(WPR/RC35/SR/5)
SUMMARY RECORD OF THE FIFTH MEETING New Town Hall, Civic Centre, Suva Friday, 7 September 1984 at 9 a.m. CHAIRMAN: Dr T.M. Biumaiwai (Fiji) CONTENTS
1.
Consideration of proposed programme budget estimates (continued) ••••••••••••••••••••••••••••••••••••••••••••••• 1.1 Proposed programme budget estimates, 1986-1987 (continued) ...... •........ ..• • . . ... . • . • • . . . . •.. . • . • . • . ... . .
108 108
2.
Sub-Committee on Technical Cooperation among Developing Countries: Report of the Sub-Committee Sub-Committee on the General Programme of Work 3.1 Report of the Sub-Committee ••••••••••••••••••••••••••• 3.2 Membership of the Sub-Committee •••••••••••••••••••••••
114
3.
117 121
- 107 -
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1.
CONSIDERATION OF PROPOSED PROGRAMME BUDGET ESTIMATES; Agenda (continued from the fourth meeting, section l)
Item 8 of the
1.1
Proposed programme budget estimates, 1986-1987: Item 8.2 of the Agenda (Documents WPR/RC35/3 and WPR/RC35/INF DOC/3) (continued from the fourth meeting, section 1.1)
Public information and education for health (pages 58-62) There were no comments. Research promotion and development (pages 63 .. 65) There were no comments. General health prote<;tion and promotion (pages 66-76) Mrs ENGLISH (Australia), referring to Nutrition (8.1), said that her Government would like to see the proposed nutrition programme make specific mention of the priorities laid down for immediate action at a recent meeting of the United Nations Administrative Committee on Coordination Sub-Committee for Nutrition, viz. that there should be a coordinated country-level approach by the agencies in the area of food and nutrition and a global strategy for the eradication of vitamin A and iodine deficiency disorders. A coordinated approach was particularly necessary in the formulation of national food and nutrition policies, on which the proposed WHO nutrition programme for the Region laid special emphasis. It was needed all the more in that FAO was developing a programme to draw up national food and nutnt1on policies in six island countries of the Pacific. Vitamin A and iodine deficiency disorders, and anaemia caused by low iron intake were major problems in some countries of the Region. Means were available for preventing simple deficiency diseases and thus eliminating, for example, blindness due to xerophthalmia, and cretinism and deaf-mutism associated with iodine deficiency. The shortage of suitable nutrition manpower for implementing national food and nutrition policies was a particular problem in certain countries of the South Pacific and, if the 1989 nutrition target was to be reached, more training courses would be needed. The proportion of the budget devoted to nutrition seemed very small. It was increasingly accepted that a nutritious diet supplying a balanced intake of food energy and nutrients was essential to health and a key factor in the prevention of and recovery from illness. In Australia diet-related diseases were responsible for more than 60% of morbidity and mortality. Such diseases, particularly those resulting from overnutrition, were a growing problem in many countries of the Region. Dr TO GIAY (Viet Nam) said that the struggle to overcome hunger and malnutrition in developing countries with low production and high population growth was a very difficult and complex task, which called for a multidisciplinary and multisectoral approach through a coordinated national plan with precise objectives.
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In Viet Nam, in addition to foodstuffs produced on State and collective farms, an important source of food that must be further developed was the so-called VAC ecosystem (vegetable gardens, livestock and fish-rearing) among families and small cotmDunities, wbich provided a wide variety of foods to enrich and diversify the basic ration. In regions where land was still available, it was possible to assign 10-15% of the arable land to family food production. Other important issues were the means of preserving food already delivered, ensuring good quality, building up a food industry and teaching rational ways of cooking food and conserving its nutritive value. While it was very difficult to increase food production by 5-10%, ex;perience had shown that 30-40% of what was produced could easily be lost as a result of faulty storage and preservation. It was essential to establish model patterns of nutrition for pregnant and nursing mothers, pre-school-age children, schoolchildren and students, workers, farmers and the sick, and to give them wide publicity among the population. In order to utilize to the full the nutritive value of foodstuffs, to ensure the prov~s1on of economical but nutritious meals, to control nutritional and deficiency diseases and to ensure that nursing mothers had a good flow of milk, it was essential to provide the whole population, and particularly women, with at least a modicum of knowledge concerning the food needs of adults and children, the nutritive value of different foodstuffs, the benefits of breast-feeding, the dietary needs of pregnant women and nursing mothers, and the nutrition of sick children, particularly those suffering from diarrhoea. He considered that nutrition activities. increased funds should be made available for
Dr BAVADRA (Fiji) thanked WHO on behalf of his country for the role it had played in developing the nutrition programme in Fiji. WHO was cooperating in the implementation of national food and nutrition policies developed jointly by UNDP and FAO, par_ t icularly in regard to training. WHO in~ercountry personnel in Suva had provided invaluable cooperation. et~~phasis
Dr SUNG-woo LEE (Republic of Korea) reiterated his appeal for greater on Nutrition (8.1), Oral health (8. 2) and Accident prevention (8.3). There appeared to be a 40% decrease in funds for activities in accident prevention in the 1986-1987 budget. He believed that the present level of expenditure should have been maintained.
Dr NAIR (Regional Adviser in Nutrition), replying to the questions raised by the representative of Australia, said that the two recommendations made earlier in 1984 by the ACC Sub-Committee for Nutrition had been taken into consideration by WHO. Xerophthalmia and other deficiency diseases were receiving greater a• ttention than in the past. WHO had always cooperated with the other United Nations agencies, as was the case in Fiji. The ACC Sub-Committee was itself responsible for interagency coordination at all levels. WHO was continuing to support six nutrition training programmes in
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the Region. Training facilities were also available in many countries and support was forthcoming from Hawaii, which, although outside the Western Pacific Region, was close to some of the Member States in the Pacific. Caution had to be exercised, however, since, at most only 15 of the 67 people awarded fellowships in nutrition over the past years had reaained in nutrition. Requirements, and particularly the level at which training should be provided, would be carefully considered before any new training programme was embarked upon. The REGIONAL DIRECTOR, responding to the suggestion by the representative of the Republic of Korea that present levels ·of funding . f or work on accident prevention should be maintained, said that more support from extrabudgetary sources was expected. Negotiations were in progress with some major associations of vehicle manufacturers in some countries. The most common accidents in the Region were traffic accidents, of which children were frequent victims. It was only cOORDon sense that all parties concerned should cooperate in the accident prevention programme. With regard to nutrition, WHO had, from the beginning and at every level, collaborated with other United Nations agencies, particularly with UNICEF in its work on the nutrition of mothers and children. Protection and promotion of the health of specific population groups (pages 77-87) Dr KOTEKA (Cook Islands), referring to Maternal and child bealth, including family planning (9.1), said that his Government attach.d great importance to the health of mothers and children and to family planning and was grateful to WHO for its valuable technical collaboration in developing programmes. The United Nations Fund for Population Activities (UNFPA) and UNICEF had also provided noteworthy support. '!'he coaabilled activities of those agencies had enabled his country to reduce infant mortality from 33 per 1000 live births to 21 per 1000 live births in 19\83. Family planning now covered 30% of women of reproductive age. Dr BAVADRA (Fiji) said that his country also regarded Maternal and child health as a priority programme and had been concentrating on it for a number of years. Without WHO cooperation and aasietance from UNDP, UNFPA and UNICEF, it would have been impossible for Fiji, with its islands scattered over a wide area of ocean, to achieve the coverage neceas~ry to bring about the improvement in maternal and child care, which bad resulted in maternal mortality being reduced from 60 per 100 000 in 1977 to 46 per 100 000 in 1981 and the infant mortality rate from 31.9 per 1000 live births in 1977 to 22 per 1000 live births in 1983. Protection and promotion of mental hea. l th (pages 88-97) Dr HAN (Director, Programme Man.(lgement), in reply to a question from the representative of Japan, explained that the 474% increase in the 1986-1987 budget estimates for Prevention and control of alcohol and · drug abuse (10.2) over the allocation for 1984-1985 was accounted for by a larger number of requests, particularly from China and Papua New Guinea. More intercountry activities were planned in the form of workshops and working groups and it was intended to step up epidemiological reeear~h.
. SUMMARY RECORD OF THE FIFTH MI!TING
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Promotion of environmental health (pages 98-113) There were no comments. Diagnostic, therapet.ltic and . rehab.ilitative technology (pages 114-132) Mr BOYER (United States of America) welcomed the efforts to make essential drugs available to poorer populations at the lowest possible cost, and found the 53% increase in the budget for such activities well 111erited. The United States Food and Drug Administration (FDA) was prepared to provide countries of the Region with training in good manufacturing practices and quality control, together with advice and information on the quality, safety and efficacy of drugs and vaccines. In particular, the Food and Drug Administration was •illing to share its expertise on the quality control and development of hepatitis B vaccine. Such services would be provided on a bilateral basis, and would be additional to the cooperation his country provided through WHO, The REGIONAL DIRECTOR, in welco111ing that offer, reminded the Committee that the United States Food and Drug Administration had been active on a bilateral basis for some ti111e, notably in China with reg4rd to the quality control of drugs and biological substances. It bad also released some of its staff to serve as consultants for WHO programmes. For example, a senior Food and Drug Administration official had spent one month in the Philippines to conduct a training course on drug evaluation. It was less expensive for WHO to use govern111ent experts as consultants than to recruit outside experts. The Governments of Australia, Japan and New Zealand had also provided consultants on the same basis, and it was to be hoped that there would be more of such arrangements. Mr BOYER (United States of America) commended the Chinese approach to mechanisms to promote the distribution of essential drugs and the quality control of food and drugs, and suggested that it could usefully serve as a model for other countries of the Region. Dr HAN (Director, Programme Management), in reply to a question from the representative of Japan, said the budget allocation for Rehabilitation (12. 5) had been increased by 242% in response to government requests, in particular from China, Lao People's Democratic Republic and the Republic of Korea. It was intended to initiate an intercountry project on community-based rehabilit4tion. Dr BAVADRA (Fiji) said that drug supplies had long been a serious health and political problem in his country. The introduction of WHO's bulk purchasing scheme had led to significant improvements, and had made it possible to set up community pharmacies in rural areas, where people could obtain previously unavailable drugs at reasonable prices. Fiji was grateful for Australia's assistance the quality control of drugs, and welcomed the offer of facilities by the United States Food and Drug Administration. There had been some press criticism of the use in Fiji of contraceptives that were not app.roved for use in tthe United States of Atllerica, and it would be helpful if the situation could be clarified.
in
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Dr MARSALLON (France) drew attention to the pharmacological research on medicinal plants being conducted by ORSTOM in Noumea. The practice of plant-based traditional medicine in the Pacific area was extensive and effective, but it presented certain risks. The plant alkaloids used were highly active, but the concentration of the active ingredient varied widely according to season, storage methods, and other factors. That variability had led to many accidents, especially among children, and there was unquestionably a need for research and for quality control. The REGIONAL DIRECTOR pointed out that, in view of the public concern in such countries as Fiji and Vanuatu at the use of Depo-Provera as a contraceptive, the issue bad been discussed by a WHO expert group in consultation with the United States Food and Drug Administration. Since better alternative drugs were readily available in the United States, the use of Depo-Provera for contraceptive purposes was not recoamtended in that country. However, it was not banned, and its use was still approved for certain other limited indications. The WHO group had agreed that the drug was still useful for family planning purposes in many countries. It would be helpful if the United States Food and Drug Administration would make a formal statement confirming that view. A similar situation had arisen in respect of oral rehydration salts, which were not approved for use as a drug by the United States Food and Drug Administration. However, a dialogue had been established, and the Food and Drug AdministratioJn bad agreed that rehydration salts could be used as a food. Consequently, their use in diarrhoeal disease control had been extended to the United States trust territories in the Region. The research conducted by France on traditional medicine in the Pacific area was greatly appreciated. It was time to promote the more effective use of traditional medicine in the Region. Disease prevention and control (pages 133-178) Replying to a query from the representative of Japan regarding the 536% increase in the budget allocation for Sexually trans111itted diseases (13.11), Dr HAN (Director, Programme Management) stressed that, in view of the situation in the Region, an even greater increase could be justified. The rise in the incidence of neonatal syphilis and the appearance of antibiotic-resistant strains of gonococci were causing great concern. Proposals for projects had been received from .New Caledonia and Viet Nam. WHO activities would consist in providing consultants, supporting national training courses, and strengthening laboratory ,capability. Health information support (pages 179-181) There were no comments. Support services (pages 182-190) In reply to a question from Dr TAPA {Tonga) regarding the geographical representation of Member States among WHO staff, Dr VIGNES {Legal Counsel) stated that under the WHO Constitution the right to decide on staff appointment was vested in the Director-General.
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Dr BAVADRA (Fiji) welcomed the trend towards recruiting people to work as consultants in their own countries. Some projects were best carried out by local experts. Dr KHALID (Malaysia) also welcoaed the increased use of local people for national programg~es. However, capable international staff would always be needed at the Secretariat. Even the best expert was rarely seen as a prophet in his own country, and decision-makers tended to take more notice of a foreign adviser or consultant. Information annexes Dr SUNG-WOO LEE (Republic of Korea), referring to the table on page 195, asked why it was proposed to increase the budget allocation for Fiji by 74.2%, far more than for aoy other country. In particular, the table on page 247 indicated a 615% increase in the costs of the Office of the WHO Programme Coordinator in Suva, which seemed strange for an office that bad been in existence for many years. Dr HAN (Director, Programme Management) explained that the budget estimates for Fiji contained two components. One was the cost of technical cooperation with that country, expressed as a country planning figure. It was proposed to increase that figure from US$900 000 in 1984-1985 to US$1 000 000 in 1986-1987. The second component was the cost of the WHO Programme Coordinator's Office. The Office in Suva was responsible for all countries or areas in the South Pacific area, and in previous budgets its costs had been divided among those ·countries or areas. In the budget estimates for 1986-1987 all the costs of the Office were shown under Fiji, which accounted for the apparent sharp increase in the allocation to that country. Mr BOYER (United States of America) invited the Regional Director to outline the process whereby he apportioned the available funds to the various countries or areas of the Region. W~Js he following the suggestion made by the Director-General at the thirty-fourth session of the Regional Committee, that preference be given to countries that were trying hardest to achieve health for all by the year 2000 and to implement primary hedth care? The REGIONAL DIRECTOR replied that WHO had formulated a number of criteria or guidelines for determining allocations to countries. First of all, preferential support was given . to countries or areas that were using WHO resources in accordance with the strategy laid down by the Health Assembly for attaining health for all. Second, the stage of development of each country was taken into account, measured in terms of socioeconomic and health indicators such as population size, physician/population ratio, per capita GNP, and life expectancy. Third, consideration was given to the country's ability and readiness to make opti11u111 use of WHO resources. Fourth, the availability of support from other sources, such as bilateral arrangements or resources provided through WRO's intercountry programme, was taken into account. Finally, special consideration was given to the needs of new Member States. It was only in recent years tha.t China had become an active member of the Organization; the budget allocation for that country was regularly increased by substantial amounts because cooperation was still
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being built up. India.
The allocation for China was still only half of that for
In addition to such criteria, the continuous dialogue within the Regional Committee was a major tool in preparing the budget proposals. The proposals were, of course, sub]ect to examination by the Regional CotlllDittee, and the country planning figures established by the Regional Director were not definitive. A considerable proportion of the resources allocated to Fiji was devoted to the medical school, which trained students from all the Pacific islands. There being no further comments, the CHAIRMAN instructed the Rapporteurs to draft a resolution concerning the proposed progratmne budget estimates for 1986-1987. (For consideration of the draft resolution, see the seventh meeting, section 1.2). 2. SUB-COMMITTEE ON TECHNICAL COOPERATION AMONG DEVELOPING COUNTRIES: REPORT OF THE SUB-COMMITTEE: Item 10 of the agenda (Document WPR/RC35/5)
Dr KHALID (Malaysia), in the absence of the Chairman and the Rapporteurs of the Sub-Committee on Technical Cooperation among Developing Countries, introduced the report of the Sub-Committee. The Sub-Committee had met from 28 to 29 June 1984 to consider the report of the visits of its members to Fiji, Papua New Guinea and the Philippines, and to make recommendations for the promotion of technical cooperation in training in primary health care, with particular reference to its managerial and support aspects. While all countries were reorienting their staff, planning and management of health care systems, with emphasis on community participation and intra- and intersectoral coordination, to the primary health care approach, there was still room for improvement. There was variation between countries in the stage of implementation reached, and it was noted that experiences in one country were not necessarily directly applicable to others. Research and development projects in primary health care had very strong training components. Information exchange among countries was not satisfactory and the inventory of training activities conducted by countries in the Region should be more comprehensive and complete. The Sub-Committee bad made six recommendations, which were contained in document WPR/RC35/5. The Sub-Committee had also recommended that, in 1985, it should address itself to traditional medicine, with particular reference to herbal medicine and acupuncture. Dr SUNG-WOO LEE (Republic of Korea) commended the excellent report and thanked the Sub-Committee for its in-depth observations regarding the development of primary health care in the Region. He endorsed the recommendations of the Sub-Committee and Ob$erved that their implementation would require considerable support from WHO. He also supported the topic proposed for consideration in 1985, particularly as herbal medicine and acupuncture were widely practised in some parts of the Region.
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Mr LAVEA (Samoa) said that there was good cot11111unity involvement in primary health care in his country on account of the village women's committees; that would be strengthened through national workshops for health workers and committee leaders. Close technical cooperation existed with American Samoa, Fiji and New Zealand. He thanked the Gover0111ent of New Zealand for its long-term cooperation in accepting patients for medical care when appropriate facilities were lacking in Samoa. Mr CAO YONGLIN (China) expressed his appreciation of the report, which provided useful information on the situation in countries. He stressed the importance of technical cooperation in training for primary health care as a means to achieving health for all. Training activities such as workshops and seminars could play an effective role in technical cooperation by providing developing countries with useful opportunities for the exchange of experience and by stimulating the promotion of primary health care. The WHO collab'orating centres for primary health care established in China had made a positive contribution in that field. He commended the Sub-Committee's recommendations, particularly those concerning information exchange, the designation of additional WHO collaborating centres, the strengthening of research and development in primary health care and the development of national capabilities for training in primary health care. He urged Member States to implement those recommendations as far as possible. His delegation believed that an increase in the membership of the Sub-Gommittee would be beneficial to its work. Dr TAPA (Tonga) thanked the Sub-Committee for its excellent report on an important topic. He noted the Sub-Committee's observations and supported its , recommendations, including the topic proposed for consideration in 1985. Mr YOSHIDA (Japan) endorsed the need to accord high priority to the primary health care approach in order to overcome health problems. He underlined the importance of appropriate training for health leaders and workers in order to develop a sound primary health care system, and the need for intercountry and interregional technical cooperation in primary health care activities. The different levels of socioeconomic development in countries and areas were reflected in the development of their health systems. He believed that technical cooperation, in particular appropriate information exchange, could contribute to the sound planning of national health care systems. National evaluation and monitoring of programme activities were essential to ensure effective health systems development. Japan had attained a high standard of health through the development of a primary health care system, and, in view of its extensive experience in that respect, his country could make an important contribution to technical cooperation through the provision of information on training of health workers. Japan would participate very actively in technical cooperation programmes related to training and the exchange of information on primary health care. Dr DANG HOI XUAN (Viet Nam) ' expressed his appreciation of the excellent report of the Sub-Committee, which highlighted many important
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problems. After thirty years of war, Viet Nam looked forward to cooperation with other countries, particul.srly in traditional medicine, cor1trol of malnutrition and primary health care. His country had established a number of models based on a multidisciplin•ry approach, an<l would welcOtDe an exchange of experience with other countries. The REGIONAL DIRECTOR info.t'1Ded the represe,ntative of China that WHO recognized the need to increase tbe membership of the Sub-Co011Dittee, particularly in view of the complex topic proposed for 1985. However, such an increase would have budgetary implications. He noted that the Sub-Committee on the General Prog:ra11ltne of Work bad eight members, while the Sub-Committee on Technical Cooperati()ll atnong Developing COuntries bad only four. He proposed that a review of the activities, membership and structural arrangements of both sub-c0111mittees should be undertaken with a view to submitting a proposal concerning their future work and structure to the next session of the Regional Co1Ptnittee. In the meantime, should the Sub-Committee on Technical Cooperation among Developing Countries have difficulty in fulfilling its task related to traditional medicine, he would be willing to provide additional advisory support. Mr CAO YONGLIN (China) agreed with that proposal. Dr KEAN (Australia) recalled that the Sub-Committee on the General Programme of Work had been established in 1976 and that on Technical Cooperation among Developing Countries in 1977. He endorsed the need for a review of their composition and methods of work to ensure that maximum benefit was derived from their resources. He welcomed the Regional Director's proposal in that regard. In particular, he considered that the terms of reference related to the country visit and tbe subsequent meeting in Manila required reconsideration, as well as the number of countdea to be visited. The inclusion of an elective period during which Sub..oCcAmtittee members could explore particular areas of interest during a country visit was suggested. The possibility of holding a meeting in the country visited at the end of the visit, instead of in Manila, could also be considered. His delegation would look forward to receiving the report of the review at the next session. Dr KHALID (Malaysia) supported the views expressed by the representative of Australia. He sugge,ste_d that, to fa~ilitate arrangements and to render the work of the Sub-Com,mittee more eff•ctive, detail.• of the information and the consultations required by the Sub-Co11ltnittee should be sent to the host country prio~ to a visit. Dr TAPA (Tonga) agreed that there was a need to review the structure and membership of both Sub-Committees and to submit a report to the oext session thereon. The REGIONAL DIRECTOR noted the agreement of all representatives to the proposed review, which wo~ld be prepared in coneultation with Metnber States for the thirty-sixth session of the Regional Col811iittee. In the absence of further comments, the CHAIRMAN asked the Rapporteurs to draft an appropriate resolution. (For · consideration of the draft resolution, see the seventh meeting, section 1.3).
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3. 3.1
SUB-COMMITTEE ON THE GENERAL PROGRAMME OF WORK: Report of the Sub-Committee: (Document WPR/RC35/6)
Item 11 of the Agenda
Item 11.1 of the Agenda
Dr KOINUMA (Japan), presenting the report of the Sub-Committee on the General Programme of Work in the absence of the Chait111an, Rapporteur and other members of the Sub-Committee, said that section 1 of the report gave a brief introduction and described the terms of reference and membership of the Sub-Committee. The Sub-Committee • s findings and recommendations with regard to its review and analysis of WHO cooperation with Met~~ber St,t.tes, which was the first of its terms of reference, were presented in section 2 of the report. Health manpower development, including the training of c01nmunity health workers, as well as the role of academic iaetitutions in health development bad been the subject reviewed by the Sub-Co11Ulittee in 1984. In carrying out its t~sk, the Sub-Committee bad visited Malaysia, Solomon Islands and Vanuatu from 12 to 17 March 1984. As the time spent by the Sub-Committee in the three countries had been limited, the review had had to be essentially broad and general in nature. The summary of findings on the country visits of the Sub-Committee were given in section 2.2 of the report and the recolllUlended areas for WHO collaboration which should be continued and further strengthened in the future in section 2.3. The second of the terms of reference of the Sub-Committee related to the monitoring and evaluation of strategies for health for all by the year 2000. In this connection, the Sub-Committee bad reviewed the Common Framework and Format for Evaluating Strategies for Health for All, the report on which was contained in section 3. He recalled that the plan of action for imple111enting the strategies for health for all by the year 2000, as approved by resolutions WHA35.23 and WPR/RC32.R5, provided for continuous monitoring a'l)d evaluation of those strategies. Member States were requested to monitor and evaluate their strategie$ and to submit their reports to the Regional Director every two years. Monitoring of progress had been undertaken for the first time in 1983, while the first evaluation of strategies would be done in 1985. During the discussions on the regional synthesis of the monitoring reports at the thirty-fourth session of the Regional Committee in 1983, a number of representatives had voiced their difficulties in understanding the wording of the questions and the significance of the indicators used in the Common Framework and Format for monitoring the strategies. The Secretariat had therefore felt that it would be in the best interests of Member States and the Secretariat if the Common Fralllework and Format for Evaluating Strategies for Health for All, to be used in reporting in 1985, could be reviewed by the Sub-Committee on the General Programme of Work, keeping in mind the comments made on the monitoring format.
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In its review of the Common Fra~ework and Format for evaluation, the Sub-·Committee had observed that many qu~stions needed further clarification or examples. However, since it was a global document intended for use by all the regions, the Sub-Committee did not wish to propose any restructuring of the format itself. Instead, it had proposed that a summary of all the points raised, containing s•1pplementary illustrative information, be prepared and submitted to Member States. Such information had been summarized in the ten-page docutllent appended to Annex 4 of document WPR/RC35/6. The appendix should be referred to as Member States considered each question in the Common Framework and Format. In its review of the questions contained in the Common Framework and Format, it was possible that members of the Sub-C®~~Dittee might have overlooked certain points that needed further clarification. It was also possible that some . p arts of the appendix, which the Sub•Committee had tried to keep as simple and straightforward as possible, might still need further explanatory comments. The Sub,..Committee hoped, therefore, that representatives would not hesitate to make known any further needs in that respect. Mr YOSHIDA (Japan) congratulated the Sub-Committee on its report on the country visits to review health manpower development, and expressed appreciation of the Sub-Committee's comments. In Japan the number of doctors had now reached the same level as in the western advanced countries, as a result of great efforts to ensure the provision of adequate health personnel as a first priority. His country was now facing such problems as geographical maldistribution and inadequ~tte cooperation among the medical care facilities. Efforts were therefore being made to consolidate national health manpower and to review the actual policy of m~tnpower development in the light of future community health needs and to coordinate health and medical services in line with the rapid progress of medical science. In that context, he expressed the hope that it would be pos.sible for WHO to gather systematically information on the various educational syst~ms of the Member States in the Region. The information 1Dight include tbe nQ1Jles of academic institutions, requirements for approval of those institutions, education programmes, the number of trainees, and national examinations to obtain qualifications. Dr KHALID (Malaysia) thanked the Sub-Committee for its report, and expressed appreciation of its visit to his country to discuss various aspects of health manpower development and visit a few of the health facilities. He agreed with all the Sub-Committee's recOGRDendations regarding health manpower development, but wished to m.ake cer tain collllllenta and clarifications regarding the report on Malaysia to avoid misunderstanding. Regarding teacher training, Malaysia was well aware of the need to upgrade the quality of teachers - both · of nurses . and o.f other health personnel. Multidisciplinary workshops had been held for various categories of teachers, but these had been limited to priority areas because of resource
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constraints. The establishment of a teacher training centre had had to be postponed owing to unavoidable circumstances, but the faculty members trained for the centre were being used to conduct short upgrading programmes for teachers of various categories of personnel. Secondly, regarding the statement that academic institutions were in general insufficiently involved in the planning and evaluation of health programmes, he pointed out that, while it was generally agreed that academic institutions bad a role to play in that respect, their participation depended upon the structural and functional arrangements for health programme development in the individual countries and the capacity of the institutions to undertake those functions. Thirdly, it was stated that continuing education programmes for the various categories of health personnel were, for the most part, conducted on an ad hoc basis and at different frequencies for the various categories of health personnel. Malaysia recognized, of course, that its continuing education programmes could be further improved - but activities of that nature necessarily depended upon needs, capacities and priorities. It was neither possible to avoid ad hoc arrangements nor necessary to have continuing education programmes for different categories of staff at the same frequencies. He regretted that the Sub-Committee bad not been in Malaysia for a longer period in order to have a much better picture of its programmes and problems. Dr ACOSTA (Philippines), referring to the comments just made by the representative of Malaysia, drew attention to the statement at the end of section 2 of the Sub-Committee's report, noting that, in view of the limited time spent by members of the Sub-Committee in each country, the reviews were essentially broad and general in nature, and to recommendation (8} in section 2.3 to the effect that country visits by members of the Sub-Committee should be limited in future to one or at most two countries to enable them to undertake a review of WHO cooperation in greater depth. He fully supported that recommendation, which might ~lso be relevant to the Sub-Committee on Technical Cooperation among Developing Countries. Dr TIRA (Kiribati) expressed appreciation of the Sub-Committee's report. The points raised were in fact applicable to Kiribati, although it was not one of the countries visited. He stresse.d the importance of the involvement of WHO in the monitoring system, which would help considerably to ensure that the budget was used appropriately and that programmes were proceeding in the right direction. Mr CAO YONGLIN (China) said it was significant that the subject of the Sub-Committee's review had been health manpower deveh>pment, which was not only a priority of WHO and most Member States but also vital for the improvement of health services and the achievement of health for all. All the countries visited were formulating national policies and plans for health manpower development, and making efforts in various ways to train the different categories of health personnel. Those plans and policies, however, had not been fully implemented owing to restrictions imposed by
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REGIONAL COMMITTEE:
THIRTY--FIFTH SESSION
economic and other conditions. Following the country visits the Sub-Committee had identified problems and put forward recommendations for solving them. Those recommendations would also be helpful for other countries. He supported recommendation (8), to which the representative of the Philippines had already referred. After reviewing the Common Framework and Format for Evaluating the Strategies for Health for All, the Sub-Committee had provided af!ditional information and explanations on certain itellls, Which would undoubtedly assist Member States in evaluating progress in implementing their health-for-all strategies. The Sub-Committee, which would be submitting an evaluation report on the implementation of the strategy to the Regional Committee for review, as part of the overall process of evaluation at national, regional and global levels, had an important mission. It was to be commended on the work it had already achieved. Dr TAPA (Tonga) congratulated the Sub-Cotlllllittee on its comprehensive report. Regarding health manpower development, he bad already streued the great importance his country attached to that subject. He fully. supported all the recommendations made by the Sub-Committee, including rec~endation (8), which should be taken into consideration when the role and functions of the Sub-Committee were discussed at the next session of the Regional Committee. He also agreed with most of the observations of the Sub-Committee resulting from its review of the Common Framework and Format for Evaluating Strategies for Health for All, and the WPR Appendix to Annex 4 of document WPR/RC35/6. He would support a review of the structure and role of the Sub-Committee, as had been discussed in relation to the Sub-Committee on Technical Cooperation among Developing Countries. Dr HAN (Director, Programme Management), referring to the review of the structure and terms of reference of the Sub-Co1amittee, said that, as previously stated by the Regional Director, the Secretariat would undertake the preparatory work so that the subject could be discussed at the next session of the Regional Committee. In reply to the representatives of Kiribati and Jap.an, he said that monitoring was one of the components of health manpower development, and it was hoped to provide a report on the status of progress in that area to a future session of the Regional Committee. Regarding the number of countries to be visited and the duration of the visits, that aspect had been discussed at considerable length by the Sub-Committee itself at its meeting in June. When the new me111bers of the Sub-Committee had been nominated, the Secretariat would suggest that a brief meeting of the Sub-Co111tnittee be held, and it would then have an opportunity to discuss the subjects to be selected for country visits, the countries to be visited, and the duration. In the absence of further c01lmlents, the C'HAIRMAN invited the Rapporteurs to prepare a suitable draft resolution. Since the Sub-Committee's report covered different subjects, it wight be preferable to
SUMMARY RECORD OF THE FIFTH MEETING
121/122
prepare separate draft resolutions. (For consideration of resolutions, see the seventh meeting, sections 1.4, 1.5 and 1.6). 3.2. Membership of the Sub-Committee: Item 11.2 of the Agenda
the
draft
The REGIONAL DIRECTOR said that the members of the Sub-Committee on the General Programme of Work were the representatives of Australia, Fiji, Japan, Papua New Guinea, the Philippines, Singapore, Tonga and Viet Nam. The three-year periods of tenure of the representatives of Australia, Papua New Guinea and Viet Nam would expire with the current session of the Regional Committee. The Committee bad to decide which Member States should appoint representatives to replace them. It might wish to consider designating China, Cook Islands, and Samoa to replace them. Dr TAPA (Tonga) supported that proposal. He said that represent a good balance - one large country and two small ones. it would
Dr MARSALLON (France) also supported the proposal, but expressed regret that the Sub-Committee did not now include any members from the French-speaking countries. The CHAIRMAN said that that point bad been ooted. In the absence of any further comments, be observed that the proposal put forward by the Regional Director was approved, and be invited the Rapporteurs to prepare an appropriate draft resolution. (For consideration of the draft resolutio.n, see the seventh meeting, section 1.7).
The meeting rose at noon.