional framework under which the tech nology transfer is happening. The state of readiness; t he willingness and abilities of t he receiving institution; the linkages to other internal end users of the products of technology and healthy image and reputation of such institutio ns all these are i mportant considerations for successful and beneficial technology transfer efforts . The third issue involve factors on the part of the provider country . How flexible is the provider country in making available its technology ; how close the partner countries are in terms of language, distance, cultural differences; the planning horizon of the provider countries - these are matters that count greatly . I wish to amplify a l ittle bit of this last item because many times the user countries are left holding the bag because the provider country had meanwhile changed its mind about the technology or about its transfer. There has to be some way of sustaining the exchange over a longer period than a year or two. The fourth issue is the policy and programme framework wi t hi n which the technology transfer is being undertaken. How strong, how logical, how sound and how clear the policy and programme framework is - clearly this is an important issue . Finally the user country has to be wary of impatience for results or benefits . On one hand, user countries should not simply allow technology t ransfer to happen without looking at it from the standpoint of what benefits they obtain but on the other hand, such countries also have to be aware that most technology transfer activities occur over a longer life span tha n other projects. What are the implications of these issues to WHO? 1 would like to raise basically two issues. The first is t he need to plan the technology transfer better. In this regard, 1 would like to point out the need for WHO assistance to help a user country clarify the issues
- 17/18-
Annex 4
for decision-making and create the necessary preconditions for successful technology transfer. Another need is the assistance in planning the actual process of technology transfer, including the design of the right combination of hardware, software, and manpower interventions. In this regard, there may be a need to focus WHO's resources and influence on the particular problems that may be specific to each user country. Some situations would have basically disease control problems wherein the technology transfer come in the form of diagnostic, therapeutic or delivery system technologies. There may be other countries whose problems are still basically the health systems infrastructure where the nature of the technology transfer would be slightly different. In that regard, Hr Chairman, I would like to share these views with the rest of the experts this afternoon. Thank you.
- 19 ANNEX 5
REACTION OF A PROVIDER COUNTRY by Dr K. Fujisaki
I am honoured to have been asked to serve as a reactor before this distinguished meeting. Japan has been appreciative of the importance of technology transfer in the field of health, and as Dr Romualdez cited, last year there was a meeting in Tokyo entitled the WHO Bi-Regional Conference on Technology Transfer in the Health Field and the report of the meeting has been given to you. I suppose that conceptual framework and the elements which serve as guidelines with respect to technology transfer are already described in this report. Today I am assigned as a reactor on the side of the provider country, so I would like to confine my presentation to general principles that we use when we implement and evaluate the technology transfer programme within t he framework of multilateral and bilateral cooperation. I am not going to touch upon detailed issues but I would like to touch upon issues which I consider basic. First, I would like to give you some framework of technology transfer, just a broad one, which is a fundamental one and very basic to the framework of technology development itself and the mechanism of transferring the technology. The technology development itself is currently undertaken in a manner quite
independent from technology transfer in most provider countries because most of the researchers in private companies or public institutes do not consider, at the onset of the development of a particular technology the application of that technology or development to developing countries. It is only after technologies are developed that it comes to the stage of transferring to other countries, so there is no connection between these two stages at the outset. With respect to the stage of transferring some technology to developing countries, we have two mechanisms as many other
provider countries, again, multilateral cooperation and bilateral cooperation . Multilater al cooperation of course is through channels of WHO and bilateral cooperation mechanism serves on the basis of agreement between Japan and counterpart country, just after
discussing what kind of technical cooperation should be developed between two countries on what conditions and for what period of time. And components of these mechanisms are the following: when we cooperate with other countries through WHO, we send experts, receive trainees in Japan, and have our institutes designated as WHO collaborating centres , thereby we cooperate with WHO in developing some particular areas of science and technology. We also hold various types of conferences or workshops, and these are the components of our collaboration with other countries through the channels of WHO. On the other hand, through the mechanism of bilateral cooperation, the story is quite different. We first set the framework of a project. For instance, as Mr Taguiwalo has already referred to, we have various types of cooperation programme
- 20 -
Annex 5
with a country like the Philippines, and before the start of such programmes, we discuss about the conditions and substance of the cooperation. And then we divide the content of cooperation into three categories . One is to send our experts to t he counterpart country, and also we receive trainees in our country, and we also offer some particular equipment and facilities which are considered necessary to implement the technology transfer process in that particular framework of the particular programme . Now, after clarifying these scheme of cooperation, I would like to raise my concern about the effectiveness or the way of implementing the cooperation. First is regarding multilateral cooperation. As provider country, we are not worried about the quali ty of technology transfer through the channel of WHO because WHO is a tech.n ology agency, as Dr Tapa stated at the start of this meeting . So it is quite easy for us to cooperate with WHO in terms of technology transfer as far as quality is concerned. However, we have some concern about the capability of the user countries, particularly in the area of resource mobilization. We have made little organized effort to prepare a sort of inventory of capabilities to be able to respond to the requests from WHO but in a more systematic way . Now let's get to the point of bilateral cooperation. I am more concerned about technology tranfer issue in t his area. As Mr Taguiwalo mentioned, we have many technology transfer projects all over the world. The Research Institute for Tropical Medicine project has been cousl.dered 1.n Japan as one ot the most successtul projects we have ever conducted. However, we are not quite sure about the quality or degree of success in many other projects because we are not well informed about the situation in developing countries particularly in the area of technology development. In this context, I would like to refer to three points concerning technology transfer which were already introduced by Dr Romualdez during his introduction of the guiding principles of technology transfer as discussed last year by the Bi-Regional Conference. The first point is priority setting, the second is supporting mechanism such as technological infrastructure and self reliance of the countries which receive the cooperation, and the third point is the assessment of technology transfer effort. Let us start with the first point. Those who were engaged in cooperating with developing countries to introduce our technology are often not familiar with existing situations and we have not organized yet in such a manner as to exp.a nd knowledge in areas such as priority setting . We receive requests from countries and if a particular country places a lot of emphasis in a particular programme which we find to be well- designed and appears to warrant success , we are in a position naturally to support such a programme. We have no way of placing the priority of our own in a particular country because it might be considered as invasion of sovereignty. So it is important that the requests should be well deliberated and used for the people in that country.
- 21 -
Annex 5
The second point is supporting mechanism such as technology infrastructure and self reliance. These issues are also important, very important because even i f we try to transfer technology, when t he recipient country does not possess enough infrastructure, it will be a failure after two or three years of effort . Sustainability of the technology transfer effort in a country can not be assured unless that country has the capability and resources of maintaining the obtained technology. The third point is another area where we lack knowledge. There may be three levels of evaluation of technology transfer. The basic way or the first step is to assess the technology transfer itself. If a particular technology is transferred to a particular counterpart person we may call it successful. However, i t could happen that t he technology is utilized for the benefit of a particular institute i n the area without any effort of diffusing to more expanded areas. which is the objective of the cooperation. Perhaps we s hould consider the expansion and diffusion of particular technology to benefit a wider population and not just the institution or area which first received the assistance. And the third level of evaluation of technology transfer is an outcome measure, which is how this technology affected eventually the quality of health of the population in general or how the standard of health has improved through the cooperation effort. We are not very much sure about what kind of assessment we should make about the three levels I have just described and if we have adequate knowledge about this area. I would like to raise one more area of concern about technology transfer as a provider country, that is, concern about the appropriateness of technology . In this regard, t he nature of appropriate technology should be drawing attention. However, it seems to me that we have not yet come up with the complete list of appropriate technologies we should develop. The lag in the development of appropriate technology may be related to the voluntary mechanism of developing technology. As I mentioned earlier, in my country, technology and some skills are developed in quite independent manner from the effort of transferring technology to other countries . Since development efforts are basically on voluntary basis, there is no incentive to develop appropriate technologies both in government and in private sectors. Therefore, the provider country may need some ot her external organization to provide t hem with directions. I believe this should be WHO. As Hr Taguiwalo pointed out, we need to cooperate with WHO in many ways. The importance of WHO seems to me two fold in this respect - one is that WHO should take the initiative. While it has already done so to some extent, perhaps it should further accelerate this initiative to develop appropriate technologies which are useful to countries which have scarce resources and some limitations to their infrastructure and health manpower. So appropriate technologies which deserve much attent ion should be considered, in my view, in separate ways.
- 22 -
Annex 5
And another WHO role is to cooperate with provider countries through the whole process of coooperation programme, that m eans identification of the area of technology transfer and assessment of the feasibility of that particular programme and evaluation of the result of technology transfer. WHO has a lot of experience and technical expertise . I do not know if any other provider countr ies agree with me, but at least as far as Japan is concerned we are still short of knowledge and expertise in that area . I believe that WHO has already made various efforts in this respect. I would like to take note of the particular programme which is called special programme on technology transfer which is now t wo years old. This programme is a joint intercountry project between the Government of Japan and WHO to facilitate technology transfer among countries . Agreement on plan of operation was made i n September 1986 or two years ago. The components of the programme are as follows: ( 1) exchange of experts in the Region for tec hnology transfer;(2) research on technology transfer; (3) implementation of a policy to expedite technology transfer; (4) public information activities on technology transfer and WHO activities. Actually, the Bi-regional conference was supported by this programme. It has already succeeded in many ways, but I still think we have a long way to go, and 1 would l ike to ask WHO to make further effort. At the same time, I would like to pledge the effort on our side to continue our endeavour to carry out various cooperation programmes with countries in this Region. Maybe 1 should stop now, time is running out. 1 would like to thank you for your kind attention .