Final report of the thirtieth session of the Regional Committee for the Western Pacific

WORLD HEALTH ORGANIZATION REGIONAL COMMITTEE FOR THE WESTERN PACIFIC THIRTIETH SESSION Singapore, 2-8 October 1979 REPORT OF THE REGIONAL COMMITTEE SUMMARY RECORDS OF THE PLENARY SESSIONS MANILA Novembe.r 1979 WORLD HEALTH ORGANIZATION REGIONAL COMMITTEE FOR THE WESTERN PACIFIC THIRTIETH SESSION Singapore, 2-8 October 1979 REPORT OF THE REGIONAL COMMITTEE SUMMARY RECORDS OF THE PLENARY SESSIONS MANILA November 1979 The thirtieth session of the Regional Committee for the Western Pacific was held at the Mandarin Court, Mandarin Hotel, Singapore, from 2 to 8 Octob.er 1979, under the chairmanship of Dr Andrew G. K. Chew (Singapore), with Tan Sri (Dr) Raja Ahmad Noordin (Malaysia) as Vice- Chairman. Dr So Fo1iaki (Tonga) and Mr Nguyen Van Trong (Viet Nam) were the Rapporteurs. The Regional Committee met on 2, 3, 4, 5 and 8 October. The report of the Committee, including the resolutions adopted during the session, will be found in Part I of this document on pages 1-92; the summary records of the plenary meetings in Part II on pages 101-216. In 1979 the Sub-Committee on the General Programme of Work had met on 28 and 29 June and on 1 to 3 August and the Sub-Committee on Technical Cooperation among Developing Countries on 26 and 27 March. The reports of the two Sub-Committees will be found in Part I of this document on pages 51-84 (Annex 4 and Appendix 1) and pages 85-92 (Annex 5). t ~ ~, ..I.' , . " ' " f .. " "0 .. .. I .. CONTENTS INTRODUCTION ••••.•••••••..••••••••••.••••• ' ••••••••• ',' • 1 I. REPORT OF THE REGIONAL DIRECTOR COVERING THE PERIOD 1 JULY 1977 TO 30 JUNE 1979 ••••••••••••••••••••••••••• 2 II. PROGRAMME BUDGET, 1980-81 •.••.•••••••••••••••••••••••• 4 III. SUB-CO~ITTEES OF THE REGIONAL COMMITTEE • 0" ••••• •••••• 7 1. Sub-Committee on the General Programme of Work 7 2. Sub-Committee on'Technical Cooperation among Developing Countries ............................ . 9 IV. FORMULATION OF STRATEGIES FOR HEALTH FOR ALL BY THE YEAR 2000: REVIEW OF PROGRESS •••••••••••••••••••• 9 V. OTHER r1A.TTERS •.••••.•...•••..•.•••......••.••••••.•••• 12 1. Seventh General Programme of Work cov~ring a specific period (1984-89): Preliminary review of nature, objectives, structure and method of prepara t10n .............................. ~ . . . . 12 2. Contribution of health to the New Inte~national 3. 4. 5. 6. Economic Order . ................................. . Correlation of the work of the World Health Assembly and the Regional Committees •••••• 0 ••• 0 ••• Country health programming ••••••••••••••••••••••• Study of the WHO fellowship programme •••••••••••• Development 'of biomedical and health services research (including research strengthening and career ~tructures in tropical countries) ••••••••• 7. Review of the cancer situation in the Western 13 14 15 16 17 Pacific Region ........ ,.;........................ 17 8. Immunization ~ervices and their evaluation ••••••• 9. Status of the antimalaria programme ••••••••••.••• 10. Dia~rhoeal.diseases control, including cholera ••• 11. Radiation medicine in public health •••••••••••••• 12. Host Agreement between the Government of the Republic of the Philippines and the World 18 19 20 21 Health Organization •••••••••••••••••••••••••••••• 21 VI. 13. 14. 15. CONTENTS Selection of topic for the Technical Presentation during the thirty-first session of the Regiona 1 Committee •.••••.•.••.••••.•.•••••• Time and place of the thirty~first and thirty- second sessions of the Regional Committee •••.••••• Reports received from governments on the progress of their health activities ...•••..•.••••••••• ~ •••• RESOLUTIONS ADOPTED BY THE REGIONAL COMMITTEE •.•••••••• WPR/RC30.R1 WPR/RC30.R2 WPR/RC30.R3 WPR/RC30.R4 WPR/RC30.R5 Rules of Procedure of the Regional Committee for the Western Pacific ••••••• Report of the Regional Director ••.•••••• Budget performance 1978 - direct services to governments •.•.•.••.••••••.•• Changes in the programme budget for 1980-81 ................................ . Special Programme for Research and Training in Tropical Diseases: Joint 21 22 22 23 23 24 25 25 Coordinating Board ••.•.•••• ~............ 25 'V1PR/RC30. R6 WPR/RC30. R7 WPR/RC30.R8 .'. WPR/RC30. R9 WPR/RC30.R10 WPR/RC30.R11 WPR/RC30.Rl2 WPR/RC30.R13 WPR/RC30.RI4 Technical Cooperation among Developing Countries ......................... .,..... 26 Membership of the Sub-Committee on Technical Cooperation among Developing Countries ....................•......••.. 26 Sub-Committee on the General Programme of Work .....•............•........... . ' ... Membership of the Sub-Committee on the. General Programme of Work ••••••••••••••• Cost of travel of representatives Strategies for health for all by 27 27 28 the year 2000 .....•..................... 28 Seventh General Programme of Work covering a specific period (1984-1989) ••• Health and the new international economic order .......................... Provisional agenda of the sixty-fifth session of the Executive Board •••.•••••• 29 30 30 t i \ ... • CONTENTS WPR/RC30.R15 Resolutions of regional interest adopted by the Thirty-second World Health Assembly and the Executive Board at its sixty-third session •••••••••• 31 WPR/RC30.R16 Country health programming ••.••••••.•••••• 31 WPR/RC30.R17 The WHO fellowship programme •••••••••••••• 32 WPR/RC30. RIB WPR/RC30.Rl9 WPR/RC30.R20 WHO's role in the development of biomedical and health services research (including research strengthening and career structures in tropical countries) ••• The cancer situation in the Western Pacific Region .•.......................... Immunization services and their 33 34 eva lua tion ......................•......... 34 WPR/RC30.R21 Antimalaria programme •••••..•••••••••••••• 35 WPR/RC30.R22 WPR/RC3q.R23 WPR/R.C30.R24 WPR/RC30.R25 WPR/RC30. R26 WPR/RC30. R27 Programme on diarrhoeal diseases control ................................... 35 Radiation medicine in public health ••••••• Host Agreement between the Government of the Republic of the Philippines and the World Health Organization •.•....•••••• Topic of Technical Presentation 36 36 in 1980 ••••••••••••••.•••••••••••••••••••• 37 Thirty-first and thirty-second sessions of the Regional Committee •.••••••••••••••• 37 Resolution of appreciation •.••.••••••••••• 37 ANNEXES 1 List of nongovernmental organizations whose representatives made statements to the Regional COlTJIIli t tee ................................................. 39 2 Agenda ••.••••• ~ •••••••.••••••••••••••••••••••••••••.•.••• 41 3 List of representatives ................................. . 43 CONTENTS 4 Report of the Sub-Committee of the Regional Committee on the General Programme of Work, Part I •••.•••••••••••• 5 Report of the Sub-Committee of the Regional Committee on Technical Cooperation among Developing Countries 51 (TCOC) ..................................... _.............. 85 ... ... .. PART I REPORT OF THE REGIONAL COMMITTEE ... ... - (WPR/RC30/Z8) INTRODUCTION The thirtieth session of the Regional Committee for the Western Pacific was held at the Mandarin Court, Mandarin Hotel, Singapore, from 2 to 8 October 1979. The formal opening took place on Tuesday, 2 October 1979 and was attended by His Excellency, Mr Toh Chin Chye, Minister for Health, who welcomed the Committee to Singapore. The Director-General of WHO, Dr H. Mahler, was also present. The session was attended by representatives of Australia, China, Japan, Malaysia, New Zealand, Papua New Guinea, Philippines, Republic of Korea, Samoa, Singapore, Tonga, and Viet Nam and of Member States responsible for territories or areas in the Region. Representatives of the United Nations, the United Nations Children's Fund, the United Nations Development Programme and the Office of the United Nations High Commissioner for Refugees, the International Committee of Military Medicine and Pharmacy and 20 nongovernmental organizations in official relations with WHO were also present. The Committee elected the following officers: Chairman Dr Andrew G.K. Chew (Singapore) Vice-Chairman Tan Sri (Dr) Raja Ahmad Noordin (Malaysia) Rapporteurs in English Dr S. Foliaki (Tonga) in French Mr Nguyen Van Trong (Viet Nam) Formal statements were made by the Representatives of the United Nations Children's Fund, the United Nations Development Programme and the non-governmental organizations listed in Annex 1. The agenda appears as Annex 2 and the List of Representatives as Annex 3. The report of the Sub-Committee on the Rules of Procedure of the Regional Committee for the Western Pacific was presented to the Committee at the second plenary session by the Chairman of the Sub-Committee, Dr F. Chastel of France. The Sub-Committee had met on 1 October 1979 to review Rule 51 of the Rules of Procedure, relating to nomination of the Regional Director. Rule 51 had provided for the election of not less than two and not more than three candidates from among the persons proposed for the post of Regional Director and for a separate vote to be taken for each of the candidates to be elected. Recognizing that submission of a single name to the Executive Board would bring the Rules of Procedure into line with those of other regional committees, the Sub-Committee recommended that Rule 51 should be amended to allow for the election of one candidate, whose name would be submitted to the Executive Board. The Committee accepted the Sub-Committee's recommendation (see resolution WPR/RC30.R1). 2 REGIONAL COMMITTEE: THIRTIETH SESSION The reports of the two Sub-Committees of the Regional Committee - the Sub-Committee on the General Programme of Work and the Sub-Committee on Technical Cooperation among Developing Countries - were also presented to the Committee (see Part III). At the twenty-ninth session, in August 1978, the Committee had provided for continuity in representation from the Region at meetings of the Joint Coordinating Board (JCB) of the Special Programme for Research and Training in Tropical Diseases by selecting one representative, from the philippines, for a period of two years from I January 1978 and one, from Malaysia, for three years. Since, by attending only two meetings of the JCB, the representative of the Philippines would have had little opportunity by the end of 1979 to become sufficiently involved in the work of the Board and the Special Programme, the Committee reappointed him to attend meetings of the JCB for a further period of three years (see resolution WPR/RC30.R5). In doing so, it noted the interest of the Government of Samoa, a country deeply involved in filariasis research, in having a representative appointed as a member of the JCB at a future date. The Committee appointed Dr A. Acosta (Philippines) moderator of the Technical Presentation on "Acute Respiratory Infections" to be held during the thirtieth session. In the course of nine plenary sessions, the Committee adopted 28 resolutions which are set out in Part VI. PART I. REPORT OF THE REGIONAL DIRECTOR COVERING THE PERIOD 1 JULY 1977 TO 30 JUNE 1979 The Committee noted that the biennium had been a period of reorientation and preparation for the considerable task of developing strategies for the attainment, by all peoples of the world, of an acceptable level cf health by the year 2000. Intensive efforts over the two-year period for the promotion of primary health care had provided evidence, by the end of the biennium, of a definite swing towards development activities. There had also been major developments in promoting health management, through country health programming and medium-term programming, and in establishing the information systems to support them. In August 1978, the agreement had been signed between the Government of Malaysia and WHO for the establishment of the western Pacific Regional Centre for the Promotion of Environmental Planning and Applied Studies (PEPAS). Staff members had moved to Kuala Lumpur in January 1979 and were already fully involved in the Centre's programme of cooperation with countries. Also in August 1978, and also with the Government of Malaysia, an agreement had been signed for the establishment of a regional centre for research and training in tropical diseases at the Institute for Medical Research, Kuala Lumpur. Those were only two of the projects through which the Government of Malaysia was contributing to technical cooperation in the Region. The representative of Malaysia commented on others, such as development of the health management information system and studies being carried out on the risk approach in maternal and child health care. .. .. -REPORT OF THE REGIONAL COMMITTEE 3 It was noted that plans had been made for a regional programme of greatly intensified activities for diarrhoeal diseases control, with emphasis on oral rehydration. As part of the newly-developed programme for the control of respiratory infections, the first surveillance unit had been established at the Institute of Medical Research, Goroka, Papua New Guinea. Progress had been made towards' the establishment of a South Pacific joint pharmaceutical service. In November 1979 there was to be a conference of ministers of health of South Pacific and other interested countries of the Region to discuss the political and technical implications of establishing such a service. In addition, a real effort had been made to integrate research activities within individual technical programmes. A health services research programme had been developed. The regional coordinating group for the mental health programme had been established in accordance with the resolution adopted at the twenty-ninth session. l In addition, to keep pace with developments in the Region, a number of intercountry activities in the field of mental health and the prevention and control of drug dependence had been planned for the biennium 1980-81. Implementation of the expanded programme on immunization had continued and had been accompanied by a growing realization that a regional programme, to be effective, must also include countries with advanced immunization services. The Committee evinced particulnr interest in the' nctivities carried out in the field of health manpower development, on which effortfl to achieve health for all by the year 2000 would depend. A balance had to be struck between providing fellowships for study abroad and carrying out training within countries with the help of consultants. For some small countries the absence of health personnel on fellowships meant a break- down 1n the delivery of health care. It was agreed that health professionals other than physicians should be given greater opportunity for training abroad, though it was noted that middle and lower level health workers, primary health care workers, were usually trained within countries and that those who had exhausted local training pOSSibilities, the higher level workers) together with those who were eligible for postgraduate training, were the ones who went abroad. The Committee requested that a breakdown should be included, by country of origin, of participants in group educational activities, in the report of the Regional Director covering the period 1 July 1979 to 30 June 1981. Under a separate item of the agenda the Committee discussed the fellowship programme in greater depth and asked the Regional Director to continue evaluation of the programme, particularly the utilization of former fellows on return to their home countries (see resolution WPR/RC30.R17) • The Committee heard with pleasure of the signature, in October 1978, of a memorandum of understanding between the Government of China and ~~o governing technical cooperation in health activities. The memorandum had resulted in intensified cooperation in 1979. The representative of China commented on some aspects of that cooperation. 1 See resolution WPR/RC29.R12, Report of the WHO Regional Committee for the Western Pacific, twenty-ninth session, 1978, pages 27-28. 4 REGIONAL COMMITTEE: THIRTIETH SESSION There was discussion on whether or not establishment of a sub-committee on programme and budget, which was discontinued in 1977, should be reinstated or whether programme budget should be discussed by the Sub-Committee on the General Programme of Work. The Committee did not reach a conclusion for the time being, since it was felt the terms of reference of the Sub-Committee were already quite ex.tensive. PART II. PROGRAMME BUDGET, 1980-81 1. Review of budget performance in 1978 The Committee noted that, in monetary terms, Annex I of document WPR/RC30/3 showed a rate of 'implementation of the programme under the regular budget for 1978 of 99.91%. That was higher than the implementation rate in 1977, which had been 95.75%. As had been the case in the past, however, because of currency fluctuations and the continually increasing cost of staff, consultants, supplies and equipment and fellowships, the figure. did not represent the true rate of programme delivery, which was lower. In reply to specific questions, the Committee noted the following: (1) the programme classification structure in existence at the time the 1978 programme budget had been implemented, and under which the information given in document WPR/RC30/3 therefore had to be presented, differed from the programme classification structure utilized for preparation of the programme budget estimates for 1980-81. In the newer classification structure, the smallpox eradication programme and the expanded programme on immunization, formerly combined, were separated. In the Western Pacific Region all expenditure in 1978 had been under the latter programme; (2) the large difference between the revised budget allocation for health education and the obligations incurred was because of additional provisions to Lao People's Democratic Republic; (3) despite the low rate of implementation of the funds allocated for health of working populations in 1978, the programme accelerated in 1979 and was to be intensified in 1980-81 after consultants had visited countries in the Region in response to resolution WPR/RC29.R14 adopted by the Committee at its last session; (4) environmental health was being promoted through the Western Pacific Regional Centre for the Promotion of Environmental Planning and Applied Studies (PEPAS) with relatively new activities, such as those to control air pollution, expanding rapidly. 2. Review of changes in the erogramme budget for 1980-81 The Committee recalled that when, in May 1979, the Thirty-second World Health Assembly had approved the proposed programme budget estimates for 1980-81, it had been the first time both the programme and the budget were approved on a fully integrated basis. Up to that time, while awaiting the necessary constitutional amendments, the programme .. • ... REPORT OF THE REGIONAL COMMITTEE 5 had been developed on a biennial basis but the budget developed, presented and reviewed on an annual basis. In 1978, the Regional Committee had reviewed the 1980-81 programme budget proposals for the Western Pacific Region and had requested the Regional Director to transmit them to the Director-General for inclusion in the global programme budget which had been approved in May. Since then, developments at country level had, for a variety of reasons, such as progress in country health programming or reorientation. of government priorities connected with the formulation of strategies for health for all by the year 2000 and for the delivery of primary health care, resulted in some changes. A brief review of the significant ch~nges would be made by the Thirty-third World Health Assembly in May 1980. In order to provide the Executive Board and the Health Assembly with material for their review and to be as involved in the brief review of programme changes as they had been in the full review of the proposed programme budget, the six Regional Committees were to discuss regional programme changes at their regular sessions in 1979. Information drawn from the regional reports would be consolidated as the basis for the Director-GeneralIs report, which would first be considered by the Executive Board at its sixty-fifth session, in January 1980. The Board would then submit the changes, together with any recomnlendations, to the World Health Assembly. The Health Assembly would merely note the changes, its formal approval not being required. The Committee reviewed the inforlnation given in document WPR/RC30/4, which consisted in three parts: (1) Major programmes, programmes and sources of funds (pages 5 to 14) (2) Regular budget planned figures and extrabudgetary resources at country and intercountry level (pages 15 to 20) (3) Country or area technical cooperation programme (pages 21 to 40) It was noted that: (1) the programme of cooperation with China was expected to involve additional funds which would be allocated from overall savings or from extrabudgetary resources. The United Nations Development Programme had provided US$650 000, mainly for the health manpower development programme that was to be executed by WHO, but additional funds would have to be found from other sources; (2) a considerable reduction in the budgetary provision for the Philippines could be observed under section 2.2.2: Country health programming (page 31). This had resulted from the establishment of the Philippines/WHO Health Development Coordinating Committee, which had brought about a change in the method of coordination between the Government and WHO. 6 REGIONAL COMMITTEE: THIRTIETH SESSION Study of the significant changes in the programme budget for 1980-81 revealed the following general trends: (1) as they passed out of the promotional phase, priority programmes, such as primary health care and the expanded programme on immunization, were being implemented to an ever increasing extent through general health services development programmes; (2) resources for research promotion and development were being reallocated to individual programmes; (3) extrabudgetary resources for the family health programme had increased, making possible a reallocation of regular budget funds; (4) governments were tending to seek bilateral cooperation in the field of environmental health; (5) in the cooperation extended towards health manpower develop- ment, emphasis was being given to the promotion of traininp; of health personnel and to the development of national and regional teacher training and related activities; (6) cooperation related to national health information systems was changing from developmental activities to activities for the implementation of such systems through the health statistics programmes; (7) under the staff development and training programme, activities were intensifying to meet the demand for a reorientation of staff in support of national and regional strategies for achieving the objective of health for all by the year 2000. The Committee received assurance that, in spite of the current global inflation, the amount of the budget could be considered realistic. World-wide inflation had been taken into account 1n the budgeting process by including reserves within major cost components. The 1980-81 programme budget provided for flexibility in that funds could be transferred between major programmes. In that context, the Government of Samoa's plans for 1980 were noted, for postgraduate training of nurses in public health nursing and midwifery in order to strengthen primary health care for the benefit of the rural population. While remaining within the amount of the resources allocated to the country, the US$SO 000 this was expected to cost might be transferred to the primary health care programme from another programme; otherwise the possibility of utilizing savings would have to be investigated. , -_ ... _--" _._-_ .... -. _._---- The Committee noted that, in planning the 1982-83 programme budget, account would be taken of the new political entities expected to come into being within the Trust Territory of the Pacific Islands by the end of 1981. It also noted that the figure of US$626 200 in the last two columns of the table on page 29 of document WPR/RC30/4 should be US$616 200. ... .. ... • REPORT OF THE REGIONAL COMMITTEE . 7 The Committee adopted two resolutions: on the budget performance in 1978 and on the changes in the programme budget for 1980-81 (see resolutions WPR/RC30.R3 and WPR/RC30.R4). The Committee also reviewed the Regional Director's report on the use of his development programme for 1978, 1979 and 1980-81 and the teJltative budget projections for the financial period 1982-83. PART III. SUB-COMMITTEES OF THE REGIONAL CQ}1MITTEE 1. Sub-Committee on the General Programme of Work 1.1 Report of the Sub-Committee, Part I (including the study of WHO's structures in the light of its functions) The Committee noted that the Sub-Committee had met twice during 1919, in March and in August. Between the two meetings, two groups of members had visited countries of the Region, in April 1979, in fulfilment of the two main components of its terms of reference, review and analysis of the impact of WHO's collaboration with countries, and the study of WHO's structures in the light of its functions. The subjects for review under the former had been primary health care, including its health manpower development aspects, drug policies and management as it related to primary health care and certain aspects of disease control, for example tuberculosis. The Committee reviewed and endorsed the views expressed in the report of the Sub-Committee, attached as Annex 4. It also requested the Sub-Committee to meet during the current session to discuss the way in which the regional report on WHO's structures in the light of its functions (see Section 4, Annex 4, page 54) should be transmitted to the Director-General for inclusion in his global report to the Executive Board in January 1980. It authorized the Regional Director to transmit that report to the Director-General without further reference to the Regional Committee (see resolution WPR/RC30.R8). In reviewing the Sub-Committee's recommendations on WHO's structures in the light of its functions, the Committee noted that much emphasis had been given to the increasingly active involvement of the Regional Committee in the work of WHO and its role as a major policy-making organ and a forum for promoting technical cooperation between Member States. It expressed concern at the difficulties encountered by certain Member States in raising the funds to cover the cost of attendance of their representatives at the Regional Committee. Noting that the cost of travel of a delegate from each Member State to the Horld Health Assembly was borne by the Organization, the Committee adopted a resolution recommending to the Executive Board and, through it, to the World Health Assembly that action should be taken for WHO to consider financing the cost of travel, excluding per diem, of a representative from each Member State to attend sessions of the Regional Committee (see resolution WPR/RC30.RlO). The intention was that all Member States should be able to claim reimbursement of the cost of travel of one representative, altho~gh th.e more affluent States would presumably not take advantage of the entitle- ment. The representative of France expressed the wish that, should the World Health Assembly decide that only certain Member States were to be entitled to reimbursement, which those Member States should be would be at the discretion of the Regional Director. 8 REGIONAL COMMITTEE: THIRTIETH SESSION The Committee noted further that, in January 1979, in response to the Declaration of Alma-Ata, the Executive Board had prepared a document setting out the guiding principles and essential issues for formulating national and regional strategies for the attainment of an acceptable level of health for all by the year 2000. 1 The document contained a timetable which provided for its dissemination to Member States between January and May 1979; its review by the Thirty-second World Health Assembly in May; commencement by Member States to develop national strategies and plans of action after l~y 1979; and a first review by regional committees of the progress made in the last quarter of 1979. The Sub-Committee was already carrying out the study on WHO's structures in the light of its functions. Those functions were to be geared to supporting Member States in developing and implementing their national policies, strategies and plans of action. It followed that, to produce meaningful results, the Sub-Committee also needed to be closely involved in reviewing the reactions of Member States to the Executive Board document and synthesizing them for review by the Regional Committee. When it had met in March 1979, therefore, the Sub-Committee had undertaken to recommend to the Regional Committee that its terms of reference should be expanded to include the studies connected with the formulation of strategies for health for all by the year 2000. The Committee accepted the Sub-Committee's recommendation and confirmed that its terms of reference should be expanded (see resolution WPR/RC30.R8). The Committee's deliberations on the subject are reported in Part IV of this report. 1.2 Report of the Sub-Committee, Part II (formulation of strategies for health for all by the year 2000) The Committee understood that partly because, at the time the Sub- Committee on the General Programme of Work had undertaken to review progress towards development of national strategies and plans of action for health for all by the year 2000, expansion of its terms of reference had not yet been considered by the Regional Committee, and partly for the sake of good order, the report of the Sub-Commi\:tee: on. that question had been prepared separately, as Part II of document WPR/RC30/1l (see Part tv of this report). 1.3 Membership of the Sub-Committee The Committee decided that the period of tenure of members of both standing sub-committees of the Regional Committee should be three years and that an effort should be made to distribute membership on an equitable basis, so that no Member State was represented on both sub-committees at the same time. The representatives of Australia, Malaysia and Philippines were replaced as members of the Sub-Committee on the General Programme of Work by representatives of China, Samoa and Singapore. In the future, membership would be reconsidered whenever a member had served for three years. A resolution was adopted to that effect (see resolution WPR/RC30.R9) • 1 . Document A32/8 presented to the Reg~onal Committee under cover of document WPR/RC30/l1 Part II Add.2; reproduced with revised timetable in document WHA32/1979/REC/l, Annex 2. .. .. ... w • REPORT OF THE REGIONAL COMMITTEE 2. Sub-Committee on Technical Cooperation among Developing Countries 2.1 Report of the Sub-Committee 9 TheCornmittee noted that the Sub-Committee on Technical Cooperation among Developing Cpuntries had met in March 1979. It had briefly reviewed activities in the fields of primary health care and drug policies and management~ the two programmes recommended for study in 1978~ under which WHO would continue to encourage technical cooperation among developing countries, and the new prograrnm~ recommended for study in 1979~ he~lth manpower development. See Annex 5 for the report of the Sub-Committee. Discussion focused on the true meaning of the term technical cooperation, a concept spelled out in the WHO Constitution. The essence of the concept was that Member States worked together to identify what was to be done and cooperated in doing it. Cooperation could be among developing countries or between a developing and a developed country. The role of WHO in technical cooperation with and among countries depended on the differing needs of Member States. The Committee requested the Sub-Committee to discuss the meaning of the term technical cooperation in depth~ together with mechanisms for implementation of the concept and the role to be played by WHO (see resolution WPR/RC30.R6). 2.2 Membership of the Sub-Committee In the same way as for the Sub-Committee on the General Programme of Work, the Committee decided that membership of the Sub-Committee on Technical Cooperation among Developing Countries should henceforth be for three years and that its composition would be reconsidered whenever a member had served for that period of time. The representatives of Japan and Singapore were replaced as members of the sub-Committee by representatives of Australia and the Philippines (see resolution WPR/RC30.R7). PART. IV. FORMULATION OF STRATEGIES FOR HEALTH FOR ALL BY THE YEAR 2000: REVIEW OF PROGRESS The Committee.noted that the Declaration of A1ma-Ata, adopted by the International Conference on Primary Health Care held in A1ma-Ata, USSR~ in September-1978~ had called on all governments to formulate national policies, strategies and plans of action to launch and sustain primary health care, as part of a comprehensive national health system~ in coordination with other sectors. The Declaration had also called for urgent and effective international - in addition to natlonal·-actlon to develop and implement primary health care throughout the world, particularly in developing countries. The World Health Organization had lost no time in responding to that call. The Executive Board, at its sixty-third se~sion in January 1979, had prepared guiding principles and essential issues for formulating strategies for health for all by the year 2000. . -- -.---.-. , ~ -~ . - . . --' .. - .. - _. - ------~-.-- 10 REGIONAL COMMITTEE: THIRTIETH SESSION The document had been presented to the Thirty-second World Health Assembly in May 1979. 1 The Health Assembly had invited Member States to consider the immediate use of the document, individually as a basis for formulating national policies, strategies and plans of action, and collectively as a basis for formulating regional and global strategies. The document also provided for a first review of progress by the regional committees at their 1979 sessions. In the Western Pacific Region, the tasks involved in preparation for the Regional Committee's first review of progress had been undertaken by the Sub-Committee on the General Programme of Work (see Part III, Chapter 1). The report of the Sub-Committee, document WPR/RC30/11 Part II, contained its comments and recommendations and abstracts of the progress reports submitted by Member States. Annex 2 of the document contained a list of ten issues it was • proposed should be addressed by regional strategies. The regional strategy was intended to give effect to regional health and related socioeconomic policies. It would thus have to be based on national policies, strategies and plans of action as seen from a regional perspective. It would have to indicate priority issues for international action within the Region, as well as the broad lines for that action in the health and other sectors concerned, to be undertaken by the Member States of the Region individually and collectively. Rasing their reports on the four questions set out below, eight representatives described the action being taken in their own countries. Repeated emphasis was placed on the need to improve the quality of health manpower: (1) What steps had been taken or would be taken in the country to obtain political commitment at highest governmental and political level, and what obstacles had been or would be faced? (2) What were the main preparatory steps being taken and mechanisms being established to promote intersectora1 and intrasectoral action and support? (3) What had been done or was being planned for the exchange of information, .experience, training and expertise among countries for the formu1atipn of policies, strategies and plans of action, in the spirit of TCne? (4) What WHO support was being used or would be required, and in what form, for support to· the formulation of national poliCies, strategies and plans of action at country level? 1 Document A32/8 presented to the Regional Committee under cover of document WPR/RC30/ll Part II Add.2; reproduced with revised timetable in document WHA32/l979/Rec/1, Annex 2. • "" ... REPORT OF THE REGlONAL COMMITTEE It was noted with appreciation that, to achieve the objective of health for all through the strengthening of primary health care in developing countries and also to combat health problems affecting both developed and developing countries, the Government of Japan would continue its contributions and was considering increasing its support for cancer research. The Committee asked the Sub-Committee on the General Programme of Work to include a discussion on how its report on the formulation 11 of strategies for health for all by the year 2000 was to be transmitted to the Director-General for submission to the Executive Board, an the agenda of the meeting of the Sub-Committee during the current session. It authorized the Regional Director to transmit the regional report to the Director-General without further reference to the Committee • It was noted that the timetable agreed to at the World Health Assembly provided for the submission of reports on national strategies and plans of action to the Regional Committee in 1980 and for progress in formulation of a regional strategy to be reviewed at the same session. It followed that the reports of Member States on national strategies and their proposals for a regional strategy would be needed by mid-April 1980 at the latest, to enable the Sub-Committee to meet, carry out its heavy schedule, and prepare its report in time for it to be despatched to Member States as a Regional Committee document. To that end the Committee requested the Regional Director to develop an outline for Member States to follow when preparing their reports on national strategies and plans of action, taking into consideration the general framework discussed by the Sub-Committee. It also authorized the Regional Director to submit an outline of suggested objectives, targets and indicators for the Region and to establish mechanisms to support the formulation of national and regional strategies (see resolution WPR/RC30.Rll). After some misgivings had been expressed as to when the objectives, targets and indicators for the Region should be developed, it was confirmed that national strategies must form the basis for the development of regional and global strategies, otherwise the latter would not mean very much. Different kinds of indica tors would be needed, d~E!ll_dJ,n.8_()t1 the targets. The time sched-\i-le contained in the documen-t-prepared by the Executive Board was a difficult one, especially with regard to targets, but it had been agreed, after discussion at the Board, that even if more time were to be allowed the position would not be much changed. Different countries had reached different stages of development and the process was not a finite one, ending with a report to the Board in January and to the Health Assembly in May. The launching of ideas at global and regional levels formeci an integral part of global and regional strategies~- The Committee was referred to the proposal of the Executive Board, contained in document WPR/RC30/ll Part II Add.2, that as part ~!~~~ strategy for achieving health for ali-by the year 2000, global and regional health development advisory councils should be established. The Director-General intended to establish a global council after preliminary discussions on the form it might take. The essential idea was to establish a mechanism for consultation with other sectors, agricultural and environmental, for example, whose participation would be needed for the attainment of the goal. 12 REGIONAL COMMITTEE: THIRTIETH SESSION The Executive Board had also felt that the global strategy should envisage the strengthening of global mechanisms, such as the establishment of an appropriate body of participating countries for attracting bilateral and multilateral funds and for ensuring that they were channelled into priority activities in countries. The wish had been expressed by a number of donor agencies that an international health funding group might be established, to decide how the considerable funds devoted to international health work were to be utilized. The involvement of developing countries and the WHO regions in the funding group was regarded as important, and it was proposed that eventually the Committee should appoint a member to represent the recipient countries of the Western Pacific Region in the group. Since the group had not yet been definitely established, however, it was decided that the propbsal would be considered again at the next session. PART v. OTHER MATTERS 1. Seventh general programme of work covering a specific period 1984-89): Pre1iminar review of nature ob ectives structure and method of preparation (Document WPR RC30 25) The Committee noted that preparation of WHO's general programmes of work was the responsibility of the Executive Board. For the first time, the regional committees were being asked to comment on the draft material, before the Committee as document WPR!RC)'O!25, prior to review by the Board, to ensure that they were involved from the beginning. The Seventh General Programme of Work was bound to differ from its predecessor because of the important policy decisions taken by the Health Assembly since the Sixth Programme had been prepared. The objectives would focus on the long-term goal of health for all by the year 2000. It should represent the needs of Member States to enable them to implement national strategies for attaining that goal. In place of the fragmented structure of the past, would be one single vertical system - the health system itself - into which all other programmes would be fed. The classification structure of the Programme might therefore be quite different from that of the Sixth General Programme of Work, in that it would focus on priority issues for WHO action, divided into three broad categories of interrelated programmes - health systems programmes, health technology programmes and promotional and support programmes. Approaches as a means of attaining the objectives of the Seventh General Programme of Work would have two broad aspects: coordination, which would include the availability of valid information on hea 1 th programmes and systems; and technical cooperation, which would, include the use of valid information. An endeavour would be made to include in the broad lines for WHO action related action in sectors other than health, as far as WHO could influence them. .. .. .. .. ... .. REPORT OF THE REGIONAL COMMITTEE 13 The proposals for the nature, objectives, structure and method ot preparation of the Programme, if eventually accepted by the Executive Board, would entail profound changes in ministries of health and in WHO at all levels, to reflect the integration of existing vertical programmes into a single system within which they supported each other. For example, countries often had a general health service and a separate malaria control service. The intention was to have one service only, with an overall strategy for the country as a whole for delivery at the appropriate service level. That would call for a much more effective dialogue than was now usual between the staff working on technologies and other staff working on the infrastructure. It had been to achieve a single viable health system of that kind that the Executive Board had asked the Director- General in 1971 to change the thrust of wao's programme. That had been attempted, not very successfully, in the Fifth and Sixth General Programmes of Work, and a further attempt would be made in the Seventh. The findings of the current study of WHO's structures in the light of its functions· would be relevant in that respect. Having made its preliminary review of the material for preparation of the Seventh General Programme of Work, the Committee adopted a resolution noting the proposals for its structure (see resolution WPR/RC30.RI2). 2. Contribution of Health to the new international economic order (Document WPR/RC30/14) The Committee recalled that the subject of the Technical Discussion during the Thirty-third World Health Assembly in 1980 would be "The contribution of health to the new international economic order". It reviewed the discussion paper submitted as document WPR/RC30/l4. It was concluded that the document set out fairly well the contribution health could make to the new international economic order. Health was concerned with the whole life span of every individual and ill health was not just a technical but a social and economic problem. Health could form an important bridge between national and international economic development efforts and WHO should seize every possible opportunity to prove that its strategies for health for all were in themselves a contribution towards economic development. That needed to be proved, not only at the technological but at the political level, so as to demonstrate to the world the benefits of investment in health; that it was not just a service provided to consumers but a contribution to national productivity. A resolution was adopted urging Member States to continue their efforts in the transfer of appropriate technology and resources, in technical cooperation among both developed and developing countries and in implementa,tion of the primary health care approach towards improved health for all; and also to continue their efforts towards health development, without which genuine socioeconomic develop- ment could not be attained (see resolution WPR/RC30.R13). The Committee noted that the delegation of the United States of America to the current thirty-fourth session of the United Nations General Assembly was submitting a draft resolution entitled "Health as an integral part of development" and would appreciate support from other delegations. 14 REGIONAL COMMITTEE: THIRTIETH SESSION 3. Correlation of the work of the World Health Assembly and the regional committees 3.1 session of the Executive Board The Committee noted with approval the efforts being made to correlate the work of the World Health Assembly, the Executive Board and the regional committees (see resolution WPR/RC30.R14). 3.2 Resolutions of the Thirt -second World Health the Executive oard at its sixty-third session The Committee considered' the following resolutions: and WPR/RC30/13) (1) Development of the mental health programme (resolution WHA32.13); (2) Workers' health programme (resolution WHA32.l4); (3) Development and coordination of biomedical and health services research (resolution WHA32.lS); (4) Review of the medium-term programme for the promotion of environmental health (resolution WHA32.31); (5) Smallpox eradication (resolutions WHA32.32 and EB63.R5); (6) Respiratory diseases (resolution WHA32.33); (7) Leprosy (resolution WHA32.39); (8) Development of the WHO programme on alcohol-related problems (resolution WHA32.40); (9) Action programme on essential drugs (resolution WHA32.4l); (10) WHO long-term programme for maternal and child health (resolution WHA32.42); (11) Proposed programme budget for the financial period 1980-81: programme review: traditional medicine programme (resolution EB63.R4); (12) Voluntary fund for health promotion (resolution EB63.R24); (13) Action in respect of international conventions on .narcotic and psychotropic substances (resolution EB63.R29); (14) WHO's human health and environment programme - evaluation of the effects of chemicals on health (resolution EB63.R19). A summary of the ca.meots made on specific resolutions is given below: .. .. .. ... REPORT OF THE REGIONAL COMMITTEE 15 3.2.1 Development of the mental health prograltBIle (resolution WHA32.13) The rep.resenta tive ·of the Philippines, who spoke to this resolution, received confirmation that the Special Account for the Mental Health Programme, established as a sub-ac~ount of the Voluntary Fund for Health Promotion, would be similar to those for malaria and smallpox eradication. 3.2.2 Respiratory diseases (resolution WHA32.33) The representative of Samoa spoke to this ,ceso1ution. He asked about research on respiratory diseases in the Region, especially pneumonia. The Committee was reminded that the Technical Presentation would provide a detailed account of the work being undertaken at the Institute of Medical Resea'rch, Goroka, papua New Guinea on pneumonia and the develop- ment of a pneumonia vaccine. It was proposed to estabHsh survei IJ.8nce units for the collection of epidemiological data and for research on respiratory diseases. 3.2.~ Voluntary Fund for Health Promotion (resolution EB63.R24) The representative of Samoa was informed that the Voluntary Fund for Health Promotion was the fund which received the voluntary contributions of governments, organizations and individuals towards the work of WHO. Donors in the Western Pacific Region included the Governments of Australia, Japan, New Zealand and the United Kingdom of Great Britain and Northern Ireland and the Japan Shipbuilding Industry Foundation. 3.2.4 Action in respect of international conventions on narcotics and psychotropic substances (resolution EB63.R29) The representative of the United States of America spoke to this resolution. His Government was glad to see the increased attention being given to efforts to combat the illicit use of narcotic and psychotropic substances, in particular the development of a programme of research in the epidemiology of drug abuse. He wished to urge stronger measures to reduce drug abuse, especially in the medical uses and if possible in curbing illicit traffic. He was assured that increasing attention was being given by WHO, in cooperation with the United Nations Division of Narcotic Drugs, UNFDAC and USAID, to the treatment and prevention of drug abuse, as well as to epidemiological research. 3.2.5 WHO's human health and environment.programme - evaluation of the effects of chemicals on health (resolution EB63.R19) The representative of Samoa spoke to this resolution endorsing its content aild expressing appreciation of the cooperation being extended at present by a ~~O expert in evaluating Samoa's environmental health problems. . 4. Country health pro&ramming (Document WPR/RC30/15) The Committee recalled that at the last session of the Regional Committee, the representative of New Zealand had rightly pointed to country health programming as a fundamental process in the planning of national health services. As a result of his comments, the subject 16 REGIONAL COMMITTEE: THIRTIETH SESSION had been placed on the agenda of the current session. Document WPR/RC30/15 described the policy basis for country health programming, the principles and the procedures, and the past efforts of WHO in the Western Pacific Region. It also referred to country health programming as a tool for technical cooperation and described mechanisms for its support. The Committee was pleased to note the activities being undertaken in American Samoa. It urged Member States to introduce or strengthen country health programming for integrated health development; set up adequate mechanisms for implementation and further development of country health programming; establish national centres for health development which would undertake training and research in country health programming; and cooperate with each other in training activities and in exchanging experience in country health programming research and development, in the spirit of regional self-reliance in health matters. It requested the Regional Director to continue to cooperate with Member States in introducing and strengthening the country health programming process and to strengthen mechanisms for the support of country health programming at national and regional levels. It adopted a resolution to that effect (see resolution WPR/RC30.RI6). 5. Study of the WHO fellowship programme (Document WPR/RC30/16) The Committee recalled that, in 1976, the World Health Assembly had adopted a resolution asking the Director-General to intensify efforts to develop the concept of integrated health services and manpower development, of which the fellowship programme was a major component. All involved in the fellowship programme, in both governments and WHO, had for some time been concerned to improve the manner in which they were responding to changing trends in training. A thorough review was needed of the programme and of the procedures used to select fellows and utilize them on their return home. The arrangements made by host countries to establish and implement training programmes also needed to be studied. In WHO, in particular, new policies could not but affect the Organization's attitude to the award of fellowships. It was clear that the award of fellowships not related to specific national health projects had led to fragmentation of health manpower resources. Fellow- ships had to serve health programmes developed through national health planning or country health programming. At its twenty-eighth session. the Regional Committee had, on the initiative of the Government of New Zealand, adopted a resolution requesting the Regional Director to convene a meeting to discuss the scope of concerted regional cooperation on such aspects of health manpower development. The Conference on Regional Cooperation in the WHO Fellowship Programme had been organized in February 1979. It was attended by senior government representatives, able to make recommenda- tions for the improvement of fellowship planning and selection mechanisms at country level; improved administration by WHO; better information sources; action by receiving countries; and monitoring and evaluation of the programme. • • • REPORT OF THE REGIONAL COMMITTEE 17 The Committee reviewed and commended the plan for implementing the recommendations of the Conference contained in document WPR/RC30/l6. The representative of the United Kingdom of Great Britain and Northern Ireland referred particularly to the priority being given by his country to relating fellowships to specific national projects in which it was cooperating. A resolution was adopted which emphasized the recommendations of the Conference aimed at rationa1~zing the administrative arrangements for receiving and supporting an 1ncre~sed number·of fellows. The Regional Director was requested to continue to evaluate the programme, with particular reference to the utilization of former fellows on return to their home countries (see resolution WPR/RC30.R17). 6. The Committee referred to document WPR/RC30/17 and commended the Regional Director on his use of extrabudgetary resources for strengthening biomedical research in the Region. It heard the representative of Papua New Guinea speak of the promising results of research into pig bel and pneumonia vaccines which had been carried out at the Institute of Medical Research, Goroka in cooperation with WHO. It was noted that 1979 had seen further consolidation of the programme. The impact had been measurable in terms of the number of activities being implemented and the increased relevance of research to local needs. Resources, hitherto contained in the research promotion and development programme, had been allocated to individual technical programmes - mainly communicable disease programmes - for the develop- ment of research components. The work of the six technical advisory bodies of the Western Pacific Advisory Committee on Medical Research (WPACMR) as task forces had concluded and they had become sub-committees. One of the sub- committees, the Committee was informed, was that on health services and occupational health. WPACMR had stressed the need to conduct research on that subject, which had received little attention in the Western Pacific Region so far. There was also a need for more information on problems of occupational health in the Region (see also Part II, Chap'~er 1(3» ~ Lastly, the Committee felt that accelerated efforts should be made to provid~_~areer str\lctures~nd employment C?pportuni ties fo~ _r~.!e,~~,cll_, workers. Resolution WPR/RC30.R1S was adopted to that effect, endorsing also the recommendations of WPACMR. 7. Review of the cancer situation in the Western Pacific Re ion (Document WPR/RC30 IS) The Committee noted that a resolution adopted by the Executive Board at its sixty-first session (1978) invited the regional committees to undertake regular reviews of the cancer situation in their regions. 1 1 See resolution EB61.R29, WHO Handbook of Resolutions and Decisions, Volume II (3rd edition), 1979, page 78. 18 REGIONAL COMMITTEE: THIRTIETH SESSION The Committee itself had decided that such a review should be included in the agenda of the present session. Document WPR/RC30/18 provided the background for the review. It was noted that information for the document had been gathered from many sources, including official documents and consultants' reports. Analysing the data had proved difficult, especially the figures on common sites of cancer. What the document did reveal was the lack of knowledge of the situation in the Region. Representatives were able to provide additional information on the statistics for their countries. The working group which was to meet in Manila, star~ing on 15 October, was to discuss methods for collecting information. Better epidemiological information was particularly important in order to pinpoint cancer etiology. Despite the lack of statistics, however, the document did show a remarkable range of site incidence in the Region. The Committee asked the Regional Director to support Member States in their activities towards promotion of national cancer information systems, particularly the development of population-based and hospital- based cancer registries for assessment of the nature and magnitud~ of the cancer problem. It also asked him to update the information on the cancer situation in the Region for a future session of the Regional Committee. It adopted resolution WPR/RC30.R19. . 8. Immunization services and their evaluation (Document WPR/RC30/19) The Committee agreed that the expanded progr~mme on immunization represented one of the simplest and most effective activities the Organization could encourage. The target of the Programme was to provide immunization against the six diseases covered - diphtheria, measles, tetanus, tuberculosis, pertussis and poliomyelitis - for all children by the year 1990. That could be achieved, through using the primary health care approach within the health services delivery system, only if adequate information bases, both regional and national, were established to enable adequate evaluation of the programme. The representatives of China, Malaysia, Singapore and Viet Nam described the situation in their own countries and the representative of the United States of America the situation in the Commonwealth of the Northern Mariana Islands. The representative of China referred to four essentials for the development of a successful programme: (Jl !mmunization units should be set up to establish plans adapted to local conditions and ensure .. that all vaccines reached the population for which they were intended within the shortest possible time; (2) immunization personnel should receive special training and the number of trainees should be determined according to the volume of work to be carried out; (3) the masses had to be educated to realize the importance of immunization; and (4) a card system had to be instituted, to ensure full coverage but that nobody was immunized twice. The representative of New Zealand spoke of the need for public relations action to persuade parents to bring children for immunization particularly when the incidence of disease waned. Simple record-keeping was also important so that field workers would not be hampered in their task by excessive paper work. .. .. .. REPORT OF THE REGIONAL COMMITTEE 19 The representative of Samoa referred particularly to the incidence of tropical ulcer, one of causes of which was the bacillus of diphtheria. Studies were necessary to determine the role of the cutaneous form of diphtheria in natural immunity. The Committee agreed with the represent~tive of the United Kingdom of Great Britain and Northern Ireland when he emphasized the importance of the cold chain. That was a vital problem, especially in the South Pacific, where much of the transport of vaccines was by boat. The Committee concluded its discussion on the item by emphasizing the importance of quality control and by referring to the possible advantages of bulk purchasing of vaccines, which might be one of the functions of the proposed joint pharmaceutical service for the South Pacific. It recommended that Member States should strengthen the evaluation component of their immunization services within the overall framework of national health information systems. It adopted resolution WPR/RC30.R20. 9. Status of the antimalaria programme (Document WPR/RC30/20) The Committee reviewed document WPR/RC30/20. It noted that some national authorities were still failing to provide budgetary support to maintain the programme at the required level. Sustained government commitment remained a prerogative for progress. Development of adequate manpower and orientation with regard to malaria of general health services staff had to have priority. Operational research activities were also of importance in determining the best approaches to control, and also cost- benefit ratios. Applied field research had to' continue. Safeguarding their freedom from malaria was an important goal for countries that had reached the maintenance phase. The representatives of Malaysia, Papua New Guinea, Singapore. and Viet Nam reported on the situation in their own countries and the representative of the United States of America on the situation in Guam which was becoming increasingly interested in the promotion of tourism. In reply to questions posed by the representative of the United Kingdom of Great Britain and Northern Ireland the Committee heard that chloroquine resistance had been found in the Bougainville area of Papua New Guinea and that the regional antimalaria team had reported resistance in all malarious countries or areas of the Region, except New Hebrides and Solomon Islands. Multisectoral activities were receiving increasing attention. China, for example, was associating the efforts of the community, industry and agriculture with those of the health services, in its attempt to eradicate the disease. There were still advantages to he gained from specialization among malariologists, but they were becoming increasingly aware that they could not work in isolation. The Committee adopted resolution WPR/RC30.R21 once ~g~.in urgin~ Member States to intensify their efforts for combating malaria and to collaborate in training and research activities. 20 REGIONAL COMMITTEE: THIRTIETH SESSION 10. Diarrhoeal dfseases control, including cholera (Document WPR/RC30/2l) The Committee recalled that the Technical Presentation at the twenty-ninth session had been on the subject of diarrhoeal diseases, including cholera, typhoid and paratyphoid. The problem was of such importance in the Region that the Committee had adopted a resolution aimed at accelerating the development of an intensified control programme. 1 plans for a regional programme had subsequently been developed, in parallel with plans for a global programme. The solution to the problem clearly lay in the provision of adequate sanitary and waste disposal facilities. That, however, could only be a long-term solution, since it was beyond the immediate means of many developing countries. The short- or medium-term solution lay in oral rehydration and related international coilaboration delivered through the primary health care approach. The representatives of Malaysia, Philippines and Viet Nam commented on their national programmes and the representative of the United States of America on the programme in the Trust Territory of the Pacific Islands. The Committee noted with interest that a research institute for tropical diseases had been established in the Philippines with the cooperation of the Government of Japan and was expected to begin to function in 1981. The willingness of the Government of Japan to provide bilateral support with a view to effective control in the Region was appreciated. As expressed by the representative of the United Kingdom of Great Britain and Northern Ireland the Committee hoped that, now an intensive programme had been developed, it would advance as quickly as possible, since diarrhoeal diseases were responsible for more reported deaths than any of the six diseases under the Expanded Programme on Immunization. However, immunization was a long-established procedure; the oral rehydration programme was much newer and many countries were encountering difficulties in reaching the primary health care level quickly. ·Immuni- zation could be carried out through occasional visits by health workers, but diarrhoeal diseases had to be treated when they happened, by local health workers or by mothers. The question of quarantine was of particular importance. The inadvisability of cholera vaccination had to be recognized officially since it was difficult for some health authorities to resist government pressure for that ineffective measure which caused inconvenience to travellers and involved useless expense. The only answer to the cholera problem was adequate surveillance, backed by such long-term measures as improved water supplies and sanitation. Cholera, however, was just one of the diseases covered by the diarrhoeal diseases control programme, which it was hoped Member States, with the support of WHO, would take steps to strengthen. A resolution was adopted to that effect which also urged Member States to maintain vigilant surveillance for cholera and to take prompt action if it was detected (see resolution WPR/RC30.R22) • 1 See resolution WPR/RC29.R15, Report of the WHO Regional Committee for the Western Pacific, twenty-ninth session, 1978, pages 30-31. -. .. .. . REPORT OF THE REGIONAL COMMITTEE 11. Radiation medicine in public health (Document WPR/RC30/22) The Committee noted that radiation medicine services formed an essential part of the process which s.tarted with primary health care .21 and ended in referral of a patient to a specialized health institution. Coverage by radiation medicine services in the Region was poor; specialized personnel were lacking, as were training facilities; and utilization of existing facilities was inadequate. Document WPR/RC30/22 contained a comprehensive plan for radiation services at the national level which ,could be adapted to the needs of the Region. The present aim was to ensure appropriate services with basic, simply maintained, radiological equipment able to withstand fluctuations in operating electric voltages • The representatives of China, Malaysia, Republic of Korea and Singapore spoke of the development of radiation medicine services in their countries and looked forward to improved technical cooperation in that field in the future. The Committee noted with appreciation the interest of the Government of New-Zealand, expressed by its representative, in continuing participatiot\ in the regional programme by providing opportunities for training in radiation protection. The importance of training technicians in the maintenance and repair of radiological equipment was also emphasized and endorsed by the representative of France. The Committee adopted a resolution recognizing the need to strengthen national capabilities for planning and developing radiological services, and urged Member States to collaborate in improving practices in the medical use of ionizing radiation and radionuclides as well as the protection of radiation workers and the population (including patients) against excessive exposure to ionizing radiation (see resolution WPR/RC30.R23). 12. Host Agreement between the Government of the Republic of the Philippines and the World Health Organization (bOcument WPR/RC30/23) The Committee noted that after discussion between the Government of the Philippines and WHO on reinterpretation of Section 22(g), Article VIII of the Host Agreement, agreement had been reached which made further negotiation inappropriate (see resolution WPR/RC30.R24). 13. Selection of topic for the Technical Presentation during the thirty-first session of the Regional Committee (Document WPR/RC30/24) After representatives had spoken in favour of both "Country health programming" and "Community involvement in the development of health services" as the topic for the Technical Presentation during the thirty- first session of the Regional Committee, the Committee put the question to the vote and finally selected "Community involvement in the develop- mentof health services" (see resolution WPR/RC30.R25). A proposal, made by the representative of Australia, that the practice of arranging a technical presentation during sessions of the Regional Committee should be discontinued, was not accepted. 22 REGIONAL COMMITTEE: THIRTIETH SESSION 14. Time and place of the thirty-first and thirty-second sessions of the Regional Committee The Committee decided that the thirty-first session of the Regional Committee should be held in Manila from 9 to 15 September 1980. The dates were agreed to after some discussion on whether the duration of the session should be five working days - from Monday to Friday - or five working days with a weekend inbetween - from Tuesday to Monday. The Committee accepted with appreciation the invitation of the Government of the Republic of Korea to hold the thirty-second session in Seoul, noting the reservation expressed by the representative of China (see resolution WPR/RC30.R26). 15. Reports received from governments on the progress of their health activities The Chairman acknowledged the following reports presented to the Committee: (1) AUSTRALIA - National health activities during 1978-1979; (2) CHINA - Some major features in the health services of the People's Republic of China in the past year; (3) FRENCH POLYNESIA - The public health service in French Polynesia: organization, activities and development (French only); (4) HONG KONG - Brief report on progress of health activities, 1978; (5) JAPAN - Report on the progress of health activities in Japan (1978); (6) MALAYSIA - Brief report on the progress of health activities; (7) NEW CALEDONIA AND DEPENDENCIES - Brief report on the progress of health activities, 1978; (8) NEW ZEALAND - Brief report on the progress of health activities, 1978/79; (9) REPUBLIC OF KOREA - Report on progress of health activities; (10) SAMOA - Summary on filariasis research work in Western Samoa; (11) SINGAPORE - Brief report on the progress of health activities; (12) USA-PACIFIC BASIN JURISDICTIONS - Report on health activities, 1979, (13) VIET NAM - Brief report on the progress of health activities in the Socialist Republic of Viet Nam, September 1978 to September 1979 (French only). • . REPORT OF THE REGIONAL COMMITTEE PART VI. RESOLUTIONS ADOPTED BY THE REGIONAL COMMITTEE WPR/RC30.Rl RULES OF PROCEDURE OF THE REGIONAL COMMITTEE FOR THE WESTERN PACIFIC The Regional Committee, Recalling resolution WPR/RC29.R20 on the Rules of Procedure of the Regional Committee for the Western Pacific; , Having considered the report of the Sub-Committee established to study Rule 51; DECIDES to replace the present Rule 51 of the Rules of Procedure with the following text: Rule 51 Not less than six months before the date fixed for the opening of a session of the Committee at which persons are due to be nominated as Regional Director, the Director- General shall inform each Member that he will receive proposals for the names of persons for nomination by the Committee as Regional Dlrector. Any member may propose the name of one or more persons for the post of Director, submitting with the proposal particulars of each person's qualifications and experience. Such proposals shall be sent to the Director-General, so as to reach him at the Headquarters of the Organization at Geneva, Switzerland, not less than twelve weeks before the date fixed for the opening of the session. The Director·deneral shall, not less than ten weeks before the date fixed for the opening of the session of the Committee, cause copies of all proposals for nomination for the post of Director (with particulars of qualifications and experience) received by him within the period specified, to be sent to each Member. If no proposals have been received by the Director- General in time for transmission to Members in accordance with this Rule, Members shall be informed accordingly not less than ten weeks before the opening of the session of the Committee. The Committee shall itself establish a list of candidates, composed of the names proposed in secret by the representatives present and entitled to vote. If the Director in office is available for reappointment, the Director-General shall inform each Member accordingly at the time he invites proposals for names of nominees for the post of Director. The name of the Director in office thus available shall automatically be submitted to the Committee and shall not require a proposal from any Member. 23 24 REGIONAL COMMITTEE: THIRtIETH SESSION The nomination of the Regional Director shall take place at a private meeting of the Committee. The Regional Director is elected by secret ballot from amongst the persons proposed in accordance with this Rule. For this purpose each representative entitled to vote shall write on his ballot paper the name of a single candidate chosen from among the persons proposed. If no candidate obtains the majority required, the candidate who obtains the least number of votes shall be eliminated a.t each ballot. If the number of candidates is reduced to two, there shall be as many ballots as are necessary to secure a majority for either candidate. In the event of a tie between the remaining candidates after three such ballots, the whole voting procedure established by this paragraph shall be recommenced. The name of the person so nominated shall be submitted to the Executive Board. Second meeting, 2 October 1979 WPR/RC30.R2 REPORT OF THE REGIONAL DIRECTOR The Regional Committee, Having reviewed the report of the Regional Director on the work of the World Health Organization in the Western Pacific Region during the period 1 July 1977 to 30 June 1979,1 1. NOTES with satisfaction the manner in which the programme was planned and carried out; 2. COMMENDS the Regional Director and his staff for the work accomplished. Third meeting, 3 October 1979 1 Document WPR/RC30/7. .. • • REPORT OF THE REGIONAL COMMITTEE 25 WPR/RC30.R3 BUDGET PERFORMANCE 1978 - DIRECT SERVICES TO QOVERNMENTS The Regional Committee f. NOTES the report of the Regional Director on budget performance for the financial year 1978;1 2. REQUESTS the Regional Director to make reports of a similar nature to future sessions of the Regional Committee. Third meeting, 3 October 1979 WPR/RC30.R4 CHANGES IN THE PROGRAMME BUDGET FOR 1980-81 The Regional Committee, Having reviewed the report on significant changes in the programme budget for the biennium 1980-81,2 NOTES the changes made and the reasons for those changes. Third meeti.op,. 1 October 1979 WPR/RC30.R5 SPECIAL PROGRAMME FOR RESEARCH AND TRAINING IN TROPICAL DISEASES: JOINT COORDINATING BOARD The Regional Committee, Recalling resolution WPR/RC29.R11 and the fact that the period of tenure of the representative of the Government of the Philippines as a member of the Joint Coordinating Board of the Special Programme for Research and Training in Tropical Diseases expires on 31 December 1979; Noting that, since the appointment of the representative of the Government of the Philippines to the Board was retroactive, he has served for less than the two-year period; REAPPOINTS the representative of the Government of the Philippines for a period of three years up to 31 December 1982. Fifth meeting, 4 october 1979 1 Document WPR/RC30/3. 2 Document WPR/RC30/4. 26 REGIONAL COMMITTEE: THIRTIETH SESSION WPR/RC30.R6 TECHNICAL COOPERATION AMONG DEVELOPING COUNTRIES The Regional Committee, Having considered the report of the Sub-Committee on Technical Cooperation among Developing Countries,l 1. AGREES with the recommendations contained in the report; 2. REQUESTS the Regional Director to take appropriate action to put those recommendations into effect; 3. REQUESTS the Sub-Committee to discuss in depth the meaning of the term technical cooperation apd mechanisms for implementation. Fifth meeting, 4 October 1979 WPRiRC30.R7 MEMBERSHIP OF THE SUB-COMMITTEE ON TECHNICAL COOPERATION AMONG DEVELOPING COUNTRIES The Regional Committee, Recalling operative paragraph four of resolution WPR/RC29.R19 regarding membership of the Sub-Committee on Technical Cooperation among Developing Countries, 1. DECIDES that, in future, membership of the Sub-Committee on Technical Cooperation among Developing Countries shall be on a rotational basis; 2. FURTHER DECIDES that: (1) during the thirtieth session of the Regional Committee, the representatives of Japan and Singapore shall be replaced as members of the Sub-Committee by the representatives of Australia and Philippines; (2) from the thirtieth session, the period of tenure for members of the Sub-Committee shall be three years; (3) composition of the Sub-Committee therefore shall be reconsidered whenever a member has served for three years; 3. THANKS the representatives of Japan and Singapore for their services to the Sub-Committee. Fifth meeting, 4 October 1979 1 Document WPR/RC30/l0. • -REPORT OF THE REGIONAL COMMITTEE 27 WPR/RC30.R8 SUB-COMMITTEE ON TIlE GENERAL PROGRAMME OF WORK The Regional Committee, Having considered Part I of the report of the Sub-Committee on the General Programme of Work,l 1. ENDORSES the views expressed in the report; 2. REQUESTS the Regional Director to take those views into consideration in developing the programme of cooperation for the Region; 3. REQUESTS the Sub-Committee to meet during the present session and to discuss the way in which the regional report on WHO's structures in the light of its functions should be transmitted to the Director-General; 4. AUTHORIZES the Regional Director to transmit the regional report to the Director-General without further reference to the Regional Committee; 5. REQUESTS the members of the Sub-Committee to continue, as their main task, review and analysis of WHO's collaboration with Member States; 6. CONFIRMS the Sub-Committee's amended terms of reference to include the studies connected with the formulation of strategies for health for all by the year 2000. Fifth meeting, 4 October 1979 WPR/RC30.R9 MEMBERSHIP OF THE SUB-COMMITTEE ON THE GENERAL PROGRAMME OF WORK The Regional Committee, Recalling resolution WPR/RC29.R8 regarding membership of the Sub- Committee on the General Programme of work, 1. DECIDES that: (1) during the thirtieth session of the Regional Committee, the representatives of Australia, Malaysia and Philippines shall be replaced as members of the Sub-Commitee by the representatives of China, Samoa and Singapore; (2) from the thirtieth session, the period of tenure for members of the Sub-Committee shall be three years; (3) composition of the Sub-Committee therefore shall be reconsidered whenever a member has served for three years; 2. THANKS the representatives of Australia, Malaysia and Philippines for their services to the Sub-Committee. Fifth meeting, 4 October 1979 1 Document WPR/RC30/ll Part I. 28 REGIONAL COMMITTEE: THIRTIETH SESSION WPR/RC30.RlO COST OF TRAVEL OF REPRESENTATIVES The Regional Conunittee, Referring to resolution WPR/RC4.R18, which recommended that the travelling expenses of Member and Associate Member States for attendance at sessions of Regional Committees be borne by the Member and Associate Member governments; Noting that the cost of travel, excluding per diem, of a delegate from each Member State to the World Health Assembly is borne by the Organization; Recognizing the increasing involvement of the Regional Committee in the work of WHO and its role as a major policy-making organ and a forum for promoting technical cooperation between Member States of the WHO Western Pacific Region; Stressing the need for all Member States of the Region to be involved in the deliberations of the Regional Committee; 1. SYMPATHIZES with those Member States that, because of financial constraints, have either been unable to send representatives to sessions of the Regional Committee in recent years or have sent representatives despite the financial hardship involved; 2. RECOMMENDS to the Executive Board and, through it, to the World Health Assembly that action should be taken for wHo to consider financing the cost of travel, excluding per diem, of a representative from each Member State to attend sessions of the Regional Committee. Seventh meeting, 5 october 1979 WPR/RC30. Rll STRATEGIES FOR HEALTH FOR ALL BY THE YEAR 2000 The Regional Committee, Having considered Part II of the report of the Sub-Committee on the General Programme of Work and the progress made by Member States of the Region towards the development of national strategies and plans of action, together with the issues to be addressed by regional strategies,l 1. AUTHORIZES the Regional Director to transmit the regional report to the Director-General without further reference to the Regional Committee; 2. AGREES that regional strategies, based on national strategies, should be developed for attainment by all of a level of health that will permit each person to lead a socially and economically productive life; 1 Document WPR/RC30/ll Part II. .. ... • .. .. ... REPORT OF THE REGIONAL COMMITTEE 3. RECOMMENDS that Member States: 4. (1) should submit reports on their national strategies and plans of action to the Regional .Director no later than mid-April 1980; (2) at the same time, should make proposals to the Regional Director on the issues to be addressed by regional strategies; REQUESTS the Regional Director to: (1) develop and despatch to Member States an outline for them to follow when preparing their reports on national strategies and plans of action, taking into account the general framework discussed by the Sub-Committee; (2) take whatever steps are necessary to: (i) develop suggested indicators, targets and objectives for the Region; (ii) establish mechanisms to support the formulation of national and regional strategies; (iii) ensure that a report, based on Member States' own reports on national strategies and plans of action and proposals for the issues to be addressed by regional strategies, is presented to the thirty-first session of the Regional Committee to enable it to review the progress made. 29 seventh meeting, 5 October 1979 WPR/RC10.Rl2 SEVENTH GENERAL PROGRAMME OF WORK COVERING A SPECIFIC PERIOD (1984-1989) The Regional Committee, Having made a preliminary review of the nature, objectives, structure and method of preparation of the Seventh General Programme of Work covering a specific period (1984-1989), NOTES the proposed structure of the programme aimed at supporting Member States to refine and implement their strategies for health for all by the year 2000 and at evaluating progress towards the attainment of tha t goa 1. Seventh meeting, 5 October 1979 30 REGIONAL COMMITTEE: THIRTIETH SESS ION WPR/RC30 ~ R13 HEALTH AND THE NEW INTERNATIONAL ECONOMIC ORDER The Regional Connnittee, Noting resolutions 3201 (S-VI) and 3202 (S-VI) adopted by the General Assembly of the United Nations; Recognizing that socioeconomic development is dependent on the health of the population contributing to it; Further recognizing the leading role to be played by WHO in the promotion of health in order to contribute to the New International Economic Order; Bearing in mind its deliberations on the formulation of national strategies and plans of action towards health for all by the year 2000; 1. URGES Member States of the Region to continue their efforts in the transfer of appropriate technology and resources, in technical cooperation among both developed and developing countries and in implementation of the primary health care approach towards improved health for alIi 2. FURTHER URGES Member States to continue their efforts towards health development, without which genuine socioeconomic development cannot be attained. Seventh meeting, 5 October 1979 WPR/RC30.R14 PROVISIONAL AGENDA OF THE SIXTY-FIFTH SESSION OF THE EXECUTIVE BOARD The Regional Committee, Having considered the main items of the provisional agenda of the sixty-fifth session of· the Executive Board,l NOTES with approval the efforts being made to correlate the work of the Regional Committees, the Executive Board and the World Health Assembly. Seventh meeting, 5 October 1979 1 Document WPR/RC30/l2. .. WPR/RC30.R15 REPORT OF THE REGIONAL COMMITTEE RESOLUTIONS OF REGIONAL INTEREST ADOPTED BY THE THiRTY-SECOND WORLD HEALTH ASSEMBLY AND THE EXECUTIVE BOARD AT ITS SIXTY-THIRD SESSION The Regional Committee TAKES NOTE of the following resolutions adopted by the Thirty- second World Health Assembly and the Executive Board at its sixty-third session: WHA32.13 - Development of the mental health programme WHA32.14 - Workers' health programme WHA32.l5 - Development and coordination of biomedical and health servtces research WHA32.31 - Review of the medium-term programme for the promotion of environmental health WHA32.32 EB63.R5 - Smallpox eradication WHA32.33 - Respiratory diseases WHA32.39 - Leprosy WHA32.40 -Development of the WHO programme on alcohol-related problems WHA32.41 EB63.R20 - Action programme on essential drugs WHA32.42 - WHO long-term programme for maternal and child health EB63.R4 - Proposed programme budget for the financial period 1980-1981: programme review: traditional medicine programme EB63.R24 - Voluntary fund for health promotion EB63.R29 - Action in respect of international conventions on narcotic and psychotropic substances EB63.R19 - WHO's human health and environment programme - evaluation of the effects of chemicals on health 31 Seventh meeting, 5 October 1979 WPR/RC30. R16 COUNTRY HEALTH PROGRAMMING The Regional Committee, Recalling resolutions WHA3l.l2 on country health programming and Wl~32.30 on the formulation of strategies for health for all by the year 2000; 32 REGIONAL COMMITTEE: THIRTIETH SESSION Reiterating the importance of country health programming for health development; Having considered the present status of country health programming in the Region;l 1. URGES Member States to: (1) introduce and strengthen country health programming for integrated health development; (2) set up adequate mechanisms for implementation and further development of country health programming; (3) establish national centres for health development which will undertake training and research in country health programming; (4) cooperate with each other in training activities and in exchanging experience in country health programming research and development, in the spirit of regional self-reliance in health matters; 2. REQUESTS the Regional Director to continue to: (1) cooperate with Member States in introducing and strengthening the country health programming process; (2) strengthen mechanisms for tne support of country health programming at national and regional level. Seventh meeting, 5 october 1979 WPR/RC30. R17 THE WHO FELLOWSHIP PROGRAMME The Regional Committee, Having rev:1.ewed--ihe report presented by the Regional Director on the WHO fellowship programme; 2 Considering that implementation of the recommendations made by the representatives of Member States at the Conference on Regional Cooperation in the WHO Fellowship Programme will improve the health manpower develop- ment programme in general and fellowship activities in particular; Recognizing that those recommendations carry with them the support of Member States and that the improvements suggested will depend upon the national will to use the fellowship programme more effectively; 1 Document WPR/RC30/15. 2 Document WPR/RC30/16. ... ... .. ... REPORT OF THE REGIONAL COMMITTEE 1. THANKS the Member States that have up to the present received fellows for· training; 33 2. ENDORSES the proposals for future action, on the part of WHO and Member States, in implementation of the recotmnendatio.ns of the Conference, particularly the recommendations aimed at rationalizing the administrative arrangements for receiving and supporting an increased number of fellows; 3. URGES Member States to accept full responsibility for implementing those proposals in collaboration with WHO; 4. REQUESTS the Regional Director to continue evaluation of the fellow- ship programme, particularly of the utilization of former fellows on return to their home countries. WPR/RC30.R18 Seventh meeting, 5 October 1979 WHO'S ROLE IN THE DEVELOPMENT OF BIOMEDICAL AND HEALTH SERVICES RESEARCH (INCLUDING RESEARCH STRENGTHENING AND CAREER STRUCTURES IN TROPICAL COUNTRIES) The Regional Committee, Having considered the Regional Director's progress report on the development of biomedical and health services research (including research strengthening and career structures in tropical countries),l 1. THANKS the Regional Director for his report; 2. NOTES with satisfaction: (1) the Regional Director's continuing success in attracting extrabudgetary funds for research; and (2) the discernible impact of the regional research programme at country level; 3. REQUESTS Member States to establish explicit goals for the strengthening of national research capabilities and to increase efforts to . improve career structures for research workers; 4. ENDORSES the recommendations of the Western Pacific Advisory Committee on Medical Research, made to the Regional Director at its fourth session; 5. REQUESTS the Regional Director to implement those recommendations. Seventh meeting, 5 October 1979 1 Document WPR/RC30/l7 • 34 REGIONAL COMMITTEE: THIRTIETH SESSION WPR/RC30.R19 THE CANCER SITUATION IN THE WESTERN PACIFIC REGION The Regional Committee, Having reviewed the report on the cancer situation in the Region presented by the -Regional- Director, 1 1. URGES Member States to direct their cancer control activities towards promot1on of national cancer information systems, particularly the development of population-based and hospital-based cancer registries, for assessment of the nature and magnitude of the cancer problem; 2. REQUESTS the Regional Director to: (1) provide support in those activities wherever feasible; (2) update the information on the cancer situation in the Western Pacific Region for a future session of the Regional Committee; (3) promote international cooperation in cancer research and the training of workers in cancer research and control. Seventh meeting, 5 October 1979 WPR/RC30.R20 IMMUNIZATION SERVICES AND THEIR EVALUATION The Regional Committee, Having considered the report presented by the Regional Director,2 1. NOTES the need for national evaluation of immunization services, as a means of: (1) ensuring efficient management of those services to reach the target population; and (2) providing information for the regional expanded programme on immunization; 2. RECOMMENDS that Member States should strengthen the evaluation component of their immunization services within the overall framework of the national health management information system; 3. REQUESTS the Regional Director to: (1) take steps to build a regional information system for the expanded programme on immunization, through intensified collaboration with Member States in information sharing; 1 Document WPR/RC30/l8. 2 Document WPR/RC30/19. .. ... ... ... REPORT·OF THE REGIONAL COMMITTEE (2) provide collaboration in developing national capability in the evaluation of immunization programmes. Seventh meeting, 5 October 1979 WPR/RC30.R2l ANTIMALARIA PROGRAMME The Regional Committee, Having considered the report presented by the Regional Director on the status of the antimalaria programme;l Recalling resolution WPR/RC29.R13; 1. THANKS the Regional Director for the information provided; 2. URGES Member States to: (1) intensify their efforts for combating malaria as set out in resolution WPR/RC29.R13; (2) collaborate in training and research activities in the field of malaria; 3. REQUESTS the Regional Director to continue to provide the necessary support. Eighth meeting, 8 October 1979 WPR/RC30.R22 PROGRAMME ON DIARRHOEAL DISEASES CONTROL The Regional Committee, Having reviewed the report submitted by the Regional Director;2 35 Having considered inter alia that cholera immunization of travellers, using the vaccine at present available, will not prevent the spread of cholera; 1. NOTES the outline for a regional programme in diarrhoeal diseases control; 2. URGES Member States to strengthen their programmes in diarrhoeal diseases control; 1 Document WPR/RC30/20. 2 Document WPR/RC30/2l. 36 REGIONAL COMMITTEE: THIRTIETH SESSION 3. REQUESTS the Regional Director to extend all possible support to Member States to enable them to establish programmes or strengthen existing programmes; 4. FURTHER URGES Member States to maintain vigilant surveillance for cholera and to take prompt action if it is detected. Eighth meeting, 8 October 1979 WPR/RC30.R23 RADIATION MEDICINE IN PUBLIC HEALTH The Regional Committee, Having considered the paper presented by the Regional Director;l Recognizing the need to strengthen national capabilities for planning and developing radiological services; 1. URGES Member States to collaborate in improving practices ih the medical use of ionizing radiation and radionuclides as well as the protection of radiation workers and the population (including patients) against excessive exposure to ionizing radiation; 2. ENDORSES the proposed plan for better coverage and utilization of radiation medicine services; 3. REQUESTS the Regional Director to continue efforts in the Western Pacific Region towards cooperation in establishing and developing radiodiagnostic, radiotherapeutic and nuclear medicine services, as appropriate, for the overall development of comprehensive health care programmes. WPR/RC30.R24 Eighth meeting, 8 October 1979 HOST AGREEMENT BETWEEN THE GOVERNMENT OF THE REPUBLIC OF THE PHILIPPINES AND THE WORLD HEALTH ORGANIZATION The Regional Committee, Having considered the report submitted by the Regional Director on the progress of negotiations between the Government of the Republic of the Philippines and the World Health Organization on interpretation of Section 22(g), Article VIII of the Host Agreement, NOTES that agreement has been reached which makes further negotiation inappropriate. Eighth meeting, 8 October 1979 1 Document WPR/RC30/22. ... ... ... REPORT OF THE REGIONAL COMMITTEE WPR/RC10. R2S TOPIC OF TECHNICAL PRESENTATION IN 1980 The Regional Committee, Having considered the topics suggested by the Regional Director for the Technical Presentation during the thirty-first session of the Committee, 1 DECIDES that the subject of the Technical Presentation in 1980 shall be "Community involvement in the development of health services". Eighth meeting, 8 october 1979 ItJPR/RC10. R26 THIRTY-FIRST AND THIRTY-SECOND SESSIONS OF THE REGIONAL COMMITTEE The Regional Committee, Rearing in mind resolution WPR/RC21~. RIO, 1. CONFIRMS its decision that the thirty-first session of the Regional Committee shall be held at regional headquarters in Manila; 2. DECIDES that the dates of the thirty-first session shall be from 9 to 15 September 1980; 1. EXPRESSES its appreciation to the Government of the Republic of Korea for its invitation to hold the thirty-second session in Seoul in 1981; 4. ACCEPTS the invitation of the Government of the Republic of Korea provided a satisfactory agreement is concluded between the Government and WHO. Eighth meeting, 8 october 1979 WPR/RC30.R27 RESOLUTION OF APPRECIATION The Regional Committee EXPRESSES its appreciation and thanks to: (1) the Government and people of the Republic of Singapore for: 1 Doc~ment WPR/RC30/24. 37 38 REGIONAL COMMITTEE: THIRTIETH SESS ION (i) having invited the Regional Committee to hold its thirtieth session in Singapore; (ii) the excellent arrangements and facilities provided; and (iii) the generous hospitality received; (2) the Honourable Minister for Health for having addressed the formal opening of the thirtieth session of the Regional Committee; (3) the Chairman and other officers of the Committee; (4) Dr A.N. Acosta, for acting as moderator of the Technical Presentation and Dr 1. Douglas for making the Presentation; (5) the representatives of the United Nations Children's Fund, the United Nations Development Programme and the nongovernmental organizations tor their statements; (6) the Regional Director and the Secretariat [or their work in connexion with the session. Ninth meeting, 8 October 1979 WPR/RC30.R28 ADOPTION OF THE REPORT The Regional Committee, Having considered ihe draft report of the thirtieth session of the Regional Committee, ADOPTS the report. Ninth meeting, 8 October 1979 1 Document WPR/RC)O/28. .. • ; • REPORT OF THE REGIONAL COMMITTEE 39/40 . ANNEX 1 LIST OF NONGOVE~NTAL ORGANiZATIONS WHOSE REPRESENTATIVES MADE STATEMENTS TO THE REGIONAL COMMITTEE In addition to the representatives of the United Nations Organizations noted on page one of the report, representatives of the following non- governmental organizations made statements to the Committee: INTERNATIONAL COUNCIL ON ALCOHOL AND ADDICTIONS WORLD FEDERATION OF SOCIETIES OF ANAESTHESIOLOGISTS WORLD COUNCIL FOR THE WELFARE OF THE BLIND INTERNATIONAL DENTAL FEDERATION WORLD FEDERATION OF HEMOPHILIA INTERNATIONAL FEDERATION FOR INFORMATION PROCESSING INTERNATIONAL COUNCIL OF NURSES INTERNATIONAL PLANNED PARENTHOOD FEDERATION WORLD ASSOCIATION OF SOCIETIES OF (ANATOMIC AND CLINICAL) PATHOLOGY INTERNATIONAL SOCIETY OF RADIOGRAPHERS AND RADIOLOGICAL TECHNICIANS INTERNATIONAL FEDERATION OF SPORTS MEDICINE .. ... .. REPORT OF THE REGIONAL COMMITTEE ANNEX 2 AQINDA 1. Opening of the session • 2. Address by the retiring Chairman 3. Address by the Director-General 4. Election of new officers: Chairman, Vice-Chairman and Rapporteurs 5. Address by the incoming Chairman 6. Adoption of the agenda 7. Programme budget 7.1 Review of budget performance in 1978 1.2 Changes in the programme budget for 1980/81 8. Acknowledgement by the Chairman of brief reports received from governments on the progress of their health activities 9. Report of the Regional Director 41 10. Rules of Procedure of the Regional Committee (resolution WPR/RC29.R20) 11. Special Programme for Research and Training in Tropical Diseases: Joint Coordinating Board (resolution WPR/RC29.Rll) 12. Sub-Committee on Technical Cooperation among Developing Countries (resolution WPR/RC29.R19) 12.1 Report of the Sub-Committee 12.2 Membership of the Sub-Committee 13. Sub-Committee on the General Programme of Work (resolutions WPR/RC29.·R8 and WPR!RC29.R18) 13.1 Report of the Sub-Committee 13.2 Membership of the Sub-Committee 14. Strategies for health for all by the year 2000: review of progress towards development of national $trategies and plans of action 15. Correlation of the work of the World Health Assembly and the Regional Committees 15.1 Consideration of the agenda of the sixty-fifth session of the Executive Board 42 REGIONAL COMMITTEE: THIRTIETH SESS ION 15.2 Consideration of resolutions of the Thirty-second World Health Assembly and the Executive Board at its sixty-third and sixty-fourth sessions 16. Contribution of health to the new International Economic Order 17. Country health programming 18. Study of the WHO fellowship programme 19. Development of biomedical and health services research (including research strengthening and career structures in tropical countries) 20. Review of the cancer situation in the Western Pacific Region 21. Immunization services and their evaluation 22. Status of the antimalaria programme (resolution WPR/RC29.R13) 23. Diarrhoeal diseases control, including cholera (resolution WPR./RC29 • R15) 24. Radiation medicine in public health 25. Host Agreement between the Government of the Republic of the Philippines and the World Health Organization (resolution WPR./RC29.R9) 26. Statements by representatives of the United Nations, the Specialized Agencies, intergovernmental and nongoveiiunent:al"-organfzations iii -- official relations with WHO . 27. Selection of topic for the Technical Presentation during the thirty- first session of the Regional Committee 28. Time and place of the thirty-first and thirty-second sessions of the Regional Committee 29. Adoption of the report of the Committee 30. Closure of the session Supplementary agenda item 1: Seventh General Programme of Work covering a specific period (1984-1989): preliminary review of nature, objectives, structure and method of preparation .. .. • AUSTRALIA " .. CHINA v FRANCE \, JAPAN y' REPORT OF THE REGIONAL COMMITTEE 43 ANNEX 3 LIST OF REPRESENTATIVES 1. REPRESENTATIVES OF MEMBER STATES i Dr G. Howe 11s Director-General of Health Department of Health Mr C.H. Stuart Dep.uty Hi&h Commissioner Australian High Commission in Singapore Dr Hsu Shou-jen Deputy Director Foreign Affairs Bureau Ministry of Public Health Dr Liu Xirong Deputy Chief Division of International Organizations Foreign Affairs Bureau Ministry of Public Health Dr He Hongming Deputy Chief Division of Planning Bureau of Planning and Finance Ministry of Public Health Mr Cao Yonglin ' Official Foreign Affairs Bureau Ministry of Public Health Dr F. Chastel Direct,eur des Services de Sant~ du Territoire de la Polyn~8ie fran~ai8e Dr T. Saburi Director-General of Medical Affairs Bureau Ministry of Health and Welfare (Chief Representative) (Alternate) (Chief Representative) (Alternate) , (Alternate), (Adviser) vi (Chief Representative) 44 REGIONAL COMMITTEE: THIRTIETH SESSION JAPAN (continued) Dr Y. Hirose First Secretary MALAYSIA NEW ZEALAND PAPUA NEW GUINEA v PHILIPPINES v PORTUGAL, Embassy ot Japan in the Philippines Dr Y. Kawaguchi Deputy Director International Affairs Division Minister's Secretariat Hinistry of Health and Welfare Tan Sri (Dr) Raja Ahmad Noordin bin Raja Shahbuddin Director General ot Health Ministry of Health Haji (Dr) Abdul Talib bin Latiff Director of Health Services Ministry of Health Dr Eddy K.C. Lo Assistant Director of Health (Epidemiology) Ministry of Health Dr H.J.H. Hiddlestone Director-General of Health Department of Health Dr B.W. Christmas Deputy Director-General of Health (Public Health) Department of Health Dr A. Taru tia Secretary for Health Ministry of Health Dr A.N. Acosta Assistant Minister of Health Ministry of Health Dr M.J. de Campos Magalhaes Reparti~ao Provincial dos Servi~os de Saude e Assist~ncia 01 visao T~cnica Macao (Alternate) , (Alternate) (Chief Representative) (AI ternate) (A 1 terna te) (Chief Representative) (A 1 terna te) ... REPUBLIC' OF v J KOREA ' SAMOA 1/ SINGAPORE REPORT OF THE REGIONAL COMMITTEE 45 Dr Chang Kyong Shik Direc'tor-Genera 1 (Chief Represen,tative) Bureau of Medical Affairs Ministry of Health and Social Affairs Mr Park Yeon Soo Counsellor Embassy of the Republ~c of Korea in Singapore Mr Jeon Moo Geun International Affairs Officer Ministry of Health and Social Affairs Dr Solia Tapeni Faaiuaso Acting Director of Health Health Department Dr Andrew G.K. Chew Permanent Secretary (Health)/ Director of Medical Services Dr J.M.J. Supramaniam Deputy Director of Medical Services (Hospitals) Dr Koh Thong Sam Medical Superintendent (Alternate) ~ (Adviser) v (Chief Representative) (AI ternate) '. (Adviser) \ Dr D.I. Pakshong (Adviser) \ Medical Superintendent Maternal and Child Health Services Dr Soh Chio Siong (Adviser). Deputy Medical Superintendent Woodbridge Hospital Dr Tan Ban Cheng Senior Radiologist (Therapy) Ii (Adviser) Dr Lam Sian Lian (Adviser) '. Senior Registrar Maternal and Child Health Services Dr Chan Kai Lok Head Vector Control and Research Department Ministry of the Environment Dr Goh Kee Tai Senior Registrar Head, Quarantine and Epidemiology Department Ministry of the Environment (Adviser) " (Adviser)', 46 REGIONAL COMMITTEE: THIRTIETH SESSION SINGAPORE ( continued) TONGA UNITED KINGDOM" OF GREAT BRITAIN AND NOR'nlERN IRELAND UNITED STATES \ OF AMERICA Mrs Yeo Keng Choo (Adviser) , Head Personnel and Administration Department' Ministry of Health Miss T.S. Devi Training Coordinator Ministry of Health Dr S. Foliaki Director of Health Dr J.A.~. Nicholson Medical Adviser (Adviser) . Overseas Development Administration London Dr R. Fischer (Chief Representative) Associate Director Office of lnternational Health Department of Health. Education and Welfare Dr S.L. Weinstein (Alternate) Regional Health Administrator Public Health Service, Region IX San Francisco, California Dr F.S. Cruz (Adviser) Director Public Health and Social Services Guam Dr M. Kumangai Director Public Health Service Trust Territory of the Pacific Islands Dr F. Palacios Medical Officer Chief of Staff for (Adviser) (Adviser) Administration and Supportive Services Department of Health Government of the Northern Mariana Islands, Saipan Mr M. Tunoa Administrator Department of Health American Samoa (Adviser) .. .. .. .. .. UNITED STATES V OF AMERICA (continued) VIET NAM V REPORT OF THE REGIONAL COMMITTEE Miss B.Harvey Political Officer American Embassy in Singapore Mr Nguyen Van Trong Directeur du ~partement des Relations extE!rieures Ministere de la SantE! Mr Nguyen Xuan Thu Pharmacien sp~cialiste DE!partement des Relations extE!rie~res Ministere de la SantE! \' (Adviser) 47 (Chief Representative) (Al terna te) \ II. REPRESENTATIVES OF THE UNITED NATIONS AND RElATED ORGANIZATIONS UNITED NATIONS UNITED NATIONS CHILDREN'S FUND UNITED NATIONS DEVELOPMENT PROGRAMME OFFICE OF THE UNITED NATIONS HIGH COMMISSIONER FOR REFUGEES Miss L. DrUke UNHCR Associate Programme Officer in Singapore Mr T. C. Mc Dermo t t / UNICEF programme Officer in Jakarta Mr K. Satrap . Regional Representative of the United Nations Development Programme in Malaysia, Brunei and Singapore Mrs Minna Chiew Programme Officer of the United Nations Development Programme in Malaysia, Brunei and Singapore Miss L.DrUke UNHCR Associate Programme Officer in Singapore 48 REGIONAL COMMITTEE: THIRTIETH SESSION III. REPRESENTATIVES OF OTHER INTERGOVERNMENTAL ORGANIZATIONS INTERNATIONAL COMMITTEE OF MILITARY MEDICINE AND PHARMACY Colonel (Dr) Seet Lip Chai Member of the International Committee of Military Medicine and Pharmacy Chief Medical Officer Headquarters, Medical Services Singapore IV • REPRESENTATIVES OF NONGOVERNMtNTAL ORGANIZATIONS INTERNATIONAL COUNCIL ON ALCOHOL AND ADDICTIONS WORLD FEDERATION OF SOCIETIES OF ANAESTHESIOLOGISTS WORLD COUNCIL FOR THE WELFARE OF THE BLIND INTERNATIONAL ASSOCIATION OF CANCER REGISTRIES INTERNATIONAL DENTAL FEDERATION INTERNATIONAL FEDERATION OF GYNECOLOGY AND OBSTETRICS ,/Dr A.P. Diehm Director Central Drug and Alcohol Advisory Service lIea 1 th Commias ion of New South Wales Sydney . Dr Chin Mun Kui ; Alumni Association Medical Centre in Singapore ,Miss W. Ng Executive Director Malayan Association for the Blind Kuala Lumpur " Professor K. Shanmugaratnam Department of Pathology University of Singapore . Dr O. Hennedige Singapore Dental Association Professor Charles Ng President Obstetrical and Gynaecological Society of Singapore .. .. .. REPORT OF .THE. REGIONAL COMMITTEE .. · 49 WORLD FEDERATION OF HEMOPHILIA INTERNATIONAL FEDERATION FOR INFORMATION PROCESSING CHRISTIAN MEDICAL COMMISSION INTERNATIONAL COUNCIL OF NURSES INTERNATIONAL FEDERATION OF OPHTHALMOLOGICAL SOCIETIES INTERNATIONAL PAEDIATRIC ASSOCIATION INTERNATIONAL PLANNED PARENTHOOD FEDERATION WORLD ASSOCIATION OF SOCIETIES OF (ANATOMIC AND CLINICAL) PATHOLOGY INTERNATIONAL FEDERATION OF PHARMACEUTICAL MANUFACTURERS ASSOCIATIONS INTERNATIONAL UNION OF PHARMACOLOGY .. v Dr Gino Tann Indonesia Mr Sam Chong wo Ministry of Health Singapore .,/Dr Khoo Oon Teik Hope Clinic Singapore Medical Centre _ .. - , Mr Bernard Sao Fook Onn Principal Nursing Officer Primary Health care Services Ministry of Health Singapore v Dr A.S .M. Lim Singapore. Medical Centre ,Dr K.B. Phua President Singapore Paediatric Society Professor W.K. Ng University of Singapore Department of Social Medicine and Public Health vDr Moses Yu President Singapore SOCiety of Patholog v'Mr Dielenberg clo Malaysian Pharmaceutical Trade and Manufacturers Association Malaysia , Mr Koh Choon Hui President Singapore Association of Pharmaceutical Industries ·Professor J.E. Gardiner Fa~ulty of Medicine University of Singapore 50 REGIONAL COMMITTEE: THIRTIETH SESSION WORLD FEDERATION OF PROPRIETARY MEDICINE MANUFACTURERS INTERNATIONAL SOCIETY OF RADIOGRAPHERS AND RADIOLOGICAL TECHNICIANS INTERNATIONAL FEDERATION OF SPORTS MEDICINE INTERNATIONAL LEAGUE AGAINST RHEUMATISM / MrF. Na tsuo President EISAI Asia Regional Services Pte. Ltd. Tokyo '/ Mr K. Vaithilingam Vice-President for Asia/Australasia Region International Society of Radiographers and Radiological Technicians Singapore \/ Dr C.K. Ciam Head, Sports Medicine and Research Centre Singapore /Dr Tay Chong Hai Singapore Medical Centre .. ... • REPORT OF THE REGIONAL COMMITTEE ANNEX 4 REPORT OF THE SUB-COMMITTEE OF THE REGIONAL COMMITTEE ON THE GENERAL PROGRAMME OF WORK PART I 1. INTRODUCTION Members of the Sub-Committee on the General Programme of Work met twice in 1979. The first meeting was held from 28 to 29 March 1979, 51 after which country visits were made to Papua New Guinea, Solomon Islands, Phil ippines, Viet Nam and ehe Republic of Korea, in tha t order. The second meeting was held from 1 to 3 August 1979 to review the reports of the country visits and to prepare a final draft report for the thirtieth session of the WHO Regional Committee for the Western Pacific in October. The following members were present at the first meeting of the Sub-Committee in March 1979: Dr Dennis Stanbury, Australia Dr Takayuki Nose, Japan Dr Abdul Talib bin Latiff, Malaysia Dr Bryan Christmas, New Zealand Dr Francisco Aguilar, Philippines Dr S. Fo1iaki, Tonga Mr Nguyen Van Trong, Viet Nam Mme Le Thi Thu Ua, Viet Nam (Interpreter) The following members were present at the second meeting in August 1979: Dr Dennis Stanbury, Australia Dr Yuji Kawaguchi, Japan Dr Abdul Talib bin Latiff, Malaysia Dr Bryan Christmas, New Zealand Dr Francisco Aguilar, philippines Dr S. Foliaki, Tonga Mr Nguyen Van Trong, Viet Nam Mr Nguyen Van Truong, Viet Nam (Interpreter) The minutes of the meeting held from 28 to 29 March 1979 are attached as Appendix 1. The meeting held from 1 to 3 August 1979 was formally opened by Dr H. Nakajima, who had recently assumed the post of Regional Director. Dr Nakajima welcomed the representatives from Australia, Malaysia, New Zealand, Philippines, Tonga and Viet Nam, all of whom had attended the initial meeting in March, and also Dr Kawaguchi from Japan who was attending for the first time. The Regional Director stressed the importance of the continuity of representation on the Sub-Committee as a means of achieving effective participation in regional planning and he further emphasized the regional 52 REGIONAL COMMITTEE: THIRTIETH SESSION significance of the policy changes involved in the two position papers to be reviewed by the Sub-Committee in preparation for the thirtieth session of the Regional Committee in October 1979. 1,2 Dr Abdul Talib was elected Chairman and Dr B. Christmas, Rapporteur, assisted by Dr S. Foliaki and Dr D. Stanbury. A detailed examination was made of the two important position papers: "Study of WHO's structures in the light of its functions",l and "Formulating strategies for health for all by the year 2000".2 Part I of this report, to be presented to the Regional Committee as provisional agenda item 13.1, contains the Sub-Committee's reco~~endations with regard to the country visits made by its members and summarizes the comments of the contributing Member States and of the Sub-Committee on document DGO/78.1. Part II summarizes the Sub-Committee's deliberations on document A32/8 and will be presented to the Regional Committee separately as provisional agenda item 14. 2. TERMS OF REFERENCE For 1979, the terms of reference of the Sub-Committee were as follows: (1) In relation to its review and analysis of WHO's collaboration with countries, the subjects chosen for study were: (i) primary health care within the broad context of comprehensive health services, focused particularly on the health manpower development aspects and the use of auxiliaries (continuation of the review made in 1978); (ii) drug policies and management as it related to primary health care a~d certain aspects of disease control, e.g. tuberculosis. (2) In relation to the "Study of WHO's structures in the light of its functions", specifically: (i) to conduct the study in the Region together with the Regional Director on behalf of the Regional Committee; (ii) to ensure adequate consultations with all governments of the Region on the basis of the Director-General's background paper, including selected visits to countries as necessary; (iii) to monitor the progress of the study in the Region, making sure in particular that the necessary dialogue took place between governments and WHO; lDocument DGO/78.l, issued under cover of document WPR/RC29/l8. 2Document A32/8 presented to the Regional Committee under cover of document WPR/RC30/11 Part II Add.2; reproduced with revised timetable in document WHA32/l979/REC/l, Annex 2. .. ., • • ... ... • ... REPORT OF THE REGIONAL COMMITTEE (iv) to prepare a report to the 1979 session of the Regional Committee based on the consultations with governments; and (v) to prepare a final regional report based on the discussion at the 1979 session of the Regional Committee so as to permit the Director-General to prepare his global report for submission to the Executive Board in January 1980. 53 (3) At the meeting in March 1979, the Regional Director introduced document A32/8 to the Sub-Committee, after which the Sub-Committee undertook to recommend to the Regional Committee that its terms of reference should be expand~d to include the studies connected with the formulation of strategies for health for all by the year 2000. It was recommended that this expansion of the Sub-Committee's terms of reference . should be confirmed by the Regional Committee at its thirtieth session. 3. REVIEW AND ANALYSIS OF WHO'S COLLABORATION WITH COUNTRIES 3.1 General observations and recommendations on the country visits The reports on the country visits to Papua New Guinea and Solomon Islands and to Philippines, Viet Nam and Republic of Korea were presented (Appendices 2 and 3) • The Members of the Sub-Committee making the visits made the following observations and recommendations: They were greatly impressed with the state of development of country health programming or similar planning processes in the countries visited and with the methods whereby the health administrators had utilized limited trained manpower resources to develop a basic health care service at the village level. They had also come to appreciate the considerable difficulties that were being overcome in the deployment of peripheral health services to meet the needs of diverse scattered and frequently isolated groups of people. In some of the countries visited, while the task of central planning and setting of priorities was being achieved, that of implementation had still to be surmounted. In the brief review made of the existing services, three priorities had become apparent: (1) the need to accelerate the training programme for national staff; (2) the need to strengthen health improvement services at all levels; and (3) the need to motivate communities to strive for a better health status. (1) Training By accelerating the training programme for national staff, the existing dependency on WHO technical staff and expatriates in some of the countries visited should be lessened. By adding more national staff to the general health service, the communities would recognize, by the presence of their own people, the significance their governments attached to health development within each country. Wherever and whenever 54 REGIONAL COMMITTEE: THIRTIETH SESSION appropriate, key WHO technical staff should disengage from any role in which they might be considered to be acting as operational officers. The practice of WHO staff, advisers or consultants to serve as stop-gap replacements for national staff should be avoided, except in emergencies and then only for a limited period of time; for example, of not more than six months. Continuation beyond such a period weakened the resolve for replacement and further delayed the accession of national staff. (2) Health improvement While it was evident that health care services must be upgraded and extended, any such development should not be accelerated in advance of the application of health improvement services. Environmental sanitation, better nutrition and general education could substantially reduce the demand for costly reparative services, particularly in the field of maternal and child health and communicable diseases control. Such basic measures were the principal means of reducing infant and adult mortality and morbidity in countries that had achieved a high level of health. (3) Community participation The communication gap between central health planners and the community was a universal problem. Health workers at all levels should be trained in new methodologies which placed much greater emphasis on the active understanding and cooperation of the population in determining their own health service requirements, and in attaining better standards of health. In-service training and education in the appropriate technology for better communication between health workers and the community were still needed. There was also a need for training in health management, particularly at the local level, in those countries in which health service organizations were undergoing devolution. Such training would reinforce the advantages of local knowledge and close community contact, especially where there were problems related to lack of management skills and limitations of operational efficiency due to inability to work as a member of a team. 3.2 Conclusion Priorities for training, health improvement and community participation were well recognized by the health administrations concerned and the visiting members of the Sub-Committee felt that they should be considered by the WHO Regional Programme Committee in determining future technical cooperation. Future WHO support should be directed towards educational, rather than operational, activities, and the mechanisms for helping health staff at all levels to implement more effective health improvement services and achieve better communication with the communities should be given special consideration. 4. STUDY OF WHO'S STRUCTURES IN THE LIGHT OF ITS FUNCTIONS The Sub-Committee reviewed the comments received from. Member States of the Western Pacific Region on the background paper "Study of WHO's structures in the light of. its functions".l Replies were received from 1· Document DGO/78.l, issued under cover of document WPR/RC29/l8. ~ • .. .. ... REPORT OF THE REGIONAL COMMITTEE 55 16 countries, including detailed comments from Australia, Japan, New Zealand, Papua New Guinea, Singapore, Tonga and Viet Nam. In general, all countries accepted the proposal for review and reorganization and agreed that the Organization should become more active in promoting health as an essential component of social and economic development at country, regional and global level. 'Some caution was expressed with regard to the mechanisms whereby such a health promotion role was to be implemented. It was endorsed that programmes for improving the health status of the global population should be developed on a collaborative basis but the implementation must be adapted to ensure that no country was coerced into accepting a formula for health action that was pot fully agreed toby its government or consistent with the political and social aspirations of its people. The strength of WHO in the past had been in its policy of non- interference in the internal affairs of Member States and its significant technical input and cooperation. If the Organization were to undertake a more active influential role, the emphasis should continue to be on technical cooperation, but recipient countries should also participate on an active partnership basis and not merely as passive or even involuntary recipients. The proposal to accord regional officeR A p,rcater opportunity to develop regional programmes flpeclficaL1y taUon'd to local needs WAfl strongly supported. In effect the central Headquarters function would be concentrated on promoting and coordinating those regional programmes and on overall policy formulation. The Sub-Committee felt it was important, however, that Headquarters should retain a real measure of responsibility for overall coordination so that WHO maintained its global aims and policy and did not disintegrate into six independent and possibly competitive regional health organizations. No implication was intended that Headquarters functions should be limited to coordination since the formulation of broad global strategies and programmes was still considered essential. The Sub-Committee considered that, since many countries in the Region still lacked the resources to train or recruit sufficient specialists to meet their own needs, the RegLanal Office should continue to retain a cadre of specialists, even if the number of generalists required strengthening. Recruitment to regional appointments however should not be restricted to staff within the Region but should be effected rather on the basis of training, skills and experience, Nevertheless, as a long-term policy, the Region should aim to develop training programmes to provide expertise at regional and national levels. Bilateral and multilateral arrangements whereby countries with special expertise could cooperate with other countries to develop specific health programmes should be encouraged at the regional level. Such programmes might be regarded as pilot schemes which could serve as useful models for other countries to emulate. The Regional Committee could give a lead by encouraging those countries to develop individual programmes to deal with health problems peculiar to the Region • 56 REGIONAL COMMITTEE: T~IRTIETH SESSION The role of the WHO representative was reviewed. Although most countries accepted the proposed change of designation to programme coordinator~ the Sub-Committee expressed some reservations. The present WHO Programme Coordinator was still regarded more as an official representative of the .Regional Office and as a coordinator with external agencies than as a programme organizer in the countries of his area. If a number of programmes were to be undertaken in a country, the proper agent for coordination and evaluation was seen to be the health administration of that country. The functions of the WHO representative could well continue to be expanded to include those of adviser and coordinator of cooperation provided by WHO without infringftig on the rol~. of the locs,1 health . - administration as coordinator for the implementation of national programmes. For that reason, the Sub-Committee considered that the title of WHO Representative was still the more appropriate one. In some countries. the need for a resident liaison officer to act as intermediary between the local health administration and WHO was stressed. The frequency of World Health Assembly meetings was considered and the existing practice of annual meetings was advocated but of a shorter duration, although provision in the agenda of some time for review of the progress of programmes and the outcome of resolutions seemed desirable. Although it was recognized that some form of geographical regrouping might be necesRary in the future as the number of Member States increased and the proportionate contributing populations decreased, questions such as the variat.ion of Executive Board representation and contributions were considered but deferred. ... .. .. .. REPORT OF THE REGIONAL COMMITTEE APPENDIX I REPORT OF THE SUB-COMMITTEE ON THE GENERAL PROGRAMME OF WORK ON ITS MEETING HELD IN MANILA, 28 and 29 MARCH 1979 57 The meeting of the Sub-Committee of the Regional Committee on the General Programme of Work was opened by Dr Francisco J. 01, Regional Director, who welcomed the representatives of Australia, Japan, Malaysia, New Zealand, Philippines, Tonga and Viet Nam. Dr Dy referred to the agenda, which included the programme for country visits to the Philippines, Republic of Korea and Viet Nam by the representatives from Austral'ia, Japan and· the Philippines and to Papua New Guinea and Solomon Islands by the representatives from Malaysia, New Zealand, Tonga and Viet Nam. The visits had been scheduled to take place immediately after the meeting. The Regional Director then drew attention to an important additional item which he proposed to ask the Regional Committee to consi.der adding to the terms of reference of the Suh-Committee, namely the studies connected with the formulation of strategies for health for all by the year 2000. A document had been prepared by the Executive Board of WHO which was intended for review by the Thirty-second World Health Assembly in May 1979. The document had been drafted as the proposed basis for formulating national policies, strategies and plans of action for use by countries individyally and collectively at local, regional and global level. This document, and another important position paper "Study of WHO's structures in the light of its functions,,2 were to be included in the working agenda of the Sub-Committee for preliminary consideration during the present two-day meeting. The Regional Director urged representatives to take the opportunity afforded by their country visits to bring the two documents to the attention of heads of governments and health ministries and to invite their consideration and comment. Representatives then elected Dr Francisco Aguilar Chairman, and Dr Bryan Christmas and Dr Dennis Stanbury Rapporteurs. Dr Hirshman, Director, Programme Management, led the discussion on the work schedule and the country visits. The Sub-Committee adopted the work schedule and the proposed arrangements for country visits. It was then agreed that a second meeting should be held in Manila from I to 3 August 1979 to review and edit the reports of the country visits and to discuss recommendations regarding the two tabled documents, A32/8 and DGO/78.l. Dr Birshman confirmed that the initial purpose of the visits 1 Document A32/8 presented to the Regional Committee under cover of document WPR/RC30/l1 Part II Add.2; reproduced with revised timetable in document WHA32/l979/REC/I, Annex 2. 2Document DGO/7B.l, issued under cover of document WPR/RC29/l8. 58 REGIONAL COMMITTEE: THIRTIETH SESSION was to assess the efficacy of the WHO technical collaboration programmes in relation to primary health care (PHC). The Committee also agreed that the visits should be used to discuss the tabled documents with government leaders and senior officials. In considering document A32/8, representatives discussed the signi- ficance and meaning of the terms in the title "Health for all by the year 200011 • Most agreed that the initial emphasis should be on the _c:leveJgpment of l:t~~lth care services and ;111 agreed that any such strategy depended on community participation. Arising out of the discussion on PRe and the development of future health services, the following recommendations were made: (1) health care services should be developed peripherally as much as possible in cOl'ltradistinction to the allocation of scarce funds for costly central medical services that might be inappropriate and inaccessible; (2) in PRC programmes, more emphasis should be given to preventive and educational services and not merely to the provision or expansion of curative services; (3) in order to measure improvement of the health status of the community as a result of allocation of funds for health service development, appropriate health indicators should be developed that were nationally and internationally acceptable; (4) health planners should re-examine existing health services to ensure the most effective use of resources and manpower; (5) health and related services should be developed so as to offer to the individual the greatest opportunity for self-sufficiency in health. With regard to document DGO/78.l, it was agreed to defer detailen consideration until the next meeting of the Sub-Committee in August. During the general discussion, some reservations were expressed with regard to the prospect of the formation of additional committees within the WHO structure. All agreed, however, with the principle for the proposed changes, namely, to establish within the organizational structure processes that would enable guidelines for policy and priority decisions to emanate from the periphery and for recommendations to pass from countries to the Regional Committee and then to the World Health Assembly, rather than to be promulgated from the global office toihe Region. Discussion on the second day concerning WHO collaboration with PHC programmes centred on the importance of community participation. The Sub- Committee reviewed the definition of PRC and concluded that it involved the development by individual countries of basic health services appropriate to their needs. Such development must occur in conjunction with community participation and with the support of other health-related agencies within the country. It was recognized that the felt needs of the community must be taken into account by the health administrator when developing a health service plan for the area. Furthermore, for any health plan to become effective, the community must not only be consulted but actively involved in the development and operation of the programme. .. .. ... ... .. ... REPORT OF THE REGIONAL COMMITTEE 59/60 WHO could assist with specialist technical support but the planning and administration must be undertaken by the country itself. Specific activities by the WHO Regional Office included the arrangement of seminars on PHC throughout the Region, collaboration in conducting an intercountry workshop on PHC between Malaysia and the Republic of Korea, collaboration in research and development projects in the Philippines and Papua New Guinea, and training of village health workers in Solomon Islands. The regional intercountry team on promotion of primary health care was continuing its work throughout the Region. In considering the topic of health manpower training, the representatives acknowledged that teaching programmes for PHC workers should be competence-based, i.e. the training should be designed to fit the person for the specific task. These new approaches could well lead to the radical modification of established curricula for medical workers, both in content and course duration. The Sub-Committee concluded with a discussion on drug policies and management as it related to primary health care and certain aspects of disease control, e.g. tuberculosis. Members of the Sub-Committee were urged to assess the extent to which countries they visited controlled the selection of drugs used within the country and the procedures adopted to obtain adequate low-cost supplies of drugs and dispense them to the community. The attitudes of physi.cians and consumers to the proposed bulk supply of "generic label" drugs and the attitude of proprietary drug firms should also be considered. The Sub-Committee considered the usefulness of medicinal plants as a means of reducing costs and endorsed the need for further research to explore the efficacy and appropriate therapeutic application of this form of medicine . ... ,- ... REPORT OF THE REGIONAL COMMITTEE APPENDIX 2 REPORT OF THE SUB-COMMITTEE ON THE GENERAL PROGRAMME OF WORK ON THE COUNTRY VISITS TO PAPUA NEW GUINEA AND SOLOMON ISLANDS Members of visiting team Dr B.W. Christmas Deputy Director-General of Health (Public Health) New Zealand Dr S. Foliaki Director of Health Tonga Dr Abdul Talib bin Latiff Director of Health Malaysia Mr Nguyen Van Trong Director,._Department of External Relations Ministry of Health Viet Nam Mme Le Thi Thu Ha Interpreter Viet Nam Dates of visit PAPUA NEW GUINEA 30 March - 6 April 1979 Areas visited Port Moresby (Central Province), Mount Hagen (Western Highlands), Madang (Madang Province) Introduction 61 The programme for- the team was arranged by Dr Y.H. Paik, WHO Programme Coordinator, Papua New Guinea. During the visit, discussions were held with senior Health Department staff, the Director of the Health Education Institute, and the Deans of the College of Allied Health Sciences at Port Moresby and Mount Hagen. The team also visited provincial health offices at Mount Hagen and Madang, a health centre at Tambul. an aid-post training centre, an 62 REGIONAL COMMITTEE: THIRTIETH SESSION environmental sanitation demonstration unit and a local aid post. At Madang, visits were paid to a nurse training school, a provinciai hospital and the WHO Malaria Research Unit. On the final day, a brief interview was held with the Minister of Health and the Assistant Secretary of External Affairs. The importance of the proposals in' tre two documents "Study of WHO's structures in the. light of its functions", and "Formulating strategies for health for all by the year 2000 .. 2 was stressed but lack of time did not. permit any detailed analysis or commentary. Health status The rate of natural increase is 2.1% per annum with a high birth rate (44 per 1000) offset by a high infant mortality rate (approximately 90 ~ per 1000 live births) and a total mortality r~te of 15 per 1000. 45.1. of the population are under the age of 15 years. The leading causes of death are accidents and violence, 12.7%; pneumonia, 6.8%; cancer, 5.7%; other respiratory diseases, 5%; meningitis, 4.5%. Administration Since July 1978, the Government of Papua New Guinea has adopted a policy of devolution, with the transfer of certain powers and functions to the local governments of the 19 provinces. Health services have been included in this programme and much of the responsibility for implementing health care and health improvement services for the community is now vested in the provincial health officer. The provincial health officer is therefore responsible to the provincial government for the administration of all health services within the province and to the national government for certain public health functions of national importance. The respective roles of provincial health and national health administrations, however, are still being defined. Health policy and country health programme The basis for the development and reshaping of the country's health services is the National Health Plan, 1974-1978, adopted by the Government of Papua New Guinea in 1972 and operated by a national health planning committee, chaired by the Secretary of Health and responsible to the· Minister of Health. The WHO Programme Coordinator is a member of the Committee. The aims of the plan were: I Document DGO/78.1, issued under cover of document WPR/RC29/l8. 2 Document A32/8 presented to the Regional Committee under cover of document WPR/RC30/ll Part II Add.2; reproduced with revised timetable in document WHA32/l979/REC/l, Annex 2. .. REPORT OF THE REGIONAL COMMITTEE - equalization of services - improved rural services - decentralization - integration - self -reliance - simplification The health problems that prompted the Plan were:' (1) poor health status in rural and highland areas, particularly in young children; . (2) too high a birth rate; (3), increased demand for urban hospital services; (4) inequality and distribution of services; (5) poor integration of health care and health i~provement services; (6) too many central decisions; (7) unrealistic standards and lack of community involvement. 63 The current priorities of the National Health Planning Committee are: (1) to expand rural water supplies and sanitation; (2) to reduce hospital expenditure by utilizing existing health services, extend rural and family services, and improve family planning; (1) to reorientate the malaria control programme to make it more cost-effective; (4) to develop health manpower planning and training programmes; (5) to establish a sub-committee on primary health care to develop a number of pilot projects, e.g. the New Ireland scheme. These priorities and the National Health plan are now subject to a central coordinating group (the National Planning Office), which is responsible for developing a comprehansive national public expenditure plan for the period 1978-1981. Thus health planning is linked in with other programmes of socioeconomic development. The National Public Expenditure Plan is a comprehensive project geared principally to rural development and as a matter of policy provides for an additional incremental budgetary growth of 3%, which is allocated specifically each year for new projects related to rural welfare. Hence the National Planning Office serves as an effective instrument for the coordination of intersectoral activities relevant to primary health care at the village level. All projects for aid provided by international agencies are also coordinated within this plan. 64 REGIONAL COMMITTEE: THIRTIETH. SESSION Health services The Department of Health under the Minister of Health, with the Secretary of Health as his chief technical adviser and administrator, i.s responsible for most of the health services. In rural areas, church groups have a greater share of services, but through close liaison these supplementary services are fully integrated within the national health administration. The Secretary of Health has two first assistant secretaries~ one responsible for health care, and the~ther for health improvement services. There are also specialist staff of various disciplines, including training, planning and research; maternal and child health, and family planping; malaria, tuberculosis and leprosy control. The organization of health services in Papua New Guinea has been adapted to meet the special needs of the population of some three million, which is thinly distributed over a large land mass and a number of islands, where the mountain ranges and sea limit acc.ess and render communication difficult. The task is further complicated by the multi- plicity of languages and relative isolation of many tribal groups from modern technological development and present-day sophistication. Much of the population is still evolving from a subsistence to 8 capital-based economy. As a result, for a number of years the health administration of Papua New Guinea has developed its own type of primary health care service. The basic health worker is the aid-post orderly, who may possess only a rudimentary education, yet is capable of being trained to undertake simple health care procedures, and to initiate elementary health protection measures in the villages and hamlets within the population area he serves. In addition to the treatment of cuts and skin sores and the dispensing of symptomatic remedies, the aid-post orderly is also trained to diagnose and treat with specific drugs, cases of pneumonia and malaria, and to identify those cases that require referral to the l1ealth centre. The aid-post orderly is also expected to act as a local health educator. He is instructed in the aftercare and management of cases discharged from the health centre, the supervision and administration of maintenance treatment for cases of leprosy and tuberculosis and t_~E!_prophylactic control of malaria. An aid- post orderly· usually serves a population of 500 to 1500. He is responsible to the health extension officer (HEO), who is a more highly trained health worker based at a health centre. The health extension officer is able to diagnose and treat a wide range of cond-it10ns and is also trained in basic obstetrics. He--{s· trained in management and is in charge of the health centre and its staff. The health centre serves as the intermediate health care station between the field health worker, the aid-post orderly and the provincial hospital; thus the health extension officer acts as a diagnostic screen to sort out those serious cases that warrant referral to the provincial hospital. Staff attached to the health centre include a maternal and child health sister, a health inspector, possibly a malaria control section, and .. • .. ... REPORT OF THE REGIONAL COMMITTEE 65 orderlies for nursing and environmental control duties. The health centre usually contains a small maternity unit and some general hospital beds. Since July 1978, responsibilities for peripheral health care services, including immunization, maternal and child health, family planning and disease surveillance, have been delegated to the provinces. The provincial health of.ficer has become responsible to the provincial government for the administration of all provincial health services, including the hospitals, health centres and aid posts. Health improvement programmes, which include malaria, environmental sanitation, sexually transmitted diseases, leprosy and tuberculosis, occupational health and dental health services, are also delegated to the provincial level. Each provincial health officer has a team of supporting staff (several health extension officers, health inspectors, and maternal and child health and community health nurses, who have undergone special training) responsible for organizing those programmes within each province. The role of the national health office staff is to provide technical advice and guidance, assist with planning and, where practicable, evaluate progress. Health services administration The national government Rtill retains respomdhll1.ty for hospitals, hase medical stores, medical training, family health (planning), nutrition, quarantine, dental health and mental health services. A health centre, depending on the special needs and distribution of the local population, serves approximately 20 000-50 000 people. A provincial hospital usually has 200-300 beds and is staffed by specialists, a surgeon, a paediatrician and/or an obstetrician, and three or four general medical officers. The provincial hospital provides general hospital in-patient and some out-patient services for the province. Provincial populations vary but average 250 000. Some hospitals and health centres are financed and administered by church groups, but there appears to be a very close working relationship between the various religious groups and the State, so that duplication of services does not occur and the development of each component .is complementary. There are four base hospitals, at Port Moresby, Goroka, Lae and Rabaul, where more specialized treatment and diagnostic services are available • Training and manpower development Aid-post orderlies receive two years' training, which includes extensive practical experience at one of three training centres. Health extension officers, who are required to have a higher pre-entry educational level, undergo three years' training, followed by a one-year internship at a health centre or hospital. Health extension officers are trained at the College of Allied Health Sciences at Madang. Health inspectors also undergo a three-year course at Madangand qualify by Sitting the Royal Society of Health examinations .. Nurses are trained at the College of Allied Health Sciences at Port Moresby (and at some church schools), where they undergo a three-year course. 66 REGIONAL COMMITTEE: THIRTIETH SESSION Dispensers, medical technologists and radiographers are also trained at Port Moresby. After three or four years' experience, health extension officers and, where appropriate, nurses and health inspectors, can take a post-basic diploma course at the College at Port Moresby in health services administration, conununity health, health education or nutrition. These courses can offer a wide range of career opportunities in the health services and in the avenues of health care and health promotion. A health manpower training and developtnent progranune setting future numerical targets has been included on a long-term basis in the current regional health plan. Drug policy Papua New Guinea appears to have a very effective programme for the purchase, quality control and distribution of drugs. By using a bulk purchase team based in Sydney, all drug orders are prepared in large quantities once or twice a year and tendered for on a world-wide basis. Usually, the lowest tender is accepted. Quality control prior to purchase is effected by having samples tested by arrangement at the National Biological Standards Laboratory, Canberra. On occasions, where shelf life or thermo- lability is a significant factor, samples are provided for testing after exposure to ordinary working conditions in Papua New Guinea. Use of drugs is controlled internally by the compilation of a master list of drugs. The items on this list are restricted in distribution according to three categories: drugs for general distribution; drugs that may be obtained on prescription only and are issued to medical practitioners; and those that are restricted to specialists based at hospitals. Amendments and deletions to the master list of permitted or purchased drugs are made on the advice of a national pharmaceutical advisory conunittee, chaired by the First Assistant Secretary of Health. The annual cost of drugs in Papua New Guinea, including vaccines, amounts to 1 million kina, approximately one fiftieth of the health budget. Community participation The process of devolution of health services to the provinces is in keeping with the aims of the National Health Plan to bring the health services closer to the people. As yet, few local health committees are operational at the village level, although villagers are expected to provide for the construction and maintenance of aid posts, and local government councils contribute to the installation of public water supply and sanitation projects. A recent scheme to involve local councils more direc~ly in the malaria control project appears to be making good progress. Involvement of village groups in the selection, nomination and financial support of trainees for the position of aid-post orderly-has been less successful. Either villagers have felt that local expenditure should be directed to other priorities, such a.s highway construction and maintenance, or there have been no suitable young persons available. Whatever the reason, the number of trainees fell short of the required establishment and recruitment had to revert to a central authority. • , t REPORT OF THE REGIONAL COMMITTEE 67 In the field of family planning and maternal and child health, women's groups have been utilized, particularly in the urban areas, and this local support is to be fostered on a wider scale in the future. Some experimental projects, involving the use of volunteer workers in communal health projects in villages, are being tried out. In some areas, health aid workers have assisted in the reporting of new cases of epidemic disease and in supervising the treatment of cases of leprosy. A very interesting pilot project is being tested in Madang. In one village, volunteer women workers are helping to administer prophylactic, antimalarial drugs to children aged 0-6 years. This has already attained an 85% success response after several months. The scheme has now been accepted in two other villages and could later be extended to cover the entire district. Collaboration with WHO WHO collaborat~on is based on the priority needs stated in the ~ational Health Plan and the ongoing appraisal of demands for external inputs identified through the national health programming exercises carried out by the Health Department. Coordination of the support provided by WHO is the responsibility of the WHO Programme Coordinator based at Port Moresby. He enjoys a particularly favourable position in that he is a member of the various working subcommittees of the Departm~nt of Health, not as adviser, but as a full member. He is therefore fully conversant with the problems, plans and policies of the Department. The collaboration of WHO in Papua New Guinea is quite extensive, consisting at present of 19 staff members. The evidence of this cooperation can be seen at various levels of the health service, including development of primary health care services with emphasis on maternal and child health, family planning, better nutrition, expansion of the immunization programme, improvement of malaria control, improvement of basic sanitation with provision for safe and adequate water supply, especially to the rural communities, the improvement of staff training, particularly by revising and expanding the curriculum for aid-post orderly training to conform more to the primary hea!th care concept. There is also a major orientation of various disease control programmes, especially the malaria control programme. Research programmes have been implemented on resistance of malaria parasites to chloroquine, and on the development of a vaccine against pneumococcal pneumonia, both diseases of priority concern in the country. Education and training, especially the provision of fellowships for post-graduate and undergraduate training of national health staff and the organization and implementation Df national seminars and workshops conducted by WHO consultants in various fields of health, has been one of the major areas of WHO collaboration in the past years. SOLOMON ISLANDS Health services The healtQ services of Solomon Islands are included in the portfolio of the Minister of Health and Welfare. The Permanent Secretary is the permanent head of the service, and the Under-Secretary (Health) is the 68 REGIONAL COMMITTEE: THIRTIETH SESSION chief medical adviser responsible for international health and for the planning and coordination of medical services. The central organization of the National Health Service is based at Honiara and comprises nine divisions: - communicable disease control - personal health services - health education - environmental health services - nursing - laboratory services - pharmaceutical services - dental health - hospitals and clin±cs. The Central Government is pursuing a policy of decentralization, the administration of health care services, including district hospitals and the responsibility for developing environmental health and health improve- ment programmes, being delegated to provincial governments. At the provincial level the health services are administered by a senior or principal medical officer, who is responsible to the local government council. His senior staff include several medical officers, a senior nursing officer, a health inspector and supporting administrative staff. Usually the provincial health administration is based at the provincial hospital. The largest central hospital, which contains 158 beds, is situated at Honiara and serves as the main referral hospital. There are five smaller council hospitals based in the other provinces, and two mission hospitals. Also within the provinces, a number of area health centres are being developed. These are a new concept and are intended to provide basic health care services for the local population. They are expected to act as an intermediary stage between the provincial hospital and the rural health clinics, and will probably be directed by a health worker trained to the equivalent of the Papua New Guinea health extension officer. It is also intended that a health inspector and nurses and malaria control sections will be assigned to these units, which will probably each have up to 20 beds. The present rural health clinics, of which there are 60-70 planned (a number of which are already in operation), are the present peripheral stations for health care and maternal and child health services. Such clinics are usually staffed by two nurses, one female, who concentrates on maternal and child health, and one male, who undertakes most of the visits to the villages. At present, these rural health clinics refer directly to hospitals any cases they are unable to treat locally, but they are able to cope with most uncomplicated deliveries, provided the women are able and willing to travel to the clinic. Each clinic serves about 1500-3000 people. The rural health clinic al~o undertakes immunizations and conducts family health programmes. A project developed with cooperation from WHO was the training of village health aids. As an extension of the rural health clinic, a number of health aid posts were created, which were generally staffed by assistant nurses who had received one year's basic training. The success of these local posts encouraged the Government further to expand the service and to promote community participation at the village level by inviting villagers to nominate suitable persons to undergo an elementary • REPORT OF THE REGIONAL COMMITTEE 69 training programme of three months, prior to appointment as village-based health aids. The initial programme began in 1978 when nursing officers and medical officers from each of the provinces attended a special course to prepare them to operate training programmes in their own provinces, to prepare these new primary health care workers for their future positions. Subsequently, training courses were conducted for the first batch of health aids and, to date, 37 aids have been trained and are operating in the villages. The responsibility for future programmes now rests with the provinces and the villagers will assist by providing accommodation for the aid posts. Drug policy and management Drugs are provided free of charge to all Solomon Islanders. The annual budget for medical supplies' - which includes drugs, supplies and vaccines - amounts to US$250 000 or 12-1/2% of the total recurrent health budget. This is not adequate and shortages of drugs and supplies do occur. In fact, shortage of medical supplies is one of the major concerns of the Ministry of Health. Overseas purchasing of drugs is done by the Government Supply Department through the Crown Agents in the United Kingdom and other government agents in various countries 'or areas such as Australia, Hong Kong, Malaysia, New Zealand and Singapore. The two major suppliers are the United Kingdom and Australia. Occasionally, in case of special or urgent need, the Ministry can order drugs directly without going through the Government Supply Department. Quality control of drugs purchased is non-existent and depends entirely on the word of the supplier or of the agent concerned. Drugs are distributed by the Central Medical Store and Pharmacy on two-monthly requisitions by the various health institutions, such a6 hospitals, rural health units and clinics. The departmental approved list of drugs divides the drugs available into three categories: category A includes drugs available to hospitals for use by specialists and medical officers; category B includes drugs available to rural health units for use by registered nurses; category C comprises drugs for use in village clinics by non-registered nurses. A very limited line of medicaments - namely, antimalarial drugs, aspirin, cough and stomach mixtures - is also available to the village health aids. Traditional medicine;' based on the use of herbs and medicinal plants, was a part of the tradition and culture of the Solomon people long before the arrival of the missionaries and the introduction of western medicine and drugs. Fortunately the practice has been maintained, especially in the villages, up to the present time. There is a strong interest within the Health Department in conducting proper surveys and studies of traditional medicine, particularly the use of medicinal plants, with regard to its efficacy and the possibility of incorporating such practices into the delivery of health care, including primary health care. The Government has stated its interest in the study and use of medicinal plants and traditional medicine. 70 REGIONAL COMMITTEE: THIRTIETH SESSION Collaboration with WHO WHO's collaboration in Solomon Islands can be seen in the priority areas of health services. WHO has collaborated in the programme of development of comprehensive health services, namely the training of village health aids, the malaria eradication programme, and the family health programme. WHO support can also be seen in the tuberculosis control programme and the promotion of environmental health, in the form of consultants, experts, fellowships and the provision of supplies and equipment. During the discussions and meetings of the members of the Sub-Committee with high-ranking officers in the Ministry of Health and government leaders, the collaboration and suppor~ of WHO and its field staff in solving the priority health problems of the country were welcomed and appreciated. The Minister of .,i Health expressed his interest in exchanging experience with other countries .. in the Region in the fields of health services organization, training of health manpower, development of traditional medicine and utilization of medicinal plants. He hoped that WHO would continue to collaborate through the assignment of consultants and experts lind thereby help Solomon Islands to solve its difficulties and improve the development of its health services. GENERAL OBSERVATIONS AND RECOMMENDATIONS The Tnembers of the Sub-Committee who visited Papua New Guinea were greatly impressed with the state of development of. the country health programme and the methods whereby the health administrators had, over the years, utilized limited trained manpower resources to develop a basic health care service at the village level through the use of the aid-post orderly. Similarly, the members of the Sub-Committee came to appreciate the considerable difficulties being overcome in the deployment of peripheral health services to meet the needs of diverse scattered and frequently isolated groups of people who make up the population of the country. The task of central planning and setting of priorities has been achieved; that of implementation has still to be surmounted. In their brief review of the existing services, three major priorities became apparent: the need to accelerate the training programme for national staff; the need to strengthen health improvement services at all levels; and the need to motivate communities to strive for a better health status. 1. By accelerating the training programme for national staff, the present dependency on WHO technical staff and expatriates should be lessened. By adding more national staff to the general health service, the communities ()j:_Papua New Guinea and Solomon Islands would recognize, by the presence of their own people, the significance their Government attaches to health development within each country. Wherever and whenever appropriate, key WHO technical staff should disengage from any role in which they may be considered to be acting as operational officers. The practise of WHO staff, advisers or consultants to serve as stop-gap replacements for national staff should be avoided, except in emergencies and then only for a limit~~ period of time, say, not more than six months. Continuation beyond that period weakens the resolve for replacement and further delays the accession of national staff. ... REPORT OF THE REGIONAL COMMITTEE 71/72 2. While it is evident that health care services must be upgraded and extended, any such development must not be accelerated in advance of the application of health improvement services. Environmental sanitation, better nutrition and general education can substantially reduce the demand for costly reparative services, particularly in the field of maternal and child health and communicable diseases control. These basic measures have been the principal methods of reducing infant mortality and adult morbidity in all developed countries. 3. The communication gap between central health planners and the community is a universal problem. Health workers at all levels have to be trained in new methodologies which place much greater emphasis on the active understanding and cooperation of the population in determining their own health service requirements~ and in attaining better standards of health. In-service training and education in the appropriate technology for better communication between health workers and the community are stil~ needed. 4. The priorItIes for training, health-Tmprovement and health education are well recognized by the health administrations and in the view of the members of the Sub-Committee, should be considered by the WHO Regional Prosz;ramme Committee in determining future technical cooperation. Future WHO support should be directed to educational, rather than operational, activities, and the mechanisms for helping health staff at all levels to implement more effective health improvement services and better communication with the communities should be given special consideration • REPORT OF THE REGIONAL COMMITTEE APPENDIX 3 REPORT OF THE SUB-COMMITTEE ON THE GENERAL PROGRAMME OF WORK ON THE COUNTRY VISITS TO THE PHILIPPINES, VIET NAM AND THE REPUBLIC' OF KOREA Members of visiting team Dr T. Nose Deputy Director International Affairs Division Minister's Secretariat ' Ministry of Health and Welfare Japan Dr D. Stanbury Senior Medical Officer International Health Branch Department of Health Australia REPUBLIC OF THE PHILIPPINES Dates of visit 30 March and 2 April 1979 Health status 73 The leading causes of death in the Republic of the Philippines are: pneumonia, tuberculosis, cardiovascular diseases, gastroenteritis, bronchitis, malignancies, avitaminosis and other nutritional deficiencies, and accidents. The trend of mortality has shown a gradual shift from the communicable diseases to the chronic degenerative diseases, e.g. heart diseases and malignant neop1asms;-;hich can be asc~ibed to the -increasing life expectancy of the population which reached 60 years in 1975. Protein calorie intake per capita in the Philippines is lower than in a number of other Asian and South-East Asian countries and in some areas malnutrition is a major problem. The health budget in 1974 was 477 400 pesos, which represented 3.4% of the total national budget. The net expenditure for health amounted to 5.43 pesos per capita in 1974, which was a slight decrease from that of the previous year. Health services The Ministry of Health is responsible for supervising and administering a comprehensive health care system for the whole Republic, based on the administrative organization of the country. Centrally the Ministry consists 74 REGIONAL COMMITTEE: 'THIRTIETH SESSION of a number of bureaus, staff services and various offices from which the three basic health care facilities (tertiary, secondary and primary) are administered. The tertiary care level consists of medical centres and special and regional hospitals; the secondary care level of provincial and emergency hospitals. The primary health care level is divided into rural health unit main centres and subsidiary barangay health stations. The rural health units are operated by a public health team consisting of a municipal health officer (MHO), who is the team leader, a public health nurse (PHN), a rural sanitary inspector (RSI) 'and a rural health midwife (RHM), who mans the barangay health station. A barangay health worker (voluntary) may assist the rural health midwife at the barangay health station. A widespread private health care system also exists, extending from the primary health care level to the secondary and tertiary levels, the latter being especially well represented in the highly urbanized areas of the country such as Metro·-Manila and the large cities. There are over 60 000 hospital beds available in the whole country, of which over 40% are private, equivalent to a bed/population ratio of I bed for every 700 people. Of that number, over 40% are 1n the greater Metro Manila region. A maldistribution of physicians, similarly favouring the urban areas, also exists. National health plan Various national health plans have been formulated including those for 1978-1982; 1978-1987; 1987 to 2000 and the 1979 operational plan. Those plans have provided priorities in the delivery of health care services and effected a systematic allocation of resources in the Ministry of Health and other government agencies as well as private medical communities. They have been incorporated into the overall socioeconomic development plan of the Government. The National Health Plan is the first documented health plan for the country. The Plan has addressed itself to the following major problems facing the health sector: - communicable disease control - malnutrition - high population growth - inequitable distribution of health resources - unsatisfactory sanitation of the environment Objectives To resolve adequately the above problems, the following health and administrative obJectives were adopted: (1) Health objectives Health objectives comprise: (i) provision of satisfactory preventive, curative and rehabilitative services to the population; .. .. "" .. REPORT OF THE REGIONAL COMMITTEE (ii) attainment by the popUlation of an acceptable health and nutrition status; (iii) limitation of population growth to a desirable level. To attain those objectives, the health service aims to: (i) reduce thp general level of morbidity; 75 (ii) reduce the crude death rate from 10.6 per thousand population in 1976 to 9.4 per thousand in 1982; (iii) reduce the infan~ mortality rate from 74 per thousand live births in 1976 to 65 per thousand live births in 1982; (iv) improve the nutritional status of the whole population, particularly the vulnerable group, such as infants, children and pregnant women; (v) improve the sanitation of the environment by providing half of the population with potable drinking water and half of the households with sanitary toilets. To provide 17% of those living in urban areas with safe drinking water; (vi) limit population growth to an acceptable level of 2.08%. (2) Administrative objectives Administrative objectives comprise: (i) full implementation of the restructured health care delivery system (RHCDS); (ii) improvement of the health statistical system through development of the management information system (MIS); (iii) redirection of the manpower development programme to meet the needs of the health services; (iv) strengthening of the referral system at all levels of health care; (v) managerial development for health administrators at all levels. Strategies The following strategies have been endorsed by the Ministry of Health to achieve those objectives: (1) effectively implement the restructured health care delivery system (RHCDS). particularly in rural areas, in regard to 76 REGIONAL COMMITTEE: THIRTIETH SESSION satisfying the hospitalization needs of the people in all ,areas; (2) strengthen health facilities so that there is an equitable distribution of health services, especially in remote areas; (3) promote the utilization of paramedical staff and trained indigenous health workers in areas where medical professionals are unavailable; encoulage standardization and simplification of health services procedures in order to achieve optimum performance from health workers; . (4) promote cooperation and coordination with other agencies, both governmental and private, in order to achieve maximum utilization of available resources; (5) improve planning, budgeting, supervision and control of activities, including peripheral health units, through the establishment of a management information service (MIS). Health manpower development Innovative training programmes for health care personnel and provision of community health programmes have been developed by the University of the Philippines system: the Tacloban project of the Institute of Health Sciences on the island of Leyte, and the comprehensive community health programme (CCHP) in Bay, Laguna. The Tacloban project consists of a nine-step-Iadder course of training for a range of health care personnel from barangay health worker to fully-fledged doctor of medicine in a single, continuous and united curriculum. The selection of students is left to the people where the health worker will work. By this means it is hoped to overcome the maldistribution of health workers, especially phYSicians, in rural areas. There have been favourable early reports of this training innovation after some initial teething problems. The comprehensive community health programme (CCHP) in Bay, Laguna, provides training programmes for health workers as well as health programmes with community participation. Other universities train doctors and dentists and there are many institutions, government and private, which train nurses and allied health workers for both urban and rural health services. Collaboration with WHO WHO has collaborated satisfactorily with the rural health services, especially in Nueva Ecija province, and with the activities of the Project Management Staff as well as in numerous other areas. .. ... ... .. ... REPORT OF THE REGIONAL.COMMITTEE 77 It is recommended that further WHO collaboration should be considered in: (l)strengthening the expanded programme on immunization, especially in regard to tuberculosis and poliomyelitis; (2) training, including the provision of appropriate manuals such as The P':'ir.t8ry Health Worker, 1 and equipment for primary health care workers such as paramedical staff and barangay auxiliaries; (3) strengthening nutritional assistance for protein calorie malnutrition, avitaminosis, anaemia and thyroid disorders; (4) appointing a WHO Programme Coordinator for the Philippines, who would further promote the very good collaboration already in existence. VIET NAM Dates of visit 6 -11 April 1979 General information In 1978 the natural population increase in Viet Nam was 2.6% and the expectation of life at birth was 45 years. National health development strategy Health is an integral part of the social and economic development of the country. The basic task of the health services remains the establish- ment of favourable conditions for the protection and promo·tion of the health of the people, which has been severely affected by long and arduous wars. The national political and health authorities have five main objectives: (1) to extend and strengthen the health network; (2) to provide maternal and child care; (3) to promote the provision of medical care in dispensaries; (4) to prevent epidemics; (5) to develop pharmaceutical production. 1 World Health organization, The primary health worker: working guide, guidelines for training, guidelines for adaptation (experimental edition). Geneva, 1977. 78 REGIONAL COMMImE; THIRTIETH SESS ION Priority problems to be solved are the following; (1) completion of the organization for health throughout the country from the central to the basic level in order to provide all individuals with medical care of improved quality; (2) promotion of drug production within the country and importation of certain drugs and chemical substances to meet the requirements for prophylaxis, treatment and medical research; (3) intensification of medical research activities and the application of technical progress in order to establish the necessary material and technical potential for the future; (4) strengthening of the training of supervisory staff of all categories; (5) improvement of the quality of treatment, in particular emergency and intensive care in large urban centres. Epidemiological situation (August 1978) During the year prior to August 1978, increasing effort was directed to the control of communicable diseases throughout the country, especially in the southern region. There was a considerable reduction in the incidence of cholera, malaria and plague. There was some increase in cases of dengue fever, enteric diseases and influenza as well as in cases of poliomyelitis in the southern provinces. Spread of disease was limited by instituting epidemiological control measure in ports, airports and high population density regions close to epidemic areas. Immunization of children with BeG and poliomyelitis vaccine was carried out on a wide scale, utilizing the personnel of basic health stations. DPT vaccine was administered only in day nurseries. At national level, the Ministry of Public Health took measures to strengthen and develop vaccine production centres. As a result of an energetically implemented malaria control programme, nearly 1 million inhabitants were protected by DDT spraying. Epidemiological control measures reduced the malaria parasite rate in the north by 14 times since 1958, to 0.14% and in the south by 10 times since 1975, to 10%. ... ... .. .. .- REPORT OF THE REGIONAL COMMITTEE A strong impetus was given to the venereal disease control programme in the southern provinces following assistance from the Government of Australia, resulting in a considerable improvement in the situation. During the year under review, various environmental health and sanitation activities were undertaken throughout the country, especially in the southern provinces, including the rural areas, directed to improving sanitary sewage disposal. In the course of the year, the Ministry consolidated and unified the health network dispersed throughout the country. Health stations are common to over 90% of communes in the north and to 85% of communes in the south. All districts in the north and over 90% of districts in the south have a general hospital. Local health institutions are being encouraged to develop 79 traditional medicines and practices, including cultivation of medicinal plants for the production of common drugs, and the practice of acupuncture. Structure and organization of public health work The Ministry of Public Health is responsible for the organization and administration of all health care for the country, both curative and preventive. The Ministry also manufactures and distributes medicines, trains health workers and carries out medical research. Public health work is organized on the lines of the administration. There are four tiers: the commune or grassroots level, the district level, the provincial level and the central level: (1) the commune or grasl';roots level consists of communes, factories, schools and administrative services. In each of these units, there is a health station responsible for hygiene, ensuring the medical examination and treatment of each family, llsing if possible traditional medicines and acupuncture, administering first aid, carrying out prenatal examinations and attending normal confinements; (2) the district (or town) level has a public health office, which supervises preventive health measures in the area . It has a hospital with specialists, hygiene and anti- epidemic brigades and a pharmacy; (1) the provinoial (or city) level has a public health department, responsible for all the medical and sanitary services in the province or city. The network is composed of larger specialist hospitals, polyclinics, a hygiene and epidemiology centre, including units for tuberculosis and malaria. It also has a material medical depot, a bureau for checking pharmaceutical products, pharmaceutical factories, pharmacies and secondary medical schools; 80 REGIONAL COMMITTEE: THIRTIETH SESSION (4) the central level has institutes of medicine and pharmacy, specialized and general hospitals, sanitaria, colleges of medicine and pharmacy, a public health college, pharmaceutical factories, medical equipment and chemical products factories, a medical publishing house and a central medical library. The Ninis ter of Public Hea 1 th is a member of the Council of Ministers. He is assisted by Vice-Ministers, the offices of the Ministry and specialized departments. A scientific and technical council also advises the Minister. Health care facilities By the end of 1976, in the whole country, there were 8215 commune health stations with over 60 000 beds, 548 specialized hospitals, 912 infirmaries with 87 000 beds, 102 sanitaria, 20 research institutes, 38 specialized health centres, 33 tuberculosis centres, 32 venereal diseases centres, 37 malaria centres, 20 centres for maternal and child welfare and family planning, 27 leprosaria, 8 colleges of medicine and pharmacy, 34 secondary school level medical colleges, which also train laboratory attendants. There were 8300 doctors of medicine, 2394 pharmacists and 38 933 auxiliary health workers. All in-patient treatment in the country is provided free for all levels of the community in the State-run hospitals. Collaboration with WHO The Ministry of Public Health places great importance on the collaboration which has occurred between it and WHO, especially in the context of the present situation. Areas where WHO experts have cooperated include the organization of medical and analytical laboratories, family planning, malaria control, production of medicinal plants. WHO fellowships have also been provided. The WHO Programme Coordinator has supervised or been involved in a number of programmes sponsored by such organizations as the United Nations Children's Fund, the United Nations Industrial Development Organization, the Office of the United Nations High Commissioner for Refugees, the International Committee of the Red Cross and a number of bilateral programmes of various governments. The HHO Programme Coordinator stressed the humanitarian aspect of a number of those programmes in view of the dire needs of many of the people of the country at the present time and emphasized that WHO and its Member States should keep this aspect to the fore in their reviews of various programmes. - .. .. ... REPORT OF THE REGIONAL CplfM=I_.TT;;,;E_E ______ - ______ 8;;..;;;..1 REPUBLIC OF KOREA Dates of visit 12-17 April 1979 Health status (1) Vital statistics Vital statistics in 1975 were as follows: natural increase 1.Tt; crude birth rate 24%; crude death rate 7%; and expectation of life at birth 66 years in males and 70 years in females. (2) Epidemiological situation Of the enteric diseases, there have been sporadic cases of typhoid but cases of cholera have not been reported since 1971. Malaria is endemic, particularly in the western mountainous area. Japanese encephalitis occurs in small epidemics every few years. On the other hand, no cases of smallpox have been reported since 1961. Prevalence surveys of pulmonary tuberculosis were carried out in 1965, 1970 and 1975, with the cooperation of WHO. The prevalence rate of pulmonary tuberculosis was 5.1% in 1965, and was reduced to 3.3% in 1975. The rate of infectious pulmonary tuberculosis was 0.9% in 1965 and reduced to 0.7% in 1975. Approximately 45.5% of the population is infested with one or more forms of intestinal parasite, and certain other parasites, such as Ch10norchis sinensis and Trichocephalus trichiurus, cases of these types being estimated to number 6 million. This will require a long-term educational programme in addition to control measures in the rural areas. The Republic of Korea faces the health problems observed 1n both underdeveloped and developed countries. Partly because of the relatively young population and problems related to environmental health, communicable diseases rank high in importance. On the other hand, having regard to the gains being made in the cQntrol of those diseases and the longer life span of the population (an increase of 11 years over the last decade), increases in the degenerative diseases, such as cardiovascular diseases and cancer, as well as in accidents, mainly in industry, have been observed. Problems have also been encountered in the fields of environmental pollution and industrial health as a result of rapid industrialization. (3) Organizational structure The organizational structure of the national and social welfare programmes consists of two parts: the Ministry of Health and Social Affairs and the Office of Labour Affairs. 82 REGIONAL COMMITTEE: THl~TIEIH SESS ION Health services are provided at different levels by the national and provincial general hospitals, health centres and subcentres and other facilities such as laboratories, sanitaria and private hospitals and clinics. The present organization and staffing, as well as the current stage of development, do not permit them to meet fully the health demands of their areas, particularly in rural areas, in spite of general underutilization of the existing facilities. The improvement and expansion of the public health care service and the social welfare system were the major objectives of government public health policy in 1976. In order to give medical care benefits to as many persons as possible, the Government expanded public health service facilities in the rural areas and made it mandatory for medical personnel to serve for a certain period in remote rural areas. In order to attain the policy objective of providing equal medical benefits for the rural population, the Government drafted doctors for 69 doctor less health centres in 1976. The Government also founded the Korean Health Development Institute (KHDI) in April 1976. KHDI conducts research and evaluation to develop effective measures and methods for the formation of national health policy. That Institute also conducts demonstration projects in selected areas to develop and evaluate a comprehensive health care system, including prevention of disease, diagnosis, treatment, rehabilitation, medical insurance, long- and short-term health care demand, improvement and maintenance of community health, training of staff engaged in the demonstration programme, information exchange, and joint studies with research institutes in and out of the country. It also conducts research projects on health care requested by the Government and provides professional consultation to the National Health Council, which is responsible for policy development in relation to the health care delivery system and its problems. KHDI has conducted various basic surveys, while a comprehensive health care demonstration project for three Gun areas, covering approximately 500 000 population, commenced in 1977. The Korean National Tuberculosis Association (KNTA) has been responsible for national tuberculosis control activities and has undertaken overall screening of tuberculosis patients registered at the health centres, in order to help improve the efficiency of the latter. The Government and KNTA jointly endorsed the implementation of initial and re-treatment chemotherapy trials, which were to be carried out by the Institute of Tuberculosis. Provincial tuberculosis control committees were organized by provincial governments to implement re-treatment programmes for the initial chemotherapy failure cases registered at the health centres. It is expected that those committees will form the nuclei of tuberculosis control activities in their respective provinces in the future. KNTA activities of assistance for the government programme consist inter alia in the production of BCG vaccine, operation of the central supervisory team, operation of the provincial (city) supervisory teams and operation of libraries. .. ... REPORT OF THE REGIONAL COMMITTEE Collaboration with WHO in health care activities The collaboration of WHO with the Ministry of Health and Social Affairs has been active in a number of areas, especially in regard to primary health care. 83/84 WHO has supported the establishment of the Korean Institute of Tuberculosis and has cooperated with the various activities of the United Nations Children's Fund in the fields of training of scientists and the supply of equipment and textbooks. The conference on primary health pare and related fields such as maternal and child healt~ and tuberculosis control, arranged by the recently established KHDI, have been aided by WHO. An area for useful collaboration between the Ministry and WHO is the use of medicinal plants, in which the Republic of Korea has considerable expertise. The ~~O Programme Coordinator has developed a close and effective relationship with the Ministry of Health and Social Affairs. REPORT OF THE REGIONAL COMMITTEE ANNEX 5 REPORT OF THE SUB-COMMITTEE OF THE REGIONAL COMMITTEE ON TECHNICAL COOPERATION AMONG DEVELOPING COUNTRIES (TCDC) The Sub-Committee on.Technical Cooperation among Developing Countries held its fourth meeting in Manila on Monday and Tuesday, 85 26 and 27 March 1979. The meeting was opened by the Regional Director, Dr Francisco J. Dy. The following attended: Dr Shuichi Tani, Japan Mr Moo-geun Jeon, Republic of Korea Dr J.M.J. Supramaniam, Singapore The representative from Papua New Guinea was unable to be present. The following members of the Sub-Committee on the General Programme of Work attended as observers: Dr Dennis Stanbury, Australia Dr Takayuki Nose, Japan Dr Abdul Talib bin Latiff, Maiaysia Dr Bryan Christmas, New Zealand Dr S. Foliaki, Tonga Mr Nguyen Van Trong, Viet Nam Mme Le Thi Thu Ha, Viet Nam (Interpreter) Dr J.M.J. Supramaniam was elected Chairman. The Regional Director expressed appreciation to the governments of the members of the Sub-Committee on Technical Cooperation among Developing Countries and the Sub-Committee on the General Programme of Work for allowing their representatives to attend. Members of the Sub-Committee on the General Programme of Work had made useful contributions to previous meetings of the Sub-Committee on Technical Cooperation among Developing Countries, hence the decision to invite them to the present meeting. The recommendations of the present meeting of the Sub-Committee would not only be reported to the Regional Committee at the thirtieth session but would also make a useful contribution to the Technical Discussion on Technical Cooperation among Developing €ountries during the Thirty-second World Health Assembly. . The Sub-Committee had before it the following background documents: (1) "Technical Cooperation among Developing Countries in Health Manpower Development", which gave a progress report of activities in the areas of primary health care and drug policies and management, problems in health manpower development, specific activities which could be undertaken in the field of health manpower development, and a basis for possible recommendations; 86 REGIONAL COMMITTEE: THIRTI£TH SESSION (2) Report of the United Nations Conference on Technical Cooperation among Developing Countries, Buenos Aires, 30 August to 12 September 1978; (3) Report of the Conference on Regional Cooperation in the WHO Fellowship Programme, Manila, 6 to 12 February 1979 ; (4) An addendum to Annexes 3 and 4 of document WPR/RC29/l0 Rev. I, national programmes or projects with technical cooperation among developing countries (TCDC) components or with potential for the development of TCDC in China, the Republic of Korea and Singapore (see Appendix 1). "Technical Cooperation among Developing Countries in Health Manpower Development", which was the principal background document, was developed from the regional medium-term progrannne for health manpower development, the report of the Conference on Regional Cooperation in the WHO Fellowship Programme and records available within the Regional Office. The Sub-Committee noted that elements of technical cooperation among developing countries had always been incorporated in WHO programmes and had been implemented a8 far as p08sible. The technical cooperation among developing countries activities promoted and Unplemented in the Region by WHO in the fields of primary health care and drug policies and management were reviewed. Those two programmes had been recommended by the Sub-Committee, at its initial meeting in 1977, for study in 1978. Among the activities were the intercountry workshop on primary health care for Malaysia and the Republic of Korea. collaboration with training institutions in Australia, Fiji, Papua New Guinea and Philippines; provision of vaccines by one Member State to other Member States; development in the Philippines of a "cold box" for the expanded programme on immunization, which was also used in other countries; development of a bulk purchasing scheme for pharmaceuticals among the South Pacific countries; the memorandum of agreement and plan of implementation between the Government of the People's Republic of China and the World Health Organization, governing technical cooperation in health activities; and the programme of the Government of Singapore which enabled fellows from other Asian countries to study in Singapore. In accordance with a resolution adopted by the Regional Committee in 1978, which accepted the recommendations contained in the reports of the Sub-Committee's second and third meetings, the subject of study in 1979 was health manpower development. I Nevertheless, encouragement of technical cooperation among developing countries in primary health care and drug policies and management would continue. lSee resolution WPR/RC29.R19, Report of the Regional Committee for the Western Pacific, twenty-ninth session, 1978, pages 32-33. .. .. .. ... ... REPORT OF THE REGIONAL COMMITTEE 87 In addition to budgetary implications, considered to be important in ensuring cost-effectiveness, the Sub-Committee discussed three categories of problem related to health manpower development: (1) Policy, planning, operations and technology: the relevance of present health manpower development programmes to national requirements and conditions; the importance of monitoring such requirements and conditions; inadequate collaboration between trainers or educators and those responsible for health care delivery; the categories of staff required and in what proportions. Emphasis was placed on the need for programmes for professional health staff to be flexible by encouraging the training of generalists rather than specialists; (2) Administration of fellowships: planning the fellowship programme; selecting suitable institutions and countries in which fellows might study; language of study; utilization of fellows on return to their home countries; evaluation of the usefulness of training; (3) Application of technical cooperation among developing countries: need for improvement in institutions or in courses, to ensure that training programmes are suitable. This could be achieved by providing the receiving country with more information on the country sending the fellow. Those involved in the training themselves needed to keep abreast of the latest trends in their own field •• The Sub-Committee considered that technical cooperation among developing countries was a multidimensional process which could be bilateral or multilateral in scope and subregional. regional or interregional in character. It was also considered that, while the main flow of technical cooperation would be among two or more developing countries, the support of developed countries and of regional and interregional institutions was vital. Bearing that in mind, the Sub-Committee recommended to the Regional Committee that WHO should: ( 1) (2) continue to promote the development of health manpower relevant to the needs of Member States, within the context of national health plans, and collaborate in activities towards that end; encourage exchange of information on health manpower development policies, training programmes, and training needs. Thi's could be achieved through exchange of technical materials, curricula and, where feasible, staff; lsee resolution WPR/RC29.RI9, Report of the Regional Committee for the Western PacifiC, twenty-ninth session, 1978, pages 32-33. 88 REGIONAL COMMITTEE: THIRTIETH SESSION (3) encourage ways and means of supporting technical cooperation among developing countries activities in health manpower development, especially coordination between training institutions and the agencies providing their resources. Contact between groups of institutions in a country, or between groups of countries and funding agencies, could be facilitated to formulate and discuss the provision of support for technical cooperation among developing countries strategies. The strengthening of training institutions, including library facilities, should continue; (4) encourage the ministries of health of Member States to circulate information on fellowships available to other ministries responsitile for health-related programmes, such as port health, occupational health, air pollution control, vector control, or sanitation; (5) consider intensifying support for language training, as appropriate. The Regional Office should also ensure that all available courses are listed in the Registry of Training Courses Available for Health Personnel in the Western Pacific Region. That such courses exist should be drawn to the attention of governments in correspondence on fellowships; (6) prepare a manual of guidelines for evaluation of the effectiveness and appropriateness of fellowship programmes. The manual should include suitable forms to enable both fellows and governments to report when the fellowship ended and on utilization after the fellow had returned home. Courses should be evaluated and the governments of both sending and receiving countries sent copies of the evaluation report; (7) endeavour to have fellows at the place of study within six months of receipt of the application. To enable this to be done, Member States were urged to submit fellowship applications early, since late applications hampered placement; It was also considered desirable that fellows should be informed of when they were to depart as early as possible and at least one week before the fellowship commenced; (8) support meetings of national fellowship officers together with other measures to ensure effective planning and the sharing of information and problems. The Sub-Committee proposed that the next topic to be considered should be "The primary health care aspects of communicable disease control" • .. .. - ... 'I I , ." NATIONAL PROGRAMMES OR PROJECTS WITH TECHNICAL COOPERATION AMONG DEVELOPING COUNTRIES (TCnC) COMPONENTS OR WITH POTENTIAL FOR THE DEVELOPMENT OF TCncl Nature of the national programmes/projects PEOPLE'S REPUBLIC OF CHINA2 Primary health care Appropriate technology for health Health manpower development Health manpower development/biomedical research Academy of Traditional Chinese Medicine, Beijing - Institute of Traditional Medicine - Institute of Acupuncture and Moxibustion Chinese Academy of Medical Sciences, Shanghai - Institute of Parasitic Diseases - Institute of Oncology Chinese Academy of Medical Sciences, ~eijing - Institute of Cardiovascular Diseases - Institute of Oncology Fie ld for TCne Exchange of information Study tours/meetings Training in acupuncture 1. Exchange of in forma t ion and experience 2. Study tours and missions 3. Training courses 4. Conference/seminars IAddendum to Annexes 3 and 4 of document WPR/RC29/l0 Rev. 1. 2In formation taken from a review of documentation available in the Regional Office. Present WHO cooperation Yes Yes Yes Yes3 3All agreed in principle; some Institutes are actually engaged in cooperation rest are either in the process of development or will soon be developed. while the Suggestions for improvement through National United Nations WHO Bilateral action Agencies Agencies lJ> '" ~ ~ H ::< I-' ~ "d ~ t-i ~ t-i ~ ~ Q H ~ C') ~ H t-i ~ tz:I I~ NATIONAL PROCIW01ES OR PROJECTS WITH TECHNICAL COOPERATION AMONC DEVELOPING couwnlES (TCDC) COIfPOIIENTS OR WITH P(lTENTIAL FOR TRE DEVEt.OPMEMT OF TCDC Nature of the national progra.mes/projects First Medical College, Shanghai - Acupuncture Anaesthesia Research Laboratory - Institute of Cardiovascular Diseases Medical College, Beijing - Acupuncture Anaesthesia Research Laboratory Institute of Tuberculosis, Beijing College of ~raditional Medicine, Shanghai College of Traditional Medicine, Nanjing Chung Shan Medical College, Guan~zhou Institute of Tropical Diseases, Friendship Hospital, Beijing Field for TCDC 5. Consultants 6. Referrals for special examination 7. Contracts for special activities Present WHO coopt'rat ion Su~gestions for improvement throu~h National United Nations WHO Bilateral action Agencies Ageneies Pharmaceuticals and biologicals • Chinese Academy of Medical Sciences, Beijing - Institute of Materia Medica Ministry of Health, 5eijing - Institute of Biological Products - Institute for Control of Pharmaceutical and Biological Products Chinese Academy of Medical Sciences, Kunming - Institute of Medical Biology Institute of Biological Products, Shanghai ( 1 .( \0 o ~ en t-I ~ t"" i ~ g ~ ~ en to::! CIl CIl t-I i '( ,( Nature of the national programmes/projects REPUBLIC OF KOREA Primary health care Korea Health Development Institute Health services research Korea Health Development Institute SINGAPORE Workers' health Department of Social Medicine and Public Health,' University of Singapore Industrial Health Department, Ministry of Labour Health services research Research and Statistics Unit, Ministry of Health Maternal and child health/family planning Maternal and Child Health Services, Ministry of Health Singapore Family Planning and Population Board « NATIONAL PROGRAMMES OR PROJECTS WITH TECHNICAL COOPE.RATION AMONG DEVELOPING COUNTRIES (TCDe) COMPONENTS OR WITH POTENTIAL FOR THE DEVELOPMENT OF rCDC .. ,. ( Suggestions for improvement through Field for TeDC Present "''HO cooperation National United Nations WHO Bilateral Intercountry visits; seminars; exchange of information; exchange of staff Exchange of information and technical documents; seminars; contracts for special activities Training courses Exchange of information Contracts for special activities Exchange of information Exchange of information action Agencies Agencies Ad hoc Yes Yes Yes No No Yes = tV ~ i-i ~ ~ fa = Cl H o s: t:"' n ! ~ ~ ..0 .... Nature of. the national programmes/projects Research and training in fertility regulation Department of Obstetrics and Gynaecology, University of Singapore Oral health Institute of Dental Health, Ministry of Health Immunology WHO Immunology Research and Training Centre, University of Singapore Health statistics 'II' Research and Statistics Unit, folinistry of Health « NATIONAL PROGRAMMES OR PROJECTS WITH TECHNICAL COOPERATION AMONG DEVELOPING COUNTRIES (TCDC) COMPONENTS OR WITH POTENTIAL FOR THE DEVELOPMENT OF TCDC Suggestions for improvement throu~h Field f.or TeDC Present "'HO cooperat ion National United Nations "'HO 8ilateral Training courses Exchange of information Training courses Exchange of information Training courses Exchange of information Exchange of information • Yes Yes Yes Yes Yes Yes Yes action Agencies Agencies ~. \0 N ~ !;) H ~ t'" n ~ 8 t-i III H ~ ~ ~ III U) to2 U) U) H g