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WORLD HEALTH ORGANIZATION
ORGANISATION MONDIALE DE LA SANTE
REGIONAL OFFICE FOR THE WESTERN PACIFIC BUREAU RtGIONAl DU PACIFIQUE OCCIDENTAL
REGIONAL COMMITTEE Twenty-eighth session Tokyo 6-12 September 1977 Provisional agenda item 17
WPR/RC28/l0 30 June 1977 ORIGINAL: ENGLISH
TECHNICAL COOPERATION AMONG DEVELOPING COUNTRIES
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1.
INTRODUCTION
1.1 Technical cooperation among developing countries (TCDC) has emerged as a major trend in international social and economic cooperation during recent years. For the World Health Organization, technical cooperation signifies activities that have a high degree of social relevance for Member States, in the sense that they are directed towards defined national health goals and that they will contribute directly and significantly to improvement of the health status of their populations through methods that they can apply now and at a cost they can afford now. The Organization is committed to develop national self-reliance in matters of health by cooperating with countries and fostering cooperation among countries in ways which are relevant to the population. 1.2 Following discussions in the UNDP Governing Council, the United Nations Economic and Social Council and the United Nations General Assembly, the WHO Executive Board adopted resolution EBS7.RSO on TCDC, underlining the need to work out practical measures in the health field. l The World Health Assembly subsequently endorsed the Board's proposal in resolution WHA29.4l and singled out TCDC as an area requiring the Organization's full collaboration through the regional committees and regional offices. 2 The Regional Committees for the Americas, the Eastern Mediterranean and the Western Pacific subsequently adopted similar resolutions. 3
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lWHO Handbook of Resolutions and Decisions, Vol. II (2nd ed.), 1977, p. 13.
2 Ibid •
3Resolutions XXIX and XL of the XIX Pan American Sanitary Conference, 1974; resolution EM/RC24A/R.7 of Sub-Committee A of the Regional Committee [or the Eastern Mediterranean, 1974; and resolution WPR/RC2S.Rll (Hand hook of Resolutions and Decisions of the WHO Regional Committee for the y,'estern Pacific, Vol. I, 1976, pp. 167-168).
WPR/RC28/1O page 2 1.3 A report l was submitted to the sixtieth session of the Executive Board in May 1977 in accordance with resolution EB59.R52,2 reviewing the policy background of TCne and the preparations for the World Conference on TCne which is being organized by the United Nations in Buenos Aires in March 1978. It also reviews the action taken by WHO through, for example, setting up Tcne focal points in regional offices and a central point in the Regional Office for the Americas/Pan American Sanitary Bureau. A copy of the resolution adopted by the sixtieth session of the Executive Board 3 following discussion of this document is attached as Annex 1. 2. PRINCIPLES AND OBJECTIVES
The following principles and objectives may be borne in mind in considering a plan of action for TCDC: 2.1 Appropriate technology
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In the field of TCne, emphasis must be placed on the realistic sharing of appropriate technology to tackle the enormous problems faced. Technology used in one country is by no means necessarily applicable to another country in different circumstances; highly sophisticated methodology is not necessarily suitable for developing countries. This factor is of paramount importance to the Organization in considering a plan of action, since TCne can constitute an admirable vehicle for the development of appropriate technology by the developing countries themselves; TCDC can be a means of providing low-capital cost and effective technology which meets the critical needs of the developing countries and at the same time enhances their individual and collective self-reliance. The delivery of essential health care requires appropriate technology which people can understand and which the non-expert can apply. This has direct relevance to primary health care and hence to rural development in general. Primary health care, which is one of the Organization's priority mandates, offers exemplary prospects for technical cooperation with international support and broad TCne ramifications. Major reorientation and adaptation of existing health services, including immunization and nutrition programmes - are required by each country, which will evolve its own formula; at the same time each country should be able to profit from the experience and knowledge of other countries at a comparable level of development. 2.2 Water supply and waste disposal systems
Another area of activity which is of crucial importance is the provision of adequate and safe water supply and waste disposal systems. Without these, de/2loping countries cannot hope to advance fully or adequately to control gas trointestina 1 infections, While this s ti 11 reql1 i 1
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Document EB60/7, 16 May 1977.
2WHO Official Records, No. 238, 1977, p. 33, 3Resolution EB60.R4, 24 May 1977.
WPR/RC28/10 page 3
substantial input from international agencies and developed countries, the latter should be encouraged to concentrate, in making their input, on low-cost technology and to make use of the qualified experts and firms available in the developing countries that will have to bear the burden of the work. In this respect TCne has a major role to play in sponsoring the establishment of firms which can master and apply the lowcost environmental health technology needed. 2.3 Manpower development
The development of health manpower including the training of junior professionals in the developing countries is a third major area of activity. For WHO, training is central to development and its planning must be part of national health programme development. The training of all categories of health personnel must be orientated towards greater self-reliance, taking into account the priority health needs of the developing countries and enabling them to equip themselves to solve the specific problems confronting them. Tcne approaches should be explored persistently and tried out in every training and education programme, seeking to apply new techniques and to make increased use of national training centres which can be recognized in the regions as being effective, attractive and suitable. If TCne succeeds in this aspect alone, it would constitute an important achievement in human endeavour. 3.
ACTION PROPOSED AT REGIONAL AND SUBREGIONAL LEVELS
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3.1 Stress should be laid on ways and means of facilitating collaboration among developing countries through regional and subregional arrangements. This is a crucial point for the future, if only to open the way for association among governments and the pooling of technical resources as pointed out to the UNDP Governing Council. l Such subregional groups should receive continuous encouragement and support from the international organizations which, by their nature, have a multicountry cooperative mandate. 3.2 There have been various forms of cooperation in the health sector at multicountry and subregional levels. For example, bilateral cooperation has been a common practice in the Americas, with the conclusion of agreements in fields such as food and nutrition, control of communicable diseases including zoonoses, and health manpower. These TCDC activities are implemented through intercountry programmes and multinational centres. Three groups of countries have concluded agreements for subregional technical cooperation, with WHO providing support at their request; initiatives for activities are multiplying as the countries' institutional structures crystallize while the ministers of health hold annual meetings to discuss matters of common interest and to implement activities which are TCne by nature. The five countries in the Association of South-East 1
UNDP document DP/69, adopted at the UNDP Governing Council's eighteenth session (June 1974) and amended at its twenty-third session (January 1977).
WPR/RC28/l0 page 4
Asian Nations (ASEAN) are developing common health objectives and programmes, also with WHO collaboration. In the Eastern Mediterranean Region, the Council of Arab Ministers of Health and the Council of Ministers of Health of the Gulf States are moving in the same direction. 3.3 The role of the WHO regional committees is important in stimulating TCDC arrangements among the developing countries. Moreover, the committees are a natural forum for discussing regional activities and promoting a better understanding of the objectives of TCDC. It is therefore suggested that the Regional Committee discuss TCDC in depth so that it can play a more active part in designing the programmes of the Western Pacific Region along TCDC lines. A subcommittee on TCDC might be established to advise the Regional Committee on practical approaches to be adopted in this respect. At the same time, the Regional Committee could contribute in reviewing many of the problems which will arise in connexion with TCDC including the political, legal, commercial and other adjustments which may have to be made. 3.4 The WHO regional offices, having direct connexions through the WHO country network with governments and the field offices of UNDP and other agencies, constitute another asset. This structure allows present and future activities to be reviewed and reorientated towards TCDC, taking due account of technical constraints and working out practical ways of weaving TCDC concepts into the canopy of the total programme seen from both the country and the intercountry standpoints. This will necessarily involve the development of new operational guidelines for the promotion of TCDC. Continuous dialogue is taking place between WHO's intergovernmental committees and the regional offices. The Regional Office for the Western Pacific has already been designated a focal point for TCDC, with specific responsibility for programme matters on the one hand and TCDC/ INRESl on the other. 3.5 The Organization would welcome more emphasis being placed on the essential role of the developing countries in designing and using appropriate local technology. Two examples in the health field will illustrate the fundamental importance of the regional and subregional levels in TCDC: 3.5.1 The expanded programme on immunization lays emphasis on activities in the developing countries, where it is estimated that less than 10% of the 80 million children born each year are being immunized. The programme involves direct action at the country level, with WHO cooperation, in formulating plans for vaccination programmes including the procurement of vaccines. The programme seeks to reduce the dependence of the developing world on developed countries to meet its vaccine needs. But vaccine production in developing countries is naturally dependent on the transfer of technology and a strategy should therefore be evolved for this purpose by the developing countries, with the collaboration of WHO and bilateral and multilateral agencies as appropriate. In view of the limited needs for vaccine in many countries, vaccine production need not take place in ;
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lUNDP Information Referral System for Technical Cooperation among Developing Countries.
WPR/RC28/10 page 5/6
all of them; instead regional production centres could be established, involving agreement and collaboration among the countries. The provision of cold chains is an important requirement for which sound but inexpensive techniques are being tested at Kumasi University in Ghana. TCne is a logical approach for these activities. 3.5.2 Drug policy and management has direct TCne implications for developing countries in their efforts to determine which drugs they really need for their health delivery systems, whether to import them or try to produce them locally, and how to ensure that the needed drugs reach the consumer in usable form. Work has begun in formulating general principles and criteria for the selection of essential drugs, taking into account the resources of western and traditional medicine, and a list of 150 such drugs has been established. Activities in this area will involve the development of national and regional capacity for drug production, while ensuring that they complement the drug studies carried out under the WHO Special Programme for Research and Training in Tropical Diseases. WHO has initiated negotiations with various United Nations agencies on this subject and an UNCTAD/m~IDO/WHO task force has been set up to explore ways of promoting TCne in the drug field. A tentative programme on drug poliCies and management is being drawn up for countries in South-East Asia and it is hoped that a similar programme will be developed in the Western Pacific Region. 3.6 The creation or expansion of centres of excellence in the developing world is of vital importance and should be a routine function in the TCDC process. 3.7 Further, every use should be made of collaborating centres specialized in different technical fields to support training and research in the developing countries. The multiplication of such centres is a basic TCDC objective and WHO, in its international role, sees itself as a proper vehicle for promoting their use and financing the exchange of staff between them. 3.8 With regard to training through fellowships and other means, WHO believes that a number of obstacles will have to be overcome such as the limited training facilities and capacities of the developing countries, language barriers, attitudinal barriers and legal obstacles to the recognition of educational programmes and institutions in developing countries. In the meantime every effort is being exerted to develop regional teacher training centres in the health field, located in developing countries. 4. CONCLUSION
The Regional Director would welcome the views of the Regional Committee on the above recommendations and on ways by which WHO can best attain the objectives of TCDC. He invites the Regional Committee to consider the establishment of a subcommittee to advise on practical approa~hes to be.adopted in the development of TCDC for his guidance, and to reV1ew period1cally the issues which will arise including the political legal, commercial and other adjustments which may have to be made. '
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ANNEX 1 II
RESOLUTION OF THE EXECUTIVE BOARD OF WHO
Sixtieth Session
EB60.R4 24 May 1977
TECHNICAL COOPERATION AMONG DEVELOPING COUNTRIES The Executive Board, Having considered the report on technical cooperation among developing countr1es (TCDC) submitted by the Director-General in accordance with resolution EB59.R52; Noting with satisfaction the action taken by WHO to collaborate with UNDP and other organs in furthering the concept of rCDC in compliance with the resolutions of the United Nations General Assembly and the Economic and Social Council and with resolution WHA29.4l; Recalling resolutions WHA28.75, WHA28.76, WHA29.48 and WHA30.43 on the principles governing technical cooperation with developing countries; Welcoming the progress already made by developing countries in achieving self-reliance in health matters through cooperation for health development in the spirit of resolution EB57 .R50; Reiterating the importance for WHO to establish adequate methods and arrangements to facilitate cooperation among developing countries for the attainment by all their citizens by the year 2000 of a level of health that will permit them to lead a socially and economically productive life; 1. NOTES with satisfaction the report of the Director-General and the action already taken to promote TCDC in WHO; _ 2. ENDORSES the proposals contained in this report for future action by WHO to promote and implement TCDC; 3. REQUESTS the Director-General to promote the implementation of these proposals in WHO's activities and programmes in the light of the discussion on them in the Board and to ensure that they are brought to the attention of the Regional Committees at their next sessions; 4. REQUESTS the Regional Committees to study these proposals and to examine further ways of promoting TCDC for health development as appropriate to the region; 5. RECOMMENDS active WHO participation in the preparatory activities for and in the deliberations of the World Conference on TCDC being organized by the United Nations in Buenos Aires in 1978; 6. URGES all Member States and particularly governments of the developing countries to give priority attention to TCDC principles and approaches in their health and related programmes, making use, as necessary, of the support of the Organization in its coordinating role in furthering technical cooperation among the developing countries; and 7. INVITES all Member States to participate actively in the Technical Discussions on technical cooperation in the field of health among developing countries to be held at the Thirty-second World Health Assembly. Fourth meeting, 24 May 1977 EB60/SR/4 1 Document EB60/7. . 1
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