(WPR/RC24/SR!3)
SUMMARY RECORD OF THE THIRD MEETING Q.ueen Margaret College, Wellington Wednesday, 29 August 1973 at 9.00 a.m. CHAIRMAN: Dr C.N. Derek Taylor (New Zealand) CONTENTS
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Address by the Director-General ...
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Address by inooming Chairman ............................... .
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Acknowledgement by the Chairman 8f brief reports received from governments on the progress of their health act1vi ties ..................................... 91
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Report of the Regional Direotor ••••••••••••••..••••••••••••• Resolutions of regional interest adopted by the Twenty-sixth World Health Assemhl:r .•.•••••••••••••••••••••••
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REGIONAL COMMITTEE:
TWENTY-FOURTH SESSION
Third Meeting Wednesday, 29 August 1973 at 9.00 a.m. PRESENI'
I.
Representatives of Member States AUSTRALIA Dr H.M. Franklands Dr R.W. Cumming Mr R.J. Tyson Dr Chen Hai-feng Professor Shih Cheng-hsin Dr Chang Kuan-hua Mr Tsao Yung-lin Dr D. Singh Dr J. Laigret Dr Teruhiko Saburi Dr Rintaro Okamoto Professeur Agrege Sok Heangsun Dr Kadeva Han Dr My Samedy Dr Phouy Phoutthasak Dr Tiao Jaisvasd Visouthiphong Tan Sri Datuk (Dr) Abdul Majid bin Ismail Dr S.K. Mukherjee Mr Onn bin Kayat Dr H.J.H. Hiddlestone Dr C.N.Derek Taylor Dr G. Blake-Palmer Dr R. Dickie Professor C.W. Dixon
CHINA
FIJI FRANCE JAPAN KHMER REPUBLIC
LAOS MALAYSIA
NEW ZEALAND
SUMMARY RECORD OF THE THIRD MEETING
PHILIPPINES PORl'UGAL REPUBLIC OF KOREA
Dr A.N. Acosta Dr J.B. Duarte Pinheira Dr L. Amarchande Dr Mr Dr Dr Sung Hee Rhee Byoung Rok Lee Sung Kyu Ahn Kyong Shik Chang
REPUBLIC OF VIET-NAM
Dr Truong-Minh-Cac Dr Pham-Van Dr Nhan-Trung-Son Dr Ho Guan Lim Dr J .L. Kilgour Dr G. Choa Dr Mr Dr Dr J.C. King F.S. Cruz M. Kumangai J. Nunn
SINGAPORE UNITED KINGDOM UNITED STATES OF AMERICA
WESTERN SAMOA
Honourable Seiuli Taulafo Dr J.C. Thieme Mr Faapoituulao Atoa
II.
Representatives of the United Nations and Related Organizations UNITED NATIONS AND UNITED NATIONS DEVELOPMENT PROGRAMME Mr IV. Hussey
III.
Representatives of Other Intergovernmental Organizations SOUTH PACIFIC COMMISSION Dr Anne-Laure Bourre
IV.
Representatives of Non-governmental Organizations INTERNATIONAL DENTAL FEDERATION INTERNATIONAL COMMITTEE OF CATHOLIC NURSES INTERNATIONAL COUNCIL OF NURSES INTERNATIONAL PLANNED PARENTHOOD FEDERATION INTERNATIONAL SOCIETY OF RADIOLOGY WORLD VETERINARY ASSOCIATION Brigadier J. Ferris Fuller Miss P. Dudderidge Miss T. Burton Dr R. Black Dr G.D.T. Harper Mr R.C. Watson
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REGIONAL COMMITI'EE:
'IWENI'Y-FOURI'H SESSION
v.
WHO Secretariat
DIRECTOR-GENERAL SECRETARY
Dr H.T. Mahler Dr Francieco J. Dy
Sill4MARY RECORD OF THE THIRD MEETING
91
1
ADDRESS BY 'IRE DIREC'IDR-GENERAL:
Item 3 of the Agenda His statement
Dr MAHLER, Director-General, addressed the meeting. appears in Annex 1. The CHAIRMAN thanked the Director-General given those present much food for thought. He General that the Regional Committee would keep of any problems and expressed the hope that as come to regard this as one of his more forward 2
and said that he had assured the Directorhim fully informed time passes he would looking regions.
ADDRESS BY INCOMING CHAIRMAN: CHAIR~N
Item 6 of the Agenda His statement appears in
The Annex 2.
addressed the meeting.
3
ACKNOWLEDGEMENT BY 'IRE CHAIRMAN OF BRIEF REPOR'TS RECEIVED FROM GOVERNMENTS ON THE PROGRESS OF THEIR HEAL'IH ACTIVITIES: Item 10 of the Agenda
The CHAIRMAN acknowledged reports on the progress of health activities received from the following countries and territories: Australia, French Polynesia, Hong Kong, Japan, Khmer Republic, Macau, Malaysia, New Zealand, Republic of Korea, Portuguese Timor and the Republic of Viet-Nam. A number of reports had been submitted by the Government of Laos but copies were not available for distribution; these were with the WHO Secretariat and would be available to those interested. Dr FRANKLANDS (Australia) referred to the report submitted by Australia and asked that the following corrections be made. On page 1, it was stated that there was a 1.35% levy on taxable incomes for health services and that a matching government subsidy went with it. This was not so; the government subsidy was tied to the 1.35% levy on taxable incomes. On page 3, mention was made of the Australian Government making available $400 000 for the anti-smoking campaign. The amount should be approximately $484 000. The CHAIRMAN said that the changes would be noted. Dr CHEN (China) stated that at the World Health Assembly in May this year the Vice-Minister of Health of his country had explained his Government's programme fully. Therefore no report had been submitted to thii!! session.
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REPORT OF THE REGIONAL DIRECTOR: (Document WPR/Rc24/3)
Item 11 of the Agenda
In introducing the Annual Report. the REGIONAL DIRECTOR said that the strengthening of the basic health services so that these were within
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REGIONAL COMMITTEE:
TWENTY-FOURTH SESSION
the reach of the people living in the most remote areas was a primary objective of the health programme in all developing countries. As resources and technical personnel were limited, there was a need for governments to review existing resources, to assess their needs, to establish priorities and to draw up realistic plans so that WHO resources could be deployed in the proper direction. For this reason. particular attention continued to be given to national health planning. WHO was now trying to develop a health planning methodology which would meet the requirements of developing countries within the Region. A draft of a health planning manual had been prepared and was being tried out in some WHO-assisted projects. Health practice research was another method being employed in some countries to obtain information on the strength or weaknesses of the health services. Attention was also being focused on the management of projects. One of the techniques being developed in this area was project systems analysis. The three project formulation exercises carried out in the Philippines. Singapore and Malaysia in 1971 had been reviewed. Plans were now being made to hold a workshop towards the end of this year to consider how techniques could be simplified and to determine better ways of introducing this method to governments. Studies were in progress to determine whether the project systems analysis concept could be used in planning WHO assistance. He asked representatives if they had any suggestions on the areas in which they considered WHO assistance in this aspect of their health programme could be helpful. Rapid population growth and overpopulation were considered to be the major threats to health for the majority of the people of the developing world. At one time family planning services had been considered an activity outside of the basic health services. Country appraisals had led to the development of more comprehensive projects of a multidisciplinary nature. and the concept of family health interlinking maternal and child health. family planning. nutrition and health education had gained much wider acceptance. In the most developed countries of the Region, where infectious diseases had largely been controlled, much work was being done to combat the "diseases of civilization" that had now gained prominence _ cardiovascular diseases, cancers, obesity and so on. However, the background diseases were also a major problem in the less developed countries of the Western PaCific, even though hidden under superimposed acute illnesses. He referred particularly to the poor nutritional status of many of the children and their mothers in the Region and cited as an example a study carried out in Latin America, where conditions were not too disimilar in which nutritional deficiency was found to be involved as an underlying cause in 57% of child deaths. The Organization hoped to assist governments in building up the nutritional status and resistance of the individual through the broad based approach of family health. Priority areas in the family health programme were the management of pregnancy, including family planning, prOVision of the nutritional requirements for pregnancy, growth and development, and the prevention and management of infectious diseases in the child.
SUMMARY RECORD OF THE THIRD
~rING
Health education was essential if the family health programme was to be successful. A new activity during the period under review had been the production of educational materials for use in family health programmes. These had been developed in cooperation with various experts and agencies interested in famIly planning, community development, education, extension work/communications, and the social and economic aspects of family health. This integrated approach had increased interest in family planning and provided a broader basis for future work. The long-term inter-country programme on health laboratory services, which had been approved by the Committee at its twenty-second session (resolution WPR/RC22.RI9), had gained momentum. Production and control of biologicals were being improved. The material collected by a consultant for the Directory of Medical and Allied Laboratories in countries and territories of the Region had been consolidated and the Directory should be available for distribution next year. A number of countries were now participating in the inter-regional programme of quality control in clinical biochemistry organized by Headquarters with the assistance of the Centre for Disease Control, Atlanta. There was also increasing recognition that health laboratory services must be a component of the general health service. More laboratory support was thus being given to specialized programmes, particularly those related to the surveillance and control of the communicable diseases. In view of the almost universal shortage of trained health professionals, an important part of WHO's programme of assistance was the development of health manpower. A major development during the period under review had been the establishment of the Regional Teacher Training Centre in the University of New South Wales, Sydney. Aspects which merited particular attention included the preparation of staff who would have responsibility for directing and supervising lower level categories, the adaptation of curricula to meet each country's needs, and the training of auxiliary personnel so that they may undertake multipurpose rather than specialized work. An excellent example of how the combined efforts of governments and WHO could lead to success was the progress which had been made in connexion with the training of nurses in Laos. This was one of the projects described on page 73 of the report. for had had use The first edition of the registry of training courses available health personnel in the Western Pacific Region, which the Committee requested at its twenty-second session (resolution WPR/RC22.RlI), been distributed. He hoped that this would result in even wider being made of the training facilities available in the Region.
The Regional Director then referred to the communicable diseases. Although these continued to diminish in many parts of the world they still remained a major cause of mortality and morbidity in many developing countries of the Western Pacific Region. More vigorous and sustained efforts were required to combat them. For example, the re-emergence of cholera in some countries clearly stressed the need for improved sanitation, the provision of a potable water supply, and the construction of sanitary latrines. A well organized surveillance service so that cases could be detected early and effective steps taken to control any outbreaks which should occur was also essential.
91',_ _ _ _ _~RE~G~I::::ON~t>.~L~G:.:::O~MM~IT::.:T!:.!E:::E::..:.:_TW.:..::.:E:::NT:.=...:Y.=-::.:FO;:,:UR~TH;.:.'~SE:::S::.:S:::.;I:.::O:;:N'___ _ _ _ __ Although there had been a remarkable reduction in the mortality rate of tuberculosis in many countries and this had been accompanied by a considerable decline in morbidity, severity and infection rates, this was not, unfortunately, the case everywhere because the new experience and techniques available were not being used. The tuberculosis control programme in the Republic of Korea, described on pages 88-92 of the report, demonstrated the effectiveness of BGG vaccination, case-finding by simple sputum examination, and ambulatory treatment applied on a mass scale. The Regional Director drew attention to the fact that a lO-year programme of WHO assistance in dental health had been initiated during the twelfth session of the Regional Committee, which had also been held in Wellington. This had culminated in the WHO regional workshop on dental health services held in Singapore in May 1972. The IO-year factfinding period had given way to the period of implementation of dental health programmes. Greater emphasis was being placed on the development of preventive programmes in dentistry. At the same time, new thoughts were emerging as far as the inter-country programme was concerned. One of these was the possibility that in the field of clinical research and dental health education of the public, countries might be grouped together according to similar problems, and possibly cultural backgrounds. For example, Hong Kong, Singapore, Malaysia and the Republic of Korea - one group; Tonga, Samoa, Fiji, another group, etc. Dental health educational material, methods and media could be shared by a group of countries and at the same time benefit each country. Research findings, for example in periodontal diseases, in one country might be applicable to the group, and not to that country alone. During the period under review, WHO had provided a broad range of technical assistance in the field of environmental health. The first seminar in the long-term inter-country programme in environmental pollution, approved by the Committee at its twenty-third session (resolution WPRjRc23.R17), had taken place in May 1973. This had promoted a very successful exchange of ideas on air pollution which led to the formulation of a considerable number of conclusions and of suggestions for regional action. The Organization was now studying means for the expansion and acceleration of the long-term programme through the organization of working groups and training courses on special aspects and general high-level review of the position of governments vis-a-vis environmental pollution. In closing, the Regional Director expressed the hope that the Committee would make a detailed review of the report. Its comments would provide him with an indication of whether WHO assistance was being channeled in the right direction. He also requested suggestions as to how some of the problems which he had mentioned, for example, the need to improve project management, the poor nutritional status of children and mothers, and those related to the communicable diseases, could be tackled better. The proposals made during the meeting would assist the Regional Office in planning the inter-country programme which was being used as a tool to stimulate activities throughout the Region as a whole.
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The CHAIRMAN proposed that in accordance with previous custom and with the approval of the Committee, the Report should be reviewed section by section. He then invited representatives for comments. Dr TRUONG-MINH-CAC (Republio of Viet-Nam) referred to the statement made the previous day by the delegation from the People's Republic ot China regarding the Vietnamese delegation. Viet-Ham was engaged in delicate negotiations and this was not the plaoe to make comments which might preJudioe the outoome of those talks. The Government of the Republic of Viet-Ham exercised full authority over South Viet-Ham. Any suggestion to the contrary was inadmissible. Dr Truong-Minh-Cac then thanked the Regional Office for its prompt response to the requests made by his country. Hardly a month after the signature of the cease-fire a WHO delegation had visited Saigon to discuss additional assistance for the post-war period. A oonsultant in rehabilitation had already arrived and other experts were expected. Dr KINO (United States of America) oommended the Regional Direotor on the report. He noted particularly the stress laid on the quality of the overall health programmes in the Region, espeCially as regards management techniques. He agreed that WHO's assistance to countries must have measurable impact. To obtain the full oommitment of oountries in the area WHO's impact must be evident to them. Dr King was particularly pleased to see the emphasis plaoed on family health and health manpower development. Dr SABURI (Japan) congratulated Dr Taylor on his eleotion as Chairman and also the Regional Director on an exoellent report. This provided clear evidence that the Region was making exoeptional progress in its programmes and in its search for solutions to complex health problems in a rapidly changing world. He referred to the activities of the National Institute of Public Health in Saigon and said that the Japanese Ministry of Health strongly supported the work of such institutes and noted the importance whioh WHO attaohed to them. Dr PINHEIRA (Portugal) congratulated the Regional Direotor on the precision and clarity of the Report. The public health programmes in Portuguese Timor and Macao were patterned on the guidelines and principles established by WHO. ' Dr PHOUTTHASAK (Laos) referring to the statement on health manpower development in the Introduotion said that the seoond group of qualified nurses in Laos had Just graduated, so that the country now possessed 27 registered nurses. Dr THIEME (Western Samoa) oommended the Regional Direotor on his comprehensive report. Western Samoa had established the basic system of health servioes but had to ask itself the following questions:
REGIONAL COMMITTEE:
TWENTY-FOURTH SESSION
(a) Is the health programme meeting the basic needs of the people; (b) Is the capacity of the health staff fully utilized; (c) Which are the priority items within the total health programme. His government reoognized the need to develop health information services on the one hand and operational research schemes on the other. In collaboration with WHO, health records and reporting systems had been developed and improved. An analysis had also been made of the work load and activities of health personnel. In turn, this had led to improvements in staffing patterns which had enabled the people to be served better espeCially those in the rural areas. Senior health staff in Western Samoa had also studied the WHO dooument "Organizational Study on Methods of Promoting the Development of Basio Health Services". The principles outlined therein would be used for the long-term development of the oountry's health services. Dr KILGOUR (United Kingdom) congratulated the Regional Director on the quality and clarity of the report. He was particularly interested in the work carried out in the dependent territories of the United Kingdom in the area. The health services in these territories were currently under re-appraisal and his presence at the meeting of the Regional Committee underlined the United Kingdom's resolve to support WHO's programmes in the Region. Dr MAJID (Malaysia) also congratulated the Regional Director on his excellent report. As a result of the WHO-assisted operational researoh study on rural health in Malaysia, a new category of health personnel had evolved, the community nurse who would eventually replace midwives in the midwifery clinios. The oommunity nurse would be a multi-disciplinary person carrying out midwifery work, preventive health servioes, and also minor medioal treatments. A training programme for this new class of nurse had begun with a view to re-training midwives at present working in midwifery clinios. Three new schools for retraining midwives had been established, partly assisted by funds from the World Bank. Dr FRANKLANDS (Australia) said it was evident that every endeavour had been made to carry out the Committee's programmes during the past year, and undoubtedly they would ha~e been expanded but for financial and policy limitations. He was pleased to note that the Regional Training Centre in Sydney would be of benefit to the Region as a whole. Dr SINGH (Fiji) commended the Regional Direotor for his comprehensive survey of developments in the Western Pacific Region during 1972/73. Fiji had already provided the basio struoture for dispensing health oare but the structure needed up-grading. Dr Singh thanked WHO for its help, espeCially in the field of laboratory services.
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Dr ACOSTA (Philippines) congratulated the Chairman on his election to office and the Regional Director on the quality of his report, which was notable for its clarity and preciseness. He then stated how deeply the Philippine Government regretted the closing of the International Malaria Eradication Training Centre in Manila. The only centre now available in the Philippines was the National Malaria Eradication Centre, Manila, eetab1ished in 1967 to meet the training needs of sub-professional staff. In the past the professional personnel of the National Malaria Eradication Centre had been sent to the International Malaria Eradication Centre. With the closure of the International Centre and an increase in staff in the National Centre, the National Centre was now in a position to train professional as well as sub-professional staff. It was also now able to receive trainees from other countries in the Region. The curriculum for the courses was based on the "Handbook on Malaria Training" issued by ~mo in 1966. It was planned to offer the following formal courses: Basic Course for Microscopists, 8 weeks, June-July 1973; Senior Course for Professional Staff, 12 weeks, July-September 1973; Combined Course in Epidemiology, Entomology and Parasitology, 10 weeks, October-December 1973; Malariology for Public Health Officers, 6 weeks, January-February 1974; Integrated Public Health Course for Sub-professional Staff and General Health Services, 8 weeks, April-May 1974 • Dr 'IHIEME (Western Samoa) stated that with the assistance of WHO and UNICEF, Western Samoa had completed two mass medication programmes against filariasis, in 1965 and again in 1971. As a result, the microfilaria carrier rate among the general population had decreased from 19.4% in 1965 to less than 0.2% in 1972. The density of micro-filaria in the blood of carriers had also been reduced to a low level. Thanks should be expressed to WHO and UNICEF for assistance in this programme but credit should also be given to Western Samoa's own health workers, particularly those at the most basic level, also volunteer workers in the field. It was obvious that the battle against filariasis could not be rega.rded as won. He hoped, however, that the right answer would be found in the not too distant future. The Western Samoa Government was ready to cooperate with WHO to the full in finding the correct solution to this problem as this would benefit all afflicted countries. Dr RHEE (Republic of Korea) congratulated the Chairman, the ViceChairman and Rapporteurs on their election. After complimenting the Regional Director on his Annual Report, Dr Rhee stated that his country had remained free from some of the quarantinable diseases, such as smallpox, for many years and the incidence of diseases like tuberculosis and parasitosis was falling. He considered it an honour to find a report on the Korean National Tuberculosis Programme included in the Annual Report (page 88). The Korean population growth rate had fallen from 2.7% in 1961 to 1.9% in 1971 and the goal for 1976 was 1.5%.
REGIONAL COMMITTEE:
TWENTY-FOURTH SESSION
Dr SINGH (Fiji) referred to the problem of malnutrition in island communities. This was a topic of particular interest and he hoped WHO would continue to support investigations in this field. Dr VISOUTHIPHONG (Laos) referred to the summaries of selected projects, in particular that relating to the nursing education programme in Laos. The training of auxiliary nurses and auxiliary midwives in Laos had now been integrated. There being no further comments, the CHAIRMAN thanked the Region~l Director for his Report and said that the few questions asked demonstrated its completeness. He then invited the Rapporteurs to prepare a draft resolution for consideration by the Committee at its next meeting. (For consideration of draft resolution, see the fifth meeting, section 2.1.) 5 RESOLUTIONS OF REGIONAL INTERE.'3T ADOPTED BY THE TWENTY-SIJITH WORLD HEALTH ASSEMBLY: Item 12 of the Agenda (Document WPR/RC24/4 ) Twenty-fifth Anniversary of the World Health Organization (resolution WHA26.3)
5.1
5.2 Smallpox Eradication Programme (resolution WHA26.29) The REGIONAL DIRECTOR drew attention to operative paragraphs one and three. 5.3 Or anizational Study on Methods of Promoting the Davelo ment of Basic Health Services (resolution WHA2 .35) The Committee noted the above resolutions without comment. 5.4 Coordination within the United Nations System: General Matters (resolution WHA26.49)
The REGIONAL DIRECTOR drew attention to the fact that the World Health Assembly resolution cited resolution 2975 XXVII of the United Nations General Assembly. Both this resolution and that of the World Health Assembly placed emphasis on country programming, project implementation, and the essential participation of countries in improving delivery capacity. As noted by the Committee on a number of occasions there had been a continuing decrease in the funds allocated by UNDP. It was, therefore, important to ensure that the proposals made by the a",lthori ties found a place in the overall country programme and that projects once approved would be implemented expeditiously. The Director-General had been requested to present periodically to the Executive Board reviews on activities assisted by UNDP and on r
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the partioipation of the Organization in the planning and implementation of oountry programmes. It was hoped that governments would keep the UNDP and WHO, as executing agency of health projects, fully informed of the progress being made in implementing approved projects. WHO was prepared to help the health authorities in whatever way it could in the form1llation of programmes and projects of high quality for possible UNDP financing. Dr RHEE (Republic of Korea) expressed his appreciation of the assistance provided by the UNDP to Korea. Through this programme and the advice of WHO his Government had developed many important programmes, including a maternity-centred family planning project and seminars on family health with UNFPA assistance, and toxicological expertise on pesticides in consultation with FAO. An air pollution programme was planned. This year with UNFPA funds it was planned to improve the national family planning programme, which should also improve the general public health of the people of Korea. 5.5 Drug Dependence (resolution WHA26.5 2 ) Dr MAJID (Malaysia) expressed concern over the increasing drug abuse among youths. His Government planned to attack this problem before it became uncontrollable. In the late 1960's authorities had become aware of the increasing use of morphine, heroin and dangerous sedatives, with an increase in trafficking in marijuana. A Central Narcotics Bureau had been established and amendments made to the Dangerous Drugs Ordinance. Attention was being focussed on the problems of drug abuse and some control achieved by treatment on a voluntary basis. Malaysia would participate in the pilot survey to determine the extent of the problem of drug abuse and its wider implioations. The extent of the problem was not known but some interesting features had been unoovered, providing a useful analysis of the types of dependenoe. The majority of persons surveyed had been found to be addicted to heroin and morphine, opium was oonfined to the older age groups and addiction to other dangerous drugs was in the 16-35 age grrup. Several agenCies were planning programmes for the rehabilitation of addiots in prison and in hospital but resource personnel were few. There Gould be no success without assistance for the addiot. A mutual exchange of assistanoe and expertise was essential. 5.6 Committee on International Surveillanoe of Communicable Disease (resolution WHA26.54)
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Dr KILGOUR (United Kingdom) expressed his Government's pleasure with this resolution, whioh had resulted in the removal of an irrational requirement regarding cholera. The proteotion of travellers from exposure to contaminated food and water was of special interest.
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5.7
Additional Regulations of 23 May 1973 Amending the International Health Regulations (1969) in particular with respect to Articles 1, 21, 63-71, and 92 (resolution WHA26.55)
Dr OKAMOTO (Japan) said that his Government had accepted these new additional regulations without reservation. When the El Tor vibrio infection began to spread outside of Indonesia in 1959, the Japanese Government had supported the proposal of the Fifteenth World Health Assembly that this should be considered as a cholera infection. It had applied rather strict cholera quarantine oontrol prooedures, including stool examination, to olarify many of the aspeots of this disease. The joint JapanjPhilippines/WHO Cholera El Tor Study and the Cholera Working Group under the Japan/Vnited States of Amerioa Cooperative Medical Science Program had, at the same time, started studies. As a result of the experience obtained by these groups, his Government had decided that many aspects suoh as the role of the oarrier, the progress of treatment, the viability of cholera vibrio in food in cargos, the role of environmental sanitation, etc., need no longer be feared as in the past. It had also been proved that there was little value in cholera vaccination. The relaxation of the provisions in the International Health Regulations regarding cholera meant the abolition of unnecessary quarantine procedures whioh had been imposed on travellers from abroad. 5.8 Urgent Need for Suspension of Testing of Nuclear Weapons (resolution WHA26.57) Dr FRANKLANDS (Australia) stated that his country was one of the 18 co-sponsors of this resolution. Australia was opposed to any act that would detract from the quality of the environment. Dr HIDDLESTONE (New Zealand) supported the statement of the Australian representative. Dr LAIGRET (France) said that his oountry had voted against this resolution at the Twenty-sixth World Health Assembly. Detailed explanations had been given at that time and there was no need for further oomment since Franoe's position had not changed. Dr Laigret said that in his oapacity as Direotor of Health in Frenoh Polynesia, he was in a good position to oomment on the experiments being oonducted in the area. The health personnel in French Polynesia oonsisted of approximately 800 persons, including some 50 government medical officers and some 20 private practitioners. Nothing in their reports suggested that the experiments had had any effect on the health of the people. 5.9 WHO's Human Health and Environment Programme (resolution WHA26.58) The Committee noted the above resolution without oomment.
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5.10
Development of Environmental Manpower (resolution WHA26.59)
Dr THIEME (Western Samoa) said that as Western Samoa was an agrioultural country with only small-scale industries, their environmental health problems were mainly concerned with the lack of sanitation facilities, a safe water supply and trained sanitation workers. With the support of WHO, assistant health inspectors were now being trained locally and with the provision of WHO fellowships to train health inspectors overseas, the environmental health programme would continue to develop. Dr HIDDLESTONE (New Zealand) stated that his Government was continuing to expand the teaohing of health scienoes within training programmes for environmental manpower. For example, a post-graduate diploma course for public health engineers had been initiated. The trai~ing of health inspectors was being reviewed and would be extended to two years. Priority would be given to using trained manpower to best advantage within this field. There being no further comments, the CHAIRMAN asked the Rapporteur"! to prp.pare appropriate resolutions. (For consideration of draft resolutions, see the fifth meeting, sections 2.2 and 2.3.)
The meeting rose at 11.55 a.m.
Su}'IMAFY RECORD OF THE THIRD MEET ING
·\NNEX 1 ADDRESS BY THE DIRECTOR-GENERAL I take this opportunity to abuse the privilege of the Director-General to express a few of his reflections about the state of affairs of the organization as he may see it. I hope you will realize that I only look at the organization from a very few weeks of experience. Nevertheless I will try to express myself on a few points which I think are of some concern to the organization in the future. When I try to sense the historical forces at play in internationalism, it seems somewhat as though the strong post-war idealism gradually waned and led into the first United Nations Develop~ent Decade, which in turn led, rightly or wrongly, to disappointment and to a dangerous low point of cynicism, despair and defeatism. However, I now sense a beginning of a general awareness in all of us as if we were in the same global space-ship and that if we are to prevent mutiny we must muster the conscience and will it takes to tackle the social indecencies prevailing on board. There are hopeful signs, on one hand, that the most disfavoured of our space-ship start realizing that self-reliance is the indispensable physical and moral quality to better their own lot and, on the other hand, also that the most favoured on board equally realizing that paternalism carries the seed within it of ultimate self-destruction. This is perhaps a somewhat naive synthesis, but I am convinced that it is highly significant for you to make up your minds as to what kind of moral climate your organization is likely to find itself in over the next 10 to 20 years. If there is no such positive moral climate you should tell your Director-General because in that case he should not be searching, through you, for new visions of the Organization's destiny but rather be content with plodding along the road of pragmatism in a socially irrational world. Today I do not intend to express my opinion on any particular of WHO's well-known programme priorities, but rather to raise two broad issues that I personally believe have considerable bearing on WHO's future mission. They are : firstly, the problem of co-ordination and secondly, the problem of relationship between central technical services and direct assistance to countries. There is still a very long time to go before WHO becomes the international health conscience that the Constitution so clearly envisages. But one important technique for moving in this direction is, in my opinion, coordination. Now, I believe that this word, which implies, according to ~ Oxford dictionary "bringing parts into proper relationship" has gradually lost much of its punch through overand misuse. It is my personal opinion that the aggressive methodological development of coordination techniques will be one of the primary tasks for WHO in the seventies. Clearly WHO has in several fields a very creditable record of such coordination, but I am sure it has mostly been in areas without strong national positions, such as in a number of communicable diseases. When it comes to such major
, y'
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REGIONAL COMMITI'EE:
TWENTY-FOURTH SESSION
areas of coordination as, for instance, "comparable indices of health status", "health manpower development", "health services development", "the development and standardization of medical technology for the major problems such as mental diseases, cardiovascular diseases and cancer", then we have barely started to put down our feet on these thorny roads. Prophesying is at best a risky affair, and as somebody said, particularly about the future, but gazing into the crystal ball of WHO's destiny, I am convinced that a vigorous emphasis on coordination in the best sense of the word is likely to remove many present doubts as to WHO's future mission and thereby progressively weld together a dynamic consensus support for this mission from all the Organization's Members. There is, in my op1n10n, no doubt that such a concept of coordination will require a very high degree of confidence in the Organization from developed and developing countries alike. As an example of what I think is demanded from the developed countries, I believe they would have to establish national WHO coordinating units with a high level of technical competence in order both to mobilize national resources for WHO-coordinated studies as well as to ensure implementation of consensus decisions reached by WHO's governing bodies. As long as the majority of developed countries are not really prepared to let WHO get under their national skins, I do not think international health coordination will receive that moral tour de force without which it will remain a passive game. I believe I here should emphasize that when using the word WHO I do not mean its constantly changing secretariat, but the constitutional instrument in its holistic sense. As an example of what is demanded from the developing countries, I believe they might even go so far as to legalize the acceptance of WHO as the only international body responsible for assisting them with the coordination of all external inputs tofue health sector. There is a considerable amount of lip service paid to this principle, but I am afraid that the practice of it leaves much to be desired. If such changes in attitudes progressively should be forthcoming from Member States, I am sure that your OrganiZation will condition its reflexes to respond adequately to the challenge. The beneficial consequences deriving from such a coordination approach would be many indeed, but I shall only single out a few that I consider are particularly important : namely a greater sense of participation in, and particularly responsibility for, the Organization's programme by all Member States; secondly an improved short-, medium- and long-term planning of WHO's programme through a meaningful relationship betweenfue general programme of work covering a specific period and the aggregation of individual country programmes; third a much better identification of priorities for concentration of WHO efforts, leading to a reduction in the present detrimental inconsistencies in Member States' attitudes towards WHO's programme priorities; fourth a vast acceleration in promoting scientific progress in health technology and in making all Member States benefit from it; fifth increased possibilities for mobilizing additional resources beyond WHO's regular budget for the health care sector in developing countries; and lastly a much increased managerial efficiency deriving from WHO's own structure from Headquarters through Regional Offices to country levels and vice versa.
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I am aware that all this is a long-term and complex process, but it is in my opinion important for all Member States to realize that if this is what they expect from the Organization then not only small homeopathic adjustments in present attitudes but radical departures from these will have to be generated in each country. We need much more work done at national level in order to generate the new ideas required from concept to implementation if we are to move in this direction. This also requires a deep mutual trust between Member States with a broad based dynamic consensus as to whither WHO should go in the seventies and eighties. And if you wish to move the Organization along this uneven road, I plead with you to pay heed to the experience from child psychology, namely that indifference and punishment retard the child's potential growth. In consequence you should ensure that your Director-General and his colleagues, to whom you have entrusted the responsibility of executing your ideas, do not, in such an important transitional period, become self-defensive with all its negative consequences in regard to ultra resistance to creativity and change. I have first touched upon coordination because it leads me straight into the problem of the Executive Board's next organizational study, "The interrelationships between the central technical services of WHO and programmes of direct assistance to Member states". Permit me first of all to say that I do believe the Board must assume an increasing responsibility for the Organization's programme and work. It is therefore of critical importance that the DirectorGeneral constantly improve the relevance of documentation provided to the Board and that its members, on the other hand, are increasingly prepared to share the collective decision-making process within the Board's constitutional mandate. I underline share and collective, because if the Board's deliberations degenerate into a series of monologues, then they will hardly be of much use to the Organization. As a digression on this theme, Regional Committees might perhaps be better used than in the past for preliminary discussions of important items coming up in the following World Health Assembly. As a minimum this would serve to draw attention of Members to items requiring much more home-work than in the past before they arrive at the Assembly. Such an Assembly item will certainly be the Board's next organizational study. I shall now return to the substance of the Board's organizational study and why I consider it of extreme importance in connexion with the above concept of coordination. You are certainly aware that in the so-called UNDP Jackson report the central technical services were singled out as the "natural role" for the specialized agencies, whereas considerable doubt was expressed as to either the appropriateness or the competence of these agencies in regard to direct country assistance. You are equally aware of the fact that this view is more or less shared by a not inconsiderable number of governmental authorities in developed and developing countries alike. Now, WHO's Constitution makes both central technical services and direct country assistance integral parts of the Organization's life. What is more, successive Boards and Assemblies have emphasized over and over again the need for a planned inter-dependence between these two aspects of WHO's work. If we are to preserve this inter-dependence, which in my opinion makes WHO much more than a cool technocracy and rather what I will call a warm social technocracy, then you will have
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TWENl'Y-FOURTH SESSION
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to make sure that this inter-dependence finds its dynamic expression in words and particularly in deeds. I would permit myself to put forward for your reflection a few minimum requirements for keeping the Organization's programme as one integral whole: and the first one I would think aloud is that direct country assistance unequivocally reflects and interacts with the Health Assembly's priority setting. A danger exists in my op~n~on in two tendencies, one being that of considering the broad, non-quantified priorities laid down in the general programme of work covering a specific period as a carte blanche for any conceivable assistance activity; the other tendency being that of considering the individual countries' wishes as to types of assistance as the supreme guide for the Organization, Many real arguments can certainly be brought forward in support of both attitudes. But I am of the firm personal opinion that, unless we can develop programming and evaluation techniques whereby we do bring the two processes of central and peripheral priority setting into explicit relationships, the Organization may well degenerate into serving in a purely managerial role in country assistance. I have used the word "degenerate" deliberately, because it is my conviction that the Organization, as THE international health agency, potentially has much more to offer than management only. As I have said earlier, the emphasis on WHO's coordinating role at the country level could substantially contribute to bringing the two priority setting processes together, and I believe that the practical entry into this country coordination is through the methodology of country programming. By country programming I understand the systematic assessment of health problems and the socioeconomic context in which they exist, aimed at identifying areas susceptible to change. In addition, it should be an attempt to ascertain the resources required to induce and sustain such Changes in health problems and health services and to identify those which might effectively be provided by external resources. I would therefore plead with all Member States interested in receiving external support for their health sectors that they give almost dramatic emphasis to developing a country programming capacity and that they let WHO play a significant partnership role in this development. Now a second requirement I think is important is that direct country assistance has significande in national develop-ental terms. In my personal opinion this implies that such assistance has measurable impact on the priority areas specified in the general programme of work covering a specific period. The emphasis here is on "measurable" and "impact" because there is perhaps a slight tendency for WHO's direct country assistance to be more in the nature of palliative homeopathy than preventive and curative therapy of health problems. If this is true, it could be dangerous for the Organization in that we would not get the full feed-back on our performance in these priority areas and we could easily be lulled into a confusing complacency.
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Because WHO's resources are as limited as they are I think it is important to select projects for WHO support where 1) the government is aggressively resolved to make a success offue project; furthermore that the national staff are competent, motivated and able to succeed; more, that the project will promote self-sustaining growth; and finally that WHO can provide the essential technical know-how. Now the implementation of all this in turn hinges upon governments' willingness, yes, wish to make I'IHO a vigorous partner for coordinating external resources. It is my deep conviction that, should this concept of coordination gradually become a reality, then the Organization could become instrumental in mobilizing far greater resources for national developmental projects than could ever become available from its regular budget. Meantime it is particularly important that the regular budget is being used in a way to build up the confidence in the Organization both in developed as well as in developing countries. The last requirement I feel is important is that direct country assistance exploits to the full the knowledge and resources available throughout the Organization. As I have already said earlier, it is of the utmost importance to managerial efficiency that Member States treat the Organization's structure as one indivisible, mutually supporting entity from Headquarters through Regional Offices to the countries and vice versa. Any undue emphasis on hierarchkal structural barriers within this entity will lead to waste and fractionation. I believe the Regional Committees have a broad responsibility in ensuring that WHO is not seen in a fragmented light because otherwise I am afraid the Organization might tend to fall apart into a network of disjointed bureaucracies. Mr Chairman, I would like to emphasize that the above reflections constitute my present, personal vision of your organization, and that it is quite possible that discussion in the forthcoming Boards and Assemblies may radically modify this vision. My purpose in expressing these thoughts to the Regional Committee today is certainly not to prejudice your thinking : it is solely to promote your deeper reflection before you go to debate these two important issues at forthcoming World Health Assemblies. Thank you Mr Chairman.
SUMMARY RECORD OF TnE -;'ET:',fj iltEETING
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ANNEX 2
ADDRESS BY INCOMING CHAIRMA.l\J
I am very conscious of both the honour and responsibility that you have bestowed upon me by electing me as Chairman for this twenty-fourth session of the Regional Committee. Particularly as this is a special occasion in that we are celebrating the Twenty-fifth Anniversary of the Forld Health Organization. An addi tional satisfaction for me is that my first experience of this Regional Committee was in this hall in 1961 when I was a member of the panel of speakers in the Technical Discussions. The topic was dental health and the Q1airman was Colonel Ferris Fuller now Brigadier Ferris Fuller who is also at this session representing the International Dental Federation. Those of you who know me will not be surprised to know that my contribution was concerned with health education. The Department of Health here, and I know the New Zealand Government, are both proud of the work done by our dental division. Our system of using dental auxiliaries - or dental nurses as we call them here - to supplement the dental profession, has spread throughout the world, including a number of the countries represented here today. With assistance from Colombo Plan, Special Commonwealth Aid to Africa Plan, and WHO, we have assisted 21 countries either by providing training here in New Zealand, or by seconding dental nurses to work in those countries. We have also provided dental officers as conSUltants. This year, in response to a request from Australia, the Department of Health has undertaken to give basic school dental nurse training to 100 Australian stUdents. Twenty-six commenced study in March of this year and a further 30 are due next week. The objective is to give an impetus to the development of a National School Dental Service in Australia. Also, three senior school dental nurses have left to take up teaching appointments in a new programme for schoolchildren in Saskatchewan, Canada. Our dental service began about 50 years ago and T mention it today partly because of the association with this hall that I have just mentioned and also because it spread to other countries at about the time WHO was getting started twenty-five years ago. Our health education people have set up a display for you here in the Main Building in the Main Hall and I hope you will all find time to see it. They have also provided you with supporting material about health education activities. In this you will note that our first health education officers were appointed in 1948, the same year that the Constitution of WHO was adopted. So that is another twenty-fifth anniversary.
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T\>JENTY-FOURI'H SESSION
The Department of Health in New Zealand has run a course in health ed'.lcation for some years now - since 1,?59. It is one academic year and successful students receive a diploma from the Royal Society of Heal~h jn England. To date it has been mainly a course to train our own health education officers but over recent years we have had students from overseas. Unfortunately, this has been li~ited by physical lack of space but the position has now changed. Just last week we were advised that an educational institution, the Central Institute of Technolo~y at Lower Hutt, has agreed to take over the course. They would, I know, be pleased to have overseas students 'lIld I hope that this will be of interest to some of you. The course will continue to cover one academic year for the Royal Society of Health Diploma and we are hopeful that it will st,art next March and there will probably be a certificate from the course. Also 25 years ago the final arrangements were being made to establish a National Health Statistics Centre in the Department of Health. Previously, New Zealand's health statistics were compiled in the Vital Statistics Section of the Department of Statistics, and consisted of two ongoing collection schemes - one for mortality statistics and one for publlc hospital in-patient morbidity statistics. The following years have witnessed a considerable and sustained growth in the range of statistical activities undertaken by the Centre. ",rational collection schemes now also cover perinatal mortality and private hospital in-patient morbidity. National registries for cancer, for psychiatric patients and for blindness are well established, while developmental work on drug dependency and congenital malformations registries is well advanced. There has also been significant development in the statistical coverage given to the fields of environmental health and health manpower resources. The importance of reliable health statistics to the development of sound basic health services needs no emphasis, and as the work of our National Health Statistics Centre has become more widely known, i~ has been invited to play an increasing role in international activities, particularly in those programmes initiated by WHO. Projects at present being undertaken with WHO include the training of people from the Western Pacific Region in health statistics and medical records procedures, the participation in the statistical study of social and biological factors in perinatal mortality and the development of an international perinatal certificate of causes of death. I am very pleased that Dr Harold Turbott was mentioned by Dr Mahler at the opening ceremony. A previous Director-General of Health, he will be joining us from time to time during this meeting. Dr Turbott can be said to have brought New Zealand to WHO and WHO to New Zealand. In addition to his practical contributions to the work of the Regional Committee Meetings and Assemblies, he was elected to the Executive Board in 1952 and again in 1963. In 1960 he became President of the World Health Assembly, the only New Zealander to be so honoured.
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In conclusion, may I on behalf of all of you, reiterate th@ ','''!lcnm o we give to the delegation from the People's Republic of China. We look forward to working with them. As successive reports from the Regional Director have shown, we have made steady progress over the past 25 years in improving the health of the Region, but there is still plenty to be done. In the first instance, it is the responsibility of member gov'emments to take the initiative. WHO can only asstst when asked, hut giv"!n the opportunity to help they have valuable expertise and experience, that th~y can bring to bear. Unfortunately, their resources are, of necessi ty, limited, but wi thin these resources - to quote from the Regional Director's Report: "WHO stands ready to help in whate""!r W'iY it can, so that by our combined efforts health services can be brought nearer to all people of this region." I am confident that the deliberations of this twenty-fourth session of the Regional Committee will make further progress towards this objective.
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