WORLD HEALTH REGIONAL OFFICE FOR ORGANIZATION SOUTH-EAST ASIA Meetin& of the Consultative Committee SF?6 /PnM/~~nr /. 10 for Programme Development and Management Kathmandp, Nepal, X9-23 October 1983 23 October 1983 PSPORT OF THE MEETII!G OF THE CONSULTATIVE COMMITTEE E3R PRoGRAMME DEVELOPMENT AND MANAGEMENT * The Small Committee was established in 19&C! following the Regional Committee Resolution SEA/RC33/RiO. This mechanism was sustained by yet another resolution SEA/RC36/Rll in 1981 which nxnnndad thn RcmnP nf atahiaet- matters to be brought to its atteution. - - - - - - - - - - - - - ---r- “^“.e”J”.eC Ye The thirty-fifth session of the Regional Committee examined the"small group" mechanism by phich it was increasingly becoming intimately associated with the working of the Organization, and found this mechanism useful for examining at length different subjects, with its analysis and findings to be considered by the Regional Committee itself at subsequent sessions. It was agreed that an appropriate terminology would have to be found for this Committee. The "Small Committee" which met in &p!ril 1983, after taking into account the wide-ranging nature of issues shbmitted to it in the past, recommended that it be renamed "Consxltative Committee for Programme Development and Management". The report on this Meeting (SEAfXCPIMeet.3/7) was submitted to the Sub-Committee on Programme Budget of the 36th Regional Committee for its consideration. The Small Committee (now recommended to be renamed-as the Consultative Committee for Programme Development and Management) met at Kathmandu, Nepal, from 19 to 23 %tober 1903.- A summary of the Committee’s 4 deliberations and recon:aendation.:/ are contained in the attached reportwhich has three distinct sections. Section 1 contains t:lc d3nslusione of thk Consultative Committee’ on t%e review of the implementation of WHO's Collaborative Programme during the first 18 months of the biennium. This Section will be discussed by the Sub-Committee on Proyramme Budget.--_I !.- Section 2 contains the cements of the Consultative Committee on Common Framework and Format for hvaluating the Strategies for Health for All by the Year 2000. Th?.s Section will be discussed at the plenary----. __-- along with agenda item 13 of the Regional Committee, Monitoring of Progress-y-----2 in Imnlementinsr Strtiteo.les for Health for All bv the Year 2000.. ----,+ Section 3 contains the conclusions of the discussions on the RD's Annual Report as requested by the 35th sassion of the Regional Committee, along with suggestions regarding the format and contents of the annual report in the coming years. This section will he discussed at the plenary along with RC agenda item No. 7, Thirty-fifth Annual Report of the Regional . Director - a review of the annual activities.
,: : SEA/PDM/Meet 4/9 ~INTRODUCTION 1 : The thirty-fifth session oL yhe Regional Committee epdorsed~ tee recommendation that t.>.e, “Syll Commilqtee” established under Resqlution SEAIRC34/Rl?, should undertake a ?z$ew of iinancial ?nd tech&al :’ implementation of ~O’S Fo?laborative,activities every six months. ‘,The Regional Committee also endqrsed the r&omm&ndation that the, “Small Cqmmittee” should carry aut) &I in-depth review of the Regional,Director’s Anqua Report and submit i+s findings,, together with country-speqif,jc problems to the Regional Committee. 1,l In pursuance of this directive,, the Regional Director copvened a meeting Qf t&e “Small C&tmittee” (no6 proposed to be renamed as thi “Consultative Committee on Programme Development and Managqnent”) wqth the following terms of reference: ( 1 ) Review o f implementation rqf WHO collaborat<ve programme in the Member Countries during the first 18 m&hi of the biennium. .19,82-1983; ‘, (2) Common Framework and Format for Evaluating Strategies for .Health for All; (3) In-depth review of the Regional Director% Annual Report, a n d (4) Format for Future Annual Reports of the Regional Direct’or. ,1,2 The Committee met in Kathrr: ndu from 19 td 23 October ,1983, with ,Mr P . P . Chauhan (In$ia) do Chai..r::fc, rind Cr Samlee Plianbangchang (Thailand) as Rapporteur. A list of participants *is attached (Anne? 1)‘. SECTION j. REVIEW OF IMPLEKENTATION OF WHO COLLABORATIVE PROGRAMME IN THE ME&3ER COUNTRIES ‘DURING THE FIRST 18 MONTHS OF THE BIENNIUM 1982-1983 2. The Committee considered the information provided in respect of country and inter-country programmes on the technical as well as financial aspects of implementafion.,~nder WHO’s Regular Budget during the first 18 months of th;e biennium 1982-1983, viz:, January’1382 to June 1983 (back- .ground document SEA/PDM/Meet 4/3). 2.1 Xt‘was noted that the ,jmplementation of the co?.laborative ramme was generally satisfactory. Since individual country delivery enrages as of 30 June i9S3 :-:inged from-47 to 90, giving a regional average of 69 per cent, it might be necass%ry to accelerate the process of’ delivery in a few‘kfember States. It was felt that the achievement of ahvsieal tareets o f the co&$aborativg programme should be more sharply al.‘aspects of the programme delivery. There were ttion of various components with short-term ering 59% delivery as against -_-_-* __.-_ -----.- was, ip. iolpe cases, linked up with the recruitment df s,hort-term consultants since the subsidy component was essentially earmarked for workshops and other training courses to be conducted with the assistance of the consultants concerned and, in other countries, the programme priorities dictated diversion of.funds from this component to the other areas. 2 . 2 In order to facilitate .future’reviews of programme implementation, the Committee recommended that the working paper should also include the 2.3 The Committee noted that countries had developed different joint government/WHq mechanisms for planning, implementation, monitoring and evaluation of the WElO’s collaborative programme. It also took note of the special exercises that yere going on in different countries, namely, the programme budgeting exercise‘in Thailand, the Government of ‘Indonesia/WHO Special Collaborative Programme, the Huvsqul Primary Health Care Programme in Mongolia, etc. The Committee further noted the efforts that were being made by ilember States to monitos the implementation of national programmes for health development, the objective being the optimal use of resources, for health development at the country level. Many of these efforts; however, were in an evolutionary stage. For meaningful monitoring, the countries would require up-to-date and accurate information on programme delivery status. After an exhaustive discussion of the working paper9 the Committee made the following comments and recommendations: The cost of extra-regional fellowships was becoming prohibitively high; ‘implementation in case,of fellows from several countries; The util@ation of regional facilities for training was reaching a plateau. A good proportion of WHO fellows continued to ha sent to countries outside the Region, ,Several requests for ad-hoc and unstructured fellowships for observation tours, and study visits could not be meaning-, fully implemented since’(l) the country requirements were not clearly,articulatedd (ii) in some cases t h e p r o p o s e d receiving institutions/governments did not iave facilities for undertaking these activities; the necessary The prospective fellows sometimes did not fulfil the qualification requirements; < k&.: Postgraduate training in developed countries sometimes resulted in the fellows returning with sophisticated and advanced knowledge that could not be utilized due to lack of relevgnt facilities in the countries. This led to ..diversion of resources which could have been utilized for the development of regional institutions. The Committee recommended that: A (i) The implementatjon of the fellowship programme should be planned’jointly by fhe government ‘concerned, WPC&R and the Regional Office in order to identify the specific ‘requirements of the governments, and also to identify the rg training institutions to make the fellowship. programme ‘jc m&e relevant and.effective; (ii) ,.The Regiir?al..Office should update the directory of training institutions within the Region, giving information .on the types of courses available, the periodicity of the e courses, and entrance requirements. This should clearly % , Indkcate those institutions that are willing and ready to 43, accept fellows; .4 (iii) : Support should be given to further strengthen the existing 8 institutions within the Region to meet the training require- men@ of the.Mer&er States as far as possible, and 0 4 2 (iv) Support for English language training facilities should be extended to fellows from needy countries. L Short-Term Consultants . ..* . . - L J Tne l o w implementation o r this component was due to various factors such as difficulty in obtaining terms of reference on time, delays in clearance by the recipient government, .and diversion of funds to other components. The Committee felt that govern&sts should identify and prorpptly ccmmu$cate precise. terms of reference for the consultants to the Regjorral Off ice ,. the governmnt 3 The Or.ganization should, upon request, provide lists of candidates available, together with their bio- data, so thn! ~p8rmxr:~~ nay suggest suitable candidates for selection and appoin.tr.iZ!;lt 2:’ “.?c Organization. 2.6 * ’L;onltor’L-:c , :;i? !Evvlua t ion-C.--e -:tc rccozrmzndations of the “Small Committee” held i n _ - -__- -‘-cl------ ----“- i) to evolve a ruitable information system for monitoring implementation of the WO’s collabor?t.ive programme. While efforts at the country level have succeeded in prc?riding a rough estimate of’funds committed and funds available, sornq governments felt that more precise information on actual obligetio3.s sY-.~::?..l b? periodi-ally furnished by the Regional Office, so a s to enable L~E,G tc ccr,eler,zte implementation o f t h e c o l l a b o r a t i v e programme. 2.7 The Corzittee also examined the question of the retention of a separate identity of I+?Y)“~ resources distinct from the national budget. Recently th+e Ans been a trend in some countries to integrate WHO’s resources completeiy rrith the national budget. This, the Committee felt, might reduce t?s e1Cmeil.t of flexibility and impede timely implementation of the collaborative programmes. I P. factor that militated against complete integration of resources w;1s the need to maintain accountability far WHO’s resources, Vhile the Organization was in the process of giving authority to the countries to mould their collaborative programme within the frame- work of 14r~S’s guideliq.es I:?c~d on country needs, it also felt that the Q need for clea: definition and recognition of the catalytic role of WO’s inputs could not be ignored. The consensus was that an effort should be made to ccntiuue :?i+zF~ the existing system of programme financing, The Qanization should provide all possible support not only for pronitoring of N-:0 s the entire effort collaborative programmes but also for monitoring “health far :cr national health development in order to attain the alI” ohj.ective. Lhi3.e disc:tsoin3 the impleaelltation of the inter-country projects, it was felt that: ths Ceiivcry of the research programme was rather slow i n scne cases . I t fie.-.zrged that the major obstacle in the way of smooth implementation of the research programme was the lack of acceptable a a research protocols. The Organization has already initiated action to train national researchers in the technique of developing suitable research protocols, However’ , this effort has to be further stimulated and strengthened. COMMON FR#&fEWORR AND FOR,MAT FOR EVALUATING STRATEGIES FOR HEAL??’ FCR ALL BY THE YEAR 2000 memoer brates i n 3. The Committee noted that the first evaluation report based on the proposed format (document SZA/PDM/Meet 4/4) would be submitted by the IIf “.. ’ March 1985, that the responsibility for evaluation of the HFA strategies mainly rested with the Member States, and that the purpose of the proposed draft of the Common Framework and Format was to support the countries in this effort. I, %& SEA/PDM/Meet 4/9 Page 5 SEXTION 2 - 3.1 After reviewing the document SEA/PDM/Meet 414 item by item and i critically assessing its adequacy for evaluating the strategies for “health for all” at country level, conclusions: the Committee arrived at the following (1) The proposed &a~?ework and Format would generally meet the requirements for information generation for under- taking the first evaluation of the HI:‘A strategies; In\ -e . ” . . _. atf.1 UI view ot the present state of development of the national health information systems E it may be difficult for some- _ of the Member States to respond to all the*questions framed in the format. However a a l l e f f o r t s should t,e made by the Member States to generate and collect as much inforamtion as possible using the proposed Framework and Format in order to meaningfully evaluate HFA strategies. (3) In this national effort for evaluating %?A strategies at country level9 the Organization should provide necessary support within its available resources. (4) Based on the experience gained in the first evaluation e f f o r t , the Framework and Format may be reviewed with the aim of &king it more effective for subsequent evaluation exercises. The Committee suggested some editorial changes in the Format. These are given in Annex 2. IN-DEPTH REVIEW OF THE REGIONAL i &RECTOR's ANNUAL REPORT 4. The Committee considered the background document SEA/PDM/Meet 4/7 and decided to review the Regional Director’s Annual Report chapter by chapter with a view to identifying the m&in programme thrusts, the issues facing the countries and the possible solutions thereof, including necessary supportive action from KqlO. 4.1 IntroductioE ( p p . v i i - x x v i i i ) The Committee agreed that the "TntroductionY' to the 35th Annual Report of the Regional Director zzx”;o adequately the request- made by -the Regional Committee in its last session for a short summary .highlighting the major programme activities contained in the Report, The Committee decided to discuss the “‘Introducticn”’part by part along with the relevant chapters of Part I of the Annual P.eport. 4.2 S t r e n g t h e n i n g o f llealth S e r v i c e s ( p p . l-41) ,The Committee noted that efforts had been made in the past to train high-level administrators in health planning and management. However, adequate attention was not being paid to the training needs of middle and lower level health administrators, although some countries of the Region were trying to extend .health planning processes at provincial and district levels as a "bottom-up" approach. Ln associated problem was lack of appropriate training modules for planning at provincial and district levels. The Committee felt that WE0 should take the leadership role in this field and help the countries in trai.nin:z the middle and lower level health ..A-f,‘,c--c--- The CoEittr,c ::c.Y Lnf:-;rTic rl. that c7n. inter-country project located in the Regional Office, along with the relevant country projects, was now supporting the Member States iii providingtraining in health planning to national health administrators according to the specific needs of each country. The Committee suggested that WZO should collaborate with the countries, u t i l i z i n g rcsocrces of this project to assist governments'in preparing training modules in health plantxing for middle and lower level health administrators and in conducting c$rse~ for training of trainers in th i s f i e ld . The l:?lltl.lal exchange of expc+ence &led by the different countries in d i s t r i c t - l eve l he,-!lth planning should also be supported by WHO, either through field visits or thro!lgh thr cr:;anization of appropriate seminars/workshops. In addition, a regional training centre for health planning and management should ?IC: developed using a Suitable existing institution as a base. ’ The Committee noted that the Seventh General Pragramme of Fork. -laid emphasis on a balanced development of inf However 1_ _ in actual practice in most countries,.I - C.Fll ‘LA:-- ---..! rastructure and technology. sophisticated teihnology is s development or use of LALI~ ue~ng cuntlnued, blocking,scarce resourcef; and thereby delaying rapid development of much-needed health c,q I., a.-.----- a lary health care approach year 2000, it was’poipted ealtn care was poorly understood even:’. _- .i n makers who insisted.,pn_.- * . .- infrastructure. ’ This trend need’s L” UC rrvrrue~. .a. !Jhile- discussing the i‘mportance o f prim for reaching.the goal of heal 0 th for all by the out that: the concept of primary bl--’ ” * now by many: political and professional decisio having sophisticated health technologies’and facilitiee slml~ar to,those in developed countries, The, Committee felt th-- -* c,‘,,,l -1-i __-. 1 ‘:‘~ ’ . should clearly define their health policies so that, in aLlocation or - , _r.. . -scarce resources for nearrn dWelOpment, -_ t o prim&ry hea: - high priority would be given . . . Lth care consisting of balanced, promotive, pieventive, ~ curative ana rehabilitative cc ” - iomponents,wrthin was need for educating the health administrate an affordable cost. There politicians, including parliamentarians in the rs > ‘professionals and ‘the ‘, approa’&, for nationa- hnel&h Aa-r~7 ,----A .-- -1. primary health care . i II=cII~~~ UCV~LU~?WXI~ so mat the resources were preferentially *. --- L ._ m aL’located for PWC se&ices. The Committee noted withsatisfaction that WHO had made a start in this regard by collaborating with the Inter-Parliamentary D&on to conyene a meeting of parliamen- tarians in Manila this year, The Gommittze suggested that, tihile formulating the WHO’s programme budget for the biennium 1986-1987, ,, development of infrastructure for providing primary health care to ‘the ’ a underserved population should be accorded high priority. w SEA/PDM/Meot 4/9 ” Page 7 Organization of Basic Health Services, Health Services Research and Primary Health Care In the area of.he+lth services research, while the SEA/ACMR had formulated a well-knit conceptual framework, there was inadequate effort to operationalize this concept. In view of the multidisciplinary nature of the HSR, precise methodology should be evolved to transform the coinzept into practice. There wtis a need for organizing sc&stifi.d working groups ro aevc~op maiLxiu .‘.. I lor HSR in which WHO could,play a useful,,r,ole. Traditional Medicine, th . . ‘*: . ., , . -- wicnin t . ” . The Committee noted that WHO’s policy so far had been to support le countries in utlrizing the existing traditional systems of medicine . . . ‘he framework of primary health care as’far‘as practicable, The major thrust of WHO’s programme was, however, on the utili?ation of practitioners of traditional medicine with appropriate reorientstion training within the framework of primary health care, and in developing LLSL~ VL LraoLtional ULU~~D diseased. However, ~iitl~ GUUCU oe usea for treating common the Committee felt that the notion of the: universal acceptability and cheaper cost of the traditional systems of medicine needed to be evaluated. Family Health, Nursing, Nutrition and Medical Care : The Committee recalLed the discussions at the 35th sessim~af the Regional Committee on the insufficient WHO regular budget allocation-to. maternal and child health programmes in the Region and suggested that Member States and WHO should ensure allocation of needed funds to this programme while formulating WHO’s collaborative activities in respective countries. The Committee felt that this was all the more important now’because the emph&is of UNFPA Supported activities was rapidly shifting from MCH-based family planning programmes to population control activities where MCH develooment received reduced emphasis and limited support. The Committee also noted that, barring one or two countries, there was need for increased coordination among the concerned government departments in integrating various components of family health programme, e,g.$ MCH, nutr.ition, health education and. family planning. Efforts should be made by the health ministries to bring about effective coordination of the different components of the family health programme. ‘. Since health education was an important element of-the health for all strategies, action should be taken joint’ly by WHO and Member States to accelerate aperationalization of the recommendatiotis made during the technical discussions, “New Policies for Health Education in Primary Health Care”, inthe 36th World.Health Assembly. While reviewing the activities in this programme area; the Committee was informed of the newly launched Y’Ii@ACT~t programme in which WHO swas a co-sponsor, The blue-print for a plan of action emerging from the three-day seminar on the “lMPACTY programme held in New Delhi would be utilized to develop a world-wide programme for prevention and eontro’l of avoidable ’ disability. The major components of the programme were related to control of blindn&s, deafness and orthopaedie disability due to injuries and diseases like leprosy and arthritis, Drug Policies and Managemknt- In the field of drug policies and management, the major issues facing the countries related to the formulation of a list of essential drugs; quality control, production and procurement of drugs and,logistics. mile it was felt that WHO support in all these four areas would be needed, it was essential for the gov&xtments tr streamline their drug policies and, as a first step, identify a list of essential drugs. SEA/PDiJ/lleet 4 I3 While some facilities were available in all the countries to test the quality of drugs> this stage , both imported and locally produced, it,was, at very difficult for th,? national authorities to carry out q u a l i t y c o n t r o l tests for a l l the drugs dirculating i n the,,lparket i f t h e nuatber of drugs, continued to .be as large as ,it was now.. mat. was therefore, needed. was the p:reparat$on of. a list,, of essential ,drugs, and development of faCili.ties for their quality control. The Committee .suggested that WHO should supportnational efforts in quality co,titrol through the training of,.ataff and provision for essential equipment, r e a g e n t s a n d s t a n d a r d s . . . . ‘,. ~,The Comnqittee fel,t,that there was’tremendous scope for’ TCDC in the field of drug procurement and. production .in the Region as. wel’r, as’ irn training of manpower an@ in quality as.surance. The, Nember S t a t e s shtiuld seriously consider .the question of attaining regional self- reliance in respect of essential drugs by using the ”! TCDC approach. 4.3 Disease Prevention and 6(Mzyol - Communicable Diseases (pp. 42-74)__i- I The Committee reviewed the activities relating to this programmearea in ,general and, in particular,~~,the efforts being .made, i,n the fields o f epidemiologizal s u r v e i l l a n c e , tuberculosis,, leprosy acute diarrhoeal diseases,, malaria, 9 sexually-transmit ted diseases .’ apd the expand.ad programme on immunization. Epidemiological Surveillance The Committee emphasized that the.present training programmes in epidemiological surveillance were not adequately field-oriented in most countries; this was making it d.’ Ificult t o c a r r y ..ut epide&olegic& surveillance of the important cormilunicable diseases. Stereotyped traini in epidemiology on the pattern followed in developed countries &as often not suitable for the countries of this Ragion. WHO should therefore mak every effort in collaboration with the governments to develop fioid-. oriented epidemiological surveillance system as well’as field-orieeted training of raanpower as a priority. The Commit tee. nofed the present efforts being made in Indonesia and Thailand in thig,regard.‘ ng .e Acute ~Diarrhoeal Diseases I. The Committee reviewed the efforts made for the control of diarrhoeal diseases by emghasizing training of manpower and production’of ORS. The Committee endorsed the present .policy of WHO in giving firat priority to the reduction of mortality by the use of ORS therapy, which had proved.extremely effective in treating acute diarrhoeas due to all etiological agents. The Committee further emphasized that, diarrhoeal diseases, in order to reduce morbidity due to sufficient attentio:x should be paid to other programme . areas such as health education, water supply and sanitation, and improvement of environmental conditions, including food safety. After reviewing the information contained in the Annual Report, the Committee expressed its concern at the continuing incidence.of malaria, despite efforts made for its control by the governments in collaboration with international agencies. In addition to the technical problem of resistance of parasites to anti-malaria drugs, and of vectors to insecticides, the problem of shortage of manpower and of resources for procuring drugs and insecticides was impeding progress. It was therefore necessary to accelerate the pace of research in order to solve the technical problems and mobilize further resources in support of the service programme. Since malaria had already become a national public health problem in several countries of the Region, there was an urgent necessity to mobilize participation of the community in the activities of this programme. While sgoradic efforts were being made in this ; regard in a number of countries, there was need for concentrated and continuous efforts to involve the community. . _ that there was no conclusive evidence that BCG was ineffective in preventing tuberculosis among children. BCG vaccination progrsmmes should therefore be continued. R+zgion, the Committee expressed its concern at the slow pace of progress, One of the problems of the exisr:%g treatment regimen was its long duration. Horeover, resistance to the commonly used drug, dapsone, was c- * not unusual. The Committee, recalling the recommendation of the technical discussions during the 35th Regional Committee with ‘regard to use of multi-drug therapy on a universal basis for the treatment of leprosy, noted that some countries in the Region had already adopted this as a major strategy for leprosy control. However, the problem of case- I detection and case-holding on the one hand, and the high, cost of multi- drug therapy on the other, were adversely affecting progress in controlling the disease. The Committee noted with Satiefaction that the efforts for developing a leprosy vaccine under the TRR programme were progressing well and hoped that a field trial with this vaccine would be launched in the near future. The Committee recommended that the _ Organization should intensify its efforts to support the governments in controlling this disease. I resistant strains of Gonoi more or less satisfactoril improving and accelerating the pace. .,“Z ‘_I At present, the’ necessary’&&& . i * < ..:!‘.::. : :,:.: ,i’ !;:i& ?e governments were d&eloping programmes in the fields of-cancer,,, and eardrovascular diseases, according to the extent of the problem”in”P their cq~,lngr$es. G+!iea are needed in the +&lemi,ologicgl as&&s of these diseaw iP order to define, clearly the. extent, of the $ri&Iem: &a! ~;:!,: alSO WYP, 9f. t$Sk!i$%. them at thig early stage before they: be&me’3&jo~~t :~c2f health problems, - k?W should actively supper t the, efforts of’ $~e”gpver~~~&ts in this respJj% through a well-cpordinated inter-country programme. ” . “-““~_ ,‘< ,” ; :d C J $i : between smoking and several lung diseases, cardiopulmonary diseases, such as chronic cardiovasculardiseaqes and cancer* It’ felt’that, despite‘ the economic aspects of tobacco cultivation and resistance from multi- national corporations, the governments shoul’d,discourage tobacco cultivation, replacing it with alternate and equally lucrative crops, The Cormnittee noted that eight Hember Countries had accorded high priority to .the prevention of blindness programme, and project activities were being undertaken. However P The programme was proceeding satisfactorily. it felt that WC should play an active.role in mobilizing further extra-budgetary resources for this programme. Health Laboratory Services The"Committee emphasiyad the need for close linkages between health Iaboratory services a& communicable disease control efforts. There was also a need for quality assurance of laboratory services. It was also felt that app~opria~~.~,!.abo-at~ry services should be developed in primary wealth cer.t?:es, i:or this? the minimum services and the type of manpower required should be identified. Governments should then take measures tc de*relop ti:e eacilitieo 3nd to train a sufficient number of specific t?nk- xiwtcd laboratory personnel. WE0 should support the governments in this effort. The Committee noted that the Regional Committee will discuss the International Drin!cing Water Supply and Sanitation Decade activities under agenda item 16. The Committee therefore did not enter into a detailed discussion of the subject at this stage: it emphasized only a few urgent matters. The Committee felt that%*while the implementation of the Decade Plan was making varying degrees"of progress in different countries, the water supply programme was not producing the necessary impact on the health status of the population. There were many reasons. for this. Water supply alone without appropriate sanitation may not produce the desired results. Another important reason may,be that people do not utilize the iacj.lities because of a lack of health education. It was therefore desirable that water supply, sanitation and health education should be provided as a package to improve the sitbPtian. / The-Committee took note of the fact that the Decade programme was being imple. Jnted ia most SEAR countries by the Ministries of Public Works and was o:'tx:" '%,e\nl-; ,-.onsidcred as a prop,ramme fey facility development only, without paying adequate attention to the health aspects. It was imperative that the WHO's collaborative country progranme shorlld provide the requi$ite inputs to the Decade programme In or&r to ensure ijr0per program&e thrusts.. Occupational Health While reviewing the activities in the countries of the Region, - the Committee felt that this was an area where inter-sectoral collabora- tion was absolutely essential in order to ensure the safety of workers and to promote workers' health in general. It also noted that the other departments that were actively engaged in setting up industrial plants and other activities often did not involve the health ministry in taking care of the health aspects of the population involved. The rhile noting the constraints in developing food safety programmes the Comittee felt.that three areas that needed attention ion and its implementation governing food rid (iii) inter-sectoral coordination. The the Committee observeiS that i lnd data were eenerallv collected jss of the needs of health planners and other users ., There was a . gap between the generation of information and its utilization. A serious effort should be made *o produce user-oriented information. The Committee emphasized the need for proper linkages between the information system and epidemiological survaillsnce: The Committee noted with satisfaction that the H’ZLLIS programme was providing both sophisticated scientific information from developed cientific and health programme information from the countries of the’ R.egion, NRLLIS was thus meeting the need for technical information exchange and in this process it was also providing unpublished.information generac3d in the countries o f the Region. The Committee nOted the very exhaustive informatian provided in the Annual Report on various aspects of health manpower development. was observed that the actual requirements of the countries for various types of health personnel had TtQt been worked out and the training programme’s for these personnel were being conducted regardless,of the utilieation’capacity of’the health services. The Committee reiterated th the national governments land th,e Organization should jointly to widely disseminate the WSMIJ concept. . The eovernments should undertake a nroiection of health mannowe rending upon. their coun$rg situations. WHO, f or i t s part , should continue to hold regional seminars/workshops on various aspects of health manpower development so that broad guidelines could be evolved for 3EA/PDH/Tcleet 4 /9 ?age 14 :he benefit of health administrators/planners in relevant aspects of nanpower planning, production an!. utilization. The Committee also noted the serious problem of “brain drain” in many of the countries of the Region. Besides depriving the countries If the se rv i ces o f trained:personnel, thereby affecting the delivery of lea1 th care 9 this has also resulted in wastage of resources, as medical education was provided at‘heavily subsidised cost. Some governments were :rying to arrest this brain drain by enhancing the “bond” ,amount 8116 also ?y introducing a compulsory service.period after graduation. There was a need to provide within the Region, in the spirit of TCDC, post-graduate training facilities to t@ose countries which did not -tave such fac i l i t i es . The Committee was informed that health manpower levelogment was chosen by the second meeting of the Health Ministers 1s one of the priority subjects for TCDC. The Ctimmittee noted the encouraging results that were accruing irom the training and utilization of T8As. It noted that wherever ,roper supervision had heen exercised. TBAs had proved to be extremely useful and cost-effective. The joint efforts of WHO and Member Countries should be continued in developing TBA programmes. The Committee noted that new. formats had been evolved to facilitate termination-of-studies reports for carrying out an evaluation of, the :ellowships programme. It was informed that, owing to a poor response from )oth the fellows and the government departments concerned9 it had not )een ‘possible successfully to carry out appropriate evaluation. The :ommittee’ recommended, .that a joint WROjgovernment mechanism should be lsed at the country level to carry out periodic evaluation. Such a mechanism would also help in the effective implementation of the programme. i.7 ‘Research Promotion and Develonment, Women health and Development, and Technical Information and R e f e r e n c e S e r v i c e s: .,.! I. The Commitree noted the efforts made in Promoting research both under thi: WRO’s regula? budget and under special programmes such,as TDR lnd HRP. In this connection, the Committea observed that there was need for better coordination among those programmes in order to avoid duplica- rinn. The f!nmmirree nl so c+mnhasi.zcxi t h a t occasional direct communication----.. -*_- --------- ---- --I----- ---- ----- ------ ----- -~ Jith researchers by the TDR and HRP programmes without the knowledge of rhe concerned governmental authorities was likely to create confusion and should be avoided. The Committee appreciated the efforts of the SCA/ACMP. towards r&rate efforts for- ac~;lerd~co impLemencaiion of research YLugLawes within these frameworks. I%.: Committee suggested that the s and procedures for* .I.-. . . anproving sapport to research projects ~ommictee was Informed matters generated under sponso C e upon tne $& 4.5 Organizational and Administrative Matters (pp.1 ._. While reviewing the activities undertaken in this field, the. - that all important and relevant reports on technical rship qf WHO were sent to the governments oncerned.. These were selectively brought out as publications dependingrequirement of progr&mes and demand .from the countries. 31-152) --.-The Committee reviewed the information provided under this section Iot the Annual Rey, . . )ort and felt that it adequately reflected important I activities related to organizational and administrative matters duringthe year. 4.9 Activities Undertaken by Covernments zth the.Help of WHO K153-204T I The Committee reviewed the information provided in respect of thecountry activitias but felt that the information contained in this sectionwas mainly a'repetition of what had been include;-1 in Part I of the report2nd pnllld ha n~rtit+aA Fre,o :-ha F..I-*.wc -n-..-'-s.I--- w--e.. “I Y.UIL1~C.a J.-L.,Lu CL1T; ‘.ULUl.~ rt$pxJr Lb c 5. e Format for Future AnnuaL Reports of the Regional Director _.__ ,_I_ The Committee reviewed the background paper on the Format for sports of the Regional Director (document SRA/PDM/Meet 4/6)r*,,#,- -^-- -----.- 3 LI Future Annual RE and made the fol LUWLLLF recommenaarions: tieneral rrogramme ot Work. (1) The future annual reports should be prepared based on the Programme Classification Structure of the Seventh. n -__ (2) The "Introduction" to the Annual Report of the Regional Director should contain a summary similar to the one produced fo Director. r the 35th Annual Report of the Regional Zart I and Part II should be retained as at present. As for Part III, only the list of country and inter-country projects in operation during the period . . should be retained. The narrative portion, depicting the activities undertaken by the Government with the help of WHO as presenred in Part III of the report. (3) The reporting period should remain 1 July to 3c! June as at present. In conformity with this, ishc data in the administrative section of the Annual Report, Pari II, should cover the period 1 July to 30 June instead of 1 June to 31 I-lay as at preserk. (4) The existing routine' annexes should be deleted and provided as information documents. However, any annexes required to illustrate statements made in the body of the Annual Report may be included as necessary..'
Professor 0. Jamba First Deputy Minister of Health People’s Republic of Mongolia.11 -- - * Dr R. Arslan Public Health Officer Foreign Relations Dqartment Ministry of Public Walt& Ulan Bator a D? "L,.E. Singh Chief, E:p Directorate-General of Health Services His Majesty's Government of Nepal IKst1msnd~.-"a-. SRI LAMA Dr E.Tohan Rodrigo Deputy Director (PHS) Ministry of 5lealth Dr Ssxnlee Plianbangchaag Secretary .' National Advisory Board fox Disease Prevention and Control Ministry of Public Health WHO SECRETARIAT . Dr M.A. Rahman, Director, Programne Management Hr R. Helmholz, Director, Suppokt Prograuune EIr S.L. Khatri, Budget and Finance Officer I& C. Zielinski, Reports and Documents Officer Nr f-i. Subramanyan, Technical OffiFer' ~Programing and Itifbmation) MK D.P. Marwah, Ad&&trativa Aaaiatant Iteta 6.2 : Item 7.1 : Item 8.1 : Item 8.2 : Item 12.4 : Item 16.3 : Item 17.2 : It should read, “Have you evolved or reoriented health policies since 19831 If yes, describe.’ It should read, “If you had developed a istrategy and plan of action, have you updated them since 1983?” The words “what measures” should be replaced by the trorda “what steps” in line 2. i,~-,St ; This should read, “Dave there bean subsequent developments regarding community involvement since 19831” Delete tbe words “in order”. The word “ma<ie” in line 1 utay be replaced by the words “drawn up”. The words “medical profession” should be replaced by “medical praf essionala” , Delete the words “in order”. Pirst sentence should read, “tfhat eupport h&e ydu p r o v i d e d f o r the implementation of health strategies of developing countries.” Delete the words “connexion with”. This should read, “What are the main obstacles to such cooperation and what measures do you propose to take to overcome them?’ Delete the words “causes of”. The title should read, “Intersectoral Coordination ‘and Collaboration”. Add the mrds, “coordination and” after the word “intersectoral”. Delete the words “in order”. Add the words “of health services” after “utilieatio~“.