(WP/RC16/Min/2 Bev.1) .~
MINUTES OF THE SECOND MEEl'ING
Central. Of'f'icial.s· Training. Institute . -ThUrsday, 16 September 1965at 3.00 p.m. CHAIRMAN: . Dr Youn Keun eM
CONTmTS
1 2
Election of the Regional. Director ••••••••••••••••••••••••. ~ • • • Report of the Regional. Director •••••••••••••••••••••••••.•••• Statements by Representatives of the United Nations and ~cial.ized Agencies
120 120 130
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ll8
RIDIONAL COMMITTEE: SIXTEENTH SESSION
Second l>i!eting Thursday. 16 September 1965 at 3.QOp.m.
PRESENT
I.
Representatives of AUSTRALIA
~mber
states Dr H.E. Downes Dr Aka Toua
.... CAMBODIA CHINA FRANCE JAPAN
-
.
Mr N.C.K. Evers Dr C.J. Ross-Smith Dr In Sokan Dr Keo Pbann
Dr C. K. Chang Dr T.C. Hsu
Medecin General M. Orsini Medecin Colonel Thenoz Dr N. Tatebayashi Mr S. Mltani Dr J. Urata Dr Koukeo Saycocie Dr L. w. Jayesuria Dr R. Dickie Dr C.N. Derek Taylor Dr C.S. Gatmaitan Dr T.A. Gomez Dr A.N. Acosta Dr N.C. de Andrade
LAOS
MALAYSIA
NEW ZEALAND PHILIPPINES
PORl.'UGAL
Dr M.F. Matias REPUBLIC OF KOREA Dr Youn Keun Cha Dr Chang Dong Min
Dr Hyang Jong Park REPUBLIC OF VIET-NAM Dr Duong Cam. Chuong Dr C.H. Gurd ~
UNITED KINGDOM
,
MrntJl'ES OF THE SECOND MEm'ING ,~
112
)
" UNITED STATES OF. AMERICA Dr J. Watt Dr R.K.C. !ee Dr Masashi Makabe Dr J.C. Th1ere
WESTERN SAMOA
II. " ~.
Observers of Non-Member States SINGAPORE
Dr Thong Kah !eong
III. Representatives of the united Nations and SPecialized Agencies UNITED NATIONSi TECHNICAL ASSISTANCE BOARD AND UNITED NATIONS SPECIAL FUND 'I:..
Mr W. R. Lucas
UNITED NATIONS CHILDREN'S FUND
Mr A. E. z..i:Bain
ri.
Representatives of other intergovernrental organizations SOUTH PACIFIC COMMISSION Dr G. Loison
V.
Representatives of non-governrental organizations INTERNATIONAL DENTAL FEDERATION INTERNATIONAL UNION FOR
Dr U.S. Oh Dr G. Loison
~.
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HEALTH EDUCATION MEDICAL WOMEN'S INTERNATIONAL ASSOCIATION THE WORID MEDICAL ASSOCIATION >-/
Dr C.H. !ee Dr C.T. Kim Dr C.J. Ross-Smith
,
VI.
WHO Secretariat DIRECTOR-GENERAL SECRETARY
Dr M.G. Canda.u Dr I.C. Fang Regional Director
120
1
ELECTION OF THE REGIONAL DIRECTCR: (Document WP/RCl6(4)
Item 11 el the Agenda'
The Committee went into private session at J.OS p.m. and resumed in public session at 4.30 p.m.
The CHAIRMAN announced that at the private meeting, the Committee had adopted the following resolution:
"The Regional Committee, Considering Article 52 of the Constit~tion,
In accordance with Rule 51 of its Rules of Prooedure, 1.
NOMINATES in the order of.:preference as indicated by the order of their election the names of the following persons for the post of Regional Direct~for the Western Pacific: Dr Francisco J. Dy Dr R. vI. Greville
2. DECIDES that these names shall be submitted to the Executive Board; and
3. ~UESTS the Director-General to proJlOS9 .toO the Executive Board that it authorize him to issue a contract to the Regional Director for a period .of· rive years fr.om.l July 1966."
2
REPORT OF THE REGIONAL DIRECTOR: (Document WP/RCl6/S)
Ite.'1l l2 of the Agenda
The REGIONAL DIRECTCR, in introducing the Annual Report, informed the Committee that in this year's report an attempt had been made to summarize the situation when WHO established a temporary office in 1950, to mention some of ,the major developments in order to give a pioture of today and - most itllportant of all - to look to the future.
MINUTES OF THE SECOND MEErmG
121
He considered that gcvernments in the Regicncculd be proud cf what had been achieved. Despite unsettled ccnditicns in a number cf
areas, there was nct cne . country which cnuld nct show scme tangible evidence cf the efforts made to. improve,the health cf its peeple. Naticnal departments of health had been strengthened;' in some countries long-term planning had beco;ne a reality; of preventive medicine had been re.cegnized; extended to. areas olhere.' ev~n
the impor.tance
services were being
c :lrative medicine had not been availce~~unicable
able befere; measures to. combat the
diseases had been
impreved; immunizationpregrammes were .being expanded everywheve: regienal training facilities had' been develep'Jd; 'thaT€ were mcre trained staff available - althcugh never encugh methcds were being intreduced. d~iell
-n~ id~as
and
HColever pleas'ant it weuld be to.
cnly en achievements, the si tuatien had to. be reviewed The Repcrt mention~d,
objdctively. pregress.
therefere, preblems as well as
He did net intend to. give a detailed account of either
but wished merely to. mentien a fewsclected pcint's which he believed merited attent.ien. , Pessibly crie:ef the greatest probl<Jms facing' health workers, particularly in the develcping ceuntries, was how to obtairi the necessary funds not enly to. raise the standard cf health ef the people but to. maintain what had bst3n achisved. had be~n
So often progrestl
slewed down becausd of insuff.ic:l.Qnt funds tv improve tl18
buildings selected fer centres or clinics, to purchase the necessary J -.
suppli:es, to. give more adequate pay to. the staff, to provide the transpert required if services were to. be expa~ded
to the periphery,
122
RIDIONAL COMMIi"rEE: SIXTEENTH SFSSION
to maintain the equipment.
Services started had sometimas limped th~
along and, in some cases, had ceased all together bacause
facilities necessary to maintain them had not been provided.
It
wou14 be unwise to embark on new programmes unless there was adequate financial support to alsure good results and to maintain the results achieved. The income of the health workers must be raised. This was so low
in many developing countries that doctors and nurses often left government service to work in private practice, many even sought employment abroad. This meant a loss to the country' and :Ln a way a loss to viHO.
If this trend continued, it would n3Ver be possible to provide the health workers required. Sufficient funds must be made available at the national level to support the health programme. Thl:l llconomic planners must be convinced
that without good health, social am economic development would be a very slow process indeed. They must realize that investment in health
was one of the most successful investments a government 'could make. The next point to which the Regional Director referred was the: need to strengthen "lnd expand regional training facilities so that staff might study and learn in enviro!l.'1I<:nts similar to their own.' The shortage of well-qualifiedand-trained medical and health personnel _ would remain a deterrent to the development and improvement of health services far some y,~ars
to come.
Every possible effort must also be progra~es
exerted to improve and expand national training
so that
governments could produce as rapidly as possible their own supply of well-trained heal~~:personnel.
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.
The staff trained abroad should
MINUTES OF THE SECOND MEm'ING
123
be used in the best way possible to the mutual be.nefit of themselves and their countries and, most important of all, they should be given the facilities so that they could perform their work com;petently. Further efforts "WOuld be required to combat malaria, tuberculosis and El Tor cholera. Although there had been no recent outbreaks of
smaJ.l.pox, every effort must be made to maintain the status quo and make sure that it did not again invade the Region. One of the items
on the agenda was "WOrld-wide smallpox eradication, which could be achieved i f there was a cO-OJ?erative effort on the :part of all governDEnts. He suggested that tl;lis was one of the priorities to which full
attention should be given in the next few years. Finally, there was the question of environmentaJ. sanitation. This
was a field where the financiaJ. req$ements were so tremendous that it sometimes appeared as though little progress had been made.
In some
countries there were still. no pro:per sewerage systems, garbage disposal was still primitive, water su:p:plies inadequate and unsafe. If environ-
mental sanitation services .rare improved, many of the gastro-intestinaJ. diseases "WOuld disappear. Work in. this field cost money but there were
a number of international organizations which were willing to invest funds to assist governments to deaJ. with this problem. field to which priority should be given in the future. The Regional Director then stated that he was fully aware that
This was another
there i-Tere many achievements in many countries which i-Tere not recorded in the Report. It had, hoi-Tever, only been possible to refer to the He empha-
activities which had been carried out with WHO assistance.
sized, however, that no progress would have been possible without the
124
understanding:, sympath.Y, interest and good:w:l.ll ot the governments in-the Region. On the suggestion of' the CHAIRMAN, the Report was discussed section
by section.
Part (pages
II,
Section 2.4:
Radiation Health and Radiation Medicine
9-50)
Dr TAILOR (New Zeal.and) recalled that during the discussion of' this
subject at the fifteenth session at the Regional. Committee the New ZeaJ.and Representative had not been present as he had been engaged in a committee dealing with the proposed alterations to the Rules of Procedure. He had thus been unable to contribute to this item. He theref'ore
wanted it to be recorded that over the twenty years since the enactment of the Electrical. Wiring (X-Ray) Regulations in 1944, New ZeaJ.and had maintained a complete record of' all X-ray installations, and f'or at least sixteen years since the enactment of' the 'Radio-Active Substances Act of' 1949 this radiation protection· service had covered all aspects of' radiation hazard-. A copy of' the -annuBl- report of' tbe -. National. .
Radiation Laboratory and a copy. -of"a booklet g1ving a short' history of' the Laboratory arid its activities would be h8.nded over to the Secretariat. His Director-General of' Heal.th would be glad to send copies-'to the representatives Who might be interested. Part II. Section 6.1: (pages 76-78) Bacterial and Diarrhoeal Diseases
Dr HSU (China) referred to the table on page 78 giving the number
of' El. Tor cholera cases and deaths reported f'rom the Region from 1961
KIm1.l'ES OF THI!l. SlOOOND
~ING
125
to .31 *y .1965 and· drew attention to the fact that tbe· carrier reported was in fact imported. He hoped that :I(he table could be aorrect~d.
Since
1963 to date not a single indigenous case of cholera had occurred in Taiwan. Section 6.3.1: Yaws (pages 85-88)
Dr ANDRADE (Portugal) referred to the section on yaws and stated .
.
that at the last seE'<;ion of the Regional Committee there had been a note in the Regional Director's Report concerning the lack of information on the situation in Portuguese Timor. He had informed the Committee at He wished now to
that time that a control programme was in operation.
add that only 7 per cent. of the population (about 35 000) were in hY,perendemic areas 'and less thari 5 per cent. (about 25 000) in meso~ndemic or hypo-endemic areas. Mass treatiDentbad been started in the hY,per-
endemic areas and this would be followed by the treatment of early cases in the hypo-and meso-endemic areas.
Dr HSU (China) reported that, as mentioned ·in the Regional Director IS Report", .the JDBJ,aria eradication project bad been completed last. year in the Province of Taiwan, China. He understood that the Province waS' now On behaJ.:f.' of his Government, be
registered as a malaria-free area.
expressed deep appreciation to the World Health Organization and to the staff of the Regional Office for the extensive assistance given to the project. He also took the opportunity to thank the Government of the
United states of America, for the assistance given by the Agency for International Development.
126
REGIONAL COMMI'!"rEE;: SIXTEENTH sEssION
Dr WATT (United States of America) stated that the Regional Director's fifteen years of practice had paid off quite well. This
report was one of his best efforts and certainly a worthy tribute to his abilities and leadership over the last fifteen years. He had
found the report readable and informative, one which had set a high standard for the Regional Director's successor. He hoped, however,
that the Regional Director, before he left, would do one more service for the Region, something he had started really verbal introduction. whe~giving
his
Dr 1tJatt stated that after reading the report,
he had felt that the Regional Director had been rather modest, he had held back somewhat and only hinted at what might be done in the future. In his verbal introduction, however, the Regional Director
had given an even better impression of his ability to see the future than could be obtained from the document. It would be quite important
for the guidance of his successor and also for the representatives who met annually to review the progress in the Region, i f he were willing to set out the goals which he could see achievable by collaborative work in the. Region. For example, the Regional Director had mentioned :)~fi!li-:'dr
much more forcibly and
in his speech his conviction that The combined efforts
smallpox was something that did not have to exist.
of all countries could assure that it woUld no longer affect the peoples of this region. This would also make Dr Candau1s job easier when it
came to seeing that the other regions of the world did as well as the Western Pacific. Dr Watt then referred to the subject of cholera.
History had i'he areas
shown that this was a disease mankind did not have.,to have.
that had been invaded by this micro-orga..'1iam had freed themselves of
the disease many times, <:Inly to have it ria-invade theteri'itories once free. ·1'his was a tragedy but it shQwed;·With certainty that the Western Pacitic did not have to havecholera.~ays must therefore be found, and coUld, to rid .the Region of the disease; The Region was a long
way from saying that it knew what those ways were, certainly this was true for the endemic home· of this micro--organism. The fact that
it !mew how to fight back against those defenses man had raised had been shown in the last four y~ars by the way the El Tor vibrio had left its ancestral home and involved many regions normally free of this organism. As a result of the fifteen years l work done, the base
and experience were now available to do the job seriously and to find out where this organism was and where the disease was, so that an attack coUld be organized against it in such a way that the objective of not having cholera would be achieved. This was something at which Before Dr Fang
the Regional Director had also hinted in his speech.
left, Dr 1riatt hoped that he would sit down and leave his cons.:::rvative, normal, deliberate self as the Regional Director, and put on the hat of the man who woUld really lay down the goals of the future. When
he had done so, Dr Watt was sure that everybody woUld be glad to follow his suggestions, Dr GURD(United Kingdom) also congratulated the Regional Director •. The pi'ogra'Tlme for the Region had been gradually built up over the years to the comprehensive level of today. The Regional Director had earned .
the gratitude and admiration of the medical administrators of the area
,
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because this widely-based programme had been built up on relatively lean financial resources. A solid structure now existed which would
provide a sure basis for the incoming regional director to build upon.
128
Dr ORSnU (France) thanked Dr Fang for the Report he bad submitted
to the Committee.
While reading it, he had been mainl.y struck by the ailmjni stra-
fact that it provided very clear guidelines for public health tors.
By looking back, it ws possible to measure the e:t':t'orts made and
the results obtained which it was hoped would be still more positive and numerous in the future. Referring to the introductory remarks of
Dr Fang, Dr Orsini stated that he appreciated the philosophy of the past
fifteen years.
Doctors could recommend such and such operations to
governments but it was very difficult to obtain the necessary funds. It ws in the compromise bet'Ween the desire and conviction on the one hand and the satisfaction of the needs on the other wherein the future of this region lay. The countries in the Region presented very different
problems according to the sector concerned but as a whole the results obtained by Dr Fang had been very positive and were very encouraging for the future. Dr IN SOKAN (Cambodia) extended this thanks to Dr Fang 'Who had spared
no effort to realize the objectives of the Organization.
His Government
greatly appreciated his qualifications and ws impressed by the account given in the report of the progress made. Dr GATMAITAN (Philippines) stated that the Report, which covered the
dramatic transition in fifteen years of health conditions in the Western Pacific Region, ws a 'Wl'itten history singular in itself. The Philippine
Government ws specially pleased to have observed that the activities of WHO in this part of the globe had so judiciously spread to the basic health needs of a developing country, beginning from the most needed items such
...as campaigns ~nst comm:unic~ble
l.?9. diseases, stl'engthening Of"the: .bas.ic
national. heal.th services, the improvement of the environment and training and education progrEllllmas. It w.l.shed to express its gratitude for the
val.uable technical. assistance given by the RegiOnal. Office to its public heal.th, tubercu1osis, leprosy, lIIIIlaria eradication and medical ca;re programmes. care "WaS
One significant event in the COl.Ul.try's programme of medical.
the recent adoption of the Hospital. Licensure Law.
Tbe Philippine
Department of Heal.th cou1d now su;pervise properly not only government hospital.s but al.so p:.:ivately operated ones. In the heal.th educat.ion
programme attention had recently been given to environmental. heal.th, maternal. and child heal.th and the prevention of' El .Tor .cholera. He wished al.so to talte .this opportl.Ul.ity to convey his Government's respects to the Government ·of Japan which, w.l.th WHO, had splendicUy joined efforts in the pursuit of knowledge about El Tor cholera. The
studies 'Were going on very 'Well and had aJ.ready resu1ted in significant findings from which the Region wou1d benefit greatly •. His delegation agreed with Dr Fang's comments that in this part of the world communicable . ". .. . diseases wou1d contiriUe to placeS. hEiavY burden on· lle8J..th admiriistrations for many years. to· come. It
was, hQ:weveX', col;l;f'ident
thatal.l.~mber
govermnents . ~u1d respond w.l.thunderstanding and with their resources to . ~et
this ·need.
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,. The CHAIRMAN suggested that the Rapporteurs draft an appropriate
resolution for presentation to the Committee.
(For consideration of
draft resolution, see minutes of the fifth meeting, section 2.)
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130
SIJ!,TEENTH SESSION
3
STATErom'S BY REPRE.'3ENTMIVES OF TIm UNITED NATIONS AND· SPECIALIZED AGENCIES
At the invitation of the Chairman, the follo¥dng Representatives presented statements. 3.1 Representative of' the United Nations, Technical Assistance Board and United Nations Special Fund Mr IDCAS conveyed to the Committee the very best wishes of' the
Secretary-General of the United Nations, the Executive Chairman of the Technical Assistance Board, Mr David Owen, and the Mmaging Director of the United Nations Special Fund, Mr Paul Hoffman. The Technical
Assistance Board and the Special Fund were closely associated with WHO and other specialized agencies of the United Nations and so the decisions of this meeting would be of great interest to the Executive Chairman and the Managing Director. On the personal plane, he had had the greatest
pleasure in his short but meIlPrable association with Dr Fang and l'IOuld like to ¥dsh him good health and prosperity in retirement. of the United Nations Children I s Fund Mr McBAIN conveyed to the Committee .thegreeUmgs of UNICEF and
good ¥dshes of Mr Brian Jones, his Regional Director.
This was the first
time that such a meeting had been held in the Republic of Rbrea and the event signified the increasing interest of the GoverIlllent in the development programmes of the United Nations and its specialized agencies. Those present would have an opportunity of' noting the significant evidence on all sides of a country in the progressive stages of national development. WHO and UNICEl1' had been playing an active part on an increasing . \
scale in the health and social welfare aspects of this development.
MINUTES OF. THE 'SEC9@ MEErING
121
From t;be first days of, the Regional Office for the Western PaCific" WHO and UNICEF bad been associated inf~iendly
co-operation in a number
of projects. , He 'Wished to express his own and his colleagues I warm appreciation of the effective assistance they bad receiVed from WHO. Although UNICEF was interested in a 'Wid,e range of activities benefitting children and youth, health programmes continued to absorb .the ma.jority of its funds. Mt' McBain then referred to two, sign;!.ficant trends in UNICEF
philosophy.
The first was the increasing effort to encourage, and assist
governments to include deliberate and carefully designed plans for children and youth in their general development planning. sector for children ~ ~
A separate
was not proposed, but efforts to co-ordinate
activities among the various ministries and government departlDents whose responsibilities included in one way or another the welfare of children and youth, so that this neglected sector of the' population - numerically over 40 per cent. in most countries - might receive special,thought, in the inte,rest of assuring healthy, educated and productive f'uture citizens who could . pl,ay their ..." . . -. .part fully, . in' national. 4evelbl>ment. Related to this. general subject wstbe,~problem
of adequate national In many countries of' '
budgets for health, education and s9cial 'Welfare.
the Region, this matter could bear objective examination in the light
.
of modern socio-economic knowledge, with a view to establishing 'Whether it ws really a fact that the human resources sector of' the various economies ws receiving all the attention countries could afford. UNICEF believed that i f governments could be encouraged to regard
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expenditures on health, education and social welfare as investments,
132
RmIONAL
CO~EE:
SDITEENTH SESSION
it would be found possible to increase substantially the sum annually allocated. to programmes in these fields, thus encouraging increased participation by the United Nations and the bilateral agencies. referred to the theme of vlorl.d Health Da3' some years back, ~
He Cost
of Sickness and the Price of Health n , and suggested that it was possibly the time when, with the assistance of the economists, the human resource factors in development might be studied further. The second aspect to which UNICEF was now giving attention was how
to reach the pre-school child aged one to six years.
Studies had shown
that insufficient attention appeared to have been given to preventive health measures, home and community care, nutrition, and early education for this group. They would, however, be given particular emphasis in
future project planning for UNICEF assistance. In clOSing, Mt- M::Bain paid tribute to the retiring :Regional Director.
All those 'Who had worked with him in both UNICEF and WHO had enjoyed the happiest and most constructive of relationships, had benefitted from his wise advice and guidance, and would always remember his warm and cheerful personality. Fihally, Mt- MCBain pledged UNICEF t S co.;.operation to the
new Regional Director and stated that his organization looked forward to many years of effective joint activity in expanding health projects T
in the Region.
(For further statements presented, see minutes of the
third meeting, section
4, fourth and fifth meetings, section 1.)
The meeting rose at 5.15 p.m.