liORLD HEALTH ORGANIZATION REGIONAL COvilYIITTEE Fourth Session Tokyo 3rd to 8trr September 1953
"\ifP /RC4/TD5
2nd September 1953 WESTERN P.. ~CIFIC REGION
TECHNICAL DISCUSSIONS
EVALU~TION
QUESTIONS
In what ways did the Technical Discussions meet your expectations in regard to health planning?
In what ways did the Technical Discussions fail to meet your expectations in regard to health planning?
What did you like best about the were conducted?
lJaY
Technical Discussions
What did you like least about the way the Technical Discussions i'ferc conducted?
4th September 1953 REGIOlLU. COHLiiTTEE Fourti1 Session Tokyo 3rd to 8th septcrJber 1953 WESTERN P~CIFIC
REGION
TEGriNIC;~.L
DISCUSSIONS
REPORT OF GROUP I;. First Session 3rd Scptebber 1953, 3:30 -
5:00 P. M.
Following the panel discussion tor nll participants, Group A had a group s:CSsion in o. scpc:.rate. room. · The ::1cmbors in Group ~~ are Dr. M. Y~guchi (Japan), Dr. s. Kotarai (Japan'), Dr. H. Shiga (Japan), Dr. R. ~briol (Phil~p pines), Dr. \v. G. Evans (U.K.), Dr. J. H. Cruikshank (U.K.), Dr. H. DoLien (u.s ••"'.), and Dr .. R. Firth (\lHO). The discussion leader .-m.s Dr. DeLien. Dr. Yamaguchi ·Nas nar.1cd as the rapporteur. ;~t first, general discussion vms nadEJ on i'rhat subjects should be te!kcn up, particula.rly on the definition of 11Public Hoalth 11 • .ri.ftq! sane talk, the topic centered around ccoprehensive long rang~ health planning.
It was unanimously agreed that tho disease picture should be 1~.ado clear, :L.'1 order to establish comprehensive health planning in tho comra.unity. In this connection, there was considerable discussion of health surveys. It is true that v;cll-planned and beautiful health surveys viere nade in some countries 'b.u t they afton ended only as a survey without any actual public health activities. Yet, it is necessary to know the actual need and sociocconomic '.'..l status in hen.lth planning. This type of survey ::>oor.1s to be very :important n.nd should be carried out in co-operation 1·1ith rokted fields -- agr:iculturul, educational, etc. - .. ah1ays presupposing .iDr.wd:iatc future activity. In conjunction t,·ith th0 socio-economic aspect, the;; question of insuro.ncc and public as sis tancc .-;as rD.iscd.
Oftentiw::s., health plo.nn:ing :is mude for short periods of time, frequently rene•wd, and this is not so effective as a long range hcn,lth plan, it Has pointed out. Consequently, the need for 11 vurposoful health survey lms u:tphusizcd in order to establish long ro.ng>l:;lcnlth planning.
I Second Session (Group A)
TECHNICAL DISCUSSIOIJS Group rl. Page 2 Second session 4th Septernbcr 1953; 9:15 - 10:30 A.H. In the second session, "Funds for Public Health Work" was taken as the topic to begin with.
It was emphasized that a. Health, Officer 1-J:ien considering his budget should bear in mind the \\rholo budgetary .position of his comtrJ m1d the competing claims,for instance, of education, comr.1unications, agriculture, etc. The op~imuril proportion of a country's resources to be ruade available for public health work is not necessarily the maximum. The national budget for health work may be divided into two categories. One is the regular budget 1-1hich is appropriated by the respective country; the other is the support from outside -- say \'lHO, UNICEF, MSlt., etc. The l.?.ttor part of the fmd was discussed at length. The necessity for co-ordination 'of financial support from outside was poin~ed out. WHO assists .:m incl.ividw:l.l country through the ·govemuont ngcncies, but co-ordination of public health wbrk l;ithin the respective country is desirnble for the effective utilization of \VHO assistance.
V'f!'Y often the public health budget is estimated by personnel 'ofl.'thout 'dell-thought long range progrll111lnO planning, very important.
f~a.nc? wh~ch ~s
In-between, the audio-visual aici problem for public health education was raised. Beautiful films produced in foreign countries are often i.nadequate for the PJ,blic health education of tho local la.y people. Locally produced ones, even though they are technicclly ver,y poor, app~al very much oore to the local people. It was suggested that some sort of WHO assistance -- financially and/or technically is worth1-1hile to promote the production of J,.ocal films, \'thile, on the other hand, scientific films for the training of p'!J,blic health personnel .are very instructive. · Concerning 1'lHO technical eXPerts, it wa.s pointed out that co-ordination .between countries might prove econooucal in view of the vocy limited number of highly qualified experts. · It might be advisable for one expert to cover several countries having similar problems and no competition should be llk'\do by several organizations far one expert. .At the same time, it W1?.s strongly emphasized that j:.mblic health personnel should be trained locally o.s far as possible i.n their respective public health fields to meet local n~eds. It was suggested that samo sort of assistanca b.1 WHO in this -connection is very desirable. RECOl-!H.El~TIONS:
(1) Health officers should consider tne total socio-oconondc pictve and problems related thereto in developing requests for health
/ funds.
(2)
It m~
TECHNICAL DISCUSSIONS Group .d. Page 3 funds. (2) It uay be necess.:J.ry in some terr.itorics to undertake rosoo.rch to clarify relevant social and econonic factors.
(3) It is axiomatic that all countries should develop long range plun11ing for their health progrrunme. It is the feeling of the camnittee that surveys shoW.d not be r.aade unless they arc going to be actively used in health progr~~es.
(4)
(5) ~•udio-visual aids should be conditioned to the conrrunity in -,·hich they arc to be used and not necessarily technically perfect but rather to have local colour and interest. (6) 1"/hen e territory requests assistance frOla WHO in a health programoc, it uould be adventageous if WHO informed neighbouring territories of this project so that if the neighbouring administration Nero contanplating a similar project the 1~0 expert operating in the c,rca could afford assistr.nce, if so requested. (7) It h reconu:tended that, for reB. sons of economy' continuity of progrilWle and immediate locc:.l law-:dedge, the raost carcful co."1sidcration should be t,tiven to prograrr.t:1es of training local personnel. (8) Discussion Group A rocoiunends that consideration be given to the follov-1ing draft resolution l'lhich coulci be forl:r.rdccl tu the Cor.1Dittec: CONSIDERING tho..t the.: first function of the ivorld Health Orge.."1izn.ticn as listed in A.rticle 2 of the Constitution is 11 to act as tho directing and co-ordinating authority on L~ternational hunlth 1·Jorkn and Ki~OWING
that thoro arc in existence very many international orgmiza.tions concerned partly or "t,·tholly l-Iith health, ::.nd
KNOt'liNG that there is a 1vorld shortacc of expert personnel, and KNOWING that the.: total resources avc..ila.ble for meeting hoalt-.h problems are inadequate, and l<~hilc
RECOGNIZIOO. that certain agencies possess particular advantages li1 special fields, nevertheless
/ RECONl'iENDS to the
TECHNIC.;.L DISCUSSIONS Group~.
Page
4 RECOHLENDS to tho Ncmbor Governments that consideration be given to iiwiting the Orga.nizo.ti:.;n to exercise to a greater extent the co-ordinating authority given to the Orga'Ylizution by ••rticlo 2 of the Constitution.
WORLD HE.\LTH ORGANIZATION RTIXZIJN~L
4
S~ptember
1953
CONHITTEE
WESTE?Jf PACIFIC R:iniON
Fourth Session Tokyo 3rd to 8th SeT,tember 1953 HEALTH PIANNING
TECHNICAL DISCUSSIONS
Report of Group
B
(Submitted by Dr. Richard K.
c.
lee)
Dr. R. E. At'!dorson o£ the United Kingdom was the leader of the group. Seven official delegates and ten or more other ptrticiplnt~ aided . in ihe deliberations. The group met in two long sessions with an intermission at the second meeting. The Chairman encouraged was a free and easy flow of ~up participation and there discus.,..~.on on this broad su~ject.
Three nnin aspects of the subject were chosen. After a thorough and detailed discussion, a smaller was selected by the chair tq prepare the proper resolutions to rorry out the conclusions reached by the' group. The group again met to discuss the. proposed resolutions and after further discussion, adopted the following resolutions as its raport on the subject of Health Pla~~ing: co~ittee
RESOLUTION I - Discussion, Group B.
RECOGNIZING the importance of community· participation in health planning, and REALIZING that the ps.rticipg.tion of certain alements of the community are essential in health planni~g, RECOMMEID!S that the following be integrated and enlisted to accomplish this purpose: 1. 2. Agencies and associations concerned with health education of the public Civic organizations Voluntary health and ,,relfare agencies Professional Organiw.tions and ancillnry groups Government agencies Educational authorities Specially interested groups such as Jnrent teachers' associations and such newly created agencies as may be set up to deal with specific problems Greatest possible local fina.nci;.l.l responsibility and support
3. 4. 5.
6. 7.
8.
RESJIJJTION 2 - Discussion Group B REALIZING the need of legislative support for health planning P..ECOMHENIS the necessity for the enactment of suitable legislation to implement successf'u.l health planning
T:OOiiNICAL DISCUSSIOlS Group B Page 2
and the e:xarnina~cion of existing legislation with the view to removing th~Xil such obstacles that may exist to the implementation of the health plan. RFSOWTIOK 3 - Discussion Group B COmiDERING the necessity of personnel planning as an integral rart of health planning, REJJOGNIZING the blperta.nt effect of housing on the momle of personnel, R:En0MMENL8 that in the implementation of this objective the following fa.ctors be considered:
(a)
Adequate and continuOWi training of 'health persOh:nal to keep race with current needs of health projects, programme and facilities Adequate compensation by health administrations of health personnel by means of salaries, leaves, security, retirement benefits and the like That health authorities should take adequate steps in the light of existing circumstances to ensure that its personnel is suitably acconnnodated.
(b)
(c)
UORLD HEALTH ORGANIZATION REGIC~JAL
/1- ,3epte.mber 195.3 :~"ESTBRE
COHEITTEE
PACIFIC .REGION
Fourth Session Tokyo 3rd to Sth September 195.3
· TECHruc;~L DISCUSSIONS
REPORT OF GROUP C Group C, under the leadership of Dr. H. B. Turbott of Ne'l'/ Zealand, considered primarily three subjects :in relation to health planning:
(1) Developnent of the health plan; (2) Personnel planning; (3) The assistance 1*£0 in health planning.
of
A.
Development of the Health Plan
1. It was unanimously agreed thz.t every country should have a health plan, though .r:art of the group felt tr.at ~ong~tq~ planning need not be obligatory. Plans should be developed by a team of persons representative of health and social . fields under the ieadership of a q~lifiod medical person. 2. In order to develop a health plan for a given area, it J.s necessary to know, b:Z means of surveys, the needs of the area, 1 ·mat is being done to meet. the need, •'<'hat should be done and 1-~hat could be done i>'1 relation to economic and m.anpoucr resources •
.3. It is necetJsary that a Social Anthropologist be included in the survey team. · 4. Host effective health ple.ns \"lill b ·.;; realized uhen National Health Authorities invite out side groups into the planning - such groups 1\fould be non-official health o1·g.s.;:1izations, as \.,roll as :interested persons and groups from other than health fields. 5. Probably the best developed plc.ns ldll be those dre.\'Jll up by the i~ational Health Authorities ~rith the co-opero.tion and assistance of local groups and organizn.tions; thereafter, international aid could be sought to covor any gnps or problms. B. Personnel Planning
1. _ C onsideration of personnel must be giv0n a high priority in health planning·. 2. Pln.l'lning must include pre-service training, as planned in-service education. l'TCll
o.s
/ :3.
Extra post graduate
TECHlUQ DISCUSSIONS Group C Page 2
3. Extra post graduate education must be provided for, as required.
4. Public.health training programnes uoulcl·havo less difficulty in recruiting personnel if the liaison between the preventive and curative aspects of disease •·1ere emphasized in undergraduate progrc..!lties of all kinds. It is recomrnended that countries plan to achieve this objective. 5. In recruiting por3onnel for training progran1r.1es, pre-selection iiwthods should be employed, guided \'mere possible by a psychologist, preferably ·a national of the country, where this would be pos3iblc. 6. f
Planning must provide adequate pay and housing for a.ll l\'orkcrs. A superannua:t.ion schane must be provid'Jd for within the planning.
7.
8. Health supervision must be eXtended to nil vrorlcors, not only at pre-omployr.tent tliaos but G.t regular intervals throughout the t'forlcers' service lifo. C. Hmt can WHO best assist in Health Planning?
It l'tas the opinion of the group that WHO should carry on Hith training and instructional progro.nt:1es throughout the t·:orld; hm·w vcr, thoro \'illS an even split of opinion OVOI' hO'/l hiuch aSI;)istance w-1!10 :;houJ.d give in the country's health programme, one side f~eling that nclp to countries should be .lirJ.itcd to ·tho contro~ling oi diseases of i·l orld-;·;ide incidence,. l".Jhile the otlier s~·do ·f(Jlt ·that .. co\lntri cs -should be helped in any bremen of health 1-1or~ ·,rhorc they f0lt assistance was needed.
- SUbr.iitl.cd by Miss Virgin1u. M. Ohlson
lvORLD HEALTH ORGANIZATION REGIONAL COI~IMITTEE
5th septanber 1953 WESTERN PACIFIC REGION
Fourth Session Tokyo 3rd to Sth September 1953
TECHNICAL DISCUSSIONS
HEALTH PlANNING Opening Remarks by Dr.
o.
R. McCoy
Health planning is a basic part cf every type of health work. Therefore, it is of direct concern to everyone connected with a health organization regardless of individual functions or responsibilities. Healt,h planning takes place at all levels of a health organization. At each of these levels there is corlpetition for available resources -- ntoney, facilities, manpower. For this reason, it is essential that planning be co-ordinated in order that a proper balance may be achieved among the various efforts devoted to health :improvement. This inJ:lediately brings up the question: co-ordination of planning be brought about?· l. 2. 3. How can such
Shall it be entirely within the health organization itself? Or, shall it be the responsibility of a commission of advisers outside the health department? Or, as unfortunately is sometimes true, will it be decided merely by a budgetary officer Mio holds the purse strings?
These are questions which might be taken up by the discussion groups. In l:rief - What is the most desirable method to co-ordinate health planning? In considering this subject, it must be remembered that there not only is competition for available resources at various levels within a health organization, but also at the higher level of th.e various departments of the government. How can health planners meet the competition at this level -- other de.mands concerned with social welfare, for education, for public works? In this connection, it is my opinion that too much reliance has been placed on the huraanitarian appeal of health improveinent and too little on the economic aspects. Humani/ tarian considerations may
TECHNIC~L
DISCUSSIONS
Page 2
taria.n considerations uay attract greatest attention from the public, but in dealing l':ith budgetary officers, firm facts and figures count most heavily. The savings in tho economy of tho country 1·Jhich are J:rought about by health improvement need to be emphasized. Bu~ Hhat individual countries con supply figures as to the value of htu:nan lives that are saved -- especially those in tho younger age groups v1here preventive Llcdicinc and public health arc most effective? Also, 1·1hat facts can be produced as to the c.xtont of the reduced drain on the econotw \·1hen sickness is prevented -- o~ th~ increased productivity ~•hen the health and nutrition of 't;orkers are iraproved? These subjects also might be considered b~ the discussion groups. In brief, the question is -- To what extent and in 1>1hat way can econornic considerations be integrated into health planning? I will turn noH to another subject that is always a problem Hherevcr health Hork is conducted -- that is, personnel. .rl,s long as health departments exist, I think they "'ill o.hw.ys have a shortage of :r:ersonnel. ..t least, Ihave never heard of one yet that admitted having m ough trained people to do tho 't'rork that needed to be done. This means that planning of projects continually must aim for a balance betl'Jeen naterial facilities and personnel. Usually, it appears the balance is weighted too heuvily on the side of Lmtcrial facilities. As a rule, it seems easier to find r.wncy for buildings, supplies, and equipoent than to obtain money for salaries of health workers. ~lso, health officials often arc reluctant to spend uoncy for the proper training of their personnel needed for health operations. HoH can this situation be met in health planning? Is it a problenl sufficiently distinct to W<lrrant separate planning? Or should it be an integral part of every type of health planning? The latter certainly seems the nore logical; but v.hen handled in this \'ray, the personnel aspect of health planning frequently seems to be neglected. :Most of us here have the point of vicl'J of the health officer, and thus far, my discussion ho.s rather follo~;ed this vimvpoint. But health plruming not only concerns the people i'lho carry out health . operations. It is of even more :importance to those for v1hom the 1:ork is done. It is axior.mtic that public health \'fork must have understanding and co-operation \lithin the ccrnr.1unit;y-, if it :is to be effective. Therefore, it is appropriate nm1 to . turn to consideration of conununity and far,lily factors that influence health planning. The question might be stated in this way: vJhat elements "for community co-operation must be included in health planning? ·This r.art of the discussion I shall turn over to Dr. Raymond Firth, Professor of .:Jlthropology in the University of London at the London school of Economics. He is a short-te.rL.l consultant for ~'lHO and recent~ attended the Child hental Health Seminar in AUStralia.
WORLD HEA.LTH ORGANIZATION RIDIONAL.·COMMITTEE Fourth Session' Tolcy'o 3I'd to 8th Sept embar:. 1953
5th September, 1953.
WESTERN PACIFIC RmiON TECHNICAL DISCUSS! ONS
HEALTH PLANNING AND· COMMUNITY ORGANIZATION by ~nd
Firth
I am taking as rrr:r main theme that of community participation. In document TD/4, .it is stated that in.health1 as in other subjects of gcwerrunental concem, it is possihle to make the most rapid progress when the people being served are keen, or even better still, are anxious to receive the services. The same point is made by the ~ocument on health s'l.n'Vey design. No doubt we can find exceptions to this. Great medical progress has. undottbtedly been made in remedying the health of people who were apathetic. But I imagine that genera~ speaking the idea is accepted that the eo-operation of the people is an importanit element in health planning •. B.l.t while this· is so., a lot of questions are still involved. We can assume that ·people are -al~ys keen to get well. If that is so, why then do they bot always take advantage of the heal:ijl'.Planning that is ,d one for them? The reasons, I thinlt, can be divided into three .main categories. .The first is that of ~tupidity, ignol"Clnce .and fear what we may call a geil;eral lack of understanding pf.:what is wanted. The second category is wba t is often called carelessness meaning by this tl:at the people are willing to co-operate and !mow how to do so, but in their range of preferences the" necessary h~lth measll'Pes com£l lower than some other ways of expending their energy• . The third category is that of resistance, meaning by this ~t they may know what to do but definitezy they do not· want to do it. They have .an attitude o+ objectioJ:l for. what they consider to be good and· po:&~tive reasons. If. th~: lack of interest. in health measures is due s~pzy to. a lack of 'lJX¥ierstanding~ either with or without rear, thm it ~Y :~, that a fairly sftnple failure in communiCation is responsible. Remedie~ may range from rooro attention to the.· language of comrmmication, to Sl more outgoing attitude of personal sympathy., or· to more elaoorate or more specific programmes of health education. (Perhaps the use of specialzy re.~Qrded talks 'in the vex-nacula.r may help here, or that of special:cy designed films.) But if the. lack of interest is due to competing preferences for time and attention or to definite objections to the health measures, then we . have to go deeper. Cases of this ~re well known to everyone. It should be reali~ed that the behaviour of people in these circumstances is not just X: andom. It fo;tlows a pattern:' am .ia. part of a system of behaviour which they adopt in other aprd.::J..ar situations. Moreover, this system of behaviour has a structure in which the various el~ts are so inter-related that by affecting one ·yov.~ also influence others. It is necessary then, in attempting to enlist community ·.participatiorr or overcome conmunity objections, that there should be some knowledge of the structure and of the organization of the communitY ...- the framewrk of the ordinary activities of the people.
~is also necessaey to know something of their values the ideas that they have, often, with strong emotion, about·tbe kinds of activities and things that are proper and good. Sympatey1 education and proof by experience can do ··a lot to convince people who resist health -~~s even i f the h~alth worker'is going on rule-of-thumb meth6ds. "' art they are not enough. Ths7 must be backed by lalowle~e. Much time can be saved and much more accomplished if the health worker does know just what the structure and the values of the people are and how they out across the developnenl; of health work or can be used to contribute to it. But the structUre of the co!IIIIUility is not always perceptible by ordinary observation. It needs systematic study. It is sensible to think then that better results will be achieved if the health planner takes the possibility of such things into consideration and makes some provision in his Pt'ogranrne :Co~ getting information about them and co-operating *ith ozo ut:il:tzJ. ng them.
the most efficient use of' resources over · a given time in relation to a set of health needs or requirements. These needs or requirEmEnts are either given in the situation alreaey or have to be assessed·. And realistic planning means tald.ng account of all factors that. can be envisaged- ndt in waving some aside because they do not se<n to fit :Uito the · plan. Planning then implies a lmowledge of what resources are available or potentially available, and ideas on how they can be mobilized and used• art it must start from some assessment of requirements or needs. Ibth of these'impl.y attention to social an:i eultural aspects of canmuni ty life.
Planning is a word defined diff'erent~ 'by di..f'ferent people. But 1 for ou.r purposes here, it can be;said to be preparation far
In the Wester.n Pacific Region, there is great diversity of 'tt.ese social and cultural aspects. Specific knowledge of' them is important for two broad reasons. The first is that with the great modern use ot international personnel it is advisable for them to have some knowledge of the ld.rxls of societies in which ~hey workthey ehould have a considerable degree of cultural receptivity. The second r~son is that., even in a single countr,y which is of multi• cultural character, it may well happen that a person :troin one cultural group· will be working among the people of' aoothor. Here, too, then there is need for this kind of special cultural knowledge. I suppose it is correct to say that 1n recent years one great trend in health measures has been a moving out more and more .f:rm the hospital to the home. This results from :maey factors. But one of them is the very general recognition that w:Lth the growing eost of health services, it 1s'ex.pedient that the oonmunity should be· enlisted in its· ow defense. . "A Home Guard for Health" might be the slogan here. It means particularly a transfer to the local field of'. part of the costs· of health measures 1 especially in lalx>ur and in that more ·~tangible oost.; responsibi.lity. If this is so, the -implication · 18 ·that what goes on in the home._ or in the village or urban housing b.lock or tenE!Dent hoUSe - is impOrtant for the health planner to know.
/It
is part of the
-3It is part of t:Q.e pro~ess of "getting down to the grass roots" or in local te~".t.o.;_;t..be .rice ro.o.ts."" as one might say. ot_ ~urs_e·, a ~eaf' ~eal of. ~hat goes on in the . home !2. known froo{ the dil;)trict h~alth. nurs~. the: social welfare worker, the hospita1 al.(ll()n!)r, the local medical practitioner, the hospital dress~r~ ·· :Bilt·I put it to llOU· that there is still a fair~ big :f.'ieid ot such domestic and local matters coneerned with health a boot ·which. information ~vailable to heal~ pl~umers in ~my country still vague. For exB.mple., even in the hig~ developed countries we still do not know enough about conunon fami:cy- patterns or about differences in nutrition and in personal hygiene among various groups of the · population. . What we . do ' know is still for the most part tniystematic and impressionistic. For· the so-ca~d "underdeveloped CO'\.tntries" this is still more the case. Lot me briefly refer to·a few aspects Where information is lacking and would be ver,y useful1
more
is
(a) ~e first is nutrition. Here collaboration of nntrition 1-rork with sdcial anthropolOgy wOuld be very useful since the anthropologists have developed interview techniques and techniques of collecting information systematically about food habits• bOliefs am taboos against the backgrotmd of social and economic life. In ' New Guinea, for instance, some very interesting work is being done on these lines by a nutrition worker trained in social anthropology. (b) Ideas a tout the etiolo Rece:ali work by soeJ.a an po og s s J.n a n merJ.ca has s own how the ideas of people there about disease often include a division· of diseases into "hot" and 11 0<:!ld"_. with cures thought to result from application of remedies of opposite type. Something analogous occurs among Malays. Some of the symbolic notions involved are rather akin to those of the madi.Gv.aLdoctrine of signatures. The suggestion is that if such ideas are known by the health planner they may be used - in therapy to .get the patient on the Side of the doctor, and in preventive medicine to get the community in rapport wi. th the health worker. (c) Ideas about treatment: There is~frequently in the West ern Pacific Region a dichotomy of another kind. · Diseases are divided into two categories, those which are thought to be curable by Western medicine and those which arc thought not to be eo ~able. In Latin .America it has been said that the all¢ged ignorance of Western trained doctors and nurses about the latter category of diseases and local remedies has hampered people in seeking aid. On the other hand, i f they feel that the doctor already knoWs about the treatment they follow in their local practice, then they are more readi]¥ incl.ined to accept his advice. Much of the local practitioner's diagnosis and treatment must, of course, be regarded as inadequate and even wro~ cy practitioners trained in We~torn science. One can expect that in the course of time, particularly as '\rllstern medicine becomes more efficacious, much Of this local treatment 'Will disappear. On t .he other hand, not all of it is necessaril\v of this kind. As the work of Gimlette in Malaya indicates, there. is, often something _ of what may be callod a primit;ve phn.rma.'c opeia, .with certain drugs of.'· limited efficacy. Sol!W3 aspects ·of manipulation may also be effective . Whether this be so or not, it is a question worth considering in a. given co\llltry as to whether the health plaiUler might not take into oonsideration what is being done by local practitioners of the "medicine-man" type, and see if their co~peration can be enlisted in health wrk. /(d) Psychology
(d) .PsJ(chology of the ~tients Whatever be the -Q9ois.ion ,about the c~a£ive ro.1e of he !ocal practitioner .from tne pby$~cal point of view1 tl1ere is· no doubt tl'lat paychologicalJ¥ he. has the confidence of his patie~t~· This he gets by various 111e~;_ some ·:of which like ritual 'd ancing or m~diumisti~ performances, cettaillJ¥ :n.ot a,yailable, to the' health pl.a.I1Ilar. BJ.t a atucy of his methods might give useful information as to ways in which the confidence and/morale of the people might be secured and maintained 1n health work. fr~
lht I want to emphasize that the information to be gained social and .cultural. studi.~ is by no means onq negative in its applica~~on. It has important positive aspects •
. t~:.a
.~e~~th.:(:!og;=~~YC:~ij!~~ot~e! i!;g:uc~;~nat~~JTI!lunity
capa.city of the people. to pay far · services or to maintain them by their own labour. . Hence, it is important for the health planner to hav~ :as adequate data as possible on the eoonomi.c structure of the 9omrinmity, its income levets, capacities for di~~t1rent ~ - of expenditure, available lal::x:>ur resources, competing claims am wants. It is not easy to get such information adequate~ even in a cash aeon~. Blt1 in man,y of the countries of the Western Pacific Region, especially in the · rural areas 1 a· groat deal of the economic relations are in ld.nd and not· on:cy in cash. FBtima.tion in such conditions is extremezy difficult. H~o Sj)ecial study is l"e-quired. Impressions alone are not enough. In getting the data, the services of· an anthropologist with training in economics or an · economist with training in anthropology could be of great use. (f) Group structure: In the effort to get coJIIIlUility participation, it may oo very important t-o know what are the structure and functions of the various types of groups in the community. For instance, many of the societies of the Western Pacific Region have a · structure in which there is faction and rivalr.y between the groups. Knowledge of this may holp·even in such small matters as selecting a site f-or a health centre. If the group structure is not known, the stte . selected may be silclf that the group concerned may attempt to keep other groups· off or ~loit the siting for its own ~dvan~a~e. Again, it may be possible to enlist the spirit of rivalr.y and campetition .to promote health servicee. One community can be encouraged to strive for a better health service than its neighbours. This can be a wasteful process but, if carefull\Y handled and w.i th proper knowledge of the structure of the groups concerned, it need not, but can be of advantage •.· Again, such knowledge is useful in forming now local organizations of a voluntary or semi-official kind. Most organizations s~ek an ance~try and1 i f it can be shown that the new organization can find roots in a tra.d i tional one, then ·its basis will be more . solid. Ibt to do this adeq:Uatel.Y again needs a proper knowledge of what the various forces and . groups .in the oommuni_ ty already arc. (g} Responsi 1.:d.~ and leadership: In acy health programme, one of the .stumb Sl()CkS !'requeiltly is in gett;Lng local people to take responsibility and in getting good ~eaders not only with initiative but also .w ith influence enough -··t o be able to induce the people to follow than. /Here the trouble may
-5Here the trouble may lie in inadequate knowledge of the basic principies on.: which status in the society really depends. . In stime ·societies, for l3Xaniple, the real influence lies uns~pected by th~'outside observer.in the hands of elders who, through-' lea-dership <"fld.nsbi:p groups or the possession of ritual status or: :the control of' e66riomic··power~ , dominate the community. · If the health planner ha&'a knowledge of how status is obtained and held in the conmunity, then it may be much easier for him to calculate what his leadership resources may be, and to enlist community participation as, for example, in getting members of a village health committee. There is another way in which the social anthropologist in particular can be of use, that is, in acting as a social thermometer when health programmes are under way. From his intensive observations in the commu.nity1 he is usually in a position to test tho reactions of the people to health measures as they are put into operation, and so provide the health planner with data which he can use in any revision of his programme. From what I have said, it will be seen that material on the social and economic structure of the community is important both in the assessment of requirements and evaluation of resources • How is provision for attaining such information to be fitted into the plan? One way is by stimulating the interest of the health workers themselves in attaining such material as they can. And some training in the general principles of social anthropology wo~d increase the precision of many of their observations, as for example, if they oolleet social material as part of case histories. Another way in which more could be dono is by the ana~sis of routine data in more systematic form from demographic, economic and sociological angles. But a difficulty here is frequently lack of time. The social worker or medical man rarely can spare a great deal of time for special enquiries. Hence, help is needed from elsewhere·. Somo muterial of use to· ·the health planner can be obtained from economists, social anthropologists and other research workers primar:l.ly engaged in other pro blens. But to be of much value, the nature> of the problems and the kind of material to be collected need to be worked out in collaooration 'With the health planhor before hand. Speoifical.:cy oriented enquiries 1 either of a sociological survey type or an analysis of special problems, arc the most effective. (A considerable amount of such work is now baing done in Latin America.) Sometimes, the field anthropologist can work as a close member of a team. More often because the scopa., timing and inliensity of his enquiries are very different from those of the workc.t .his fello1-T members, he is best allowed to proceed on his Ol~. But there is a great deal to be said for including the social anthropologist as a definite part of the health planning organization, not simply uaing his s ervices·for one or two years and then allo1dng him to retire from the scene; This would obviously involve proper budgetary provision for him. On the other hand, it would mean that'he becomes familiar with the problems and that continuity is maintained. /In concl·J.sion,
I would emphasize tha~ the social social ap.thropology, in rela~ion to .health planning canno~ act simply· as keys. in .a d~or.. · The p;roblems ar~ comp;lex and refractory. ..'l'her.e ~e few si,mple solu.tio..n.s in overcoming resis~ce to and secur.ing. active co-operation in a heal1;ll p~gramme. But, if progress is slow, every f!.dvasce maqe: on a basis Of systematic knowledge will be made on a mu.ch surer foundation. I~ ~conclusion,
sc;en~~· including
WORLD HEALTH ORGANIZaTION REGIONAL COMlUTTEE
6 september 1953 \lEST::illN PACIFIC REGION
Fourth Session 3rd to 8th Septetlber 1953 Tokyo
TECHNICAL DISCUSSIONS
HEALTH PL.:JmiNG Sumaary of Activities
.At the first meetine,o.: the Fourth Session of theRegiQnal Committee· on 3rd September, the Chairman designated as lloderator of: the Technical. Discussions Dr. O. R. l.J.tcCoy, the Observer from Jih e Rockefeller Foundation. The r4oderator, in an introductory speech tc tho Cocmittee, outlined the purposes of the discussions and the proposed n'l&lfler of conducting them. He invited the Observers to join the dinc.ussions and. listed tho names of those Representatives and Observers ~ho had been placed in the Discussion Groups A, B, and C. The Groups lwre as follows: Grou;e A Dr. You Chhin Dr. Ha.r.1-Kom-sann Dr.H. Shan Lang Colonol·Demange Dr. Yamaguchi Dr~ s. Kotami Dr• H. Shiga Dr. R. •-~.briol Dr. ~~~. G. Evans Dr. J. H. Cruikshank Dr. H. DeLi en Dr. H. r.ln.rcel Dr. Tran-Van-Thin Dr. T. Tamiya Dr. H. Kumabe Dr. Pha.m van Chat Dr. R. -Firth Group B Dr. c. H. Yen Dr. T. c. Hsu Dr. H. Oka Dr. Y. Hatsumoto .tviiss M. Kaneko Dr. R. Padua Dr. J. ..... R. Cabral Dr. R. E. ~derson Dr. J. H. Liston Dr. u. K. c. Lee Dr. s. Ke:i.I:latsu Ku~ana
Grou;e C Dr. T. c. Hsu Dr. J. c. l'f. Wang Dr. H. Ishida l•ir. I. Nakamura Dr. H. J •· T. Bijlmer Dr. H. B. Turbett IV.ir • Ivi. C. ;..ngeles Dr. N. Doraisingham Dr. s. Takami Dr. T. Hura.matsu Miss S. Hayashi Dr. E. Ketcher Miss V. Ohlson Iviiss E. Rauch
Mr. s.
Dr. N. Irimujiri Dr. J. Ono Dr. J. o. Raffety Dr. o. n. lJ.icCoy
The l~!oderator designated Dr. Horace DcLien as leader of Group ~' Dr. H. B. Turbett as leader of Group B, and Dr. R. E • •inderson as leader of -Group C. In th c follm~ing afternoon the Technicc..l Discussions commenced with a panel discussion betlvccn the Hoderator and Professor Firth, The panel discussion, vJhich lasted approm1a tely an hour, was followed by discussions within the groups. Each group elected a Rapporteur \iho vtould present a report to tho
I -third Technical Discussicn
TECHNIC.U. DISCUSSIONS Summary of ~\cJ~i.vit:i.es Pago ·2
third To.OhnictiLDi:seussion. meeting. •·..t the conclusion of the meeting, the Steering Committee, 1 :hich hJ.d i~let half an hour before the c 0Uit1encement of the panel discussion hud its second meeting, at 1·[rlich the progress uade by the various groups was reviel<Ted. On 4th september, the three Discussion Groups metagain indepcndenUy. ..~.t the end of these meetiri.gs, each group had decided upor. those points l'rhich they wished to ·report to the final Lleeting.
On 5th Septor~tber, the final meeting took place. &J,ch Rapporteur presented :m oral report ~or his group. Written reports had 'b een circul.ated. ReCOrLI!itenda.tions were con&idered and then the Moderator arranged for an evaluation of the Cliscussion~. Sliw.ll sub-groups were formed l'Iithin the room ana a spokesman for each BI'oup expressed to the full meeting the opinions of th~ individual groups. This l"tas :t:.Ollowed by a short genefoal . discussi~n of the tetHmiques anployed during the Technical ·Discussions. In conclusion, the Hoderator, Professor Firth, and i•lembers of the secretariat :qerc thanked .for the assistance which they had. given. Technical Discussion documents are as follows: (1) The ·o:Pening rcraarks 'lhe opening rer.uarks o~
~cb
have boon mmeographed
the ·Moderator. Professor Firth.
ot
(3) Heport from Group A. (4} n.eport fran Group ·B.
(5)
Report fraa Group d.· summary l<Iinutos of the final Technical Discussion Neeting. "Heal.th Planni:hgft - Paper prep;lrcd by the Governr.1ent of Vietnam. "General Organization of a Country's Public Health Services" - Paper prepared by Dr. Henri liarcel. This sUr!Llary.
(6) (7)
(8) (9)
WORlD HEALTH ORGANIZATION BJ.!:QIONliL COMNI1W Fourth Session 3rd to 8th Septenbe.r 1953 Tokyo
6 September 1953 HES'rERN PACIFIC BEGION TECHNICAL DISCUSSIONS
THIRD TECHNICAL DISCUSG IOU MEETING (5 September 1953) 1. TilE PROGR.~IiliE
The meetb1g opened at 9:10 a.n. The oaet:h1g. 2. VISIT OF NR. PATE, EXECUTIVE DIRECTCR OF mT:tCEF ~derator
outli•1.ed the prograr.nne for the morning
The Hodera"Gor announced that Mr. Pate, Executive Director of UiHCEF 1 had arrived and would address the L'leeting for a few minutes. Mr. Pat.e was introduced by the Director-General. Mr. Pate thanked the Moderator for the opportu.rlity of say:ing a few words. He explained that he was proceeding to United Nations Headquarters to attend the semi-annual meeting of .the ill{ICEF Executive Board which was scheduled to coi:'.nence the followi.Ytg Tuesday. In Japan, he had discussed wit..l-J. the _ _government joint plans for the long-term relief of those who had suffered fron the recent floods. In Korea, he had discussed with the Government matters concerning emergency relief progranmes. Lllte the Director-General, he referred to the importance of co-operation between UNICEF and W H O. He referred also to the successive fmancial crises experienced by UNICEF. In spite of these, however, over US$1901 0001 000 had been contributed to UiHCEF. The approaching meot:ing of the Executive Board would consider malci."1g one of the largest allocations for the last few years. The Moderator thanked 1-1r. Pate for his speech.
3. REPORT FROM GROUP A The report from Group A was presented by Dr. Yamaguchi. (See separate document) Dr. Yamaguchi surr.ma:rized the report. Dr. Padua thought that the draft re solution (recommendation no. 8) would be strengthened with the addition of a reference to the need for generous financial support. During the discussion, the meet:lng 1 while in agreement with Dr. Padua's suggestion, felt that it would not be a~propriate to incorporate it :in the draft resolution. value of
eo-oro :1m tion
Dr. DeLien and Dr. Yen both refe r r ed to the :inportance and connnittees.
It was noved 'bJ Dr. DeLien and seconded by Dr. Cruikshank that the following resolution be adopted and forwarded to the Regional Committee' /"CON SIDERDm
Thir~
Technical Page 2 "CONSIDERTI~G
Di~oussion }~eting
that the first function of the \-lorld Health ~tion as listed in Artfcle 2 of the Const.itution is •to act as the directing and co-ordinating authority on the 'international health work' arrl KNCMmG that there are in existence very many international organizations concerned partly or wholJ,y with health, and KNOWnm that there is a world shortage of expert personnel, and
KNaHNG that the total resources available for meeting health problems are inadequate, and while RBCOGNlZ.lliG that certail1 agencies possess particular advantages in special fields, nevertheless RECOl·1HE!IiDS to tho Hember Governments that consideration be given to inviting ' the Organization to exercise to a greater extent the coordll'latL~g authority given to the Organization b.y Article 2 of the Constitution."
4.
ARRIVAL OF DR. KOTCHER
The Hodcrator welconed the FOA Observer 1 Dr. Katcher, vrho had just arrived.
5. REPORT FROK GROUP B The report fron. Group B was presented ~· Dr. Lee. (See separate docunont.) The follow:L.'"lg draft resolution was discussed: "RECOGNlZTI!G the :inportance of cor!ll!'Ulllity participation :in health planning, and P.EALlZilTG that the particir:ation of certain clements of the conmnmity are essential n1 health plann~g, RI~COUl;EliDS
that the .following be i."'ltegrated and enlisted accomplish this purpose: education of the pubiic 2. Civic organizatlons
to
1. Agencies and associations concerned with health
3. Voluntary health and wel.fare agencies 4.., Pro£essional organizations a nd ancillary groups
5.
Government agencies
Third TeChnical Discussion Moe-t.ing Page 3
6. Educational authorities 7. Specially :interested groups such as y.Jarent teachers' . associations and such ne\-1ly created ageucies as may be set up to deal with specific problems Greatest possible local financial responsibility and support
8.
It was suggested that the word "integrated" contained in the recoinr-endation part of the resolution was not quite appropriate. Ho\trever, as the Regional. Co:rnmittee would not need to take action on the resolution, it was decided to make no alteration. The following draft resolution was discussed a "REALIZDTG the need of legislative support for· health planning RECOMMENDS the necessity for the enactment of suitable legislation to mplcuent successful health planning and the exar.lination of existing legislation with the view to removing therefrom such obstacles that may exist to tho :implementation of the health plan." Thi§ resolution was acceptod. The Neet:ing then considered the following draft resolutions "CONSIDERING the necessity of personnel plann:ing as an integral part of health plann:ing, RECOGNIZING the inportant effect of housing on the morale of personnel, RECOr·:X1ENDS that :in the inplomentation of this objective the following factors be considered: {a) Adequate and continuous training of health personnel to keep pace with current needs of health projects, progr~~ and facilities Adequate compensation by health administrations of health personnel by neans of salaries, leaves, security, retirement ·bcnefits and the like That health authorities should take adequate stops :in the J ight of' exist:L.'lg circumstances to ensure that its personnel is suitably .acco:rnmodated."
..
(b)
(c)
During the discussion, reference was made to the inadvisability of constructing institutions without planning for the trained personnel requL'l"6d to staff such institutions. · The Rapporteur sa:id that Dr. Cabral had referred to the difficulties experienced by small countries in undertaking training prograrnnes. In this respect, Dr. Cabral thov.ght that neighbouring countries /could
Third Tochnical Disous.sion Moe-t.ing Page 4 could be of help. Dr. Gm1ther suggested.that the words "and other conditi~~s of employment" be added' to the second phrtlse of the resolution. Tho Heeting accepted this suggestion, but the Moderator considered that no formal action would be needed as the resolution v10uld not have to be forwarded to tho Regional Co~'l1littee.
6.
RLPORT FROli GROUP C ~iiss
The report from Group C was presented by (See separate document.)
Ohlson.
Miss Ohlson explained that tho group had not prepared any formal resolutions. During her summary of the discussions, Hiss Ohlson observed that a social anthropologist should be i.'1cluded in a surveyteam. At the conclusion of the discussion, the Moderator announced that·there would be a 15-minute recess. 7 • SUBJECT FOR TECHNICAL DISCUSSIONS AT THE 5th SESSION OF THE REGIOl!AL CONHITTEE
Dr. DeLien moved that the following subject be chosen for tho discussions 1 "Public Health AdministratiDn with Particular Reference to the Org&~ization of Hoalth Departments". The notion was seconded by Dr. Guntbor.
Tho Moderator announced that it had informally been suggested to hi;;". thct "Rural Hoa.lth" night be suitable. Dr. Yen agreed with Drs. DeLien and Gunther that the subject fir~t suggested would follow logically from "Health Planning". He also thought that "Rural Health" would be a suitable subject for discussion 1n 1955 after the 1954 discussion on public hoalth administration. The mot ion was carr:isd • 8. EVALUATION OF THE DISCUSSIONS
. The Hoderator invited tho participants to rnake frank -and candid coi!llilents regarding the discussions. He thought this would be useful to the secretariat jn arrang:i.J.1g for supsequ~nt discussions. He :Uwited Hr. Keyos to &scribe the eYaluation technique to be used• :Hr. Keyes explained the "buzz group" system, and the participants formed seven small groups of five or six individuals and selected a spokesman. For ten minutes, these groups discussed the four following questions: (~' In what ways d~ ~1e Tecll!l.ical Disecussions meet your expectations ill rogaad tQ, health planning?
/(2)
In what
Th.ird Technical Discussion ~&tlrig Page 5 (2) In what ways did the Technical Discussions fail to meet your expectations in regard to health plannL'lg?
(3) What ·Gil. :id you ljJ<e bo st about the way Technical Discussions wero conducted? (4) \-That cH.d you like least about tho way the Technical Discussions were conducted' The Moderator then invited a spokesman for each group to report on tho op:inions expressed. The opi.'1ions are su..."llJ1".arizod as follo'\otS: Question Nunber 1. a. One group did not understand the question; one group did not reply. b. Two groups indicated that they came with no expectations and hence, the discussions wore a surprise. c. Two groups reported that the participants had cone with an open m:ind and had received many new ideas. d. Fj,ve groups :indicated that there had been a good exchange of ideas and that they had considered the discussions to have been well worthwhile. Question Nunbcr 2. aThroe groups had no critical comments to nuke.
b. One group felt that thoro were insufficient background documents. c. One group thoucht that there was too nmch doeut1entation and :insufficient t:ime to read it. d. Two groups reported th.::lt although many ideas were expressed, nothing new of a tecru1ical n~ture was learned. c. Three groups stated that the subject was too broad and should have been nore specific. f. One group sa:i.d that the munber of countries :in one discussion group was too srnall. Question Uumber 3.
a.. All groups appreciated tho free exchange of ideas, the personal contacts, and the discussions around the tables. b. Two groups stated that the techniques used were good. /c. Four
Third Technical Discussion Meeting Page 6 c. Four or five spokesmen said that the panel should have been larger. d. Two groups mentioned the very pleasant informality which had prevailed. e. Three groups specially mentioned the small discussion groups as being popular. f. One group considered that the Technical Discussions had been well planned and that tho procedures had been orderly. g. One group reported on the will:Jngness of people to modify their ideas after hearing the opinions of others •
Question Number
~;.,.
a. Three groups stated that the subject of the discussions had been too broad. b. One nan said that an alternative to the panel could be a speech from an outstanding authority on the subject under consideration. c. It was suggested b,y two groups that the discussions should be held later at which t:ime participants llOuld be better acquainted. d. Two groups referred to the shortness of time available for the discussions.
c. L'1 elaboration of "d", two groups sa:id there was no t:ine to prepare and discuss resolutions. The Jvloderator then summarized the more important po:ints which had been made and expressed his opinion that they wouli be very useful in improving subsequent discussions. 9.
THE ARRIVAL OF DR. RAFFETY
The Hoderator welcomed to the meeting the FOA Observer, Dr. Raffety, l-Tho had just arrived. 10. EXPfu.;SSIONS OF APPREC rATION Drs. DeLien and Cruikshank thanked the Moderator, Professor Firth, and the members of the secretariat for the assistance which had been given during the discussions. 11. REPORTS ON THE DL'3CUSS IONS
The Moderator invited Dr. Patterson to speak on this subject. Dr. Patterson invited the meeting to indicate the form :in which the /reports
Third Technical Discussion Meeting Page 7 reports should be prepared. It was decided that minutes of the third Technical Discussion Meeting would be prepared. Also 1 there would be a short summary of the whole proceedings. In this summary, there would ·~ . listed all of the mimeographed documents relating to the discussf~ns. The Meeting adjourned at l2a05 p.m.
---
vJORLD HE.J.TH
QRG;u~I&iTION
3rd september 1953 WESTERN PACIFIC REGION
REGIONAL COlilHTTEE Fourth Session Tokyo Jrd to 8th September 1953
SPEECH BY DR. HENRI 1-wtCEL Excellencies, Ladies and GentlGmen, Y~ Dear Colleagues,
~ CIL~llU<IA.N
Aft er Geneva, Manila, Saigon, >·w are now meeting again and this year in Tokyo on the gracious invitation of the Japanese Goverruucnt. Allow me on your behalf and in my own name to express our most sincere thanks to His Excell.:mcy, the President, to their Excellencies, · the I\iliriisters or' the Japanese Government far the great interest they are good enough to show for o,ur medical ' meeting and for the most cordial welcome their representatives have given us. This is a fortunate opp.o rtunity for us to meet again anP. I 11ill riot say to rene'"' acquaintances, for, after three conf erences, v!e have become ;r.J.ore than mere colleagues, vie have all becoae friends. This is an opportunity to strengthen our -friendship and, I cannot help saying it, but I am sure that I am pressing the thoughts of you all, . to visit this country l'lherc bloom. the most beautiful chrysanthenurns in the World, this calmtry 1iJhere water and hills meet and mix their colours under a clear blue sky.
ex-
~~e arc starting to vrork in the midst of this beautiful setting and arriong hosts \vhose fri endliness is overwhelming •
.i~t tho sixth vJorld Health .n.ssenibly, the Director-. General summed 'up the uain WHO activities in the various regions for 1952. 1:fe have all read his interesting r eport. The Regional Diroctor frotn Han:ila v1ill give us a summary of the activities of our Uestern Pacific. Region. ~le arc pleased to note that in the course of these past. y ears, our · Region has shovm as much · interest and courage as all the other ·regions in th e improvement of health conditions ~ong its population ••• this despite the political difficulties ranging frau minor disputes to open conflicts '>lhich have hampered health activities • .
;~lso, there have b een many difficulties encountered in the recruitment of qualified personnel. If I say this, it is
/
beca use I believe
Page 2
because I believe that our Committee deserves as much consideration vlithin the Organizntion as vrell as all the other regional committees • .A.ll 'this goes to prove that 1...re doctors accomplish a similar task whereever we happen to be in the world and that the medical work and me- ·. dicine more than anything else will enable East and ~~est to meet and to understand each other; because only one aim is guiding us to help reduce the suffering of others and to help humanity to reach better physical and mental-well-being• . : May .out, ·example . inspire the paths that we take so that our ideo. of hurJ.an. kindness may insure universal security all over the 1 ·rorld. Our workload is very heavy, cons:iJ::lering the very short time lJe have. itJnong other items, the ag·:mda contains two important questions. The first is the establismJent of a work ·programme for the year 1955; the second is the discus.s ion of health planning in one particular country. · · · It is unusual that a Chairman in his opening speech should develop at . great length the problerus vlhich are submitted to the consideration of th0 committee; however, you vlill allow me to express my satisfaction in noting that despite the great distances · which · separate us; :in spite of . the great differences of latitude; the C?lilllate; in spite of the rarity or even the absence of an exchange of infonaation, our work:L.ig progranuaes are so similar that one might think that we have established them together. This is simply because the same dise.a ses, rua.laria, tuberculosis and others affect us v dth the same violence; it is because .our attention is drawn to the same medical and social problems, mother and child health, training of nurs·e s and ·others. This similarity of health problems should :induce us to consult each other r.1ore often than ·we have done so far to prepare together effective :plans to control these cor,lf,lOn diseases. The south East · ~sia Region organized tHo conferences, one, last year, on yaws ·control in Thailand, . and one, this year, on nutrition in Indonesia. The v vestern Pacific had a tuberculosis conference in the Philippines. ~11 this is. very l·l ell and it surely is · the very. duty of an international organization. What I should like to see, however, apart from these big conferences, vihere in too short a t:iL1e too.' many things are discussed, is the establishment of closE;r r elations araong health authorities of various countries, of raor·e frequent correspondence and of frequent- .friendly visits, or an exch~ge of information which, because of its )..Jurezy technical character -:.wuld not be restrict-ed by · diplomatic formalities ·. Thus W3 ~:auld t·ealize our mm shortcomings, He vmuld profit by the achievemmts of · our neighbours, and :'fie would thus put up a better strategy to combat .diseases. Gentlemen, in the course of the present session, we shall have to establhn the raain lines of health services of one particular country.
I
It is -vrith
Page .3 It is 11ith great pleasure that I see the World Health Organization putting on its agenda a question vmich, in my opinion, should be given priority over many others. I think it is superfluous to show that even in a prosperous country, a governrnent •~i.ll never be able to J.ccor.lplish any health plan if every professional medical officer does as he chooses, if he does not obey one discipline, one rule, such a country can hardly achieve an object vihich is in the interest of the whole population because of the lack of a general plan and because of the ~~ck of co-ordination of health activities. This question should have been considered a long time ago, in fact at the very beginning of the ~lorld Health Organization. It is obvious that any kind of work must be co-ordir~ted, must be organized if it is to be carried out as it should. hild that is the very aim of the "\Jorld Health Organization. I shall not go into more details in regard to this i tern but I should like to suggest that this meeting prepare a clear and concise plan of its discussions to avoid that they be dral'm up as long as other discussions on the economic importance of preventive medicine, of the training of medical and auxiliary personnel, on tuberculosis, syphilis, typhoid fever, etc. The members of the 1c.Jcstern Pacific Regional Comhlittee will be proud to be able to submit to the Seventh World HeJ.lth .i.ssembly, a concise and constructive plan on a point which Ne all have at heart. our vwrk will be greatly facilitated by the summary \rhich was prepared by our Regional Director. I should like to take this opportunity to thank, on behalf of the Regional Committee, our Director of the Regional Office, D~. Fang, for the valuable help he has given us in the :L11plementation of WHO progranunes in our countries and for his courteous and pleasant attitude and for an understanding of tho Dany health problems vve have to solve. I should not be doing my duty if I did not thank most sincerely all the personnel of the Hanila Office Hho, from the highest to the very lowest of its members, has helped me so '\'Jell in accomplishing our duty durd..ng the 1-Jhole of this last year. I should like to thank most sincerely the Japanese Government for their generous invitation and I should like on behalf of the Regional Co.mr;1ittee for the Western Pacific to express to his l\iaj esty, the Emperor of Japan, our most respectful \vi shes for a long life, happiness and prosperity for himself and for his people. Gentlemen, I declare the Fourth Session of the Regional Comr:1ittee of the ~vestern Pacific open.
STATEMENI'S BY REffiESENTJiTIVES ·ON FROGRESS OF HEALTH ACTIVITIES (AGENDA ITEl-1 7) STATEl:VIOO BY" CHJEF REPRESENTATIVE, aUSTRALIA. Australia not only has its Seat of Governr.1cnt ~'lithiri · the Region but. is alsO, like our ~c:i,.ghbour, Nc1-r Zealal}d;· responsible for · Torritor~os tvithin the Region • . It oa.y. be of interest to l1crabcrs that the CorJJmonwealth Hedical Benefits Scheme has now been established~ · This scheme was mezationed briefly at the Third Regional Cbmlilittee N<:;cting •. "COl·il:lOI\ThJEALTH HEDICh.L BENEFITS ·
"The Commonwealth l:icdical Benefits Scheme, which forms part of the Nu.tional Health service, was established vdth the promulgc:.tion of the National Health (Medica;L Benefits) Regulations -Statutory Rules 1953,. No. 21. · It cam~ into opern.tion on 1st July; ·1953, ·and applies to medical services rerrl ered to insured persons on or after that date. To qualify for Government assistance, insurance. organisations must satisfy the W.nister for Health thc9.t they are financially and actwirfly sound, ·and that any- . surplus will be devoted solely to the interests of members. If the Minister is satiified on these points, and i! the rules of the organisation do not contain any proyision i'ihich is considered to be objectionable, th.t? Government pays what a.re described as· JCoomonwealth benefits' for medical and surgical: services r .e ndored to mtnbers or to dependents of mer.1bers. Comnonwoalth benefits depend on the service rertdered, and arc payable in accordance with schedules .laid down by law. 11
"The organisation adds to the Conmonwealth benefit, an amount .from its . own funds.. This amount r..m,y ·not be .less · than the Cor:unonwealth benefits, but it r~1ay ·he i:iore, pro;. vided the combined anounts lo not exceed 90% of the fee c1:1arg9d by .the physician or tho surgoon who rendered the service. The mauber is expected to pay the doctor, whose fees, incidentally are not subject to any form of control. The member then seeks the appropriate rd.1;1bursomcnt from the insurance organisation. "The amount charged by Cl.l1 insurance organisation to a member depends on the fanily responsibilities of the member and the extent of the cover he seeks. Hernbership is usually subject to a waiting period, and although medical examination is not required as a condition of membership, full benefits are not payable for ailments or conditj.ons in evidence at the time of joining the organisation. /The amount
Page 2
"T~e ·amount _ addcd . Py . sp-:1.o ()rg13,n;Lza.tions._is tho same as the aocii~on:wealth .bene-fit.··,:.>In,.gen:eral, these organi~ sations charge a single person 1/6 a week for full cover, or 1/- a week for . a . reduced range of services. A person Nith '!epend&nts woUld be charged 2/~ a week for full -cover·, or 1/6 a week for the small~r· range of services,;
. . nQrga.'l.isations 1~hich add from th.eir o\'m funds, benefits of up to one-and.-two· thirds times . the Cbl:JrJ.onwea.lth benefits, charge higher arJount$, .e. g., .3/- a week for full cover for a person \'lith dependants. · · "The :aumtlnltisF qUoted are -r.1erely 6xa.t1plos, but they are a fair indication .of +.he cost of meobership of an: approved insurance orgaid.'sation. · · "Furth gr particulars appear in the official bookLet, which als.o contains the schedules in detail. "Therefore, the Commonwealth of· .~ustra.lia has na-r substantially ccr~pleted its plans for a National Health service consisting of raedical:, hospital and pharraaceutical benefits, a pensioners• medical scrvi.c~r, :a comprehensive a.rttituberculosis sbhelil~, and froe milk for school childr~. The other ·f-a~cet~ of the Na~ional Health Servib~ were referred to briefly. by the t~.ustralian Delegate at! the Third ·Session.11 .~ the Austr~lian Territories, Pnpua and Now Gui.pea, ~a.uru and Norfolk Island,". New Guinea and Nauru. · arc administered under Tr\l's t. To :improve meQ:l.cal s.ervices .the Australian •GovornLlent ha·s sought some limited WHO aid an~ .·in the future :wi:l_l . probably .seek fYrther aid, ~rtiqtHirly for New Gu.i.ilea to meet the problems of r;lalaria rind tubel;'culosis~ 'undoubtedly the major health problems in that Territo17~ Australia believes 't hat WHO is one of the 111ost important specudized agencies, and :valuing its membership, will assist to t~o fullest extent possible in . tho accom• plishment{ of its p~pose~ It is believed that th·o advisory sorvi.ces of WHO can help to a·chieve the health ,programr.te in ·the ;"ustraliari Territories by spec;i.a.list advice and the granting of fellowships for officers to study over. s eas, especiallY in ;nalaria, tuberculosis and health education generally•
l'lORLD HEALTH ORGANIZATION REGIONAL COMMITTEE Fourth Session Tokyo 3rd to 8th September 1953
3rd September 1953 WESTERN PACIFIC REGION
DR.• CANDAU' S ADDRESS TO THE REGIONAL Cll•lMITI'EE FOR THE WESTERN PACIFIC
Mr. Chairman, gentlemen:
May I first of all say how 2appy I am to be present at this Fourth Session of the WHO Regional Committee for the ~'[estern Pacific. This is my second trip to the Westem Pacific Region. In 1951 I attended your second Regional Cammittee Meeting. To be able to rene\v my acquaintance with many participants, and to have been able to do so in this lovely land of Japan has been doubly a pleasure. Six weeks ago, Dr. Brock Chisholm handed over to me the duties of the office of Director-General of the World Health Organization. I am well a\<rare that my task is made subtly difficult by having to follow such a man as Dr. Chisholm. }1a,ny of you will have personal memories of his visit to coun~ tries of the i'festem Pacific · Region. We here, and many more besides, Hill always be in his debt for the so':7ld guidance he gave during the first years of our Organization. There is, I believe, a strong symbolical value in the fact that, at the very start of my new job in tmo, I have been given the opportUnity to visit most of our Regions. This ""ill help to underline, if such emphasis is still needed, the essential role played by Regional Committees and the Regional Offices in our Organization. Much has been said about the advantages and disadvantages of the regionalized and decentralized pattem l'*tich · the First World Health Assembly laid down for the Organization. Some critics thought that the cost of such a scheme made it a luxury for a young organization. Others doubted the very principle of regionalization. They argued that in the long run it might defeat the world-wide aims for which WHO 'ir1as created. I am sure that the experience gained by WHO during the last five years has justified those ~mo have constantly fought for the fullest possible de~entralization of WHO's activities. / I have worked
Page 2
I have worked for an almost equal time at Headquarters and in one of the Regions. For my part, I am convinced that but for regionalization, most of the results for v1hich WHO can be credited could not have been achieved. However, as with all other concepts, regionalization may _ mean different things to different people. Therefore, m saying that I am committed to a policy of total regionalization, it may be useful to me to define my oMl. conception of such a policy. To my mind, regionalization is much -more than a mechanical division of assignments between Headquarters and the six offices we have established. If it were only that, there would indeed exist a very real risk of splitting the Organization into six parts (I should say seven, with Geneva) and of thus actually destroying the universal aspect of WHO. But this is far from being the case. There is more to the regionalization policy than adapting techniques and methods to the local needs and conditions of the various countries. There is expressed in that concept a fundamental policy in human relationships \·Jhich is often missed and sometimes not sufficiently appreciated. For me, regionalization is essentially a recognition of the fact that promotion of health on a vforld basis must be a truly tvro-l'i"ay operation between independent and equal partners. It is precisely because the terms "developed" and "underdeveloped" still carry for many people an undertone of superiority and inferiority, that I deplore their generalized use in connexion with the various Technical .Assistance schemes. The choice of words may seem an unimportant matter • . Int ernational co-operation, hm'l"ever, is still a delicate plant. A whole programme may fail to come to fruition because of misunderstandings due to unfortunate expressions or attitudes on one side or the other. I think that, with some exceptions, WHO has so far managed to avoid such misunderstandings. There is a growing realization among people associated v1ith WHO that any rigid distinction between those who "give" and those who "receive" is not only meaningless, but may actually become harmful vJhen applied to international work. This is certainly true on th e technical side. As the Director-General's Introduction tot he 1953 Progi-arrune points out, many of the field projects carried out as demonstration and research work must be considered as more than services rendered to one specific country. Indeed, in combating or studying malaria, bilharziasis, trachoma, cholera, etc. - under widely differing geographical / and climatic conditions
P~e
3
and climatic. conditions - He are actually adding to vrhat we already know about t·he epidemiology of these diseases. And added knowledge ·will enable us to perfect the >-Toapons i'lhich we have today for the fight against illness. But the opportunities provided by WHO for incroas~ contacts between more and more people in so many different countries arc yielding results which go far beyond the strictly medical field. The understn.nding of, and the respect for, the ways of life, the t:::-aditions, and the political, social and economic systems prevailing in tho various countries .is admittedly the cornerstone on which the peace of tornorrmv i'rill be built. It is only by developing all types of intellectU;'\l o.nd cultura.l contacts between tno people that such understanding anq respect can be obtained. These contacts arc relatively less developod today than ever before in histor.y. There is indeed a sad irony in the fact that •·rith all tho truly admirable means of communication >ve have, there is today less communication betvwen great groups of men than in the roadless, mechanically-underd.eveloped Middle Ages. · Anything that breaks doi'm that 1vall of separation will work for progress and peace. In that sen: :o it c.::m be said that our meetings, seminars, conferences, visits of teams and experts not only ni.akc us better health specialists, but provide us with thi:; best possible testing grounds for a true international understanding in actiono I am firmly convinced that the success of all United Nations agencies depends on the extent to vJhich these contacts across national, political and economic .frontiers aro going to be multiplied in the next fov1 years.
In. my own ,l imited oxpcrionce, I have seen many times the mere transfer of techniques, skills and supplies froni one country to another ie meaningless unless it is accompanied by a thorough appreciation of the local problems. lrJo must do everything in our power to encourage all efforts to bring about genuine co-operation botvfccn the nations of the >mrld however small. tha~.
Tho UN Expanded Pro0:.:arrimo for Technical Assistance is one of the most important of these efforts. During the recent meetings of several UN bodies in Genev<:.. - ECOSOC, TAB - some of \·;hich I was n.b1e to attend, everybody roco,gnizcd the importance of the Technical Assistance progra.mmes to the future of our society. Yet there were doubts, expressed by sane responsible people, about the practical possibility of ensuring the financial means for the carrying out of that programrne.
I
I cannot believe
Page 4
I -cannot believe that such a short-sighted policy could in the long run be defended by anybody. I most sincerely hope that the results alreaqy achieved by the Technical Assistance pro~ramme, and, more :importantly, the amount of international goodwill which it has succeeded in building up in many parts of tho world, will not be jeopardized by economics vmich arc indeed often ridiculously small compared to the mon~ tho world is spending for non-constructive purposes. It is indeed strange to contemplate the disparity between our efforts to save and secUre life on tho one hand, and the expensive taking of it on the other. I am told that the Korean i•mr is rcughly estimated to have cost both sides about ten thousand million dollars a year to maintain. The Regular budget for this year for the entiru \'{orld Health Organization is less ·than nine million dollars; for the lriestern Pacific Region for this year, the Regular Budget is only a little over half a million, or one twenty thousandth ( .0002) of the cost of the Korean .
"''mr.
The future of the United Nations Int~rnational Children's Emergency Fund is another important factor in the plans of WHO for the next years. As you knovT better than I, our Organization has established a perfectly smooth Harking relationship i"l'ith UNICEF vlhich augurs well for the success of many important joint health projects. Failure on the part of UNICEF to mobilize the supplies and equipnent necessary for its \vork 1·muld mean a serious bloi"i' to lvorld health in general. Since vffiO is constitutionally responsible for the coordination of international work in tho fiold of health, it must do its utmost to support all bilatoral and multilateral, governmental or non-governmental attempts to promote tho health standards of all countries. Personally I am determined to 1~1aintain and to develop · the policy followed by my predecessor in seeing to it that, through the co-ordinating machinery of HHO, the resources which are today available for the health of tho Horld shall be used in the most effectivc v1ay. Perhaps here I should· remir. d you that in order to comply vJith its total progranune of tJOrk WHO must have more funds and, above all, must be able to count on those funds. I believe that the measure of success of WHO at the end of its fifth year of existence is not in any p:J.rticular result a chieved, but r ather its ability to develop among its Member states a sense of world conscience as far as health is concerned. We all know, and deplore, the serious handicap ~~ich the absence of a number of comtries from the activities of vffiO means to. the Organization. I trust that the recent devclopucnts in the int ernational situation, revealing ru1 earnest will on all sides to put
/ an ond to
Page 5
an end to lihat ha.s became kno"i'm as the cold war, may pave the way .for WHO to regain th0 universal character it must ha.ve i t it is to promote health on a world-wide basis. In your own region we have recently seen the cessation of human conflict in one country giving hope that a constructiv... attitude might replace tho tensions of the past. The deliberations of your Committee, and those taking place this month in other regions, prove tha.t men ~ sit around the table and freely qiscuss their problems, not only in relation to themselves, but also to their region as a '\tihole and ultimatel;y in reletion to the Horld. Again I am grateful to you for the experience I am going to gain in the next few days 1 and I l'Tish you cv;.;ry success in your ~ndeavours.
FOURTH MEET IN G OF T HE WHO REGIONAL COMMITTEE FOR THE WESTERN PACIFIC
NOTES. FOR THE INFORMATION OF REPRESENTATIVES AND OBSERVERS
Time of Meeting Place of Meeting :
10:00 a.m., Thursday, 3.rd September, to 8th September, 1953. The Josui·Kaikan Building, Hi totsubashi Street, Tokyo.. atte. ohed map) (see
BEFORE ARRIVAL a) Ascertain quarantine requirements. (Travellers by air from Calcutta are recommended to be in pcmsession of the International Vaccination Certificate for cholera as well as smallpox; those from Korea are recommended to be in Ji>Ossession of International Vaccination Certificate for typhus and smallpox.) · b) Cable estimated time of arrival, includin~ airline and f.light · number, to the Ministry of Health and Welfare, Japan, (cable address: KOSEISHO, TOKYO) ·as soon as possible, giving details of membership of' d-elegations, with full names and titles, whether accompanied by dependents or not. In the event of any change after cabling, a further cable should be sent ·giving all new' '· particulars. c) Pack as for summer. The early part of September is warm in Tokyo but the middle and lotter p~rts may be cool. A light rainooat is advised. Those accustomed to a tropical climate would be wise to bring reasonably warm clothing. Evening dress will not be nece ssary. Those desiring to make recreation trips to mountainous areas are advised to bring light woolen clothing.
ON ARRIVAL You will be met at Haneda Airport (about 3/4 hour's ride by oar from Central Tokyo) by representatives of the Government. Youwill be requested to go through routine procedures in the airport but these will be simplified as muoh as . possible for you. Do not fail to retain the yellow coverad currency book rthich will be handed to you, following currency declarations, a't the airport. You are advised to declare all currencies brought into Japan since currency not deol ered cannot be change d. Surplus funds may be taken out of the cruntry if all funds are daolare·d on arrival. You may change currenoy 'on entry at -a-branoh of the Fuji Bank at Haneda Airport, and yen to the amount equivalent to US$50 maybe re-converted on leaving the airport if you have your o~rrenoy book with its appropriate entries. The exchange-rates are -as follows:
-2Dollars to Yen Yen to Dollars ~
$ 1 2 3
~
$ 2& 78 3.06 3.34 3.62 3.89 4.17
'
5
6 7 8 9
360 720 1.oao 1;440 1,800 2,160 2,520
1.ooo 1,100 1,200 1, 300 1,400 1,500 1,600 1~700
4.45
2,880 3,240 3,600
4.73 s.oo 6.28
10
1,800 1,900 2,000 3,000 4,000 5,000
5.56 8.34 11.12 13.89
In order not to have ~ excess of yen on departure, it is suggested that traveler's cheques be cashed only as· needed. ThE:)y may ·~e cashed at any of the citY. banks, at tourist agencies. and at the Imperial. Hotel.
DURING STAY
Rooms for representatives and observers fro:(D. abroad are tentatively reserved at tm Imperial Hotel, situated in iobe.~cent~e of. Tokyo. Pr.ices are as follows: Without bath Single r.oom Double room Meals - Breakfas-t Lunch Dinner ¥1 ,s.oo With· bath
'¥2,100 to '¥3,500 ¥5,200 to ¥4,900 ¥400 ¥600
¥800 to ¥1,000
It is anticip et ed that hotel accomodation will be scarce in September and it is therefore necessary to have definite bookings as early as possible~ Owing to other internationa 1 conferences being schedule.Q. for the same month, it may not be possible to make bookings at first class hotels for those requesting same after .August 20th.' In some oases, it may be necessary to share a room w;i th another representati.~e ..or observer. Transportation will. be furnished for all official occasions; a. bus .service will operate between the hotel and the mooting place. There are also numerous taxis in Tokyo, prices being as follows: . First 2 kilomet-res: La;rge size taxi Medium size taxi Small size taxi ¥100 ¥ 80 ¥ 70 Every further 500 metres ¥20 ¥20 o¥20.
-:3-
An information service will operate throughout the meeting for the convenience of all visiting representatives and observers. The following facts are offered in advance, for your interest: Some of the nine larg.e department stores of Tokyo are within walking distance of the Imperial Hotel. Department stores are open 6 days a week until 5:30p.m. and are closed on Mond~y.s. Firm prices prevail in department stores and there is no bargaining. It is usually possible to find someone who speaks English in these establishments. Ma:r;1y goods of excellent qU9.li~y are available but thef!le are not usually cheap in price; however, such items as crumeras and binoculars are exempt from domestic tax. There are a number of restaurants in downtown Tokyo, around Ginza Street and Yurakucho Station, serving food of the western type. In · some cases a service charge of 10% is included in meal bills. Usually, no tipping is required. Many representatives and observers will no doubt wish to eat traditional Japanese dishes such as sukiyaki, tempura and su.s hi. A recommended restaurant centre is ar rund Ginza Street, within walking distance of the Imre rial HotU. Recommended (on "Z" Avenue), off staged, reservations Hall, near Yurakucho theatres are: Kabuki-za, Ginza-Higashi, Chuo-ku, the Ginza, where traditional plays are brilliantly being usually necessary; and the Nichigeki Music Station, whEre modern musical shows are staged.
The Japanese Travel Agency, opposite Tokyo Station, and its branch in the Imperial Hate 1, will advise on travel wi t~in the oountry. English is spoken at the Agency. The following trips are suggested: 1. Nikko - beautifully preserved Shintoist shrine area in mountains ·not far from Tokyo. May be Vi owed in one day but overnight stay is recommended. Prices approximately ¥1,500 for rail fares and ¥3,000 for hotel room. 2. Hakone .Area (hot springs and en excellent view of Mt. Fuji). This is an overnight trip costing appro:rime.tely ~8,000, everything included. 3. A visit to Osaka, Kyoto, and Nara (the first, a leading Jap8Ilese industrial centre; the others the ancient cultural ·centres of the country). This is a 4-day trip costing approximately ¥26,000, everything included. Simil er trips may -·be arranged to other places of interest such as Kamakura (a historioal area with a ~ reat Buddha and temples end shrines), about 1-1/2 hours by train from Tokyo Central Station, and Atnmi Spa, (scenic beauty, facing the sea) about 2-1/2 hours by train. From Atemi Spa one can visit the Hakone area. Rail fares are not normally expensive and Japanese rural inns are generally good 6.nd reasonable in price. It should be remembered that few of Japan's 85 millions speak English, and almost none of the Tokyo taxi drivers.. It is therefore advised that written directions be obtained before starting on a journey. Further, although taxis are not dear, diB'tances are great ill Tokyo (population, 7-1/2 millions).
-4Tokyo Central Post Office is alongside Tokyo Central Station. Postage rates e.re as follows: 1. 2. Aero grams : 45 yen ~t'Ql;lghout the wo:rl d Letters & Post Cards, via ai rmai 1: Airmail letter.s (per 10 gm.) Hong Kong Korea Taipei Singapore Saigon Manila Laos Cambodia. Australia u.s.~
Airrmil post cards 30 yen It tl
-------------------------------- ... -.---
35 yen
" " 50 yen It
" II
----------------~--
...
New Zeal and
-------·------
70 yen II
" "
--------------------------------------·--:.. _ -------
36 yen II
" " tt
-------------
40 yen
-------
" "
The following is a list of embassies, legations and missions relevant to Western Pucifi o countries: Name of Embassy or Legation American Embassy Australian Embassy British Embassy Chinese French
Telephone (48)-7141 (45)-4101-6 (33)-5551 (45)-4131-5
Address Me.ntetsu Bldg., 2 Akasaka-Aoicho, Minato-ku, Tokyo 9 Mita-Tsunamachi, Minato-ku, Tokyo 1 Ichiban-cho, Kojimachi, Chiyoda-ku, Tokyo l Azabu-Fujimacho, Minato-ku, Tokyo Shimazu House~ 11 Toyowake, Shibuyaku, Tokyo 1-5 Azabu-Takeya:cho, Minato-ku, Tokyo 1 Shiba-Sakueoho, Minato-ku, Tokyo 26 Kojime.chi-Sanba:n-cho, Chiyoda-ku, Tokyo Rm. 415, Nikka:\!su Int' 1 Bldg., l-1 Yuraku~cho, Chiyod~-ku, Tokyo 39 Ke.miyama-oho, Shibuya-ku, Tokyo
"
"
(48 )-4161-4 (45)-4004 (43)-2329 (33)-2133, 2170 (27~-3193
Korean Diplomatic Mission Netherlands Embassy New Zeal end Legation
Philippine Mi asian
Portuguese Legation
(46)-1366
Note: No legations or consulates have as yet been established in Japan for Cambodia, Laos and Viet-Nam, b~t the French Embassy may be consulted on diplomatic matters pertaining to these countries.•
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