(WPR/RC2lJSR/ 5)
'. SUMMAltY RECORD OF THE FIFTIl MEETING
WHO ConfeTenee Hall Monday. 7 September 1970.at 9.00 a.m. CHAIRMAN: Dr K. Abltay (Laos) CONTENTS
1
Consideration of draft resolutions ••••••••••••••••••••••••.••. 138 Time. place and duration of the twenty-second and twenty-third sessions of the Regional Comm.ittee ................... -.•••••••••••••••••••••••••••. t! ••••
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139
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Proposal by Dr Ismail (Malaysia) to hold a conference at ministerial level to be attended by ministers of health of countries of the Region immediately prior to tbe World Health Assembly (May 1971) ............. , •...•.. ~ . • • • • . • • • • . • • . • • • • • • 144
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Consideration of draft resolutions (resumed) ••••••••••••••••
147
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136
REGIONAL COMMITTEE:.
TWENTY-F~RST
SESSION
Fifth Meeting 7 Sep.tember 1970 at 9.00 a.m. PRESENT I. Representatives of Member States AUSTRALIA Dr Dr Mr Dr Mr H.M. Franklands L. Rov;l.n K. Adair E. Thomson P.W. Carroll
CAMBODIA CHINA FRANCE JAPAN
Dr Pruoch Vann Dr C.K. Chang Dr K.P. Chen Medecin-General J. Rondet Dr A. Cheval Dr Mr Mr MI; T. M. K. N. Takizawa Yamasaki Watanabe Maekawa
LAOS
Dr Kbamphai Abhay Dr Phouy Phoutthasak Dr Tiao Jatsvasd Visouthiphongs Dato (Dr) Haji Abdul Hajid bin Ismail Dr Chong Chun Hian Dr Abdul Khalid bin Sahan Dr C.N.D. Taylor Dr J. Azurin Dr G. Balhin Dr T.A. Gomez Dr Diego Hora Silva Dr M.H. Lee Dr C.D. mn Dr Koh Thong Sam ~erreira
MALAYSIA
NEW ZEALAND PHILIPPINES
PORTUGAL REPUBLIC OF KOREA SINGAPORE
SUMMARY RECORD OFTBE FIFTH MEETING UNITED KINGDOM UNITED STATES OF AMERICA Dr G.H. Choa Dr K.L. Thong DrM. Beaubien Dr J.K. Shafer Dr L.J. Florio Colonel R.T. Jensen Dr Nguyen Dang Que Dr Nguyen Tuan Phong
137
VIET';"NAM
II.
Representatives of other intergovernmental organizations . ¢ SOUTH PACIFIC COMMISSION Medecin-General J. Rondet
III. Representatives of non-governmental organizations INTERNATIONAL DENTAL FEDERATION INTERNATIONAL FEDERATION OF GYNECOLOGY AND OBSTETRICS ,
Dr F.G. Rojas Dr V. Fugoso Dr E. Congco Dr H.B. Panlilio Dr I.Y. Zalamea Mrs M.R. Ordonez Dr A.M. Maglacas Dr E.I. de Castro Mrs G.B. Senador
INTERNATIONAL HOSPITAL FEDERATION MEDICAL WOMEN'S INTERNATIONAL ASSOCIATION INTERNATIONAL COMMITTEE OF CATHOLIC NURSES INTERNATIONAL COUNCIL OF NURSES INTERNATIONAL PLANNED PARENTHOOD FEDERATION LEAGUE OF RED CROSS SOCIETIES IV. WHO Secretariat SECRETARY
Dr Francisco J. Dy Regional Director
138
REGIONAL COMMITTEE:
TWENTY'-'FIRST SESSION
The CHAIRMAN thanked Dr Lee (Republic of Korea), Vice-Chairman. for having taken the Chair in his absence at the previous _eeting. 1 CONSIDERATION OF DRAFT RESOLUTIONS The CHAIRMAN explained that revisions had been suggested to documents WPR/RC2l/WP/5 and WPR/RC21/WP/9 and these would with later (see sections 4.1 and 4.2). The Committee then considered the following draft resolutions. 1.1 General programme of work for the Western Pacific Reglon covering a specific period (Document WPR/RC2l/WP/6) Decision: The draft resolution was adopted, without comment (see resolution WPR/RC2l.R7). 1.2 Health aspects of population dynamics (Document WPR/RC2l/WP/7) Medecin-General RONDET (France) suggested an improvement in the French text. namely. to replace the phrase "aux services d,'hygiene de la maternite et de l·'enfance" by "aux services de protectibn maternelle et infantile" in operational paragraph 2. remain unchanged. It was so agreed. Decision: The draft resolution, subject to the above modification to the French text, was adopted (see resolution WPR/RC2l.R8). 1.3 The role of the health administration in the control of environmental pollution (Document Dr BEAUBIEN (United States of America) proposed two amendments to the existing text. The English text would ~e
dealt
SUMMARY RECORD· OF THE. FIFTH MEETING
139
The first concerned involvement of other international organizations in the proposed general survey .L,paragraph 1 (i2.1 as there would be some overlapping of WHO activities with those of FAO. WMO. ILO, ECAFE, and other bodies. paragraph 1: He would suggest the following addition to operative "RECOMMENDS that the general survey of environmental
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conditions in the Region also identifies the problems which may require close co-ordination with other international organizations", paragraph before operational paragraph 2, and the addition of a new paragraph: "AUTHORIZES the Regional Director to advance the time frame of the above steps to earlier periods than those suggested, as circumstances so warrant. having in mind the United Nations Conference on the Problems of Human Environment. scheduled in 1972 in Stockholm." steps of the programme if circumstances permitted. Decision: The draft resolution, as amended, was adopted (see resolution WPR/RC21,R12). 1.4 Reports by governments on the progress of current programmes receiving WHO assistance (Document WPR/RC21/WP/10) Decision: The draft resolution was adopted, without comment (see resolution WPR/RC21.R9). 1.5 Long-term financial indicators (Document WPR/RC21/WP/11) Decision: The draft resolution was adopted, without comment (see resolution WPR/RC21,R10). The second amendment was intended to allow the Regional Director to advance the
2
TIME,PLACE AND DURATION OF THE" TWENTY-SECOND AND TWENTY-THIRD . SESSIONS OF THE REGIONAL COMMITTEE: Item 23 of the Agenda The CHAIRMAN observed that, so far, no invitations had been
received for the twenty-second and twenty-third sessions of the Committee. He enquired whether representatives had been given any
instructions on the matter by their respective governments.
140 Dr FRANKLANDS (Australia) observed that the same requElst concerning the location of the Regional Committee meeting had been made some two years ago. and it had been decided to defer the final selection until 1 January of the following year in order t() give representatives the opportunity to discuss the matter with their governments. He asked whether on the present occasion the decision -,
could also be deferred. Medecin-General RONDET (France) supported this proposal, Dr AZURIN (Philippines) remarked that it was not possible to hold a Regional Committee away from regional headquarters \lnleS$ the host government paid the additional costs involved, quarters. As a'rule. the Organization paid for meetings held away from regional headThe Western Pacific Region was the only one in which the Since the Western Pacific Region .host country had to bear the cost.
covered a larger area than any other. it would be an extremely valuable experience for representatives to obtain an insight into conditions in other countries of the Region. He suggested' that an amount of say $15 000 annually be included in the budget fpr the purpose of holding fairly frequent meetings away from regional headquarters - perhaps two or three times in each four-year peri9d. The REGIONAL DIRECTOR said that an extra $15 000 mig\lt be adequate if the meeting was held, for example. in Kuala Lumpur or perhaps in Japan. If the meeting were held in Western Samoa a
tentative estimate. which had been made some time ago, was $54 000 today this figure was more likely to be in the order of $60 000. He would of course leave a decision to the Regional Committee but would remind them that if the costs were to be borne by the Regional Office additional funds would have to be made available. If the Western, Pacific Region decided to follow the other regions. then the effort of the Region to make the other region$ conform to its practice would be negated.
SUMMARY RECORD OF THE FIFTH MEETING Dr ISMAIL (Malaysia) supported Dr Azurin's point of view. was considerable merit in having a change of location.
141 There
One advantage
was that representatives obtained an insight into local conditions and could form a sounder judgment on problems in other countries than their own. If the Regional Office would subsidize or bear the whole cost of holding a meeting away from Manila, he felt sure that many countries would issue invitations. Dr FRANKLANDS (Australia) said that if the proposal of the Representative of the Philippines were accepted it would mean a considerable increase in the regional budget. He saw no reason why the Regional Office could not provide the amount of money which was normally allocated for the Regional Committee to be held in Manila, leaving any host country to pay the additional costs of holding in their country. i~
He requested the comments of the Regional Director.
The REGIONAL DIRECTOR replied that the Representative of the Philippines was correct. The Western Pacific Region was the only region where the additional cost of holding a meeting of the Regional Committee outside of regional headquarters was borne entirely by the host government. The World Health Assembly, in its resolution WHA9.20, had invited "the attention of the regional committees to the desirability of host governments participating in the increased cost resulting from holding regional committee meetings outside the regional headquarters, as has been done in some regions". In resolution WPR/RC19,R4 the Committee had reaffirmed the principle enunciated in its resolution WPR/RC4.R3 that extra expenses over and above those normally incurred when regional committee meetings are held at regional headquarters should be borne by the host government. It had also considered that the extra costs borne by the host government should be offset by any savings accruing to the Regional Office allocation for the Regional Committee for the financial year concerned.
142
REGIONAL COMMITTEE:
TWENTY-FIRST SESSION
Dr FRANKLANDS (Australia) requested the outcome of pavagraph 4 of the resolution in which the Regional Committee had requested the Director-General to bring the matter to the attention of the World Health Assembly,
The REGIONAL DIRECTOR said no action had been taken on that particular point, If $10 000 were allocated for the Regional
Committee and this was not all expended by the Regional Office, the balance would be used to reduce the amount payable by the host government.
Dr CHANG (China) referred to the estimates quoted by the Regional Director and asked what items these sums would cover.
The REGIONAL DIRECTOR said that the additional costs to be paid by the host government were the air fares of the Secretariat from Manila to the site of the meeting and return, per diem, air freight of documents, equipment - typewriters and interpretation equipment, etc, - if equipment were not available in the host country. The host
country would also be required to provide suitable officeaccommodation and conference rooms.
Dr ISMAIL (Malaysia) asked why it was not possible to follow the practice of the other regions, i,e., that the costs would be borne by the Regional Office, with the various countries of the Region paying additional contributions for this purpose,
Dr AZURIN (Philippines) pointed out that it was the total budget of the WHO which was concerned, not the regional budget, What other
regions were doing could probably also be done by the Western Pacific Region, He felt that a uniform practice was necessary rather than
that the Western Pacific Region should continue its different practice.
'1
SUMMARY RECORD OF THE FIFTH MEETING
1.43
Dr FRANKLANDS (Australia) asked the Regional Director the extent of the possible savings from the appropriation to offset. the cost of holding the meeting in another country.
The REGIONAL DIRECTOR said that i t was very unlikely that there would be any savings to support a meeting in another country.
Dr AZURIN (Philippines) considered that an additional appropriation needed to be placed in the budget for the purpose of holding .the meeting outside of the Regional Office.
Dr CHANG (China) considered i t would be interesting for the Committee to know the amount allocated in other regions t-o meetings of the Regional Committee and how they were made. A careful study
should be made on a country-to-country basis, taking into account all available facilities. further study. He thought that the entire matter required
The REGIONAL DIRECTOR said that, in general, when a Regional Committee decided to hold its meeting away from regional headquarters, the decision to do so was taken two years in advance.. The relevant
resolution was then transmitted by the Regional Dire.ctor to the Director-General. The appropriate allocation reflecting such a pro:~rammeand
meeting was included in the proposed
budget estimates.
The Executive Board examined the matter and referred it to the World Health Assembly, following which the necessary allocation was earmarked. He then quoted figures from the proposed programme and budget for 1971 relating to the costs of the meetings of the Regional Committee in other regions, which were considerably higher than those in the Western Pacific Region.
The CHAIRMAN, summing up the various points of view, said that Dr Franklands had cited the former procedure, namely that the host
144
REGIONAL COMMITTEE:
TWENTY-FIRST SESSION
>-
country should bear the cost of the meeting; Dr Azurin, supported by Dr Ismail, considered that all costs should be borne by meeting should be held in rotation in Member countries; and that a decision be taken later. Medecin-General RONDET (France) supported the statement that the whole matter required further study. any decision on it now. The CHAIRMAN proposed that the resolution on this item should specify that the question of the cost of holding a meeting of the Regional Committee outside of regional headquarters had been raised, the Secretariat should be requested to study the problem in detail and submit the results of such a study to the twenty-second session. If no invitation was forthcoming to hold the Regional Committee in another Member country, the twenty-second session should be held at Manila, taking as the final date for decision 1 January 1971, in accordance with the usual practice. If there should be an invitation, the Regional Director should be authorized to accept it on behalf of the Committee. Dr AZURIN (Philippines) supported the proposal of the Chairman. He suggested also that the Secretariat should study the situation in other Regions and provide this information to the Committee at its next session. By this time it should be able to reach a decision. (For consideration of draft resolution, see the sixth meeting, section 1. 2.) 3 PROPOSAL BY DR ISMAIL (MALAYSIA) TO HOLD A CONFERENCE AT MINISTERIAL LEVEL TO BE ATTENDED BY MINISTERS OF HEALTH OF COUNTRIES OF THE REGION IMMEDIATELY PRIOR TO THE WORLD HEALTH ASSEMBLY (MAY 1971) Dr BEAUBIEN (United States of America) wondered what purpose would be served by holding such a meeting. He was in favour of postponing
wHo D~
and that Chang had
asked that the Regional Office study the whole question more thoroughly
•
SUMMARY RECORD OF THE FIFTH MEETING
145
Dr ISMAIL (Malaysia) clarified his proposal by explaining that the reason for a conference was that in many countries of the Region, in particular his own, health and medical projects were generally governed by the national policy laid down by the Minister of Health. A number of such projects might be beneficial to several countries in the Region so there would be an advantage in allowing policy-makers to discuss programmes and see whether~
with better co-ordination, The most appro-
activities could be carried out more effectively,
priate time for such a discussion was just before the World Health Assembly. His Government had requested him to put forward the
proposal to the Regional Committee.
The REGIONAL DIRECTOR explained that, if the proposal of the Malaysian Government was accepted, he presumed that it would be an informal meeting. WHO would only have to provide a conference room The scope of the
and normal facilities for interpretation, etc.
meeting would fall outside the World Health Assembly. As a suggestion - not a recommendation - consideration could be given to the idea of inviting Ministers of Health to attend the next meeting of the Regional Committee. He would be prepared to
provide space and interpretation facilities on the understanding that it would be an informal and completely unofficial meeting.
Dr CHANG (China) said that he appreciated the proposal but there were difficulties in accepting it. His delegation was not
authorized to give a decision, since Ministers were of Cabinet rank. Often the Chief Delegate to the Assembly was on the
diplomatic side, and did not come from the Ministry of Health. In his opinion, it would be very difficult to bring Ministers of Health in the Region together.
Dr TAYLOR (New Zealand) agreed with the previous speaker, From his experience - and he had attended only one Health Assembly
146
REGIONAL COMMITTEE:· 'IwENn:;';;FIRST SESSION
there had been a meeting of Commonwealth delegations to discuss the next Commonwealth Medical Conference and related matters, land presumably that practice would continue in future. However, they had discussed problems from the global, rather than from the regional. viewpoint. Mr WATANABE (Japan) said that although he appreciated the merits of such a conference he shared the views of the previous speakers regarding the difficulties. The timing suggested also created difficulties since it was proposed at the time of the annual parliamentary sitting in Japan and it would be impossible for the Minister of Health to leave the country. Dr AZURIN (Philippines) supported the proposal of the Representative of Malaysia. However, he felt that the proposal as .it stood was He requested the somewhat nebulous and that at this stage it was rather pt;emature to present it to the Ministries of Health in the Region. place and duration of meeting. Medecin-General RONDET (France) said that although his delegation considered that such a meeting would have some good results i t would also create many difficulties and there would be many on its agenda. nical people. di~advantages.
Representative of Malaysia to make a formal presentation giving agenda,
Furthermore, the Regional Committee was no longer discussing the items This concerned political action and they were all techHis delegation would therefore not support a resolution
on this subject. The CHAIRMAN suggested two possibilities to the Representative of Malaysia: (1) that the Government of Malaysia should write to the other governments concerned to explain its point of view; and (2) that a resolution could be put forward stating that the Government of Malaysia wished to convene such a meeting. reply on behalf of their Ministers. He suggested these t~o
alternatives
in view of the fact that it was difficult for the Representatives to It would obviously 'be difficult
7
SUMMARY RECORD OF THE FIFTH MEETING
147
for the Ministers to attend such a meeting. particularly the'Ministers of larger countries. Dr ISMAIL (Malaysia) said that he had brought up the subject on the instructions of his Government and at this particular juncture on the advice of the Secretariat. He agreed that the subject was not on the agenda, that it was somewhat nebulous. and that the Representatives did not have the necessary mandate to decide on this rather political issue. He gladly accepted the advice of the Chairman and perhaps, following a discussion with the Regional Director, a formal proposal could be put forward to ascertain the views of the various governments of the Region on this subject. Medecin-General RONDET (France) said that not only did the Representatives not have the mandate to accept something of this nature in the name of their Ministers but they also did not have the mandate to propose such a meeting. 4 CONSIDERATION OF DRAFT RESOLUTIONS (resumed from section 1) The Committee considered the following revised draft resolutions. 4.1 Training of national health personnel (Document WPR/RC21/WP/5 Rev.l) Decision: The draft resolution, as amended, was adopted (see resolution WPR/RC21.RII), 4.2 Comprehensive and co-ordinated teacher training programme for health personnel (Document WPR/RC2l/WP/9 Rev.l) Attention was called to a correction to be made in itenl'3.L Only one workshop should be organized in 1971 g not "four". Dr PHOUTTHASAK (Laos) stated that without being opposed to the draft resolution, his delegation had certain reservations. His country was French-speaking and the training of teachers in the English
148
REGIONAL COMMITTEE:' TWENTY-FIRST SESSION Their teachers WQuld have
1aqguage would be of little advantage to it.
to be trained either in Lyons or perhaps in Paris. Dr BEAUBIEN (United States of America) was concerned about the draft resolution as it was submitted. r>The purpose of the regional teacher training centre needed to be clearly understood - that it was a teacher training institution or centre and not a centre to train in subject matters of health. He welcomed the change to "academic institution" in the revised draft of the original wording "medical school" as it was now possible to imagine that ,a College 9f Education or a Teacher Training College might be a suitable institution for this type of activity and cQuld perhaps be considered witl:lill the broad study to be made. This was an important proposal because it The selectiolli of the Another point ,that might Was committed. the Organization to a long-term programme which, would contin\1e to the second development decade. institution must be carefully consids1:'ed.
be clarified was the category of teachers to be trained and a reference to this effect might be included in the draft resolution. it possible to train'various categories of health instructors in a single institution or must the programme be flexible andallQw for a mixture of teaching personnel. that would be ta\1ght. The last point which he felt needed careful consideration was the methodology or the art of teaching , Would it be applicable to all the'countries in This was a serio\1s and He the Region or to most of them or must. there be a varying type Qf programme to suit indiVidual country needs. complex problem and he would question whether this type of survey could ba dona and the activity start in 1971 with a workshop. would suggeat s~e
reword in, of the draft resolution.
For one thing. he would like to call attention to the second paragraph of the reviaed draft: "Notinl the wide-spread and serious shortaleof adequately trained teachars in the broad field of health;lI. This stated only part of the problem and not the real problem to which attention was beinl drawn. Ha would like to sUllest that the following
SUMMARY RECORD OF THE FIFTH MEETING
149
be added:
"
and the need to strengthen the training of such He was prepared to submit a sug-
teachers in the art of teaching;",
gested redraft on this but would like to hear othe:'r' comments if there were any.
Dr AZURIN (Philippines) agreed that the resolution should be reworded.
Dr FRANKLANDS (Australia) referred to the wordings "an academic institution should be selected" (item 1) and "negotiations to be undertakenwith an institution" (item 2), As had been pointed out, it would
not be possible in one institution to arrange for training in all disciplines in the broad field of health. This could be varied by This would give the
stating "one or more academic institutions".
Secretariat an opportunity of selecting the area or the country in which the teacher training activity could be carried out, If the first
institute could not carry out all the required teaching, another institution could be co-opted to carry out teaching in the areas which were deficient in the first.
Dr
ROSS~SMITH,
Assistant Director of Health Services, referred The setting up of an
to the point raised by the delegation from Laos.
institution ,or centre would not prevent the country from sending, if it' wished, under the regular fellowships programme, fellows to other countries for training. For example, in the 1972 programme of assist-
ance to the Royal School of Medicine in Laos, a three-year fellowship was provided for the training of a faculty member from the School. , Provision had also been made for a workshop in medical education which would enable visiting consultants to spend some time at the Royal School of Medicine and advise its faculty members on their work.
Dr TAYLOR (New Zealand) believed that one institution could undertake this form of teaching. He agreed with the Representative of the
United States of America that the question of timing was important.
150
REGIONAL COMMITTEE:
TWENTY-FIRST SESSION
One year might be too short to endeavour to reach the
st~ge
where the
The (lHA;t~ requ9s>~d t!ree1MppGmooult5i t<a;(s.lllbmit ~ n~ draft
resolutidn takiifi'gt-int0 ,.account the recommendations and comments made (see the sixth meeting, section 1.1).
-~ke~&Q~tlnglri~~
at 11.45 a.m.