CHAIRMAN:
(WPR/RC18/SR/l Rev.l)
SUMMARY RECORD OF THE FIRST MEEl'ING
National Cheng chi University Wednesday. 13 September 1967 at 10.00 a.m. Dr C. K. Chang
-~
CONTENI'S 1 2
Formal opening
............................................. •••••••••••••••••••••••••••••••
80 80
Address by retiring Chairman
3
,
'.l,
Election of new officers: and Rapportours
............................................ •••••••••••••••••••••••••••• •••••••••••••••••••••••••••••••
Chairman, Vice-Chairman
80 81 87 88
4
Address by the Director-General Address by incoming Chairman Adoption of the agenda
5 6
•••••••••••••••••••••••••••••••••••••
7 8 • '9
Statement by the Chairman of the Technical Discussions Establishment of the Sub-Committee on Programme and Budget ••••• ••. •••••••••••• •••• ••••• ••• •••• •• ••••••••••• ••••
88
89
Acknowledgement by the Chairman of brief reports received from governments on the progress of their health activities ••••••••••••••••••••••••••••••••••••••••••
10 II
Report of the Regional Director Announcements
............................ ..............................................
90 102
- 77 -
18
REGIONAL COMMITTEE: EIGHTEENTH SESSION
First Maeting Wednesd~,
13 September 1961 at 2.30 p.m. PRESENT
1.
Representatives of !ember States AUSTRALIA
Dr Dr Mr Dr Dr Dr Dr Dr Dr Dr Dr
H. E. Dovm.es J.S. Boxali G.N. Bilney E. S. Stuckey
CHINA
C. K. Chang T.C. Hsu S.C. Hsu K.P. Chen L.P. Chow Yao Tung Wang K. Y. Fan
JAPAN
Dr J. Ohmura Mr K. Watanabe Mr M. Iijima Tan Sri (Dr) Mohd. Din bin Ahmad Dr Chong Chun Hian Mr Chin Su Bin Dr D. M. Cameron
MALAYSIA
NEW ZEALAND PHILIPPINES PORTUGAL
Dr C.N.D. Taylor Dr A.H. Cruz Dr J.B. Pinheira
REPUBLIC OF KOREA
Mr Dr Mr Mr
Chul Soon !Iobon K;yong Shik Chang Chang Souk Kim Kae Chul Lee
SINGAPORE
Mr Yong Nyuk Lin Dr Connie Lim Kim Loan Mrs S. Ba.ha.rudd1n
UNITED KINGDOM
Dr C.H. Gurd Dr S. Tapa Dr R. K. C. Lee Dr J.E. Banta
UNITED STATES OF .AMERICA
Dr J.K. Shafer
SUMMARY RECOlU> OF THE FIRST MEF!I'ING
79
VIET-NAM
WESTERN SAIDA II.
Dr H.C. Thieme
Representatives of the United Nations and Specialized Agencies UNITED NATIONS UNITED N.A!rIONS CHILDREN'S FUND Mr A. E. Meager Mr A. E. Meager
III.
Representatives of other intergovernmental organizations INTERN.A!rIONAL COMMITI'EE OF MILITARY MlIDICINE AND PHARMACY Lieutenant General Yang Wen-Tab, M.D. Dr G. Loison
,
;{
SOUTH PACIFIC COMMISSION
IV.
Representatives of non-governmental organizations INTERNATIONAL DEN'l'AL FEDERATION INTERNATIONAL FEDERATION OF GYNECOLOOY AND OBSTETRICS THE WORLD MlIDICAL ASSOCIATION, INC. Dr E.14. Sison Dr Ping Yen Ifei Dr T.M. P'eng
"
'-.c
INTERN.A!rIONAL COUNCIL OF NURSES
Miss Tao-Chen Yu Professor Daphne Chun
INTERNATIONAL PLANNED P.ABENTHOOD FEDERATION
V. 'J.
1VHOSecretariat DIRECTOR-GENERAL ASSISTANT DIRECTOR-GENERAL SECRETARY Dr M. G. Candau
Dr J. Karefa-Smart Dr Francisco J. Dy Regional Director
80
RmIONAL C<HfiTl'EE: EIGHTEENTH SESSION
1
FORMAL OPENING:
Item 1 of the ProvisionaJ. Agenda
In the absence of Dr Thor Peng Thong, retiring Chairma.."'l, and Dr S.R. Sayampanathen, retiring Vice-Chairman, the REGIONAL DIRECTOR declared open the eighteenth session of the Regional Committee for the Western Pacific. His Excellency, Mt- Ching-chung Hsu, Minister of the Interior,
welcomed the representatives to Taipei (see Annex 1 for copy of his speech) • His Excellency, Mt- Chia-kEUl Yen, Vice President and Prime
Minister, and the Director-GeneraJ. aJ.so addressed the meeting (see Annexes 2 and 3 for copies of their speeches).
With the completion of the formal opening, the Committee adjourned and reconvened at 2.30 p.m. at the NationaJ. Chengchi University.
2
ADDRESS BY RETIRING CHAIRl-Wf:
Item 2 of the ProvisionaJ. Agenda
In the absence of the retiring Chairman, Dr Thor Peng Thong, and the retiring Vice-Chairman, Dr Sa~anatha.n,
the speech of the retiring
Chairman was read by the REGIONAL DIRECTOR (see Annex 4 for full text).
ELECTION OF NEW OFFICERS: CHAIRMAN, VICE-CHAIRMAN AND RAPPORTEURS: Item 4 of the ProvisionaJ. Agenda 3.1 Election of Chairman Dr LEE (United States of America) nominated Dr CHANG (China) as
Chairman. Decision:
Dr CHANG was elected with acclamation.
SlJl.lMARY RECORD OF THE FIRST MEm'ING
81
3.2
Election of Vice-Chairman Dr THIEME (Western Samoa) nominated Dr LEE (United States of America)
as Vice-Chairman; this was seconded by Dr DIN (Malaysia).
-
Decision:
Dr .LEE was elected unanimously.
3.3 Election
of Rapporteurs
Dr OHMURA (Japan) nominated Dr TAYLOR (New Zealand.) as Rapporteur
for the English language; this was seconded by Dr GURD (United Kingdom). Mr' MOON (Republic of Korea) nOminated Dr THUAN (Viet-Nam) as
Rapporteur for the French language; this was seconded by Dr BO:X,ALL (Australia) • Decision: Dr TAYLOR and. Dr THUAN were unanimously elected Rapporteurs.
4
ADDRESS BY THE DIRECTOR-GENERAL:
Item
3 of the PrOVisional Agenda
The DIRECTOR-GENERAL stated that it uas a pleasure for him to attend
the eighteenth session of the Regional Committee for the Western Pacific and participate in its deliberations.
The Committee had on its agenda
many important subjects.
It would discuss the report of the Regional
Director for 1966-19671 make an evaluation of what had been done and. comment on the way the work had been carried out. At the same time I the
Committee would discuss the proposed programme and budget estimates for
1969.
The Director-General reminded the Committee that its comments and
suggestions on the programme and budget proposed for 1969 for the Region
82
RmIONAL COMMITl'EE: EIGlm!ENTH SESSION
would be taken into cons1deration when he prepared the programme and budget proposals :for the Organization as a Board and the Health Assemb~y.
\Tho~e
:for presentation to the Executive
It 1vould be seen that the budget was a
relatively small one compared to the needs and the problems to be raised. This .ms normal and happened every year. It would continue for many years
until the situation had improved all over the world. The Director-General pointed out that health departments were finding it more and more difficult to defend their own budgets at the government level because the world was being predominated more and more by the economists. It was therefore necessary for the ministries of health to learn
how to speak in the terms of the economists and hOyT to Justify health programmes in the light of the economic and social programme of the country. This was extremely important not only in discussing the regular
budget of the Organization but also ,Then looking at ,That vras known as the United Nations Development Programme. Ministries of health were in com-
petition with other ministries for more projects under the Technical Assistance component of the United Nations Development Programme or under its Special Fund component. These had to be Justified in economic WHO's
terms if governments were to give them the necessary priority.
percentage in the Technical Assistance component of the United Nations Development Programme had decreased every year and had always been very small in the Special Fund component. Governments could not correct the
situation if ministries of health .Jere not strong enough and could not speak the language of economists to impose their position on the other branches of government. There had been discussions on the value of
health in economic development - whether health should be considered
--..,r
SUMMARY RECORD OF THE FIRST MEETING
a consequence of economic development or whether it played an important part in economic development. Little by little governments ,Tere realizing
that health was important to economic development and that it was impossible to build up an econo~
on the sbotDLders of sick people. make
They were also
beginning to realize that they had to
large investments in health,
to start with, in order to enable the country's manpouer to be used to a maximum. Of
course, the problem '\las of great
co~lexity.
One
sbould
knou exactly how to use the manpower produced and .That .vould be the economic d.evelopment of a country that would justify the manpower to be created no.,. In certain areas of the world the problem vTaS si~ler,
but
in others population growth made it extremely difficult to plan what should be done. sions. The Director-General said that there should be no illu-
The people already born should be assisted and health programmes
should be developed around them. He
then referred to the subject of the technical discussions and
stated that he did not believe that any programme of family planning built up on a moral basis or vlith due regard to human dignity could be carried on >lithout a basic health service. No family planning programme
would be a success if there was no minimum health service to carry it on. This also applied to any mass c~aign
like malaria eradication and only te~orary
smallpox eradication vrhich would give
results i f there
was no permanent health service to support the work that had been done. It was difficult for governments to decide on the programme that they should have; to build a health plan was quite a challenge. The
health administrators of the past thought that health planning vras only a question of deciding on priorities in the health field; health planning
84
REGIONAL COMMI'l'I:EE:: EIGlfrEEN'l'H SESSION
was much more.
A health plan should be made, not in isolation, but in the Education,
context of the economic and social development of a country.
agricultural improvement and industrialization were important in the improvement of health, and health vas important to their improvement. Governments would have to decide on the priorities and then formulate a health plan for the years to come, taking into consideration all other factors related to economic and social development. To be effective,
the health plan should have a perspective of what uas going to happen in the next ten years. Many diseases would disappear and new ones would
appear or become more important. This was an extremely new and important field and WHO was doing its best to promote the training of health planners. It bad started an
experimental course for its own staff in order to be able to assist governments to do the same. Many schools of public health had been trying
to organize training courses for health planners, but it was difficult to know \That should be taught. being gained. However, little by little, experience was
A number of courses 'irere being conducted in the Western
Hemisphere - in the United States of America, Chile, Venezuela, Brazil and in other countries in Latin America. The course for vffiO staff had
been organized in the University of the West Indies in Jamaica, with practical training in Trinidad where health planning had been developed. It was hoped that with the co-operation of the EconOmic Commissions of the United Nations, it would be possible to conduct similar courses in the other parts of the world - in Africa and in Asia for the Western Pacific and South-East Asia Regions. This would be one of the important
activities in the near future and many of the health administrators
SUMMARY RECORD OF THE FIRST MEEl'ING
attending this meeting might wish to consider using fellowships or organizing training centres for their own staff to learn about health planning. This would facilitate the inqx>rtant task of convincing the
economists in the government of the importance of health projects. In the technical discussions J family planning would be considered as part of the maternal and child health programme. The Director-General
referred to the statement he had made to the Economic and Social Council of the United Nations in July. the l)osition of lfflO. In this statement he had tried to clarify
The World Health Assenibly had passed resolutions
over the last three years defining the role of the Organization in the field of human reproduction and had laid down principles that deserved to be commented. upon. He had stated that the inter-relationship between
population change and health was extremely complex, manifesting itself in a v~iety
of ways.
Changes in population might have profound qualitaIncreases in popula-
tive and quantitative effects on health and disease. tion size o~
age structure often created pressing demands for health Family planning measures, when indi-
services and the health personnel.
cated, where most effective and safely carried out at the same time as other aspects of mother and child care were being attended to. The ante-
natal, natal and post-natal periods during which basic care was provided to mothers gave outstanding opportunities for health education on personal hygiene, infant care and fertility regulation. The integration of family
planning services into the health activities, using existing health facilities and personnel, prevented the fragmentation of health services, utilized personnel who had traditional contact with patients and the population
ave
avoided the weakening of what was often a limited basic health
86
REGIONAL COMMITl'EE: EIGHTEENTH SESSION
programme.
Activities related to training in the basic, clinical and
public health aspects of human reproduction, including family planning and fertility regulation, had expanded rapidly in recent years. What
was also urgently needed at present "as a better understanding of the determinants and consequences of fertility trends. In this connexion, co~arative
support had been given to what was hoped to be a series of
epidemiological field studies of population groups aimed at collecting baseline information on various indices of human reproductive function, especially as they were affected by different environments. Among other
areas of research, WHO was stimulating and supporting studies related to fertility regulating agents, especially those developed in the past decade. Such research was ~rtant
in order both to increase the effectiveness
of
those agents and devices as contraceptives and to ensure maximum safety in their use under varying conditions. The Director-General e~hasized
that research was necessary not only
to improve present methods but also to solve some of the old problems in human reproduction. At the IVth Horld Congress on Fertility and Sterility
held in 1962 by the International Fertility Association, the very incomplete lmow1edge of biologists and the medical profession of the facts relate.d to the reproductive function had been made clear to all concerned. Until now little was known about many things being discussed and the methods of control used. WHO had looked into the question of the ovula-
tion cycle, for instance, in order to stimulate research in all aspects of the menstrual cycle in women, including basal body te~rature
changes
and other indications of ovulation as they might be used in fertility control. WHO had also been conduct:i."lg periodic meetings on the use of
SUMMARY RECORD CF THE FIIlST MEETING
87
contraceptive pills and intra-uterine devices.
The cultural background of
dirferent communities must be respected and in this connexion it was important that there should be an interpretation of the action of some of the contraceptives. The use of intra-uterine devices could, for example, The
be vorld-wide i f there were a right interpretation of their action. Organization believed that these things were important and had to be
studied, and was also concerned about the possible change in attitudes. The
Organization had also to be aware of changes in the problems For instance, the use of contraceptives had for many years Those problems were in great part being ~lith
involved.
raised religiOUS problems. resolved.
However, in countries
minority population groups the
question of family planning could very quickly become a political matter. It could also become of political consequence if a country felt that a policy of population control was being imposed on it or on certain sections of its populations by foreigners. WHO
,vas sometimes criticized for dragging its feet in matters of The Director-General believed it important to dispel The resolutions adopted by the Health Assembly,
family planning.
any such impression.
to which be had already referred, had made it clear that IlliO could advise and assist governments, upon request, in the development of their programmes, provided that a policy of family planning had already been established independently by the government concerned.
5
ADDRESS BY INCOMING CHAIRMAN: The
Item 5 of the Provisional. Agenda
CHAIRMAN requested that his address should be postponed until
Thursday.
88
RmIONAL COMMr.l'rEE: EIGHTEENTH SESSION
6
ADOPUON OF !rHE AGENDA: (Document WPR/RCl8/l)
Item 6 of the Provisional Agenda
!rhe CHAIRMAN moved the adoption of the agenda.
Decision: adopted.
In the absence of any comments, the agenda was
7
S!rA!rEMEN'I' BY !rHE .CHAIRMAN OF !rHE !rECHNICAL DISCUSSIONS: of the Agenda
Item 7
The CHAIRMAN announced that, in accordance with the resolution
adopted by the Regional Committee at its eleventh session, the Regional Director, in consultation with the Chairman of the Regional Committee, had selected Dr L.P. Chow, Associate Director, Family Planning and
Population studies Programme, !raichung, as Chairman of the fuchnical Discussions. He then invited Dr Chow to speak.
Dr CHOW (China) said that it was a great honour :eor him to have
been appointed Chairman of the fuchnical Discussions, particularly when the subject was "'l'he Integration of Maternal and Child Health and Family Planning Activities in the General Health Services fl. Organized efforts
to bring down fertility were now being vigorously undertaken on a national scale in many countries throughout the world. It was extremely important
that this effort should be closely related to the general programme for maternal and child health. Because of this, any achievement obtained as
a result of pOOling the wisdom and efforts of the participants in the technical discussions would mark a milestone in the ultimate goal of the '{odd Health Organization to enhance the health and welfare of all
StMfARY RECORD.' OF THE FIRST MEm'ING
people.
He was
confi~ent
that with the contribution and co-operation of
all present something significant would be achieved. The first plenary session would be held on Frid~, 15 September at
2.30 p.m.
Details of the arrangements made had already been distributed.
(For consideration of the report of the technical discussiOns, see the fourth meeting, section
3.)
8
ESTABLISHMENT OF THE SUB-COMMITrEE ON PROGRAMME AND BUDGET: Item 8.1 of the Agenda In accordance with the prinCiple of rotation, it was agreed that
the membership should be cOllq)osed of the Representatives of Australia, China, Japan, New Zealand, Republic of Korea, the United Kingdom and Viet-Nam. p.m. on It was also agreed that the Sub-Committee would meet at 2.30 14 September, and that, if necessary, discussions would
Thursd~,
continue on M:lnd~ morning.
(For consideration of the report of the Sub-
Committee, see the fourth meeting, section
2.)
9
ACKNOWLEDGEMENT BY THE CHAIRMAN OF BRIEF REPORTS RECEIVED FROM· GOVERNMENTS ON THE PROGRESS OF THEIR HEALTH AaI'IVITIES The CHAIRMAN acknowledged reports on tr~
progress of health activities
received from the follOwing countries: MlJ.~ia,
Australia, Guam, Hong Kong, Japan,
New Zealand, Philippines, Republic of Korea, Singapore, Taiwan, The Australian
Trust Territory of the Pacific Islands and Western Samoa.
Government had submitted two additional reports: (1) the Twenty-Ninth Annual Report of Work Done under the M!dical Research Endowment Act
1937,
--
(2) Report of the National Health and Medical Research CounCil, Sixty-
90
REGIONAL COMMI'l'I'EE:. EIGH'l.'EmrH SESSION
third Session, 4 November 1966.
The Government of Japan had aJ.so submitted
a Brief Report on Public Bea.J.th Administration in Japan covering the period January 1966 - August 1967.
10
REPORT OF THE RIDIONAL DIRECTOR: (Document WPR/RC18/3)
Item 10 of the Agenda
The REGIONAL DIRECTOR, in introducing the Report, referred to the filet
that there were still
l!IS.Dy'
areas in the Region where the benefits of The reasons for this were nume-
heaJ.th were being denied to the people.
rous - inadequate financiaJ. resources to support the expansion of programmesj the shortage of trained manpower, the improper utiJ.ization of quaJ.ified staff, the need to improve public administration in government offices and to establish personnel policies which would prevent the exodus of so many qua.J.if'ied staff to the developed countries. These
-
problems were faced by every developing country but fortunately they were not unsurmountab1e. First and foremost, the economic planners must
be convinced that heaJ.th was an important part of the socio-economic development programme. To do this, reaJ.istic planning was required in
terms of manpower needs and resources, taking into consideration popule.tion increases and the need both to expand and to improve the qua.J.ity of the hea.J.th services. HeaJ.th p1a.nning was a continuous process and there It was essentiaJ. that
were few people who had experience in this field.
as many senior hea.J.th administrators as possible had an opportunity of familiarizing themselves not only .,ith planning as applied to heaJ.th but also in relation to economic and social development. Included in the ..-
1969 programme proposaJ.s were two projects: an inter-country adviser whose
SUMMARY RECORD OF THE FIRST :t4I!lIlIllNG
91
main duty would be to assist governments, upon request, in the planning and co-ordination
or
national health programmes as part of national
developnent plans, and an inter-country training course for senior public health administrators in .the Bagion. These two activities would be conti-
nued for as many years as the need existed. An important achievement during the period under review was the
decision of the Governnent programme in West Malaysia.
or
Malaysia to undertake a malaria eradication other governments had continued to do their However, in a
utmost to reach the objective of malaria eradication.
number of cases, success was being jeopardized by the lack
or
effective
basic health services without which it was impossible to consolidate and maintain the aims achieved.
The icportance
or or
the governcents of countries
where eradication programmes were being undertaken, or planned, nccording priority to the provision of personnel and the financial and adminis-
trative facilities needed to accelerate the development of basic health services had been emphasized by the Twentieth World Health Assembly. A
new development was the establishment of independent teams to assess the progress of the malaria eradication programme.
It was hoped that by the
end of next year independent assessments would have been made of all the malaria programmes in the Bagion. The community approach to the control
or
tuberculosis was rapiclly'
gaining acceptance.
BCG vaccination programmes were expanding, combined
smallpox and BOG vaccination, first. given full-scale application in China (Taiwan), was now being tried out in other countries in the Bagion. Sputum snear examination as a primary case-finding method was being used more extensively. In general, substantial progress had been made in all
tuberculosis programmes receiving vnIO assistance.
92
REGIONAL COMMITl!EE: EIGllrEEImi SESSION
A small outbreak of smallpox in Sarawak had been quickly brought under control. but pointed to the importance of governments maintaining their smallpox vaccination campaigns and establishing maintenance programmes and epidemiological surveillance services. This disease was still
a world-wide problem and unless ,;ell-considered precautions were taken it could invade the Region again. problem in some countries. Japanese encepbalitis ,laS
an increasing
Efforts were being made to organize control
programmes, to carry out studies on the isolation of the virus, to intensify vector control. The production of vaccine for large-scale
immunization campaigns was receiving attention.
It was evident that The prompt
governments were better prepared to deal with cholera El Tor.
identification, reporting and isolation of cases were immediate solutions to the problem. The final solution rested on improved environmental
sanitation and the Regional Director was therefore happy to report that activities in this field had expanded considerably. In the South Pacific area, WHO's main activity had been to advise
governments on the construction of simple water systems, the provision of sanitary latrines often being a complementary accomplishment. These
works were being undertaken by the central governments and the loc8.l authorities, with material assistance from UNICEF. In some countries,
emphasis was being given to the establishment of units at the central level for purposes of planning, administration and supervision. Environ-
mental sanitation pilot projects leading to the development of countrywide environmental sanitation programmes were being operated in others. Assistance in the development of large municipal projects which would qualify for assistance under the Special Fund component of the United
SUMMARY RECORD OF THE FIRST MEm'lNG
Nations Development Programme was a new trend.
Tbe first such proJect
in the Region was a mastel". plan for a sewerage system for the »mila metropolitan area. Poor nutrition was the cause of many health problems and it was gratifying to report that a regional. nutrition programme taking shape. .TaS
gradually
Nutritional. concepts and activities were being progres-
sively introduced and integrated into other health programmes, particularly those concerned with maternal. and child health and the training of' health personnel. The trend was to help governments develop practical programmes
of' applied nutrition in which health, education, agriculture and community
development were involved. Early in the year the post of medical officer in education aDd training had been filled. This had helped to ease the burden of the
Regional. Office as the education and training of staff at various levels and in different categories was a maJor part of the regional programme.
The number of individual fellowships awarded during the period under
review had reached the figure of 252, representing an increase of' about
7 per cent. over that of last year.
So important was this part of the re ..
giona! programme that a special item on the appraisal of the fellowship proGr~
had been included on the agenda of the Regional Committee.
Two changes had been made in the staffing pattern of the Regional.
Office.
The posts of regional adviser in public health admjnistration
and regional. public health administration officer had been replaced by
two new posts, one in cOlllllD.lIlity health services and the other in the organization of medical care. In concluding, the Regional Director said that progress in the
~
development of health services could never be spectacular - there were
1-.
94
REGIONAL COMMl'l"l'EE: EIGlfrEENTH SESSION
too many old problems still unsolved and new ones appeared daily.
If
health services were to be provided on a nation-wide basis, national health planning was essential so that the very best was made of whatever resources were available. Congratulatory remarks were e::.-tended by the Representatives of China, Japan, Malaysia, the Philippines and the United Kingdom to the llegional Director and his staff for the excellent and comprehensive report submitted to the Committee.
..
On the suggestion of the CHAIRMAN, the Report was discussed section by section. Introduction (pages ix-xvi) Dr DIN (Malaysia) stated that there was close co-ordination and co-operation between M3.laysia and Thailand. This had started with
malaria border meetings and these had expanded to cover other subjects such as cholera, smallpox and many other communicable diseases. In fact
there now existed in the northern border between Malaysia and Thailand an action committee to deal with any communicable and infectious diseases in that area. This year, about eighty medical officers of health from
Thailand had undertaken a post-conferelloe tour :in M3.laysia after their annual conference. This bad been a vlOrthwhile effort and his Government
hoped very IIDlch to make a similar visit to Thailand. Part I, section 1: MUaria (pages 3-11)
Dr CRUZ (Philippines) informed the Committee that the malaria
eradication campaign in the Philippines was now receiving excellent
SUMMAR! RECORD OF '!'HE FIRST MmnNG
95
financial support.
In addition to the
1:6
000 000 provided in the national
budget J it had been possibl.e during the last six months to get an appropriation of
;3
000 000, thus mald.ng a total budget of
h
000000.
The
anticipated funds reported during the seventeenth session of the BegionaJ. Committee had now become a reality. It was hoped that with guidance
from WHO and AID his Government would soon be able to submit a successful report on its eradication programme. Dr T. C. HSU (China) expressed appreciation of the assistance provided
by mID.
In his country the importanc.e of the role of health in economic
and social development was fully understood.
This '\las shown by the There bad
annual increase in the government a.ppropriation for health.
been thirty cases of malaria during the period under review but these had been :1mIlrediately brought under control.
WHO and the United states
Governnent had assisted the national malaria eradication programme, which was now integrated into the basic health services. ,-
Although malaria had
been eradicated, its control was stilJ. considered an important heal.th activity. There had not only been no reduction in the budgetary provi-
sion for this disease but last year the appropriation had been increased by $1 000 000. Dr Dnf (Malaysia) stated that a ma.laria pilot project in west
M3J.aysia, which had started in 1960, had been compl.eted in 1963. Governnent had then undertaken a pre-eradication campaign. hoped that an eradication programme might start in 1966.
His
It had been However, as in
many other countries, the financial. aspects of the programme had been a
problem.
A modified form of an eradication programme was now being
96
REGIONAL CO!«t'ITEE: EIGHTEENTH SESSION
undertaken using the funds earmarl-..ed for the control of mal.aria.
It was
hoped that by 1969 there would be enough funds to start a proper eradication project. Section 2: Communicable Diseases (pages 11-25)
Dr GURD (United Kingdom) said that the South Pacific had been
particularly fortunate in the amount of assistance being provided by WHO and he would like to say how much this was appreciated.
Fiji had had a tuberculosis control programme for some ten years. However, some three years ago, it had been noted that the quarterly notifications showed a sequential fall. and it had been decided to undertake a mass campaign. The first step was to ensure that all. pre-school.
children were protected, and all. pre-school children not exhibiting a
BeG scar were vaccinated without prior Mantoux testing.
All school-
children were then Mantoux-tested, although there was a very low incidence (about O.O"5/looo) of infectious tuberculosis in this group. campaign had then covered the adult Fijian population, that is the indigenous South Sea Islanders. The Fijians had an incidence of tuberThe
culosis which was seven times that of the Indians and Europeans, who made up a bigger proportion of the population than the indigenous Fijians. The statement in the report that the Government of Fiji
''haa launched a
tuberculosis campaign in which the whole population was to be tuberculintested!t actually should read !tall. adult Fijians". Forms had been produced
for the campaign so that the results could be analyzed on a computer. As of January
1967, lZ7 000 forms of the 166 000 adult Fijians tested These had
had been returned to the Statistical Office for analysis.
97 reveeJ.ed tbat over 90 000 persons had been vaccinated with .BeG and were negative, while 33 000 had been adjudged as requiring mass miniature X-ray. So far, only 15 000 films bad been actually tal;:en and of that
number, 142 bad X-ray and other findings suggestive of tuberculosis. The skin-testing, or initial :part of this prograume, was now nearing
completion and by the middle of next year, it was hoped to coq>lete the X-ray work, and have a full statistical analysis so that very coq>lete figures on the current position of tuberculosis in Fiji would be available • .::
The REGIONAL DIRECTOR thanked the Representative of Fiji for his
explanation. Dr OHMlJRA (Japan) said that in P~ril 1967, the method. used for .BeG
vaccination bad been changed from intracutaneous injection to :percutaneous mult1:puncture. This new method. had proved to be more effective as it Another improvement to be introduced next year was This had been
caused less erosion.
the use of PPD instead of old tuberculin for testing.
recommended by the Tuberculosis Control Council of Japan and the production of PPD was now under way.
Dr CRUZ (Philippines) referred to the joint agreement between Japan and the Republic of the Philippines in connexion with a vaccination pro-
gramme against polioll\Yelitis.
The vaccines had already been received by
the Department of Health and a pilot area bad been selected. bad started on 1 August and the first dose bad been completed.
Vaccination It was
anticipated that the second dose ,rould be completed by the end of September. His Government wished to acknowledge this assistance from the
Government of Japan which bad been made possible through the Overseas
98
RmIONAL COMMITl'EE: EIGHTEEN'I'H SESSION
Technical Cooperation Agency. Last year there bad been a serious epidemic of ba.eIIIDrrha.g1c fever in Manila between June and. September. programme had been established. The bilharziasis pilot control project in the Philippines, which had
However, with the help of WHO, a control
.
been assisted by WHO, had formerly been under the Bureau of Research and. Laboratories. Later however, it had been recognized that this should be Consequently, a National Schistosomiasis Commission
a national programme.
composed of different representatives of various departments of the Government had been formed. The Commission bad had its second meeting at the
end of August under the chairmanship of the Secretary of Health, and. agreement bad been reached that control measures against snail fever should be implemented. Special funds had aJ.ready been released for this purpose.
The President of the Philippines, after being informed of the magnitude of
the problem, had provided additional funds for the programme.
It was
intended, following further study of the problem, to ask WHO for assistance. The Philippine Government was presently evaJ.uating the benefits that had been derived from a single dose of vaccine against cholera El Tbr.
Dr Cruz hoped that the report on the field studies would soon be available. Dr CHONG (Ma.1.~sia) said that his Government was most grateful to
the Philippine Government for its donation of 120 000 doses of freezedried smallpox vaccine which had been received when most needed. Freeze-
dried vaccines had been found to be IID.lch more reliable than the liquid vaccine. It had been discovered that two of the four cases of smallpox
in Sarawak had been vaccinated Vii th liquid vaccine and one had died later on. There bad been no complications in those who had been vaccinated
SUMMARY BECORD OF THE FIRS'!' MEETniG
99
with freeze-dried vaccine. Referring to the statement of the Chief Representative of Mal~sia
concerning the need for inter-regional and inter-country co-operation, Dr Chong said that Mal.~sia
was having difficulties in the prevention and
control of communicable diseases, particularly along the 800-mile boundar,y with Indonesia where diseases such as cholera. and maJ.uia were prevalent. His Government would be interested in knowing what control measures were being undertaken on the other. side of the boundary, particularly in the southern part of Borneo, which came under the South-East Asia Region. He was glad to note that WHO was taking the initiative in reviving the
inter-country maluia conferences which had been held in past yeus.
He
hoped that this would. be the beginning of many more inter-country or interregional conferences to solve common health problems. Dr HSU (China) ref'erred to the subject of international qUSJ:antine
and expressed appreciation to WHO and to the Governments of Japan,
Hong Kong, the Philippines and Singapore for their assistance in improving international quarantine services. During the past few yeus, WHO had
granted a number of fellowships to international quarantine officers to enable them to visit outstanding qUSJ:antine stations throughout the Region. He attached great importance to such fellowships, part1cululy in view a£
the increasing worry of governments that the qUSJ:antine services of other countries might adopt excessive action, thus violating the provisiOns of the International Sanitary Regulations and hampering international traffic. This type of fellowship permitted qUSJ:antine a£ficers to exchange views and obtain a closer understanding of' each other's problems.
100
With the assistance of UNICEH' and WHO, his Government had started a series of mass polioll\YEllitis campaigns, the first one having been rompleted towards the end of March this year. One million children below the age of
three had been immunized with Sabin vaccine.
Dl.u'ing the past six months,
only 14 cases had been reported and, after some investigations, it had been discovered that the persons concerned had not been vaccinated. A
comparison of the same period in 1966 aIld 1965 showed that in 1966, 194 cases had been reported aIld in 1965 there had been 380. In past years,
polioll\YEllitis had been considered a very important communicable disease. in Taiwan with three to seven thousaIld paralytic cases a year. His Govern-
ment was very grateful to UNICEF for its material assistance and to WHO for the advisory services it had provided in connexion with the campaign. Japanese encephalitis had been continuously reported from Japan, Korea and Taiwan aIld the number of cases was increasing year by year. The disease was not only a major concern of the health administration but
of his Government as a whole.
He wished therefore to thank the Director-
General for arranging to undertake a research programme on the epidemiological aspects of the disease. As mentioned in the Regional Director's
report, a preliminary Japanese encephalitis vaccine field trial had been carried out in Taiwan. The vaccine had been found to be 80 per cent. However, its use would
effective and had been accepted by many experts.
require considerable financial support and without this it was unlikely that any government would be able to undertake a com;plete mass vaccination oampaign. Although he had brought this subject up at many past
meetings of the Committee, he wished to take the opportunity of the presence of the Director-General to em;phasize that he considered this disease came next to cholera in importance in the Region.
SUMMARY RECORD OF THE FIRST MEPmNG
101
Dr Hsu then sta.ted that bis Government had been receiving quite a
large amount of assistance from WHO and UNICEF in the control of trachoma, smaJ.J.pox, tuberculosis and venereal diseases. He expressed gratitude to
the experts assigned by WHO for their very useful and val.ua.ble assistance and to UNICEF for the supplies it had provided.
Dr LEE (United states of America) commended the Representative of China for his persistent leadership in the attack on polio~litis
and
the Regional Director and UNICEF for the assistance they had given to the campaign, the results of which spoke for themselves. Dr Hsu' s
request for support in order that his Government could obtain some Japanese encephalitis vaccine to perform the task that he and his fellow workers had in mind deserved support. Dr THIEME (Western Samoa) thanked the Organization for the rapid
action it had taken in connexion "lith the reassignment of a short-term consultant in filariasis in Western Samoa. He also informed the Committee
that his Government would act as host for the WHO seminar on filariasis control which would take place next year. Dr CRUZ (Philippines) reported that, in view of the serious public health problem caused by rabies in the Philippines, his Government hoped to receive assistance from WHO and the United states Agency for International Development in connexion lTith a programme for rabies eradication. His country was in a favourable situation as far as an eradication programme was concerned since there was only one reservoir of infection, canines. (For continuation of discussion, see the second meeting, section 1.)
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RmIONAL COl-t4I'l'TEE: EIGHrEENTH SESSION
11
.ANNOUNCEMENTS The CHAIRMAN suggested that the Committee should follow its usual
practice to meet from 9.00 a.m. to 12.00 noon, with a short recess at about 10.30 a.m. and from 2.30 to 5.00 p.m., with a short recess at about
4.00 p.m., subject to the proviso that these times could be altered the progress of work required it.
if
It was so agreed.
The meeting rose at 4.50 p.m.
SUMMARY RECORD OF THE FIRST MEETING
103
ANNEX 1 ADDRESS BY
ms EXCELLENCY, CHING-CHUNG HSU, MINISTER OF THE INTERIOR
Your Excellency Mr Vice-President, Honourable Delegates, Ladies and Gentlemen, The eighteenth session of the Regional Committee for the Western
Pacific of the World Health Organization is scheduled to be held in Taipei from 13 to 19 September. I should like to extend a IIIOst sincere and hearty
welcome to the delegates of the 11:!mber governments, to Dr Candau and his colleagues, and to the representatives of other United Nations and nongovernmental agencies. The principle of rotation of having your regional committee meetings in !ember countries is a good system. It provides IIIOre chances for the We are
health officials to observe health activities in other countries.
honoured that the eighteenth Regional Committee decided this year to accept our invitation to meet in Taipei. The Regional Ot'fice for the Vlestern Pacific has been established
for eighteen years.
Dr I.C. Fang served as the first Regional Director
until 30 June 1966 when he retired. his contribution to this region. success and honour.
There is no need for me to mention
I am. happy to say that we share in his
Dr Francisco Dy, the present Regional Director, in
the short period of one year's service, has implemented 97 projects in
17 countries and territories, has awarded 252 fellOl.,ships and has sponsored 10 seminars or conferences in connexion ,nth public health in this region. His success commands the respect of all !ember States.
104
RmIONAL~: EIGltliE~B
SESSICti
This year, the World Health Organization i8 assisting our Government _ in eight continuing projects in the following f'ields: mental health, trachoma. control, environmental health, medical rehabilitation, cotml1Wlicable diseases control, pb¥sical a.nd. occupational therapy, smallpox vaccine production a.nd. training of' health persoxmel. progress has been made. With WHO assistance, much
:Besides, UNICEF, the United Nations Development
Programme and the World Food Programme have rendered valuable assistance to some of' the WHO-assisted projects in our country, I should like to take
this opportunity to thank them all. PUblic health problems increase with rapid economic development and social cbanges. To tackle the health problem in a country, close
co-operation and collaboration bet,reen the ministries concerned is of' primary iJI!portance. The solving of' some specific problems is dependent
upon the f'ullest co-operation of' !ember countries. the leadership and guidance of' WHO.
This again requires
I have asked the health agencies concerned to arrange a ield trip a.f'ter your meeting.
two-~
The itinerary includes visits to our
ocal health administration, the KlB Institute, a population study centre a rural health centre. I hope you will be able to observe some of'
our health activities on the tour. In clOSing, I wish you every success in your deliberations.
SUMMARY RECORD OF THE FIRS!' MEm'ING
10:5
ANNEX 2
ADDRESS BY HIS EXCELLENCY1 CHIA-KAN lEN VICE-PRESIDENT. AND PRIME MINISTER
Minister Hsu, Ladies and Gentlemen, It is my great pleasure to have the privilege of addressing the opening ceremony of the eighteenth session of the World Health organization Regional Committee for the Western Pacific. I would also
like to express, in the name of the Government and people of the Republic of China as well as myself, our earnest welcome to delegates, World Health Organization officials and observers from other international organizations, especially to the Director-General, Dr M.G. Candau, who came here from afar to personally direct this regional discussion. We deem it an honour to have the highest official of the
World Health organization set foot on the Chinese soil for the first time in the past twenty years. As you, Ladies and Gentlemen, know, the World Health organization is one of the specialized agenoies of the United Nations. The Constitu-
tion of this organization was signed on July 22, 1946 by representatives of 61 states. The significance of the World Health organization can be
seen from the first page of its Constitution in which emphasis is laid on the principles that the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being, and that
L
.
the health of all peoples is fundamental to the attainment of peace and security and is dependent upon the fullest cooperation of individuals and States.
106
REGIONAL COMMITl'EE: EIGHTEENl'H SESSION
During the past twenty years the World Health Organization has rendered valuable assistance and help to M3mber states and areas in promoting public health with commendable achievements. Not only in the
prevention of diseases but also in other areas such as provision of counsel in the field of health, training of specialized personnel, promotion of research work on health and so on and so forth, the Organization has always taken a leading part to enlist talents of the whole world for solving health problems of individual Member States. No wonder the number of Member States grows from 61 in 1946 to 128 as of now. I wish to express my admiration and respect to Dr Candau and
other officials of the World Health Organization for their achievements. We of the Republic of China have always attached importance to the promotion of public health. In his Supplementary Chapters on National
Fecundity. Social Welfare. Education and Health and Happiness to the Principle of People's Livelihood, President Chiang Kai-shek tells us. "Healthy citizens make a healthy nation; only if a nation is healthy, can it be prosperous and strong." In the past twenty years our efforts in the field of public health
can be summarized as follows: network throughout Taiwan.
First, we have established a public health
Even in the remote and mountainous areas Therefore public health Second, we have
there is one health station in each village.
activities can be carried out deep in the countryside.
achieved satisfactory results so far as prevention of epidemic diseases is concerned. For example, fifteen years ago we put bubonic plague
under effective oontrol on the island of Quemoy where the epidemic had
SUMMARY RECORD OF THE FIRST MEETING
107
been notorious.
Another example is the eradication of malaria from
~wan
which contributes to the enhancement of the health of the people which in turn is an important factor for the agricultural and industrial development of the nation. During the past decade we have made oonsiderable progress in the
field of economio development 6 but rapid economio growth must be achieved in co-ordination with the changing social patterns which, in turn 6 are natural results of economio growth. In other words, sooial
reoonstruotion must be so designed as to synchronize with the present situation and possible future development. In this oonnection, publio
health is immediately interlocked with economic development and human resources. That is why we consider the promotion of publio health as
one of the important targets of our social reconstruotion programme. As I understand, promotion of maternal and mild health will be one of the main themes to be discussed in this meeting. I am confident
that ooncrete results will come out from your deliberations. Maternal and child health is closely related to the welfare of the next generation. Each and every government would list this kind of work We have made consider-
as one of the main parts of health administration.
able progress in this field here in Taiwan espeoially in midwifery, child nutrition, the ostablishment of nurseries during harvest and the promotion of health education in the rural areas. According to a recent survey, 74 per cent. of' the pregnant women in Taiwan received pre-natal and post-na.tal care. It is our aim to further the
well-being of pregnant women and children by training more health workers
108
and encouraging private organizations and institutions to work closely with the Government.
We sincerely hope the results of your deliberations
will benefit us in our programues. In conclusion, I wish all of you, Ladies and Gentlemen, every success
and good health.
StM-1ARY RECORD OF THE FIRST MEm'ING
109
ANNEX 3 ADDRESS BY DR M.G. CANDAU. DIRECTOR-GENERAL Your Excellency. Vice-President and Prime Minister. Your Excellency, Minister of Interior, Excellencies, Ladies and Gentlemen. It is both a privilege and a pleasure to welcome here today the Representatives of the Member States of the Western Pacific Region, the Representatives of the United Nations and the Specialized Agencies, the Representatives of the other inter-governmental organizations, and the Representatives of non-governmental organizations. It is also a privilege
and a pleasure to have this opportunity to thank the Host Government for all the arrangements made to ensure that the eighteenth session of the Regional Committee is a success. and to pay public tribute to the traditionally warm hospitality with which we have been received. The Regional Committee, in the life of the World Health Organization. plays a very important role. It is the Regional Committee that studies
the health problems of the Region, gives guidance to the Regional Director, and advises the Director-General. Of the subjects that the
Committee is going to discuss, the report of the Regional Diroctor for the period July 1966 to June 1967 and the proposed programme and budget estimates for 1969 are some of the most important. The analysis of these
documents will reveal that the most important health problem which the
110
REGIONAL COMMITTEE: EIGHTEENrH SESSION
world is facing today in the field of health is the problem of manpower a great shortage of manpower· exists especially in the developing countries of the world. In my report to the Economic and Social Council this year, I
emphasized that.
In a very general sense it can be said that the level
of social and economic development of a country is closely related to its stock of trained health manpower and how it utilizes its services for the benefit of the population. Conversely, the lack or poor utilization of
qualified health manpower is probably the most important factor inhibiting the establishment and expansion of a proper health programme to such an extent that the nation's health problems may have serious repercussions on its economic development. Health programmes cannot be based entirely
on the existence of a certain number of highly qualified physicians but rather on a team in which the activities of physicians are complemented by those of supporting professional and auxiliary staff in such fields as nursing, midwifery, sanitation, dentistry, veterinary public health and pharmacy. Training suited to the conditions and needs of the individual developing countries will ensure a more rapid and economic increase in the number of personnel at all levels and may help to offset the serious drain of trained manpower which some countries have experienced in recent years. Fewer trained personnel will be tempted to emigrate if they can
secure most of their advanced training in the culture and environment in which they will subsequently work. The "brain drain" can be moderated by
upgrading local education and research institutions.
SUMMARY RECORD OF 'mE FIRSr MEEl'ING
111
The right of the individual and his family to health was proclaimed as early as the Universal Declaration of Human Rights in 1948, but, 8ince then, the peoples of the world have been increasingly conscious of this fundamental right and expect their governments to take steps to implement it. Health is an integral part of human dignity and is of basic However, this
importance to economic prosperity and social development.
right to health can only be realized when health services and facilities are made available to the population as a whole. Both developed and
developing countries encounter difficulties in satisfying the increasing demands for health services, although the situation is more urgent and acute in the latter. Poor health standards are among the more potent factors which account for the disparity between the developing and developed nations. Health is a prerequisite for education, for agricultural productivity as well as for manpower supply to industry. In the presence of the wide-
spread endemic disease, it is difficult for a community to cope with its food requirements as illness saps the strength of the worker and drains limited family resources. In a report on the Development and Utilization
of Human Resources in Developing Countries, it was noted that "Ill health is almost certainly the greatest single cause of the loss of productivity man-hours in the developing countries and is often responsible for the premature loss of experienced workers from the active labour forces. The
upper age limit of productive capacity is very often determined by health". The problem may be aggravated by population growth, rapid urbanization and industrialization.
112
RIDIONAL COMMITTEE: EIGHTEENTH SESSION
One of the principal problems of economic development is to determine the extent of the role which each sector of the economy of a country is to play. Obviously, the answer is hard to give. In the search for a
solution to this problem, as it affects developing countries, one is struck by the inter-dependence of the social and economic fields. History shows that, once begun, the development process in a country continues irrespective of the availability of external aid, bilateral or multilateral. All that assistance can do is accelerate, concentrate and In the field of health, the results of
make development more efficient.
such assistance will best be seen in a long-term perspective since the impact of health on the levels of living, while undeniable, is slow in making itself apparent. Balanced development, including an initially
heavy investment in health, tending as it does to build up a basis in human resources, may prove to be the most durable in the long run. Mr Vice-President, it is a pleasure for me to thank you in the name
of the Regional Committee for the Western Pacific for your presence here today and for your stimulating words. Your welcome to the Regional
Committee and what you said about health is very important to us. To you also, Mr Minister of Interior, I convey the thanks of the Regional Committee.
--
SUMMARY RECORD OF 'rHE FIRST MEETIm
113
ANNEX 4 ADDRESS BY THE HErIRINa CHAIRMAN, DR THOR PENG THONG
Ladies and Gentlemen, I apologize for not being present at the opening of the eighteenth session of the Regional Committee for the Western Pacific. It would have been a pleasure for me to have completed my duty as retiring Chairman by welcoming our distinguished guests and participating in your work as Cambodian Representative. There is no doubt that any regular attendant at the meetings of this Committee would deeply regret missing a session. Having had the
priviledge of representing my country several times at these meetings, I am in a position to appreciate fully their importance. Each session
provides the representatives with an opportunity to work usefully both in their country's interest and for the whole Region. Indeed, the recommendations and advice resulting from the discussions held in perfect mutual understanding through a remarkable common effort serve as a useful reference for the Regional Director in carrying out his difficult as well as delicate task. Thus, in spite of the various problems which preclude a global solution for our Region, the Regional Office has been able to provide to all Member states the assistance required to meet their particular needs. Suitable programmes have been developed, The results achieved
so far might appear disappointing in the eyes of an onlooker who is not
114
RIDIONAL COMMI'l"I'EE: EIGHl'mmI SESSION
aware of local conditions.
However, it cannot be denied that these
results are among the factors contributing to the progress made in the socio-economic field by the countries which have received such assistance. If it is recognized that the solution to any public health problem is closely related to the existing basic health services, one should also admit that the necessary investments to develop such services are usually beyond the available resources of the countries concerned. Governments
have done their very utmost to break out from this vicious circle. These factors must be taken into account in all programmes of assistance if they are to be successful. Committee is always done in this spirit. Before closing, may I wish full success to the eighteenth session of the Regional Committee for the Western Pacific. This is why the work of our
_/