Final report of the twenty-ninth session of the Regional Committee for the Western Pacific

WORLD HEALTH ORGANIZATION REGIONAL COMMITTEE FOR THE WESTERN PACIFIC TWENTY-NINTH SESSION Manila, 21 to 25 August 1978 REPORT OF THE REGIONAL COMMITTEE SUMMARY RECORDS OF THE PLENARY SESSIONS MANILA November 1978 r WORLD HEALTH ORGANIZATION REGIONAL COMMITTEE FOR THE WESTERN PACIFIC TWENTY-NINTH SESSION Manila, 21 to 25 August 1978 REPORT OF THE REGIONAL COMMITTEE SUMMARY RECORDS OF THE PLENARY SESSIONS MANILA November 1978 The twenty-ninth session of the Regional Committee for the Western Pacific was held at the WHO Conference Hall, Manila, from 21 to 25 August 1978, under the chairmanship of Dr A.N. Acosta (Philippines), with Dr S. Fo1iaki (Tonga) as Vice-Chairman. Dr M. Charpin (France) and Dr A. Tarutia (Papua New Guinea) were the Rapporteurs. The Regional Committee met on 21, 22, 23, 24 and 25 August. The report of the Committee, including the resolutions adopted during the session, will be found in Part I of this document on pages 1-102; the summary records of the plenary meetings in Part II on pages 109-214. Since the twenty-eighth session, the two sub-committees of the Regional Committee had each met twice; the Sub-Committee on the General Programme of Work on 15 and 16 June 1978 and on 23 August 1978 and the Sub-C01IIIDittee on Technical Cooperation among Developing Countrles on l3,and 14 June 1978 and on 24 August 1978. The reports of the two Sub-Committees will be found in Part I of this document on pages 47-78 (Annexes 4 and 5) and 79-102 (Annexes 6 and 7). CONTENTS mTRO DU CT ION •••••••••••••••••••••••••••••••••••••••••• I. REPORT OF THE REGIONAL DIRECTOR COVERING THE PERIOD 1 JULY 1977 TO 30 JUNE 1978 ••••••••••••••••••••••••••• II. REVIEW OF THE PROGRAMME BUDGET, 1980-1981 ••••••••••••• 1. Review of budget performance in 1977 •••••••••••••• 2. Review of the proposed programme budget estimates for 1980-81 ••••••••••••••••••••••••••••••••••••••• I I I • OTHER 11A. TTERS ••••••••••••••••••••••••••••••••••••••••• 1. Resolutions of regional interest adopted by the Thirty-first World Health Assembly and the Executive Board at its sixty-first session •••••••• 2. WHO's role in the development and coordination of biomedical research: greater involvement of the Regions in research ••••••••••••••••••••••••••••••• 3. Special Programme for Research and Training in Tropical Diseases: Joint Coordinating Board: selection of government representatives ••••••••••• 4. Regional coordinating group on the mental health progra1llllle ••••••••••••••••••.•••••••••••••••••••••• 5. Status of the antimalaria programme ••••••••••••••• 6. Workers' health programme ......................... 7. Host Agreement between the Government of the Republic of the Philippines and the World Health Organization •••••••••••••••••••••••••••••••••••••• 8. Time and place of the thirtieth and thirty-first sessions of the Regional Committee •••••••••••••••• 9. Selection of topic for the Technical Presentation during the thirtieth session of the Regional CoDllll1 t tee •••••••••••••••••••••.•••••••••••••••••••• 10. Reports received from governments on the progress of their health activities •••••••••••••••••••••••• IV. SUB-COMMITTEES OF THE REGIONAL COMMITTEE •••••••••••••• 1. Sub-Committee on the General Programme of Work .... 2. Sub-Committee on Technical Cooperation among Developing Countries •••••••••••••••••••••••••••••• 1 2 6 6 7 10 10 14 14 15 16 16 17 17 18 18 19 19 20 v. CONTENTS RESOLUTIONS ADOPTED BY THE REGIONAL COMMITTEE ••••••.•• 21 WPR/RC29.Rl WPR/RC29.R2 WPR/RC29.R3 WPR/RC29.R4 WPR/RC29 • R5 WPR/RC29.R6 WPR/RC29 • R7 WPR/RC29.R8 WPR/RC29.R9 WPR/RC29.R10 WPR/RC29.Rll WPR/RC29.R12 WPR/RC29 • R13 WPR/RC29.R14 WPR/RC29.R15 WPR/RC29.R16 Nomination of the Regional Director 21 Expression of appreciation to the Regional Director .•.•••••••••••••••••• 21 Report of the Regional Director ••••••• western Pacific Regional Centre for the Promotion of Environmental Planning and Applied Studies (PEPAS) ••••••••••••••• Resolutions of regional interest adopted by the Thirty-first World Health Assembly and the Executive Board at its sixty-first session Budge"t performance 1977 - Direct ...... 22 22 23 services to governments ••••••••••••••• 24 Proposed programme budget estimates for the biennium 1980-1981 •••••••••••• Membership of the Sub-Committee on the General Programme of Work ••••••••••••• Interpretation of the Host Agreement between the Government of the Republic of the Philippines and the World Health 24 24 Organization •••••••••••••••••••••••••• 25 WHO's role in the development and coordination of biomedical research: greater involvement of the Regions in research •••••••••••••••••••••••••••••• 25 SpeCial Programme for Research and Training in Tropical Diseases: Joint Coordinating Board •••••••••••••••••••• 27 Regional Coordinating Group on the mental health programme ••••••••••••••• 27 Antimalaria programme ................ 28 Workers' health ••••••••••••••••••••••• 29 Programme on diarrhoeal disease control .•........................••.•. 30 Topic of Technical Presentation in 1979 ••••••••••••••••••••••••••••••• 31 .' WPR/RC29.R17 WPR/RC29 • R18 WPR/RC29.R19 WPR/RC29.R20 WPR/RC29.J.21 WPR/RC29 • R22 CONTENTS Thirtieth and thirty-first sessions of the Regional Committee ••••••••••••• Sub-Committee on the General Programme of Work ••••••••••••••••••••••••••••••• sub-Committee on Technical Cooperation among Developing Countries •••••••••••• Rules of Procedure of the Regional Comadttee for the Western Pacific ••••• Adoption of the report •••••••••••••••• Resolution of appreciation •••••••••••• ANNEXES 1 List of non-governmental organizations whose representatives made statements to the Regional 31 12 32 33 33 34 COIIIDl t tee •...••..............•.........•.......•...... 35 2 3 4 5 6 7 Agenda •••••••••••••••••••••••••••••••••••••••••••••••• List of representatives ••••••••••••••••••••••••••••••• Report of the Sub-Committee of the Regional Committee on the General Programme of Work •••••••••••••••••••••• Report of the Sub-Committee of the Regional Committee on the General Programme of Work •••••••••••••••••••••• Report of the Sub-Committee of the Regional Committee on Technical Cooperation among Developing Countries ••• Report of the Sub-Committee of the Regional Committee on Technical Cooperation among Developing Countries ••• 37 39 47 77 79 101 ~ ~ +' ~ p., No I~ Ii · : ~- PART I REPORT OF THE REGIONAL " COMMITTEE -~ ;-- (WPR/RC29/22) INTRODUCTION The twenty-ninth session of the Regional Committee for the Western Pacific was held in Manila from 21 to 2S August 1978. The Government of the Republic of the Philippines acted as host to the session. The formal opening took place on Monday, 21 August and vas attended by His Excellency, Dr Clemente S. Gatmaitan, Minister of Health, vho welcomed the Committee to the Philippines. The Director-General of WHO, Dr H. Mahler, was also present. The session was attended by the Representatives of Australia, China, Japan, Malaysia, New Zealand, Papua New Guinea, Philippines, Republic of Korea, Samoa, Singapore, Socialist Republic of Viet Nam and Tonga, and of Member States responsible for territories or areas in the Region. Representatives of the United Nationl Development Programme, the United Nations Children's Fund, the International Labour Organilation, the South Pacific Commission and 27 non-governmental organizationl in official relations with WHO were allo present. The Committee elected the following officers: Chairman Rapporteurs in English in French Dr A.N. Acolta (Philippinel) Dr S. Foliaki (Tonga) Dr A. Tarutia (Papua New Guinea) Dr M. Charpin (France) Formal statements were made by the Representatives of the United Nations Development Programme, the United Nations Children's Fund, the South Pacific Commission and the non-governmental organizations listed in Annex 1. The agenda appears as Annex 2 and the List of Representatives as Annex 3. At the second plenary meeting the Committee went into private session to consider nominations for the post of Regional Director. The Committee nominated for submission to the Executive Board, in order of preference as indicated by the order of their election, Dr Hiroshi Nakajima (Japan) and Dr Raja Ahmad Noordin (Malaysia) (see resolution wn/RC29.Rl). The Committee adopted a resolution conveying its appreciation to Dr Francisco J. Dy, the present Regional Director, and declaring him Regional Director Emeritus. Dr Dy will retire on 30 June 1979 after more than twenty-nine years of service, thirteen of them as Regional Director (see resolution WPR/RC29.R2). 2 REGIONAL COMMITTEE: TWENTY-NINTH SESSION The Committee appointed a sub-committee to examine Rule 51 of its Rules of Procedure. The Sub-Committee will report on its recommendations to the thirtieth session (see resolution WPR/RC29.R20). At the fifth plenary meeting, the Committee considered the background paper prepared by the Director-General following the adoption of resolution WHA3l.27 which requested him to re-examine the Organization's structures in the light of its functions. It agreed that the standing Sub-Committee on the General Programme of Work, with expanded terms of reference, was the most suitable forum to carry out the study proposed and the country visits involved. Consequently, the Committee revised the membership of the Sub-Committee by increasing it to seven composed, up to the thirtieth sell ion, of the Representativel of Australia, Japan, Malaysia, New Zealand, Philippines, Socialist Republic of Viet Nam and Tonga (see resolution WPR/RC29.R8). The Committee also, at the eighth plenary meeting, approved expanded terms of reference for the Sub-Committee to enable it to carry out the study (see resolution WPR/RC29.R18 and also Part IV, Section 1.2). At the fifth plenary meeting the Committee made the Sub-Committee on Technical Cooperation among Developing Countries a standing sub- committee composed, up to the thirtieth session, of Representatives of Japan, Papua New Guinea, Republic of Korea and Singapore (see resolution WPR/RC29.R19 and also Part IV, Section 2.2). The Committee selected Malaysia and the Philippines as the two Member States to send reprelentatives to attend meetings of the Joint Coordinating Board of the Special Programme for Research and Training in Tropical Diseases, the former for a period of three years and the latter for a period of two years, both from 1 January 1978 (see resolution WPR/RC29.Rll and also Part 111, Section 3). The Committee appointed Dr J.A.B. Nicholson (United Kingdom) moderator of the Technical Presentation on "Diarrhoeal diseases including cholera, typhoid and paratyphoid", to be held during the twenty-ninth 1.lsion. It later adopted resolution WPR/RC29.R15 on the future programme of diarrhoeal disease control. In the course of nine plenary lelsionl, the Committee adopted 22 resolutions which are let out in Part V. PART 1. REPORT OF THE REGIONAL DIRECTOR COVERING THE PERIOD 1 JULy 1977 TO 30 JUNE 1978 The Committee noted that the Regional Director'l report thil year was a brief one following the decision to prelent only lignificant matters and developments in even-numbered years, when the programme budget estimates were being conSidered, and a comprehtnsive report covering the previous biennium in odd-numbered years. lSee resolution WPR/RC27.R8, Handbook of Resolutions and Decilionl of the WHO Regional Committee for the Western Pacific, Volume II, 1978, pages 11-12. REPORT OF TIlE REGIONAL COMMITTEE 3 Progre,s had been made in promoting country health programming and medium-term programming and in developing the information systems to support them. MUch effort had been expended on encouraging countries to think in terma of TCDC. Both developed and developing countries had an important role to play in that endeavour. The idea of appropriate technology for health wal allo receiving increaling attention in the Region. The Committee noted the progrell made with the relearch programme. On 8 August 1978 the agreement had been ligned between the Government of MalaYlia and WHO for the initial phase of development of the Institute for Medical Res.arch, Kuala Lumpur, as a regional centre for research and training ,in tropical diseale8 and nutrition. In relpon.e to a re.olution. WHA29.72. adopted by the Twenty-ninth World Health As.emb1y. which asked the Director-General to intensify efforts to develop the concept of integrated health services and manpower development, a global study was being initiated. The relo1ution of the twenty-eighth leaaion of the Committee on changing trenda in training had been a step towards taking practical action to implement the Health Assembly resolution and had resulted in the organization of a regional conference to be held in Manila early in 1979. 1 It was agreed that the action and diacussions at national level which would follow the Conference should make a valuable contribution to the study and that a report would be presented to the thirtieth session of the Regional Committee. The Committee heard with pleasure that the agreement between the Government of Malaysia and WHO for the establishment of the Western Pacific regional centre for promotion of environmental planning and applied studies (PEPAS) would be signed on 7 September 1978 and that the first staff members were expected to take up their positions before the end of the year. In clarification of operative paragraph seven of resolution WPR/RC28.R13, which provided for the Advisory Committee of PEPAS to meet biannually, when in fact the intention had been for it to meet biennially, that is once every two years, the Committee adopted resolution WPR/RC29.R4. In reviewing the report programme by programme, the Committee first noted with interest the progress being made in the People's Republic of China in integrating traditional and We. tern medicine to create a new Chinese medicine and pharmacology, and looked forward to increasing exchange of scientific knowledge in that area. It also noted that, aa it had requested in resolution WPR/RC28.R14, a multi- disciplinary working group to consider problema of road traffic accidents had been established. The regional programme waa accelerating in 1978, in close coordination with the global programme which, in accordance with the policy of decentralization, waa the reaponaibility of the Regional Office for Europe. 1 See resolution WPR/RC28.R16, Handbook of Resolutions and Decisions of the WHO Regional COmmittee for the Western Pacific, VolUme II, 1978, page 27. 4 REGIONAL COMMITTEE: 'tWENTY -NINTH SESS ION 1. Medium-term programming The Committee was assured that the priority assigned in the preparation of medium-term programmes was one of timing and was not a comment on the relative importance of programmes. 2. Country health programming It was agreed that country health programming had to be a national effort. In the case of the Philippines it was being developed in amplification of an already-existing national health plan. An additional advantage, it was hoped, from the exercise in the Philippines would be the establishment of a collaborating centre from which other Member States of the Region could benefit. On the initiative of the Representative of New Zealand it was agreed that the subject of country health programming should be included in the agenda of the thirtieth session of the Regional Committee. 3. Research promotion and development In voicing its gratification that much research activity had been decentralized to the Regions, the Committee was aware that every Region had a responsibility to the global whole of the Organization, no matter where the resources were located. Member States must decide on the priorities for research themselves and, though those priorities might have a regional flavour, they were all significant for the global collection of information. It was hoped that the intensified regional input would have a major impact on WHO's research programme as a whole. 4. Primary health care Representatives of Malaysia, New Zealand, Papua Bew Guinea, Philippines, Samoa and Socialist _epublic of Viet Bam all emphasized the importance of WHO's cooperation in activities for the promotion of primary health care, including training. It was noted that a research and development study on primary health care was being carried out in Tacloban, Philippines. 5. Maternal and child health Representatives of the Philippines and Socialist Republic of Viet Bam described family planning activities in their countries. There was some discussion on the use of depot-medroxyprogesterone acetate for family planning purposes in maternal and child health services. WHO had an expanded global programme in research on human reproduction with a wide network of collaborating centres and the use of depot-medroxyprogesterone acetate under certain conditions was one of the very carefully investigated possibilities for family planning. The Director-General's comments on the value of WHO as a neutral agency in developing programmes such as family planning were noted. 6. Nutrition The Committee noted that the Master of Community Health (Nutrition) Course to be given at the University of Queensland was expected to commence in 1979. It was hoped to coordinate the field training, which would be the responsibility of the University of the Philippines, with a nutrition planning course to be instituted between the Philippines-Netherlands university sy.tems. REPORT OF THE REGIONAL COMMITTEE 5 7. Health education A Representative of Malaysia described the postgraduate course for training health education specialists in Malaysia. Papua New Guinea was quoted as being a country where the much needed change of emphasis from training in the classroom to training in the field was being carried out and a Representative of Papua New Guinea described some aspects of the middle-level course there. 8. Mental health Representatives of China. Papua New Guinea and tbe Philippines commented on the importance of community participation in treating the mentally ill. The Committee noted the action being taken by the Regional Office to identify drug abuse problema and means of overcoming them. The Director-General's comments on the need for a mental health component in prtmary health care were noted. 9. Prophylactic, diagnostic and therapeutic substances The C~ittee noted the iaportant work on Nev caledonian flora being carried out in the laboratories of OISTOM and also the importance, in the delivery of primary health care, of having essential medicaments readily available (see al80 Part III. Section 1.5). 10. Acute respiratory infections The Committee noted with great interest a Representative of China's remarks regarding research activities on acute respiratory infections in his country. This was a definite area in which WHO could collaborate and other countries would have much to learn from experience in China. 11. Sexually transmitted diseases A Representative of the Socialist Republic of Viet Ham advised the Committee of the present situation in his country with regard to sexually transmitted disease8. 12. Filariasis The Committee noted the comments of the Representative of France on the situation in New caledonia and those of the Representative of Samoa on the situation in his country. 13. Malaria In answer to a question from the Representative of France. attention was drawn to the report of the work.hop on drug-resistant malaria, held in Manila from 23 May to 2 June 1978, which had developed proposals and a protocol for the use of antimalarials. 6 REGIONAL COMMITTEE: TWENTY-NINTH SESSION 14. Expanded programme on immunization Representatives of the Philippines and Samoa spoke of the situations in their countries with regard to DPT vaccination; in the former country two injections only being given, the second combined with one BCG injection. The BCG scar was used as a marker. 15. Cardiovascular diseases Representatives of Malaysia, Papua New Guinea and Samoa all stressed the upward trend in the incidence of cardiovascular diseases in developing countries and the Representative of New Zealand spoke of investigations to develop a preventive programme in his country. It was noted that a hypertension control programme was to be developed for the Philippines. Studies and exchange of information on control activities provided excellent opportunities for technical cooperation among developing countries and, because of intensified activities in the control of cardiovascular diseases, a Regional Adviser was being proposed for 1980-81. 16. Staff development and training In reply to a comment made by the aepresentative of New Zealand, it was noted that attention was being paid to the management training of health, and also health-related, staff so that the management process would be a combined one for the government as a whole and not just for the health sector. WHO was ready to cooperate in conducting national management training courses. The Committee adopted a resolution noting the significant matters and the developments resulting from the work of WHO in the Western Pacific Region in the period uader review and cam.ending the Regional Director and his staff on the work accomplished (see resDlution WPlt/RC29.R3). PART II. REVIEW OF THE PROGRAMME BUDGET, 1980-1981 1. Review of budget performance in 1977 The Committee noted that document WPR/aC29/3 gave a review of the budget performance in extending technical cooperation with, and services to, governments in 1977. Once again, increasing costs of staff, including consultants, supplies and equipment, and fe11owahips, together with currency fluctuations, had made the rate of programme delivery given in Annex 1 of the document somewhat artificial. The WHO Programme Coordinator for the Socialist Republic of Viet Nam, whose post was shown in Annex 5 of the document, had taken up his duties in November 1977. 1 As soon as it had become clear that there would again be no programmes in Democratic Kampuchea, ·because contact had still not been established with that country, U8$430 000 had been returned to Headquarters for reprogramming. lThe title of WHO Representative was changed to WHO Programme Coordinator following the adoption of resolution WBA31.27 by the Thirty- first World Health Assembly. 3 . REPORT OF THE REGIONAL COMMITTEE 7 2. Review of the proposed programme budget estimates for 1980-81 It was noted that this was the first t~e the programme budget proposals had been presented by programme only. The new format resulted from the wish of Member States to have more flexibility in carrying out their programmes by leaving the details to be worked out nearer the year of implementation l when priorities and trends in programmes would be better known. The policy background to the change in presentation was given in the explanatory notes to document WPR/RC29/4 and a broad indication of what government requests might be in the Regional Director's programme statement. The country programme statements prepared by Member States gave the national health strategy each country hoped to carry out in 1980-81. The amounts shown under the programme headings, which followed the new WHO programme classification structure brought into effect on 1 January 1978, were the amounts allocated to Member States to implement that strategy. Within the individual programmes, the amounts could be used in any way Member States wished and could be carried over from the first year of the biennium to the second. It was remarked that this latter change was very important for flexibility and the new approach to biennial programme budgeting. Countries would be able to decide at a much later date what to do with their allocations; they could adjust to current needs instead of having to plan in detail several years ahead. Within the longer two-year period, projects could be brought forward or postponed as the need arose. WHO Programme Coordinators would be in constant touch with governments in developing the details of their programmes. The 1980-81 regular budget proposals amounted to US$32 495 000, an increase of US$5 862 000 over the US$26 633 000 budget for 1978-79. The increase was partly made up of US$2 703 566 "real increase", which was within the allowable figure computed for the Regional Office for the Western Pacific by Headquarters and which included WPRO's 2% programme increase. 2 It also included the amount resulting from the shift of resources from Headquarters to the Region. The remaining US$3 158 434 was the estimated cost increase due to inflation and other factors. The Director-General's answer to a Representative of Australia's question as to how, if it became necessary to reduce the budget for the biennium for any reason, the reduction would be distributed among Member States, was noted. If, for example, the 1980-81 proposed programme budget were not to be approved by the World Health Assembly, he would first of all seek further extrabudgetary funds. If that were not enough and in view of the almost certain resistance of Member States to the cutting-out of any particular programme, he might have to reduce regional allocations. In that case it would be for the Regional Directors to decide where to make the reductions. One way would be for the developed countries to renounce any projects from which they benefited under the regular budget. A pragmatic approach would have to be adopted towards intercountry projects. ISee resolution WHA30.23, WHO Official Records, Ro. 240, page 11. 2See resolution WHA31.23, WHO Official Records, No 247, page 15. 8 REGIONAL COMMITTEE: TWENTY-NINTH SESSION Several R(>presentatives queried reductions, in certain programmes, ill lhe allocatiolls lor 1980-81 over those for 1978-79, which they thought did not seem to be in line with the importance attached by WHO to those programmes or with the priority given by the Regional Committee to the objectives of the Sixth General Programme of Work covering a specific period {1978-83 inclusive).l It was noted, in explanation, that a decrease in funds allocated reflected a decline in government requests, since individual governments did not necessarily give the same priority to programmes as did the Regional Committee as a whole. As far as extrabudgetary funds were concerned, funding agencies committed funds to WHO nearer the time of implementation and therefore amounts for 1980-81 were not yet committed and could not be shown in the document. Another point to be taken into consideration was the fact that appropriation sections overlapped to a considerable extent. For example, it appeared that provisions for health manpower development were decreasing. Almost every section contained a health manpower development component, however, and in reality the allocation was rising. A summary of comments on specific programmes is given below: 2.1 Major programme: General prograuae develo_nt and _nagaent Programme: Country health prograa.ing (2.2.2) Following a query from the Representative of New Zealand it was noted that the amount of US$l 302 300 allocated to country health progr ... ing for the biennium 1978-79 was to cover the costs of "intaining the WHO Programme Coordinators' offices; including their own and their staff's salaries. Other activities connected with country health programming, such as training courses, were funded from other programmes. It was agreed that this presentation was not fully .atisfactory and that the 1982-83 programme budget presentation should give a breakdown of country health prograuadng activities. 2.2 Major programme: Regional Director's development programme (2.5) The Committee noted that document WPl/aC29/5 showed the final figures for funds utilized from the Regional Director's development programme in 1977. The activities listed for 1978 and 1979 had in fact already been approved by the Committee at the twenty-eighth session, except for an amount of US$95 800 which had nov been programmed for the Western Pacific regional centre for the promotion of environmental planning and applied studies (PEPAS). The funds for 1980-81 had not yet been allocated to specific programme areas. 2.3 Major programme: Health services development Programme: Health services research (3.1.6) Following queries from the Representatives of Malaysia and the Philippines the Committee noted that at the time the programme budget estimates were prepared it had not been pos8ible to provide precise figures for each research activity under the intercountry programme; lSee resolution WPR/RC26.R12, Handbook of Relolutiona and Decisions of the WHO Regional Committee for the Western Pacific, Volume I, 1976, page 5 and re80lution WPR/RC27.R14, Ibid, Volume II, 1978, pages 2-3. REPORT OF THE REGIONAL COMMITTEE therefore the major programme of research promotion and development contained funds for health services research. Now that the Working Group on Health Services Research, held from 14 to 18 August 1978, had been able to formulate a programme it would be possible to allocate funds; how they had been allocated would certainly be reflected in the next programme budget presentation. 2.4 Major prograuae: Mental health (3.3) 9 A comment was made by the Chairman on the fact that the only funds available for intercountry mental health activities were provided under the regular budget, although considerable extrabudgetary resources might have been expected. The Director-Genera1'1 explanation wal noted that, traditionally, governments had given a low priority to mental health. Now, however, it was recognized as a major public health problem, as serious in developing as in developed countries. The ground had been prepared for governments to contribute to mental health activities. particularly within primary health care, and the time was ripe to appeal to Member States in the Region to support them. 2.5 Major programme: Noncommunicable disease prevention and control Prograaae: Cancer (4.2.1) In reply to a query from a Representative of Australia, it was noted that a larger amount of funds had been provided for intercountry activities in 1978-79 than in 1980-81 in order to promote the programme. It was hoped that this Itimulation would attract extrabudgetary resources for 1980-81. 2.6 Major programme: Promotion of environmental health Programme: Recognition and control of environmental hazards (5.1.3) In reply to a query from a Representative of Papua New Guinea it was noted that, by 1980-81. responsibility for intercountry activities under the programme recognition and control of environmental hazards would be taken over by the Western Pacific regional centre for the promotion of environmental planning and applied studies, the funds for which were allocated under the programme environmental health planning and management (5.1.1). 2.7 Major prograuae: Health manpower development Programme: Educational development and support (6.1.3) The Committee noted that the UNDP funds which had hitherto supported teacher training centres for health personnel were available only until the end of 1978. Additional support would, however, be provided from funds donated by the Japan Shipbuilding Industry Foundation. 10 REGIONAL COMMITTEE: 'IWENTY-NINTH SESSION 2.8 Najor progratmne: Health information Programme: Health literature services (7.1.4) The Committee noted that there was active collaboration, on an informal basis, between WHO and SEAMIC. 2.9 Major programme: General services and support programmes Programme: Staff development and training (8.1.1) In answer to a comment on the small amount allocated to staff development and training it was noted that major support and cooperation in staff training activities came from Headquarterl. Funds from the Regional Director's development programme could also be used. * * * The Committee agreed that it was not appropriate to examine in detail the individual country or area programme statements, although the Representative of France noted with satisfaction that the Regional Director had continued to allocate a substantial part of the available resources to the Socialist Republic of Viet Nam. The Committee adopted two resolutions: on the budget performance in 1977 and on the proposed programme budget estimates for the biennium 1980-81 (see resolutions WPR/RC29.R6 and WPR/RC29.R7). PART III. OTHER MATTERS 1. Resolutions of regional interest adopted by the Thirty-first World Health Assembl and the Executive Board at its stxt -first lession (Document WPR RC29/8) The Committee considered the following resolutions: (1) Medium-term programming for the implementation of the Sixth General Programme of Work covering a specific period (1978- 1983 inclusive) (resolution WHA31.l0); (2) Development of health programme evaluation (resolution WHA31.11) ; (3) Country health programming (resolution WHA3l.l2); (4) Development of health information systems (resolution WHA31.20); REPORT OF THE REGIONAL COMMITTEE 11 (5) Members in arrears in the payment of their contributions to an extent which may invoke the provisions of Article 7 of the Constitution (resolution WHA31.24) ; (6) Organizational study on WHO's role at the country level, particularly the role of the WHO representatives (resolutions WHA31. 27 and EB6l. R34) ; (7) Action programme on essential drugs (resolution WHA3l.32); (8) Drug policies and management: medicinal plants (resolution WHA31.33) ; (9) Action programme of appropriate technology for health (resolution WHA31.34); (10) Managerial process for health development (resolution WHA31.43) ; (11) Programme on diarrhoeal diseases control (resolution WHA3l.44) ; (12) Coordination within the United Nations system: activities financed from extrabudgetary sources within the United Nations system (resolution WHA31.51); (13) Expanded programme on immunization (resolution WHA31.53); (14) Smallpox eradication programme - current status and certification (resolution WHA3l.54); (15) Maternal and child health (resolution WHA3l.55); (16) Long-term planning of international cooperation in cancer research (resolution EB6l.R29). A summary of the comments made on specific resolutions is given below: 1.1 Medium-term General Pro inclusive) Sixth 1978 -1983 The Representative of New Zealand spoke to this resolution. In answer to his query as to how Member States could collaborate effectively in developing medium-term programmes, the Committee noted that the medium-term programme of the Organization was based on, and formulated to carry out, the Sixth General Programme of Work covering a specific period (1978-1983 inclusive). Medium-term programmes for various areas were prepared in close consultation and collaboration with Member States of the Region, who had been requested to indicate the areas in which they wished to have WHO's collaboration in terms of the WHO Sixth General Programme of Work. WHO would continue to work closely with Member States and, with their collaboration, the effort would result in realistic medium-term programmes. , ., 12 REGIONAL COMMITTEE: TWENTY-NINTH SESSION 1.2 Development of health programme evaluation (resolution WEA31.11) Two Representatives spoke to this resolution. A Representative of Australia commented on the necessity for effective evaluation of health programmes. A Representative of the Philippines said that evaluation methods were being built into health programmes in the Philippines from the planning to the implementation stage and staff were being given the requisite training. 1.3 Country health programming (resolution WHA31.l2) A Representative of the Philippines spoke to this resolution. He made a statement on the development of a country health programme for the Philippines. 1.4 Development of health information systems (resolution WHA31.20) A Representative of Malaysia spoke to this resolution. He said that his country was glad to be associated with WHO in developing health information systems. However, the process was more complex and comprehensive than had been thought, and a delay of more than one year had already been incurred. His country was currently working with WHO to see how to obtain stronger collaboration in order to ensure the success of the programme. 1.5 Action programme on essential drugs (resolution WHA31.32) The Committee noted that because a large segment of many countries did not have access to the most essential drugs and vaccines, and the high cost of medicaments was a great hindrance to the delivery of health care, WHO had convened an Expert Committee in October 1977. That Committee had produced a report. 1 It was now possible for governments to supply their hospital and community dispensaries with not more than 20 essential drugs. Most manufacturers of pharmaceuticals were willing to provide those drugs at very reduced prices. In doing so, they would dispense with proprietary names, instead labelling the products generically. Three Representatives spoke to this resolution. The Representative of Samoa said that one of the aims of his government was to work with other countries or areas in the South Pacific to form collective purchasing schemes, which it was hoped would result in the speedier and less expensive supply of essential drugs. Such drugs were currently being ordered from the United Kingdom, New Zealand, and certain South-East Asian countries. They took three to six months to obtain. He stressed the need for adequate quality control of drugs and requested WHO's assistance in obtaining drugs at a lower cost and more rapidly, as well as its advice on the type of drugs needed. IWHO Technical Report Series, No. 615, 1977. 1~ __ REPORT OF THE REGIONAL COMMITTEE 13 The Representatives of Australia and the United Kingdom said that, following a request from the Director-General. their governments were considering what support they might give. 1.6 Action programme of appropriate technology for health (resolution WHA3l.34) Two Representatives spoke to this resolution. The Representative of New Zealand was informed, after enquiring whether "appropriate technology for health" referred to a methodology or to actual instrumentation, that in fact it meant a simple technology, appropriate for the community, that could be carried out with local resources. The Representative of the United Kingdom .aid that, in seeking appropriate technologies for health, particular consideration should be given to the ideas to be found at the grass-roots level. 1.7 Expanded programme on immunization (resolution WHA31.53) The Representative of the United Kingdom spoke to this resolution. He said that his Government wished to stress the importance it attached to immunization. especially in maternal and child health and, consequently. it was making a contribution, not only in the form of vaccine but by working with WHO, particularly in cold chain research. It was interested also in the evaluation of immunization programmes and would be glad to consider possible support, preferably through one of the multilateral agencies and through country programmes. 1.8 current status and certification The Representative of New Zealand spoke to this resolution. He asked at what stage Member States of the Region might consider no longer demanding smallpox vaccination as a requirement for entry into their territories. The Committee was then informed that a global commission on smallpox eradication, after consulting the World Health Assembly and holding a series of meetings in 1979, would probably judge that the requirements should be dropped. 1.9 Long,term planning of international cooperation in cancer research (resolution E861.R29) The Committee noted that the Executive Board had invited regional committees to undertake regular reviews of the cancer situation and agreed that the subject should be placed on the Agenda of the thirtieth session. 14 REGIONAL COMMITTEE: TWENTY-NINTH SESSION 2. WHO's role in the development and coordination of biomedical research: reater involvement of the Re ions in research (Document WPR RC29 11, Add. 1 and Corr.l) The Committee noted that, the work of establishing the Western Pacific Advisory Committee on Medical Research (WPACMR) and its task forces having been completed and their preliminary recommendations endorsed by the Regional Committee, the past year had seen a considerable expansion in research activities. It was not by chance that this had coincided with the appointment of a medical officer responsible solely for the research programme. Several working groups had been held to plan research programmes in individual fields, the latest of which was that on health services research held from 14 to 18 August 1978. 1 January 1978 had seen the decentralization of responsibility for administering research grants and research training grants and quite a number, in a variety of fielda, had been awarded by the Regional Office over the past eight montha. In April 1978 the WPACMR had held its third session in Kuala Lumpur, where the regional centre for research and training in tropical dileases and nutrition was being established. Recommendations of particular interest had been in connesion with the programmes of research in pneumonia and respiratory infections and in diarrhoeal diseases, to mention only two. In endorsing the recommendations of the third session of the WPACMR, Representatives referred particularly to (1) efforts to promote an interdisciplinary multicountry programme of research in diarrhoeal diseases; (2) the proposed meeting of directors of medical research councils; (3) proposals for intensified research in filariasis; and (4) the proposed regional symposium on parasite immunology. The Representative of the United Kingdom asked whether there had been any collaboration in the field of diarrhoeal diseases research with the Cholera Research Laboratory, Dacca, Bangladesh. It was noted in reply that there had not been any specific cooperation with that laboratory, but a regional programme in diarrhoeal diseases was being formulated, the key to which was to establish links between institutions. The expertise in setting up effective programmes in diarrhoeal diseases was largely concentrated in the South-East Asia and Western Pacific Regions of WHO. The Committee adopted a resolution endorsing the recommendations of the WPACMR (see resolution WPR/RC29.RIO). 3. Special Programme for Research and Training in Tropical Diseases: Joint Coordinatin Board: selection of overnment re resentatives Documents WPR/RC29/12 and Add.l) The Committee noted that the Memorandum of Understanding on the Administrative and Technical Structures of the Special Programme for Research and Training in Tropical Diseases provided for the establish- ment of a Joint Coordinating Board (JeB) consisting in 30 members. - .' REPORT OF THE REGIONAL COMMITTEE 15 Among the members would be twelve government representatives, selected by those who contributed to the resources of the Special Programme, and twelve government representatives selected by the six Regional Committees; two by each Committee. All the selected members would attend the first meeting of the JCB to be held on 15 and 16 November 1978. The contributors to the resources of the Special Programme had already selected their twelve government representatives, for different durations of tenure in order to provide for some continuity in member- ship when the time came for reappointment, but all commencing on 1 January 1978. Member States from the Western Pacific Region selected by the contributors were Australia, the United Kingdom, and the United States "of America. The Regional Committee now had to select, from among those directly affected by the diseases dealt with by the Special Programme, the two Member States it wished to be members of the JCB. The Committee selected Malaysia and the Philippines as the two Member States to send representatives to attend meetings of the JCB, the former for a period of three years and the latter for a period of two years, both from 1 January 1978. It adopted a resolution to that effect Csee resolution WPR/RC29.Rll). 4. on the mental health ro ramme The Committee recalled that, at the twenty-eighth session, when discussing the resolution adopted by the World Health Assembly on mental retardation, a suggestion had been made that a regional coordinating group for the mental health programme might be established. This would be linked to the global coordinating group and the regidnal poordinating groups already in existence. It would monitor and evaluate the implementation of the medium-term programme for mental health adopted by the Thirty-first World Health Assembly in resolution WHAll.21. The Committee agreed that the most important concern of the mental health programme was that it should be socially relevant; and noted pocument WPl/RC29/ll which described the functions of regional coordinating groups and the various types of national coordinating mechanisms in operation. The document also gave the proposed terms of reference and composition of a coordinating group for the mental health programme in the Western Pacific Region should it be considered feaSible to establish such a group. A Representative of China supported the proposal and stressed the importance of community partiCipation in mental health work. A Representative of the United States of America also supported the proposal and the fact that a much broader approach had been adopted, not merely orientated towards research, but taking public health and social aspects into consideration. The Committee adopted a resolution requesting the Regional Director to establish a coordinating group for the regional mental health programme in order to strengthen and facilitate collaboration with the global coordinating group as well as with Member States; and 16 REGIONAL COMMITTEE: TWENTY-NINTH SESSION authorizing him to appoint the members and convene the meetings of the group as and when necessary (see resolution WPR/RC29.R12). 5. Status of the anttmalaria programme (Document WPR/RC29/14) The Committee recalled the discussion at the twenty-eighth session of the Regional Committee on the topic of the 1978 Technical Presentation. At that time it had been decided that the status of the antimalaria programme in the Region should be placed on the Agenda of the twenty- ninth session. A stage had been reached at which there was no marked progress in the control of aalaria. In some places the situation had, unfortunately, even deteriorated. A much more flexible approach was needed than had hitherto been applied, to enable a qUick chanse to alternative control m .. sures should conventional methods prove unsuccessful. Research activities were being intenlified in coordination with the Special Programme on Research and Training in Tropical Diseases. The develop- ment of the primary health care concept was opening the way for inclusion of a number of mea lures for the control of malaria in remote rural areas where the disease remained a considerable problem. The training of adequate manpower had always been a problem and remained so. Reprelentatives of China, MalaYlia, Papua New Guinea, Philippines and Socialist Republic of Viet Nam, all agreed that the report was a very comprehensive one and related the malaria situation existing and the anti .. larial measures being taken in their own countries. Representatives of the United Kingdom and the United States of America praised the report, the latter stating that a prerequiSite for controlling .. laria on a large scale val a political decision on the part of governments to provide the necessary long-term support, and both stresling the need for community participation in malaria control activities. It was noted that vectors at the ·edges of their normal range were more amenable to control measures. The Committee adopted resolution WPR/RC29.RI3 appealing to Member States to support antiaalaria programmes, urging them to undertake a number of measures to ameliorate the situation and requesting the Regional Director to continue to support and cooperate with them in their endeavours (see resolution WPR/RC29.R13). 6. Workers' health programme (Document WPR/RC29/15 and Corr.l) The Committee noted that a review of the workers' health programme in the Western Pacific Region had been placed on the Agenda of the Regional Committee at the specific request of the World Health Assembly, which wished to promote active URplementation of regional programmes of work in occupational health. There was no doubt that, despite some progress since the Committee had adopted resolutions WPR/RC22.R3 and WPR/RC23.R4 in 1971 and 1972, national capabilities for planning and developing occupational health r - .. ~- REPORT OF THE REGIONAL COMMITTEE 17 services needed to be strengthened. Workers in small industry and in agriculture, and migrant workers, were under-serviced and presented the greatest problem. The Committee agreed with a Representative of Malaysia when he said that good relationships between the Ministry of Health and the Ministry of Labour were of great importance for occupational health ac ti vi ties. It noted that the School of Public Health, University of Otago awarded a diploma in industrial health and that the diploma of public health there had a strong occupational health component. A Representative of the Philippines referred to "work-related situations". As more and more women joined the labour force, there were repercussions on the health of infants and older children left without adequate care. Health education in the factories was needed. A Representative of China referred to the necessity for unified leadership in occupational health matters together with laws, regulations and criteria, all of which existed in China; to the fact that much depended on prevention; and to the fact that international ana bilateral cooperation should be intensified. The Committee adopted a resolution recognizing the need to strengthen national capabilities for planning and developing occupational health services; urging the collaboration of Member States in developing knowledge and practice; and requesting the support of the Regional Director in intensifying the efforts of the World Health organization towards occupational health (see resolution WPR/RC29.R14). 7. Host A reement between the Government of the Re ublic of the Philippines and the World Health organization Document WPR RC29/16) The Committee noted document WPR/RC29/l6, which set out the present situation with regard to the renegotiation of Section 22(g) , Article VIII of the Host Agreement between the Government of the Republic of the Philippines and the World Health Organization. It noted the remarks of a Representative of the Philippines and the Regional Director and asked them to continue negotiations in order to arrive at a satisfactory conclusion and to report on the progress made to the thirtieth session of the Committee (see resolution WPR/RC29 .R9) • 8. Time and place of the thirtieth and thirty-first sessions of the Regional Committee The Committee reiterated with pleasure its acceptance of the invitation of the Government of Singapore, which had now been confirmed, to hold the thirtieth session in Singapore. It decided that the dates of the session should be tentatively from 4 to 10 September 1979. 18 REGIONAL COMMITTEE: TWENTY -NINTH SESS ION The Committee also decided to hold the thirty-first session in Manila (see resolution WPR/RC29.R17). The Government of the Republic of Korea confirmed the tentative invitation made to the Regional Committee at the twenty-eighth session to hold a future session of the Regional Committee in Seoul. It proposed to extend the invitation for the thirty-second session. 9. Selection of to ic for.the Technical Presentation durin the thirtieth session of the Regional Committee (Document WPR RC29/l7) The Committee selected "Acute respiratory infections" as the topic of the Technical Presentation during the thirtieth session of the Regional Committee (see resolution WPR/RC29.R16). Since a number of representatives had strongly favoured the topic "IDmlUnization services and their evaluation" it was agreed that subject be discussed as an item on the Agenda of the thirtieth session. 10. Reports received from governments on the progress of their health activities The Chairman acknowledged the following reports presented to the Committee: (1) AUSTRALIA - National health activities during 1977-1978; (2) CHINA - Some major events in the health work of the People's Republic of China in the past one year since July 1977; (3) HONG lONG - Brief report on progress of health activities, 1977 ; (4) JAPAN - Report on the progress of health activities in Japan (1977) ; (5) MACAO - Brief report on the progress of health activities - 1971; (6) MALAYSIA - Brief report on the progress of health activities; (7) NEW CALEDONIA - Brief report on the progress of health activities, 1976-1977; (8) NEW ZEALAND - Brief report on the progress of health activities, 1977/78; (9) PAPUA NEW GUINEA - Brief health report; (10) SINGAPORE - Brief report on the progress of health activities; (11) SOCIALIST REPUBLIC OF VIET HAM - Health activities of the Socialist Republic of Viet Nam in 1977. -~ ?- REPORT OF THE REGIONAL COMMITTEE 19 PART IV. SUB-COMMITTEES OF THE REGIONAL COMMITTEE 1. Sub-Committee on the General Programme of Work The Committee noted that resolution WHAll.27 had been adopted by the Thirty-first World Health Assembly as a result of the Executive Board's organizational study on WHO's role at the country level. The resolution had requested the Director-General to re-examine the Organization's structures in the light of its functions. Document WPR/RC29/l8 contained a background paper prepared by the Director-General for that re-examination. It wal a very comprehensive and important document with far-reaching implications. Among the Iteps outlined for conducting the re-examination was a proposal tbat the Regional Committee should establish an ad hoc group or a sub-committee to carry out a study which would include conSUltations with governments. A report would then be submitted to the thirtieth session of the Regional Committee and a final regional report prepared, to enable the Director-General to present a global report to the Executive Board in January 1980. The Director-General described to the Committee the ideology which had prompted some of the personal reflectionl contained in his back- around paper. Representatives of Australia, China and the United States of America voiced the general opinion of the Committee that the Director- General's background paper was a most important document, to be given careful consideration. Since the Regional Committee for the Western Pacific had already established a sub-committee on the general programme of work, the Committee was of the opinion that the terms of reference of that Sub-Committee should be expanded, to enable it to study the Director-General's background paper in depth and carry out the tasks involved in the new study. A Representative of the United States of America stated that he hoped the Sub-Committee's new and tmportant responsibilities would not be diminished by its other responsibilities. The Committee agreed to change the membership of the Sub-Committee (see Section 1.1 below) and to ask the Sub-Committee to meet during the present session, with the new members, to discuss its expanded terms of reference and its method of work for the coming year (see Section 1.2 below) • 1.1 Membership of the Sub-Committee The Committee recalled that, at the twenty-eighth session, it had made the Sub-Committee on the General Programme of Work a standing sub- committee; it had added two members to the original four; and had decided that the membership should be reconsidered at the twenty-ninth session. It had also decided that, each year, two of the six members should retire and two new members be appointed. The four original members of the Sub-Committee were representatives of Australia, Fiji, Malaysia and Philippines. The two appointed at the twenty-eighth session were representatives of Japan and the Socialist Republic of Viet Nam. 20 REGIONAL COMMITTEE: TWENTY-NINTH SESSION Considering the fact that it was proposed to expand the terms of reference of the Sub-Committee to include the study on WHO's structures in the light of its functions, the Committee decided to expand the membership to seven, replace a representative of Fiji by a representative of Tonga and add a representative of New Zealand. It would reconsider the question of membership, including rotation, at the thirtieth session (see resolution WPR/RC29.RS). 1.2 Reports of the Sub-Committee The Committee considered the reports of two meetings of the Sub- Committee, held on 15 and 16 June and 23 August 1978. The report of the first meeting, presented to the Committee at the fifth plenary meeting, is attached as Annex 4 and that of the second meeting, presented to the Committee at the eighth plenary meeting, is attached as Annex 5. The Committee agreed with the recommendations contained in the two reports, including the expanded terms of reference listed in the second report to enable the Sub-Committee to undertake the study of WHO's structures in the light of its functions (see resolution WPR/RC28.R18). 2. Sub-Committee on Technical Cooperation among Developing Countries 2.1 Establishment of the Sub-Committee The Committee agreed to make the Sub-Committee on Technical Cooperation among Developing Countries a standing sub-committee of the Regional Committee (see resolution WPR/RC29.R19). 2.2 Reports of the Sub-Committee The Committee considered the reports of two meetings of the Sub- Committee, held on 13 and 14 June and 24 August 1978. The report of the first meeting, presented to the Committee at the fifth plenary meeting, is attached as Annex 6, and that of the second meeting, presented to the Committee at the eighth plenary meeting, is attached as Annex 7. The Representatives of Australia, China, Malaysia, Singapore and the United States of America voiced the Committee's agreement to the recommendations contained in the report of the first meeting of the sub-Committee. The Committee also agreed to the recommendations contained in the report of the second meeting (see resolution WPR/RC29 • R19) • REPORT OF THE REGIONAL COMMITTEE 21 PART V. RESOLUTIONS ADOPTED BY THE REGIONAL COMMITTEE WPR/RC29.Rl NOMINATION OF THE REGIONAL DIRECTOR The Regional Committee, Considering Article 52 of the Constitution; and In accordance with Rule 51 of its Rules of Procedure; 1. NOMINATES in the order of preference as indicated by the order of their election the names of the following parlons for the post of Regional Director for the Western Pacific: Dr Hiroshi Nakajima Dr Raja Ahmad Noordin 2. DECIDES that those names shall be submitted to the Executive Board; and 3. REQUESTS the Director-General to propose to the Executive Board that it authorize him to issue a contract to the Regional Director for a period of five years from 1 July 1979. Second meeting, 21 August 1978 WPR/RC29.R2 EXPRESSION OF APPRECIATION TO THE REGIONAL DIRECTOR The Regional Committee, Considering that Dr Francisco J. ny is leaving the World Health Organization on 30 June 1979, after serving for m~re than twenty-nine years, thirteen as Regional Director, 1. EXPRESSES its appreciation to Dr ny for his efficient leadership and management of the Regional Office for the Western Pacific, for his contribution to international public health, and for his tact in the promotion of international understanding; 2. DECLARES Dr Francisco J. ny, Regional Director Emeritus of the World Health Organization. Second meeting, 21 August 1978 22 REGIONAL COMMITTEE: TWENTY-NINTH SESSION WPR/RC29 • R3 REPORT OF THE REGIONAL DIRECTOR The Regional Committee, Having reviewed the short report of the Regional Director, covering significant matters and developments resulting from the work of the World Health Organization in the Western Pacific Region during the period 1 July 1971 to 30 June 1978,1 1. NOTES with satisfaction the progress achieved; 2. COMMENDS the Regional Director and his staff for the work accomplished. WPR/RC29.R4 Fifth meeting, 23 August 1978 WESTERN PACIFIC REGIONAL CENTRE FOR THE PROMOTION OF ENVIRONMENTAL PlANNING AND APPLIED STUDIES (PEPAS) The Regional Committee, Having reviewed resolution WPR/RC28.R13, adopted by the Committee at its twenty-eighth session, by which the Advisory Committee to the Western Pacific Regional Centre for the Promotion of Environmental Planning and Applied Studies (PEPAS) was established, and in particular operative paragraph 7; Having further considered the frequency with which the Advisory Committee should meet; DECIDES that the Advisory Committee should meet as often as the Regional Director considers it to be necessary but, in prinCiple, once every two years. Fifth meeting, 23 August 1978 1 Document WPR/RC29/7. -- REPORT OF THE REGIONAL COMMITTEE 23 WPR/RC29.R5 RESOLUTIONS OF REGI<EAL INTEREST ADOPTED BY THE THIRTY- FIRST WORLD HEALTH ASSEMBLY AND THE EXECUTIVE BOARD AT ITS SIXTY-FIRST SESSION The Regiona 1 Committee TAXES NOTE of the following resolutions adopted by the Thirty-first World Health Assembly and the Executive Board at its sixty-first session: WHA31.10 - Medium-term programming for the implementation of the Sixth General Programme of Work covering a specific period (1978-1983 inclusive) W8A3l.ll - Development of health programme evaluation W8A31.12 - Country health programming WHA31.20 - Development of health information systems W8A3l.24 - Members in arrears in the payment of their contributions to an extent which may invoke the provisions of Article 7 of the Constitution W8A3l.27 - Organizational study on WHO·s role at the country level, EB61.B34 particularly the role of the WHO representatives WHA3l.32 - Action programme on essential drugs WHA31.33 - Drug policies and management: medicinal plants WHA3l.34 - Action programme of appropriate technology for health WHA31.43 - Managerial process for health development WHA3l.44 - Programme on diarrhoeal diseases control WHA3l.5l - Coordination within the United Nations system: activities financed from extrabudgetary sources within the United Nations system WHA3l.53 - Expanded programme on immunization WHA3l.54 - Smallpox eradication programme - current status and certifica tion WHA3l.55 - Maternal and child health EB6l.R29 - Long-term planning of international cooperation in cancer research Fifth meeting, 23 August 1978 24 REGIONAL COMMITTEE: TWENTY-NINTH SESSION WPR/RC29 • R6 BUDGET PERFORMANCE 1977 - DIRECT SERVICES TO GOVERNMENTS The Regional Committee 1. NOTES the report of thelRegional Director on budget performance for the financial year 1977; and 2. REQUESTS the Regional Director to make reports of a similar nature to future sessions of the Regional Committee WPR/RC29 • R7 Seventh meeting, 24 August 1978 PROPOSED PROGRAMME BUDGET ESTIMATES FOR THE BIENNIUM 1980-1981 The Regional Committee, Baving examined the proposed programme budwet estimates for the biennium 1980-1981 to be financed from the regular budget and other 80urces of funds,2 REQUESTS the Regional Director to transmit the proposals to the Director-General for consideration and inclusion in his proposed programme budget for the biennium 1980-1981. Seventh meeting, 24 August 1978 WPR/RC29.R8 MEMBERSHIP OF THE SUB-COMMITTEE ON THE GENERAL PROGRAMME OF WORK The Regional Committee, Notwithstanding resolution WPR/RC28.R20, which contains operative paragraphs relating to the membership of the Sub-Committee on the General Programme of Work, 1. DECIDES that the membership of the Sub-Committee be revised as follows : (1) the membership be expanded to seven; (2) a Representative of Fiji be replaced by a Representative of Tonga; (3) a Representative of New Zealand be added to the membership of the Sub-Committee; lDocument WPR/RC29/3. 2Document WPR/RC29/4, Add.l and Corr.1. REPORT OF THE REGIONAL COMMITTEE 25 2. APPOINTS the Representatives of Australia, Japan, Malaysia, New Zealand, Philippines, Socialist Republie of Viet Nam and Tonga members of the Sub-Committee until the thirtieth session of the Regional Committee, when the question of membership, including rotation, will be considered again. WPR/RC29.R9 Seventh meeting, 24 August 1978 INTERPRETATION OF THE HOST AGREEMENT BETWEEN THE GOVERNMENT OF THE REPUBLIC OF THE PHILIPPINES AND THE WORLD HEALTH ORGANIZATION The Regional Committee, Recalling resolution WPR/RC28.R5 on the interpretation of the Host Agreement between the Government of the Republic of the Philippines and the World Health Organization signed on 22 July 1951, in particular Artiele VIII, Section 22(g); Having considered the information and the report presented by the Regional Director and the Representative of the Government of the Republic of the Philippines on the present situation; 1. NOTES the situation as it exists at present; 2. REQUESTS the Government of the Republic of the Philippines and the Regional Direetor to continue their negotiations and discussions in order to arrive at a satisfactory conclUSion; 3. FURTHER REQUESTS the Regional Director to report on the progress made at the next session. WPR/RC29.R10 Seventh meeting, 24 August 1978 WHO'S ROLE IN THE DEVELOPMENT AND COORDINATION OF BIOMEDICAL RESEARCH: GREATER INVOLVEMENT OF THE REGIONS IN RESEARCH The Regional Committee, Having considered the Regional Director's progress report on the increaSing involvement ·of the Western Pacific Region in the fevelopment and coordination of biomedical and health services research, 1. THANKS the Regional Director for his report; 1 Document WPR/RC29/ll, Add. 1 and Corr.l. 26 REr.lONAr. COMMITTEE: TWENTY-NINTH SESSION 2. NOTES with satisfaction: (1) the Regional Director's initiative in accelerating the flow of funds for research, which has made it possible to establish a substantial programme with a new multidisciplinary emphasis involving connllunication between scientists in the Region; (2) that all activities proposed at the second session of the Western Pacific Advisory Committee on Medical Research and endorsed by the Regional Committee have been implemented; (3) the increasing pace in decentralizing the activities of the global programme of research promotion and development; (4) the regionalization of the WHO Special Programme for Research and Training in Tropical Diseases which is proceeding satisfactorily; (5) the cooperation between the WHO Regional Offices for the Western Pacific and South-East Asia in implementing research activities; (6) the efforts being made to promote an interdisciplinary programme of research in diarrhoeal diseases; 3. ENDORSES the recommendations of the Western Pacific Advisory Committee on Medical Research, made to the Regional Director at its third session, which include proposals to: (1) strengthen: (a) the Institute of Medical Research, Papua New Guinea by establishing a pneumonia and acute respiratory disease research unit; and (b) the virus laboratory and related laboratory facilities, Fiji; (2) seek further financial resources for research activities in filariasis including support for the Institute for Medical Research, Malaysia, to expand its efforts in that area; (3) support research in clonorchiasis and paragonimiasis; (4) develop training in the epidemiology of noncommunicable and communicable diseases; (5) establish a panel of experts in health services research to support research in the Region; (6) convene a working group composed of librarians from the larger medical libraries in the Region to start planning a library network to improve the supply of literature to research workers in developing countries; (7) promote a regional symposium on parasite immunology; -< REPORT OF THE REGIONAL COMMITTEE (8) organize a meeting between the most appropriate individuals in Member States holding posts equivalent to that of director or leader of a national medical research council; 4. REQUESTS the Regional Director to tmplement the above-mentioned recommendations; 27 5. AUTHORIZES the Regional Director, should additional funds be forthcoming, to allocate them, with the concurrence of the Western Pacific Advisory Committee on Medical Research, to research activities which conform to the objectives of the regional programme, reporting on their use to the subsequent session of the Regional Committee; 6. REQUESTS Member States to: (1) establish appropriate codes and regulatory mechanisms to ensure that medical research is conducted according to ethical principles; (2) provide career structures which permit research workers to devote their ttme fully to research and which attract young workers. WPR/RC29 • RII Seventh meeting, 24 August 1978 SPECIAL PROGRAMME FOR RESEARCH AND TRAINING IN TROPICAL DISEASES: JOINT COORDINATING BOARD The Regional Committee, In accordance with the Memorandum of Understanding on the Advministrative and Technical Structures of the Special Programme for Research and Training in Tropical Diseases,l SELECTS as the two Member States of the WHO Western Pacific Region whose representatives shall be members of the Joint Coordinating Board, the Philippines, for a period of two years up to 31 December 1979 and Malaysia, for a period of three years up to 31 December 1980, commencing on I January 1978. WPR/RC29.R12 Seventh meeting, 24 August 1978 REGIONAL COORDINATING GROUP ON THE MENTAL HEALTH PROGRAMME The Regional Committee, Realizing the growing world-wide concern for problems of mental health, not least the importance of psychosocial factors in relation to health as expressed in resolutions WHA27.53 and WHA29.2l; lDocument WPR/RC29/12 and Add.l. 28 REGIONA I. C(JMMlITEE: TWENTY -NINTH SESS ION Noting with satisfaction the broad emphasis on social relevance in the regional mental health programme and the steps already taken towards implementing that programme; Recognizing the immense impact on health experienced throughout the Region as a result of rapidly changing life styles and value systems; Recognizing further the need to ensure that mental health programmes at national and regional levels are coherent, socially relevant and better coordinated; 1. URGES Member States to formulate or review, as necessary, mental health policies within overall health policies; consider establishing national coordinating mechanisms for mental health programmes; and intensify collaboration with WHO; 2. REQUESTS the Regional Director to establish a coordinating group for the regional mental health programme in order to strengthen and facilitate collaboration with the global coordinating group as well as with Member States; 3. AUTHORIZES the Regional Director to appoint the members of the coordinating group and convene meetings of the group as and when necessary. Seventh meeting, 24 August 1978 WPR/RC29.R13 ANTIMALARIA PROGlWIME The Regional Committee, Baving considered the information presented by the Regional Director on the current status of the antima1aria programme in the Western Pacific Region;l Noting with concern that in several countries or areas of the Region the programme has lost momentum dur.ing recent years and in some has even shown signs of deterioration; 1. URGES Member States to: (1) continue, and where necessary strengthen, the support given to the antimalaria drive in order to improve the epidemiological situation, particularly among underprivileged groups in remote rural areas; (2) assign priority, in the accelerated development of a genuinely effective integrated rural health infrastructure that reaches the periphery, to the more malarious regions and, ,towards this goal, solicit the cooperation of other agencies involved in rural development; lDocument WPR/RC29/14. J REPORT OF THE REGIONAL COMMITTEE 29 (3) study alternative approaches to the control of malaria in areal where conventional measures have failed to produce the desired effect and promote other applied field research activities in an attempt to resolve immediate problems; (4) give appropriate attention to the development of health man- power with adequate orientation in malaria; 2. APPEALS to those Member States of the Region in a position to do 10 to support the antlmalaria programme; in particular: (1) programmes in which, without such support, only a minimal degree of malaria control over extensive areas could be achieved; (2) such specific undertakings as would greatly enhance national capabilities to achieve self-reliance in malaria control, including the production and/or formulation of antimalarial drug. and insecticides; 3. BEQUESTS the Regional Director to continue: (1) to explore sources for providing adequate training and orientation on malaria for staff of the general health services and the antlmalaria services in particular; (2) to cooperate with Member States in studying and developing alternative approaches to the control of malaria, together with other applied field research activities; (3) to cooperate with Member States in strengthening malaria vigilance operations in countries in the maintenance phase; (4) to report on the situation at the thirtieth session. Seventh meeting, 24 August 1918 WPR/RC29.R14 WORJ(ERS' HEALTH The Regional Committee, Baving considered the report by the Regional Director on the workers' health programme in the Western Pacific Region;l Recalling resolution WHA29.S1 adopted by the Twenty-ninth World Health Assembly; 1. THANKS the Regional Director for his report; lDocument WPR/RC29/IS and Corr.l. 30 REGIONAL COMMITTEE: TWENTY-NINTH SESSION 2. RECOGNIZES th~ need to strengthen national capabilities for planning and developing occupational health services; 3. URGES Member States to collaborate in developing knowledge and practice in detecting and controlling workers' health problems, including occupational and work-related diseases and disability, and measures for the effective prevention of occupational risks and diseases; 4. ENDORSES the strategies and approaches proposed by the Regional Director for a regional programme; 5. REQUESTS the Regional Director to intensify the World Health Organization's efforts in the Western Pacific Region towards coopera tion in: (1) improving preventive occupational health services at the national level and in work places, with the participation of workers themselves; and promoting the coordination of occupational health services between ministries concerned and national health programmes; (2) developing criteria and guidelines for the evaluation and prevention of occupational health hazards; (3) stimulating the monitoring of work environment and workers' health and promoting the application of occupational health epidemiology. Seventh meeting, 24 August 1978 wn/RC29.RlS PROGRAMME ON DIARRHOEAL DISEASE CONTROL The Regional Committee, Concerned by the rates of morbidity and mortality from acute diarrhoeal diseases, particularly in children; Having reflected on the discussion during the Technical Presentation, which stressed the health and socio-economic aspects of diarrhoeal diseases; Noting with satisfaction resolution WRA3l.44 and the action already taken by the Organization at the country and regional levels. in order to establish programmes aimed at the control of diarrhoeal diseases; 1. URGES Member States of the Region to cooperate in the regional programme for control and to establish national progrflmmes within the framework of primary health care; REPORT OF THE REGIONAL COMMITTEE 2. REQUESTS the Regional Director: (1) to solicit from Member States contributions, in funds or in kind, towards the development of the programme of diarrhoeal diseases in developing countries of the Region; (2) to cooperate with UNICIF and other international and national .gencies in obtaining support for .ction ag.inst diarrhoe.l disease.; 31 (3) to promote technic.l cooperation with and among Member State., in particular in the training of health workers at different levels and in the .xch.ng. of .xp.ri.nc. g.in.d by tho.e Member State.; (4) to promote r .... rch .ctiviti ••• tm.d .t the d.v.lopm.nt and ev.lu.tion of v.riou. .y.tems of di.rrhoe.l di.e ••• control in rural .nd .ub-urb.n popul.tions .t high ri.k; 3. REQUESTS the •• Sional Dir.ctor to k •• p th. R.gional Committ.e informed of the progr ••• mad. in the impl.mentation of the reSional programme on diarrhoeal di •••• e. control. Eighth meeting. 2S Augu.t 1978 WPR/RC29 • R16 TOPIC OF TECHNICAL PRESENTATION IN 1979 The Regional Committee, Having considered the topics suggested by the Regional Director for the Technical Presentation during the thirtieth session of the Committee,l DECIDES that the subject for the Technical Presentation in 1979 shall be "Acute respiratory infections". Eighth meeting, 25 August 1978 WPR/RC29.R17 THIRTIETH AND THIRTY -FIRST SESS IONS OF THE REGIONAL COMMITTEE The Regional Committee 1. EXPRESSES its appreciation to the Government of Singapore for confirming its offer to act as host to the thirtieth session of the Regional Committee; l»ocument WPR/RC29/17. 32 REGIONAL COMMITTEE: TWENTY-NINTH SESSION 2. CONFIRMS that the thirtieth session will be held in Singapore, the tentative dates being from 4 to 10 September 1979, provided mutual agreement is reached between the Government and WHO by 31 March 1979; 3. DECIDES that the thirty-first session. in 1980, will be held at regional headquarters in Manila. Eighth .eeting, 2S August 1978 WPR./RC29 • R18 SUB-COMMITTEE em THE GENERAL PltOGRAMo1E OF WORK The Regiona I Comm! ttee. Baving cODaifered the reports of the Sub-Committee on the Gener.l Proar .... of Work, 1. AGREES with the recommendations contained in the two reports; 2. REQUESTS the Regional Director to take appropri.te .ction to put thoae rec0m.8ndationa into effect; 3. EXPANDS the terms of reference of the Sub-Committee on the Gener.l Progr .... of Work to include the study of WHO's structures in the light of its functioD8i 2 6. REQUESTS the Sub-Committee to submit a report on this study to the thirtieth session of the Regional Committee. WPlt/RC29 • R19 Eighth meeting, 2S August 1978 SUB-CmtfITTEE ON TECHNICAL COOPERATION AH>NG DEVELOPING COUNTRIES The Regional Committee. Baving considered the reports of t~e Sub-Committee on Technical Cooperation among Developing Countries, 1. AGREES with the recommendations contained in the two reports; 2. REQUESTS the Regional Director to take appropriate action to put those recommendations into effect; l»ocuments WPR./RC29/9 and WPR/RC29/20. 2Document WPR/RC29/1B. 3Documents WPlt/RC29/l0 and WPR/RC29/2l. REPORT OF THE REGIONAL COMMITTEE 3. DECIDES that the Sub-Committee should become a standing sub- committee of the Regional Committee; 33 4. CONFIRMS the decision taken at the twenty-eighth session that the membership of the sub-Committee remain the same during the twenty-ninth session and that it be reconsidered at the thirtieth session. Eighth meeting, 25 August 1978 WPR/RC29.R20 RULES OF PROCEDURE OF THE REGIONAL COMMITTEE FOR THE WESTERN PACIFIC The Regional Committee, In accordance with Rule 53 of the Rules of Procedure of the Regional Committee for the Western Pacific, 1. EStABLISHES a sub-committee to study Rule 51 of the Rules of Procedure of the Regional Committee; 2. DECIDES that the members of the Sub-Committee shall be a representative of Australia, France, Samoa and Singapore; 3. REQUESTS the Sub-Committee to report its recommentations to the Committee at the thirtieth session. Eighth meeting, 25 August 1978 WPR/RC29.R21 ADOPTION OF THE REPORT The Regional Committee, Having considered the draft report of the twenty-ninth session of the Regional Committee,l ADOPTS the report. Ninth meeting, 25 August 1978 lnocument WPR/RC29/22. 34 REGIONAL COMMITTEE: TWENTY-NINTH SESSION WPR/RC29. tt22 RESOLUTION OF APPRECIATION The Regional Committee, EXPRESSES its apprec1a tion a nd thanks to: (1) the Government and people of the Republic of the Philippines for acting as host to the twenty-ninth session and for their generous hospitality; (2) His Excellency the Minister of Health for having addressed the formal opening of the twenty-ninth session of the Regional Comm1. t tee; (3) the Chairman and other officers of the Committee; (4) Dr J.A.I. Nicholson, for acting as moderator of the Technical Presentation anel Dr I. CVjetanovic for _k1nS the Presentation; (5) the representatives of the United Nations Development Programme, United Nation. Children's Fund, International Labour Organisation, the South Pacific Commission and the non-governmental organizations for their statements; (6) the Regional Director and the Secretariat for their work 1n connexion with the ses8ion. . Ninth tlleeting, 25 August 1978 r REPORT OF THE REGIONAL CO*ITTEE ANNEX 1 LIST OF NON-GOVERNMENTAL ORGANIZATIONS WHOSE REPRESENTATIVES MADE STATEMENTS TO THE REGIONAL CmoftITTEE 35/36 Representatives of the following non-governmental organizations made statements to the Committee: WORLD COUNCIL FOR THE WELFARE OF THE BLIND INTERNATIONAL DENTAL FEDERATION CHRISTIAN MEDICAL COMMISSION THE WORLD MEDICAL ASSOCIATION, INC MEDICAL WOMEN'S INTERNATIONAL ASSOCIATION WORLD FEDERATIOit FOR MENTAL HEALTH IN'1'IRNATIONAL COUNCIL OF IUlSES PERMANENT COMMISSION AND INTERNATIONAL ASSOCIATION ON OCCUPATIONAL HEALTH WORLD FEDERATION OF OCCUPATIONAL THERAPISTS INTERNATIONAL FEDERATION OF OPHTHALMOLOGICAL SOCIETIES INTERNATIONAL COUNCIL OF SOCIETIES OF PATHOLOGY INTERNATIONAL PAEDIATRIC ASSOCIATION WORLD FEDIRATION OF PUBLIC HEALTH ASSOCIATI<lfS LEAGUE OF RED CROSS SOC IETIES REHABILItATION INTERNATIONAL INTERNATIONAL FEDERATION OF SPORTS MEDICINE WORLD VETERANS FEDERATION REPORT OF THE REGIONAL COMMITTEE 37 ANNEX 2 AGENDA 1. Opening of the session 2. Address by the retiring Chairman 3. Address by the Director-General 4. Election of new officers: Chairman, Vice-Chairman and Rapporteurs 5. Address by incoming Chairman 6. Adoption of the agenda 7. Proposed programme budget estimates, 1980 and 1981 8. Acknowledgement by the Chairman of brief reports received from governments on the progress of their health activities 9. Nomination of the Regional Director 10. Report of the Regional Director 11. Resolutions of regional interest adopted by the Thirty-first World Health A.semb1y and the Executive Board at its sixty-first seslion 12. Sub-Committee on the General Programme of Work 12.1 Report of the Sub-Committee 12.2 Membership of the Sub-Committee 13. Sub-Committee on Technical Cooperation among Developing Countries 14. 15. 16. 17. 18. 13.1 Establishment of the Sub-Committee 13.2 Report of the Sub-Committee WHO's role in the development and coordination of biomedical research: greater involvement of the Regions in research Special Programme for Research and Training in Tropical Di8eases: Joint Coordinating Beard: selection of government representatives Regional coordinating group on the mental health programme Status of the antimalaria programme Workers' health programme 38 REGIONAL COMMITIEE: 'lWENTY-NINTH SESSION 19. Host Agreement between the Government of the Republic of the Philippines and the World Health Organization 20. Statements by representatives of the United Nations, the Specialized Agencies, intergovernmental and non-governmental organizations in official relations with WHO 21. Selection of topic for the Technical Presentation during the thirtieth ses.ion of the Regional Committee 22. Time and place of the thirtieth and thirty-first sessions of the Regional Committee 23. Adoption of the report of the Committee 24. Closure of the session -- r REPORT OF THE REGIONAL COMMITTEE ANNEX 3 LIST OF REPRESEN~TIVES 1. REPRESEN~TIVES OF MEMBER S~TES AUSTRALIA Vi .. / Dr D.B. Travers (Chief Representative) CHINA ' FRANCE " First Assistant Director-General Medical Services Division Australian Department of Health , Mr K.J. Bareham First Secretary Australian Embassy in the Philippines \~ Dr Hsu Shou-jen Responsible Person Bureau of Foreign Affairs Ministry of Public Health Mr Sun Tsung-chiang First Secretary Embassy of the People's Republic of China in the Philippines (Alternate) (Chief Representative) (Al terna te) Dr Chin Wen-tao (Alternate) Associate Professor Department of Infectious Diseases Shanghai Dr Hu Ching-li Responsible Person Pediatrics Department Jui Chin Hospital Shanghai Mr Wu KDu-kao Staff Member Bureau of Foreign Affairs Ministry of Public Health M4decin G4n6ral M. Charpin Chirurgien des ~pitaux des Arm6es Directeur de la Sant4 en Nouvelle-Cal6donie (Alternate) , (Interpreter)' 40 REGIONAL COMMITTEE: TWENTY-NINTH SESSION ''! JAPAN , Dr T. Saburi (Chief Representative) Director-General Medical Affairs Bureau Ministry of Health and Welfare Dr A. Tanaka (Alternate) '. Director-General Public Health Bureau Ministry of Health and Welfare Dr F. Otani (Alternate) Councillor for Science and Technology Minister's Secretariat Ministry of Health and Welfare Mr S. Kaneda (Alternate) Director International Affairs Diviaion Minister's Secretariat ~ Ministry of Health and Welfare --.- Mr M. Taniguchi (AI temate) Minister Embassy of Japan in the Phi lippines Dr K. Kiikunl (Alternate) Technical Officer General Affairs Bureau Minister's Secretariat Ministry of Health and Welfare Mr T. Yano (Alternate) Second Secretary Embassy of Japan in the Philippines MALAYSIA Tan Sri (Dr) Raja Ahmad Noordin (Chief Representative) bin Raja Shahbudin -"<. Director-General of Health Ministry of Health Dr Abdul Talib bin Latiff (Alternate) Director of Health Ministry of Health Mr Wan Mamat bin Wan Muda (Alternate) Principal Assistant Secretary (International Health) Ministry of Health Mr Choo Eng Guan (Al ternate) Second Secretary Malaysian Embassy in the Philippines -,... NEW ZEALAND- PAPUA NEW ./ GUINEA PHILIPPINES REPORT OF THE REGIONAL COMMI'l'TEE Dr B.W. Christmas Deputy Director-General of Health (Public Health) Department of Health Dr A. Taru tia Secretary for Health Department of Health Dr M. Wainetti Assistant Secretary Medical Training Dr A.N. Acosta Assistant Minister of Health Ministry of Health Dr F. Aguilar Executive Director Project Management Staff Ministry of Health Dr J. Dizon Director Bureau of Health and Medical Services Ministry of Health Dr L.E. Manapsal Head Executive Assistant Ministry of Health Dr H. Bamiro Regional Director Ministry of Health Dr A. Angara Chief Division of Maternal and Child Health Ministry of Health (Chief Representative) (Alternate) . (Chief Representative) (Alternate) . (Alternate) \ (Alternate) (Alternate) (Alternate) . Mrs L. Zamora (Alternate) Health Adviser Ministry of Health Counsellor E.C. Garrido (Alternate) Office of United Nations Affairs and International Conferences Ministry of Foreign Affairs 42 REGIONAL COMMITrEE: TWENTY-NINTH SESSION PORTUGAL \ REPUBLIC OF kOREA SAMOA SINGAPORE SOCIALIST REPUBLIC OF VBT HAM Dr J.H.E. Pialho Acting Director of Medical and Health Servic'es Macao Mr Chang Souk Kim (Chief Representative) Counsellor Embassy of the Republic of Korea in the Philippines Mr Woo Sang Lee (Alternate) Second Secretary and Consul Embassy of the Republic of Korea in the Philippines Mr Moo Geun Jeon (Alternate) Director Division of International Affair. Ministry of Health and Social Affairs Mr Chang Soo Kim International Organizations Division I Bureau of International Organizations Ministry of Foreign Affairs Dr Solia Tapeni Faaiuaso Acting Director of Health Health DeparbDent Dr Andrew Chew Guan Khuan Permanent Secretary (Health)1 Director of Medical Services Mr Nguyen Van Trong Directeur D6partement des Relations ext'rieures Minist~re de la Sant4 Dr pham Ngoc Que D4partement des Relationa exUrieures Minist~re de la Sant4 (Alternate) (Chief Representative) (Alternate) REPORT OF THE REGIONAL COMMITTEE Itl --------------~~~~~~~~~~~~~~~------------------ TONGA UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND Or S. Foliaki Uire~tor of Health Dr J.A.B. Nicholson Medical Adviser Ministry of Overseas Development London UNITED STATES, Dr R. Fischer OF AMERICA Associate Director Office of International Health Department of Health, Education and Welfare Washington Dr G. Van Der Vlugt United States Agency for International Development ManUa (Chief Representative) (Adviser) II. REPRESENTATIVES OF THE UNITED NATIONS AND RELATED ORGANIZATIONS UNITED NATIONS DEVELOPMENT PROGRAMME UNITED NATIONS CHILDREN'S FUND INTERNATIONAL LABOUR ORGANISATION Mr B. Devarajan Resident Representative of the United Nations Development Programme in the Philippines Mr A.Y. Morvan United Nations Development Programme in the Philippines Dr Wah Wong UNICEF Representative Manila Mr M.N. Unni-Nayar Director ILO Area Office in the Philippines 44 REGIONAL COMMITTEE: TWENTY-NINTH SESSION III. REPRESENTATIVES OF OTHER INTERGOVERNMENTAL ORGANIZATIONS SOUTH PACIFIC COMMISSION Dr T. Kuberski Epidemiologist South Pacific Commission New Caledonia IV. REPRESENTATIVES OF NON-GOVERNMENTAL ORGANIZATIONS INTERNATIONAL UNION OF ARCHITECTS WORLD COUNCIL FOR THE WELFARE OF THE BLIND INTERNATIONAL SOCIETY OF BLOOD TRANSFUSION INTERNATIONAL DENTAL FEDERATION INTERNATIONAL DIABETES FEDERATION WORLD FEDERATION FOR MEDICAL EDUCATION INTERNATIONAL EPIDEMIOLOGICAL ASSOCIATION Mr C.A. Santos-Viola Philippine Institute of Architects Mr H. Iwahashi Vice-President World Council for the Welfare of the Blind, and Chief Director Nippon Lighthouse Welfare Center for the Blind Japan Dr G.C. Caridad Philippine National Red Cross Dr P.E. Gonzales Makati, Metro Manila Dr R.C. Navia Manila Central University College of Dentistry Dr Lim Uy Ching President Philippine Diabetes Association Dr J. Cuyegkeng Vice President of the World Federation for Medical Education, and President Ramon Magsaysay Medical Center Professor P.C. Campos College of Medicine Philippine General Hospital REPORT OF THE REGIONAL COMMITTEE INTERNATIONAL HOSPITAL FEDERATION THE INTERNATIONAL LEPROSY ASSOCIATION CHRISTIAN MEDICAL COMMISS ION THE WORLD MEDICAL ASSOCIATION, INC MEDICAL WOMEN'S DfTERNATIONAL ASSOCIATION WORLD FEDERATION FOR MENTAL HEALTH INTERNATIONAL COUNCIL OF NURSES PERMANENT COMMISSION AND INTERNATIONAL ASSOCIATION ON OCCUPATIONAL HEALTH WORLD FEJERATION OF OCCUPATIONAL THERAPISTS INTERNATIONAL FEDERATION OF OPHTHAlMOLOGICAL SOCIETIES INTERNATIONAL COUNCIL OF SOCIETIES OF PATHOLOGY 45 Dr J.P. Caedo, Jr Council Member of the International Hospital Federation, and Director GSIS General Hospital Dr J.N. Rodriguez San Juan, Metro ManUa Dr S.M. Wale Silliman University Medical Center Dr A.Z. Romualdez President-Elect World Medical Association Dr P.D. Chua Secretary-Treasurer Confederation of Medical ASSOCiations in Asia and Oceania (eMMO) Dr F. del Mundo Director The Children's Medical Center Philippines, Inc Dr L.L. Ignacio Vice-President of the World Federation for Mental Health for the Western Pacific Region Mrs F.M. Valdez Member of the International Council of Nurses Board of Directors, and Chairman . Board of Nursing Professional Regulation Commission Philippines Dr B.R. leverente, Jr Philippine Refining Company, Inc Mrs S. De GUio World Federation of Occupational Therapists Regional Representative to WHO Region of Western Pacific "New Zealand Dr R. Fajardo Manila Doctors Hospital Dr E. Pantangco Ma1cati Medical Center 46 REGIONAL CO!l!ITrEE: TWENTY-NINTH SESSION INTERNATIONAL PAEDIATRIC ASSOCIATION WORLD FEDERATION OF PROPRIETARY MEDICINE MANUFACTURED INTERNATIONAL ASSOCIATION FOR CHILD PSYCHIATIY AND ALLIED PROFESS IONS WOBLD FEDERATION OF PUBLIC HEALTH ASSOCIATIONS LEAGUE OF BID CROSS SOCIETIES REHABILITATION INTERNATIONAL COUNCIL FOR INTERNATIONAL ORGANIZATIONS OF MEDICAL SCIENCES INTERNATIONAL FEDERATION OF SPORTS MEDICINE WORLD VETERANS FEDERATION Dr P. Santos Ocampo Secretary-General Association of Pediatric Societies of the South-East Asian Region Colonel J.P. cardenas, Jr Executive Director Drug AS8ociation of the philippines, Inc Dr D. V. Angtuaco Hi-Eisai Pharmaceutical Inc Dr L. Lapuz Taft Avenue, ManUa Dr J. Azurin World Federation of Public Health Associations Reaional Liaison Officer for the WHO Regional Office for the_ Western. Paci,fic, and Deputy Ministerof'Bealth Dr K. Seevara tnam League of Red Cro.. Societies Regional Officer for Asia and the Pacific Dr G.C. Caridad Assiatant Secretary General for Operations Philippine National Red Cross Professor C.A. Floro President The Philippine Foundation for Rehabilitation of Di.abled Dr D.J. Tablan The Philippine Foundation for Rehabilitation of Disabled Professor P.C. Campos College of Medicine Philippine General Hospital Dr P.V.J. Macarae$ Makati. Metro ManUa Dr P.R. Sotto Vice-President for Internal Affairs Veterans Federation of the philippines REPORT OF THE REGIONAL COMMITTEE ANNEX 4 REPORT OF THE SUB-COMMITTEE OF THE REGIONAL COMMITTEE ON THE GENERAL PROGRAMME OF WORK Manila, 15 and 16 June 1978 The Sub-Committee on the General Programme of Work held its second formal meeting in Manila on 15 and 16 June 1978. The following attended: Dr R. Cumming, Australia Dr J.B. Senilagakali, Fiji Dr T. Nose, Japan Dr E. Nakamura, Japan (Observer) Tan Sri (Dr) Raja Ahmad Noordin, Malaysia Dr F.N. Aguilar, Philippines Dr Nguyen Ba Can, Socialist Republic of Viet Nam Miss Le Thi Tu Ha, Socialist Republic of Viet Nam (Interpreter) The Sub-Committee elected Dr J.B. Senilagakali as Chairman and Dr R. Cumming as Rapporteur. In opening the meeting, Dr Francisco J. Dy, Regional Director, welcomed the members and expressed the hope that the discussions would be useful. 1. TERMS OF REFERENCE OF THE SUB-COMMITTEE. As discussed by the Sub-Committee at its initial meeting in TokYOl, it was stressed that the primary purpose of the Sub-Committee's work would be to review and analyze the impact of WHO's collaboration with countries rather than the activities of countries themselves. It was also decided that the Sub-Committee should initially concentrate on "Primary health care within the broad context of comprehensive health services, focussed particularly on the health manpower development aspects and the use of auxiliaries" • 47 It was further agreed that the members of the Sub-Committee should visit a number of countries in the Region to review activi\ies in this connexion. lSee Report of the Regional Committee for the Western Pacific, twenty-eighth session, October 1977, Annex 4, pages 59-61. 48 REGIONAL COMMITTEE: TWENTY-NINTH SESSION The following description of primary health care as agreed to by the Regional Conference on Primary Health Care' was accepted by the Sub-Committee: "A Primary health care programme is an intimately linked group of activities, closely and effectively coordinated with the social, economic and related health services to help individuals, families and communities deal with the many-sided problems of living, in particular with health problema. The programme is part of a responsible and accountable health service system. It recognizes and gives form to the dynamic and reciprocal interaction necessary between health and socio-economic factors; between the provider and the consumer, promoting personal and community responsibility and involvement in their own health care. Primary health care stresses the importance of health promotion and development, increasing the capability of individuals, families and communities to live a healthy life, without overemphasizing treatment of disease." 2. BACKGROUND At an informal meeting of the Sub-Committee held in Manila in November 1977, it was decided that the representatives of Fiji, Japan, and the Socialist Republic of Viet Nam should visit. Malaysia and the Philippines; and the representatives of Australia, Malaysia, and the Philippines should visit Fiji and Samoa (later changed to Tonga), the visits to be carried out in March/April 1978, and a report prepared for the Regional Committee on the findings. It was agreed that it would be relevant for the members of the Sub-Committee not only to look at the relatively new aspects of WHO's collaboration in primary health care, but also at the considerable collaboration in health manpower development such as, for example, in medical assistant or village health worker training. The countries named were all those in which it was felt there was sufficient activity to make a visit useful, and in which WHO's collaboration and its impact on the country could be observed. The guidelines prepared for the use of members in assessing the usefulness of WHO's activities in countries are attached as Appendix 1. The reports on the visits to the four countries are attached as Appendix 2. 1See Final Report of the Regional Conference on Primary Health Care, January 1978, page 6. - .. ( REPORT OF THE REGIONAL COMMITTEE 3. WHO'S PRESENT ROLE IN COLLABORATION WITH MEMBER STATES IN PRIMARY HEALTH CARE (a) The Sub-Committee noted the stimulating role which WHO has played in the Region in the propagation of the concepts of primary health care and associated community development. The intercountry multidisciplinary team based -in Manila has been of considerable significance in this respect. Ilr.l (b) Similarly, WHO country-based staff, in particular the WHO health services development teams (functioning in most developing countries in the Region) and the WHO Programme Coordinators (formerly known as the WHO Representatives)l have also had significant effects in stimulating and assisting in the development of primary health care concepts and programmes. (c) The Sub-Committee stressed, however, that the main impetus for development of primary health care services must come from the governments of Member States themselves. Cd) WHO's emphasis on country health programming (including the management aspects) has primary health care as one of its components. (e) WHO has stimulated field studies and research conducted by national and international agencies. (f) A number of other programmes in which WHO has collaborated over the years have important primary health care ~omponents. For example, environmental sanitation for which WHO normally has staff based in the countries and where the emphasis is particularly on rural water supply and rural sanitation. In many countries there is collaboration in the training of village health workers, medical assistants, health extension officers, nurses and midwives. Similarly, there are important primary health care components in communicable disease control, health laboratory services, the expanded programme on immunization, and in nutrition, where a Manila-based intercountry team is to be established. (g) WHO's activities in the primary health care programme have received· strong support from the fellowship programme and from the interchange of information and visits arranged by WHO. The national seminars on primary health care which have been held in the four countries visited by members of the Sub-Committee have played a most important role. (h) WHO's collaboration with other agencies, particularly UNICEF and UNDP, and with interested non-governmental organizations has also ensured that the primary health care programme is developed on a multisectoral basis. ISee resolution WHA31.27, WHO Official Records, No 247, page 17. 50 REGIONAL COMMITTEE: TWENTY-NINTH SESSION 4. ASSESSMENT OF WHO'S PRESENT ROLE An assessment of WHO's activities was made in each of the countries visited, using the guidelines given in Appendix 1. In general, the Sub-Committee felt that WHO's activities, up to the present, have played an important and valuable role in the development of primary health care, both directly, and indirectly through many of its other programmes. However, the Sub-Committee noted a number of areas of activity where it felt that WHO could play a more active role in collaboration with Member States. It also considered that Member States could make more effective use of WHO if they had more knowledge of its resources in experience and expertise. While WHO has been active in collaborating with Member States in the development of appropriate manpower, the Sub-Committee considered that area was worthy of every encouragement and study, particularly in terms of task definition in primary health care. The Sub-Committee felt it was too early to evaluate accurately the impact of WHO's primary health care activities at country level, but it did note that, in the countries visited, objectives to be attained had been clearly set out, at least in qualitative terms. 5. RECOMMENDATIONS FOR INCREASED IMPACT OF WHO'S COLLABORATION IN PRIMARY HEALTH CARE (a) WHO should play a more stimulating role in demonstrating to Member States the benefits of the primary health care concept and in overcoming resistance to change in this respect. (b) Countries should be more fully informed of WHO's resources so that they can make better use of the Organization's facilities with respect to primary health care programmes. (c) The collection, evaluation and exchange of all relevant experience and information in primary health care should be further developed. (d) Intercountry visits of workers responsible for, and involved in, primary health care should be encouraged. (e) WHO should give consideration to arranging meetings on a sub-regional basis of senior national personnel, particularly those dealing with policy and implementation of primary health care programmes. (f) WHO should continue to support national and intercountry seminars in order to stimulate primary health care development and, in particular, to encourage community participation. (g) Appropriate training modules in primary health care should be developed to fit local needs. / REPORT OF THE REGIONAL COMMITTEE 51/52 (h) In view of the fundamental importance of adequate numbers of appropriately trained health personnel for primary health care services, WHO should encourage further studies into that aspect. (i) In-house training and orientation should be continued to ensure that all WHO staff members are thoroughly conversant with primary health care concepts. (j) WHO should adopt a more flexible approach to the supply of basic equipment and the local costs involved in rural health facilities. (k) WHO should continue to promote the use of a list of essential drugs for primary health care, and as much self-reliance as possible in the provision of such drugs in primary health care including the use of loca11y- produced drugs such as medicinal plants and their derivatives. (1) WHO should continue to playa coordinating role with respect to bilateral programmes of technical cooperation in primary health car~. (m) The closest possible linkages should be maintained with the programme of technical cooperation among developing oountries (TCnC) and the concept of TCDC should be applied in all primary health care programmes. (n) Field studies and research by national and international agencies should be encouraged. (0) WHO should ensure that adequate evaluation is built into its collaborative programmes of primary health car~. 1 1. General REPORT OF THE REGIONAL COMMITTEE APPENDIX 1 GUIDELINES FOR ASSESSING THE USEFULNESS OF WHO'S ACTIVITIES IN COUNTRIES PARTICULARLY IN THE FIELD OF PRIMARY HEALTH CARE ACTIVITIES The following guidelines are intended for use by members of the Sub-Committee on the General Programme of Work for its assessment of WHO's role in primary health care developments at the country level. 53 The purpose of such an assessment is to lead to improvements in the orientation of WHO's cooperation with its Member States so as to render that cooperation more effective and more efficient. Time and other limitations dictate the nature of such an assessment, which will take the form of consUltations with individuals and groups in countries selected by the Sub-Committee and in agreement with the governments concerned. The members of the Sub-Committee will naturally wish to have consultations as broad as possible, not only with the national health administrations but also with representatives of other relevant social and economic authorities, as well as with the WHO Representative and representatives of other United Nations agencies and funding bodies, and of multilateral and bilateral agencies. 2. Questions for assessment The following questions might be usefUl for the assessment: 2.1 The rationale for WHO's involvement in primary health care activities 2.1.1 Are the problem areas where WHO has been cooperating with the country, or is planning to cooperate, of major public health importance for the country? 2.1.2 Does WHO's.involvement relate to programmes mentioned in the Organization's General Programme of Work or specific resolutions of the World Health Assembly, the Executive Board or the Regional Committee? Does WHO's involvement relate to relevant objectives of its medium-term programme? 2.1.3 Is WHO's involvement leading to identifiable improvement in the health status of the people concerned? 2.1.4 Is WHO's involvement promoting the progressive development in the country itself of the programmes concerned? 2.1.5 If WHO was not involved what effect would this have on the development of the health programmes concerned? S4 REGIONAL COMMITTEE: TWENTY-NINTH SESSION 2.2 Planning, management and evaluation of cooperative programmes/ projects in primary health care 2.2.1 Have objectives of the primary health care programmes/projects been clearly stated either in qualitative or in measurable terms? 2.2.2 Have appropriate plans of work, with a time schedule and milestones been established for the attainment of those objectives? 2.2.3 Have indicators been established for the evaluation of the efficiency of implementation and effectiveness of the primary health care programmes in solving the health problems concerned? 2.2.4 Have methods been clearly defined for implementing the primary health care programmes/projects and are they appropriate? 2.2.5 Are the investments in human and financial resources, as well as the physical faCilities, appropriate and adequate? 2.2.6 Is there appropriate and adequate collaboration between WHO and the national health authorities and institutions, and other relevant sooial and economic sectors, as well as other bilateral and multilateral agenCies? 2.3 Areas of cooperation 2.3.1 For which of the following types of activity has cooperation between WHO and the oountries concerned been found 'most fruitful?: (a) development of national health plans and programmes (such as country health programming); (b) formulation and management of health programmes/projects; (c) implementation of programmes/projects funded by other agenCies; (d) coordination of multilateral and bilateral cooperation, including the channelling of resources into priority programmes; (e) prOVision of equipment and supplies; (f) prOVision of fellowships. 2.3.2 What role is being fulfilled by the WHO Representative with respect to the above areas of cooperation? 2.3.2.1 Is the WHO Representative an active partner in the development of national health plans and programmes and in the formulation and management of health programmes/projects related to primary health care or other programmes? 2.3.2.2 What is the role of the WHO Representative with respect to the implementation of programmes/projects related/to primary health care funded by other agencies? REPORT OF THE REGIONAL COMMITTEE 2.3.2.3 Does the WHO Representative participate in coordinating multi- lateral and bilateral cooperation in the fields of health? 55/56 2.3.2.4 Is the WHO Representative involved in the selection of candidates for fellowships? 3. Conclusions 3.1 Do WHO's activities related to primary health care development in the country meet with the approval of the national authorities concerned? If not, what would they like to have changed or improved? 3.2 How can the rationale for WHO's cooperation in primary health care with its Member States at the country level be strengthened? 3.3 How can the planning, management and evaluation of cooperative programmes/projects in primary health care in countries be improved? 3.4 How can WHO's coordinating role be best fulfilled at the country level in order to ensure maximum benefit through cooperation between the national authorities, WHO and all other international, multilateral and bilateral agencies? REPORT OF THE REGIONAL COMMITTEE APPENDIX 2 VISITS OF THE MEMBERS OF THE SUB-COMMITTEE OF THE REGIONAL COMMITTEE ON THE GENERAL PROGRAMME OF WORK MALAYSIA AND THE PHILIPPINES Members of the visiting team Dr Nguyen Ba Can, Director, Department of Plan, Ministry of Health, Socialist Republic of Viet Nam Dr To Nose, Deputy Director, International Affairs DiVision, Minister's Secretariat, Ministry of Health and Welfare, Japan Dr JoB. Seni1agaka1i, Permanent Secretary for Health, Fiji MALAYSIA Dates of visit 26 February - 4 March 1978 General information Malaysia is a federation of thirteen states. Peninsular Malaysia consists of eleven states of the former Federation of Malaysia. East Malaysia comprises Sarawak and Sabah on the Island of Borneo. The Capital, Kuala Lumpur, is situated in Peninsular Malaysia. The population at the end of 1970 was 10 536 7430 In Peninsular Malaysia this is made up of Malays, Chinese and Indians. Health planning and development Malaysia is now in the middle of its third development plan. Since Independence in 1957, considerable emphasis has been placed on rural health development. As a result, rural health services have been given prominence in federal budgeting. The main thrust has been directed to reducing poverty, disease and illiteracy and to bridging the socio-economic gap between the urban and rural population. Planning and programming of health service activities have been undertaken at federal, state and district levels and later, especially in the second and third development period, at community level with community participation. 57 58 REGIONAL COMMITTEE: TWENTY-NINTH SESSION The future of health services in Malaysia is embodied in the overall Government Development Plans. The Health Plan is part and parcel of the Government's total socio-economic programme based on the New Economic Policy. It is designed to improve coverage and attain equitable and balanced distribution of the health services. The health and family planning programmes, together with other social programmes in the fields of education, housing, et~., have an important role to play in the achievement of the objectives of the New Economic Policy. The provision of improved health services will not only lead to better quality of life through general improvement of health conditions but, by reducing loss of working hours through illness, will increase labour productivity. Family planning leading to the desired level of growth of the population will also contribute to the development objectives of improving living standards in the nation. Health objectives To promote the health of the individual and of the nation as a whole so that they can measure up to the needs created by the country's economic development and continuing social progress; to develop a training capability within the country so that training programmes can be appropriately designed to suit local needs and dependence on foreign sources for training can be reduced; to produce and provide adequate and well-trained staff for all the services and at all levels; to achieve a well-balanced and well-distributed health service which is consistent, alert and resilient to the changing pattern of health problems and demands resulting from an improving socio-economic environment; to eradicate or control endemic communicable diseases and reduce human suffering and wastage; to support and complement the family planning programme; to provide high quality diagnostic and curative services so that maximum recovery is achieved in the shortest possible time; to provide high quality preventive and curative dental care to the people; to strengthen the pharmaceutical and medical supplies services in order to provide adequate support for all the other services to achieve their stated objectives and goals; to strengthen the health planning and implementation capability of the Ministry of Health not only at Headquarters but also at intermediate or state level; to continue and expand clinical research into local health problems. '- REPORT OF THE REGIONAL COMMITTEE System of rural health service In the thirteen states, health activities are coordinated and monitored by the Ministry of Health at federal level. Implementation of health policies is left to the state director of health services in each state, His health budget comes from a state budgetary allocation made by th~ federal Government. Each state is divided into administrative and health districts, the boundaries for both being in some cases not the sam~. In the health district there is good health coverage of the rural population. Peripherally, the target, and this has been achieved in most of the states, is to have a rural health clinic covering a population of 3000-4000. The clinic is known as the rural community clinic and is run by a community nurse who has had two years of training. She lives in a quarter-cum-clinic but, with the upgrading of the midwife clinic to the rural community clinic in the two tier delivery system of rural health services, separate accommodation is being slowly introduced. The original basic plan for a rural health unit comprises one main health centre, four health sub-centres and 20 midwife clinics, to serve a rural population of 50 000. As a result of a study, using operational research techniques, jointly conducted by WHO and the Government, it was decided to convert the three-tier system to a two-tier system (main health centre, rural community clinic). This will improve the level of service at the periphery as there will be a doctor and a dentist available for every 15 000/20 000 population instead of 50 000. The scope of service at the midwife clinic level will be expanded to provide rudimentary ambulatory patient care, maternal and child health care, family planning, et'J" in addition to the present domiciliary midwifery service; with the unipurpose midwife becoming a multipurpose community nurs~. The existing health infrastructure of the basic rural health service is estimated to be serving some 50% of the rural population. Although the Government is giving the highest priority to the development of basic rural health services, it is estimated that complete coverage of the rural population can only be achieved by 1990. Organizational str~cture Malaysia's health and medical care system may be characterized as a pyramid of referral institutiona. At the base of the pyramid is a network of community nurse clinics, providing outpatient and maternal and child health servicea. There are 1293 of these, supervised from sub-health centres. In the sub-health centre, hospital assistants, nurses, assistant nurses, midwives and public health nurses run the service, with regular visits from medical officers, dentists and sanitary inspectors from the main health centres. Each health district has a main health centre providing hospital and outpatient services. The staffing at that level is more elaborate and provides numerous auxiliary services. In each state there is a general hospital to which referral is made from lower down the organization. 60 REGIONAL COMMITTEE: TWENTY-NINTH SESSION The health service operational area ends at the community nurse level where the health of the people is looked after in their respective areas, especially in maternal and child health services. At village level, health services are not yet properly organized although the village committee has responsibility for health. The Health Department has carried out a survey in 44 districts to identify underserved areas as well as local manpower and physical resources which can be utilized in planning a primary health care approach. The information is now being processed and indications are that, in many areas, the village people have the enthUsiasm to provide an organizational structure at village level to tackle health problems in their own are~o Health manpower development Malaysia trains a wide range of health workers to meet both its hospital and outpatient needs in the urban and rural areas. It trains physicians, hospital assistants, dentists, dental surgery assistants, dental nurses, nurse/midwives, assistant nurse/midwives, public health nurses, health inspectors, and assistant health inspectors, and public health nurses for rural health services. They provide services at different levels of the rural health organization structure. Primary health workers are considered to be those at the peripheral level such as the public health nurse/midwife and the community nurse. Collaboration with WHO WHO collaboration and assistance is seen at different levels of the health organization from federal to village level. At village level the malaria eradication project was the only area of WHO involvement. At other levels, especially at the rural community clinics, sub-health and main health centres, although currently WHO collaborative activity is not visible, WHO has contributed substantively in the development of the three-tier system and has partiCipated in operational research, leading to the reorganization of the health delivery system from the three-tier to the two-tier system. UNICEF involvement in health services delivery, through prOVision of medical equipment, was noticeabl~. WHO has collaborated with the Government, mostly at federal level, in various health activities which are passed down the organization for action. This mostly involves training of health personnel through WHO fellowships and implementation of World Health Assembly and Regional Committee resolutions. In relation to primary health care activities, a survey of underserved areas was initiated by the Government. WHO's collaboration will be in co-sponsoring the national workshop on primary health care in May 1978, follow-up with evaluative methodology and in-depth studies, as well as collaboration through intercountry projects. REPORT OF THE REGIONAL COMMITTEE General observation The Malaysian health service is very well organized from the federal level to the rural health units. However, better coverage is sttll to be attained. Indications are that this goal is within reach, with the survey to identify underserved areas and the proposal to incorporate the findings of the survey in the mid-term review of the Third Malaysia Plan in 1978 as an action plan for a primary health care strategy. 61 At the time of the visit, evidence of WHO's involvement in other major public health programmes was no longer visible, with the exception of malaria and environmental sanitation. By the very nature of its method of operation, WHO's collaborative effort is more evident at the central level, although the benefits do flow to the periphery where identification with WHO is not so apparent. The development of rural health services, including the establishment of the rural health training school, nutrition and health education are three areas where WHO collaboration has been most important. The role of the WHO Representative in relation to primary health care is not known yet, but he keeps in close touch with developments in that field. Most of what has been happening is mainly through the efforts of the Ministry of Health, which has requested WHO collaboration in the development of a national information system and through the services of the team for the promotion of primary health car~. PHILIPPINES Dates of visit 6-10 March 1978 General administrative and health organization The Philippine archipelago is made up of 7100 islands which are divided into 12 regions. Each region is made up of prOVinces, totalling 76 in the whole Republio. Each province is made up of municipalities and each municipality is made up of villages or barangays. The organization of the health service follows the administrativ~ organization and is headed by the Minister of Health. In the regions, the regional directors of health are the heads. At provincial level the provincial health officer is responsible for health matters. At the municipal level, the municipal health officer is responsible for municipal health matters and for the administration and operation of the rural health unit, consisting of a rural health centre and several barangay health centres. 62 REGIONAL COMMITTEE: TWENTY-NINTH SESSION The barangay forms the lowest level of the administration. This is equivalent to a.vi11age in Malaysia. Each barangay is headed by a barangay captain elected by the people, with a barangay council to assist him. System of health delivery The model for the health care delivery system is based on the level of health care, determined primarily by the size of the population and its geographical distribution and the number of health workers. Thus, there are six basic levels from which health services are provided. These are: (a) home level; (b) barangay level; (c) municipal level; (d) provincial level; (e) regional level; (f) state level. In all levels of the health care delivery system, different basic health services are provided for the population. The coverage and level of services provided varies from region to region and also within provinces, municipalities and barangays in the same re-gion. In the least developed regions, an attempt is being made to upgrade health services to meet national objectiveBo At national and regional levels, major health activities are confined to hospital services and the training of health manpowe!". In the rural health sector, there is a health centre and several barangay c1inicB. They form the rural health unit. The municipal health officer in the rural health unit visits the barangay health stations regularly. He is assisted at the unit by a public health nurse and a sanitary inspector. The use of health auxiliaries in the barangay health service, especially in Leyte and Laguna, needs special mention. These are not formally trained health professionals but members of the barangay with adequate education, who have been trained to provide basic health services so as adequately to meet the basic health needs of the people in the area they serve. It is not an extension of the existing government health system but a unit supported by the people in the community. The group noted the use of a village shop for consumable goods as a sales source for basic pharmaceutical products. REPORT OF THE REGIONAL COMMITTEE Health manpower development One of the problems facing the rural health service is the difficulty faced in attracting physicians to serve in the rural areas. As a consequence, the physician population ratio favours the urban centres. 63 There is therefore maldistribution of physicians in the country. To meet this problem a nine-step-Iadder course was introduced by the University of the Philippines, a government-financed training institution. The aim of the University of the Philippines academic programme is to produce the entire range of health care personnel from barangay health worker to fully-fledged doctor of medicine in a single, continuous and united curriculum. There are several points of entry and exit. The trainee, at the time of exit from the institution, is well equipped and prepared to fill a definite place in the delivery of health care at different levels of the health organization. There is no wastage in training and the system ensures full benefit from cost of training and fulfilment of the more capable and ambitious stUdents. The selection of students is left to the people where the health worker will work and the student has a moral obligation to the people who have selected him for training. This is the Tacloban project at the Institute of Health Sciences of the University of the Philippines system on the Island of Leyt~. Other universities train doctors and dentists and there are many institutions training nurses and allied health workers for both urban and rural health services. The Comprehensive Community Health Programme (CCHP) of the University of the Philippines system in Bay, Laguna is a good example of a training institution designed to provide health workers for the changing situation in health services delivery. Apart from research work and training of health personnel, the CCHP carries out many health programmes with community participation. It trains barangay health workers, pharmacy aids, dental aids and multipurpose health workers. The main objectives of the CCHP are: (a) to train students to become more effective health workers in a rural setting; (b) to develop strategies for a comprehensive health care delivery system at the primary level, as related to the total health care delivery system; (c) to provide services to the community through existing agencies and active participation of the people so as to provide the medium for training and research. The CCHP is an excellent example of training health auxiliaries for primary health car~. Field trip One of the observations that needs to be highlighted as a result of the visit to the barangay clinics is the lack of basic medical facilities which the barangay health workers have been trained to use during training at the provincial institutions. These include clinical thermometers, 64 REGIONAL COMMITTEE: TWENTY-NINTH SESSION sphygmomanometers and stethoscope~. Secondly, remuneration of barangay health workers, if continued under the present system from outside sources, might affect the primary health care delivery once the outside source is withdrawn. Collaboration with WHO WHO has closely collaborated with the University of the Philippines system in the Tacloban project by providing consultant services in research and development. Further collaboration is expected in curriculum development and evaluation of health manpower development. WHO has collaborated in primary health care seminars and the provision of fellowships. It has helped in public health programmes and communicable disease prevention and control. ---- REPORT OF THE REGIONAL COMMITTEE FIJI AND TONGA Members of the visiting team Dr D. Stanbury, Senior Medical Officer, International Health Branch, Department of Health, Australia Tan Sri Dr Raja Ahmad Noordin, Director-General of Health, Ministry of Health, Malaysia Dr F.N. Aguilar, Executive Director, Project Management Staff, Department of Health, Philippines FIJI Dates of visit 27-31 March 1978 General information Fiji is an independent Dominion within the British Commonwealth centrally situated among the other island territories of the South West Pacific, composed of 320 islands, 105 of which are permanently inhabited. 6S It has a total area of 18 272 square kilometers with Viti Levu as the largest island (10 386 sq. km.) and Vanua Levu (5 535 sq. km.) as the second largest. Of the 591 116 total population, 44.6% are Fijian, 50.6% are Indian, and 4.8~ are of other origin. SuVa is the Capital with a population of about 63 000. Fiji has all the advantages of a tropical climate without undue extremes of heat and humidity. The south-east trade winds blow from May to November, tempering the heat and bringing the temperature down. This is the driest period. Between November and April, the winds are more variable and temperature rises into the· low nineties with high humidity. Economy is dependent primarily on agriculture. The main crops are sugar cane and coconuts, which accounted for nearly two thirds of the total exports in 1976. Gold mining makes a valuable contribution to the export trade and manganese mining is fast developing. The population growth rate in 1975 was 2.3~, whereas the country is aiming at a rate of 2%. The crude birth rate, as recorded in 1975, was 29/1000 (29.30 /00), while the target was 25/1000. The crude death rate is 6.30 /00. Of the total number of deaths, 70~ were medically certified. 66 REGIONAL COMMITTEE: TWENTY-NINTH SESSION The leading causes of death are: heart diseases, senility, immaturity and early diseases of infancy, pneumonia, and neoplasms. Two diseases, heart diseases and diabetes, are of increasing importance in the country and will need special attention. The recurrent budget for health in 1975 was F$9 583 087 representing 9.38~ of the total recurrent budget for the country. The net expenditure for health amounted to F$l5.42 per capita. Medical expenditure has increased by more than 2l~ over the last year. General health services in Fiji Administration of health services The central health authority is the Ministry of Health whose responsibility is the administration and operation of the health services which are predominantly government, supplemented by 60 private medical practitioners, two private mission hospitals, 12 dentists, and a few other private health agencies. The Minister of Health is responsible for formulating health policies and legislation, assisted by the Permanent Secretary for Health. The Permanent Secretary for Health and two Directors of Medical Services are responsible for the implementation and smooth running of health policies and services. Administration at the regional level is carried out by divisional medical officers and their staff, responsible for their respective divisional health aotivities. The sub-divisional staff under a sub-divisional medical officer are responsible for curative and preventive servioes, assisted by area medical stations and district nursing stations which are in direct contact with the rural population. The training of health manpower needed by the health service delivery system at its various levels is the responsibility of the Fiji School of Medicine and the Fiji School of Nursing. There is minimal training activity going on at the field level. The health care delivery system The country has been divided into four divisions, not only administratively but also for the purpose of delivery of health services. A -- divisional general hospital of around 200 beds is at the division headquarters level and provides inpatient and outpatient care that cannot be met by the lower level sub-divisional hospltai of 12 to 52 beds, located at the sub-division headquarters. There are 15 sub-divisions in the country made up of 46 areas. Each area has a health centre, manned by a physician and a nurse. Within each area are district nursing stations manned by a district nurse. There are 86 nursing stations in the country. Urban and periurban areas have been divided into zones and are served by zone nurses (see page 75: (1) Table on Health Stations and Population served by Administrative Division as of end of 1976; (2) Pyramid of Fiji REPORT OF THE REGIONAL COMMITTEE Health Services). The health centre and the district nursing station are the first contact of the population with the health service and provide curative and preventive services in an outpatient capacity. 67 (a) Curative or therapeutic services. These are delivered by health personnel from special divisional and sub-divisional hospitals, health centres and district and zone nurses and vary from simple medical procedures and treatment at the lowest level to highly specialized services in the special and divisional hospitals. (b) Hospital services. Each division has a main hospital which provides outpatient and inpatient services for the population in the immediate vicinity: at Suva for the Central Division; Lautoka for the Western Division; Labasa for the Northern Division; and Levuka for the Eastern Division. The Colonial War Memorial Hospital, with a 331 bed capacity, is the most comprehensively staffed hospital, while the Lautoka Divisional Hospital, with a 220 bed capaCity, is the main specialist facility for the western part of Fiji. There are also 11 sub-divisional hospitals, three area hospitals, three special hospitals, and 44 health centres, operated by the Government, and two private hospitals subsidized by the Government. The basic unit in the structure of the Ministry of Health is the health centre, which provides both curative and preventive services. (c) Preventive services - The task of promoting family planning and health education has been assigned to the Family Health Unit of the Ministry of Health. Although family planning has been practised in Fiji for almost 15 years, it is the Government's concern to improve the protection rate and further motivate the people to accept family planning for their own and for the country's benefit. The Government has adopted family planning as a national policy. - Immunization activities are being undertaken by the district and zone nurses to .protect the population from infectious diseases. Coverage is very high and thus dramatic results have been obtained in preventing and reducing the incidence of tuberculosis, poliomyelitis, tetanus, whooping cough, diphtheria and rubella. - The health inspectorate personnel are responsible for the environmental health and sanitation activities in Fiji. They provide professional and technical advice to City Councils and rural authorities as to the legislation related to water supply, sewage, refuse disposal, etc. 68 REGIONAL COMMITTEE: TWENTY-NINTH SESSION - Maternal and child health.services are carried out by the nursing staff in the rural areas. Antenatal and postnatal clinics are conducted in all hospitals except the three special hospitals. - Fiji emphasizes preventive dentistry. Regular visits are made by the dental team to provide dental serviceB. - School health services are performed by the nursing staff who also regularly check on the immunization status of schoolchildren. Development of primary health care in Fiji In response to the resolution of the Twenty-eighth World Health Assembly stressing the need to accord high priority to the urgent task of promoting primary health care in order to improve the health of the under priVileged, a national seminar on primary health care was conducted in Fiji from 26 to 29 July 1977. It was a joint undertaking by the Ministry of Health, the World Health Organization and UNICEF, the aim of which was to enable exchange of views and experiences to help the Ministry of Health to introduce a new system of primary health care, based on community involvement and participation. Primary health care is provided through a reasonably good infrastructure of health serviceB. In addition to the divisional and sub-divisional hospitals, general and special hospitals and health centres mentioned earlier, 86 nursing stations in rural areas and 80 nursing zones in periurban areas are providing primary health care and are responsible for immunization, maternal and child health services, school health services and treatment of Simple ailments. There is a well established referral system. Because of the difficulties faced in delivering health care to all th~ people, especially those living in rural and remote areas, the Ministry of Health has conducted seminars on health education to enlist the support of rural populations to participate in providing basic health services. Sanitation in villages and settlements has been the responsibility of th~ people themselves with the supervision of the health inspectorate staff. Village health committees are being set up to provide a health clinic to b~ run by the people in the respective villages and settlements. The primary health care programme is being developed in five stages~ (1) dialogue with the people. Two sub-divisional heads have already been assigned to meet the people in their respective areas, where the pilot project is being carried out; , (2) collection of health information and data at village level by health workers and village people; (3) task analysis of future village health workers; (4) training of village health workers; REPORT OF THE REGIONAL COMMITTEE (5) setting up of village health clinics, feed-back, follow-up, and continuing education of village health workers. 69 The rural health problem is being tackled through a cooperative approach and ownership by the people, on a similar basis to the cooperative movement now well established in Fijian villages. Fiji's primary health care programme is part and parcel of Fiji's rural development programme. Collaboration with WHO WHO's role is to collaborate with the Government upon request and also to provide stimulation and information. WHO provides training possibilities through fellowships and courses but it should also be mentioned that Fiji provides placement for many WHO fellows from abroad at the Fiji School of Medicine. The WHO team for the promotion of primary health care and other Manila-based staff has collaborated with Fiji in primary health care development. The WHO Representative for the South Pacific, based in Suva coordinates WHO's collaboration with Fiji and is the key WHO staff member for the dialogue between WHO and the Government. This includes discussions and collaboration on primary health care. WHO maintains, based in Suva, intercountry teams who cover the South Pacific area, including Fiji. The main team concerned with primary health care is the public health advisory services team which is interdisciplinary and contains a public health administrator, a nurse/midwife, and a statistician. Other staff who relate in part to primary health care are a sanitarian and a sanitary engineer in an environmental health advisory services team. Fiji country staff include a laboratory adviser, a paediatrician, whose work also touches on primary health care, and a medical assistant training officer. WHO is collaborating with the Government in Fiji's country health programming exercises. 70 REGIONAL COMMITTEE: TWENTY-NINTH SESSION TONGA Dates of visit 1-6 April 1978 General information Tonga is a kingdom constituted under a monarch. The Kingdom includes some 169 islands, 36 of which are inhabited. It has a total land area of 289 square miles. Most islands are of coral limestone and generally low. The capital is Nuku'alofa on Tongatapu. The total population, as recorded in 1975, is 100 105. The 1966 census reveals that Tonga's population is almost homogeneous, with Tongans representing 98.3%. The climate from May to November is cool for the tropics, and humidity is low. December to April is the wet season when the temperature rarely rises above 900 , but humidity is high. Hurricanes occur occasionally, being more frequent in the northern part of the Kingdom. Tonga is an agricultural country, with agricultural products as the main export items. The Government has also started a deep-sea-fishing industry and tourism is of some importanc~. Some vital and health statistics are: rate of natural increase of population - 2.1%; crude birth rate - 240 /00; crude death rate - 2.840 /00. Only about 30% of deaths are medically certified. Less than 30% of births are delivered by traditional birth attendants. The ten leading causes of morbidity are: influenza, gastro-enteritis, broncho-pneumonia, infantile diarrhoea, dengue fever, lobar pneumonia, dysentery (all forms), filariasis, gonorrhoea and typhoid. The health recurrent budget for 1975-1976 was T$702 000 representing 11.9% of the total recurrent budget of the country. Per capita expenditure amounted to $7.0. General health services in Tonga The following remarks relate only to Tongatapu, as time precluded visits to other islands. REPORT OF THE REGIONAL COMMITTEE Administration of health services The Minister of Health is responsible for the formulation of policies and liaison with international agencies on medical and public health programmes, assisted by the Director of Health. The Director of Health is responsible to the Minister for the implementation and general administration of the various policies and programmes and the efficient running of the Ministry as a whole. 71 For administrative purposes, the Kingdom is divided into ten medioal and public health districts based on the location of the three hospitals and seven rural dispensaries. Four of the dispensaries have hospital beds. In all, there are 294 beds, giving a ratio of one bed for every 315 persons. In the Third Development Plan, five health units will be constructed and the existing rural dispensaries will function as health centres. Eaoh health centre will be manned by a doctor or medical assistant and a public health nurse who will be responsible for maternal and child health/family planning services. At the periphery there are at present 27 maternal and child health clinics staffed by a public health nurse, who is responsible for the maternal and child health/family planning service. Eight more maternal and child health clinics will be built during the Third Development Plan of 1975-1980. The policy is strategically to locate a health centre in a village or on an island with a surrounding population of at least 2000 people and to build more clinics at the periphery. Objectives and strategies The objectives and strategies of the health sector in the country's Third Development Plan of 1975-1980 are as follows: (a) to reduce further the rate of national growth through the strengthening of maternal and child health, family planning and health education programmes; (b) to reduce further the morbidity and mortality from preventable diseases to the lowest possible level, through intensification of the control of oommunicable diseases, health education, environmental sanitation, immunization, maternal and child health/school health, dental health, nutrition and medical care programmes; (c) to improve the early diagnosis and prompt treatment of preventable and non-preventable diseases, through medical oare, laboratory services, health education and training; 72 REGIONAL COMMITTEE: TWENTY-NINTH SESSION (d) to improve the capability of all levels of the health services in terms of physical and manpower resources, through greater emphasis on fully-integrated preventive and curative services and the placement of facilities at the periphery; (e) to increase the number and improve the effective working performance of health manpower, through recruitment and training. The health care delivery system Public health services are under the charge of the Senior Medical Officer, who is directly responsible to the Director of Health for their administration, and include environmental sanitation, community water supply, control of communicable diseases, maternal and child health/family planning services, health education and a health statistics unit. Health education aims at promoting public awareness and use of health services; providing training for health workers; establishing better working relationships between the Ministry and other related agencies; and the enlisting of community support for and acceptance of health programmes. Health services (a) the health centres, in addition to providing curative services, also provide a maternal and child health/family planning service; (b) family planning became accepted Government policy from 1962 and is implemented as an integral part of the maternal and child health services of the Ministry of Health in collaboration with WHO. The maternal and child health/family planning service is directly controlled by the central level. It was observed that the maternal and child health clinics have no resident nurses. They are usually transported by van daily to the clinics and surrounding villages. Generally maternal and child health/family planning clinic sessions are held weekly at the maternal and child health clinics and monthly at village level; (c) the immunization campaign is also operated from the central level by special staff who visit the clinics and villages. Immunization given is: DPT (triple vaccine), poliomyelitis vaccine, tetanus toxoid (to pregnant mothers) BeG and typhoid immunization to contacts; (d) dental care emphasizes preventive dentistry, provides a school dental service, and operates from the central level; (e) school health services are provided jOintly by public health, clinical and dental services; (f) the nutrition service is an integral part of the maternal and child health/family planning service and is provided through well-child clinics; REPORT OF THE REGIONAL COMMITTEE (g) the environmental sanitation campaign as far as Tongatapu is concerned, is operated from the central level by a staff of eight, including a senior health inspector, one health inspector, four assistant health inspectors, and two trainees, The Environmental Health Section of the Public Health Division at the Ministry is responsible for the improvement of environmental sanitation, communicable disease control, provision of safe water supply, sewage and domestic waste disposal, as well as for pollution control, covering both the towns and the villages, Hospital services 73 There are three hospitals in the Kingdom of Tonga, with a total capacity of 256 beds. There are also seven rural dispensaries located at: Mu'a and Kolovai on Tongatapu; Angoha on 'Eua; Nomuka and Ha'afeva in the Ha'apai group of islands; and one each on Niuatoputapu and Niuafo'ou. Some of those dispensaries have inpatient wards: at 'Eua with 16 beds; Nomuka with 6 beds; Ha'afeva with 6 beds and Niuatoputapu with 10 beds, There are, all in all, 294 hospital beds available throughout the Kingdom. With the exception of two outpatientcl1nics conducted by the Roman Catholic sisters and a school health centre established by the Latter Day Saints Mission for its high school at Liahona, all health services are the responsibility of the Government. There are no private medical practitioners in the Kingdom. Primary health care development in Tonga Tonga started to develop the concept of primary health care through a seminar on the subject held with WHO collaboration from 12 to 17 July 1977. The objectives of the seminar were: (1) to examine the strengths and weaknesses of the present health care delivery system; (2) to explore possible cooperation and collaboration among Government development programmes and community organizations; (3) to develop general guidelines for the future development of a primary health care programme for the country. Reliance is being placed on the active partiCipation of the Women's Committees at national and local level, It is hoped that those committees will initiate active community participation in the planning, implementation and evaluation of primary health care programmes. Other primary health care activities such as maternal and child health/family planning, immunization and environmental sanitation work are being undertaken by Government health workers who are not community based. The local Water Board is in charge of developing schemes for the supply of safe water to the communities, Linkages would need to be further established between the various sectors in regard to the development of a primary health care programma. 74 REGIONAL COMMITTEE: TWENTY-NINTH SESSION Collaboration with WHO The role of WHO is essentially the same as detailed in the Fiji report. In Tonga, however, WHO has fewer staff and direct collaboration at country level is through a laboratory adviser and a maternal and child health/family planning adviser. The bulk of collaboration in primary health care development comes from the intercountry teams based in Suva, particularly the public health advisory services team, and the Manila-based promotion of primary health care team. The WHO Representative has the same important role as for Fiji. A great deal has been done by WHO in the past in Tonga in environmental sanitation, which is basic to primary health care. In the development of Tonga's water supply, based on drilling into the fresh water lens floating on top of salt water under coral islands, WHO has played a major role. WHO has also collaborated with Tonga in health manpower development, particularly of nursing staff. ." REPORT OF THE REGIONAL COMMITTEE 75/76 TABLE HEALTH STATIONS AND POPULATION BY ADMINISTRATIVE DIVISION AS AT END OF 1976 District Nursing Zone Division Sub-divisions Health Centres Stations Nurses Population Number Number Number Number Central 4 12 16 23 206 875 Western 5 11 29 32 238 547 Northern 3 13 21 2 103 122 Eastern .2 10 20 gj 39 524 TOTAL 15 46 86 80 588 068 -- -- -- == =::==== THE PYRAMID OF FIJI HEALTH SERVICES PERMANENT SECRETARY FOR HEALTH HEADQUARTERS DEPARTMENTS TRAINING AND SPECIAL SERVICE MINISTER FOR HEALTH DCHS,DPMS,CNS,PHI,PAS FSM,FSN,CDO,SPECIAL HOSPITALS (4) DIVISIONAL HOSPITALS URBAN AND PERIURBAN POPULATION SERVED BY ZONE NURSES HEALTH CENTRES DISTRICT NURSING STATIONS Jl' JC • ,.. VILLAGES t '\ t\ II " " X It '" II II II •• X II '", C ,. /I II ,. II II A II I( II Primary health care programmes will be introduced at all levels marked "x" in the pyramid. Legend: CDO CNS DCMS DPMS FSM FSN PAS PHI - Chief Dental Officer - Controller of Nursing Services - Director of CUrative Medical Services - Director of Preventive Medical Services - Fiji School of Medicine - Fiji School of Nursing - Principal Assistant Secretary - Principal Health Inspector , REPORT OF THE REGIONAL COMMITTEE ANNEX 5 REPORT OF THE SUB-COMMITTEE OF THE REGIONAL COMMITTEE ON THE GENERAL PROGRAMME OF WORK Manila, 23 August 1978 The Sub-Committee of the Regional Committee on the General Programme of Work held its third formal meeting in Manila on 23 August 1978. Following the resolution adopted by the Regional Committee on the membership of the Sub-Committee, the following attended:' Dr D.B. Travers, Australia Dr F. Otani, Japan Mr T. Yano, Japan (Observer) Tan Sri (Dr) Raja Ahmad Noordin, Malaysia Dr B.W. Christmas, New Zealand Mr Nguyen Van Trong, Socialist Republic of Viet Nam Dr Pham Ngoc Que, Socialist Republic of Viet Nam (Observer) Dr S. Foliaki, Tonga The Representative of the Philippines was not able to attend. Tan Sri (Dr) Raja Ahmad Noordln was elected Chairman, and Mr Nguyen Van Trong, Vice-Chairman. 1. Terms of reference The Sub-Committee considered its terms of reference and agreed that, in addition to reviewing and analyzing the impact of WHO's collaboration with countr.ies, the Sub-Committee should, to enable it to carry out the tasks involved in the study of WHO's structures in the light of its functions,2 include the following: (1) to conduct the study in the Region together with the Regional Director on behalf of the Regional Committee; (2) to ensure adequate conSUltations with all governments of the Region on the basis of the Director-General's background paper, including selected visits to countries as necessary; (3) to monitor the progress of the study in the Region, making sure in particular that the necessary dialogues take place between governments and WHO; lSee resolution WPR/RC29.R8. 2See resolution WHA31.27, WHO Official Records, No 247, page 17. 78 REGIONAL COMMITTEE: TWENTY-NINTH SESSION (4) to prepare a report to the 1979 session of the Regional Committee based on the consultations with governments; and (5) to prepare a final regional report based on the discussion in the 1979 session of the Regional Committee so as to permit the Director-General to prepare his global report for submission to the Executive Board in January 1980. 2. Method of work during the coming year (a) WHO's structures in the light of its fUnctions The Sub-Committee recommended that all Member States in the Region be requested to comment on the document prepared by the Director-General,1 that the replies be collated in the Regional Office and presented for consideration to a meeting of the Sub-Committee to be held in Manila in late March 1979, after which a decision would be taken as to the further action required by the Sub-Committee to enable it to prepare a report for presentation to the thirtieth session of the Regional Committee. (b) Review and analysis of WHO's collaboration with countries The Sub-Committee decided that in relation to its studies on the General Programme of Work the subject for review for the coming year would continue to be primary health care including its health manpower development aspects. The Sub-Committee would also consider drug policies and management as it related to primary health care and certain aspects of disease control, e.g. tuberculosis. The Sub-Committee would as far as possible coordinate its work and meetings with the Sub-Committee on Technical Cooperation among Developing Countries. The Sub-Committee agreed that the Secretariat should decide on the splitting up of the Sub-Committee for country visits, and the countries to be visited. It was suggested that it would be more convenient for most members of the Sub-Committee to combine the meeting in late March 1979 with country visits, and that members should be informed by the Secretariat of the arrangements proposed as soon as possibl~. 'See document WPR/RC29/18. REPORT OF THE REGIONAL COMMITTEE ANNEX 6 REPORT OF THE SUB-COMMITTEE OF THE REGIONAL COMMITTEE ON TECHNICAL COOPERATION AMONG DEVELOPING COUNTRIES (TCDC) Manila, 13-14 June 1978 The Sub-Committee on Technical Cooperation among Developing Countries (TCDC) held its second meeting in Manila on Tuesday and Wednesday, 13 and 14 June 1978. The following attended: Dr E. Nakamura, Japan Dr Kyong-Shik Chang, Republic of Korea Dr J.M.J. Sup raman iam, Singapore (Chairman) The representative of Papua New Guinea was not able to be present. The following members of the Sub-Committee on the General Programme of Work attended as observers: Dr R. Cumming, Australia Dr J.B. Senilagakali, Fiji Dr T. Nose, Japan Dr Nguyen Ba Can, Socialist Republic of Viet Nam Miss Le Thi Tu Ha, Socialist Republic of Viet Nam (Interpreter) 19 1. In welcoming the members and opening the meeting, the Regional Director emphasized the importance of, and the commitment of the World Health Organization to, the principle of technical cooperation among developing countries. The Sub-Committee had before it resolution WHA31.41 a<:iopted by the Thirty-first World Health Assembly, a copy of which is attached as Appendix 1, together with a proposed regional schedule of aotion on TCDC as requested by the Sub-Committee at its initial meeting in Tokyo on 7 September 1977. 1 Discussions had been held between WHO Representatives and the relevant authorities in the following countries: Fiji, Lao People's Democratic Republic, Malaysia, Papua New Guinea and Republic of Korea. Information regarding the People's Republic of China and the Philippines came from a review of available project documents in the Regional Office. Information on the Socialist Republic of Viet Nam, although not received in time to be included in the paper, was taken into account during the discussion. ISee Report of the Regional Committee for the Western Pacific, twenty-eighth session, October 1977, Annex 5, pages 63-66. 80 REGIONAL COMMITTEE: TWENTY-NINTH SESSION As a result of the discussion, a plan of action (Appendix 2), a list of eXisting national programmes/projects having TCDC components (Appendix 3), and a list of those with potential for the development of TCDC (Appendix 4), were compil ed • In view of the broad scope of the subject, the Sub-Committee decided to discuss the promotion of TCDC in general, and to concentrate particularly on the TCDC aspects of two current priority areas: (1) primary health care (PHC) and (2) pharmaceutical and drug management and control. With regard to the former, the Sub-Committee also considered the primary health care aspects of appropriate technology for health including health laboratory serVices, health manpower development, and water supply and waste disposal systemB. The selection of primary health care as a priority area for discussion was most appropriate as it had also been chosen for consideration by the Sub-Committee on the General Programme of Work. The presence of members of that Sub-Committee proved useful in the deliberations. Specific TCDC activities to be undertaken in connexion with the two priority areas could be: study tours; exchange of information, experience, and research findings; collaborative research and development projeots; fellowships; adaptation of curricula for training of some categories of health manpower such as laboratory technicians and nursing personnel; and utilization of equipment and reagents in health laboratory services, The Sub-Committee recommended the following for the consideration of the Regional Committee: WHO should: (.1) promote the adoption of TCDC among Member States as a national policy, and request governments to take action to enhance their TCDC activities, so that mutual benefit can be derived through such collaboration; (2) encourage governments to create national focal points in order to stimUlate TCDCj (3) continue to gather information to enable the Organization to identify, with Member States, areas for further TCDC activities; (4) consider primary health care as a high priority programme for TCDCj (5) develop an impro.ved understanding of, and support for, the implementation of primary health care, which is of paramount importance to any national health programme. Areas in which such cooperation could be achieved include health manpower training, the coordination of immunization programmes, and stUdies to determine the applicability and acceptability of health activities in relation to the needs of the community. In conjunction with this and bearing the cost in mind, it is considered important for strengthening primary health care that appropriate technology, REPORT OF THE REGIONAL COMMITTEE 81/82 including suitable equipment and techniques, be developed. A good and safe water supply and adequate waste disposal facilities are also essential prerequisites, as unsafe water and unsatisractory sanitation are responsible for many diseases; (6) consider pharmaceutical and drug policies management and control as of priority for Member States in the Region. The areas in which technical cooperation could be achieved are: (a) the bulk purchase of drugs on a competitive tender basis and the import of raw materials to be made into pills, tablets, ampoules, etc; (b) the establishment of lists of essential drugs so as to decrease costs; (c) the enactment of legislation for the control or medicines and to provide for the quality control of drugs dispensed to the community; (d) making readily available biological products such as vaccines and antisera for use in emergency situations in Member States; (e) establishing research and study projects on traditional medicine and the use and evaluation, on a scientific basis, or medicinal plants; and (f) sharing the results of such studies and experience through a system of collaborative centres and cooperative relationships; (7) ensure the strengthening of collaboration with all relevant agencies and institutions in carrying out TCDC activities in the Region. The Sub-Committee proposed that the next programme to be considered should be health manpower development in general. REPORT OF THE REGIONAL COMMITTEE R1 APPENDIX 1 RESOLUTION OF THE WORLD HEALTH ASSEMBLY THIRTY-FIRST WORLD HEALTH ASSEMBLY WHA31. 41 TECHNICAL COOPERATION AMONG DEVELOPING COUNTRIES The Thirty-first World Health Assembly, 24 May 1978 Bearing in mind the resolutions of the United Nations General Assembly and Economic and Social Council on the importance of the·fullest possible economic and technical cooperation among developing countries, Mindful that many developing countrie.:, I~ttD!ber States of WHO, are developing and strengthening their programmes of health ne~~rk with the aim of attaining total population coverage in the shortest possible time that national conditions permit; Recalling resolutions WHA28.7S, WHA28.76, WHA29.48, WHA30.JO, WHAJO.43. EB60.R4 and EB61.R19 on programme budget policy and technical cooperation with developing countries; Convinced that technical cooperation among developing countries is an important instrument for technological liberation of developing countri.s particularly in the fields of research, development and training and exchange of experience and information on health care; Bearing in mind that health constitutes an integral component of overall development programmes of the developing countries for which appropriate mechani.ms of cooperation should be created at regional and interregional levels; Realizing that the developing countries have attained a degree of development allowing the establishment of profitable cooperation with mutual benefits, , ..• INVITES lhe Regional Committees: (1) to diacuss an~or reinforce at their 1978 sessions technical cooperation among. developing countries for the promotion of health care, and (2) to set up appropriate regional and interregional mechanisms for developing and strength~~ing TCDC, in health; 2. URGES Member states, and in particular the developing countries: (1) to cooperate among themselves for the development of their national health services; (2) to collaborate actively within their regions in the establishment and effective use of national .research and training centres; (3) to collaborate with WHO in the development and promotion of TCDC and in ensuring support for its realL?;ation; 3. REQUESTS the Director-General: (1) to strengthen WHO's programme of TCDC; (2) to collaborate with ~he developing countries for the establishment and promotion of TCDC; 84 REGIONAL COMMITTEE: TWENTY-NINTH SESSION (3) to .upport in all po •• ibla way., with the mean. at hi. di.po.al, the establishment and maintenance of the centre. for rene referred to in operative paragraph 2 (2) above; (4) to attract extrabud.etary fund. for the .upport of technical cooperation among developing countrie. on health project.~ (5) to report to the Thirty-.econd World Health A •• embly on progre •• made in this re.pect. * * * Thirteenth plenary meeting. 24 May 1978 A31/VR/13 \ -c 1. 2. 3. 4. TCDC as a national policy: Sources of identifica- tion for the TCDC plan of action Na tiona I TCDC focal point created: Coordination for TCDC at the country level by the WHO Repre- aentative2 I , TECHNICAL COOPERATION AMONG IEVELOPING COUNTRIES PlAN OF ACTION People 8 Lao People s Papua Republic Fiji Democratic Malaysia New of China Republic Guinea Formulated x Accepted in J)rinciple z x Not yet officially accepted UNDP country progra_ Country_health prograllDing x x Other sources (specify) x At the Ministry of Health In other ministries and departments Not yet created z x With the UNDP Resident Representative (INRES)1 x x With other United Nations Agencies x With national agencies involved x x I Information Referral System for Technical Cooperation among Developing Countries ~ow WHO Programme Coordinator Republic Solomon Philippines of Korea Samoa Islands x x x x x x x x x x x x x x x x x Tonga x x x x > "1:1 ~ ~ ~ N .:,r i E3 i J-:J ~ ~ E=1 Cl ~ I:"" (") ~ t-I a ~ 00 VI " 00 '" "S; / " EXISTlNG NATIONAL PROGRAMMES/PROJECTS WITH TECHNICAL COOPERATION AKJNG IEVELOPING COUNTRIES COMPONENTS Su~estions for imDrovement throuah Nature of the national Field for TCDC Present WHO National United Nations WHO Bilateral pro 1 ec ts/ proar8Dlles cooperation action ARencies Agencies PEOPLE'S REPUBLIC OF CHINAl Prima !I health care Exchange of Yes infol'llllltlon A22ro2riate techno lOBI for Study tours/ Yes health meetings Health man20wer devel0e!!nt Training in Yes acupuncture f!:!! 1. Fiji School of Medicine Training of health Provision of staff, + - + + manpower consultants, fellowships 2. Leprosy Training Centre, Fiji Training of leprosy Provision of inter- + - + + workers and country staff, research fellowships 3. Primary health care, Fiji Intercountry Advisory services + + + + visita, seminars by country and intercountry staff, supplies and equipment _L..-..---- -- -- --- - - - - - - lInformation taken from a review of documentation available in the Regionsl Office. > ." ." toS Z 0 ~ :>< w .~ ~ g ...; ~ ffl ~ (j) ~ I:"" n i ~ ~ toS -: • EXISTING NATIONAL PROGRAMHES/PROJEC1S WID TECHNICAL COOPERATION AMONG IEVELOPING COUNTRIES CQHlI(M;NTS (continuation) Su estions for rovemenf clIrou h Field for TCDC Present wm National United Nations WHO B ilateral coo eration action Agencies LAO PEOPLE'S DEMOCRATIC REPUBLIC 1. Primary health care - Develop a primary health care Exchange of Study tours and + + + network information meetings 2. Pharmaceuticals and dru lI'.an3gem~nt and_contro). - Development of traditional Exchange of Study tours. + + + + medicine information meetings. supplies and equipment MALAYSIA I Health se~ices development - Rural health services I (Exchange of WHO participated + ( information in development and ( operational (Field observation research Family health Technical coopera-' - Food and nutrition programmes I (Exchange of + + + ( information tion - Integration of family planning ( (Field observation ( (Training l ~ \ ' " 00 00 I~ (j) IS I~ ~ I~ 1t:rJ .~ 12: :;1 I~ I; en t-4 I~ 'I EXISTING NATIONAL PROGRAMMES/PROJECTS WITH TECHNICAl. COOPERATION AMONG DEVELOPING COUNTRIES COMPONENTS (continuation) Suggestions for improvement through Nature of the national Field for TCDC Present WHO National United Nations WHO Bilateral pro1ects/proRrammes cooperation action Agencies ARencies Pharmaceutical and drug 20licies management and control - Drug policies and management (Exchange of Technical coope- + (inf orma tion ration - National drug control laboratory ( (Fie ld vis i tI ( (Training Disease- 2revention and control - Control of dengue haemorrhagic (Exchange of Technical coops- + + + fever (informa tion ration ( - Disease surveillance (Pield viii tI Fellowships ( - Expanded programme ~n (Training immunization ( Promotion of Environmental Health - Community water supply project ( (Exchange of Technical coope- + + + - Excreta disposal. use of pour- (information ration flush toUets ( (Pield obserY.tion - Getting community involvement ( ~ "'~1.1. ~ ';j o ~ ~ ffl ~ c;') H ~ t"' (") ~ H ~ t>j 00 \0 EXISTING NATIONAL PROGRAMMES/PROJECTS WITH TECHNICAL COOPERATION AMONG DEVELOPING COUNTRIES COMPONENTS (continuation) Suggestions for improvement through Nature of the national protecta/prograames Health man20wer devel02!!nt • Public Health Institute: training of health education speclaliaU - Training of c~lty 'DUne/ a1dwives - Tralnlnl of traditioaal birth attendanta PAPUA NEW GUINEA . Health mane ower devel0e!ent - Faculty of Hedicine. Univeraity of Papua New GulDea • Port Horesby Collele of Allied Health Science. - Madana College of Allied Health Sciences - P9rt Moresby Hatioul Dental School ~ , Fleld for TCDC ( ( (Exchanle of (1nfomatlon ( (r1.1d vialt. ( ( traininl of health personnel fre. other developinl cauotrie. I I, Present WHO National United Nations Bilateral cooperation action Agencies WHO Agencies CoDlultanta + + + Technical coope- ratton + . + + Australian Papua New Guinea Education and Training Yes Scheme ~- , , I \0 o [:I C') S ~ t"' n i a " I drs ~ en till en en 1-1 i , ~ .,., EXISTING NATIONAL PROGRAMMES/PROJECTS WITH TECHNICAL COOPERATION AMONG I.:VELOPING COUNtRIES COMPONENTS (continua tion) SU~2estions for im~rovement through Nature of the national Field for TCDC Present WIlO National United Nations WHO Bilateral ~_roj ec ts U>r~~rammes cocperation action Agencies Agencies PHILIPPINES 1 Health maneower develo~ent - Institute of Public Health: Training of Consultantships, postgraduate training in public health personnel fellowships to health, hospital administration, Member States, nutrition. general programme development and support - Veterans Memorial Hospital Training in Fellowships and anaesthesiology consultantships - Ministry of Health Exchange of Sponsors study information and . visits/observations technical documents, field observa tion, inservice training in various fields Produc tion of reagents and simple laboratory equipment ~----- lInformation taken from a review of documentation available in the Regional Office. ., I I I , i = ~ i ~ ~ a ~ C") ~ i > t"'" i a tJr:.I '-0 J UISTDIG RATIONAL PlWGIWImS/PllOJECl'S VIm TECHRICAL COOKlATI(II AlDiC IEVEIDPIBC COUNTRIES ~ (continuation) SuaaeaUons for blDro..-at through Nature of the national Field for !CDC Preaent WHO Rational United Nations WHO Bilateral pro1eets/proaraDmJes cooperation action uenelea Alleneie. ~ Primary health care Intercountry Yea + + + + vi.ita, aeldnars SOWHClf ISLANDS Prt.a!Z health care Intercountry Yea + + + + viai ta. a .. iura ~ Primarl health care Intercountry Yea + + + +- visits, aeainara --- -- -_ ... _- - -_ ....... - - -- -- --- ~L..-- i ~ . ,. ~ 4, \0 to) = c:'l .... ~ t"4 n i· B e ~ ds ~ fI) till fI) en .... i ~ Nature of the national pro1ects/pro~rammes llll - 1979-1980 - A project on drug policies and management - South Pacific countries - Subregional research laboratory in Fiji (Wellcome Virus Laboratory) - South Pacific Centre for Management Training/ Country Heal th PrograDllling 1 NATIONAL PROGlWH:S/PROJECl'S WIm POTENTIAL FOR THE DEVELOPMENT OF TCDC u22estions for im Field for TCDC Prese!lt WHO National Uni ted Na tioIl8 coopera tion action Agencies To develop cooperative programmes on drug management and the bulk purchasing of drugs for some countries in the South Pacific To serve as a Yes New research and Zealand reference Medical laboratory for the Research South Pacific Council countries Production of reagents and simple laboratory equipment To develop a Yes Univer- - centre where dty of training South programmes and Pacific advisory service. may be available to South Pacific countries or area. ,~ WHO WHO Collabo- rating Centre for Virus Reference & Research. Melbourne, Australia + Bilateral Agencies I , Institute of Social and Adm1- nistrative Studies/ Universit}/ of the South Pacific + > 'V ~ ~ I-f >< .po ., = ~ t-i ~ i1 ~ ~ t"4 (') i ~ \0 ~ Nature of the national projects/progr81lllles LAO PEOPI.E' S DEMOCRATIC REPUBLIC Prima!2 heal th care As from 1979 - Acupuncture - Teaching of traditional medicine in medical and paramedical schools - Teaching of acupuncture in medical and parame- :' ~, dicd schools - Training of • national doctor,in malariology' - Training of • national medical .ssistant in entomology Pharmaceuticals and druS 201icies manasement and control - Development of research components on medicinal plants in the Department of Traditional Medicine of the MOH/Vientiane J NA'rIONAL PROGRAMHBS/PROJEC'rS WITH POTENTIAL FOIl ,THE DEVELOPMENT OF TCDC (continuation) Suggestions for improvement thIDu h I Field for TCDC Present WHO National United Nations WHO Bilateral! cooperation action Agencies Agencies i ! ! , I i I rralDina Fellowship + + - + I TralDlDg CcmsuI tants + + + + I i ! I I rrainlDg Consultanta ... + + + rralDlng Fellowship + - - -(l year) rralniDa Fellowship + - - -(6 months) Fundamental Consultants - + - + zesearch I L , , \0 ~ 1=1 n ~ I t:Iit I ~ fn pa fit fit ; .~ I 1, Nature of the national projects MAlAYSIA Prima!Z health care - Identification of underserved areas and local resources as basis for planning PRC strategy - Strategies for getting community involvement and participation - Health services research in under- served, served or over-served areas Health information slstem - Development of a health management information system , NATIONAL PROClW1MES/PROJECTS WITH PO'JD1'rIAL FOR THE DEVELOPMENT OF TCDC (continua tion) Sug~ estions for improvement through Field for TCDC Present WHO National United Nations WHO Bilateral cooperation action Agencies ~gencies Co-sponsoring + {Health (Training national workshop {services { (researel: (Exchange of ( (information (Evalua- ( ( tion (Field observation Exchange of ConauI tants + + information Field observation ------ -.-------~--- ., I £: ~ .; O· ~ S 1: G") i t"' n i a toll \0 VI Nature of the national projects/programmes PAPUA NEW GUINEA Ae2roeriate technoloBl for ~ - Malaria control programme - Institute of Medical Research. Goroka - Public Health Laboratory Services Department of Bea1 th ) NATIc:ttAL PROGRAMMES/PROJECTS WITH POlDTIAL FOR THE DEVELOPMENT OF TCDC (continuation) Suggestions for imProvement throu h Field for TCDC Present "'HO National Uni ted Na tiona WHO Bilateral cooperation action Agencies AJ!:encies Applied research Yes + + + - for development of community partici- pation in malaria control techniques Field trial of Yea + - + United pneumonia States of vaccination America Agency Applied research Yea + - + - on impact of rural water aupply on reduction of dbeasea Locally produced Yes + - + -kits for collection of water and dairy products Production of ,. reagents and simple laboratory equipment --- ----~ ) , , I , I I .< \0 0\ ~ t-f ~ t'" n i ~ I ~ !i! :it = en en a ., . '. ~ . NATIONAL PROGRAMMES/PROJECTS WITH POTENTIAL FOR THE DEVELOPMENT OF TCDC (continua tion) , Suggestions for improvement throu h I Nature of the national Field for TCDC Present WHO National United Nations WHO Bilateral I projec ts/programmes cooperation action A.8encies Agencies I . - Department of Health Research on deve- Yes + - + - lopment of appropriate diagnostic I techniques by using . medical laboratory assistants at rural health centres Pharmaceutical and druS To develop a Yes + +1 + +1 eolicies management and national processing or or control plant for drug - - tableting and packaging for domestic consump- tion as well as for supplying to neigh- bouring countries Prerequisite: A feasibility study -- -- , - --- - - ------- ------ ---- --------- ----- I Discussions on this particular aspect were inconclusive. ", ~ ~ ~ i = n .... i > t"f (") i § tzJ \0 " Nature of the national Droiects/Dro2rammes Water su~~ll and dis~osal system - Department of Health - Institute of Medical Research Health manDower develOPment - National Malaria Training Centre - Planned diploma courae in education of allied health personnel (National teacher training centre) - Training courae fo~ medical laboratory aasiatants .1 NATlmAL l'ROGlWIolES/PltOJECTS WITH PO'l'!NTIAL FOR THE DEVEIDPHENT OF TCDC (continua tion) Suggestions for i1lJl)rovement throu h Field for TCDC Present WHO National United Nations WHO Bilateral cooperation action A2encies AI!:e&'lcies Applied soclo- + + + - anthropological study on attitude of people towards water aupply and sanitary facilities Training of health Yea + - + -personnel from I other developiq Australianl countries Will be + - + Papua New i Guinea I Education and Train- ing Scheme Adaptatia. bJ other Ye. + - + - countrt .. of the traini., .. terials. docuaents and approaches to auit their local needs ~ ( , ( .' \0 00 E: en t-4 ~ t"' n ~ t-4 a tIa ~ ~ ds ~ = C'n C'n i -1 Nature of the national projects/programmes PHILIPPINESI Health manpower development - Institute of Public Health - College of Architecture, University of the Philippines - Institute of Health Sciences - Philippine Heart Center MinistrI of Health - Radiation Health Office Count!I health erosrammins collaboratina centre National Institute of Tuberculosis National Public Health LaboratorI , \ NATIONAL PROGIWH:S/PROJECTS WITH POTENTIAL FOR THE DEVELOPMENT OF TCDC (continua tion) Suggestions for imProvement throu h Field for TCDC Present WHO National United Nations Bilateral cooperation action Agencies WHO Agencies Training of Yes sanitarian Training of Fellowships architects in design of health facilities Training in Consultants primary health and grants care Training in Consul tants cardiology and fellowships Training in repair Consultants of X-ray equipment and fellowships Training in Still being formed country health on WHO promotion prograllDing and and support progr81lDe management Research and Consul tants training Vaccine production Consultants (needs further assistance) -~ IInformation taken from a review of documentation available in the Regional Office. "' ~ I"CI g to; ~ gJ ~ c;') t-I i > t"" n i B \0 \0 ...... t-' o o REPORT OF THE REGIONAL COMMITTEE ANNEX 7 REPORT OF THE SUB-COMMITTEE OF THE REGIONAL COMMITTEE ON TECHNICAL COOPERATION AMONG DEVELOPING COUNTRIES (TCDC) Manila, 24 August 1978 The Sub-Committee of the Regional Committee on Technical Cooperation among Developing Countries (TCDC) held its third meeting in Manila on 24 August 1978. The following attended: 1 • Mr T. Yano, Japan Dr M. Wainetti, Papua New Guinea Mr Moo Geon Jeon, Republic of Korea Dr Andrew Chew Guan Khuan, Singapore Dr Andrew Chew Guan Khuan was elected Chairman. Terms of reference 101 The Sub-Committee considered the suggestion for the next subject of study made at the second meeting of the Sub-Committee (see page 81) and agreed that for the following year the subject of study should be the TCDC components of health manpower development in the Member States of the Region. 2. Method of work for the next year The Sub-Committee endorsed close collaboration with the Sub-Committee on the General Programme of Work and agreed that there should be continuation of the desirable practice that members of one Sub-Committee should, as far as possible, be observers at meetings of the other. The Sub-Committee agreed that the next meeting of the Sub-Committee be held immediately before or immediately after the next meeting of the Sub-Committee on the General Programme of Work in late March 1979, a convenient timing to be decided by the Secretariat, who would also prepare appropriate background documentation for the meeting, after consultation with Member States in the Region. The Sub-Committee would decide at that meeting whether country visits were necessary. The Sub-Committee agreed that members would also provide to WHO any further information they had on existing and potential TCDC components in health manpower development and suggested that all countries be encouraged to do this. It was noted that the recommendations of the United Nations Conference on TCDC, to be held in Buenos Aires from 30 August to 12 September 1978, would probably be available to the Sub-Committee for its March 1979 meeting, and also the results of the Conference on Regional Cooperation in the WHO Fellowship Programme to be held in Manila in February 1979. 102 REGIONAL COMMITTEE: TWENTY-NINTH SESSION The Sub-Committee also noted that the Regional Committee had requested the continuation and enlargement of Appendix 4 to the report of the second meeting (pages 93 to 99)1. The Sub-Committee hoped that as far as proved feasible there would be continuity of the persons attending the Sub-Committee meetings. lSee page 185 of this volume, Summary Record of the Sixth Meeting.