WORLD HEALTH ORGANIZATION
REGIONAL OFFICE FOR THE WESTERN PACIFIC BUREAU IU~GIONAL DU PACIFIQUE OCCIDENTAL
• .
ORGANISATION MONDIALE DE LA SANTE
REGIONAL COMMITTEE Thirty-fourth session Manila
WPR/RC34/SR/3 6 September 1983 ORIGINAL: ENGLISH
PROVISIONAL SUMMARY RECORD OF THE THIRD MEETING WHO Conference Hall, Manila Tuesday, 6 September 1983 at 9.00 a.m. CHAIRMAN: Datuk (Dr) Abdul Khalid Saban (Malaysia)
CONTENTS
1.
Address by the incoming Chairman Statement of the Chairman of the Executive Board ••.•••••••• Report of the Regional Director (continued) •••••••••••••••
3 3 4
2.
3.
Note: Corrections to this summary record should be given to the Programme and Reports Officer, Room 326, or handed to the Enquiry Desk in the lobby of the Conference Hall, within 24 hours of its distribution.
WPR/RC34/SR/3 page 2 For the List of Representatives at separately issued document WPR/RC34/DIV/l. the thirty-fourth session, see
WPR/RC34/SR/3 page 3
1.
ADDRESS BY THE INCOMING CHAIRMAN:
Item 5 of the Agenda
The CHAIRMAN addressed the Committee (see Annex 1). 2. STATEMENT OF THE CHAIRMAN OF THE EXECUTIVE BOARD
Mr HUSSAIN (Chairman of the Executive Board) congratulated Dr Nakajima on his nomination as Regional Director for a second consecutive term. He drew the attention of representatives to the statement by the Director-General in which he had referred to three specific points that played a vital role in a country's journey to attain an acceptable level of health for its citizens, namely, its encounters with political tension; its fortune with economic recessions; and its ability to establish a viable infrastructure for health. These were realities that came along with additional details. Most of them took the status of good health for granted: its value was usually never realized unless they suffered from an illness. But the important tasks and services performed by doctors and all other health personnel both curative and preventive, had been the actual reality which enabled them to enjoy good health. Perhaps the health sectors of a large number of countries were given such a low priority by their administrations because of this dominant mentality he had just described. It was extremely important therefore for every individual to be concerned about his or her health, and to be aware of good health and the means to attain it. The primary health care approach demanded knowledge and that health should be affordable for everyone. Each person had to become a total partner in this important investment, which brought great returns both to the individual artd to the society. Without a healthy body no one could sustain a healthy mind or enjoy the pleasures of life. Governments were upheld by communities for their own sake. National will and political commitment could only be guaranteed if the individual members of the community could understand their basic needs and accepted them as their direct responsibility. But how were they to do that? How were they to create such an understanding where it did not exist? He said that it was surely not by establishing costly, unmanageable, sophisticated hospitals or by supplying all kinds of medicines to add further confusion. Most dangerou~ly, such confusion created conflict which resulted in mistrust. Although there was not a solution to every problem, there were solutions to many problems. Communication or creation of awareness could also solve many problems. It could teach individuals how to avoid illness. If individuals in a community could avoid illness, they could stay healthy, active and productive. Such a community could take the responsibility of positive development. He stressed the word "positive", since development should not mean the inheritance of problems that had been discarded by others. However, very often the concept and philosophy of development held by many tended to ignore the most basic elements of life: good health, peace and love, or love of all of them. Development therefore should mean efficient management of life without dependency. Similarly, development of health should mean efficient management of a healthy life without dependence on others.
WPR/RC34/SR/3 page 4 3. REPORT OF THE REGIONAL DIRECTOR: Item 9 of the Agenda (Document WPR/RC34/3, Corr.l and Corr.2) (continued from the second meeting, section 2) Promotion of Environmental Health (pages 63-69)
Chapter 10:
Dr XU SHOUREN (China) expressed appreciation of the progress achieved in the last two years in the improvement of the environment, an area which his Government considered of utmost importance for disease prevention and general health improvement, and thus a key factor in the attainment of health for all by the year 2000. Since the founding of the People's Republic of China in 1949, mass campaigns organized by the Patriotic Health Movement had resulted in the eradication or control of many diseases in urban and rural areas. More recently, this Movement had been involved in an important national project related to the United Nations International Drinking-Water Supply and Sanitation Decade (IDWSSD) and the establishment of improved moral, spiritual and material standards. Cooperation between China and WHO was encouraging. A Food Hygiene Act had been approved by the People's Congress and brought into effect two months earlier. The usefulness of the Centre for the Promotion of Environmental Planning and Applied Studies (PEPAS) was generally recognized and he hoped that its work would be extended, with Regional Office support, for the greater benefit of the countries of the Region. Dr TAPA (Tonga) congratulated the Regional Director on the excellent presentation of Chapter 10 of the report. Referring to Section 10.2 "Basic sanitary measures", he said that his Government had given very high priority to environmental sanitation since 1958 when the first cooperative project had been initiated with UNICEF -and WHO. Under the tripartite arrangements WHO had provided technical cooperation; UNICEF had provided one third of the cost of materials; one third of the costs had been borne by the village and one third by the Government, which had also provided local support and encouraged community participation. Whatever success was achieved in the Water Decade would, in reality, be due to the sound basis established by this very successful project. In cooperation with WHO and other United Nations agencies, by January 1983 his country had achieved a water supply coverage of 90% in urban and 80% in rural areas, and sanitation coverage of 90% and 63% in urban and rural areas, respectively. In the urban areas no major problems were foreseen with regard to water supply; the development of rural water supply was in the final stages needed to meet the Decade goals; the extensive damage caused by the March 1982 hurricane was being repaired. Training of village water committees in first level maintenance, operation and repair was required. His Government aimed to meet the Decade goals for drinking-water supply by 1985. However, a major thrust was needed in urban and rural sanitation schemes. Urban sanitation was under study in the main city of Nuku' alofa: the main problems concerned low-lying areas and poor drainage. An important effort was required in rural sanitation for the prov1s1on of proper excreta disposal facilities; the Government would provide the material which would be installed by the community. The Ministry of Health, with WHO cooperation, had drafted a National Sanitation Programme which was awaiting Government decision; however, implementation of this programme would depend on external financing.
WPR/RC34/SR/3 page 5
An agreement had been signed with WHO for a two-part case study covering water supply and sanitation activities, and a pilot project for parasite control through environmental measures. This study, which when completed would surely prove useful to other countries of the Region, had been made possible thanks to the laboratory being constructed with the generous assistance of the Government of Japan and WHO cooperation. The activities of this laboratory would concentrate on water supplies, food hygiene and environmental monitoring. He urged WHO and other United Nations agencies to continue their support to the important area of basic sanitation, and requested governments to influence donor agencies to respond favourably to those countries seeking support in this area. Dr LIU GUO-BIN (Director, Drug Policy, Environmental Health and Health Technology) thanked representatives and their governments for their consistent support of the environmental health programme, including the International Drinking-Water Supply and Sanitation Decade. Valuable lessons could be drawn from the experience described by the representatives of China and Tonga. Source materials and reports were available in the Secretariat and could be consulted by representatives. Dr SIALIS (Papua New Guinea) said that his country was experiencing difficulties in meeting its environmental health goals, particularly in island and mountain communities. 12% of the population of 3 000 000 had safe water and 12% sanitation. The Government had drawn up a nationwide Decade programme. WHO, UNICEF and UNDP, together with Australia and the Federal Republic of Germany, had given valuable help and the World Bank had provided a loan to help finance the Decade programmes in several provinces. The REGIONAL DIRECTOR said that attainment of Decade goals depended on the participation of both governments and peoples. WHO had developed really appropriate technology such as the use of ferrocement for reservoirs and locally made toilets, a material that was durable and reasonably cheap and could be installed by the people themselves with a little advisory help. He felt that the use in this way of appropriate technology developed in the countries themselves was a real breakthrough. Chapter 11: Health Manpower Development (pages 70-89)
Dr SUNG WOO LEE (Republic of Korea) expressed his appreciation of the fellowships programme over the previous two years but asked the Secretariat to explain why the distribution of fellowships in relation to population was so uneven. Dr XU SHOUREN (China) said that health manpower development was of the utmost importance for attaining health for all by the year 2000 through primary health care and his Government was making every effort on its own and in cooperation with WHO to develop health manpower in China. The sending of students abroad on fellowships under arrangements with other countries or international organizations had become an important component of health manpower development and was giving excellent results. It was important, however, that the course of study should be in line with the
WPR/RC34/SR/3 page 6
requirements of the fellow's home country and that when he returned there he should be able to apply what he had learnt, adapting it to local conditions, needs and possibilities. He thought that the meeting to be held later in the year on management and organization of the fellowship programme would be very valuable. Dr TAPA (Tonga) said that the goal of health for all by the year 2000 could only be attained by properly training the human beings called upon to attain it. Tonga had received substantial assistance from WHO in developing health manpower, particularly for the Tonga Health Training Centre. Consultants had reviewed the curriculum and evaluated the results of training. Those trained at the Centre would in future be termed Health Officers, to emphasize the primacy of the public health component over the purely curative aspects. His government greatly appreciated WHO's cooperation in setting up the Centre and also in supporting the School of Nursing, Tonga 1 s other formal health manpower training institution. The progress in health and medicine achieved by Tonga in the previous 25 years would have been unthinkable without the fellowships programme and the country's Director of Health would be attending the Manila meeting already mentioned. Mr BOYER (United States of America) said that the chart "Fellows by profession" did not show clearly the relevance of the types of study undertaken to the needs of primary health care programmes. An attempt should be made in future reports to break down the information in such a way as to demonstrate that relevance. Mr NGUYEN DUY CUONG (Viet Nam) expressed his appreciation of the charts and graphs concerning fellowships and of the ample space given to health manpower development in the Report. He would like more information on the reasons for the very uneven distribution of fellowships in relation to population. The chart showing the distribution of fellows by fields of study revealed that less than 10% of fellows studied subjects connected with environmental health. He believed that the percentage was inadequate, particularly in view of the needs of the United Nations Drinking-Water Supply and Sanitation Decade programmes. I t would be of great utility if the results obtained from the granting of fellowships could be evaluated and made known to Member States. Dr SPOONER (Vanuatu) said that his Government attached particular importance to health manpower development, since after Independence it had been faced with a grave shortage of health manpower, particularly physicians. His country greatly appreciated the help given by WHO and other United Nations agencies and by the Governments bf Australia, Fiji, New Zealand, and Papua New Guinea in offering facilities for the training of Vanuatu nationals. Vanuatu had embarked on its own on the training of nurse practitioners, a category of manpower between nurse and physician level, and had instituted three-month refresher training courses for nurses. WHO had been asked for cooperation in training environmental health officers. A pilot project on primary health care had been launched and seminars and workshops on primary health care would be held early in 1984.
WPR/RC34/SR/3 page 7
Dr CHRISTMAS (New Zealand) said that, because of its geographical isolation, his country had always ~reatly appreciated the WHO fellowships programme as providing very valuable opportunities for contacts with people in other countries. As for who should be sent, the Government believed it best to choose those who were potential leaders, so that what they learnt could be passed on to others directly or indirectly once they returned. It was impractical to send primary health care workers abroad for training. Evaluation of the results of the fellowships programme was difficult but its benefits could be seen in the fellows' conceptual approach to their future work, in their innovative ideas and their enthusiasm. It was important to ensure that fellows applied what they had learnt once they returned home. He congratulated the Secretariat on the commendably clear presentation of all the relevant information on health manpower development. Dr BANZON (Philippines) said that as early as 1980 the Government of the Philippines had started training 100 rural physicians for the implementation of primary health care. In 1982 nine thousand rural midwives had been given training in community organization and development so that they would be able to initiate and develop health activities in the villages they served. In the same year the public health midwives and the rural physicians who were to supervHe the midwives were given training in the concept of primary health care and the management of primary health care activities. The rural health units were integrated with the district hospitals. In 1983 the provincial health offices were integrated with the provincial hospitals with a view to ending the compartmentalization of curative and preventive services. Provincial and assistant provincial health officers were selected on the basis of tests of managerial effectiveness and given training in management. Meanwhile the training of village health workers and other primary health care personnel had been continuing. In addition to the new medical school in Western Mindanao, mention should be made of the community-based Institute of Health Sciences in Tacloban, established earlier, which trained students from remote villages as village health workers, midwives, community health workers and nurses, who later went on to medical college. The country had received cooperation in its training of primary health workers from WHO, UNICEF, the World Bank, USAID and several nongovernmental organizations. Mr LAVEA LIO (Samoa) observed, in response to a point raised by the representative of the Republic of Korea, that the relatively large number of fellowships allocated to Samoa was no doubt due to the fact that his country was among the least developed countries. Dr SIALIS (Papua New Guinea) thanked WHO and donor countries for providing funds for workshops in the field of primary health care development in his country. He was concerned, however, that the health sector was not keeping up with the other major sectors of development. More resources and expertise were needed in the former sector so that the gap did riot widen further. Moreover, while manpower was being trained to provide health services to the people, too little attention was given to teaching the community to appreciate and assume it~ own responsibilities in health matters. That was another area where further action was called for.
WPR/RC34/SR/3 page 8
BIUMAIWAI (Fiji) wished to associate himself with the Dr representatives of other island countries in thanking WHO for all the help it was providing in the field of manpower development. Fiji had reached the stage where it would be cutting down on its recruitment of doctors from overseas, as its 90-year old medical school was now offering a full degree course. The automatic absorption into Government service of medical students from the Fiji School of Medicine would end by 1986, by which date the country would be self-sufficient in health manpower. It was in the support disciplines that Fiji's need was greatest; these would now be taken over by the Institute of Technology. Owing to the excessively high cost of providing dental training, an arrangement had been reached with the Government of Australia whereby Fiji's dental students would as from 1984 be sent to Australia. Although there was a continuing need for expertise for its School of Medicine, Fiji expected to be able to cope with its future manpower requirements. Dr CHANG (Regional Adviser in Health Manpower Development), replying to a question asked by representative of the Republic of Korea, explained that a number of factors were taken into account in distributing fellowships. They included the priorities which each country set in its health programme, the availability of local training facilities and - especially in the case of South Pacific countries - the extent of the shortage of properly trained professional health manpower. In the South Pacific, WHO had been concentrating on long-term fellowships in basic medical training, which explained the large number of fellowships currently held in those countries. From the cost standpoint, the arrangement was particularly economical, most of the fellowships being allocated for training in medical education, dentisty and pharmacy in Fiji. Another important factor in awarding fellowships was the implementation rate of each country. With regard to the question of the distribution of fellowships by profession raised by the representative of the United States of America, he pointed out that primary health care was intersectoral and an integral part of all health activities and that, although the number of fellowships for physicians was relatively high, their training was mainly in the primary health care field. The table on page 80 of the Report gave a more balanced view of the areas of study by holders of fellowships. As to the evaluation of fellowships, to which the representative of Viet Nam had alluded, a survey carried out for the thirty-second session of the Regional Committee in 1981 had shown that 92 per cent. of the fellows questioned believed that their training had been essential or useful to their present activities. Some 83 per cent. had returned to their country of origin and were working in the field for which they had been trained; of the remainder, 9 per cent. were continuing their studies outside their country of origin, 2 per cent. had left the health sector and 6 per cent. had failed to respond to the questionnaire. About 32% had undertaken short-term studies (3 to 6 months), 31% 6 to 12 months and 37% 12 months or longer. 69~ of the fellows had studied in countries of the Western Pacific Region. As the representative of China had mentioned, a regional meeting of national fellowship offic'ers of the Western Pacific Region was scheduled for October 1983, when one of the main topics for discussion would be the utilization of fellowships. That, combined with operation of a new computerized monitoring service, suggested that the evaluation process would in future be much more efficient. At the same time the WHO Executive Board had adopted a new
WPR/RC34/SR/3 page 9
policy towards the conducive to the more increased from about integral part of each
fellowship programme which it was hoped would he efficient utilization of fellowships (whose number had 350 a year in 1979 to between 530 and 560) a~ an country's health manpower development programme.
The REGIONAL DIRECTOR agreed that there were considerable differences among Member States of the Region in the per capita attribution of fellowships. Proportionately, the small South Pacific countries, for example, received more fellowships than the large countries. The Region had one-third of the population of all developing count.ries in the world, but the regional share of WHO's budget was far smaller; thus criteria based on the ratio of fellowships to population were unworkable. The small, recently independent island countries particularly needed fellowships because they were seriously lacking in trained health manpower. Physicians receiving WHO fellowships were equipped to give leadership in health activities based on primary health care, both in government and throughout the country. The proportion of fellows not returning home was very small. WHO was carefully monitoring and evaluating its fellowships programme, in cooperation with countries. The role fellowships played varied from country to country. It was costly to set up medical, or even nursing schools, and some countries found it more cost-effective to send students abroad. When health manpower development was integrated into long-term planning of health services, however, many countries were able to meet a large part of their training needs locally. The WHO Programme Coordinators should be ready to work with governments in planning overall health manpower development, of which the fellowships programme was one component. The CHAIRMAN observed that the WHO fellowships programme was very successful. Much depended, of course, on the countries and on the fellows themselves. Chapter 12: Health Information (pages 90-96)
Dr XU SHOUREN (China) said that the chapter discussed an important subject on which the Region had done considerable work in recent years. Biomedical information was important in determining the population's health status, and in formulating and monitoring health programmes to improve it. He expressed appreciation of WHO's cooperation with his country in the health information field, and proposed that the exchange of health experience among countries of the Region should be increased. The CHAIRMAN, speaking as the representative of Malaysia, said that in the past his country had emphasized person-to-person health information. However, with the adoption of the strategy for health for all, more stress was being placed on obtaining community support. The Ministry of Health had embarked on a programme to make much more use of the mass media. Many components of the health for all strategy depended on community involvement and on drastic changes in practice and attitudes. Great use was being made of the rural radio, since the written press reached and represented the views of those who were already served.
WPR/RC34/SR/3 page 10
Mr HUSSAIN (Chairman of the Executive Board) said that the concept of health information systems came in with the strategy for health for all based on primary health care. Any health information system had an important role both for the servers, to meet the people's needs, and the served, to express those needs. A survey conducted in the Maldives had shown that many people were not even aware of the existing health services that were intended to serve them. Decision-makers in turn needed to be aware of expressed needs in planning services. Mr NGUYEN DUY CUONG (Viet Nam) said that, on the adoption of the regional strategy for health for all, his country had reviewed the structure of its health services. In that process, for which considerable information was needed, it had developed certain indicators, and would like to hear more about the use of health indicators in other countries. Dr DE SOUZA (Australia), referring to section 12.2.1 of the report, on health literature services, recalled that in April 1982 Australia had begun providing a free MEDLARS search and photocopy service to developing countries in the Western Pacific Region under a memorandum of understanding signed by the National Library of Australia, the Australian Department of Health and WHO. The provision of that service was in recognition of the need in the Region for a biomedical information system to assist health and biomedical researchers, planners, teaching staff and practitioners in their work. The agreement had been for an initial period of three years. He was glad to announce that the current agreement for the provision of MEDLARS services was now to be extended by the Government of Australia for a further two years. That extension meant that the current service would continue until 31 March 1986. In the meantime, he supported the steps taken by WHO to investigate the possibility of enlarging the scope of the agreement with a view to establishing a regional biomedical information network. He looked forward to progress in that new and important area of regional cooperation. The REGIONAL DIRECTOR expressed his gratitude to the Government of Australia for the valuable service it was providing, which was now being extended for a further two years. WHO would seek to build up a biomedical information network as a component of the health management process. In reply to the representative of Viet Nam, he suggested that the question of indicators should be discussed under item 13.1. The current status of indicators in the Region was described in the relevant document (WPR/RC'J4/7). Dr TAPA (Tonga) agreed with other speakers in emphasizing the importance of health information systems. As to health information of the public, he was perturbed at the cottlic way in which human beings were depicted in the WHO pamphlet entitled "Health for all - one common goal". Health for all was an achievement of human beauty, and it should be shown as something beautiful. He suggested that WHO should evaluate the impact of the pamphlet and other similar material. The CHAIRMAN noted that "Health management information system development" would be the topic of the Technical Discussions to be held on Friday, 9 September.
WPR/RC34/SR/3 page 11
Cha ter 13: Chapter 14:
Staff Develo The Regional
(pages 97-98) 99-102)
There were no comments. Chapter 15: The Regional Structure (pages 103-110)
Mr BOYER (United States of America) was puzzled by the absence of figures for budgetary obligations beyond the end of 1981 in a report that covered a period up to June 1983. He thought that, as discussion of the 1982-1983 budget had already taken place in the governing bodies of the Organization, figures might have been given also for that biennium. More might have been said about WHO's resources and how they were spent in the Region. Mr KAKAR (Director, Support Programme) replied that the representative of the United States of America would appreciate that only authenticated figures, i.e. those based on the audited reports of the Organization, had been quoted. It might be misleading to quote obligations up to the end of 1983 as if they reflected actual programme delivery. Mr BOYER (United States of America) said that he thought it should have been possible, for example, to add a line for 1982-1983 and even for 1984-1985 in the table on page 108 of the report showing obligations, provided that it was made clear in an appropriate way that they were estimates. The regular budget figure for the Region was likely to be accurate even for the later biennium. Dr TAPA (Tonga) noted that the table in section 15.1.4 showed a total of 33 vacant posts for project staff. He asked why they had not been filled, and whether the gap had affected the technical cooperation programme in the Region. The REGIONAL DIRECTOR replied that WHO's recruitment policy and guidelines imposed limitations, for example, on the number of nationals recruited from any country; and the competency available in a given group of countries was not always easily reconcilable with the needs of recipient countries, i.e. those for whom the staff were recruited. He also mentioned the difficulties created by language barriers. Everything possible was done to fill gaps by moving competent staff around and using those available for shorter periods, but conditions in the field were not always attractive, and fewer nationals were interested in joining WHO in the field than some years earlier. Meanwhile, it was felt to be better to use the mobility of fewer staff than to fill a vacant post with inadequately qualified staff. Dr TAPA (Tonga) expressed concern about the project staffing situation in view of the approach of the year 2000 and the goals WHO had set. He wondered whether the stricter require~ents could not be sotllewhat relaxed.
WPR/RC34/SR/3 page 12
PART II: 1.
Review of selected programmes pages 113-128) control the outlook for
Malaria
Dr SUNG WOO LEE (Republic of Korea) asked what was malaria eradication or control in the Region.
Dr SIALIS (Papua New Guinea) said that malaria was a problem in his country, as was the use of DDT against vectors. He asked what new methods of control could be recommended by WHO, and how measures were to be incorporated in primary health care. Dr XU SHOUREN (China) said that malaria especially with the development of Plasmodium chloroquine. was a pressing problem, falciparum resistance to
Malaria still seriously affected the population in certain areas of China. The epidemic situation was not stable. There were some two million cases annually, and technical cooperation was desirable, especially in research on new drugs. He mentioned the promising Chinese compound, Ching hao su. Dr OGATUTI (Solomon Islands). said that in his country the situation was fluctuating and there were difficulties with ensuring supplies and use of substances for its control. If chloroquine longer effective, what other drug could be recommended, and how soon vaccine be available for practical use? malaria regular was no might a
The CHAIRMAN said that in his country, Malaysia, in spite of concerted efforts against malaria there was an increase in morbidity and mortality in Peninsular Malaysia, and a problem also existed 1n Sabah, although 1.n Sarawak malaria was under control. Chloroquine resistance had developed 1.n some areas, and spraying of houses with DDT was not always acceptable to the population. He expressed fears about the loss of malariologists' expertise; a programme was needed to keep alive the necessary skills and interest in malaria. Primary health care would not be sufficient to control malaria in endemic countries, and the report showed increases in many parts of the Region. Dr NGUYEN DUY CUONG (Viet Nam) said that the current endemic malaria situation required a combination of preventive measures involving the participation of the local population; international cooperation to find a solution to the problem of drug resistance; and technical cooperation to help countries to face the task of malaria control. Dr ROMUALDEZ (Philippines) said that the structure put in place 20 years earlier in the Philippines had not proved effective in eradicating malaria, and there had been a change to a decentralized structure with regional centres and a primary health care approach. Research was directed to new forms of control including biological control, and the population was being involved in community control measures.
The meeting rose at 1200 noon.
WPR/RC34/SR/3 page 13 ANNEX 1
ADDRESS BY INCOMING CHAIRMAN
Distinguished Representatives to the Regional Committee, the Director-General of the World Health Organization, the Regional Director of the Regional Office for the Western Pacific, Representatives of Nongovernmental Organizations and Specialized Agencies of the United Nations, the World Health Organization Secretariat, Ladies and Gentlemen: I wish to take the opportunity to welcome the Honourable Mr M.M. Hussain, Minister of Health, Maldives, currently Chainnan of the Executive Board of the World Health Organization, to this session of the Regional Committee. We are happy that the Honourable Mr M.M. Hussain is able to be with us. I am greatly honoured and I wish to thank the Committee for electing me Chairman of the thirty-fourth session of the Regional Committee for the Western Pacific. My election to the Chairmanship is indeed a great honour to my country. The task that you have placed before me is a heavy, onerous one. I shall do my best to live up to your expectation and to conduct the affairs of this meeting to the standards that have been set by my predecessors. As your newly elected Chairman, I wish to put on record my appreciation to my immediate predecessor, the Honourable Dr S. Tapa of Tonga, for having so ably and understandingly chaired the thirty-third session of the Committee. I wish, also, to welcome and congratulate the new Vice-Chainnan, Dr A.V.P. Ogatuti, the Rapporteur in English Dr E.H.A. Monteiro, and the Rapporteur in French Dr Jose da Paz. I am sure we shall be able to work closely together and do our best in the discharge of our duties. The Chairmanship of an international meeting such as this is not an easy task. However, I am confident that with your kind cooperation and understanding, with the guidance and support of the Regional Director and his staff, and the valuable collaboration of the Vice-Chairman and Rapporteurs, it will be possible for us to carry out the task before us. In September 1981, at its thirty-second session, this Committee rightly set for itself the Regional Strategy for Health for All by the Year 2000. The strategy sets out how this overall goal will be achieved and the underlying principles involved. The realization of this goal is no easy task. Apart from the political commitment that must necessarily exist, the strategy calls for an open-mindedness in our approach, re-appraisal of current programmes, structures, methodologies, resource utilization and manpower development, and a readiness to look beyond medical technologies in solving existing or emerging health and health-related problems. How we should go about it, and what are the most appropriate entry points for such changes will depend upon national circumstances and capabilities. What is obvious is that the countdown has started, and hence there is a sense of urgency in the air.
WPR/RC34/SR/3 page 14 Annex 1
What I am not certain about is whether the message has been adequately driven home both within and outside medical circles. Within the medical profession itself, concern for professional perfection, achievement and quick results, in the face of increasing public expectation, fueled by powerful high cost, high technology lobbies, will render the selection of options more difficult. I am not saying that high cost, high technology medicine has no place in our strategy, or that primary health care is cheap. The question that we should ask is "Within the resources that we have and the capabilities at our disposal, how , do we provide the most for all?" I would like to sugges.t that we require boldness and innovativeness in our approach; unfreezing of established concepts, practices and values; and a sustained power for relentless persuasion and lobby for the changes that are desired. The multi-causation of many illnessess and the increasing importance of disease conditions related to human behaviour, style of life and physical and chemical environment, and the absence of specific .e ffective medical technologies for their treatment or prevention call for an interdisciplinary or intersectoral approach. This demands an ability to manage our boundaries effectively, to recognize interfaces, and to relate to others, when and where necessary. Sometimes the entry point for effectively solving or minimizing health problems may not be the health sector. They may be better dealt with through the educational system, as anti-poverty programmes or as a concerted community movement, with health agencies and administration playing a supportive or catalytic role. The term "opportunist•• is usually used in its derogatory sense. But in our effort to achieve HFA/2000, we may have to take on that role; that is, to search out and recognize opportunities, seize them and exploit them to the full for the realization of the ()Verall goal. To me the biggest challenge that we now face is how to muster yet greater support for our strategy, how to "de-medicalize" some issues hitherto considered exclusively medical domains, how to network with other disciplines and sectors, how to reorganize or restructure programmes and services and thost importantly, how to influence decision makers. In many cases contents are clear, but processes are more complex. Perhaps in progrannnes or projects relating to managerial improvement, greater stress needs to be given to these aspects. In this context, the current thrust and interest in management issues are shared by many national administrations which are becoming increasingly aware of the gap between performance and desired results, between cost and benefit. One of the biggest problems faced by many countries, such as mine, in cost containment is the rising price that we have to pay for so called new or improved technologies, either in the form of skills that have to be acquired; or drugs, materials; or equipment that have to be purchased. Whilst labour cost can be determined locally, many countries have neither enough capability nor enough time for technology assessment, and to a large extent they rely on claims made by manufacturers and vendors. Since the cost of technologies takes up a sizeable proportion of the health bill, any effort to assist countries in making the right choices would, I presume, be most timely and welcome. Such effort could take the form of a regular,
WPR/RC34/SR/3 page 15 Annex 1
sustained and comprehensive exchange of information and experiences, the setting up of an effective technology clearing house, certification by appropriate authorities of countries of origin, increasing support for the development and use of appropriate technologies, and others that would enable countries to get maximum benefit from their investments. I do realize that actions along these lines are going on. But, since the countdown on health for all by the year 2000 strategy has begun, the necessity for these measures appears to become more obvious and critical. This Committee adopted a Regional Strategy for health for all by the year 2000 in September 1981. An agenda item of this current session is "Monitoring of progress in implementing the strategies". I am sure we are going to have an interesting discussion on this agenda item. There is also the Report of the Regional Director for the year 1981/1983. Without appearing to be pre-empting or unduly influencing discussion on these two matters, I think it is correct for me to say that the Regional Strategy is gradually having an effect on both international and national activities. That we have been able to do this in a short period of two years is a measure of our commitment and a tribute to the Regional Director and his staff to whom, if I may, I wish to extend a very warm appreciation and thanks. I would be failing in my duty if I did not make reference to Dr Mahler who is here with us today. As you know, Dr Mahler is the driving force behind the global strategy for health for all by the year 2000 and, listening to him speak or reacting to comments from the floor at the recent World Health Assembly or following his worldwide activities, I cannot but admire his forcefulness, dynamism and relentless conunitment in pursuit of our goal. There is a lot more that needs to be done. This meeting is part of a continuing dialogue. I look forward to a fruitful exchange of views and experience during this week so that we can be informed of various problems that confront us. Some of these may have serious implications in the implementation of the strategy. But I have no doubt, given your wisdom and understanding, and with your cooperation, we will be able to tackle them effectively. I now wish you every success in your deliberations. Thank you.