(WPRjRc18/SR/3 Rev.l)
SUMMARY RECORD OF THE THIRD MEEl'ING
National Chengchi university Friday, 15 September 1967 at 9.00 a.m. CHAIRMAN: '" ~ ... '-
Dr C.K. Chang
CONTENl'S 1 2
Address by incoming Chairman
•••••••••••••••••••••••••••••••
152 153 154 159
Consideration of draft resolutions
...•.........•.........•.
3 f,
Twentieth Anniversary of the World Health Organization ••••••••••••••••••••••••••••••••••••••••••••••• Appraisal of the fellowship programme in the Western Pacific Region ••••••••••••••••••••••••••••••••••••••••••••• Statements by Representatives of the united Nations and Specialized Agencies, of intergovernmental and nongovernmental organizations in official relations with WlIO ••••••••••••••••••••••••••••••••••••••••••••••••••••••••
4 5
161
6 I,.
The establishment of a WHO medical school in the Western Pacific Region ••••••••••••••••••••••••••••••••••••• Selection of topic for the Technical Discussions during the nineteenth session of the Regional Comnittee •••••••••••••••••••••••••••••••••••••••••••••••••
18)
7
178
- 149 -
150
REGIONAL COMMl'l*.rEE: EIGHTEENTH SESSION
THIRD MEETING Friday, 15 September 1967 at 9.00 a.Dk
PRESENT I.
Representatives of Member States AUSTRALIA
• Dr Dr Mr Dr Dr Dr Dr Dr Dr Dr Dr H.E. J.S. G.N. E. S. C.K. T.C. S.C. K.P. L.P. T. S. Downes
Boxall Bilney Stuckey
CHINA
Chang Hsu Hsu Chen Chow Chen K. Y. Fan
JAPAN
Dr J. Ohmura Mr K. Watanabe Mr M. Iijima Tan Sri (Dr.) l-t:lhd. Din bin .Ahmad Dr Chong Chun Hian Mr Chin Su Bin
MALAYSIA
Dr D.M. Cameron Dr Ariffin bin Marzuki NEVI ZEALAND
,
",
Dr C.N.D. Taylor Dr A.H. Cruz Dr A. N. Acosta
PHILIPPINES PORTUGAL REPUBLIC OF KOREA
Dr J.B. Pinheira Dr F. Mltias Dr Kyong Shik Chang Mr Chang Souk Kim Mr Kae Chul Lee Dr Connie Lim Kim Loan Mrs S. Baharuddin
SINGAPORE UNITED KINGDOM UNITED ST.A!I'ES OF AMERICA
Dr C.H. Gurd Dr S. Tapa Dr R. K. C. Lee Dr J.E. Banta Dr J.K. Shal'er
SUMMARY RECORD OF THE THIRD MEETING
151
VIET-NAM WESTERN SAM)A
Dr L@ Nhftn ThuS.n Dr
J.e.
Thieme
II. >-
Representatives of the United Nations and Specialized Agencies UNITED NATIONS UNrI'ED UNITED
Mr A.E. Meager Mr A.E. Meager Mr Jan Van Heerden
NATIONS CHILDREN I S FUND NATIONS DEVELOPMENT
PROGRAMME
III. Representatives of other intergovernmental organizations INTERNATIONAL COMMI'lTEE OF MILITARY MEDICINE AND PHARMACY SOUTH PACIFIC COMMISSION IV. Lieutenant General Yang Wen-Tab, M.D. Dr G. Loison
Representatives of non-governmental organizations Im'ERNATIONAL DENTAL FEDERATION INTERNATIONAL COUNCIL OF NURSES Dr E. M. Sison
Miss Tao-Chen Yu
V.
WHO Secretariat DIRECTOR-GENERAL ASSISTANT DIRECTOR-GENERAL SECRErARY Dr M.G. Candau Dr J. Karefa-Smart Dr Francisco J. Dy Regional Director
152
REGIONAL COMMITTEE: EIGHTEENl'H SESSION
,.. ,
f
I
1
ADDRESS BY INCOMING CHAIRMAN:
Item 5 of the Agenda
The CHAIRMAN extended a warm welcome on behalf of the Regional Committee to the Representatives of the United Nations and Specialized Agencies, intergovernmental and non-governmental organizations. The
Committee was honoured to have at this session the Director-General, Dr Candau, and his Assistant Director-General, Dr Karefa-Smart. Although the Western Pacific Region covered a vast area, a feeling of friendship and mutual interest existed between Member countries; with each government responding immediately to the needs of the other. Communicable diseases were still the major problems in most countries. Health authorities were grateful to WHO for the assistance it had given in connex1on with environmental sanitation, studies of the local epidemiological patterns of certain diseases, the strengthening of laboratory services and the training of staff, all of which were fundamental to the oontrol of the communicable diseases. He was pleased to note that continued attention was being given to national health planning which should be an integral part of any country's economic development plan. Although, as pointed out by the Regional
Director, economic development plans had been prepared in sixteen countries and territories in the Region, few of these, unfortunately, took into consideration the health aspect. This might be due to lack of co-
operation and co-ordination between ministries, and in this respect it was the public health administrator who should take the lead in improving this situation and convincing the finance officers and economic planners of the importance of health.
SUMMARY RECORD. OF THE THIRD MEErING
153
Shortage of personnel was a universal problem and espeoially affeoted the developing oountries. Ways and means must be found to improve this
situation and the solution would vary from oountry to oountry. In closing, the CHAIRMAN thanked the Regional Direotor and his staff
for the assistanoe they had given to health programmes in the Region, and his fellow representatives for the honour and privilege of serving as their Chairman.
2
CONSIDERATION OF DRAFT RESOLUl'IONS
2.1 Annual Report of the Regional Direotor Dr OHMURA (Japan) proposed that the operative paragraphs be modified
as follows: "1. NOTES with satisfaction the inorease and widening of
activities and the progress made; 2. COMMENDS the Regional Direotor and his staff for the work
aocomplished and for produoing an exoellent report." In the absence of oomments, the CHAIRMAN stated that the revised text of the resolution would be oonsidered at the next session. (For consideration of draft resolution, see the fourth meeting, seotion 1.1.) 2.2 IsPlementation of Resolution WHA19.31 Dr OHMURA (Japan) asked if the last paragraph of the resolution meant that the policy would be reviewed by the Health Assembly.
154
REGIONAL COMMITTEE: EIGHrEEm'H SESSION
The DIRECTOR-GENERAL confirmed that the Assembly would review the recommendation. Decision: There being no further comments, the draft resolution was adopted (see resolution WPRjRc18.R2).
3
'IWENTIEI'H ANNIVERSARY OF THE WORLD HEALTH ORGANIZATION:
Item 12 of the Agenda (DocUlllEmt
WPR/ RC18/5 )
The REGIONAL DIRECTOR stated that it was highly desirable that the commemoration of the Twentieth Anniversary of WHO should be used to make the objectives and the work of the Organization better known to the public in general and to health workers and medical students in particular. would require special efforts on the part of governments. A limited This
amount of information material would be produced both at WHO Headquarters and the Regional Office, but if the widest possible publicity was to be given to the celebration, governments would have to reproduce and distribute what they received from WHO. At its second session, the
.
"
Regional Committee had adopted a resolution recommending the designation by each country and territory in the Region of a permanent public infor~
tion liaison officer to consult with the Regional Office on the most effective ways of carrying out public information activities. He appealed
to the representatives to take action on this resolution, as this would certainly facilitate the public information aspects not only of the Twentieth Anniversary but also of the Organization's work as a whole and World Health Day in particular.
·
../
SUMMARY RECORD OF THE THIRD MIml'mG
155
Certain proposals had been made which required deoisions by the Regional Committee:
(1) the nomination of one or two speakers who would
address the oommemorative meeting at the TWenty-first World Health Assembly; (2) how the event should be oelebrated at regional level: Committee might possibly wish to set aside part of the first day
the
of the
next session to oonsider the theme chosen for World Health Day and the whole Twentieth Anniversary Year; (3) whether the Committee might wish to endorse the proposal that Heads of states oould# if they saw fit# send speoial messages to WHO# whioh would be published and# in so far as pOSSible, distributed on the day of the opening of the Twenty-first World Health Assembly. The CHAIRMAN stated that speakers from the following Governments had addressed the Tenth Anniversary of WHO: r ':....,.
Australia, Cambodia, China, The Regional
Japan, the Philippines, Republio of Korea and Viet-Nam.
Committee was now asked to nominate one or two speakers who would address the commemorative meeting at the Twenty-first World Health Assembly. Dr DIN (Malaysia) proposed that the Chairman and Vioe-Chairman of
this Committee should address the oommemorative meeting. The REGIONAL DIRECTOR suggested that it might be more useful if the Committee nominated countries, instead of the names of representatives, to ensure that the chief delegate to the Committee would b3 the one to address the Twenty-first World Health Assembly.
156
REGIONAL COMMITl'EE: EIGHI'EENTH SESSION
Dr LEE (United States of America) thought that it would be better
to nominate Member countries in the Region rather than territories.
Dr THIEME (Western Samoa) suggested that countries which had not
been selected to address the meeting during the last celebration should be
nominated.
Dr LIM (Singapore) proposed and Dr DIN (Malaysia) seconded the
nomination of Japan as one of the speakers for the occasion. Dr GURD (United Kingdom) proposed and Dr THIEME (Western Samoa) seconded the nomination of Australia as the second speaker. It was so agreed. The CHAIRMAN then referred to the second point raised by the Regional Director concerning plans for the celebration at regional level which might include the consideration. from the regional aspect. of the theme which the Director-General would choose for World Healt:J. Day in 1968. Dr LEE favoured the recommendation of the Regional Director that
-- '
the first day
of the nineteenth session. which would be held in the
Philippines. should be devoted to the commemoration of the Twentieth Anniversary of WHO. WHO should work closely with the Secretary of Health
of the Philippines and all the organizations involved and interested in this particular programme and in the activities of WHO.
SUMMARY RECORD OF THE THIRD MEETING
157
It was agreed to accept the Regional Director's suggestion. The CHAIRMAN then referred to the third point in the Regional Director's proposal that Heads of States could, if they saw fit, send special messages to WHO. These messages would be published and, in so
far as possible, distributed on the day of the opening of the Twentyfirst World Health Assembly. Dr LEE referred to the penultimate paragraph on page 2 of the
document and asked why emphasis had been given to medical schools and medical associations. He also wondered why other academio and professional
organizations had not been oonsidered, e.g., Schools of public health and professional sohoo1s in the allied field. He considered that these
organizations played a very active role in carrying out WHO programmes and activities so that they deserved closer attention.
Dr TAYLOR (New Zealand) expressed the hope that the earliest possible
notification of the theme for the 1968 World. Health Day would be made inasmuch as special efforts would be -exerted by countries and territories in this regard. It would also be particularly helpful if early copies of
materials to be produced could be received from Geneva and the Regional Offioe, as these would be asked for by the publicity peopJ.e. He
appreCiated
that this matter had not been overlooked but it was most important that this aspect be looked into by WHO. The DIRECTOR-GENERAL thanked the Representative of the United States of America for calling his attention to the question of why emphasis had
158
REGIONAL COMMlTTEE: EIGHl'EENTH SESSION
been given to medical schools and medical associations. sions ~t
During the discus-
the Executive Board and the Health Assembly, the impression obtained
was that the medical profession as a whole knew too little about WHO, so that it was considered a most opportune time to elll.Phasize to medical students the illl.POrtance of WHO and to try and raise their greater interest in the Organization. On page 4 of document A20/AFL/2J., mention had been
made of the non-governmental organizations in official relations with WHO, and it was hoped that they would invite their national branches to participate in the celebration, thus ensuring greater action at the country leveL Needless to say, WHO had also the same concern in raising the
interest in WHO of nursing and public health schools, as well as of many other institutions, as it did of medical schools and medical associations.
Dr LEE stated that he had been a member of the United states delegation to the Assembly held in Minneapolis in 1958. He had been impressed
by the involvement of the press, businessmen and other professions in the City of Minneapolis. Since that time, WHO had gone far, and he hoped
that the Organization would see fit to involve not only health workers but also governmental and non-governmental workers in the Philippines during the celebration next year. In this way, full advantage of oommu-
nity participation, rather than just professional participation, could be taken. (For consideration of draft resolution, see the fourth meeting, section 1.4.)
SUMMARY RECORD OF THE. THIRD Ml!'El'ING
159
4
APPRAISAL OF 'l"'rlE FELLCMSHIP PROGRAM'IJE IN THE WESl'ERN PACIFIC REGION: Item 13 of the Agenda (Document WPR/RC18/6) The REGIONAL DIRECTOR referred to document WPR/Rc18/6, which
summarized the types of fellowships awarded by WHO. the objective of the WHO fellowship programme, and the types of persons to whom WHO fellowships were granted. Information was also given on how the fellowship programme Between 1 July 1951 and
was planned and the type of reports required.
30 June 1966, a total of 1414 fellowships and territories in the Region.
had been awarded to countries
The increasing number being awarded each
year brought into sharper focus problems which, if not satisfactorily resolved, could impair the whole programme. Some of these problems had
been listed in the document, as it was felt that a full discussion of the situation would be beneficial both to Member governments and the Organization. r "
--
Dr BANTA (United States of America), on behalf of the United States delegation, congratulated the Regional Director on his report. The
fellowship programme had been well developed and the report adequately covered significant practices related to it. He also wished to reite-
rate the importance of this programme in the solution of overall manpower shortage, particularly in the light of the Director-General's recommendations. Referring to the Regional Director's report on the subject, he wondered whether one of the tables presented could show the breakdown of the places where the fellowships had been taken and which countries
160
REGIONAL COMMI1'BE: EIGHTEENTH SESSION
had been involved.
He .also wanted to know where the family planning
component of individual country fellowships had been placed. or whether they formed part of the maternal and child heal.th fiel.d. The REGIONAL DIRECTOR referred to the second question of the United states Representative and stated that family planning was considered an integral part of health services and it had never been planned to indicate it as a separate fellowship programme. awarded in this field. As regards the placement of fellows, much information was available and it was hoped to present this during a subsequent appraisal of the fellowship programme. Fellowships were being awarded within the Region This arrangement resulted from a However, To date, no fellowship had been
•
to the greatest extent possible.
resolution adopted by the Regional Committee some years ago.
training had sometimes to be arranged in other parts of the world, when suitable arrangements and facilities were not available within the Region. Dr THIEME (Western Samoa) referred to the Regional Director's Annual
Report and noted that in spite of the recommendation made to arrange a fellowship programme within the Region, a total of 118 fellowships had been undertaken in other regions, compared to 102 fellowships awarded in the Western Pacific Region. The REGIONAL DIRECTOR pointed out that, mentioned earlier, when-
8.8
ever facilities were available, WHO endeavoured to make placement within the Region.
SUMMARY RECORD OF THE THIRD MEETING
161
Dr GURD (United Kingdom). oommenting on the points raised by the
Representative of the United States of America. stated-that the fellowship programme reflected the requests from the territories concerned. The fact that there was a small family planning content should not be taken to indicate any lack of interest in family planning in the Region. The International Planned Parenthood Federation was working actively in the Region and the territories in the South Pacific had cause to be grateful to it for fellowships. in particular to Singapore. for actually training many of their people in.family planning. The Regional
Director had referred to frequent delays in the selection, early nomination and submission of full documentation on candidates, but the governments were not always at fault in this respect. Communications
inside the territories in the South Pacific could be very slow and people might have to be brought in for proper governmental and medical assess(
,
'--
ment.
The Regional Office might have to accept some part of the blame noti~ications
because some of the
that the fellowship had been finally
awarded came very late.
5
STATEMENTS BY REPRESENTATIVES OF THE UNrrED NATIONS AND SPECIALIZED AGENCIES, OF INTERGOVERNMENTAL AND NON-GOVERNMENTAL ORGANIZATIONS IN OFFICIAL RELATIONS WITH WHO: Item 15 of the Agenda At the invitation of the CHAIRMAN, the following representatives
presented statements. 5.1 Representative of the United Nations Development Programme
Mr VAN HEERDEN expressed his appreciation at having been invited to
-..,-
participate in the Regional Committee.
Ever since their inception, the
162
REGIONAL COMMlT'!'EE: EIGHI'EENl'H SESSION
r-
Expanded Programme of Technical Assistance and the Special Fund. now both incorporated in the United Nations Development Programme. had striven. through the provision of expert advice. fellowships and equipment. to assist developing countries to attain the ideals of health. prosperity and peace of mind. Health was an integral function of It was therefore appropriate
economic growth on any desirable scale.
that health projects should figure among the major recipients of the United Nations Development Programme Technical Assistance funds, particularly regional and inter-regional projects. which allowed for the exchange of ideas between specialists from allover the world. contribution to health projects could be on a much larger scale. The United
Nations Development Programme funds were, however. largely dependent on the amount of voluntary contributions made by
governments to the Programme.
The governments themselves had to decide, in requesting assistance, which sector of their economy deserved priority and whether health should take precedence over agriculture, industry. education, social welfare, public administration. statistics, community development or any of the many fields in a developing country's economy which needed assistance. He "
expressed the hope that the time would come when voluntary contributions by governments to the Programme would be on such a generous scale that there would be little difficulty in satisfying the many demands for assistance. Mr Van Heerden stressed his office's readiness to assist
•
WHO to the best of its ability in its activities throughout the Region.
SUMMARY RECORD OF '!lIE THIHD MERrml
5.2 Representative of the United Nations and UNICEF Mr MEAGER transmitted the greetings of the Secretary-General and the
Director of the UNICEF Regional Office for East Asia and Pakistan. UNICEF had always been ready to broaden the scope of its assistance in relation to the needs of Children, provided these needs had a high priority in the planning of the Government. technical advice of WHO. UNICEF was guided by the
In May 1966, in response to the increasing
interest shown by Governments in programmes and family planning, the UNICEF Executive Board had adopted a resolution requesting the UNlCEFjWHO Joint Conunittee on Health Policy to advise it as to the best way in which UNICEF might participate in such programmes. This matter had been
considered by the Joint Committee in February 1967 and the UNICEF
.
Executive Board in June had accepted its reconunendations • The Joint Committee had recommended that "the types of projects in family planning for which a country might request UNICEFjWHO assistance would be those directed at: (1) training in MCH care, including family planning,
for the health personnel, and (2) the expansion of the basic health bervices including the maternal and dhild health services. The need for
rapid expansion of health services to provide scope for family planning as an integral part of the health services should be recognized. The
normal preventive and curative activities of those services should in no way be reduced or impaired. II This meent that the UNICEF Executive Board had given approval to the UNICEF Secretariat to reconunend. on the basis of government requests, assistance to a maternal and child health programme
164
REGIONAL COMMI'I'fEE:· EIGm.'EENl'H SESSION
including family planning. lines for such projects.
Assistanaa would be along the traditional UNICEF might also consider helping in a training
course which would give a more general maternal and child health orientation to family planning workers or vice versa. In August 1966, two
recommendations had been approved by the Executive Board and allocations had been made to India and Pakistan for additional aid to rural health services which, in their maternal and child health services, included family planning. The assistance consisted, in the case of India, of
transport, kits for traditional birth attendants, audio-visual aids, books and equipment for primary health centres and sub-centres. The
assistance to Pakistan consisted of transport, health centre equipment, audio-visual aids and paper. UNICEF assistance to family planning :f~ly
depended to a large degree on the integration of activities into the general health services.
planning
•
The subject of the technical
discussions was therefore most appropriate and he wished to commend Dr Chow for the excellent and stimulating paper which he had prepared.
Family planning services could be no more than one aspect of a comprehen~ive
programme for children and UNICEF's concern continued to be for the
whole child, to prepare him for an active and useful life, as well as to protect him from diseases, hazards and handicaps.
5.3 Representative of the South Pacific Commission Dr LOrsON stated that relations between WHO and the South Pacific
Commission continued to be cordial and fruitful.
Although the Commission
had its own programme and budget I whenever there was a possibility of
SUMMARY RECORD OF THE THIRD MEETING
165
duplication of projects, the two organizations combined their efforts, personnel and budgets so that they could do their utmost for the ,rell-being of
the populations of the Pacific area.
In
1967 the Commission had
organized two rather special meetings - for the first time in the Region one on the health problems of populations living on atolls and another on eosinophilic meningitis. The latter had also been attended by participants
from Japan, China (Taiwan) and Thailand as this disease had become more important in these countries. arranged. A course on mental health had also been
In December, assistance would be given to the Kingdom of Tonga
in connexion with a seminar on family planning. vlHO assistance had been particularly profitable in the field of
nutrition.
FAO and UNICEF had made generous contributions which had
permitted the organization of two courses in nutrition; one in New Caledonia for French-speaking trainees and the other in Western Samoa for English-speaking ones. advantage of these courses. Almost a hundred participants had taken At the same time research work ~re.s
being
undertaken on energy metabolism in New Guinea and on dental caries in New Caledonia and Western Samoa. In future years the Fiji School of
Medicine would also participate in the applied nutrition programme. Seminars on the administration of health education services and on housing sanitation, and a conference on poisonous fish, which would be organized in co-operation with American and Japanese universities, would be included in the 1968 budget of the Commission. would also participate in the WHO seminar on filariasis. joint tuberculosis training course was proposed. The Commission
In 1969, a
In closing Dr 10160n, on behalf of the Secretary-General
of
the
COmmission, Sir Gawain Bell, expressed the Commission t s appreciation of
;::.l66;;.;;.~_ _ _ _.;.;REG=I;.;::;ONAL=
COMMITI'EE: EIGH'l'EEtmi SESSION
the assistance which WHO had given.
The Commission had been happy to He hoped that
welcome the Reg10nal Director last July in New Caledonia.
a representative from WHO would attend the Seventh South Pacific Conference which would be held in Noumea in october.
5.4 Representative of the International Dental Federation Dr SISON conveyed the greetings of the International Dental
Federation and the Asian Pacific Dental Federation.
During the annual
meeting of the Federation held in Paris last month, the Asian Pacific Dental Federation had been accredited the official representative body of the Federation for the South-East Asia. tlnd Western Pacific Regions of WHO. Dr Bienvenido Erafia, as Secretary-General of the Asian Pacific Dental
Federation, had been elected as counsellor of the International Federation, the first Asian to occupy this post. The topic "Integration. of maternal and child health and family planning activities into the general health services" was a timely selection. In no other part of the world had the importance of maternal
nnd child health activities been more keenly felt in promoting public health than in the Far East. It was only fitting that due prominence be
given to maternal and child health and family planning activities as important aspects of the general health services. As the official repre-
sentative of the Federation, he wished to emphasize that a maternal and child health programme could not be considered comprehensive unless dental health was included as one of its components.
SUMMARY RECORD OF THE THIRD MEETING
167
5.5 Representative of the International Planned Parenthood Federation Professor CHUN. Regional Chairman of the Federation. summarized the activities taking place in the Region. The Family Planning Association in Hong Kong was a voluntary organization but substantially subsidized by the Government with a yearly grant amounting to about one-half of the total expenditure which. for the past year, had been equivalent to US$78 950. local and overseas donations. The rest was contributed by
Induced abortion was illegal and the
reduced birth-rate from 40 in 1956 to 24.9 per 1000 in 1966 had been substantially achieved through planned parenthood. The Age Specific Birth
Rate Study financed by the Population Studies Center of the University of Michigan on over 10 000 birth records from 4 hospitals and maternity homes had revealed that 50 per cent. of the drop in the birth-rate over the years 1961-1965 was attributable to family planning. The target set was to Current acti-
reduce the birth-rate to 20 per 1000 by the end of 1970.
vities included 66 I.U.D. clinics and 44 general session clinics offering other methods (clinic attendance figures for the year 1966 were
0) 957 equivalent to 16 per cent. of the total married women between 20-44 years old range); a follow-up programme and visits to patients who failed to return to the clinic by thirty field workers. Of the 12 000
patients who had failed to return to the clinic in the past year. 6000 had been contacted personally and approximately 3000 had returned to the clinic for further advice. A regional training course for leaders of This would be
family planning workers would be organized in November. ~
attended by representatives from all four countries in the Region.
168
REGIONAL COMMITTEE: EIGHTEENTH SESSION
The only country to have controlled the population explosion effectively was Japan which had halved its birth-rate in the course of a few years. It was now the lowest in the Region, 18.5 per 1000. The
Government has sent five family planning nurses to India at the invitation of the Indian Government. Requests for assistance had also been received
from Pakistan and Malaysia and more were anticipated. The National Family Planning Programme in Korea was included in the Government Development Plan in 1961. The aim was to reduce the natural
increase rate to 2 per cent. by the end of 1971 (1955-1960 - 2.88 per cent. and 1961-1966 - 2.7 per cent.). To acilieve this, the target set was:
1 000 000 I.U.D. insertions per year, 150 000 using traditional methods and 150 000 vasectomies. In 1966, there had been 4 000 000 I.U.D. insertions and 20 000 vasectomies had been performed. be achieved. It was hoped that the target would soon
An estimated 2200 full-time doctors and 1700 practitioners Activities of the
were assisting in the family planning programmes.
Planned Parenthood Federation of Korea during the past year had included t:r:-aining programmes, publicity and education, survey and research, and various pilot projects. The birth-rate in Okinawa had dropped substantially from 40.2 per 1000 in 1950 to 2.14 in 1964. Since the Family Planning Association
had not been established until 1965, this drastic decrease could not be attributed to planned parenthood but, most probably to the practice of induced abortion. The activities of the Association since 1966 had
consisted of lectures and film shows for members of the Midwives Association, Nurses Training School, Women's Association, etc., training
SUMMARY RECORD OF THE THIRD MEEl'ING
18)
courses for practical family planning instructors. publicity and educational programmes and sending delegates to various seminars and conferences and training courses in the Western Pacific Region.
5.6 Representative of the World Medical Association, Inc. Dr P'ENG conveyed the greetings and best wishes of the World Medical
Association.
Both WHO and the World Medical Association had the same In the past. the Association had
interest in the health of the people.
emphasized preventive medicine for the control of the communicable diseases and sanitation of the environment. At present activities were
focused on curative medicine, the treatment of diseases in order to reduce human suffering. He considered the topic chosen for the technical discus-
sions a most encouraging sign as it meant that health workers were now
•
committing themselves to achieve what Professor Winslow had said at the end of his definition of Public Health "to enable every citizen to realize his birth-rate of health and longevity" • This represented a great step forward in public health work. the fourth meeting, section 5.) (For further statements presented, see
6
THE ESTABLISHMENT OF A WHO MEDICAL SCHOOL IN 'J.'tili WESTEFlN PACIFIC REGION: ITEM PROPOSED BY THE GOVERNMENT OF MALAYSIA: Item 14 of the Agenda (Document wpR/Rcl8/8) Dr DIN (Malaysia) said that the proposal for the establishment of a
World Health Organization school in the Western Pacific Region actually attempted to solve a common problem through one approach. The document
:>-
stated the related facts and gave the information which had prompted this
170
approach.
It was perhaps unneoessary to stress too strongly that there 'lhis
was a serious shortage of doctors in many oountries in the Region. shortage also existed in developed or developing countries in other parts of the world.
WHO and national governments often emphasized the "
importanoe of health and this stimulation had not been left unheeded. Each country in its own wa:y was moving towards the attainment and promotion of good health. While health departments were striving for
better results, what was also important was that the people of these oountries were beooming more oonsoious of the benefits of good health. The response was positive and there were demands for more and better medical oare and preventive services. by mere trained personnel. This good trend could only be met
The Direotor-General himself had stressed Training programmes had been However, this -'-:-
the need for more trained personnel.
expanded in many countries, very oonsiderably in some.
effort had been limited to auxiliary personnel, thus leaving the higher grade of professionals. suoh as dootors, dentists, nurses and pharmaoists partly out of foous in the whole pioturQ., This waS not unreasonable because the courses for professional graduates were long, very intensive and they consumed considerable sums of money. A gap had been created,
which was a very important link because these were the people who were required to supervise, organize and administer the medical and health programmes. Some countries, on their own initiative, had built medioal
schools in spite of financial and other difficulties but these were exceptions, particularly in the developing countries. This situation was
reflected in the small number of medioal schools that had been established
SUMMARY RECORD OF '!'HE THmD MEETING
171
in developing countries in recent years.
other countries looked for
assistance abroad either by sending students to medical schools of :friendly countries or by recruiting doctors and dentists from friendly neighbours. The students sent abroad were limited in number and the number was falling in view of requirements in these countries. only be temporary measures. At best, these efforts could
Countries that had built their own medical
Schools were receiving considerable help not only from WHO but also from other national and international sources, thus reducing the load on their governments. It appeared that many countries required more and more
doctors and they were in the unhappy position of not being able to fill their Schools or to do so fast enough to meet the growing demands for doctors. It was on these grounds that the Malaysian delegation felt that a medical school should be established somewhere, under an efficient and well_established international organization suCh as WHO. One possible
effect of such a move would be the bringing together of many different nationals not only towards the common subject of health but also towards ,:) greater understanding, co-operation and human comradeship among many nations in the Region. this venture. There was also the complex problem of recognition of the different medical schools. The Malaysian delegation felt that such a school could This In fact, WHO could lead the rest of the world in
provide the standards necessary for an adequate medical education. approach was not new.
WHO had, in the past, undertaken the training of
many categories of personnel for various projects, for example. the
training of staff in malaria eradication programmes.
These were training
programmes of a minor nature but they could be major projects. The proposal was far from simple; it was very complex in the extreme. There were known and unexpected difficulties that went with such a project - i.e o , the financing of such a venture, the problem of language, the choice of site and locality, etc. As far as finance was concerned,
one had read occasionally that certain governments were keen to assist projects which were regional in character. Some people might say that
the difficulties to be faced in implementing the project were almost unsurmountable, but WHO had faced and had overcome many difficult problems before. The Malaysian delegation felt that WHO could meet this challenge
and prepare to add another feather to the many in its cap, feathers which denoted various major accomplishments and achievements. The DmECTOR-GENERAL believed that t.ile :;]ep:t"esentative of Malaysia was aware of his interest, his concern and his belief in the importance of medical education. He had repeatedly told the Health Assembly these last
few years that he believed that the really enduring work that could be done by an international organization such as WHO was to educate the nationals of the countries to take over their own responsibilities. permanent solution to their medical problems could be found by the importation of large numbers of foreign staff. Such staff could assist No
in some phase of the development of the health service and the development of training institutions but could not do much more than that.
--
SUMMARY RECORD -- OF THE THllID MEETmG. '
173
WHO's policy was not to stimulate
t~e
creation of international Instead, WHO
organizations or any type of international institution.
did its utmost to encourage national institutions to reach a standard at which they could be utilized for international training or for international research. One of the reasons for the adoption of this policy
was the fact that there was no continuity, no real root unless a national government took the major responsibility for the development of the institution. The proposal of the Government of Malaysia might however be interpreted in another way. It need not necessarily mean an international
medical school but a regional medical sohool established by a group of oountries within the Region with WHO shouldering the responsibility for its administration.
An example of a regional institution was the The Pan American
Institute of Nutrition of Central Amerioa and Panama.
Health Organization was responsible for its admini.stratian but the Institute itself belonged to a group of oountries that took the responsibility for ~suring
the oontinuity of its programme.
There was, as everyone knew, a great shortage of medical schools, but there were a number of major difficulties inherent in the proposal. One was the diffioulty of ensuring its finanoing on an adequate and long-term basis. It might be easy to obtain the initial financial
assistance of a group of countries for, say $50 million - but Who would guarantee the financial future of the school? There was also the problem This, he be-
of recruiting and building up the faculty to run the school. lieved, had a direct bearing on the financing.
It added to the difficulty
REGIONAL COMMrrTEE: EIGHTEENTH SES=S::;:I:.;O;:;N":..-_ _ _ _ _ __
,
of recruiting the right teaching staff if the project was not a permanent one. People would naturally shy away from taking posts that had no solid Therefore.not only the material problem of
basis nor foreseeable future.
assured financing but also the difficulty of acquiring the right personnel were involved. If there was a possibility of assuring permanent financing
it might be feasible to find a qualified faculty as there was much attraction in the type of challenge presented by the Representative from Malaysia. Another factor which should not be forgotten was that the school should be a "bilingual" one as in the Western Pacific Region there was an urgent need for this type of institution. This was not an impossibility
today, although it was not as easy as having a school in just English or French. This type of school moreover would have to be different from the classical medical school. It must provide training in the medical
sciences where those studying for the paramedical profession could also receive initial instrv.ction. rarts of the world. The school could also have another major role to play in the training of teaching staff. There was a dearth of teaching staff throughout the This pattern was proving a success in other
world which made it impossible to increase the number of medical schools. There was always a difficulty in training teaching staff because if they were sent abroad they were apt to stay there and one immediately encountered the problem of the so-called "brain drain". the "brain drain" was natural indeed. The cause of
People who went abroad for further
175
studies often found their foreign environment full of material possibilities which did not correspond to the realities at home. had, for L~stance,
The hospitals abroad
the laboratory facilities, the modern resources for These
electronics, etc., which could not be found in their home country.
people could not be expected to return to work under completely different conditions. The Director-General stressed the importance of having a training centre for the training of teaching staff. important to the Region. He thought this was extremely
He, of course, could see many very real diffi-
culties in the implementation of the proposal but as Director-General of WHO he was prepared to meet the challenge if there was some assurance of financial assistance on a permanent basis. Another consideration was the diploma. It was important for the
school, even though it might be administered by WHO, to belong to a government or group of governments since it was the government or group of governments which had to establish the legislation recognizing the validity of the diplomas granted by the school. '1rganization could do this. The Director-General said that he had been unable to study the matter more fully, but he believed that the proposal had possibilities despite the many difficulties and the Secretariat, Dr Karefa-3mart who was responsible for education and training, Dr Dy and he himself were prepared to face the challenge it presented. Dr LEE (United States of America) thanked the Director-General for
No international
his clear presentation of the problem and congratulated the Malaysian
REGIONAL COf:!Ml'I°l:EE:: EIGH1'EENI'H SESSION
.delegation on the school 1n Kuala Lumpur wh1ah he had heard was doing rouah to meet the medical manpower shortage. He fully agreed with the
Director-General and the Malaysian Representative on the need to support training institutions. The Secretariat had submitted good documentation
on the fellowship programme 1n the Western Pacific but there was no 1nventory as a whole of what WHO was doing 1n the Region to support exist1ng training 1nstitutions. A similar evaluation of the assistance The idea of a
being given to these institutions would be most useful.
regional medical sahool had been discussed in four western states in the United States of America and the conclusion had been reached that each state should fund its own existing institution rather than develop a regional school because of the administrative, recruitment and other difficulties which had just been described by the Director-General. He agreed with the Director-General that each country must do more to
be able to develop its own institutions. -
,.
Dr CRUZ (Ph1lipp1nes) .drew attention to the number of physicians 1n
the Philippines shown in Appendix A of the document and stated that the figure given related only to physicians1n government service, both 1n the Department of Health and in the Ph1lipp1ne A:rrrry. would furnish the correct figure to the Secretariat. The REGIONAL DIRECTOR po1nted out that an asterisk had been plaoed after the figure and the footnote 1ndicated that 1noomplete data were
on
h1s return, he
SUMMARY RECORD OF THE THllID MEETING
177
available.
The Secretariat would be very happy to receive up-to-date
information from Dr Cruz. Dr HSU (China) recalled that the Assembly had recommended the
stimulation of bilateral assistance in the fields of health and medical science. Bilateral assistance between oountries should be encouraged and
the Regional Director might seek the possibility of obtaining bilateral assistance from Hember countries in the Region. The REGIONAL DIRECTOR stated that, as the term implied, bilateral assistance meant assistance extended by one country to another. He did
not believe that, as an international organization, WHO should approach a gove~~ent
and request it to provide assistance to another.
Dr GtIRD (United Kingdom) supported the approach suggested by the
•
Representative of the United States of America.
He thanked the Director-
General for his very full analysis of the problem. It seemed that, in general, the Malaysian Representative's idea was supported, as well as the need to develop medical education. Nevertheless,
his delegation felt that the feasibility of applying the principle was, at this time, perhaps more important than agreeing to it. He suggested that
the Malaysian Government be given more time to develop this theme and look into the feasibility of obtaining the capital requirements and the guarantee of recurrent finance for many years to come. At the same time,
the Regional Office should examine its side of the issue so that the matter could be further discussed at the next meeting of the Committee when the problems relating to the proposal were available in detail for analysis.
178
REGIONAL CQMIIlI'!"I$E: "p;IGHl'EENl'H SESSION "
Dr LIM (Singapore) believed that if a special school were set up there
would be many difficulties not only in language but also in finance. were already many good medical schools in the Region.
There
Rather than setting
up another institution. WHO should give further assistance to the strengthening of the teaching administration of these schools. Dr OHMURA (Japan) stated that his delegation realized the serious
shortage of health personnel in developing countries and the position of the Representative of Malaysia in presenting this proposal. The problem,
however, inyolved many diffioulties which the Direotor-General had mentioned. His delegation supported the suggestion of the Representative
of the tJn1ted States of America that instead of establishing a regional or an international school existing national institutions should be strengthened. There being no further comments, the CHAIRMAN requested the Rapporteurs to prepare an appropriate resolution for this item. (For consi-
deration of draft resolution. see the fourth meeting. section 1.5.)
7
SELECTION OF TOPIC FOR THE TECHNICAL DISCUSSIONS DURING THE NlNETEENI'H SESSION OF THE REqIONAL C(MIJl'l'l'EE: Item 16 of the Agenda
(Document WPR/RC1817) Dr LEE (tJn1ted States of America) considered that "Health Planning
as an Administrative Tool" would be a most interesting subject for the next technical discussions. If this subject were chosen. he asked if
other international organizations could jointly assist in the preparations
SUMMARY RECOOD -OF THE THllID MEEl'ING
179
and people such as economists and planners could participate in the discussions. The REGIONAL DIRECTOR stated that if these persons were designated members of government delegations or were representatives of intergovernmental or non-governmental organizations in official relations with WHO, they could certainly participate.
Dr CRUZ (Philippines) supported the proposal of the Representative "'--
of the United States of America.
Dr DOWNES (Australia) said that his delegation believed that the Regional Committee should give priority to communicable diseases and that "The Planning and Organization of a National Epidemiological Service" and "The Changing Concepts in Tuberculosis Control" were important topics. Tuberculosis was the greatest problem in the Region and a great deal could be learned about its control. Previous speakers had already mentioned Recently he had had the pleasure of
what they were doing in this field.
visiting Papua and New Guinea with Dr Reyes of the Regional Office and
Dr Stuckey, and the way in which tuberculosis was being tackled was a very fine example of the changing concept in tuberculosis control. baby within reach was given BCG in addition to triple antigen. Every
BeG was
given during the child's life at intervals, supplemented. of course, by mass miniature radiotheraphy. The best topic would be one that was
concerned with communicable diseases.
If the Committee wanted a broad
subject, he would suggest "The Planning and Organization of a National
180 ,_ _ _ _--=REG=,;,IO;:;NAL=_C;;;,;O:;.;,.MMIT;;.;='l;,;;'EE=.::.:..,;E;,;;I;;;;;G;,;;lf;:;;I'E;;;;;/O;;;;,;m'H;;;;;....;;SE;;;;;-;;;;SS;;;,;I;;.,;;O;;;,;N_ _ _ _ _ __
Epidemiological Service" but "The Changing Concepts in Tuberculosis Control" was an important subject for the Region. Dr
THIEME (Western Samoa) supported the proposal to select "Health
Planning as an Administrative Tool", since during the past two days it had been indicated that not enough health planning was being done by the
departments a.r health.
More attention should be given to this so that
there could be better understanding between the health personnel and the economists. Dr
LIM (Singapore) agreed with the views expressed by the Repre-
sentatives of the United States of America. Philippines and Western Samoa. "Health Planning as an Administrative Tool" and "Administrative In a
Aspects of Public Health Administration" were inter-related. health structure proper administration was necessary.
-, Dr
DJN (f-la.laysia) supported the topic "Health Planning as an
Administrative Tool" and said that after the war many countries in the Region had developed their programmes more or less on rough estimates. It was time that they developed their programmes with proper health planning. In the absence of further comments, the CHAIRMAN suggested that the proposals be put to a vote. Decision: "Health Planning as an Administrative Tool" was selected as the topic for the technical discussions for 1968 (see resolution WPR/RC18.R8). The meeting rose at 12.00 noon.