SEA/RC53/16 - Follow-up actions takenon the resolutions of the previous five sessions of the Regional Committee, meetings of the health ministers and health secretaries

REGIONAL COMMITTEE Fifty-third Session

Provisional Agenda item 15 SEA/RC53/16 28 August 2000

FOLLOW-UP ACTIONS TAKEN ON THE RESOLUTIONS OF THE PREVIOUS FIVE SESSIONS OF THE REGIONAL COMMITTEE, MEETINGS OF THE HEALTH MINISTERS AND HEALTH SECRETARIES

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CONTENTS Page 1. INTRODUCTION............................................................................................................... 1 2. SUMMARY OF ACTION POINTS AND ACTION TAKEN............................................... 1 Strategic Direction 1 ......................................................................................................... 1 Strategic Direction 2 ......................................................................................................... 4 Strategic Direction 3 ......................................................................................................... 5 Strategic Direction 4 ......................................................................................................... 8 3. CONCLUSIONS...............................................................................................................11

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1.

INTRODUCTION

The forty-seventh session of the Regional Committee, in 1994, with a view to following up on the decisions and resolutions adopted by the Regional Committee, decided that Member Countries should forward a progress report on the actions taken at the country level to the Regional Director. Similarly, the Regional Director would submit a report on actions taken by the Regional Office. In accordance with the above decision, action points arising from the resolutions of the forty-ninth session of the Regional Committee were circulated to the Member Countries for necessary actions and informing the Regional Office of the progress in the implementation thereof. Each year, an information document, listing the actions taken by the Member Countries as well as the Regional Director, is submitted to the Regional Committee for noting. As proposed by the Royal Thai Government, an item was included in the agenda of 53rd session of the Regional Committee to review the implementation of the resolutions and decisions of the Regional Committee during the last five years. Accordingly, the Secretariat prepared this document which provides a succinct account of the actions taken on important resolutions and decisions of 48th to 52 nd sessions of the Regional Committees (RC), 13 th to 17 th Health Ministers’ Meetings (HMM) and 1st to 5th Health Secretaries’ Meetings (HSM). For easy reference, the material is presented by subject under the four WHO strategic directions. The gist of the resolution(s) and decision(s) adopted and recommendation(s) made on each subject at these fora are listed first, followed by a brief account of the actions taken thereon. Full details are presented in chronological order, and categorized by type of meeting in document SEA/RC53/16 Add.1. 2. SUMMARY OF ACTION POINTS AND ACTION TAKEN

Strategic Direction 1 (1) Roll Back Malaria (RC52, 17 th HMM) The 52nd session of the Regional Committee urged Member States to give national commitment to Roll Back Malaria (RBM) and implement it through adequate resource allocation, intercountry collaboration and to promote locally accepted preventive measures. The Regional Committee requested the Regional Director to enhance the capacity of the public health delivery system and help develop a network of experts and institutions. The 17th HMM reiterated the above, identified areas for priority action, and requested WHO to assist in resource mobilization. Actions taken All malaria-endemic countries in the Region showed strong commitment to implement RBM. Intercountry collaboration was enhanced through border meetings and intercountry meetings. SEARO helped establish a RBM technical resource network and developed RBM district-level guidelines. WHO also provided technical assistance to the

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countries in their efforts for resource mobilization for RBM. (2) Leprosy Elimination (RC49) The 49th session of the Regional Committee urged Member States to intensify leprosy surveillance, strengthen diagnostic facilities and solicit community participation in case detection. It requested the Regional Director to support national leprosy programme reviews and national campaigns to eliminate leprosy. Actions taken Countries of the SEA Region adopted a strategy to eliminate leprosy as a public health problem during 2000-2005, based on enhancing public awareness, improving capacity, implementing (Multi Drug Therapy) MDT effectively, and strengthening monitoring and evaluation. WHO supported these efforts and reviewed progress. (3) Stop Tuberculosis Initiative (17th HMM and 5th HSM) The 17th Meeting of the Health Ministers urged Member States to further expand Directly Observed Treatment, Short-course (DOTS) by ensuring political commitment, adequate resources, continued drug supplies and multisectoral partnerships. The meeting also urged Member States to carry out IEC activities and to disseminate examples of successful approaches. WHO assistance to Member Countries in resource mobilization and promotion of teaching of DOTS in medical schools was also requested. The 5 th HSM broadly reiterated the above and urged Member States to strengthen monitoring of default tracing. Actions taken DOTS strategy was actively expanded in all countries of the Region and now covers 30% of the people. Efforts are under way, with support from WHO, to ensure mobilization of resources. Many countries of the Region formed successful partnerships for its implementation. Models were being developed for successful supervision of DOTS. Guidelines on the role of NGOs, medical schools and private sector were prepared by WHO. In July 2000, SEARO organized a meeting to enhance the role of medical schools in DOTS. Successful examples of implementation were being disseminated in the WHO newsletter. (4) Eradication of Poliomyelitis (RC49 and 4th and 5 th HSMs) The 49th session of the Regional Committee urged Member States to ensure political commitment towards polio elimination, collaboration with neighbouring countries in synchronizing National Immunization Days (NIDs) and establishment of adequate surveillance mechanisms. The committee requested the Regional Director to facilitate synchronization of NIDs and solicit donor support to national efforts. The fourth HSM urged Member States to carry out mopping up operations along with the NIDs. The fifth HSM reiterated this and asked WHO to review its criteria to continue NIDs.

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Actions taken Political commitment remains high in all countries of the Region. NIDs/SNIDs were conducted in all countries. Many of these were coordinated with neighbouring countries through SEARO. Acute Flaccid Paralysis surveillance was introduced in all countries. WHO supported national efforts by enlisting the assistance of several donor agencies, including World Bank in the drive towards polio eradication. Mopping up operations were carried out in some countries. SEARO was in the process of reviewing criteria used to determine the continuation of NIDs. (5) AIDS (RC52) The 52nd session of the Regional Committee urged the Member States to accord high priority to HIV/AIDS by providing the required human and financial resources and enhancing national capacity. It requested the Regional Director to support Member States in enhancing surveillance. Actions taken All Member Countries accorded a high priority to HIV/AIDS. SEARO was supporting countries in surveillance. Guidelines for AIDS/STI surveillance including behavioural surveillance were developed. AIDS information was being disseminated through AIDS watch, a SEARO newsletter. (6) Emerging/re -emerging Diseases (14th HMM) The 14th Meeting of the Health Ministers urged Member States to strengthen their capacity for rapid response to epidemics and called for intersectoral and international collaboration. WHO was requested to assist countries in strengthening surveillance. Actions taken Rapid response teams were established in all Member Countries. Countries also held border meetings to address the issue of cross border epidemics. SEARO organized a consultative meeting on case definition of diseases with epidemic potential and developed draft guidelines. SEARO also assisted two countries in strengthening their surveillance systems. (7) Thalassaemia (RC48) The 48th session of the Regional Committee urged Member States to increase awareness for thalassaemia prevention and control and requested the Regional Director to facilitate exchange of information between Member Countries.

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Actions taken Two countries of the Region developed comprehensive national plans of action for thalassaemia control and prevention. All countries carried out awareness raising campaigns. WHO technically supported national and international workshops on thalassaemia. (8) Transborder Health Problems (14th , 16th and 1 7th HMMs) The 14th Meeting of the Health Ministers urged Member States to cooperate with one another in the control of emerging and re-emerging diseases, particularly in the border areas. The16th HMM urged Member States to develop uniform disease co ntrol strategies and requested WHO to convene a high-level policy meeting to address the challenges posed by communicable diseases in the border areas. Actions taken Border meetings were held between Myanmar and Bangladesh and also between other countries. A protocol for reporting epidemics in the border areas was developed. WHO SEA and Western Pacific Regions were also cooperating in the area of transborder malaria in the Mekong area. Strategic Direction 2 (1) Tobacco Free Initiative (4 th HSM, RC52, 17th HMM) The fourth Meeting of the Health Secretaries urged Member States to review and develop policies and strategies for tobacco control. Subsequently, RC52 passed a resolution urging Member States to constitute multisectoral national councils for tobacco contro l, adopt policies that would reduce tobacco consumption among the vulnerable groups, participate in the development of the WHO Framework Convention on Tobacco Control (FCTC), and promote regional advocacy. The Regional Committee also requested the Regional Director to facilitate the participation of Member States in the negotiation process of FCTC. The 17th HMM supported the idea of national councils and focused on advocacy and demand reduction. The meeting urged Member States to develop time-bound plans of action for tobacco control, emphasizing the legal and fiscal aspects. The meeting requested WHO to continue its advocacy with multilateral agencies and support Member States technically. Actions taken Multisectoral national councils were established in some Member Countries. Comprehensive legislation and regulations were in place in some Member Countries. South East Asian Anti-Tobacco (SEAAT) flame was launched. Member Countries participated in the FCTC negotiation process with WHO support. The Prime Minister of India inaugurated a WHO International Conference on Global Tobacco Control Law: Towards a WHO Framework Convention on Tobacco Control, January 2000. The

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Director-General of WHO launched the World No Tobacco Day in this Region (Bangkok, Thailand), in May 2000. (2) School Health (16th HMM) The 16th Meeting of the Health Ministers urged Member States to expand and strengthen their school health programmes through partnerships and to pilot healthpromoting schools. The meeting requested WHO to strengthen co llaboration with Member States and assist in situation analysis. Actions taken Most Member Countries strengthened their policies on school health and expanded their school health programmes, in many cases making use of strategic partnerships. In most countries, health-promoting schools were piloted. WHO supported situation analysis in some of the countries and was developing guidelines for health promoting schools. (3) Poison Control (RC52) The 52 nd session of the Regional Committee urged Member States to establish/strengthen poison control initiatives and to raise awareness on the dangers of arsenic and fluoride- contaminated water. The Regional Committee requested the Regional Director to support Member States in the above and in conducting multi-centre studies related to organophosphorus and other chemicals in the Region. Action taken In some Member Countries, national plans of action were developed and National Poison Control Centres established. National plans of action to prevent arsenic contamination were developed in three countries. Following regional workshops in SEARO and Kathmandu, pesticide databases were being established in four countries. To strengthen analytical services, SEARO provided IPCS guidelines and supported training of laboratory staff. Health promotional material and a monograph on arsenic poisoning were under preparation. A multi-centre study on organophosphorus pesticide poisoning was underway. Strategic Direction 3 (1) Renewal of Health for All (HFA) (RC48, RC49, RC50) The 48th session of the Regional Committee urged Member States to undertake policy reviews and country consultations to form a basis for HFA renewal. It requested the Regional Director to support Member States and report progress to RC49. RC49 urged Member States to complete the evaluation of HFA strategies and to intensify advocacy and participation of all sectors in the HFA renewal process. RC50 urged Member States to develop national plans and programmes based on the renewed HFA strategies and

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in the light of the ‘Declaration for Health Development in the 21 st Century’ and requested the Regional Director to support Member States in their efforts. Actions taken Countries of the Region undertook steps towards HFA renewal including raising awareness, policy reviews and situation analysis. The third evaluation of HFA was completed and submitted to headquarters. SEARO advocated with Member Countries for HFA renewal. Based on a series of wide-ranging consultations, the “Regional Declaration on Health Development in the SEA Region in the 21 st Century” was adopted, which was subsequently endorsed by the Regional Committee. (2) Public Health in the 21st Century (5th HSM) The fifth Meeting of the Health Secretaries urged Member States and WHO to develop plans of action to implement th e ‘Calcutta Declaration’, with stress on institutional capacity-building. Actions taken The ‘Calcutta Declaration’ was widely distributed in the Member Countries and initiatives were taken in some of the countries. (3) Quality Assurance in Laboratories (RC49) The 49th session of the Regional Committee urged Member States to strengthen quality assurance in laboratories through establishing national accreditation and quality assessment schemes. It requested the Regional Director to facilitate international cooperation in developing standard reference material and in establishing international quality assurance schemes. Actions taken All countries of the Region strengthened/established external quality assurance schemes. These efforts were supported by WHO consulta nts and experts from international collaborating centres. WHO prepared documentation on quality assurance and laboratory networking. (4) Traditional Medicine (16th and 17 th HMMs and 5th HSM) The 16th Meeting of the Health Ministers urged Member States to comp ile and share information on traditional systems of medicine. The meeting requested WHO to designate more collaborating centres on traditional medicine, make efforts to prevent valuable information from misuse and commercial exploitation, and to assist the countries in regulation, standardization and quality assurance. The 17 th HMM further urged Member States to strengthen national legislation and policies on traditional medicine

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and to widen its use in national health systems. 5th Meeting of the Health Secretaries recommended adoption of an approach and a policy on traditional medicine, and integrate it, as appropriate, in the national health care service. It also recommended strengthening of the technical unit of traditional medicine in WHO and institutionalizing intercountry collaboration. Actions taken SEAR countries continued various activities to promote traditional medicine. In one country, Good Manufacturing Practices were introduced in the pharmaceutical unit manufacturing traditional medicines. In another, measures were being taken to standardize traditional medicine. SEARO redesignated three collaborating centres in traditional medicine and had recruited consultants in traditional medicine from time to time to assist countries. WHO produced documentation on the conservation and protection of traditional medicine. SEARO was also collaborating with WPRO in standardization and quality assurance of traditional medicine. SEAR countries, namely, Bhutan, DPR Korea and Sri Lanka integrated traditional medicine in the national health care services. (5) Alternative Financing of Health Care (RC48) The 48th session of the Regional Committee urged Member States to study and explore alternative financing for health care, while making optimal use of available resources including that of the private sector. Actions taken Countries of the Region were continuing efforts to explore alternate sources of financing, such as user fees, health insurance, health cards etc. They were also in the process of improving the efficiency of their health care services in order to make optimal use of the available resources. (6) Health Sector Reform (RC50) The 50th session of the Regional Committee urged Member States to effectively manage health sector reform, with broad participation, using WHO collaborating centres. It requested the Regional Director to support Member Countries in information exchange and multilateral coordination. Actions taken Countries of the Region continued broad-based health sector reforms in areas such as decentralization, alternative financing, restructuring and efficiency. Six countries of the Region prepared Health Sector Reform Profiles based on a common framework developed by a SEARO working group.

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Strategic Direction 4 (1) Regional Health Declaration (2nd and 3 rd HSMs and 15th and 17 th HMMs) The second Meeting of the Health Ministers urged Member States to prepare to meet the health challenges of the 21 st Century and requested WHO to prepare a draft declaration on health development in SEAR countries in the 21 st century to be submitted to the 15th HMM. It adopted the ‘Declaration on Health Development in the South East Asia Region in the 21st Century’ in August 1997. The third HSM urged Member States to ensure that the Declaration received endorsement at the highest level and wide support. The 16th and the 17 th HMMs urged Member States to expedite the implementation of the Declaration and to make a time bound action plan for that. Actions taken The Declaration was endorsed by the Regional Committee, and was widely distributed in the Member Countries. Countries were incorporating its principles and policy guidance in their health development policies and plans. (2) Health in Social Development (13th HMM) The 13th Meeting of the Health Ministers stressed the importance of investment in health for social development, particularly the importance of investing in the health of women and other vulnerable groups, and urged Member States to develop indicators for social development and forge partnerships with the private sector. Actions taken Six Member Countries had prepared country health profiles and national health accounts. The World Health Report 2000 provided sensitive indicators to assess and improve the performance of the health system. As per the guidance of the Ministers, a monograph on Poverty and Health was published in 1997. A new department of Sustainable Development and Healthy Environments with a unit for Health and Sustainable Development, was established in SEARO. (3) Women, Health and Development (RC51) The 51st session of the Regional Committee urged Member States to integrate a gender perspective into health policies and programmes and establish multisectoral partnerships for gender-sensitive advocacy. It requested the Regional Director to provide technical assistance to Member Countries and intensify gender mainstreaming of WHO programmes. Actions taken A WHD regional profile was developed. Gender disaggregated data was collected and presented in the Regional Health Report 1998. A review of existing tools for gender and development was underway. A database on women's health was also being developed.

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(4) Status of Women (RC49) The 49th session of the Regional Committee urged Member States to identify suitable women candidates to assume positions of responsibility. It requested the Regional Director to identify and overcome obstacles to the recruitment and retention of women, urge Member States to encourage participation of women in the work of WHO, and to periodically assess the progress in this regard. Actions taken Countries of the Region took steps to promote women at decision-making levels. SEARO took positive steps to enhance women’s recruitment. Trends of women’s recruitment and participation in WHO were being analyzed. (5) Trade -Related Aspects of Intellectual Property R ights (TRIPS) (4 th HSM) The fourth Meeting of the Health Secretaries called on Member States for intersectoral collaboration in the negotiating process of the World Trade Organization (WTO) agreements to prevent adverse effects on the health sector. The meeting also requested SEARO to facilitate intercountry exchange of information. Actions taken A regional consultation on WTO multilateral agreements was held in Bangkok. Follow-up action was being taken by the Member Countries and SEARO. WHO was playing an active part in information exchange and advocacy, and a regional working group was monitoring progress. (6) Intercountry Cooperation in Drugs and Pharmaceuticals (16th HMM) The 16th Meeting of the Health Ministers urged Member States to ensure availability of good quality raw materials for drugs at competitive prices and to collaborate with other sectors in preventing any adverse effects on drug prices due to trade agreements. WHO was requested to facilitate exchange of information on availability of drugs and raw materials. Actions taken In the wake of the economic crisis, countries of the Region initiated collaboration with one another in obtaining raw materials for drugs. Ministries of health collaborated with other sectors in ensuring that drug prices were not affected by trade agreements. An information document was published by WHO and distributed to Member Countries. (7) Intercountry Cooperation in Health Development (3rd and 5 th

HSMs)

The third Meeting of the Health Secretaries urged Member States to follow up and review the areas identified at the International Conference on Intercountry Cooperation in the 21 st Century, and to institutionalize intercountry cooperation. The 5th Meeting of

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the Health Secretaries noted the progress in this regard. Actions tak en Countries of the Region collaborated with those of the WPRO Region in institutionalizing intercountry cooperation. Meetings were held in Chiang Mai, Bali and Manila. Following these, the Manila declaration was adopted, identifying seven priority areas for cooperation. SEARO provided technical support for these activities along with WPRO. (8) Technical Cooperation among Developing Countries (TCDC) (13 th HMM) The 13th Meeting of the Health Ministers urged Member States to collaborate among themselves, particularly in the areas of emerging/reemerging diseases, drugs and vaccines, and human resource development for health. Actions taken Since the 13 th HMM, the chairman of the Health Minister’s Forum was playing a crucial role in fostering intercountry cooperation. Member Countries were making use of this and bilateral ministerial visits for increased cooperation. SEARO organized border meetings and intercountry meetings to discuss issues of common interest. (9) Partnerships for Health (14th and 15 th HMMs, RC51 and 2nd and 3 rd HSMs) The 14th and 15th Meetings of the Health Ministers stressed intersectoral partnerships and identified potential areas for partnerships. RC51 urged Member States to forge strategic partnerships for advocacy on women’s health. The second and third HSMs also stressed the importance of partnerships for health development. Actions taken Countries of the Region developed strategic intersectoral partnerships. The roles of the private and NGO sectors were also increasing in most countries. Since early 1990s, WHO had been advocating and supporting multisectoral partnerships in crucial areas such as HIV/ AIDS. Intersectoral action for health was also been fostered through the regional meetings of parliamentarians. The Regional Director authored a book: “Partnerships: New Health Vision”. (10) Programme Budget (RC50, 3rd HSM) The third Meeting of the Health Secretaries urged Member States to launch a campaign to protect regional allocation. It requested the Regional Director to support Member States and to convene an intercountry meeting before 51st World Health Assembly. Actions taken

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With active support from the Regional Director, countries of the Region launched a very successful campaign during WHA, which protected, to a large extent, the regional allocation. (11) WHO Collaborative Programme (2nd and 4 th HSM) The second Meeting of the Health Secretaries urged Member States to increase the efficiency of implementing WHO collaborative programmes. The meeting agreed to pool unabsorbed budget for implementation under the intercountry mechanism. It requested WHO to monitor the status of implementation and keep the countries informed. The fourth HSM requested WHO to provide technical guidance regarding the quality of proposals and to expedite processing of program activities. It agreed not to ask the Regional Committee to fund any intercountry programme in the absence of well developed proposals. The fifth Meeting of the Health Secretaries recognized the importance of linking country achievements to WHO strategic directions and goals. Actions taken SEARO was continuously reviewing the quality of the proposals as well as the progress of implementation of collaborative programmes and keeping countries informed through the WHO -Government coordination mechanism. The question of delegation of authority for speedy implementation was also under continuous review. ICP II for 2000-2001 biennium was jointly developed by the countries and WHO in a transparent manner. Country achievements were linked to WHO strategic directions missions and goals in the preparation of the PB 2000-2001. (12) Health Effects of the Economic Crisis (3 rd HSM) The third Meeting of the Health Secretaries urged Member States to study the short and long-term effects of the economic crisis in order to devise appropriate strategies for meeting future challenges. It requested WHO to facilitate intercountry cooperation in the area. Actions taken Studies on the health effects of the economic crisis were conducted by Indonesia and Thailand, with support from WHO. A re gional consultation on the subject was organized, and it was also discussed in a regional meeting of parliamentarians in Jakarta. 3. CONCLUSIONS

A review of the actions taken by the Member Countries and the Regional Director revealed that prompt action was initiated by the countries and the WHO Regional Office on all the resolutions and decisions of the Regional Committee and recommendations of the meetings of the health ministers and the health secretaries. As the Regional Committee might note, while some actions were time bound, others were continuing in

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nature. Thus, the countries and the Regional Office were pursuing the implementation of the resolutions, decisions and recommendations in letter and spirit. The Regional Committee might wish to note the progress as contained in this report.



Details of follow-up actions taken on the Resolutions, Decisions and Recommendations of the previous five Regional Committee Sessions, Health Ministers Meetings and Health Secretaries Meetings Recommendations R EGIO NA L COM MITT EE RC52, Dhaka, Bangladesh, 6-9 September 1999 Roll Back Malaria (SEA/RC52/R5) Urges Member States to: (1) to demonstrate national commitment towards the RBM initiative; (2) to mobilize resources for sustaining evidence-based strategies to ensure concerted and sustainable efforts for RBM; (3) to collaborate with neighbouring countries regarding activities related to, among others, the monitoring of multidrug resistance, vector resistance to insecticides, and enhancing epidemic preparedness and response, and (4) to promote multiple preventive measures to reduce malaria transmission by locally acceptable means and to ensure rational use of insecticides, both in public health and in agriculture, and strengthen policy frameworks and guidelines to meet the emerging requirements. SEA/RC53/16 (Add.1) (1) (2) All malaria endemic countries of the Region have shown commitment to implement the Roll Back Malaria initiative. RBM technical resource networks were established in the Region on (a) transmission risk reduction (b) surveillance, information management, epidemic -preparedness and response, and (c) drug resistance and policy to mobilise resources for evidence-based and sustainable malaria control. Enhanced collaboration was solicited through International Border meetings to monitor resistance in the parasite and vectors, and rapid response to control epidemics. Guidelines to implement RBM at the district level were prepared on (a) diagnosis, treatment and transmission control (b) strengthening district health system, and (c) community mobilization and advocacy. Action Taken

(3) (4)

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Recommendations Request the Regional Director:

Action Taken

(1) to enhance the capacity of the programme for securing and mobilizing community participation, intersectoral collaboration and cooperation to roll back malaria;

(2) to develop the technical capacity of the public health delivery system, including that of the private sector in the Member States, for the prevention of malaria, early diagnosis and prompt treatment, and

WHO assisted countries of the Region in strengthening their health infrastructure, particularly their District Health Systems based on PHC, to effectively combat malaria through partnerships, including those with private practitioners. Guidelines on Strengthening District Health Systems were prepared. Support was being provided to all endemic countries of the Region in the implementation of the Roll Back Malaria initiative. Pilot districts were identified and situation analysis was conducted by respective Member Countries for systematically implementing intensive multisectoral activities. RBM guidelines on advocacy and vector control were developed. An RBM technical resource network in resource mobilization was established in the Region; Countries were technically assisted in mobilizing external assistance, including from the World Bank Group. Member Countries were provided technical cooperation in priority areas through the following bilateral and multilateral meetings. June 22, 1999 Task Force meeting Myanmar-Thailand border malaria, Yangon. September 1, 1999: UNICEF/WHO meeting on RBM Mekong, Yangon November 11, 1999: Biregional meeting of DPR Korea, Myanmar, Thailand and WHO/WPRO, Kunming

(3) to identify the available resources in the Member States

and extend the required technical and financial support to help develop a network of experts and research institutions to substantially improve the quality of the programme.

Strengthening Poison Control Measures (SEA/RC52/R6) Urges Member States:

(1) to consider establishing/strengthening poison control initiatives as an important part of chemical safety and control of environmental health hazards, with emphasis on risk assessment and risk management due to poisoning from chemicals and various contaminants, such as arsenic and fluoride in ground water;

(1) A regional workshop on Pesticide Poisoning Database in SEAR countries was held in SEARO, May 1999, followed by a regional workshop on Strengthening Poison Prevention and Treatment Programme at Kathmandu, Nepal, 13-17 September 1999. A monograph on prevention of Arsenic contamination in water and Arsenicosis was in an advanced stage of finalization and a Plan of Action was developed.

(2) to formulate, develop and implement plans of action for the

establishment of poison information and treatment centres, which inter alia would include manpower development, epidemiological studies, and dissemination of information to the public on the safe use of chemicals in agriculture, industry and health; diagnosis and to improve patient management;

(2) Plan of Action for Poison Prevention and Treatment Programme for country level action was developed by the National Poison Control Centres and WH O support areas to assist them in implementation of national plan identified.

(3) to develop analytical toxicological facilities for early (3) To strengthen analytical services for laboratory diagnosis of poisoning, forensic toxicology, therapeutic drug monitoring etc. the following activities were carried out: i) ii) iii) IPCS guidelines for analytical toxicological services were provided National staff sent for training in the Regional Laboratory at Birmingham, U.K. Training material and handbooks for laboratory staff on analytical methods were under preparation.

Recommendations

Action Taken

(4) to undertake epidemiological studies and activities related to prevention and management of arsenic toxicity, which is a public health problem of serious magnitude in Bangladesh and affected districts of West Bengal in India;

(4) Training courses were held to train health personnel in epidemiology and prevention and management of arsenic toxicity in Bangladesh and India.

(5) to formulate strategies and policies to undertake w elldesigned health education/promotion campaigns for developing capacity among the affected communities to recognize the dangers of arsenic and fluoridecontaminated water, and

(5) Guidelines and health promotional materials for health workers were under preparation with WHO support.

(6) to strengthen cooperation between health and other (6) Activities to establish pesticide poisoning database in cooperation with Health, Agriculture, Industry and others, supported by development sectors to prevent the misuse of chemicals and accidental poisoning. the WHO regional budget, were under implementation.

Requests the Regional Director:

(1) to collaborate and support Member States in strengthening national poison control capacity;

(1) The WHO Regional Office supported regional consultation on: a) b) c) d) Pesticide Poisoning Database Workshop, 5-7 May 1999 Environmental Epidemiological Training in Sept/Oct 1999 Strengthening Poison Prevention and Treatment Programme 13-17 Sept 1999 Establishment of a Pesticide Poisoning Database in India, Indonesia, Nepal and Thailand (under implementation)

(2) to

provide guidance on the methodology and epidemiological principles of data collection, analysis, diagnosis and treatment of pesticide poisoning due to consumption of water with a high content of arsenic, fluoride or other chemical contaminants; establishing poison control facilities and capacity building; prevent cases of poisoning in the Member States; and

(3) to support the development of national plans of action for (4) to support information dissemination and education to (5) to support multi-centre studies related to poisoning with organo-phosphorus and other chemicals in the Region.

(2) A plan of action on Prevention of Arsenic Contamination in Water and Arsenicosis in Bangladesh, India and Thailand was prepared to: a) b) c) d) e) Strengthen national capacity in case detection; Develop guidelines and health promotion materials for health workers; Develop research agenda and support for preparation of research proposals in areas of casual cofactors for arsenicosis and mitigation factors; Strengthen water system surveillance and control at all levels, and Support development of arsenic removal and testing techniques SEA/RC53/16 (Add.1) Page 3 WSH-PHE/HQs collaborated in the preparation of the POA and was facilitating on-going discussions with UNF and UNICEF tow ards the mobilization of additional resources.

(3) Multicentric Study on Organophosphate Pesticide Poisoning in collaboration with Medical Toxicology Unit of Guy’s and St. Thomas” Hospital, London, U.K. was supported. A review workshop was held in Bangkok late December 1999.

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Recommendations Tobacco or Health: Actions for the 21s t Century (SEA/RC52/R7) Urges Member States:

Action Taken

(1) to constitute a multisectoral national council, including the

Ministries of Health, Education, Labour, Commerce, Foreign Trade, Agriculture, Information and Broadcasting, External Affairs, Law and Finance, under the chairpersonship of the Head of State/Government to facilitate nationwide tobacco control activities; consumption, particularly among children, women and the poor, including inter alia : restricting and prohibiting advertisements and promotion of all forms of tobacco products; enforcing regulations governing the packaging, visibility and effectiveness of health warnings; increasing taxes on tobacco products; intensifying consumer education on health hazards of tobacco; undertaking cessation programmes; expanding and enforcing smokingfree areas, and conducting focused research; for tobacco control activities;

SEARO urged Member Countries to establish multisectoral national councils, which were in operation in some Member Countries.

(2) to adopt and strengthen policies which will reduce tobacco

While Thailand had a comprehensive legislation for tobacco control, in Sri Lanka legislation was being enacted. Draft legislation was ready in Nepal. A few states in India enacted legislation viz. NCT of Delhi, Goa, Kerala. In some Member Countries, some regulations were in place to reduce tobacco consumption, restrict and prohibit advertisements on the electronic/print media, impose heavy taxes on tobacco products, declare islands smoke-free etc.

(3) to dedicate a portion of taxes earned on tobacco products (4) to regular nicotine not used for therapeutic purposes as a controlled drug;

A bill, awaiting parliamentary approval in Thailand sought 2% of the revenue earned from alcohol and tobacco excise taxes to be channelled to support the Health Promotion Fund.

(5) to actively participate in the development and negotiation

Member Countries supported for participation in the development and negotiation of the WHO FCTC and related protocols.

of the WHO Framework Convention on Tobacco Control and related protocols in accordance with resolution WHA52.18, and intercountry activities, such as the South-East Asia AntiTobacco (SEAAT) Flame. As part of regional advocacy for policy change, the SEAAT Flame launched in India on 7 January 2000 was expected to travel to all the Member Countries. It had already covered six Member Countries. Member Countries were organizing various programmes to spread awareness among public about the hazards of tobacco consumption.

(6) to promote regional advocacy for policy change through

Recommendations Requests the Regional Director:

Action Taken

(1) to facilitate the strengthening of WHO collaborating centres and other centres of excellence, as identified by the Member States, to provide the necessary technical support in research, surveillance and training on tobacco cessation;

(2) to continue to support Member States in their national

tobacco control programmes, particularly in the areas of multisectoral policies, intercountry and interregional collaborative activities; of Member States in the development and the negotiation process on the WHO Framework Convention on Tobacco Control and possible related protocols, and

Continued support was being provided to Member Countries in their national tobacco control programmes

(3) to provide technical assistance to facilitate the participation

Technical assistance was being provided to facilitate the participation of Member Countries in the development and the negotiation process on the WHO FCTC.

(4) to urge the WHO Director-General to advocate with WTO on the issue of tobacco trade in view of its negative implications to the Region.

Intensification of HIV/AIDS Surveillance (SEA/RC52/R8) Urges the Member States:

(1) to accord high priority to HIV/AIDS surveillance by providing the required human and financial resources, and

(2) to further strengthen national capacity for comprehensive Requests the Regional Director:

All Member Countries accorded high priority to HIV/AIDS. SEARO supported the countries in surveillance. Guidelines for AIDS/STI surveillance including behavioral surveillanc e were developed. AIDS information was being disseminated through AIDSwatch, a SEARO newsletter.

(1) to enhance support to Member States in their efforts to intensify HIV/AIDS surveillance through provision of technical and material assistance;

(2) to promote intercountry collaboration in surveillance activities, monitor the progress and report to the Regional Committee, and SEA/RC53/16 (Add.1) Page 5

(3) to assist Member States in developing national capacity in HIV/AIDS surve illance through training and strengthening of laboratory diagnostic facilities.

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Recommendations RC51, New Delhi, 7-11 September 1998 Partnerships for Health Development with the Focus on Women’s Health and Development (SEA/RC51/R7) Urges Member States:

Action Taken

(1) to integrate a gender perspective into health policies and programmes in order to effectively address women’s health issues and women’s access to quality health care throughout their life span;

WHD Regional Profile was developed. This would be utilized for advocating to countries including gender perspective in health policies.

(2) to make optimal use of national and international institutions, WHO collaborating centres and nongovernmental organizations. In establishing multisectoral partnerships for gender-sensitive advocacy and development;

(3) to collect and analyze from a gender perspective, data, disaggregated by sex and other relevant factors, using existing and evolving health information systems at all levels, special surveys, research studies and other appropriate sources, and

(4) to ensure increased participation of women in national health development, especially at policy formulation and decision-making levels. Requests the Regional Director:

(1) to intensify the gender mainstreaming in all WHO One of the critical requirements of gender mainstreaming was collection of data disaggregated by sex, age and other variables programme through implementation of specific strategies, capacity building and allocation of appropriate human and financial resources; throughout the lifespan approach. In this regard, the Regional Office collaborated with the national focal points in the countries in the collection of such data, which were presented in the Regional Health Report 1998 ‘Focus on Women’. An STC was recruited for four months in 1999-2000 to assist with a review of existing tools and resource materials related to gender and development and gender and health, and the adaptation of the existing materials (or development of new materials where needed) specific to gender mainstreaming in health and relevant to the SEAR context. A preliminary draft was prepared which needed to be reviewed before finalization. Through collaboration with a prominent NGO in India and in partnership with the Government of India the Regional Office recently launched the ‘National Profile on Women, Health and Development’. An STC was recruited for three months to collect summaries of data available from various sources for the development of a database on women’s health for wider dissemination in countries. She would also assist in the development of a web page on women’s health.

(2) to provide technical support to Member States in their efforts to integrate a gender perspective into health policies and programmes, including the development adaptation and use of suitable tools for gender mainstreaming.

(3) To provide technical support to Member States in their initiatives in foster partnerships for improving women’s health and development and for prompting gender equity in health, and

Recommendations

Action Taken A technical publication comprising in-depth comparative regional analysis of women’s health was nearing completion. Follow -up activities were proposed for 2000-2001.

(4) to continue efforts in cooperation with the Member States in monitoring women’s health in the Region and to widely publicize information on women’s health to mobilize increased political and public support. Intensifying Action on Priority Health Challenges (SEA/RC51/R8) Urges Member States:

(1) to intensify time-bound action on priority health issues affecti ng the Region, and

Countries of the Region were addressing their priority health issues, including those of women and children, through their national health plans as well as through the WHO collaborative programmes.

(2) to target women, children and other vulnerable groups through intensified intersectoral and community action. Requests the Regional Director to take appropriate and timely action to support Member States in intensifying action on priority health challenges, including mobilization of external resources for the purpose.

Method of Work of the Regional Committee (SEA/RC51/R9) Decides that the Consultative Committee on Programme Development and Management (CCPDM) will deal with the following tasks at its meeting preceding the Regional Committee: In pursuance of this, since 1999, the CCPDM had been reviewing the Programme budget, as well as annual and semi-annual programme implementation, and reports of country representatives attending meetings of coordinating bodies of global programmes. Its report containing the conclusions and recommendations of the Members was submitted by the Regional Director to the Regional Committee for its review and noting. The technical discussions were also being held during the CCPDM and its report containing conclusions and recommendations submitted to the Regional Committee for discussion in the plenary session.

(1) to review programme budget, including biennial country and intercountry programme proposals, as well as annual and semi-annual programme implementation;

(2) to review reports by country representatives attending meetings of the coordinating bodies of global programmes, and

(3) to hold technical discussions.

SEA/RC53/16 (Add.1) Page 7

SEA/RC53/16 (Add.1) Page 8

Recommendations Requests the Regional Director:

Action Taken

(1) to implement these decisions from the fifty -second session of the Regional Committee and to place the CCPDM reports relating to the above items before the Regional Committee for consideration under its relevant agenda item(s), and

Done during RC52

(2) to review and modify, if necessary, the terms of reference of the CCPDM as well as its composition in order to ensure its efficient functioning in accordance with the above decision.

RC50, Thimphu, Bhutan, 8-12 September 1997 Programme Budget for 1998-1999 (SEA/RC50/R2) Urges Member States:

(1) to raise in the Governing Bodies the issue of regional and country priorities so that actual country needs for health development are reflected in the list of WHO priorities.

Bhutan, DPRK and Maldives adequately raised their country priorities with the government bodies. Indonesia prepared Programme Budget for 1998-1999 in close collaboration with WHO country office reflecting WHO/country priorities. Sri Lanka raised a number of relevant issues at the appropriate fora. Professional staff both at regional and country offices were briefed to vigorously monitor implementation towards full utilization of funds. RD/DPM/PDs/Chiefs and RAs during their visits also followed up. In Bangladesh, although the rate of implementation as of 30"' June 1998 was very low, Government as well as the WHO technical staff working in different programmes in Bangladesh were reminded to boost up their the rate of implementation. In Bhutan, with combined efforts, the obligation at the country level had crossed 75% by mid-July1998. In DPRK, action was taken to ensure timely implementation of all the collaborative programmes. In Maldives, the GoM/WHO Advisory Committee Meeting also attended by the Hon’ble Health Minister, made strong commitments to achieve 100% financial obligation of the 75% allocated budget for country activities by end December 1998. In Myanmar, the MoH in close collaboration with the WR’s Office had monitored the progress of implementation of RB PoAs to meet the target of 75% obligation by 31 December 1998. In Sri Lanka, all attempts were made by WRO and the national authorities concerned to achieve the targets.

(2) to call for a strong commitment and joint endeavours by the Member States and WH O to meet the target of obligation of 75% of the funds by 31 December 1998, and 100% by 30 September 1999,

Recommendations Health Sector Reform (SEA/RC50/R3) Urges Member States:

Action Taken

(1) to explore effective strategies for the political and In Bangladesh, activities like integration below thana level, restructuring the MoH and Family Welfare at the central level and administrative management of the process and content of health sector reform and to involve policy makers, providers of health services and the public in this process,

unification of a number of activities, e.g. MIS, logistic, health education at the central level, programme approach from project type approach (HPSP) and sector-wise programme implementation from project type implementation, formulation of national health policy (which was under finalization), launching of Health and Population Sector Programme (HPSP) for five years from 1st July 1998, were undertaken. In Bhutan, necessary reforms were carried out to improve the performance in the health sector. The Public Health Engineering Cell was transferred along with its staff from Public Works sector to Health Sector to improve coordination of Water and Sanitation activities with other health programmes. In DPRK, regular meetings for management of public health services were organized at both policy and technical levels. In Indonesia, health sector reform was undertaken with support from group of planners and policy makers. Most efforts concentrated on issues such as decentralization and human resources for health. In Maldives, in the formulation of the HMP (1996-2005) and in the Renewal of Health-for-All strategies, private sector as well as NGO participation was solicited. GoM was committed to health sector reform, through privatization, introduction of user charges and health insurance. In Myanmar, a number of reform activities in management, organization and financing in health sector were implemented. Recent development of reforming the health committees at various levels was one of the effective strategies for the political and administrative management of the process and content of health sector reforms. In Nepal, the Health Secretary commissioned an approach paper to address issues of decentralisation, specifically the scope and content of decentralisation, roles of the various levels etc. which was perceived as a preliminary step towards establishing pilot districts for health sectored centralisation. MoH planned to pilot test alternative financing schemes and provision of services through the nongovernment sectors. In Sri Lanka, efforts were made by the national authorities concerned to promote reforms. In Thailand, further steps were taken to develop field models through research and development programmes, training, etc. In DPRK, ac tions were undertaken to improve the role of national centres for excellence and WHO collaborating centres in overall national health development. In Indonesia, the Bureau of Planning, the National Institute of Health Research and Development and the Faculty of Public Health, University of Indonesia, were all active in health reform. These institutions would increase their involvement and additional institutions and agencies were likely to join initiatives in health sector reform. In Maldives, increased efforts were made on appropriate consultations for promoting exchange of experiences on health sector reform, with the institutions of Member Countries.

(2) to make optimal use of national institutional and other mechanisms as well as WHO collaborating centers to plan and manage reforms effectively.

Requests the Regional Director:

(1) to promote exchange of experiences on health sector

A meeting of the Working Group on Health Sector Reform was organized during December 1997 to: (a) review and update activities undertaken by countries with respect to health sector reform, and (b) develop a common framework for country profile on health sector reform for countries in the South-East Asia Region. SEA/RC53/16 (Add.1) Page 9

reform through appropriate consultations, documentation and dissemination, including the use of national and international institutions, WHO collaborating centers and other technical forums, with a critical assessment of all aspects of the impact of such reforms. their own health sector reform measures, and

(2) to provide technical support to Member States to pursue (3) to coordinate with other international agencies, including financial institutions, in order to provide support to national efforts for health sector reform.

Based on the common framework approved by the Working Group, country health profiles on health sector reform were prepared in six countries by December 1998. Through Asia-Pacific Health Economic Network and Regional Working Group on Health Sector Reform, efforts were made to coordinate with other international agencies to provide support to national authorities on health sector reform.

SEA/RC53/16 (Add.1) Page 10

Recommendations Evaluation and Renewal of Health-for -All Strategies (SEA/RC50/R4) Urges Member States:

Action Taken

(1) to continue their efforts to develop national health plans

and programmes based on renewed Health-for-All strategies and in the light of the results of the third evaluation

In Bangladesh, the Steering Committee on renewal of HFA endorsed a document prepared by the Core Working Group for finalization of the Final Draft of Renewal of Health for All Strategies, Bangladesh. In Bhutan, the Third Evaluation coincided with the Seventh Five-Year Plan when the country was getting ready to prepare for the next plan. The evaluation revealed the weaknesses and strengths of all health programmes. Hence, these lessons were applied while developing the Eighth Plan and the renewed HFA goals were adopted as national goals in almost all health programmes. In DPRK, efforts to develop national action plans in the context of third evaluation of HFA strategies were under way. In Indonesia, many of the results of the HFA strategy were incorporated into drafts of the five-year plan (Repelita VII). In Maldives, the HMP was developed simultaneously with the HFA renewal strategies and after the results of the third evaluation exercise. Based on this, national priority areas were identified and expressed in the DPoA 1998-1999. Myanmar had adopted HFA goals with primary health care approach in the first policy statement of National Health Policies. Third evaluation of national HFA strategies was done with involvement of representatives from all departments under MoH and respective health programme and project managers. Current National Health Plan 1996-2001 and all programmes and projects were formulated on the basis of updated national HFA strategies and in the light of the results of the CFE3. In Nepal, the renewal of the Health-for-All strategies was undertaken within the context of developing the Second Long Term Health Plan. Using elements of the Second Long Term Health Plan and the Ninth five-year plan as a guide, national health plans and programmes were developed including district health systems, community drug programme, etc. Thailand had developed the Eighth National Health Plan in which programmes and projects were mostly in accordance with renewed Health-for-All strategies and in the light of the results of the third evaluation. In Bangladesh, the bifurcated structure of MIS separated for health and family welfare was unified and consolidated to strengthen research, monitoring and evaluation processes. In Bhutan, due importance was given to improve the HMIS and research during 1998-1999 biennium in plans of action. In DPRK, technical capabilities for effective health management information systems were substantially improv ed through provision of equipment and training courses for the nationals. In Indonesia, a system of monitoring and analysis of basic data was being developed. In Maldives, steps were taken to improve the HIS, with special emphasis on generating and use of disaggregated data, improving the quality of data collected and making use of appropriate informatics technologies for policy making, planning, allocation of resources, and monitoring and evaluation. In Myanmar, National Health Management Information System was developed and implemented nationwide since 1995.This system covered national health plan activities across the country from village level to central level. Now the system was starting to expand to include information from the voluntary health workers at grass root level. In Nepal, the Department of Health Services, MoH with financial and technical support from LJNFPA, was actively engaged in the development of health management information system focusing on district level programme data. Supplementing these efforts was a personnel information system developed with the cooperation of GTZ. Initial steps were taken to strengthen the research, monitoring and evaluation processes within the context of district health strengthening activities and the programme of the Nepal Health Research Council (NHRC). Turning to efforts to strengthen research, I-IMG through the NHRC was in the process of - revising the national health research agenda, - developing mechanisms for the promotion and coordination of health services research at local, district, regional and central levels. In Thailand, the health information system was strengthened. Some records and reports on health activities were revised to serve as monitoring tools.

(2) to improve their health management information systems, with particular reference to strengthening the research, monitoring and evaluation processes.

Recommendations

Action Taken In Bangladesh, the policy guidance laid down in the “Declaration” was consistent with the policy/strategies and plans of the Government. Steps were taken to ensure that the policy guidance of the Declaration were fully integrated into the health sector strategies and PoAs. In Bhutan, copies of the Declaration were distributed to all ministries, divisions, UN and bilateral agencies, and other relevant institutions. In DPRK, the national authorities took into consideration the policy guidelines of “Declaration on Health Development in SEAR into the 21 st Century” into their national health policy. In Indonesia, the Declaration was translated into Indonesian language for circulation to all MoH units and provincial health offices for use for policy and planning guidance, especially in formulating Repelita VII. In Maldives, the policy guidance laid down in the Declaration was incorporated into the strategies for national health development. In Myanmar, the Declaration was introduced to the National Health Committee which was the highest policy making body for health in the country, at its 25th meeting in March 1998. The principles set in the Declaration were used as a guideline in formulation of plans and programmes for national health development. In Nepal, the Declaration was translated into Nepali language and printed for wide distribution to HMG senior officials, programme directors, parliamentarians, and other agencies. The mechanisms and possible timetable for future monitoring and evaluation exercises of HFA strategies were discussed during the meeting of HST Regional Advisers in HQ. Member Countries were informed about the new targets for HFA in 21" Century. The issue of indicators for new targets was presented and discussed during the ACHR, Colombo, in April1998. A working group for coordinating the implementation of the Regional I Health Declaration was constituted in the Regional Office. A Regional Consultation on implementation of Regional Health Declaration was held at Colombo in February 1998. The Health Secretaries of SEAR countries at their third meeting, held in Bangkok, Th ailand, in February 1998, reviewed actions taken on implementation of the Regional Health Declaration and made important recommendations. A PoA for implementation of the Regional Health Declaration was considered and endorsed by the 33rd meeting of the CCPDM.

(3) to take necessary steps to further adapt and integrate the policy guidance laid down in the “Declaration on Health Development in the South-East Asia Region in the 21 st Century” into their national health policies and plans.

Requests the Regional Director:

(1) to continue to support Member States in their efforts to improve the monitoring and evaluation of Health-for-All strategies;

(2) to further strengthen collaboration with Member States to achieve the targets of for Health for All by the year 2000 and beyond;

(3) to provide all possible support to Member States in their

efforts to develop health policies and plans in accordance with the "Declaration on Health Development in the SouthEast Asia Region in the 2 1st Century", and

(4) to submit the report of the third evaluation to WHO The Regional contribution was prepared. headquarters as the regional contribution for the preparation of the World Health Report 1998. WHO Collaborating Centres (SEA/RC50/R5) Urges Member States:

(1) to identify, support and develop national centres of expertise that will meet the criteria for designation as WHO collaborating centres;

In DPRK, a few more centres of national excellence were being identified to be proposed as WHO collaborating centres . There were 6 WHO Collaborating Centres in Indonesia. Two other WHO Collaborating Centres were in the process of being designated, namely, Prevention of Deafness and Hearing Impairments, and Adolescent Health. In Maldives, there were no centres of expertise. However, if IHS continues to be developed and strengthened as planned, then it could meet the criteria for designation as WHO collaborating centre.

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SEA/RC53/16 (Add.1) Page 12

Recommendations

Action Taken In Myanmar, there was only one WHO collaborating centre which was the Rodent Control Demonstration Unit (RCDU) of the Department of Health. Meanwhile Myanmar was in the process of preparing an institutional profile along with the collaborating centres questionnaire for the Institute of Nursing to become the national centre of excellence and ultimately be designated as the WHO collaborating centre of nursing and midwifery. The Ministry of Health was in the process of proposing the Institute of Community Health under the Department of Medical Sciences, Prevention of Blindness Programme and Leprosy elimination programme under the Department of Health, and HMIS development under Department of Health Planning as the National Centres of Expertise for further intensified WHO regional collaboration. In Nepal, the WHO country office encouraged the MoH and its donor partners to make use of the Health Materials Learning Centre, for the translation and adaptation of publications and learning materials for use in Nepal. Support was provided to staff at the maternity hospital to allow their participation at scientific meetings. In Sri Lanka, efforts were continued. In Thailand, the country had realized the importance of technical resources of WHO collaborating centres available in Thailand as those resources were in support of national health development. There were currently 15 WHO collaborating centres.

(2) to make use of the technical expertise available in the Region and elsewhere, particularly the technical resources of WHO collaborating centres within and outside the Region, in supporting national health development, and

Bangladesh had been involving its only one WHO collaborating centre in supporting the national health development. In DPRK, collaboration between concerned national institutions and WHO collaborating centres within and outside the Region was strengthened.

(3) to evolve sustainable mechanisms for optimal use of Increasing number of DPRK fellows under different subjects of study were sent to various WHO collaborating centres in the Region, WHO’s resources through the involvement of national centres of expertise and WHO collaborating centres. such as those in Thailand and in India, using WHO fellowship programmes. In Indonesia, WR’s Office tried to use resources to assist the centres to strengthen their capacity and monitored their activities. In Nepal, technical and financial resources were provided to national centres of expertise used by WHO and MoH, to strengthen the institutions and further enhance their expertise (e.g. staff and curriculum development at IOM and BPKIHS).

Requests the Regional Director:

(1) to take steps to further strengthen the cooperation between WHO and its network of collaborating centres and national centres of expertise, to increase their involvement in the development and management of WHO priority programmes in the Region, and

A consultative meeting of WHO Collaborating Centres and Centres of Expertise in the Areas of Reproductive Health & Emerging/Re-emerging Infectious Diseases was held in SEARO in September 1997 and concrete recommendations were made to increase their involvement in the development of WHO priority programmes in the Region. All recommendations were followed up.

(2) to support and promote the designation of a large number of collaborating centres in the Region while ensuring a balance by area of speciality and geographical representation.

Technical support was provided to promote and designate new centres and re-designate existing centres in the Member Countries. Services of WHO Collaborating Centres i.e. NEERI, Nagpur, were enlisted to carry our assessment of various arsenic field-testing kits.

Recommendations RC49, Chiang Mai, Thailand, 9 -14 September 1996 Renewing the Health-for-All Strategies (SEA/RC49/1) Urges Member States:

Action Taken

(1) to complete the third evaluation of national HFA strategies

and finalize the country report by March 1997 involving all the concerned sectors in the process; consultative processes relating to the renewal of national HFA strategies in the light of the said evaluation, and national HFA strategies.

(2) to intensify the participation of all concerned sectors in the

(3) to mobilize all concerned in implementing the renewed Requests the Regional Director:

(1) to support Member States in their efforts to further improve

In Bangladesh, the need to renew the national HFA strategies was well received by the Government. The mobilization started and coincided with the development of the health sector strategy and the health policy. Bhutan prepared the Eighth Plan incorporating the strategies for Health-for-All. It also developed the renewed HFA strategy in line with that of WHO. As the renewed strategies were actually the strategies adopted for the Eighth Plan, all concerned sectors were geared to implement them and resources were planned for their implementation. In India, the exercise relating to the third evaluation of National Health-for-All (HFA) Strategies and Renewal of National Health-for-All Strategies were completed. This exercise involved extensive consultation with state governments, other related departments, the voluntary sector and professional bodies as well as international donors. The results of the evaluation were being scrutinized for approval at the highest policy-making levels. The third evaluation of national HFA-2000 strategies in Indonesia was completed and the report sent to WHO/SEARO. During the process all concerned sectors were inv olved. The evaluation results would be used as inputs for the Seventh Five-Year Development Health Plan. In Maldives, the evaluation process was completed and the first draft of the report was compiled. In Myanmar, WHO was involved in the evaluation exercise through the services of a consultant. WHO emphasized the intersectoral character of both the evaluation of the HFA 2000 strategies and the implementation of the renewed national HFA strategy. The WHO Representative used all available fora for disseminating this idea. In Nepal, renewal of the Health-for-All strategies was being undertaken in conjunction with the development of the Second LongTerm Health Plan (SLTHP), which included the health component of the Ninth Five Year Plan. As part of the SLTHP development process, a two-day preliminary national workshop was held for leaders from the health sector, the Ministry of Health and related ministries, public and NGO sectors, etc., to raise awareness, discuss the status of health sector development, receive inputs and garner support for the SLTHP development process. A series of working groups was established with membership drawn from various sectors to develop the various components of the SLTHP. With the preparation of an initial draft, workshops were h eld to raise awareness and elicit additional input from the public for the SLTHP. Employing the data derived from the various studies and comprehensive analyses undertaken, specific sections of the HFA evaluation were developed by representatives of the Ministry of Health, other relevant ministries (National Planning Commission, Housing and Physical Planning, etc.) and private and NGO sectors. The draft document was then presented for discussion at a national workshop with participants drawn from all concerned sectors; and revisions made as warranted, based on the participants’ input. In order to facilitate and accelerate the process of evaluation of HFA 2000 and renew HFA strategies and to define regional priorities, the Regional Office convened an intercountry meeting in Colombo, Sri Lanka, from 9-13 December 1996. SEAR countries have integrated the process of renewal of their national HFA strategies in their health development plans in the context of their overall socio-economic development plans, as per their planning cycles. The consultative processes in this behalf were being undertaken with the participation of all concerned sectors, including NGOs, academic, media, UN agencies and donor organizations and the private sector. The results of the third eva luation of national HFA strategies were being used as an input while proceeding with the reviews of health policies and plans and preparing for the future. This facilitated more active participation of all partners in implementing the renewed HFA strategies. The Regional Director supported the above activities through a series of consultations and meetings at the regional level. Starting with the informal consultations on renewal of HFA strategies in August 1995, the subject had been discussed by the Health Ministers, Health Secretaries, CCPDM and the Regional Committee.

the process of monitoring and evaluation of HFA strategies and utilization of the evaluation results in national health development. to intensify WHO's advocacy efforts aimed particularly at high level decision-makers, related to renewing the healthfor-all strategies, and the third evaluation with a view to utilizing such results in the renewal of the HFA strategies at country level and for defining regional priorities.

(2)

(3) to convene an intercountry meeting to review the results of

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Recommendations

Action Taken WHO advocacy efforts for health were enhanced in several ways. Besides institutionalizing the Health Ministers Forum and initiating the convening of annual meetings of Health Secretaries, a conference of parliamentarians on Health and Development was organized in collaboration with the International Medical Parliamentarians Organization in July 1996 in Bangkok, Thailand. A monograph on Poverty and Health, circulated during the Fourteenth Meeting of the Health Ministers, was reviewed by the second meeting of the Health Secretaries. This was revised by a penal of experts and published as a WHO document.

Regional Health Report (SEA/RC49/R2) Urges Member States:

(1) to develop, improve and integrate the national health In Bangladesh, attempts were made to improve the current information gathering and distribution through the development of an systems into the managerial processes for health development;

(2) to generate timely statistics and use the health information systems for priority setting, planning, monitoring and evaluation, and

(3) to make national health information systems functional by using standard methods and procedures in generating timely, relevant comprehensive and valid data/information.

MIMS system and training of relevant staff. In Bhutan, WHO assisted the Health Division in improving this area by providing necessary informatic equipment and fielding short-term consultants to provide technical guidance. ICD-10 was introduced as the basic classification and format for reporting diseases. Training was provided to medical doctors. Computers were provided to Health Department headquarters so that these reporting and information systems could be properly monitored and necessary data generated in time. The radio communication system, with which many far-flung health facilities were connected to health headquarters, was also used for health information, besides facilitating the referral of patients. In India, 40% of the states/Union Territories (UTs) were covered by the Health Management Information System (HMIS). A review meeting was held in March, 1996, in which states/UTs expressed the need for updating the format of the present HMIS in meeting information needs of all concerned in the light of the experiences gained so far and recommended the review of the formats by a Task Force. Accordingly, a Task Force was constituted by the Ministry of Health and Family Welfare to evolve a comprehensive MIS to meet the requirements of all. Integration of separate HMIS, developed for national programmes like leprosy, blindness and malaria proved highly successful. In Indonesia, a comprehensive Management Information System was established. The concept included the district-based surveillance system. In Maldives, a technical committee was established to improve the health information system. In Myanmar, the National Health Plan 1996-2001 was the basis for the work of the health services cov ering the various levels of the national health system. Much attention was given to the improvement of the Health Management Information System (HMIS). In February 1997, a national seminar on HMIS took place in Yangon. A WHO consultant assisted the Department of Planning and Statistics in the collection and utilization of data and information. In Nepal, a series of related information systems was developed and implemented to generate timely statistics for use in management decision-making, priority, priority setting, planning, monitoring and evaluation. These systems included: Health Management Information System (HMIS); Hospital-Based Information System (HoBIS); Human Resources Development Information System (HuRDIS), and Logistics Management Information System (LMIS). WRO, Sri Lanka provided technical support to make the national health information system functional. The first Regional Health Report published in 1996 provided a general perspective of health development in the Region within the context of the political, environmental, social and economic situation in the ten SEAR countries. The Regional Consultation on Health Indicators, held in SEARO in November 1996, clarified the methodologies used in estimating the health-related indicators, and recommended that WHO should continue to use data from both national and other sources in preparing the Regional Health Report and other regional publications, The publication of the report would be an annual feature. The 1997 edition would focus on developments in HFA/PHC during the 20 years since Alma Ata (1977-1997), trace significant developments, and address both successes and failures in HFA initiatives within the Region. Each year's report would analyse relevant time-trend data to reflect the changes in health developments in the Region and provide a critical analysis of the health situation relevant to the particular topic.

Requests the Regional Director:

(1) to continue to provide necessary support to the Member

States in the functioning of their national health information systems; focusing on specific themes of relevance to the Region in subsequent issues; tables to reflect progress in health deve lopment; situation in the Member States, and national figures.

(2) to continue to publish the Regional Health Report annually,

(3) to include in the Report time-trend data in the statistical (4) to provide in the Report a critical analysis of the health (5) to ensure the data used in the Report are consistent with

Recommendations Promoting the Status of Women (SEA/RC49/R3) Urges the Member States to make systematic efforts to identify suitable women candidates at various decision-making levels to assume positions of responsibility as well as to prepare them for future roles. Requests the Regional Director:

Action Taken

(1) to identify the obstacles in the recruitment and retention of women in professional posts and to develop and implement an appropriate plan to overcome these obstacles;

Countries took steps to increase opportunities for women at decision-making levels. In Bangladesh, a Gender Issues Unit was established in the MoH&FW to address issues of gender equality among health personnel along with health services delivery. Increasing number of women was employed at higher levels of functioning in the government. In Bhutan, women had equal opportunities as men. Trend showed that more women were given opportunities for higher education and more educated women were filling important government positions. The National Women’s Association, headed by one of the King’s sisters, gave employment opportunities and looked after women, especially in the rural areas. Through the historic 73 rd and 74th amendments to the Constitution, reservations were made for women in Panchayats (village councils)/municipal bodies in India to ensure their participation at the decision-making forums in critical grassroots level. In the services sectors, government also encouraged recruitment of women in all fields. In Indonesia, efforts were made to identify suitable women candidates at various decision-making levels. In Maldives, the government policy was to encourage the participation of women at all levels of the administration and there were no gender differences in educational and job opportunities. In Nepal, in addition to placing women in high level decision-making roles within the MoH, and Department of Health Services, qualified women were recruited to positions as programme heads and section officers to develop leadership quality in them and to acquire necessary experience to assume greater responsibility. The senior staff of the Regional Office and WROs were requested to identify suitable women candidates for vacant post s. Following the directives of the Regional Director, no selection proposal was processed unless the short-list included at least one woman candidate. A panel of women professional staff was approved by the Regional Director from which one female staff was invited to represent the interests of women at the Regional Senior Staff Selection Committee (RSSSC) meetings. A Working Group was constituted under the chairmanship of Director, Administration and Finance, to carry out a study on the employment and participation of women in the work of WHO. The objectives of the study was to analyse trends of women's recruitment over the past five to ten years, identify facilitating and hindering factors within and outside the Organization, assess the effectiveness of actions taken by SEARO, and propose strategies to overcome the identified obstacles. The Working Group collected data on the current situation and trends in women's recruitment and employment in professional posts in the Regional Office, WRs' Offices, and country -based projects and data on women's participation in WHO governing and advisory bodies, technical and advisory committees and expert advisory panels. Interviews were also being conducted with Programme Directors and professional staff to identify the underlying factors and obstacles. This effort at its regional level was being carried out in close association with the work undertaken at Headquarters.

(2) to continuously urge the Member States to encourage and promote the participation of women at health policy levels and in the Governing Bodies as well as in the work of WHO, and

(3) to assess periodically the progress made in this regard.

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SEA/RC53/16 (Add.1) Page 16

Recommendations Quality Assurance in Laboratory Practices (SEA/RC49/R4) Urges Member States to:

Action Taken In Bangladesh, the first phase of quality assurance system was established by the Institute of Public Health (IPH) at five medical college hospitals and three regional hospitals in the 1998-1999 biennium. Technical guidance was provided on Quality Assurance System for Clinical Microbiology at the central, regional and peripheral laboratories in Bangladesh. One workshop was held at the IPH to formulate recommendations about Quality Assurance System development in Bangladesh. Bhutan recruited two consultants - one for strengthening quality assurance in health laboratory in terms of blood and blood products safety and another for strengthening quality assurance in terms of clinical microbiology. In India, the National Institute of Biologicals was established by the MoH&FW in joint collaboration with USAID and OECF (Japan) as an apex institution for quality control of biologicals products such as vaccines, blood and blood products, reagents and immunodiagnostic kits used in the country. Nine national laboratories had the capability to implement External Quality Assurance Scheme (EQAS) in laboratory medicine covering more than 1,000 laboratories. Standard Operating Procedure Manuals (SOPMs) were prepared and field-tested. National workshops on quality assurance of laboratory services were held. Fifteen lead centres were identified for carrying out quality control tests. Quality assurance in health laboratory services was covered in the health development programme in Indonesia. For this purpose, the MoH planned activities to improve the quality of health laboratory services, provided resources for the activities and stimulated the participation of the private sector. Besides allocating annual budget for quality assurance activities, the MoH motivated the professional communities, associations of private health laboratories and other private organizations to provide resources. The MoH, in collaboration with professional communities organized technical training and workshops for laboratory personnel, provided the equipment, conducted EQAs and distributed manuals and guidelines. It also provided new laboratory instruments and reagents to strengthen the national centres, provided fellowships and training abroad for technology transfer, and conducted technical cooperation with other countries’ national centres. MoH in collaboration with national health laboratories were also ready in initiating accreditation process in the laboratories. In Maldives, the International External Quality Assurance Scheme programme was established at the Indira Gandhi Memorial chemistry. In Myanmar, strengthening of laboratory services was a part of the National Health Policy. Efforts were made to increase the capacity and capability of the National Health Laboratory, Yangon. A consultant visited Myanmar in connection with assisting nationals in improving QA. EQAS expanded to peripheral areas in different laboratories.

(1) to formulate/strengthen national policies and provide adequate resources to ensure quality assurance in laboratory services;

(2) strengthen national capacity to improve the performance and quality of laboratories;

(3) develop and strengthen national centres for undertaking external quality assessment schemes, and

(4) accelerate the development of laboratory accreditation, both in the government and private sectors. Requests the Regional Director:

(1) to assist Member States in advocating the concept of integrating quality assurance activities in health laboratory practices; strengthening of national policies;

(2) to provide technical support in the formulation/ Hospital (IGMH). A consultant assisted the government in organizing National External Quality Assessment (NEQA) in clinical (3) to support human resource development aimed at quality assurance in laboratory practices in Member States;

(4) to facilitate international cooperation in the mobilization of technical and financial resources and supply of standard reference laboratory materials, and

Recommendations assessment schemes covering laboratory services.

Action Taken establishing forty-four laboratories at the district level (four at the district level and forty in the primary health centres), with the supplementary support of other donors, including WHO and JICA, Japan. A consultant visited various laboratories to do situation analysis and conducted workshops in QA programme. In DPR Korea, consultants were recruited to help nationals in QA in microbiology, blood transfusion services and radiological and radiotherapy services. Translation of Regional Publication on Quality Assurance in Korean language was being done by nationals. As a result of recommendations of the consultant, most of the equipment for laboratories, blood transfusion centres were procured. In Sri Lanka, an international consultant was recruited to strengthen QA programme in laboratories as well as in blood banks. Laboratories were participating in IEQAS in various disciplines and also organizing NEQAS for intermediate laboratories. In Thailand, the Department of Medical Sciences was involved in organizing NEQAS in laboratory medicine for most of peripheral laboratories in the country. All countries were supported in strengthening QA programme through the visit of a consultant and conducting GEA. Guidelines on QA were prepared and disseminated to all Member Countries. The regional publication on Health Laboratory Services in support of Primary Health Care in South-East Asia, incorporating national laboratory policy, appropriate use of quality assurance, was revised and distributed to all Member Countries. Guidelines on Standard Operating Procedures for Haematology and Microbiology and Gonococci were prepared and disseminated for adoption by Member Countries. Four issues of QA Newsletter published and sent to all Member Countries for exchange of information and sharing success stories. A total of 64 laboratories were supported to take part in IEQAS in different disciplines in Member Countries. Now the stage was set to start evaluation process and before the end of biennium, evaluation on QA would be completed and documented. Guidelines on Accreditation in Laboratory Medicine was being prepared for the use of Member Countries. To ensure selection of good quality kits, an intercountry consultation was being organized to prepare guidelines for proper selection of kits. At the WHO level, documentation on quality assurance (QA) was prepared. A document on Health Laboratory Services Network incorporating national policy and quality assurance, was distributed to all Member Countries. The Standard Operating Programme Manual on gonococcal antimicrobial susceptibility testing was also distributed to Member Countries. Workshops were held to train trainers in QA programme in clinical microbiology and/or clinical chemistry in all Member Countries where standard reference material was supplied. Visits of experts from international collaborating centres were mobilized to technically assist Member Countries in the establishment of QA programm es in health laboratory services. A total of 64 laboratories were supported to take part in the IEQAS in different disciplines in all Member Countries. SEA/RC53/16 (Add.1) Page 17

(5) continue to promote international external quality The MoH, Nepal, undertook an aggressive programme to develop and further strengthen its network of laboratories including

SEA/RC53/16 (Add.1) Page 18

Recommendations Elimination of Leprosy (SEA/RC49IR5) Urges Member States:

Action Taken

(1) to review the national leprosy programme regularly; (2) to intensify surveillance of leprosy cases, particularly at health centres, outpatient departments of general hospitals, skin clinics, especially private clinics;

(3) to establish facilities at appropriate levels for the diagnosis and treatment of suspected cases as well as for the follow up of patient compliance, and cases.

Leprosy was a special and important public health problem due to the social consequences of permanent disability and stigma. Leprosy was a disease of the poor and marginalised. SEA Region contributed almost 80% of the global caseload. Bangladesh, Bhutan, Maldives, Sri Lanka and Thailand had reached elimination goal of less than 1 case per 10 000 population. Indonesia expected to reach elimination by the end of 2000. Three endemic countries - India, Myanmar and Nepal were likely to achieve elimination at the national level by 2003 and possibly at the district level by 2005. On March 2000 there were 576,510 cases under MDT treatment with PR 4 / 10,000 population. Nepal had the highest prevalence 6/ 10 000 followed by Myanmar PR 5.9/ 10 000 and India 5.1 / 10 000. So far 9.3 million persons had been cured from leprosy with MDT in the SEA Region since 1985.

(4) to encourage community participation in identifying leprosy The strategy for the elimination of leprosy as a public health problem in SEAR during 2000-2005 focussed on: Requests the Regional Director: § Enhancing public awareness, political commitment and creating demand for elimination of leprosy in the society; § Improving the capacity of general health services staff; § Monitoring and adequate supply of the best quality of MDT to all endemic Member Countries; § Improving MDT Services through Leprosy Elimination Campaign (LEC) and Special Action Projects for Elimination of Leprosy. § Treating patient with MDT; § Monitoring, review and evaluation of national leprosy programmes; § Prevention of deformities. WHO continued to support LEC s and SAPEL in India, Nepal, Myanmar, Indonesia and Bangladesh in order to intensify case detection and MDT services. Independent evaluation of national leprosy programmes was carried out in Bangladesh, Myanmar, Indonesia, and Nepal during 1997-1999 and in M arch 2000 for India. WHO would provide technical support to all Member Countries in achieving the elimination goal by the end of 2005 with special emphasis to Bangladesh, Indonesia, Myanmar, Nepal and India. In Bangladesh, regular quarterly reviews were undertaken in the MOH&FW and at the central, divisional and district levels. Workshops for medical and nursing college teachers and for medical nursing students were conducted. Information on the early signs of leprosy and measles for their prevention and control was provided through TV, radio, print media and advocacy at the district level. A national seminar on Community Action for Leprosy for Local Community Leaders was conducted. Leprosy elimination campaigns would cover 61 out of 64 districts,

(1) support the national leprosy programme review; (2) continue to provide necessary technical support to Member States for developing1strengthening surveillance for leprosy cases at the primary health care level, and in their efforts at leprosy elimination, and

(3) support national campaigns for the elimination of leprosy, especially in highly endemic and in inaccessible areas

Recommendations

Action Taken In Bhutan, leprosy had almost been eliminated as a public health problem. Besides, leprosy surveillance was built into the health system and regular surveillance was being carried out. Facilities existed in some basic health units and in all district and regional referral hospitals for diagnosis and treatment of suspected cases as well as follow -up of patient compliance. Village health workers belonging to the communities helped in identifying leprosy cases and following up on treatment. Through constant health education, the stigma relating to the disease was reduced to a great degree and sometimes the patients themselves came forward for treatment. The communities also helped in identifying leprosy cases and reporting to health facilities. From the government side, not only were these practices now somewhat institutionalized but also strengthened through the continuous provision of health education about the disease and also training of village health workers and health personnel. The National Leprosy Eradication Programme in India was being implemented in 490 districts. The present approach was based on early detection of cases and their prompt and regular domiciliary treatment with MDT, using staff trained in leprosy. It also provided services through mobile leprosy treatment units. Health education was organized for patients, their families and the community to make them aware of the need for treatment and that free treatment was available for this disease. Deformity and ulcer care as well as medical rehabilitation services for leprosy patients were being given to needy persons. This resulted in a substantial decline in the number of persons requiring treatment. In Indonesia, a national consultation meeting on leprosy was conducted to review the programme regularly. Detailed strategies as well as activities to achieve the target of leprosy elimination by the year 2000 were formulated with support from all quarters. Maldives planned activities to eliminate leprosy as a public health problem. Mobile teams were organized periodically to peripheral levels for screening and family health workers placed in the islands were trained to recognize suspected cases. In Myanmar, the National Leprosy Programme was reviewed annually. Active contact surveys and mass surveys were conducted annually for 2030% of the rural population by leprosy teams. Passive case-finding activities were carried out at OPDs of general hospitals, skin clinics and private practitioners’ clinics. Community participation in the programme was promoted mai nly through IEC materials. In Nepal, as part of its efforts to eliminate leprosy, district leprosy assistants were appointed in all regions, and training provided to them. Community health volunteers were oriented to increase case detection and reduce defaulter rates. Multi-drug therapy (MDT) was extended to a minimum of 70 districts. NGO coordination meetings were institutionalized to formulate plans of actions, and monitoring of leprosy control activities by essential indicators introduced. MoH also undertook concerted efforts to improve the management of the leprosy programme at the central and district levels. To further strengthen district-level capabilities for implementing leprosy programmes, basic training in leprosy was provided to district- level TB/leprosy assistants and village health workers. In Sri Lanka, national efforts were producing good results. The Regional Office reviewed the existing progress reporting forms from the Member Countries to make the monitoring of the critical indicators on a half-yearly basis. Assistance was also provided for identifying and training monitors to undertake leprosy elimination monitoring (LEM) in the identified areas in Member Countries with the guidance of LEP/WHO-HQ. In February 1996, SEARO organized a meeting of all programme managers of the leprosy endemic countries in the Region to review the progress achieved and to strengthen/sustain the programme towards the goal of leprosy elimination. The Regional Office, with support and guidance from LEP/HQ, strengthened the programme by subjecting the Indonesia and Nepal programmes to independent evaluation during 1996. The leprosy programmes of India and Bhutan were being supported by WHO for independent evaluation to ascertain the progress with special focus on the World Bank -supported projects in India. National programmes were encouraged and supported for computerization of data to upgrade the quality of monitoring and timely institution of correctives. During 1996, active involvement of primary health care staff in undertaking leprosy programme tasks was further strengthened through refresher training at all levels besides increasing the political commitment and administrative support towards the goal of leprosy elimination as a public health problem.

SEA/RC53/16 (Add.1) Page 19

SEA/RC53/16 (Add.1) Page 20

Recommendations

Action Taken Under the guidance of LEP/HQ, the Regional Office promoted national leprosy programmes in the Member Countries to generate and submit special action projects for the elimination of leprosy (SAPEL) to accelerate the progress in areas where the MDT services had not yet reached due to accessibility problems. Currently, SAPEL projects were operational in India, Indonesia, Nepal, Bangladesh and Myanmar. The Regional Office supported LEP/HQ in promoting and stimulating Member Countries in seeking the support of leprosy e limination campaign (LEC) approach to detect, review and treat hidden leprosy cases of consequence in difficult areas for accelerating the goal of leprosy elimination.

Eradication of Poliomyelitis (SEA/RC49/R6) Urges Member States:

(1) to ensure political commitment towards the eradication of poliomyelitis and mobilization of adequate financial resources for sustaining National Immunization Days (NIDs) until the interruption of wild poliovirus transmission has been fully documented and to continue routine immunization activities;

(1) Political commitment was secured for ensuring interruption of transmission by end of the 2000 and continued to remain high. In order to ensure that interruption of poliovirus was achieved by the end of the year 2000, all countries in the Region were conducting either NIDs or SNIDs as determined by the epidemiological situation. India conducted six rounds of NIDs/SNIDs in 1999 and 2000, and planned to conduct two rounds of SNIDs in high-risk states followed by two rounds of NIDs in 2000. Bangladesh conducted two additional NIDs in April and May 2000, and was planning to conduct three rounds in the winter of 2000/2001. Nepal would match its strategies as closely as possible with India’s. DPR Korea would also conduct NIDs in 2000, while Indonesia would be conducting SNIDs in conflict- affected provinces. Maldives, Bhutan, Sri Lanka and Thailand would also conduct SNIDs. Since the implementation of polio eradi cation activities, Nepal and Myanmar reversed the declining trends in routine immunization coverage. All countries strengthened the cold chain network. The capacity of health workers and vaccinators was enhanced through repeated training. (2) Since 1996, Bangladesh, India, Myanmar, Nepal, and Thailand synchronized NIDs in December 1996 and January 1997. Pakistan, in the Eastern Mediterranean Region, and China in the Western Pacific Region synchronized their NIDs/SNIDs with India and Myanmar respectively along the border areas since 1996. The holding of border meetings between China and Myanmar facilitated coordination between the two countries. The Joint WHO-UNICEF Meeting held in March 2000 in Kathmandu facilitated dialogue on cross-border cooperation between polio-endemic countries in SAARC and neighbouring regions. A meeting on cross-border cooperation between Bangladesh and Myanmar was concluded in June 2000 in Yangon. (3) Beginning in 1997, efforts to strengthen surveillance were enhanced. Currently, all countries had implemented active surveillance for acute flaccid paralysis (AFP); and Bangladesh, India, Indonesia, Nepal, Myanmar, Sri Lanka, and Thailand were conducting AFP surveillance, linking AFP and laboratory data by a unique identifying number. AFP surveillance relied on the SEAR Polio Laboratory Network. Of the 17 network laboratories, 15 were fully accredited. The laboratories in Dhaka and Pyongyang were being strengthened for review. In 1999, the non-polio AFP rate in the Region ranged from 0.39 to 1.80 per 100 000 population aged less than 15 years of age, with the Regional average at 1.34. collection of two stool specimens from AFP cases ranged from 51 percent to 84 percent by country while the Regional average was 73 percent. (4) Through the Regional ICC and country-Ievel ICCs, SEARO had been able to galvanize support for polio eradication from several donor agencies. The entry of the World Bank into India’s initiative was on note and also led to support by the Bank for India’s routine immunization programme.

(2) to collaborate with neighbouring countries in the synchronization of NlDs to enhance the impact of polio eradication efforts, and

(3) to establish adequate surveillance mechanisms through monitoring AFP reporting procedure as well as through a network of quality laboratory services in the Region to ensure the long-term impact of the programme

Recommendations Requests the Regional Director:

Action Taken In addition to SNIDs, India planned NIDs for December 2000 and January 2001. Myanmar, Nepal and, to an extent , Bangladesh would synchronize their NIDs with those of India. Thailand was conducting SNIDs, which would be synchronized with NIDs in Bangladesh, Myanmar and India. The emphasis was on quality in all countries.

(1) to facilitate the synchronization of NIDs among countries within the Region and those of neighbouring regions;

(2) to collaborate with interested agencies in ensuring adequate support to the national efforts in poliomyelitis eradication, including the strengthening of surveillance of acute flaccid paralysis;

(3) to further strengthen NID activities under the supplementary intercountry.

RC48, Colomb o, Sri Lanka, 12-18 September 1995 Renewing the Health-for-All Strategy (SEA/RC48/R1) Urges Member States:

(1) to take all initiatives and actions necessary to raise the awareness of the general public, political leaders, health ministers and related sectors, and all other concerned with social and economic development in order to place human health at the centre of development and to address the serious health challenges of the coming decades;

WHO fielded one consultant in Bhutan from I January to 14 March 1996 to assist the Health Division to prepare their inputs for the VIll Five-Year Plan. While preparing their inputs, the progress of various programme areas was reviewed through several rounds of meetings with the Programme Managers and strategies were revised so as to achieve the HPA goals before the end of the Plan. The final input of the health sector was then discussed in the Annual. Health Conference (5-8 March 1996) which was attended by all decision-makers in the Ministry of Health and Education, the Programme Managers, District Health Supervisory Officers (now called Ozongkhag Sowai Gnamdrel Gopen), District Medical Officers, and the WHO Consultant. Indonesia completed a major intensive exercise in developing a new 25-year long-term development plan covering the period 19942019. This plan included a 25 year long-term health development plan covering the same period. The government considered the process used to develop this plan to be consistent with the process for HFA renewal strategy. It represented Indonesia's contribution to the Regional and Global HFA renewal. The WHO renewal document was distributed in May 1995. Starting in April 1996, a formal review of the Sixth Five-Year Development Plan was conducted which would serve as an input into the Seventh Five -Year Development Plan covering the period April 1999 to March 2004. This review and development process would take approximately one year. The policy changes obtained through review of successes in PHC, analysis of health trends, and the extensive consultation process, were placed in the national Health Laws, No.23, September 1992, and the 25 year longterm health development plan, issued in 1993. The consultative process was initiated in December 1991 when meetings were held to develop the 25-year long-term development plan. These series of meetings and activities involved many sectors and organizations. An action plan, known as the Sixth FiveYear Development Plan, was developed within the MOH during the period April-September 1993, refined in the National Planning Board in February 1994, signed by the President in March 1994 and became effective in April 1994 for the period April 1994 to March 1999. SEA/RC53/16 (Add.1) Page 21

(2) to undertake a comprehensive review of health policies, covering all aspects of social and economic development, and placing appropriate emphasis upon health promotion and primary prevention;

(3) to undertake country consultations on health challenges

and major policy orientations which would promote consensus and serve as a basis for the elaboration of renewed national, regional and global health strategies for Health for All, and health sector as well as international sources.

(4) to mobilize resources, both from within and outside the

SEA/RC53/16 (Add.1) Page 22

Recommendations

Action Taken The health sector continued to receive substantial external inputs from UN agencies, multi- and bilateral agencies, and international and national NGOs. It also provided operational and maintenance support from local government development budget as well as from other sectors, such as water supply and sanitation, family planning, etc., community participation such as the PKK, women's involvement also provided substantial resources to support PHC. In Maldives, it was considered appropriate to combine the HFA renewal efforts with those towards drafting a Health Master Plan (1996-2005), as these involved similar actions. Since November 1995, a Planning Committee had been working to do a situation analysis. This would take into consideration contributions from a wide range of organizations and individuals, including those at the grassroots level. A series of seminars and workshops were held for the purpose in April and May 1996. In Nepal, renewal of the Health for All Strategies was being undertaken within the context of the development of the Second Long Term Health Plan (SLTHP) which included the health component of the Ninth Five Year Plan. As part of the SLTHP development process, a two day preliminary national workshop was held for leaders from the health sector, the Ministry of Health and related ministries, public and NGO sectors, etc. to raise awareness, discuss the status of health sector development, receive input and garner support for the SLTHP development process. A series of working groups were established with membership drawn from various sectors to develop the various components of the SLTHP. With the preparation of an initial draft, regional workshops would be held to raise awareness and elicit additional input from the public for the SLTHP. These would be supplemented with a national workshop to obtain final input and generate national awareness of the strategies and policies to be pursued under the SLTHP. The initial phase in the development of the SLTHP included a comprehensive situational analysis focusing on the health policy context including the principal instruments of health policy that established the framework for health sector development, and existing programmes policies. Complementing these efforts was a review and discussion of the role of the health sector in national development noting the health sector's contribution and relationship to sustainable development, poverty alleviation, equity and economic growth. As part of the comprehensive situational analysis for the development of the SLTHP, a review was being undertaken of Nepal's demographic profile; the changing trends in communicable and non-communicable diseases: burden of disease trends as well as an assessment of the health services delivery system including the public, private and NGO sectors. Based on this analysis, the major health challenges would be identified and relevant policies and strategies developed through the multi-sector SLTHP development process. HMG's donor partners - bilateral and multilateral donors, INGOs and NGOs including but not limited to WHO, UNFPA, UNICEF, World Bank, GTZ, ODA, were mobilized to support the development of the SLTHP. In Sri Lanka, a series of educational activities were being carried out by the Health Education Bureau under the Ministry of Health to raise the health awareness of the general public. The Bureau, in collaboration with NGOs, conducted some orientation meetings for community leaders on health related issues. A task force was set up and working to develop an information package for public education on health problems, issues, policy options, service provisions and their roles in health care. A task force on policy analysis was set up. Two studies were undertaken as part of the policy analysis. Based on the findings of the studies, a consultative meeting would be organized on policy issues and options. The policy framework of the health sector was being reviewed by the Health Advisory Committee in order to delineate policy orientations required in the light of existing situations. A working group was set up to prepare a plan for development of human resources for health. Four task forces under the working group were constituted. A core group of professionals was working to integrate personal preventive care with curative service in hospitals.

Recommendations

Action Taken During the period under review (Sept.1995-May 1996), the national allocation for the health sector had increased. Philanthropic donations for health development activities were received for the construction of facilities and procurement of medical equipment. "Sramadana" (Manual labour work) campaigns launched as a community participation programme in the public sector, contributed to the improvement of medical care institutions and public health activities. In some cases, material support was also received in addition to people's voluntary work. A number of N GOs were working to promote community health. Two loan agreements were signed with the Korean and French governments. The Korean loan would be utilized for improving physical facilities in three hospitals and for the procurement of equipment the for district hospitals. Medical and surgical equipment for the cardia-thoracic unit of the Teaching Hospital at Kandy would be procured with French aid. Negotiation with JICA for setting up a Nurses Training School at Sri Jayawardenapura were finalized. Financial support from the World Bank and ADB was obtained under the ongoing projects. It was planned to select some innovative approaches and implement them on experimental basis in the current biennium, with WHO support. In Thailand, the distribution of HFA renewal documents was effected. A preliminary meeting of the administrative board of the Ministry of Public Health and Permanent Secretary's office was held and a national consultative process was initiated and a formal review of successes since Alma Ata and identification of future challenges were under way.

Requests the Regional Director:

(1) to support country -level activities on "Renewing the Healthfor-All strategies;

(2) to consult all Member States and international partners of WHO in the process, and

Consolidated brief of developments up to and including RC48 (resolution No. SEA/RC48/RI), developments leading to the adoption of resolution WHA48.16, outcome of the informal consultation organized by h t e Regional Director in August 1995, consultation document, ‘Renewing the Health-for-All - Elaboration of a Policy for Equity, Solidarity and Health" issued by national health-for-all strategies; HQ, recommendations of 28th CCPDM, was shared with WRs so that they might assist the countries in suitably initiating the processes at the country level. WRs were individually briefed during their 44th meeting with the Regional Director in November 1995: a presentation was also made to them jointly; it was followed by a discussion. Briefing materials for "Health Managers", "Media" and "Policy Makers" relating to renewal of the HFA strategy, received from HO, were locally printed and distributed to WRs for sharing with the national health authorities. An interregional consultation was held at HQ in December 1995: its outcome was shared with the WRs. The Health Secretaries of SEAR countries discussed the subject as an agenda item during their first meeting in January 1996, and agreed to initiate and sustain country consultations for renewal of the HFA strategies, leading to the formulation of revised country specific strategies, as per the agreed time table. A meeting of Parliamentarians on Health in Development of SEAR was organized in Bangkok, Thailand, where this subject, among others, was reviewed. At its 49th session, the Regional Committee also discussed this under the agenda item, WHO Response to Global Change Progress Report.

(3) to report on progress to the Regional Committee in September 1996

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SEA/RC53/16 (Add.1) Page 24

Recommendations Prevention, Control and Treatment of Thalassaemia (SEA/RC48/R3) Urges the Member States concerned to increase community awareness through information, education and communication with a view to ensuring their effective participation in the prevention, control and treatment of Thalassaemia.

Action Taken Indonesia belonged to a "thalassaemia geographical belt", having a carrier rate 5-6 % ; B -thalassaemia was prevalent, Lthalassaemia was rare. Some areas had a carrier rate of almost 8%. There were three approaches to prevent, control and treat thalassaemia: (1) Public service (diagnosis and treatment); (2) education, through women's organizations, TV, radio, newspapers at least once a year; and (3) research. Special clinics for thalassaernia were set up in Jakarta, Bandung and Yogyakarta and were being planned in other provinces. Their activities included increasing community awareness in addition to diagnosis and treatment. In Maldives, under the National Thalassaemia Centre, a National Programme of Action was launched. Under this programme, regular blood transfusions and chelation therapy were given to thalassaemic children. Counselling sessions were provided to all the thalassaemics, parents and carriers. The programme had a strong prevention component that included screening, health education, counselling for parents, carriers and high risk couples and genetic counselling. The Society for Health Education (SHE) started a nationwide thalassaemic screening programme. A quarter of the population had already been screened. Awareness programmes were carried out in schools and through the media. WHO supported the printing of posters and booklets on the prevention of thalassaemia as well as procurement of essential S&E for enhancing diagnostic capacity of NTC and regional hospitals. Training on thalassaemia counselling and programme management was provided through fellowships. Nepal did not at present have reliable or sufficient data on the incidence or prevalence of thalassaemia to indicate the extent to which thalassaemrnia was a public health problem. In the absence of such data and given existing health chall enges and established health priorities, it was felt that diversion of existing limited resources to IEC efforts directed towards thalassaemia prevention, control and treatment at present was not warranted. In Sri Lanka, committees comprising health officers, education officers, other key officers of the government departments and community leaders were set up at different levels. These committees were functioning to increase community awareness, in addition to ongoing health education activities carried out by the Health Education Bureau. Screening and awareness programmes, particularly for school students were intensified. Education materials, booklets, handouts, posters, banners were disseminated. Thalassaemia flag day was observed in different DDHS areas. Special campaigns were launched to motivate people to donate blood for thalassaemia. In Thailand, five-year and twenty-year strategic plans for the prevention, control and treatment of thalassaemia were prepared. Community awareness was increased using p rint and electronic media. These forms of communication were used to inform and educate the public of the signs, symptoms, available health services, treatment and self- care. Information was developed for public broadcast and for focused impact on health p ersonnel. Special emphasis was placed on the early recognition and detection of thalassaemia by the public and health personnel at every level. Participation was enhanced by involving public school health teachers and students as well as health personnel in the community. With a view to providing effective and efficient diagnosis, haematological laboratories were set up in many departments, laboratory facilities were upgraded and the staff imparted training.

Requests the Regional Director to facilitate the exchange of information between Member States on the prevention, control and treatment of thalassaemia.

The Government of Maldives organized a workshop with experts from Thailand and India in Male. WHO technically supported national and international workshops and conferences on thalassaemia and facilitated participation of specialists from the countries of SEA Region

Recommendations Resource Mobilization for Intercountry Collaborative Programmes (SEA/RC48/R4) Requests the Regional Director to implement the supplementary intercountry programme proposals, after transferring resources by adjustment within the country allocation of the1996-1997 programme budget on a pro rata basis and obtaining approval from the Director -General for effecting the tran sfe r. Alternative Financing of Health Care (SEA/RC48/R5) Urges the Member States:

Action Taken

Funds for implementing the supplementary intercountry programmes were mobilized on a pro rata basis and Director-General's approval obtained for the transfer of funds.

(1)

to study and explore alternative financing of health care and introduce appropriate reform measures, while fostering integration, complementarity and partnership between the public and private sectors; to make optimal use of all available resources and mobilize additional resources for achieving the health-forall goals, including incremental growth in the national health and health-related budgets where possible, and to harness the resources of the private sector while introducing suitable regulatory measures to ensure quality of service, social responsibility and protection for the consumer, especially for the underprivileged.

(2)

All the decision-makers in the Government of Bhutan were aware of how the cost of health care services were recovered from the service users all over the world. However, they all felt that the basic health services should still be free as the modern health care service, given its late start in the country, had not yet won the full confidence of the people. Meanwhile, the concept of charging for health services was already being introduced into the country with caution. A cost-recovery system was introduced in the border areas. The Ministry of Finance was developing a coding system of salary for the government employees so that the scale of income could be taken for working out the eligibility for free health services some time later. A study would be carried out for this purpose during the course of the VIll Five -Year Plan. WHO was supporting the Health Division would assess the cost recovery potential of hospital cabins in Thimphu. In Indonesia, work was done to improve and update the comprehensive database on public sector health expenditures and revenues to analyse trends in public sector expenditures and subsidies. Analysis was started on large household survey databases to determine health expenditures and facility utilization by income groups. There was some evaluation of progress in implementing the Health Card to provide free services to the poor. More work was done to develop various prepaid systems of heal th care as well as expanding government health insurance schemes. There was growth in government expenditures in the health sector. Despite zero growth policy for the civil service, doctors, midwives and dentists were hired on a contractual basis for remote areas. To supplement this, donor assistance, especially from the development banks, was increased substantially, with emphasis on the basic health centres in five provinces. The government encouraged private sector (including foreign) investment in hospi tals, so that increased demand for referral services could be met by the private sector. At the same time, work was being done to continue development on the hospital accreditation system. Recently, a large project was started to develop quality assurance for health centres in five provinces. Short and long-term fellowships continued for staff of the MOH and faculties of public health. In addition, a capacity -building project was started recently with emphasis on planning and policy analysis for health and other sectors involved in human resource development. In Maldives, a preliminary study was done and a report submitted by a consultant in 1995. A more detailed study would be conducted by local consultants with WHO support. User charges were introduced at IGMH and welfare expenditure was streamlined and reduced. Male' water and sewerage services were privatized. The old central hospital was leased to the private sector and opened on 15 March 1996. Thirty -one students received fellowships training during 1995. Twenty -five students were sent to attend short-term courses. Other categories of health workers were being trained at IHS. SEA/RC53/16 (Add.1) Page 25

(3)

SEA/RC53/16 (Add.1) Page 26

Recommendations

Action Taken In Nepal, alternative financing of health care services was being explored at a broad policy level within the context of the development of the Second Long Term (SLTHP) and at an ongoing programme basis. Attention was being focused on health care financing mechanisms and the public/private mix, that is, the role of public, private-for-profit sectors' and community's role in financ ing health care. At a programme level, a series of concrete steps were taken to broaden and further strengthen ongoing "community drug programmes," including but limited to: operations research for overcoming administrative constraint to effective operation of community drug schemes, and strengthening of the operational unit within the Department of Health Services responsible for community drug programmes. To increase the efficiency and effectiveness of the health sector and thus obtain a more optimal use of available resources, the Ministry of Health was continuing its efforts to strengthen programme management through the targeted training of human resources; undertaking with the assistance of its donors partners functional analyses of the various divisions in the Department of Health Services, refining division objectives, clarifying job descriptions; developing and implementing management information system nationwide, and undertaking a series of activities to strengthen the District Health System in a broad array of districts. To make better use of the technical resources, the Ministry continued to enhance the clinical/technical skills of its medical and paramedical personnel; developing and adapting standard treatment protocols in areas including but not limited to TB, leprosy, ARI/CDD, basic and essential safe motherhood services; improving monitoring and supervision, etc. Augmenting efforts to optimize the use of the available budget were made to increase health-related budgets resulting in an increase in the percentage of the national budget allocated to health, and the earmarking of village development committees' local development monies specifically for health. Within the context of SLTHP, HMG was developing the necessary policies and strategies to further expand private sector participation in the health sector while assuring quality of services provided. In the specific area of HRH training, the Ministry of Health convened a working group to develop specific criteria, rules and regulations governing the establishment, operation and accreditation of government, NGO and private medical colleges and other institutions for the training of paramedical personnel. In a related vein, the working group would also be addressing the issue of "centre of excellence", establishing specific criteria for their establishment, operation and monitoring. Within the Detailed Plan of Action for the HMG/WHO Collaborative Programme 1996-1997 funds were allocated for training one individual in health economics at the masters level, and for the training of health post staff and community drug committee members on the administration and management of revolving drug schemes. Working with its other donor partners, Ministry of Health was further developing community drug schemes including the necessary human resources training components. In Sri Lanka, a seminar on alternative financing of health was organized to sensitize health managers and decisions makers about the need for such financing. One research study on prospects of increasing paying beds in the government hospitals was undertaken and was in progress. Another study was designed and proposed to SHS Division WHOIHQ. This study was designed to assess the demand for medical care services in the private sector. The overall h ealth policy placed emphasis on health promotion and primary prevention. The different aspects of the policy were being looked into in the context of the changing situation. The emphasis would continue to be on health promotion as a component of social and economic development. Efforts were under way to recategorize public sector hospitals and determine graded service provisions for each category of hospitals with a view to promoting efficient use of hospital resources.

Recommendations

Action Taken A number of consultative meetings were planned during the biennium, such as: orientation meetings of key managers on policy issues and options and a meeting on the review of existing gaps and needs of health legislation. The government policy was to promote the development of the private sector in health in order to widen people's choices in seeking care and lessen the burden of free provision of health services in government institutions. Private medical institutions were regulated by a set of rules embodied in an Act of the Parliament. The Act required accreditation of private medical institutions, based on specific criteria concerning facilities and services. The functions of the council constituted for the purpose of this Act include registration and supervision of private medical institutions; formulation of quality assurance programme for patient care, -implementation of schemes of recruitment for staff in such institutions; development of manpower for such institutions; organization of group educational activities; collection, dissemination and sharing of information with the private sector for optimum use of resources. A series of educational activities were planned in the current biennium. Some of them were already under implementation. Educational activities included: consultative and orientation meetings; training in health and epidemiological services planning and financial management and training of community health volunteers; skill development training of nurses and other technical groups, and training of medical faculty members in educational science. Training of selected key managers of the Planning Unit of the Ministry of Health in health care financing, insurance, government and NGO collaboration, project evaluation techniques and educational management programmes was designed in keeping with the renewed strategies for Health for All. A fairly large number of community health volunteers would be trained as a strategy for improving community health, with emphasis on the health of the underprivileged and slum dwellers. The ongoing activities for preparing the plan for human resources development would suggest ways and means for developing human resources with multi-disciplinary skills and expertise. In Thailand, there were a few studies and projects done by Health System Research Institute, Health Insurance Office and Bureau of Health Policy on health care financing, health security and insurance and privatization. The recommendation of the studies were used for policy making to improve equity in accessibility to health care service and guarantee the standard quality of health care. Thailand had developed different systems for each target group as follows: (1) User fee System; (2) Free services for low -income group, children aged 1 -12 years, the aged, the handicapped, monks, community leaders and village health volunteer; (3) Health card as voluntary health insurance scheme for self- employed groups and groups of people who did not avail any type of health welfare; (4) Compulsory social security scheme for every enterprise with more than 10 employees, and (5) Health welfare for government and state enterprise officials. For cooperation between public and private sector, the Ministry of Public Health launched a project that the private enterprises invest in building up special in-patient department ward in three public hospitals. The legal aspects of the project was being worked out. SEA/RC53/16 (Add.1) Page 27 The Ministry of Public Health initiated the project on hospital accreditation to ensure standard quality of health care in both government and private sectors. The improvement of Acts and other legal regulations was being done to control health care provision in both private and public sectors.

SEA/RC53/16 (Add.1) Page 28

Recommendations Transfer of Member States from one Region to another (SEA/RC48/R6) Requests the Regional Director to transmit the view of the Regional Committee regarding the transfer of Member States from one region to another to the Director-General for bringing it to the attention of the Executive Board. Method of Work of the Regional Committee – Preparation of the Report of the Regional Committee (SEA/RC48/R7) Requests the Regional Director to implement this decision from the forty -ninth session of the Regional Committee.

Action Taken The resolution as well as the summary of discussions were transmitted to HQ soon after the RC. This item also came up before the ninety -seventh session of the Executive Board and the forty-ninth World Health Assembly. A resolution (WHA49.6) was adopted in line with the views of the SEAR Regional Committee.

Rule 19 of the Rules of Procedure was amended as follows: The Secretariat shall prepare a summary report of the session reflecting the discussions on the various agenda items and containing the resolutions adopted. The report shall be prepared in English and adopted prior to the closure of the session. Sound recordings of the plenary meetings of the Regional Committee shall also be made. Such recordings of the whole or part of the session shall be kept for ten years and made available to Member Countries on request.

Recommendations HEALTH MINISTERS MEETING 17th Meeting of Ministers of Health, Yangon, Myanmar, October 1999 Global Health Projects: Action at Country Level (a) Roll Back Malaria For Member Countries (1) In view of the importance of risk factors in the disease transmission, the countries should lay emphasis on environmental and ecological-based approaches for vector control, including the use of insecticide-treated bednets. The countries should make efforts to strengthen health infrastructures and capacity building, including that of private practitioners that would facilitate integration of RBM in the prevention and control of communicable diseases within the PHC setting and district health system.

Action Taken

Transborder cooperation for more effectively combating diseases such as malaria received a fillip in the recent past. Environmental and ecological based approaches for vector control, particularly biological methods of killing mosquito larva, including use of insecticide-treated bed-nets, were being developed/implemented in many SEAR countries An intercountry workshop on alternative vector control strategies was conducted in Yangon, Myanmar, in May 1999, with emphasis on bio-environmental approach, including the insecticide-treated mosquito nets. Operational Guidelines on the use of insecticidetreated mosquito nets were prepared. SEAR countries were strengthening their health infrastructure, particularly their district health systems, and PHC to effectively combat malaria in partnership approach, including private practitioners, towards prevention and control of communicable diseases. Malaria-free country (Maldives) assigned high priority to surveillance, particularly to vector control, to prevent all mosquito-borne diseases. In Nepal, the country was stratified on the basis of epidemiological and operational variables and specific approaches were developed for prevention and control of malaria in each zone. Integrated approach to vector control was under re-evaluation. In Myanmar, the national mosquito control committee, which was multisectoral, developed guidelines for mosquito control for the entire country. Environmental measures for mosquito control and insecticide-treated bed-nets were popularized during the National Malaria Week (7-13 May 2000). Guidelines on strengthening district health system were prepared for (a) RBM core group, (b) mainstreaming RBM into district health system,(c) management of severe malaria, referral system, and medical audit,(d) access to care and prevention, packaging delivering care to common disease, (e) malaria information system, drug supply and management, and (f) surveillance, epidemic preparedness, monitoring of drug resistance, mapping of malaria and Geographical Information System.

(2)

For WHO (1) WHO should assist Member Countries with regard to technical collaboration in priority area through bilateral or multilateral arrangements, including periodic review of progress. Support was being provided to all endemic countries in the Region in the implementation of the Roll Back Malaria initiative. Pilot districts h ad been identified and situation analysis conducted by respective Member Countries for systematically implementing intensive multisectoral activities.

SEA/RC53/16 (Add.1) Page 29

SEA/RC53/16 (Add.1) Page 30

Recommendations (2) WHO should assist Member Countries in resource mobilization for the extension of universal access to health care for the poor and vulnerable groups and provide technical support through resource networking.

Action Taken Countries were technically assisted in mobilizing external assistance, including World Bank Group, for their programmes for prevention and control of Malaria. Member Countries were assisted with regard to technical collaboration in priority areas through the following bilateral and multilateral meetings. June 22, 1999 Task Force meeting Myanmar-Thailand border malaria, Yangon. September 1, 1999: UNICEF/WHO meeting on RBM Mekong, Yangon November 11, 1999: Biregional meeting of DPR Korea, Myanmar, Thailand and WHO/WPRO, Kunming RBM technical resource network in resource mobilization was established in the Region;

(3)

WHO should assist Member Countries in the development and promotion of advocacy materials on the selective use of insecticides for vector control. STOP TB Initiative High -level government commitment is essential for accelerating DOTS implementation in the South-East Asia Region, in order to achieve nation-wide coverage with DOTS in all countries by the year 2005. Adequate resources, both in human and financial terms, should be mobilized by each Member Country. To enhance the impact of TB control and to reduce TBassociated mortality, various sectors within and outside the health ministry should be actively involved. These include private practitioners, medical schools and NGOs, as well as relevant departments within the government sector. While expansion of the DOTS strategy remains a top priority, the Member Countries, before embarking on DOTS implementation in a new area, must first ensure an uninterrupted supply of anti-TB drugs; training of health personnel; capacity building for laboratory diagnosis; and supervisory mechanism for monitoring patient compliance and treatment outcome.

RBM guidelines on the promotion of advocacy material and vector control were developed.

(b) (1)

For Member Countries High-level government commitment existed in SEAR countries. For example, DPR Korea and Myanmar planned to achieve nationwide coverage with DOTS by 2003. In Nepal, DOTS coverage had already increased to 69%. Maldives had already ac hieved 100% coverage. The Ministerial summit in Amsterdam, Netherlands, 22-24 March 2000, on “TB in high-burden countries and sustainable development” enhanced government commitment and mobilization of resources, both internal and external, for TB control. Countries were taking feasible measures to involve the government and nongovernment sectors, including private practitioners, to combat TB. Guidelines were developed by WHO for roles to be played by NGOs, medical schools and private sector in TB control and the same were being used to enhance the role to be played by these sectors. For example, in Nepal, a TB Control Network Meeting was held every quarter and all interested parties were invited to promote coordination. In DPR Korea, health professionals, medical colleges, research institutions and social agencies were being involved. In Myanmar, the Ministries of defence, labour, transportation and industry and the People’s Police Force were already involved. In view of the low incidence rate in the Maldives, treatment was through public health/administrative network. As this was fundamental to the successful implementation of DOTS strategy, all feasible efforts were being made by the countries, with WHO technical assistance, as required, to have these five elements in place before DOTS strategy was initiated for implementation in an area.

(2)

(3)

Recommendations For WHO (1) WHO should assist Member Countries in resource mobilization and in facilitating intercountry collaboration in areas such as procurement and indigenous production of anti -TB drugs, exchange of country experiences and success stories, and strengthening of TB control initiatives across borders.

Action Taken Tuberculosis control in the highly endemic countries was discussed during the Ministerial Conference on “Tuberculosis and Sustainable Development” held in Amsterdam in March 2000. WHO/SEARO published Guidelines on Resource Mobilization and distributed it widely. Countries were mobilizing resources, including external, for TB control. Intercountry collaboration between India and Indonesia, and possibly India and Myanmar, in the areas of procurement of raw materials and indigenous production of drugs was initiated. Several initiatives and projects with the involvement of private sector and NGO in National TB control programmes were supported; their outcomes documented and disseminated through annual programme managers’ meetings and through publication of a quarterly newsletter “AIDSwatch”. Guidelines on cross-border TB control were developed. An intercountry meeting at Chiangmai (Thailand) on cross-border issues was supported. A meeting of interested parties (MIP) to enhance and accelerate the process of partnerships for increased resources for TB control was being planned towards the end of year 2000.

(2)

To promote the teaching of DOTS in medical schools, WHO should organize a meeting of medical college deans, professors as well as the representatives of medical associations and councils.

A meeting to enhance the role of medical schools in TB Control was organized by WHO in Chennai, India, from 5 -7 July 2000. It was attended by 22 participants from seven Member Countries. As an outcome of this very successful meeting, medical schools in the Region endorsed the policies and strategies adopted by the National TB Control Programmes and further agreed to teach and practice the DOTS strategy in their respective institutions. They also agreed that modifications in the medical curricula were required to better orient medical students to public health delivery practices in order for them to play a more effective role in the future especially with regard to priority health concerns such as Tuberculosis and HIV/AIDS. Participating medical schools also expressed interest to be involved in programme planning and evaluation.

(c) (1)

Tobacco Free Initiative Urgent attention should be given to the development and implementation of time -bound national plans of action on tobacco control, in coherence with the Regional Action Plan, emphasizing the legislative and fiscal aspects. Countries should, in collaboration with WHO, collect and analyse data on the economic im plications of tobacco and use such data for the purposes of advocacy and planning. Innovative strategies should be implemented to bring about behavioural change through IEC activities, as part of public health interventions for tobacco control. Urgent steps must be taken to constitute multisectoral national councils on tobacco control. To reduce tobacco cultivation and supply, national strategy, including crop substitution, should be developed and implemented. First Action Plan for Tobacco Control – Years 2000 to 2004 was developed by WHO. Member Countries were supported in the development of their national plans of action on tobacco control. Countries were developing anti-tobacco legislations and campaigns. Import duty on tobacco products was increased.

For Member Countries

(2)

SEARO recruited an STC to provide technical support to Member Countries in the conduct of a study on the economics of tobacco control. Selected Member Countries would be supported for conducting similar studies in their respective countries.

(3)

SEARO produced various advocacy materials as part of public health interventions for tobacco control. Countries were adopting various types of innovative strategies, such as no-smoking household, no-smoking districts/atolls, to bring about anti-tobacco behavioural changes. Multisectoral national councils existed in some countries. Efforts by remaining Member Countries in this behalf would be technically supported by WHO. Agricultural diversification and crop substitution were being practiced, inter alia, in Bangladesh and in some states in India. In countries like Maldives, no tobacco was cultivated. SEA/RC53/16 (Add.1) Page 31

(4) (5)

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Recommendations For WHO (1) WHO should continue to provide technical support to Member Countries to develop and implement national policies, strategies and plans of action on tobacco control. WHO should intensify and sustain its advocacy efforts to mobilize political commitment for tobacco control. WHO should collaborate with various multilateral and bilateral agencies to assist Member Countries in developing programmes on crop substitution.

Action Taken

WHO was providing continued technical support to Member Countries in the development and implementation of national policies, strategies and plans of action on tobacco control.

(2)

All feasible actions in this behalf were being undertaken. For instance, the Hon’ble Prime Minister of India inaugurated a WHO International Conference on Global Tobacco Control Law: Towards a WHO Framework Convention on Tobacco Control, in January 2000 in New Delhi. In Thailand, DG/WHO launched the World No Tobacco Day in May 2000. SEARO had been consistently working very c losely with multilateral/bilateral agencies. A regional inter-agency Consultation on Tobacco Control was scheduled for 2 -3 November 2000.

(3)

The Use of Traditional Medicine in Health Care System For Member Countries (1) Countries should develop and strengthen national policies on traditional medicine. Countries such as India, Myanmar and Sri Lanka, had full-fledged Departments of Indigenous Medicine under their Ministries of Health. Bhutan, DPR Korea and India had public hospitals and other centres of indigenous medicines. Some countries, such as DPR Korea and Myanmar, had laid down the policy and guidelines in respect of traditional medicine. In Nepal, there was due emphasis on the ayurvedic system of medicine in the National Health Policy. Member Countries were promoting the use of traditional medicine in their national health care systems. This was facilitated by the recommendations of the regional consultation on Development of TRM in SEAR, held in SEARO in September 1999. Many countries were implementing this recommendation as per their capacity, which itself was being strengthened. WHO supported Myanmar in this behalf as requested by its Government

(2) (3)

Governments should promote the use of traditional medicine in their national health care systems. Well-planned, controlled and appropriately designed clinical trials should be carried out on standardized products used in traditional medicine to determine their safety and efficacy. Countries should enact appropriate legislation and draw up regulations to protect the national heritage of available medicinal plants and prevent them from exploitation. Steps should be taken by the countries to draw up regulations for the use of systems of traditional medicine, the practitioners of these systems and the products. In view of the existing potential for the export of certain medicinal plants, countries should draw up a strategy for such export.

(4)

The Regional Consultation on WTO Multilateral Trade Agreement and their Implications on Health – TRIPS, Bangkok, 16-18 August 1999 made a recommendation for country action in this regard.

(5)

Countries were in the process of developing/strengthening regulations on TRM systems, practitioners and the products concerned. Teaching and research institutes were being properly regulated and strengthened. Promotional activities were also being undertaken in this regard. Some countries such as India and DPR Korea were already exporting medicinal plants and/or their products. Others were looking into this potential.

(6)

Recommendations For WHO (1) WHO should assist national governments in understanding and preparing themselves for the implications of TRIPS and other binding international treaties or agreements so that steps are taken to protect the interests of public health in developing countries. WHO should assist national governments in the identification, cultivation and conservation of medicinal plants and in improving their yield. WHO should assist countries in carrying out research and development on the quality, safety and efficacy of herbal medicines. WHO should assist countries by promoting intercountry collaboration in the standardization, quality control and use of medicinal plants.

Action Taken

SEARO was preparing a book on TRM, dealing with policy issues and currently available technology. One of the chapters was on “Protection of traditional systems of medicine, patenting and export promotion of medicinal plants”. Professor C.M. Correa, a wellknown international authority, was writing this chapter.

(2)

WHO was providing assistance to Member Countries upon request. A book enti tled “The Conservation of Medicinal Plants” was published by WHO, IUCN (The World Conservation Union) and WWF (World Wide Fund for Nature) for the information of Member Countries. WHO was assisting Member Countries through the country projects supported by WHO regular budget. SEARO’s publication entitled “Standardization, Preclinical Toxicology and Clinical Evaluation of Traditional Systems of Medicine and Herbal Preparations for Safety and Efficacy including Ethical Aspects” was distributed among SEAR countries. Intercountry collaboration in the standardization, quality control and use of medicinal plants was being carried out by ASEAN countries, with WHO support, in their technical cooperation programme in the area of pharmaceuticals. SEAR countries continued various activities for the promotion of traditional medicine. In one country, good manufacturing practices (GMP) were introduced in the pharmaceutical unit manufacturing traditional medicines, and production system was modernized along with the introduction of the system of quality control. In another country, measures were being taken to standardize its traditional medicine.

(3)

(4)

16th Meeting of Ministers of Health, New Delhi, September 1998 National Capacity Building for PHC (1) The allocation of resources for primary health care, as differentiated from total investment in health, should be enhanced. This would be a direct investment in human development, contributing to economic development and social harmony. WHO should intensify support to Member Countries in capacity building through, inter alia, the development of guidelines on capacity analysis and intercountry activities for sharing experiences. From time to time, Member Countries had been conducting a situation analysis in order to identify the gaps, including resource allocation, in the implementation of primary health care and taking steps to bridge those gaps, particularly through decentralization, partnership approach and intersectoral collaboration.

(2)

At the regional level, intercountry practical training on district health systems based on primary health care was continued to be conducted. During 1995-1998, 131 participants from SEAR countries attended these training programmes. The seventh round of training was held during July – August 1999. Besides, an intercountry consultative meeting for revision of the curriculum and venues of training was held in March 1999. Accordingly, the venues of training were changed from Indonesia, Sri Lanka and Thailand, to India, Myanmar and Thailand in order to support institutional strengthening in a larger number of SEAR countries.

Strengthening School Health Programmes (1) National policies and strategies for school health should be developed and strengthened in the larger context of health development in Member Countries. Clearly defined advocacy mechanisms to highlight the need to improve the health of schoolchildren should be adopted and sustained. In cooperation with the education sector, a comprehensive School Health Programme was developed. Important health topics such as nutrition, hygiene and sanitation, reproductive health and sexually transmitted diseases were incorporated in school curricula. Health topics such as harmful effects of alcohol and tobacco and malnutrition and iodine deficiency were included in the school curriculum, along with preventive measures for diseases such as diarrhoea, malaria and HIV/AIDS. Health workers visited schools to give lectures on the prevention of major diseases. Provision of Vitamin A was initiated and deworming activities were planned. SEA/RC53/16 (Add.1) Page 33

(2)

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Recommendations (3) School health programmes should be expanded by including all health concerns highlighted in the Regional Health Declaration. Operational research should be undertaken, to assess the magnitude and identify the determinants of health problems among schoolchildren. his would facilitate effective planning, implementation and evaluation of school health programmes. Partnerships with relevant ministries such as education, urban planning, environment, internal affairs, as well as NG0s, the private sector and communities should be strengthened. Also, partnerships with international agencies and organized groups such as teachers' unions and women's organizations should be facilitated. New partnerships should be created to maximize resource availability and their utilization in support of school health programmes. Resources for school health programmes should be increased through specific budgetary allocations. This would cover training, school health services, nutrition and food supplementation, deworming activiti es, curriculum review and system support. School health should be integrated into PHC and other health development programmes. A Pilot health promoting school project should be introduced in selected schools. On the basis of experience gained, the coverage of the project should be progressively increased. WHO should support situation analysis in Member Countries and create appropriate mechanisms for exchange of information on success stories in school health. Collaboration with Member Countries in school health programmes should be intensified.

Action Taken School health was stressed in the national health policies and health development plans, and its importance emphasized in the revised national primary school curriculum. The school health programme was expanded, both in content and extent. Rapid Assessment and Action Planning Process (RAAPP II) were undertaken in Indonesia to address these concerns. Some others also took sim ilar initiatives.

(4)

(5)

Such arrangements existed in certain Mem ber Countries. Efforts were being made to establish partnerships with NGOs, the private sector and communities in other countries. Efforts were also being made to create new partnerships with relevant agencies to maximize resource availability and their utilization in support of school health programmes.

(6)

Countries were requested to increase allocations for school health programmes to cover the areas indicated. Some countries allocated enhanced resources, both financial and human, including community resource, for school health programmes.

(7)

In one country the concept of health-promoting school was integrated, as a key strategy, in the health promotion plan through partnership among all related ministries and NGOs, advocacy, mobilization of resources and training of personnel. Significantly, the concept was extended to cover out-of-school underprivileged children – street/working children – as well. A situation analysis was conducted, and mental health was included in school health programmes. Situation analyses were supported in Bangladesh, India, Indonesia and Thailand. Financial and technical support was provided to Bhutan and Maldives to strengthen their school health programmes. School health curricula in India, Sri Lanka and Thailand were shared with other SEAR countries. Participants from Bangladesh, India and Indonesia to an international mega country health promotion network meeting were supported in order to strengthen intercountry collaboration in school health.

(8)

Recommendations Promotion and Participation of Traditional Medici ne in Primary Health Care (1) The importance of traditional medicines in countries of the Region should be highlighted, inter alia, by designating more WHO Collaborating Centres in Traditional Medicine to strengthen biregional and intercountry collaboration. Information about medicinal plants and practices of the different traditional systems of medicine should be compiled and shared among countries to promote intercountry cooperation. Efforts should be made by WHO to see how the valuable knowledge and information on traditional medicines could be protected from misuse and commercial exploitation. WHO should assist countries in setting up procedures for quality assurance such as standardization, quality control and clinical evaluation of traditional medicine and plants through intercountry cooperation. WHO should assist countries in regulating the use of traditional medicines regarding their safety and efficacy. WHO should promote the study and propagation of other traditional practices such as yoga and naturopathy. A study should be carried out to help promote the export of selected traditional medicines plants and herbs from the Region.

Action Taken

All three WHO collaborating centres in the Region in the field of traditional medicine were redesignated. Other centres in traditional medicine would be considered for designation as WHO collaborating centres in due course as and when that became feasible. SEARO, in collaboration with WPRO, was assisting ASEAN countries in standardization of quality control and utilization of herbal medicine. Other SEAR countries were also being assisted in the area of quality assurance in traditional medicine.

(2)

(3)

The Regional Consultation on WTO Multilateral Trade Agreement and their implications on Health – TRIPS, Bangalore, 16-18 August 1999, has made practical recommendations for countries to protect traditional medicines from misuse and commercial exploitation. SEAR countries continued various activities for the promotion of traditional medicine. In one country, good manufacturing practices (GMP) were introduced in the pharmaceutical unit manufacturing traditional medicines, and production system was modernized along with the introduction of the system of quality control. In another country, measures were being taken to standardize its traditional medicine. WHO monograph on selected medicinal plants (Vol.1) was published and distributed to Member Countries. “Regulatory Situation of Herbal Medicines – A World-wide Review” was also published and distributed. In August 1 999, WHO organized a regional consultation on “WTO Multilateral Trade Agreements – its Implications on Health – TRIPS” in Bangkok, Thailand. WHO continued to assist the countries in quality control and clinical evaluation of traditional medicines and plants. Assistance in the propagation of traditional practices such as yoga and naturopathy was also being provided according to Member Countries’ plans of action. A study in India, by its Department of Indian Systems of Medicine & Homeopathy, on national requirements of medicinal plants, which could provide information for exports, was being supported by WHO. Similar studies in other countries could also be supported through the regular WHO country budgets.

(4)

(5)

(6)

(7)

15th Meeting of Ministers of Health, Bangkok, Thailand, August 1997 New Partnerships in Health Development (1) The major issues in health development in the Region are related to ensuring equity. However, poverty, uncontrolled population growth and rapid urbanization remain some of the biggest challenges, which are part, of much wider, interconnected development issues that need to be addressed holistically. The Regional Health Declaration, adopted by the Health Ministers in August 1997 and endorsed by the Regional Committee in September 1997, was committed to equity, particularly gender equity, and accords the highest priority to the health needs of the poor. It reiterated that the state of health was an outcome of interactions of biological, socioeconomic, and environmental etc. factors: therefore, all of them needed to be addressed holistically in health development. SEA/RC53/16 (Add.1) Page 35

SEA/RC53/16 (Add.1) Page 36

Recommendations (2) Intersectoral cooperation including community participation, as an important strategy of the 'Primary health care approach, has contributed significantly to the health gains achieved by the countries of the Region over the past few decades. However, achieving an equal status among different actors involved has beers usually difficult. Such cooperation can be further enhanced through partnerships, a shared vision and goat, a shared value for health and a shared commitment among the different actors invoiced. It is essential to strengthen the existing partnerships and forge new ones for improving the health status of the people. With the expanding private sector in most countries, the respective roles of the public and private sectors need to be further clarified. The governments should determine the appropriate mix of the roles of the two sectors, particularly with regard to advocacy, facilitation and regulation. Certain areas where appropriate partnerships should be fostered among countries of the Region are: traditional medicine; vaccine development; human resource development; communicably disease control, particularly in HIV/AIDS; health sector reform, arid health promotion. At the same time, the need to further nurture and strengthen the existing partnerships was stressed.

Action Taken The World Health Declaration, adopted by the World Health Assembly in May 1998, recognized that the improvement of the health and well-being of the people was the ultimate aim of socioeconomic development. It affirmed commitment to equity, social justice and gender perspective, and emphasized the importance of reducing inequities by paying the greatest attention to the poor. The role of partnership among different sectors involved in health development was strengthened by the workshop on district health system based on primary health care in 1998 in Jaipur, India. Intersectoral cooperation, inter alia, in the form of village health workers/volunteers, community involvement and decentralization were built-in in national health development plans. Countries were adopting various approaches for fostering partnerships and multisectoral actions for health. A regional consultation on Public/Private Partnership for Health: Role of Governments was convened, in Jakarta in December 1997, for enhancing the understanding in the Member Countries of the nature of public/private mix in the delivery of health care services; identifying the approaches to be adopted in setting appropriate mix of the two sectors; ensuring that standards in respect of such areas as appropriate treatment of regimens were clearly defined; and ensuring the adequacy of human resource competence and quality of treatment facilities. The Regional Director authored a book, “Partnerships: A New H ealth Vision” An international conference on Inter-Country Cooperation for Health Development in the 21st Century was held in Chiang Mai, Thailand, in December 1997. The conference selected thirteen areas for intercountry cooperation and identified focal points/institutes to deal with those areas in the countries concerned. The Fourth International Conference on Health Promotion was organized in Jakarta in July 1997. This was followed up by a regional consultation on Tobacco and Alcohol in Colombo in November 1997 and an intercountry consultation on Health Promoting Schools in Bangkok in December 1997. The Regional Office organized a consultative meeting of WHO Collaborating Centres concerned with reproductive health and emerging/re-emerging infectious diseases in September 1997. Countries were collaborating with each other, on a bilateral basis, in many areas of health development, particularly in the area of development of human resources for health.

(3)

(4)

Health Development in the South-East Asia Region in the 21st Century (1) The Regional Health Declaration should serve as the basis for health development in the Region as well as in Member States. The Regional Health Declaration (RHD) was widely distributed. A working group for coordinating the development of a p lan of action for implementation of RHD was established in the Regional Office. To develop a regional plan of action and a framework and approaches for implementing the principles and policy directions of RHD, a regional consultation on Implementation of the Regional Health Declaration was held in Colombo in February 1998.

Recommendations (2) The philosophy and the intent of the Declaration can be properly translated into action only by fostering new partnerships and strengthening the existing ones.

Action Taken The declaration was endorsed at the highest level of the government in some countries. It was translated in certain national languages and its message widely disseminated. Its principles and policy guidance were being incorporated in national health policies and health development plans. Steps were being taken to integrate the policy guidance of the Regional Health Declaration into health sector strategies and plans of action. In this process, the partnership approach with other sectors as also community, NGOs and the private sector and professional organizations were underlined. Wider issues and health challenges relating to poverty, population explosion, urbanization etc. were being holistically addressed in national development plans. WHO collaborated with Member Countries in the Region in organizing consultative/advisory meetings and strengthening of partnership with other sectors including NGOs, UN and other agencies. WHO also supported the countries in the formulation of short and long term strategic plans of action for health development during the course of review of the respective national health policies as per their planning.

(3)

WHO should provide technical and other support to Member States to help them formulate their short, and long-term strategic plans of action for health development.

14th Meeting of Ministers of Health, Jakarta/Bandung, Indonesia, October 1996 Public-Private Mix for National/State Health Development in the Light of Globalization and free Market (1) The mix of public and private sectors for health development should be determined in accordance with the specific of political, socioeconomic, demographic and epidemiological conditions of the respective countries. (2) Besides monitoring the functioning of the private health care sector, government could encourage private sector to provide health insurance to its workforce, regulate the standard of health manpower and ensure that the services provided by public sector institutions are of a satisfactory standard. New, Emerging and re-emerging Infectious Diseases: Prevention and Control

A number of consultations were organized by the Regional Office on different aspects of health sector reform, which had a bearing on public-private mix for health development. The countries undertook third evaluation of their strategies for HFA/2000 and also renewed the health-for-all strategy as an integral part of their health development planning. During these processes, various issues relating to public-private mix were addressed. Countries also adopted several measures to encourage the participation of the private sector in health development with suitable regulatory measures. In many countries, private sector provided health insurance to its employees. Services provided by public sector institutions were being improved. Regulatory bodies such as medical councils were regulating the standards of medical education. Professional bodies were conducting continuing medical education for their members.

(1) National capabilities need to be urgently strengthened for

a quick response and to prevent epidemics. Early warning systems and rapid response mechanisms should be developed by all countries. countries must quickly exchange information and cooperate with one another in responding to these diseases.

(2) Intercountry collaboration is of utmost importance, and

The Regional Office provided technical assistance to develop a core group of skilled epidemiologists to strengthen the national surveillance infrastructure as well as for epidemic preparedness and response. For example, two-year Field Epidemiology Training Programmes (FETP) were developed in Thailand and Indonesia. A similar two-year programme was being developed in India. The National Institute of Communicable Diseases (NICD), Delhi, India, also conducted an annual three-month international Field Epidemiology Training Programme for medical officers as well as an annual four-week international training programme on Epidemiology for para-medical staff. For epidemic preparedness and response, the Regional Office conducted 10-day intercountry training courses to strengthen the national capabilities to effectively respond to disease outbreak before they assume epidemic proportions. Rapid Response Teams (RRTs) were established in Member Countries at the national level and efforts were being made to expand RRTs to provincial and district level.

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SEA/RC53/16 (Add.1) Page 38

Recommendations

Action Taken A technical meeting on the management of dengue epidemic was held at SEARO, New Delhi in November 1996, and draft guidelines developed. The Regional Office also organized a consultation on case definition for the surveillance of communicable diseases with epidemic potential, in Colombo, Sri Lanka, in May 1997. Draft guidelines of case definitions of 12 communicable diseases were prepared. Cost-effective interventions, like immunization, were being increasingly used by Member Countries. Laboratory services and surveillance systems were being upgraded and strengthened in SEAR countries. WHO/SEARO and Member Countries successfully collaborated in conducting several border meetings for coordinating the prevention and control of diseases, such as malaria, kala-azar and STD/AIDS. WHO/SEARO assistance to Bangladesh for HIV/AIDS Surveillance consisted of provision of guidelines and fielding of a technical staff/consultant to assist in implementation and review of activities relating to HIV/AIDS surveillance. WHO was actively assisted in TB control which was one of the successful models in the Region as well as in providing technical support in improving blood transfusion system, building laboratory capacity and in information, education and communication (IEC).

(3) Cost-effective interventions like immunization, and the prevention and control of infectious diseases must be intensified.

(4) WHO can assist Bangladesh and Bhutan in national capacity building for strengthening the surveillance system, establishing blood screening procedures, strengthening laboratories and the IEC system.

13th Meeting of Ministers of Health, Colombo, Sri Lanka, September 1995 Health Ministers’ Meeting: An Appraisal (1) Regional Office should produce monographs on issues of high priority The Regional Office published, inter alia, the following monographs/books/literature on priority issues: • • • • • • • (2) (3) Advisers should meet prior to Health Ministers’ Meeting. Field Visit should be substituted by a retreat, where feasible, to enable greater informal interactions Poverty and Health, 1997 AIDS – The Challenge AIDS – No time for Complacency AIDS Watch Stopping Tuberculosis Tuberculosis and HIV Forging new partnerships to stop TB

Advisers were regularly meeting since the 16th meeting of the Health Ministers, prior to the meeting of the Health Ministers. The Full day field visit, since the 14th meeting has enabled greater informal interactions among them. In a three-day meeting, an overnight retreat was perhaps not cons idered feasible by the respective host governments.

Recommendations TCDC: New Look – New Modalities

Action Taken WHO organized an intercountry meeting in November-December 1995 to share the experiences of National Immunization Days and consider regional self- sufficiency regarding consumption and production of polio vaccines. Besides convening intercountry meetings on vaccine supply and quality of national control laboratories, WHO organized four border meetings to tackle common health problems, particularly Malaria and Kala Azar. A bi-regional meeting of SEAR and WPR on prevention and control of communicable diseases in border areas was also held in October 1996. NIDs were being synchronized between/among neighbouring countries.

(1) Besides prevention and control of communicable and

other new, emerging and re-emerging diseases such as Malaria on the borders between countries of the region, initiatives should also be followed in other health matters such as implementation of the immunization programme through observation of common National Immunization Days, tackling health problems related to iodine deficiency and iron deficiency, etc. Formulation of common strategies for joint health programmes along the borders would be especially relevant. Regional cooperation in respect of drugs and vaccines could include production, procurement, testing facilities and quality assurance, aimed at regional self-reliance. Human resources for health should be developed through training of the nationals of one country in the institutions of another. There could also be joint ventures in the establishment/expansion of training facilities by cooperating countries, as also creation of training infrastructure by one country in another, e.g., India establishing a medical college in Nepal. Practical mechanisms should be evolved to institutionalise arrangements for regular exchanges of information and experiences. The Regional Office should function as the focal point to facilitate compiling and disseminating information. Application of TCDC for prevention and control of the pandemic of HIV/AIDS (in the immediate perspective), and control of severe forms of malaria of the drugresistant type. WHO collaborating centres should be more effectively used, which, in turn, may warrant their strengthening and upgradation, and better utilization of their capacities. TCDC should be more adequately budgeted for in the national budgets.

(2)

In the wake of economic crisis in Indonesia and Thailand, intercountry cooperation among SEAR countries was initiated in the field of pharmaceuticals and their raw materials. Under the auspices of the Health Ministers Forum, the Chairman of the Forum visited selected Member Countries of the Region to promote mutual good would and understanding. In several cases, such visits concretized bilateral cooperation for health development, especially in the area of training of human resources for health and exchange of health personnel. WHO also had the privilege of facilitating bilateral visits of health ministers of some of the countries of the Region in order to promote regional solidarity in health development. These visits also enhanced bilateral cooperation, particularly in the field of development of human resources for health. The annual meetings of health ministers and health secretaries, conference of parliamentarians, intercountry meetings, training workshop, etc. were mechanisms to ensure regular exchange of information and experiences.

(3)

(4)

(5)

Intercountry cooperation, including regular exchange of country experience, had been taking place on a regular basis.

(6)

Fuller use of WHO collaborating centres was being made wherever feasible. Not only the collaborating centres, but other institutions of excellence/expertise in SEAR countries were being upgraded/strengthened.

(7)

Many SEAR countries budgeted for TCDC, though such provisions might not be under the aegis of the health ministry. SEA/RC53/16 (Add.1) Page 39

Health in Social Development

(1) Appropriate health indicators should be developed so that socio economic development and improvement in the quality of life may be assessed against those indicators.

With a view to improve the performance, SEARO collaborated with six Member Countries in preparing country health profiles and national health account. Six countries had already submitted reports on this. The World Health Report 2000 addressed the issues of health system performance through health implementation, fair financing and responsiveness indicators. The Report provided sensitive health indicators to assess and improve the performance of health system.

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Recommendations

Action Taken Health fora, such as the World Health Assembly, Regional Committee, Meetings of Ministers and Parliamentarians, intercountry consultations in the context of globalization and health and health development, were being increasingly used, at national and international levels, to promote partnerships and multisectoral action for health.

(2) Health fora should be open to other sectors in order to enable them to have a better appreciation of the health implications of their policies and programmes. Meaningful action for protection and promotion of health and positive health of the people will require multisectoral contribution. (3) No society can be healthy if its women do not have equal access to health care. The health of future generations depends upon women's health and, therefore, Society must accord the highest priority to women's health. The resources of the private sector should be harnessed and effectively deployed in complementary partnership, including joint ventures, with public sector outlays. Additional resources, from within the country (budgetary and non-budgetary) and outside should be mobilized for the health sector.

Women’s health and related profiles were developed in various SEAR countries. Reproductive health was being given increasing importance in national policies and plans. WHO and other UN agencies were a lso promoting reproductive health in all feasible ways.

(4)

Private sector involvement in medical education and provision of health care had increased in most SEAR countries.

(5)

Resources from the health sector were gradually increasing in SEAR countries over time.

Action Points HEALTH SECRETARIES MEETING 5th Meeting of Health Secretaries, New Delhi, February 2000 Major Achievements of WHO Collaborative Programme during the Biennium 1998-1999, and the Programme’s main thrusts during the Biennium 2000-2001 (1) Significant achievements in various health development programmes recorded by SEAR countries, in collaboration with WHO, should be linked to the progress towards WHO’s strategic goals and mission, and specific instances of significant successes and failures of WHO collaboration with Member Countries should be reflected in the progress reports to be presented to the Regional Committee, so that useful lessons can be drawn for the future.

Action taken

The development of PB 2000-2001 took into account the significant achievements made by Member Countries in various health development programmes and was linked to WHO’s strategic directions, mission and goals. The future progress reports of implementation would reflect specific instances of significant successes and failures of WHO’s collaboration with Member Countries with a view to learning useful lessons for the future.

(2)

Support through Fellowships and Supplies and Equipment should continue to be provided, especially to the least developed countries, as part of the WHO collaborative technical programme and projects. The existing joint government/WHO coordination mechanism should be further strengthened for planning, implementation, management and evaluation of WHO country collaborative programmes, with technical support, as necessary, from the WHO regional and country offices so that the expected results are fully achieved. WHO and Member Countries should jointly ensure timely implementation of collaborative activities during the biennium 2000-2001, inter alia, through preparation of technically sound proposals for implementation.

As a result of efficiency saving exercise, reductions were effected in the areas of fellowships and study tours, supplies and equipment, travel etc. However, the need of the least developed countries for WHO support through fellowship and supplies and equipment, as a part of the package of technical services to be provided, was noted. Therefore, some flexibility within the categories under the overall ceiling would be allowed to countries in line with clearly identified priorities at national level. The Joint Government/WHO coordination at the country level played a very active role in the planning, formulation, implementation, monitoring and evaluation of WHO’s collaborative programmes in the respective Member Countries. Meetings of these coordination mechanisms were held at regular intervals to review, inter alia, the status of implementation of collaborative programmes; formulation of biennial country programmes; assessment and evaluation of WHO country collaborative programmes etc. In this exercise, technical support was extended by the WHO Regional Office and country offices as necessary.

(3)

(4)

In order to ensure timely implementation of country programmes and optimal utilization of WHO’s scarce resources, the Regional Office had advised the countries to implement 75% of the total allotted budget of the biennium (activities) by 31 December 2000 and the remaining 25% by 30 September 2001. In this process, the emphasis was placed on implementation of technically sound programme activities rather than utilization of funds. WHO country offices and the Regional Office undertook an internal review of obligation proposals to ensure that such proposals were of good quality and technically sound.

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SEA/RC53/16 (Add.1) Page 42

Action Points (5) Member Countries with common borders and facing major communicable diseases, such as polio, HIV/AIDS, TB, kala-azar and malaria, should organize border area meetings at regular intervals, with necessary tec hnical support from WHO.

Action taken Several bilateral and intercountry initiatives were supported for control of communicable diseases, including HIV, TB and malaria, in border areas. “Hot Spots” were identified along borders and successful interventions documented a nd disseminated. With specific reference to TB control, guidelines for planning and implementing programmes in border areas were prepared. Synchronized plans of action were developed to tackle border malaria and kala-azar problems more effectively and also to coordinate RBM activities.

Public Health in the South-East Asia Region in the 21st Century (1) Besides widely disseminating the message of the Calcutta Declaration, Member Countries should develop plans of action to implement the recommendations of the Conference, and integrate the same in their health development plans. WHO should extend all necessary technical support to the Member Countries and periodically review the progress being made in the Region. WHO should also develop a regional plan of action to enhance institutional capacity, using the ICP budget, if possible, to implement the recommendations of the Calcutta Conference. Institutional capacity building should be an essential component of intercountry and regional cooperation. Wide dissemination of the Calcutta Declaration on Public Health in the form of pamphlets and photo-frames, was done among the Member Countries so that the countries hold related activities in this area. One of the important initiatives was undertaken in association with the Indian Public Health Association. In an annual joint meeting of the Indian Public Health Association, Indian Association of Epidemiologists and Indian Society of Malaria and Other Communicable Diseases held at Agra, India, during 10-12 March 2000, a special session on the Calcutta Declaration was supported and the Regional Office participated in a big way to give a push to this initiative among the convention of the largest public health professionals of all levels. The Agra Resolution further endorsed this and requested the Government to take all necessary initiatives. In association with the Department for International Development (DFID), it was proposed to hold a few state level activities in furtherance of the declaration. Selective Ministerial level initiatives were also made in a few Member Countries and the progress was under constant review. Deliberations on the recommendations of the Calcutta Conference at various platforms would lead to their implementation at country level. The regional policy related to placement of fellows for studies in the field of Public Health stated that t regional institutions should be more frequently utilized.

(2)

Traditional Medicine in the South-East Asia Region (1) An approach and a policy on TRM should be developed in order to foster its growth, inter alia, through standardization/good manufacturing practices. Member Countries should strengthen their national programmes on traditional medicine on the basis of such a policy in the context of the challenges of globalization. Traditional medicine may be duly integrated, as appropriate, in the total national health care services. The technical unit in WHO should be appropriately strengthened by the inclusion of experts in traditional medicine. Further, an institutionalized network for intercountry collaboration for the development of traditional medicine should be established in SEAR in collaboration with other regions. A regional consultation on development of traditional medicine in the South-East Asia Region was convened in SEARO from 14-17 September 1999 to discuss national policy and strategy for the development and use of traditional medicine; TRM programmes and identify their possible role in the district health system and primary health care and to strengthen the involvement of WHO collaborating centres and national centres of expertise on TRM and PHC in improving district health system. SEARO was assisting Member Countries according to their national priorities in developing their national TRM programmes. Traditional medicine was being integrated in the total national health care services by countries such as Bhutan, DPR Korea, Myanmar and Sri Lanka, based on the national policy of their Government. Traditional medicine consultants were being recruited as required from time to time to further develop and strengthen specific aspects of the national TRM programme. In the past few years, WHO consultants had visited Bangladesh, Bhutan, Myanmar, and Nepal. For establishing institutionalized network for intercountry collaboration in TRM, this would be one of the terms of reference for the three former WHO collaborating Centres in the Region, which were now being redesignated.

(2) (3)

Action Points Review of Progress of Polio Eradication in the Countries of South-East Asia Region (1) Countries should conduct and synchronize the additional rounds of NIDs, SNIDs, and Mopping-up Operations, as appropriate, with special attention being given to ensuring their quality through adequate planning, training and supervision, and focusing on reaching hard-to-reach and unreached areas. WHO should review the criteria for the continuation of NIDs, or shift to SNIDs, particularly in those countries where no wild poliovirus has been in circulation. The national certification committees (NCC) should be operational until the South-Eas t Asia Region is certified to be polio-free, the time-frame for certification being at least three years from the date of the last indigenous case of wild poliovirus in the Region. Further, the poliofree countries should develop a plan of action for effectively dealing with imported polio.

Action taken

In addition to SNIDs, India was conducting NIDs in December 2000 and January 2001. Myanmar, Nepal and, to an extent, Bangladesh would synchronize their NIDs with that of India. Thailand was conducting SNIDs, which would be synchronized with NIDs in Myanmar, Bangladesh and India. The emphasis was on quality in all countries.

(2)

This would be subject of discussions at the SEAR/Expanded Programme on Immunization Technical Consultative Group meeting to be held in Calcutta from 24-26 August 2000. Every Member Country in the Region had a NCC that was active. Polio-free countries were exercising surveillance, as deemed necessary, for dealing with imported polio.

(3)

Review of Progress of Tuberculosis Control in the Countries of South -East Asia Region (1) The issues of resource constraints, both human and financial, and building national capacities for further expanding DOTS should be urgently addressed by forging sustainable multi -sectoral partnerships with all concerned. The successes of DOTS in the Region should be widely disseminated with a view to enhancing the commitment and greater involvement of private practitioners. The monitoring and default-tracing mechanisms should be strengthened. DOTS services in cities also need to be improved in order to increase the proportion of cases with successful outcomes. WHO/SEARO at various fora was actively promoting action to ensure that resources, both financial and human, were available to implement successfully the TB control programmes at national level. Guidelines on the subject were also prepared and disseminated to Member Countries. Meetings were being organized to find mechanisms for enhanced involvement of various sectors including medical schools, NGOs, private sector, etc. A Meeting of Interested Parties (MIP) was also being planned later this year. All high-burden countries in the Region participated in the Ministerial Conference in Amsterdam, March 2000, which was successful in putting TB high in the political and development agendas. Successful examples of DOTS implementation, of which there were many in the Region, were being disseminated through WHO newsletter and various other mechanisms. Models were being developed for successful supervision techniques so crucial for the success of the TB control programmes. Examples of successful DOTS implementation in urban areas were also being shared among countries.

(2)

(3)

Report on Intercountry Cooperation in Health Development (ICHD) in the 21st Century

SEA/RC53/16 (Add.1) Page 43

(1) SEARO will extend technical support to the ICHD mechanism in collaboration with WPRO and donor agencies.

In the light of this recommendation, a joint meeting of SEARO, WPRO and HQ was held in Geneva during the 53rd WHA to discuss the sharing of responsibilities as well as the me chanisms and the modalities of WHO support to ICHD. Meanwhile, TCDC for health development, mostly on a bilateral basis, facilitated by WHO as required, had been going on between SEAR countries.

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Action Points 4TH MEETING OF HEALTH SECRETARIES, NEW DELHI, FEBRUARY 1999

Action taken

Review of the Actions Taken on the Outcomes of the Third Meeting of Health Secretaries and the Sixteenth Meeting of Health Ministers Review of the Joint Government/WHO Collaborative Programme during 1998-1999 (1) WHO/SEARO and country offices should provide adequate technical guidance quickly regarding the quality of proposals. Wherever feasible, they should discuss such proposals with project managers in the field. While implementing reform of the WHO structure, provision of greater decision-making powers to WHO country offices and SEARO may be considered for expeditious processing of programme activities. WHO should effectively monitor the implementation of the joint government/WHO collaborative programmes. Feedback should be provided directly to higher decision- making levels in the Ministries of Health. The intercountry programmes should be prepared jointly in a transparent manner, with definite terms of reference (objectives, results and activities), without any additional administrative cost for the Regional Office, or diversion of benefits from the countries. The Regional Committee should not be asked to finance/fund ICP in the absence of such well-developed proposals/programmes in September 1999. While ensuring continuing flexibility of the WHO budget, there is a need to adhere to the prescribed rules, regulations and procedures, as also properly account for the observations made by the auditors – internal and external. The Regional Office should obligate funds for all proposals, after thorough discussions with the countries as to their technical soundness, by 31 March 1999 to ensure that the activities can be completed and funds liquidated by 31 December 1999. During the implementation of Programme budget for 1998-99, WHO Regional Office and country offices reviewed the proposals received from the countries for obligation to ensure that they were of good quality, technically sound and relevant to the countries’ plan of action. In case of any deficiencies, the matter was discussed and sorted out by the WHO country office with the national authorities concerned. The question of delegation of more decision-making powers to WHO country office was continuously reviewed by the Regional Director, with a view to ensuring timely and speedy processing and implementation of programme activities.

(2)

(3)

The status of implementation of WHO country collaborative programmes was reviewed at periodic intervals both by the senior staff in the Regional Office and at the country level by the joint WHO/Government coordination mechanism. Health Secretaries were informed of the position regarding delivery of the joint programmes as required. The supplementary intercountry programme (ICP-II) for 2000-2001 was developed jointly in a joint Programm e Workshop held in March 1999 attended by senior officials from the Ministry of Health and WHO country offices. These programmes, with clearly outlined expected results and activities, were further discussed by the CCPDM in September 1999.

(4)

(5)

The observations made by the internal and e xternal auditors, with regard to implementation of country collaborative programmes, were noted by the Regional Office and WHO country offices and were adhered to while implementing the activity proposals.

(6)

Full implementation of 1998-99 programme budget had been achieved through constant dialogue with the national authorities concerned and after review of their technical soundness and relevance to the countries’ plans of action.

Action Points TRIPS and the Health Sector in the South-East Asia Region (1) The Ministries of Health of Member Countries should collaborate with concerned authorities in other ministries in the implementation of the WTO agreements. Revision or formulation of national patent laws and other related regulations may be in line with the provisions of the transit ion period and other substantive provisions in Section 5 of the TRIPS Agreement. Safeguards should be provided, particularly in regard to the health sector. The Ministry of Health should establish a focal point or a working group to deal with matters relating to WTO agreements, including the TRIPS Agreement. Appropriate WHO/SEARO meetings should include topics on TRIPS and other agreements of WTO so as to allow Member Countries to interact and exchange experiences and information. A special intercountry consultation on the subject may be organized by SEARO, preferably before the Fifty -second World Health Assembly, in order that Member Countries are well informed about it. WHO/SEARO should assist Member Countries in the implementation of TRIPS and other WTO agreements pertaining to the health sector.

Action taken

In view of the growing evidence of potential impacts of globalization and grade liberalization on health, a Regional Consultation on the Implications of WTO Multilateral Trade Agreements on Health – TRIPS was organized in Bangkok, in August 1999 with wide-ranging participation of Ministries of Health and Trade, national institutions, civil society groups, national and international NGOs and UN and intergovernmental agencies including WTO. The consultation considered extensively a number of potential health implications arising from the protection of intellectual property rights (IPR) under the TRIPS agreement and recommended actions to be taken at the regional and country levels to safeguard health in the process of IPR reform. This consultation heightened the awareness of the issue among various sectors and stimulated further discussion at country and regional levels. WHO supported and facilitated preparation of country status papers on International Trade in Health Services in the Millennium, for Thailand and Indonesia for their presentation at the interregional Meeting – Trade and Health – Preparing for the Millennium, held in Washington, 3 -5 November 1999. Information, papers and publications on WTO agreements were provided to ASEAN workshop on TRIPS Agreement and Access to Drugs held in Jakarta, Indonesia, 2-4 May 2000. Technical and financial assistance was also provided for preparation of ASEAN Regional Action Plan on Impact of Globalization and Liberalization on Trade and Services on the th ASEAN Health Ministers’ Meeting, Yogyakarta, 25-27 April 2000. Health Sector adopted in the 5

(2)

(3)

(4)

Case studies on the impact of TRIPS on pharmaceutical sector in Indonesia and foreign commercial hospital operations in relation to GATS in India would soon be undertaken. A regional working group of WHO’s coordination on WTO issues was meeting periodically to discuss the progress of WHO’s activities on trade-related health issues at global and regional levels.

Briefing on Special Projects (a) Roll Back Malaria (1) All Member Countries should adopt the Roll Back Malaria initiative as a priority in their health agenda. Appropriate advocacy material should be developed to secure governmental support and people’s participation. Roll Back Malaria should focus on mobilizing both internal and external resources through networking. All endemic countries in the Region were committed to implement Roll Back Malaria initiative. Pilot districts had been identified and respective Member Countries were conducting situation analysis. Two meetings were held in the Region, viz., intercountry meeting of National Malaria Control Programme Managers, Pattaya, Thailand, 22-27 February 1999 and implementation of collaborative activities on Roll Back Malaria in the South-East Asia Region, New Delhi, India, 4 -6 May 1999. The meetings were organized to help all Member Countries to adopt RBM initiative as a priority in their health agenda. SEA/RC53/16 (Add.1) Page 45 RBM was mobilizing both internal and external resources through the mechanism of a Technical Support Network (TSN) set up in the South-East Asia Regional Office. TSN would have national chapters in their respective countries, and comprise three networks on (I) Transmission Risk Reduction (TRR), (ii) Surveillance, Information Management and Epidemic Preparedness and Response (SIE), and (iii) Drug Resistance and Policy (DRP)

(2)

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Action Points (3) Roll Back Malaria should undertake strong advocacy for the development of a system to manage intersectoral collaboration and to sustain partnerships at all levels, with effective involvement of the community. Roll Back Malaria at the country level should aim at strengthening the district health system to ensure access to quality care and effective anti -malaria measures to high-risk groups. Member Countries should work jointly to solve multidrug resistant malaria and other aspects of the problem at the global, regional and national levels.

Action taken RBM guidelines on community mobilization and advocacy including intersectoral collaboration to sustain partnerships and effective community involvement were prepared.

(4)

RBM guidelines to strengthen district health system to ensure quality care and effective anti-malaria measures to high-risk groups were prepared.

(5)

Multi -drug resistant malaria problem was being addressed by the RBM Mekong project. In addition, two biregional meetings were organized viz., SEAR/WPR biregional meeting on control of malaria in Kunming, Yunnan Province, China, 3-5 November 1999 and biregional meeting on the Mekong Roll Back Malaria Initiative, Bali, Indonesia, 4-5 May 2000.

(b) Polio Eradication (1) In order to attain the global target, Bangladesh, India and Nepal should conduct two rounds of nationwide, house -to-house, mopping-up campaigns immediately before the next NIDs in December 1999 and January 2000. Meanwhile, states/districts in these three countries should immediately accelerate the implementation of mopping-up campaigns. Adequate supplies of vaccine should be ensured for this purpose. The polio situation in DPR Korea should be defined for taking appropriate action. In the remaining SEAR countries, progress needs to be sustained for achieving certification of polio eradication. Tobacco Free Initiativ e Member countries should develop comprehensive national tobacco policies and strategies to protect the vulnerable groups from the hazards of tobacco. Member countries should implement and review the existing fiscal policies and legislative measures to enhance the implementation of the Tobacco Free Initi ative. Member Countries were developing national policies aimed at tobacco control. WHO was supporting selected Member Countries for the development of comprehensive national tobacco policies and strategies. Member Countries were reviewing and developing their fiscal and legislative mechanisms to curb tobacco consumption. Selected Member Countries were being supported by WHO for development of legislation for tobacco control Bangladesh, India and Nepal had stepped up their programmes on polio eradication. A modified strategy for National Immunization Days was being implemented in Bangladesh. In India, four states conducted intensive National Immunization Days in March 1999. In addition, four nationwide rounds of intensified NIDs were carried out in the last quarter of 1999 and January 2000. These were followed by sub-national immunization days in eight high-risk states during February and March 2000. Similar activities were planned and conducted in Nepal. India conducted mopping up operations in several states in response to isolation of wild poliovirus in the first half of the year 2000. Both Nepal and Bangladesh were developing mopping up guidelines and plans.

(2)

(3)

DPR Korea improved its reporting of AFP cases in the year 2000. The polio laboratory was equipped and two technicians trained in Beijing. The polio situation would become clearer once the polio laboratory became operational. A National Coordination Committee was established. Other countries continued to conduct NIDs/SNIDs and strengthened AFP surveillance

(4)

(c) (1)

(2)

Action Points (3) Member countries should develop and implement new and effective strategies such as raising the real price of tobacco; totally banning all forms of advertisement, sponsorship and promotion; and enforcing a comprehensive ban on smoking in all enclosed public places. WHO and Member Countries should ensure dedicated and sustained funding for health promotion interventions.

Action taken In some Member Countries, certain regulations were in place to reduce tobacco consumption, e.g., prohibition on smoking in public places, restriction and prohibition on advertisements on the electronic/print media, imposition of heavy taxes on tobacco products, declarati on of smoke-free islands etc. A bill, awaiting Parliamentary approval, in Thailand sought 2% of the revenue earned from alcohol and tobacco excise taxes to be channeled to support the Health Promotion Fund. While Thailand had a comprehensive legislation for tobacco control, in Sri Lanka legislation was being enacted. Draft legislation was ready in Nepal. A few states in India, viz. NCT of Delhi, Goa and Kerala, enacted appropriate legislation. Member Countries were providing funding for health promotion interventions and increased allocations for health promotion. WHO was rendering all feasible technical assistance in this respect.

(4)

3rd Meeting of Heal th Secretaries, Bangkok, Thailand, February 1998 Review of WHO collaboration with its Member States in the South -East Asia Region: Regional Implications of the important decisions/resolutions of the 101st session of the WHO Executive Board Regular budget allocation to regions (Resolution EB101.R10) (1) Member Countries of SEAR should launch a campaign to mobilize public opinion, through the international NGOs and the media across the countries of the affected regions, on the implications of the recommended model of the WHO Executive Board, for allocation of regular budget to Regions, stressing the need for equity in terms of population, poverty, disease burden, past record in efficient utilization of funds, topographic location, etc. Efforts should also be made to coordinate the campaign with similarly affected countries in other regions, for securing their support during the discussions on this subject at the World Health Assembly in May 1998. WHO/SEARO should actively provide all relevant technical and other information to the Member countries in the Region to facilitate their efforts to protect the allocation of WHO regular budget to the South-East Asia Region. The combined efforts of the country representatives during the 51 st WHA in May 1998 led to the adoption of resolution WHA51.31. This resolution stated that the Executive Board-recommended model for allocation of WHO Regular budget to the regions should be applied in a flexible manner to minimise adverse effects on countries, whose budgetary allocations would be reduced. It also recommended that the formula be implemented gradually so that the reduction for any Region did not exceed three per cent per year and was spread over a period of three bienniums. As a result of this Resolution, the estimated total cuts for the Region for the three bienniums (beginning 2000-2001) would be about US$ 10.9 million, as against US$48 million estimated earlier. Further, the least developed countries of the Region, namely, Bangladesh, Bhutan, Maldives, Myanmar, Nepal, and in particular, DPR Korea, which was a country in greatest need, would not have to bear any decrease in their budget over the 1998-1999 level.

(2)

WHO Regional Office provided a fact sheet containing all relevant technical and other information relating to allocation of WHO regular budget to the regions with a view to facilitate the Member Countries’ efforts to protect the regional allocation.

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Action Points (3) The Regional Director, South-East Asia Region, should convene a meeting of delegates from Member countries of the Region to the Fifty -first World Health Assembly in Geneva on the day before its opening (i.e. Sunday, 10 May 1998) in order to brief them on the latest developments, and with a view to identifying the most feasible strategy to be pursued at the Assembly. The Regional Office would coordinate the efforts of all concerned in this regard.

Action taken The Regional Director convened a meeting of delegates from the Member Countries of SEARO to the Fifty -first World Health Assembly and briefed them on the latest developments relating to allocation of WHO regular budget to the regions.

Health Impact of Economic Crisis (1) The health impact of economic crisis needs to be studied and appropriate strategies devised to meet both short -and long- term adverse health effects of such a crisis. Intercountry cooperation can mitigate the adverse health impact of economic crisis through exchange of information and experience, technical assistance, aid and trade, including barter, which should also be facilitated by WHO. Member Countries concerned may list and quantify their requirements of different raw materials for manufacturing pharmaceuticals and inform India of the same. India may then examine the possibility of meeting the requirements through appropriate means. The health impact of economic crisis was deliberated upon in a conference of parliamentarians and at other consultations.

(2)

Intercountry cooperation was facilitated between Indonesia and Thailand as also between these countries and India, particularly for regional procurement of pharmaceutical and their raw material. The advantages of such cooperation were highlighted at a highlevel intercountry meeting.

(3)

Indonesia initiated action in this respect and a list of items required was conveyed to the Government of India. Further action would depend upon the commercial and other considerations between the two countries.

Intercountry Cooperation for Health Development in the 21st Century (1) The areas of intercountry cooperation, identified in the report of the International Conference on Intercountry Cooperation for Health Development in the 21st Century, should be reviewed from time to time. Follow -up actions should be pursued so that available national and international funds are effectively utilized for activities which directly benefit the poor and vulnerable sections of the population. There is a need to refine/institutionalize the mechanisms of intercountry cooperation to realize its full potential. While bilateral cooperation for health development between countries of the Region was being strengthened, the report of ICHD was reviewed at a subsequent meeting of health secretaries as also in a biregional meeting with WHO/HQ at Geneva.

(2)

Intercountry cooperation for control of diseases, including polio eradication, particularly at the border areas, was receiving increased attention. Border meetings between neighbouring SEAR countries for control of malaria were institutionalized as they were held regularly. Efforts to tackle the problem of arsenic contamination of underground w ater were also intensified.

Action Points 2nd Meeting of Health Secretaries, Bali, Indonesia, February 1997 Review of the Monograph on Poverty and Health (1) Poverty should be viewed holistically. Macro economic and social policies should accelerate economic growth and raise the levels of education and health. Health can be improved in conditions of low economic status. Micro interventions should be integrated focussed on women and targeted on the poor. Member States should increase their efficiency in implementing WHO’s collaborating programme. Carry over of activities from 1996-1997 biennium should be avoided. A part of the country budget, which could not be absorbed on time, should be pooled for implementation under intercountry mechanisms. CCPDM should be informed of the benefits accruing to Member States from implementation of these activities. In-country training programmes and regional fellowships should be promoted. WHO should pay special attention to promote technical cooperation among countries particularly in respect of human resources for health, control of diseases in the border areas and prevention and control of micronutrient deficiency disorders.

Action taken

The Monograph on Poverty and Health was reviewed by a panel of experts. It had since been published as a WHO document incorporating the decisions/recommendations of the Health Secretaries. The monograph was widely distributed as an instrument of advocacy for health. Member Countries were assigning a high priority to health improvement and poverty reduction in their plans and using investments in health as an entry point for poverty alleviation.

(2)

WHO and SEAR countries made concerted and vigorous efforts to implement the WHO collaborative programme for 1996-1997 biennium and achieved 100% programme implementation and budget utilization. While the majority of the countries achieved 100% or higher performance, no country achieved less than 95% US$2.15 million, pooled from country budgets for implementation under intercountry mechanism, was fully utilized. A report on the benefits accruing to the Member Countries from this arrangement was presented to the CCPDM in September 1997.

(3)

(4)

An analysis of the regional and extraregional fellowships during 1994-1995 and 1996-1997 biennia showed that almost all SEAR countries were promoting in-country training programmes with a view to achieving cost - effectiveness and strengthening training institutions in the countries of the Region. The number of fellowships within the Region was also showing an increasing trend. Through allocations of seats in medical colleges and other institutes, deputations and training of health personnel etc., SEAR countries were cooperating with one another for development of human resources for health. WHO had been facilitating such cooperation. Further to various intercountry border meetings in the past, an intercountry border meeting on malaria and kala-azar (Bangladesh, Bhutan, India and Nepal) was held in Dhaka in October 1997. A regional consultation towards Elimination of Iodine Deficiencies Disorders was held in SEARO in February 1997. Another Regional Consultation on Nutritional Status of Adolescent Girls and Women of Reproductive Age was held in SEARO in November 1997. The Regional Office was working on a publication on health promotion and protection, including nutrition. The decisions and recommendations of the Health Secretaries were properly implemented as reflected in the Declaration on Health Development in the South-East Asia Region in the 21st century, which was adopted by the health ministers at their 15th Meeting in August 1997 and endorsed by the 50th Session of the Regional Committee. A Working Group had been established in the Regional Office to coordinate the development of an action plan for supporting the implementation of the Declaration, and to coordinate WHO support to Member Countries to integrate the policy guidelines of the Declaration in their national health policies and plans. A regional consultation on the Implementation of the Declaration was held in Colombo, Sri Lanka, from 9-11 February 1998, with a view, inter alia, to developing a framework and approaches for implementing the policy guidelines of the Declaration.

(5)

(6)

It is now time to prepare for meeting the health challenges of the 21st century in a holistic manner through partnership approach. Growth of population and urbanisation needs to be planned and checked to achieve the desired level of health in the 21 st century. The management of the health system should be decentralised. Ethical aspects in providing health care services should be carefully taken into account in view of the increasing role of the private sector and advancement in science and technology.

(7)

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Action Points WHO Technical Co-operation with Member States (1) Member States should increase the efficiency of their performance in the implementation of the WHO country collaborative programme. Concerted efforts should be made to utilize maximally the local expertise and involve WHO collaborating centres, as appropriate, in such implementation. A part of the country budget which could not be absorbed on time should be pooled for implementation under an intercountry mechanism in the context of regional co-operation and solidarity. In this process, particular, attention should be paid to activities of short duration to be completed within 1997, with demonstrable tangible outputs; supporting TCDC activities among the Member States; and tackling common issues at border areas. The pooled resources may also be used for supporting the countries in greatest need and those which have demonstrated a high absorption capacity by fully utilizing the regular budget allocations. WRs should continue to provide information on the status of delivery of the WHO country collaborative programme to the focal point concerned in the Ministries of Health to facilitate their effective monitoring. The WRs should also alert the Health Secretaries and/or the Directors-General of Health Services in case of low programme delivery so that timely remedial measures can be implemented. Member States and WHO should especially promote incountry and regional fellowships and training programmes with a view to achieve in cost- effective outcomes and to strengthen training institutions in the Region. Member States and the Regional Office should ensure that all activities for the 1996-1997 biennium are completed as much as possible, within the biennium, since a carry-over will affect programme implementation of the next biennium.

Action taken

WHO and SEAR Countries made concerted and vigorous efforts to implement the WHO collaborative programme for 1996-1997 biennium and achieved 100% programme implementation and budget utilization. While majority of the countries achieved 100% or higher performance, no country had achieved less than 95%.

(2)

US$ 2.15 million, pooled from country budgets for implementation under intercountry mechanism, was fully utilized as per the guidance of the health secretaries for supporting TCDC activities and tackling common health issues/diseases at border areas.

(3)

Bhutan and DPR Korea were provided additional support: Bhutan demonstrated high absorption capacity and DPR Korea was a SEAR country in greatest need.

(4)

Compliance with this recommendation in letter and spirit led to full utilization of the biennium budget for 1996-1997.

(5)

In-country training and regional fellowships had steadily increasing with the cooperation of Member Countries. An analysis of the regional and extra-regional fellowships during 1994-1995 and 1996-1997 showed that almost all SEAR countries were promoting in-country training programmes with a view to achieving cost-effectiveness and strengthening training institutions in the countries of the Region and regional fellowships. Further cooperation of all countries in this behalf would substantially improve the position. The WHO collaborative programmes for 1996-1997 was implemented 100%.

(6)

Action Points (7) Information on the benefits accruing to Member States, with the amount of funds involved, from implementation of activities under the supplementary intercountry programme (ICP 11) should be compiled and presented at the next meeting of the CCPDM in April 1997. In light of the current availability of resources for health development in the Region, WHO should pay special attention to promoting and facilitating technical cooperation among countries (TCAC), particularly in the areas of development of human resources for health, controlling diseases in the border areas, and prevention and control of the health problems relating to micronutrient deficiencies.

Action taken A report on the benefits accruing to the Member Countries from this arrangement was presented to the CCPDM in September 1997.

(8)

Through allocations of seats in medical colleges and other institutes, deputations and training of health personnel etc., SEAR countries were cooperating with one and another for development of human resources for health. WHO had facilitating such cooperation. Further to various intercountry border meetings in the past, an intercountry border meeting on malaria and kala-azar (Bangladesh, Bhutan, India and Nepal) was held in Dhaka in October 1997. A regional consultation towards Elimination of Iodine Deficiencies Disorders was held in SEARO in February 1997. Another regional consultation on Nutritional Status of Adolescent Girls and Women of Reproductive Age was held in SEARO in November 1997. The Regional Office was working on a publication on health promotion and protection, including nutrition.

Health Development in SEAR in the 21st Century (1) Partnership should be the key approach to meet the health challenges of the future in an effective and holistic manner. The decisions and recommendations of the Health Secretaries were properly reflected in the Declaration on Health Development in the South-East Asia Region in the 21st century, which was adopted by the Health Ministers at their 15th Meeting in August 1997 and endorsed by the 50th Session of the Regional Committee. A Working Group was established in the Regional Office to coordinate the development of an action plan for supporting the implementation of the Declaration, and WHO support to Member Countries to integrate the policy guidelines of the Declaration in their national health policies and plans. A regional consultation on the Implementation of the Declaration was held in Colombo, Sri Lanka, from 9-11 February 1998, with a view, inter alia, to develop a framework and approaches for implementing the policy guidelines of the Declaration. This concern was duly reflected in the Regional Health Declaration. Countries were ensuring that demographic and urbanization factors were taken into account at the stage of planning for national development so that they did not jeopardize health development in the 21 st century. The draft Declaration to be adopted by the Ministers was prepared on the basis of a series of wide-ranging consultations involving all stakeholders. It took into account the past experiences as also the future challenges and opportunities.

(2)

To achieve the desired level of health in the 21st century, the growth of population and urbanization in many countries needs to be planned and checked as effectively and as early as possible. The Declaration, to be endorsed by the Fifteenth meeting of Health Ministers, should be based not only on past experiences in the Region, especially those in implementing HFA-2000 strategies, but also on the future scenario within the framework of the social, cultural, political and economic perspectives as envisaged individually in countries and collectively in the Region. In the light of the increasing demand for health care services in the next century, in terms of both quantity and quality, the management of the health system should be appropriately decentralized at all levels of development from policy planning to operations.

(3)

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(4)

The health systems in SEAR countries were being decentralized in the light of the conditions and needs of the respective countries.

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Action Points (5) In the light of the increasing role of the private sector and advancements in science and technology, the ethical aspects in providing health care services to the population at large should be carefully taken into account when health policies and plans are formulated.

Action taken Member Countries were taking ethical considerations into account while reviewing/developing their national health policies and health development plans.

1st Meeting of Health Secretaries, SEARO , New Delhi, 29-31 January 1996 For Countries: (1) Countries should suitably institutionalize intercountry cooperation, especially activities relating to health problems in border areas, through local bodies (district administrations, including defence authorities, if necessary), with provision of technical back-up by the concerned national programmes, agreement between neighbouring countries and earmarking of requisite funds. Countries should initiate and sustain the processes of country consultations for renewal of HF A strategies, leading to the formulation of revised country-specific strategies, as per an agreed timetable. WHO continued to promote intercountry cooperation for tackling common health problems at borders. Myanmar and Thailand recently concluded a Memorandum of Understanding (MOU), envisaging establishment of joint border health committees at the central level and along the border. Regular border coordination meetings between Bhutan and India were being held. Malaria and kala-azar were included as regular agenda items in border meetings periodically held at the district level between Nepal and India.

(2)

During the process of reviewing their health policies and while proceeding with their health development plans, countries were also renewing their HFA strategies as an integral part of national plans for health development. The principles of equity, social justice, gender perspective, sustainability and solidarity formed the basis of these plans. Approaches like the social safety net and minimum needs programmes, including health needs of the poor were adequately accommodated in these plans. Following a series of national meetings on renewal of HFA strategies, an intercountry meeting on Evaluation and Renewal of Health For All Strategies was held in December 1996, in Colombo, where it was agreed that WHO would facilitate extraction of countries’ renewal of HFA strategies from their development plans. WHO/SEARO organized a series of intercountry meetings on the subject. WHO and Member Countries were collaborating in developing epidemiological surveillance and early warning systems by strengthening the network of public health laboratories and training of staff for effective management of any future outbreaks. Rapid response teams had also been formed, both in SEARO and in some countries. Programmes for prevention and control of these public health problems were being further strengthened with the involvement of NGOs, other health-related ministries and the private sector. Prov ision of safe blood and blood products was being expanded. Priority was being accorded to social marketing of condoms, targeting interventions and effective management of STDs. External resources had also been mobilized. WHO’s role in AIDS prevention and control would remain crucial. SEARO would continue to support countries in respect of STDs, blood safety, clinical management and surveillance.

(3)

Countries should upgrade and strengthen laboratories and related manpower for epidemiological surveillance to meet the challenge of new, emerging and reemerging infectious diseases Countries should intensify efforts, with WHO support, for the prevention and control of STD -HIV/AIDS

(4)

Action Points For WHO (1) WHO should expand interaction with health-related sectors and ministries, using Government/WHO mechanism, and support Ministries of Health by strengthening their capabilities and capacities in intersectoral coordination.

Action taken

The WHO Ninth General Programme of Work (1996-2001) was focused on integrated programmes/projects. The Government/WHO Collaborative Programmes formed an integral part of national health development plans and provide them with critical technical support. WHO programmes such as Health Concerns in Environment (HCE) promoted an intersectoral approach to managing critical national environmental issues. Seven countries of the Region were formulating national plans of action for Health and Environment. Programmes such as the healthy cities initiative, prevention and control of infectious diseases, including AIDS and women’s and children’s health also focused on partnership and intersectoral action. Countries in the Region were implementing these programmes as part of their health development plans. There were several instances of intersectoral collaboration and integrated projects successfully tackling various public health problems. For example, the WHO-supported national initiatives for polio eradication by 2000, through national immunization days (NIDs) and integrated management of childhood diseases highlighted the efficacy of intersectoral acti on and the cost-effectiveness of integrated projects. As the district health system, based upon primary health care (PHC), operated more efficiently with intersectoral action, WHO’s technical collaboration with Member Countries for improving the management of the district health system had been further intensified. The Monograph on Poverty and Health analyses the efficacy of intersectoral action and notes several initiatives that had been successfully launched in the Region linking health development with poverty alleviation and employment generation programmes.

(2)

WHO should play a catalytic and coordinative role in promoting and supporting new partnerships. The capacities of local NGOs should also be enhanced through WHO technical cooperation.

The primary focus of WHO collaboration with NGOs was to promote tripartite partnership among government, NGOs and WHO in support of national health development. For complementing government initiatives, WHO intensified collaboration with Rotary International for control of EPI targeted diseases; with the International Association of Lions Clubs in “Sight First Programmes”; and with the Christoffel Blinden Mission and Hellen Keller International in the prevention of blindness. WHO also collaborated with the Sasakawa Foundation for supporting SEAR countries in EPI, leprosy control, and prevention of blindness programmes. An assessment of the current situation of WHO/NGO collaboration in the Region was undertaken. An intercountry consultation was held in 1997 to develop a regional plan of action to improve partnership between WHO and international NGOs at the regional level, and for the development of guidelines for promotion of NGO-Government-WHO collaboration in countries. Traditionally, partnership between the health sector and the private sector was limited. In the changing scenario, however, the important role of the private sector as a partner in health was recognized. WHO was exploring various options of building partnerships with the private sector in ways that were in consonance with its mandate. Meanwhile, private health care was growing in most countries, and WHO has organized several discussions on the subject for promoting partnership with the private sector.

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Action Points (3) WHO should support governments in coordinating external assistance for national health development by bilateral donors, UN agencies and funding institutions.

Action taken Improving and strengthening the capacity of Ministries of Health for coordination of external aid for the health sector was accorded high priority by WH O. An Aid Coordination mechanism was set up, on an experimental basis, in the Ministry of Health, Nepal with technical assistance from WHO. The Organization was working closely with ministries of health, funding banks and donors, for mobilizing and coordinating external resources for the health sector, e.g., WHO’s collaboration in the World Bank-assisted projects in Bangladesh, India and Indonesia, and in the Asian Development Bank (ADB)-assisted projects in Bangladesh and Indonesia. WHO technically assisted these countries in project formulation, programme implementation, procurement of supplies, and programme evaluation. In certain cases, WHO was also responsible for the execution of technical components of such projects. The Organization was able to convince the banks about the technical soundness and viability of these projects and has also participated in the formulation of ADB's health sector funding policy, round table meeting for Bhutan and the donors’ meetings for Maldives. Bangladesh and Nepal participated in the first workshop on Managing Aid Negotiations for Health Development held in Ottawa in 1994 and, as a follow-up, WHO held a workshop in Myanmar in February 1997 and in Intercountry Workshop in Nepal in March. The subject of public-private mix for health development was deliberated upon at the fourteenth Meeting of Ministers of Health in October 1996. Prior to this, Alternative Financing of Health Care had been taken up as a subject of Technical Discussions at the 48th S ession of the Regional Committee in September 1995. A kit on privatization of health care was published by WHO/SEARO in 1995. The entire gamut of health sector reforms would be the subject of Technical Discussions at the 50th Session of the Regional Committee in September 1997.

(4)

WHO should provide forums for further exchange of views and discussion of the issues relating to health sector reform, including alternative financing of health care and privatization, as the same warranted systematic support and research to foster evidencebased policy reforms.