Final report of the thirty-fifth session of the Regional Committee for the Western Pacific

WORLD HEALTH ORGANIZATION REGIONAL COMMITTEE FOR THE WESTERN PACIFIC THIRTY -FIFTH SESSION Suva, 5-11 September 1984 REPORT OF' THE REGIONAL COMMITTEE SUMMARY RECORDS OF THE PLENARY MEETINGS Manila November 1984 WORLD HEALTH ORGANIZATION REGIONAL COMMITTEE FOR THE WESTERN PACIFIC THIRTY-FIFTH SESSION SUVA, 5-11 September 1984 REPORT OF THE REGIONAL COMMITTEE SUMMARY RECORDS OF THE PLENARY MEETINGS MANILA November 1984 NOTE The thirty-fifth session of the Regional ColDtllittee for the Western Pacific was held in Suva from 5 to 11 September 1984. Dr T.M. Biumaiwai (Fiji) was Chairman and Mr W. Korisa (Vanuatu) Vice-Chairman. Dr Q. Reilly (Papua New Guinea) and Mr Vannareth Ratsapho (Lao People's Democratic Republic) were the Rapporteurs. The Regional ColDtllittee met on 5, 6, 7, 10 and 11 September. The report of the ColDtllittee will be found in Part I of this document on pages 1-48; the summary records of the plenary meetings in Part II on pages 51-163. - ii - CONTENTS INTRODUCTION ••••••••••••••••••••.•••••••••••••••••• • • • • · . • • _. 1 I. REPORT OF THE REGIONAL D !RECTOR COVERING THE PERIOD 1 JULY 1983 TO 30 JUNE 1984 •••••••••••••••••••••••••••••••• 2 I I. PROGR.AM!-IE BUDGET ~ •••••••• -· ••••••••••••••••••••• • ••••••••• -• • 5 III. SUB-COMMITTEES OF THE REGIONAL COMMITTEE ••••••••••••••••••• 11 IV. 1. Sub-Committee on the General Programme of Work 2. Sub-Committee on Technical Cooperation among Developing Countries: Report of the Sub-Committee OTRER MA. TTERS •••••••••••••••••••••••••••••••••••••••••••••• 1. Health Resources Group for Primary Health Care: 11 12 14 Membership of the Group •••••••••••••••••••••••••••••••• 14 2. Correlation of the work of the World Health Assembly, the Executive Board and the ·Regional Committee . . . . . • . . • . • . . • • . • . . . . • • . . . • . . • • . • • • • • 14 2.1 Consideration of resolutions of the Thirty-seventh World Health Assembly and the Executive Board at its seventy-third and seventy-fourth sessions 2.2 Consideration of the agenda of the seventy-fifth session of the 14 Executive Board ..•................• -. . . . . . . . . . . . • . . 15 3. Women, health and development •••••••••••••••••••••••••• 16 4. Hepatitis as a public health problem ••••••••••••••••••• 17 5. 6. 7. WHO Guidelines for drinking-water quality . ........ ·-... . Selection of topic for the Technical Discussions in conjunction with the thirty-sixth session of the Regional Committee Time and place of the thirty-sixth and · thirty-seventh sessions of the Regional Co1111Dittee 8. Reports received from governments on the 19 20 20 progress of their health activities •••••••••••••••••••• 20 - iii - v. CONTENTS RESOLUTIONS ADOPTED BY THE REGIONAL COMMITTEE ......... ,_ .... 21 WPR/RC35.Rl Report of t~e Regional Director 21 WPR/RC35. R2 Programme budget for 1986-1987 ••••••••••••••• 22 WPR/RC35.R3 Sub-Committee on Technical Cooperation among Developing Countries 22 WPR/RC35 .R4 Health manpower development •••••••• • ••••••••• 23 WPR/RC35.R5 Evaluating the Strategies for Health for All by the Year 2000 ••••••••••••••••••••• 25 WPR/RC35.R6 Sub-Committee on the General Programme of Work 26 WPR/RC35.R7 Membership of the Sub-Committee on the General Programme of Work •••••••••••••••• 26 WPR/RC35.R8 Women, health and development 27 WPR/RC35.R9 Membership of the Health Resources Group for Primary Health Care • • • • • • • • • • • • • • • • 28 WPR/RC35.Rl0 Members of WHO in the Western Pacific Region entitled to designate a Member of the Executive Board ••••••••••••••••••••••• 28 WPR/RC35.Rll Action Programme on Essential Drugs and Vaccines . . . • . • . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 9 WPR/RC35.Rl2 Resolutions of regional interest adopted by the Thirty-seventh World Health Assembly and by the Executive Board at its seventy-third session ••••••••••• 30 WPR/RC35.Rl3 Correlation of the work of the World Health Assembly, the Executive Board and the Regional Committee . . . . . . . . • . . . . . . . . • • . . . . . . . . • • . • . • • • . 30 WPR/RC35.Rl4 Viral hepatitis B as a public health problem............................... 31 - iv - l. 2. CONTENTS WPR/RC35.R15 Guidelines for drinking-water quality • • • • • • • • 32 WPR/RC35.Rl6 Technical discussions........................ 33 WPR/RC35.R17 Thirty-sixth and thirty-seventh sessions of the Regional Committee 33 WPR/RC35.Rl8 Resolution of appreciation................... 34 ANNEXES AGENDA ................................ -. ................... . 35 LIST OF REPRESENTATIVES •••••••••••••••••••••••• ·• ••••••••••• 37 3. LIST OF NONGOVERNMENTAL ORGANIZATIONS WHOSE REPRESENTATIVES MADE STATEMENTS TO THE REGIONAL COMMITTEE • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 4 7 - v - PART I REPORT OF THE REGIONAL COMMITTEE (WPR/RC35/14) INTRODUCTION The thirty:-fiftb session of the Regional Committee for the Western Pacific was held in Suva from 5 to 11 September 1984. The session was attended by the representatives of Australia, China, Coote Islands, Fiji, Japan, Kiribati, Lao People's Democratic Republic, Malaysia, New Zealand, Papua New Guinea, Philippines, Republic of Korea, Samoa, Singapore, Solomon Islands, Tonga, Vanuatu and Viet Nam and of Member States responsible for territories or areas in the Region. Observers attended from Negara Brunei Darussalam. Representatives of the United Nations Children's Fund and the South Pacific Commission · and of twelve nongovernmental organizations in official relations with WHO attended the session. The Committee elected the following officers: Chairman Vice-Chairman Rapporteurs in English . . Dr T.M. Biumaiwai (Fiji) Mr W. Korisa (Vanuatu) Dr Q. Reilly (Papua New Guinea) in French Mr Vannareth Ratsapho (Lao People's Democratic Republic) Formal statements were Nations ChiJdren 's Fund, nongovernmental organizations made by the representatives of the South Pacific Commission (see Annex 3). the United and nine The agenda appears as Annex 1 and the list of representatives as Annex 2. The report of the Regional Director on the work of WHO during the period 1 July 1983 - 30 June 1984 was presented to the Committee at its second and third plenary meetings (see Part I) . The Cdmmittee reviewed the budget performance in 1982-1983 at its third plenary meeting, and the proposed programme budget estimates for 1986-1987 at its third, fourth and fifth plenary m~aetings (see Part!!). The report of the Sub-Committee on the General Progra11111le of Work was presented to the CoQIIlittee at its fifth plenary meeting. The report of the Sub-Committee on Technical Cooperation among Developing Countries was also presented to the Collllllittee at its fifth plenary meeting (see Part Ill). The Committee elected Tonga as the tbember from the Western Pacific Region of the Health Resources Group for Primary Health Care for a period of two years from 1 January 1985, replacing the Philippines whose term was due to expire on 31 December 1984 (see resolution WPR/RC35.R9). 2 REGIONAL COMMITTEE; THIRTY-FIFTH SESSION The Committee recommended to the Executive Board, and through it to the World Health Assembly, that consideration be given to increasing the number of Members from the Western Pacific Region entitled to designate a member of the Board from the current three to four (see resolution WPR/RC35.Rl0). The Committee appointed Professor Tu Gi§y (Viet Nam) Moderator of the Technical Discussions on "Malnutrition, growth and development", held in conjunction with the thirty-fifth session. In the course of eight plenary meetings, the Committee adopted eighteen resolutions, which are set out in Part V. PART I. REPORT OF THE REGIONAL DIRECTOR COVERING THE PERIOD 1 JULY 1983 TO 30 JUNE 1984 The Committee noted that the Organization had continued to collaborate in the endeavours of Member States to reshape their health systems for the achievement of the goal of health for all by the year 2000 through the forsulation and implementation of national health-for-all policies and strategies and the promotion and application of the managerial process for national health development. Member States were very well aware of the mechanisms developed for the monitoring and evaluation of progress in implementing the national strategies. After the first exercise in monitoring, which had been reported to the Committee in 1983, gratifying conclusions could be reached. Although the magnitude of the tasks facing Member States, particularly developing countries, and the constraints, such as shortage of skilled manpower and budgetary stringency, aggravated by the adverse economic climate, were formidable, reasonable progress was nevertheless being made by countries in promoting the concept of primary health care, which remained the key to the achievement of health for all. Health care coverage was being expanded; the active participation of individuals, families and communities in health matters was being encouraged on the basis of the principle of self-reliance. Efforts were being made to ensure the reorientation and retraining of health manpower, particularly of health workers at the periphery; managerial capabilities were being strengthened, particularly at the intermediate or first referral level, which was vital for the implementation of primary health care at the community level . The Secretariat had actively collaborated in all those areas and in particular in relation to health systems development, organization of health systems based on primary heal~b care, and health manpower. Of particular significance in the field of health manpower development were the efforts being made to more actively involve universities, including medical schools, and health training institutions in the REPORT OF THE REGIONAL COMMITTEE 3 prep'aration and i11lplementation of health-for-all policies and strategies. That included efforts to ensure a community-oriented approach to medical education and greater relevance of the curricula to the real needs of health services and communities. Meetings of directors and representatives of school• and departments of public health and ~f deans of medical schools had been held in Manila during the year, to discass issues arising in that connection. WHO had also continued to cooperate in the reorientation of training institutions in accordance with the principles of a community-based approach and task-oriented curriculum. In that regard, the Committee took note of resolution Wl:lA37. 31 on the role of universities in the strategies for health for all, which had recently been adopted by the Thirty-seventh World Health Assembly. The Committee also took note of resolution WHA37.17, adopted Thirty-seventh World Health Assembly, which urged Member States, other things, to accord the highest priority to, and assume responsibility for, the continuing monitoring and evaluation of health-for-all strategies. by the among full their It observed in that connect1.on that it would be necessary to carry out a first evaluation of the regional strategy in 1985. To facilitate the preparation of the regional evaluation, Member States would be requested to evaluate their own national strategies. The evaluation reports, based on the Common Framework and Format, which had been reviewed by the Sub-Committee on the General Programme of Work in June 1984, should reach the Secretariat by March 1985. The representatives of twenty Member States spoke to the report. The representative of China noted with satisfaction that priority was being accorded to strengthening the managerial process for national health development and health information system development, thereby developing national capability to formulate, implement and ·evaluate the health-for,...all strategies. ' In the same context, the representatives of Malaysia and the Philippines drew attention to the need to develop and further refine mechanisms for monitoring and evaluating progr~ss towards achievement of the health-for-all goal, and stressed the importance of developing managerial capabilities among those responsible for programme implementation. In particular, the representative of Malaysia believed that , middle-level management shouldbe further strengthened. The Committee he.ard with interest a report by the representative of Fiji on the progress of health services development in that country and noted the important role played by WHO cooperation and the primary health care approach in that achievement, particularly in the areas of water supply, immunization, nutrition ana breast-feeding, bulk purchase of essential drugs and organization of primary health care .seminars at village level. The representatives of seven Member States spoke in relation to health manpower develop8lent. The representative of Japan voiced his country's continuing concern for the development of human resources, an example of its cooperation in that field being the joint Japan/WHO project on health 4 REGIONAL COMMITTEE: THIRTY-FIFTH SESSION laboratory technology in Tonga. A number of representatives expressed satisfaction at the results achieved by WHO in the placement ' of fellows and the sponsoring of workshops and training courses, artd urged the strengthening of such activities. The Committee acknowledged with appreciation the offer extended by the representative of France to contribute to a positive cooperation, which could have recourse to the medical, human and technical skills available in the territories of the Pacific, and in particular the utilization of the hospitals~ technical institutions and nursing schools in the French territories for the training of auxiliary health personnel. In the course of its review of diagnostic, therapeutic and rehabilitative technology, the representatives of Fiji and Viet Nam drew attention to the indispensable role of traditional medicine in primary health ca:re, particularly in developing countries where health resources were often inadequate. The Committee heard a report on the status of traditional medicine in Viet Nam, including the use of herbal medicines and acupuncture in primary health care. The representative of Viet Nam urged a more complete exchange of information on traditional medicine between developing countries and the organization of annual seminars to promote exchanges of experience. In relation to the disease prevention and control programme, the representatives of Japan, Papua New Guinea, Singapore, Solomon Islands, the United Kingdom of Great Britain and Northern Ireland and Viet Nam expressed concern at the deterioriation in the malaria situation, which continued to be a critical problem in certain parts of the Region, particularly in Papua New Guinea, Solomon Islands and Vanuatu and in certain countries of the Indochinese peninsula. In reply to the representative of Papua New Guinea, the Committee heard a report from the Secretariat on recent advances in malaria research, which had led to the development of potential vaccines. The Committee also heard reports on mefloquine and its use in chloroquine-resistant falciparum malaria; the treatment of pernicious malaria; and the potential value in malaria control of Qinghaosu, which was currently undergoing trials in China. The representatives of Australia, New Zealand and the United States of America referred to the usefulness of including in future reports of the Regional Director narrative information on programme objectives and related achievements, as well as suggestions for appropriate follow-up. The Committee took note that, while efforts would be made in the future to improve the format, the question of changing the reporting format was a matter for further discussion at the global level. REPORT OF THE REGIONAL COMMITTEE 5 PART II. PROGRAMME BUDGET 1. Review of budget performance in 1982-1983 The CotDDlittee noted that the total regular budget provision of US$39 522 500 for 1982-1983 reflected the amounts accepted by the Regional Committee at its thirty-first session in 1980 and an additional amount of US$753 500 made available by the Director-General. The rate of implementation of the budget bad been 99.99%. The implementation figure of US$39 521 421 included activities totalling US$775 258, which had originally been allocated to the Regional Director's Development Programme and subsequently reclassified, on implementation, to the programme under which the activity took place. Additional extrabudgetary resources had become available during the implementation period and the amount of such resources actually implemented in 1982-1983, namely US$19 287 850, was well in excess of the amount indicated in the estimates proposed to the Regional Committee. The Committee observed that, although there were differences between th~ original programme budget estimates and the implemented figures, reflecting changes in government priorities, the priority programmes originally agreed upon by the Committee remained the same. The representatives of China, Samoa and Tonga expressed their satisfaction at the increases in total allocations, particularly those from sources other than the regular budget, for a number of programmes, including Maternal and child health and Communicable disease prevention and control. The representative of Tonga urged donors to continue to support the programme budget and to help the smaller countries whose resources were limited. ln reply to questions raised by the representatives of China, Japan, the Republic of Korea and the United States of America, the Committee heard an explanation from the Director, Programme Management of some of the major differences between allocation and implementation, particularly under the programmes Appropriate technology for health, Health services research, Maternal and child health, Noncommunicable disease prevention and control, Promotion of training and Health statistics. With regard to the general aspects of performance, the Committee noted. that, while broad programmes covered in the programme budget were approved two years : before implementation, detailed programming followed one year prior to implementation. In the meantime, changes in government priorities might occur, which were reflected in the subsequent collaborative activities between Member States and WHO. Funds not used in certain programme areas were transferred to other programmes where extra expenditure was necessary. In response to the suggestion of the representative of New Zealand, the Cc;,mmittee noted that future reports of budget performance would provide more detailed explanations of major increases and decreases. In general the Committee felt that the differences in the amounts allocated and actually implemented in various programmes reflected the flexibility of budget performance, which was an important consideration in ensuring optimum use of available resources. 6 REGIONAL COMMITTEE: THIRTY-FIFTH SESSION A number of representatives expressed their satisfaction with the overall implementation rate of 99.99%, and noted that that result had been achieved through careful and close buagetary mon1toring in order to better meet the massive needs of the Region. In reply to a question by the representative of Malaysia concerning difficulties in programme implementation stemming from the inability to fill vacant posts, the Committee heard a report on the situation of professional staff recruitment in the Region, which had markedly deteriorated as a result of post adjustment decreases, resulting in the reduction of incomes of international professional staff to a level well below that of national civil servants in comparable posts. In consequence, insufficient candidates were forthcoming from countries on the approved list which were highly developed or paid large contributions. The Committee took note of the comments of the Director-General in that regard, who stressed the need for a dual cost-effective approach to the problem, based on encouragement of short-term assignments of one or two months by WHO staff or consultants to Member States, and increased use of the expertise becoming available in some countr1es of the Region. For the foreseeable future, the Organization would continue to need health experts of the highest quality, recruitment of whom was incompatible with the imposition of rigid criteria for the geographical distribution of staff. 2. Proposed programme budget estimates, 1986-1987 The Committee noted that 1986-1987 was the second programme budget biennium under the Seventh General Programme ot Work. The budget had been prepared in close the Region, and included activities, themselves, which responded to their needs goal of health for all. consultation with governments in identified by the countries and priorities for achieving the The highest percentage (45.8%) of the regular budget was allocated to the broad category of programmes classified under health system infrastructure, which was in accordance with the aim of the Seventh General Programme of Work of promoting and strengthening comprehensive health systems based on primary health care. In consonance with the trend towards the reorientation of programmes for the achievement of health for all, the Health manpower programme continued to account for the highest proportion of resources (19.1%), with approximately 89% of the provision going directly to countries. That reflected the high priority given by countries in the Region to the preparation of health manpower to meet the requirements of the health system. Disease prevention and control was second in importance ( 15. 9%), followed by Health system development (12.6%) and Organization of health systems based on primary health care (11.9%). REPORT OF THE REGIONAL COMMITTEE 7 During 1986-1987, most of WHO's collaboration would be provided through country programmes. In addition, an intercountry programme had been maintained in view of the heterogeneous nature of the Region. which made such a programme a more effective and economical means of providing cooperation. The Committee noted some of the specific areas in which cooperation would be concentrated during the.biennium. They included the strengthening of national capabilities to define priority health problems and formulate and implement the necessary measures for their solution, on the basis of a sound information system, together with efforts to find an effective and efficient means of health care delivery. To achieve that, the strengthening of the health manpower planning component of the managerial process for national health development was of importance, as well as measures to improve coordination between the producers and users of health manpower, and to improve national policies and systems for the optimum deployment and utilization of health personnel. Continuing support for the International Drinking Water Supply and Sanitation Decade was another such area. By 1986 they would be entering the second half of the Decade and efforts to improve basic sanitation would be deployed in such areas as training of manpower at all levels and improvement of the capabilities of communities to operate and maintain the systems themselves. The problem of viral hepatitis B was also of major concern in the Western Pacific Region, where more than 100 million people were carriers of the virus. In some countries of the Region, traditional medical practices formed part of the national health systems, and there was growing recognition of the role they could play in primary health care. Efforts would be made to integrate them into the general health system. With regard to the formulation of the 1986-1987 proposed programme budget estimates, the Committee observed that the original provisional allocation from the Director-General had been US$54 748 000, comprising US$28 362 000 for countries and US$26 386 000 for Regional Office and intercountry activities. However, by the time the 1986-1987 estimates had been finalized for the Regional Co11111littee, the rate of exchange for the Philippine peso bad moved from peso 7.95, used in the preparation of the 1984-1985 programme budget, to peso 14 to the US dollar. After calculating the currency exchange savings on items of expenditure identified with the Philippine peso, the allocation for 1986-1987 had been reduced by US$3 460 500, resulting in the existing net provisional allocation of US$51 287 500. Of that amount, US$28 362 000 had continued to be allocated to country activities and US$22 925 500 to Regional Office and intercountry programme act1v1t1es. The overall regular budget increase was US$5 162 500 or 11.2% over the 1984-1985 allocation of US$46 125 000, and consisted of: (a) a real increase of US$966 000 or 2.1%, (b) a statutory cost and inflation increase of US$7 657 000 or 16.6%, and (c) a reduction resulting from the currency exchange savings of US$3 460 500 or 7.5%. A number of representatives expressed concern at the proposed budgetary increases. In particular, one representative regretted the absence of an analysis of the real increase proposed as well as of the cos~ increases of 13.5% and 20% proposed for country and Regional Office/intercountry levels respectively. He observed t ,bat the combined (WPR/RC35/14) INTRODUCTION The thirty-fiftb session of the Regional Committee for the Western Pacific was held in Suva from 5 to 11 September 1984. The session was attended by the representatives of Australia, ·china, Coole Islands, Fiji, Japan, Kiribati, Lao People's Democratic Republic, Malaysia, New Zealand, Papua New Guinea, Philippines, Republic of Korea, Samoa, Singapore, Solomon Islands, Tonga, Vanuatu and Viet Nam and of Member States responsible for territories or areas in the Region. Observers attended from Negara Brunei Darussalam. Representatives of the .· United Nations Children's Fund and the South Pacific Commission and of twelve nongovernmental organizations in official relations with WHO att~oded the session. The Committee elected the following officers: Chairman Dr T.M. Biumaiwai (Fiji) Vice-Chairman Mr W. Korisa (Vanuatu) Rapporteurs in English Dr Q. Reilly (Papua New Guinea) in French Mr Vannareth Ratsapho (Lao People's Democratic Republic) Fot"11al statements were made by the representatives of Nations Children's Fund, the South Pacific Commission nongovernmental organizations (see Annex 3). the United and n1ne The agenda appears as Annex 1 and the list of representatives as Annex 2. The report of the Regional Director on the work of WHO during the period 1 July 1983 - 30 June 1984 was presented to the Committee at its second and third plenary meetings (see Part I). The Committee reviewed the budget performance in 1982-1983 at its third plenary meeting, and the proposed programme budget estimates for 1986-1987 at its third, fourth and fifth plenary meetings (see Part II). The report of the Sub-Committee on the General Programme of Work was presented to the Conittee at its fifth plenary meeting. The report of the Sub-Committee on Technical Cooperation among Developing Countries was also presented to the Co111t11ittee at its fifth plenary meeting (see Part III). The Committee elected Tonga as the member from the Western Pacif.ic Region of the Health Resources Group for Primary Health Care for a period of two years from 1 January 1985, replacing the Philippines whose term was due to expire on 31 December 1984 (see resolution WPR/RC35.R9). REPORT OF THE REGIONAL COMMITTEE 9 The representatives of a number of developing countries urged that ~ympathetic considera't:ion be given to the proposed budget, which was based on the needs and requests of individual countries~ Not only was external cooperation essential to the attainment of the goal of health for all but also the greatest possible flexibility in the allocation of funds, particularly during that most decisive phase of development of the primary health care programme, when reorientation, reorganization and retraining were of paramount importance. In its review of the proposed budget estimates by individual programme area, the Committee noted the following in reply to specific questions or comments: .Health manpower The budget allocations reflected the high priority accorded to health manpower development by Member States. The total amount allocated, including US$4.9 million aliocated to fellowships within other programme areas, was US$13.7 million and represented 30% of the total regular budget for the Region. Close attention was given to the way in which the fellowship programme was used. The Regional Commit~ee had itself evaluated and endorsed the programme two years previously. The fellowship programme was particularly invaluable to small newly independent States, which had previously relied heavily on expatriate staff and for which the setting up of schools for health personnel was not feasible. General health protection and promotion 1. Nutrition The two recommendations made earlier that year by the United Nations Administrative Committee on Coordination Sub-Committee for Nutrition, calling for (a) a coordinated country-level approach by the agencies in the area of food and nutrition, and (b) a global strategy for the eradication of vitamin A and iodine deficiency disorders, had been taken into consideration by WHO. Xerophthalmia and other deficiency diseases were receiving greater attention than in the past. WHO had always cooperated with the other United Nations agencies, as was the case in Fiji. The ACC Sub-Committee was itself responsible for interagency coordination at all levels. WHO was continuing to support six nutrition training programmes in the Region, while training facilities were also available in many countries. 2. Ace id.ent prevention More support from extrabudgetary sources was expected for work on accident prevention. Negotiations were in progress with major associations of vehicle manufacturers in some countries. Ptotectic)t) and promot:i.on of mental health The 474% increase in the 1986-1987 budget estimates was accounted for by a larger nu11ber of requests from countries, particularly China and Papua New Guinea. More intercountry activities were planned in the form of workshops and working groups and it was intended to intensify epidemiological research. 10 REGIONAL COMMITTEE: THIRTY-FIFTH SESSION Diagnostic, therapeutic and rehabilitative technology 1. Drug and vaccine quality, safety and efficacy The Committee acknowledged with appreciation the offer of the United States Food and Drug Administration to provide countries of the Region with training in good maufacturing practices and quality control, together with advice and information on the quality, safety and efficacy of drugs and vaccines, and also to share its expertise on the quality control and development of hepatitis B vaccine. Such studies would be provided on a bilateral basis. The Committee observed that the Food and Drug Administration had already been active on a bilateral basis for some time, notably in China with regard to the quality control of drugs and biological substances. It had also released some of its staff as consultants for WHO programmes. The Governments of Australia, Japan and New Zealand had also provided consultants on the same basis and it was to be hoped that there would be more of such arrangements. 2. Rehabilitation The budget allocation had been increased by 242% in response to requests from China, Lao People's Democratic Republic and the Republic of Korea. It was intended to carry out an intercountry project on community-based rehabilitation. 3. Essential drugs and vaccines In view of the public concern in such countries as Fiji and Vanuatu at the use of Depo-Provera as a contraceptive, the issue had been discussed by a WHO expert group in consultation with the United States Food and Drug Administration. The Group had agreed that the drug was sti 11 useful for family planning purposes in many countries. It would be helpful if the United States Food and Drug Administration would make a formal statement confirming that view. 4. Traditional medicine The Committee noted with appreciation the research being conducted by France on traditional medicine in the Pacific, particularly the pharmacological research on medicinal plants carried out by the Office de la recherche scientifique et technique outre-mer (ORSTOM) in Noumea. It took note of the comments of the representative of France in that regard. Disease prevention and control The Committee observed, with respect to the 536% increase in the budget allocation for the control of sexually transmitted diseases, that an even greater increase could be justified. The rise in the incidence of neonatal syphilis and the appearance of antibiotic-resistant strains of gonococci were causing great concern. REPORT OF THE REGIONAL COMMITTEE 11 Support services Regarding the geographical representation of Member States among WHO staff, the Committee noted that, under the WHO Constitution, the right to decide on staff appointment was vested in the Director-General. Information annexes The Committee heard an explanation of the 74.2% increase in the budget allocation for Fiji. In the same context, it took note of the process whereby available funds were apportioned among the various countries in the Region, which was based on a number of criteria or guidelines that had been formulated. PART III. SUB-COMMITTEES OF THE REGIONAL COMMITTEE 1. Sub-Committee on the General Programme of Work 1.1 Report of the Sub-Committee (Document WPR/RC35/6) The report of the Sub-Committee on the General Programme of Work was introduced by Dr KOINUMA (Japan) in the absence of the Chairman, Rapporteur and other members of the Sub-Committee. The Committee noted that health manpower development, including the training of community health workers, as well as the role of academic institutions in health development, had been the subject reviewed by the Sub-Committee in 1984 in the context of its review and analysis of WHO cooperation with Member States, which was the first of its terms of reference. In carrying out its task, the Sub-Committee had visited Malaysia, Solomon Islands and Vanuatu from 12 to 17 March 1984. As the time spent by the Sub-Committee in the three countries had been limited, the review had had to be essentially broad and general in nature. The Committee took note of the summary of findings on the country visits of the Sub-Committee and the recommended areas for WHO collaboration which should be continued and further strengthened in the future. The second of the terms of reference of the Sub-Committee related to the monitoring and evaluation of strategies for health fo~ all by the year 2000. In that connection, the Sub-Committee had reviewed the Common Fra111ework and Format for Evaluating Strategies for Health for All. The Committee recalled that the plan of action for i mplementing the strategies for health for all by the year 2000, as approved by resolutions WHA35.23 and WPR/RC32.R5; provided for continuous monitoring and evaluation of those strategies. Member States were requested to monitor and evalu~te their strategies and to submit their reports to the Regional Director every two years. Monitoring of progress had been undertaken for the first time in 1983, while the first evaluation of strategies would be done in 1985. 12 REGIONAL COMMITTEE: THIRTY-FIFTH SESSION During the discussions on the regional synthesis of the monitoring reports at the thirty-fourth session of the Regional Committee in 1983, a number of representatives had voiced their difficulties in understanding the wording of the questions and the significance of the indicators used in the Common Framework and Format for monitoring the strategies. The Secretariat had therefore felt that it would be in the best interests of Member States and the Secretariat if the Common Framework and Format :for Evaluating Strategies for Health for All, to be used in reporting in 1985, could be reviewed by the Sub-Committee on the General Programme of Work, keeping in mind the comments made on the monitoring format. In its review of the Common Framework and Format for evaluation, the Sub-Committee had observed that many questions needed further clarification or examples. However, since it was a global document intended for use by all the regions, the Sub-Committee did not wish to propose any restructuring of the format itself. Instead, it had proposed that a summary of all the points raised, containing supplementary illustrative information, be prepared and submitted to Member States. Such information had been summarized in the ten-page document appended to Annex 4 of document WPR/RC35/6. The representatives of six Member States spoke in support of the report of the Sub-Committee. In reply to points raised by representatives during the discussions, the Committee observed that preparatory work for the review of the structure and terms of reference of the Sub-Committee would be undertaken by the Secretariat so that the subject could be discussed at the thirty-sixth session of the Committee. In the meantime, the Committee requested the Sub-Committee to continue to: ( 1) review and analyse the impact of WHO's cooperation with Member States; and (2) review, monitor and evaluate the implementation of strategies for health for all by the year 2000 (see resolution WPR/RC35.R6). The findings and recommendations of the Sub-Committee with respect to health manpower development were reflected in resolution WPR/RC35.R4; its findings and recommendations in relation to its review of the Common Framework and Format for Evaluating the Strategies for Health for All by the Year 2000 were reflected in resolution WPR/RC35.R5. 1.2 Membership of the Sub-Committee The Committee decided that, from the thirty-fifth session, the representatives of China, Cook Islands and Samoa should replace those of Australia, Papua New Guinea and Viet Nam as members of the Sub-Committee for a period of three years (see resolution WPR/RC35.R7). 2. Sub-Committee on Technical Cooperation among Developing Countries; Report of the Sub-Committee (Document WPR/RC35/5) The report was introduced by the representative of Malaysia in the absence of the Chairman and the Rapporteurs of the Sub-Committee on Technical Cooperation among Developing Countries. The Sub-Committee had REPORT OF THE REGIONAL COMMITTEE 13 met on 28-29 June 1984 to consider the report on the visits of its members to Fiji, Papua New Guinea and the Philippines, and to make recommendations for the promotion of technical cooperation in training in primary health care, with particular reference to its managerial and support aspects. It bad noted that, while all countries were reorienting their staff, planning and management of health care systems, with emphasis on community participation and intra- and intersectoral coordination, to the primary health care approach, there was still room for improvement. There was variation between countries in the stage of implementation reached, and it was noted that experiences in one country were not necessarily directly applicable to othe~s. Research and development projects in primary bealth care had very strong training components. Information exchange among countries was not satisfactory and it felt that the inventory of training activities conducted by countries in the Region should be more comprehensive and complete. The Sub-Committee had in consequence made six recommendations, which were contained in document WPR/RC35/5. The Sub-Committee had also recommended address itself to the topic of traditional reference to herbal medicine and acupuncture. that, in medicine, 1985, with it should particular The representatives of seven Member States spoke in support of the Sub-Committee's report. In response to the observation of the representative of China, that an increase in the membership of the Sub-Committee would be beneficial to its work, the Committee acknowledged the need to increase its membership, particularly in view of the complex topic proposed for 1985. It was noted, however, that such an increase would have budgetary implications. It was agreed therefore that a review of the activities, membership and structural arrangements of both Sub-Committees of the Regional Committee should be undertaken with a view to submitting a proposal concerning their future work and structure to the thirty-sixth session of the Regional Committee. The Committee noted the comments of the representative of Australia that the terms of reference related to the country visit and the subsequent meeting in Manila required reconsideration, as well as the number of countries to be visited, and that there should be an elective period during which Sub-Committee members could. explore particular areas of interest during a country visit. It also noted the suggestion of the representative of Malaysia that details of the information and the consultations required by the Sub-Committee should be sent to the host country before the visit. The recommendations of the Sub-Committee and the discussions of the Committee concerning the structure, terms of reference and method of work of the Sub-Committee were reflected in resolution WPR/RC35.R3. 14 REGIONAL COMMITTEE: THIRTY-FIFTH SESSION PART IV. OTHER MATTERS 1. Health Resources Group for Primary Health Care: Membership of the Group (Document WPR/RC35/7) The Committee heard an explanati()n from the representative of the Philippines, as representative of the Western Pacific Region on the Health Resources Group for Primary Health Care, of the functioning of the Group and its terms of reference. The Committee noted that a major function of the Group was to help countries in need to develop a system to analyse their needs and assess the resources required. Its function was not to raise funds but rather to study methods of helping countries to identify their needs. A nu~ber of countries had been assisted by the country resources utilization reviews. Meetings of the Group provided some indication of the extent to which donors were prepared to provide assistance. The Committee decided to elect Tonga as the member to represent the Region on the Group for a period of two years from January 1985 (see resolution WPR/RC35.R7). 2. Correlation of the work of the World Health Assembly, the Executive Board and the Regional Committee 2.1 Consideration of resolutions of the Thirty-seventh World Health Assembly and the Executive Board at its seventy-third and seventy-fourth sessions (Document WPR/RC35/8) The Committee considered the following resolutions: ( 1) Prevention and control of vitamin A deficiency and xerophthalmia (resolution WHA37.18) (2) Collaboration within the United Nations system - General matters; Abuse of narcotic and psychotropic substances (resolution WHA37.23) (3) International standards and units for biological substances (resolution WHA37.27) (4) Infant and young child nutrition (resolution WHA37.30) (5) Action Programme on Essential Drugs and Vaccines (resolution WHA37.32) (6) Rational use of drugs (resolution WHA37.33) (7) International Programme on Chemical Safety (resolution EB73.Rl0) A summary of the comments made on specific resolutions is given below: 2.1.1 Infant and young child nutrition (resolution WHA37.30) The Committee observed that annual reports from Member States due in March 1985 would serve to present a consolidated report on the subject to the Regional Committee at its thirty-sixth session. REPORT OF THE REGIONAL COMMITTEE 15 The representative of the Philippines reported to the Committee on a national movement for the promotion of breast-feeding, which had been officially launched in his country in March 1983, involving eighteen government agencies and representatives of the private sector in its work. WHO and other international agencies had given their full cooperation. 2.1.2 Action Programme on Essential Drugs and Vaccines (resolution WHA37 .32) In response to comments made by the representative of Malaysia, the Committee adopted a resolution on the Action Programme, urging Member States to intensify their efforts to strengthen \}at·ional capabilities to ensure the supply of essential drugs, and requesting the Regional Director inter alia to convene a meeting of an ad hoc subcommittee of the Regional Committee to consider means of cooperation among_ Member States in that field, and t9 report to the Committee at its next session on the current situation · in regard to the Programme, including the outcome of the meeting (see resolution WPR/RC35.Rll). 2.2 Consideration of the agenda of the seventy-fifth session of the Executive Board (Document WPR/RC35/9) The representative of Japan introduced a draft resolution, co-sponsored by the representatives of Australia, China, Fiji, Japan, Kiribati, New Zealand, Philippines, Republic of Korea and Tonga, concerning Members of the World Health Organization in the Western Pacific Region entitled to designate a person to serve on the Executive Board. In the light of the ensuing discussions and the explanation provided by the Legal Counsel, WHO Headquarters, the Committee decided to recommend to the Executive Board, and through it to the World Health Assembly, that consideration be given to increasing the number of Members from the Western Pacific Region entitled to designate a member of the Board from the current three to four (see resolution WPR/RC35.Rl0). The representative of Vanuatu proposed consideration of a draft resolution concerning the inclusion in the Committee 1 s agenda for its thirty-sixth session of the topic of the health hazards to the people of the Western Pacific Region due to the testing of nuclear weapons and the dumping of nuclear waste. After discussion and in the light of Rule 36 of the Rules of Procedure for the Regional Committee, the Committee decided to accept the proposal of the representative of the Republic of Korea, that the Committee should not consider a resolution on the subject but that the discussion should be reported in the records. The Committee noted that the concern expressed during the discussions would be reflected in the report of the Regional Director to the Executive Board. 16 REGIONAL. COMMITTEE; THIRtY-FIFTH SESSION In response to the representative of the Philippines, who referred to the increasingly serious problem of sources of nuclear energy and the potential risk for communities in the vicinity of nuclear power plants, the Committee observed that that concern would be reflected in the report of the Regional Director to the Executive Board and might be usefully discussed at the meeting of the Progra1D1Be Committee preceding the Executive Board's next .session. 3. Women, health and development (Document WPR/RCJS/10) The Committee reviewed document WPR/RC35/10. It noted that, as part of the United Nations activities aimed at improving the status of women within the framework of development, WHO had given attention to the integration of various aspects pertaining to women within certain of its programmes. The document before the Committee provided a summary of information available on activities specifically related to women in health and development, initiated in the Region with WHO collaboration, including a brief outline, based on information received from Member States, of the current social and health status of women in the Region. The Committee noted that the approaches used by WHO in promoting women's health issues within its overall programme included: promotion of the intersectoral approach in improving the health status of women; collection, synthesis and dissemination of information concerning women, health and development; and involvement of women 1 s organizations in health and development activities, particularly in relation to primary health care. The representatives of sixteen Member States spoke in relation to this topic and expressed their strong support for the action proposed in section 3 of the document. Most of the representatives, in reporting on the current status of activities in their countries, referred to the indispensable and positive contribution of women's associations or organizations, voluntary or otherwise, in promoting the role of women in health and social and economic development, in particular in such areas as maternal and child health care, family planning, disease prevention and control, environmental sanitation and drinking-water supply, and local food production, with the resultant reduction in morbidity and infant mortality. The representatives of Malaysia and Papua New Guinea endorsed the statement contained in the document, that the social status of women could not be examined in a uniform manner because of the widely differing societies within the Region in terms of industrialization, culture and political and economic systems, and noted that in consequence strategies and programmes needed to be adapted to local communities and local cultures. The representative of Tonga, while endorsing the action proposed in the document, regretted the absence of any reference to such issues as prostitution or pornography, as examples of the ways in which men injured the special dignity of women through domination and exploitation. The representative of Australia supported steps to improve the collection of statistics by differentiating data according to age, sex and REPORT OF THE REGIONAL COMMITTEE 17 ethnic group since measures of mortality and vital statistics failed to reflect true levels of morbidity among women. The Committee beard a report from the Director, Division of Family Health, WHO Headquarters, on the status of activities during the United Nations Decade for Women, with particular reference to specific activities of WHO. The Committee adopted reflecting some of the resolution WPR/RC35.R8). a resolution on women, concerns expressed by health and development representatives (see 4. Hepatitis as a public bealtb problem (Document WPR/RC35/ll) 'nle Committee had before it for review document WPR/RC35/ll describing the current situation of act1v1t1es for the control, prevention and surveillance of hepatitis B in the Region and providing a brief outline of proposed collaborative activities~ including the development of low-cost plasma-derived vaccine and research on a new vaccine, using the recombinant deoxyribonucleic acid (DNA) technique. It was noted that there were an estimated 215 million chronic carriers of hepatitis B virus throughout the world, approximately 168 million of whom resided in the Western Pacific Region and other countries in Asia. Hepatitis B virus infection, in particular the persistent hepatitis B virus carrier state, was shown to be closely associated with the development of chronic liver diseases such as active chronic hepatitis, liver cirrhosis and primary hepatocellular carcinoma. The representatives of sixteen Member States commented on various aspects of this topic. The Committee agreed that hepatitis was a serious public health problem in the Region, and in some countries a major problem, and endorsed the efforts being made by WHO to prevent and control hepatitis B. It was agreed that the active participation of Member States in the surveillance, prevention and control of the disease was of the utmost importance. A number of representatives described the current situation in their countries in some detail and informed the Committee of measures being taken by their health authorities in relation to research, production of vaccines or diagnostic reagents, and prevention, control and surveillance activities. The Committee agreed that, while commercial hepatitis B vaccine derived from plasma was available and had been shown to be efficacious in preventing transmission of the virus, the current cost of the vaccine was prohibitive. It was therefore unrealistic to use such vaccines on a wide scale. and a number of countries had adopted the strategy of selective immunization for such high-risk groups as health care personnel (hospital and laboratory workers), babies born to mothers positive for hepatitis B surface antigen, home contacts of acute cases etc. Other strategies for control mentioned by representatives included the definition of high-risk groups, health education on the mode of transmission, particularly for high-risk groups, management of blood 18 REGIONAL COMMITTEE; THIRTY-FIFTH SESSION transfusion and blood products, screening of blood donors, sterilization of equipment in hospitals and laboratories, etc. The Committee noted that limited production of plasma-derived hepatitis B vaccine had started or was starting in three countries (China, Japan and the Republic of Korea; in oroer to meet local requirements. The representative of the Republic of Korea informed the Committee that by 1985 its production capacity would attain 10 million doses. The representative of Singapore stated that the first batch of vaccine produced from locally collected plasma was expected to be ready in 1986 and available to other countries in the Region. The representative of France stated that his Government was prepared to cooperate in the control of the disease and had available a plasma-derived vaccine, which was still, however, very expensive. Among other points noted by the Committee in reply to questions were the following: (1) Research was in progress on the development of a new hepatitis B vaccine using the recombinant DNA technique in several countries. However, while good progress had been made, further studies would be needed before it could be made available for general use. Techniques for purification of such vaccines were very complicated. (2) The costs of plasma-derived vaccine had recently decreased and new developments in production techniques should accelerate the trend. Technica 1 cooperation was important in that respect, and negotiations were under way to investigate the possibility of establishing several production centres to supply the vaccine needs of all countries in the Region at low cost. (3) Hepatitis B plasma-derived vaccine was very effective not only for the protection of adults but also for the prevention of mother-to-infant transmission of infection. It was also heat-stable. Thus a cold chain was not absolutely necessary and distribution presented no problem. (4) Progress had been made recently in the development of diagnostic techniques. It was hoped that reliable reagents would soon be available for use under field conditions. (5) There was no evidence so far for or against the existence of an insect vector. The development of sensitive methods for detecting hepatitis B virus such as DNA hybridization techniques should permit investigation of that topic in the near future. (6) Studies had shown that three or four doses of vaccine alone protected approximately 90% of neonates. Other studies showed that that percentage increased when immunoglobulin was administered in addition. However, the high cost of immunoglobulin limited the applicability of the combination, particularly for large-scale use in developing countries. REPORT OF THE REGIONAL COMMITTEE 19 Noting the comments of representatives during the discussions of this agenda item, the Committee adopted a resolution on this topic to reflect the various preoccupations of Member States (see resolution WPR/RC35.Rl4). 5. WHO Guideline$ for drinkin -water qualit Documents WPR/RC35/12 and WPR/RC35/INF DOC/2) The representative of New Zealand, introducing this item which had been proposed by his Government, observed that the New Zealand Standards for Drinking-Water Quality, referred to in document WPR/RC35/INF DOC/2, were based on the recently published WHO Guidelines for drinking-water quality, which had superseded the International standards for drinking-water. The new WHO Guidelines had taken over three years to develop, with the cooperation of many participants from many countries. In adapting those Guidelines for its own use, the New Zealand Board of Health had reduced the exp~anatory material and omitted criteria irrelevant to the country, but had added some herbicides and other substances that were sometimes present in water in New Zealand. Modifications would be needed from time to time as new chemicals entered the water supply. The result was a set of New Zealand Standards that reflected the national environment. They could not be used elsewhere without modifications, and it was to be hoped that other countries would draft standards of their own. The New Zealand Standards would be used by local authorities for assessing the quality of water supplies and for developing suitable monitoring and sampling programmes. New Zealand had raised the subject in the Regional Committee partly because, almost half-way through the International Drinking Water Supply and Sanitation Decade, it seemed appropriate to emphasize the need to provide a pure water supply, as that would influence the health standards of a population more than any other single event. Developed countries needed to remember that their health standards were based on such fundamental factors as a pure water supply and adequate waste disposal methods. The preparation of the New Zealand Standards was a recogn1t1on that it was not enough merely to provide a sophisticated water distribution scheme. Without proper management and monitoring of performance, such schemes would present an even greater danger than the village well. The representatives of Australia, China, Malaysia and Tonga commented on different aspects of the topic. The representative of Malaysia observed that a number of technical and operational problems remained to be solved if the Decade objectives were to be achieved, including among others; (1) inadequacy of efforts to provide for safe excreta disposal; (2) inadequate operation and maintenance, shortage of staff and resources in support of existing water supply and waste disposal systems; (3) use of inappropriate over-sophisticated technology leading to maintenance difficulties; (4) shortage of trained manpower, who were concentrated in urban areas. The representative of China supported the Guidelines, which would lead to monitoring, help ensure water quality and serve as a reference. The representative of Australia expressed support for the recotDtDendations contained in section 4 of document WPR/RC35/12, with the 20 REGIONAL COMMITTEE: THIRTY-FIFTH SESSION exception of the second sentence of recommendation (1) urging authorities to develop national drinking~ater standards from the Guidelines for drinking-water quality. It would be a retrograde step to insist on national standards rather than considering cost, risk and benefit factors. Desirable rather than absolute standards might be appropriate, with the WHO Guidelines to be used where ther~ was a major cost penalty in achieving the desirable standard. The Committee adopted a resolution on this topic urging Member States to undertake a number of appropriate measures and requesting the Regional Director inter alia to intensify support for the promotion of national drinking~ater standards through the use of the Guidelines, and to continue to cooperate with Member States in the development of national programmes for the monitoring, surveillance and control of drinking~ater supplies (see resolution WPR/RC35.Rl5). 6. in conjunction with The Committee reviewed document WPR/RC35/13 Rev.l, which proposed four topics for discussion in 1985. The Committee decided to select the topic of "The role of traditional medicine in primary health care" as the subject for discussion. It was observed that the Sub-Committee on Technical Cooperation among Developing Countries had already recommended that, in 1985, it should consider the technical cooperation aspects of traditional medicine, with particular reference to herbal medicine and acupuncture. An attempt would therefore be made to coordinate the two recommendations. The CotmDittee 1 s attention was also drawn to the suggested framework and plan of action that had be•n formulated by WHO Headquarters in preparation for the Technical Discussions during the Thirty-eighth World Health Assembly in 1985 on the subject of "Collaboration with nongovernmental organizations in implementing the Global Strategy for Health for All". It had been reproduced for the Committee's information as document WPR/RC35/INF DOC/1. 7. Time and place of the thirty-sixth and thirty-seventh sessions of the Regional ColiiiDittee The Committee decided that the thirty-sixth session of the Committee would be held at regional headquarters in Manila from 16 to 20 September 1985. It was also decided that, in the absence of an invitation for the thirty-seventh session, that session would likewise be held in regional headquarters in Manila. 8. Reports received from governments on the progress of their health activities The Chairman acknowledged the following reports presented to the Committee: REPORT OF THE REGIONAL COMM:{.TTEE 21 (1) Australia - Report on progress of national health activities (2) China - Brief report on the progress of health services in the People's Republic of China, 1983-1984 (3) Hong Kong - Progt"ess report on health activities, 1983 (4) Kiribati - Brief report on the progress of health activities (5) Lao PeQple's Democratic Republic activities Short report on health (6) Republic of Korea situation Progress report on the national health (7) Samoa - Health and health services status, 1984 (8) Singapore - Brief report on the progress of health activities (9) Solomon Islands development Brief report on general health s ervices (10) Viet Nam - Brief report on the health situation PART V. RESOLUTIONS ADOPTED BY THE REGIONAL COMMITTEE WPR/RC35.Rl REPORT OF THE REGIONAL DIRECTOR The Regional Committee, Having reviewed the report of the Regional Director on the Work of WHO in the Western Pacific Region during the period 1 July 1983 to 30 June 1984,1 1. NOTES with satisfaction the manner in which the programme was planned and carried out; 2. COMMENDS the Regional Director and his staff for the work accomplished. Seventh meeting, 10 September 1984 lDocument WPR/RC35/4. 22 REGIONAL COMMITTEE: THIRTY-FIFTH SESSION WPR/RC35. R2 PROGRAMME BUDGET FOR 1986-1987 The Regional Committee, Having examined the proposed programme budget estimates for the biennium 1986-1987 to be financed from the regular budget and other sources of funds,l REQUESTS the Regional Director to transmit the proposals to the Director-General for consideration and inclusion in his proposed programme budget for the biennium 1986-1987. Seventh meeting, 10 September 1984 WPR/RC35. R3 SUB-COMMITTEE ON TECHNICAL COOPERATION AMONG DEVELOPING COUNTRIES The Regional Committee, Having considered the report of the Sub-Committee on Technical Cooperation among Developing Countries;2 Recalling resolution WHA31.41 and noting resolution WHA37.16; Commending the activities being undertaken by Member States of the Region in the field of training in primary health care, and recognizing the potentials for technical cooperation, but also noting the problems encountered and the need to strengthen technical cooperation; 1. THANKS the Sub-Committee for its work; 2. URGES Member States: (1) to develop primary health documentation; documentation on care and to their experiences in tra1n1ng in intensify the exchange of such (2) to maintain complete lists of all their existing and planned training activities in primary health care and to disseminate them as necessary; lDocument WPR/RC35/3. 2Document WPR/RC35/5. REPORT OF THE REGIONAL COMMITTEE 23 (3) to undertake more research and development activities in primary health care and to ensure their continuity; (4) to encourage health and health-related professional bodies to intensify their participation in primary health care and to be actively involved in techn~cal cooperation with other countries; (5) to develop further the capability of their institutions for training and research in primary health care; (6) to strengthen their mechanisms for technical cooperation in health activities and to exchange information on their needs and policies with respect to technical cooperation; 3. REQUESTS the Regional Director: ( 1) to support Member States in their efforts to strengthen their capabilities for technical cooperation in health activities; (2) to promote linkages among the research and development projects in different countries; (3) to consider the designation of additional suitable institutions as collaborating centres in primary health care; (4) to make whatever arrangements are necessary to enable the Regional Comtnittee to study, at its next session, the structure, terms of reference, and method of work of the Sub-Committee on Technical Cooperation among Developing Countries in relation to the structure, terms of reference and method of work of the Sub-Committee on the General Programme of Work; 4. REQUESTS the Sub-Committee, in the meantime, to address the subject of the technical cooperation aspects of traditional medicine, with particular reference to herbal medicine and acupuncture. Seventh meeting, 10 September 1984 WPR/RC35.R4 HEALTH MANPOWER DEVELOPMENT The Regional Committee, Having considered the report of the Sub-Committee on the General Programme of Work;l loocument WPR/RC35/6. 24 REGIONAL COMMITTEE: THIRTY-FIFTH SESSION Stressing the crucial importance of the proper management of health manpower resources for the attainment of the goal of health for all by the year 2000; Appreciating the need for a coordinating mechanism for the integrated development of health manpower and health services; Recognizing the need to coordinate in addition the within the health manpower development process, such production, deployment, utilization and continuing education; various steps as planning, Emphasizing the need to obtain makers, health administrators and health manpower development; a more positive response among policy trainers to innovative approaches to 1. URGES Member States; ( 1) to set up and strengthen mechanisms for coordination, review and continuous monitoring to ensure comprehensive and harmonious health manpower development, covering such areas as policy formulation, planning, production and deployment; (2) to prepare sufficient numbers of . teachers in the health sciences and of health administrators in the application of methods of community and task-oriented education so as to enable them to review and reorient the basic training programmes and to formulate and implement schemes for continuing education; (3) to encourage the health services and tra1n1ng institutions to design and implement research and development activities in the area of health manpower development; 2. REQUESTS the Regional Director: (1) to study alternative ways and means of ensuring development of health manpower policies and plans achieving greater effectiveness and efficiency in management of health personnel; the comprehensive with a view to the training and (2) to collaborate in the organization of national workshops aimed at developing and strengthening capabilities for progressively introducing changes at existing training institutions directed towards a community-oriented education; (3) to encourage the introduction of innovative educational approaches, particularly community-oriented and problem-solving teaching, in selected existing and newly established schools of medical and nursing education, and to foster the exchange of information on the application of such approaches to health manpower development; REPORT OF THE REGIONAL COMMITTEE 25 (4) to collaborate in designing and conducting research on subjects of special concern to Member States, including the monitoring of the health manpower development process. Seventh meeting, 10 September 1984 WPR/RC35.R5 EVALUATING THE STRATEGIES FOR HEALTH FOR ALL BY THE YEAR 2000 The Regional Committee, Having considered the report of the Sub-Committee on the General Programme of Work; Recalling resolution WPR/RC32.R5 by which it accepted the plan of action for monitoring and evaluating implementation of the Regional Strategy for Health for All by the Year 2000; Recalling also resolution WPR/RC34.Rl2 urging Member States to initiate activ1t1es relevant to the development of mechanisms and procedures for evaluating 1n 1985 the effectiveness of national health-for-all strategies; Noting resolution WHA37 .17 urging Member States to accord the highest priority to and assume full responsibility for the continuing monitoring and evaluation of their strategies; 1. THANKS the Sub-Committee on the General Programme of Work for reviewing in detail the questions contained in the Common Framework and Format for Evaluating the Strategies for Health for All, and for preparing the supplementary information document intended to assist Member States in answering them; 2. ACCEPTS the proposed Common Framework and Format for evaluating the strategies, together with its appendix; 3. REQUESTS Member States to use the Common Framework and Format as the basis for evaluating their national health-for-all strategies and for preparing the progress report to the Regional Director due in March 1985; 4. REQUESTS the Regional Director: {1) to provide the necessary support to Member States 1n the preparation of their reports; (2) to prepare a regional synthesis of the reports, to be submitted to the Regional Committee at its thirty-sixth session. Seventh meeting, 10 September 1984 26 REGIONAL COMMITTEE: THIRTY-FIFTH SESSION WPR/RC35. R6 SUB-COMMITTEE ON THE GENERAL PROGRAMME OF WORK The Regional Committee, Having considered the report of the Sub-Committee on the General Programme of Work; 1. THANKS the Sub-Committee for its work; 2. REQUESTS the Regional Director to make whatever arrangements are necessary to enable the Regional Committee to study, at its next session, the structure, terms of reference, and method of work of the Sub-Committee on the General Programme of Work in relation to the structure, terms of reference and method of work of the Sub-Committee on Technical Cooperation among Developing Countries; 3. REQUESTS the Sub-Committee, in the meantime, to continue to; (1) review and analyse the impact of WHO's cooperation with Member States; (2) review, monitor and evaluate the implementation of strategies for health for all by the year 2000. Seventh meeting, 10 September 1984 WPR/RC35.R7 MEMBERSHIP OF THE SUB-COMMITTEE ON THE GENERAL PROGRAMME OF WORK The Regional Committee, Recalling resolutions WPR/RC30.R9 on the period of WPR/RC32.R9 on the number of members of the Sub-Committee on Programme of Work; tenure and the General Noting that the three-year periods of tenure of the representatives of Australia, Papua New Guinea and Viet Nam end at the thirty-fifth session of the Regional Committee; 1. DECIDES to appoint the representatives of China, Cook Is lands and Samoa as members of the Sub-Committee for three years from the thirty-fifth session, in addition to the representatives of Fiji, Japan, the Philippines, Singapore and Tonga; 2. THANKS the representatives of Australia, Papua New Guinea and Viet Nam for their contributions to the work of the Sub-Committee. Seventh meeting, 10 September 1984 REPORT OF THE REGIONAL COMMITTEE 27 WPR/RC35.R8 WOMEN, HEALTH AND DEVELOPMENT The Regional Committee, Recalling resolutions WHA28.40, WHA29.43 and WHA36.21; Noting the action being taken to promote the active involvement of women in health and development; Having reviewed the report of the Regional Director on the present situation of women in the context of health and development in Member States of the Western Pacific Region;l 1. URGES Member States: (1) to collect information on the social and health status of women and to incorporate sex and age factors in the existing data collection and reporting system in order to facilitate the identification of women's health problems as a basis for action; (2) to strengthen social support measures for women by enhancing the existing family and community support mechanisms and by initiating and implementing concrete social support policies and programmes to meet the changing needs of women, so as to improve their health and social status and enable them to perform their multiple roles in the family and in society; (3) to strengthen the capacity of women's groups or organizations for effective participation in integrated primary health care; (4) to promote awareness of the need to protect and improve the health status of women through community health education programmes; (5) to undertake research to help identify health needs and problems specific to women; (6) to develop a mechanism for monitoring the social and health status of women; (7) to accelerate the integration of issues related to women and health in all health programmes; loocument WPR/RC35/10. 28 REGIONAL COMMITTEE: THIRTY-FIFTH SESSION 2. REQUESTS the Regional Director: (1) to give priority to the implementation of appropriate measures aime.d at strengthening the provision of health care for all women and enhancing their participation in health and development as part of the regional strategy for heal~h for all; (2) to mobilize financial support from extrabudgetary sources. WPR/RC35.R9 Seventh meeting, 10 September 1984 MEMBERSHIP OF THE HEALTH RESOURCES GROUP FOR PRIMARY HEALTH CARE The Regional Committee, Recalling resolutions WHA34.37, EB69.R4, WPR/RC3l.Rl7 and WPR/RC33.R7; Noting that the two-year period of tenure of the Philippines as the member of the Health Resources Group for Primary Health Care from the Western Pacific Region will end on 31 December 1984; 1. ELECTS Tonga as the member from the Western Pacific Region of the Health Resources Group for Primary Health Care, for a period of two years from 1 January 1985; 2. THANKS the representative of the Phil i ppines for his services to the Group. Seventh meeting, 10 September 1984 WPR/RC35.Rl0 MEMBERS OF WHO IN THE WESTERN PACIFIC REGION ENTITLED TO DESIGNATE A MEMBER OF THE EXECUTIVE BOARD The Regional Committee, Recalling resolution WPR/RC32.R7 on the number of Members from the Western Pacific Region entitled to designate a member of the Executive Board; Recalling also a similar previous recommendation of the Sub-Committee on the General Programme of Work, which was endorsed by the Regional Committee; Maintaining the principle that health for all by the year 2000 means health through the people; REPORT OF THE REGIONAL COMMITTEE 29 Reiterating the fact that the Western Pacific Region has the h,igl)est population of any WHO region; Noting that the number of Member States in the Western Pacific Region bas significantly increased since resolution WPR/RC32.R7 was adopted; Remaining aware of the present criteria for electing a Member entitled to designate a person to serve on the Executive Board; RECOMMENDS to the Executive Board, and through it to the World Health Assembly, that consideration be given to increasing the number of Members from the Western Pacific Region entitled to designate a member of the Board from the current three to four. Seventh meeting, 10 September 1984 WPR/RC35.Rll ACTION PROGRAl'fME ON ESSENTIAL DRUGS AND VACCINES The Regional Committee, Having considered resolutions WHA37. 32 and WHA37. 33 on the Action Programme on Essential Drugs and Vaccines and the rational use of drugs; Recalling resolution WPR/RC32.Rl7 by which it noted the approaches that would form WHO's plan of action in implementing the Action Programme; Co'IDIIlending the steps already taken to implement the Action Programme on Essential Drugs and Vaccines and to increase national capability in drug quality assurance, manpower development, and drug production and distribution; 1. URGES Member States to intensify their efforts in the strengthening of national capabilities in order to ensure the supply of essential drugs to their people; 2. REQUESTS the Regional Director: (1) to cooperate with Member States in measures to introduce and implement drug policies in order to improve national capabilities in drug quality assurance, manpower development, national or regional drug production, the use of drugs, prescription practices, and the provision of complete and unbiased information about drugs to members of the health profession and the public; (2) to foster the exchange of information among Member States on drugs, including quality assurance, drug registration, rational distribution systems to meet the health needs of Member States, and drug safety and efficacy; 30 REGIONAL COMMITTEE: THIRTY-FIFTH SESSION (3) to convene, within available resources, a meeting of an ad hoc subcommittee of the Regional Committee, composed of representatives of select~d Member States, tb consider means of cooperation among Member States in this field; and to report to the Regional Committee at the thirty-sixth session on the current situation in regard to the Programme, including the o'-'tcome of the meeting; (4) to endeavour to muster increased extrabudgetary resources for activities relating to the Action Programme on Essential Drugs and Vaccines in the Region. Eighth meeting, 11 September 1984 WPR/RC35 .Rl2 RESOLUTIONS OF REGIONAL INTEREST ADOPTED BY THE THIRTY-SEVENTH WORLD HEALTH ASSEMBLY AND BY THE EXECUTIVE BOARD AT ITS SEVENTY-THIRD SESSION The Regional Committee TAKES NOTE of the following resolutions adopted by the Thirty-seventh World Health Assembly and by the Executive Board at its seventy-third session: WHA37 .18 WHA37 .23 WHA37.27 WHA37.30 EB73.Rl0 WPR/RC35.R13 Prevention and control of vitamin A deficiency and xerophthalmia Collaboration within the United Nations system - General matters: Abuse of narcotic and psychotropic substances International standards and units for biological substances Infant and young child nutrition International Programme on Chemical Safety Eighth meeting, 11 September 1984 CORRELATION OF THE WORK OF THE WORLD HEALTH ASSEMBLY, THE EXECUTIVE BOARD AND THE REGIONAL COMMITTEE The Regional Committee, Having considered the main items of the provisional agenda of the seventy-fifth session of the Executive Board,1 lDocument WPR/RC35/9. REPORT OF THE REGIONAL COMMITTEE 31 NOTES with satisfaction the efforts being ·made to correlate the work of the Regional Committee, the Executive Board and the World Health Assembly. Eighth meeting, 11 September 1984 WPR/RC35 .Rl4 VIRAL HEPATITIS B AS A PUBLIC HEALTH PROBLEM The Regional Committee, Having considered the report of the Regional Director on hepatitis as a public health problem;l Concerned at the high prevalence of viral hepatitis B in many countries of the Region and the effects of its long-term sequelae; Recognizing that technology for the production of a vaccine effective in preventing the transmission of hepatitis B virus exists l.n some countries of the Region, as well as sensitive and rapid methods of diagnosis usable at all levels; Considering that the cost of both vaccine and reagents could be substantially reduced through the further development of production within the Region; Considering also the need to intensify research for the development of new vaccines and diagnostic reagents; 1. URGES Member States: ( 1) to formulate programmes for the prevention and control of viral hepatitis B and to initiate these programmes in a phased manner; (2) to strengthen laboratory capability to ensure that aero-epidemiological surveys of the population are effectively carried out, particular attention being given to such groups as blood donors, pregnant women and persons at high risk of infection; 2. REQUESTS the Regional Director: (1) to stimulate the further development, production and monitoring of safe, effective and low-cost hepatitis B vaccine derived from human plasma and of diagnostic reagents; (2) to develop a vaccination scheme, covering the most vulnerable groups such as newborns and using the most appropriate dosage; lnocument WPR/RC35/ll. 32 REGIONAL COMMITTEE: THIRTY-FIFTH SESSION (3) to encourage research on the development of a new hepatitis B vaccine using modern biotechnology, in particular recombinant DNA technology, with a view to its eventual production; (4) to continue to strengthen cooperation with Member States in the exchange of information an~ training of scientists; (5) to foster cooperation between countries in the transfer of technology for the production of vaccines and diagnostic reagents; (6) to continue in his endeavours to mobilize extrabudgetary resources and to increase the allocation of such resources to the programme for prevention and control of viral hepatitis B. Eighth meeting, 11 September 1984 WPR/RC35 .Rl5 GUIDELINES FOR DRINKING-WATER QUALITY The Regional Committee, Recalling resolutions WHA34.25, WHA36.13 and WPR/RC34.R4 on the International Drinking Water Supply and Sanitation Decade; Recognizing the importance of safe drinking water and adequate sanitation services as essential components in the primary health care approach to the goal of health for all by the year 2000; Having reviewed the refort of the Regional Director on the Guidelines for drinking-water quality; 1. URGES Member States: (1) to update their national drinking-water standards, taking into consideration the Guidelines for drinking-water quality; (2) to develop and implement monitoring, surveillance and control programmes to ensure the safety of drinking water; and (3) to initiate a community-level information and education programme that will foster awareness of the people's right to safe drinking water and of the people's responsibility for the proper use and maintenance of water supply systems or facilities to ensure the safety of drinking water, whenever the community is directly involved in their operation and maintenance; lDocument WPR/RC35/12. REPORT OF THE REGIONAL COMMITTEE 33 (4) to improve further the operation and maintenance of existing water and sanitation systems and to institute programmes for their rehabilitation; 2. REQUESTS the Regional Director: (1) to inteQsify support to Member States for the promotion of national drinking-water standards through the use of the Guidelines; (2) to continue to cooperate with Member States in the development of national programmes for monitoring, surveillance and control of drinking-water supplies to ensure their safe use; (3) to intensify activities at the WHO Western Pacific Regional Centre for the Promotion of Environmental Planning and Applied Studies in support of national progralD1DeS for the International Drinking Water Supply and Sanitation Decade. Eighth meeting, 11 September 1984 WPR/RC35 .Rl6 TECHNICAL DISCUSSIONS The Regional Committee, Having considered the topics suggested by the Regional Director for the Technical Discussions in conjunction with the thirty-sixth session of the Regional Committee,! DECIDES that the subject of the Technical Discussions in 1985 shall be "The role of traditional medicine in primary health care". Eighth meeting, 11 September 1984 WPR/RC35.Rl7 THIRTY-SIXTH AND THIRTY-SEVENTH SESSIONS OF THE REGIONAL COMMITTEE The Regional Committee, Recalling resolution WPR/RC24.Rl0; 1. CONFIRMS its decision to hold the thirty-sixth session of the Regional Committee at regional headquarters in Manila; lDocument WPR/RC35/13 Rev.l. 34 REGIONAL COMMITTEE; THIRTY-FIFTH SESSION 2. DECIDES that the dates of the thirty-sixth session shall be from 16 to 20 September 1985; 3. NOTES that no invitation has been received for the thirty-seventh session; 4. AUTHORIZES the Regional Director to accept, on behalf of the Regional Committee, any such invitation which may be extended and to inform all Member States of the Region before the thirty-sixth session of the Regional Committee, the dates and place to be confirmed at that session; 5. DECIDES that if no invitation is received, the thirty-seventh session of the Regional Committee shall be held at regional headquarters in Manila. Eighth meeting, 11 September 1984 WPR/RC35 .Rl8 RESOLUTION OF APPRECIATION The Regional Committee EXPRESSES its appreciation and thanks to: (1) the Government and people of Fiji for: (a) having invited the Regional thirty-fifth session in Suva; Committee to hold (b) the excellent arrangements and facilities provided; (c) the generous welcome and the hospitality received; (2) the Chairman and other officers of the Committee; its (3) Professor Tu Gi!y, for having accepted to act as moderator of the Technical Discussions; (4) the representatives of the United Nations Children • s Fund, the South Pacific Commission and the nongovernmental organizations for their statements; (5) the Regional Director and the Secretariat for their work in connection with the session. Eighth meeting, 11 September 1984 REPORT OF THE REGIONAL COMMITTEE ANNEX 1 AGENDA 1. Opening of the session 2. Address by the retiring Chairman 3. Address by the Director-General 4. Election of new officers; Chairman, Vice-Chairman and Rapporteurs 5. Address by the incoming Chairman 6. Adoption of the agenda 7. Acknowledge~ent by the Chairman of brief reports received from govern~ents on the progress of their health activities B. Consideration of proposed programme budget esti~ates 8.1 Review of budget performance in 1982-1983 8.2 Proposed programme budget esti~ates, 1986-1987 9. Report of the Regional Director 10. Sub-Committee on Technical Cooperation among Developing Countries: Report of the Sub-Committee 11. Sub-Committee on the General Programme of Work 11.1 · Report of the Sub-Committee 11.2 Membership of the Sub-Committee 35 12. Health Resources Group for Pri~ary Health Care: Membership of the Group 13. · Correlation of the work of the World Health Assembly, the Executive Board and the Regional Committee 13.1 Consideration of resolutions of the Thirty-seventh World Health Assembly and the Executive Board at its seventy-third and seventy-fourth sessions 13.2 Consideration of the agenda of the seventy-fifth session of the Executive Board 36 REGIONAL COMMITTEE: THIRTY-FIFTH SESSION Annex 1 14. Women, health and development 15. Hepatitis as a public health problem 16. WHO Guidelines New Zealand) for Drinking-Water Quality (item proposed by 17. Selection of topic for the Technical Discussions in conjunction with the thirty-sixth session of the Regional Committee 18. Time and place of the thirty-sixth and thirty-seventh sessions of the Regional Committee 19. Statements by representatives of the United Nations, the Specialized Agencies, and intergovernmental and nongovernmental organizations in official relatione with WHO zo. Closure of the session AUSTRALIA CHINA REPORT OF THE REGIONAL COMMITTEE 37 ANNEX 2 LIST OF REPRESENTATIVES I. REPRESENTATIVES OF MEMBER STATES Dr B.P. Kean Assistant Director-General International Health and Tuberculosis Branch Department of Health Mr Peter McDonald Third Secretary Australian High Commission Fiji Mrs Ruth English Principal Nutritionist Department of Health Dr Liu Xirong Deputy Director Foreign Affairs Bureau Ministry of Public Health Mr Cao Yonglin Deputy Chief Division of International Organizations Foreign Affairs Bureau Ministry of Public Health Dr Wang Zhao Deputy Chief Division of Acute Communicable Diseases Health and Epidemic Prevention Department Ministry o f Public Health Mrs Shen Huimin Official Foreign Affairs Bureau Ministry of Public Health Mr Cai Zixian Third Secretary Embassy of the People's Republic of China in Fiji (Chief Representative) (Alternate) (Adviser) (Chief Representative) (Alternate) (Alternate) (Adviser) (Adviser) 38 Annex 2 COOK ISLANDS FIJI FRANCE JAPAN REGIONAL COMMITTEE; THIRTY-FIFTH SESSION Dr George Koteka Secretat:y Ministry of Health Dr T.M. Biumaiwai Permanent Secretary for Health and Social Welfare Dr T.U. Bavadra Assistant Director Preventive and Primary Health Services Ministry of Health and Social Welfare S. Exc. M. Daniel Dupont Ambassadeur de France l Fidji Dr Albert Marsallon Chef de la Mission d'inspection de la sant~ et des pharmacies de la Nouvelle-cal~donie His Excellency K. Yoshida Ambassador of Japan to Fiji Dr S. Kitagawa Counsellor for Science and Technology Minister's Secretariat Ministry of Health and Welfare Dr N. Koinuma Deputy Director International Affairs Division Minister's Secretariat Ministry of Health and Welfare Dr T. Kato Deputy Director Planning Division Pharmaceutical Affairs Bureau Minister's Secretariat Ministry of Health and Welfare (Chief Representative) (Alternate) (Chief Representative) (Alternate) (Chief Representative) (Alternate) (Alternate) (Alternate) KIRIBATI LAO PEOPLE'S DEMOCRATIC REPUBLIC MALAYSIA NEW ZEAlAND REPORT OF THE REGIONAL COMMITTEE Mr S. Machida Second Secretary Embassy of Japan ~n Fiji Mr Y. Iwabuchi Officer International Affairs Division Minister's Secretariat Ministry of Health and Welfare Dr Y. Hasegawa International Affairs Division Minister's Secretariat Ministry of Health and Welfare Dr Tawita Tira Secretary for Health and Family Planning Anne;K 2 (Alternate) (Alternate) (Adviser) 39 M. Vannareth Ratsapho Vice-Ministre de la Sante publique (Chief Representative) M. Khamkeo Souvannavong Directeur du Service d 'Hygi~ne Minist~re de la Sante publique M. Bovora Chounlamounthy Chef de Cabinet adjoint Responsable des Relations exterieures Minist~re de ta Sante publique (Alternate) (Alternate) Datuk (Dr) Abdul Khalid bin Saban (Chief Representative) Director-General of Health Ministry of Health Mr Abdul Karim Marzuki High Commissioner for Malaysia to Fiji Dr R.A. Barker Director-General of Health Department of Health (Alternate) 40 REGIONAL COMMITTEE; THIRTY-FIFTH SESSION Annex 2 PAPUA NEW GUINEA PHILIPPINES PORTUGAL Dr Quentin Reilly Secretary for Health Dr Antonio N. Acosta Deputy Minister of Health Dr Mario Manuel de Jesus Pinho da Silva Director of Medical and Health Services Macao REPUBLIC OF KOREA Dr Sung-Woo Lee Director-General SAMOA SINGAPORE Bureau of Medical Affairs Ministry of Health and Social Welfare Mr Hong-Suk Hwang Director International Affairs Division Ministry of Health and Social Welfare Mr Seung-Moo Park Second Secretary Embassy of the Republic of Korea in Fiji The Honourable Mr L. Lavea Minister of Health Dr George Schuster Acting Director General of Health Dr Goh Kee Tai Head Quarantine and Epidemiology Department Ministry of Environment (Chief Representative) (Alternate) (Alternate) (Chief Representative) (Alternate) SOLOMON ISLANDS TONGA UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND UNITED STATES OF AMERICA REPORT OF THE REGIONAL COMMITTEE 41 The Honoura~le Richard Harper Minister for Health and Medical Services Mr P. Funifaka Permanent Secretary Ministry of Health and Medical Services The Honourable Dr s. Tapa Minister of Health Dr K.L. Thong Director of Medical and Health Services Hong Kong Dr T. Y. Chau Assistant Director (Service Development and Planning) Hong Kong Dr C. Everett Koop Surgeon General and Director Office of International Health Department of . Health and Human Services Mr Neil Boyer Director ijealth and Narcotics Programs Bureau of International Organization Affairs Department of State Mr Howard Lerner Director Office of North Africa and the Middle East Office of International Health Department of Health and Human Services Annex 2 (Chief Representative) (Alternate) (Chief Representative) (Alternate) (Chief Representative) (Alternate (Alternate 42 Annex 2 VANUATU VIET NAM REGIONAL COMMITTEE: THIRTY-FIFTH SESSION Mr Greg Calvo Deputy Director Environmental Services Department of Public Health Northern Mariana Islands Dr Nofo Siliga Director of Health American Samoa The Honourable Mr Willie Korisa Minister of Health Mr Selwyn Leodoro First Secretary Ministry of Health Dr William H. Mitchell Director of Health Ministry of Health Miss Judy Araileo Nurse Tutor Ministry of Health Professeur Dang Hoi Xu§n Ministre de la Sant~ (Adviser) (Adviser) (Chief Representative) (Alternate) (Alternate) (Alternate) (Chief Representative) Professeur Tu Gi§y (Alternate) Directeur Institut national de la Nutrition M. Nguyen van Trong (Alternate) Directeur Departement des Relations internationales Minist~re de la Sante M"le Le Th i Th u H§ (Alternate) Administratrice adjointe du programme €!t interpr~te Departement des Relations internatiomales Minist~re de la Sante REPORT OF THE REGIONAL COMMITTEE Annex 2 II. OBSERVER OF A NON-MEMBER STATE NEGARA BRUNEI DARUSSALAM Dr (M~s) P. Durayappah Senior Medical Officer of Health Mrs Fatimah Haji Mohd Jamil Health Facilities Officer III. REPRESENTATIVES OF THE UNITED NATIONS AND RELATED ORGANIZATIONS UNITED NATIONS Mrs Judy Otto CHILDREN'S FUND Programme Officer Fiji IV. REPRESENTATIVES OF OTHER INTERGOVERNMENTAL ORGANIZATIONS SOUTH PACIFIC COMMISSION Dr Richard Taylor Epidemiologist V. REPRESENTATIVES OF NONGOVERNMENTAL ORGANIZATIONS INTERNATIONAL AGENCY FOR THE PREVENTION OF BLINDNESS INTERNATIONAL DENTAL FEDERATION INTERNATIONAL FEDERATION OF HEALTH RECORDS ORGANIZATIONS Mr Ronald F. Texley c/o Helen Keller International Dr Paul Swinburn 41 Symonds Street Auckland New Zealand Miss Phyllis Watson Australia 43 44 REGIONAL COMMITTEE: THIRTY-FIFTH SESSION Annex 2 CHRISTIAN MEDICAL COMMISSION INTERNATIONAL COUNCIL OF NURSES WORLD FEDERATION OF OCCUPATIONAL THERAPISTS WORLD ASSOCIATION OF SOCIETIES OF (ANATOMIC AND CLINICAL) PAtHOLOGY INTERNATIONAL FEDERATION OF PHARMACEUTICAL MANUFACTURERS ASSOCIATIONS WORLD FEDERATION OF PROPRIETARY MEDICINE MANUFACTURERS INTERNATIONAL SOCIETY OF RADIOGRAPHERS AND RADIOLOGICAL TECHNICIANS Mr.s Elenoa Abariga Bishop's House P.o. Box 35 Suva Fiji Mrs Molly Tamani President Fiji Nurses Association Lautoka Fiji Miss Jeanine Millsteed Rivette Canberra, A.C.T. Australia Professor Toru Ishii , c/o Department of Clinical Pathology Showa University School of Medicine Japan Mr M.D. Eppingstall Pharmaceutical Manufacturers Association of New Zealand Dr Koji Naito Senior Managing Director Eisai Company Limited Japan Mr Benjamin Bhagwan c/o Department of Radiology Lautoka Hospital Lautoka Fiji REPORT OF THE REGIONAL COMMITTEE LEAGUE OF RED CROSSAND RED CRESCENT SOCIETIES INTERNATIONAL COUNCIL OF WOMEN Mrs Judith Finau Mrs Peggy Johnson Mrs Jokapeci Koroi Fiji Nurses Association Suva Fiji 45/46 Annex 2 REPORT OF THE REGIONAL COMMITTEE ANNEX 3 LIST OF NONGOVERNMENTAL ORGANIZATIONS WHOSE REPRESENTATIVES MADE STATEMENTS TO THE REGIONAL COMMITTEE 47/48 In addition to the statements of the representatives of the United Nations Children's Fund and of the South Pacific Commission, representatives of the following nongovernmental organizations made statements to the C0111mittee; International Agency for the Prevention of Blindness/Helen Keller International International Dental Federation International Federation of Health Records Organizations Christian Medical Commission International Council of Nurses World Federation of Occupational Therapists Interrtational Society of Radiographers and Radiological Technicians League of Red Cross and Red Crescent Societies International Council of Women PART II SUMMARY RECORDS OF THE PLENARY MEETINGS Agenda Item No. 1. 2. 3. CONTENTS Opening of the session ············~························· Address by the retiring Chairman •••••••••••••••••••••••••••• Address by the Director-General ••••••••••••••••••••••••••••• 4. Election ofnew officers: Chairman, Vice-Chairman 54 54 55 and Ra.pporteurs • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 54 Technical discussions; Appointment of a Moderator •••••••••• 54 5. Address by the incoming Chairman ......•...•................. 6. Adoption of the agenda . .................................... . 7. Acknowledgement by the Chairman of brief reports received from governments on the progress of their 82 55 health activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .70 8. Consideration of proposed programme budget estimates 9. 10. 8.1 Review of budget performance in 1982-1983 ••••••••••••• 8.2 Proposed programme budget estimates, 1986-1987 •••••••• Report of the Regional Director ••••••••••••••••••••••••••••• Sub-Committee on Technical Cooperation among Developing Countries: Report of the Sub-Committee .......... ll. Sub-Committee on the General Programme of Work 12. 11.1 11.2 Report of the Sub-Committee ••••••••••••••••••••••••••• Membership of the Sub-Committee ••••••• • ••••••••••••••• Health Resources Group for Primary Health Care: Membership of the Group •.••......•.•••.•••....•.••...••.••• • 13. Correlation of the work of the World Health Assembly, 86 92, 98, 108 70, 82 114 117 121 131 the Executive Board and the Regional Committee.............. 137 14. 13.1 Consideration of resolutions of the Thirty-seventh World Health Assembly and the Executive Board at its seventy-third and seventy-fourth sessions •••••••• 137 13.2 Consid.eration of the agenda of the seventy-fifth session of the Executive Board •••••••••••••••••••••••••• 139 Women, health and development ••••••••••••••••••••••••••••••• 124 - 51 - Agenda Item No. 15. 16. CON'l'ENTS Hepatitis as a public health problem ••••••••••••••••••••••• 141 WHO Guidelines for Drinking-Water Quality •••••••oooo•oooooo 152 17o Selection of topic for the Technical Discussions in conjunction with the thirty-sixth ses~ion l8o of the Regional Co11ltnit·tee •••••••• o. o o •••••• o ••••• o. o o...... 154 Time and place of the thirty-sixth and thirty-seventh sessions of the Regional C011ltnittee o•••••••••••o••••oo••••o• 156 19. Statements by representatives of the United Nations, the Specialized Agencies, and intergovernmental and nongovernmental organizations in official relations with WHO •• • ••••••••••••.••••••••••••••••••••••••• •.......... 157 Statement by ari observer oooo•o~oo•••••••o•oo•••o••••oo••o•• 157 Proposed inclusion of a further item in the Regional Committee's agenda at its thirty-sixth session ••••••oo•o••• 157 Resolution of appreciation ••••••••••••••••••••••••••••••••• 160 20o Closure of the session ••••••••••••••••••••••••••••••••••••• 160 - 52 - L 2. 3. 4. 5. 6. {WPR/RC35/SR/l) SUMMARY RECORD OF THE FIRST MEETING New Town Hall, Civic Centre, Suva Wednesday, 5 September 1984 at 9 a.m. CHAIRMAN: Datuk ~Dr) Abdul Khalid bin Saban (Malaysia) later: Dr T.M. Biumaiwai (Fiji) CONTENTS Formal opening of the session Address by the retiring Chairman •••••••••••••••••••••••••••• Election of new officers: Chairman, Vice..,.Chairman an·d. Ra.pporteurs· ••••• ·• •••.•..•••••••••••••••••••••••••••••.•• Technical discussions: Appointment of a Moderator ••••••••.• Address by the Director-General •••.••••••••••••••••••••••••• Adopt ion of the agenda ...........................•.......... - 53 - 54 54 54 54 55 55 54 REGIONAL COMMITTEE: THIRTY-FIFTH SESSION 1. FORMAL OPEN1NG OF THE SESSION: Item 1 of the Provisional Agenda Dr KHALID, retiring Chairman, declared the thirty-fifth session of the WHO Regional Committee for the Western Pacific open. The Committee observed ane minute's silence in memory of the late Dr Jos~ da Paz. 2. ADDRESS BY THE RETIRING CHAIRMAN: Item 2 of the Provisional Agenda Dr KHALID made a statement to the Committee as retiring Chairman (see Annex 1 for a copy of his statement). 3. ELECTION OF NEW OFFICERS: CHAIRMAN, VICE-CHAIRMAN AND RAPPORTEURS: Item 4 of the Provisional Agenda 3.1 Election of Chairman Mr K. YOSHIDA (Japan) nominated Dr T.M. BIUMAIWAI (Fiji) as Chairman; this was seconded by Mr L. LAVEA (Samoa). Decision: Dr BIUMAIWAI was elected unanimously. Dr Biumaiwai took the chai.r. 3.2 Election of Vice-Chairman Dr s. TAPA (Tonga) nominated Mr W. KORISA (Vanuatu) as Vice-Chairman; this was seconded by Dr A.N. ACOSTA (Philippines). Decision: Mr KORISA was elected unanimously. 3.3 Election ofRapporteurs Dr LIU XIRONG (China) nominated Dr Q. REILLY (Papua New Guinea) as Rapporteur for the English language; this was seconded by Dr G. KOTEKA (Cook Islands). Dr DANG HOI XUAN (Viet Nam) nominated Mr VANNARETH RATSAPHO (Lao People's Democratic Republic) as Rapporteur for the French language; this was seconded by Mr D. DUPONT (France). Decision: unanimously. Dr REILLY and Mr VANNARETH RATSAPHO were elected 4. TECHNICAL DISCUSSIONS: APPOINTMENT OF A MODERATOR The CHAIRMAN moved the appointment of a moderator for the Technical Discussions and proposed Professor TU GIAY (Viet Nam). Decision: The proposal was adopted unanimously. SUMMARY RECORD OF THE FIRST MEETING 55/56 5. ADDRESS BY THE DIRECTOR-GENERAL: Item 3 of the Provisional Agenda The CHAIRMAN invited Dr H. Mahler to address the meeting (see Annex 2 for a copy of his statement}. 6. ADOPTION OF THE AGENDA: Item 6 of the Provisional Agenda (Document WPR/RC35/1 Rev.l) The CHAIRMAN moved the adoption of the· agenda. Decision: In the absence of comments tbe agenda was adopted. The meeting rose at noon. SUMMARY RECORD OF THE FIRST MEETING 57 ANNEX l ADDRESS BY THE RETIRING CHAIRMAN Distinguished Representatives to the Regional Committee, the Director-General of the World Health Organization, the Regional Director of the Regional Office for the Western Pacific, Representatives of Nongovernmental Organizations and Specialized Agencies of the. United Nations, the World Health Organization Secretariat, Ladies and Gentlemen: I feel extreaely honoured and privileged for being given this opportunity to address this distinguished Committee as its retiring Chairman. The past one year has indeed been a happy, rewarding and educational experience for me. I would like to thank you once again for electing me the Chairman of the thirty-fourth session and for the cooperation and understanding that you have extended to me during my tenure of office. Today we have reassembled in this beautiful and colourful setting to deliberate on the health problems of our Region. I am extremely happy to meet again old friends and make new ones. I have always been impressed by the atmosphere of cordiality, understanding and cooperation shown at meetings of this CotiRDittee. I have no doubt this tradition will prevail again, and look forward again to an extremely fruitful and rewarding session. Since our last meeting, two new Member States have joined our Organization. I refer to Cook Islands and Kiribati. It is with great pleasure that I welcome the honourable representatives of these two Member States. I would also like to extend a warm welcome to the observers of Negara Brunei Darussalam. I would also like to extend a special welcome to the Director-General of the World Health Organization, Dr Halfdan Mahler, to the current session of the Committee. In spite of his busy schedule, be bas found time to be with us. His presence indicates his personal continuing interest in the Region, and the dynamic leadership that he has always shown. To our host, the Government of Fiji and all its officials and people, I would like to extend on your behalf our warm greetings and a very big thank you for all the arrangements and facilitation for this meeting. The warm hospitality shown to us is most appreciated, and I am sure each and everyone of us is going to enjoy our stay here. It is often said a committee is as strong as the secretariat that supports it. We will be discussing later the report of the Regional Director.. Nevertheless, it may not be out of place for me even at this 58 REGIONAL COMMITTEE: THIRTY-FIFTH SESSION Annex l juncture to commend the secretariat for the work done during the last year. The appointment of Dr P.iroshi Nakajima as Regional Director for a further period of five years from July this year should provide the necessary continuing leadership. I would like to congratulate him on his re-appointment and wish him all the best in his new tenure of office. If I may, I would like to touch briefly upon some important events and issues that may be of interest to distinguished members of this Committee. At the last meeting of this Regional Committee, we adopted no less than twenty-four resolutions. They provide the framework for Member State/WHO collaboration, new thrust or direction, re-emphasis or merely reminders that greater effort and commitment are needed in order to reach our goal of Health for All. During the last year, I had the opportunity in my own personal capacity, as a member of the Executive Board or as Chairman of this Committee, to attend a number of forums organized by WHO. Among others, these forums discussed subjects directly related to some of the resolutions which we had adopted. I found the deliberations at these meetings extremely interesting and useful, aside from being highly educational to me personally. With your indulgence, I would like to share with you some of the issues raised and conclusions made at these meetings. Prompted by a mood of discouragement in some quarters and a possible implementation shortfall, WHO convened a consultation to review progress of the International Drinking Water Supply and Sanitation Decade. The objectives of the consultation w~re to advise WHO how the Organization can support IDWSSD efforts of Member States, and to provide improved concepts and tools to WHO for promotion of the Decade with Member States and international support agencies. Among the constraints repeatedly identified were; the low priority given to the sector by governments, the imbalance between coverage in urban and rural areas, inadeQuacies in operation and maintenance, difficulties of quality monitoring, particularly in rural areas, problems relating to community participation and choice of technology, shortage of properly trained staff, the need to strengthen sector institutions, and SUMMARY RECORD OF THE FIRST MEETING 59 Annex 1 failure to attract external financial support for accelerated programmes. The consultation identified f1ur major thrusts if we are to improve on our performance" These are more ~.ntensive Decade promotion campaigns at national and international level, mobilization of local money, linkage of Decade activities with primary health care, and emphasis on system rehabilitation, operation and maintenance. In the light of these findings and recommendations, the Committee may like at an appropriate time to review in more detail the implementation of the Decade programme in this Region. As Chairman of this Committ~e, I was invited to attend the ninth session of the Western Pacific Advisory C01ll0littee on Medical Research. I wish to congratulate the Committee on its work in promoting appropriate research mechanisms, methodologies and priorities. In particular, I would like to commend it on the significant progress that has been made in supporting health service research activities in the Region. An area that needs greater attention and more extensive studies is the financial aspect of health care. Allocative issues and cost containment are major concerns of many governments. Health system studies that ~an improve productivity and effectiveness .or reduce health care cost and improve management generally can expedite the correction of existing imbalances and inadequacies. One of the most important i::ems on the Thirty-seventh World Health Assembly agenQ.a was the monitoring of the progress in implementing strategies for health for all by the year 2000. The Health Assembly noted the intimate relationship between the attainment of the health-for-all goal, socioeconomic development and commitment to and the preservation of world peace. It recognized that cooperation among all countries and support by developed countries and international organizations can contribute to a more rational use of resources. While noting the progress that had been made thus far, it was acutely aware of the enormity of the overall task still lying ahead. The resolution on this subject addressed itself among others to the regional committees. It urges the regional committees: (1) to give increased attention to the review of national strategies by Member States; (2) to identify positive and negative factors which facilitate or impede the implementation of national strategies with a view to promoting or resolving them; (3) to stress the importance of mutual cooperation among Member States; and 60 REGIONAL 'COMMITTEE: THIRTY-FIFTH SESSION Annex 1 (4) to carry out a first evaluation of the regional strategy in 1985. I hope we will be able to take up this resolution at the appropriate time. Another important subject on the agenda of the last World Health Assembly and extensively discussed was the Action Programme on Essential Drugs. The availability of essential drugs is one of the integral components of the health-for-all strategy. A number of examples of the implementation of the Action Programme at country level were described. The Assembly called for the convening of an international conference of all interested parties in 1985 to discuss many outstanding issues which need to be resolved. I am sure all of us look forward to the outcome of this conference. But whatever form the discussion at the conference may take, I hope it will not detract us from the primary objective of the Action Programme. We shall be discussing the proposed programme budget estimates for 1986-1987. I am certain the proposals are going to be examined against a backdrop of prevailing worldwide economic recession and shortage of money supply. Representatives are going to scrutinize the sums involved, the increase that is being requested, as well as allocation by programmes. Questions on whether we are making the best use of the resources available may also be asked. But from whatever angles representatives may wish to approach these budget proposals, I hope they will be given appropriate and sympathetic consideration. Nothing touches our tender feelings more than the sick and the dying, the gross poverty and squalour of many communities, or the complete lack of basic facilities that the more fortunate among us take for granted. When we adopted the health-for-all strategy, it is implied that a more concerted effort at both the national and international planes is called for to correct the present imbalances and inequities. Given that commitment and sincerity of purpose, I am confident we shall be able to meet those individual and collective obligations. In conclusion, allow me once again to thank all of you for your cooperation and understanding, and to wish all of you every success in your de liberations. SUMMARY RECORD OF THE FIRST MEETING ANNEX 2 ADDRESS BY DR H. MAHLER DIRECTOR-GENERAL OF THE WORLD HEALTH ORGANIZATION to the THIRTY-FIFTH SESSION OF THE REGIONAL COMMITTEE FOR THE WESTERN PACIFIC Suva, Fiji, 5-11 September 1984 OPPORTUNITIES FOR HEALTH FOR ALL 61 Mr Chairman, Excellencies, Honourable Representatives, Ladies and Gentlemen, Colleagues and Friends, 1984 1. For WHO 1984 is a year of opportunities. Four major events in particular mark this year in the Organization. These are the start of the evaluation of the strategies for health for all, the gathering momentum of the Seventh General Programme of Work, preparations for the programme budget for the biennium 1986-1987 and the progressive introduction of the new managerial arrangements for the optimal use of WHO's resourc.es by Member States. These are all interlinked, but each has its very own characteristics, so I shall refer to them .one by one, particularly as they affect this region. Evaluating strategies for health for all 2. I shall start with the evaluation of your strategies for health for all. Are you really building up new health systems or modifying exi~ting ones as indeed envisaged in the Global Strategy for Health for All, that is, with primary health care as the main focus and with the rest of the healt\1 system supporting it? Are you expanding the coverage of your population with primary health care and are you expanding the range of care you are providing? Are your people learning more about health so that they can assume growing responsibility for their own health and for that of their family and the community in which they live? Are they using the measures that are being made available tO them? Do they have sufficient clean water at a reasonable cost and do they have and use decent sanitary facilities? Do women have access to care before, during and after pregnancy? Do infants and young children get the kind of nutritious food they reCJuire? Are old people enabled to look after themselves properly, and are those who can not do so provided with humane care by their family and their community? Are appropriate measures being taken to prevent and control those diseaaes that can be prevented and controlled, and is clinical care available to those whose health has broken down momentarily or chronically? Do all your people have access to the vaccines and 62 REGIONAL COMMITTEE; THIRTY-FIFTH SESSION Annex 2 essential drugs they require at a cost that they and the country can afford? And are your people deriving positive health benefits from these measures? For example, is their life expectancy at birth increasing and their infant mortality rate decreasing? Is mortality being postponed until old age, and morbidity being reduced? 3. These are the kind of questions that have to be answered fearlessly, and the obstacles to achieving positive answers identified clearly, if you are to be enabled to take the necessary remedial action. It will not help us to hide the real situation from ourselves, and it will not be of much use identifying obstacles to progress if we do not take the necessary action to overcome them. Yes, honourable representatives, strange as it may sound, revealing obstacles can be a most useful way of identifying opportunities for achieving our desired goals. That is what I meant when I remarked to the Health Assembly this year that evaluation must be used as a springboard for action and not as a mere exercise in history. Seventh General Programme of Work 4. We learnt years ago that one of the main obstacles to attaining the goal of health for all by the year 2000 is the weakness of the health infrastructure in most countries. This applies not only to developing countries in which there are far too few suitably trained health workers, inadequate health facilities, and not enough joint action for health and development of the health sector and other social and economic sectors. It also applies to more economically advanced countries in which there is often irrational training and irrational use of health workers, wasteful overlapping of the care provided by health facilities and unrelated action by a whole host of sectoral agencies whose activities can strongly affect health both positively and negatively. 5. Indeed, it was the recognition of these obstacles that gave rise to the opportunity to overcome them by setting forth in the Global Strategy for Health for All the principles on which to build up sound health systems based on primary health care. And it was the preparation of the Seventh General Programme of Work that gave rise to the opportunity of reaching a worldwide consensus that in the years to come WHO must make powerful efforts to support its Member States in building up the infrastructures of their health systems and in taking up the slack in existing ones. I wonder how many of you have taken the trouble to read and re-read and read again the Seventh General Programme of Work since you reviewed a draft of it some years ago? I can only recommend that if you have not done so you should do so now. After all, I am afraid most of us do have a tendency to pay lip service to new ideas and then to put them aside and continue business as before. 6. Even if you forego the details of the Seventh Programme, it is worthwhile recalling the principles that run through it because these are valid, not only for WHO support to your strategies, but for the very SUMMARY RECORD OF THE FIRST MEETING 63 Annex 2 strategies themselves. And that applies whether you are a developing country or a highly industrialized one. These principles for building up national health systems emerged clearly as a consensus at Alma-Ata six years ago. They involve planning and implementing primary health care systematically until all the population has access to motivated health workers who are adequately trained, equipped and supplied to carry out their duties. tbey involve support by succeeding levels of the health system infrastructure and by other social and economic sectors involved. They involve the delivery by the health infrastructure of health technology that is truly appropriate for the country concerned~ To do that requires identifying appropriate technologies, generating them when they do not exist, and seeking social and behavioural measures to support, yes indeed, supplant technical measures. Above all, building up health systems in this way involves people so that it is they who in the final analysis shape and control the country's health system; after all it is theirs, I believe. Daunting? Yes, but worthwhile struggling for, because that, I humbly submit, is the shape of health systems to come - well before the year 2000, I hope. 7. Your Seventh General Programme of Work may seem an obstacle to the freedom of choice, but I am convinced that it offers you a golden opportunity to reshape your health systems in ways that you agreed to collectively. Identifying obstacles to doing that can at the same time reveal opportunities to channel your own resources along the right lines, and, for many of you, to channel substantial resources along those lines from external partners. The developmental history of the past 20 years has clearly shown the utter futility - more than that, the counterproductivity of fragmented activities undertaken in developing countries by well-meaning but misguided development agencies. These activities have often eaten up the energies of limited human resources in the developing countries and they have limited the breadth of vision of the staff of development agencies and thus of the agencies as a whole. WHO has unfortunately not been an outsider to this state of affairs. I sincerely hope I am wrong, and I shall be more than happy if you correct me, but I have the impression that we are still hankering after past technical assistance relationships and that the trans1t1on from subservience to participatory democracy is taking much too long to complete. Programme budget proposals for 1986-1987 8. If I am wrong, surely this should be revealed in the programme budget proposals for 1986 and 1987 that you are about to debate, and that, once you have endorsed, you will be submitting to your Director-General before I make final proposals to the Executive Board and the World Health Assembly. Are you using WH0 1 s resources to build up your health systems along the lines I have just referred to, or are you still making requests for ad hoc WHO projects in your country and for gap-filling equipment and supplies or scarcely relevant fellowships? Will you even reveal the true situation by scrutinizing the way WHO's resources are being used in the different 64 REGIONAL COMMITTEE; THIRTY-FIFTH SESSION Annex 2 countries of the Region, or will you fight shy of that and merely look at intercountry and regional activities? Will you investigate the intercountry proposals and how they were arrived at? Did they materialize from the joint needs of a number of countries in the Region as identified through dialogue between their governments and WHO, or did they descend from above? 9. One of the most disturbing facts that came to light in the recent firet attempt at monitoring the Strategy for Health for All was that most countries do not know how their resources for health are distributed. They do not know how much goes to primary health care and how much to the rest of the health system, and they certainly do not know how resources are used by the different sectors in ways that affect health. Nor is it clear at all how health services are financed and how much people are able and ready to pay to protect and restore their health. Unless we know all that, how can we make wise programme budget decisions? So here is another obstacle that can become an opportunity, an opportunity to make serious efforts to clarify just how and where and when and why and by whom and for whom we are spending on health as a first step to putting right what is wrong. We have in our collective policies and strategies for health for all sufficient indications as to what: is right, so it should not be so difficult to reveal what is wrong with a view to putting it right. 10. Will governments have the courage to do that and to act accordingly? Here is surely an area in which it would be highly justified to use WHO's resources in your country. These are so infinitely small as compared with most national health budgets that they will become drops in the ocean if they are used as just another of the many inputs into your health budget. But if you use WHO's resources to unfold the obstacles and ways of overcoming them, these resources will become a key to many doors. 11. First of all, if you use WHO's resources in your own country in the ways I have just outlined, you will be in a strong position to reveal bow best to deploy your own resources. And that applies to both developing and economically more advanced countries. Then, those of you in need will be able to identify the purposes for which your government might well look for external resources, taking into account that all capital expenditures must ultimately incur recurrent expenditures and that these latter have to be planned for as well. Tbis same WHO key could therefore open the door for enlightened external support based on equally enlightened identification of national priorities and soliciting of support for them by governments. I hope there is no doubt in anybody's mind that the ultimate responsibility for orchestrating all internal and external resources for health lies with the governments of all the countries concerned. However, if you are still convinced that WHO is your active and intimate partner in health, as I am and as you all solemnly declared you were some years ago, if you are still convinced of that, then WHO's resources, whose size may at first sight appear an obstacle, could in fact be turned into a first class opportunity to focus all resources for health in your country in such a way as to derive optimal benefit from them. SUMMARY RECORD OF THE FIRST MEETING 65 Annex 2 12. Please remember, you are entitled to draw on WHO's human resources to the maximum of its capacity, no matter where these resources reside - in your own country, at intercountry or regional level, in other regions, or at global level. It may be very easy to forget that in an island in the middle of the Pacific Ocean, but just look at the vast potential of the forces concentrated here for this Regional Committee. And just imagine the effect of bringing to bear equally mighty forces from other parts of the world to cooperate with you in your efforts. This WHO universality offers all of you vast opportunities for fruitful cooperation, if only the Regional Committee and the Regional · Office which serves it know how to exploit them. If you do not exploit them, then you will with your own hands convert an opportunity into an obstacle. Remember, to make the most of resources it is necessary to display resourcefulness. New managerial arrangements 13. It is the display of this kind of resourcefulness by you and by your Secretariat that is needed to make the most of the new managerial arrangements for technical cooperation between you and your WHO. After all, these new arrangements aim at making optimal use of WHO's resources in the light of the Seventh General Programme of Work in support of national strategies for health for all. Last year I outlined how they should work inside your countries and in particular how you can make the most of your responsibilities for WHO's resources through a careful and continuing dialogue with your Secretariat. And by dialogue I do not mean WHO expecting endorsement of all and any proposals; I mean a two-way c~unication conducted within the boundaries of collectively agreed policies. Last year, I also pointed out that these new responsibilities make you equally responsible for accounting for the use of WHO's resources to your fellow Member States in the Region and indeed all over the world. This year I shall attempt to summarize how your Regional Office can best support you in your new responsibilities. 14. If you have identified through joint policy and programme reviews what is needed from WHO in your country in the way of technical, administrative and financial support, as well as what is needed to facilitate intercountry cooperation, if you have identified all that, the question that then has to be tackled is how these needs will be provided promptly, efficiently and effectively. To do that at the regional level requires the ability to view WHO's cooperation with each one of your countries as a whole and to bring to bear on the spectrum of your needs all the supportive action that is required, whether that is technical, administrative or financial. And to do that in a well-coordinated way requires the capacity to focus a multiplicity of disciplines on solving your problems with you. It requires insiabt to seize possibilities for facilitating cooperation between groups of countries, either with in the Region or in neighbouring regions or even distant regions. It requires the ability to muster the most suitable technical expertise and the support of other sectors, wherever that exists, inside and outside the Region. Yes, even from WHO's headquarters in Geneva! 66 REGIONAL COMMITTEE: THIRTY-FIFTH SESSION Annex 2 15. Is all that asking too much of your staff in the Region? I think not. I realize that these ,net.' arrangements may be giving rise here and there to feelings of insecurity, and even deep anxiety in case technical cooperation degenerates into hand-outs of WHO's funds for indiscriminate use by Member States. May I remind you that the same sentiment surfaced when the Health Assembly in 1976 adopted resolution WHA29.48, which demanded the transfer of massive resources from headquarters for direct technical cooperation with countries. The fears were dissipated when a new programme budget policy was defined to make sure that those massive resources would really bring benefit to Member States and would not be used as mere ephemeral palliatives. I have the feeling that, by the same token, we now need a clear statement of progra1Dille budget policy for the support of the Regional Office to Member States in the light of the new arrangements for cooperating with you. What is more, I also feel that the time has come for you, together with your Regional Director, to monitor seriously the way WHO's resources are being used in accordance with the new managerial arrangements. I intend to do just that throughout the whole Organization, but I am sure my assessment would be greatly enhanced if you participated properly in the process. 16. Quite apart from the intrinsic need to ensure that your Organization's resources are used most effectively and efficiently to support you in reaching t .he goal of health for all, quite apart from that I have to admit that there is another pressing reason for monitoring bow our resources are being used. As I told the Health Assembly this year, WHO has not been spared the growing criticism of the United Nations system - criticism over alleged irrelevant undertakings, overlapping of efforts, excessive bureaucracy and poor management of resources. If we do no use our resources to the best advantage, the technical cooperation component of our regular progratmne budget could well be criticized out of existence. After all, we are the only specialized agency to have such a large component of technical cooperation in our regular budget. If we are deprived of that it could mean the end of our regional arrangements, for these are the mainstay of our technical cooperation with Member States. Yes, honourable representatives, it could mean for all practical purposes the end of our regional committees and our regional offices or at least the kind of regional committees and offices we know t .oday. To avoid that we must certainly t'll8ke sure that we are using our resources optimally and to do that we must use them in such a way as to ensure compliance with collectively agreed policy in order to reach our common goal. 17. I can well understand that, for those who have grown accustomed to WHO working under different conditions, these newer ways of cooperating and joint monitoring of cooperation may seem a dreadful obstacle, but I humbly submit that they are an unusual opportunity to rise to the challenge of this closing period of the Twentieth Century by displaying a new blend of health expertise, for it is nothing less than that, and flourishing professionally . and personally in the process. I am convinced that at this juncture these ways of cooperating are the proper interpretation of our SUMMARY RECORD OF THE FIRST MEETING 67 Annex 2 Constitution concerning relationships between your WHO and its Member States. I shall therefore continue to put all my weight behind them and I know that your Regional Director will do no less. So I would beg of you, honourable representatives, to fulfil your constitutional role with respect to the work of the Region and to make sure that all Member States, all of you, obtain the kind of support from WHO that you are entitled to and which the new arrangements have been devised to supply you with. 18. At the risk of repetition, may I remind you that you are entitled to support from your Organization as a whole and not just from its regional component. But in the same manner, you are accounfable to your Organization as a whole and not just to its regional component. Regional self-reliance is most certainly not the same as regional autonomy; that was never envisaged in WHO's Constitution. Being part of a whole is not an obstacle; it offers quite on the contrary unique opportunities. These opportunities include placing at the disposal of every single one of you the collective policies and wisdom of all WHO's 164 Member States. They also include strengthening you with the tremendous political and moral force that your Organization has acquired over the years. So I can only advise you to avail yourselves of every opportunity to use the weight of that political and moral force in your country in order to ensure that your government as a whole and your people as a whole understand what you are trying to do to achieve health for all with them and for them. Worldwide solidarity for health for all 19. It may sound paradoxical, but those of you who may feel that you need WHO support least are the ones that are in the best position to make most use of it. There exists a terrible danger that our Strategy for Health for All will join the ranks of other initiatives that started with bright hopes of better social justice in their area of concern, only to lead to those who had much having more and those who had little having less. You can prevent that from happening, honourable representatives, by displaying solidarity among yourselves to ensure that the weaker are indeed supported by the stronger. As 1 have said on innumerable occasions, history has shown that such solidarity is not so much a manifestation of charitable altruism as of enlightened self-interest. I realize that some of you may consider the added responsibility of ensuring that all peoples reach the goal of health for all by the year 2000 as an obstacle to your people reaching it. But if you bear in mind the moral imperatives that gave rise to the very concept of health for all and that inspired the attempt to materialize it, if you bear that in mind I am sure you will come to consider this apparent obstacle ~s yet an added opportunity to work together both inside and outside the Region. If you do that, you will derive added strength to carry out even more energetically your health strategies inside your own countries. 20. Mr movement Chairman, honourable towards health for representatives, last all a marathon race, year I called the riddled however with 68 REGIONAL COMMITTEE: THIRTY-FIFTH SESSION Annex 2 obstacles. I hope I have be.en able to convince you that, by identifying these obstacles and clarifying their nature, they can be converted into unusual opportunities. So let us lose no opportunity to clear away the obstacles in order to arrive at our target together. We can do that if we apply the might of WHO as one united organization. If we do so, I have no doubt that we shall reach the finishing line at a steady pace and with a light heart. Thank you. 1. 2. (WPR/RC35/SR/2) SUMMARY RECORD OF THE SECOND MEETING New Town Hall, Civic Centre, Suva Wednesday, 5 September 1984 at 2.30 p.m. CHAIRMAi:~: Dr T.M. Biumaiwai (Fiji) CONTENTS Acknowledgement by the Chairman of brief reports received from governments on the progress of their health activities ••••••••••••••••••••••••••••••••••••••••. Report of the Regional Director ••••••••••••••••••••••.•••• - 69 - 70 70 70 REGIONAL COMMITTEE: THIRTY-FIFTH SESSION 1. ACKNOWLEDGEMENT BY THE CHAIRMAN OF BRIEF REPORTS RECEIVED FROM GOVERNMENTS ON THE PROGRESS OF THEIR HEALTH ACTIVITIES; Item 7 of the Agenda The CHAIRMAN acknowledged reports on the progress of health activities received from the following countries or areas: Australia, China, Hong Kong, Kiribati, Lao People's Democratic.Republic, the Republic of Korea, Samoa, Singapore, Solomon Islands and Viet Nam, which were being distributed to the Committee. 2. REPORT OF THE REGIONAL DIRECTOR; Item 9 of the Agenda (Document WPR/RC35/4) The REGIONAL DIRECTOR, introducing the report on the work of WHO during the period 1 July 1983 - 30 June 1984, said that the Organi2:ation bad continued to collaborate in the endeavours of Member States to reshape their health systems for the achievement of the goal of health for all by the year 2000 through the fonnulation and implementation of national health-for-all . policies and strategies and the promotion and application of the managerial process for national health development. Member States were very well aware of the mechanisms developed for the monitoring and evaluation of progress in implementing the national strategies. After the first exercise in monitoring, which had been reported to the Committee in 1983, gratifying conclusions could be reached. The magnitude of the tasks facing Member States, particularly developing countries, was great. The constraints, such as shortage of skilled manpower and budgetary stringency, aggravated by the adverse economic climate, were formidable. Nevertheless, reasonable progress was being made by countries in promoting the concept of primary health care, which remained the key to the achievement of health for all. Health care coverage was being expanded; the active participation of individuals, families and communities in health matters was being encouraged on the basis of the principle of self-reliance. Efforts were being made to ensure the reorientation and retraining of health manpower, particularly of health workers at the periphery; managerial capabilities were being strengthened, particularly at the intermediate or first referral level, which was vital for the implementation of primary health care at the community level. The Secretariat had actively collaborated in all the areas just mentioned. In that connection, he particularly drew attention to the sections of the report dealing with health systems development, organization of health systems based on primary health care, and health manpower. Of particular significance in the field of health manpower development were the efforts being made to more actively involve universities, including medical schools, and health training institutions in the preparation and implementation of health-for-all policies and strategies. That included efforts to ensure a community-oriented approach to medical education and greater relevance of the curricula to the real needs of health services and commun1t1es. Meetings of directors and representatives of schools and departments of public health and of deans of medical schools had been held SUMMARY RECORD OF THE SECOND MEETING 71 in Manila during the year, to discuss issues arising 1.n that context. WHO had also continued to cooperate in the reorientation of training institutions in accordance with the principles of a community-based approach and task-oriented curriculum. In the same context, he drew the Committee's attention to the findings and rec01111Dendations of the Sub-Committee on the General Programme of Work at its recent meeting in June. Of particular importance was resolution WHA37.31 on the role of universities in the strategies for health for all, which had recently been adopted by the Thirty-seventh World Health Assembly. In the introduction to the report, he had referred to the fi .rst monitoring exercise by Member States reported to the Committee in 1983. In the same context, he wished to draw the Committee 1 s attention to the very important resolution WHA37.17, adopted by the Thirty-seventh World Health Assembly, which urged Member States, among other things, to accord the highest priority to, and assume full responsibility for, the continuing monitoring and evaluation of their health-for-all strategies. It would be noted in that connection that the Regional Committee was being asked to carry out a first evaluation of the regionai · strategy . in 1985. To facilitate the preparation of the regional evaluation, Member States would be requested to evaluate their own national strategies. The Director-General had already referred to the kinds of questions that had to .be answered if the evaluation was to be honest and true. It was hoped that the evaluation reports prepared on the basis of the Common Framework and Format, which had been reviewed by the Sub-Committee on the General Programme of Work in June 1984, would reach him by March 1985. The Regional Committee would wish to study the matter in greater detail when it came to consider the report of the Sub-Committee under agenda item 11.1. Dr TAPA (Tonga) commended the Regional Director and his staff for the achievements reported, and expressed his appreciation also to the Director-General and . staff of WHO Geneva for their support to the Region. The first session of the Regional Committee to be held during the second term of office of the Regional Director was significant, and augured well for the future of their highly populated area. In view of their meagre natural resources, the small islands of the Western Pacific Region had great need of the technical support of WHO and other governments, bilateral aid as well as all other forms of cooperation. Dr KITAGAWA (Japan) congratulated the Regional Director and his colleagues on the very clear and comprehensive report and noted w+th satisfaction the steady progress made in the development of programmes at regional and country levels. Among the programme areas of specific interest to his delegation was, first, health systems development. Formerly, Japan had experienced very high mortality rates from tuberculosis and other communicable diseases. However, there had been rapid progress in improving the general level of health of the population with the result that, with the decline in infant mortality, the average life expectancy in Japan was now among the highe~t in the world. The establishment of health centres 72 REGIONAL COMMITTEE: THIRTY-FIFTH SESSION throughout the country during the past thirty years represented an important achievement in the field of public health. The major activities of such centres, namely, general medical examinations, early diagnosis, health education and promotion, reflected the changing trends in disease, rising medical costs and the growing concern with health. In the context of the total health care system such centres now constituted an important link with existing health facilities. In accordance with the Global Strategy, emphasis was being given to the development of health systems based on primary health care. In terms of technical cooperation with developing countries, special attention was paid to the development of human resources. An example of successful collaboration was the joint Japan/WHO project on health laboratory technology in Tonga, aimed at strengthening national capability in laboratory technology. Another area of particular concern to his country - and indeed to many other countries was the prevention and control of cancer and cardiovascular diseases, which were now the leading cause of death in Japan. A ten-year strategy for cancer control, promoting intensive and diversified research and involving international cooperation, had been adopted in June 1983. A general meeting of WHO collaborating centres concerned with stomach cancer had been held in Tokyo in July 1984. A WHO workshop on health for the elderly, with special reference to the control of cardiovascular diseases, would be held in October 1984 ~n Fukuoka. He requested the Regional Director to follow the progress made in the control of those diseases and to make further efforts to promote research and the exchange of information and experiences. He also noted with interest the reorientation of malaria control programmes, which gave new hope for control of that persistent problem. Approximately 40% of mankind were at risk from that disease and the situation was aggravated by the resistance both of the vector to the pesticide and of the parasite to the commonly used drugs. In view of the grave situation, a special committee for malaria control bad been set up in the Japan International Cooperation Agency (JlCA) to integrate malaria control in line with the WHO strategy. Japan was conscious of its responsibilities within the Region and hoped that WHO would continue its efforts to improve health conditions throughout the world. Mr LAVEA (Samoa) thanked the Regional Director for his excellent report. The major health problem in Samoa was the acute shortage of doctors, which bad been brought to the attention of the World Health Assembly in 1983 and 1984. As an interim solution, UNDP had responded favourably to a request for ten United Nations Volunteer doctors on a cost-sharing basis. A university foundation course bad been started in Samoa, which, it was hoped, would provide a sound foundation for further training in medical schools overseas. He thanked the Regional Director for according fellowships for such training in Samoa. Dr KOOP (United States of America) thanked the Regional Director for his report and verbal presentation. He believed it would be useful in future to include narrative information on programme objectives and related SUMMARY RECORD OF THE SECOND MEETING 73 achievements with suggestions for appropriate follow-up. That would enable Member States to assess their own progress in terms of regional strategies. He warmly endorsed the Director-General's statement and strongly supported his forthright and courageous questions to Member States. In the context of health for all, the United States of America was taking strong measures to solve the leading public health problem by calling for a 'smoke-free' society by the year 2000. Other health projects would be linked to health for all in a similar manner. Dr LIU XIRONG (China) commended the Regional Director on his concise report; its comprehensive introduction gave a clear picture of the work done in the Region and the progress achieved over the past year. He expressed appreciation of the work done by the Regional Director in pr001oting technical cooperation in the medical and health field among Member States of the Region and of the efforts made to improve the health of the people. He noted with satisfaction the work done in supporting the implementation, monitoring and review of programme activities in the Seventh General Programme of Work so that activities were better suited to health conditions and needs, thus promoting implementation of the health-for-all strategy at country and regional levels. He was pleased to see that priority was being given to strengthening the managerial process for national health development and health information system development, thereby developing national capability to formulate, implement and evaluate health-for-all strategies. Regarding manpower development a very important aspect considerable work had been done by WHO in the placement of fellows and in sponsoring workshops and training courses, with good results; he hoped that work in that field would continue to be strengthened. New work initiated by the Regional Director during the past year included programmes on the health of the elderly, the development of community-based rehabilitation, and the publication of a standard acupuncture nomenclature. There was no doubt that the significance of all those programmes would very soon be apparent. Hepatitis was a serious problem in the Region, and the work done in that field - including support for the production of diagnostic reagents and hepatitis B vaccine - was much appreciated. The constant interest of the Director-General in the work in the Region, the guidance be provided, and the increased budgetary allocation to the Region were particularly welcome. Dr SUNG-WOO LEE (Republic of Korea) commended the Regional Director on his excellent and comprehensive report, and expressed special thanks for the technical cooperation with his country during the past year. Mr DUPONT (France) commended the Regional Director on his France was prepared to support any action of WHO in the Region, report. and to 74 REGIONAL COMMITTEE: THIRTY-FIFTH SESSION contribute to a positive cooperation, which could have recourse to the medical, human and technical skills available in the territories of the Pacific. It was hoped that the French territories in the Region would follow WHO's. recommendations regarding the goal of health for all. The results of research could be made available to the Organization as a whole and to the Western Pacific Rf"gion; the hospitals, technical institutions and nursing schools in those territories could be used for the training of auxiliary health personnel. Dr KRALID (Malaysia) congratulated the Regional Director on his concise but comprehensive report, which indicated that satisfactory progress had been made in implementing programmes at country and regional level. Regarding the health situation and trend assessment, be hoped that further refinement of health-for-all indicators would be undertaken and that the problems faced by Member States in collecting and interpreting data would be further studied. The true value of those indicators and the health-for-all monitoring system would only be realized when they were used in health system improvement. Resolution WHA37.17, adopted by the Thirty-seventh World Health Assembly, required the regional committees to carry out a first evaluation of the regional strategies in 1985. He believed that that exercise would be more complex and difficult than the preparation of the first monitoring report; although it was going to be a national undertaking, he hoped that WHO would continue to help Member States in preparing the evaluation report. With regard to health manpower development, he believed that middle-level management should be further strengthened. More emphasis should be given to planning and evaluation methodologies, team building, organization dynamics, structural arrangements, communication, supervision, various aspects of personnel management, and even such basic skills as organizing a meeting, influencing decision-makers, and bringing about changes. Regarding public information and education for health, appropriate use of the mass media should be further developed. He had already referred to research promotion and development, essential drugs, and the International Drinking Water Supply and Sanitation Decade in his opening address. Dr KEAN (Australia) commended the Regional Director on his report and reiterated the point made by the representative of the United States of America that the report could be made even more useful to Member States if progress and problems were measured against objectives, both at the overall and the programme level. Dr REILLY (Papua New Guinea) congratulated the Regional Director on his report and expressed thanks for the support given to his country over the past year. The Director-General had referred to the problem of malaria control, which was a serious preoccupation both in Papua New Guinea and the Region as a whole. Papua New Guinea was reorganizing its spraying programme SUMMARY RECORD OF THE SECOND MEETING 75 owing to technical problems; it was returning to more traditional approaches to vector control and making drugs more readily available to people in the villages. A primary health care approach was being followed, and community participation was being introduced. He would be grateful to receive more information from the Regional Director regarding progress in research on malaria vaccines. Mr SOUVANNAVONG (Lao People's Democratic Republic) commended the Regional Director on his concise, clear and comprehensive report. The Regional Office had achieved considerable progress during the past year, and his country had received active support from the Organization. Regarding the support services, he shared the concern expressed about the expenditure on the WHO Programme Coordinators' Offices; in his country the allocation for the WHO Programme Coordinator's Office represented a substantial proportion of the total funds allocated. He wished to congratulate the Regional Office on the spirit of economy it had shown, as well as on all its other achievements. Dr DANG HOI XUAN (Viet Nam) congratulated the Regional Director on his excellent report. The purpose of health activities in his country was to try to resolve rationally the various public health problems in the context of a developing country which had rather limited material resources and had suffered so much from the sequelae of war. The Government had to satisfy the demands of the people. Health was regarded as one of the most important goals of economic and social progress and the people's welfare - and, at the same time, as the mainspring of all progress. Its concept of health coincided exactly with that adopted by WHO and with the Declaration of Alma-Ata regarding primary health care and the goal of health for all by the year 2000. On the basis of a thorough study of the health situation in the country and the high birth rate and population growth, the following principles had been adopted: ( 1) the health service must serve to promote production and national defence, protect life and be available to the working people; (2) it must be based on preventive medicine; (3) it must integrate modern and traditional medicine; (4) it must be based on the masses and their own forces, with the assistance of the Government and international cooperation, which must be further extended. The guiding principles and the strategy for building up the public health services in Viet Nam required the effective cooperation of WHO. Such cooperation had already produced good results; the threat of major epidemics had been considerably limited, the incidence of poliomyelitis was low, and communicable diseases were being progressively eliminated. Maternal and child health, including nutrition, continued to be one of the main activities of the health services. The goal to be achieved by 1985 was a natural growth rate of 1.7 per cent. Viet Nam was very interested in international cooperation ~n the medical and pharmaceutical fields; such cooperation was essential for the promotion of health in all countries and at the same time made it possible to exploit the national resources available in a rational way. Cooperation between countries having similar natural, geographical and climatic 76 REGIONAL COMMITTEE: THIRTY-FIFTH SESSION conditions would be particularly fruitful; in an atmosphere of peace and stability it would provide the right conditions to achieve health for all by the year 2000. Dr BARKER (New Zealand) supported the suggestion representatives of the United S~;ates of America and Australia: Director's excellent report could be further improved if it achievements according to objectives. made by the the Regional were based on Dr KOTEKA (Cook Is lands) congratulated the Regional Director on his comprehensive report and expressed his thanks for the support given to Cook Islands. Referring to the comments of the Director-General in his review of the approaches needed to achieve health for all, he stressed that the Government of Cook Islands would continue to promote strategies to achieve that goal. He thanked all Member States of WHO, and in particular New Zealand, for supporting the application of Cook Is lands for membership of WHO. Dr THONG (United Kingdom of Great Britain and Northern Ireland) congratulated the Regional Director on his comprehensive report. Dr DA SILVA (Portugal) congratulated the Regional Director on his outstanding report and thanked all representatives for their tribute to Dr Jos~ da Paz. Dr ACOSTA (Philippines), referring to the section covering the managerial process for national health development, stressed the importance of developing mechanisms for monitoring and evaluating progress made towards health for all. In that regard, he agreed wholeheartedly with the representative of Malaysia. It wa~ equally important to train those responsible for implementing programmes in order to develop managerial abilities. He thanked the Regional Director for his collaboration on those two issues. Dr BAVADRA (Fiji) stated that WHO had played an important role in developing health services in Fiji. Since 1981, Fiji had given priority to primary health care, and the cooperation of local and intercountry WHO staff had made possible the attainment of certain goals sooner than might otherwise have been expected. In the area of water supply, WHO and UNICEF had collaborated in the organization of training programmes on the use of low-cost methods for the construction of ferrocement supply systems. Funding from WHO had also permitted the organization of primary health care seminars at village level. A WHO team had reviewed the immunization programme, and the major recommendations resulting from that review were now being implemented. The infant mortality rate in Fiji had already been reduced from 40 per 1000 in 1974 to 22 per 1000 in 1982, an achievement that was largely attributable to the cooperation of WHO and the primary health care approach. In the field of nutrition, significant progress had been made in the development of a national food and nutrition policy, and a committee had been established to supervise and coordinate its implementation. WHO and UNICEF had cdllaborated in nutrition projects aimed at schoolchildren, and SUMMARY RECORD OF THE SECOND MEETING 77 1n promoting breast-feeding. In addition, WHO had collaborated in convening a working group to draw up a code on the marketing of breast-milk substitutes. Advice on the draft code was now being obtained from all interested organizations before it was presented to the Cabinet for adoption. WHO had also helped to set up a national bulk purchase scheme for essential drugs in Fiji. The scheme had been established in 1981 and had now been extended to rural areas, where community pharmacies were serving as outlets for those drugs. Through WHO-funded primary health care seminars, people had come to realize the importance of · community health workers in providing basic care services~ By the end of 1983, 630 village health workers had'go~e thrbugh the various training programmes, and the total number of health workers had increased from 1 per 347 population in 1980 to 1 per 259. Local consultants had been recruited to develop a standard training curriculum and a set of practical guidelines for village health workers. WHO had cooperated in an evaluation of primary health care in Fiji. The report of the evaluation was not yet complete, but the major findings had already been discussed and implemented. Both local and intercountry WHO resources had been used in developing primary health care in Fiji. Fiji supported the maintenance of a strong intercountry programme. Intercountry programme staff were generally familiar with the situation in a country, which facilitated exchange of ideas and experience, and intercountry meetings provided an opportunity for neighbouring countries to interact, both professionally and socially. Dr GOH KEE TAl (Singapore) congratulated the Regional Director on his report, and expressed his gratitude for the inclusion of viral hepatitis as a separate topic on the agenda, noting that it was an important public health problem in Singapore. Mr HARPER (Solomon Is lands) said that the concept of primary health care had been accepted in Solomon Islands in 1980, when a seminar had been held. WHO had collaborated in the training of village health aides, and training workshops were now being carried out at provincial level. The aim was to allow people to participate fully in programmes intended to supply their health care needs. The primary health care programme had been progressing well, but malaria continued to be a crucial problem. Malaria was a major cause of death in Solomon Islands, and problems had been encountered in obtaining the n~cessary finance for its control. WHO was therefore requested to cooper,ate , by providing funds for insecticides, drugs, equipment and expertise to help combat malaria. The Committee then considered the report of the Regional Director section by section. Introduction There were no comments. 78 REGIONAL COMMITTEE~ THIRTY-FIFTH SESSION General programme development There were no comments. Health systems development There were no comments. Organization of health systems based on primary health care There were no comments. Health manpower There were no comments. Public information and education for health There were no comments. Research promotion and development There were no comments. General health protection and promotion (pages 13-14) Dr SUNG-WOO LEE (Republic of Korea) health were so important that they should greater detail. The same applied t .o accident felt that nutrition and oral be treated separately and in prevention. Protection and promotion of the health of specific population groups (pages 14-15) There were no comments. Protection and promotion of mental health (page 15) There were no comments. Promotion of environmental health (pages 16-17) Dr KHALID (Malaysia) said that the Western Pacific Regional Centre for the Promotion of Environmental Planning and Applied Studies (PEPAS) was called upon to play a very important ro1e in the International Drinking Water Supply and Sanitation Decade programme, both in Malaysia and in other parts of the Region . Dr TAPA (Tonga) said that the promotion of environmental health was an important element in primary health care in his country. Ninety-one per cent. of the total population now had access to safe water and it was hoped to achieve complete coverage well before the target year of 1990. Sanitation, however, was lagging considerably behind. The UNDP/WHO pilot sanitary disposal and sewage project had been successful and would be continued under a recent agreement with the World Health Organization. SUMMARY RECORD OF THE SECOND MEETING 79 Diapostic, therapeutic and rehabilitative technol.o&y (pages 17-19) Dr DANG-HOI XUAN (Viet Nam) said that in recent years WHO and many countries throughout the world had begun to show increasing interest in traditional medicine's role in health development, partly because health resources in many of the developing countries were inadequate but even more so because traditional medicine was effective. Only sixteen years remained before the year 2000 and, unless all possible resources were mobilized, including traditional medicine, it would prove very difficult f()r some developing countries to attain the objective of health for all by that year. For many years past, Viet Nam had been basing its health promotion plans on a judicious combination of traditional and t~odern medicine and traditional methods of treatment such as herbal medicines and acupuncture were in constant use in primary health care. Each commune had been recommended to cultivate thirty-five species of medicinal plants to treat a range of common symptoms and ailments, such as feverishness, coughs, diarrhoea, etc. Certain traditional methods of effective treatment appreciated by the population bad been used in health establishments at various levels but, apart from the practical side, modern scientific research methods bad been applied to some aspects of traditional medicine in a number of scientific and technical establishments such as the Institute for Acupuncture, an institute for traditional pharmacology and the institutes of traditional medicine. Experience over a number of years had shown that traditional medicine could play a very important role in primary health care, was feasible in developing countries and helped reduce health coste. Viet Nam proposed that information on traditional medicine should . be expanded under WHO auspices by a more complete exchange of information between developing countries, that study programmes on the subject should be further extended in developing countries of proven capacity in that domain. and that WHO should organize annual seminars to exchange experience and to make recommendations to the Organization on the protDotion of traditional medicine as part of primary health care. Dr BAVADRA {Fiji) said that primary health care in the rural areas of Fiji was unthinkable without the use of traditional 11edicine and a workshop on that subject was to be held in November. Fiji was also conducting a survey in cooperation with WHO on the condition and needs of the elderly. 80 REGIONAL COMMITTEE: THIRTY-FIFTH SESSION Dr TAPA (Tonga) thanked the Government of Japan and WHO for the project culminating in the establishment of a new public health laboratory in Tonga. His country was also grateful for the cooperation received from the WHO Pharmaceutical Officer in organ1z1ng the joint purchase of pharmaceuticals when the previously proposed South Pacific pharmaceutical service had been modified. (For continuation of the discussion, see the third meeting, section 2). The meeting rose at 4.50 p.m. 1. 2. (WPR/RC35/SR/3) SUMMARY RECORD OF THE THIRD MEETING New Town Hall, Civic Centre, Suva Thursday, 6 September 1984 at 9 a.m. CHAIRMAN: Dr T.M. Biumaiwai (Fiji) CONTENTS Address by the incoming Chairman •••••••••••••••••••••••••••• Report of the Regional Director (continued) ••••••••••••••••• 82 82 3. Consideration of proposed programme budget estimates 3.1 Review of budget performance in 1982-1983 ••••••••••••••• 86 3.2 Proposed programme budget estimates, 1986-1987 •••••••••• 92 - 81 - 82 REGIONAL COMMITTEE: THIRTY-FIFTH SESSION 1. ADDRESS BY THE INCOMING CHAIRMAN: Item 5 of the Agenda The CHAIRMAN addressed the Committee (see Annex 1). 2. REPORT OF THE REGIONAL DIRECTOR: Item 9 of the Agenda (Document WPR/RC35/4) (coutinued from the second meeting, section 2) Disease prevention and control (page 20) Dr THONG (United Kingdom of Great Britain and Northern Ireland) expressed appreciation of the collaboration of WHO in antimalarial activities in Hong Kong, formerly an endemic area. The late 1940s had seen an average annual morbidity of 1000 - 2000 cases with annual mortality ranging between 100 and 800. Malaria bad become a notifiable disease in the 1950s when reported cases had declined to an average of 500 annually; there was a further decline to an average of 20 cases annually by 1975. Mortality in the meantime had dropped from 89 in 1950 to zero in 1957. The disappearance of malaria transmission was attributed mainly to the elimination of breeding sites through rapid urbanization and pollution. However, some sparsely populated districts still provided a favourable natural habitat for vector breeding. From 1978 to 1983, two deaths had been recorded and on average 50 cases had been reported annually, the majority being imported by travellers and refugees, mainly from South-East Asia. Hong Kong 1 s position as an international trading centre, subject to considerable population movement, rendered it highly vulnerable to the importation of malaria from neighbouring countries. Moreover, the prevailing epidemiological situation, coupled with economic, social and political considerations, precluded the control or quarantine of imported cases. The increase in imported malaria cases in recent years had resulted in outbreaks of local transmission, for example in the New Territories where 19 cases had been reported in late 1983. A total of 125 cases had been reported in 1983 of which 30 were indigenous. In response to his Government's request, WHO had promptly provided teams compr1s1ng malariologists and entomologists to undertake epidemiological investigations and advise on remedial measures. A parasitologist had also been sent to conduct training courses in laboratory diagnostic techniques. For Hong Kong the best means of preventing the exportation of endemic malaria lay in early detection and immediate treatment of cases, combined with local vector control measures and routine anti-malarial activities in areas harbouring active and potential breeding sites. Concerted efforts were being made by all government departments concerned to achieve effective control of the disease. Considerable importance was attached to training, in order to improve the level of malaria expertise, which had lapsed during the intervening relatively trouble-free years. Consideration was now being given to the training of health personnel in all aspects of malaria epidemiology and control. Fortunately, the main malaria parasite, Plasmodium vivax, was still sensitive to chloroquine, unlike P. falciparulD, the species prevalent in solDe other areas. He requested the Secretariat to report on the latest advances in regard to treatment. SUMMARY RECORD OF THE THIRD MEETING 83 Dr BAVADRA (Fiji) said that, while malaria was not endemic in his country, there was a constant threat of introduction of the vector and, therefore, his Government followed with concern the situation in neighbouring countries such as Vanuatu, Solomon Islands and Papua New Guinea and was ready to assist in control measures. In the light of his experience in Solomon Islands . in the early 1970s, he believed the primary health care approach, based on community involvement, to be particularly appropriate for malaria control in rural areas. Consideration should therefore be given to strengthening primary health care in the Region to help countries such as those mentioned to achieve control. His country was ready to provide support in that respect. Dr ACOSTA (Philippines) believed that WHO should clarify the situation regarding the use of BCG in the prevention of tuberculosis. The results of the study on the efficacy of BCG in India had created doubts am<mg policy makers concerning its value, which WHO should endeavour to dispel. Dr PAIK (Chief, Research Promotion and Development), in reply to the representative from Papua New Guinea, said that, although the global eradication of malaria was not achievable in the foreseeable future, various new tools now being developed under the Special Programme for Research and Training in Tropical Diseases might pave the way for better control. One such tool was vaccines. Recent advances in research had led to the development of several potential vaccines, some of which were likely to undergo preliminary testing over the next few years. Protective antigens of several species of plasmodia had been identified and analysed. Their production by genetic engineering and polypeptide synthesis was being studied. As a result of recent developments, malaria vaccine research was expected to progress from basic laboratory investigations to pilot production and safety testing of vaccines. The most useful vaccine might prove to be a combination of antigens from parasites at different stages of the life-cycle. He informed the representative of the United Kingdom of Great Britain and Northern Ireland that the main alternative drugs for use against resistant P. falciparum were Fansidar and Meloprim. It was anticipated that mefloquine would soon be released for use exclusively against chloroquine-resistant P. falciparum. More widespread use carried the danger . of development of resistant strains. Qinghaosu was currently undergoing trials in China; it had been found that even chloroquine-resistant strains of P. falciparum and P. vivax were sensitive to that antimalarial. Studies had also revealed its possible value in the treatment of cerebral malaria. Qinghaosu was currently being used in China on a trial basis and was not yet available for malaria control programmes in other countries. Dr GOH KEE TAl (Singapore) understood that a drug company would shortly be marketing mefloquine combined with other drugs such as pyrimethamine and sulfadoxine. Since in vitro studies in Thailand had shown resistance to mefloquine in falciparum -;:;;araria, he asked how WHO would control use of that drug to prevent the emergence of mefloquine-resistant strains. 84 REGIONAL COMMITTEE: THIRTY-FIFTH SESSION Dr PAIK (Chief, Research Promotion and Development), responding to Dr Gob Kee Tai, said that mefloquine should not be used alone or for the treatment of ordin~ry mal~ria cases; it should be used exclusively for the treatment of chloroquine-resistant falciparum malaria. Studies had shown that its use in combination with other drugs, for example sulfonamides, could delay the inducement of r~sist~nce. Dr DANG HOI XUAN (Viet Nam) requested WHO to indicate the most effective drug treatment schedule for use against pernicious malaria caused by P. falciparum. Dr PAIK (Chief, Research Promotion and Development) replied that a combination of qu1n1ne and tetracycline for five days was being used very effectively in some countries of the Indochinese peninsula for the treatment of pernicious malaria. At the request of the Government of Viet Nam, WHO was seeking a consultant to develop guidelines on the management of severe clinical malaria cases. Health information support (page 25) There were no comments. Support services (page 26) There were no comments. External coordination for health and social development (page 26) There were no comments. Regional Committee (page 27) There were no comments. The REGIONAL DIRECTOR thanked the Committee for the comments on his report - the result of collaborative work on the part of so many. The representatives of Australia, New Zealand and the United States of America had suggested that the report should be based on assessment of p.rogress in implementing the health-for-all strategy. It was indeed hoped that it would become possible to do that. However, it was a short annual report, covering two general programmes of work (July - December 1983 being included in the Sixth Genera 1 Programme of Work, and January - June 1984 in the Seventh); there were therefore some difficulties in amalgamation. Moreover, the first six months were covered by the 1982-1983 budget, which .did not include target indicators, and the second six months by the 1984-1985 budget, which included indicators. Efforts would be made in the future to improve the format. The first reports on evaluation of the healtb-for-all strategy (to be discussed later) were due in March 1985, and would be reflected in the next biennial report,· covering the period up to June 1985. It was hoped that all countries would report in good time, that is, by March 1985. Changing the reporting format was, of course, a global matter, and not merely regional. The subject would therefore . have to be discussed at the global level. · SUMMARY RECORD OF THE THIRD MEETING 85 With reference to cardiovascular diseases, studies were being carried out on hypertension, stroke, and rheumatic and ischaemic heart disease; in particular, epidemiological surveys were being conducted in the South Pacific area with support from the South Pacific Commission and the Government of Australia. Regarding malaria, Qinghaosu - which had been developed as a result of collaboration between China and the Special Programme for Research and Training in Tropical Diseases - was proving to be particularly effective for cerebral malaria, but a few years would be needed before it could come into common use. Replying to the representative of Singapore, he said that WHO had already warned about abuse of mefloquine. WHO trials had been strictly controlled. Countries should closely follow WHO guidelines. Referring to the remarks made by Dr Paik, he said that expert studies indicated that the best standard treatment for pernicious malaria in Viet Nam was probably provided by a combination of quinine sulfate and tetracycline. Fanaidar was recommended for use in some areas, while in others further studies were required, particularly on Qinghaosu. The representative of the United States of America had referred to smoking. It was planned to implement not only an anti-smoking campaign but also studies of indoor pollution - a problem which, in contrast to outdoor pollution, seemed to be worsening, as indicated by the increase in lung cancer in some countries in Asia. It was hoped that many Member States would collaborate in the studies and support the move to ban smoking in aircraft. Regarding health information , systems development, to which the representative of China and others had referred, be said that some difficulties were being experienced in the development ot software, but studies were progressing quite rapidly. Emphasis would also be placed on improving communication systems. The collaboration of the United States of America and the use of the satellite above Solomon Islands would doubtless be of considerable help in that respect, and it was hoped that further collaboration of that type would be forthcoming. With regard to health manpower development, he expressed appreciation of the offers made by the representative of France and others, and stressed the importance of international collaboration in that field. Note had been taken of the remarks by the representative of the Republic of Korea concerning oral health and nutrition. Regarding traditional medicine, there bad been considerable developments in the field of acupuncture. However, it was essential that WHO should collaborate with nongovernmental organizations in that respect, and the recent establishment of a worldwide federation on acupuncture was particularly welcome. 86 REGIONAL COMMITTEE: THIRTY-FIFTH SESSION The representative of the Philippines had raised the question of BCG vaccination. Resolution WPR/RC32/Rl6 provided a clear reply to that query. WHO's policy was that BCG vaccination should be carried out in countries where the infection rate was more than 0.5 per 100 among children. Chemoprophylaxis on a nationwide scale was too expensive, and favoured the development of drug resistance so that the usefulness of the drug in treatment of the disease was diminished. Dr PAIK (Chief, Research Promotion and Development) said that two steps had been taken in view of the possible development of resistance in mefloquine: first, combinations of mefloquine with other antimalarials were being developed, and a pharmaceutical formulation of mefloquine with sulfadoxine and pyrimethamine would be available very soon; and, second, WHO was advising countries on the rational use of mefloquine and mefloquine combinations, cautioning them against indiscriminate use, which might lead to the development of resistance. The CHAIRMAN said that, in the absence of any further comments on the Regional Director's report, he would ask the Rapporteurs to prepare an appropriate draft resolution. (For consideration of the draft resolution, see the seventh meeting, section 1.1). 3. CONSIDERATION OF PROPOSED PROGRAMME BUDGET ESTIMATES: Item 8 of the Agenda 3.1 Review of budget performance in 1982-1983: (Document WPR/RC35/2) Item 8. 1 of the Agenda The REGIONAL DIRECTOR, introduting the review of budget performance in 1982-1983, said that the information contained in document WPR/RC35/2 was presented under the programme classification of the Sixth General Programme of Work, of which 1982-1983 was the last biennium. The programme budget estimates referred to in the second column of Annex 1 reflected the amounts noted by the Regional Committee at its thirty-first session in 1980 and an additional amount of US$753 500 subsequently made available by the Director-General, making a total regular budget provision of US$39 522 500 for 1982-1983. The . rate of implementation of the programme budget in 1982-1983 had been 99.99%. Included in the implementation figure of US$39 521 421 were activities totalling US$775 258, which had originally been allocated to the Regional Director's Development Programme but which, on implementation, had been reclassified to the programme under which the activity took place as shown in Annex 2. In addition to the regular budget prov1s1on, extrabudgetary resources amounting to US$19 287 850 had been implemented in 1982-1983. That amount was well in excess of the amount shown in the 1982-1983 proposed programme budget estimates presented to the Regional Committee, because more extrabudgetary resources had become available during the implementation period. SUMMARY RECORD OF THE THIRD MEETING 87 While there were differences between the original programme budget estimates and the implemented figures due to changes in government priorities, the priority programmes agreed upon by the Regional Committee at the time it considered the 1982-1983 programme budget had remained the same. Health manpower development, communicable disease prevention and control, health services development and promotion of environmental health had accounted for the highest proportion of the implemented program~e budget. Dr SUNG-WOO LEE (Republic of Korea) said that the implementation of the programme budget for 1982-1983 seemed to be well balanced, but he noted that the allocations for Health services development (3.1), Prophylactic, diagnostic and therapeutic substances (3.4), Health manpower development (6.1), and Health information (7.1) had not been fully used. The sums indicated for the implementation of Health services research ( 3 .1. 6) and Pharmaceuticals and bio log ica 1 s (3. 4. 2) were considerably lower than the allocations. He asked how the balance was used. Mr BOYER (United States of America) said that document WPR/RC35/2 was useful in that it showed the emphasis given to the various parts of the budget, the increases and decreases. The increases of nearly US$1 million for Communicable diseases prevention and control (4.1) and some US$300 000 for Basic sanitary measures (5.1.2) were fully understandable in the light of the problems of the Region. He likewise approved the decrease of some US$400 000 for Promotion of training (6.1.2). The United States had already expressed doubts about priority being accorded to the fellowship programme. On the other hand, he queried the decrease of some US$200 000 for Pharmaceuticals and biologicals (3.4.2) an area rece1v1ng increasing attention in WHO. Likewise, the decrease of s010e US$150 000 for Health statistics (7 .1.1) was surprising in the light of the many comments at the previous session of the Regional Committee concerning the difficulties countries were experiencing in replying to WHO questionnaires. Improvements in that area were ·· essential for evaluating progress in the health-for-all strategy. The Thirty-seventh World Health Assembly, when it had reviewed the implementation of the 1982-1983 budget, had been informed that WHO had used only 96.68% of the total budgetary allocations. That proportion was usual for the larger organizations, which were not expected to implement their budgets 100%. He was therefore surprised that the Regional Office had been able to implement 99.99% of the budgetary allocations, and wondered how that had. been possible. The Regional Director had mentioned an additional US$753 000 provided by the Director-General for the Region; he wondered whether the Regional Office had overspent its allocations and had had to be helped by the Director-General. Dr TAPA (Tonga) expressed great satisfaction at the overall ~utplementation r•te of 99.99% and the extrabudgetary funds received. He was ple$sed to note the increases in the total allocations (including those from . S~JJrces Qther than the regular budget) for a large number o.f programmes. He was also satisfied with the financing and implementation of the Regional Pirector' s · Development Programme. He would urge donors to continue to support WHO's programme budget, thus helping the smaller countries, whose resources were limited. 88 REGIONAL COMMITTEE: THIRTY-FIFTH SESSION Dr KITAGAWA (Japan) asked for some explanation of the large differences between the budget allocations and the sums actually used for certain programmes. For example, the sums used for Appropriate technology for health (3.1.5) and Maternal and child health (3.2.1) far exceeded the budget allocations, while a large proportion of the sums allocated for Health services research (3.1.6) and Other noncommunicable diseases (4.2.4) was not used. Dr KHALID (Malaysia) congratulated the Regional Director on a good budget performance for 1982-1983. He thought that the differences between allocation and implementation in various fields reflected the flexibility of the budget. Each budget was prepared two or three years in advance, and it was quite possible that national priorities might change during that period. Flexibility was important in order to make the best use of available resources, while continuing to promote primary health care. Dr BARKER (New Zealand) referred to the allocation under Health statistics (7 .1.1), which had not been fully implemented. The representative of the United States of America had implied that that meant that the amount of work done had been reduced, but that was not necessarily so. In a 11 countries, it was important to obtain maximum performance at least cost. He would be interested to know the reasons for the underspending, and thought that, in general, it would be useful if, in presenting the review of budget performance, the Secretariat could indicate the areas where there had been major differences between allocation and implementation, g1v1ng the reasons. Therefore he supported the representative of Malaysia regarding the need for flexibility in implementing the budget, in order to take account of developments occurring during the budget period. Dr LIU XIRONG (China) thought that the implementation of 99.99% of the budget was a great achievement, which was a result of the joint efforts of WHO and Member States. He believed that the priority given to Communicable disease prevention and control (4.1) and Health services development (3.1) in the budget met the health needs of the Region. The allocation of approximately US$19 million in extrabudgetary funds from UNDP and UNFPA accounted for approximately 50% of the regular budget. He expressed his gratitude to those agencies and also to the Regional Director and his team for their efforts to promote such cooperation. Dr Liu agreed with the representatives of Malaysia and New Zealand regarding the need for flexibility in implementing the programme budget. He asked for more information on the implementation of Programme planning and general activities (4.2.0). Mr LAVEA (Samoa) thanked the Regional Director for his clear and concise report on the budget, and asked for further comments on the changes in national priorities that had occurred. He thanked those responsible for providing extrabudgetary funds under Family health (3.2), and in particular Maternal and child health (3.2.1). He requested that more consideration be given to obtaining extrabudgetary funds for Health education (3. 2 .4). He also noted with appreciation that substantial extrabudgetary funds had been allocated to Communicable disease prevention and control (4.1). SUMMARY RECORD OF THE THIRD MEETING 89 Dr HAN (Director, Programme Management) said, in regard to the general aspects of performa~ce, that the broad programmes covered in the programme budget were accepted by the Committee two years before implementation. Detailed programming followed one year prior to implementation. As had been pointed out 1n the discussion, changes in government priorities occurred during the process and the changes were reflected in collaborative activities between Member States and WHO. The figure to be found in document WPR/RC31/4 reflected the position two years before implementation of the programmes concerned. In the meantime the operational budgets had changed · and what seemed like marked increases or decreases did not necessarily reflect the actual differences between the operational budget figures and the amounts actually used. The sums not used 1n certain programme areas were of course transferred to other programme areas where government requests and requirements made extra expenditure necessary. Responsibility for shortcomings in implementing the programme budget approved by the Committee admittedly lay in some cases with the Secretariat, in others with Member States. In Appropriate technology for health (3.1.5), the seeming 84% increase in the implementation figure over the original estimates was much higher than the actual difference between the operational budget figure and the amount in fact spent. Some of the increase that did occur was due to the cost of additional supplies and equipment and fellowships requested by Member States as well as to inflationary cost rises. With regard to Health services re.search (3.1.6), there had been only 21% implementation. That was partly due to the Secretariat's failure to provide one particular country with the scientist requested (he had declined the position at the very last minute) and partly to a decision not to replace another scientist who had resigned from an intercountry project but to assign Secretariat staff from time to time to carry out his functions. With regard to Maternal and child health (3.2.1), the original estimate had had to be increased, when the operational budget came to be discussed, to over US$400 000, so that implementation was actually 100% and reflected the priority assigned by governments to that programme area. In Pharmaceuticals and biologicals (3.4.2), underimplementation had been due to inability to recruit one consultant for a particular country and to the fact that some of the fellowships provided for had not been taken up. With regard to Programme planning and general activities (4.2.0), under major programme Noncommunicable disease prevention and control (4. 2), the fall from US$129 800 to zero was due to the decision to convert the post of Regional Adviser in Cardiovascular Diseases at the Regional Office into an intercountry project post to enable the incumbent to work more closely with the countries. The amount had therefore been completely absorbed into Cardiovascular diseases (4.2.2). In one of the most important programme areas, (6.1.2), underimplementation of some US$400 000 was factors. Promotion of training due to a number of 90 REGIONAL COMMITTEE: THIRTY-FIFTH SESSION In the case of some of the fellowships awarded, the candidates had failed in the language proficiency tests and it had proved difficult to replace them. The duration of other fellowships had been reduced from six to four months, with resultant savings. Sometimes the training had been carried out in the Region itself, again reducing costs. It had been possible to complete other fellowships in the previous biennium, thus removing their cost from the budget under discussion. In addition, there had been delay in filling some vacancies, some meetings had been financed from extrabudgetary resources, and it had been impossible to recruit some of the consultants originally envisaged. In programme area Health statistics ( 7 .1.1), underimplementation had been due to non-recruitment of some of the consultants envisaged and to a decision not to buy some of the equipment originally planned and to the fact that WHO Geneva had become responsible for one of the meetings. In conclusion, he could assure the representative of New Zealand that in future more detailed reasons would be given for major increas~s and decreases. Mr UHDE (Director, Support Programme), replying to the representative of the United States of · America, said that they had achieved 99.99% implementation of the 1982-1983 programme budget by careful budgetary monitoring with a view to better meeting the massive needs of the Region. the · same high implementation rate bad been achieved in 1980-1981. The Western Pacific Region had thus not contributed much to reducing the global implementation rate to 96%. The sum of US$753 500 to which reference had been made had been allocated by the Director-General for specific purposes such as research on hepatitis B and the development of primary health care in Fiji, Samoa and Solomon Islands, and not to cover any budgetary deficit. Mr BOYER (United States of America) thought that the Secretariat 1 s skill in so closely monitoring the programme budget could usefully be shared with other WHO regions. Dr KHALID (Malaysia) wondered whether the problems in filling posts in the Region as a result of post adjustment changes were not adversely affecting programme implementation and asked what steps were being taken to overcome the difficulties. The REGIONAL DIRECTOR said that the situation was definitely worsening. It had been the policy to deploy intercountry staff in the Philippines, where the cost of living was relatively reasonable, but recent reductions in the post adjustments that made up a substantial proportion of salaries had led to total incomes for professional staff falling considerably below those of national civil servants in comparable posts. Recruitment of international staff had become correspondingly more difficult. The situation was that an insufficient number of candidates were forthcoming frOtD countries on the approved list which were highly developed or paid large contributions, while in developing countries, and particularly in the least developed countries, recruitment by WHO of even one of the small number of professional staff available might gravely jeopardize an SUMMARY RECORD OF THE THIRD MEETING 91 already frail health system. The staff at the Regional Office were already sacrificing some of their annual leave in an effort to alleviate the situation. The DIRECTOR-GENERAL pointed out that for many years the Health Assembly and Executive Board bad been considering how best to mobilize human resources to support Member States. The present difficulties had to a great extent been anticipated, and he had for some time been endeavouring to encourage short-term assignments by WHO permanent staff or consultants in order to support Member States in implementing their own health policies. Countries generally did not need two or three years of continuous expertise in a particular field, but one or two months at a time. The Region had found a sensible formula for using resources for intercountry activities in that way. The formula was proving effective and needed to be developed further. Another cost-effective approach was to make more use of the increasing expertise becoming available within some countries of the Region. With a small contribution from WHO, perhaps in the form of moderate fees or per diem allowances, national experts could be mobilized to carry out tasks on behalf of the Organization. For the foreseeable future, WHO would, continue to need health experts of the highest quality, both in Geneva and in the regions. It was important for Member States to realize that recruitment of the best possible experts was incompatible with the imposition of rigid criteria for the geographical distribution of staff. WHO had been more successful than some other agencies precisely because it had always put competence before geographical distribution. It was a highly specialized agency which would stand or fall by its competence, and it should not be expected to abide by political decisions taken by foreign ministers at the United Nations General Assembly. Although as Director-General he tried to achieve the broadest possible geographical distribution of staff, he resisted the idea that the number of staff from a given country should reflect that country's contribution to the regular budget. Member States of the Region were urged to use their influence at the Health Assembly and Executive Board to ensure that he had sufficient flexibility in selecting staff. Moreover, if countries continued to promote conventional medical practice, in complete contradiction of the policies they themselves had collectively agreed upon within WHO, their staff would be unsuitable for work with WHO. Member States that seriously attempted to implement WHO policies would automatically produce staff better suited for WHO recruitme~t. In order to maintain the competence of the Organization, it was also necessary to acquire additional resources for the continuous training of staff. Countries appreciated the need for such training for their own staff, and the same applied at the international level. Changes were constantly taking place in every field, and even the best qualified staff must be kept up to date and prepared for as~uming different responsibiliti~s. While the quality of expertise within WHO's research programmes was very high, there was a serious shortage everywhere of "health generalists" - 92 REGIONAL COMMITTEE: THIRTY-FIFTH SESSION people who could understand health policies, think in epidemiological terms, and translate that epidemiological thinking into managerial action. That was why WHO was making great efforts to convince Member States of the importance of management. All the regional committees had given priority in recent years to research on health systems, but the results so far had been little short ·of disastrous; virtually all health delivery systems suffered from mismanagement. In conclusion, Dr Mahler emphasized his belief · in management by exception. In cases where expertise required by Member States could not be provided if the recommended recruitment quotas were complied with, he would be prepared to make exceptions, even though that would lead to criticism from the Organization's governing bodies, for it was the only way to maintain the competence and efficiency of WHO. 3.2 Proposed . programme budget estimates, 1986-1987: Item 8.2 of the Agenda (Documents WPR/RC35/3 and WPR/RC35/INF DOC/3) The REGIONAL DIRECTOR, introducing the proposed programme budget estimates for 1986-1987, informed the Committee that the programme budget for the current biennium 1984-1985 was being implemented on schedule. While there had been some reallocation of resources between the different programmes to meet government requests, the changes bad been few, and the majority of resources continued to be allocated to programmes of funda~ental importance to the goal of health for all. The trend towards reorientation of programmes for the achievement of the health-for-all goal was reflected in the proposed programme budget estimates for the biennium 1986-1987. After presenting a br,ief out line of the contents of the programme budget contained in document WPR/RC35/3, the Regional Director drew attention to some of the highlights of the proposed programme budget estimates, as well as to some of the budgetary and funding concepts used in preparing the estimates. The period 1986-1987 was the second programme budget biennium under the Seventh General Programme of Work, which in turn was the first of three general programmes' of work to provide support to Member States in implementing their strategies for health for all by the year 2000. Having been prepared in close consultation with governments in the Region, the proposed programme budget estimates included activities identified by the countries themselves, which responded to their needs and priorities for achieving the goal of health for all. The highest percentage (45.8%) of the broad category of programmes infrastructure, which was in accordance Programme of Work of promoting and systems based on primary health care. the regular budget wa~ allocated to classified under health system with the aim of the Seventh General strengthening comprehensive health SUMMARY RECORD OF THE THIRD MEETING 93 In consonance with the trend towards the reorientation of programmes for the achievement of health for all, Health manpower continued to account for the highest proportion of resources (19.1%), with approximately 89% of the provision going directly to countries. That reflected the high priority given by countries in the Re~ion to the preparation of health manpower to meet the requirements of the health system. Disease prevention and control was second in importance (15.9%), followed by Health system development (12.6%) and Organization of health systems based on primary health care (11. 9%). During 1986-1987, most of WHO's collaboration would be provided through country programmes. In addition, an intercountry programme had been maintained in view of the heterogeneous nature of t"e Region, which made such a programme a more effective and economical means of providing cooperation. Citing examples of some of the specific areas in which cooperation would be concentrated during the biennium, the Regional Director said that strengthening of national capabilities to define priority health problems and to formulate and implement the necessary measures for their solution, on the basis of a sound information system was one, together with efforts to find an effective and efficient means of health care delivery. To achieve that. the strengthening of the health manpower planning component of the managerial process for national health development was of concern, as well as the introduction of measures to improve coordination between the producers and users of health manpower, and to improve national policies and systems for the optimum deployment and utilization of health . personnel. Continuing support for the International Drinking Water and Sanitation Decade was another. By 1986 they would be entering the second half of the Decade and efforts to improve basic sanitation would be deployed in such areas as training of manpower at all levels and improvement of the capabilities of communities to operate and maintain the systems themselves. Later in the session the Committee would be considering the problem of viral hepatitis B, which was of major concern in the Western Pacific Region, where more than 100 million people were carriers of the virus. In some countries of the Region, traditional medical practices formed part of the national health systems, and there was growing recognition of the role they could play in primary health care. Efforts would be made to integrate them into the general health system. After the publication earlier in 1984 of the Standard acupuncture nomenclature, more work would be carried out on the standardization of acupuncture nomenclature and the strengthening of training activities. Commenting on the formulation of the 1986-1987 proposed programme budget estimates, the Regional Director said that the original provisional allocation from the Director-General had been US$54 748 000, comprising US$28 362 000 for countries and US$26 386 000 for Regional Office and intercountry activities. However, by the time the 1986-1987 estimates had been finalized for the Regional Co1DIDittee, the rate of exchange for the Philippine peso had moved from peso 7. 95, used in the preparation of the 1984-1985 programme budget, to peso 14 to the US dollar, and since then to peso 18 to the US dollar. After calculatihg the currency exchange savings 94 REGIONAL COMMITTEE: THIRTY-FIFTH SESSION on items of expenditure identified with the Philippine peso, the allocation for 1986-1987 had been reduced by US$3 460 500, resulting in the existing net provisional allocation of US$51 287 500. Of that amount, US$28 362 000 had continued to be allocated to country activities and US$22 925 500 to Regional Office and intercountry programme activities. The overall regular budget increase was US$5 162 500 or 11.2% over the 1984-1985 allocation of US$46 125 000, and consisted of: (~) a real increase of US$966 000 or 2.1%, (b) a statutory cost and inflation increase of US$7 657 000 or 16.6%, and (c) a reduction resulting from the currency exchange savings of US$3 460 500 or 7.5%. He emphasized that the statutory cost and inflation increase of 16.6% over a two-year period, which was about 8.3% annually, was low considering that the projected annual inflation rates in many developing countries were well in excess of 30%. The low cost increase meant that, in imp~etllenting the 1986-1987 programme activities, it might be necessary to absorb certain costs to stay within the regional budget allocation. With regard to country activities, the amount of US$28 362 000 had been allocated for 1986-1987 as against US$24 137 100 for 1984-1985, representing an increase of US$4 224 900 or 17.5% over the 1984-1985 biennium. The increase comprised: (a) a real increase of US$966 000 or 4%, and (b) a statutory cost and inflation increase of US$3 258 900 or 13.5%. The Director-General might however eventually decide to either reduce or completely eliminate the 4% real increase of US$966 000 at the time of finalization of the Organization's proposed programme budget for 1986:-1987. The current allocation for country activities should therefore be regarded as tentative and subject to reduction. The amount of US$22 925 500 bad been allocated for Regional Office and intercountry programme activities in 1986-1987 as against US$21 987 900 in 1984-1985. The increase of US$937 6.00 or 4.3% was the net result of a statutory cost and inflation increase of US$4 398 100 or 20%, and . currency exchange savings of US$3 460 500 or 15.7%. No net real increase bad been allowed for Regional Office and intercountry programme activities. Sources of funds other th~n the regular budget which might be available to the Region for the 1986-1987 biennium were difficult to forecast with any accuracy. An amount of US$5 094 000 had, however, been · estimated for 1986-1987, but it was hoped that, in response to resolutions of the World Health Assembly urging the mobilization of support for the implementation of health-for-all strategies, the leve 1 of extrabudgetary contributions for the biennium 1986-1987 would at least equal that for 1984-1985. (For continuation of the discussion, see the fourth meeting, section 1.1). The meeting rose at noon. SUMMARY RECORD OF THE THIRD MEETING 95 ANNEX 1 ADDRESS BY THE INCOMING CHAIRMAN Distinguished Representatives to the Regional Committe~, , the Director-General of the World Health Organization, the, Regional ' Di~ector of the Regional Office for the Western Pacific, ' Representatives of Nongovernmental Organizations and Specialized Agencies of the United Nations, the World Health Organization Secretariat, Ladies and Gentlemen; I am greatly honoured and wish to thank the Committee for electing toe Chairman of the thirty-fifth session of the WHO Regional ColDtDittee for the Western Pacific. I .am very well aware of the fact that my election is, in one ·way, a reflection of the Regional Committee's wish to honour my country -: Fiji. As a matter of fact, this is the first time I have been elected cha.irm~n of an international meeting of this kind. While I cannot claim that the task you place before me will be accomplished to the same degree of satisfaction that you have experienced from past appointees, I will attempt my personal best to live up to your level of expectation. As your newly elected Chairman, I wish to welcome and congratulate the new Vice-Chairman, the Honourable Mr. Korisa, Minister of Health, Vanuatu; the Rapporteur in English, Dr Reilly of Papua New Guinea, and the Rapporteur in French, Professor Vannareth, Vice-Minister for Health of Lao People 1 s Democratic Republic. I am sure we shall work closely together and do our best in the discharge of our duties to the best of our ability. The chairmanship of an international meeting such as this Coll11Dittee, which has to deal with diverse difficult problems and needs in the Region, is not an easy task. However, l am confident tl)at, with your kind cooperation and understanding, the guidance ~nd support of the Regional Director and his staff and the valuable collaboration of the Vice-Chairm•n and Rapporteurs, it will be possible for us to carry out the task before us. Allow me to refresh your memories on some of the important issues discussed by the C01l11Dittee at its thirty-fourth session in Manila. We noted the need for Member States to explore new ways of promoting community participation in the prevention of drug abuse, the need to demonstrate the feasibility of cardiovascular diseases control through primary health care, and the Coll11Dittee Is concern about the continuing massive morbidity and the high premature mortality from acute respiratory infections, which remain one of the leading causes of death in both industrial and developing countries of the world. Furthermore, while we acknowledged progress in implementing the health-for-all strategies and the noticeable trend towards integration of preventive and curative services as well as decentralization, we recognised the need to maintain and strengthen country efforts to promote intersectoral coordination and community participation. 96 REGIONAL COMMITTEE; THIRTY-FIFTH SESSION Annex 1 We also expressed concern at the inadequate response in submitting progress reports as part of evaluation and urged Member States to continue to develop and improve their monitoring and evaluation systems. Other items discussed included: (1) regional cooperation in vector control; (2) malaria 1n relation to the decreasing effectiveness of residual spraying; (3) our concern at the increasing resistance to dapsone in the treatment of leprosy; (4) feeding of infants and young children in relation to the implementation of the International Code of Marketing of Breast-milk Substitutes; (5) fluoridation as a means of intensifying preventive dental programmes; (6) the recognition of safe drinking services as key elements in primary health for all by the year 2000. water and adequate sanitation health care and the attainment of This year we have an extensive agenda before us. Together with many other important items, we have included for discussion the role of women, both as recipients and as providers of health care. It should be appreciated that greater priority must be accorded to women's health. The goal will be difficult to achieve, not only because women make up half of the world's population but also because women's health directly affects the health of children and that of the family as a whole. Finally, I wish to remind Distinguished Members that the Technic a 1 Discussions in conjunction with this session will be on "Malnutrition, growth and development". While I emphasize the importance of developing strategies that will assist Member States in their endeavours to control malnutrition as part of primary health care, I am mindful of the progress so far attained by Member States in implementing the International Code of Marketing of Breast-milk Substitutes and other projects aimed at improving the nutritional status of children in the Region. I look forward to a fruitful exchange of views and experience during the week so that we can be informed of various problems that confront us, some of which may have serious implications for the implementation of the strategies for health for all by the year 2000. I now wish you every success in your deliberations. Thank you. (WPR/RC35/SR/4) SUMMARY RECORD OF THE FOURTH MEETING New Town Hall, Civic Centre, Suva Thursday, 6 September 1984 at 2.30 p.m. CHAIRMAN: Dr T.M. Biumaiwai (Fiji) CONTENTS 1. Consideration of proposed programme budget estimates (continued) . . . . . . . . . . . . . . . . . . . . • . . . . . • . . • • . . . • • • . • . . . • • • . . 98 1.1 Proposed programme budget estimates, 1986-1987 (continued) •••••••••••••••••••••••••••••••••••••••••••• 98 - 97 - 98 REGIONAL COMMITTEE: THIRTY-FIFTH SESSION 1. CONSIDERATION OF PROPOSED PROGRAMME BUDGET ESTIMATES: Item 8 of the Agenda (continued from the third meeting, section 3) 1.1 Proposed programme budget estimates, 1986-1987: Item 8.2 of the Agenda (Documents WPR/RC35/3 and WPR/RC35/INF DOC/3) (continued from the third meeting, sectiou 3.2) Mr UHDE (Director, Support Programme) presented supplementary visual information concerning the proposed regular budget estimates for 1986-1987, providing, in particular, an analysis of real, cost and currency in-creases and decreases by budget level, and illustrating real and cost incl"eases in regional regular biennial budgets during the period 1980-1987, as well as increases in country and intercountry budgets from 1980 to 1987. The Committee noted a significant increase in country allocations from US$17 485 100 to US$28 362 000 during the period 1980-1987, with a lesser increase in intercountry allocations from US$11 243 300 to US$16 067 600. Dr KITAGAWA (Japan) congratulated the Regional Director and his staff on the preparation of the programme and budget estimates for 1986-1987. He believed that, within budgetary limitations, resources should be allocated to high priority programmes. He drew the Committee's attention to the fact that an increase in the budget would imply an increase in the contributions of Member States. His country was attempting to reduce the national budget in the face of a severe financial crisis; accordingly, he believed that the proposals for 1986-1987 should be kept low. Dr SUNG WOO LEE (Republic of Korea) commended the Regional Director and his staff on the excellent preparation of the proposed programme budget estimates for 1986-1987. Mr BOYER (United States of America) expressed satisfaction at the inclusion of information on the budgetary implications of proposed new programme activities. In his view the regional presentation of such information was more effective than in the global programme budget document. However, he suggested that, in future, similar information should be included on regional and intercountry programme activities. He noted with pleasure the emphasis given both in the Regional Director's introduction and throughout the document to community self- reliance ; self-help by individuals and communities to complement government action was increasingly important. Similarly, the emphasis given to the need for effective national monitoring and evaluation procedures to ensure the effective use of resources in countries was gratifying and possibly resulted from discussions at the thirty-fourth session of the Regional Committee concerning inadequacies in the WHO monitoring framework. The increased attent i on paid to alcohol and drug abuse was commended. He hoped that similar attention paid to essential drugs would result ~n implementation by Member States of programmes ensuring access to a limited number of products. Noting the decrease in the allocation for administrative support from 10.52% to 7.41%, and recalling the allocation of 16.5% by WHO at global level for overheads and similar support, he wondered whether a lesson might be drawn from the Western Pacific Region in that respect. SUMMARY RECORD OF THE FOURTH MEETING 99 Appreciation was expressed of the useful information document and visual display concerning the prograanne budget. His Government shared the concern of Japan regarding budgetary increases and wished to retain a zero growth in the budgets of WHO and other international organizations. The United States could accept thP. 4% increase in country allocations if this was offset in the total budget of the Organization. He expressed concern at the absence of an analysis of what constituted the real increase proposed. Similarly, he regretted the lack of an analysis of cost increases in relation to the figures of 13.5% and 20% proposed for the country and regional levels, respectively. Information to clarify the basis from which these percentages were drawn would be helpful. Inflation was decreasing generally, and had declined to 4% in the United States. While a somewhat higher rate would be acceptable for WHO, the current figure of 16.6% seemed too high, particularly in the absence of any guiding analysis. A combination of the real increase and the cost increase resulted in an increase of 18. 7% in the proposed budget estimates. His Government would be unlikely to support an increase of 18.7% in the WHO global proposals, even with a zero programme growth. On the other hand, it was gratifying to note the adjustment made to take account of the favourable exchange rate in the Philippines. His Government believed that the equation of the exchange rate adjustment should be automatic. The fact that it implied a net budgetary increase of 11.2% should not obscure the actual increase of 18.7%. Mr UHDE (Director, Support Programme) agreed with the representative of the United States of America that there was a possibility that the overall figures would be changed once the global programme budget had been finalized. However, he reassured the Committee that the cost increases given were low, the total annual increase being only about 8%. Extensive surveys had been made in formulating the budget, and the increases were, in fact, inadequate when factors such as inflation were considered. In 1983, a World Bank report showed that inflation in developing countries was over 50%, compared with less than 10% in industrialized countries. In view of such wide deviation between developing and developed countries, it was felt that the cost increases in the budget were not excessive. There were as yet no details from individual countries, and certain assumptions based on past trends had had to be made in reaching the figure of 4% real increase for country activities. Since the 18.7% total increa8e included a statutory cost increase of 2.5%, the effective increase due to real growth and inflation was only 16.2%. The REGIONAL DIRECTOR added that the general policy had been to maximize the country allocations at the expense of regional and intercountry activities. Referring to inflation, he pointed out that, in addition to the "natural" inflation that was occurring in many parts of the Region, there was also the added inflation stimulated by the high exchange rate of the US dollar. It was not possible to allow for all such inflation in the budget, since it would have necessitated minus real growth in «;he programme budget and it was intended to try to absorb extra costs in the intercountry programme and in the Regional Office. 100 REGIONAL COMMITTEE; TllikTY.i..FIFTlt SESSION Mr BOYER (United States of America), supportipg the coaPDenta of the Regional Director, stated that lack of money shoQld not necessitate a reduction in progra101De activities. Staff should be stiaaulated to be more efficient in their use of available funds, and it was pleasing to b~ar that the Regional Office was trying to absorb eome of the coat increases. Dr LIU XIRONG (China) thought that ·the proposed prograaame budaet estimates were sounc:Uy based on pl"Opoaals by the various countries, and took account of the need for develop111ent within the Region. The progra1D1De budget was in line with the ptd.nc.ipbae laid down in the Seventh General Progra10111e of Work, aOd took into consi(leration the various areas requiring strengthening in order to achieve bealtb for all by the year 2000. The estimate was therefore perfectly acceptable, aod he tha.Uked the Regional Director and his st.aff for their efforts. Considering the important developa1ents that bad oecurred in all areas of activity in the Region, the increase in the nuaber of Meaber States, and the effect of inflation, the increase of 11.2% in the regular budget between 1984-1965 and 1986-1987 was necessary. 'lbe increase in real terms was only 2.1%, which he did not consider to be very high. '!be proposed progra1D1De laid stress on particular activiti••; for exatDple, there was an increase of 17 • . 5% in tbe allocation to count·ries and territories, an increase of 10. 9%' for intercountry programme.&; and a reduction of 8.6% for the Regional ().ffice. The efforts taade t;a reduce Regional Office e~penditure and increase the allocations to health· activities deserved appreciation. The large increase in the regular budget funds alloc.a~ed to Health situation and trend assessment (3 .1) -.,ae necessary, as w'r(!! t.._~ increases in the fields of Workers' health (9.3), Health of the elderly (9.4), Malaria (13 .3), Diarrhoeal diseases (13 .6), and Es,eential dr-..gs al)d vaccines ( 12. 2). The important field of Oral bulth (8.2) delilerve<l to be strengthened, but unfortunately, the budget alloc4.tion ha~ been rechlced by 13.4%. the. Regional CotDlDittee should also take accou-nt of the neecl expressed by ~be majority of · Member States ·for tr4dit:i,onal medicine, and iner~se the b\.l4&•t allocation accordingly. The present allocation was quite insufficieu.t (12.4). Prevention and control of cardiovascular diseases was another important area. Reports indicated that morbidity and mortality due to qyperteneion, coropary disease, etc. were increasing, and it was thus import.ant to strengthen that progralDIJle ( 13 .16). Appropriate increases in fund8 sh.ould be dlc:>cated to those thr.:ee areas by transferring resources from other progra10t11e areas. Dr KHALID (Mah.yeia) asked for clarification regarding the extt:"ab\.ldgetary fun~til. which were much lower than ~bose av•il•ble for 1984:..1985, and be wished to know to what extent the figures were fixed. SUMMARY RECOil) OF THE POll.llTli )fJETING 101 Dr HAN (Director, Progra~ Ma~ag~ent) replied that only firm commitments had been incluqed in the progr,81DIIIe bu<lget. . Data on input that had ~ot yet been fi'rmly cOUllllitted by other organiaati~s, perhaps because their programming cycle did not cov.er tbe period 1986-1987, would be supplied to Member S.tates as they becawe available. Dr KEAN (Australia) co1111Dended the Regi:Onal Director on the format of the budget presentation, particularly . the information documents and explanations provided. The budget cont;a.ined a number of very co1DIIIendable trends - especially the emphasi's on tbe develop11)ent of expertise in Health situation and trend asaessmet)t (3.1) - an aspect that was particularly important for the health-for-all strategy. Be welcomed the Regional Director's references to cost absorption; any attempt to absorb costs was commendable. Dr TAPA (Tonga) congratulated the ]l.ejional Dire-ctor and his staff on the programme bu<lget presented. As tb~ r~preseatative . of a small State, which had a population of only 100 OQO an<t was a•ilesse9 at the minit$u18 rate in the scale of as~essaents for the WHO budget (0.01%), he spoke in all hulllility to States contributing a hitb percent•ge of tb.e budget (including Australia, China~ Japan, and tbe Utiitec\ . Stetes of America) and ·.· . urged sympathetic consideration of the budget p,roposed by tbe Regional Dir.~ctor. It was based in the maio on the needs and r~quests o·f individual countries. Every government bad the righ·t to accept or oppose the proposed increases. However, be referred to tbe sta!tement on page 1/2 of clocumeot WPR/RC35/INF DOC/3 that the esti111ates for ·country activit.ies included a real increase of 4% as compared with the a~roved level for 1-984-198'5. Re would stress that the noble goal of health f.or all could only be achieve:d at the country level. The statement cited wnt oq to note t_,,at ebe incr:,eaee wa.s conditional and subJect to review and decision by the Director-General at the time of finaliz:ation of WHO's proposed progra•e bu(j;get for 1986-1987. None , of those . pret~t at the . Regional CoiJIQ),ittee was a p.:ropbet, and . $ble to for.esee wllat the i~fh1tion ra·tes would . actu~gly b.-. in 1;9~6-1987, or what was goi1;1g to happen beween the cun·ent ses.eion and 1ka:y 198·5, when the Health Asse..,ly wquld be ct;n.Jeidering tl:u~ 1986,-1987 .budget. He w,ould urge the more wealthy countries to consider the real needs of the small countries of the Region. Mr HARPER (Solomon Islands) said that bis Government h.i,gbly appreciated the new approach adopted by the ll~giooal Director in selecting proj·•cts and assigning priorities in the 1986~1987 budgetary allocations. In Solomon Islands, the primary health care concept had be.en applied to the health services only since 198(), which aeaot that reorientation., reorganization and retraining were of param<>Unt iQiport.ence. Outside cooper at ion would be essential if his covntry was to achieve the objective of health for all by the. year 2000, p4rt:icular.lY in the traini"g of physicians, nurses, nursing aid,~~ at)(! villag~ -h.alth worke,rs. It woul<i l,l~ de!sir4,~.fe to .set up a WHO offi~e · i~ Ho~iara ·t<> enable pfo.-pt dechicms to be taken on mae'te.rs of importance in cons.ultation witb the 1\egioaal D.irector. ··He suggested that the post of malariologist be re-established and extrabudgetary assistance sought in support o.f the organization in Solomon Is lands of a health system baaed on primary health caT"e. 102 REGIONAL COMMITTEE: THIRTY-FIFTH SESSION Dr KHALID (Malaysia) said that the 11.2% increa•e in the regular budget included substantial •nd well-justified increases in the sums allocated for Health system deveJop~ent (3), __ Research promotion and development (7), Protection anc;l Pr01Dot\on o·f the health of specific po.pulation grotipe (9), Protection and pro'olotion of mental h.a:lth 00), and Diaanostic, the-rapeutic and rehabilitative technology ~li). the 20.9% increase in allocations for Promotion of Environmental health ( 11) and the increase of U;S$1 25.0 000 in the amount set aside for Health system developurent (3) were fully justified. He assutDed that efforts · t+ iaprove lPOnitori:.-g of health-for-all progratll1De8 would continue to be in~eQa::i;fied. The planaed training in the use of computers sbould be accot!J.pani•d by training in the application of information in support of decision""tnatcing. When drawing up estimates for Pw<Otllotion of Enviro~e.etal heal-tb (11), account should be tatcen of the recent ~ot~aultation to review progrees in the International Drinking Water Supply an~ Sanit•tion Decade. Sanj.tation was lagging behind dJ;'i.nk~na-water e,upply. UtiDP ehO\I.ld review its decision to terminate its c·ontribt,Jtion to certain Deeadie projects and reduce its contribution to others since international cooper•ti:On was required more than ever before at a time wh•n certain countries were striving to accelerate their Deead~ activities. More support should be given to PEPAS; although some o·f its activities required review. Elnphaeis · sb~t~ be laid on t:rainit;tg in system rehabilitation, operation and maint.~aoce, and on tbe pi'eparation of. 111anuals for training ~nagere and field etaf.f as a wty o·f overcot~ing ·tbe abortage of such staff in many countries. The Centre sboufd give more attention to Decade needs. The increase of US$1 205 800 proposed for Disease prevention and control (13), with con.tinued emphadl on malaria and diurhoeal dheaae·s, was justified. Malaria control through primary health care had been proposed and docum.ents should be p-r;epared on that subject in order to provide information for countries concerned. In regard to Acute respiratory infections (13.7), he welc()Jlled the proposed collaboration in the trainina of peripheral he.altb workers arid the production of manuats. In the era of antibiotics, it should be possible to prevent deaths fro& such diseases if front:-1 ine workers were given proper training. He hoped that the Action Progr.-e for Es$ential Drugs and Vaccines could be developed . fur.ther in tlle a-.l.on, particularly at country level. Small cou.ntries were at a particular disadvantage in reg:ard to drug prices and quality control. He propos~d a reaional consult.ation to map· out a strategy for the action progratm~e. He fully s.upported the proposed progr...-e blof:dget · estimates for 1986.-1987• SUMMARY RECORD OF THE FOURTH MEETING 103 Dr TIRA (Kiribati) ~ndoreed the plea made by the representative of Tonga. He woul~ welcome the g"Ceatest possible flexibUity in allocating funds, particularly as many co1;1ntriea 'were just ente:rtng upe»n the most decisive phase in developing their' primary health care prograQIIJles. He could assure representatives that Kiribati would exercise strict budgetary control over funds allocated to it. The CHAI~N pr,oposed that the programae bud;get document be considered by programme area. '' 1. Governins bod.iea {pages 21-23) There were no co1111lent$. There were no comments. 3. Health system Q.eveloQ!!nt (pages 34-47) 'l;'hel'e were no cQlllrJlente. 4. of'bealtb bealt:b- care There were QP cQmiJlenta. 5. Health ~!!f~er (page4t 53-57) Mr BOYER (United States of Aaeric•) said tb•~ Health m&opower, including fellowships, accounted for 19.1% of the rea~lar budget if that programme alone was taken into account and probably for as much as 30% if fellowsh~pe under ot.,er headings were io~~ucled. He felt that such a high perc~ntage probably was not justified in vi•¥ of the· fac,t ' that ;ome national governments appeare4 - to be using fellowah.i.ps as a cateb~all category not spec~fically related to particular WHO priorities or to the general programme of work. Six countries or areas used the whole of their allocations frolJl WHO for health manpower development and others used almost as high a proportion. Fellowships should only be allocated if they were to serve a specific purpose in the attainment of WHO's objec~ives. Dr KEAN (Australia) expreued a__gree1Qent with the comm.eats of the representative of tbe United States of A11lerica. In 1982 Australia had provided training fol" 22 WHO fellows and ig 1984 it ha.d already placed 104 fellows. There was a tendency for countries to make repeated requests for the same type of training, which suggested that, on returning to their cot,t.ntries, fellows were being employed a.s field workers rather than as tra.iners. Mo~eove.-e, s~cb repeat requests had le:d some Australian . -. ·-.::-· -·: ::' . . ' . - ·_ <-_ ' - -· . " ' - -. :-- . ·;t;, institutions to set q,uotas for fellowship students. Funds allocated for health 11anpower pr9grammes could be used in other ways. A more practical approach would be to set up training programmes in the countries tbemselv~e, for staff at all levels. 104 REGIONAL COMMITTEE; THIRTY-FIFTH SESSION Dr BARKER (New Zealand) said his country's experience was similar to that of Australia. People were sometimes selected for fellowships without any consideration of the country 1 s needs, and on returning home they found no vacancies in the field in which they had been trained. Dr TAPA (Tonga) said that, although he understood the reservations of some other delegations, his Government was happy that the bulk of the WHO funds allocated to Tonga was spent on health manpower development. Human resources were the most important of all resources, and the biggest single need in the health field was for properly trained personnel. Tonga appreciated WHO's support for its efforts to improve the quantity and quality of its health manpower, and would continue to give top priority to the development of health personnel. Dr KHALID (Malaysia) shared the views expressed by the representatives of the United States of America and Australia regarding the importance of making the most effective use of resources. His own country consistently endeavoured to produce a programme-based budget, in which all requests for fellowships or consultant services were related to specific programmes. His delegation agreed that in general it was preferable to select for fellowships people who would be able to pass on their training to others when they returned to their own country. Malaysia followed that approach in most instances, but it was not feasible in the case of highly specific programmes that required very few staff, and for which a local training programme would not be justified. Dr LID XIRONG (China) outlined the efforts made in China to make the most effective use of the WHO fellowship programme. Since 1949, the number of health personnel in China had increased from 500 000 to almost 3 million, but the available manpower was still insufficient, in both quantity and quality, to meet the demand. Accordingly, the Government attached great importance to health manpower development, and greatly appreciated the support of WHO, which since 1978 had provided training abroad .for almost 300 Chinese health workers through its fellowship programme, The 100 who had already returned had learnt a great deal and had become valuable workers and trainers. Fellowships were one of the most important of all WHO's activities and~ on the basis of an analysis of the realities of the country's situation, the Chinese Government and health authorities had decided to use 50% of allocated WHO funds for that purpose. China fully endorsed the importance attached by WHO to health manpower development. Dr HAN (Director, Programme Management) pointed out that the budget allocations reflected the high priority given to health manpower development by Member States. In the 1984-1985 programme budget, US$8.84 million was allocated to health manpower development, including US$4.2 million for fellowships. Other components of health manpower development included long-term staff, consultants, supplies and equipment. In addition, US$4. 9 million was allocated to fellowships within other programme areas, so that the total amount allocated to health manpower development was US$13.7 million, about 30% of the total regular budget for the Region. Some programmes funded with extrabudgetary resources also contained a substantial fellowship component. SUMMARY RECORD OF THE FOURTH MEETING 105/106 Fellowships available under the Health manpower programme were not no.rmally allocated to specific programmes until detailed programming was undertaken. Of the 798 fellowships provided under the regular budget for 1984-1985, 95% had been allocated to specific programme areas at the time of detailed programming, in other words one year before the fellowships were dueto be taken up. That seemed a satisfactory performance, particularly in view of the policy of flexibility in programming. Countries were not always able to determine their training needs and to find suitable candidates two or three years in advance. The REGIONAL DIRECTOR said he paid close attention to the way in which the WHO fellowship programme was used. Two years previously, the Regional Committee bad taken the initiative of evaluating that programme, and had endorsed it. The programme was particularly useful to the small newly independent States which in the past had relied heavily on expatriate staff. It was not feasible for them to set up schools for health personnel, and WHO fellowships were invaluable to them. Fellowships were essential for a developing country. When China resumed its active membership of WHO in 1978, cooperation had at first been confined to fellowships, and was gradually expanding to other areas. When Japan was a developing country, it had made full use of the WHO fellowship programme. Most of the country's senior medical officers had benefited from it, and were now prepared to pass on their knowledge to other nations. (For continuation of the discussion, see the fifth meeting, section 1.1). The meeting rose at 5 p.m. (WPR/RC35/SR/5) SUMMARY RECORD OF THE FIFTH MEETING New Town Hall, Civic Centre, Suva Friday, 7 September 1984 at 9 a.m. CHAIRMAN: Dr T.M. Biumaiwai (Fiji) CONTENTS 1. Consideration of proposed programme budget estimates 2. (continued) ••••••••••••••••••••••••••••••••••••••••••••••• 108 1.1 Proposed programme budget estimates, 1986-1987 (co-ncinued) -·~·············· · ··•••-•••••••••••- ···•~···~··· 108 Sub-C01D1llittee on Technical Cooperation among Developing Countries: Report of the Sub-Committee 114 J. Sub-Committee on the General Programme of Work 3.1 Report of the Sub-Committee ••••••••••••••••••••••••••• 117 3.2 Membership of the Sub-Committee ••••••••••••••••••••••• 121 - 107 - 108 REGIONAL COMMITTEE: THIRTY-FIFTH SESSION 1. CONSIDERATION OF PROPOSED PROGRAMME BUDGET ESTIMATES; Item 8 of the Agenda (continued from the fourth meeting, section 1) 1.1 Proposed programme budget estimates, 1986-1987: Item 8.2 of the Agenda (Documents WPR/RC35/3 and WPR/RC35/INF DOC/3) (continued from the fourth meeting, section 1.1) Public information and education for health (pages 58-62) There were no comments. Research promotion and development (pages 63~65) There were no comments. General bealth protection and promotion (pages 66-76) Mrs ENGLISH (Australia), referring to Nutrition (8.1), said that her Government would like to see the proposed nutrition programme make specific mention of the priorities laid down for immediate action at a recent meeting of the United Nations Administrative Committee on Coordination Sub-Committee for Nutrition, viz. that there should be a coordinated country-level approach by the agencies in the area of food and nutrition and a global strategy for the eradication of vitamin A and iodine deficiency disorders. A coordinated approach was particularly necessary in the formulation of national food and nutrition policies, on which the proposed WHO nutrition programme for the Region laid special emphasis. It was needed all the more in that FAO was developing a programme to draw up national food and nutnt1.on policies in six island countries of the Pacific. Vitamin A and iodine deficiency disorders, and anaemia caused by low iron intake were major problems in some countries of the Region. Means were avai table for preventing simple deficiency diseases and thus eliminating, for example, blindness due to xerophthalmia, and cretinism and deaf-mutism associated with iodine deficiency. The shortage of suitable nutrition manpower for implementing national food and nutrition policies was a particular problem in certain countries of the South Pacific and, if the 1989 nutrition target was to be reached, more training courses would be needed. The proportion of the budget devoted to nutrition seemed very small. It was increasingly accepted that a nutritious diet supplying a balanced intake of food energy and nutrients was essential to health and a key factor in the prevention of and recovery from illness. In Australia diet-related diseases were responsible for more than 60% of morbidity and mortality. Such diseases, particularly those resulting from overnutrition, were a growing problem in many countries of the Region. Dr TU GIAY (Viet Nam) said that the struggle to overcome hunger and malnutrition in developing countries with low production and high population growth was a very difficult and complex task, which called for a multidisciplinary and multisectoral approach through a coordinated national plan with precise objectives. SUMMARY RECORD OF THE FIFTH MEETING 109 In Viet Nam, in addition to foodstuffs produced on State and collective farms, an important source of food that must be further developed was the so-called VAC ecosystem (vegetable gardens, livestock and fish-rearing) among families and small cc:>mmunities, wbich provided a wide variety of foods to enrich and diversify the basic ration. In regions where land was still available, it was possible to assign 10-15% of the arable land to family food production. Other important issues were the means of preserving food already delivered, ensuring good quality, building up a food industry and teaching rational ways of cooking food and conserving its nutritive value. While it was very difficult to increase food production by 5-10%, experience had shown that 30-40% of what was produced could easily be lost as a result of faulty storage and preservation. It was essential to establish model patterns of nutrition for pregnant and nursing mothers, pre-school-age children, schoolchildren and students, workers, farmers and the sick, and to give thetn wide publicity among the population. In order to utilize to the full the nutritive value of foodstuffs, to ensure the prov1s1on of economical but nutritious meals, to control nutritional and deficiency diseases and to ensure that nursing mothers had a good flow of milk, it was essential to provide the whole population, and particularly women, with at least a modicum of knowledge concerning the food needs of adults and children, the nutritive value of different foodstuffs, the benefits of breast-feeding, the dietary needs of pregnant women and nursing mothers, and the nutrition of sick children, particularly those suffering from diarrhoea. He considered that increased funds should be made available for nutrition activities. Dr BAVADRA (Fiji) thanked WHO on behalf of his country for the role it bad played in dev.eloping the nutrition progra1llllle in Fiji. WHO was cooperating in the implementation of national food and nutrition policies developed jointly by UNDP and FAO, particularly in regard to training. WHO intercountry personnel in Suva had provided invaluable cooperation. Dr SUNG-woo LEE (Republic of Korea) reiterated his appeal for greater emphasis on Nutrition (8.1), Oral health (8.2) and Accident prevention (8.3). There appeared to be a 40% decrease in funds for activities in accident prevention in the 1986-1987 budget. He believed that the present level of expenditure should have been maintained. Dr NAIR (Regional Adviser in Nutrition), replying to the questions raised by the representative of Australia, said that the two recommendations made earlier in 1984 by the ACC Sub-Committee for Nutrition had been taken into consideration by WHO. Xerophthalmia and other deficiency diseases were receiving greater a,ttention than in the past. WHO had always cooperated with the other United Nations agencies, as was the case in Fiji. The ACC Sub-Committee was itself responsible for interagency coordination at all levels. WHO was continuing to support six nutrition training programmes in 110 REGIONAL COMMITTEE: THIRTY-FIFTH SESSION the Region. Training facilities were also available in many countries and support was forthcoming from Hawaii, which, although outside the Western Pacific Region, was close to some of the Member States in the Pacific. Caution had to be exercised, however, since, at most only 15 of the 67 people awarded fellowships in nutrition over the past years had reNined in nutrition. Requirements, and particularly the level at which training should be provided, would be carefully considered before any new training programme was embarked upon. The REGIONAL DIRECTOR, responding to the suggestion by the representative of the Republic of Korea that present levels of fuQding for work on accident prevention should be maintained, s~id that more support from extrabudgetary sources was expected. Negotiation~ were in progress with some major associations of vehicle manufacturers in some countries. The most common accidents in the Region were traffic accidents, of which children were frequent victims. It was only common sense that all parties concerned should cooperate in the accident prevention programme. With regard to nutrition, WHO had, from the beginning and at every level, collaborated with other United Nations agencies, particularly with UNICEF in its work on the nutrition of mothers and children. Protection and romotion of the health pages 77-87) Dr KOTEKA (Cook Islands), referring to Maternal and child: health, including family planning (9.1), said that his Government attached great importance to the health of mothers and children and to family planning and was grateful to WHO for its valuable technical collaboration in developing programmes. The United Nations Fund for Population Activities (UNFPA) and UNICEF had also provided noteworthy support. The coaabined activities of those agencies had enabled his country to reduce infant mortality from 33 per 1000 live births to 21 per 1000 live births in 19:83. Family planning now covered 30% of women of reproductive age. Dr BAVADRA (Fiji) said that b~s country also regarded Maternal and child health as a priority progratmne and bad been concentrating on it for a number of years. Without WHO cooperation and aasistapce from UNI>P, UNFPA and UNICEF, it would have been impossible for Fiji, with its islands scattered over a wide area of ocean, to achieve the coverage necessary to bring about the improvement in maternal and child care, which bad resul.ted in maternal mortality being reduced from 60 per 100 000 in 1977 t~ 46 per 100 000 in 1981 and the infant mortality rate from 31.9 per 1000 live births in 1977 to 22 per 1000 live births in 1983. Protection and promotion of mental health (pages 88-97) Dr HAN (Director, Programme Mano$gement), in reply to a question from the representative of Japan, explained that the 474% increase in the 1986-1987 budget estimates for Prevention and control of alcohol and · drug abuse (10.2) over the allocation for 1984-1985 was accounted for by a larger number of requests, particularly from China and Papua New Guinea. More intercountry activities were planned in the form of workshops and working groups and it was intended to step up epidemiological reeear~h. SUMMARY RECORD OF THE FIFTH MIBTING 111 Promotion of environ~ental health (pages 98-113) There were no comments. Diagnostic, therapeutic and rehabilitative technology (pages 114-132) Mr BOYER (United States of America) welcomed the efforts .to make essential drugs available to poorer populations at the lowest possible cost, and found the 53% increase in the budget for such activities well merited. The United States Food and Drug Administration (FDA) was prepared to provide countries of the Region with training in good manufacturing practices and quality control, together with advice and information on the quality, safety and efficacy of drugs and vaccines. In particular, the Food and Drug Administration was ~illing to share its ~xpertise on the quality controLand development of hepatitis B vaccine. Such services would be provided on a bilateral basis, and would be additional to the cooperation his country provided through WHO. The REGIONAL DIRECTOR, in welcoming that offer, reminded the Committee that the United States Food and Drug Administration had been active on a bilateral basis for some time, notably in ·china with regard to the quality control of drugs and biological substances. It bad also released some of its staff to serve as consultants for WHO programmes. F·or example, a senior Food and Drug Administration official had spent one month in the Philippines to conduct a training course on drug evaluation. It was less expensive for WHO to use government experts as consultants than to recruit outside experts. The Governments of Australia, Japan and New Zealand had also provided consultants on the same basis, and it was to be hoped that there would be more of such arrangements. Mr BOYER (United States of America) commended the Chinese approach to mechanisms to promote the distribution of essential drugs and the quality control of food and drugs, and suggested that it could usefully serve as a model for other countries of the Region. Dr HAN (Director, Progra111t11e Management), in reply to a question from the representative of Japan, said the budget allocation for Rehabilitation (12. 5) had been increased by 242% in response to government requests, in particular from China, Lao People's Democratic Republic and the Republic of Korea. It was intended to initiate an intercountry project on community-based rehabilitation. Dr BAVADRA (Fiji) said that d:rug supplies had long been a serious health and political problem in his country. The introduction of WHO's bulk purchasing scheme had led to significant improvements, and had made it possible to set up community pharmacies in rural areas, where people could obtain previously unavailable drugs at reasonable prices. Fiji was grateful for Australia's assistance in the quality control of drugs, and welcomed the offer of facilities by the United States Food and Drug Administration. There had been some press criticism of the use in Fiji of contraceptives that were not approved for use in lihe United States of Al!lerica, and it would be helpful if the situation could be clarified. 112 REGIONAL COMMITTEE; THIRTY-FIFTH SESSION Dr MARSALLON (France) drew attention to the pharmacological research on medicinal plants being conducted by ORSTOM in Noumea. The practice of plant-based traditional medicine in the Pacific area was extensive and effective, but it presented certain risks. The plant alkaloids used were highly active, but the concentration of the active ingredient varied widely according to season, storage methods, and other factors. That variability had led to many accidents, especially among children, and there was unquestionably a need for research and for quality control. The REGIONAL DIRECTOR pointed out that, in view of the public concern in such countries as Fiji and Vanuatu at the use of Depo-Provera as a contraceptive, the issue bad been discussed by a WHO expert group in consul tat ion with the United States Food and Drug Administration. Since better alternative drugs were readily available in the United States, the use of Depo-Provera for contraceptive purposes was not recoaaended in that country. However, it was not banned, and its use was still approved for certain other limited indications. The WHO group had agreed that the drug was still useful for family planning purposes in many countries. It would be helpful if the United States Food and Drug Administration would make a formal statement confirming that view. A similar situation had arisen in respect of oral rehydration salts, which were not approved for use as a drug by the United States Food and Drug Administration. However, a dialogue had been established, and the Food and Drug Administrati•Jn had agreed that rehydration salts could be used as a food. Consequently, their use in diarrhoeal disease control had been extended to the United States trust territories in the Region. The research conducted by France on traditional medicine in the Pacific area was greatly appreciated. It was time to promote the more effective use of traditional medicine in the Region. Disease prevention and control (pages 133-178) Replying to a query from the representative of Japan regarding the 536% increase in the budget allocation for Sexually trans11itted diseases ( 13 .11), Dr HAN (Director, Programme Manage1Dent) stressed that, in view of the situation in the Region, an even greater increase could be justified. The rise in the incidence of neonatal syphilis and the appearance of antibiotic-resistant strains of gonococci were causing great concern. Proposals for projects bad been received from .New Caledonia and Viet Na11. WHO activities would consist in providing consultants, supporting national training courses, and strengthening laboratory ,capability. Health information support (pages 179-181) There were no comments. Support services (pages 182-190) In reply to a question from Dr TAPA {Tonga) regarding the geographical representation of Member States among WHO staff, Dr VIGNES {Legal Counsel) stated that under the WHO Constitution the right to decide on staff appointment was vested in the Director-General. SUMMARY RECORD OF THE FIFTH MEETING 113 Dr BAVADRA (Fiji) welcomed the trend towards recruiting people to work as consultants in their own countries. Some projects were best carried out by local experts. Dr KHALID (Malaysia) also welcoaed the increased use of local people for national progratm;~~es. However, capable international staff would always be needed at the Secretariat. Even the best expert was rarely seen as a prophet in his own country, and decision-makers tended to take more notice of a foreign adviser or consultant. Information annexes Dr SUNG-WOO LEE (Republic of Korea), referring to the table on page 195, asked why it was proposed to increase the budget allocation for Fiji by 74.2%, far more than for any other country. In particular, the table on page 24 7 indicated a 615% increase in the costs of the Office of the WHO Programme Coordinator in Suva, which seemed strange for an office that had been in existence for many years. Dr HAN (Director, Programme Management) explained that the budget estimates for Fiji contained two components. One was the cost of technical cooperation with that country, expressed as a country planning figure. It was proposed to increase that figure from US$900 000 in 1984-1985 to US$1 000 000 in 1986-1987. The second component was the cost of the WHO Programme Coordinator's Office. Tbe Office in Suva was responsible for all countries or areas in the South Pacific area, and in previous budgets its costs had been divided among those ·countries or areas. In the budget estimates for 1986-1987 all the costs of the Office were shown under Fiji, which accounted for the apparent sharp increase in the allocation to that country. Mr BOYER (United States of America) invited the Regional Director to outline the process whereby he apportioned the av~i.lable funds to the various countries or areas of the Region. w,.s he following the suggestion made by the Director-General at the thirty-fourth session of the Regional Committee, that preference be given to countries that were trying hardest to achieve health for all by the year 2000 and to implement primary health care? The REGIONAL DIRECTOR replied that WHO had formulated a number of criteria or guidelines for determining allocations to countries. First of all, preferential support was given . to countries or areas that were using WHO resources in accordance with the strategy laid down by the Health Assembly for attaining health for all. Second, the stage of development of each country was taken into account, measured in terms of socioeconomic and health indicators such as population size, physician/population ratio, per capita GNP, and life expectancy. Third, consideration was given to the country's ability and readiness to make opti11um use of WHO resources. Fourth, the availability of support from other sources, such as bilateral arrangements or resources provided through WHO's intercountry programme, was taken into account. Finally, special consideration was given to the needs of new Member States. It was only in recent years that China had become an active member of the Organization; the budget allocation for that country was regularly increased by substantial amounts because cooperation was still 114 REGIONAL COMMITTEE: THIRTY-FIFTH SESSION being built up. The allocation for Cbina was still only half of that for India. In addition to such criteria, the continuous dialogue within the Regional Committee was a major tool in preparing the budget proposals. The proposals were, of course, subject to examination by the Regional Cot~~~~~ittee, and the country planning figures established by the Regional Director were not definitive. A considerable proportion of the resources allocated to Fiji was devoted to the medical school, which trained students jirom all the Pacific islands. There being no further comments, the CHAIRMAN instructed the Rapporteurs to draft a resolution concerning the proposed programme budget estimates for 1986-1987. (For consideration of the draft resolution, see the seventh meeting, section 1.2). 2. SUB-COMMITTEE ON TECHNICAL COOPERATION AMONG DEVELOPING COUNTRIES: REPORT OF THE SUB-COMMITTEE: Item 10 of the agenda (Document WPR/RC35/5) Dr KHALID (Malaysia), in the absence of the . Chairman and the Rapporteurs of the Sub-Committee on Technical Cooperation among Developing Countries, introduced the report of the Sub-Collllllittee. The Sub-Committee had met from 28 to 29 June 1984 to consider the report of the visita of its members to Fiji, Papua New Guinea and the Philippines, and to make recourmendations for the promotion of technical coopera.tion in tratning in primary health care, with particular referencce to its managerial and support aspects. While all countries were reorienting their staff, planning and management of health care systems, with emphasis on community participation and intra- and intersectoral coordination, to the primary health care approach, there was still room for improvement. There was variation between countries in the stage of implementation reached, and it was noted that experiences in one country were not necessarily diTectly applicable to others. Research and development projects in primary health care had very strong training components. · Information exchange among countries was not satisfactory and the inventory of training activities conducted by countries in the Region should be more comprehensive and complete. The Sub-Committee had made six recourmendations, which were contained in document WPR/RC35/S. The Sub-Committee had also recommended that, in 1985, it should address itself to traditional medicine, with particular reference to herbal medicine and acupuncture. Dr SUNG-WOO LEE (Republic of Korea) courmended the excellent report and thanked the Sub~Committee for its in-depth observat:ions regarding the development of primary health care in the Region. He endorsed the recommendations of the Sub-Committee and Ob$erved that their implementation would require considerable support from WRO. He also s .upported the topic proposed for consideration in 1985, particularly as herbal medicine and acupuncture were widely practised in some parts of the Region. SUMMARY RECORD OF THE FIFTH MEETING 115 Mr LAVEA (Samoa) said that there was good cotmnunity involvement in primary health care in his country on account of the village women's committees; that would be strengthened through national workshops for health workers and committee leaders. Close technical cooperation existed with American Samoa, Fiji and New Zealand. He thanked the Government of New Zealand for its long-term cooperation in accepting patients for medical care when appropriate facilities were lacking in Samoa. Mr CAO YONGLIN (China) expressed his appreciation of the report, which provided useful information on the situation in countries. He stressed the importance of technical cooperation in training for primary health care as a means to achieving health for all. Training activities such as workshops and seminars could play an effective role in technical cooperation by providing developing countries with useful opportunities for the exchange of experience and by stimulating the promotion of primary health care. The WHO collab'orating centres for primary health care established in China bad made a positive contribution in that field. He commended the Sub-Committee's recommendations, particularly those concerning information exchange, the designation of additional WHO collaborating centres, the strengthening of research and development in primary health care and the development of national capabilities for training in primary health care. He urged Member States to implement those recommendations as far as possible. His delegation believed that an increase in the membership of the Sub-Gommittee would be beneficial to its work. Dr TAPA (Tonga) thanked the Sub-Committee for its excellent report on an important topic. He noted the Sub-Committee's observations and supported its recommendations, including the topic proposed for consideration in 1985. Mr YOSHIDA (Japan) endorsed the need to accord high priority to the primary health care approach in order to overcome health problems. He underlined the importance of appropriate training for health leaders and workers in order to develop a sound primary health care system, and the need for intercountry and interregional technical cooperation in primary health care activities. The different levels of socioeconomic development in countries and areas were reflected in the development of their health systems. He believed that technical cooperation, in particular appropriate information exchange, could contribute to the sound planning of national health care systems. National evaluation and monitoring of programme activities were essential to ensure effective health systems development. Japan had attained a high standard of health through the development of a primary health care system, and, in view of its extensive experience in that respect, his country could make an important contribution to technical cooperation through the provision of information on training of health workers. Japan would participate very actively in technical cooperation programmes related to training and the exchange of information on primary health care. Dr DANG HOI XUAN (Viet Nam) · expressed his appreciation of the excellent report of the Sub-Co111tllittee, which highlighted many important 116 REGIONAL COMMITTEE: THIRTY-FIFTH SESSION problems. After thirty years of war, Viet Nam looked forward to cooperation with other · countries, particularly in traditio}lal 1Jledicine, cQpt.rol of malnutrition and primary health care. His country had established . a number of models based on a multidhciplin«ry approach, and would welco.e an exchange of experience with other countries. The REGIONAL DIRECTOR info.r&~ed the repres~ntative of China that WHO recognized the need to increaee tbe membership of the Sub-Coaittee, particularly in view of the complex topic proposed for 1985. However, S!JCh an increase would have budgetary implications. He noted ~bat tbe Sub-'Committee on the General ProgratD1De of Work had eight members, ,.;.bil.e the Sub-Committee on Technical Cooperati()ll a1Dong Developing Countries bad only four. He proposed that a review of the ac.tiviti;ea, members.bip and structural arrangements of both sub-committees should ·be undertaken with a view to submitting a proposal concerning their future wOrk and structure to the next session of the Regional Co~ittee. In the meantime, should the Sub-Committee on Technical Cooperation among Developing Countries have difficulty in fulfilling its task related to traditional 111edicine, he would be willing to provide additional advisory support. Mr CAO YONGLIN (China) agreed with that proposal. Dr KEAN (Australia) recalled that the Sub-Committee on the General Programme of Work had been established in 1976 and that on Technical Cooperation among Developing Countries in 1977. He endorsed the need for a review of their composition and methods of work to ensure that maximum benefit was derived from their resources. He welcomed the Regional Director's proposal in that regard. In particular, he considered that the terms of reference related to the country visit and the subsequent meeting in Manila required reconsideration, as we.ll as the number of countri.e8 to be visited. The inclusion of an elective period during which Sub..;,eo-ittee members could explore particular areas of interest during a country visit was suggested. The possibility of holding a meeting in the country visited at the end of the visit, instead of in Manil•, could also be considered. His delegation would look forward to receiving the report of the review at the next session. Dr KHALID (Malaysia) supported the views expressed by the representative of Australia. He sugge,ste_d that, to fa~ilitate arr~mgeD.lents and to render the work of the Sub-Co~ittee more eff•~.tive, detaib of the information and the consultations required by the Sub-Committee sbould be sent to the host country prio~ to a visit. Dr TAPA (Tonga) agreed that there was a need to review the structure and membership of both Sub-Committees and to submit a report to the next session thereon. The REGIONAL DIRECTOR noted the agreement of all representatives to the proposed review, which wo~ld be prepared in coneultatio·n with Member States for the thirty-sixth session of the Regional co.aittee. In the absence of further cotmllf!nts, the CHAIRMAN asked the Rapporteurs to draft an appropriate resolution. (For consideration of the draft resolution, see the seventh meeting, section 1.3). SUMMARY RECORD OF THE FIFTH MEETING 117 3. SUB-COMMITTEE ON THE GENERAL PROGRAMME OF WORK: Item U of the Agenda 3.1 Report of the Sub-Committee: Item 11.1 of the Agenda (Document WPR/RC35/6) Dr KOINUMA (Japan), presenting the report of the Sub-Committee on the General Programme of Work in the absence of the Chait111an, Rapporteur and other members of the Sub-Committee, said that section 1 of the report gave a brief introduction and described the terms of reference and membership of the Sub-Committee. The Sub-Committee • s findings and recomtDend•tions with regard to its review and analysis of WHO cooperation with Me'IJ)ber St•tes, which was the first of its terms of reference, were presented in section 2 of the report. Health manpower development, including the training of co-unity health workers, as well as the role of academic iastitutions in health development bad been the subject reviewed by the Sub•C®Imittee in 1984. In carrying out its t~sk, the Sub-Committee bad visited Malaysia, Solomon Islands and Vanuatu from 12 to 17 March 1984. As the. ti'llle spent by the Sub-Committee in the three countries had been limited, tbe review had had to be essentially broad and general in nature. The sumtDary of findings on the country visits of the Sub-Co11l11littee were given in section 2.2 of the report and the recollltDended areas for WHO collaboration which should be continued and further strengthened in the future in section 2.3. The second of the terms of reference of the Sub-ComtDittee related to the monitoring and evaluation of strategies for health for all by the year 2000. In this connection, the Sub-Committee bad reviewed the Co111non Framework and Format for Evaluating Strategies for Health for All, the report on which was contained in section 3. He recalled that the plan of action for imple111enting the strategies for health for all by tbe year 2000, as approved by resolutions WHA35.23 and WPR/RC32 .RS, provided for continuous monitoring and evaluation of those strategies. Member States were requested to monitor and evaluate their strategies and to submit their reports to the Regional Director every two years. Monitoring of progress had been undertaken for the first time in 1983, while the first evaluation of strategies would be done in 1985. During the discussions on the regional synthesis of the monitoring reports at the thirty-fourth session of the Regional Committee in 1983, a number of representatives had voiced their difficulties in understanding the wording of the questions and the significance of the indicators used in the Common Framework and Format for monitoring the strategies. The Secretariat bad therefore felt that it wol.lld be in the best interests of Member States and the Secretariat if the Common Fr811lework and Format for Evaluating Strategies for Health for All, to be used in reporting in 1985, could be reviewed by the Sub-Committee on the General Programme of Work, keeping in mind the comments made on the monitoring format. 118 REGIONAL COMMITTEE: THIRTY-FIFTH SESSION In its review of the Common Fra~ework and Format for evaluation, the Sub-·Committee had observed that many questions needed further clarification or examples. However, since it was a global document intended for use by all the regions, the Sub-Committee did not wiSh to propose any restructuring of the format itself. Instead, it bad proposed that a sutntnary of all the points raised, containing s•1pplementary illustrative information, be prepared and submitted to Member States. Such information had been summarized in the ten-page docuaent appended to An~ex 4 of docu~ent WPR/RC35/6. The appendix should be referred to as Member States considered each question in the Common Framework and Format. In its review of the questions contained in the CoiiiQlon Framework and Format, it was possible that mnbers of the Sub-CPllllllittee might have overlooked certain points that needed further clarification. It was also possible that some parts of the appendix, which the Sub•Committee had tried to keep as simple and straightforward as possible, might still need further explanatory comments. The Sub.-Committee hoped, therefore, that representatives would not hesitate to make known any further needs in that respect. Mr YOSHIDA (Japan) congratulated the Sub-Committee on its report on the country visits to review health manpower development, and expressed appreciation of the Sub-Committee's comments. In Japan the number of doctors bad now reached the same level as in the western advanced countries, as a result of great efforts to ensure the provision of adequate health personnel as a first priority. His country was now facing such problems as geographical maldistribution and inadequate cooperation among the medical care facilities. Efforts were therefore being made to consolidate national health manpower and to review the actual policy of m,flnpower develop~ent in the light of future community health needs and to coordinate health and medical services in line with the rapid progress of medical science. In that context, he expressed the hope that it would be possible for .WHO to gather systematically information on the various educational syst~ms of the Member States in the Region. The information might include. the n411les of academic institutions, requirements for approval of those institutions, education programmes, the number of trainees, and national examinations to obtain qualifications. Dr KHALID (Malaysia) thanked the Sub-Committee for its re.port, and expressed appreciation of · its visit to his country to discuss various aspects of health manpower development and visit a few of the health facilities. He agreed with all the Sub-Committee's recocnmendations regarding health manpower development, but wished to ua.ake certain comments and clarifications regarding the report on Malaysia to avoid misunderstanding. Regarding teacher training, Malaysia was well aware of the need to upgrade the quality of teachers - both · of nurses and of other health personnel. Multidisciplinary workshops had been held for various categories of teachers, but these had been limited to priority areas because of resource SUMMARY RECORD OF THE FIF1'H MEETING 119 constraints. The establishment of a teacher training centre had bad to be postponed owing to unavoidable circumstances, but the faculty members trained for the centre were being used to conduct short upgrading progra1DUles for teachers of various categories of personnel. Secondly, regarding the statement that academic institutions were in general insufficiently involved in the planning and evaluation of health programmes, he pointed out that, while it was generally agreed that academic institutions had a role to play in that respect, their participation depended upon the structural and functional arrangements for health programme development in the individual countries and the capacity of the institutions to undertake those functions. Thirdly, it was stated that continuing education prograannes for the various categories of health personnel were, for the most part, conducted on an ad hoc basis aQd at different frequencies for tbe various categ9ries 9f health personnel. Malaysia recognized, of course, that its continuing education programmes could be further improved - but activities of that nature necessarily depended upon needs, capacities and priorities. It was neither possible to avoid ad hoc arrangements nor necessary to have continuing education prograannes for different categories of staff at the same frequencies. He regretted that tbe Sub-Committee bad not been in Malaysia for a longer period in order to have a much better picture of its prograames and problems. Dr ACOSTA (Philippines), referring to the comments just made by the representative of Malaysia, drew attention to the statement at the end of section 2 of the Sub-Committee's report, nodng that, in view of the limited time spent by members of the Sub-Committee in each country, the reviews were essentially broad and general in nature, and to recommendation (8} in section 2.3 to the effect that country visits by members of the Sub-Committee should be limited in future to one or at most two countries to enable them to undertake a review of WHO cooperation in greater depth. He fully supported that recommendation, which might also be relevant to the Sub-Committee on Technical Cooperation among Dev~loping Countries. Dr TIRA (Kiribati) expressed appreciation of the Sub-Committee's report. The points raised were in fact applicable to Kiribati, although it was not one of the countries visited. He stressed the importance of the involvement of WHO in the monitoring system, which would help considerably to ensure that the budget was used appropriately and that programmes were proceeding in the right direction. Mr CAO YONGLIN (China) said it was significant that the subject of the Sub-Committee's review had been health manpower developutent, which was not only a priority of WHO and most Member States but also vital for the improvement of health services and the achievement of health for ell. All the countries visited were formulating n.ational policies and plans for health manpower development, and making efforts in various ways to train the different categories of health personnel. Those plans and policies, however, bad not been fully implemented owing to restrictions imposed by 120 REGIONAL COMMITTEE: THIRTY-FIFTH SESSION economic and other conditions. Following the country visits the Sub-Committee had identified problems and put forward recommendations for solving them. Those recommendations would also be helpful for other countries. He supported recommendation (8), to which the representative of the Philippines bad already referred. After reviewing the Common Framework and Fot'11lat for Evaluating the Strategies for Health for All, the Sub-Committee bad provided af!ditional information and explanations on certain iteUls, which would undoubtedly assist Member States in evaluating progress in implementing their health-for-all strategies. The Sub-Committee, which would be submitting an evaluation report on the implementation of the strategy to the Regional Committee for review, as part of the overall process of evaluation at national, regional and global levels, had an important mission. It was to be commended on the work it had already achieved. Dr TAPA (Tonga) congratulated the Sub-Co'lllfllittee on its cotnprehensive report. Regarding health manpower development, he had already streued the great importance his country attached to that subject. He fully . supported all the recommendations made by the Sub-Committee, including recommendation (8), which should be taken into consideration when the role and functions of the Sub-Committee were discussed at the next session of the Regional Committee. He also agreed with most of the observations of the Sub-Committee resulting from its review of the Common Framework and Fortnat for Evaluating Strategies for Health for All, and the WPR Appendix to Annex 4 of document WPR/RC35/6. He would support a review of the structure and role of the Sub-Committee, as had been discussed in relation to the Sub-:-Committee on Technical Cooperation among Developing Countries. Dr HAN (Director, Programme Management), referring to the review of the structure and tens of reference of the Sub-co1mnittee, said that, as previously stated by the Regional Director, the Secretariat would undertake the preparatory work so that the subject could be discussed at the next session of the Regional Committee. In reply to the representatives of Kiribati and Japen, he s.aid that monitoring was one of the components of health manpower developlllent • and it was hoped to provide a report on the status of progress in that area to a future session of the Regional Committee. Regarding the number of countJ;"ies to be visited and the duration of the visits, that aspect had been discussed at considerable length by the Sub-Counnittee itself at its meeting in June. When the new me111bere of the Sub-Committee had been nominated, the Secretariat would suggest that a brief meeting of the Sub-Co111mittee be held, ancl it would then have an opportunity to discuss the subjects to be selected for country visits, the countries to be visited, and the duration. In the absence of further c0111ments, the CUAIRMAN invited the Rapporteurs to prepare a suitable draft resolution. Since the Sub-Committee's report covered different subjects, it tnigbt be preferable to SUMMARY RECORD OF THE FIFTH MEETING 121/122 prepare separate draft resolutions. (For consideration of the draft resolutions, see the seventh meeting, sections 1.4, 1.5 and 1.6). 3.2. Membership of the Sub-Committee: Item 11.2 of the Agenda The REGIONAL DIRECTOR said that the< members of the Sub-Committee on the General Programme of Work were the r~presentatives of Australia, Fiji, Japan, Papua New Guinea, the Philippines, Singapore, Tonga and Viet Nam. The three-year periods of tenure of the representatives of Australia, Papua New Guinea and Viet Nam would expire with the current session of the Regional Committee. The Committee bad to decide which Member States should appoint representatives to replace them. It might wish to consider designating China, Cook Islands, and Samoa to replace them. Dr TAPA (Tonga) supported that proposal. He said that it would represent a good balance - one large country and two small ones. Dr MARSALLON (France) also supported the proposal, but regret that the Sub-Committee did not now include any members French-speaking countries. expressed from the The CHAIRMAN said that that point bad been ooted. Io the absence of any further comments, he observed that the proposal put forward by the Regional Director was approved, and he invited the Rapporteurs to prepare an appropriate draft resolution. (For consideration of the draft resolutio.n, see the seventh meeting, section 1.7). The nieeting rose at nooo. 1. (WPR/RC35/SR/6) SUMMARY RECORD OF THE SIXTH MEETING New Town Hall, Civic Centre, Suv.a Friday, 7 Septetaber 1984 at 2.30 p.m. CHAIRMAN: Dr T.M. Biumaiwai (Fiji) CONTENTS Women, health and development •••••••••••••••••••••••••••••• 124 2. Health ReSO\lrces Group for Primary Health Care: Membership of the Group • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 131 - 123 - 124 REGIONAL COMMITTEE: THIRTY-FIFTH SESSION 1. WOMEN, HEALTH AND DEVELOPMENT: Item 14 of the Agenda. (Document WPR/RC35/10) The REGIONAL DIRECTOR said that the document before the Committee provided a summary of information available on activities specifically related to women in health and development initiated in the Region with WHO collaboration, including a brief outline, based on information received from Member States, of the current social and health sta.tus of women in the Region. Emphasis was placed on strengthening the involvement of women's organizations in health and development activities. Section 3 of the document presented various proposals for future action for the consideration of the Committee. Dr SUNG-WOO LEE (Republic of Korea) informed the Committee that the Korean Women's Development Institute had been established with strong support from his Government. There bad been a strong desire on the part of women 1 s associations in the Republic of Korea to have a national organization that could speak authoritatively on their behalf and act as a catalyst in attempts to solve women's problems. The Institute would undertake comprehensive research projects on an autonomous basis, provide education and training to develop women 1 s potential, take various initiatives to promote the full participation of women in the political, economic, social and cultural spheres, promote tbe integration of women in development and take measures towards the achievement of full equality. In recognition of women's important role in health and development, the Institute had collaborated with WHO in organizing in 1984 a consultative meeting on women 1 s health. The Institute had collected all available data and information on women's health since 1970 and the meeting had dealt, in subcommittees, with the health of rural women, of female industrial workers and of women in the various service sectors. Five research protocols had been drawn up as a result of the discussions. The Institute was interested in being designated as a WHO collaborating centre for women, health and development. DR KOOP (United States of Atnerica) said that his country strongly supported initiatives designed to improve the role of women in health. They were concerned in the United States with affording women special protection as recipients of health care and special encouragement and opportunities as providers of health care. The Secretary of the Department of Health and Human Services and the Deputy Surgeon-General were both women. The Public Health Service was in partnership with 54 private voluntary agencies in teaching women the ways in which prenatal medical care, nutrition, smoking, alcohol, medication and exercise affected the outcome of pregnancy. As for providers of health care, the great majority of nurses, physician's assistants and nurse practitioners were women and United States medical schools were admitting more women every year. The various organizations in Heart Association, the American Association, depended heavily on educational programmes. the private sector, such as the American Cancer Society and the American Lung women volunteers 1n implementing their SUMMARY RECORD OF THE SIXTH MIIETING 125 Most of the barriers preventing the employment of women in certain health-care jobs had already been removed and steps were being taken to remove the few remaining. Mrs ENGLISH (Australia) said that the development and health of women were special concerns of the Government of Australia, both in Australia itself and in its aid programmes. Within its overall policy of ensuring that all people had adequate access to health care, the Governl!lent was concerned to afford protection in areas of specific concern to women, such as maternal and child health care, care of adolescents, family planning and reproductive health care, with specific attention to the needs of disadvantaged ~roups and of elderly women, who made up the majority of the aged population. The Government's broad policy was to secure equal rights for women in all matters and to. introduce the requisite reforms by taking appropriate administrative and legislative measures, including the ratification of international conventions designed to guarantee equal rights for women. An Office of the Status of Women had been set up to carry out surveillance and advocacy of women 1 s issues and to advise the Government on policies to improve the status of women. To overcome the cultural bias against women that did exist in some forms in Australia, a Commonwealth Sex Discrimination Act had been passed in August 1984 with a view to eliminating the disadvantages experienced by women and some minority groups in such fields as education, employment and social services, as well as health. Women 1 s roles were changing in all countries of the Region. An increasing number of women were entering the paid workforce and many of them experienced stress as the result of their having to combine the functions of home-maker and wage-earner. Women were also exposed to additional occupational hazards, many of them caused by the concentration of women in low-status, boring and repetitive jobs. In administering Australia 1 s aid programme it was recogni•ed that women in developing countries made an important contribution to economic and social development. They were responsible for a large part of agricultural production, distribution and marketing as well as for household work, care of the children and often care of the old and disabled. It was eesential, therefore, that women be given an opportunity to contribute to and benefit from aid programmes concerned not only with health but with a whole range of other activities, such as agriculture and education. For the 1984-1985 programme year, the Government of Australia had established a central fund with a view to singling out projects specifically designed to meet the needs of women in the developing countries. With regard to the proposed action programme, Australia s.upported steps to improve the collection of statistics that would throw light on differences between the sexes by diff~rentiating data according to age, sex, and, where applicable, ethnic group, since measures of mortality and vital statistics failed to reflect true levels of morbidity among women. 126 REGIONAL COMMITTEE: THIRTY-FIFTH SESSION Since women played a large role in coiDUlunity organizations, often working in a voluntary capacity in addition to shouldering their other responsibilities as home-makers and wage~earners, training and resources should be made available to enable such organizations to function more effectively. With regard to family planning services, the Govern111eot of Australia had announced that it would consider sympathetically proposals for assistance in the population field from countries in its region. Dr HASEGAWA (Japan) reported that, in accordance with the principles and objectives of the United Nations Decade for Women, Japan was making every effort to improve women's status and their role in the process of development and to promote maternal health as a starting point fo.r ensuring lifelong health for the future generations. He sincerely hoped that programmes of family health and welfare and progra1111lea and policies on nutrition· and environmental hygiene and sanitation would be further developed in the Region and that the participation of women in decision-making at all levels could be further promoted in that connection. Mr LAVEA (Samoa). said that, with WHO and UNICEF support, water tanks for rainwater catchment had been installed in three of Samoa's health districts. The Organization had also helped women's c~ittees to establish cooperative vegetable gardens by providing wire-netting, tools, seeds, pesticides and fertilizer, while the women provided the labour. :Proceeds from the sale of the vegetables went into a revolving fund for the purchase of more seed, fertilizer and pesticides. Women's co1Dtl'littees throughout the country were assisting in primary health care activities. DR WANG ZHAO (China) said that 50% of Chi.na 's health workers were women, who, among other things, had built up a maternal health service on a mass basis. The health authorities had chosen two ways of promoting the participation of women in health development - through providing universal maternal health care and promotiQ.g the participation of women in health work, particularly family health care. Maternal and child health services were provided at all levels throughout China and regular refresher training for staff ensured constant improvements in their quality. In accordance with the principle that prevention must come first, women were given work suited to them physically and sp~cial care was provided during pregnancy, lactation, and the cb~nge of life. Screening for cervical cancer was available. There had been c()()peration with WHO over the past few years in regard to perinatal care and the medical management of pregnancy. Such work would be expanded once sufficient el[perience had been accumulated. China was now implementing the strategy fo.r the attainment of health for all by the year 2000, for which the active p~rticipation of c01111Qunities and individuals was essential. Women had a very important role to play in that regard and took an active part in discussions on the subject at every level. Women's associations helped the health authorities in carrying out disease prevention and control, fa1DilY plannina activities and improved environmental sanitation and drinking-water supply. The role played by women in the development of the health services could not be overestimated. SUMMARY RECORD OF THE SIXTH MEETING 127 Dr TIRA (Kiribati) reported that Kiribati had an intensive maternal and family planning programme. Women were encouraged to take responsibility for their own develop111ent, and the women's organization was now one of the biggest nongovernmental organizations in the country. Through that organization, women had achieved a certain level of a.utono'qly, and had shown their interest in govern,..ent progra~es, such as those coneerned with family planning and child health. Dr Tira · thanked WHO, other United Nations agencies, and USAID for their support of women's develop1Dent •progratotDes in. Kiribati. Dr THONG (United Kingdom of Great Britain and Northern Ireland) said that, in Hong Kong, g.reat significance was att;ached to t'he contributions of women, who enjoyed high regard in all quarters of society~ During the past 20 years, women had begt,m to play a much greater role in community activities, and women's organizations participated in the promotion of health, and social and economic developl!lent. The adult literacy rate for women was · 78% and 36% of students in higher education were female. Women enjoyed equal occupations~ status with men, l.l.nd comprised 36% of the work force. Women also held high positions in government serv.ice. All women had easy access to health facilities, and there was an ample supply of maternal and child health and family planning services. Life expectancy for women in Hong Kong was 7 8 years, compared with 7 3 years for men. The crude birth rate had fallen from 33.5 per 1000 population to 15.4 per 1000 in the last 20 years; over 99.5% of births took place in hospital or maternity homes, and the maternal mortality rate was only 0. 07 per 1000 births. All this showed that Hong Kong was in full agteement with all efforts to improve the health and social status of women, and it was hoped that other Member States would accord high priority to the pursuance of those objectives. Dr DANG HOI XUAN (Viet Nam) stated that health care was a basic right of both women and men. Equality betweell women and men was enshrined. in the constitution of Viet Nam, and in line with that v.arious measures bad been taken to protect the health of women and to ensure conditions in which women could both raise a family and contribute to general development. Durin,g pregnancy, women were entitled to 60 days' leave and were relieved of various duties. A network existed for the protection of women; each quarter bad its own health station and maternity unit, and every district hospital had a department of obstetrics. In developing countries such as Viet Nam, development of family planning activitie.s was important for economic development and improvement of health status. There was also a major movement in Viet Nam to provide nutritional education for women. WHO, UNICEF and FAO bad collaborated in defining m1n1mum nutritional requirements, and that Programme was aimed particularly at women because women were generally responsible for feeding children and other members o f the family. A ser i es of five lessons had been developed, dealing with ( 1) expectant and nursing mothers; (2) breast-feeding; (3) nutrition of children up to three years of age; (4) nutrition of sick children, in particular t hose with diarrhoea; and (5) hygiene. Dr DA SILVA (Portugal) reported that some progress bad been made in Macao 1n the area of women , health and development. There was now a law 128 REGIONAL COMMITTEE: THIRTY•FIFTH SESSION providing for leave for women during pregnancy, and one fixing a mini•um age at which people could be employed. These laws were not seen as id•al, but represented an important step forward, and should make an i•portant contribution to maternal and child health, which bad top priority in the Macao health service. Already all babies were delivered in hospital. Dr BARKER (New Zealand) thought that pr.obably th.e m()st i~~aportant basic right for women was the right to vote, which had been accorded in New Zealand in 1894. Since then, women bad made gre.at contributions to both health and social development. The health seTvices were pred011linantly staffed by women, and the intake of students to medic•l school now had a majority of women. In New Zealand, a major voluntary organization bad for many years been responsible for maternal and child health, and as a result the infant mortality rate had improved greatly. The Minister of Social Welfare had recently been appointed also Mini•ter in Charge of Women's Affairs, with special responsibility for en-suring ttun the gains alreaqy made by \iomen would be further advanced. Health care develop11lent in tbe future would require the combined resources of both women and 'Q)en, and New Zealand strongly supported the recomt1lendations made in document WPR/RC35/10. In many countries, the life expectaoc.y for woJDen w•s now higher tnan that for men, and a large proportion of the diffe.rential was directly attributable to causes that were preventable, e.g. smoking. It was therefore of concern that, in New Zealand, one of the po_pulation groups that smoked most heavily was now women aged 18-~4 years. Dr KHALID (Malaysia) welcomed and supported the attention be~ng given to women, health and development, because a 111ore c-onceJ'ted effort was needed to improve the economic and social well-being of women. The potential contribution of women to development in general and he<!lltb in particular, had not been fully exploited, and the subject should be examine.d more closely. He supported the proposed action to improV'e infonoation, to increase the involvement of women's or.ganiza.tions in he«ltb devel.opmeot, aod to formulate a system to monitor the social and healtb status o.f wo•n· Many health programmes already involved women, even if that was not explicitly stated. Social, cultural and educational barriers to the involvement of women in development were. now ~eing r8utoved, but· furth(!lr recognition was still needed of the close relationship between women, health and development. Dr Khalid endorsed the state.aent in section 2.2(1) of ' d:OCU11ent WPR/RC35/10, that the social status of women in the Western Pacifie Region could not be examined in a unifona 'Ql&nner because of the widely differing societies. However, while strategies ·and progra1111De8 bad to be tailored to local communities, there were also cQiimon grounos and interests. In that context, be supported the proposals in section 3 of that document. Dr REILLY (Papua New Guinea) stated that Papua R.ew Guinea recognized the role of women in health and d~.~elop~•1lt aQd supported the proposals contained in document WPR/RC35/l0. He · reiterated tbe statement by the representative of Malaysia that the c00cept of tbe role of wQeen depended on the local culture. lri Papua New Guin~a, th~re weJ'e ·~ 700 ethnic groups, SUMMARY RECORD OF THE SIXTH MIETENG 129 each with its own idea of how woaen should participate in society. However, the Government recognized the i11portant role of wo.ne.n in society. There were maternal and child health and f811lily plannin'g services througbout the country. Women were now taking a role in politics. A workshop had been held recently, with the help of WHO, on the role of women in primary health care. Women currently he~d positions at all levels of health work, but the tDOst peripheral health worke.rs were mostly male, which sometimes caused problems since women wert often :reluetant to discuss specific female problema with a male health worker. It was intended to rectify that situation, since it was recognized that the health of the worker reflected the health of the whole family. Dr KOTEl<A (Cook Islands) said that his (;overl!l•en:t recognize<l the important role of women in society and developiae·nt • and supported the recommendations contained in the document. In Cook islan(ia there was a voluntary women's organization, the Cbild Welfare Association, which was a st.rong force in promoting health, environmental sanit«tion and local food production. Its work had played a considerable part over the years in reducing morbidity and infant mortality. Dr TAPA (Tonga) said that in Tonga women enJoyed a higher social rank than men, which helped them fulfil their leadership role in the home, in the village and in nongovernmental development organizetions such as the Tonga Women's Development Association, the Tonga Family Planning Association, and the Tonga Red Cross Society. In the civil service tbe terms of e11lployment were the same for women as for men. The risks and discomfort to which they were exposed during and after pregnancy gave women a special kind of hU1!1an dignity. · · It was a pity that the report made no reference to the ways in which 8len· injured that dignity by dominating and exploiting women; for exa11ple, it made no mention of s.uch issues as prostitution or pornography. ·Until there was more frank discussion of such issues, men would remain an obat•cle to the proper fulfilment of women's role in health and developmant. His Government endorsed the proposed action outlined in section 3 of the document under discussion. Dr BAVADRA (Fiji) said that the ebsence of any mention of collaboration between WHO and Fiji in the document shouM not be in~erpreted as the non-existence of suc:h collaboration. Re.ferril;lg to the approaches described in section 1, he said that the Governmeat of Fiji had identified primary health care as a priority in its eighth Developa1ent Plan. Now, in the fourth year of the Plan, the increasing role of woaen in development was apparent. The Soqosoqo Jakamarama Fijian Women's Society, numbering some 10 000 members, which had been actively proQWti.q& primary health care in villages, was a fine example of women as providers of bea;Lth care. Suppot:'t had been provided by agencies such as ONFPA and WltO, which bad funded village-level seminars on primary healt~ c~re. As regards women as recipients of health, maternal and child health had been identified as a priority progra10111e in 1976, and together with 130 REGIONAL COMMITTEE: THIRTY-FIFTH SESSION family planning such services were being strengthened. through primary health care in collaboration with WHO and UNFPA. WHO's participation was highly appreciated by his Government. Women now held senior positions in the Civil Service .and in commerce, as well as in trade union movem~nts through which UNFPA channelled funds for the development of women. Surveys conducted by the National Food and Nutrition Committee (NFNC), a collaborative undertaking supported by WHO and· UNFPA, had revealed that 29% of mothers in Fiji breast-fed their infants for the first three months. Through the efforts of NFNC it was hoped to extend to other sectors the favourable working conditions, including fully paid maternity leave, enjoyed by women in the Civil Service. He was confident that, with the support of NFNC, nongovernmental and other professional organizations, further improvements would be introduced for working mothers. It was gratifying to note the improvement in the health of women in Fiji as a result of those health initiatives: the life expectancy of women was now 66 years as opposed to 64 years for men; maternal mortality rates had dropped from 156 per 100 000 in the 1970s to 42 per 100 000 in 1982; infant mortality had dec lined from 40 per 1000 live births in the 1970s to 23 per 1000 live births in 1982. He anticipated that further information on the health status of women in Fiji would be provided by the representatives of nongovernmental organizations. Dr PETROS-BARVAZIAN (Director, Division of Family Health, WHO, Ger~eva) welcomed the opportunity to gain first-hand knowledge of the situation in the Western Pacific Region and said that the wide range of issues discussed underlined the complexity of the topic under consideration. The issue of women's life expectancy and mortality, raised by several representatives, was of particular interest from the global perspective. It should be emphasized that figures for mortality alone could not reflect the real health status of women in developing countries and could be even misleading. For example, for the classical indicator of maternal mortality, the differential from the lowest to the highest levels was 200-fold; the corresponding figures for perinatal, infant and children under-five mortality were 20-, 25- and 50-fold respectively. Those striking differences, particularly in relation to maternal mortality, could be explained by the fact that most causes of maternal mortality were preventable through the application of available science and technology. However, the important fact to remember was that maternal mortality figures for developing countries, high as they were, only reflected a small proportion of a much larger problel!l of morbidity, ill health and poor quality of life of the majority of women in developing countries. Those were mainly a result of the poor health of women in general and complications of pregnancy and childbirth without the necessary health care. That type of life-long suffering was sometimes taken for granted "as part of the life of women", particularly when the educational and social status of women was low. Such needless suffering bad an important bearing both on the Quality of life and on the global objective of health for all. With the launching of the United Nations Decade for Women in 1975, and following the Mexico Conference, WHO's governing bodies had recommended that SUMMARY RECORD OF THE SIXTH MEETING 131 the issue of women, health and development should be an integral part of all WHO ongoing programmes. Indeed, most of those programmes concerned women either as beneficiaries or as participants as well as the issue of women's health as a key to their participation in overall development. One example was water and sanitation where an Inter-Agency Task Force on Women and the International Drinking Water !lupply and Sanitation Decade ( IDWSSD) had been formed to permit the participation of women in all aspects, including training in the maintenance ?f water pumps. During the first five years of the Decade, WH.O had been mainly concerned insofar as women, health and development were concerned with the policy and promotion aspects; the second five years would see the formulation of activities at the country, regional and global levels. WHO's specific activities related to the Decade included discussions at the regional committee meetings in 1984 and the preparation of a paper on "Forward-looking strategies of implementation for the advancement of w0111en and concrete measures to overcome obstacles to the achievement of the goals and objectives of the United Nations Decade for Women: Equality, development and peace during the period up to the year 2000 at national, regional and international levels, Sub-theme: Health" as an integral part of the health-for-all strategies in support of Member States. An internal evaluation by WHO to be included in "The report on the review and appraisal of progress achieved and obstacles encountered by the United Nations system in support of the goals and objec.tives of the United Nations Decade for Women", had been undertaken concerning · specific progratlltlles in relation to women; progratmDe components related to women; and the situation of women in the system. The regional offices and WHO Geneva had designated focal points with the aim of coordinating and stimulating action within various programmes. Participation in the Regional Committee session would provide valuable guidance for future activities as well as in the preparation of the third paper by WHO, based on Member States' replies to the Health aod Nutrition component of a questionnaire issued by the Branch for. the A<lvancement of Women, which would be included in the overall progress report to be presented at the World Conference to Review and Appraise the Achievet~~ents of the United Nations Decade for Women, to be held in Nairobi, Kenya, in July 1985. In the absence of further comments, the CHAIRMAN requested the rapporteurs to prepare an appropriate draft resolution. (For consideration of the draft resolution, see the seventh meeting, section 1.8). 2. HEALTH RESOURCt:S GROUP FOR PRIMARY HEALTH CARE: MEMBERSHIP OF THE GROUP: Item 12 of the Agenda (Document WPR/RC35/7 Rev.l) The REGIONAL DIRECTOR said that agenda item 12 referred to the need to nominate a developing country fl"om the Region as a wmber of the Health Resources Group for Primary Health ~re. Document WPR/RC35/7 Rev.l, with its annex, provided some background infOJ:'mation on the subject. 132 REGIONAL COMMITTEE: THIRTY-FIFTH SESSION Papua New Guinea had been the first country to be elected as the representative of the Western Pacific Region in the Group. It had held office from 1980 to 1982 and had been succeeded by the Philippines whose term would expire on 31 December 1984. The Regional Committee would therefore wish to elect a developing country to represent the Region in the Group for a period of two yea-rs from 1 January 1985. In helping the Committee to make the eelection, he wished to recall the terms of reference of the Group. Its purpose was to help mobilize and rationalize resources in accordance with international health policies determined by the Health Assembly. However, the Group was not a pledging body, a fund-raising mechanism, or a vehicle for attracting extrabudgetary funds for WHO's progra1D1De. Its role wa~t rather to generate ideas, solve problems and stimulate action. The CHAIRMAN asked for proposals for the no•inatio11 of a de~eloping country to replace the Philippines on the Health a~·aouro . te Group for Primary Health Care. Dr ACOST,A (Philippines) said th:at, at tt).e ll~e•ber ,;l9(J3 ··~eti ... ·of ~t1e Health Resources Group, it had been th·e consensus that the Group ittould be flexible and pragmatic in its advisory role, without rigid terms of reference; that it should be guided by resolution EB69.R4, with me~bership open-ended to accommodate representatives of developing countries, the donor community, nongovernmental organizations and the United Nations system. There had been difficulties in interpreting the country resource utilization (CRU) exercise; he had explained that it was not intendec:l to raise funds but to identify a country's own resources and at the same time list its requirements. If a country already had a document that fulfilled that purpose, it would not require a country resource utilization exercise. He proposed the election of Tonga as member of the Group. Dr REILLY (Papua New Guinea) seconded that proposal. Mr LAVEA (Samoa) considered that the Region sbould continue to be represented in the Group; it needed to be kept well informed about developments 1n the mobilization of resources, which were becoming increasingly scarce and were badly needed to augm.ent those locally available. He understood that the broad terms of reference of the Group were, first, to promote the rational use of all available resources required for primary health care in developing countries and for the achievement of health for a 11 by the year 2000, in accordance with the priorities recognized by WHO's Member States and incorporated in resolutions of the Health Assembly and the United Nations General Assembly; and, second, to stimulate the mobilization of resources, including those of the developing countries themselves and of donors, to achieve the goal of h.ealth for all, using primary health care as the main method, facilitating appropriate utilization of resources by donors and recipient countries. He supported the proposal to elect Tonga to represent the Region in the Group. Tonga met the necessary ·criteria; it was a developing country, and one which could effectively convey the collective message of the developing countries of the Region. SUMMARY RECORD OF THE SIXTH MEETING 133 Dr KHALID (Malaysia) asked whether a report was available on the proceedings of the Group; what the mechanism was for transmitting the views of the Regional Committee to the Group through the Region 1 s representative in the Group; and what the method was for feedback from the Group to the Regional Committee. Mr BOYER (United States of America) said that expectations as to what the Group was to accomplish seemed to vary. The document before the CotmDittee provided a detailed explanation of why the Group had been established, but little information about what it had achieved or whether it was functioning well. He asked if further details could be given. Dr LITTAUA (External Relations Officer) said that the feedback mechanism to the Regional Committee was not yet clear, but the subject would be discussed at a meeting in Geneva in November 1984. Progress reports were available. Dr ACOSTA (Philippines) said that the Group was mainly a meeting of the representatives of donor countries and organizations principally concerned with providing assistance to projects in countries particularly in need. However, the Group had been expanded to include representation of the developing countries needing assistance. A major function was to help countries in need to develop a system to analyse their needs and assess the resources required. Its function was not to raise funds but rather to study methods of helping countries to identify their needs. A number of countries had been assisted by the country resource utilization exercise. Meetings of the Group provided some indication of the extent to which donors were prepared to provide assistance. He was not sure whether the reports on the meetings should be distributed generally. Dr LITTAUA (External Relations Officer), giving examples of the result of the Region 1 s participation in the Group, said that in 1983 a country resource utilization review had been conducted in Papua New Guinea and the report was being used there for planning; there would be further follow-up in 1985. There were also plans for a country resource utilization review to be carried out in Solomon Islands towards the middle of 1985. It was hoped that it would be possible to report on the results of these two country resource utilization reviews at the next session of the Regional Committee. Mr BOYER (United States of America) trusted that country resource utilization reviews were linked to the national strategies for health for all. Dr ACOSTA (Philippines) reiterated that he had always maintained in the Group that a country that had already carried out similar exercises for health planning did not need a country resource utilization review. He fully agreed with the representative of the United States of America that it should be a strictly coordinated undertaking. Dr KHALID (Malaysia), referring to the first two paragraphs of the introduction to the document, asked what action had been taken to promote the transfer of resources between countries, which was mentioned as a function. 134 REGIONAL COMMITTEE: THIRTY-FIFTH SESSION Dr ACOSTA (Philippines) said that the Group walil trying to coordinate all assistance at the international level, and to make use of WHO's central position to help stimulate and coordinate the transfer of resources. The REGIONAL DIRECTOR said he would include an account of the current discussion in his report to the Executive Board. The Group was global in character and it seemed that some further clarification was required with regard to its influence at regional level. The CHAIRMAN noted that the proposal to elect Tonga met with the Committee's approval, and invited the Rapporteurs to prepare an appropriate draft resolution. (For consideration of the draft resolution, see the seventh meeting, section 1.9). The meeting rose at 5 p.m. 1. 2. 3. (WPR/RC35/SR/7) SUMMARY RECORD OF THE SEVENTH MEETING New Town Hall, Civic Centre, Suva Monday, 10 Septe•ber 1984 at 9 a.m. CHAIRMAN: Dr T.M. Biumaiwai (Fiji) CON·'l'ENTS C~nsideration of draft resolutions •••••••••••••••••••••••• Correlation of the work of the World Health AsseQlbly, the Executive Board and the Regional Cotmnittee •••••••••••• 2.1 Consideration of resolutions of the Thirty-seventh World Health Assembly and the Executive Board 136 137 at its seventy..,th ird and seventy-fourth sessions • • • • • • ·. 137 2.2 Consideration of the agenda of the seventy-fifth session of the Executive Board •••••••••••••••••••••••• 139 Hepatitis as a public health problem ••·••••••••••••••••••• 141 - 135 - 136 REGIONAL COMMITTEE: THIRTY-FIFTH SESSION 1. CONSIDERATION OF DRAFT RESOLUTIONS The CotD1IIittee considered the following draft resolutions; 1.1 Report of the Regional Director (Document WPR/RC35/Conf. Paper No. 1) Decision: The draft resolution was adopted without comment (see resolution WPR/RC3S.Rl) 1.2 Programme budget for 1986-1987 (Document WPR/RC35/Conf. Paper No. 2) Mr BOYER (United States of America) felt that the wording of the draft resolution implied acceptance of the proposals by the Director~General unchanged and recalled the assurance given during the discussion that the Director-General would reconsider the regional allocation, including programme growth. Similarly, in response to representatives' comments regarding different priorities and needs, and the desire of some for different programme emphases, the Regional Director had indicated that the country allocations were open to change. Note had also been taken of the continuing fluctuations in the Philippine peso/US$ dollar exchange rate, which could affect the dollar costs. He wished it to be placed on record that the budget proposals should be considered in the context of the discussions at the session. The REGIONAL DIRECTOR said that such comments were usually reflected in his verbal report to the Executive Board on significant regional developments, including regional committee matters. Decision: The draft resolution was adopted without further cotD1IIent (see resolution WPR/RC35.R2). 1. 3 Sub-Committee on Te'chnical Cooperation among Developing Countries (Document WPR/RC35/Conf. Paper No. 3) Mr YOSHIDA (Japan) said that several projects hacl been promoted by his Government through the Japan International Cooperation Agency aimed at helping developing countries to build up their national capability for the production of essential drugs. In the Western Pacific Region, collaboration was planned with the Government of Lao People's Democratic Republic in the development of technology for the production of essential drugs; in the Philippines a feasibility study had been initiated concerning the construction of a quality control centre for food and drugs and technical cooperation for the improvement of those items. Dr KHALID (Malaysia) proposed insertion of the words "for technical cooperation" after the word "potentials" in the preamble. With regard to operative paragraph 3 (3), he noted that some institutions had already been designated as collaborating centres for primary health care in the Region; therefore, he suggested insertion of the word "additional" before the words "suitable institutions". Decision: The draft resolution, as amended, was adopted (see resolution WPR/RC35.R3). SUMMARY RECORD OF THE SEVENTH MEETING 137 1.4 Healtq manpower development (Document WPR/RC35/Conf. Paper No. 4) 1.5 1.6 1.7 Decision: The draft resolution was adopted without comment (see resolution WPR/RC35.R4). for all b ear 2000 Decision: The draft resolution was adopted without comment (l!lee rel!lolution WPR/RC35.R5). of Work Decision: The draft resolution was adopted without comment (see resolution WPR/RC35.R6) on the General Pro ramme of Work 7 Decision: The draft resolution was adopted without comment (see resolution WPR/RC35.R7). 1.8 Women, health and development (Document WPR/RC35/Conf. Paper No. 8) Dr BAVADRA (Fiji) referring to ~be discussion of this item, said that the figure of 29% given in his intervention for the nu~ber of women in Fiji breast-feeding their infants for the first three months of life was incorrect and related to Indian women only. The correct figure was 68%. Decision: The draft resolution was adopted without further comment (see resolution WPR/RC35.R8). 1. 9 Membership of the Health Resources Group for PriUif;ty Health Care (Document WPR/RC35/Conf. Paper No. 9) Decision: The draft resolution was adopted without comment (see resolution WPR/RC35.R9) 2. CORRELATION OF THE WORK OF THE WORLD HEALTH ASSEMBLY, THE EXECUTIVE BOARD AND THE REGIONAL COMMITTEE: Item 13 of the Agenda 2.1 Consid~ration of resrilutions of the Asaembl and the Executive Board at seventy-fourth sessions: Item 13.1 of the Agenda The REGIONAL DIRECTOR said that document Wl>R/RC35/8 contained resolutions adopted by the Thirty-seventh World Health Assembly and the Executive Board at its seventy-third session which were considered to be of significance for the Western Pacific Region. A number of other resolutions had been adopted by the Health Assembly, which ne.eded to be brought to the attention of the Co111mittee. Those resolutions were related to other items 138 REGIONAL COMMITTEE: THIRTY-FIFTH SESSION of the agenda and had already been considered. The two resolutions adopted by the Executive Board at its seventy-fourth session were not of direct relevance to the work of the Regional Committee for the Western Pacific. The Committee would wish to consider each resolution separately. 2.1.1 Resolution WHA37.18 - Prevention and control of vitaain A deficiency and xerophthalmia The REGIONAL DIRECTOR drew attention to operative paragraphs 2 and 3. The narrative of document WPR/RC35/8 provided a background for discussion of that resolution. There were no comments. 2. l. 2 Resolution WHA37. 23 - Collaboration within the United Nations system - General matters: Abuse of narcotic and psychotropic substances The REGIONAL DIRECTOR drew attention to operative paragraph 1. There were no comments. 2.1.3 Resolution WHA37.27 biological substances International standards and units for The REGIONAL DIRECTOR drew attention to the recommendations under part I and part II, operative paragraph 3. The narrative of document WPR/RC35/8 provided a background for discussion of that resolution. There were no comments. 2.1.4 Resolution WHA37.30- Infant and young child nutrition The REGIONAL DIRECTOR drew attention to operative paragraph recalled that the topic for the Technical Discussions during the session was "Malnutrition, growth and development". 2. He current The Regional Director recalled that, as the Regional Committee had agreed in 1982, Member States would report to him annually on that subject. The reports submitted early in 1984 had contributed to the Director-General's report which had given rise to the resolution. In 1985, reports would be used to present a consolidated report on the subject to the Regional Committee. He recalled that those reports were due in Manila in March 1985. Dr ACOSTA (Philippines) reported that a national mov.ement for the promotion of breast-feeding had been officially launched in the Philippines in March 1983 under the leadership of the Minister of Health. Eighteen government agencies and the representatives of the private sector, including the medical and allied professions, were jointly involved in its work, which during the first year was concerned with policy formulation, research, SUMMARY RECORD OF THE SEVENTH MEETING 139 infortnation and education. Govermuent policies in regard to the promotion of breast-feeding had been reviewed and recommendations made to increase their effectiveness. Research on breast-feeding had been further encouraged with a view to applying the findings in field activities. Additional subjects for research had been singled out and individuals and groups were being assisted in embarking on the investigations needed. A massive education and publicity programme, aimed particularly at the urban poor and the rural population, had been carried out, with full use of the media in su~port of the direct activities of the health workers and groups concerned. All sorts of educational materials had been produced to help drive the message home. WHO and other international agencies bad wholeheartedly cooperated. 2.1.5 Resolution WHA37.32- Action Programme on Essential Drugs and Vaccines The REGIONAL DIRECTOR drew attention to operative paragraphs 2, 3 and 5. Dr KHALID (Malaysia) suggested that, in view of the importance of the Action Programme to the implementation of the health-for-all strategy and the concern shown by many countries in that regard, the Committee should adopt a resolution calling inter alia for the convening of a meeting on the subject in the Region and a report by the Regional Director on the results of its deliberations to the Regional Committee at its next session. He was willing to submit a proposed text. In the absence of further discussion, Rapporteurs to prepare a draft resolution Dr Khalid. (For consideration of the draft meeting, section 1.1)~ the CHAIRMAN requested the on the lines suggested by resolution, see the eighth 2.1.6 Resolution WHA37.33 - Rational use of drugs The REGIONAL DIRECTOR drew attention to operative paragraphs 1 and 2. There were no comments. 2.1.7 Resolution EB73.Rl0- International Programme on Chemical·Safety The REGIONAL DIRECTOR drew attention to operative paragraphs 1 and 2. There were no comments. In the absence of further comments, the CHAIRMAN asked the Rapporteurs to prepare an appropriate draft resolution. (For consideration of the draft resolution, see the eighth meeting, section 1.2). 2~2 Consideration of the a enda of the of the Execut1ve Board; Item 1 .2 of the Agenda The REGIONAL DIRECTOR said that he had reported for a number of years on the correlation between the work of the Regional Committee, the Executive Board and its Programme Committee, and the World Health Assembly. 140 REGIONAL COMMITTEE; THIRTY-FIFTH SESSION At the current session, the Regional Committee was again taking the initiative in introducing issues which might need to be discussed in the governing bodies of the Organization. Items on the agenda of the Committee during the current session which might precede debate at glob~. l level were hepatitis as a public health problem and the WHO Guidelines for drinking-water quality. Dr ACOSTA (Philippines) asked leave to bring up under the agenda item they were discussing the increasingly serious problem of sources of nuclear energy and the potential risk for communities in the vicinity of nuclear power plants. The REGIONAL DIRECTOR assured the representative of the Philippines that his concern would be duly reflected in his report to the Executive Board and the matter might usefully be discussed at the meeting of the Programme Committee prior to the Executive Board's next session. The International Atomic Energy Agency was primarily responsible for studying problems of nuclear safety and for consulting sister agencies on such aspects of it as lay within their respective domains. Dr KITAGAWA (Japan), introducing a draft resolution, co-sponsored by Australia, China, Fiji, Japan, Kiribati, New Zealand, Philippines, Republic of Korea and Tonga, concerning Members of the World Health Organization in the Western Pacific Region entitled to designate a person to serve on the Executive Board (Document WPR/RC35/Conf. Paper No. 10) said that the Western Pacific Region contained over a quarter of the world's total population and comprised a constantly increasing number of Member States. Equitable geographical distribution would then require the Region to be given a quota of four Members entitled to designate a person to serve on the Executive Board as against the existing three. He hoped that discussions would result in the present inequitable distribution being corrected. Dr BARKER (New Zealand) agreed that the Western Pacific Region, in view of its large population and huge area, was under-represented. Dr BAVADRA (Fiji) considered that a further reason for increasing the number of Members entitled to designate a person to serve on the Executive Board was that the Region's Member States were scattered over such a huge area of the globe. Dr TAPA (Tonga) pointed out that the preambular paragraphs of the proposed dra.ft resolution provided ample justification for the suggested increase. Dr LIU XIRONG (China) felt that the question was a highly important one and said that his country fully endorsed the proposal before them. Mr BOYER (United States of America) said that, as a representative of a Member State which belonged to another WHO region, he did not wish to enter into a discussion of the substantive issue before them but he agreed that an increased "quota" for the Reaion would seem to be desirable. It could come about either through a changed regional distribution of Members SUMMARY RECORD OF THE SEVENTH MEETING 141 entitled to designate persons to serve on the Executive Board as at present constituted or as part of an overall expansion of the Board's membership. However, the manner in which it came about was not strictly a matter for the Committee to pronounce upon. Dr BARKER (New Zealand) concurred. The decision should be left to the Executive Board and the World Health Assembly. Dr VIGNES (Legal Counsel, WHO Headquarters) said that from the legal point of view .the representative ·of New Zealand was absolutely correct. It was for the World Health Assembly to decide on the number of Member States in each of WHO's six regions entitled to designate a person to serve on the Executive Board and indeed the point came up for discussion and decision in the Health Assembly every year. At the moment the number of Member States in a region so entitled was based on the total number of Member States in that region. If population were also taken into account, the Health Assembly might feel impelled to recotmDend some ..,redistribution" either with regard to the Board's current membership of thirty-one persons or on the basis of an increased membership. If the Committee adopted the resolution before it, the Regional Director would undoubtedly bring it to the attention of the Executive Board when he reported on significant regional developments, including regional committee matters. The Director-General would also doubt less draw the Board's special attention to the regional resolution. The Board would then decide to look into the matter further, to defer consideration to a later date or to remit the whole question to the World Health Assembly for consideration of the substantive issues. In the absence of further comments, the CHAIRMAN asked the Rapporteurs to prepare an appropriate draft resolution. (For consideration of the draft resolution, see the eighth meeting, section 1.3). 3. HEPATITIS AS A PUBLIC HEALTH PROBLEM: Item 15 of the Agenda (Document WPR/RC35/ll) The REGIONAL DIRECTOR recalled that, during its thirty-fourth session, the Committee had decided that the subject of the public health significance of hepatitis should be brought to the at.tention of Member States and presented as a separate item at the thirty-fifth session. Hepatitis B virus infection was highly prevalent in the Region and constituted a serious public health problem. Of the eetimated 215 million chronic carriers of hepatitis B virus throughout the world, approximately 168 million resided in the Western Pacific Region and other countries in Asia. It had been shown that hepatitis B virus infection, in particular the persistent hepatitis B virus carrier state, was closely associated with the development of chronic liver diseases such as active chronic hepatitis, liver cirrhosis and primary hepatocellular carcinoma. Document WPR/RC35/ll described the current situation of hepatitis B surveillance, prevention and control activities in the Region. Section 4 of the document provided a brief outline of proposed collaborative activities in the Region, particularly the development of low-cost plasma-derived vaccine and the research on a new vaccine, using recombinant DNA techniques. 142 REGIONAL COMMITTEE: THIRTY-FIFTH SESSION Dr SILIGA (United States of America) said that his delegation endorsed the efforts being made by WHO to prevent and control hepatitis B, and agreed with the areas selected for collaboration with Member States. Active participation by Member States in the surveillance, prevention and control of the disease was of the utmost importance. The United States Centers for Disease Control and the National Institute of Allergy and Infectious Diseases, through bilateral agreements with China and Japan, had been collaborating in the development and testing of vaccines, the assessment of the ability of the vaccine to prevent mother/infant transmission, the establishment of laboratory technology for measuring the induction of protective antibody by vaccine, and the dissemination of research findings. Studies indicated that both the United States and Chinese vaccines were efficacious in preventing the hepatitis B virus carrier state in infants born to carrier mothers. It was noted that evidence from India suggested that hepatitis non-A/non-B was a frequent form of the disease among Asian adults and might be associated with acute liver failure in pregnancy. Dr SUNG-WOO LEE (Republic of Korea) said that his country was paying increased attention to the prevention of hepatitis B, since it had emerged as a more serious public health problem than anticipated. The health authorities bad concentrated on the development of a plasma-derived hepatitis B vaccine, and production had started in August 1983. Some 3. 7 million doses had been produced in the first 12 months, and by 1985 the Republic of Korea would have a production capacity of over 10 million doses. His country looked forward to greater collaboration within the Region in the control of hepatitis B. Dr THONG (United Kingdom of Great Britain and Northern Ireland), describing the experience with hepatitis B virus infection in Hong Kong, said that the infection rate rose from 3.3% in children under five to a peak of 11.4% in the 21-30 years age group. The overall prevalence of hepatitis B antibody was 33.3%, and the rate was b igher for males than for females. Infection 1.n infants probably resulted from perinatal or intrafamily transmission. The increase in prevalence with increasing age could be attributed to infection from fellow schoolchildren and later on to sexual transmission. Viral hepatitis was the only major communicable disease in Hong Kong that had shown no signs of decline in the last two decades. The acute form was a notifiable disease, and in 1983 there had been 1783 cases with 28 deaths. In the same year there had been 1013 deaths from primary hepatocellular carcinoma, the second commonest cause of death among the malignant neoplasms. Cllronic liver diseases and cirrhosis of the liver occupied tenth rank among the leading causes of death, accounting for 349 deaths in 1983. Viral hepatitis B caused 66.3% of cirrhosis cases and was a major cause of hepatocellular carcinoma. It was a major public health problem, and the authorities in Hong Kong . were fully committed to measures to control its spread. Screening of blood donors had been standard practice since 1975, and steps were taken to m1.n1.m1.ze contamination of the environment by blood, blood products and tissue fluide. Health education SUMMARY RECORD OF THE SEVENTH MEETING 143 was provided, especially for high-risk groupe. Potentially tbe most effective means of containing and ultimately eliminating hepatitis B was immunization, but the current cost of the vaccine was prohibitive. Hong Kong had accordingly adopted a strategy of ~l'elective immunization for high-risk groups with the aim of reducing the pool of carriers 1.n the population and breaking the chain of transmission. One of the groups selected was health care personnel in frequent contact with blood and blood products. The other consisted of babies born to mothers pos1t1ve for hepatitis B surface (HBs) antigen; almost all such ba.bies contracted the disease, and had a 25% chance of dying from liver disease. They also became the prime source of infection for the rest of the population, transmitting the disease to their playmates in childhood and to their sexual contacts in adult life. The procedure adopted in Hong Kong was to administer hepatitis B imtnunoglobulin shortly after birth, followed by active immunization with hepatitis B vaccines. The initial results of evaluation studies were most encouraging. Much research on hepatitis remained to be done. Any modification or extension of the control programme would have to take into account past experience, the cost of the vaccine, available resources, new advances in vaccine development, and the latest epidemiological information. His delegation strongly supported the recommendation for closer collaboration and the active participation of Member States in the surveillance, prevention and control of hepatitis B in the Region. Dr DANG HOI XUAN (Viet Nam) pointed out that viral hepatitis was a major public health problem in hie country, where the annual incidence was estimated to be 120 cases per 100 000 population. The central hospital in Hanoi treated 287 cases per annum, with a case fatality rate of 5. 2%. Of 2000 patients tested by immunoelectrophoresis, 3.35% had proved positive for HBs antigen. Radiological and passive haemagglutination tests had also been cond"Ucted to detect HBs antigen and had revealed prevalence rates of 13.2% in hospital personnel and 15.6% in patients. Chronic hepatitis and primary hepatocellular carcinoma were frequently encountered in Viet Nam. Vaccination against hepatitis could not yet be introduced on a wide scale on account of the high cost of vaccine. Efforts to produce a cheaper vaccine sho"Uld be encouraged. In the me~otirne the control strategy co,nprised health education for health personnel (with emphasis on the importance of aseptic procedures and the avoidance of unnecessary blood transfusions), screening for HBs antigen at local and central laboratories, and the organization of a collaborating centre for reference and research on viral hepatitis at the Central Institute of Epidemiology and Hygiene in Hanoi. Technical cooperation with WHO collaborating centres for reference and research on viral hepatitis was extremely important. Dr WANG ZHAO (China) said that threatening people's health and social Region and the world as a whole, and was present discussion was therefore welcome. viral hepatitis was increasingly and economic development in the a matter of growing concern. The In China the incidence rate of hepatitis B, in particular, was high. In .1983 the total number of cases reported was 735 954; and the positivity 144 REGIONAL COMMITTEE: THIRTY-FIFTH SESSION rate for HBs antigen was on average 8.83%. The Government had attached great importance to the prevention and treatment of viral hepatitis, givi-ng priority- to research on vaccine development and prevention of transmission between mothers and children. Regarding prevention of transmission, there was , strict s~rveillance of blood donors and management of blood transfusion and blood products, and sterilization of equipment in hospitals and laboratories. Those measures had resulted in some improvements, but it was felt that a specific preventive measure was needed to combat the disease. Plasma-vaccine had been tested in China, including observation in human beings. Good protection was provid.ed and medium-scale production had begun. Procedures for larger-scale production would be finalized as soon as possible, but the plasma vaccine would be insufficient for the population of China. Good progress was being made in research on developtllent of recombinant DNA vaccine. Some of the diagnostic reagents required had been produced and were of good quality. Regarding production, efforts were being concentrated on lowering costs and ensuring quality. S<MDe institutes were testing monoclonal antibodies and developing DNA hybridization techniques. Vaccines and diagnostic reagents would be available in large Q\.lantities, and an overall strategy was being prepared. China was embarking on both basic and clinical research, e.g. on incidence rates in different areas and among different groups of people, the identification of high-risk groups, and the response and reaction of those vaccinated, including short- and long-term effects. China had received considerable cooperation from WHO; it looked forward to collaborating with other Member States in that field, and hoped that WHO's programme in that area would be strengthened. Dr MARSALLON (France) said that a survey of 9810 sera of various origins in New Caledonia (including blood banks and maternal and child health centres) showed 418 to be positive for hepatitis B: a mean prevalence of 4.2%. An ethnic study indicated considerable differences: 1% among European ethnic groups, 5% among Melanesian grou.ps, and 8% among Polynesians. Further attention should be given to epidemiological surveys. The prevalence rate among expectant mothers was 5% ( sli$btly higher than the average), and the transmission rate fr.om mother to child was about 60%. Preventive measures were being organized, priority being given to those most exposed (health personnel), and to protecting children born of infect;ed mothers. · It was prO-posed to ca-rry out vaccination against hepatitis B. France w.as prepared to cooperate with Member State.s in the Region in the control of hepatitis B. It had available a vaccine for three injections at intervals of one month, and a booster a year later. It was derived from plasma and, unfortunately, was still very expensive. It hoped to have available a recombinant DNA vaecine in the near future. Mr KITAGAWA (J•pan) said that in Japan it was estima.ted that b,4tween 2 and 3 million person·s (approximately 2% of the population) were pera:i•tently infected with hepatitis B virus. In 1980 31 000 deaths (4.3% of all deaths) had been due to chronic hepatitis, liver cirrhosis or hepatoma, which were often associated with hepatitis B virus infection. The control of the disease was therefore one of the most important public health issues in Japan. SUMMARY RECORD OF THE SEVENTH MEETING 145 The Ministry of Health and Welfare had organized a study group on hepatitis in 1963, which had been conducting laboratory, clinical and epidemiological investigations on hepatitis A and hepatitis B. According to an epidemiological study carried out by the group in 1981, 180 000 persons suffered from acute hepatitis (20% of those were due to hepatitis A and 30% to hepatitis B). The three control measures available in Japan for hepatitis B were the screening of blood for transfusion; paasive itmnunization with anti-hepatitis B human immunoglobulin; and active immunization with inactive hepatitis B vaccine. HBs antigen ecre•ning of blood transfusion had been carried out since 1972. Anti-hepatitis B human i11l1Dunoglobulin became available in 1981; its injection immediately after accidental transmission of hepatitis B virus during medical practice made it possible to prevent infection. As good results without significant side-effects had been obtained through clinical trials of plasma-derived hepatitis B vaccine, its commercial production would be started before the end of the year and it would become available throughout the country in 1985. A pharmaceutical company was trying to produce hepatitis B vaccine by using a genetic engineering technique. Although not everyone was at risk of being infected with hepatitis B, the virus was transmitted extremely easily in high-risk groups. A careful study had therefore been made to determine which population groups should receive immunization and it had been decided to give priority to immunizing the newborn of HBe antigen positive mothers. The project would soon be initiated with government funds. As about 1 050 000 babies were born annually iri Japan, and the HBe antigen positive rate was about 4%, about 6000 newborns would receive hepatitis B vaccine. The prevalence of hepatitis B in Japan was thought to be very high, and the epidemiological study that bad been conducted was considered inadequate. Since the virus was associated with various serious diseases such as chronic hepatitis, liver cirrhosis and hepatoma, its control would bring significant benefits to the country's health and economy. Hepatitis B vaccine was becoming available in several countries, and its appropriate use should significantly reduce disease. However, the plasma-derived vaccine was very expensive and production capacity was limited. Moreover, knowledge about the nature of hepatitis B virus was inadequate. There was a need for intensive research. Dr BAVADRA (Fiji) said Fiji bad been con•iderins for some time the possibility of launching an immunization programtDe for selected groups, including laboratory and hospital workers. It had, however, been hampered by the high cost of the vaccine and the serological studies required. It therefore welcomed the progress made by Metllber States in research in that field, and looked forward to further collaboration. Dr GOH KEE TAI (Singapore) said that, with the elimination and control of most communicable diseases in Singapore, viral hepatitis had emerged as a disease of major public health importance and had been made a notifiable 146 REGIONAL COMMITTEE: THIRTY-FIFTH SESSION disease in 1976. The annual morbidity rate was 20 per 100 000 and the case fatality rate 1%. Hepatitis B virus was responsible for about 50% of cases of acute hepatitis, and hepatitis A virus for about 25%. Outbreaks of hepatitis A traced to the consumption of raw or inadequately cooked shellfish imported from the Region occurred from time to time. The overall prevalence of HBs antigen carriers in Singapore was 6%, and it had been estimated that there were 150 000 carriers in the community; the carrier rate was higher among young adult Chinese males. Chronic hepatitis B infection was closely associated with such sequelae as chronic hepatitis, cirrhosis and heptocellular carcinoma. There were about 500 cases of chronic hepatitis and cirrhosis annually in a population of 2. 5 million; hepatocellular carcinoma was the third leading cancer in the country, with between 400 and 500 new cases diagnosed each year. Epidemiological investigations bad shown that hepatitis B virus transmission occurred both vertically (mother-to-infant) and horizontally (person-to;..person), through both parenteral and inapparent parenteral routes. Per,inatal transmission was responsible for 50% o.f cases of the carrier state; it had been estimated that each year about 900 babies born to carrier mothers became persistent carriers. In view of the socioeconomic and public health importance of hepatitis B, the Government had accorded top priority to its control. The strategies were: definition of the high-risk groups; education of the public on the mode of transmission and prevention; and the local production of vaccine for i1DIIlunization progratD1IIes. The high-risk groups had been identified through aero-epidemiological surveys; they were the infants of hepatitis B carrier mothers, hospital and laboratory workers, and home contacts of acute cases and chronic carriers. The vaccination programme had started in March 1983; more than 5000 people bad been vaccinated so far, and no adverse reactions had been reported. It was planned to vaccinate about 14 000 people a year in high-risk groups. Vaccine was being produced in Singapore in collaboration with a United States company, and the first batch of vaccine produced from locally collected plasma was expected to be ready in 1986 and available to other countries of the Region. Dr SCHUSTER (Samoa) asked whethel;' the Secretariat could provide the CoOJillittee with the latest information on hepatitis B with reference to vaccine and rea.,gent production, the standardization of products, potency, quality, the reco1lltllended dose for i~~ni.zation, and the cost to Member States requiring supplies. He noted that several Member States had started production "to some extent" for national requirements, and wondered what that actually implied. Mr VANNARETH RATSAPHO (Lao People's Democratic R~public) said that hepatitis A was the most frequent form of hepatitis in his country. There were often small outbreaks, Europeans being particularly affected. Next in importance came hepatitis B, associated with the re-use of materials intended for once-only use (for reasons of economy), and emergency or repeated transfusions of blood which had not been tested for HBs antigen. Other forms of hepatitis were rare. SUMMARY RECORD OF TME SEVENTHMEETIN& 147 In connection with hepatitis B, cirrhosis of the liver - found equally frequently in men and women - was one of the main causes of hospitalization (3. 5% of hospital admissions). Alcoholism was not the main cause; although rice alcohol was popular with the people, it was not a daily drink. Khong Island bilharziasis, even though limited in extent, gave rise to serious sequelae. In 1983 the study of sera from 50 cirrhosis patients showed HBs antigen positivity in 55% of cases, indicating tbat post-hepatitis cirrhosis was frequent. Cancer of the liver accounted for about 8% of cancers and was second in importance after cancer of the uterus. An increase in the number of cases of cancer of the liver had been noted in recent years at the Sethatbi:ratb and Mahosot hospitals. The three main etiological factors cited were the use of defoliants during the war, aflatoxins, and Australia antigen. The last-named seemed the most important; a preliminary study on 30 cases of liver cancer showed that 60% carried the HBs antigen, which was found quite frequently in the Lao population (about 7% according to electro-immunodiffusion and 10% according to passive haemagglutination). It would therefore seem that carriers of HBs antigen were at high risk of developing primary cancer of the liver. Viral hepatitis in its various forms and its serious long-term sequelae accounted for a considerable proportion of bos.pital admissions in his country and constituted a serious public health problem. The Ministry of Public Health had therefore set up a committee to determine the history of all forms of viral hepatitis and to develop and assess effective and inexpensive means of preventing and treating it and its sequelae. Technical and material cooperation from WHO for the control programme that had been set up would be welcome. Dr KEAN (Australia) commended WHO and individual countries for their work on the prevention and control of hepatitis. Australia had been collaborating with WHO for some years in combating hepatitis and other viral diseases, in particular through the WHO Collaborating Centre for Virus Reference and Research in Melbourne. In 1973, the Collaborating Centre had con<lucted a WHO-sponsoTe<l workshop, attended by persone from the South-East .Asia and Western Pacific Regions, on the production of reagents for rapid diagnostic tests of viral infections. Negotiations were under way to establish a centre in Melbourne to train workers fro~ .tbose two Regions in techniques for the control of viral diseases. In Australia, exposure to hepatitis B virus occurred pred®linantly among persons whose occupation, illness, or personal habits brought them into frequent contact witb blood products or other body fluids. However, in the indigenous Aboriginal population and certain immigrant groupe, there was a high endemic prevalence of hepatitis B virus car~iers. In 1983, the National Health and Medical Research Council bad issued a recoliJII'I(:mdation that priority areas for action should be the protection of the C011Nnunity, through the prevention of any increase in the nUlllber of carriers of hepatitis B virus, and the protection of individuals at high risk of acquiring the diseas,e. Three groups were to be given first priority for vaccine administration. Those were: (a) all neonates and children under 5 years of age in populations with a carrier rate of 5% or more; (b) chronic renal failure patients and recipients of multiple blood transfusions; (c) other bigh-risk groups. 148 REGIONAL COMMITTEE: THIRTY-FIFTH SESSION Dr TAPA (Tonga) thanked the Regional Director for the highly informative document, WPR/RC35/ll, which confirmed that viral hepatitis B was a serious problem in the Region. He thought that everything possible should be done to break the line of transmission from mothers to infants. The high cost of diagnostic kits and vaccines was a matter for concern. He was pleased to endorse and sur?ort the reco0101endations in section 4 of the document, and expressed the intention of his Government to collaborate with WHO and individual Member States in the surveillance, prevention and control of the disease. Dr MITCHELL {Vanuatu) thanked the Regional Cot11111iti:ee for ra1ung the topic under discussion. A survey in the central hospital in Vanuatu in 1983 had shown that 18% of blood samples from donors were positive for HBs antigen. However, in view of the fact that there were no national statistics on viral hepatitis, and no facilities for collecting them, there were currently no plans to introduce hepatitis B vaccine. He asked whether there was any evidence for vector transmission of hepatitis A or hepatitis B, given the sporadic occurrence of hepatitis B 1n certain sections of the population. Dr UMENAI (Regional Adviser in Communicable Diseases), in reply to the questions posed by various representatives, said that the currently available plasma-derived vaccines were very effective, riQt only for the protection of adults but also for the prevention of mother-to-infant transmission of infection. Two recent minor studies had indicated that three or four doses of the vaccine given 24-48 hours, one month, three months and six months after delivery protected almost 90% of infants. Recently, the cost of plasma-derived vaccine bad fallen considerably, and new developments in production techniques should accelerate the decrease in price. A rec0t11binant DNA vaccine was being developed in several countries, but improvements in techniques were required before the vaccine could be produced on a large-scale, and it was expected to be five to ten years before the vaccine would be available for large-scale use. Since the production of plasma-derived vaccine involved much simpler techniq·ues, it was expected that both types of vaccine would be used in the future. A recent meeting of the Task Force on Hepatitis B had recommeo<led that regional guidelines on the production of diagnostic reagents, standardizced laboratory procedures for detection of hepatitis virus markers, and strategies for control programmes and vaccine use be published. In the Western Pacific Region, non-A non-B hepatitis virus infection generally resulted from blood transfusion, in contrast to the situation in South-East Asia, where waterborne infection also existed. So far, there had been no report of a water-borne non-A non-B hepatitis epidemic in the Western Pacific Region. Research was in progress to determine the etiological agent of non-A non-B hepatitis, and it was hoped to develop a diagnostic method for that infection in the future. SUMMARY RECORD OF THE SEVENTH MEETING 149 The REGIONAL DIRECTOR said that there was now global interest in the problem of viral hepatitis B. Quality control requirements for hepatitis B vaccine had been drawn up by an expert group. So far, vaccines bad been produced mainly in Europe and the United States of America, but work was being carried out in various countries of the Region and it was hoped that the Region would soon achieve self-sufficiency in vaccine production. There had recently been progress in the development of diagnostic techniques, and it was hoped that reliable reagents would soon be available for use under field conditions. The cost of plasma-derived vaccine had been decreasing rapidly. The use of plasma collected through blood donation progra111t1les should help to further reduce the price. The Regional Director stressed the importance of technical cooperation 1n that field. Negotiations were under way to investigate the possibility of establishing several production centres to supply the vaccine needs of all countries in the Region at low cost. In that context, he acknowledged the offer made by the representative of Singapore. The development of recombinant DNA vaccine was promising, but further studies were needed before it could be made available for general use. In addition, the techniques for purification of recombinant DNA vaccines were very complicated. The approach adopted by the Regional Office was to try to reduce the costs of plasma-derived vaccines, through technical cooperation and organized blood collection, while also supporting research on the production of recombinant DNA vaccines. The Regional Director drew attention to the fact that the hepatitis B plasma-derived vaccine was heat-stable. Thus a cold chain was not absolutely necessary, and distribution of the vaccine did not present a problem. In determining a vaccine policy, it was necessary to define the populations at risk. Neonates and members of tbe medical profession were obviously at risk; another possible high-risk group was hospitalized patients. It was important that governments realize that the prevention of viral hepatitis B was an important activity, which would have significant effects on the health of populations in the long term. Referring to the controversial issue of safety testing of vaccines in chimpanzees, the Regional Director expressed ~he hope that the problems would soon be solved. Dr REILLY (Papua New Guinea), following up on the comtDents of the representative of Vanuatu, asked whether any surveys had been done to determine whether any insect vector was involved in the transmission of hepatitis B. 150 REGIONAL COMMITTEE: THIRTY-FIFTH SESSION Dr UMENAI (Regional Adviser in CotJRQunicable Diseases) replied that there was so far no evidence for or against the existence of an insect vector. The development of sensitive methods for detecting hepatitis B virus such ,as DNA- hybridization techniques should permit the investigatio.n of that topic in the near future. Dr BARKER (New Zealand) asked for comments on the relative values of administering vaccine plus immunoglobulin and vaccine alone in neonates. Dr UMENAI (Regional Adviser in Communicable Diseases) replied that immunoglobulin was very useful in helping prevent infection. Studies had shown that three or four doses of vaccine alone protected approximately 90% of neonates. Other studies showed that that percentage increased when immunoglobulin was administered as well. However, the high cost of immunoglobulin limited the applicability of the combination, particularly for large-scale use in developing countries. It was thus 4 matter for individual countries to decide which method was most appropriate for their particular situation. - In the absence of further comments, the CHAIRMAN requested the Rapporteurs to prepare an appropriate draft resolution. (For consideration of the draft resolution, see the eighth meeting, section 1.4). The meeting rose at noon. 1. 2. (WPR/RC35/SR/8) SUMMARY RECORD OF THE EIGHTH MEETING New Town ij~ll, Civic Centre, Suva Tuesda;r;, 11 September 1984 ~t 9.00 a.m. CHAIRMAN: Dr T.M. Biumaiwai (Fiji) later: Mr W. Korisa (Vanuatu) then: Dr T.M. Biumaiwai (Fiji) CONTENTS Consideration of draft resolutions •••••••••••••••••••••••• WHO Guidelines for Drinking-Water Quality ••••••••••••••••• 3. Selection of topic for the Technical Discussions in conjunction with the thirty-sixth session 152 152 of the Regional Committee ••••••••••••••••••••••••••••••••• 154 4. Time and place of the thirty-sixth and thirty-seventh sessions of the Regional Committee •••••••••••••••••••••••• 5. Statements by representatives of the United Nations, the Specialized Agencies, and intergovernmental and nongovernmental organizations in official relations 156 with WIIO • • • • • • • • • • • • • • • • • • • • • . • • • • • • • • • • • • • • • • • • • • • • • • • • • • 15 7 6. 7. 8. 9. 10. Statement by an observer •••••••••••••••••••••••••••••••••• Proposed inclusion of a further item in the Regional Committee's agenda at its thirty-sixth session •••••••••••• Consideration of draft resolutions •••••••••••••••••••••••• Resolution of appreciation •••••••••••••••••••••••••••••••• Closure of the session ••••••••••••••••••••····•·····•····· - 151 - 157 157 160 160 160 152 REGIONAL COMMITTEE: THIRTY-FIFTH SESSION 1. CONSIDERATION OF DRAFT RESOLUTIONS The Committee considered the following draft resolutions: 1.1 Action Prograwme on Essential Dr~gs and Vaccines (Document WPR/RC35/Conf. Paper No. 11) Decision: The draft resolution resolution WPR/RC35.Rll). was adopted without comment (see 1.2 Resolutions of regional interest adopted by the Thirty-seventh World Health Assembl and the Executive Board at its sevent -third and seventy-fourth sesstons Document WPR RC35 Conf. Paper No. 12 Decision: The draft resolution was adopted without comment (see resolution WPR/RC35.Rl2). 1. 3 Correlation of the work of the World Health Assembly, the Executive Board and tbe &esional Committee (Document WPR/RC35/Conf. Paper No. 13) Decision: The draft resolution was adopted without comment (see resolution WPR/RC35.Rl3). 1.4 Viral hepatitis B as a public health problem (Document WPR/RC35/Conf. Paper No. 14) Mr LAVEA (Samoa) proposed the addition of the words "and monitoring" after "production" in sub-paragraph (1) of operative paragraph 2. Decision: The draft resolution was adopted as amended (see resolution WPR/RC35.Rl4). Mr KORISA (Vanuatu), Vice-Chairman, took the chair. 2. WHO GUIDELINES FOR DRINKING-WATER QUALITY: Item 16 of the Agenda (Documents WPR/RC35/l2 and WPR/RC35/INF DOC/2) DR BARKER (New Zealand), pointing out that the item bad been proposed by his Government, introduced the New Zealand Standards for Drinking-Water Quality contained in document WPR/RC35/INF DOC/2. They were based on the recently published WHO Guidelines for drinking-water quality, which had superseded the International standards for drinking-water. The new WHO Guidelines had taken over three years to develop, with the cooperation of many participants from many countries. In adapting those Guidelines for its own use, the New Zealand Board of Health bad reduced the explanatory material and omitted criteria irrelevant to the country, but had added some herbicides and other substances that were sometimes present in water in New Zealand. Modifications would be needed from time to time as new chemicals entered the water supply. The result was a set of New Zealand Standards that reflected the national environment. They could not be used elsewhere without modifications, and it was to be hoped that other countries would draft standards of their own. The New Zealand Standards would be used by SUMMARY RECORD OF THE EIGHTH MEETING 153 local authorities for assessing the quality of water supplies and for developing suitable monitoring and sampling programmes. New Zealand had raised the subject in the Regional Committee partly because, almost half-way through the International Drinking Water Supply and Sanitation Decade~ it seemed appropriate to emphasize the need to provide a pure water supply, as that would influence the health standards of a population more than any other single event. Developed countries needed to remember that their health standards were based on such fundamental factors as a pure water supply and adequate waste disposal methods. The preparation of the New Zealand Standards was a recognition that it was not enough merely to provide a sophisticated water distribution scheme. Without proper manage111ent and monitoring of performance, such schemes would present an even greater danger than the village well. Dr KHALID (Malaysia) congratulated the Regional Director and the Government of New Zealand on their respective reports. Many operational and technical problems remained to be resolved if the Decade objectives were to be achieved. At a consultation on the Decade, held in Geneva in June 1984, a number of those problems had been discussed at great length: ( 1) there was concern that, while many countries were actively engaged in setting up water-supply systems, they were not making similar efforts to provide for s~fe excreta disposal; (2) many existing water supply and wa•te disposal systems were fast breaking down on account of inadequate operation and maintenance, shortage of staff and resources, and the low status of administrative staff and maintenance areas; (3) many countries had adopted · inappropriate, over-sophisticated technology, which led to difficulties in maintenance; (4) the shortage of trained manpower was ari obstacle to the achievement of the Decade objectives; too many of the staff were based in urban areas; development of water supply systems needed to be better integrated with primary he.alth care activities, particularly in terms of manpower in rural areas; (5) regional centres bad an important part to play in the development of the Decade programme; (6) there were administrative and structural obstacles to the implementation of a comprehensive and integrated Decade programme. The Committee was urged to adopt the draft resolution contained in document WPR/RC35/Con£. Paper No. 15. Dr TAPA (Tonga) thanked the Regional Director and the Government of New Zealand for their reports. His delegation endorsed the three recommendations contained in section 4 of document WPR/RC35/12, and supported the draft resolution contained in document WPR/RC35/Conf. Paper 15. Dr WANG ZHAO (China) said that it was tbe duty of governments to provide the population with safe water of good quality and in sufficient quantity. China therefore supported the objectives of the International Drinking Water Supply and Sanitation Decade, and actively participated in the Decade, which was extremeiy important for the improvement of health in both urban and rural areas. China supported the scientifically based guidelines for drinking-water quality, which would lead to monitoring and help ensure water quality. He thanked all those who had collaborated in the preparation of the Guidelines. 154 REGIONAL COMMITTEE: TH.IRTY-FIFTH SESSION Activities for monitoring water supplies in China were being carried out with particular stress on rural areas. Standards that had been prepared in 1976 were now being revised. As stated in the document before the Committee, geographical and economic conditions varied considerably from country to country, and sometimes even from region to region within a given country, and there were differences in the availability of water supply and sanitation. The guidelines prepared by WHO would serve as a reference in that area. Dr KEAN (Australia) supported in principle the proposal t;o use guidelines for drinking-water quality, rather than standards as used earlier. He concurred with the thought expressed in document WPR/RC35/12 that appropriate water quality in a particular circumstance should reflect overall cost, risk and benefit factors. He also supported the recommendations contained in section 4 of the document, with the exception of the second sentence of recommendation (1), urging responsible authorities to develop national drinking-water standards from the Guidelines for drinking-water quality. Having established guidelines, it would be a retrograde step · to insist on national standards rather than considering coet, risk and benefit factors. Desirable, rather than absolute, standards might be appropriate, with the WHO Guidelines to be used where there was a major cost penalty in achieving the desirable standard. In some cases it would be appropriate to develop those on a national basis, but in others regional or other areas might be more appropriate. In the absence of further comments, the CHAIRMAN requested the Rapporteurs to prepare an appropriate draft resolution. (For tonsideration of the draft resolution, see section 8.1). · 3. SELECTION OF TOPIC FOR THE TECHNICAL DISCUSSIONS IN CONJUNCTION WITH THE THIRTY-SIXTH SESSION OF THE REGIONAL COMMITTEE: Item 17 of the Agenda (Documents WPR/RC35/l3 Rev.l and WPR/RC35/INF DOC/1) The REGIONAL DIRECTOR said that the Technical Discussions on chosen in 1983, namely, "Malnutrition, growth and development", held the previous day. the topic had been The Committee now needed to select a topic for the discussions to be held in 1985. Document WPR/RC35/13 Rev.l contained four proposals. He recalled that in 1983 the Committee had adopted a resolution on the prevention and control of cardiovascular diseases. That subject had also been extensively discussed during the review of the report of the Sub-Committee on Technical Cooperation among Developing Countries when it had been suggested that cardiovascular diseases control would be an appropriate subject for the Technical Discussions during a future session. Sufficient data had now been assembled on the subject, which was therefore being put forward as one of the proposed topics for discussion in 1985. Turning to the Technical Discussions during the Thirty-eighth World Health Assembly in 1985, he recalled that the subject would be "Collaboration with nongovernmental organizations in implementing the Global SUMMARY RECORD OF THE EIGHTH MEETING 155 Strategy for Health for All11 • He had been asked by the Director-General to draw the attention of the Committee to a suggested framework and plan of action that had been formulated in preparation for the Technical Discussions. It had also been reproduced for its information as document WPR/RC35/INF DOC/1. It would be noted that Member States, nongover.nmental organizations and all individuals or bodies in~olved in ~mplem~nt1.~g the global strategy had been invited to give their 1.deas for 1.nclus10n 1.n the background paper to be prepared for the Health Assembly. Any comments should therefore be submitted to the Regional Director for transmittal to the Director-General, or sent directly to him. Dr TAPA (Tonga) favoured the selection of the topic "Current trends in cardiovascular disease control". Adequate justification was provided in document WPR/RC35/13 Rev.l. Mr LEODORO (Vanuatu) proposed that the topic 11Health hazards resulting from the testing of nuclear weapons and tbe dumping of radioactive matter in the Region11 should be included in the agenda of the next session of the Regional Committee. The REGIONAL DIRECTOR said that the subject proposed by the representative of Vanuatu was of global rather than regional interest and, as such, should be considered by the Executive Board, its Programme Committee, or the Health Assembly. He would include reference to the subject in his report to the Executive Board. Dr SUNG-WOO LEE (Republic of Korea) proposed the selection of ''The role of traditional medicine in primary health care11 as the subject for the Technical Discussions. In addition to the reasons given in document WPR/RC35/13 Rev.l, he felt that it would be an appropriate subject in view of the recommendation of the Sub-Committee on Technical Cooperation among Developing Countries and the request made to the Sub-Committee in resolution WPR/RC35.R3 to address the subject of the technical cooperation aspects of traditional medicine, with particular reference to herbal medicine and acupuncture. Dr DANG HOI XUAN (Viet Nam) representative of the Republic of Korea. supported the proposal of the Dr LIU XIRONG (China) also supported that proposal. It would be most useful to have an opportunity for exchange of experience on traditional medicine, which had an important role to play in the improvement of the health services. Mr SOUVANNAVONG (Lao People's Democratic Republic) also supported that proposal. The CHAIRMAN asked members of the Committee to indicate their preference, and noted that the majority were in favour of the selection of "The role of traditional medicine in primary health care'' as the topic for the Technical Discussions at the thirty-sixth session of the Regional Committee. 156 REGIONAL COMMITTEE; THIRTY-FIFTH SESSION The REGIONAL DIRECTOR said that he was bappy that traditional medicine had been chosen. as the topic for the Technical Discussions in 1985. However, the subJect of cardio~ascul~r disease control was also important, and he therefore proposed that 1t be 1ncluded as an agenda item for the next session of the Regional Committee. Several meetings on the role of traditional medicine in primary bealtb care had already been organized and others were planned. A symposium on that topic, arranged jointly with the International Congress of Internal Medicine, would take place in Japan in October 1984. The Sub-Committee on Technical Cooperation among Developing Countries had already recommended that, in 1985, it should consider the technical cooperation aspects of traditional medicine, with particular reference to herbal medicine and acupuncture. An attempt would therefore be made to coordinate the two recommendations. In the absence of further comments, the CHAIRMAN noted that there was agreement on the topic of "The role of traditional medicine in primary health care", and requested the Rapporteurs to prepare an appropriate draft resolution. (For consideration of the draft resolution, see section 8 . 2). 4. TIME AND PLACE OF THE THIRTY-SIXTH AND THIRTY-SEVENTH SESSIONS OF THE REGIONAL COMMITTEE: Item 18 of the Agenda The REGIONAL DIRECTOR said that, in accordance with resolution WPR/RC24.Rl0, which stipulated that sessions should not be held outside Manila in two consecutive years, the thirty-sixth session in 1985 would be held in Manila. He proposed that the thirty-sixth session should be held from 16 to 20 September 1985. '!bose dates were suggested with a view to ensuring that the dates of the six regional committees overlapped as little as possible, thereby enabling the Director-General to attend at least part of all the regional committees. Since the thirty-sixth session would be held in Manila, an invitation could be extended to hold the thirty-seventh session outside regional headquarters. If no invitation was forthcoming, the thirty-seventh session would be held in Manila. The CHAIRMAN, in the absence of comments, requested the Rapporteurs to prepare an appropriate draft resolution. (For consideration of the draft resolution, see section 8.3). SUMMARY RECORD OF THE EIGHTH MEETING 157 5. STATEMENTS BY REPRESENTATIVES OF THE UNITED NATIONS, THE SPECIALIZED AGENCIES, AND ·INTERGOVERNMENTAL AND NONGOVERNMENTAL ORGANIZATIONS IN OFFICIAL RELATIONS WITH WHO: Item 19 of the Agenda At the invitation of the CHAIRMAN, statements were presented by the following: United Nations Children's Fund South Pacific Commission International Agency for the Prevention of Blindness/Helen Keller International International Dental Federation International Federation of Health Records Organizations Christian Medical Commission International Council of Nurses World Federation of Occupational Therapists International Society of Radiographers and Radiological Technicians League of Red Cross and Red Crescent Societies International Council of Women 6. STATEMENT BY AN OBSERVER At the invitation of the CHAIRMAN, a statement was presented by the observer from Negara Brunei Darussalam, Dr P. Durayappah. Dr BIUMAIWAI (Fiji) resumed the Chair. 7. PROPOSED INCI.USION OF A FURTHER ITEM IN THE REGIONAL COMMITTEE'S AGENDA AT ITS THIRTY-SIXTH SESSION Mr LEODORO (Vanuatu) proposed the consideration of a draft resolution concerning the inclusion of an item in the Regional Committee's agenda for its thirty-sixth session. The wording of the ·proposed resolution was as follows: THAT the health hazards to the people of the Western Pacific Region due to the testing of nuclear weapons and the dumping of nuclear wastes be discussed as an agenda topic ~t the next regional meeting, the thirty-sixth session in Manila in September 1985. The question was an important one for all the peoples of the Region, who were exposed to the dangers of radioactivity from fallout and the leakage of radioactive material. The REGIONAL DIRECTOR agreed that the question was an important one, although in his op1n1on it was of global rather than regional scope. Discussion of the subject at the next session would raise several difficulties. In the past Member States proposing new agenda items had assumed full responsibility for preparing background documentation. lf that task were left to the Secretariat, he could not see where it was to find the financial means or the expert manpower required. Three countries or areas in the Region had tested nuclear weapons and, if a study was to be valid, an 158 REGIONAL COMMITTEE: THIRTY-FIFTH SESSION ~~pert group would need to visit all the test sites so that the epide~iological effects of the tests could be monitored. Little information was available on the effects on health of nuclear weapon tests. As for the dumping of radioactive waste in the Pacific, he knew that it had been proposed but did not think that any dumping had actually taken place. Monitoring would have to be cor.:iucted for a ~uch longer period than one year if they wished to obtain valid results. Of course, he was not opposed to discussion of the subject but the difficulties should be borne in mind. Dr ACOSTA (Philippines) proposed that, in view of the difficulties of implementing the proposed resolution, the operative paragraph should be amended to read: REQUESTS the Regional Director to study the possibility of including the item in the agenda of the next meeting. Dr REILLY (Papua New Guinea) thought that the topic under discussion was an important one, and reflected the worries of many countries in the Region. He understood that sufficient documentation on past experiences of dumping of waste and nuclear testing was available, and it should be possible for an expert committee to advise the Secretariat on that matter. It would therefore be beneficial to have a report by an expert technical committee, preferably to be presented at the next meeting of the Regional Committee. The REGIONAL DIRECTOR confirmed that there were sufficient data on the consequences of nuclear explosion, but scanty information on the consequences of nuclear weapon testing, which were greatly affected by such factors as type of test, season, population, etc. Since the summary record of the meeting would include the present discussion, the proposed resolution was perhaps unnecessary, and the subject could be included on the agenda of a future session of the Regional Committee, when sufficient information was available. Mr LEODORO {Vanuatu) said that he lmew that some information was already available. A team had recently been sent, through the South Pacific Regional Environment Programme, to the site at Mururoa, where data had been collected and a report produced. That report should be sufficient as a basis for further work, and he would thus like to maintain the resolution as proposed. The REGIONAL DIRECTOR pointed out that the team referred to might not have investigated the health situation, which would have required long-term epidemiological studies. Dr TAPA (Tonga) expressed the op1n1on that the Regional Committee had a duty to be concerned about any activity likely to have an adverse effect on the health of populations in the Region. He was sure that no one would deny that activities involving radiation did take place in the Region. He asked tor clarification of the wording of the propo~al. SUMMARY RECORD OF THE EIGHTH MEETING 159 The REGIONAL DIRECTOR said that preparation of the draft resolution for consideration would require a prolongation of the session with all the attendant logistical problems. Moreover, some delegations would need to consult their Governments on such a delicate issue. In view of the political aspects, the Secretariat also needed sufficient time to prepare the background, particularly since the subject also concerned the International Atomic Energy Agency (IAEA). Mr BOYER (United States of America) suggested that the Regional Director, in his report to the Executive Board, should convey the preceding discussion and the serious concern expressed by delegates. He believed the subject went beyond WHO's area of responsibility and competence, and shared the Regional Director's feeling that, in view of its political overtones, the matter might be more appropriately raised in other forums of the United Nations, for example the United Nations General Assembly. So far, the Regional Cotllll!ittee had rightly dealt with areas in which effective action could be taken. An expert study of the subject would require additional funds at a time when resources were already scarce. Dr BARKER (New Zealand) <;iSSociated himself with the proposal of the representative of the United States of America and urged caution in view of the political complexity. A team from Australia and New Zealand had visited Mururoa last year and his Government had clearly indicated its opposition to the testing per .!..!• irrespective of any health consequences. The National Radiation Laboratory was monitoring sources of radiation in and around his country and information on natural and artificial radiation was thus available • Those services were offered to some of the other countries of the Pacific. However, sufficient expertise did not exist . to undertake the type of study proposed, for which IAEA assistance would be required. Mr LEODORO (Vanuatu) noted the various comments, including the proposal put forward by the Regional Director and the representative of the United States of America. He clarified that it had not been his intention to have the item discussed at the current session but to reach agreement on its inclusion in the agenda for the next session. After some further discussion, Dr SUNG-WOO LEE (Republic of Korea) formally proposed that the Committee should not consider a resolution on the subject, but that the discussion should be reported in the records. The proposal was supported by several representatives. At the request of the CHAIRMAN, Mr UHDE (Director, Support Programme) read out Rule 36 of the Rules of Procedure for the Regional Committee. In the light of that Rule, the CHAIRMAN invited the Committee to vote on the proposal of the representative of the Republic of Korea, that being the proposal furthest removed from the original proposal presented by the delegation of Vanuatu. T,he proposal was accepted by 17 votes to none, with three abstentions. 160 REGIONAL COMMITTEE: THIRTY~FIFTH SESS!ON Dr KEAN {Australia), Dr KHALID (Malaysia), Dr BARKER (New Zealand), Dr ACOSTA (Philippines), Dr SUNG-WOO LEE (Republic of Korea), Dr GOH KEE TAl (Singapore), Dr BAVADRA (Fiji), Dr TIRA (Kiribati), Dr DANG HOI XUAN (Viet Nam) and Dr KITAGAWA (Japan) took the floor to explain their votes, which in no way reflected a lack of concern at the testing of nuclear weapons in the Region and the resulting health hazards. The REGIONAL DIRECTOR assured representatives that his report to the Executive Board would reflect the concern expressed during the Regional Committee at the health hazards created by the testing of nuclear weapons, and he would enter into consultations on the subject with other United Nations agencies and with nongovernmental organizations. 8. CONSIDERATION OF DRAFT RESOLUTIONS 8.1 WHO Guidelines for Drinking-Water guality (Document WPR/RC35/Conf. Paper No. 15) Decision: The draft resolution was adopted without (see resolution WPR/RC35.Rl5). comment 8.2 of topic for the Technical Discussions in conjunction with .,..sixth session of the Re ional Committee WPR/RC35/Conf. Paper No. 16) Decision: The draft resolution was adopted without (see resolution WPR/RC35.Rl6). comment 8.3 Time and place of the thirty-sixth and thirty-seventh sessions of the Regional Committee Document WPR/RC35/Conf. Paper No. 17) Decision: The draft resolution was adopted without comment (see resolution WPR/RC35.Rl7). 9. RESOLUTION OF APPRECIATION Dr Acosta (Philippines) presented a draft resolution of appreciation. Decision: The draft resolution was adopted by acclamation (see resolution WPR/RC35/R18). 10. CLOSURE OF THE SESSION: Item 20 of the Agenda The CHAIRMAN delivered a closing address to the Regional Committee (see Annex 1). He thanked representatives for their cooperation and declared the thirty-fifth session of the Regional Committee closed. The meeting closed at 1.20 p.m. SUMMARY RECORD OF THE EIGHTH MEETING 161 ANNEX 1 CLOSING ADDRESS BY THE CHAIRMAN Dr Nakajima, Distinguished Representatives, Ladies and Gentlemen, has come for stock-taking. What have we The time accomplished? truly advance What measures will flow from our deliberations the goal of "Health for All by the Year 2000". concretely which will Perhaps the most basic and stirring accomplishment is one all too often left unnoticed - that we have sat down together. We have gathered here representatives of the most populous nations and some of the smallest nations on earth. We have brought together the most highly industrialized nations with some of the least developed. We have gathered nations representing a multitude of religious, linguistic, ethnic, political, social and cultural heritages. Sitting down together here in Suva, we have proved all these separations superfluous to our determined solidarity and unwavering commitment to a common dream ,.. the attainment by all of our peoples and each of our citizens of the highest possible level of health. But that is not all. We have succeeded in determining together just how we intend to allocate the resources necessary to achieve that dream - based on a spirit of practicality and a clear set of priorities, policies and programmes. Dr Mahler challenged this Regional Committee to make 1984 a "a year of opportunities". Did we meet that challenge? I am happy that we can answer most vigorously - yes. The report of the Regional Director, as well as the specific country reports, provide solid proof of a real build up of new health systems or modification of existing ones as envisaged in the Global Strategy for Health for All - fully focused on primary health care. These same reports, as well as subsequent questions and interventions, have made equally clear the co1JllDitment of Member States in the Western Pacific Region to the principles and objectives of the Seventh General Programme of Work. Our deliberations on programme budget proposals for 1986-1987 are perhaps the ultimate demonstration of our resolve to make a reality of health for all, to convert obstacles into opportunities "based on enlightened identification of priorities". Finally, the Member States of the Western Pacific Region have been active in developing managerial arrangements for technical cooperation between countries and with WHO. The efforts in joint policy and programme development need no better showcase than this Regional Committee. Can we possibly return to our countries unmoved and unmotivated to sink back into what the Director-General has called "business as usual"? 162 REGIONAL COMMITTEE; THIRTY-FIFTH SESSION Annex 1 Honourable Representatives, may I suggest that to do so would not only be uncharacteristic of those gatt-~red here, but so contrary to the spirit of this session in Fiji as to be unthinkable. Yet we are of a practical bent, we know the realities and the day-to-day struggles required to make progress. That is why our work toward thorough-going monitoring, relentless evaluation and fearless answers to difficult questions is so apt and so urgent. That is why we must all strive to redouble our efforts for effective utilization of the resources - both human and financial - of our WHO. That is why we must make technical cooperation between Member States, in this region and globally, an irresistible force for health for all. This Regional Committee in its resolutions has covered the cycle of progress from evaluation of need, to planning, to accomplishment, to monitoring and reevaluation. - We have reviewed and commended and sent requisite 1986-1987 Director-General. the report of the Regional Director proposed budget estimates to the - We have urged Member States to intensify the technical cooperation between developing countries, especially with regard to training. We have called for a strengthening of health manpower development policies and programmes. - We have examined closely and accepted the proposed Common Framework and Format for Evaluating the Strategies for Health for All by the Year 2000. - We have considered the report by the Sub-Committee on the General Programme of Work, and established the membership of this Sub-Committee as well as that of the Health Resources Group. We have discussed resolutions of regional interest adopted by the Thirty-seventh World Health Assembly, and recommended to the Executive Board (and through it to the World Health Assembly) an increase in the number of Board Members from the Western Pacific Region from three to four. - We have drafted well-considered and detailed resolutions on "Women, health and development", "Essential drugs and vaccines" and "Viral hepatitis" - each of which deserves priority attention, Shall these be idle murmurings or banners for practical and forceful progress? The joint work of the weeks and months ahead, when we have returned to our home countries, will be the true test. It is perhaps my SUMMARY RECORD OF THE EIGHTH MEETING 163 Annex 1 prerogative as Chairman to challenge you to make the first order of business on your return the review of this session's proceedings - in the light of your . own country context and the tools required for your active collaboration in the tasks before us. In my earlier address, I noted some of the important issues discussed at the Regional Committee's previous session on several special issues of interest for this region. We have this session heard further reports on technical cooperation, the role of women, hepatitis, malnutrition and water-quality. May I take this occasion to reiterate my concern that we recognize the need in such areas of special interest to maintain and strengthen country efforts to promote intersectoral coordination and community participation elements of our work without which all accomplishments will be fleeting. In conclusion, may I express my thanks to Dr Nakajima, the members of the Secretariat and the technical staff who have assisted me as Chairman. I would also like to thank my distinguished colleagues around the table for making my job as Chairman a pleasant task. Finally, on behalf of the people of Fiji, I bring warm thanks for honouring us by holding here in Suva the thirty-fifth session of the Regional Committee for the Western Pacific of the World Health Organization. With a wish for our common success in reaching the goal of health for all by the year 2000, this session is now closed.