(WPR/RC38/SR/4)
SUMMARY RECORD OF THE FOURTH MEETING Red Cross National Training Centre, Beijing Wednesday, 9 September 1987 at 2.30 p.m. CHAIRMAN: Professor CHEN MINZHANG (China) CONTENTS ~
1•
Report of the Regi onal Director (continued) Sub-Committee on Programmes and Technical Cooperation .................................... ........
122 123
2.
2.1 3.
Report of the Sub-Committee, Part I
••••••• ••••••••
123
Regional Priorities under the Eighth General Programme of Work: Report of the Sub-Committee, Part II
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- 121 -
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1.
REPORT OF THE REGIONAL DIRECTOR - Item 7 of the Agenda (Document WPR/RC38/2) (continued from the third meeting, section 2)
Part II: 1•
Review of selected programme areas (pages 209-244) Centre for and Applied the Promotion of Studies (PEPAS)
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Western Pacific Regional Environmental Planning There were no comments.
2.
Nursing (pages 231-244)
Dr BIUMAIWAI (Fiji) expressed his appreciation of the views on nursing set out in the chapter under review. In his country, nurses were the backbone of the health services. In 1983, WHO had responded favourably to Fiji's request for a nurse consultant to review the nursing curriculum in order to take into account the changes that had occurred in the role of nurses since the adoption of primary health care in 1978. The changes she recommended were put into effect in 1984. Further changes suggested by a nurse consultant, who had been in Fiji during the current year and had evaluated the new curriculum, would be of invaluable assistance to Fiji's nursing personnel. The Japanese Government had made a generous grant towards the establishment of Fiji's School of Nursing, which would function as a regional training centre, 25% of its places being set aside for neighbouring countries. It was the policy of his Government to give nurses a central role in the country's health services. The Rapporteurs should be asked to draft a resolution expressing appreciation of the contribution made by nurses to the implementation of health programmes in the Region. Dr SUNG WOO LEE (Republic of Korea) thought it noteworthy that nursing had been given separate treatment in the report. Nursing was an important component in primary health care in all developing countries, including the Republic of Korea. There were three collaborating centres for nursing in the Region - in , ia.nila, Sydney and Tokyo. His Government was considering asking WHO for its support in designating a fourth at a university college of nursing in the Republic of Korea. He endorsed the proposal for a draft resolution. Dr CHRISTMAS (New Zealand) congratulated the Regional Director and the Secretariat on their farsightedness in paying particular attention to the development of categories of nursing personnel in the Region. He supported the proposal that a resolution be drafted. It should acknowledge the valuable contribution made qy nurses to primary health care in particular and to the health services in general, with special emphasis on developing opportunities for nurses to work in those fields. Dr MAOATE (Cook Islands) supported the proposal made by previous speakers for a resolution on nursing. The Government·of Cook Islands also attached great importance to the role of nurses in the country's
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health services, as was shown by the passing of legislation recognizing the Nurses' Association and establishing a Nursing Council. · Mr MOMIN (Brunei Darussalam) said his delegation also supported the views expressed about nursing in the report. They had recently completed a reorientation training exercise in cooperation with a consultant sent by WHO. Mr TOEOLESULUSU SIUEVA (Samoa) also endorsed the proposal made by previous speakers for a resolution on nursing. His Government had approved the establishment of a new category of health worker, the community nursing officer, who would serve mainly in the rural areas. Samoa would appreciate the cooperation of a consultant to review the nursing curriculum and advise on the training of the new type of health worker.
In the absence of further comments on the chapter under consideration, the CHAIRMAN asked the Rapporteurs to prepare an appropriate draft resolution on nursing. As there were no further comments on the report of the Regional Director as a whole, the CHAIRMAN asked the Rapporteurs to prepare an appropriate draft resolution on that also. (For consideration of the draft resolutions, see the fifth meeting, sections 1.2 and 1.1 respectively. ) 2. 2.1 SUB-COMMITTEE of the Agenda ON PROGRAMMES AND TECHNICAL COOPERATION: I: Item 10.1 of ITEM 10
Report of the Sub-Committee, Part (Document WPR/RC38/5)
the Agenda
The REGIONAL DIRECTOR pointed out that the Sub-Committee's report was divided into two parts to conform to separate items on the Agenda. Part I referred to item 10.1; and Part II to item 11. He hoped the Committee would agree to discuss each part separately under the relevant agenda item. Part I of the Sub-Committee's report covered the country visits to Solomon Islands and VietNam in relation to WHO's cooperation in the fields of malaria and tuberculosis control. The CHAIRMAN said that in past years discussion of the membership of the Sub-Committee had been deferred until both parts of its report had been discussed. On the present occasion, however, in view of the proposal that the number of members should be cut and their tenure of office reduced, the Sub-Committee's membership should logically be discussed before Part II of its report was deal with. In the absence of objections to that proposal and to the Regional Director's suggestion that each part of the Sub-Committee's report be dealt with separately under the appropriate agenda item, he would call upon the Rapporteur of the Sub-Committee t~ introduce Part I of its report.
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Dr CHRISTMAS, Rapporteur o:f the Sub-Committee on Programmes and Technical Cooperation, said that the Committee had had ten members, all of whom had been able to join in the visits, and that in itself had led to the realization that it was rather an imposition on a country to have to play host to ten people at a time, although for many members of the Sub-Committee itself each visit was an education and an opportunity to exchange experience at first hand with people with similar problems to their own. The topics under consideration were malaria and tuberculosis control. The visiting team had endeavoured to discover the extent to which the countries and WHO recognized the problema, the existence of a national plan or set of priorities relating to those problems, the operational approach used, the degree of community involvement and the form of evaluation undertaken. It turned out that, by and large, both countries recognized the extent of their problems, had given them priority and had drawn up national plans for dealing with them, plans which they were implementing to the best of their ability, subject to the limited nature of the resources available. Both countries, and in particular Viet Nam, faced enormous difficulties, such as technical problems of dealing with drug resistance, logistical problems, administrative and financial problems resulting in shortages of drugs, vaccines, supplies and equipment, and problems of poor distribution, all compounded by a shortage of trained manpower and of adequate data to provide a basis for evaluation.
In Solomon Islands, the programme for malaria control was well developed but should be integrated into the general primary health care system. The country needed cooperation in training and deploying manpower, in collecting epidemiological data and in carrying out more detailed research into the problems of managing malaria. It was heartening to note that the Government of Japan was making a substantial contribution to setting up an institute of malaria. WHO should continue and expand its support for malaria and tuberculosis control. The Government should give tuberculosis control the same priority it had accorded to malaria control. In the case of Viet Nam, senior staff had shown an impressive grasp of the problems of malaria and tuberculosis control and a determination to draw up operational plans and to set targets and achieve them. Viet Nam obviously needed a great deal of cooperation in strengthening its health services and in dealing with problems at community level, although there was considerable community involvement and support. There were logistical problems due to the size of the country, financial problems in maintaining and extending the primary health care system and freely admitted management problems. Management training should therefore be made available. In Solomon Islands, better training, a better supply of drugs and more community involvement would make their operational plans more effective. In Viet Nam, an acute shortage of resources seriously hampered the logistic programme, made the operational programme more difficult to achieve and threw into relief the acute need for better management training. Despite the considerable community involvement witnessed, the maintenance and_development of Viet Nam's primary health care system needed support. Both countries were in urgent need of technical support.
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As for the membership problem it was felt that a reasonable compromise would be to reduce the number of members from ten to eight and reduce their tenure from three to two years. Mr TEPAIKA (Solomon Islands) expressed his gratitude to the SubCommittee for its review of the malaria and tuberculosis control programmes in his country. Efforts would be made to strengthen community participation and to expand activities in both fields. Supplies of insecticides and drugs and logistical concerns were a problem, and help would be required in those areas for some time. He re-emphasized his Government's gratitude to WHO and stressed the recommendation of the Sub-Committee regarding the desirability of WHO's providing technical support to the malaria training and research centre, due to open in 1988. He thanked the Government of Japan for its generosity in providing that Centre.
He agreed that consideration should be given to reducing the size of the Sub-Committee, whose visits represented a considerable financial burden for small countries with limited resources. He would advocate a reduction to four or five members in order to reduce expenses. Dr KHALID (Malaysia) thanked the Sub-Committee for its report, and stressed the important role played b,y the Sub-Committee in the workings of the Regional Office and the Regional Committee. He agreed that measures to reduce expenditure should be supported, as long as they did not also reduce effectiveness. He therefore supported the Sub-Committee's recommendation to reduce the number of its members from ten to eight, and their tenure from three to two years. It would also be useful to examine the workings of the Sub-Committee, to try to make it a more effective organ of the Regional Committee, providing information on programme planning, implementation and evaluation needed for effective decision-making.
There were two main types of activity of the Sub-Committee: meetings to discuss specific issues, as requested b,y the Regional He believed that the Committee, and visits to Member States. subjects considered by the Sub-Committee should be those areas that would have a significant impact on programme development and implementation within the Region, e.g. health system development, organization of health systems based on primary health care, and health manpower development. Consideration of these areas could have a much more lasting effect than consideration of specific problems, such as particular diseases. Regarding the visits to Member States, he thought there was a need for improved preparation. In order to ensure that the best use was made of the time available for the visit, it might be possible for the WHO representative to collect some information beforehand. Likewise, Member States receiving visits could be given information to allow them to better prepared. Examination of those areas could strengthen the work of the Sub-Committee. He believed that the SubCommittee could play a major role in reducing the work of the Regional Committee through exploratory work ~d preliminary examination of specific key areas.
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Dr WELCH (Australia) supported the comments of the Chairman of the Sub-Committee, and expressed appreciation of the cooperation extended to the Sub-Committee by the governments of the countries visited. It was evident that the countries, together with others, had great needs in the fields of malaria and tuberculosis control, and the visits had confirmed the need for care in the spending of WHO funds, and the importance of health manpower planning. He supported the comments of the representative of Malaysia regarding the need to ensure that the money spent on country visits was well utilized. In view of the importance of the Sub-Committee, it was essential to give carefUl consideration to the questions raised regarding its structure and terms of reference. He agreed that there was a need for adequate briefing of both Sub-Committee members and of the relevant people in the countries visited. That would require efforts on the part of the WHO representative in the country concerned.
Professor HOANG DINH CAU (Viet Nam) thanked the Regional Director for having sent a competent team of experts to his country. He expressed his gratitude to the members of the Sub-Committee for the excellent work accomplished. Their evaluation reflected accurately the work being done in the country, the results, and the concerns for the future. Dr MUGITANI (Japan) said that the delegation of Japan did not agree with the recommendation to reduce the number of members to eight. The main reason for the proposed reduction appeared to be the inconvenience associated with the travel arrangements for the group. He noted that, until 1981, country visits had been carried out by two separate groups, at which time they had been amalgamated and the number of visits reduced. It was important for WHO and Member States to recognize the importance of the Sub-Committee in evaluating priorities in the Eighth General Programme of Work. He therefore objected to any reduction in the number of members. Dr SUNG WOO LEE (Republic of Korea) joined with other representatives in commending the work of the Sub-Committee. He understood that one of the reasons for forming the Sub-Committee had been to allow Member States to participate in the activities of WHO more often than at the annual meeting of the Regional Committee. While he agreed with the representative of Malaysia on the need for efficient management of WHO's resources, increased participation of Member States was also important. He therefore agreed with the representative of Japan that the number of members should not be reduced. It might, however, be possible to reduce the number of participants in the country visits. Mr TAGUIWALO (Philippines) suggested that the number of members should be maintained, and that the Regional Director be asked to look at ways of reducing the burden on host countries. The methods of work of the Sub-Committee should also be examined. The Sub-Committee was a key body generating recommendations on priorities, and reducing the number of members would not necessarily make it more efficient or productive.
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Dr TAPA (Tonga) congratulated the Sub-Committee on its report. He expressed appreciation of the problems faced by the two countries visited in implementing control programmes for malaria and tuberculosis. The report of the Sub-Committee contained many recommendations to both the governments and to WHO, and the Regional Committee ought to be discussing those recommendations rather than the question of membership of the Sub-Committee, which would be dealt with under agenda item 10.2. He agreed that the Sub-Committee was an important policy-making body, and its structure should not be changed without careful consideration.
Dr NAKATANI (Japan) said that his delegation would like to maintain the number of members of the Sub-Committee at ten, and to see the implementation of some minor changes in order to improve effectiveness. Dr REILLY (Papua New Guinea) stressed the importance of bearing the SubCommittee. The members of the Sub-Committee themselves benefited from their experience; the Member States visited, the WHO Regional Office and the members of the Regional Committee also all benefited from the Sub-Committee's work. The representative of Malaysia had already referred to the terms of reference and activities of the SubCommittee and emphasized key areas. He himself, like the representative of Malaysia, had not been a member of any subcommittees. It might be worthwhile considering whether it might be preferable to have expert advisory committees which would report to the regional committees and thus strengthen the advisory ability of the Secretariat. in mind the financial aspects in relation to membership of Dr MAOATE (Cook Islands) had no problem concerning the number of members of the Sub-Committee or their terms of office. However, he would prefer the Sub-Committee to be split into two groups so that senior officials of small countries like his own would not be absent for too long.
The REGIONAL DIRECTOR said that major issues in the discussion had been the number of members of the Sub-Committee, the number of members to make country visits, and the terms of reference of the Sub-Committee (mentioned by the representative of Malaysia). During discussions at the Executive Board and the June meeting of its Programme Committee, similar issues had been raised, and one member of the Board had proposed that there should be six sub-committees of the Executive Board, each of them to make country visits in the various regions and make programme audits. In the Western Pacific Region a form of country programme audit had already been initiated two years previously, using the sub-committee mechanism. Those aspects would be discussed under agenda item 9. There were questions of whether the Secretariat or the Regional Committee should select the countries to be visited; whether Executive Board members should participate in the visits; how the audit document was to be prepared and presented to the Regional Committee. One option was to maintain the present membership of the SubCommittee (ten members) and to extend the terms of office of the three members due to expire until the next session of the Regional
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Committee, in the interests of continuity. He would propose that the status guo be maintained at least until agenda item 9 had been discussed. Mr SONG YUNFU (China) said that the Sub-Committee was an important organ, with the task of visiting countries and cooperating with the Regional Committee. He would give his detailed views on the monitoring function during discussion of item 9 of the agenda. For the moment he would simply say that he was inclined to maintain the original membership of the Sub-Committee, provided that it was adequately representative, so that it could perform the task of monitoring.
He saw the point of the proposals put forward by the representatives of Australia, Malaysia and other countries. However, in past years the Sub-Committee had not encountered such problems in its work, which suggested that the recent ones. might be fortuitous. He thus advocated maintaining the status quo for one year. If the problems should persist, the situation could be reviewed by the Regional Committee in1988 and remedial measures taken. The CHAIRMAN, with the agreement of Dr KHALID (Malaysia), proposed that discussion of item 10.2 of the agenda, Membership of the Sub-Committee, be deferred until discussion of item 9· In connection with the resolution on AIDS, which the Rapporteurs and a drafting group had been asked to prepare, he announced that five countries had thus far indicated a willingness to participate; others could still join the group.
In the absence of further comments on item 10.1, he asked the Rapporteurs to prepare an appropriate draft resolution. (For consideration of the draft resolution, see the fifth meeting, section 1 .3.)
3.
REGIONAL PRIORITIES UNDER THE EIGHTH GENERAL PROGRAMME OF WORK: REPORT OF THE SUB-COMMITTEE, PART II: Item 11 of the Agenda (Document WPR/RC38/6)
Mr McCUDDIN (United States of America), Rapporteur of the SubCommittee on Programmes and Technical Cooperation, introducing the item, said that the Sub-Committee had agreed that the basic criterion for determining priorities should be the relevance of the programme concerned to raising the national health standards to an adequate level and to achieving a minimum level of health in the context and meaning of the goal of health for all by the year 2000, with priority being given to the less privileged countries. In its desire to ensure that WHO's limited resources were put to optimal use, the Sub-Committee had considered that, while due account should be taken of the importance of specific health problems, greater weight and importance must be attached to the potential impact of the programme and to whether resources available would be more effective in alleviating and reducing health problems.
The Sub-Committee had assigned a priority rating -of A, B or in descending order of importance, to each of the programmes.
C, In
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establishing that priority rating, the Sub-Committee wished to point out that the rating was in no way binding during the six-year period of the Programme and could be altered in the future by the Regional Committee if health developments warranted any change. The Sub-Committee had decided that, subject to finalization of the details b,y the Regional Committee, in 1988 it would review WHO's collaboration in the field of health information and health informatics and, with the agreement of the governments concerned, make visits to American Samoa, Samoa, and either Japan or Singapore. The REGIONAL DIRECTOR thanked the Sub-Committee for its work and fully agreed with the criteria and basic principles it had adopted in assigning priority ratings to each of the programmes under the Eighth General Programme of Work. The Sub-Committee had had to determine priority ratings applicable to the Region as a whole, which he was sure had not been easy, considering the varying national health situations and diversity of needs among countries. Some representatives might feel that the priority ratings given were not appropriate for their country. The Regional Committee could, of course, alter the ratings, if it so wished. However, in case it was decided to leave them as they were, he assured the Committee that, in implementing the Eighth General Programme of Work, the specific needs of each country would certainly be taken into account. He hoped that the Regional Committee's approach would continue to be a flexible one, and looked forward to its guidance on the priority ratings assigned by the Sub-Committee. Of course, the diversity within the Region social, economic, demographic and environmental - made uniform application of the ratings difficult, e.g. for budgeting purposes. The whole. CHAIRMAN invited comments on Part II of the report as a
Dr KHALID (Malaysia) expressed general agreement with the proposed framework for the Eighth General Programme of Work, while noting some unavoidable overlapping in certain programme areas and the possible need for identification of new areas in the period 19901995. He also generally agreed with the write-ups for each of the programme and sub-programme areas. In giving priority to the various sub-programme areas, the Sub-Committee had considered five criteria: extent of the problem; potential impact of the programme; resources available; applicable technology available; and interest of countries. Over-riding those five criteria, the Sub-Committee had applied a number of other principles in its evaluation of the General Programme of Work. Those were the health-for-all goal, and priority to less privileged countries. The Sub-Committee had further emphasized the importance of stressing the potential impact of the proposed programme and the possible availability of r.esources during
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the period of the Eighth General Programme agreed with the principles used by the exercise.
of Work. He generally Sub-Committee in that
The fifty-three programme or sub-programme areas had been given ranking: thirty were given A ranking; sixteen, B ranking; and seven, C ranking. Top ranking was rightly given to major programme areas 2, 3, 4, 5, 6, 7, 11 and 12, and to a number of sub-programmes in the other major programme areas. Under programme 13, Disease prevention and control, apart from immunization, malaria, diarrhoeal diseases, tuberculosis and AIDS, the others all received lower ranking. He generally accepted the ranking given by the Sub-Committee, while noting ways in which it might affect, or be considered in, budget allocation: (a) It was a regional ranking of Member States' collaboration generally, which might also change in the period 1990-1995. It was perhaps most valid for regional and intercountry activities and less so for country-level activities, bearing in mind the observation of the Executive Board regarding the need for country-specificity of country-level activities. It was assumed that proposals which fell outside the General Programme of Work would not be considered at all. (b) The ranking could at best serve only as a notional guideline for budgetary decisions because, among the programme or sub-programme areas of equal ranking, some activities would require a larger allocation than others. Proposals would have to be evaluated against the details of the respective programme or sub-programme areas. Given the differing scope of each programme or sub-programme area, the "mix" of activities under each one of them would be different. (c) For country-level programmes, proposals in programme or sub-programme areas given high ranking would be considered more favourably than the rest. Each country would decide its own national priorities within the overall spirit of the General Programme of Work. (d) When allocating resources to programmes or sub-programmes of equal ranking, overriding consideration should be the potential impact of those activities and the availability of resources. All things being equal, a "total-system" impact should be considered more important and acceptable than a "one-condition" or one-disease impact. Resource utilization, management development, organizational development, productivity and efficiency of services and manpower development would be key "result areas". Though new technologies must be discovered or existing technologies improved; the current deficiencies to a large measure could be attributed to weaknesses in those key result areas. With those observations and reservations, recommendations of the Sub-Committee. he
endorsed
the
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Mr TAGUIWALO (Philippines) asked how, if the rating was intended primarily to guide intercountry activities, it was to be understood where priorities at the country level were concerned. The aim was to study the impact of programmes on a country's health system development, but what was the concept to be applied in such development activities? Much of the development work was based on a very "unsystematized" field of knowledge. To what extent were the programmes, approaches, activities and their components to be based on the proposals under consideration? Each programme allowed of a variety of approaches; for example, in water supply and sanitation, the programme could be approached from a technical or from a financial and administrative point of view; in most cases the difficulties were of the second kind.
When the programmes and approaches were broken down into their component parts, in terms of fellowships, local costs, supplies or experts, a selection had to be made. So first there was a problem of selection, of the programme, then of the approach, and finally of the components that would make it work best. The priorities must be useful in helping to select the best methodology, and there must be a meaningful dialogue about such matters between the country and higher levels. How was that dialogue to take place, remembering that WHO was a community of Member States with the Secretariat at headquarters and regional levels? Mr BOYER (United States of America) expressed appreciation of the hard work done by the Sub-Committee and of the remarks of the representative of the Philippines concerning the complexity of its task of setting priorities for so many countries with so many programmes, some of them operating at national, some at regional level.
Serious new responsibilities would be given to each regional committee, under the resolution on regional programming and budgeting adopted by the Executive Board at its seventy-ninth session, so as to ensure the best use by each country and region of the resources allocated. The Regional Committee and Member States must look forward to the next biennial programme budget exercise, when they would have the serious task of deciding how the budgetary provisions should appropriately be divided. There was also the problem of the budgetary shortfall and the resulting contingency reductions affecting programmes. The Regional Committee must consider how the cuts decided by the Director-General should be implemented in the Region and decide how the Programme of Work and the next budgetary exercise would be affected in 1988, whether by cuts "across the board", i.e. affecting all fifty-three programme areas, or by interruption of certain programmes. Dr TAPA (Tonga) said he had no difficulty in acce~ting the criteria recommended by the Sub-Committee, but he questioned the use of the term "achieving a minimum level of health" in the third paragraph of the introduction on page 2 of document WPR/RCJS/6, which could hardly be reconciled with the "highest possible level of
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health" set as an objective by the WHO Constitution. He also noted, in the penultimate paragraph of the introduction, "that the rating was in no way binding throughout the period of the Programme". Dr NAKATANI (Japan) welcomed the rating of priorities, which was important for decisions on budgetary allocation in WHO and in countries. He was concerned at the difficulty in setting priorities for fifty-three programmes, and agreed that the exercise should be further elaborated. The Regional Committee should consider further priority setting in its discussions, with positive contributions by all Member States, leaving it to the Secretariat to make the necessary arrangements so that a final rating could be decided at the thirty-ninth session.
Dr CHRISTMAS (New Zealand), Chairman of the Sub-Committee on Programmes and Technical Cooperation, agreed with Dr Tapa that "minimum level" was not what had been intended, but rather "at the very least" or "at the very minimum". The task of the Sub-Committee had not been an easy one; at one time it had appeared that all the programme areas would be in the "A" priority category except one, which he had felt should receive high priority. The implications were difficult, but a start had to be made, and the inevitable task remained for the Regional Director and the Secretariat to apply the priorities and approaches; anyone involved in programming recognized the need to be realistic. An inflexible fraJJelmrk was inapplicable, so that some flexibility had to be left for the Regional Director to apply the priority rating. He agreed with the representative of the United States of America that the Regional Committee would be facing added responsibilities in deciding on additional priorities at the implementation stage, but the Sub-Committee's main consideration in priority-setting had been to provide for many who had the lowest level of health, remembering that time was running out. Dr DARALOY (Lao People's Democratic Republic) commended the work of the Sub-Committee and agreed with its proposals. Like the representative of Malaysia, he was concerned about applying priorities in countries that had such different conditions and requirements. Not all differences could be accommodated in a single pyramidal structure, considering not only differences in health conditions but also economic differences between developed and less and least developed countries. Flexibility should certainly be a guiding principle for the application of priorities in individual countries. Professor HOANG DINH CAU (Viet Nam) agreed on the need for flexibility in applying a framework in a region of such considerable "polymorphism". The proposals were a guide for measures which each country should adapt to its health and economic conditions, defining its own objectives while taking into account the regional priorities. With reference to section 12, Diagnostic, therapeutic and rehabilitative technology (Annex 1, page 47), WHO's support would be essential to promote primary health care at the peripheral level and
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in day-to-day activities• That was directly related to the need to improve the training of staff at that level and to laboratory service support. Dr WANG FENGQI (China) noted with satisfaction that traditional medicine had been considered a priority programme area and appreciated the efforts of the Regional Director to promote Chinese traditional medicine in the Region in recent years. But he had reservations concerning the Sub-Committee's recommendation in section 12.4 (Annex 1, page 52) concerning applied research on safety and efficacy, recalling that Chinese traditional and herbal medicine had proved its value in many countries before the introduction of western medicine, although tests of safety and efficacy of treatment were necessary from time to time. The objective should be redrafted to read: "To promote research, with emphasis on applied research, particularly some treatment methods of traditional medicine, with special reference to research on the safety and rational use and efficacy of herbal medicine". Mr TAGUIWALO (Philippines) further commented that the decisions on allocation of resources would have to be made at a later stage, either in open discussion in the Regional Committee, making priorities as clear as possible, or at the discretion of the Regional Director and Member States. In all cases the method should be transparent, and the translation into budgetary terms should be as logical as possible.
The REGIONAL DIRECTOR, restricting his comments to the general matters raised by the representative of the United States of America and others concerning priorities vis-a-vis budget allocation, said that the main point was to decide whether WHO existed purely for budgetary purposes or whether it should also mobilize resources for the programmes it decided deserved priority. In the context of the General Programme of Work, it might be considered that prioritysetting was mainly a question of matching budgetary allocations to set priorities; but at the same time, when considering the contingency plan and the programme budget proposals, it was necessary to consider also resource mobilization or finding the additional resources for priority activities, and a balance must be established between the two for the future in order to fulfil the aim of health for all and beyond.
Dr HAN (Director, Programme Management) said that representatives would recall that the contributions to the Eighth General Programme of Work had been approved by the Regional Committee at its thirty-sixth session in 1985, and in 1986 they had been asked to set priorities. When approving the programme budget they had approved the individual programme objectives, targets and approaches, which were important components in programme budgeting. The representative of the Philippines had mentioned the different levels of application and the approaches already approved by the Regional Committee applied at the country, regional and global level had already been taken into account. Of the five criteria already established, besides the health-for-all strategy and ecQnomic
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development levels, one concerned the situation in individual countries. Thus, i f several countries shared a particular problem, it would automatically receive higher priority for collaborative activities and receive budgetary support accordingly. In that way, the guiding principles observed for programme priority-setting would also be reflected in budgeting. That might apply more evidently to intercountry activities, as the representat:i.ve of Malaysia had observed, but he felt it would also be the case in country activities. The wishes of the Regional Committee as to how programmes should be undertaken in certain conditions would have to be reflected, for example in applying WHO policy on ambulatory as against institutional treatment for tuberculosis. Those principles were laid down in the narrative of the General Programme of Work. He hoped that all Member States would apply the agreed principles in country programming with appropriate flexibility in view of country-specific conditions and needs. The Secretariat would do its utmost to have the priorities and flexibility reflected in the budgetary proposals. In the absence of fUrther comments on item 11, the CHAIRMAN asked the Rapporteurs to prepare an appropriate draft resolution. (For consideration of the draft resolution, see the fifth meeting, section 1.4 and the seventh meeting, section 3.1.)
The meeting rose at 5 p.m;