Joint Meeting of the Western Pacific Advisory Committee on Health Research and the Directors of Health Research Councils or Analogous Bodies, Manila, Philippines, 1-5 August 1994 : report

(WP)RPD/ICP/RPD/00 1-E Report series no.: RS/94/GE/21(PHL)

ENGLISH ONLY

JOINT MEETING OF THE WESTERN PACIFIC ADVISORY COMM ilTEE ON HEALT H RESEARCH AND THE DIRECTORS OF HEALT H RESEARCH COUNCILS OR ANALOGOUS BODIES

Convened by the REGIONAL OFFICE FOR THE WESTERN PACIFIC OF THE WORLD HEALT H ORGANIZATION Manila, Philippines 1-5 August 1994

Not for sale Printed and distributed by the Regional Office for the Western Pacific of the World Health Organization Manila, Philippines September 1994

NOTE

The views expressed in this report are those of the members attending the meeting and do not necessarily reflect the policy of the World Health Organization.

This report has been prepared by the Regional Office for the Western Pacific of the World Health Organization for governments of Member States in the Region and for the participants in the Joint Meeting of the Western Pacific Advisory Committee on Health Research and the Directors of Health Research Councils or Analogous Bodies, which was held in Manila, Philippines, from 1 to 5 August 1994.

CONTENTS

SUMMARY 1. INTRODUCTION .......... ..... ....... .... .. ................ .... .. .................. .................. 1 1.1 1.2 1.3 1.4 2. Objectives .................. .................. .................. .................. .................. 1 Participants and resource persons .................. .................. .................. ....... 1 Organization .. .................. .................. .............. .................. ................. 1 Opening ceremony .................. .................. .................. .................. ....... 1

PROCEEDINGS ... ... ................... ................. .. ... .................. .. .................. ... 2 2.1 Topics considered in plenary sessions .................. .................. ..... .... .... ..... .. 2 2.2 Topics considered by the WPACHR .................. .................. ........ ........... 15 2.3 Topics considered by the Directors of HRC/AB .................. .... ................ .. . 19

3.

CONCLUSIONS AND RECOMMENDATIONS .. ...... .. ...... .. ................ .. .......... 22 3.1 Policy .......... ... .................. .................. .................. ........... ............... 23 3.2 Programme-specific research .................. .................. ......... ....... ...... ..... .. 24 3.3 Strengthening research capability, coordination and management. ........ ..... ...... 25 ANNEXES: ANNEX 1 - LIST OF MEMBERS, CONSULTANT, OBSERVER, REPRESENTATIVE AND SECRETARIAT ................. ... .... ....... 27 ANNEX 2 OPENING ADDRESS OF THE REGIONAL DIRECTOR FOR THE JOINT MEETING OF THE WESTERN PACIFIC ADVISORY COMMITTEE ON HEALTH RESEARCH AND THE DIRECTORS OF HEALTH RESEARCH COUNCILS OR ANALOGOUS BODIES .................. 33

ANNEX 3 - PROVISIONAL AGENDA .................. .. ... .............. ................ 35 ANNEX 4 - REPORT OF THE SECRETARY OF THE WESTERN PACIFIC ADVISORY COMMITTEE ON HEALTH RESEARCH ................... ......... . ..... .. .. ... .............. .. ... ... ........ 37

Keywords Health services research I Technical cooperation I Western Pacific I Philippines

SUMMARY

The Western Pacific Advisory Committee on Health Research (WPACHR) held its fifteenth session in Manila from 1 to 5 August 1994 as a joint meeting with the Directors of Health Research Councils or Analogous Bodies (HRC/AB). One objective for both groups was the strengthening of national research capabilities. Other objectives were: WPACHR (1) (2) (3) (4) and to review recent developments in health research; to consider future direct~ons

for research in priority areas;

to review the recommendations as formulated by its subcommittees; to establish close contacts with the national bodies engaged in health research;

(5) to conduct further collaboration among WPACHR, national HRC/AB and WHO collaborating centres. HRC/AB (1) to review the present status of national systems for the organization, development, management and coordination of health research; (2) to develop a mechanism for cooperation in health research to facilitate implementation of the strategies for health for all; and (3) to promote the establishment of a single national focal point for the effective management and coordination of health research. The members of both groups met in plenary session to consider a range of discussion papers and reports on aspects of health research in the Western Pacific Region. In addition to reports from the Western Pacific and Global Advisory Committees on Health Research, these includ·ed the role of the universities and other professional bodies in national health research efforts, models for the setting of research priorities, research needs in the field of health of the elderly, the programme of the WHO Regional Centre for Research and Training in Tropical Diseases and Nutrition, and the role of WHO collaborating centres in national health research efforts. Eleven country reports from HRC/AB were considered by the joint meeting; the need to develop a strategic plan for research development was also discussed. The WPACHR gave separate consideration to research aspects of five global programmes (ARI, COD, GPA, HRP, TOR) on the basis of reports covering the 1992-93 biennium. The directors of HRC/AB discussed networking among health research managers, the funding of research, the relationship between WHO and national research programmes, training for research, and information transfer. Recommendations relating to these topics were confirmed by all participants and a full list of recommendations from the joint meeting follows (pages 22-26).

1. INTRODUCTION

1.1

Objectives Western Pacific Advisory Committee on Health Research (WPACHR) (1) (2) (3) (4) (5) and to review recent developments in health research; to consider future directions for research in priority areas; to review the recommendations as formulated by its subcommittees; to strengthen national research capabilities; to establish close contacts with the national bodies engaged in health research;

(6) to conduct further collaboration among WPACHR, national HRC/AB and WHO collaborating centres. Health Research Councils or Analogous Bodies (HRC/ AB) (1) to review the present status of national systems for the organization, development, management and coordination of health research; (2) to develop a mechanism for cooperation in health research to facilitate implementation of the strategies for health for all; (3) to promote the establishment of a single national focal point for the effective management and coordination of health research; and (4) 1.2 to strengthen national research capabilities.

Participants and resource persons

The total number of participants at the meeting, excluding secretariat staff, was 26. The list of members, the consultant, the observer, the representative from Global ACHR and the secretariat is attached as Annex 1. 1.3 Organization

The meeting was convened in the Conference Hall of the Western Pacific Regional Office (WPRO) in Manila, Philippines. This was the fifteenth meeting of the Western Pacific Advisory Committee on Health Research, and was held as a second joint meeting with the Directors of Health Research Councils or Analogous Bodies. 1.4 Opening ceremony

The Regional Director, Dr S.T. Han, in his opening address, welcomed all participants and guests including in particular the secretariat members from WHO Headquarters, Dr Mansourian, Director of the Office of Research Policy and Strategy Coordination and

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Dr Hashmi of the Special Programme for Research and Training in Tropical Diseases; Dr Tripathy, Director of the Research and Family Health Division of the South-East Asia Regional Office; Dr Jegathesan, Deputy Director-General for Research and Technical Support, Ministry of Health, Malaysia; and Dr J. V. Hodge, consultant for the meeting. For the benefit of new members, Dr Han stressed the importance of the committee, which he regarded as his main source of advice on research needed to implement priority health programmes in the Western Pacific Region. He then drew attention to the need for a review of research strategy in the Region and pointed out that the approach should now be towards solving health problems in sustainable ways through health promotion and health protection as well as curative measures. Although it was not certain that new challenges to health would be faced in the twenty-first century, strategic changes at this stage would enable WHO to respond quickly and effectively to these challenges. Dr Han asked participants to think carefully about areas of research for the future and to provide him with clear and practical recommendations, able to be applied immediately for the benefit of the Member States. Financial constraints meant that only priority areas could be considered for support at this time. He noted that the meeting would be discussing the role of the WHO collaborating centres and pointed out that greater use of the centres might provide a cost-effective approach to the provision of technical expertise for research programmes. This expertise might also be available from universities and other centres of excellence. Dr Han welcomed the involvement of the Directors of Health Research Councils or Analogous Bodies and noted that they also provided a valuable source of expertise for the meeting. He wished members a successful meeting. The full text of the Regional Director's address is attached as Annex 2. The meeting nominated Dr A. Herrin as Chairman, Dr B.A. Scoggins as Vice-Chairman and Dr Shanta Emmanuel as rapporteur. Following the opening ceremony the provisional agenda was adopted after minor changes to the order of presentations to the HRC/AB group (Annex 3).

2. PROCEEDINGS

This section is arranged according to whether the topics were considered by members of WPACHR, the Directors of HRC/AB or both groups in plenary session. The plenary session is presented first. 2.1 2.1.1 Topics considered in plenary sessions Report of the Secretary ofWPACHR

Dr A. Shirai, secretary of WPACHR and currently working with the Regional Research Promotion and Development (RPD) programme, presented a report on the Regional research programme during the previous two years. For the benefit of new members he summarized the history of WPACHR over the 18 years since its formation and of the HRC/ AB group which had been meeting from time to time over the past 14 years. The meeting in 1992 had been the first occasion on which the two groups had met together and the benefits had been sufficiently clear to justify repetition of this arrangement at the present meeting.

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Dr Shirai reminded participants of the objectives of the meeting of both groups and pointed out that the resources available to the RPD programme had been limited. This meant that support was only possible for high priority research of a focused and practical nature. Twenty research proposals costing US$236 802 were supported during the two-year period, the details of these being set out in Dr Shirai's paper. A two-week national workshop on research design and methodology had been held in VietNam in 1993, bringing the total of such workshops to 15 since they were initiated in 1981. The manual "Health research methodology: A guide for training in research methods", had been translated into the Chinese and Vietnamese languages and the right to translate and print the manual in the Croatian language had also been granted. Thirteen research training grants were awarded during the period. Dr Shirai went on to give details of the 214 WHO collaborating centres within the Region and the efforts now being made to improve communication between them through meetings of the heads and other mechanisms. Information was also provided on the activities of the WHO Special Programmes in the Region. During the 1992-1993 period the Special Programme of Research, Development and Research Training in Human Reproduction (HRP) had supported 496 research projects and institution strengthening grants within the Region at a cost of about US$3.65 million. The Special Programme for Research and Training in Tropical Diseases (TDR) had supported 142 projects during the same period, costing about US$4 million. Dr Shirai then pointed out that WHO had encouraged Member States to develop research councils or analogous bodies to coordinate their research activities and serve as a focus for WHO. Focal points for this purpose had been established in 12 countries of the Region, these being Australia, Brunei Darussalam, Fiji, Lao People's Democratic Republic, Malaysia, New Zealand, Papua New Guinea, Philippines, Samoa, Singapore, Solomon Islands and VietNam. Finally, Dr Shirai drew the attention of participants to the actions which had been taken in response to the recommendations from the previous meeting, as set out in Section 5 of his report. A number of matters were raised during the general discussion which followed the presentation. With reference to the item in the report on oral health research a comment was made that new dental equipment was to be tested in Fiji and that a new restorative process using a glass polymer fissure sealant showed promise and was being offered for use in a number of countries in the Region. The basis for selection and approval of research projects was questioned and it was noted that some 80% of applications for grants were currently approved, the relevance of the topic to priority areas being given greater weight than the cost of the project. The availability of progress reports on ongoing research was questioned and the Secretary undertook to provide these on request as they became available. Some disappointment was expressed at the lack of action by WHO on the first of the general recommendations from the previous meeting, i.e. the establishment of a task force to determine a strategic plan for health research in the Region during the next five years. This was still seen as an essential step towards the provision of advice to the Regional Director on research requirements in the Region and it was noted that the strategic plan could, if necessary, be developed incrementally, by a process of consultation with each Member State in turn. The process would serve as a useful guide to future action, both by WHO and by the countries themselves.

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Representatives from South Pacific island countries referred to the lack of WHO involvement in their research programmes until the 1991 subregional meeting on health research management and hoped that the situation would improve in the future. Dr Shirai was thanked for his presentation. The discussion had been useful in highlighting the achievements of the regional RPD programme and pointing to areas where further action was needed, such as the development of a strategic plan for research priorities at both country and regional levels. A recommendation on the strengthening of the RPD programme was confirmed (see page 23). 2.1.2 Global Advisory Committee on Health Research (GACHR) A report on some of the matters considered at the 31st session of the GACHR was presented by the secretary of the committee, Dr Mansourian, who apologized that the outgoing Chairman of the committee, Professor Gabr, had been delayed and was unable on this occasion to join in the presentation. He drew the attention of participants to a new report on health research strategy developed by GACHR, which extended the work previously done by the committee and was published last year under the title "Research for health - Principles, perspectives, and strategies". The scope of the document was revealed by the headings of the major sections, which included such topics as health needs as a guide to research needs, relevance of the economic environment to health, global problems and global solutions, the changing scene of science and technology, assessing needs and fitting research priorities and research-capability strengthening. Dr Mansourian then referred to some sections of the document in greater detail. In the section on relevance of the economic environment it was pointed out that the health consequences of structural adjustment may be adverse in either direct or indirect ways, the latter being the result of either deterioration of health services or lower rewards and incentives for personnel in the health sector. Research was needed on the effects of adjustment and of various economic factors on health. At a global level, population growth and demographic shifts remained a priority issue, with the world population expected to exceed 7 billion by the year 2010. Rapid change in the age structure of the population was also occurring. Issues such as the finite nature of natural resources, energy usage, environmental pollution and food supply were of increasing importance. The report also drew attention to the linkages between health, science and technology and the overall process of development. The developed countries should be encouraged to spend more on research to alleviate problems in the developing countries, since some 95% of available research resources are currently spent in the developed countries. Ethical issues remain prominent and new biotechnology has become a source of significant new ethical problems, such as the wish of private companies to commercialize advances in biotechnology. This was well illustrated by current research on the human genome. Human rights could be infringed by misuse of genetic diagnosis for employment-related, or insurance-related, purposes. Dr Mansourian referred to various strategies which could assist research capability strengthening. Above all, greater visibility and greater commitment were needed. He concluded by indicating that severe constraints in financial, material and human resources needed to be addressed through better methods of policy analysis, planning and research, the latter needing to be multisectoral in nature.

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In the discussion of Dr Mansourian's presentation it was agreed that health research councils play an important part in the implementation of strategies to deal with new health problems. In fact, their mandate often includes a role in the preparation and implementation of national health research strategies. In this regard they could be helpful to the GACHR and it was disappointing to note that the links between the GACHR and the research councils were insufficiently formalized. Dr Mansourian agreed with this comment and hoped that more systematic representation from HRCs would be phased in as the membership of GACHR changed in the coming years. In response to an ethical question on biotechnology and the use of fetal tissue, Dr Mansourian drew attention to the role of the Council for International Organizations of Medical Science (CIOMS), which deals with such ethical issues on behalf of WHO. Numerous CIOMS reports were available on ethical matters. Since economic questions were so closely linked with health issues, a question was raised as to whether WHO should be concerning itself more closely with such issues, e.g. the designing of health insurance. Dr Mansourian agreed that WHO should be advised to build up its expertise in this area and not rely only on expertise from other organizations such as the World Bank. As an outcome of this discussion, recommendations were finalized dealing with the need for WHO to take a broader and more multidisciplinary approach to policy and priority setting and recommending that research councils should be represented in a more systematic way on the GACHR (see pages 23 and 26). 2.1.3 efforts Role of universities, academic and professional bodies in national health research

This paper was presented by Dr A.N. Herrin. Dr Herrin pointed out that research-based policy-making needed three ingredients: (i) an appreciation by policy-makers of the value of scientific research and analysis in making policy decisions; (ii) a willingness by researchers to undertake quality research and analysis on a wide range of policy issues; and (iii) the establishment of mechanisms to formalize the interactions between policy-makers, researchers and other stakeholders in the health sector. Universities, academic and professional bodies could perform several roles in regard to research-based policymaking. These include: (i) synthesizing policy-relevant research for policy formulation; (ii) undertaking policy research and analysis on priority health issues; (iii) developing and maintaining policy relevant information and retrievable data for health policy analysis; (iv) training researchers and policy-makers in relevant skills disciplines and issues; (v) providing technical assistance to policy-makers, researchers and trainers; and (vi) serving as a forum for policy discussion and exchange among policy-makers, programme managers, researchers and trainers. It was useful, however, to view these roles within the context of health policy development, particularly in the strengthening of support systems to sustain the health policy process. In order for universities, academic and professional bodies to effectively perform the roles ascribed to them it was seen to be essential that they continue to build and maintain their capacity for research training and technical assistance. Recent international thinking on this issue had provided clear leads on how this capacity building could be achieved. There was active discussion of Dr Herrin's paper, with an emphasis on the reasons for tension and dislocation between policy-makers and the academic community and on ways in which these might be overcome. On this issue, it was noted that confrontation between researchers and policy-makers in the health sector was often less severe than in other sectors since they held in common the goal of improved health for all. Examples of successful

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interaction between policy-makers and health scientists on particular health issues were given by several members. Formalizing the methods for interaction was important but the value of informal interactions should not be underestimated. Health research councils could play an important role as broker between policy-makers and researchers, both by facilitating interaction and by funding research on health policy issues. It was important that the research in the field should be multidisciplinary in nature. Academic thinking on involvement with policy issues was becoming less rigid and it was noted that in Australia one criterion for assessing the performance of universities was their ability to cooperate successfully with industry. There remains the problem that freedom to publish the results of research was of paramount importance to academics, which would continue to cause difficulties in the case of some policy research of a sensitive nature. It was considered that the research programmes of academic institutions should ideally achieve an even balance between disciplinary and policy-making research. Each type deserves recognition and equal status, although mechanisms for assessment and reward might differ. A final point made was that it may be a frustrating task for researchers to assist in the process of transfer of new research results to policy-makers, as they were not usually encouraged or funded to do this. However, costs related to this transfer had to be met realistically if research resuits were to be useful in the policy-making process. HRC/AB might assist at this stage of the process also. 2.1.4 Priority setting for health research

This paper was presented by Dr B.A. Scoggins. He pointed out that pressures to achieve national health goals and the finite nature of resources for research made priority setting necessary in all countries. He suggested a framework and strategic plan for health research programmes, leading stepwise from the generation of resources for research to the management of these resources, the conduct of research in priority areas, the production and implementation of research results and the generation of new knowledge. This knowledge forms an essential part of the base for the next phase of research development. Another way of describing this cycle of events is that research activity leads to management information, which in turn leads to programme evaluation, policy formulation and the development of national priorities. From these come strategies, research and development (R & D) programmes, funding procedures and thus new research activity. Unfortunately, researchers in some countries are able to interrupt this loop by interacting directly with funding agencies and gaining support for research which has not been planned via the priority setting process. Many factors interact to give a project its priority status. Essentially these are the result of a balance between the strategic importance and research "leverage" of the topic. Quoting from the United States Congress Dr Scoggins indicated that priority setting should not be undertaken primarily as a response to tight funding, which would entrench existing disciplinary boundaries and focus on funding as a major determinant in the national research effort. The challenge to both policy-makers and the scientific community is to learn how to allocate resources in a manner that advanced scientific knowledge at the same time as it addressed priority issues. Policy-makers need to be asked two types of questions: (i) for a given national goal what research is most necessary? and (ii) what mechanisms for administering, performing and evaluating research would create optimal pathways from research to goal attainment?

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Dr Scoggins then listed several criteria for the setting of health research priorities, these being grouped as relevant to national health goals on the one hand and research issues on the other. In the first category are the importance of the health issue, its relationship to inequalities of health status and its relevance at a national level. In the second category are the likely impact of the research, the available research capacity, the ability to capture benefits of research in a timely fashion and the relationship of proposed new research to research already carried out. Some alternative models of the priority setting process were described, including the technique of foresight dialogue, as used by the Wellcome Trust in London, the Delphi technique, and the more traditional problem-based approach. Dr Scoggins finally noted that it was easier to rank and identify priorities than to allocate dollars between them. The presentation by Dr Scoggins provoked a lively discussion. The first point was that priority research should not be carried out only by people with a proven track record, otherwise trainees would not be able to enter the system. This aspect could be dealt with by involving young scientists in a team approach or by the use of special training grants for research on priority topics. The likely use of research findings should be an essential part of the planning process to avoid wastage of resources on research which would not be implemented. At the same time, some investment and effort were needed at the implementation stage to ensure that this process was completed successfully. The importance of regular monitoring and evaluation of implemented policies was also stressed, the point being made that programmes without built-in provision for their own evaluation were at best deficient and at worst irresponsible. As expected, different factors were used to determine health research priorities in different countries of the Region; the important thing was that the process in each case should be open and transparent, with wide consultation, to facilitate acceptance by all interested groups. The need for timeliness in the conduct of priority research was stressed. Developing countries were seen to have particular problems in relation to priority setting, since their managerial structures and research capabilities were often weak and since the interests of external donor agencies frequently distorted the priority setting process. In such countries the priorities for research might initially need to be structural rather than thematic: for example, a first priority might be the building up of the research capability needed to investigate a particular health problem, rather than the priority being the health problem itself. In summary there was clear agreement that priorities must be set and that this process would continue to differ in detail in different countries. The priority setting process needed to be transparent, with adequate consultation. Constraints in some countries made the process more difficult and these themselves need to be addressed as a priority issue. The process of priority setting should also be timed correctly in order to be most effective in terms of the setting of national health goals. Priorities should address both health and larger socioeconomic issues. Subsequent evaluation was noted to be a key factor. 2.1.5 Health of the elderly - priority issues A paper on research needs in this field was presented by Professor A.J. Campbell. As far as the Western Pacific Region is concerned, with its pressing need to control diseases affecting young people, he accepted that the need to consider health care of the elderly as a priority area might not be initially apparent. However, there are strong reasons to justify greater attention in this area, including demographic changes, reduced family support for the elderly, cultural diversity in the Region and the great scope for preventive measures in old age. These aspects were considered in turn. As far as demographic changes are concerned, rapid increases in the proportion of elderly people are occurring in most countries as a result of the combined effect of fertility control and reduced mortality from disease. A striking example is China where it is calculated

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that 40% of the population will be over the age of 65 by the middle of the next century if the one family, one child policy is maintained. Planning is needed now, especially as the development of research programmes involved a considerable time-lag when the training of research workers is required. Professor Campbell then referred to the changing patterns of care for elderly people which are occurring in many countries. These are brought about by factors such as the increased numbers of elderly people, smaller and more mobile family units, greater numbers of women in the workforce, housing which is less suited to three-generation families and higher levels of disability in old age as a result of emerging disorders such as diabetes and hypertension. The third point was that of cultural diversity, as reflected in the areas of nutrition, lifestyle (especially exercise levels) and family support. This means that there should be considerable benefit from research in different countries on such aspects as noncommunicable disease risk factors, intervention trials and methods of health care delivery. Finally, Professor Campbell mentioned that the scope for effective prevention of later ill-health, through suitable modification to lifestyle, is particularly great among those approaching old age. An outline of intercountry research in the field was given and Professor Campbell concluded his presentation by suggesting some recommendations for future research, as set out later in this report. Discussion of this topic centred on the beneficial effects of lifestyle interventions and factors which militated against the success of this approach. Evidence to date did not support the hope that increasing longevity was associated with a reduction in the duration of eventual dependency. Culturally-induced expectations of disability and dependency in old age made intervention harder. Poor housing conditions, financial hardship from early retirement and other socioeconomic factors could increase the adverse effects of aging on health. Isolation and reduced intellectual activity were known to aggravate the depression and dementia associated with old age. On the positive side, there was clear evidence of increased muscle strength and coordination, with fewer falls and fractures, as a result of exercise programmes, even for very elderly people. There was also evidence that underlying values had not changed and that families in most countries wanted to care for their older members, if supported to do so. Assistance with suitable housing was often a major requirement. Participants gave their full support to the recommendations proposed by Professor Campbell, which covered the requirement for a five-year strategic plan for research in this field including documentation and resource centre(s) within the Region, the need for health care of the elderly to be accepted as a priority area, the need for the elderly to be included in epidemiological and intervention studies, and the need for research training grants and fellowships to be allocated to this health field (see page 25). 2.1.6 WHO Regional Centre for Research and Training in Tropical Diseases and Nutrition

Dr M. Jegathesan presented a report on the Centre, first providing a brief summary of its history for the benefit of new committee members. The objectives and the short-, mediumand long-term operational plans were described, as well as the inputs from both the TDR programme and WPRO. The mechanisms for evaluation were also described, including annual meetings of the WHO/Institute for Medical Research (IMR) Coordination Committee, periodic in-house evaluations and the appointment of a special task force for this purpose in 1992.

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The recommendations of this task force, especially those relating to the "new thrust" areas of clinical epidemiology, clinical nutrition, molecular biology, biotechnology, behavioura.:. sciences, clinical research, environmental health and noncommunicable diseases, were being actively pursued. The continuing success of the Centre could be measured in terms of: (i) its ability to attract steadily increasing levels of research funds from national or international sources; (ii) its research productivity, as measured by publications and presentations (1500 publications in national or international journals since 1979 with a target of at least one publication per scientist per year); (iii) its training activities, including two postgraduate courses, with 19 and 23 foreign fellows accepted in 1992 and 1993 respectively. In addition, the Centre helped to organize a research methodology workshop in Viet Nam. The training handbook on research methodology has now been translated into the Chinese and Vietnamese languages. Experts from the Centre have also participated as consultants on malaria in Hainan, Kunming and Wuxi in China. Dr Jegathesan also described some recent happenings at the IMR including renovation of the historic buildings, establishment of a Biotechnology Division, restructuring of the Institute's 20 technical divisions into four departments, the filling of 20 scientist posts, establishment of a linkage programme in epidemiology and biostatistics with the University of Ottawa and the implementation of a three-year collaborative programme in tropical diseases research with Japan. A notable event was the initiation of a collaborative research project between the Institute, the Ministry of Health, Brunei Darussalam and the Ministry of Health, Lao People's Democratic Republic on community nutritional status. Finally, Dr J egathesan mentioned that the services of the WHO Clinical Nutritionist had been extended until the end of 1995 to enable the capability strengthening exercise in this discipline to be consolidated . During the discussion of this report, Dr J egathesan responded to a range of questions on the collaborative activities of the Regional Centre, the methods used to determine research priorities and impact, and the proposed scope of research for the Environmental Health Centre which would be included as a new item in the Seventh Malaysia Plan. Participants expressed their confidence in the continuing worth of the Centre and confirmed a recommendation that its designation as a WHO Regional Centre be extended for a further period (see page 25). 2.1. 7 Role of WHO collaborating centres in national health research efforts

Dr J. V. Hodge explained the purpose of this agenda item. Although WPACHR members had previously been kept generally informed about collaborating centres through the Secretary's report, there had been no recent consideration of the collaborating centre network as a whole and its value in facilitating research priorities within the Region. As background to such a discussion at the present meeting, illustrative reports had been requested from collaborating centres in Australia and Malaysia. It was hoped that these would serve as case studies of the wider issues to be discussed. Following this introduction, the two case reports were then presented by Professor F. M. Jones and Dr M. Jegathesan. Professor Jones described the background to the establishment of the WHO Collaborating Centre for Nursing Development in Primary Health Care in Sydney, Australia. Networking with other PHC nursing centres, both within Australia and in other countries, had started before designation of her school as a collaborating centre in 1988, and was continuing actively. Mechanisms for collaboration included acceptance of international students into graduate courses, conferences, workshops, secondment of staff and participation in a range of research projects both in Australia and overseas. The topics of research were not confined to disease-related problems but included all aspects of patient management, psychosocial,

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cultural and community issues, teenage pregnancy, drug abuse and alcoholism. A protocol was being developed with the other three collaborating centres in nursing development in PHC (in Japan, Philippines and the Republic of Korea) for a programme of collaborative research on carers of the elderly. Professor Jones was conscious of the need to make some return to WHO, especially in regard to the promulgation of research outcomes. Dr M. Jegathesan then spoke of the Malaysian experience with collaborating centres. In view of the large number now designated within the Western Pacific Region, he agreed that an analysis of their strengths and weaknesses from a research perspective was warranted, so that the collaborating centre network could achieve its greatest value for WHO. He described the four collaborating centres in Malaysia, two of which were in the IMR, one in the Public Health Institute and the fourth in the University of Malaya. The Ministry of Health had recently inaugurated an annual meeting of the heads of all these centres as a coordinating mechanism and to determine ways in which the Government might both support and make better use of their activities. A first combined annual report has been produced, with the IMR providing secretariat services for this purpose. It was expected that these activities would reinforce the relevance of the collaborating centres to national programmes and enhance the visibility of their international contribution. Dr Jegathesan also explained that the collaborating centres in Malaysia had both a participatory and a contributory role in the priority setting exercise for health research activities in the forthcoming five-year development plan (1996-2000). Ways in which the collaborating centres had contributed to WHO programmes in other countries were mentioned, including linkage with TOR activities in the Region and acceptance of a significant number of international trainees each year. It was opportune that Malaysia's requirements of its collaborating centres tallied so well with those of WHO; this ensured that effective contributions would continue to be made in the future. In the general discussion following these presentations it was reported that the GACHR had studied the collaborating centre system as a whole and had noted some variability, both in the standards of individual centres and in the effectiveness of collaboration. However, it needed to be remembered that most had little or no financial input from WHO, which lessened the influence which could be exerted when improvement was needed. When collaborating centres had clearly become ineffective from a WHO viewpoint their designation was not renewed: currently there was a turnover of between 50 and 100 centres annually. A firmer line would be taken as regards entry standards in the future. Professor Jones noted that directors of collaborating centres had a difficult task balancing their obligations to WHO with those of their own institutions and it might be considered that there was little advantage in the WHO designation. There was an advantage, through the development of international linkages, but these could only be maintained through continued effort. Dr Hashmi explained that the TOR programme had decided against the establishment of collaborating centres, on the grounds that all its requirements for collaboration could be achieved in other ways. For existing collaborating centres it was seen as important that they should have support from their own Government and from the country as a whole; this was the reason for the requirement that Health Ministries must approve the designation of centres in their country. However, Governments may need to be persuaded that in doing so they are making a worthwhile contribution to international health goals. Active coordination of national collaborating centres is being carried out by the Government of China.

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The discussion then turned to the relationship between collaborating centres and HRC/ AB in countries where these exist. It was noted that HRC/ AB could provide their Health Ministries with the expertise needed to evaluate research aspects thoroughly, which in turn would provide WHO with an assurance of scientific quality before the designation of centres was confirmed or renewed. This did not happen in practice, nor were the HRC/ AB or the scientific community necessarily aware of research being planned or conducted by the collaborating centres in their own country. The meeting considered that there was a clear need for improvement in this area and a recommendation to this effect is recorded later in the report (see page 26). Apart from the question of scientific standard, a key issue was the relationship between the collaborating centres and WHO itself, and here the variability described at the outset of the discussion was again noted. There were many examples of good collaborating centres, however, and perhaps they deserved more recognition through additional incentives. The number of collaborating centres in a given specialty area was not necessarily an index of the importance of that area to WHO. The Secretary noted that a new summary of the activities of collaborating centres in the Region was being prepared; this would serve as a useful document both for coordination between the centres and for the information of the wider community. While many coordination mechanisms were possible, the best link between collaborating centres in the Region remained Research Promotion and Development/WPRO. The lengthy discussion of this topic was brought to a close with a summary by the Chairman. He identified the three sets of questions posed in the discussion: (i) was WHO getting the most out of its collaborating centres? (ii) were these centres getting what they needed from WHO? and (iii) were the expectations of countries regarding their national collaborating centres being realized? These questions had not all been answered but some needs had been identified, attention to which could bring benefits both nationally and to WHO's programmes. The important needs were for improved exchange of information, better coordination at all levels and more attention to quality control in the processes of designation and renewal. These aspects were reflected in the recommendations brought forward on the topic (see page 26). 2.1.8 Country reports (HRC/AB) Eleven country reports on national mechanisms for health research management were presented briefly to the combined meeting. Many of these had already been considered on other occasions and recorded in the reports of previous WPACHR meetings. On1y recent changes or new country reports are described in any detail in the following summary. (1) Australia

This report was presented by Mr R. Wells. Some changes were now occurring in the structure of the National Health and Medical Research Council (NHMRC), with the creation of a new principal committee to undertake strategic planning and evaluation and amalgamation of the Health Care and Public Health committees into a National Health Advisory Committee. Relevant health data were now being collected prior to the establishment of new national health priorities. Strategies for implementation would then be planned around these priorities. A new, independently-funded breast cancer foundation was recently established by the Federal Government, with A$2.5 million in its first year, rising to A$5.2 million by 1997/98. NHMRC funds for health research in 1994 totalled approximately A$118.5 million, of which A$91.2 million was disbursed for project, programme or training grants, A$21.34 million went to research units, centres or institutions and the balance (A$6 million) covered associated costs. Approximately 10% of total research expenditure was in the public health and prevention area. The policy of NHMRC continues to favour investigator-driven research, with various mechanisms to encourage research in priority areas.

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(2)

Fiji

This report was presented by Dr N. Goneyali. The National Health Research Council of Fiji was established in 1982 but has been largely inactive in recent years. The intention is that it should be revitalized. Most research is generated by staff or students at the Fiji School of Medicine (FSM) where the new problem-based learning curriculum is stimulating greater interest in both clinical and community health research. Some of the hospital staff also have research interests. All research remains very largely dependent on external funding sources such as the South Pacific Health Research Committee of the New Zealand HRC, on which Fiji is represented by the Dean of FSM, Dr J. Samisoni. (3) Lao People's Democratic Republic

The report was presented by Dr B. Boupha. A Council of Medical Sciences (CMS) was established by the Ministry of Health in 1989 and all health research in Lao PDR comes under the joint direction of this Council and the Sciences, Technology and Environment Organization. Nine main branches of the health sector are represented on the CMS, these being public health; fundamental sciences; internal medicine; surgery; gynaecology and obstetrics; pediatrics and mother and child care; hygiene, tropical medicine and epidemiology; ophthalmology, ENT, stomatology and dentistry; and pharmacy, nutrition and drug production. The CMS is adviser to the Ministry of Health and its general and specific functions are all related to its mandate to develop the National Health Research Plan, to foster and support health research in relevant fields and to ensure that the results of research are widely initiated and used by managers and policy-makers. The criteria used by CMS for setting health research priorities are the relevance of the problem, avoidance of duplication, feasibility, political acceptability, applicability of outcomes, urgency of data requirement and ethical acceptability. The health research plan for the next three years has research capacity strengthening as its main focus. Some details of the plan were presented by Dr Boupha. Helpful financial support towards implementation of the plan was being provided by International Development Research Centre, Canada. The development of human resources for research and the strengthening of institutional research infrastructure were receiving emphasis. Examples of some ongoing and proposed research projects were given by Dr Boupha. (4) Malaysia

The report was presented by Dr Abu Bak:ar Suleiman. Government support for science and technology remains strong with some US$400 million having been allocated for all science sectors during the ten years covered by the previous and current five-year plans. Approximately 10% of this sum had been provided for health research. Preparations are now under way for the Seventh Malaysia plan (1996-2000) within which it is expected that R&D funds will increase but with an increased requirement for commercializable results. Planning must therefore take into account the need for research to be of direct or indirect value in commercial or economic terms. The Intensification of Research in Priority Areas (IRP A) programme is now being re-evaluated, and new priority setting for health research is taking account of the following factors: (i) changing patterns of disease; (ii) changing demography; (iii) lifestyle changes; (iv) new technology in medicine; and (v) government expectation of commercial returns (as mentioned above).

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The establishment of a Malaysia Science, Technology and Information Centre (MASTIC) was described. This will be a comprehensive, on-line, scientific database to facilitate rapid and effective dissemination of relevant information, serve as a tool for planning purposes and help coordinate and monitor R&D programmes. A further development described by Dr Abu Bakar was the establishment this year of a Malaysia Academy of Sciences, which will serve as an independent centre of excellence for the promotion of Science and Technology (S&T) in the country. A national biotechnology directorate is also being established. The commitment of the Government to S&T is underscored by the creation of a new Cabinet Committee on Science and Technology, chaired by the Prime Minister. (5) New Zealand

This report was presented by Dr B.A. Scoggins. He indicated that the problems experienced from restructuring were now almost over and the Health Research Council was operating effectively, as were its four statutory committees on biomedical research, public health research, Maori health and ethics of health research. These committees, and the other standing committees of the Council, have each developed their own operational plan under output headings of (i) initiation and support of health research, (ii) development of a trained workforce, and (iii) other research support activities. For 1993/94, the sum of NZ$18.8 million was allocated to these activities by the Council, with NZ$15.5 million (82%) being for the initiation and support of health research and NZ$2.1 million (11%) for workforce training. Biomedical research accounted for some two-thirds of HRC expenditure on project and programme grants and career development awards. Dr Scoggins described the activities of the Maori Health Committee and the South Pacific Health Research Committee in some detail, in view of their relevance to the work of WPACHR. Positive steps were being taken to boost research training for Maoris and to develop health research programmes which were clearly under Maori control and which were for their own benefit. The linkage between the South Pacific Health Research Committee and the Fiji School of Medicine has been mentioned earlier in the report. This Committee has recently put forward a proposal for the establishment of a New Zealand-based Centre for South Pacific Health Research, which will address the health needs of Pacific Island people resident in New Zealand. The work of the Centre could be expected to have indirect benefit also to Pacific Island nationals living in their own countries. (6) Papua New Guinea

The report was presented by Mr A. Posong. The focal point for health research in his country is the Medical Research Advisory Committee (MRAC) established in 1980 within the Ministry of Health. Initially, the work of the Committee was largely confined to the research programmes of the Institute of Medical Research (IMR) and the Faculty of Medicine of the University of Papua New Guinea. However, public health and health systems research were added later and now all branches of the Department of Health, as well as the IMR and Faculty of Medicine, have links with the MRAC. The Committee does not yet receive funds from the Government and its work is restricted mostly to the scientific and ethical clearance of research prcjects. Such funds as are available locally are fully used for infrastructure support and all support for the research projects themselves must come from overseas sources.

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(7)

Philippines

The report was presented by Dr P. Zara. The past two years have seen a shift of emphasis, with a new and more focused science and technology agenda for national development aimed towards achieving newly industrialized country status by the year 2000 (STAND Philippines 2000). This is a market-led action plan and its thrusts are reflected in the research agenda of the Philippine Council for Health Research and Development (PCHRD). While this agenda now provides for product-based technologies which impact on health care delivery (e.g. chemicals, drugs, biologicals, vaccines, diagnostics and devices), consideration will still be given to traditional areas of concern, including sociobehavioural research, as identified in earlier reports. Research capability strengthening is being stressed and seven medical schools with the potential to become centres of excellence in research and training are given priority support by the PCHRD. Clinical epidemiology units are being supported by scholarship and re-entry grants. The health R&D information network (HEROIN) has been enhanced with state-of-the-art technology and is accessible on-line in several areas. Accessibility to global communication highways is also being achieved via Internet linkages. Technology transfer is being facilitated through global search programmes, science "parks" and technology "business incubators", facilities which allow small-scale manufacture of health-related technologies (e.g. antibiotic sensitivity discs, medicinal plant products) until markets are established and businesses become self-supporting. (8) Samoa

The report was presented by Dr E. Enosa. A Health Research Council was set up within the Department of Health in 1991 as an outcome of the WPRO-sponsored subregional meeting on health research management in Suva, Fiji held in that year. To date, the Government has not allocated any funds to the Council and locally-supported research has yet to be started. All the current research projects, as summarized by Dr Enosa, are externally funded. Despite its lack of resources, the new ten-member Council does serve as the national focal point for health research and expects to gain increased recognition in this role. Its functions are to set policy guidelines and goals, and to examine all applications to conduct research in Samoa, whether from local or overseas researchers. For projects which gain its approval, the Council also functions to supervise and coordinate the research activity. The criteria set for approval of research by the Council require that the research should benefit the people of Samoa; it should identify the funding source; it must involve a local counterpart if the research group is external; the research data should become the property of the Department of Health (although this point would be considered further); surveillance and inspection of the research should conform to its original objectives and progress reports should be provided; local counterparts' names should be included in publications; and the approval of the Council should be obtained before research results are finally published. (9) Singapore

The report was presented by Dr Chen Ai Ju. A new national focal point for health research, the National Medical Research Council (NMRC) was established at the beginning of 1994 as a response to a government White Paper on affordable health. The Council is already operational and functions as an independent body, with its own budget from the Government. It comprises a Chairman and 12 members, made up of doctors, research scientists and health administrators representing the Ministry, university and hospital sectors. The intention is for this to become the Government's main avenue for the funding of health research, although some research will continue to gain support through universities and through the S&T Development Board.

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New research facilities are being established in the university and in three new institutes, representing the three major causes of morbidity and mortality: these are the Cancer Centre, Heart Centre and Neuroscience Centre. NMRC has established review procedures for the assessment of grant proposals, and a National Medical Ethics Committee will advise the NMRC. Safety and ethical aspects of clinical drug trials are separately reviewed for the Minister of Health by an existing group, as required under the law. The NMRC will be awarding research fellowships and using other means to strengthen research capability in Singapore, which is still deficient as a result of the predominant service orientation of most health facilities. Dr Chen drew attention to a list of research areas proposed for the next two to three years. These related to the leading causes of ill health, such as cancer, heart disease, stroke, diabetes, aging, liver disease, rheumatic and autoimmune diseases, nutritional problems and endocrine disorders. (10) Solomon Islands

The report was presented by Mr B. Bakote'e. The Solomon Islands Medical Training and Research Institute (SIMTRI) was continuing its programmes of education and research, with support from donor agencies such as JICA, WHO and AIDAB. It remained the focal point for health research in the Solomon Islands. A Nursing Research Unit was established within SIMTRI in 1993 and more recently a Public Health Laboratory has been added but is not yet fully functional. Malaria remains the major topic for research, being the main public health problem in the country. Much of the research is operational in nature and its extent is determined by the availability of external funding. Mr Bakote'e gave examples of current and planned projects in the areas of entomology, parasitology and operational research. (11) VietNam

The report was presented by Dr Dang Due Trach. The Scientific Council of the Ministry of Health remains the national focal point for health research in Viet Nam, the only structural change since the last report being the creation of a working group on medical equipment to aid development of instruments and tools needed by health facilities. Recent research has centred on the control of major communicable diseases and the development of vaccines, drugs and diagnostic kits. Viet Nam is now self-sufficient in production of BCG vaccine. Future research will emphasize the same areas, plus operational research for a rural health programme and the development of research at two new medico-surgical reference centres, in Hanoi and Ho Chi Minh City. Undergraduate and postgraduate medical training is being revised to include a research component. Ethical evaluation of research takes place at two levels, these being the institutional ethics committee and the Scientific Council itself. 2.2 Topics considered by the WPACHR

2.2.1 Diarrhoeal disease control (CDD) programme/acute respiratory infections (ARI) programme A report on these programmes was presented by Dr A.E. Permin, Associate Professional Officer, ARI/WPRO. Dealing first with the ARI programme, Dr Permin explained that its objectives are to reduce mortality from ARI, rationalize the use of antibiotics, reduce morbidity from ARI and reduce complications from these diseases, which still show high prevalence throughout the Region. Standard protocols for case management were explained, ranging from

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home care without antibiotics to admission to hospital with antibiotic treatment for the most severe cases. During this reporting period, the research in this programme concentrated on case management, behaviour and communication, preventive interventions and health systems research. Some examples of recent research in the Western Pacific Region were given by Dr Permin. These included the testing of the WHO focused ethnographic study protocol and the protocol for local adaptation of ARI messages and maternal comprehension of these messages; modification and finalization of a manual for ARI workers; a control programme for ARI in Yonchon county, Republic of Korea; chemical studies of pneumonia, meningitis and sepsis in young infants and of suspected meningitis in children below five years; and the effectiveness of Haemophilus intluenzae type B vaccine. Turning to the CDD programme Dr Permin explained that the objectives of the programme are to reduce mortality and morbidity from acute diarrhoeal disease and associated ill effects and, in particular, to reduce mortality from cholera. Strategies continued to rely on the use of oral rehydration therapy and correct management of clinical cases of dysentery, coupled with improved nutritional practices and improved domestic and personal hygiene. The main research areas of the CDD programme were case management in hospitals and other health facilities, case management in the home, prevention of diarrhoea, and national programme development. Examples of recent research in the Western Pacific Region were given. These included a qualitative study on the use of foods and fluids during diarrhoea on children under two years, with emphasis on rice and rice water; health workers' practices in regard to the dietary management of diarrhoea; development of a research proposal to evaluate the impact of a national CDD programme on childhood mortality in the Philippines; evaluation of an algorithm for the inpatient management of persistent diarrhoea; and effects of breast-feeding beyond 12 months on infant growth, to determine whether there is an association between prolonged breast-feeding and malnutrition in infancy. In the ensuing discussion of both the ARI and the CDD presentations, it was noted that cotrimoxazole was still advocated as a first-line antibiotic of choice, despite the occurrence of allergic reactions to the drug. Ease of administration was a major consideration in this regard. In response to a question on ARI in the elderly, Dr Permin confirmed that the emphasis of the ARI programme remained on children, since they had the highest risk of these diseases; mothers were also emphasized in view of their educational importance, but there was no intention as yet to focus on older age groups. The question was raised as to whether the programme intended to involve itself in areas of research wider than the mainly clinical studies reported, e.g. logistic, economic, and other factors associated with ARI management, including the consistency of implementation of intervention programmes beyond the test stage. Dr Permin replied that household follow-up studies were now being undertaken in some countries and that the programme was also investigating the impact of immunization, nutrition, environment, spacing of children, and maternal education, among other topics. Communication was regarded as still inadequate and studies of this factor and of the performance of health workers were also being undertaken; however, more studies were needed. Behavioural factors, including compliance with management regimes, were seen to be important in the success of intervention programmes, for example, national protocols may not be popular if the use of drugs is not advocated in all cases. Recommendations were framed dealing with the need for more research on behavioural factors, strengthening of communication, and cholera management (see page 24).

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2.2.2

Global Programme on AIDS (GPA)

This report was presented by Dr R.M. Sarda, Medical Officer, Regional Team on the Global Programme on AIDS/WPRO. Dr Sarda explained that his unit contributed to research undertaken by WHO Headquarters, but that many other components of WHO also had an input into the research agenda. He described the five main units involved in research in the GPA programme. These were the Vaccine Development Unit, the Clinical Research and Product Development Unit, the Social and Behavioural Studies and Support Unit, the Prevention Research Unit and the Office of Sexually Transmitted Diseases. The work programme for each unit was summarized. The emphasis in social and behavioural studies had now moved from the earlier knowledge, attitude and behaviour studies into more sophisticated studies, e.g. sexual negotiation between women and men, the potential impact of the female condom on gender relationships and studies of contextual factors affecting risk-related behaviour, particularly amongst young people in developing countries. In the discussion following Dr Sarda' s paper, it was clear that the present stage of the AIDS epidemic in the Region requires a continued emphasis on prevention. Surveillance is already a major activity in some countries and needs to be maintained. Avoidance of use of contaminated needles and syringes must be emphasized and the use of disposable syringes encouraged. Diagnostic tests were discussed and it was noted that the inexpensive Particle Agglutination Test should be used first. This should be repeated if positive, followed by the ELISA test if still positive. This would obviate the need for the more expensive, Western Blot method in most cases. The development of further low cost diagnostic tests should continue to be encouraged. These points were incorporated in recommendations (see page 24). The different laboratories in the South-East Asia Region were described and it was mentioned that they exchange information on a regular basis. With regard to risk-taking behaviour among young people, it was noted that there had been some 40 KAP studies in different countries to date but the more sophisticated sociobehavioural studies had been carried out in only one country. It was seen as important that such studies should be repeated in other countries in view of social and cultural variations. Strategies for prevention would need to be country-specific if control programmes were to succeed. 2.2.3 Special Programme on Research, Development and Research Training in Human Reproduction (HRP) A report on recent activities of the HRP was presented by Dr J. Annus, Medical Officer, MCH/FP, WPRO. He referred to the mandate of the programme and its funding, cosponsored by UNDP, UNFPA, the World Bank and WHO, and confirmed that an active and fruitful relationship existed between HRP and WPRO. Dr Annus went on to describe HRP's development strategy for the Asia-Pacific Region, which includes additional support for research capacity building, informing scientists about HRP, institutional development and encouragement of countries in (a) the establishment of national research priorities, (b) intraregional cooperation, and (c) the development of self-reliance in training. HRP had awarded grants totalling US$3.65 million to countries in the Western Pacific Region during the 1992-1993 biennium, bringing the total since 1972 to over US$41 million. Among the grants in 1992-1993, 55 were related to training or skills development and 28 were to maintain or upgrade facilities for research. The underlying basis of HRP support is to identify and address national research priorities, to apply research results to policies and programmes and to participate in the global research effort to improve reproductive health.

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The research projects supported in the Region by HRP were then summarized; they fall mainly into the two categories of epidemiological research and technology assessment. The discussion of Dr Ann us' paper was wide-ranging and included ethical issues in relation to assisted reproduction (for which some WHO guidelines are available), the stance of WHO on unsafe abortion, the efficacy of condoms including prevention of HIV infection, the acceptability of the various contraceptive techniques in different sociocultural settings and WHO support for natural family planning techniques. It was agreed that areas of controversy and debate are more than usually dependent on the outcomes of research and the continuing importance of the HRP research programme was reaffirmed. The need for further sociobehavioural research to increase the acceptability of contraceptives is the subject of a recommendation from this discussion (see page 24). 2.2.4 Special Programme for Research and Training in Tropical Diseases (TDR)

A progress report on the activities sponsored by TOR during the last two years was presented by Dr J.A. Hashmi, Responsible Officer, Research Capability Strengthening, TDR. Following a wide-ranging review and consultations within and outside the programme during 1993, the R&D component of TOR was restructured from early 1994. Instead of the previous disease-specific steering committees, three new components were established, i.e. strategic research (SR), product research and development (PRO) and applied field research (AFR), with increased emphasis on the latter two components. The last six months' experience indicated that the restructured programme is functioning satisfactorily. Funding for TOR activities had reduced somewhat in the 1992-1993 biennium but a comprehensive programme of research and training was being maintained. Between 1975 and 1993, TOR had allocated US$27 million within the Western Pacific Region, US$15 million being for R&D activities and US$12 million for research capacity building. Dr Hashmi presented some highlights of TOR activities related to malaria, schistosomiasis, lymphatic filariasis and leprosy. For malaria, TOR is supporting a range of clinical, public health, antigen and vaccine studies, with the most promising of the vaccines (Colombian vaccine SPf66) now undergoing clinical trial. Impregnated bednet trials have shown a 20-40% reduction in mortality for children under five years. Strategies are being developed for improving compliance with multidose therapy and for encouraging consistent national policies for the use of artemisinin derivatives in uncomplicated falciparum malaria. Schistosomiasis research has centred mainly on improvement of natural resistance through vaccine development and use. Six antigens of Schistosoma mansoni have now reached an advanced stage of development and are currently undergoing confirmatory independent testing in experimental animals. A multicentre study in Africa demonstrated that questionnaires administered through the school health system could determine target communities for control of urinary schistosomiasis. Dr Hashmi indicated that filariasis diagnosis had benefited from the development of assays for circulating antigen, and ultrasonography now allowed direct localization of parasites in scrotal lymphatics. Local hygiene measures have proved most successful in the management of elephantiasis. Multidrug therapy for leprosy has reduced the prevalence of this disease from 5.4 million in 1985 to 1.7 million and new combined therapies are currently being evaluated, with results expected in 1997.

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Finally, Dr Hashmi described a new training grant format- the regional linkage grant for research training. Four such grants, involving 13 different institutions with complementary skills, have been awarded, and 13 young scientists selected for training. Dr Hashmi was thanked for his most informative presentation and the continuing importance of the TDR programmes in the Region was re-emphasized. The effectiveness of coordination at regional level between the special programmes and regional research programmes was discussed. It was noted to be possible, although unlikely with present arrangements in the Western Pacific Region, that the same individual could obtain several research training grants from different WHO sources. Improved coordination between the Regional Office and the special programmes on research training matters was seen to be desirable to avoid this possibility. Dr Shirai reassured participants that there were close links at a practical level and that such a problem was very unlikely. Alternatives for new drug development were discussed, given that pharmaceutical companies were withdrawing on the grounds of poor economic returns in this area. Dr Hashmi explained that TDR now obtains untested compounds from pharmaceutical companies and passes these to screening laboratories. Compounds which show some promise are then referred back to pharmaceutical companies for further development. This arrangement is better than TDR becoming involved itself in the synthesis of new chemical compounds and a reduced price could then be negotiated for products to be used within the public sector. This mechanism for drug development was seen to be particularly attractive, given the huge cost of new drug development generally. 2.3 2. 3.1 Topics considered by the Directors of HRC/AB Networking of HRC/ AB members

Dr Dang Due Trach presented his paper on this topic. He proposed that a steering committee of two or three members should coordinate the development and implementation of an information network for the benefit of HRC/ AB throughout the Region. The meeting agreed that there was a need for an improved networking arrangement among the HRC/AB within the Region. The members from the smaller countries with developing research interests were particularly anxious that the networking should provide them with contacts and information about the range of activities undertaken and opportunities available in the countries with more extensive research activities. The meeting endorsed the approach to networking proposed by Dr Trach. It was decided that a list of information topics would be developed into a handbook for use by member countries to assist them in identifying the range of activities undertaken by the HRC/ AB within the Region. It was agreed that member countries would provide information about their country arrangements in relation to the listed topics. The country contributions would be consolidated by Australia, circulated as a loose-leaf handbook to member countries and copied to RPD/WPRO. The information would be updated annually. 2.3.2 Funding of research

Mr R. Wells presented this topic and described the strategy used by the NHMRC in Australia to obtain funds from both governmental and nongovernmental sources. Mechanisms had been established to enable the NHMRC to obtain additional funds for research purposes, one being that donations from the private sector were income-tax deductible. Research funding levels in Australia are influenced by recognition of the following factors: (a) the importance of the contribution made by research to the quality of health education and service provision; (b) the need to solve distressing and costly health problems; (c) the importance of

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maintaining a high quality research community; (d) the importance of producing high quality, successful research; and (e) the need to provide a strategic focus on health problems of current concern. The meeting discussed a range of possible strategies for individual HRC/ AB to pursue to augment research funding from both governmental and private sources. It was agreed that there is a need for more research funding in all member countries. Discussion took place about the desirable level of research funding. The Australian Government's objective of increasing health and medical research funding to 2% of national health expenditure by the year 2000 was noted. Other countries considered that this would not be a reasonable objective for them in the foreseeable future, given their relatively low level of research funding currently. The availability of research funding from WPRO ($237 ,000 over the past two years) was noted. A discussion then took place on ethical aspects of health research and on evaluation of research outcomes. It was agreed that the availability of ethical guidelines was important and that existing and new guidelines developed by countries should be included in the handbook being developed as part of the HRC/ AB networking arrangements (see 2.3.1 above). In particular the meeting was concerned that any research conducted in the Region should take account of local cultural issues and sensitivities. Participants also discussed the importance of evaluation of research, both at the level of individual projects and at the level of the total national research effort and its overall contribution to national health goals. Members agreed that evaluation arrangements should also be included in the proposed handbook. 2.3.3 Relationship between WHO and national research programmes

Dr Abu Bakar Suleiman presented his paper on this topic. He pointed out that the role of WHO could be considered as promotive, supportive and coordinating. Promotive activities were conducted through the global and regional ACHRs, meetings of directors of HRC/AB, workshops, seminars and conferences on research as well as the research components of the WHO special programmes. Supportive activities were through institution strengthening and research capability strengthening, areas in which WHO had made its greatest impact. Various coordinating functions were also described. In the discussion of Dr Abu Bakar's paper, it was noted that member countries have differing involvement in WHO programmes, the extent of involvement varying according to countries' needs. The sustainability of research programmes was identified as an important factor. It was agreed that the WHO policy of not funding research which did not have country endorsement should be maintained. The need for WHO communication with HRC/AB as well as health ministries, with respect to requests for funding of individual projects, was strongly endorsed by member countries. One difficulty noted by some countries was the tendency of WHO to fund short-term projects only. It was considered that WHO-funded research should include longer-term projects where this was appropriate to the research area and the country needs. The importance of linking the training of research personnel with health research funding was noted. As part of the discussion, Dr J .A. Hashmi outlined the TOR programme as an example of long-term, interregional research on a matter of high priority and sponsored by WHO. The programme included substantial support for training to PhD level of researchers in tropical

- 21 -

medicine. It had been evaluated in 1993 and a report of that evaluation was published. The TDR programme has been the basis for most of the WHO support for strengthening research institutions in the Western Pacific Region. There was discussion about the difficulties of intercountry research cooperation in the Asia/Pacific region where different WHO regions were involved. Direct country-to-country contact was often cumbersome and other regional forums, e.g. ASEAN, did not focus directly on health issues. Some recent WHO initiatives involving interregional cooperation, e.g. in relation to AIDS, were noted. Some Pacific Island countries advised that there was a need for better communication to them of information about the various forms of research assistance available to them through WHO and other sources. As an outcome of the discussion, recommendations were confirmed regarding the need for development of regular communication between WPRO and the HRC/ AB and the need for further WPRO initiatives to facilitate research collaboration between countries and between regions (see page 26). 2.3.4 Training for research

A paper on this topic was presented by Dr P. Zara who described the strategies used in her country for building and maintaining human resources for health research. Guiding principles used are the need for a good match between development of human resources and priority research programmes, the importance of equitable distribution of capabilities in health research, the need for maximum involvement of the Department of Health and other government agencies in human resources development and a requirement for the private sector to be actively involved. The development of suitable research institutions and centres of excellence is seen to be an essential part of a human resources development programme. Other components are scholarships and fellowships, research training grants, incentives, and a comprehensive scientific career programme. During discussion of Dr Zara's paper, it was noted that many countries experience difficulties in retaining trained researchers in the research field because of better opportunities for qualified personnel in administration or the private sector. The need to establish, where possible, suitable career structures for researchers was strongly endorsed. The mixed successes of countries in attracting good expatriate researchers back to their countries of origin were discussed. It was agreed that the countries with larger research infrastructures should more actively support the training of researchers from smaller countries. It was stressed that the level of research training should be commensurate with the level of sophistication appropriate to the countries' research needs. It was noted that WHO plays a significant role in the provision of training in research for developing countries in the Region. However it was agreed that more needs to be done to provide innovative solutions to support the training needs of smaller countries, particularly in relation to small-scale research projects on practical health service delivery issues. A recommendation on this aspect was confirmed (see page 25). 2.3.5 Information transfer

This topic was presented by Dr Chen Ai Ju. The rapid proliferation of new findings in science and technology made efficient communication networks essential, both among the medical community and between this community and the lay public. Communication between scientists is achieved through personal information exchange, oral presentations, audiovisual

- 22-

aids, teleconferencing, computer networks, publications and (for the future) electronic journals. The importance of proper communication of scientific findings and health information to the lay public was stressed. The various mechanisms for information exchange between researchers were noted in the discussion which followed this presentation. Some smaller countries indicated that, because of funding problems, they have difficulties in accessing a reasonable range of current literature to keep abreast of research developments. It was agreed that countries with particular difficulties in accessing the literature should write to Australia and New Zealand who would offer support where possible or could use the WHO country budget. An emerging problem of communication of research findings to the public was noted. Generally, the mass media have a poor record of dealing with health issues because of a tendency to oversimplify and often distort the issues. It was agreed that a more proactive approach on the part of HRC/ AB was warranted as a means of encouraging a more balanced coverage of relevant issues in the media. The New Zealand initiative in appointing a dedicated Publicity Officer was noted. It was noted that the issue of communication between researchers and health policy-makers had been extensively and adequately discussed in the joint WPACHR and HRC/AB meeting as part of the consideration of Dr A.N. Herrin's paper on the Role of Universities, Academic and Professional Bodies in National Health Research Efforts. 2.3.6 Other matters

Two other topics were discussed during the meeting of directors of HRC/ AB. These were the role of WHO collaborating centres in national health research efforts and the need to involve China, Japan and the Republic of Korea in the HRC/AB network. The relationships between HRC/AB and WHO collaborating centres in their countries were discussed in the context of the research activities of the centres. Member countries were concerned that under the present arrangements there was, in some countries, very little involvement of HRC/AB with the national WHO collaborating centres. It was recognized that national governments' requirements must be met and that any change to existing arrangements could not violate these requirements. Recommendations on this topic were confirmed during the plenary discussion on the role of WHO collaborating centres (see page 11). Participants were also concerned at the continued absence of representatives from China, Japan and the Republic of Korea in the meeting of directors of HRC/AB, since these countries were major contributors to health research in the Region. It was agreed that further effort should be made to identify focal points for health research in these countries and a recommendation on this matter was later confirmed (see page 26).

3. CONCLUSIONS AND RECOMMENDATIONS

The members of the Western Pacific Advisory Committee on Health Research and the Directors of Health Research Councils or Analogous Bodies made the following joint observations and recommendations:

- 23-

3.1 3.1.1

Policy Strategic plan for research Recommen ded that:

(1) WPRO give priority to the development of a five-year strategic plan for health research for the Region. (2) The strategic plan be developed by a task force appointed by the Regional Director from the WPACHR and the HRC/ AB members and staff of WPRO. (3) The task force consider the following criteria for inclusion of a research programme in the strategic plan: (a) that WPRO be involved either by provision or facilitation of funding support or provision of technical expertise and adviee; (b) that there would be advantages in a Regional or intercountry collaborative research programme.

(4)

The terms of reference of the task force be as follows: (a) (b)

to establish the criteria and process for identification of priorities; to establish priorities for research as determined by these criteria;

(c) to develop a plan for implementation of strategies in the recommended priority areas, which would include (for each area): (i) (ii) (iii) (iv) (v) goals and objectives proposed activities proposed time-frame for implementation proposed funding sources and cost outcome measures for programme evaluation.

(5) The task force be requested to report its findings to the next joint meeting of WPACHR and HRC/ABs in July 1995. 3.1.2 Global ACHR

Noted that the report of the Global ACHR, based on the 1993 document "Research for health: Principles, perspectives and strategies", recommended new dimensions to give proper emphasis to infrastructural, economic, environmental and sociobehavioural aspects. Recommen ded that policy planning and priority setting for health research be promoted and that scientists with a broader range of skills in health research including specialists in political, economic, social and behavioural sciences be recruited or trained to help in policy research.

-24-

3.2 3.2.1

Programme-specific research Secretariat

Noted the actions taken by the WPRO Secretariat in response to the recommendations made at the last WPACHR meeting and the progress made towards strengthening the research capabilities in Member countries by means of national workshops in research design and methodology, research training awards and research grants. Recommended that these activities be further enhanced and strengthened. 3.2.2 (1)

Special programmes ARIICDD

Noted with satisfaction the progress made by the programmes on acute respiratory infections and control of diarrhoeal diseases in the past two years. Recommended that: (a) the programmes be strengthened by further preventive research and research into case management, especially behavioural research concerning health workers and mothers; (b) methods of improving communication between health workers and mothers and between health workers themselves be investigated;

(c) (2)

the CDD programme give proper emphasis to prevention and control of cholera.

GPA

Noted the progress made by the Western Pacific Region in regard to the global programme on AIDS, in particular its emphasis on prevention. Recommended that WHO: (a) provide guidelines on the appropriate use of existing diagnostic tests in a cost-effective manner; (b) support initiatives to develop diagnostic testing methods which are of low cost, high sensitivity and specificity, and can be applied easily and rapidly.

(3)

HRP

Noted with satisfaction the progress made by the Special Programme on Research, Development and Research Training in Human Reproduction and the active cooperation between HRP and th~ Regional Office. Recommended that further behavioural and social research be undertaken to increase the acceptability of contraceptives in developing countries. (4)

TOR

Noted with satisfaction the actions taken by the WHO's Special Programme on Research and Training in Tropical Diseases in the Region during the 1992-1993 biennium.

-25-

3.2.3

Health of the elderly

Noted the increasing age of populations in the Region, the potentially adverse effects of social and cultural changes on the elderly and the great scope for preventive measures in old age. Recommen ded that: (1)

WHO/WPR O encourage individual countries to: (a) (b)

include health care of the elderly as a priority area; include elderly people in epidemiological and intervention studies.

(2) a five-year strategic plan be developed for coordinating research in health care of elderly people in the Region. In the plan consideration should be given to investigating the effects of differences in lifestyle, nutrition and care. The plan should include means for developing one or more documentation and resource centre(s) in the Region . (3) short-term research training grants and research fellowships be used in the area of health care of the elderly. 3.2.4 Regional Centre for Research and Training in Tropical Diseases and Nutrition

Noted with satisfaction the achievements and the continued successful implementation of the objectives of the Regional Centre and the intercountry collaboration between Brunei Darussalam, Malaysia and Lao PDR. Recommen ded that the activities of the Centre be endorsed and that the Centre continue to be designated as the WHO Regional Centre for Research and Training in Tropical Diseases and Nutrition. 3.2.5 Health promotion and environmental health

Recommen ded that the Subcommittees on Health Promotion and Environmental Health be convened as soon as possible to provide guidance to WPRO and WPACHR on new research needed in these two important areas. 3.3 3.3.1 Strengthening research capability. coordination and management Research capability strengthening Recommen ded that: The different research training needs of countries in the Region be recognized and innovative means be developed and implemented to assist needy countries with practical support in the development of a trained research workforce. 3.3.2 Research coordination

Noted with pleasure that Australia has agreed to create and circulate a resource handbook to assist directors of HRC/ AB in networking.

-26-

Recommended that: WPRO establish regular communication mechanisms with HRC/AB as well as countries' (1) health ministries with respect to support of specific research activities. This could be achieved by copying relevant correspondence. WPRO undertake further initiatives to facilitate research collaboration between countries (2) and between regions (in particular SEARO) on particular health issues (e.g. communicable diseases, malaria) where intercountry action is needed to deal effectively with the problem. 3.3.3 Research management Recommended that: In reviewing the membership of the Global ACHR, consideration be given to ensuring (1) that there is adequate representation of research councils on the Committee. WPRO encourage health ministries to seek advice from their HRC/ AB, where (2) appropriate, in the process of designation or re-designation of WHO collaborating centres which have a research component to their activities. WPRO require WHO collaborating centres that have a research component to their (3) activities to inform their national HRC/ AB annually of their activities for inclusion in the HRC/ AB network handbook. Further effort be made by RPD/WPRO, with assistance from the existing HRC/AB (4) group, to ensure that China, Japan and the Republic of Korea identify a focal point for health research administration to allow a representative to be invited to the next HRC/ AB meeting and to participate in the network arrangements. The next meeting of the HRC/ AB be again held as a joint meeting with WPACHR, with (5) a specific time set aside on the agenda for the HRC/AB representatives to meet on their own.

-27-

ANNEX 1

WORLD

HEALTH ORGANIZATION

ORGANISATION MONDIALE DE LA SANT~

REGIONAL OFFICE FOR THE WESTERN PACIFIC BUREAU R~GIONAL DU PACIFIQUE OCCIDENTAL

JOINT MEETING OF THE WESTERN PACIFIC ADVISORY COMMITTEE ON HEALTH RESEARCH (WPACHR) AND THE DIRECTORS OF HEALTH RESEARCH COUNCILS OR ANALOGOUS BODIES (HRC/ AB) Manila, Philippines 1-S August 1994

WPR/RPD/RPD(l )/94/IB/2 25 July 1994

ENGLISH ONLY INFORMATION BULLETIN NO. 2 PROVISIONAL LIST OF MEMBERS, CONSULTANT, OBSERVER, REPRESENTATIVE, AND SECRETARIAT 1. WPACHR Members Dr A. John Campbell Professor and Head Department of Medicine University of Otago Medical School P.O. Box 913, Dunedin New Zealand Dr George N. Davies Emeritus Professor 10 Roedean Street Fig Tree Pocket Brisbane Q 4069 Australia Professor M. Parameshvara Deva Professor and Head Department of Psychological Medicine Faculty of Medicine University of Malaya Pantai Valley 59100 Kuala Lumpur Malaysia

- 28Annex 1

Dr Shanta C. Emmanuel Assistant Director of Medical Services (Evaluation and Planning Division) Director, Research and Evaluation Department Ministry of Health College of Medicine Building 16 College Road Singapore 0316 Republic of Singapore Dr Alejandro N. Herrin Professor School of Economics University of the Philippines Diliman Quezon City 1101 Philippines Professor Faith M. Jones Head, Department of Community and Mental Health Nursing Faculty of Nursing, Cumberland Campus The University of Sydney P.O. Box 170, East Street Lidcombe NSW 2141 Australia Professor Kenzo Kiikuni Visiting Professor Tokyo Women's Medical College 8-1 Kawada-cho, Shinjuku-ku Tokyo 162 Japan Professor Joung-Soon Kim Dean, School of Public Health Seoul National University 28 Yunkeun-dong, Chongno Ku Seoul 110-744 Republic of Korea Dr Ofelia Monzon* Consultant on AIDS Research Institute for Tropical Medicine Alabang, Muntinlupa Metro Manila Philippines

* Unable to attend.

-29Afihex l

Dr Kusuya Nishioka The Viral Hepatitis Research Foundation Yaguchi-Bldg. 2F 2-11-5 Hongo, Bunkyo-ku Tokyo 113 Japan Dr Niu Shiru Director Institute of Environmental Health and Engineering Chinese Academy of Preventive Medicine 29 Nan Wei Road Beijing People's Republic of China Dr Yung Han Paik * Consultant Korean Industrial Health Association 1022, Bangbae-3-Dong Seoul 137-063 Republic of Korea Dr Do Trung Phan Director National Institute of Hematology and Blood Transfusion Bach Mai Hospital Hanoi Socialist Republic of Viet Nam Professor Wang Heng Professor of Endocrinology and Director of Diabetes Division Peking Union Medical College Hospital Chinese Academy of Medical Sciences Beijing 100730 People's Republic of China

2. HRC/AB Members Tan Sri Dato' Dr Abu Bakar Suleiman Director-General of Health Ministry of Health J alan Cenderasari 50590 Kuala Lumpur Malaysia

* Unable to attend.

- 30Annex l

Mr Bernard Bakote' e Acting Director Solomon Islands Medical Training and Research Institute (SIMTRI) Ministry of Health and Medical Services Honiara Solomon Islands Dr Boungnong Boupha President Council of Medical Sciences Ministry of Health Vientiane Lao People's Democratic Republic Dr Chen Ai Ju Deputy Director of Medical Services (Hospitals) Ministry of Health College of Medicine Building 16 College Road Singapore 0316 Republic of Singapore Dr Taulealea Eti Enosa Director-General of Health Health Department Apia Western Samoa Dr Nacanieli Goneyali Director Hospital Services Ministry of Health Suva Fiji The Secretariat* National Research Council Universiti Brunei Darussalam Gadong Bandar Seri Begawan 3186 Brunei Darussalam

* Unable to attend .

- 31 Annex 1

Mr Andrew Posong Acting Assistant Secretary Policy Planning and Evaluation Chairman Medical Research Advisory Committee and Health Systems Research Committee Boroko Papua New Guinea Dr Bruce Scoggins Director Health Research Council of New Zealand P.O. Box 5541 Wellesley Street Auckland New Zealand Dr Dang Due Trach Deputy Director-General and Chairman, Scientific Council National Institute of Hygiene and Epidemiology 1 Yersin Street Hanoi 10 000 Socialist Republic of Viet Nam Mr Robert Wells Acting Assistant Secretary Office of the National Health and Medical Research Council GPO 9848 Canberra ACT 2601 Australia Dr Pacita Zara Executive Director Philippine Council for Health Research and Development Taguig, Metro Manila Philippines 3. CONSULTANT

Dr J.V. Hodge c/o Health Research Council of New Zealand P.O. Box 5541 Wellesley Street Auckland New Zealand

-32Annex 1

4. OBSERVER Dato' Dr M. Jegathesan Deputy Director General (Research and Technical Support) Ministry of Health J alan Pahang 50588 Kuala Lumpur Malaysia

5. REPRESENTATIVE FROM GWBAL ADVISORY COMMITTEE ON HEALTH RESEARCH (ACHR) Professor Mamdouh Gabr Outgoing Chairman, Global ACHR 162 Tahreer St. Cairo, Egypt

6. SECRETARIAT Dr B.G. Mansourian Director Oftice of Research Policy and Strategy Coordination WHO Headquarters Geneva Dr J.A. Hashmi Responsible Officer for Research Capability Strengthening of the Special Programme for Research and Training in Tropical Diseases WHO Headquarters Geneva Dr S.P. Tripathy Director Research and Family Health Division WHO Regional Oftice for South East Asia New Delhi Dr A. Shirai Short-term Professional Research Promotion and Development WHO Regional Oftice for the Western Pacific Manila Dr Chen Ken Medical Ofticer Traditional Medicine WHO Regional Office for the Western Pacific Manila

-33ANNEX2

OPENING ADDRESS OF THE REGIONAL DIRECTOR FOR THE JOINT MEETING OF THE WESTERN PACIFIC ADVISORY COMMITTEE ON HEALTH RESEARCH AND THE DIRECTORS OF HEALTH RESEARCH COUNCILS OR ANALOGOUS BODIES MANILA 1-5 AUGUST 1994

Distinguished guests, ladies and gentlemen, I am glad to welcome the distinguished members of the Western Pacific Advisory Committee on Health Research (WPACHR) and the Directors of the Health Research Councils or Analogous Bodies (HRC/ AB) to this joint meeting. Many of you are attending the WPACHR for the first time. I wish to stress how important I consider this committee to be. It is my main source of advice on the research required to implement national priority health programmes in this Region and I take your recommendations very seriously. This is the second joint meeting involving the two groups. If the outcome of the first joint meeting in 1992 is any indication, I know that the discussions this week will be very beneficial. I would like to welcome our colleagues from WHO Headquarters, Dr Mansourian, Director of the newly created Office of Research Policy and Strategy Coordination, and Dr Hashmi of the Special Programme for Research and Training in Tropical Diseases (fOR). I am pleased to note the presence of our colleague from the South-East Asia Region, Dr Tripathy, Director of Research and Family Health Division. We have with us today Dato' Dr Jegathesan, Deputy Director-General for Research and Technical Support, Ministry of Health, Malaysia. He also acts as the Research Coordinator of the Regional Centre for Research and Training in Tropical Diseases and Nutrition, located at the Institute for Medical Research in Kuala Lumpur. I would like to greet also Dr Hodge, our consultant. We look forward to your usual expert guidance during this week's activities. As the world approaches the 21st century, it is time to assess the parameters set for health-for-all by the year 2000 and to question our directions. Although many of the indicators of health status are at the target levels, we are still far from "attainment by all peoples of the highest possible level of health". Looking ahead, we can see new horizons in health. In this rapidly evolving Region, there are increasing needs for promotive and protective measures in health, as well as curative. There is a growing role for the individual, the family, the community and society as a whole to participate in health matters. Our work must respond to these developments which will mean some change in our way of doing things. In the Western Pacific Region, this approach entails careful analysis of what has been successful, or otherwise, in the past. Rather than simply responding to immediate needs, technical and financial resources must be put to solving health problems in sustainable ways. Two central concepts will be particularly important in the coming years: health promotion and health protection.

-34Annex 2

Health promotion refers to the steps that can be taken to encourage and enhance what individuals can do, in conjunction with their families, communities and society as a whole, to improve and manage their own health. Health protection recognizes the fragility of human life, and the need to provide whatever reinforcement science and other advances in learning and understanding can bring. These areas will require new skills in health workers, health policies that promote wellness, healthy environments and allocation of funds to support health promotion interventions. Individuals must be convinced to take charge of their own future by behaving in healthy ways. Their social and physical environments must be made less hostile to and more supportive of human development through better health. Looking towards the 21st century, we cannot be certain what the challenges in the health field will be. Strategic changes can, however, be made now which will provide direction for WHO to respond quickly and effectively to those future challenges. These changes are evolutionary, not revolutionary, but they have wide-ranging implications for the Organization's role as the directing and coordinating authority on international health work. We are all under tight financial constraints. We must therefore concentrate on practical activities. Only priority research projects can be supported, especially those that are applied or operational in nature and the results of which can be immediately applied for the benefit of the Member States. We must therefore think very carefully about the researchable areas in the future. Health systems research in health reform? Health behavioural aspects of some nutritional studies? Or communicable diseases? I would like you to tell me specific areas where we should concentrate our resources. I hope your recommendations will not be too wide in scope. In order to best address priority issues and to operate effectively, WHO needs to draw on all of its resources in an appropriate manner. The role of the WHO collaborating centres is the subject of one of the recommendations of the Executive Board Working Group on the WHO Response to Global Change. The use of the centres might provide a cost-effective approach to maintaining technical capabilities, providing technical cooperation, or conducting appropriate research, particularly for programme areas which have been constrained by limited resources. We should not, however, limit our involvement just to the collaborating centres. We should also include scientists in universities and other centres of excellence. I seek your guidance on how to make the best use of the resources these centres have to offer. Other sources of expertise which we seldom use and often overlook are in this room today - the individuals as well as the health research councils or analogous bodies which some of you represent. Forming a network among council and body members, for instance, will facilitate the transfer of information and technology to either the developed or the developing countries. This meeting comes at an important time for WHO. We are determined to make our programmes in your countries as effective as possible. I hope that your meeting will help this process. I wish you every success in your deliberations and an enjoyable stay in Manila.

WPR/RPD/RPD(l)/94.1-A 25 July 1994 PROVISIONAL TIMETABLE* WPACHR MEMBERS JOINT MEETING OF THE WESTERN PACIFIC ADVISORY COMMITTEE ON HEALTH RESEARCH (WPACHR) AND DIRECTORS OF HEALTH RESEARCH COUNCILS OR ANALOGOUS BODIES (HRC/AB) 1-5 AUGUST 1994, MANILA Monday, 1 August 08.30 Registration 09.00 Opening ceremony - Opening remarks - Introduction - Group photograph 09.30 Coffee break 10.00 Report ofWPACHR Secretary 10.45 Report of Global ACHR 09.00 Health of the Elderly 09.00 Role of universities, academic and professional priority issues bodies in national health research efforts 10.15 Coffee break 10.45 Priority setting for health research 10.15 Coffee Break 10.45 WHO Regional Centre for Research & Training in Tropical Diseases & Nutrition (IMR/KL) 12.00 Lunch 13.00 Role of WHO Collaborating Centres in national health research efforts 14.15 Coffee break 14.30 Role of WHO Collaborating centres in national health research efforts (continued) 14.00 Report on HRC/AB group meetings held on 1 to 3 Aug. afternoon 09.00 Dtscussion of country reports (HRC/ AB) 09.00 Report on HRC/AB group meetings held on 1 to 3 Aug. (continued) 10.15 Coffee break 10.30 Finalization of recommendations Tuesday, 2 August Wednesday, 3 August Thursday, 4 August Friday, 5 August

10.15 Coffee break 10.45 Discussion of country reports (HRC/AB) (continued)

12.00 Lunch 13.00 Report ofCDD/ARI

12.00 Lunch 13.00 Report of HRP

12.00 GROUP LUNCH

12.00 Lunch 13.00 Finalization of recommendations (continued)

14.15 Coffee break 14.30 Report ofGPA

14.15 Coffee break 14.30 Report ofTDR

14.15 Coffee break 14.30 Closing ceremony

> z ~

><

z trl

*Note: MoJDIDg sesstons on 1-5 August and afternoon sess10ns on 4-5 August to be attended JOmtJy wtth Dtrectors of HRC/ AB.

..

WPR/RPD/RPD(1)/94.1-B 25 July 1994 PROVISIONAL TIMET ABLE*

DIRECTORS OF HRC/AB JOINT MEETING OF THE WESTERN PACIFIC ADVISORY COMMITTEE ON HEALTH RESEARCH (WPACHR) AND DIRECTORS OF HEALTH RESEARCH COUNCILS OR ANALOGOUS BODIES (HRC/AB) 1-5 AUGUST 1994, MANILA Monday, 1 August 08.30 Registration 09.00 Opening ceremony - Opening remarks - Introduction - Group photograph 09.00 Health of the Elderly 09.00 Role of universities, priority issues academic and professional bodies in national health research efforts 09.00 Discussion of country reports (HRC/AB) 09.00 Report on HRC/AB group meetings held on 1 to 3 Aug afternoon (continued) 10.15 Coffee break 10.30 Finalization of recommendations Tuesday, 2 August Wednesday, 3 August Thursday, 4 August Friday, 5 August

09.30 Coffee break 10.00 Report of WP ACHR Secretary 10.45 Report of Global ACHR

10.15 Coffee break 10.45 Priority setting for health research

10.15 Coffee break 10.45 WH 0 Regional Centre for Research & Training in Tropical Diseases & Nutrition (IMR/KL)

10.15 Coffee break 10.45 Discussion of country reports (HRC/ AB) (continued)

12.00 Lunch 13.00 Networking of HRC/ AB members

12.00 Lunch 13.00 Relationship between WHO and national research programmes 14.15 Coffee break 14.30 Training for research

12.00 Lunch 13.00 Information transfer

12.00 GROUP LUNCH

12.00 Lunch 13.00 Finalization of recommendations (continued) 14.15 Coffee break

14.15 Coffee break 14.30 Networking of HRC/AB members (continued)

14.15 Coffee break 14.30 Funding of research

14.00 Report on HRC/AB group 14.30 Closing ceremony meetings held on 1 to 3 Aug afternoon

*Note: Mol1l.1Dg sessiOns on 1-5 August and afternoon sesstons on 4-5 August to be attended JOmtly wtth WPACHR Members .

.

.

- 37-

ANNEX4

REPORT OF THE SECRETARY OF THE WESTERN PACIFIC ADVISORY COMMITIEE ON HEALTH RESEARCH

1. INTRODUCTION

WHO's involvement in health research stems from article 2(n) of its Constitution, which calls on the Organization "to promote and conduct research in the field of health". The recent reorientation of the WHO research programme has ensured substantial participation by regions and countries. WHO's policy has been to support the building up of national research capabilities, particularly in developing Member States. It has also intensified its efforts to promote effective and efficient systems for health research management, including information support for research. The emphasis is on applied or operational research rather than on basic or fundamental research. WHO's research programmes generally have two interrelated purposes: to obtain results that are relevant and applicable, and to strengthen the research capacity of the countries themselves. These two purposes are evident in the work of large research programmes such as special programmes on tropical disease research, human reproduction research and diarrhoeal disease/acute respiratory disease research, but to one degree or another, they underlie all the research programmes of WHO.

2. MAJOR ACTIVITIES PERFORMED BY THE REGIONAL RESEARCH PROMOTION AND DEVELOPMENT PROGRAMME

2.1

National health research management mechanisms

Member States have been encouraged by the Regional Committee, the Advisory Committee on Health Research (ACHR) and the working group meetings of directors of health research councils or analogous bodies (HRC/ AB) to develop adequate mechanisms for coordinating their research activities. These should link research priorities to the solution of major health or health-related problems. Focal points to coordinate and manage activities have been established in Australia, Brunei Darussalam, Fiji, Malaysia, New Zealand, Papua New Guinea, Philippines, Samoa, Singapore, Solomon Islands and Viet Nam. It was recently learned that the Lao Council of Medical Sciences was first created on 28 December 1989 in Lao People's Democratic Republic but was reconfirmed only on 10 May 1993 at the time of reform in the Ministry of Health.

- 38Annex 4

2.2

Strengthening of national research capability

Activities to develop human resources in research have continued. National workshop on research design and methodology was held in Ho Chi Minh City, VietNam (1993). This was the fifteenth workshop held since 1981. The aim of such workshops is to provide a broad framework of research methodology for use in biomedical or health systems research. Since the publication of the manual on "Health research methodology: a guide for training in research methods" in May 1992, a request to reprint it was received from India and agreed upon in September 1992. The rights to translate and print it in the Croatian language were granted in February 1993. It was translated into the Vietnamese language and used in the national workshop on research design and methodology in VietNam in April-May 1993. Funds were recently provided to have 2000 copies of the translated material published. The manual was also published in Chinese in early 1994 and will be used for the forthcoming national workshop on research design and methodology in Beijing in September 1994. Thirteen research training grants were awarded during this period (Appendix 1). 2.3 Research projects supported by the Regional Office

Twenty research proposals were supported during this reporting period for a total of US$236 802 (Appendix 2). 2.4 Collaborating centres in the Western Pacific Region

As of July 1994, the number of WHO collaborating centres within the Region totalled 214 (Appendix 3). Majority of the centres are located in China (67), Japan (50) and Australia (42), representing 74% of the total number. The programme areas with the largest number include clinical, laboratory and radiological technology (21); other communicable disease prevention and control activities (19); and human reproduction research (14). The first annual meeting of the heads of all WHO collaborating centres in Malaysia was held in September 1993. It served to ensure the due recognition of their activities; to facilitate cooperation among them and other departments; and to discuss ways in which the Ministry of Health can support as well as use these centres . A meeting of the directors of WHO collaborating centres in Australia was held in Sydney on 28 February 1994. The Regional Director of the WH 0 Regional Office for the Western Pacific delivered the keynote address. Presentations were made by the Department of Human Services and Health and the Australia International Development Assistance Bureau (AIDAB). The meeting then discussed the role of WHO collaborating centres in relation to WHO, the Australian Government and each other. Several major issues relating to operations were raised: recognition of the centres capability by government; recognition of the centres responsibilities and obligations by the employing authority such as university or college; the need of long-term commitment of resources by all parties to enable sustainable development activities to be undertaken in developing countries; and possible linkage of collaborating centres into consortium for programme development purposes. I I

- 39Annex 4

3. ACTIVITIES CARRIED OUT BY HEADQUARTERS' SPECIAL PROGRAMMES IN THE REGION

3.1

Special Programme of Research. Development and Research Training in Human Reproduction CHRP)

The activities of HRP may be categorized as follows: (1) research in human reproduction; and (2) strengthening of national research capacities in reproductive health. During the biennium 1992-1993, HRP had provided about US$3.65 million to support 496 research projects and institution strengthening grants within this Region. Of the total amount, 55.3% was provided to the institutions for the purchase of equipment and supplies, together with research training and collaboration in developing expertise and planning research. Much of the supported projects involved the task force/programme areas of postovulatory methods; intra-uterine devices for fertility regulation; social science research on reproductive health; and methods for the regulation of male fertility . 3.2 Special Programme for Research and Training in Tropical Diseases <TOR)

Malaria, schistosomiasis, filariasis and leprosy continue to be the problem diseases within the Western Pacific Region. Leishmaniasis is of limited importance in China, while trypanosomiasis and Chagas disease do not occur in the Region. During 1992-1993, 142 projects were supported by TOR in this Region, with a budget of about US$4 million. Forty four percent of the total amount was allocated to institution strengthening and training activities, while the balance went to research projects. The following institutions have received institution strengthening grants: (1) ChinaInstitutes of Parasitic Diseases in Wuhan, Hubei; Zhengzhou, Henan; Chengdu, Sichuan; Simao, Yunnan; Wuxi, Jiangsu; and Haikou, Hainan; (2) Papua New Guinea- University of Papua New Guinea, Boroko; (3) Philippines - College of Social Sciences and Philosophy, University of the Philippines (UP), Diliman; and (4) VietNam- Institute of Malariology, Parasitology and Entomology, Hanoi, and Cho Ray Hospital, Ho Chi Minh City. The Department of Epidemiology, Shanghai Medical University, Shanghai; Guizhou Provincial Institute of Parasitic Diseases, Guiyang; College of Public Health, UP, Manila; and the Research Institute of Tropical Medicine, Alabang, Philippines, continue to be recipients of the joint TOR-Rockefeller Foundation grants. Guangxi Institute of Parasitic Disease Control, Nanning, and the Shandong Medical University, Jinan, are receiving the programme-based grants. The Malaria Control Service of the Philippines through WHO continue to produce and distribute globally in vitro kits for testing the sensitivity of malaria parasites to antimalarial drugs as well as low-cost portable incubators, which can be used where a constant temperature is required.

-40-

Annex 4

4. RESEARCH ACTIVITIES WITHIN WHO'S PROGRAMME OF TECHNICAL COOPERATION

The descriptions of research activities under various technical programmes are based on contributions from the respective regional programme managers. 4.1 Health systems research

The purpose of health systems research (HSR) is to provide new information on a topic or problem, typically related to some operational aspects of the health system. Health development in the Western Pacific Region is characterized by concerns for coordination of health system activities at a time when many countries are attempting to decentralize the delivery of services and there is an expanding private sector involvement; a concern for both the issues of mobilizing resources as well as making better use of existing resources; and a concern for providing a high level of quality care equitably throughout a country. It is apparent that these concerns involve issues of management rather than aspects of health technology. Consequently, the emphasis of the HSR programme within this Region is to train and support the development of HSR capabilities in operational managers. The programme also supports research, if it is related to the priority health development concerns just noted. Malaysia is the only country where on a national scale, HSR is a part of an in-service training for managers. HSR is a high priority in Malaysia where it is institutionalized in management development as well as in the processes for reaching higher levels of knowledge and information on specific issues in health. The methodology for training in HSR, developed in Malaysia, continues to be further developed and is also being applied in Papua New Guinea and the Philippines. The Public Health Institute, Kuala Lumpur, Malaysia (WHO Collaborating Centre for HSR) is a training venue for other staff of the Region. The College of Public Health, University of the Philippines, continues to support the development of HSR capabilities of the health staff in Cavite Province. The National HSR Council also supports the training of HSR in specific groups, such as the national nursing association. In Samoa, a national research committee has been established. This committee provides a type of clearance for research activities. HSR has also become an integral part of the nursing curriculum. Training in HSR continues in China and VietNam. Both are conducting various research studies on health care financing. Two major regional priority research projects are being conducted by the Korea Institute of Health Services Management, Seoul, Republic of Korea, a WHO Collaborating Centre for Health Services Management. One involves the development and application of a comprehensive analysis tool for assessing the planning and utilization of resource allocation options in the health sector. The other, using a similar methodology, is to develop a framework for helping countries to assess the various health insurance schemes with which they may be experimenting.

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4.2

Primary health care

Support was provided to the College of Nursing, Yonsei University, Seoul, Republic of Korea (WHO Collaborating Centre for Nursing Development in PHC) for establishing a data bank of human resources for primary health care (PH C) in the country. A centralized computer-based human resource bank was created with a monitoring and upgrading system that will provide information on the school health nurses, occupational health nurses, midwives, public health nurses, family physicians and general physicians for the improvement of the quality and coverage of PHC. The Center for Urban Policy Studies, University of the City of Manila, Philippines, undertook the case study of Dr M. Icasiano Community Reference Infirmary. Assessment was made of the organization, functions and management of the infirmary in order to identify the areas which require strengthening in its efforts to provide a more effective delivery of health services to its constituents. The broad goal of the Community Reference Infirmary is to lessen the load of the secondary and tertiary hospitals by servicing minor medical, obstetrical and surgical cases, emergency cases and other minor cares that require no hospitalization. The study concluded that the infirmary can provide acceptable quality health services by intensifying interagency linkages and collaboration, strengthening management and supervision, and encouraging greater community involvement and participation. Both human and financial resources remain serious hindrances to effectiveness. 4.3 Public information

A study to determine the relationship between the use of mass media and behaviours related to smoking and drinking was conducted by the WHO Collaborating Centre for Health Reporting, University of the Philippines, Diliman. It showed that the focus given to smoking and drinking by the media was generally limited, especially in comparison with other health topics, such as hygiene and remedies for health problems. The exposure of smoking and drinking topics over the media was almost entirely through advertising, which projected a positive and desirable image instead of discouraging such unhealthy behaviours or mentioning their potential adverse consequences. In the print media, the main theme of the articles centered on habits and the social aspects of smoking and drinking. The media audience reported that media messages contained little or no information which directly encouraged either smoking or drinking behaviour. Their knowledge on the effects of such behaviour was high. They were less tolerant of their relatives having these habits than strangers. However, there was much less concern for one's own smoking and drinking. Concern for health and a test of self-will to get rid of a negative behaviour were the main reasons given by those who want to quit these habits. 4.4 Health promotion

The network of WHO collaborating centres with other institutions has taken on the task to develop protocols for collecting information about existing health promotion and health needs within the Western Pacific Region and for collaborative studies. A protocol for healthy city/islands/communities/neighbourhoods projects is under development, including indicator development and standards for model healthy cities. The coordinator for this project is the Health Promotion Research Centre at Juntendo University, Tokyo, Japan (WHO Collaborating Centre for Health Behaviour Research and Health Promotion) with the support of the National Health Education Institute, Beijing, China (WHO Collaborating Centre for Health Education and Health Promotion).

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The Faculty of Medicine, University of Newcastle, Australia (WHO Collaborating Centre for Health Behaviour Research) has taken the lead in developing a protocol which will examine the types and extent of workplace health promotion being undertaken within the Region, with the support of the Shanghai Health Education Institute, China (WHO Collaborating Centre for Health Education). A draft protocol on school health promotion had been developed by the Health Promotion Research Centre at Juntendo University, Tokyo. The coordinator will be the Training and Health Education Department, Ministry of Health, Singapore (WHO Collaborating Centre for Health Education and Health Promotion). An outline for a multicentre study on lifestyles and perception of health has been developed with the support of the collaborating centre in Newcastle. The coordinator will be the centre at Juntendo University, Tokyo. The objectives of the study will be to investigate the perceptions of health in different stages of life; identify lifestyles in different stages of life; and provide an empirical basis for the development of health promotion programmes for specific stages in life. Following are some of the highlights of research activities of the WHO Collaborating Centre for Health Promotion through Research and Training in Sports Medicine (Department of Preventive Medicine and Public Health, Tokyo Medical College, Japan): Relationship between coronary risk factors and cardiovascular fitness -Based on (1) the results, the Centre has established the critical values for peak oxygen uptake for the purpose of health promotion among the Japanese middle-aged men (peak of oxygen uptake (V02) was adopted as the index of cardiov·ascular fitness). Peak V02 had significant negative correlations with age, body mass index (BMI), resting heart rate (HR), resting systolic and diastolic blood pressure (SBP and DBP respectively), serum uric acid level (UA) and serum cholesterol level. There were significantly lower values of peak V02 and maximal heart rate in smokers than in non-smokers. Habitual sleep duration was a poor predictor of work capacity, and frequency of alcohol consumption did not correlate with peak V02. Critical peak V02 values (ml/kg/min) against coronary risks - 38.9 in males in their 30s; 37.3 for males in their 40s; and 33.3 for females in their 50s. Relationships between coronary risk factors and physical fitness and exercise (2) habits in urban middle-aged Japanese females (symptom-limited maximal treadmill exercise times (TT) were adopted as the physical fitness index) - TT negatively correlated with age, BMI, SBP, triglycerides and atherogenic index and positively correlated with HDL-cholesterol and vital capacity. Subjects who engaged in regular exercise had a significantly longer TT, and lower values of BMI, SBP, DBP and HR when compared to non-exercising subjects . Effects of physical training on obesity, hypertension, hyperlipidemia and (3) disorders of glucose metabolism - Significant differences for measured values of BMI, SBP and DBP before and after a 2-month (2-3 hours/week) training period, suggested that 2-3 hours of exercise per week was effective in intervention of obesity and hypertension. Effect of short-term exercise training on the acute phase of myocardial infarction (4) There was a significant increase in peak V02 values in patients who received short-term exercise training, while no significant changes were seen in the non-exercising patients.

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Adding short-term exercise training (at an aerobic threshold) to a 2-week myocardial infarction rehabilitation programme is safe and will improve exercise capacity in the short-term and the quality of life of the patients. (5) Effect of gateball as exercise therapy on physical fitness and arteriosclerosis in the elderly - HR did not significantly increase while playing gateball. Gateball players showed a higher HDL-cholesterollevel and basal metabolic rate. Although increasing physical fitness is essential in an exercise prescription for the elderly, it is necessary to consider exercise physiological, dietary and mental health factors as well. (6) Relationship between physical fitness and coronary risk factors in urban Japanese males for the purpose of health promotion and the prevention of noncommunicable diseases (Comparison of the physical characteristics and the lifestyle characteristics of the subjects was made after sorting them into three groups (good, fair, poor) according to their peak V02.)- BMI and HR were significantly lower in the good group as compared to the other groups, and SBP, DBP, total cholesterol, triglycerides and UA were significantly lower in the good group than in the poor group but HDL-cholesterol was higher. The good group smoke less cigarettes than the other groups. Based on the results, the Centre determined the optimal V02 values against coronary risk factors and showed that these values were lower than those suggested by the Ministry of Health and Welfare in 1989. 4.5 Nursing

Most of the research conducted by St Luke's College of Nursing, Tokyo (WHO Collaborating Centre for Nursing Development in PHC) focused on care of the elderly with topics such as a study of stress of nurses in terminal care; physical, mental and social situations of the elderly in their final stages of life and related factors; mobilizing of the bedridden elderly in the home; structural analysis on the levels of life importance and life satisfaction in an advanced age; and family care givers of the demented. The next most frequent area studied was that of the nursing care practice in various settings, followed by research of methods of nursing education. A number of training programmes for educators and service providers in research, statistics and related model development were held by the College of Nursing, University of the Philippines, Manila (WHO Collaborating Centre for Nursing Development in PHC). Some concluded studies included the role of the Philippine Nurses Association in health and development; the concepts of self-regulation in nursing; and the Filipino women's brief response to induced abortion. They also prepared a monograph with research articles and development projects by nurses from countries of this Region. Faculties from the other WHO collaborating centres involved with nursing in the Region were also contributors. Two new research centres have been established within the College of Nursing, Yonsei University, Seoul , Republic of Korea (WHO Collaborating Centre for Nursing Development in PHC): the Nursing Centre for Injury Prevention and the Nursing Research Centre for Home Health Care. Each centre has its own director, steering committee and auditor. In 1988, the School of Nursing, Cumberland College of Health Sciences, Lidcombe, Australia was designated as a WHO Collaborating Centre for Nursing Development in PHC. The Cumberland College united with the University of Sydney to become a Faculty of Health Sciences in 1990. Then in 1994, the School of Nursing merged with the Faculty of Nursing which now has become the largest nursing education programme in Australia. Since the merger, a new emphasis has been placed on the conduct of research. A number of studies are underway related to the improvement of health care for the minority and high risk groups.

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4.6

Nutrition

A collaborative study on the nutritional status of the main functional groups in Brunei Darussalam is currently ongoing with the researchers from Brunei Darussalam, Laos and Malaysia. It will provide baseline data to be used for planning, and later assessing, nutritional programmes. A study on dietary intake and some micronutrient contents in serum of the Vietnamese adults in three different communes was recently completed. People selected were composed of fishermen, forestry people and peasants. The results showed that the structure of food consumption, the nutritive values and the nutrient balance of the dietary intakes of the people studied were considered fairly higher and better than the national figures. The vitamin A levels in the serum were at the bottom of the normal range. The vitamin E level and the copper content in the serum were similar in all three study sites. The zinc content in the serum of the fishermen was significantly higher than in others. The study on the evaluation of the effectiveness of iodized oil capsules was recently completed by the Food and Nutrition Research Institute, Taguig, Philippines. Although the final report is still unavaiiable due to ongoing analysis of some data, preliminary findings have indicated a decrease in the prevalence of goitre among the sampled population after one year of intervention. Other research activities included a large pilot study on the establishment of a nutritional surveillance system in China; and input into the proposed national plan of action for nutrition in China. Tonga is now analyzing the data produced from a national nutrition and noncommunicable diseases survey, supported by WHO. 4.7 Oral health

The WHO Collaborating Centre for the Development of Appropriate Technical Equipment, Procedures and Materials for Oral Care (University of Otago, New Zealand) continued to conduct research into the development of low cost appropriate technical equipment, materials and simplified treatment procedures for different settings in terms of needs. Research in training methods based on problem-solving approach where active learning is facilitated by effective simulation was also carried out. Research activities in the WHO Collaborating Centre for Research on Dental Caries and Periodontal Disease (Dental Research Unit, Health Research Council of New Zealand) included studies on the mechanisms in the initiation and prevention of caries on root surfaces; the effects of fluoridated sugar on artificial caries formation and the plaque pH; and the prime factors that cause mineralization of dental plaque. Research into the pathogenic potential (surface and biochemical characteristics) of oral streptococci and lactobacilli that is relevant to an understanding of aetiology and prevention of dental caries continues to be actively pursued by the WHO Collaborating Centre for Oral Diseases (Institute of Dental Research, Australia). The characteristics of Bacteroides relevant to the aetiology of periodontal diseases are also being studied. The current focus is on lactobacilli when circulating in the blood stream, some species of streptococci, actinomyces and candida.

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The WHO Collaborating Centre for Oral Health (Yuncheng Stomatological Health School, Shanxi, China) has been engaged in the development of human resources, delivery and support systems, and oral health programmes appropriate for the rural setting. Much progress has been achieved to date in terms of development but no evaluation of these developments has yet been conducted. The five year study on the use of pit and fissure sealants as a caries preventive measure has just been concluded by the WHO Collaborating Centre for Research and Training in Preventive Dentistry (Research Institute of Stomatology, Beijing Medical University, China). The results are being evaluated. Another study on the relative effectiveness of fluoride tablets and fluoride drops in preventing dental caries in kindergarten children is now in progress. 4.8 Accident prevention

A "multicentre research study on childhood accidents in the Western Pacific Region" has been initiated in China (Beijing and Wuhan), Hong Kong, Japan and the Philippines. The project will survey children who attend the emergency rooms of general hospitals in each country in a comparable manner. It will seek to clarify the magnitude, nature and major causes of childhood accidents. Informal reports have shown that road accidents, domestic accidents and drowning are the major risk factors of accidents among the children and that their prevalences differ from one country to another. The results will be used to develop preventive programmes in the participating countries. A close working relationship has been established with the WHO Collaborating Centre for Prevention and Control of Road Traffic Accidents, University of Adelaide, and the University of Western Australia, Perth. 4.9 Maternal and child health. including family planning

A study was undertaken in seven selected provinces in VietNam to evaluate the performance of the MCH/FP programme regarding the following problems: high fertility, malnutrition of mothers and children under five, high number of abortions and their complications, high perinatal mortality, and complication of deliveries. It was shown that the number of available staff and equipment were inadequate; drugs were in short supply; contraceptives were available in all health facilities; transportation was poor; waiting rooms were available in most centres; staff meetings were held monthly in most centres; only 37% of the managers were able to explain the MCH/FP targets within their area; regular supervisory visits were held; most health staff did not consider abortion as a FP method but felt the best way to reduce abortions was to provide more information and more accessible and affordable FP services; health staff usually explained FP methods to the clients; 69% of the health staff considered their basic training relevant to their current duties (less than 40% of nurses thought so); less than 40% of the nurses received post-basic training (higher number among other health staff members); community leaders were largely aware of nutritional disorders existing in their communities but not of the high rate of abortions, inadequate prenatal care and infectious diseases in the children; and the awareness of contraceptive methods in the community varied with the method, 98% for IUDs and 74% for oral contraceptives. 4.10 Workers' health Support was provided to the National Institute of Occupational and Environmental Health, Hanoi, VietNam (WHO Collaborating Centre for Occupational Health) for studying primary health care (PH C) approach in the prevention of silicosis. The prevalence of silicosis found in the two factories studied was 21.37%. The disease developed proportionately to increasing age and length of exposure to silica-containing dust. It was found more frequently

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in women. The most prevalent symptom observed in the patients was dyspnoea. A new simple mask (KT4-5L) was designed and applied for preventive measure. It was able to filter 90-92% of the respirable dust (to prevent the inhalation of 0.4-5 microns particle size dust), resulting in reduction of the risk of getting silicosis. A model of PHC for workers was established and contained eight elements: education; organization and consolidation of the basic network of public health; monitoring the occupational environment; workers' health care; health care for women at work; provision of drugs for the treatment of occupational and workrelated diseases; appropriate nutrition; and organization of a rational system of work and rest. Supplementary study on the early diagnosis and treatment of pneumoconiosis was performed by the researchers in Catholic Industrial Medical Centre, Seoul, Republic of Korea (WHO Collaborating Centre for Occupational Health). Fibrogenic and inflammatory mediator studies in alveolar macrophage in combination with high resolution computerized tomography, ultrathin bronchofiberscopy and bronchoalveolar lavage cell analysis were valuable in detecting the early changes of pneumoconiosis in the coal workers. Study on work-related chronic musculoskeletal disorders was undertaken by the Institute of Occupational Medicine, Beijing, China (WHO Collaborating Centre for Occupational Health). These disorders are mainly caused by static stress and long repetitive activity of the local muscle. The person with static load is more easily fatigued than the one with dynamic load. In the former case, the muscles in stress state of contraction, the blocked blood circulation, insufficient oxygen supply to the tissues, accumulation of metabolic waste products, among others - all are basis that cause work-related diseases. Other contributors are poor posture, work characteristics and work frequency. Preventive measures include physical exercises at work and improving the work condition. 4.11 Health of the elderly The home nursing care needs of the elderly were studied in urban areas in the Republic of Korea. Most were dependent on their families socioeconomically. When interacting with the healthy elderly or those with some impairment, it is crucial that the nurses develop and constantly improve skills in all forms of communication. The need to help the elderly maintain his/her self-esteem is of utmost importance. 4.12 Psychosocial and behavioural factors in the promotion of health and human development During this reporting period, two WHO collaborating centres were established to promote research and training in the field of psychosocial and behavioural aspects of health. In July 1993, the Department of Psychiatry, Fukuoka University Medical School, Fukuoka, Japan, was designated as the WHO Collaborating Centre on Psychosocial and Behavioural Aspects of Human Development. This Centre has collaborated with WHO in promoting research on counselling skills and education on communication skills. In February 1994, the Mental Health Institute, Hunan Medical University, Changsha, China, was designated as the WHO Collaborating Centre for Psychosocial Factors, Substance Abuse and Health. The Centre has collaborated with WHO in carrying out research on behavioural problems of health, including substance abuse, in China. A small financial support was provided to the Institute of Mental Health, Jinan, Shandong, China, to evaluate psychosocial rehabilitation and psychopharmacotherapy for schizophrenic patients.

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4.13 Prevention and control of alcohol and drug abuse In March 1994, a joint WHO Collaborating Centre for Prevention and Control of Alcohol and Drug Abuse was established in Sydney (The National Drug and Alcohol Research Centre, University of New South Wales) and Perth (The National Centre for Research into the Prevention of Drug Abuse, Curtin University of Technology), Australia, covering two major research centres on drug abuse. The Centre has carried out several research programmes on demand and harm reduction of drug abuse in Australia. They are expected to contribute to support training and research on drug- and alcohol-related problems in Asia and the Pacific. 4.14 Prevention and treatment of mental and neurological disorders A study on the evaluation of family training and patient education for the prevention of relapse of schizophrenia was performed by five centres in China: Shanghai, Hangzhou, Suzhou, Jinan and Shenyang. Results have shown that family training and patient education could reduce the relapse rate among schizophrenic patients by about 40%. A study on the development of community-based approach for the chronically and mentally ill patients was undertaken in five different areas in VietNam. It was shown that the introduction of mental health care component into primary health care network is the cheapest and the most effective strategy for solving the mental health-related problems in Viet Nam. The community-based psychosocial rehabilitation of people with chronic and mental illnesses is much more efficacious than that by home treatment. Recommendation was made to bring the community-based psychosocial rehabilitation into practice in a large scale throughout the country. "A pilot study on family therapy for schizophrenic patients - community mental health service in rural areas of Sichuan province, China" was recently completed. Epidemiological study showed that the main reason for the failure to carry out those mental health care plans was the lack of cooperation among the patient's families. Reasons included the very strong stigma and fatalistic attitude of the Chinese rural community towards mental illness. The intervention of providing psycho-health education to the families increased the compliance and effectiveness of the treatment. It also improved the neighbors' and friends' knowledge about the disease and changed their attitudes towards the patient from negative to supportive. It is postulated that the family's positive role in the care programmes will enable the patient to receive long-term treatment and monitoring, thereby increasing the effectiveness of the treatment, prolonging the quality of patient's life and preventing mental disabilities. 4.15 Community water supply and sanitation A study of cistern water quality and excreta disposal was completed in Gansu province, China. Treatment of the cistern water supplied to villagers from the irrigation canals with 12g/cu m of chlorine reduced the total bacteria and faecal coliform to a level safe for drinking. Although the level of residual chlorine did not reach below 0.3mg/L, water turbidity was less than 3 degrees, a safe hygienic standard. Of the population studied, 41.4% drank boiled water, while 58.6% drank 'raw' (unboiled) water. Only 49% washed hands before a meal, while 52.2% washed hands after relieving. Conclusion reached was that there are about half of the mass who do not have good hygiene habits and the excreta management was poor. 4.16 Control of environmental health hazards A cross-sectional study to assess the exposure to air pollutants among the school children, child vendors and jeepney drivers in Metro Manila was recently conducted by the College of Public Health, University of the Philippines. Mean exposure levels of the study population to total suspended particulates exceeded the Philippine standard, while excess

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exposure to nitrogen dioxide was seen in child vendors and jeepney drivers. The prevalence of respiratory symptoms (chronic cough, phlegm production, wheezing or shortness of breath) was much higher in the child vendors than in the school children. Pulmonary function test comparisons with rural children indicated a more compromised urban children population. Smoking by the parents were significant risk factors. Blood lead levels of child vendors were higher than those of school children. 4.17 Food safety A study of risk factors contributing to foodborne diseases in selected rural and urban communities in Malaysia was completed. The results will be used as the basis for intervention strategies for foodborne disease control that may be applicable in other parts of the Region. 4.18 Clinical. laboratory and radiological technology for health systems based on primary health care For the past nine years, the WHO Collaborating Centre for Research and Training in Immunology (Faculty of Medicine, National University of Singapore) has been following up the individuals immunized with either the plasma-based or the yeast-derived hepatitis B vaccines. It was found that these people still have protective levels of antibodies so they do not require boosters. 4.19 Traditional medicine (1) Herbal medicine

"Research guidelines for evaluating the safety and efficacy of herbal medicine" was developed in 1992 and published by the Regional Office in 1993. These guidelines are intended to facilitate the work of research scientists and clinicians in the field of herbal medicine as well as furnishing some reference points for the various governmental, industrial and non-profit organizations involved in research and use of herbal medicine. These guidelines have been translated into Chinese and Vietnamese. In 1993, three workshops were held in Viet Nam to introduce those principles and methodologies mentioned in the guidelines. Inventory survey of medicinal plants is being continuously supported in Laos. Some of the researches being undertaken by the Kitasato Institute, Tokyo, Japan (WHO Collaborating Centre for Traditional Medicine) include the elucidation of chemical properties and pharmacological activities of polysaccharides from herbal drugs; effects of traditional medicine on the immune-complex clearance; and use of primary cell culture to clarify the action of herbal drugs on the neurons. The Institute of Clinical Research and Information, China Academy of Traditional Chinese Medicine, Beijing (WHO Collaborating Centre for Traditional Medicine) is investigating the use of Chinese herbal medicines for the treatment of hyperplasia of prostrate gland, hyperthyroid, chronic renal failure, viral myocarditis, carcinoma of lungs and traumatic optic atrophy. Pharmacological studies by the Institute of Chinese Materia Medica, China Academy of Traditional Chinese Medicine, Beijing (WHO Collaborating Centre for Traditional Medicine) have shown that processing of herbal medicine could increase its efficacy while decreasing its toxicity. Another study indicated that the effect of qinghaosu is increased when it is absorbed

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transdermally. Other studies included assessing the toxicity of selected common herbal medicines; and the efficacy of combining tetrandrin with artemisinin in mice infected with Plasmodium berghei. Clinical investigations to determine the safety and efficacy of Chinese herbal medicines for the treatment of primary lung cancer, advanced gastric cancer, Alzheimer's disease, hepatitis B and hepatocirrhosis have been conducted by the Shanghai College of Traditional Chinese Medicine, China (WHO Collaborating Centre for Traditional Medicine). (2) Acupuncture

In June 1994, a working group on clinical research methodology for acupuncture met in Aomori, Japan, to finalize the "Guidelines for clinical research on acupuncture" which will be published later. This is thought to be the first guideline dealing with non-drug therapy. Studies involving combination of drug and acupuncture on analgesic efficacy have been carried out by the Institute of Acupuncture Research, Shanghai Medical University, China (WHO Collaborating Centre for Traditional Medicine). Clinical research on the treatment of coronary heart disease with herbal ointment applied to acupuncture points was undertaken by the Institute of Acupuncture and Moxibustion, China Academy of Traditional Chinese Medicine, Beijing (WHO Collaborating Centre for Traditional Medicine). This institute is also studying the role of the cerebral cortex, brain stem and spinal column in acupuncture analgesia. 4.20 Disease vector control The biology and appropriate control technology for Culex tritaeniorhynchus (Japanese encephalitis vector) using bio/environmental measures were studied in Viet Nam. The densities of these mosquitoes were high in April-May and August-September which correspond to the periods of rice harvests. Adult mosquitoes are most active during the first half of the night and their densities higher in animal shelters than in human habitats. The larvae were predominantly found in the rice fields. Preliminary studies showed that Bacillus thuringiensis, plant products, local larvivorous fishes and invertebrate predators hold promise as potential control mechanisms. Epidemiological and ecological studies of tsutsugamushi disease (scrub typhus) were performed in the rural endemic areas of the Republic of Korea. It was shown that Apodemus agrarius was the predominant rodent species at all collection sites; four percent of A. agrarius were infected with scrub typhus organisms; Leptotrombidium scutellare was the main vector species; L. scutellare chiggers appeared only during the autumn with a peak in October. 4.21 Parasitic diseases Epidemiologic studies on Taenia solium infection was carried out by the Shandong Institute of Parasitic Diseases, Shandong, China. The infection rates of taeniasis and cysticercosis among the study population were found to be 0.3% and 0.71% respectively, and increased with age. Most patients with taeniasis were farmers (91.2%). The infections were found equally in both sexes. Seropositive rate was 3.2%. The prevalence rate of porcine cysticercosis ranged from 0.73% to 6.2% with seropositive rate being 5.1 %. Most of the latrines were poorly constructed, majority of which allowed the free-roaming pigs to enter and feed on the feces. In some cases the latrines were linked to the pigpen, so that the animals fed

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on the feces. Human feces were also utilized as fertilizers for the vegetables. Cross contamination occurred frequently as almost all households used the same chopping blocks and kitchen knives for raw and cooked food. Generally the residents were of lower educational level, knowing very little about the diseases. An experimental study on early diagnosis and surveillance of kala azar using polymerase chain reaction (PCR) technology is now being conducted by the Jiangsu Institute of Parasitic Diseases, China. The establishment of a highly sensitive test for early diagnosis will enhance the capacity to support field studies involving kala azar. 4.22 Diarrhoeal diseases A study "addressing health workers' practices in the dietary management of diarrhea" was recently concluded by the Department of Health - Region 7, Cebu, Philippines. The results showed that the workers provided inadequate dietary advice and their knowledge, attitude and beliefs of the problems related to diarrhea were poor. It was also noted that the CDD training courses failed to impart important information and skills on the dietary management of diarrhea to the health workers. The lack of emphasis of this topic was seen in both the training programme and the training modules. There was also a perceived difference in the performance among the three classes of health workers (physicians, nurses and midwives) in terms of knowledge, attitudes, skill and practices. The differences reflected the variations in their professional training as well as in terms of their perceived roles. A study on "media presentations of follow-on milk foods" was undertaken by the Kabalikat Ng Pamilyang Pilipino Foundation, Inc., Makati, Philippines, to determine what impact media presentations of these food products possibly have on mothers' breastfeeding practices and paediatricians' prescription patterns. Preliminary findings suggest that mothers and health workers seem to differentiate follow-on milks from preparations intended as substitutes for breast milk in infants under six months of age. This appears to be a positive effect of the National Philippine Code for the Marketing of Breast Milk Substitutes which imposes a number of restrictions on advertising of all milk products intended for infants in the first year of life to the public and health professionals. On the other hand, a perceived need for follow-on milks in infants from the age of six months was very clear among mothers. A study on the "effects on growth of breastfeeding beyond 12 months" was undertaken by the Research Institute for Tropical Medicine, Alabang, Philippines. The results showed that prolonged breastfeeding was negatively associated with nutritional status and morbidity. The "qualitative study on the use of foods and fluids during diarrhoea in children less than two years of age, with emphasis in rice and rice water" (Research Institute for Tropical Medicine, Alabang, Philippines) and the "multicentre study on persistent diarrhoea" involving Hospital #1, Ho Chi Minh City, VietNam, are nearing completion. 4.23 Acute respiratory infections An ongoing study by the Research Institute for Tropical Medicine, Alabang, Philippines, is the testing of an ethnographic protocol for local adaptation of ARI messages and maternal comprehension of these messages.

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Similar studies are being undertaken in Hunan province by the Capital Institute of Paediatrics, China, a WHO Collaborating Centre for Epidemiology and Control of ARI. The latter's major thrust has been to design, implement and evaluate the impact of interventions for controlling ARI in young children through the use of a strategy combining ARI training of primary health workers, health education activities and the establishment of a supervision system. Study was done to evaluate the feasibility and applicability of WHO's ARI guidelines for standard case management in Yonchon county, Republic of Korea, by Seoul National University. The activities included collection of baseline data, training of health personnel on standard ARI case management and evaluation of the outcome of treatment. Papua New Guinea Institute of Medical Research (PNGIMR), a WHO Collaborating Centre for Epidemiology and Control of ARI, participated in a WHO "multicentre study of the clinical signs and aetiology of pneumonia, meningitis and sepsis in young infants". The objective was to determine whether clinical examination could distinguish pneumonia from meningitis, sepsis or other respiratory illnesses; identify risk factors for these diseases; determine the aetiology of these diseases in order to ensure appropriate case management. Data is currently being analyzed. PNGIMR also conducted a study on meningitis to determine the proportion of "suspected meningitis" which are in fact meningitis; determine the proportion of confirmed bacterial meningitis; and monitor antibiotic resistance patterns on Haemophilus intluenzae. Data will soon be analyzed. A study was undertaken by PNGIMR to determine the immunogenicity and tolerance of H. intluenzae type B conjugate vaccine (conjugated to outer membrane protein of Neisseria meningitidis). The first dose was administered to two-month old children, the second dose at four months of age and the booster at 12-15 months of age. Controls will be used to determine the natural development of H. intluenzae type B antibody. Other studies undertaken by PNGIMR included the determination of the effectiveness of pneumococcal vaccine in preventing hospitalization with pneumonia or meningitis by immunizing children 9-23 months old through routine services; and the determination of the immunogenicity of pneumococcal polysaccharide vaccine given to women during the third trimester of pregnancy and the persistence of pneumococcal antibodies in their offspring. 4.24 Tuberculosis Four regimens containing different combination of streptomycin, isoniazid, rifampicin, pyrazinamide and DL-473 (locally produced drug) were being tested by the National Tuberculosis Control and Research Centre, Beijing, China (WHO Collaborating Centre for Research on Chemotherapy of Tuberculosis). The objective is to shorten the intensive phase of treatment and improve patient compliance. The Research Institute of Tuberculosis, Tokyo, Japan (WHO Collaborating Centre for Reference, Research and Training in Tuberculosis) designed and produced a document on "Tuberculosis in the Western Pacific Region" in 1992. A booklet containing updated information on selected countries or areas (China, Federated States of Micronesia, Laos, Macao, Papua New Guinea and Tonga) was produced in 1993. A four month International Course on Tuberculosis is held annually at this Centre.

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4.25 Leprosy Clinical studies were initiated at the Leonard Wood Memorial Centre for Leprosy Research, Cebu, Philippines (WHO Collaborating Centre for Research and Training in Leprosy) to define the role(s) of cytokines in the immunopathogenesis of erythema nodosum leprosum (ENL). This is a WHO-sponsored collaborative effort with the University of California in Los Angeles (USA) involving 40 patients and examination of appropriate specimens (tissue and blood) taken before, during and after ENL. Thus, the role of various cytokines may be defined in ENL leading to the development of more effective intervention that may ultimately permit prevention of reactional episodes in patients. 4.26 Research and development in the field of vaccines Work on heat-stable vaccines (pertussis, tuberculosis, measles and poliomyelitis) for use in the tropical countries is being done in Japan. New BCG and pertussis vaccines are being field-tested in Thailand. Japan International Cooperation of Welfare Services (JICWELS) held a meeting on the research and development of heat-stable vaccines in Tokyo, Japan, in November 1993 with the support of WHO. 4.27 Other communicable disease prevention and control activities Hepatitis B (HB) infection is a major public health problem in this Region. Support was provided to China and Viet Nam for the local production of HB vaccine and diagnostic reagents on a large scale. Epidemiological studies on hepatitis C virus infection, which has been confirmed as a major cause of non-A non-B hepatitis, are ongoing in China (begun in 1992), Fiji (1993), Laos (1994), Papua New Guinea (1994), Tonga (1993) amd VietNam (1993). Japanese encephalitis (JE) is endemic in Cambodia, China, Japan, Laos, the Republic of Korea and VietNam. Locally produced JE vaccine is being field-tested in VietNam. Work on the development of a recombinant JE vaccine is now in progress in Japan. The characterization of a protective epitope has been successfully expressed using the E. coli system. 4.28 Other noncommunicable disease prevention and control activities A study on the "non-communicable diseases and their risk factors in urban communities of Papua New Guinea" was recently completed. The findings indicated the significant differences in the frequency of risk factors between the two study sites with different degree of modernization. In the village which is a highly urbanized community, a community syndrome of excessive dietary intake of cholesterol and fat, high serum cholesterol, cigarette smoking, increased body mass index and physical inactivity was found. Studies in other countries have shown that this syndrome is an epidemiological determinant of most non-communicable disease. This syndr.ome was not present in the other village, which was recently established and is composed of ·a very mobile population. A community-based approach to promote a healthy life-style is required to control this syndrome in the population as a whole.

-53-

Annex 4

5. ACTION TAKEN IN RELATION TO THE MAJOR RECOMMENDATIONS BY WPACHR AT ITS FOURTEENTH SESSION

RECOMMENDATIONS

ACTION TAKEN

General Recommended that the following 1. specific actions be taken in response to these issues by coordinating relevant programmes: the development by a task force of the a) WPACHR and HRC/AB of a strategic plan for health research in the Region for the next five years, to identify research needs and priorities. Special consideration should be given to methodological development to improve indicators for measurement of health status, for health services and for health research. Individual technical units have been requested to identify their priority research areas. Several programmes, particularly those of regional priority, have already done this. Development of future Regional research plans will be undertaken by the Regional Research Development Committee, an in-house committee that reviews research activities. This will be done once the targets are identified.

the adoption of specific targets to be b) achieved in this project by WHO officers, and the reporting of progress to meetings of WPACHR and HRC/AB. a consultancy to determine the c) organization and support for health-related research in the Region such as national infrastructures, resources, existing policy and strategies, and to identify deficiencies to be remedied. a project to identify needs and d) resources available for training in research methodology, and to propose appropriate training programmes. Training should focus on projects necessary in the trainee's country, and trainees should achieve competence in research. Support should be increased for training facilities, research workshops and fellowships.

This is being considered.

Training in research methodology is a continuing activity. Trainees are encouraged to develop projects that are relevant to their countries. Emphasis is being placed on training the trainers/educators so more individuals will benefit in the long run. This is true especially in a large country as China.

-54Annex 4

e) the potential users of research results should be identified and trained and a regional seminar on utilization of research results should be convened to study ways to promote research-minded management styles among decision-makers.

The task of helping managers to become more effective users of health system research is an integral part of the Regional Health Systems Research Programme. The principal thrust is to train managers how to use the techniques of health systems research to solve pressing operational problems. Through this process they also become aware of existing research and in tum, know how to understand and use the results of research conducted by others. This programme will continue to expand throughout the Region as part of the management development and health systems research programmes. Information regarding the research being done by the collaborating centres within the Region is being collected and will be distributed to collaborating centres, Ministries of Health and any interested parties. Multicentre studies are encouraged, especially those involving the collaborating centres and other institutes from both developed and developing countries.

f) a review of opportunities to strengthen technology exchange, especially between developed and developing countries of the Region, and the promotion of such cooperation through existing Collaborating Centres.

g) the creation of a regional fund-raising mechanism to promote research for health, especially in less developed countries, with the intention of attracting extrabudgetary funding to support priority health-related research. h) the establishment of a collaborative network of international agencies and NGOs involved in health-related research to improve coordination, collaboration and identification of regional research priorities and to avoid duplication of effort.

The Regional Office is facilitating the identification of resources (such as WHO Headquarters, external funding agencies) to support good research proposals in the developing countries. Representatives of international agencies and NGOs are already being involved in task forces, working groups, etc. on specific problem areas in health. During this time, the research priorities are reviewed and resource mobilization discussed.

-55Annex 4

Noted the need to enhance the efficiency of resource allocation and recommended a WHO/WPRO initiative to gather relevant information on the contributions of various WHO programmes and involvement of national, regional and international agencies in support of health-related research and training, with the intention of encouraging cooperation and collaboration with these agencies and with other regions, especially the South-East Asia Region. Recommended that WHO/SPRO should then identify some key projects where collaborative effort is warranted and establish an appropriate mechanism for bringing the relevant organizations, agencies and individuals together to plan and implement cooperative programmes. WPACHR

2.

Section 3 of this report summarizes the activities carried out by the WHO Special Programmes (HRP and TDR). Closer collaboration has been initiated with SEAR for information exchange and resource mobilization involving national and regional agencies. Few selected areas have been identified and collaboration initiated, for example, environmental health, urban health development and health promotion.

3. Noted with satisfaction the actions taken by the WPRO Secretariat in response to the recommendations made at the thirteenth session of WPACHR and the progress towards development of research capabilities in member countries by means of research grants, research training awards and research design and methodology workshops. Recommended that these activities be intensified and enhanced in the near future. Environmental health 4. Noted the progress made in the Western Pacific Region on environmental health and recommended that there be further emphasis on health-related environmental issues in urban areas, and studies on ways to promote informed decisions relating to the impact of environmental hazards on health.

Continued emphases on research grants, research training awards and research design and methodology workshops are being made to strengthen the research capabilities within the Region. The sixteenth workshop on research design and methodology is proposed for Beijing, China, in September 1994.

WHO participated in a consultative meeting organized by UNDP on urban development in Asia and the Pacific. It discussed issues of coordination and cooperation among the various sectors involved in the development process, and various approaches to improving management. A technical document, "Information management for solid waste management services" was issued in 1992.

-56Annex 4

The joint UNDP/WHO intercountry project on safety and control of toxic chemical and hazardous wastes contributed significantly to the improvement of national capabilities in the management of chemical safety programmes in China. Malaysia, the Philippines, the Republic of Korea and Singapore. Areas of common concern determined for future action were (a) the development of a chemical safety data base and provision of information services; (b) the training of professionals involved in chemical safety programmes; and (c) preparation of guidelines and manuals on chemical safety and hazardous waste management. A project to develop a hazardous waste inventory and action plan for eleven Pacific island countries was initiated. In the Philippines, a sampling and analysis investigation programme was designed to provide data for decision-making on the sustainability of the former Subic Bay Naval Base, a major development site, for future development and on the need for cleanup or site management options. In the Philippines, collaboration was provided to assess the need for new regulations on the control of toxic chemicals and hazardous waste. In Tonga, the use and storage of agricultural chemicals were assessed, and recommendations were made on how to minimize associated health risks. WHO supported the Philippines in conducting a cross-sectional survey on the effects of motor vehicle-related air pollutant emissions on the respiratory functions of transport drivers and commuters in Metro Manila. This study, completed in 1992, provided important health-related input for a report on vehicular emission control planning in Metro Manila financed by Asian Development Bank.

-57Annex 4

A follow-up study, completed in mid1993, emphasized the need for effective motor vehicle emissions control to protect the most vulnerable population groups (school children, street vendors and public transport drivers). WHO collaborated with the Philippines on the preparation of an air quality management master plan for the country. It involves improvements in fuel quality, changes in fuel pricing policy, and control of motor vehicle emissions. Information sharing in food safety field continued through the joint WHO/FAO/UNEP project for monitoring food contamination within the Global Environmental Monitoring System (GEMS); fellowships in the form of study tours awarded to 12 food safety workers from seven countries and areas; and national training courses conducted with WHO support. Furthermore, Food Laboratory of the Department of Scientific Services, Ministry of Health, Singapore (WHO collaborating centre for food contamination monitoring) and the Bureau of Food and Drugs in the Philippines which became a national participating institution under GEMS will form an important part of the information sharing network for food safety. The new "urban health development project" initiatives were started in 1993-1994, one each in China and Viet Nam. Another similar initiative is under consideration in Malaysia.

-58Annex 4

Nursing research

5.

Recommended that:

a) countries should ensure that a nursing perspective be considered during the process of policy-making on health research. b) each country should identify a focus for nursing research and provide adequate support for the conduct of useful and relevant studies according to national priorities. The College of Nursing, University of the Philippines, Manila, with the support of the other three WHO collaborating centres for nursing development in PHC (Australia, Japan and the Republic of Korea) has assembled the reports of studies done by nurses in the Region in the areas of human resource development. This collection was distributed to those individuals interested in nursing development regionwide with the hope of increasing resource sharing and collaboration. This is being considered.

c) a multidisciplinary task force at regional level should be formed to develop an action plan for research in nursing and the greater participation of nurses in health research generally. Oral health 6. Recommended that research workers should be trained as soon as possible in each country to record changes in oral health trends as one means of identifying appropriate strategies for health promotion and the prevention and treatment of oral disease.

Training and provision of support in dental epidemiology has been and is still an active component of the regional oral health programme. In October 1991, a training course was conducted in Guilin for 60 dentists who were then responsible for oral health programmes for the minority races in China. In September 1992, another training course, including a field survey, was conducted in Xiamen, China, to evaluate the oral health situation and disease pattern there. As further needs arise, technical cooperation by WHO will continue to be extended to countries in the Region.

-59Annex 4

Human resources 7. Recommended that basic training curricula for health workers should include a component of research methodology and that more advanced training courses should also be made available for selected workers. Using primary data, the Fiji School of Medicine conducted a Disease Patterns Survey to aid curriculum development in 1990 covering Fiji, followed in 1991 and 1992 by a second stage covering other island countries in the Pacific. In addition, medical students who graduate from the first tier of the School's new medical curriculum undergo a one-year field internship in their respective countries during which they each undertake a research project in health. A growing cadre of officers from the various health services in the Region supervise the students. These supervisors convene every year to coordinate and improve research methodology and supervision of the programme, and constitute a veritable extension of the school's medical faculty into all the Pacific Island countries. The WHO WPROrfokyo University internship programme was formalized in July 1993 with the aim of providing opportunity for qualified students in health professions to conduct research work on subject of their interest in the Organization for the purpose of enhancing their knowledge and understanding of international health in the Region. Health information 8. Noted the progress made by the health biomedical information programme and recommended its continuation through optimum use of new communication technology. Countries should encourage better dissemination of information from national focal points to health workers and research workers in the field. National capabilities were strengthened through national and regional training courses, fellowships and study tours on health library management and operations, including networking. Utilization of new technology in health libraries and information centres were encouraged.

- 60Annex 4

This period began a major campaign to change countries' reliance on a single source for access to international bibliographic databases. Greater visibility for the programme's goals and objectives was achieved by selecting the topic of information and communication support for primary health care as the subject of the Technical Discussion at the forty-fourth session of the Regional Committee. Microcomputers and CD-ROM equipment were provided at the Regional Office and to a number of institutions in Member States for library management and for access to various international bibliographic databases. In the area of publications, the need for improved quality, better impact, greater cost-efficiency and closer adjustment to countries' needs was emphasized. Guidelines helping health care providers to meet new demands were published in areas such as AIDS, disease vector control and traditional medicine. Health research management Noted the country reports on health 9. research management and the points put forward by directors of HRC/ AB and recommended that they continue to meet together with the WPACHR, with some time allocated for the directors to discuss specific issues relating to research organization and management. A further effort should be made to identify a national focal point for health research policy management in Japan, China and the Republic of Korea. Recommended that HRC/ AB should be encouraged to develop and implement a network for transfer of information on policies and procedures of research councils and to give attention to issues of special concern, including ethics of research, conduct of international research and training for research. The director of HRC/ AB will meet together with the WPACHR on l-5 August 1994. They will meet among themselves in the afternoons of 1-3 August to discuss matters of specific interests. More concerted efforts will be made in the future to establish a national focal point for health research management in China, Japan and the Republic of Korea. Networking among the HRC/AB as well as other specific issues will be discussed at the meeting in August.

- 61 -

Annex 4

Health-related behaviour 10. Noted the increasing importance of studying health-related behaviour in the successful implementation of Regional programmes in disease control and health promotion, and recommended that a consultative group be convened to define the contributions of political, economic, social, cultural and behavioural research as components of health development. A working group on tobacco or health was convened on 5-8 April 1994. The strategy for tobacco control for the next five years have been formulated under the overall objectives of health promotion.

-62-

-63ANNEX4 APPENDIX 1

RESEARCH TRAINING/VISITING SCIENTIST GRANTS AWARDED FOR THE PERIOD JANUARY 1992- DECEMBER 1993

YEAR/ COUNTRY OF ORIGIN

NAI\1E

COURSE

COUNTRY OF STUDY

(1992)

Malaysia Philippines Philippines Philippines Philippines Philippines Philippines Republic of Korea

Yeoh Chee Weng Robertino Esplanada Victoria Lupase Parolita Mission Jose Tiburcio Nicolas Cristina Rodriguez Cyrus Trocio Ryoung-Me Ahn

Computer Courses Workshop on Environmental Epidemiology Workshop on Environmental Epidemiology Workshop on Environmental Epidemiology Workshop on Environmental Epidemiology Workshop on Environmental Epidemiology Workshop on Environmental Epidemiology Food Hygiene: Cadmium toxicity and its protective effect materials

Malaysia Philippines Philippines Philippines Philippines Philippines Philippines Japan

-64Annex 4 Appendix l

YEAR/ COUNTRY OF ORIGIN

NAME

COURSE

COUNTRY OF STUDY

(1993)

Fiji Malaysia Philippines

Navitalai Litidamu Hanjeet Kaur Alita Baguinat

First Global European EPH Conference and City Forum New England Epidemiology Summer Programme 14th International Seminar on Environmental Assessment and Management Environmental Epidemiology Course Stationary Source Air Pollution Monitoring

Belgium U.S.A . U.K.

Philippines Philippines

Ronald Subida Jose Reynato Morente

Switzerland U.S.A.

- 65ANNEX4 APPENDIX 2

RESEARCH GRANTS AWARDED FOR THE PERIOD JANUARY 1992- DECEMBER 1993

YEAR/ COUNTRY OF ORIGIN

NAl\fE

TITLE OF RESEARCH

(1992) China Dr Xiang Mengze Community mental health service in Chinese rural areas - a pilot study on family therapy for schizophrenic patients Epidemiological studies on Taenia solium infection in Shandong province Clinical study on applicability of the WHO case management protocol for acute respiratory infections Noncommunicable diseases and their risk factors in urban communities in Papua New Guinea Impact of vehicular emissions on vulnerable populations in Metro Manila Study on the home nursing care needs of the elderly in urban areas in Korea Cost benefit analysis on health intervention programme for the elderly, year 2 Supplementary study on early diagnosis and treatment of pneumoconiosis with special reference to reactive oxygen intermediates, arachidonic acid metabolite and fibrogenic cytokine in bronchoalveolar lavage fluid Establishing a data bank of human resources for primary health care Control programme for acute respiratory infections of children in Yonchon county

China

Dr Xu Jinfan

Japan

Dr Suzuko Uehara

Papua New Guinea Philippines

Dr Elvira Beracochea

Dr E. Torres/Dr R. Subida

Republic of Korea Republic of Korea Republic of Korea

Dr So-Woo Lee

Professor Jong Huh

Dr Im Goung Yun

Republic of Korea Republic of Korea

Dr Chung Yul Lee

Dr Yong-lk Kim

-66Annex. 4 Appendix. 2

YEAR/

TITLE NAI\'IE

COUNTRY OF ORIGIN

OF RESEARCH

(1993)

China

Dr Li Tianlin; Dr Lu Xirong Prof Wang Yilan; Prof Liang Youx.in

Work-related chronic musculoskeletal disorders (year 2) Identification, evaluation and control of lead hazard in small-scale industries in rural area through primary health care (year 2) Pilot study on the control of I. solium taeniasis/cysticercosis in Shandong, China Studies on Dot-KLH-ELISA and KLH-IHA to identify Schistosoma japonicum infection (year 1) Multicentre study on childhood accidents in the Western Pacific Region Bio-psychosocial·study on subtyping of schizophrenia A comparative study of alcoholism type 1 and 2 in the Republic of Korea Development of district health management information system (year 2) Study on the relationship between micronutrients and cardiovascular diseases in the elderly people Mesocyclops for dengue vector control

China

China China

Dr Cao Wuchun Dr Li Yuesheng

Hong Kong Japan Republic of Korea Republic of Korea VietNam

Dr Chow Chun Bong; Mr Lui Ping Keung Dr Michio Toru Dr Jung Wha Kwon Dr Dal Sun Han Dr Phan Thi Kim

VietNam

Mr Vu Sinh Nam

SUMMARY OF COLLABORATING CENTRES IN THE WESTERN PACIFIC REGION (20 July 1994) Australia China Hong Kong Japan Malaysia PROGRAMME AIDS Acute respiratory infection Accident prevention Blindness & deafness Cancer Cardiovascular diseases Clinical laboratory and radiological technology Community water supply and sanitation Control of environmental health hazards Diarrhoeal diseases Disease vector control Drug and vaccine quality Environmental health in rural & urban development Food safety Health information support Health of the elderly Health risk assessment of toxic chemicals Health situation and trend assessment Health systems research and development Human reproduction research Informatics management Leprosy Malaria Maternal and child health 1 1 1 4 1 1 1 1 1 1 1 Papua New Philippines Zealand N. Guinea Republic Singapore VietNam of Korea

TOTAL 1 2 1

3 3 4

3 2 1 1 1 1

1

3 7 11

6

6 1

3

21 1

2 1 1 1 1 1

1 1 1

1 1 1

4 1

5 3 1

1 1 1 2 2 1 1 2 1 2 2 1 1 1 1 1 1 1 1 1

5

3 3 1

3 3 14

3

7

2 1 1

> z

>< ~

rr1

z

3

2

1

7

SUMMARY OF COLLABORATING CENTRES IN THE WESTERN PACIFIC REGION (20 July 1994) (Page 2) Australia China Hong Kong Japan Malaysia PROGRAMME Oral health Organization of health systems based on PHC Other communicable disease prevention Other noncommunicable disease prevention Parasitic diseases Prevention and control of alcohol and drug abuse Prevention and treatment of mental and neurological disorders Psychosocial and behavioural factors Public information and education for health Rehabilitation Research and development in the field of vaccine Research promotion and development Sexually transmitted diseases Tobacco or health Traditional medicine Tuberculosis Workers' health Zoonoses TOTAL 1 1 Philippines Papua New Zealand N. Guinea Republic Singapore VietNam of Korea TOTAL

2 6 2 1

2 2 8

5

1 4

1 1

2 3

12 1 19 4

2

5

1 1 1

1 1

1

2

10 3

1

5 1 1 1 2 2

3

8

1 1 1 2 1 1 1

2 7 5 1 2 1

1 1

1

2 1 2 12 2 11 3 214

1

1

7 1 2 42 2 1 67 1

2 1 4

2 1

2

1

50

4

7

1

10

15

14

3