(WPR/RC32/SR/7)
SUMMARY RECORD OF THE SEVENTH MEETING Hotel Shi11a, Seoul Friday, 25 September 1981 at 9.00 a.m. CHAIRMAN: Dr da Paz (Portugal)
CONTENTS
1.
Consideration of draft resolutions Action programme on essential drugs
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2.
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132 133 136
3.
Selection of topic for the Technical Presentation during the thirty-third session of the Regional Committee •••••••••• Time and place of the thirty-third and thirty-fourth sessions of the Regional Conunittee ....................................
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REGIONAL COMMITTEE:
THIRTY-SECOND SESSION
1.
CONSIDERATION OF DRAFT RESOLUTIONS The Committee considered the following draft resolutions:
1.1
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Dr HINNERS (United States of America) said that his delegation would abstain on the recommendation contained in the resolution. Decision: The draft resolution was adopted (see resolution WPR/RC32.R7).
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1.2 Dr TAPA (Tonga) drew attention to a typing error in the second line of the third preambular paragraph, where "1979-1983" should read "1978-1983". Decision: The draft resolution, as corrected, was adopted (see resolution WPR/RC32.R8).
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1.3
the General Pro ramme of Work 9
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Dr TAPA (Tonga) recalled that operative paragraph 2 had arisen out of a suggestion contained in a specific document. He requested that a reference to that document should be included in the draft resolution. Decision: The draft resolution, as amended, was adopted (see resolution WPR/RC32.R9). 1.4 Provisional a end a of the sixt -ninth session of the Executive Board Document WPR/RC32/Conf. Paper No. 10) Decision: The draft resolution was adopted without comment (see resolution WPR/RC32.R10). 1.5 Infant and young child feeding (Docum~nt
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WPR/RC32/Conf. Paper No. 11)
Dr SHINOZAKI (Japan) proposed that operative paragraph 2(3) should be deleted because its content was already covered by the terms of resolution WHA34.22. Dr HINNERS (United States of America), commenting on the third preambular paragraph, said that he still experienced difficulty with the word "requi red", in view of operative paragraph 1 of resolution WHA34. 22, which referred to the adoption of the resolution in the sense of article 23. He therefore requested that the word "requi red" should be replaced by the word "requested".
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.... Dr HAN (Director, Programme Management) suggested that, if the Committee accepted the Japanese proposal, the tenn "Code" on the fourth line of the third preambular paragraph should be given its full title. Decision: The draft resolution, as amended, was adopted. (see resolution WPR/RC32.Rll). I i
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1.6
Resolutions of regional interest adopted by the Thirty-fourth World Health Assembly (Document WPR/RC32/Conf. Paper No. 12) Decision: The draft resolution was adopted without comment (see resolution WPR/RC32.R12).
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The WHO fellowship programme
(Document WPR/RC32/Conf. Paper No. 13)
Decision: The draft resolution was adopted without comment (see resolution WPR/RC32.R13) •
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1.8
Development of health research
(Document WPR/RC32/Conf. Paper No. 14)
Decision: The draft resolution was adopted without comment (see resolution WPR/RC32.R14). 1.9 Care of the elderly (Document WPR/RC32/Conf. Paper No. 15)
Decision: The draft resolution was adopted without comment (see resolution WPR/RC32.RlS). 1.10 Regional policies in BCG vaccination (Document WPR/RC32/Conf. Paper No. 16) the previous the negative proposed that resolution.
Dr ACOSTA (Philippines) recalled that, in the discussion day, it had been recommended that steps be taken to counteract effects produced by publication of the south Indian study. He some kind of statement to that effect be included in the draft
The REGIONAL DIRECTOR said that if the representative of the Philippines had a specific amendment to propose, the secretariat would have no objection. However, he himself would suggest that the resolution be left unchanged, and the Public Infonnation officer be asked to prepare a press release covering the point. Dr ACOSTA (Philippines) said that, following the Regional Director's suggestion, he would withdraw his proposal. Decision: The draft resolution was adopted (see resolution WPR/RC32.R16).
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REGIONAL COMMITTEE:
THIRTY-SECOND SESSION
2.
ACTION PROGRAMME ON ESSENTIAL DRUGS: (Document WPR/RC32/l6)
Item 21 of the Agenda
The REGIONAL DIRECTOR said that the Action Programme on Essential Drugs had been developed 8S a result of resolutions adopted by the World Health Assembly, aimed at providing solutions to the drug procurement and distribution, as well as the quality control, problems of developing countries. At an interregional working group, held in New Delhi in December 1980, a global strategy had been proposed. During the course of 1981, the strategy had been reviewed within WHO and a draft plan of action prepared, which would be submitted to the Executive Board in January 1982. Document WPR/RC32/l6 provided some information on the present situation in the Region and the action taken. Dr DONG-MO RHIE (Republic of Korea) said he was fully aware of the importance of the action programme on essential drugs, and felt the approaches outlined in pages 5-7 of document WPR/RC32/l6 were timely and appropriate. The Republic of Korea had 270 pharmaceutical manufacturers who could produce and supply essential drugs, and it was prepared to help other countries of the Region in that regard. Dr HIDDLESTONE (Chairman, Executive Board) said that an Executive Board working group had been studying the question of the Action Programme on Essential Drugs. The most serious difficulty facing the development of the programme was highlighted in paragraph 2.1 of the document, namely that although most Member States now acknowledged the importance of formulating national drug policies, few had as yet actually done so. Over the three years since the matter had first been raised, the feelings of acrimony between Member States and the major drug companies had undergone a remarkable transformation; a great deal of misunderstanding had been removed, and much cooperation achieved. Many large drug manufacturers were now prepared to assist countries which, for economic reasons, needed help, but it was difficult to establish from the countries concerned what their actual needs were. National drug policies were thus essential if progress was to be made with the programme. Dr TAPA (Tonga) said there were a number of references in the document to the South Pacific area, and notably to the South Pacific Pharmaceutical Service (SPPS). He urged that efforts to establish the Service should be boosted so that the problems facing countries of the area in regard to drug supplies could be solved. Dr NICHOLSON (United Kingdom of Great Britain and Northern Ireland) asked what was the present position regarding the development of a sub-regional store. The REGIONAL DIRECTOR said that while relations between WHO and the pharmaceutical industry were greatly improved, some difficulties still existed. There were also problems in regard to intercountry cooperation. It was up to health officials in individual countries to press for that cooperation, so that a dialogue could be opened with suppliers for the
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SUMMARY RECORD OF THE SEVENTH MEETING
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obtaining of essential drugs for primary as well as basic health care. One reason for delay in implementation of the South Pacific Pharmaceutical Service might be political conflicts; if one country could not secure political commitment, the whole system would collapse. However, although progress was slow, advances were being made. Dr MORIOKA (Scientist, Pharmaceuticals and Drug Policy), outlining developments regarding the South Pacific Pharmaceutical Se.rvice, said that, since the last meeting of Health Ministers in Manila in 1979, a consultant had been sent to look into the financial implications of setting up a headquarters and central warehouse for the Service, as well as to examine suitable locations. A legal expert had also been sent to assess the legal position in each country, and he himself had visited several countries to check on technical conditions of storage. Recently, a draft memorandum of agreement had been prepared, copies of which had been sent to governments for their comments. A further mission was planned in October-November. It was hoped that the meeting to inaugurate the South Pacific Pharmaceutical Service would be before the end of February 1982. There being no further comments, the CHAIRMAN asked the Rapporteurs to prepare a draft resolution. (For consideration of the draft resolution, see the eighth meeting, section 2.1). . 3.
SELECTION OF TOPIC FOR THE TECHNICAL PRESENTATION DURING THE THIRTY-THIRD SESSION OF THE REGIONAL COMMITTEE: Item 23 of the Agenda (Document WPR/RC32/l7)
The CHAIRMAN explained that document WPR/RC32/17 contained suggestions by the secretariat but representatives might wish to suggest other topics for the Technical Presentation during the thirty-third session. Dr HOWELLS (Australia) wondered wheth~r the Technical Presentation was necessary at all. Although there had, in the past, been technical discussions, which were interesting to a limited number of representatives, he did not think a technical presentation was of any relevance to sessions of the Regional Committee; it was certainly of no interest to the larger countries. Dr CHRISTMAS (New Zealand) supported that view. In the past, technical presentations which were relevant to programmes of regional interest had been useful in helping representatives to prepare their thoughts for the next session (notably one on acute respiratory diseases). But he had increasingly come to feel that in the interests of economy and efficiency, the same information would be better obtained by reading WHO' technical publications such as the reports of the Expert Committees. Th~ CHAIRMAN, speaking as the representative of Portugal, concurred with the representatives of Australia and New Zealand.
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REGIONAL COMMITTEE:
THIRTY-SECOND SESSION
Dr RIDINGS (Samoa) also favoured discontinuing the technical presentation, to save time and money. The sessions could then be finished by the Friday and participants would not have to remain over the weekend. Dr HOWELLS (Australia) said that the representative of Samoa had broadened the discussion to a subject he had proposed to bring up under agenda item 24. His country had raised the question of the timing and duration of the Committee's sessions in the past, just as it had pressed for biennial health assemblies. The decision to limit the Health Assembly to two weeks in 1982 should result in more efficient work. Money should be spent on field programmes, with a minimum devoted to meetings. The costs of the Committee's sessions were enormous, whether paid by the host country or WHO. The 41 members of the Committee Secretariat in Seoul, for example, represented a huge expense for travel and per diem, and the daily cost of interpretation was very high. He found the Technical Presentation unnecessary. The Committee, working at a reasonable pace, could surely discuss its present agenda in three days, or four at the most. He therefore proposed that, for future sessions, representatives should arrive at the weekend at their convenience, and that the session should begin on Monday and end on Wednesday, or Thursday if necessary. The Technical Presentation, if still thought useful, could be held next day so that representatives who so wished could leave. He did not agree that the session needed to span a weekend to enable the report to be prepared and adopted. The draft report could be forwarded to the countries for appoval, with the added advantage that it could be considered at leisure. Dr TAPA (Tonga) disagreed with the previous speakers. The item under discussion was the selection of a topic for the 1982 Technical Presentation, not its abolition. He personally found the Presentations valuable, and he suggested that the Committee should proceed according to the agenda. An additional item might be placed on the next session's agenda, when representatives could come prepared to discuss whether Technical Presp-ntations should continue. Dr SHINOZAKI (Japan) supported the repTesentative of Tonga's statement. The Committee might be given an opportunity to discuss discontinuing the Presentations, but not at the present session. The REGIONAL DIRECTOR said that from a strict procedural point of view the representatives of Tonga and Japan were right: the Committee had adopted its agenda, and no proposal had been made for an additional item. The usefulness of the Technical Presentation, and of the Technical Discussions during the Health Assembly, had been discussed for years in different bodies in conjunction with the question of duration of sessions. At its previous session the Committee had adopted resolution WPR/RC3l.R29, in which it had decided that the 1981 session would run from the Tuesday to the following Monday, but that the 1982 session, held in Manila, should run from Monday to Friday, or Saturday if necessary. 1
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SUMMARY RECORD OF THE SEVENTH MEETING
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As pointed out in document WPR/RC32/17, in the interest of better correlation of the work of the governing bodies, the Committee might con.ider selecting a subject for the Technical Presentation that would prepare the ground for the subsequent Health Assembly's Technical Discussions. Neither the Technical Presentation nor the Technical Discussions were integral parts of the sessions, so that participants could express their personal views without the constraint of a government mandate. While the Committee had changed the title from "Technical Discussions" to "Technical Presentation", there was a tendency to return to a discussion form of procedure. He noted that, in keeping with the decision to shorten the 1982 Health Assembly to two weeks, the Technical Discussions would also be shortened and held only on the first Saturday • Should the Committee wish to express a formal opinion on the usefulness or otherwise of Technical Presentations, an agenda item and a resolution would be needed. Dr HOWELLS (Australia) doubted if his comments were out of order. Representatives were invited in document WPR/RC32/17 to suggest other.topics for discussion: he was suggesting the Committee should discuss nothing. Mr KAKAR (Director, Support Programme) said that the sending of summary records to countries for approval after the Regional Committee session would create administrative difficulties; in the budget year there was little enough time to prepare the report to the Programme Committee of the Executive Board, which met in November. Furthermore, for the preparation of the report of the session it was convenient to be able to iron out difficulties before representatives returned to their countries. Dr HOWELLS (Australia) said he saw no reason why the item could not be placed high on the Regional Committee's discussion on th first day of the session, allowing ample preparation of records thereon. The report could then be after the session. programme budget agenda for time for sent to countries
Dr CfmISTMAS (New Zealand), returning to the matter of Technical Presentations, apologized to those representatives who had never participated in a technical presentation an~ agreed that for their sake it would be more reasonable to postpone, a decision on cessation unti 1 the next session. Meanwhile he suggested that the Presentation should take place on the fifth day of the thirty-third session, so that those who did not,wish to participate could leave. The REGIONAL DIRECTOR said he thought that would be feasible. The CHAIRMAN asked representatives to indicate their preference among the topics for the Technical Presentation in 1982. Dr TAPA (Tonga), supported by Dr RIDINGS (Samoa) proposed the first topic: "New policies for health education and information in support of 'health for all by the year 2000"'. Dr SUNG-WOO LEE (Republic of Korea) proposed the fourth topic: "The risk approach in maternal and child health care and family planning through use of the primary health care approach".
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REGIONAL COMMITTEE:
THIRTY-SECOND SESSION
The CHAIRMAN called for a show of hands in a vote on the.choice of top'ic. Decision: "New policies for health education and information in support of 'health for all by the year 2000'" was selected as the topic for the Technical Presentation at the thirty-third session of the Regional Committee by 7 votes to 3, with 4 abstentions. The CHAIRMAN asked the Rapporteurs to prepare a draft resolution. (For consideration of the draft resolution, see the eighth meeting, section 2.2). 4. TIME'AND PLACE OF THE THIRTY-THIRD AND THIRTY-FOURTH SESSIONS OF THE REGIONAL COMMITTEE: Item 24 of the Agenda
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The REGIONAL DIRECTOR said that, at the thirty-first session, the Committee had decided to hold its thirty-third session in Manila. He suggested that the dates should be from 20 to 25 September 1982. As far as the thirty-fourth session was concerned, as the Regional Committee was to meet in Manila in 1982, it could, in accordance with the decision made at its twenty-first session, meet in another country in 1983. In the light of the discussion under the preceding item he would suggest adding to the agenda for the thirty-third session an item on the question of the holding of Technical Presentations at future sessions. He proposed that the Technical Presentation during the thirty-third session should be scheduled to take place on the afternoon of Friday, 24 September 1982. Dr HOWELLS (Australia) said that six days was twice as long as he thought would be necessary for the session. The REGIONAL DIRECTOR pointed out that, by resolution WPR/RC3l.R29, the Regional Committee had in 1980 decided that the thirty-second and thirty-third sessions should last five or six days. If the Committee so wished the thirty-third session could be scheduled for 20 to 24 September 1982, with the Technical Presentation bn the Friday afternoon. DrMINNERS (United States of America) ~oted that the biennial programme budget for 1982-1983 included provision for sessions of the Regional Committee that exceeded that for 1980-1981 by almost 100%. The decision on a five- or six-day session had reflected a reasonable consensus of opinion at the time, and he felt that five days would be generous. Three delegations had left the previous session before it had ended. Rule 19 of the Rules of Procedure of the Regional Committee did not require the records of the plenary meetings to be approved before the end of the session, but "as soon as possible" thereafter. Neither the Executive Board nor the World Health Assembly observed that practice. When 'the resolutions and summary records were mailed, the extra time afforded for their perusal was appreciated.
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Organized visits, as well as Technical Presentations, could be considered as separate from Regional Committee sessions and scheduled later, so that those who had to attend to other priority matters could depart. He proposed that the thirty-third session should be scheduled for five days and that the attempt should be made to curtail it further as he had suggested. He also suggested that the thirty-fourth session should be limited to five days, and that the documentation should be sent on if necessary. On the timing of consideration of budgetary matters he recognized the need to coordinate budgetary processes at different levels in WHO. If necessary, not only could the discussion on that item be held on the first day of the Regional Committee session, but the whole session might be held earlier. Then it would no longer be arguable that, because of the proximity of the Regional Committee session to the meeting of the Programme Committee of the Executive Board, representatives should await completion of reporting, and the time saved could be devoted to efforts in countries for health for all. In reply to a query by the REGIONAL DIRECTOR, Dr MINNERS stated that he was proposing five days for the session, with the Technical Presentation separate. Dr CHRISTMAS (New Zealand) said he would welcome a five-day meeting inclusive or exclusive of the Technical Presentation. Dr TAPA (Tonga) pointed out that the programme budget for 1984-1985 would be discussed at the 1982 Regional Committee and wondered whether the time needed could be estimated on the basis of the 1980 discussions. The REGIONAL DIRECTOR said that the record would have to be checked but that the discussions might even be lengthier in 1982 in view of the proposal from different countries in favour of a zero-increase budget. The World Health Assembly had not accepted the Executive Board's guidelines and proposals regarding the real increase in the budget. If the next Health Assembly provided clear guidance on the matter, the discussion on the programme budget might be shorter, but no reliable prediction was possible. Dr HAN (Director, Programme Management) informed Dr Tapa that the discussions on the programme budget in the previous year had taken up half the first morning and the whole of the first afternoon. Dr HOWELLS (Australia) seconded the proposal of the representative of the United St-ates of America that the Regional Committee session should be limited to a total of five days and that the Technical Presentation should be held separately on a voluntary basis for those who wished to attend. Dr ACOSTA (Philippines) asked whether the Technical Presentation would take place within the proposed five-day period or after the closure •
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REGIONAL COMMITTEE:
THIRTY-SECOND SESSION
Dr MINNERS (United States of America) reiterated his view that the Technical Presentation should be a voluntary activity, to be carried out after the closure. In reply to Dr HOWELLS (Australia) Dr MINNERS confirmed that his proposal was that the meeting should last for a maximum of five days. To be even more specific, he proposed that the meeting should begin on Monday and be brought to a close at latest by noon on Friday, with the Technical Presentation taking place on Friday afternoon. Dr CHASTEL (France) said that delegations ought to be given all the time they needed to discuss any of the items on the agenda. The restricted time schedule proposed might lead to discussion being cut short by the Chairman. Some caution was called for in adopting such a measure. Dr TAPA (Tonga) asked whether the formal closure would still be on the fifth or sixth day even if the Committee finished its work in three or four days. The REGIONAL DIRECTOR pointed out that, in addition to statutory agenda items, such as the biennial review of the programme budget and consideration of Executive Board and Health Assembly resolutions of interest for the work of the Region, and to items formally requested by the Board and Health Assembly; there could always be items proposed by the secretariat, although they tried to limit their number, or by Member States. The number of items was unpredictable. Furthermore, if health assemblies were shortened or held every two years, more work might well devolve on the Regional Committees. One or more night sessions might become necessary in order to cope with the work within the restricted time schedule. He would do his best to limit the length of Regional Committee sessions but the time required would depend on the number of agenda items. Dr TAPA (Tonga) was against restricting the length of the sessions. favoured six days with an earlier closure if it should prove possible. He
Dr HOWELLS (Australia) said that he had no wish to limit discussion but at the present session they had had ample time. Dr MINNERS (United States of America) ~greed that it was difficult for the Regional Director to predict the. time required but he himself was quite willing to attend night sessions if necessary. They must not forget that work tended to expand to fill the time available. In response to a request from Dr TALIB (Malaysia) the REGIONAL DIRECTOR read out the text of resolution WPR/RC31.R29, thirty-second and thirty-third sessions of the Regional Committee, adopted in 1980. Dr RIDINGS (Samoa) felt that they could have completed their work much more expeditiously at the present session. Dr CHRISTMAS (New Zealand) asked for the motion to be put to the vote.
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The CHAIRMAN said that there were two proposals before the Committee, the first calling for a six-day and the second for a five-day session. He asked those members in favour of the first proposl to raise their hands. The result of the voting on the proposal was as follows: Number of Representatives present and voting, 14; votes against, 13. The first proposal was therefore rejected. The CHAIRMAN then called for a show of hands on the second proposal. The result of the voting was as follows: 13; Number of Representatives present and voting, 14; votes against, 1. The proposal was therefore adopted. After a brief discussion in which the REGIONAL DIRECTOR, Dr HOWELLS (Australia), Dr CHEW (Singapore), Dr MINNERS (United States of America), Dr ACOSTA (Philippines), Dr CHRISTMAS (New Zealand), Dr TAPA (Tonga), and Dr SUNG-WOO LEE (Republic of Korea) took part, it was agreed that the Technical Presentation should take place on the last day of the session and should be voluntary and that the draft report and any documentation not finalized during the session should be sent out to members after the session for approval. The letter transmitting the report should stipulate that if no reply was received by a certain date it would be assumed that Member States accepted it. It was also agreed that the Regional Director should be authorized to accept any invitation for the Committee's thirty-fourth session, subject to confirmation by the Committee at its thirty-third session; if no'invitation was received, the session would be held in Manila. The CHAIRMAN invited the Rapporteurs to prepare the appropriate draft resolution. (For consideration of the draft resolution, see the eighth meeting, section 2.3). Dr TAPA (Tonga) proposed that the agenda for the Committee's next session should include an item as to whether or not the Technical Presentations should be continued. It was so agreed. votes in favour, votes in favour, 1;
The meeting rose at 11.50 a.m.