Regional Director's Thirty-fifth Meeting with the WHO Representatives, SEARO, New Delhi,14-21 November 1986

I WORLD HEALTH REGIONAL OFFICE FOR ORGANIZATION SOUTH-EAST ASIA Regional Director's Thirty-fifth Meetinq with the WHO Representatives, SEARO, New Delhi, 14 - 21 November 1986 SEA/WR35/10(Rev.l) 6 January 1987 Agenda Item 13 REPORT OF THE THIRTY-FIFTH MEETING OF THE REGIONAL DIRECTOR WITH THE WHO REPRESENTATIVES AND SUMMING UPF ISSUES TABLE OF CONTENTS Opening address by the Regional Director Statements by Agency Representatives WHO Programme Review Detailed Programme Budgeting AIDS Effects of Nuclear Accidents on Health and Health Services Panel Discussions on: (a) Implementation of HFA Strategies (b) Targetting and Intensifying of Action Plans for PHC (c) Strategy for Implementation of MCN Care Package in the context of- PHC (d) HFA Leadership Training MTFs for Eighth General Programme of Work Health Resources Mobilization Women, Health and Development Annex - Panel discussions on Agenda Item 5 Page 1 2 2 3 4 4 6 8 9 10 Agenda Item 1 - Opening Address by the Regional Director At the outset, a two-minute silence was observed as a mark of respect to the two departed staff members, Dr K.N. Seneviratne and Dr K. Nushin. The Regional Director, in his inaugural address, referred to the formulation of national strategies by the Member States for attaining the HFA/2000 goal and response of the Organization by providing a coordinated support to them in implementing their respective strategies through introduction of several innovative approaches and managerial mechanisms for strengthening the development and execution of the Organization's collaborative programmes. The Regional Programme Budget Policy, developed in close collaboration with the countries, was intended to ensure optimal use of WHO's resources for health development at the country level. Financial audit in policy and programme terms had been introduced as a mechanism to monitor the use of WHO's resources in the Member countries and country support teams established to bring about the maximization of the effect of WHO action at the country level, and to provide a coherent response to the countries' needs as speedily as possible. Referring to the current global economic situation which had adversely affected the developing countries, he hoped that the Member States would endeavour to deploy all their efforts to avoid reduction in the national budgets for health services and health-related activities with a view to achieving the objectives laid down in the global strategy for HFA/2000. WHO would also endeavour to further support Member countries in their financial planning for health through both technical cooperation and promotion of training and also in exploring extrabudgetary resources to increase their support for national health strategies. In this connection, he referred to the financial crisis which the entire UN System was passing through and said that the need of the hour was to make the optimal use of available resources through improved programme formulation and efficient management. Giving the salient highlights of the 39th World Health Assembly and the 39th Session of the Regional Committee, the Regional Director asked the WRs to continue to provide their fullest support to the Member States in implementing the many important resolutions passed by these governing bodies. Such support, he felt, was essential particularly towards national monitoring and evaluation process and the related information support towards HFA strategies, developing and implementing country action plans in line with the regional plan of action for intersectoral action for health at national and district level, establishing mechanisms of working relations between governments and NGOs at the national level, strengthening the training programmes for HFA leadership, undertaking research within the framework developed by the ACHR with a view to wPWw the results in national health developmental activities, and exploring all possible avenues for the mobilization of extrabudgetary resources. He also requested the WRs to stimulate the nationals to make the maximum use of WHO publications according to their local needs, including translations into national languages. Referring to the sixth meeting of the Ministers of Health held at Chiang Mai (Thailand) from 16 to 18 September 1986, he said that the meeting laid emphasis on the need to reinforce activities among the Member States in order to strengthen TCDC efforts, implement the national strategies for health-for-all and initiate activities for HFA leadership training. The Ministers felt that there was a need to intensify PHC programmes by the pursuit of time-bound targets for defined geographic areas to achieve HFA. As regards TCDC, he said that while WHO supported it in principle, cooperation between the countries concerned was essential if TCDC efforts were to succeed. In conclusion, the Regional Director said that in the present atmosphere of shrinking resources, it was imperative for WHO to create a very positive image that would convince the Member States and the public at large 2 of the mission of WHO and stimulate the Governments to allocate adequate resources to the health sector for achieving the HFA goal. He hoped that the WRS would continue to maintain the high-level perception and sensitivity to the situation and opportunities in the countries and support the Member States in all activities that lead to the attainment of the social goal of HFA. Statements by Agency Representatives In his address, the Resident Representative of UNDP, highlighted the major programme thrusts that emerged out of recently concluded meeting of the development assistance coordinators (MAC-III) held in Bangkok. He pointed out that the two main themes for UNDP-assisted intercountry projects during the next Cycle were human resources development and technology transfer. These themes corresponded to national priorities and, in many instances, had strong links with projects in UNDP country programmes. Increased use of national consultants, national institutions for training, and development of research, and TCDC arrangements in the regional programme were important features for implementation of the fourth IC programme. It was felt that the main thrust of human resources development continued to depend on training, and on creating a pool of managerial, technical and administrative skills with a view to supporting national capabilities in research , planning, policy formulation and project implementation. He called for closer collaboration and cooperation of UNDP and WHO working together with the governments in the combined development efforts to create a better world, free from hunger, towards HFA/2000. The Programme Officer (Health and Immunization), UNICEF South-Central Asia Region, referred to the national development activities pertaining to "Child Survival, Growth and Development" and pointed out that during the SAARC Ministerial meeting, child survival had gained a high political priority with the Member countries of SEA Region. The question of child survival had also featured quite prominently at several WHO meetings. Referring to the agenda item on AIDS, he pointed out that UNICEF was very much concerned about the situation on AIDS, since children born of mothers infected with AIDS invariably acquired the infection leading later to actual disease. Though the disease had not yet become a priority public health problem in the Region, the Member countries could not afford to be complacent, as the disease could develop into a serious health problem unless preventive and control measures were strictly enforced. It was time that WHO and UNICEF continued to step up the ongoing efforts to solicit more political will from governments to do more for children. The combined efforts of WHO and UNICEF in further promoting child survival development were still vital for the achievement of the global goals of UCI/1990 and HFA/2000. Asenda Item 2(a) - WHO Programme Review The Director, Programme Management, briefly outlined the major thrusts of the WHO's collaborative programme during the current as well as the next biennia, which conformed to the areas of priority identified in the Regional Programme Budget Policy. Giving a review of the implementation of WHO's collaborative activities in the Member States during the preceding and the current biennia, he said that the delivery of programmes funded especially by UNDP, UNFPA, and VF sources appeared to be very poor. This did not augur well for the Organization, since unless it demonstrated its capability in executing the programmes funded by these agencies according to its schedule, it would 3 lose its credibility and it could not mobilize resources from these agencies for implementing the collaborative activities. The delivery of programmes under the Regular Budget was not good either and efforts were needed at the country level to expedite the process in order to ensure that all activities were implemented according to plan. In this connection, he referred to the objection raised by the external auditor on the increase in unliquidated obligations at the end of last biennium and said that efforts should be made to liquidate all the reserves before the end of this year as otherwise these would be charged to the 1986-1987 budget provisions. In the ensuing discussions, it was stated that the WRs should be briefed on the establishment of unliquidated obligations, as the procedure for making and using such resources under the Regular Budget differed from those for UNDP, UNFPA and VF. ACTION POINT BFO to provide the WRs with a list of unliquidated obligations pertaining to his country of assignment, for which action was required at the country level, with a view to enabling them to take necessary follow up action. Agenda Item 2(b) - Detailed Programme Budgeting The Director, Support Programme, briefly described the process of programme budgeting as practised currently in the SEA Region and its proposed reorientation following the recommendations of the CCPDM, which had been accepted by the Programme Budget Sub-Committee and endorsed by the 39th session of the Regional Committee. According to these recommendations, the formulation of details for the biennium should proceed in two stages. In the first stage, complete budgetary details by component, as at present, for implementation of activities for the first year of the biennium would be submitted, together with less specific details indicating component only for the second year. Narratives for activities would cover both years. This description would constitute the detailed PB to be submitted to the Regional Committee. Development of fuller details for the second year of the biennium would constitute the second stage, in the light of a review of implementation of the first eight months of the operational biennium by October. Details for the second year should also give full information needed for implementation and should be accompanied, if possible, by the terms of reference for STCs, lists of S&E, nominations for fellowships, etc. The following points emerged from the discussions that ensued: 1. Details for both the years may be finalized, but for purposes of presenting the PB to the RC, details of components for 1988 with less details for 1989 will be included as per the recommendation of the CCPDM. If desired, activities may be further distributed by quarter. All components may, if desired, be listed for each project even though activities for all components might not be envisaged. 2. The write-ups may also include information on "expected output/outcome". 4 3. It is not necessary to split the budget allocation equally for each year. 4. Projected activities for the second year may be based also on implementation during previous biennia. 5. All funds under the country programme should be budgeted for a specified activity. Agenda Item 3 - AIDS During his presentation, PCD briefly traced the history, current situation and WHO's programme in tackling the problems posed by AIDS. He stated that the earliest case was reported in the USA in 1978. The disease was identified first by the Pasteur Institute in Paris in 1983 and then by NIH, USA. He then outlined the major and minor symptoms of AIDS in adults and children and provided the figures for the various continents where AIDS had been reported, the largest number being reported from the Americas, followed by Europe. In SEAR, only a few imported cases had been reported from Thailand and India. The WHO programme on AIDS continued to be responsible for coordinating these activities and assisting the Member countries in the design and in presentation of their national programmes, as desired by the World Health Assembly. At the regional level, SEAR0 encouraged exchange of information on AIDS and supported diagnostic kits to the Member countries on request and provided technical collaboration in the prevention and control of AIDS. WHO was ready to support the countries according to its programme on AIDS. It was necessary for the Member countries to take further necessary action in line with the recommendations of the intercountry consultation held in the Regional Office in July 1986. The Regional Director said that AIDS did not pose a major public health problem at the moment in this Region and that it could be prevented through adequate precautionary measures. Though epidemiological surveillance was desirable, it was not always practicable in view of the extensive laboratory tests and the prohibitive costs involved. ACTION POINTS 1. The feasibility of including the information on AIDS, as a part of the family planning programme, should be explored. 2. WHO and the countries should keep a strict vigilance and undertake adequate steps to inform the general public through health education about the danger posed by this disease. Agenda Item 4 - Effects of Nuclear Accidents on Health and Health Services While introducing the agenda item, SPHA(DTT) mentioned that WHO and the United Nations had been involved and concerned since 1960 with problems that were likely to arise in times of nuclear explosion and various resolutions on 5 the subject had been adopted. Considering the growing danger of thermonuclear conflict, the 34th world Health Assembly had urged all Member States to consolidate peace, reinforce detente and achieve disarmament for the release of resources for public health, An international Committee of eminent experts in medical services and public health established by the Director-General collected, reviewed and snmmarised most recent information on possible effects of nuclear explosion on health and health services. After the Chernobyl accident, a number of delegates at the 39th World Health Assembly expressed grave concern regarding international health consequences of large scale accidents and the Director-General assured the Assembly that WHO activities would be coordYnated with the other UN and international agencies, including non-governmental ~rg~anizaQian.s with a mandate in that area. This subject was also discussed by the 39th Session of the Regional Committee held in Chiang Mai (Thailand), where the Regional Director emphasized the inter-agency, inter-sectoral and inter-country nature of the problem and assured the delegates that SEAR0 would take effective and prompt steps to prepare guidelines and provide warning signals to the Member countries in the event of nuclear accidents occurring in the Region and/or globally. The health effects of a nuclear accident could be immediate and long term and could be summarized as: blast wave, thermal heat/wave, acute exposure to ionising radiation, and residual radiation injuries. The need of the hour was how the health system and the health manpower would be called upon to react in times of such accidents. The health infrastructure of a country would have to react expeditiously for such special types of emergencies or disasters as the needs,would far exceed the resources. The countries would have to keep "in preparedness" and the so-called "rescue teams" would have to be "assembled" and despatched to the accident site at a moment's notice. ACTION POINTS 1. As much authentic information as possible should be obtained and disseminated to the Member countries most expeditiously. 2. Provision of general guidelines to the countries to take effective preventive measures and to strengthen infrastructure to respond to such eventualities. 3. Effective prevention of nuclear a.cci.dent s through inter-sectoral, inter-agency and inter-country coordination, exchange of information on peaceful uses of nuclear energy and wide dissemination of information on safety measures and preventive health measures at the reactor site, formation of National Committees on the prevention and control of nuclear accidents, building up 'of data base on health information, interventions and appropriate technologies. 5. Formulation of guidelines at the national level on public and/or health actions. 6 6. Promotion of community awareness about the hazards of accidents, community preparedness to meet exigencies of the situation and building up effective inter-sectoral coordination at national levels with the Ministry of Health playing a leading role in matters of radiation health hazards in close collaboration with atomic energy establishments. Agenda Item 5: Panel Discussions on: (a) Implementation of HFA Strategies (b) Targetting and Intensification of Action Plans for PHC (c!) Strategy for Implementation of MCH Care Package (d) HFA Leadership Training Introducing this agenda item, HSI pointed out that these four topics were put together for a panel discussion, rather than presenting them separately with a view to emphasizing that the four topics were interlinked and the integrated programme thrust of the Regional Office in the recent months. The first item was on the evaluation of the strategies for PHC. Evaluation of the strategies had been done and the report of the evaluation and the 7th report of the World Health Situation had been produced. Some issues were raised during the regional discussions. These and further actions needed would be included in the presentation. The second panelist would present the topic on targetting and intensification of action plans for PHC. During the evaluation of the strategies, one issue which came up was that although there were lots of actions for implementing the strategies, the efforts were so diffused that there was no visible impact on the health status on the population. The DG's addresses to the RC as well as to the WHA indicated that confidence in the PHC approach for reaching HFA was being questioned, and therefore there was need for targetting and intensification of action plans for PHC in order to concentrate on a few programmes and on a few geographical areas. Following DG's addresses some activities were undertaken in the Regional Office in this regard. This topic was being presented by PCD rather than HSI who was responsible for the PHC area. This was purposely done to highlight the subtle changes taking place in the Regional Office. In recent months, discussions were held in the Regional Office and there was a common understanding between the Health Infrastructure and the Science and Technology programme areas on what was meant by a comprehensive health systems based on PHC. The next topic was strategy for the implementation of MCH care package as part of the comprehensive health systems based on PHC. Integrated approach to maternal and child health care in the context of PHC was the topic for technical discussions at the recent RC. The background paper that was prepared for that meeting was based on the framework on comprehensive health systems based on PHC. The last item was on HFA leadership training. All the other topics related to HFA strategies and comprehensive systems based on PHC would depend on HFA leadership training. The first objective of the panel discussion was just to give information on what the thinking in the Regional Office was as regards the efforts of various programmes of the Organization and then try to project it in its totality. This was intended to project the coordinated thrust of 7 SEARO/WHO in the coming few years. The inputs from the participants from the countries and from the Regional Office would show how this new thrust from their perspective and country situations was viewed. Referring to the implementation of HFA strategies in the South-East Asia Region of WHO, PC1 briefly traced the history of formulation and implementation of national and regional and global strategies for HFA/2000. These strategies support political commitment at the highest policy making level for formulation and implementation of national and regional objectives, targets and plans of action, promotion of health care delivery system through PHC, exchange of information etc. The evaluation of the HFA strategies in SEA Region had identified certain important issues which should be taken into consideration for improving the implementation and monitoring mechanisms. In his presentation on targetting and intensification of action plans for PHC, PCD recalled that the Director-General, while addressing the 38th session of the Regional Committee, had called for targetting for health for all to demonstrate significant health impact in defined geographical areas/populations using the primary health care approach. He pointed out that it was easier to fix targets for individual programmes and certain diseases but extremely difficult to fix targets for health infrastructure in its totality. Close coordination was essential between individual programmes within the context of health infrastructure and the resources of the various health programme at each level. There was also a need to coordinate the organizational needs, felt needs and real health needs of the people which included promotive and preventive care, information and education activities, training and orientation and delivery of continued health services at all levels. Introducing the subject relating to the strategy for implementation of MCH Care Package in the context of PHC, RFH mentioned that mothers and children were by far the most vulnerable section constituting nearly two-thirds of the total population in all the countries. Though MCH care programmes existed in the earlier days also, they did not make much impact due to various factors. With primary health care as the key approach to the attainment of HFA/2000 goal, the maternal and child health care programme was now integrated in the delivery of health services. However, there was an urgent need to utilize the available resources to the maximum extent possible, develop learning materials, identify risk groups, train manpower in first-level care, adopt PHC approach through community participation, and create a sense of greater coordination and understanding at all levels of staff that they have a common cause of serving humanity. A team approach among all types of workers should be adopted and inter-personal relations should be encouraged. Research relating to MCH programmes should be problem-oriented and new technologies should be tried in solving problems connected with MCH care. HPP briefly outlined the various steps taken at the country and the regional levels to promote HFA leadership training. These included intensive training programmes to focus the basic tenets of the HFA concept, including workshops/seminars to motivate politicians and other health professionals concerning HFA activities, and regional training courses for facilitators and providers of health, and input on HFA leadership concept in all group educational meetings. He also mentioned 8 about the global efforts made in the Region which included organization of the fourth International Colloquium on Leadership for HFA and-TCDC held in Thailand and the first Inter-Regional Dialogue on Leadership Resource and support Network Development held in India. These efforts were even appreciated by the Ministers of Health during their Six meetings held in Chiang Mai in September 1986. ACTION POINTS 1. How to deliver the programme through the health infrastructure? 2. What should be done at the country level? UNDP funded project ICP PHC 009 - Intensification of National Action Programme for Primary Health Care, is one mechanism to try out this integrated approach at the country level, albeit as an experimental process (Annex gives details of the panel discussions). 3. What could the Regional Office do to provide WRs with needed technical and managerial backstopping support? CST had an important role to play and this mechanism should be fully availed of. Agenda Item 6 : MTPs for the Eighth General Programme of Work During his presentation, PLN outlined the underlying idea behind the preparation of the Regional MTPs for the 8th General Programme of Work. The preparation of the MTPs was one of the essential features of the managerial process for WHO programme development and the Organization's General Programme of Work formed the basis for preparation of MTPs. The Regional MTPs were the regional contribution for the development of global MTPs and would be used for the preparation of corresponding programme budgets. Elaborating on the changes between the Seventh and the Eighth General Programme of Work, he said that while the principles and the structure remained the same basically, the approaches in the 8th GPW were to be indicated according to the level of implementation - country, regional and global. Also, the classified list of programmes for the 8th GPW closely followed the one for the 7th GPW, with the addition of some new programmes and some changes in the titles of certain others. The WRs had been consulted in the preparation of the Regional MTPs and, based on their contribution, the Regional Office was developing the MTPs for the various programme areas. According to the current schedule, the Regional Advisers were expected to finalize their MTPs by February 1987, which would then be finalized by the RPC in'June 1987 - in time for use for the formulation of 1990-1991 broad programme budget proposals. The Regional MTPs reflected priority areas and activities which were of interest to the Member States for implementation during the period of 8th GPW. It was essential that the WRs and the national authorities be 9 involved in this formulation. It was also stated that some countries had found the MTPs quite useful for developing their broad and detailed programme budget proposals. The Regional Director stated that the GPW and the MTPs formed a sort of work plan for the Organization. It was not expected of the countries to include activities in all the programme areas mentioned in the classified list of programmes. They could choose their priority programme areas in which they would like to undertake activities in their respective countries during the period of the GPW. However, what was important was to ensure that whatever programme activities were listed in the MTPs were actually undertaken at the country level. ACTION POINTS 1. The units which have not yet submitted their MTPs should do so soon. 2. The final 8th GPW, as approved by the Executive Board, and the Regional MTPs should be sent to the WRs and the Member Governments for their information and use. Agenda Item 7 - Health Resources Mobilization The Regional Director briefly described the global economic situation and the financial crisis being faced by the UN including WHO. He referred to the resolution WHA.29/48 as a result of which several economy measures were taken. The present crisis in WHO was due to non-payment or delayed payments and/or other political considerations in the payment of assessed contributions by certain Member States. Credibility of WHO depended on its performance and there was a possibility to raise extrabudgetary resources if well-managed and well-justified programmes were formulated and positive actions were taken to implement them. In his presentation, the Chief HRM/HQ, outlined the various avenues for resources mobilization for national health development programmes. It was indicated that nearly one-third of WHO's total money was being used towards the 'development of health system infrastructure and another one-third for science and technology thus creating a balance between these two broad areas. WHO's development policies were thus far ahead of those of other agencies and it was therefore no surprise that some donors were coming forward to assist Member countries through WHO. It was, however, important to take some positive steps to improve efficiency at all levels through productive use of available sources keeping in view the cost benefits and cost effectiveness of various programmes. Dr Kingma outlined the modalities and criteria for WHO involvement, procedures for joint action in health resources mobilization, role of WHO in bilateral project proposals and so on. The following points emerged from his presentation: 1. The major objectives of the WHO collaborative programme include the strengthening of national capacities, implementing national HFA strategies with emphasis on sound health infrastructure development, focussing technical cooperation on activities that support well-defined national HFA strategies or help develop them where they do not exist, and fostering the coordinated and optimal use of resources by governments and all involved agencies for implementation of HFA strategies of Member States. 10 2. While mobilizing health resources for countries, stress should be laid on rationalization beginning with a study of past and current utilization of available funds, i.e. patterns of resource allocation, efficiency of resource use, examining current use of external resources with focus on efficiency, equity, sustainability and cost implications. Domestic and national resources should be optimally mobilized while side by side exploring external resources. 3. WHO has to play a coordinating role. WRs should coordinate very closely with the various UN, governmental and non-governmental (both bilateral and multilateral) organizations and improve their working relations with them in order to contribute positively in the development of country health programmes and mobilize extrabudgetary resources. Those agencies which want to exclude WHO because of the 13% charge, should be encouraged for bilateral funding. 5. Community involvement is very crucial as it promotes equity and efficiency. Efforts should be made to mobilize all possible community resources. 6. WHO is not a fund raising agency and it cannot normally assume the role of "fund-raiser-by-default" i.e. for projects which the Planning bodies in the Member States have excluded from negotiations with donors, or which have not been accepted by the regular donor partners of the country. ACTION POINTS 1. The WRs, while involving themselves in the formulation of country health programmes, should encourage bilateral funding in those cases where WHO involvement was not considered necessary. However, the Regional Office and HQ should be kept informed to enable them to extend their support if and when the donors seek WHO's views for bilateral funding. 2. Proposals for extrabudgetary resources should be submitted in standard formats developed for funding agencies. Also priorities for fund-raising be fixed while submitting requests to HQ for exploring extrabudgetary resources. Agenda Item 9 - Women, Health and Development The Chairperson gave a recapitulation of the activities and achievements of the Working Group on Women, Health and Development, and introduced the Regional Plan of Action. The policy basis for further action was given in resolutions WHA.38/27 and WHA.39/18 for follow-up and implementation of the Forward Looking Strategies of the Nairobi meeting in 1985. The regional and global plans of action were now to be prepared and dealt with at a meeting in Geneva in December 1986 and the global plan of action would then be presented to the forthcoming session of the World Health Assembly in May 1987. 11 The major objectives and the main thrusts of the regional plan of action were: --------------------__^_________________----------------------------------- Major Objectives Main Thrusts -----------^--------------------------------------------------------------- 1. 2. 3. 4. 5. 6. To assess current and future trends in the health status of women in SEA Region. To intensify action plans focussing on women as providers and recipients of health care, particularly PHC. To improve techniques and methods to support MCH/FP To expand women's role in selected programme areas such as water and sanitation, nutrition, EPI, MCH/FP, diarrhoeal diseases control, etc. To collaborate with women's NGOs in mobilizing resources for promoting health activities. To promote leadership roles for women Update study on the health status of women, develop WHD data base at the regional. Strengthening and enhancing the women's dimension in various programmes. Promote research/evaluation to improve the performance of health workers, TBAs in support of MCH/FP. Promote women's participation in these programme area activities Mobilize NGOs to promote health activities and awareness of priority health problems. Leadership training of women for intensification of support to PHC. The WRs were requested to analyse the Plan of Action in relation to the needs and priorities of their respective countries and give their inputs on the following issues: 1. Which of the thrusts will make the greatest impact at country level? 2. What aspects of the women dimension in these ongoing programmes should be promoted as specific activities for development? 3. What kind of collaboration/support would be required from the Regional Office and vice-versa? 4. What should be the method for exchange of information and dialogue? 12 ACTION POINTS 1. 2. 3. 4. Those WRs, who have not submitted the write-ups on the WI-ID country situation, should do so. The WF& being the WHO focal points in their respective country, should identify the relevant national focal point and inform the Working Group on WHD in SEAR0 accordingly. The draft plan of action should be reviewed at the country level and the priorities and main thrust for their respective country should be assessed and communicated including specification about necessary collaboration/support. The dialogue and exchange of information on WHD should be reviewed. ANNEX Annex PANEL DISCUSSIONS ON AGENDA ITEM 5 While opening the subjects of discussion, HSI explained that the main purpose of these discussions was to develop or demonstrate linkages between the various topics and he therefore suggested that all the items be taken up together rather than discussing them separately. WR Sri Lanka felt that the presentations, in general, were like old wine in new bottles. It was not clear to him why the presentations were made. There were hints of some issues but they did not come out clearly. For example, the issues regarding resource allocation: what are the problems at the country level regarding resources 3 The question of targetting was also not clear. Was it targetting of the infrastructure or whether it was for every programme. With regard to the HFA progress report, the proper place to discuss it would be by the country support team for each country. The problem of equity was not touched. In HFA leadership training, the real issue was conceptual. According to the WR Bangladesh, the scenario at the country level was quite confusing because the inputs from the various agencies, in addition to those of the Governments, some of which may be conflicting. He, therefore, requested that there should be technical and general guidance from SEAR0 with regard to the approaches which should be taken up by the WRS. With regard to targetting, PCD explained that it was difficult to give details at the moment but general guidelines could, however, be given. What could be done was to plan in a better way to advise the governments. Health being a central subject and WHO-related, WHO had to be involved in it. Detailed guidelines could be developed and WHO had to be involved in a highly organized way. WHO had to look at the technical components in order to produce some impact. The management aspect should not be forgotten. We could know what was the technical input and output and advise the governments how to monitor it. This had not been developed. Concerning implementation of HFA strategies, PC1 pointed out that WHO corresponded with the countries through the Ministry of Health or the Ministry responsible for the programme in which WHO goals were identified. It should be ensured that the Health Ministries in the countries were adequately supported and strengthened. One way of achieving this goal was to ensure and identify those items which would substantially strengthen the Ministries of Health at the country level through which we enter into a dialogue. That could be possible if we had the resources - both administrative and financial. Financial resources could be explored through donors and WHO could provide very high technical support. HPP pointed out that guidelines could be developed. However, before developing these guidelines, there should be a methodology. LO-ESCAP felt intersectoral action for health and inter-agency coordination should be viewed in its entirety and it might be useful at some stage to compare notes between WHO, ESCAP and FAO, particularly with regard to the rural development. 2 WR Indonesia pointed that the question was how to deliver the Programmes or services through the health infrastructure as proposed and what should be done at the country level. WR Nepal raised the question whether the MCH was a part of the system. He also questioned whether HFA leadership training per se was sufficient. - Regarding the question raised by WR Indonesia as to how to do it, WR Sri Lanka thought that the CST mechanism was appropriate to provide the WR with the technical and managerial backstopping which they required. PLN pointed out that the national action programme for PHC -was still at the conceptual level. There was a real need for operationalizing it, especially at the grass-root/micro level. Time-bound plans of action with well-defined targets and regular follow-up were urgently needed. The WHO-supported health development projects in the countries, such as Huvsgul Aimak, Mongar Health Services Development and Integrated Family Health Package Projects in Mongolia, Bhutan and Indonesia respectively should be oriented to the principle and approaches of the intensification of national action programme for PHC, so that experiences gained from such development would be a practical lesson for both the countries and WHO to learn. WR, Thailand said that there was no name for the session of the four subjects. It could have been called "Status of HFA in SEAR0 and SEAR countries in A.D. 1986". He thought that the approach would be to find out how the Regional Office could best transfer the framework into support to the countries through country support teams. m, Nepal remarked that WRs required backstopping from the Region Office. He would send appropriate information to SEAR0 and he expected appropriate and timely feedback. PHA, Bhutan said that the countries' capabilities should be developed. WR, Mongolia suggested that the practical aspects of HFA leadership should be developed in the project ICP PHC 009. PCD said that the new UNDP Project, ICP PHC 009, would start from January 1987 with a duration of three years. This project had four elements: Diarrhoeal Diseases, ARI, EPI and Essential Drugs. A conceptual framework had been developed. It was to be seen what input and output could be obtained from this which could improve the system. Integration was a process in which depending on upto what level people were required. Whatever you had to identify and the type of people wanted, based on that the services would have to be developed. Integration was not for the purpose of service but for the purpose of giving better service to the people. WR India said that the concepts presented were excellent but they were general and could be applied all around the world. What he wanted was more content, practical and positive experience. There was no word about the private sector in the infrastructure and about financing of health care. HSI said with regard to the issue raised by the WR Sri Lanka, the WRs were the crux in this matter and it was primarily they who would have to c 3 identify the problems and issues at the country level. The aim of this panel discussion was to try and bring into one framework the various topics discussed. With regard to the questions raised by the WRs, Bangladesh, Indonesia and Nepal, it is true that the scenario at the country level was changing and sometimes confusing and the need for technical and managerial backstopping from the regional office was appreciated. The CST can play an important role in this matter. With regard to the question of why these four programme areas were selected in the new UNDP project, ICP PHC 009, it was pointed out that these were the four areas selected by the UNDP as priority areas but they wanted these programmes to be implemented through a strengthened health infrastructure. It was precisely this way that the project has been structured. A design of this project and its proposed activities were developed based on the conceptual model and therefore the model was no longer at the conceptual stage. It was also not intended that this model or framework be applied to all the countries. There was no intention that it should be imposed on any country. It was a comprehensive conceptual model which could be used according to the needs and situations of each country. Finally, the objective of this discussion was to provide information and to create an awareness of our colleagues in the countries and the regional office of the major thrusts in regard to the integrated approach to the development of comprehensive health care based on primary health care and to get suggestions for follow-up actions from our colleagues. These have been obtained and noted down and would be followed up. Concluding the discussions, the Regional Director said that the topic was a very complex and complicated one. He suggested that the word 'targetting' should be changed in the text. It could, however, remain in the title. More and more acceptance of different plans, projects, programmes in the country sometimes distinct from the HFA strategy is occurring. In order to achieve the goal of HFA, all these had to be brought into one‘concept. With regard to the inter-sectoral collaboration and coordination programme, we have to be sensitive. The other sectors would have to be stimulated in order to support the health development.