RETURN TO WHO LIBRARY, MANILA v/ORLD ILALTH ORGt.l'UZA TION REGION.I~L
REGIONAL OFFICE FOR THE b':~STZRN PACIFIC lJP/RC5/'ID/Min.l
CONMITThE
14 September 1954 ORIGIW~L:
Fifth Session Manila 10-16 September 1954 HINUTES OF THE FIRST. MiillTING OF TH'~ TECHNICAL DISCUSSIONS 1 T londay,
ENGLISH
Institute of Hygiene, lJJanila 13 September 1954 at 2:30 p.m.
MODERATOR: .DR. G. GRAHAM-cUMMING CONTENTS
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Opening remarks by the Modera tor Questions for"?anel Discussion To what extent should curative and preventive services be integrated in a health unit? 1-)hat is the relative desirability of central or local planning of health services? What use should be made of culturally informed leaders as advisers in launching and carrying on health services? Hmv- should the development of hea'lth s ervices
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be geared to the economic development of a country?
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ijow can more effective use be made of highly trained personnel through the t-raining and utilization of auxiliary workers?
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Can it be demonstrated that improved environmental sanitation is profitable or otherwise to a local community?
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HP/RC5/'ID/Min.l Page 2 O.l?illHlilG REMARKS BY THB .£V10DBRATOR
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The l>ItODERATOR having informed the Group that the scheduled di. scussions would have to be deferred until the following day, invited the ianel Members to introduce themselves. Philippines, Manila Dr. O. R. McCoy, Rockefeller Foundation, Tokyo The Panel consisted of: Dr. H~ Lara, Dean of the Institute o.f Hygiene, University of the
Dr. J. S. Peterson, Director of Public Health Services, WHO, Geneva Dr. A. F. Raper, FOii, China (Taiwan) Professor L.
c.
Riethmayer, Institute of Public Administration,
Manila
Dr. A. Dalisay, the sixth panel member, was unable to be present owing to illness. The MODERJLTOR Jtated that each member of the group was to consider himself as an individual who was free to express his own opinion independent of anyone else. Discussion was to be general and not to be related The aim of the panel was to to any one country or set of circumstances. to answer c.ll questio.o.s referred to it.
raise issues in order to stimulate discussion and the members were not bound itt the end of each question discussed by the panel, the group was invited to raise questions if they wished. 2
QUESTIONS FOR PArr-hi. DISCUSSION To what extent should curative and preventive services be integrated 'in a health unit?
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Dr. PETERSON stated that this problem was of interest in many parts of the world. There were two schools of thoughti one· which·.considered that In opening health services in a new area, this was a the basis of health services was curative medicine, the other which supported preventive services. very debatable point, as unless one was able to offer some attraction to /people, very little
HP/RC5/'ID/Min.l Page 3 people, very little response was obtained. There was, however, always the
danger that the curative part would overwhelm the preventive side. frcfsesoJ' RIEl'-HMAYKi felt that it' was to a great extent dependent
on the man who had the final responsibility.
Devotion to curative services
might result in neglect of preventive health services.
Dr, RAPER expressed the opinion that when initiating a health programme it must be curative in nature', as ih this way, people would be more interested in what was being done. Dr. LARA was of the opinion that the preventive aspects should be stressed, although in areas where there were no medical facilities, the curative approach might be more profitable in order to obtain the confidence of the people. Reference was made to the Puerto Rican attempts to introduce hospital care by establishing small hospitals within health centre units. This had been an expensive experiment, but was one way of reaching people at that time. Dr. PETERSON referred to his experiences in the Hiddle East among the refugees where the preventive aspect had seemed more important in order to prevent outbreaks of smallpox or typhoid. whether that was too high. Dr. &~ER
Twenty-five per cent
of the total budget had been spent on preventive servict' s, arid he wondered
wondered to what extent curative services should be
utilized to promote effective preventive services. 2.2 What is the relative desirability of central or local planning of health services? Professor RIETHMAYER asked whether a local health unit should be /organized
WP/RC5trD/Min.l Page 4 organized around any particular governm8nt unit that happened to be available or whethe'r it should be c entra,lly planned. and auoh other important factors. Dr. PETERSON suggested that there should be planning on the national level. Services should be envisaged which would go all over the gradual~v
In connection with the' local
health unit, he wondered about its size, how it should be administered,
country, but which would have to be
implemented in .accordance
1dth the resources and funds available. Dr. Rl~ER
stated that the pattern differed considerably in difThe test thing would be to make a careful
ferent areas in the USA.
analysis by countries, provinces and regions. Dr. McCOY sugge sted that the question depended to a great extent on the local contribution to health work. Dr. LARA was of the opinion that ther e should be a j oint responsibility, the central authority giving guidance, and the local authority seei ng that the plan was carried out. The 110DERA TOR suggested that much depended on money. r e sponsible for the health organiz ation. services. In the
United Kingdom, the l ocal government unit s wer e be coming larger and were The question was how t o finance such services, local assistance or assistance from t he c entral health How much control should the central health service have over the local authoriti es? Dr. PETERSON ·sugge sted that if there were little or no health services, then they should be initiat ed from the centre with participation by the community. A subsidy might be necessary at the beginning. /2 •3 What use
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What use should be made of culturally informed local leaders as advisers in the launching and carr,ying on health services?
Dr. R;u)ER felt that it was important to make effective use of local resources, their customs, VJalues, fears and hopes. He doubted if
WHO had so far devised procedures by which to obtain this information.
Dr. PETERSON stated that WHO was slo1vly developing procedures in this field, and referred to an article fn the Chronicle by Dr. Dorolle on the sociological factor in disease. In one of the ~VHO
Regions there was
a cultural anthropologist' attached to the staff. yet no regular approach to the question.
There -vms, however, as
Dr. RAPER stressed the importance of contacting the mature social personnel available in the area, and suggested that no progranme should be started until the best possible information had been collected on tho local picture and tho most valuable people in the community. Efforts
should be made to contact the local politicims, religious leaders, labour groups, etc. in the country and not just the people from the capital.
Dr. MORT"-..Ril. suggested that as WHO worked with the Ministry of Public Health, it was not up to the Organization to get together with such groups unless it was the wish of the government.
In replying, Dr. RAPER stated that it was WH0 1 s role to provide guidance and to bring to the attention of countries new and more effective devices than they deemed desirable.
Dr. YEN (China) wondered whether WHO wodd be able to give valuable assistance if no local support was provided. One of the first things
put in any contract between WHO and a government was the need for local support. In Taiwan in every health station, there was always a committee /elected
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elected from outstanding peop],e from small villages, such a.s .school teachers, industrial -representatives, women's clubs, etc. sources and facilities should be utilized. .;til
available local re-
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How should the development of health services be geared to the economic development of a countrr?
Dr. PETERSCN asked how much a country or community should involve itself in the cost of medical care. view: (a) If the health of the people improved, then the economy There appeared to be two points of
would rise; and (b) Health will result from an improved economy. pro gr~e
Should a health
be pushed beyond economic development,or primar,y
emphasis be placed on economic development?
Professor RIETHI'1AYER suggested that they should go hand in hand.
11. PHILIPPINE REPRESENTATIVE in the audience stated that there were
occasions in which health should be done first.
He quoted a case in the
Philippines where an economic plan had failed because all the p1.rticipants had developed malaria and the plan had had to be abandoned.
Dr. RAPER quoted an exa'llple during the depres s ion in the USA where it was found that when an adequate grant was made tC? a gricultural workers to help them not only economically but also to cover their health needs, their production had been much increased.
~\nother
PHILIPPINE REPRESENTATIVE in the audience sug gested that econo~
to develop the
of a countr,y, manpowe r wa s needed, and it was
necessar,y to build up the health of the manpower.
;Dr. RAPER asked
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Dr. RAPER asked whether the health of a country was a basic capital asset. 2.5 How can more effective use be made of highly trained personnel through the training and utilization of auxiliary workers? Dr. L\RA stated that there was a shortage of ,,.rell-trained personnel, and the question of how to make the most effective use of important one. hig~
trained personnel by training and using auxiliar,y personnel was a very Highly trained personnel were often forced to do work which might well be done by trained non-professional persons. Dr. PETERSON stated that some of the medical profession objected to the use of· auxiliary personnel. and nursing fields. This was also the case in the dental He felt that it depended to a great extent on the
community for which the personnel was sought. Professor RIETHN.".YER felt that there were instances where administrative people could take over some of the work done by professional people. Dr. L.U?:. felt that non-medical personnel should be employed for administrative duties rather than using up the time of well-trained professional persons. Dr. NcCOY stated that there were places where it was absolutely necessary to use auxiliary personnel to accomplish health work. of assistance, however, should not be the ultimate aim. Dr. HENNESSEY felt that nomenclature was very important? and that the tenns nurse, doctor, etc., should never be used in relation to auxiliary personnel. /2.6 Can it be This type
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Can it be demonstrated that improved environmental sanitation is profitable or otherwise desirable to a local community? Dr... R-:\PER stated that through modern .curative methods, immuniza-
tion, etc., it . was possible to de.crease tho death rate without changing the environment of the pe ople at all. In the W e st, the drop i n the death rate followed the improvement of water supplies, food inspection, public health campaigns in schools coupled with research work, record keeping, etc. In other parts of the world the need for improved sanitaIn China, for instance , the death rate had tion was not unde rstood.
dropped without any improvement in environmental sanitation because the people always boiled their water.
Dr. NcCOY felt that it was a question of whethe r things were considered desirable but not essential. and experience gained of th~
:\s the level of education rises In Japan, for inst ance, people Once
more comfortable way of living, people will
demand improved environment al sanitation. of night soil.
we r e now using chemic al f ertili zer and did not want t o use t he old m ethod DDT malaria control was another case in point. people had had their houses sprayed and were rid of mosquitoes, they would r efuse to accept them again. Dr. R~ER
f elt that if good demonstrati ons we re d eveloped, then Once they see that a thing pays, If the Chinese wer e
people would follow out neu practice s. they will c ontinue to demand it.
Environment al sanitation would not be
accepted unless its good effe cts \ver e demonstrat ed. introducing environmental sanitation. e ssential. their wat er. The discussions t erminated at 3:30 p.m. -o-
to stop boiling their water, then they would r e alize the advantages of The boiling of water has r elieved them of the ne cessity of doing othe r things which ar e not c onsidered H e did not c onsider, however, that they should stop boiling