(WPR/RC33/SR/2)
SUMMARY RECORD OF THE SECOND MEETING WHO Conference Hall, Manila Monday, 20 September 1982 at 2.30 p.m., CHAIRMAN: Dr S. Tapa (Tonga)
CONTENTS
l.
Consideration of proposed progrannne budget estimates (continued) .............................................. .
80 80
1.1
Proposed programme budget estimates, 1984-1985 ••••••••
- 79 -
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REGIONAL COMMITTEE:
THIRTY-THIRD SESSION
l.
CONSIDERATION OF PROPOSED PROGRAMME BUDGET ESTIMATES~ Agenda (continued from the first meeting, section 9)
Item 7 of the
l.l WPR/RC33/3) (continued from
Item 7.2 of the the first meeting,
Summaries (pages l-8) (continued from the first meeting, section 9.2)
Mr ROBERT (France), said that his delegation wished to associate itself with the questions raised by a number of other delegations regarding the 18% increase in budgetary expenditure, which would appear to run contrary to the principle of zero growth in the budgets of international organizations. Programme analyse~
Governing bodies (1.1.0-1.1.3; pages 11-12) WHO 1 s general programme development and pages 13-22)
management
(1.2.0-1.2.4:
Dr CHRISTMAS (New Zealand) asked for information on budgetary allocations for fellowships, to which there seemed to be no specific reference in the document before the Committee. An increase would seem to be justified by the considerable benefits that accrued from fellowships for many countries, including his own. Dr HAN (Director of Programme Management) replied that in the pro forma budget unit-cost calculations, an increase of about 18% in the amount allocated for fellowships had been allowed for but in many cases actual costs greatly exceeded the amounts foreseen. Fellowships were treated as programme units rather than in financial terms. However, cost constraints in ma~y instances forced the Organization to ask Member States to make adjustments so that the programmes could be implemented. In answer to a further question by the representative of New Zealand, Dr HAN estimated expenditure on fellowships at about 20% of the operating budget. Dr MINNERS (United States of America) noted that there had. been an increase of US$66 000 in Regional Committee costs. The Committee should be willing to try to control these costs, perhaps by reducing the length of its sess~ons or possibly by scaling down the act~vH~es of the Sub-Committees on the General Programme of Work and Techta.-,c;tal Cooperation among Developing Countries. He wondered also whether there might not be some ovelapping between the efforts to attract extrabudgetary funding by using seed money from the Regional Director's Development Programme and similar efforts under the heading 1.2.4 External coordination for health and social development. In addition, the text on General programme development (1.2.3) seemed to offer no explanation of the discrepancy between the 33% increase under the regional heading and the 9% under intercountry activities. Mr KAKAR (Director of the Support Programme) said that the reduction 1n the length of the Regional Committee by one day had not resulted in any
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81
significant savings. The increase of US$66 000 was largely due to a provision for the subsequent travel to the Regional Committee of representatives from Member States assessed at the minimum rate and increases in the costs of travel of members of the two Sub-Committees. Dr HAN (Director of Programme Management), in reply to the representative of the United States of America's question on possible overlapping between efforts to attract extrabudgetary funds, said that the Regional Director might assign funds from his Development Programme as seed money to commence certain activities that might later attract considerable extrabudgetary funding. A recent example had been the assignment of funds for a programme identification mission in Tonga, which had selected the strengthening of public health laboratory services. The Government of Japan had later decided to provide funds on a bilateral basis, not only for Tonga but also for other countries, with the intention of eventually strengthening public health laboratory services throughout the South Pacific. Immediately on taking up his appointment, the Regional Director had seen the important role that could be played by External coordination for health and development and had created a post of external relations officer. Since then a more formal coordination structure had been developed, particularly for relations with other international agencies and nongovernmental agencies. For instance, close coordination had been established with the United Nations Development Programme, with the result that the Regional Office had been able to participate with UNDP in formulating programmes for support from the UNDP regional programme for 1982-1986 and to act as executing agency for UNDP-funded projects totalling some 8 million dollars in 1982-1986. The 22% increase under General programme development was due to increases in statutory costs for Programme Directors and the Regional Adviser in Health Information and their staff and to increases in duty travel costs. Health system development (2.3.0-2.3.4; pages 23-34)
Dr EVANS (Australia) asked for further information on programmes 2.3.1 Health situation and trend assessment and 4.13.6 Diarrhoeal diseases, which seemed to overlap. The intercountry programme contemplated in programme 2.3.1 provided for a team, consisting of an epidemiologist and an entomologist, to be stationed in the South Pacific to continue cooperation in strengthening national epidemiological and surveillance services. Programme 4.13 .6, however, provided for a team, consisting of a medical officer and three field development officers, which would, in addition to act~v~t~es related to the immunization programme, cooperate in reducing mortality and malnutrition related to diarrhoea. As a general rule, his delegation considered that staff working in a region might be in a better position to assist Member States than special teams sent in for short periods. He did not feel that the proposals were wrong but, for reasons of economy, considered that someone already working in the area should be used instead of special teams and consultants.
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Dr HAN (Director of Programme Man~gement), in reply to the representative of Australia, explained that the structure of the Seventh General Programme of Work differed from that of the Sixth. In the latter, epidemiological surveillance had been included under the programme relating to Communicable disease prevention and control, whereas, in the Seventh General Programme of Work, such surveillance had been included with the Health situation and trend assessment programme under the new classification 2.3.1. The representative of Australia had referred to two different programme areas. Pages 359 and 360 of the budget document contained the narrative sections of the intercountry programme, including the narrative relating to programme 2.3.1. The narrative on programme 4.1;3.6 contained on page 369 related to Diarrhoeal diseases, which was a different programme area. Under programme 2.3.1, which concerned Health situation and trend assessment, members of an intercountry team would be stationed in Fiji and Papua New Guinea. One of the two medical officers would be funded from the regular. budget and the other, thanks to the Government of Australia, would be charged against the Australian contribution to the epidemiology prograittme. The intercountry team would look after both the communicable and noncommunicable disease aspects of activities in the two countries. The intercountry team for diarrhoeal diseases, currently based in Manila, consisting of a medical officer and field development officers, would look after activities in the region as a whole. In 1984-1985, activities under the Immunization programme and the Diarrhoeal diseases programme would be combined in one team with a view to integrating intercountry activities. It had not yet proved possible to integrate the activities of the Manila team with those of the Suva team; in functional relationships, however, the Suva team would cooperate closely with the Manila team. Dr MINNERS (United States of America) was surprised to note that the regular budget estimates for Health systems research under programme 2. 3. 3 showed an increase of 150% in the case of country or area provisions but a decrease of over 50% for intercountry provl.sl.ons. He would welcome an elucidation of such divergence. The objective of the medium-term programme for Health situation and trend assessment was stated, on page 24 of document WPR/RC33/3, to include the strengthening of the development of epidemiological and related services. Such epidemiological assessment was important to all. programmes, as had already been demonstrated by the success of the smallpox eradication progra111Ille. In that connexion, the National Academy of Sciences in the United States of America had recently received a substantial grant from the Agency for International Development to undertake research activities in certain areas of science, including some relating to health. One such area, which might be of interest to developing countries, was rapid epidemiological assessment. Dr HAN (Director of Programme Management), replying to the representative of the United States of America, said that the increases in
SUMMARY RECORD OF THE SECOND MEETING
83
respect of country or area provisions under programme 2.3.3 were in response to substantially larger requests for cooperation 1n health services research from Malaysia and the Republic of Korea. · The decrease in intercountry programmes had resulted from reductions in consultant services from 8 to 2 man-months and in the estimate for fellowships. The REGIONAL DIRECTOR thanked the representative of the United States of America for the information he had provided regarding assistance available from the United States National Academy of Sciences in connexion with rapid epidemiological assessment. WHO teams had visited and become operational for epidemiological surveillance in the Republic of Korea and in Micronesia in cooperation with the local authorities. Such services had proved to be effective but their cost might well increase in the future as a result, · for example, of the rising cost; of travel. Organization of heBlth systems based on pr1mary health care (2.4.0: pages 35-37) Health manpower (2.5.0: pages 38-42) Public information and education for health (2.6.0: pages 43-46) There were no comments. Research promotion and development (3.7.0: pages 47-49) General health protection and promotion (3.8.0-3.8.3: pages 50-60) Dr NICHOLSON (United Kingdom of Great Britain and Northern Ireland) asked the reason for the decline in the estimates for nutrition contained on page 54 of document WPR/RC33/3. Dr HAN (Director of Programme Management) replied that there had been a substantial decrease, amounting to US$170 000, in the case of VietNam which expected to receive substantial extrabudgetary assistance 1n nutrition from UNICEF. Dr MINNERS (United States of America) said that the Research promotion and development programme contained a brand new obligation for. 1984-1985 in the form of US$200 000 for country or area activities. He would welcome an .. explanation of this proposal. He would also appreciate an explanation of the increase in the estimate for Oral health under programme 3.8.2. The programme on Accident prevention (3.8.3) seemed to revolve around problem rather than to attack its root causes. The United States was very concerned with the problem of road traffic accidents and their relationship to alcohol; in that connexion, a Presidential Commission on Drunk Driving had been constituted in April 1982. There was clearly a close relationship between the two issues. Almost 10 million United States adults were problem drinkers while 3 million youths in the 14-17 . year age group had an alcohol problem. Losses from alcohol in the. Urii ted States, including employment losses, came to US$50 billion annually. Motor vehicle accidents were t h e leading cause o f death in the 15-24 . year · age group; almost 8000 young Americans perished annually in road accidents and a further 40 000 were injured. ~he
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REGIONAL
COMMITTEE~
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Dr HAN (Director of Programme Management), replying to the repre$en,tative of the United States of America, said that the obligation for country or area activities for Research promotion and development resulted from a special request from China for US$200 000 to upgrade its WHO collaborating centres. The estimate for Oral health had been increased as a result of a request from Viet Nam for US$400 000 to develop research activities. Dr CHRISTMAS (New Zealand) expressed interest in learning· the details of the Viet Nam request. Dr HAN (Director of Programme Management) said that details of the proposed Viet Nam activity were not yet available but could be provided in due course. Protection and promotion of the health of specific population groups (3.9.0-3.9.4~ pages 61-71) Dr MINNERS (United States of America) suggested that 1n future programme budget presentations the secretariat should perhaps consider explaining major changes, such as large increases in funds from one biennium to the next, in order to £ores tall the queries of delegations such as his own who made a sub~tantive analysis of many items. With specific reference to Health of the elderly (page 71), it would appear that the estimated obligation of US$23 000 under extrabudgetary sources for 1982-1983 for intercountry activities had acted as a catalyst for the prov1s1on of regular budget funds amounting to US$56 000 1n 1984-1985, and, although he realized that it was too early to record as committed the extrabudgetary funds that might become available to match the regular budget funds, it appeared they might have simply disappeared. Surely some indication of hopes or fears should be provided to the Regional Committee. Dr HAN (Director of Programme Management) said that Health of the elderly was a new programme to which many countries were devoting much attention. Fortunately the Japanese Shipbuilding Industry Foundation/Sasakawa Health Trust Fund had provided funds to stimulate activities, and a working group had been established to initiate the progrannne; it was hoped that other extrabudgetary funds would become available, but the programme bud~et document could only record those actually committed. The Working Group had recommended the collection of statistical data, training of nurses, and medical education in geriatrics and gerontology and related research under the intercountry programme. He referred also to China's indication of willingness to implement new activities in that area. Protection and Promotion of mental health (3.10.0-3.10.3~ pages 72-81) Dr CHRISTMAS (New Zealand) endorsed the earlier remarks of the representatives of Japan and the United States of America concerning, 1n particular, the alcohol-related aspects of psychosocial disorders, and recalled the importance that had been attached to a programme to discourage alcohol and drug abuse. It would be hard to make an optimistic start with
SUMMARY RECORD OF THE SECOND MEETING
85
the apparently reduced total budget of US$423 000 under estimated obligations for 1984-1985, although when the Seventh General Programme of Work had first been discussed by the Sub-Committee on the General Programme of Work in 1981, the importance of the problem had been stressed. Dr HAN (Director of Programme Management) agreed that Protection and promotion of mental health was a sensitive spot; unfortunately, the reduced regular budget allocation was a reflection of the consolidated priorities given by Member States of the Region to that area. There was, however, hope to be derived from the knowledge that psychosocial health-promoting activities would be carried out as part of many other programmes, and a positive picture might finally emerge so that the overall situation could be analysed and reported at a later date. Also, funds for activities to combat alcohol and drug abuse might be forthcoming from extrabudgetary sources: particularly, he thought, for drug information. It might further be possible to use collaborating centres as clearing houses for such information, without greatly adding to direct programme costs. The REGIONAL DIRECTOR, drawing attention to the summary table on page 1 of the proposed programme budget estimates, noted that the Sasakawa Health Trust Fund, which had committed US$2 644 500 in estimated obligations in 1982-1983, had not been able yet to commit itself for the next biennium, though he was confident that its support would continue. The new programme related to psychosocial factors was felt to important, although the growth was slow; there were complex situations different countries that made it hard to gain high priority attention the subject. He appealed to representatives to use their influence convey the urgency of that priority to the national level. be in for to
Dr CHRISTMAS (New Zealand) spoke of the need to give emphasis to new problems in the sociocultural setting. WHO should work in that area as a "health" rather than "medical" organization, collaborating with behavioural scientists and other experts in a multidisciplinary approach to the problem. Promotion of environmental health (3.11.0-3.11.4: pages 82-93)
Dr MINNERS (United States of America), referring particularly to food aspects of environmental health, asked how much the Regional Office hoped to achieve in coordination with the agricultural sector on the one hand and various WHO Regions on the other - for example, with the South-East: Asia Region on the problem of aflatoxins; also with donor agencies that might be able to advise on food preservation and preparation, Which affected the health aspects of food safety and maximum nutritive value. Dr E. LEE (Regional Adviser in Environmental Health) said that most such coordination took the form of "passive" or indirect aid at the global level and collaboration with FAO and such bodies as the Codex Alimentarius Commission. The regional programme was directed more to the balanc~ng of countries' priorities in food safety and hygiene.
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REGIONAL COMMITTEE:
THIRTY-THIRD SESSION
The REGIONAL DIRECTOR added that this was another example of a new regional activity following the rapid involvement of many developing countries in food production, supply and import, and the consequent growth in importance of the food safety aspects of public health. Those had to be coordinated with specific measures to ensure a more rational supply of world food resources to prevent cr1s1s. He mentioned the constant dialogue between China and the Regional Office on questions of nutrition and food production, safety and hygiene. Aflatoxins had been studied, particularly in connexion with their role in the causation of cancer, through research promotion projects and the work of collaborating centres. Fish poisoning in the South Pacific was another specific aspect of food safety and hygiene in which the Regional Office had collaborated with particular countries. Dia nostic, therapeutic and rehabilitative technolo 3.12.0-3.12.5: pages 94-110 There were no comments. Disease prevention and control (4.13.0-4.13.17: pages 111-155)
Dr NICHOLSON (United Kingdom of Great Britain and Northern Ireland), noting that the estimates under extrabudgetary sources for Disease vector control (4.13.2) were expected to diminish from US$24 300 in 1982-1983 to US$11 000 in 1984-1985, and that there was also a reduction for malaria, asked whether, assuming that the Special Programme for Research and Training in Tropical Diseases would absorb part of the activities in both those areas, an assurance could be given that there would be no important reductions in those essential activities. Dr HAN (Director of Programme Management), replied that the malaria table did not reflect the funds for malaria research under the Special Programme for Research and Training in Tropical Diseases (TDR). Dr NICHOLSON (United Kingdom of Great Britain and Northern Ireland) asked whether in that case additional funds from the Special Programme for Research and Training in Tropical Diseases were to be earmarked for malaria research, and whether some other extrabudgetary source was envisaged. Dr HAN (Director of Programme Management) replied that there was a special post to ensure the proper involvement of the Special Programme for Research and Training in Tropical Diseases in such research in the Western Pacific Region. With regard to other extrabudgetary funding in general, UNDP funding was committed only up to the end of 1983, so that its continued support, the amount of which was still under negotiation, could not be included 1n the budget tables. Dr MINNERS (United States of America), referring to programme 4.13.2, Disease vector control (page 116), asked whether vectors other than the mosquito, such as snails and ticks, were a major component of the programme. He added that the United States Academy of Sciences had recently introduced research grants in disease vector control for scientists in developing countries.
SUMMARY RECORD OF THE SECOND MEETING
87
In the United States there was renewed emphasis on a multidisciplinary approach to malaria research. Besides basic research on epidemiology, basic and applied research was being conducted on the development of a vaccine, and some work was in progress on new forms of chemotherapy. In view of the severe shortage of malariologists, he asked what efforts' were being made to provide the manpower to carry out the proj~cted activities, and what emphasis was being placed on training as compared with other activities. Dr SELF (Scientist, Vector Biology and Control) replied that governments had displayed relatively little interest in mites and fleas, the vectors of scrub typhus and plague respectively, and WHO activities were confined to specific countries. The programme was also concerned with the rodent vectors of haemorrhagic fever with renal syndrome, and with the snail vectors of schistosomiasis. Dr PAIK (Chief, Research Promotion and Development) said that the Special Programme fdr Research and Training in Tropical Diseases was currently supporting 36 centres in the Region that were engaged in malaria research projects: basic research, research on chemotherapy, epidemiology, immunology and vector control, and applied field research. There were 7 projects in Australia, 4 in China, 3 in Japan, 8 in Malaysia, 4 in Papua New Guinea, 6 in the Philippines, 2 in Solomon Islands, and one each in Viet Nam and Vanuatu. A report had been received from Chinese scientists on the preclinical development of Quing-hao-su (artemisive) and its derivatives, some of which had shown significantly better effects on cerebral malaria than the chloroquine in use at present. Dr CH'EN (Regional Adviser in Malaria) agreed that the problem of finding malariologists was a serious one: the number employed in the Region had fallen from 11 to 2 in the last 20 years. Until the 1950s, mdariology was a major area of training in the Region, but very few institutions now provided training in that field. Moreover, very few health workers nowadays were prepared to join malaria control programmes. WHO had laid emphasis on the training of the various categories of malaria workers, including malariologists; the Interregional Malaria Training Programme for Asia had recently been set up in Kuala Lumpur, and the United States had provided a senior technical officer to coordinate that project. However, the project was not designed to produce malaria workers but simply to promote national malaria training programmes. Dr EVANS (Australia), referring to programme 4.13.1 Immunization (page 112), and recalling the discussion on the subject at the thirty-second session, congratulated the Regional Director on including tuberculosis among the diseases that children should be immunized against. Despite adverse publicity, there was good evidence that BCG vaccination was still of value in the Region. At the same time he hoped that other diseases would be included in the programme if effective vaccines against them became available before 1989.
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REGIONAL
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THIRTY-THIRD SESSION
Health information su ort (5.14.0~ pages 156-157) Support services 5.15.0-5.15.4; pages 158-166) There were no comments. Information annexes Annex r. Regional Committee and Regional Office (pages 173-174) There were no comments. Annex II. Country or area programmes (pages 177-356)
Dr NOIROT (France), referring to the section on French Polynesia (pages . 209-216), said his Government requested the deletion of the last two sentences of paragraph 14. Annex III. Intercountry programme (pages 359-375)
Dr HINNERS (United States of America) drew attention to the table on page 375. It showed that the allocation for Sexually transmitted diseases had been reduced from US$12 000 in 1982-1983 to zero in 1984-1985. The problem was an important and ever-changing one, but extrabudgetary support ·in particular was much weaker than for some comparable problems. He invited the secretariat to indicate possible reasons for the lack of extrabudgetary support and ways of remedying the situation. Dr HAN (Director of Programme Management) replied that consideration had been given to including a budget line for Sexually transmitted diseases in the intercountry programme, but the regional Programme Committee had felt that to present a large number of very small budget lines was an undesirably fragmented approach to programming. If cooperation were to be requested for sexually transmitted diseases it was intended to provide it from within intercountry resources or from the Regional Director 1 s Development Programme. The REGIONAL · DIRECTOR added that, at country level, it was very difficult to implement control programmes, or even to obtain a · clear picture of the disease situation. Six years ago, for instance, reports had shown an alarmingly high incidence in . Singapore, yet that was the country of the Region where the control and surveillance of sexually transmitted diseases were most highly developed. The approach of the Regional Office, therefore, was not to identify those diseases as individual programmes but to include them within general epidemiological surveillance, stressing the role of prevention and health education at the primary health care level. There being no further comment:. s, the CHAIRMAN instructed the Rapporteurs to draft a resolution concerning the proposed programme budget estimates for 1984-1985. (For consideration of the draft resolution see the third meeting, section 2.2. and the ninth meeting, section 1.1).
The meeting rose at 4.55 p.m.