(WPR/RC32/SR/I)
SUMMARY RECORD OF THE FIRST MEETING Hotel Shilla, Seoul Tuesday, 22 September 1981 at 9.00 a.m. CHAIRMAN: later : Dr K.W. Ridings (Samoa) Mr Ooo-Ho Rhee (Republic of Korea)
OONTF.:NTS
1. 2. 3.
Formal opening of the session
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Address by the retiring Chai~an Election of new officers: Rapporteurs
Chairman, Vice-Chairman and appointment of a moderator
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4.
Technical Presentation: Adoption of the agenda
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5. 6.
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Acknowledgement by the Chairman of brief reports received from governments on the progress of their health activities •••••••••••••••••••••••••••••••••••••••••••• Report of the Regional Director
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7.
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1.
FORMAL OPENING OF THE SESSION:
Item 1 of the Provisional Agenda
In the absence of the Cllairman, the Vice-Chairman" Dr K.W. Ridings (Samoa), declared the thirty-second session of the Regional Committee for the Western Pacific open. His Excellency the Prime Minister of the Republic of Korea, Dr Duk~oo Nam, addressed the Committee (see Annex 1 for a copy of his speech). The Regional Director expressed his appreciation to the Government and people of the Republic of Korea for acting as hosts to the Conunittee during its thirty-second session (see Annex 2 for a copy of his speech). With the completion of the formal opening, the Committee adjourned and reconvened at 10.00 a.m. 2. ADDRESS BY THE RETIRING CHAIRMAN: Item 2 of the Provisional Agenda
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In the absence of the Cllairman, Dr Ridings (Samoa), Vice-Chairman, made a statement to the Committee (see Annex 3 for a copy of his statement). 3. 3.1 ELECTION OF NEW OFFICERS: CHAIRMAN, VICE-CHAIRMAN AND RAPPORTBU1tS: Item 4 of the Provisional Agenda Election of Chairman
Dr L. DIAZ (Philippines) nominated Mr DOO-HO RHEE (Republic of Korea) as Cllairman; this was seconded by Dr A. TANAKA (Japan). Decision: 3.2 Mr RHEE was elected unanimously.
Election of Vice-Chairman
Dr S. TAPA (Tonga) nominated Dr J. da PAZ (Portugal) as Vice-Chairman; this was seconded by Dr A.G.K. CHEW (Singapore). Decision: 3.3 D:r da PAZ was elected unanimously.
Election of Rapporteurs
Mr M. TOVADEK (Papua New Guinea) nominated Dr ABDUL TALIB BIN LATIFF (Malaysia) as Rapporteur for the English language; this was seconded by Dr B. CHRISTMAS (New Zealand). Dr T.M. BIUMAIWAI (Fiji) nominated Dr F. CHASTEL (France) Rapporteur for the French language; this was seconded by Dr J.A.B. NICHOLSON (United Kingdom of Great Britain and Northern Ireland). Decision: Dr TALIB and Dr CHASTEL were elected unanimously.
SUMMARY RECORD OF THE FIRST MEF.TING
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4.
TECHNICAL PRESF.NTATION:
APPOINTMENT OF A MODERATOR
The CHAIRMAN moved the appointment of a moderator for the Technical Presentation and proposed Dr A. ACOSTA (Philippines). Decision: 5. The proposal was adopted unanimously. Item 6 of the Provisional Agenda
ADOPTION OF THE AGENDA: (Document WPR/RC32/l)
The CHAIRMAN moved the adoption of the agenda. Decision: 6. In the absence of comments the agenda was adopted.
ACKNOWLEDGEMENT BY THE CHAIRMAN OF BRIEF REPORTS RECEIVED FROM GOVERNMENTS ON THE PROGRESS OF THEIR HEALTH ACTIVITIES: Item 8 of the Agenda
The CHAIRMAN acknowledged reports on the progress of health activities received from.the following countries or areas: Australia, French Polynesia, Guam, Japan, Macao, Malaysia, New Zealand, Philippines, Republic of Korea, Samoa and Singapore. The reports would be distributed to the Committee. 7. REPORT OF THE REGIONAL DIRECTOR: (Document WPR/RC32/3)· Item 9 of the Agenda
The REGIONAL DIRECTOR presented his repo,t on the work of WHO in the Western Pacific Region for the two-year period 1 July 1979 to 30 June 1981. He said that he had already spoken of the intensified effort, in 1980 and 1981, in formulating policies, strategies and plans of action for the achievement of health for all by the year 2000. Offshoots of that basic effort had been his own activities to enlist support at the highest political levels, to encourage those responsible to stand by the commitments they had made at the World Health Assembly and to start the necessary reorientation for achieving the health/2000 goal. This had involved WHO in redefining and restructuring its own functJons within the Region and also in guiding both WHO and national staff in the new policies of the Organization and in the managerial processes for health development. The Committee's deliberations during the coming week would provide evidence of the strengthened role it was playing in the work of WHO, especially through its two subcommittees. An information document was being distributed at the present session, entitled "'!he managerial process for WHO's programme development", on which the informal comments of representatives would be most welcome. Using the primary health care approach, some progress had been made during the biennium with the Expanded Programme on Immunization and with the diarrhoeal diseases control programme. With the launching of the International Drinking-Water Supply and Sanitation Decade, much was being
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REGIONAL COMMITTEE:
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done to strike at the root ~f diarrhoeal diseases problem, which lay in sanitation and water s,pplyi~ Training was also an important component of the progrannne, as was the iiptroduction of oral rehydration salt production facilities in an effort to promote regional self-reliance. Research activities had now become integral parts of individual technical programmes, and the emphasis was turning to strengthening of national capability for carrying out research. with the dissemination, in,l979, of a list of essential drugs, national essential drug lists had been developed by most Member States in the South Pacific. Progress in establishing the South Pacific Pharmaceutical Service had been necessarily slow, because of the legal intricacies involved, but it was hoped soon to finalize the arrangements so that a meeting of ministers of the countries involved could formally launch the service. The CHAIRMAN invited general comments on the biennial report of the Regional Director. Dr SUNG-WOO LEE (Republic of Korea) expressed his Government's satisfaction with the Report, the first biennial report produced by Dr Nakajima 8S Regional Director, reflecting his wisdom, efficacity and active cooperative ability. He expressed particular appreciation for all the forms of collaboration with the Republic of Korea during the biennium, noting that meetings and seminars had been held on many subjects in the country and that work had proceeded in collaborating centres and institutions, and referring especially to training of health personnel for cancer control~ Finally, he pledged his Government's further support in efforts towards the achievement of health for all by the year 2000. Dr TAPA (Tonga) commended the Regional Director on his biennial report, which was a symbol of cooperation between WHO, its Member States and other organizations in the Region and evidence of the efforts that would have to be continued to secure health for all by the year 2000. Noting the reference, in the Introduction, to the International Conference on Primary Health Care and to the Declaration of Alma-Ata as the stimuli for numerous activities, he said that the translation of the principle of primary health care into action was the major challenge facing countries and WHO. He assured the Chairman of the Regional Committee and the Regional Director of Tonga's total commitment to the regional and global objectives of health for all. The CHAIRMAN proposed that the Report should be discussed chapter by chapter. It was so agreed.
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Introduction Chapter 1: General Programme Development and Management There were no comments. Chapter 2: Advi~ory
Research Promotion and Development
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Or TANAKA (Japan), commending the establishment of the Western Pacific Committee on Medical Research, said that he was confident that it would playa vital role in consolidating efforts in countries to promote research. Chapter 3: Chapter 4: Health Services Development Family Health
There were no comments. Chapter 5: Mental Health
Dr TANAKA (Japan) urged the Regional Director to follow up the recommendations of the working group on the prevention and control of alcohol-related problems that had been held in Tokyo in May 1980 in view of the tendency for such problems to increase throughout th~ world. Dr CHRISTMAS (New Zealand), noting that causes of mental ill-health must be recognized as a factor also in physical illness and disability, agreed with the representative of Japan; alcohol and drug abuse constituted a problem of increasing quantity, meriting a programme of control in the Region, particularly in view of the declaration of 1981 as the International Year of Disabled Persons. Dr SUNG-WOO LEE (Republic of Korea) said that his Government would include activities to promote mental health in its Fifth Development Plan, starting in 1982, and requested WHO's cooperation in related planning. Chapter 6: Prophylactic, Diagnostic and Therapeutic Substances
Dr TAPA (Tonga) expressed the hope that the steady but sure progress with the ~stablishment of the South Pacific Pharmaceutical Service would rapidly bring it to full function. Dr RIDINGS (Samoa), noting that, according to the declaration of intent of the Conference of Ministers of Health held in Manila in 1979, the Service was to be established in the shortest possible time, observed that progress appeared to have been slow in recent months. He asked what stage had been reached, in particular with the feasibility study.
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REGIONAL COMMITTEF:
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The REGIONAL DIRECTOR replied that progress had been delayed not only by legal intricacies but also by some political factors. Consensus among countries of the South Pacific was awaited. The new Officer responsible for Pharmaceutical and Drug Policies, who was present at the session, would shortly be visiting the countries concerned, together with two Directors from the Regional Office, in order to finalize the agreement on establishment of the Service. A draft of the agreement had recently been dispatched to countries for information and comment. He suggested that further discussion might be left until the consideration of item 21 of the agenda, the specific item on "Action programme on essential drugs". Dr WEINSTEIN (United States of America), commending the Regional Director on his excellent report, which identified the major issues clearly and which indicated a situation better than anyone might expect, welcomed the equally clear emphasis on the need for political commitment. Cooperation in the South Pacific Pharmaceutical Service was particularly important. Chapter 7: Communicable Disease Prevention and Control
Dr NICHOLSON (United Kingdom of Great Britain and Northern Ireland) joined previous speakers in commending the biennial report. He expressed concern at the deteriorat~ion of the malaria situation in the Region, which was aggravated by the development of resistance to chloroquine in the parasite. He wondered whether new strategies should not be devised for countries where such a situation was compounded by the shortage of financial resources for control. Dr RIDINGS (Samoa), referring to section 7.3.1, expressed gratitude to WHO and the Japan Shipbuilding Industry Foundation for their support to Samoa's research activities on filariasis. The recent bipartite review had been promising and, with the completion of the research phase, Samoa was moving on to health education and a vector control campaign. It would be pleased to share its experience with other countries, having learned, for example, that it was not advisable to overburden populations with advice on too many aspects at one time. Dr SUNG-WOO LEE (Republic of Korea) noted the absence of any reference, in section 7.4.7 on arbovirus diseases, to Japanese encephalitis which, since the closing of the control unit in the Republic of Korea, had been neglected; he felt that specific activities should be instituted, not only 1n research but also in treatment, with particular attention to refinement of vaccines. The REGIONAL DIRECTOR said that, indeed, the situation in regard to malaria in the Region was deteriorating. Not only was there resistance to chloroquine, but also resistance to "Fansidar" was now appearing in some Member States. The change of behaviour of Anopheles sinensis and Anopheles balabacensis was also posing a problem. WHO was changing its malaria control policy and strategy, not only from the health viewpoint but also from the social and economic viewpoints. In spraying, for example, directives from central government to the periphery could not always achieve
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SUMMARY RECORD OF THE FIRST MEETING
63
successful results, and the participation of the community was being strongly encouraged. It was believed that malaria control should be one of the major components in primary health care activity. WHO was trying to convince those governments that still considered malaria control to be a vertical, rather than a horizontal, exercise of the need for participation of the population to achieve success. The representative of Samoa had cited the successful results of experimental filariasis control in Samoa. However, that type of control was based on DUIes medication, and if it was to be further expanded in the Region large amounts of money would be needed to buy drugs. He appeal~d to those Member States who were contributing in cash and in kind to assist the less developed countries by providing pharmaceuticals as wel1 as insectieides. The representative of the Republic of Korea had mentioned the worsening situation in regard to Japanese encephalitis. Fortunately, control of that disease in the Western Pacific Region had been fairly successful, except in China and the Indochinese peninsula and some countries of the South-East Asia Region. One strategy was mass vaccination, but unfortunately the cost of the vaccine was too high for most developing countries to afford. WHO was encouraging, a change in methods of vaccine production, from using tissue culture to cell' culture, and efforts were being _de to improve the stability of t_e vaccine; how.ever, it was not yet sure whether such a change would also mean a reduction in cost. The problem was not only that of the vector;· it was also not known which animal was the interQ!diate host in countries other than Japan, so that it was not yet certain that methods which had been applied successfully in Japan could be used in tropical developing countries. That problem was now being studied. Chapter 8: Noncommunicable Disease Prevention and Control
Dr RIDINGS (Samoa), referring to paragraph 8.2 of the report, said that in the polynesian area of the South Pacific there had been great activity on the part of epidemiologists, either from WHO, from the South pacific Commission, or from individual countries. He was pleased to note that at least some countries were now starting on the much more essential task of control. " Samoa welcomed the cooperation of WHO in starting a control programme; it would also welcome advice from other areas, notably on how to convince people to eat less, or to eat the proper food. Chapter 9: Promotion of Environmental Health
There were no comments. Chapter 10: Health Manpower Development
Dr MINNERS (United States of America) drew attention to the increasing importance being given by countries to training as part of national strategies for health for all. His Government did not regard national strategies as being fixed and un'changing; rather, as the concept 9£ health for all was translated into practical terms, training in support of that: concept would change to meet particular needs. Referring to paragr_pn lO.2, welcomed the stress laid on training of medical assistants and ",.lth personnel, though he thought that the training of primary health c", workers should have been given even greater prominence.
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REGIONAL COMMITTEE:
THIRTY-SECOND SESSION
The chart on page 87 of the report gave the impression that a very high proportion of funds for fellowships came from the regular budget. In fact, substantial support for health manpower development came from extrabudgetary sources, notably from the Special Programme of Research, Development and Research Training in Human Reproduction and the Special Programme for Research and Training in Tropical Diseases. Dr ACOSTA (Philippines) said training played a valuable role in the implementation of primary health care programmes. As the countries of the Region advanced, training became even more important, not only for the health sector but also in other related sectors. The Philippines had succeeded in fully implementing primary health care on a national scale and was beginning to realize the need for support, not only for health care itself, but for training programmes. Referring to page 80 of the Report, which stated that in 1981 WHO support for the Regional Centre for the Training of Anaesthetists was to end after ten years, he asked how in future the Centre was to operate, and how the training of students from countries of the Region was to be supported. Dr CHEW (Singapore) was concerned at the considerable increase in the cost of training programmes in the past few years, which could mean that the number of students sent for training by countries such as his own would actually decrea~e. In the context of technical cooperation, he felt t~ere was a need for Member States to help those who were less fortunate by reducing those costs. Dr TAPA (Tonga) said that Chapter 10 was the most important chapter in the whole report, since achievement of the goal of health for all depended upon how successfully health manpower development was promoted. Referring to paragraph 10.2, Tonga had already set up a health training centre, and appreciated WHO's help in that connexion. The centre was not only used for the training of medical assistants but also as a resource base for courses, such as a course on the use of oral rehydration salts. The role of teacher training centres referred to in paragraph 10.3, was important. The REGIONAL DIRECTOR, in reply to the representative of the United States of America said that, ideally, all training should be related to strategies for attaining health for all and notably to the production of primary health care workers. Though countries recognized the importance of that fact, not all of them had adapted their policies accordingly. He was now proposing that WHO Programme Coordinators should participate in the selection of fellows and also in designing training programmes and he hoped that that would result in improvements in health manpower development at country level. As to the graph on page 87, fellowships provided by the Special Programme of Research, Development and Research Training in Human Reproduction and the Special Programme for Research and Training i1'\ Tropical Diseases were not included, which accounted for the apparently uneven proportions.
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SUMMARY RECORD OF THE FIRST MEETING
65
'lbe representative of the Philippines had raised a very important point, the difficult question of training local staff in their own countries and the role of WHO. If WHO organized such training using local teachers, its role might be limited to providing salaries of teachers and meeting housing and travel costs which was not justifiable under WHO's financial regulations. The question of local costs for manpower training had been discussed both at the Executive Board and at the Health Assembly, but no satisfactory solution had yet been reached. He was conscious of the importance of the problem and care was being taken to see that it was reflected in future budget proposals. In regard to the point raised by the representative of Singapore, WHO was trying to solve the problem of higher costs for training, while endeavouring to see that as many fellows as po.sible were trained within the Region, on the basis of regional cooperation. He appealed to host countries such as Australia, New Zealand and Japan to give more support to fellowship schemes. Mr DHILLON (Chief, Human Resources) said that, under specific programmes, approximately 10% of the budget usually went to fellowships, so that in reality just under 40% of all fellowships were funded from sources other than the regular budget for health manpower development. Dr MENU (Regional Adviser in Health Manpower Development), in answer to the comments of the representative of the United States of ~erica, said that once national strategies had been properly defined, more emphasis would be placed on health manpower development for primary health care. Task analyses had been carried out in some countries in order to provide a rational basis for training. The pie chart did not reflect the group training activities carried out under the programme for the control of diarrhoeal diseases. Formal support for the Regional Centre for the Training of Anaesthetists was to end with the end of the biennium but WHO remained vitally interested. In the Region itself it seemed that the Centre had largely fulfilled its role, since few requests for training were being received, but other Regions could be encouraged to make use of its facilities. 'lbe representative of Tonga had been right to stress the importance of teacher training and a number of persons had been sent to the Regional Teacher Training Centre in Sydney for training in specific subjects. Dr MINNERS (United States of America) said that the Regional Director's new emph~sis on the role of the WHO Programe Coordinators in promoting health manpower development was extremely important and other Regions should be encouraged to follow his example. Chapter 11: Health Information
Dr EVANS (Australia) was pleased with the reference in the chapter to the facilities provided by his Government, under a formal agreement with WHO, to supply Member States in the Region, on request through WHO, with MEDLARS reprints and the results of MEDLARS searches, and hoped that full use would be made of the system. Dr TALIB (Malaysia) said that his country had found the health and information system very useful but that policy make~. also needed information on the resources being used to provide health care. ~ey were attempting to link resource allocation, resource utilization, ~he assignment of priorities and the monitoring of the resources used for heaHh .(Jare delivery. ~anagement
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REGIONAL COMMITTEE:
THIRTY-SECOND SESSION
Chapter 12:
External Coordination for Heal th and Socioeconomic. Development
Dr RIDINGS (Samoa) congratulated the Regional Director on his success in better coordinating the activities of the various international agencies and nongovernmental organizations and, in that way, considerably reducing the duplication of effort that had occurred so often in the past. Requests from individuals to carry out research in Member States also required some form of cooperation Dr WEINSTEIN (United States of America) supported Dr Riding's remarks on the need to avoid duplication of effort. If resources were to be used to best advantage, stricter coordination would be necessary. Chapter 13: Staff Development 'and Training
II 8S \
Dr GENTILE (France) stressed the need for continuing staff education. Dr TAPA (Tonga) regarded the development of WHO's human resources complementary to health manpower development, the chapter which he considered to be the most important section of the report.
The REGIONAL DIRECTOR said that the new policy was, wherever possible, to train WHO personnel jointly with government staff, particularly in the case of developing countries. For example, members of the External Relations Department of the Chinese Ministry of Public Health had undergone a short period of training on the work of WHO at the Regional Office in Manila. Developing countries should not hesitate to take advantage of the scheme when considering how best to train or retrain their Ministry of Health personnel with a view to achieving health for all by the year 2000. (For continuation of discussions, see the second meeting, section 1.)
The meeting rose at 12.00 noon.
SUMMARY RECORD OF THE FIRST MEETING
67
ANNEX 1
ADDRESS BY THE PRIME MINISTER OF THE REPUBLIC OF KOREA
Mr Chairman, Mr Regional Director, distinguished delegates, ladies and gentlemen, It i~ a great pleasure and honour for me to address you on the occasion of the th1rty-second session of the WHO Regional Committee for the Western Pacific. On behalf of the Government of the Republic of Korea and the people, I would like to extend our hearty welcome to you. Mr Chairman and distinguished delegates: as you know, the struggle to achieve bet~er health for mankind has existed since the beginning of human history. Even though the approaches to better health have been different, according to historical period and geographical and socioeconomic constraints, the goal has been always the same. I believe that international consensus on the need for more effective methodologies for achitving this goal initiated the establishment of the Wodd Health Organization as a specialized agency of the United Nations • As you are well aware, the World Health Organization has made a tremendous contribution to the happiness and welfare improvement of human beings from the humanitarian point of view since its establishment in 1948. The World Health Organization has achieved great successes, such as the prolongation'of life of mankind, and the eradication and decrease of various tropical and communicable diseases. All these achievements, I know, largely depend on the prompt exchange of information regarding health among the· nations and ~he activities of technical assistance. I would like to point out that there have been self-sacrificing contributions by the successive Director-Generals and other related officials from the beginning. I also would like to take this opportunity to emphasize that the contribution of the Organization's officials should be further strengthened. Under efforts of all by the founded on these circumstances, we have great hopes and expectations for the the World Health Organization aiming to achieve better health for year 2000, based on the primary health care concept which is equal distribution of health and medical resources.
...
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Mr Chairman and distinguished delegates: in line with such efforts of the World Health Organization, the Government of the Republic of Korea is seeking to construct a welfare society, by the expansion of health protection and social development. Especially in the field of health and medical activities, the Government has established long-range plans and initiated improvements in the health care delivery system, including primary health care programmes. The Government has expanded water supply for rural communities, strengthened environmental protection necessitated by he~vy industrialization, established maternal and child health centres na~ionwide for health im~rovement of mothers and children, and expanded the medical insurance system. Great progress has already been made.
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REGIONAL COMMITTEE:
THIRTY-SECOND SESSION
I also would like to explain to you that the above-mentioned policies are being implemented by the Government in close conjunction with the nation's long-term plan for economic and social development. As a result, the status of health and medical care in this country is rising sharply with an increasing demand by the people for welfare services due to improvements in the social and economic situation. However, in satisfying such a heavy demand we are experiencing many difficulties, such as increased budget requirements, along with needs for more manpower and facilities in the heal th fie ld. In order to solve these problems, I think understanding and agreement among all the agencies concerned with health should come first. In the meantime, functional cooperation between nations and related international organizations, including the World Health Organization, is urgently required. Mr Chairman ourselves to the Committee can be effort. I think one of you joins open way_ and distinguished delegates: I know that we have to exert utmost so that the agreed items in the WHO Regional implemented by each concerned Government with the maximum this meeting will be more meaningful and productive if each the discussions on the conference subjects in a frank and
Lastly, I should like to express my thanks to you once more for having come such a long way to visit my country for this meeting, held again in the Republic of Korea after 16 long years. r hope that this meeting will provide good motivation for strengthening the understanding and mutual friendship among member countries in this Region. '!hank you.
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SUMMARY RECORD OF THE FIRST MEETING
69
ANNEX 2
ADDRESS BY THF. RF.GIONAL OIRECTOR
Mr Chairman, your excellencies, honourable representatives, ladies and gentlemen, I listened with great pleasure to the address of His Excellency, Dr Duk~oo Nam, Prime Minister of the Republic of Korea. I am equally pleased to be able to stand before you now to express the Director-General's and my own sincere thanks to the Government of the Republic of Korea for inviting us to hold the thirty-second session here. This is the second time the Regional Committee has been held in Seoul; a reflection not only of the Government's commitment to the work of WHO in the Region, but also of the renowned hospitality of the Korean people. Unfortunately, Dr Mahler is not able to be with us until the last day of the session but, as he plans to address us in his usual inspiring manner, I shall keep my own remarks brief; referring only to the joint efforts of Member States and WHO, in striving towards achieving the goal of health for all by the year 2000. Proposals for updating the Regional Strategy for the Western Pacific, in the light of the Global Strategy adopted by the World Health Assembly last May, are before the Regional Committee at the current session, as also is a plan of action for implementation of the Strategy. Once the Regional Committee has considered them both, we hope that, with the goodwill and assistance of all our Member States, we shall be able to forge ahead with implementation of the Strategy, achieving "health for all" through primary health care. This involves rural development and community participation. It implies a basic change from the classical disease oriented approach, to an approach which deals with the foundation of health as it relates to the individual, the family and the community. I believe it is worthwhile to remember the adage that we no longer treat the individual, the segment of the community, but we are concerned with health in its totality; in other words, the community as a whole with all its manifestations, needs, hopes and expectations • In looking forward to the future, I cannot fail to comment on the example set by the Republic of Korea, as a developing nation, in its socioeconomic development and, concurrently, in its efforts for health development through community involvement. Community health workers, such as the community health practitioners, appropriately trained, will facilitate the process of extending health coverage to the whole population. Another significant achievement is the introduction of the health insurance scheme, which is making good progress. I should not fail to mention either, the remarkable success of the "Saemaul Undong" movement, which reflects the very essence of the primary heal th care approach, in
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REGIO~AL CgMMITTEE:
THIRTY-SF.COND SESSION
terms of efforts towards co~unity involvement and intersectoral development. One of the achievements of the "Saemaul Undong" movement is the progress attained in the development of rural water supply and sanitation programmes. The Tiechnical Presentation next Friday afternoon, followed by a weekend visit ~o rural water supply facilities, will provide an occasion for representatives to observe at first hand one example of the progress achieved. Judging from the past, therefore, the period of the next five-year plan should witness ever-increasing progress in attaining the goal of health for all by the year 2000. In closing, I should like to express the hope that this unique opportunity afforded by a gathering of representatives from most Member States of the Region will stimulate discussion and even lead to concrete plans in the spirit of technical cooperation among countries. Thank you, Mr Chairman, for giving me the opportunity to speak, I look forward eagerly to the coming deliberations and to the contribution they wiil make to the efforts of your Organization to achieve the ultimate goal.
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SUMMARY RECORD OF THE FIRST MEETING
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ANNEX 3
ADDRESS BY THE RETIRING VICE-CHAIRMAN
Honourable representatives of Member States of the Western Pacific Region, the Regional Director for the Western Pacific, representatives of nongovernmental organizations and specialized agencies of the United Nations, distinguished guests, ladies and gentlemen, As Mr Jaminan, Chairman of the thirty-first session of the Regional Committee, is unable to attend this session, I am honoured to be asked to present this address. It was a great pleasure to attend the thirty-first session of the Regional Committee in Manila and I should like to express my appreciation for being elected as the Vice-Chairman. The onerous task was made easier by support and cooperation rendered by the representatives and various assistance provided by the Secretariat of the Regional Office. I also wish to express my gratitude to the Regional Director for his kind guidance.
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This meeting comes at what seems to me to be a critical time in the history of WHO. Both the Organization itself and the world around it are experiencing the winds of change. WHO is critically examining its own structure and functions at a time when it is embarking on a course to meet its greatest challenge, health for all by the year 2000. While everyone will agree that changes are needed to meet this challenge, there is always a certain reluctance to depart from the old structure and old ways. Any strategy for change needs a strong stimulus to unfreeze the situation and allow progress. Surely "health for all" should be a sufficiently strong stimulus to demand change. Allow me to recapitulate some of the more important issues brought before the Regional Committee at its last session: There has been increasing emphasis in the Region on: (1) (2) (3) (4) (5) formulation of national strategies for health for all; managerial process for national health development; development and use of health and health-related indicators to measure the progress of Member States towards health for all; a multidisciplinary approach to the development and delivery of primary health care; community involvement in health and health-related activities and the training of health workers so as to reorient them to the development and delivery of primary health care; and
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SESSION
(6)
intersectoral coordination between national health agencies and other agencies whose activities have an impact on health.
At the last session of the Regional Committee, the representatives of Member States approved a regional strategy to support their national strategies, and this, in turn, contributed to the global strategy, which W88 presented to the World Health Assembly by the Executive Board in May this year. '!be development of a.global plan to carry out the strategy may well be difficult. because of adverse changes affecting all countries in the world. Recently, the International Monetary FUnd staff commented that the world's economic outlook is grim, with most of the pain of slower economic development and diminished construction inflicted upon the developing nations. Although restrictive policies implemented by the world's industrialized nations are making a dent in inflation, slower growth is cutting into the exports of the poorer nations, and all this at a time when they are struggling to pay mounting oil bills. Everyone agrees that health for all through primary health care will not be cheap - the cost will be high. '!be poorer countries will need considerable development in their health care systems, at a time when slower economic growth and increasing fuel costs will limit the supply of funds. In the poorer countries themselves, the tendency will be to put available funds into areas which will produce economic development rather than into areas seen by many politicians as non-productive areas, such 8S health. If we a re to mee t the cha llenge 0 f "hea 1 th for a 11", WHO wi 11 have to accept these many constraints and work within them. Som, of these constraints are new and were unheard of at the time when basic agreements were drafted and signed between the Organization and the Member States. If we are to achieve health for all, then, new policies and even new agreements may need to be adopted, to meet the future - the year 2000.
Now, may I thank the Government of the Republic of Korea and its Ministry of Health for extending the invitation to the thirty-second session of the Regional Committee for the Western Pacific, for their beautiful country and for undertaking the vast amount of work involved. We have an interesting and stimulating agenda which will give us ample opportunity to act as the facilitator of the process for bringing health to all in the Region. And finally, may I thank the Regional Director and his staff and all of you, for making my term as Vice-Chairman so straightforward and enjoyable.