WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR SOUTH EAST ASIA Eighth Meeting of the Consultative Committee for Programme Development and Management. melhi, 19 to 23 September 1985 SEA/PDM/Meet.8/8 23 September I.985 REPORT OF TH: FOR E EIGHTH MEETING OF THE CONSULTATIVE COMMITTEE PROGRAMME DEVELOPMENT AND MANAGEMEN"IA i - In pursuance of the directive from the Regional Committee that the CCPDM meet every six months to carry otit a review of the implementation of the Organization's collaborative programmes in the Member States the eighth meeting of the CCPDM was held in the Regional Office from 19 'to 23 September 1985. A summary of the Committee's conclusions and recommenda- Fions are contained in this report, which has four distiact sections. Section 1 contains the discussions of the CCPDM on the "Annual Report of the Regional Director", covering the period July 1984 to June 1985. This section may be considered by the Regional Committee in the session, along with the "Thirty-seventh Annual Report of the Regional Director" (agenda item No.9). I Section 2 contains its comments on the "Implementation of the WHO's Collaborative Programmes for the first eighteen months of the biennium 1984-1985, i.e. 1 January 1984 to 30 June 1985". This section will be discussed by the Sub-Committee on Programme Budget. Section 3 contains the deliberations of the Committee on "Draft Regional Programme Budget Policy". This section will be discussed by the sub-committee on Programme Budget and its comments will be placed before the Regional Committee as a part of the report of the Sub-Committee. Section 4 contains the comments of the CCPDM on "Progress made in the Joint Government/WHO Evaluation of a Priority Programme". This see'-ion will be discussed by the Sub-Committee on Programme Budget and 'the Sub-Committee's comments on the topic will be considered by the Regional Committee as a part of the Sub-Committee's Report.1; i ASECTION 1 Review of the Thirty-seventh Annual Report of the Regional Director for the period 1 July 1984 to 3 30 June 1985 SECTION 2 Review of Implementation of the WHO's Collaborative Programmes for the first eighteen months of the biennium 1 5 1984-1985, i.e. 1 January 1984 to 30 June 1985 SECTION 3 Review of the Draft Regional Programme Budget Policy 1 7 SECTION 4 Review of Progress made in the Joint Government/WHO Evaluation of a Priority Programme 1 9 ANNEX - List of Participants 2 1 SEA/PDM/Meet.8/8 INTRODUCTION In pursuance o f the directive from the Regional Committee that the Consultative Committee for Programme Development and Management (CCPDM) meet every six months to carry out a review of the implementation of the Organization's collaborative programmes in the Member States, the Regional Director convened the eighth meeting of the CCPDM in the Regional Office with the following terms of reference: Review of the Thirty-seventh Annual Report of Director for the period 1 July 1984 to 30 June 1985 the Regional 2. Review of Implementation of WHO's Collaborative Programmes for the first eighteen months of the biennium 1984-1985, i.e., 1 January 1984 to 30 June 1985 3. Review of the draft Regional Programme Budget Policy 4. Review of Progress made in the Joint Government/WHO Evaluation of a Priority Programme ' I The Committee met in the Regional Office of WHO at New Delhi from 19 to 23 September 1985. While inaugurating the meeting, Dr U Ko Ko, the Regional Director, highlighted the importance of the Committee as a working arm of the Regional Committee, as evidenced by the reference of important and specific i tasks relating to WHO programme development and management to the Committee 1 for its review and analysis. Referring to the in-depth review of the Regional i DirectOr'S Annual Report by the CCPDM, he stated that some doubts had been expressed at the 36th and 37th Regional Committee sessions about the utility of CCPDM undertaking this exercise, since it resulted in apparent duplication, and the Committee might therefore review this matter and make its recommendation on the future course of action to the Regional Committee for its consideration. As regards the directive from the Regional Committee for a joint government/WHO evaluation of a selected major priority programme in each Member State during the biennium 1984-1985, the Regional Director pointed out I that all Member States had since initiated necessary steps to undertake suchan evaluation. The Regional Director felt that the draft of the Regional I Programme Budget Policy, developed by the Working Group set up on the i recommendation of the last CCPDM, could be used by this session as a basis for i initiation of activities to prepare the Regional Programme Budget Policy. This would be submitted to the Programme Budget Sub-Committee of the Regional 11 Committee for its review. In conclusion, he hoped that the Committee would continue to contribute towards the development and management of the 1 Organization's collaborative activities in the countries of this Region and Ii also help in enhancing the understanding and cooperation in the joint effortsto achieve the goal of HFA/2000. Dr C.D. Herath of Sri Lanka was elected as Chairman and Miss Husna Razee of Maldives as Rapporteur. A list of participants is attached (see.Annex). SECTION 1 REVIEW OF THE THI’RTY-SEVENTH ANNUAL REPORT OF THE REGIONAL DIRECTOR FOR THE PERIOD JULY 1984 TO 30 JUNE 1985 I REVIEW OF THE THIRTY-SEVENTH ANNUAL REPORT OF THE REGIONAL DIRECTOR FOR THE PERIOD 1 JULY 1984 TO 30 JUNE 1985 SEA/PDM/Meet.8/8 Page 3 The Committee took up a review of the Regional Director's Annual Report chapter by chapter. Chapter 1 - Governing Bodies (pp l-7) The Committee suggested that the Member States, which were representing the South-East Asia Region on the Executive Board, be requested to include their representatives, who attended the Executive Board session, in their delegation to the Regional Committee. B The Committee also noted another suggestion with regard to evolving suitable mechanisms for nomination of candidates from this Region for the various awards instituted in the health field. In this connection, it noted that each award had its own different built-in mechanisms, in that the responsibility for nomination of candidates depended on the type of award. In the circumstances, the Committee felt that it would not be feasible to institute an uniform mechanism for nomination of candidates for the awards by the Regional Committee. Chapter 2 - WHO's General Programme Development and Management (pp 7-23) With regard to the assistance provided by WHO to Member countries to prevent emergencies from industrial disasters,~ the Committee was informed that a memorandum of understanding had been signed by India and Thailand with the International Programme on Chemical Safety (IPCS). An Intercountry Workshop on Chemical Safety in SEAR countries, in collaboration with IPCS, was held in October 1984 which identified key issues and recommended priority measures for Consultants had been 0 development and strengthening of national programmes. sent to some Member countries of the region to identify their priority I' problems in terms of control of environmental health hazards and a proposalfor an intercountry project on chemical safety and control of environmental health hazards, in which five Member countries of the region had expressed a desire to participate, had been formulated for funding from external resources. Chapter 3 - Health System Development (pp 25-43) The Committee noted the efforts made by the Member countries to strengthen their national health information systems and the managerial processes which were essential for providing crucial technical, epidemiological, statistical and managerial information for programme development and management. Some Member States had embarked on various activities suited to their needs e.g. integrated community health services development geared to meeting the needs of the rural people; pilot study for implementing the newly developed national health information system in two districts; geographical extension of Basic Minimum Needs approach; computerization of health information system, and management training of workers at all levels of health service. The Committee noted the progress made by some countries in enacting health legislation and felt that passing suitable health legislation be left to the countries concerned since the problems associated with such enactments were country-specific, However, WHO could provide technical support if any Member country needed it. SEA/PDM/Meet.8/8 Page 4 Chapter 4 - Organization of Health Systems based on Primary Health Care (pp 43-56) The Committee noted the high priority given by the Member countries for development of primary health care and the measures initiated by them to explore the methods of involving the community in the planning and delivery of the PHC. Several countries had decentralized the administrative and technical responsibility of implementing primary health care to the district level through the integration of health services, while others had used innovative approaches, such as community cooperative system, strengthening of administrative committees, training of people in the villages in the managerial skills 'of PHC and self-managed village PHC. In some countries, use of mobile teams was being made for providing health care at the periphery. Adequate manpower was being developed through appropriate training in order to ensure delivery of PHC in rural areas. Integration of health care had been achieved by providing a variety of community health workers to deliver a package of services with strong support and supervision from district level. The basic health workers had been converted into multipurpose workers through training. With regard to the extension of the PHC to the urban areas, the Committee noted that the Organization was now promoting urban PHC. Two such projects in India and Indonesia and another intercountry project were being planned. Some countries were facing constraints in implementing their PHC programmes because of the non-involvement of other ministries/departments such as planning, finance etc. The Committee noted that WHO had been promoting to bring together at a common platform all the related ministries and departments while formulating the national strategies. There was a need for the more active involvement of these departments in future. WHO would provide necessary support in this regard. As regards the point that the Regional Director's Annual Report should include evaluative aspects of the national programmes highlighting the impact of such programme activities for information of all concerned, the Committee felt that since the implementation of PHC programme in the countries was in an evolutionary stage and its evaluation was a part of the national managerial process for health development, it was necessary that the information on evaluative aspect was provided by the countries themselves to WHO for inclu,sion into the report. WHO, however, should continue to support the Member countries in undertaking evaluation activities to generate the required information. Chapter 5 - Health Manpower Development (including health manpower development activities in other programmes) (pp 56-88) The Committee noted the slow progress made towards the establishment of effective national-level mechanisms for ensuring coordination between manpower production and the needs of the health care system, comprehensive and adequately updated manpower information database, There was, however, an increasing awareness among key authorities in the Member countries for the need to improve the quality of decision-making in the areas of health manpower planning, production and management, The critical role of trained health manpower in the delivery of health services for achieving the goal of HFA/2000 was emphasized. SEA/PDM/Meet.8/8 Page 5 There were' various difficulties in arranging timely placements of fellowships in various teaching institutions within the Region and outside' viz., lack of competence/comprehension in the English language, differen; admission standards due to different media of instruction (local languages) in different countries of the Region, etc. In this connection, the Committee took note of the fact that in almost all the countries, medical doctors were reluctant to serve in the rural areas. This was also compounded by the fact that there was an increasing tendency among the medical doctors to invariably go in for postgraduate qualifications and accentuated reluctance of the postgraduates to serve in rural areas, Various mechanisms to bring about the reorientation in the attitude of the medical profession were being explored such as changes in the curriculum, compulsory service in the rural areas for a minimum period of 2-3 years, imparting training which was relevant to the needs of the people in the context of socio-economic conditions prevailing in b each Member State, etc. It was proposed that WHO might initiate necessary dialogue with the concerned institutes relating to their admission requirements, particularly the English language tests for qualified personnel who were seeking admission to specialized courses. Some of the developed countries with English as medium of instruction were prescribing very high proficiency in English language as a primary requirement for admission to the training institutions, even for short-term fellowship programmes such as study tours, etc. This was creating obstacles for the timely implementation of the fellowship programme in the Region. It was, howevet, felt that it was not possible for WHO to change the admission requirements prevailing' in the different institutions inside 'or outside the Region as these were developed according to specific country situations. As such a more feasible approach would be for the Member countries to nominate for fellowships &ualified candidates who should meet the English language and other requirements of the receiving institutions, where applicable. The Committee noted that WHO had developed sets of comprehensive self-instructional and evaluation material for learning of English as one of the steps to solve the English language problem. These were being field-tested in some of the Member States. After these had been field-tested, the modified sets would be made available to all the Member States for wider application at the national level. Development of regional training centres, regional training programmes relevant to the needs of the people, reorientation of medical education, mutual recognition of degress/diplomas, emphasis on regional fellowships in accordance with EB policies, involvement of responsible officers from the Planning, Finance and Health Ministries in the management and development of health programmes , .full utilization of available trained health personnel, curricula development, rural-based medical education with emphasis on rural situations rather than leading to city-based hospitals, eligibility criteria for admissions including the requirement of compulsory rural-service for a set period of time (say 3 years), and exchange of information, were, therefore, considered as important areas which should receive further attention. The Committee was informed that the Regional Office had produced a directory of training institutions/facilities available in the Region. WHO was always trying to bring together decision-makers, health administrators, heads of training schools, deans from the Universities, researchers, etc., in order to evolve national mechanisms for health manpower SEA/PDM/Meet.8/8 Page 6 development, to develop and implement national training programmes for producing a variety of trained health personnel including nurses, paramedical staff, auxiliaries, undergraduate and postgraduate doctors. The Committee noted that it was essential to promote regional cooperation among the Member States and also to develop self-reliance. The example of technical cooperation among developing villages (TCDV) in Thailand was a significant one, i.e. one village after having learnt the process of management and development of health care delivery, would help the other villages to initiate the same process and so on. The Committee was informed that WHO had established a PHC network for exchanging information on innovative approaches for primary health care and that two resource centres (one each in India and Thailand) had been formed as focal‘points. These would be developed further. Chapter 6 - Public Information and Education for Health (pp 89-93) The Committee noted that there was very little exchange of information in this field among the different countries of the Region and felt that material prepared in one country should be made available to the others, thus effecting considerable saving in both time and money. There was a need for a centre to receive all such material and expedite exchange of information among the countries. The Committee was informed that efforts were being made to develop a primary health care, network for which purpose two centres - one in New Delhi (India) and the other at the University of Mahidol, Bangkok (Thailand), had been identified. These centres would maintain uptodate information and collect all kinds of supporting material for primary health care which could be utilized by the Member countries. These centres would have material and information not only in terms of technology but also in terms of the various experiences that each country was developing. Chapter 7 - Research Promotion and Development (pp 95-103) The Committee felt that the countries of the Region should regularly exchange information relating to research activities and research findings in order to avoid duplication of efforts. The Committee was informed that the following mechanisms had been developed for sharing this information through: (i) meetings of the Medical Councils once in two years; (ii) Scientific working Groups meetings as necessary; and (iii) provision of bulletins from different research institutions. Further, a booklet on research activities carried out under WHO auspices was being compiled and such information would also be shared through HeLLIS network. Chapter 8 - General Health Protection and Promotion (pp 103-116) The Committee felt that the Member countries having experience in the iodized salt distribution should share this information with the other countries. The Committee also felt that WHO should find means for preserving the iodized salt during rainy or snowy seasons when it had tendency to evaporate. Iodine injections had also been tried in one country and convincing results had been achieved. This would prove helpful in the eradication of goitre. The Committee noted that, in addition to providing iodized salt and SEA/PDM/Meet.8/8 Page 7 iodine injectionsi a massive drive to educate the public in the use of iodized salt was necessary if the programme were to be a success. Research would need to be undertaken for prevention of evaporation of iodine from iodized salt. With regard to Accidents Prevention, the Committee noted the alarming increase in the accidents. All the concerned agencies like police, vehicle and driving licencing authorities, industrial units, etc. should launch a massive programme to educate public on the preventive aspects of the accidents, An integrated approach should be made to educate the public on the hazards of the use of automobile vehicles on the road, machineries, etc. Such an education should start from the school level. There should also be provision for trauma centres. The countries should have national plans and mobilize resources for the prevention of all types of accidents, including domestic, agricultural, industrial and road accidents. Chapter 9 - Protection and Promotion of Health of Specific Population Groups (pp 116-128) The Committee felt that WHO should give priority in providing technical and financial assistance to strengthen the MCH programme. The MCH programme was now being carried out in an integrated manner, embracing, among others, acute respiratory infections and diarrhoeal diseases. UNFPA and WHO were collaborating with the countries in the field of MCH and family health. The Committee felt that there was need to improve the health status and role of the women in health and development. Most of the countries had become conscious about the women's status and many bureaux and separate units had been established for them. The Committee was also informed that so far as the Regional Office of WHO was concerned, there had been a definite change in this respect as many women employees had recently been recruited in accordance with the mandate of the United Nations. A publication had been brought out by SEAR0 on this subject and steps had been taken towards women and development programme. This programme, however, did not have its own funds and was being implemented as an integral component of related collaborative programmes of WHO. Chapter 10 - Protection and Promotion of Mental Health (pp 128-131) The psycho-social factors in the promotion of health and human development were getting increasing attention in most of the countries in this part of the world. While the existing mental health programme in many countries was for the treatment of the sick individually, the psycho-social aspect was being increasingly emphasized for promoting positive aspect of mental health in the family and community. The benefit of this effort was not only confined to mental health but would produce positive impact on other programme areas as well. The problem of drug abuse was assuming menacing proportions in some countries of the region, There was a need for increasing support by the Organization in helping the countries to overcome this problem. Chapter 11 - Promotion of Environmental Health (pp 131-144) The Committee noted that the decade programme on Community Water Supply and Sanitation had been launched in the Member countries comprehensively with support from WHO, UNICEF, World Bank, bilateral agencies, etc. The governments SEA/PDM/Meet.8/8 Page 8 were making their best efforts to provide water supply for all peoples, but the target might not be achieved by 1990 owing to various factors including, in some cases, inadequate water sources. There was also the problem of poor operation and maintenance of completed schemes. The Committee noted the new strategies and approaches developed by some countries to meet their requirements of water supply, promotion of such as the provision of basic minimum needs, community-organized funding, operation and management and provision of adequate back-up support from referral levels. Some institutional realignment would be necessary to develop and deliver this programme in terms o f PHC and decade approaches. Use of facilitators, strengthening of community-level institutions, etc. were crucial issues requiring priority attention. WHO was also promoting the involvement of women in decade activities and an evaluation of this intervention was now being planned. As regards sanitation, the Committee noted that not much progress had been made in this direction and that while many of the countries might reach the target for water supply, only two or three countries might meet their targets for sanitation. With regard to other environmental health activities, the Committee noted the conclusions of a study conducted in Burma on disease patterns related to environmental health factors, and SEAR activities concerning control of chemical safety and environmental health hazards. Chapter 12 - Diagnostic, Therapeutic and Rehabilitative Technology (pp 144-159) The Committee noted that in the field of essential drugs and vaccines, the major thrust of the Organization was towards developing rational drug policies, strengthening various components of pharmaceutical supply system (PSS), assisting Member countries in improving their drug information system and strengthening the national capabilities for quality control of drugs and vaccines. The Organization had established a network of quality control laboratories for drugs and vaccines. The Committee noted the progress made by the countries in attaining self-sufficiency in respect of essential drugs and that many countries had drawn up lists of essential drugs and vaccines required in support of their health services. The major constraint some countries faced in making available essential drugs at the peripheral level, however, related to the high cost. In this connection, the Committee was informed that WHO had developed some programmes for the supply of essential drugs at an economic price. There was also a joint WHO/UNICEF programme at global level, which aimed at supply of core drugs for PHC at a cheaper price through revolving fund. This programme also would support the countries to develop their infrastructure to produce essential drugs which would be generic and provided at an economic price. The Committee was also informed that through a reimbursable purchase scheme, the Organization could purchase drugs too at comparatively reduced prices and supply them to the countries against payment in their national currency. With regard to the advisability of including Thalazol in the kit of the community health workers, the Committee was informed that Sulphathiazole had been deleted from most of the pharmacopoeia of the world owing to its high toxic content and had been replaced by many safer sulphonamides. It was therefore advisable to use safer sulpha drugs such as Sulphadimidine or a combination of trimethoprim and sulphamethoxazole (co-trimoxozole), instead of including Sulphathiazole in the kit. In the field of vaccines, the thrust was towards strengthening the countries' capability for developing quality control and the Organization was collaborating in introducing new technologies for assessing drug quality, safety and efficacy. A network of centres for testing vaccines had been established at the regional level. SEA/PDM/Meet.8/8 Page 9 With regard to traditional medicine, the Committee noted the efforts made by the countries to make use of the large number of traditional medicine practitioners, particularly in rural areas, to promote primary health care. Some of the problems faced by them in promoting the concept of traditional medicine related to lack of conviction on the part of many consumers on the efficacy of this system, unwillingness of the traditional medicine practitioners to impart their knowledge to other workers, and use of modern medicine by the traditional medicine practitioners themselves to cure diseases. The Committee noted that the Organization was collaborating with the Member countries to draw up a list of commonly used traditional medicines of known efficacy which could be used and adopted for primary health care, in preparation of a manual giving the various aspects of regimen, and in standardization of traditional medicine. The other aspect was to use the vast manpower constituted by practitioners of traditional medicine for PHC. Chapter 13 - Disease Prevention and Control (pp 161-244) The Committee noted that there existed a large gap between the resource requirements and the resources available to carry out the disease prevention and control programmes in the Member countries and that all efforts were being made to bridge this gap through mobilization of external resources through the other international, bilateral and multilateral agencies. Since a number of new programmes were being launched, it was pointed out that Member countries should decide their own priority areas to which the limited available resources should be diverted. WHO would continue to support the integration of disease prevention and control programmes into the basic health services using the primary health care approach for achieving the goal for HFA/2000. 13.1 - Immunization (pp 161-174) The Committee noted that the expanded programme on immunization (EPI) continued to be implemented in most countries of the Region. EPI activities were fully integrated with basic health services in all the Member States which were implementing EPI. However, community participation remained an important area that needed to be strengthened. The lack of trained human resources in general, and weak management in particular, were the important constraints. Immunization coverage surveys were regularly used by the countries to evaluate the programme performance, its effectiveness and efficiency. Available data on the incidence of some of the target diseases in specific geographical areas showed a downward trend indicating the impact of the programme. With regard to cold chain logistics, it was felt necessary to stimulate and coordinate research activities to facilitate development of appropriate cold chain equipment in the Region. The Committee was informed that experiments supported by WHO in the use of solar-power refrigerator in India and the Maldives indicated that at the present stage' of development solar-power refrigerator was not cost-effective and extremely difficult to maintain in the situations in the South-East Asia Region. Further research would be needed in this area. SEA/PDM/Meet.8/8 Page 10 13.2 - Disease Vector Control (pp 175-183) The Committee noted that the main constraint being encountered in many national vector control programmes was the inadequate management due to a lack of trained personnel at various levels, This was further aggravated by administrative problems and technical difficulties due to the resistance of vectors to insecticides. Owing to rapid urbanization, the urban ecosystem continued to be under great pressure. Development projects related to irrigation, dam building, collection of rainwater, clearing of forest for resettlement of population etc. were responsible for change of ecosystem and vector breeding leading to the health problem. The Committee also noted that in most countries of the Region, there existed an infrastructure for vector/pest control services. These programmes depended mainly on spraying with insecticides. Technical/ operational problems were often encountered. WHO would continue to collaborate with national vector-borne disease control programmes in strengthening entomological services for monitoring vector prevalence, in instituting appropriate intervention programmes and in developing cost-effective alternative control measures. 13.3 - Malaria (pp 183-200) The Committee noted that malaria was a high-priority public health programme in the Region which continued to pose a serious challenge. The situation did not show satisfactory improvement in spite of national and international efforts to control the disease. Technical problems of parasite resistance to antimalarial drugs and vector resistance to insecticides continued to persist. The process of integration of malaria control programmes with the basic health services and the strategy of malaria control through the primary health care approach needed to, be pursued further. WHO had developed necessary guidelines in collaboration with the Member States for the effective implementation of the integration process. It was emphasized that continued efforts should be made towards developing realistic national policies with regard to chemotherapy and vector control measures. WHO should continue to provide necessary support to this end. 13.4 - Parasitic Diseases (pp 200-203) The Committee noted that parasitic diseases (filariasis, leishmaniasis, schistosomiasis, guineaworm, etc.) continued to be a public health problem in most countries of the Region. There was lack of information about the incidence and prevalence of parasitic infections. Kala-azar was showing a tendency for resurgence in Bangladesh, India and Nepal. There was an acute shortage of drugs for the treatment of Kala-azar and urgent action was necessary to meet the need. The Committee was informed that WHO was making all possible efforts to assist the Member States in implementing national programmes for combating these diseases. It was suggested that Member States should continue to stress on the development of national capabilities in the diagnosis, treatment, control and management of such diseases. SEA/PDM/Meet.8/8 Page 11 13.7 - Acute Respiratory Infections (pp 211-214) The Committee noted that acute respiratory infections (ARI) were now recognized as a leading cause of morbidity and mortality during childhood in most of the Member countries. National committees or task forces on AR1 were established in some countries while others had initiated research activities OR intervention measures for the control of AR1 with WHO support. The Committee felt that efforts to reduce the incidence of these diseases should be further strengthened. 1 3 . 8 - Tuberculosis (pp 214-217) The Committee noted that tuberculosis control was carried out through the integrated health services as a part of basic health services in all countries of the Region. Non-availability of sufficient drugs for the b treatment of tuberculosis was a common problem in the Member States. Moreover, some of the drugs were very expensive. Problem of drug resistance was also not infrequent. In addition, the defaulter rate in respect of regular treatment was very high. It seemed that due to all these problems, most national tuberculosis control programmes lacked due momentum. A reference was made to the study conducted in India, on the effectiveness of BCG in TB prevention. It was found that BCC was effective ,in preventing TB meningitis. Two other studies, one in Indonesia and the other in Thailand, were being conducted on the same subject. It was emphasized that community awareness should be created to control this disease which was causing severe human suffering and also had an adverse socio-economic impact on the community. 13.10 - Zoonoses (pp 225-227) Rabies was identified as a priority zoonotic disease in the Region. The Committee noted that the major constraint in the development of the zoonoses programme was the lack of intersectoral collaboration. i The Committee was informed that WHO had collaborated in a project onI the experimental production of tissue-culture anti-rabies vaccine at the Pasteur Institute, Coonoor. Experimental vaccine batches were prepared and tested for immunogenicity. A manual on the production technology using the vero-cell system had been prepared. UNDP assistance was ob,tained for further strengthening the rabies control programmes in the Member countries by way of assisting national personnel in programme planning, undertaking studies on dog ecology and strengthening laboratory diagnostic facilities. WHO: continued to explore possibilities to establish collaborating centres for the production and standardization of reagents. 13.11 - Sexually Transmitted Diseases (pp 227-228) The Committee noted that health administrators in the countries of the Region were aware of the human, economic and social dimensions of the problem of sexually transmitted diseases (STD) and that it was receiving an increasing attention. Some countries had launched intensive drives to tackle the problem. SEA/PDM/Meet.8/8 Page 12 Imported cases of AIDS have been reported in one or two countries. The committee was informed that one of the diagnostic tests available for detecting the disease was the ELISA Test. WHO might be able to supply thes& kits to some of the countries on a very limited basis. However, there were fundamental problems attached to this disease which should be tackled on a priority basis. It was suggested that Member States should give priority to the development of screening, diagnostic and treatment facilities to affected populations. 13.13 - Other Communicable Diseases (pp 229-234) The Committee felt that appropriate steps should be taken to combat the outbreak of meningococcal meningitis in those countries of the Region where sporadic outbreaks occurred. The Committee was informed that an inter-country meeting was scheduled to be held in March 1986 where it was proposed to define measures for the control of meningococcal meningitis on a long-term basis. The Committee noted that the standards of personal hygiene, water and sanitation needed to be improved to control the outbreak of A and some type of non-A and non-B viral hepatitis, Further, there was also need for trial of new types of vaccines to prevent this disease. The Committee was informed that hepatitis B immunization in newborn was effective and it was the only vaccine which could be used for prevention of liver cancer. Further a protocol had also been developed to carry out a multicentric research study in six countries of the Region regarding non-A and non-B hepatitis. 13.17 - Other Noncommunicable Diseases (pp 243-244) WHO The the the The Committee .felt that there was a need for a programme on deafness. was actively involved and interested in the promotion of this programme. 38th World Health Assembly had passed a resolution in May 1985 requesting Member countries to assist in the promotion of prevention of deafness, and Regional Office had also written to the Member countries to identify focal points with whom it could contact for promoting the programme. The Committee also felt that WHO should develop appropriate technology to control the noncommunicable diseases through primary health care. Chapter 14 - Health Information Support (pp 245-251) The Committee felt that WHO publications should be made available to the countries of the Region free of cost so that the persons interested in reading these publications could make best use of them. The Committee was informed that WHO depository libraries had already been established in all countries of the'Region except in the Maldives and Bhutan where steps had been initiated to establish them. These libraries, which had been designated by WHO HQ, were receiving all WHO publications regularly. Many persons, however, were not aware about the existence of such libraries and WHO would look into the possibility of designating other depository libraries so that more people could make use of the WHO publications. A Central Research Library had been established in Mongolia in 1984 and this Library could be designated as a WHO Depository Library in order to receive the WHO publications free of cost. SRA/PDM/Meet.8/8 Page 13 The Committee also felt that support should be provided for the translation of WHO publications and also for printing of these translated publications elsewhere if such facilities did not exist in a country. The Committee was informed that WHO had a scheme which supported the translation of WHO publications into local languages bearing 25% of the cost of translation. Further, if the countries wished their own material to be published, the country budget could be utilized in appropriate cases. The Commi,ttee noted that the literature in Russian language on the World Health Day reached Mongolia very late and requested WHO to see that it reached the country well in time. In-depth Review of the Regional Director's Annual Report ai The question of in-depth review a of the Regional Director's Annual Report by the CCPDM was discussed at great length. The Committee noted the decision of the 36th Regional Committee that the RD's report be reviewed by the CCPDM and its report circulated by the Regional Committee as an information document. In view of the fact that the Regional Committee also followed identical pattern in reviewing RD's annual report as the CCPDM, resulting in a lot of duplication, and that the Regional Committee at its 37th Session did not even refer to any of the areas and problems highlighted in the CCPDM's report, the usefulness of this exercise was of doubtful value. The Committee felt that its report of the review of the. RD's Annual Report should form a basis for the Regional 'Committee's consideration of the RD'S Annual Report to obtain maximum benefit out of this exercise. AS an alternative, the Regional Committee may decide to divest the CCPDfi of this function. -U)TION 2 ‘. REVIEW OF IMPLEMENTATION OF THE WHO’S COLLABORATIVE PROCRAMMES FOR THE FCkST EIGHTEEN MONTHS OF THE BIENNIUM 1984-1985 i .e . , 1 JANUARY 1984 TO 30 JUNE 1985 SEA/PDM/Meet.8/8 Page 15 REVIEW OF IMPLEMENTATION OF THE WHO'S COLLABORATIVE PROGRAMMES FOR THE FIRST EIGHTEEN MONTHS OF THE BIENNIUM 1984-1985, i.e., 1 JANUARY 1984 TO 30 JUNE 1985 The Committee noted that the working paper (SEA/PDM/Meet.8/5) showed the status of implementation of WHO's collaborative programmes in the Member countries of the Region during the first eighteen months of the 1984-1985 biennium - i.e. 1 January 1984 to 30 June 1985 - and that, in accordance with the Committee's desire expressed at its last meeting in April 1985, information on the pipeline activities under the country programmes as well as activities carried out in the Member countries of the Region under the intercountry programme had been included in the working paper. The Committee noted that the implementation of the Organization's programme for the whole region was 66% and 'would be 83% if all the pipeline activities under processing were also taken into account. The Committee then reviewed the programme implementation in detail and the following points emerged from its discussions: (1) Implementation of the fellowships programme-lagged behind due to various factors, the main difficulties being the delay in the nomination of candidates by the Member suitable placements by WHO. States and in finding The Committee noted that on the one hand some countries felt an accute shortage of manpower, on the other they were unable to make full use of the resources from the Organization for developing their manpower through its fellowship programme. The Committee recognized the difficulties encountered both at the country level and in the Regional Office in implementing the fellowships programme. The Committee noted the serious concern expressed by some countries about the difficulties in getting suitable placement for their nationals owing to a variety of reasons, like proficiency in the English language, lack o f educational qualifications prescribed by the receiving institutions; etc. and felt that in such cases the Organization should try to secure placement for the nationals in other suitable training institutions. In this connection, the Committee realized that it would be rather difficult for WHO to approach training institutions for reservation of seats without having specific information concerning the type and field of training required. The Committee stressed the need for securing timely placement for nationals in order to ensure not only the utilization of Organization's resources in time, but also provide suitable training to the nationals. The Committee felt, therefore, that the countries should take full advantage of the Organization's fellowship programme and the TCDC'mechanism for developing their manpower and, in the meantime, the Organization should examine the problems encountered in the timely implementation of the fellowships programme both at the national and regional levels, with a view to resolving them, including securing of reservation of seats in the training institutions. SEA/PDM/Meet.8,/8IIPage lo (2) .With regard to the implementation of programme activities in the (3) Region supported by voluntary 'funds, the Committee noted that funds ‘were given by donor and bilateral agencies, such as SIDA, DANIDA, etc. for undertaking specified and non-specified activities. While the funds for implementing specified activities was the res'ponsibility of the Regional Office concerned, in the case of non-specified activities WHO Headquarters controlled the funds, As regards the suggestion 'that the country concerned should be informed about the availability of funds from voluntary sources in order to make better utilization of such resources, the Regional Office was evolving a monitoring mechanism for projects funded by voluntary sources, UNDP and UNFPA, in addition to RB funds, which would provide all the information to national authorities through the .WPCRs. It would also give the status of implementation of activities supported by extra-budgetary resources. A suggestion was made that WHO should support the countries in identifying the bottlenecks and 'in strengthening the local mechanism for the purpose. In this connection, the Committee was informed that since the beginning of this biennium, the Regional Office had been providing the WPCRs information on project delivery, indicating the financial status of implementation by component of project activities every quarter. This information together with the pipeline activities, which was available at the country level, would enable the national authorities to assess the exact status of delivery of the country programme and the activities pending implementation. The Committee recognized the difficulty bf the Regional Office in identifying the specific areas which lagged behind, since the responsibility for implementation of certain components like local cost subsidies, etc. rested with the government. The Regional Office always collaborated with the countries in implementing the activities according to their plan of action and would be ready to provide any support in regard to monitoring of country programme impiementation. With regard to activities carried out under the intercountry programme, the Committee felt that the information provided in the working paper was quite useful in assessing the benefits derived by each country from the intercountry programme. Since the broad intercountry programme, formulated in consultation with Member countries, was scrutinized and approved by the CCPDM, the Committee felt that, in the light of the country programme proposals, it should continue to identify common areas requiring support from the intercountry programme. SECTION 3 REVIEW OF THE DRAFT RECIONA BUDGET POLICY L PROC RAMME The Committee noted that a Working Group was set up by the Regional Director on the recommendation made at the last meeting of CCPDM in April 1985 to initiate preparation of the Regional Programme Budget Policy within the broad framework of the guidelines contained in document DGOl85.1. This Working Group had met in the Regional Office in July 1985, reviewed the guidelines as also their implications and had developed a draft Regional Programme Budget Policy (working paper SEA/PDM/Meet.8/6.1) for its review. The Committee also reviewed the report of the Working Group (working paper SEA/PDM/Meet.8/6,2) along with the draft Regional Programme Budget policy produced by the Group. The Committee felt that sufficient flexibility was needed during i lementation to accommodate the real needs of the Member States in their n h towards the goal of health development. It found that the guidelines were a little too rigid. The language and spirit of some of the paragraphs were not in conformity with the spirit of intimate partnership between the Organization and its Member States. The implied suggestion at places that WHO resources would be available only for certain types of activities and further that these could be withdrawn if there was inadequate implementation, was quite disconcerting. It also felt that while it was essential to implement the WHO'S collaborative programme as per plan approved by the Regional Committee, to improve the relevance of reprogramming at the end of the biennium, anticipatory use of savings to finance the approved programme of .the next biennium could be considered. WHO's resources must not be merged into the national budget and yet must be used in priority areas for the national health development efforts. WHO must use the Health Ministry as a single window for coordinating all its programmes, and access to other sectors and non-governmental organizations in the countries should be through the Ministry of Health. There was also a need to ensure that the policy was in keeping not only with the requirements of the Or nization but also with the.sovereignty and dignity of the Member States. 6 While the principle of accountability of the use of WHO's resources was valid, the procedures must be decided by mutual agreement between each Member State and the Organization depending on the specific situation prevailing in each country. The Committee appreciated the efforts put in by the Working Group in developing a comprehensive draft Regional Programme Budget Policy, adhering as far as possible to the guidelines contained in DG0/85.1, and at the same time adapting to the regional situation wherever it felt necessary so as to suit the felt needs of the Member States in this Region. The Committee reviewed in depth the draft document on the Regional Programme Budget Policy along with the guidelines provided by the Director-General (DGO 85.1) and prepared a revised draft which is contained in document RPB Policy/Draft 2 to be submitted to the Programme Budget Sub-Committee of the 38th session of the Regional Committee. The SEA/PDM/Meet.8/8 Page 18 ./ i: recommendations of the Programme Budget Sub-Committee of the Regional Committee would be incorporated into the draft for further improvement. The revised draft would then be examined and improved by the CCPDM in 1986 and submitted for consideration by the 39th session of the Regional Committee. SECTION 4 t REVIEW OF PROGRESS MADE IN. THE JOIN=? d.jVERNMENT/WHO EVALUATION OF A PRIORITY PROCRAMME I 5 3r 6% G SEA/PDM/Meet.8/8Page 19 REVIEW OF PROGRESS MADE IN THE JOINT GOVERNMENT/WHO EVALUATION OF A PRIORITY PROGRAMME The Committee noted the working paper SEA/PDM/Meet.8,!7 and the progress made by the countries in carrying out a joint government/WHO evaluation of a priority programme. The countries had evolved institutional mechanisms of their own for promoting and undertaking national/WHO programme evaluation of health programmes. management inclusive ofThey had selected priority programmes for joint government/WHO evaluation during the biennium 1984-1985. In pursuance of the directives from the Regional Committee initiated for undertaking the joint evaluation.various steps had already been carried out the evaluation. Bhutan and Bangladesh hadThough the other Member countries had initiated a the process of Evaluation of their respective priority programmes during the current biennium, country level the Committee felt that in view of the difficulties at the , ,*the process of evaluation might be completed in 1986.
SEA 'PDM/Meet. 818 Page ! 21 Dr J.A. Rashid Deputy Secretary Ministry of Health and Population Control People's Republic of Bangladesh Dr J: Norbu Co-ordinating Officer (PHC) Department of Health Services Royal Government of Bhutan Dr U Lun Wai Director Department of Health Ministry of Health Socialist Republic of the Union of Burma Mr Jon Su Ok Director, Department of External Affairs Ministry of Public Health Democratic People's Republic of Korea Pyongyang Mr Kwon Sung Yon Officer, Department of External Affairs Ministry of Public Health Democratic People's Republic of Korea Pyongyang Mr P.P. Chauhan Joint Secretary Ministry of Health and Family Welfare Government of India SEA/PDM/Meet.8/8 Page 22 INDONESIA Dr Brotowasisto Chief, Bureau of Planning Ministry of Health Republic of Indonesia Jakarta MALDIVES Miss Husna Razee Assistant Director of Health Services Ministry of Health The Republic of Maldives Ma16 rl MONGOLIA Dr 2. Jadamba Head, External Relations Department Ministry of Health Government of the Mongolian People's Republic Ulan Bator NEPAL Dr D.N. Regmi ' Director-General Department of Health Services Ministry of Health His Majesty's Government of Nepal Kathmandu Dr K.A.Dixit Chief International Health C Training Division Ministry of Health His Majesty's Government of Nepal Kathmandu SRI LANKA Dr C.D. Herath Director-General of Health Services Ministry of Health Democratic Socialist Republic of Sri Lanka Colombo . THAILAND Dr Uthai Sudsukh Deputy Permanent Secretary Ministry of Public Health Bangkok Dr Pricha Deswadi Chief Medical Officer Office of the Permanent Secretary Ministry of Public Health Bangkok WHO SECRETARIAT Dr W.A. Rahman, Director, Programme Management Mr R. Helmholz, Director, Support Programme Dr M. Sathianathan, Chief, Planning, Coordination and Dr Aung Myat, Programme Development Officer Dr Samlee Plianbangchang, Planning Officer Dr S.A. Orzeszyna, Programme'Management Officer Mr J. Mittar, Budget and Finance Officer Mr S. Subramanyan, Technical Officer (Programming and SEA/PDM/Meet.8/8 Page 23 Information Information) RESOURCE PERSONS Dr B.A. Jayaweera, Director, Research and Family Health Dr U Mya Tu, Director, Health System Infra$tructure Dr Rafei Uton, Director, Health Protection and Promotion Mr S.J. Arceivala, Chief, Promotion of Environmental Health Dr C. Kampanart-Sanyakorn, Director, Prevention and Control of Diseases Mr C.R, Krishnamurthi, Health for All Officer Mr C. Zielinski, Reports and Documents Officer Mr S,G. Muktader, Technical Officer, Development Programme