WPRlRC58/SRl3 SUMMARY RECORD OF THE THIRD MEETING (Tamna Hall B, 5th floor, International Convention Center, Jeju, Republic of Korea) Tuesday, II September 2007 at 14:00 CHAIRPERSON: Dr Chang Jin MOON (Republic of Korea) CONTENTS
page 1.
Proposed Medium-term Strategic Plan of the Western Pacific Region 2008-2013 and Proposed Programme Budget 2008-2009 ................................................................................................ . Progress towards achieving the Millennium Development Goals Improving child survival: Maternal and child health including immunization ........................................................................................ .
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PROPOSED MEDIUM-TERM STRATEGIC PLAN 2008-2013 AND PROPOSED PROGRAMME BUDGET 2008-2009: Item 9 of the Agenda (Documents WPRlRC58/4 and WPRlRC58/4 COIT.l)
The REGIONAL DIRECTOR reminded the Regional Committee that the Organization-wide draft Medium-tenn Strategic Plan 2008-2013, and the draft Proposed Programme Budget, 2008-2009, had been presented during the Committee's fifty-seventh session in 2006, together with an Overview of the Proposed Medium-tenn Strategic Plan of the Western Pacific Region 2008-2013. The Committee had been able to comment on the global documents before their submission to the Executive Board and the World Health Assembly. In addition, the Committee's comments on the Regional Overview of the Proposed Medium-tenn preparation of the document. The proposed Medium-term Strategic Plan of the Western Pacific Region 2008-2013 provided the strategic regional direction for the OrgaIlization within the context of the Eleventh General Programme of Work, the global strategic objectives and the Organization-wide expected results of WHO. In focusing the regional work of the Organization across three bienniums, the proposed Stratl~gic
Plan had been taken into account during
Medium-tenn Strategic Plan would better reflect the cross-cutting nature of WHO's work and allow a more strategic and longer-term approach to the Organization's collaborative programmes. The
proposed Medium-term Strategic Plan clearly identified the contribution to be made by the regional expected results towards the Organization-wide expected results of the 13 WHO strategic objectives. In preparing the Medium-term Strategic Plan, the document WHO in the Western Pacific
Region: A framework for action had provided the regional orientation. The Regional Committee, at its fiftieth session, had endorsed that document as a set of guiding principles for WHO's work in the Region in the early years of the 21 st century. The proposed Programme Budget of the West(:rn Pacific Region 2008-2009 would be the first biemrial budget under the six-year proposed Medium-term Strategic Plan and the fifth successive biennial budget to follow the Organization-wide results-based approach to programme management. The proposed Programme Budget had been prepared on the basis of the priorities of Member States within the Western Pacific Region. as reflected in resolutions adopted by the World Health Assembly and by the Regional Committee. Tentative budget figures for countries and areas were given for each strategic objective where WHO technical cooperation had been planned. The
preparation of the Medium-tenn Strategic Plan and Programme Budget had been an ambitious
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undertaking and there would be ongoing review and adjustment, if necessary, to meet the evolving needs of the collaborative programmes. Performance indicators would be used to monitor progress regularly and as the basis for assessments of programme budget implementation, conducted at sixmonth intervals. Fuller details of specific results expected at the country and Regional Office levels could be accessed at the WHO Western Pacific Region website; the Internet link had been provided in the overview section of the document. As a consequence of the appropriate resolution WHA60.l2,
adopted by the Sixtieth World Health Assembly, the regional allocation of assessed contribution funds for 2008-2009 was US$ 80 159 000, a 4.8% increase over the allocation for 2006-2007. The estimated increase in voluntary contribution funds was 71.2%. Those increases reflected the needs of the Region and were in line with the Organization's commitment to shift resources to countries and reglOns. Dr SUMI (Japan) said that advance planning for a longer period would not only better reflect country and regional needs but also facilitate effective collaboration. Indeed, swifter responses to health emergencies and crises demanded prior deliberation with Member States and concerned parties, as did any attempt to set priorities and ethical standards for research. He therefore looked forward to successful implementation of the proposed Medium-term Strategic Plan through solid cooperation among governments, relevant institutions and other concerned parties. Dr CHOI (Republic of Korea) said that the proposed Medium-term Strategic Plan and proposed Programme Budget 2008-2009, both of which his country endorsed, would be critical to achievement of the health-related Millennium Development Goals. Allocation of the budget to appropriate priority areas that would produce the best expected outcomes was a commendable move. The increase in voluntary contributions was also highly encouraging. For its part, the Republic of Korea hoped that its own intended voluntary contribution of US$ I million for the prevention and control of avian and pandemic influenza would promote achievement of the best outcomes for the Region in that field of activity. Concerning the proposed Programme Budget 2008-2009, the allocation of funds in accordance with a set number of strategic objectives would guarantee greater flexibility when it came to implementation. Substantial details were still lacking, however. Ideally, implementation of the budget by each Member State should be managed and coordinated by the Secretariat in order to ensure due attention to international priorities, thereby avoiding any potential conflict with national and regional priorities.
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Ms ARTHUR (France) said that she continued to regret the growing gap between assessed and voluntary contributions in view of the unpredictability that resulted. What choices and sacrifices would have to be made, for instance, if resources from voluntary contributions failed to increase in line with expectations? On another note, on the basis of its substantial work in the field of access to drugs against malaria, tuberculosis and HIV/AIDS, she requested addition of the International Drug Purchase Facility (UNITAID) to the list of international organizations working with WHO. Dr DALALOY (Lao People's Democratic Republic) said that he welcomed the conclusions drawn concerning the need to address such long-standing challenges as the reduction of infant and maternal mortality, as well as new challenges posed by, inter alia, diseases relating to rapid socioeconomic development, climate change and lifestyle. In that connection, it was essential to use the available means and knowledge to target high-risk countries that were ill-equipped, particularly in comparison with developing countries, to overcome those! challenges. His Government concentrated its efforts on eradicating the challenges of poverty through integrated rural development, with a key focus on agriculture, communication, education and health. It therefore welcomed the significant increase in the proposed budget allocation for the Lao People's Democratic Republic, which consequently hoped to further reduce its high infant and maternal mortality; guard against the threat of new, re-emerging and noncommunicable diseases; and improve its health care delivery by adopting a people-centred approach and expanding education and training for health professionals. In conclusion, he asked about plans for resource mobilization, an issue that merited greater attention. Ms BLACKWOOD (United States of America) said that she welcomed the integration of the proposed Medium-term Strategic Plan into the WHO results-based management framework at both the global and regional levels. An enabling environment within the Organization would, however, be essential to its successful implementation, as would regular assessments. Analysis of the proposed Programme Budget 2008-2009 would also be facilitated by the provision of more comparative data with the previous biennium and by wider discussion of the specific programmatic changes behind the budgetary impacts. Also w~lcoming
the successful mobilization of voluntary contributions as a trend
that was set to grow, she requested further details of the Region's work with WHO Headquarters in the area of resource mobilization. Concerning the strategic objectives, she said that the set targets with regard to regional expected result 01.006.WPOI were too low; the Secretariat should work with Member States in the Region to ensure that all IHR focal points were instead designated by 2007. The Secretariat should
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also provide technical assistance with a view to ensuring that all Member States implemented the IHR as fully as possible by 2012. With regard to regional expected result 04.007.WP01, she reminded the Regional Committee that, at the fifty-seventh session of the World Health Assembly, her Government had disassociated itself from the consensus on the WHO Global Strategy on Reproductive Health. She further wished to make clear her Government's understanding that reproductive health services did not include abortion and that the proposed Medium-term Strategic Plan contained no encouragement or compulsion for Member States of the Region to expand the availability of legal abortion. With regard to regional expected result 09.006.WPOl, she asked why the targets were so low, given the importance of food safety and its correlation with the International Health Regulations, and reco=ended an increase in assistance to Member States in that connection. Lastly, she asked what the baseline indicator of 100% for regional expected result 12.001.WPOI was intended to measure. Dr SENILAGAKALI (Fiji) acknowledged WHO as Fiji's only key partner to make a budget provision dedicated to human resource development and expressed his appreciation for the proposed increase in Fiji's budget allocation. Prepared in accordance with results-based principles, the
proposed Programme Budget 2008-2009 as a whole was both innovative and justified. In connection with the new six-monthly reporting requirement proposed to measure performance and achievement in terms of the regional expected results set forth in the proposed Medium-term Strategic Plan, he requested the establishment of a mechanism that would preclude any over-reliance on country staff for fulfilment of that requirement. Dr QI (China) said that the proposed Medium-term Strategic Plan, which his country generally supported along with the proposed Programme Budget 2008-2009, offered significant guidance for the development of health strategies and paved the way for achievement of the healthrelated Millennium Development Goals. Concerning the regional expected results, some targets gave cause for encouragement while others were too conservative insofar as they offered little prospect for change. Ideally, long-term targets should be quantified with a view to gauging any shortfall in the targets set for 2013 and channelling activities accordingly. He asked how regional and country allocations would be used specifically to achieve the strategic objectives set forth in the proposed Medium-term Strategic Plan. He also requested clarification concerning the statement that the costs of WHO's presence in countries that were included as part of the Regional Office budget in previous bienniums were now shown under strategic objectives 12 and 13 for each country hosting a WHO country office.
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Dr MATHESON (New Zealand) expressed similar support for the proposed Medium-tenn Strategic Plan and the proposed Programme Budget 2008-2009, with particular reference to the clarity of the objectives and the efforts to define end points and targets, the very existence of which was to be applauded. Bearing in mind the need to consider ways of dealing with the unexpected and ascertain the impact of such events on important areas of work already under way, he asked whether the proposed plan would deal with new c1imate-chang'~
issues through an additional objective or
through the expansion of strategic objectives 5 or 8. Ms HALTON (Australia) acknowledged the effort that had been expended in preparing the comprehensive document before the Committee, which was consistent with the new Organizationwide approach and Medium-term Strategic Plan. Such doeuments would enable upcoming meetings to focus on equitable distribution of assessed and voluntary contributions and to determine the additional work that could be undertaken to mobilize additional voluntary contributions. She commented that some of the targets in strategic objective 4, on maternal and child health, for example, were less ambitious than might have been wished, although that might be due to the large number of targets to be covered by the available resources. She suggested that, in the future, the Secretariat indicate clearly how the constraints had resulted in less achievement and what could be achieved if more resources were mobilized. As the resources allocated for regionall and intercountry activities appeared to be limited, the span of activities was determined by the availability of voluntary contributions. The document would in future allow the Committee to decide what could be financed from assessed contributions and from designated and undesignated voluntary contributions. Dr TANGI (Tonga), noting that the document projected a significant increase in the budget during the first biennium, asked whether that indicated a trend for the following two bienniums and, if so, how the increases for the remaining four years were to be funded. At the invitation of the CHAIRPERSON, representatives of the International Society of Radiographers and Radiological Technologists and the International Planned Parenthood Federation made statements to the Committee.
The REGIONAL DIRECTOR thanked representatives for their constructiw comments. Be recalled that resolution WHA5I.31 had elicited intense dialogue with a view to reversing the downswing in the Region's budget allocation. The 4.8% increase in the current regular budget was minimal, but that had been augmented by a 71 % increase in extrabudgetary funds. The challenge was to use the overall increase in the most effective way. He conceded that it had been difficult to change the presentation from that of the current biennium, in which the proposed budget was based on areas of work, to that for 2008-2013, which was based 011
strategic objectives, and that also made
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comparisons difficult. Nevertheless, the five programme areas identified as high priorities by the Executive Board and the World Health Assembly would benefit from the increase in funds. Responding to the question from New Zealand about how new and unexpected issues would be addressed in the proposed programme budget, he said that, depending on progress in addressing the issue of climate change, more donor funds would be sought. In reply to the representative of Tonga, he said that use of funds during the first biennium would serve as an indicator, so that mid-term adjustments could be made if necessary. The DIRECTOR, PROGRAMME MANAGEMENT, said that the projected increase in voluntary contributions for the period 2008-2009 would be derived by resource mobilization. By June 2007, 86% of the required sum for the current biennium had already been secured. A resource mobilization framework and strategy elaborated in collaboration with WHO Headquarters and the other regional offices would be used as a tool to mobilize voluntary contributions for the subsequent bienniums. The range of contributors to the programme budget was being expanded to include other sources, such as the private sector. He was therefore optimistic that the extrabudgetary funds necessary for implementing the proposed programme would be found. Replying to the representative of France concerning the rearrangement of priorities if all the funds were not found, he said that the Advisory Group on Financial Resources, consisting of assistant directors-general at WHO Headquarters and the directors of programme management in the regions, ensured equitable distribution of allocations both horizontally and vertically throughout the Organization; thus, no one programme would suffer unduly. In response to the comments by the representative of the United States of America on implementation of the International Health Regulations, he said that resolution WHA58.3, in which the World Health Assembly adopted the revised Regulations, requested the Director-General to collaborate in the mobilization of fmancial resources to support developing countries. He agreed that the "expected result" related to the IHR in document WPRlRC58/4 should be changed to indicate that 100% of Member States in the Region should have named focal points for the Regulations by 2009. He further agreed that the targets for food safety were low and said that they would be reviewed in the light of comments. The baseline figure of 100% for effective leadership and direction of the Organization was based on the percentage of relevant Regional Committee resolutions that had been implemented in support of the 11 th General Programme of Work. Efforts would be made to ensure that that high standard was maintained.
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He explained to the representative of China that more detail on how the budget funds would be used regionally would become available on completion of operational planning for both the Regional Office and country offices. The regional expected results encompassed those of the Regional Office and of the country offices. More information on office-specific expected results could be found on the Regional Office website. He said that the cost of country offices had not been included in the country budget tables of previous programme budget documents. He agreed with the representative of Australia that the targets for maternal and child health were not ambitious. In the past, it had been difficult to find funding for that area of work, and therefore the targets had been conservative. They would be reviewed in the context of the increased availability of resources. There being no further comments, the CHAIRPERSON requested the Rapporteurs to prepare an appropriate draft resolution for consideration later in the session. 2. PROGRESS TOWARDS ACHIEVING THE MILLENNIUM DEVELOPMENT GOALS: Item II of the Agenda (Document WPRJRC58/5) The REGIONAL DIRECTOR, introducing Agenda item II, reminded the Committee that, in September 2000, world leaders meeting in New York had unanimously endorsed the United Nations Millennium Declaration. The associated Millennium Development Goals, or MDGs, set out
measurable and time-bound goals intended to reduce poverty and promote sustainable development. Member States in the Region had made significant progress towards achieving many of the MDGs. The Committee would be hearing updates 011
three important issues that were key to
achieving the health-related Millennium Developmenl Goals: Dr Linda Milan, Director of the Division for Building Healthy Communities and Populations in the Regional Office, would present the update on Improving Child Survival: Maternal and Child Health, including Immunization; Data Dr Tee All Sian, Director of the Division on Combating Communicable Diseases, would present the update on Combating HlV/AIDS and Tuberculosis; and Dr Henk Bekedam, Director of the Division on Health Sector Development, would present the update on Health Systems Strellgthening. 2.1 IMPROVING CHILD SURVIVAL: MATERNAL AND CHILD HEALTH INCLUDING IMMUNIZAnON: Item 11.1 of the Agenda (Document WPRJRC58/6) In her introduction, the DIRECTOR, BUILDING HEAL THY COMMUNITIES AND
POPULATIONS noted that, at its fifty-sixth session, the Regional Committee had endorsed the WHOIUNICEF Regional Child Survival Strategy to accelerate and sustain action towards Millennium
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Development Goal 4. In the same session, the Committee had made a commitment to eliminate measles and to reduce chronic hepatitis B infection rates to less than 2% among 5-year-olds by 2012. In the Western Pacific Region, an estimated 2100 children were dying daily-roughly 766000 annually-from common conditions, including neonatal causes, pneumonia, diarrhoea, measles and malaria. The Regional Committee had urged Member States to demonstrate their political commitment by establishing high-level national coordinating bodies to develop national policies and strategies for implementing child survival plans and to mobilize adequate resources from all possible sources. Member States had also been urged to use the WHOIUNICEF Regional Child Survival Strategy to improve overall child survival and reduce socioeconomic disparities to achieve MDG 4. Many countries in the Region had made progress towards achieving Millennium Development Goals 4 and 5, and had developed national strategic and operational plans for maternal and child health, including immunization. To reduce childhood morbidity and mortality in primary health care settings, countries had been encouraged to implement an essential package of core interventions that included skilled antenatal, delivery and postpartum care; newborn care; nutrition; immunization of children and mothers; the integrated management of childhood illness; and the use of insecticide-treated bednets in malarious areas. Many new vaccines were expanding the range of child survival interventions to prevent pneumonia and diarrhoea. The use of a new formulation of low osmolarity oral rehydration salts together with zinc supplementation was recommended to improve home care for diarrhoea. Priority countries for maternal health had developed guidelines and service protocols to manage complications in pregnancy and childbirth. There had been progress; however, gains had been uneven within and across countries. In terms of progress towards MDG 4, three groups of countries could be distinguished: countries that were currently close to the 2015 under-5 mortality goal; countries where the goal could be achieved if recent declining trends continued; and countries that had made some progress but would require substantial efforts to reach the goal. Increased measles vaccination coverage in the Western Pacific Region had resulted in an 81 % decrease in measles mortality from 1999 to 2005, the greatest decrease among all WHO regions. In addition, preliminary data suggested that chronic hepatitis B infection rates had already declined to less than 2% among 5-year-old children in some countries, achieving the regional goal far ahead of the target. However, in most countries, coverage equity for most interventions for mothers and
children showed a wide gap in service delivery and coverage between the lowest and the highest wealth quintiles.
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Collaboration with partner agencies, including the Australian Agency for International Development, the United Nations Children's Fund, the United States Agency for International Development, the European Commission Humanitarian Aid Department, and the United Nations Population Fund and with the Government of Japan had been strengthened significantly. However, support from those various international agencies, and local nongovernmental organizations, had not been sufficient to address all maternal and child survival issues. It was well recognized that, after an impressive decline following the child survival revolution
of the 1980s, there had been a slower rate of decline in child mortality rates. The support and commitment for child and maternal health by high-level national authorities had been inadequate, resulting in unacceptably high levels of child and maternal deaths in many countries and settings. Low coverage of essential services and poor access to those services brought about by geographical and fmancial barriers posed a challenge to most countries. She recalled the Director-General's
speech to the Committee, in which she had said that "the power of existing interventions is not matched by the power of health systems to deliver ess'~ntial
care to those in greatest need, on an
adequate scale, in time'. Indeed, a major concern was weak health service delivery systems in many countries that resulted in a lack of skilled human resources and fmancial inaccessibility to services for some mothers and children. In addition, the lack of integrated, outcome-oriented monitoring and evaluation for maternal and child health, including immunization, had made it difficult to track performance among identified disadvantaged groups. The Director called for a concerted effort to reaffirm commitment to achieve the regional goals and to ensure universal access to the essential package for maternal and child survival. Dr TAM (Hong Kong, China) indicated that recent developments in maternal and child health in Hong Kong (China) were underpinned by a network of 31 maternal and child health centres. Maternal health services included antenatal and postnatal care and family planning. Child health services included new measures to encourage breast-feedmg, which had seen an increase for newborn children from 50% to 70% and for children beyond 4 months from 6% to 14% in the past decade; a programme to promote children's well-being and holistic health; and a comprehensive child qevelopment service that worked to strengthen partnerships between the education, health and social services sectors. While the childhood immunization coverage rate had been at 98% for some time, the regional goals of eliminating measles and reducing the seroprevalt!nce of HBsAg to less than 2% in 5-year-old children had become more difficult owing to an influx of young immigrants. Hong Kong (China) had introduced IPV and acellular pertussis vaccines into the childhood immunization programme in 2007,
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but it was under pressure to introduce newer, often more expensive, vaccines which, as the example of conjugated pneumococcal vaccine showed, would cost more than all the other vaccines together. She appealed to WHO for more practical guidance on what should be considered when reviewing and updating childhood immunization programmes, particularly in the area of cost-benefit analysis. Dr GO (Republic of Korea) thanked WHO for its important contribution to ensuring child survival in the Region by improving maternal and child health. The Expanded Programme on Immunization had played an important part in disease control in the Region, and Member States had improved their vaccination coverage and implemented national policies for communicable diseases control, thus contributing to a decrease in morbidity and mortality from vaccine-preventable diseases. National policies had been implemented in the Republic of Korea to improve immunization coverage and control vaccine-preventable diseases. Free screening tests were offered to all newborn babies, and medical expenses for premature babies were covered to try to prevent disabilities and deaths among newborns. Since the country's declaration that measles had been eliminated in 2006, measles coverage had been maintained at over 95% and seroprevalence of HBsAg in children aged 46 years was almost 97%. The country was pursuing timely vaccination, nosocomial outbreak prevention and enhanced surveillance to maintain its elimination status. She thanked WHO for supporting the Korean measles elimination programme and, in turn, expressed her Government's support for the regional policy to eliminate measles in the Region by 2012. Free vaccinations were offered for newborn infants with mothers who were hepatitis B carriers to help prevent hepatitis B and other chronic liver conditions; it had improved immunization CQverage in line with regional policy to keep seroprevalence of HBsAg to less than 2% in 5-year-old children; and it continued to carry out acute flaccid paralysis surveillance and to monitor IPV coverage rates to maintain its polio-free status. Improved access to reliable information and new health programmes for women encouraged better reproductive and maternal health. Geographical and financial barriers preventing access to maternal and child care were being eliminated and pilot programmes were under way to provide nutritional and health care services to disadvantaged populations, with postnatal caregivers visiting low-income families to assist mothers and newborns. Maternal and infant health was fundamental to improved population health and the Republic of Korea would continue its efforts to provide free essential medical services from pregnancy to childbirth and prenatal and postnatal care programmes to reduce infant mortality and support healthy development of infants and children, as well as to ensure child health through immunization.
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WHO should actively support the regional target of maternal and child health. The Republic of Korea fully supported WHO and was committed to global efforts to improve infant survival. Dr SUM! (Japan) commended WHO's strong regional leadership in efforts to achieve the Millennium Development Goals; however, he emphasized the need for each Member State to show commitment and ownership of those goals at the national level. Japan had supported a number of human resource development projects because it believed that they helped foster country ownership of the MDG targets and would lead to achievement of those targets. Dr OMAR (Malaysia) said that his country had made tremendous progress in reducing its under-5 child mortality rate since 1970 and he believed that achieving the goal of reducing child mortality by two-thirds by 2015 was possible. Malaysia had also made notable strides in reducing its infant mortality rate from 40.8 per 1000 live births in 1970 to 5.4 per 1000 live births in 2006. The country had achieved that by ensuring that trained medical staff assisted during births and by implementing comprehensive childhood immunization programmes that delivered free-of-charge vaccination for BCG, DPT, oral polio, hepatitis B, Haemophi/us irifluenza B and MMR. A network of health and community clinics supported by trained midwives and other health workers provided greater access to basic health care services, with specialist services introduced in 1997. Child health services were integral to controlling ,;ommunicable diseases and providing other preventive services, including rehabilitation services for children with disabilities; the Integrated Management of Childhood Illness strategy had been implemented in the states of Pahang, Sabah and Sarawak; and the Childhood Injuries Prevention Programme had played a part in highlighting child safety and preventing recreational and traffic accidents. The provision of safe water and proper sanitation in urban and rural areas had also contributed to improving health. Strong leadership and commitment was important to placing child health on the political, economic and development agenda. Malaysia reaffmned its commitment to achieving the MDG targets. Dr XIAO (China) noted that many Member St.ates had made progress towards achieving MOGs 4 l\Ud 5 and the healt\! of women and children in the Region had been greatly improved. China would give full consideration to the actions proposed for the Region's future work in that area. The country had implemented regulations on maternal and child health and had made satisfying progress in reducing maternal and under-5 mortality. In response to the regional targets of eliminating measles and reducing the seroprevalence of HBsAg to less than 2% in 5-year-old children by 2012, the Government of China had developed two
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national action plans that included ensuring high vaccination rates, increasing hepatitis B vaccination rates for newborn infants and conducting compulsory measles immunizations in key areas. Results published for 2006 showed that chronic hepatitis B infection rates in children under 5 years of age had been reduced to less than I % and that China had achieved the regional target ahead of time. China was pleased to see that new interventions were being considered and the use of new vaccines would contribute greatly to achieving the MDGs; however, many countries lacked the relevant data and the high cost of vaccines prevented their nationwide implementation by countries and areas. He agreed with the actions proposed; however, less developed countries had limited capacity and he requested that WHO provide technical and financial support where necessary. Funding should be provided to ensure that developing countries received up-to-date disease information, and research and development of new vaccines should be supported so that production costs were reduced and new vaccines were available at a lower cost and made available as widely as possible. Finally, there should be comprehensive strategies for improving children's health, including an evaluation of how malnutrition and injury might hamper a reduction in the under-5 mortality rate. Ms YUAN (United States of America) stated that child health remained a priority for the Region and more work was required to decrease regional child mortality rates. She encouraged Member States to increase funding and to develop innovative strategies for all levels of child health to tackle the magnitude of the problem and to ensure sustainability and coverage. Enhanced family and community support played an important part in those strategies, as did multiple delivery channels and effective use of resources. The proposed data systems to monitor maternal and child health programmes should be simple and achievable at the community level; more complex data collection could be introduced over time. The report provided a broad series of recommendations for improving child survival; however, it would be useful to have more examples of interventions, including appropriate training for delivery and postnatal care, tetanus toxoid immunization of pregnant women, prevention and treatment of HN infection, and improvement or provision of adequate obstetric care. The United States of America supported the need for sustained and improved coverage for existing and new interventions, but urged Member States to assess carefully the cost-effectiveness, feasibility, sustainability and training required for any new intervention. Mr TUlA (Tokelau) observed that child survival was a vital component of economic and social development, and immunization was essential to that survival, and the contribution of other
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sectors was important. He encouraged WHO and other partners to work towards achievement of resolution WPRlRC56.R8 by 2012 in small island settings. Mr COURSE (France) supported the document on maternal and child health, with its integrated approach that was focused on priorities, leaving space for vertical programmes. With regard to the fourth Millennium Development Goal, reducing child mortality, the work that had been done in the French overseas territories was bearing fruit. In New Caledonia, maternal mortality had dropped to 30 per 100 000 live births, while the infant mortality rate, at 5.7 per 1000 live births, was comparable to that of developed countries. Premature births were down to 8.4%. In French Polynesia, thanks to the same measures, with outreach obstetric consultations in the small islands, there had been great and constant improvement between 2000 and 2005, with infant mortality falling from 6.9 to 4.4 per 1000 live births and maternal mortality steady at 17 per 100000. The greatest strides had been made in vaccination in both territories, with compulsory immunization against the diseases covered by the Expanded Programme on Immunization plus vira:! hepatitis B, Haemophilus infiuenzae B and pneumococcal disease vaccination attaining coverage rates in excess of98%. Ms GIDLOW (Samoa) said that the health-relat,~d
Millennium Development Goals were an
extension of the Declaration of Alma-Ata on the subject of primary health care. Samoa had made positive progress towards the achievement of those goals through its multisectoral collaboration with various partners, with particular emphasis on poverty reduction, education, gender equality, and the accessibility, quality and efficiency of its health system. The health system reform currently under way in Samoa was supported by WHO and by such bilateral development partners as Australia, China, Japan, New Zealand and the World Bank. She voiced her country's commitment to Milltmnium Development Goals 4 and 5, even though the targets had already been exceeded. Samo;~
was currently immunizing against polio,
measles, rubella, tuberculosis, diphtheria, tetanus, pertussis and hepatitis B. With the support of WHO and UNICEF it planned to introduce Haemophilus influenzae B immunization in February 2009. It was difficult to ensure full immunization of children in a highly mobile popUlation, but the OOV<:lrmnent Wa~ Working Oil II trnckin~ system.
The national safe motherhood policy focused on antenatal, perinatal and postnatal care. Traditional birth attendants had been registered as part of the allied health workforce under new legislation. Nurses and midwives worked with traditional birth attendants through basic training programmes, with referral of high-risk pregnancies. AU traditional birth attendants now reported through the community health nursing information system.
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Ms NGUYEN THI MINH CHAU (Viet Nam) described her country's achievements and challenges in respect of the Millennium Development Goals, with remarkable reductions in the infant, under-5 mortality and under-5 malnutrition rates, as well as in the maternal mortality ratio. Many nutrition interventions and programmes targeted children and pregnant women. Immunization
coverage of children under one year of age had been in excess of 90% since 1993; the Expanded Programme on Immunization had been available in every commune since 1998, which made for equity in health care for children. Poliomyelitis had been eradicated in 2000, and neonatal tetanus eliminated in 2005. The country was aiming for measles elimination and nationwide coverage of Japanese encephalitis B vaccine by 2010, and was able to produce nine out of the 10 vaccines provided free of charge under the EPI. Children under six years of age received free health care. However, there were challenges. A common problem was financial shortage. For example, Government funding covered only 60% of EPI requirements; there were geographical and socioeconomic disparities in access to and utilization of health care; and hospitals were crowded and referrals unsatisfactory, resulting in high neonatal mortality. The Government would consider increasing investment III
health, in line with its
commitments to GAVI, and improve health care delivery. The speaker thanked GAVI, WHO, UNICEF and other donors for their support, which she hoped would continue. Future efforts would be focused more on maternal and newborn survival, including adolescent and reproductive health to reduce unintended pregnancies, with better maternal care to obviate avoidable complications, unattended deliveries and low birth weight. There would be a nutrition education programme and concerted implementation of the activities specified in the national plan for newborn health. Locally produced vaccines would be improved, adverse reactions after injection would be well controlled, and new vaccines would be added to the Expanded Programme on Immunization. Professor SANN (Cambodia) said that reducing maternal and child mortality was a high priority for his Government and reported on progress made in the country's child survival initiative. Investment in key interventions had improved child health, with infant and under-5 mortality decreasing by 30% between 2000 and 2005. More children survived, and they were healthier and better fed. The Government sought to further improve the situation by ensuring universal coverage with 12 evidence-based, cost-effective interventions that would scale up activities to improve child health. He thanked WHO for its technical and fInancial support, noting that unless efforts remained focused, coordinated and supported, the improvements might not be maintained. Maternal mortality had not improved over the previous five years, remaining at around 500 per 100 000 live births. Rural
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and poor populations were falling behind, and Cambodia's infant and child mortality rates were still among the highest in the Region. Child health did not always compete successfully for support: US$ 22 million had been allocated to communicable disease control, while maternal and child health had received under US$ 6 million. The Government of Cambodia fully supported the WHOIUNICEF Child Survival Strategy and its focus on Millennium Development Goals 4 and 5. The continuing support of WHO was required in order to improve maternal and child health. Ms LANGIDRIK (Marshall Islands) reaffirmed her country's commitment to Millennium Development Goals 4 and 5. Improvement of child survival in the Marshall Islands depended on child rearing and the health of mothers. The public health and hospital-based maternal and child health programme provided the necessary services and relevant information for the general public. Prenatal, perinatal and postnatal care were available to mothers and children. Immunization coverage was 87%. Thanks to the Centers for Disease Control in the United States of America, and to WHO, the Marshall Islands received vaccines that might not all be available in other countries. The country would continue to use the health measures advocated by WHO and other health organizations. Mothers were not only dying during pregnancy and delivery, young mothers were also dying of cancer. The rate of cancer in the Marshall Islands was probably the highest in the Pacific and it therefore had to be included in maternal and child health programmes. If the Millennium Development Goals were to b,: met, reliable data were needed from health information systems. That had been lacking, especially where health centres and communities were scattered, and electricity supplies unreliable, so that data were not regularly updated. For example, the 1999 census showed that the country had a total population of 60 000. In the proposed budget for 2004, however, the figure was 61280. Recently, however, it had been estimated that, with migration to the United States, the actual population was 52 000. That meant that health indicators would have to be changed, and a decision would have to be taken on which census figures to use as a base. Advice from WHO would be needed. Ms HALTON (Australia) welcomed the report; Australia was willing to continue its assistance in many relevant areas. The report pointed out: that achievement was patchy and not up to tile !lIIlbitious UU"gets. As the document stated, there was a need, not only need for strengthening health systems, but also for improvement of the social and non-health factors in achievement of Millennium Development Goals. It was therefore important that experts in health engage with key interlocutors in other systems. Australia had its problems with health services for indigenous peoples; it was clear that health services were necessary but alon,:, were not sufficient for the achievement of good health. WHO had to be aware that there were mlmy working to achieve the MDGs and the Organization should strive to coordinate with all those who were working towards the same goals.
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Dr DUQUE (Philippines) said that the main challenges to the attainment of the health-related MOOs were the continuing inequities in health, the need to increase investments in health and the requirement to ensure ownership and expand partnerships for all health stakeholders. The Philippines was currently developing a system to track inequities in health and target interventions to poor and marginalized population groups. Governments should institute such systems and should increase public investment in health, which must include strengthening the capacity of health systems to use the increased investment efficiently. Community initiatives should be strengthened and approaches should be localized. Intersectoral approaches would facilitate resource generation, access to information and synergistic implementation of activities. Partnerships should include civil society, business and other economic groups, and the environment, employment and education sectors. The Philippines was moving in that direction with the establishment of the Philippines Coalition against Tuberculosis, the Public-Private Partnership in Women's Health and the Malaria Network. His country supported the proposed actions for improving child survival outlined in document WPRJRC58/6, and suggested the strengthening of injury prevention and control activities, which
should include the promotion of safe toys, an emerging concern. The Philippines was making a start in those areas and was already implementing the WHOIUNICEF Regional Child Survival Strategy. It was also implementing a policy to expand facility-based deliveries attended by skilled health personnel through the establishment of a network of emergency obstetric care services, and other strategies to reduce maternal and neonatal mortality. The Philippines also supported the proposed actions for combating HIV IAIDS and tuberculosis outlined in document WPRJRC5817. The country was approaching the prevention and control of HIVI AIDS with a spirit of universal access commitments aimed at maintaining the current low prevalence of HIV infection of less than 1% in at-risk groups and the general population. Treatment and care was being provided for people living with HIV/AIDS. Strategic actions had included extension of care and treatment, and expansion of the prevention and the sexually transmitted infections programmes. Expansion of the strategic information and surveillance system and collaboration with tuberculosis programmes were also under way. He suggested that support should be provided to study the determinants of the low HIV prevalence in his country with a view to sharing that information with other Member States. The tuberculosis detection rate in the Philippines had improved from 73% in 2005 to 75% in 2006, thereby meeting the global target, and the cure rate had increased from 80% to 83% over the same period. The Department of Health was implementing a public-private mix directly-observed treatment, short course (DOTS) strategy in collaboration with the Philippines Coalition against
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Tuberculosis and the private sector to sustain those achievements. It was also giving emphasis to the treatment of multidrug-resistant and extensively drug-resistant tuberculosis. Dr KUARTEI (Palau) supported the proposed actions for improving child survival. He expressed appreciation to the Government of the United States of America for the support it had provided to his country in that area, and encouraged WHO to seek stronger partnerships between the health and education sectors, and to pay greater attention to the role of fathers in child survival. Dr MATHESON (New Zealand) said that there was consensus on the obstacles to the attainment of the health-related MDGs: inadequacies in resources, coordination, primary health care infrastructure, health system development and orientation, and the integration of health with other sectors. It was now time to move on from identifying the problems to quantifying the gaps, seeking solutions and specifying those who should take responsibility for implementation of those solutions. For example, in relation to resources, how great were th~!
needs and should the solution be sought at
country level or with other donors? Was the Regional Committee a sufficiently broad forum for addressing coordination gaps or should other mechanisms be established to support WHO's leadership role? Member States should take a positive and proactive approach: the MDGs were attainable. However, solutions to the current problems must be found in the course of the 2007-2008 biennium, and WHO must be closely involved in programme activities. Dr GAFA (Niue) acknowledged the support provided by UNFPA, WHO and New Zealand in support of Niue's activities to attain the MOOs. MDGs 1 and 2 had been attained and progress towards MDGs 4 and 5 was excellent, with immunization coverage of 97%, a low infant mortality rate, and almost 100% of births attended by trained health professionals. However, the use of contraception was resulting in a declining birth rate. As regards MDG 6, activities on malaria and tuberculosis were making good progress but the HIV/AIDS programme had stalled owing to the diversion of scare resources to noncommunicable diseas~:
and emergency preparedness programmes.
Problems relating to MOO 7 (ensuring environmental sustainability) included the use of solid fuels, the accumulation of discarded vehicles and white goods, which provided a habitat for rodents and mosquitoes, the danger of contamination of the water table, and the remaining asbestos roofmg on
many hOUlles, New Zealand and the South Pacific Applied Geoscience Commission had provided V1\luIlPI~
support in that area. In relation to MDG 8 (developing a global partnership for development),
Niue had drafted a policy on rational use of essential medicines but, because of human resource constraints, the policy had not yet been considered in cabinet. Ms BACIGALUPO (Nauru) said that, with the support of WHO, the Japan International Cooperation Agency (nCA) and other donors, Nauru had succeeded in reducing its maternal mortality
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135
ratio and had increased immunization rates, in some areas to 100%, through an aggressive outreach programme. She endorsed the comments made by the representative of the Marshall Islands. Nauru had also seen a significant increase in cancer-related deaths in women of child-bearing age, principally from cervical cancer associated with the human papilloma virus. The social and economic costs of those deaths were significant and Nauru was therefore conducting a "well-woman" screening programme. She urged WHO to consider providing support for the introduction of the human papilloma virus vaccine for relevant age groups. The vaccine was expensive and beyond the means of countries such as her own. Dr TANGI (Tonga) observed that the comments of previous speakers had clearly indicated that, although simple solutions were available for most of the problems related to MDGs 4 and 5, and Member States and WHO were well aware of the magnitude of those problems, action had still not been taken in many countries. It was simply unacceptable, for example, that half a million women in the Region should continue to die each year during pregnancy or childbirth. At the invitation of the CHAIRPERSON, statements were made by the representatives of the International Council for Control of Iodine Deficiency Disorders and World Vision International. The DIRECTOR, BUILDING HEALTHY COMMUNITIES AND POPULATIONS thanked representatives for their comments and commended Member States and other partners on their achievements in the area under discussion. She agreed with the representative of Australia on the need for careful coordination, given the increasing number of partners in the field of maternal and child health, and confirmed that other forums were being convened in which a wide variety of partners would be represented. Although resources were still inadequate, recent gains had permitted the further extension of activities to the country level. She endorsed the call by the representatives of Japan and the United States of America for greater efforts to generate resources within countries that would sustain national activities. She also endorsed the proposal made by the representatives of the Marshall Islands and Nauru that greater attention should be paid to cervical cancer prevention and control in the Pacific island countries and areas: efforts were already being made in that area in Mongolia and Viet Nam. Viet Nam was to be commended for the excellent progress it had made towards the attainment ofMDGs 4 and 5. The representative of Tonga had rightly drawn attention to the fact that the knowledge was available to implement interventions to reduce maternal and childhood morbidity and mortality and that it was time to translate that knowledge into action. WHO would do its best to support countries in that regard. The REGIONAL ADVISER, CHILD AND ADOLESCENT HEALTH, thanking
representatives for their comments, said that maternal and child health care was at the heart of health
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REGIONAL COMMITTEE: FIFTY -EIGHTH SESSION
services development and vice versa, and that the Regional Committee's call for a maintained focus on MOOs 4 and 5 by Member States and the international health community was therefore most timely. A comprehensive approach and multisectoral collaboration that combined cost-effective technical and social interventions were essential to reach those in greatest need. Steps to solve the human resource crisis to improve skilled health professional attendance during pregnancy and the perinatal period, and financial protection mechanisms for poor people would undoubtedly improve maternal health and child survival. Several countries had developed national policies and strategic plans for child survival. It was now time for coordinated scaling up of plans in a country-specific manner, with a clear expression of government investment, together with effective costing, budgeting and implementation district by district, starting with areas of greatest need. Such a procedure was under way in a number of countries and Cambodia had shown how effective it could be. It was vital to track progress in order to solve problems, collect reliable data and stimulate further action. In that context, WHO and UNICEF would be convening a joint expert consultation in Cambodia in October 2007 to devise a regional measurement strategy. The REGIONAL ADVISER, EXPANDED PROGRAMME ON IMMUNIZATION thanked representatives for sharing their experiences, plans and !;uggestions. Member States had made good progress in achieving regional EPI goals and there was iIlcreased demand for the introduction of new and underused vaccines. The high cost of new vaccines was the main obstacle to their introduction, even when they were demonstrated to be cost-effective. WHO was seeking partners to help fund immunization programmes. For example, GAVI was supporting several of the poorest countries in the Region. Innovative strategies to reduce vaccine costs, such as· advance market commitments, were also being sought, and increased capacity for new vaccine production encouraged, especially in developing countries. As indicated by the representative of the Republic of Korea, it was vital for countries that had declared the elimination of measles to maintain surveillance and immunization at a high level. There was also a need to speed up progress towards regional elimination of the disease. The ASSISTANT DIRECTOR-GENERAL congratulated the Member States of the Region on their achievements in the area under discussion, which were the most successful in the
TIl resP"p.sQ til IlOJIllIltlnts ftlillteq til coofPination, she Ilgreed that !pe inpreas!p.~ momentum in activities to attain MDGs 4 and 5 had drawn in more partners and that it was vital to Org!mi~~t!gn.
ensure adequate coordination of the many new initiatives. She reassured the Regional Committee that WHO was paying great attention to that area and was working closely with partners. For example, it was hosting the Partnership for Maternal, Newborn and Child Health, and was participating in the consolidated initiatives now called the Global Campaign for the Health MDGs. The collection of
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reliable data was vital to the attainment of the health-related MDGs and she therefore agreed that technical support should be provided to Member States to increase their capacity in that area. The meeting rose at 17:20.