Meeting of advisory committee (ACM) to review technical matters to be discussed at the sixty-first session of the Regional Committee

Meeting of Advisory Committee (ACM) to Review Technical Matters to be discussed at the Sixty-first Session of the Regional Committee Report of the Meeting WHO/SEARO, New Delhi, 30 June – 3 July 2008 Regional Office for South-East Asia SEA-PDM-13 Distribution: Restricted Meeting of Advisory Committee (ACM) to Review Technical Matters to be discussed at the Sixty-first Session of the Regional Committee Report of the Meeting WHO/SEARO, New Delhi, 30 June – 3 July 2008 Regional Office for South-East Asia © World Health Organization 2008 All rights reserved. This health information product is intended for a restricted audience only. It may not be reviewed, abstracted, quoted, reproduced, transmitted, distributed, translated or adapted, in part or in whole, in any form or by any means. The designations employed and the presentation of the material in this health information product do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. The World Health Organization does not warrant that the information contained in this health information product is complete and correct and shall not be liable for any damages incurred as a result of its use. Printed in India Page iii Contents Page Introduction ....................................................................................................................1 1. Inaugural session (agenda 1) .................................................................................1 2. Technical matters (agenda item 2)........................................................................2 2.1 Tobacco Control: Progress and plans for implementing FCTC (agenda item 2.1)......................................................................................................2 2.2. Managing human resources for accelerating reduction of maternal and neonatal mortalities (agenda item 2.2) ......................................................................4 2.3. Responding to emerging and re-emerging vector-borne diseases (agenda item 2.3)......................................................................................................7 2.4. Public health approach to combating HIV/AIDS (agenda item 2.4)....................................................................................................10 2.5. Regional Initiative on Environment and Health (agenda item 2.5)....................................................................................................13 2.6 UN reform process and health partnerships: Progress and developments (agenda item 2.6)....................................................................................................15 3. Technical Discussions: Selection of a subject for the Technical Discussions to be held prior to the Sixty-second session of the Regional Committee (agenda item 3) ....................................................................................................18 4. Governing bodies (agenda item 4)......................................................................19 4.1 Review of the decisions and resolutions of the Sixty-first World Health Assembly and the 122nd and 123rd sessions of the WHO Executive Board (agenda item 4.1)....................................................................................................19 4.2 Review of the draft provisional agendas of the 124th session of the WHO Executive Board and the Sixty-second World Health Assembly (agenda item 4.2)....................................................................................................21 5. Follow-up on selected resolutions/decisions of the last three years (agenda item 5) ....................................................................................................23 5.1 South-East Asia Regional Health Emergency Fund (agenda item 5.1).......................23 5.2 Challenges in Polio Eradication (agenda item 5.2)...................................................24 5.3. International migration of health personnel: A challenge for health systems in developing countries (agenda item 5.3)..................................................27 5.4 Regional Strategy for Health Promotion (agenda item 5.4) ......................................29 5.5 Update on scaling up prevention and control of chronic noncommunicable diseases and alcohol consumption control (agenda item 5.5) ..................................30 Page iv 6. Reports by Country Representatives on their attendance at the Meetings of the Coordinating Bodies of WHO’s Global Programmes (agenda item 6) ....................................................................................................34 6.1 UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases: Joint Coordinating Board (JCB) (agenda item 6.1)...................34 6.2 UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction: Policy and Coordination Committee (PCC) (agenda item 6.2).................................34 7. Agenda items to be discussed in the Health Ministers’ Meeting (agenda item 7) ....................................................................................................35 7.1 Millennium Development Goals (agenda item 7.1) .................................................35 7.2 Climate change and health (agenda item 7.2) .........................................................37 8. Other agenda items (agenda item 8)..................................................................40 8.1 Geographical rotation of Director-General (agenda item 8.1)..................................40 8.2 Equitable geographical distribution of the membership of the Executive Board (agenda item 8.2)....................................................................................................40 Additional Agenda items..............................................................................................42 1. Pandemic influenza preparedness: Sharing of influenza viruses and access to vaccines and other benefits ....................................................................................42 2. Counterfeit medical products .................................................................................43 Adoption of report........................................................................................................45 Closure ..........................................................................................................................45 Annexes 1. Agenda .................................................................................................................46 2. List of participants................................................................................................48 Page 1 Introduction The Meeting of the Advisory Committee (ACM) to Review Technical Matters to be discussed at the Sixty-first Session of the Regional Committee was held at the WHO Regional Office for South-East Asia (SEARO), New Delhi, from 30 June to 3 July 2008. Senior government representatives from Member countries of the South-East Asia (SEA) Region participated in the meeting. The agenda and list of participants are attached as Annexes 1 and 2, respectively. 1. Inaugural session (agenda 1) Opening remarks by the Regional Director Welcoming the distinguished delegates, Dr Samlee Plianbangchang, Regional Director, WHO South-East Asia Region, stated that the main purpose of the meeting was to review in depth and in detail the technical matters to be discussed at the Sixty-first Session of the WHO Regional Committee for South-East Asia to be held in September 2008. Dr Samlee mentioned that the provisional agenda of the Sixty-first Session of the Regional Committee comprised many important technical issues or subjects. Several of these issues or subjects had been proposed by some Member States in the Region. Since the Sixty-first Regional Committee would have very limited time, a little more than two days, to deliberate upon all technical items, the ACM had been convened in order to go through all those technical agenda items in depth and in detail. The outcomes of deliberations of the meeting of the Advisory Committee would be submitted to the Regional Committee, item by item, for its consideration and decision. This meeting was therefore, critically important in ensuring the successful completion of the agenda by the Regional Committee. The Regional Director expressed confidence in the deliberations of the Advisory Committee meeting contributing greatly to an efficient and quality outcome of the Sixty-first Session of the Regional Committee. In conclusion, Dr Samlee encouraged all participants to ensure excellent products from the meeting. Report of the ACM to Review Technical Matters to be discussed at the 61st Session of the RC Page 2 Nomination of Chairperson, Co-chairperson, Rapporteur and Drafting Group H.E. Professor Mya Oo, Deputy Minister, Ministry of Health, Myanmar was nominated as Chairperson and Dr Gado Tshering, Secretary, Ministry of Health, Bhutan was nominated as Co-Chairperson. Dr Sopida Chavanichkul, Director, Bureau of International Health, Ministry of Public Health, Thailand was nominated as Rapporteur, while Dr Yusharmen (Indonesia), Dr Laxmi Bikram Thapa (Nepal) and Dr S.M. Samarage (Sri Lanka) were nominated as members of the drafting group. 2. Technical matters (agenda item 2) 2.1 Tobacco Control: Progress and plans for implementing FCTC (agenda item 2.1) Introduction The Secretariat emphasized that the tobacco epidemic is a major global public health problem. Tobacco use is growing fast in developing countries. Some Member countries of WHO’s South-East Asia (SEA) Region are major tobacco producers. A majority of males in these countries are users of tobacco in some form. People not only smoke tobacco, but also use smokeless tobacco products in many forms. For more than two and a half decades, World Health Organization and its members along with other stakeholders debated the effective prevention and control of tobacco use globally. An international treaty, the WHO Framework Convention on Tobacco Control (WHO FCTC) was unanimously adopted at the Fifty-sixth World Health Assembly in May 2003 (Resolution WHA56.1) in response to the global tobacco epidemic. The WHO FCTC came into force in February 2005. Ten out of 11 Member countries from the Region are party to the Convention. As decided by the second session of Conference of Parties held in Bangkok, Thailand in 2007, a Protocol for the Convention on Illicit Trade in Tobacco Products is currently being negotiated. Meanwhile, the WHO Report on the Global Tobacco Epidemic 2008 has recommended a six- point policy package called MPOWER for effective tobacco control. These policies are: Report of the ACM to Review Technical Matters to be discussed at the 61st Session of the RC Page 3 � Monitor tobacco use and prevention policies (Article 20) � Protect people from tobacco smoke (Article 8) � Offer help to quit tobacco use (Article 14) � Warn about the dangers of tobacco (Article 11) � Enforce bans on tobacco advertising, promotion and sponsorship (Article 13 ) � Raise taxes on tobacco (Article 6) Discussion points � All Member countries expressed their broad consensus on tobacco control and the measures required to manage this public health problem. The Ministry of Health should take the lead role in mobilizing the multisectoral collaboration. It is proposed to include this thematic issue in the agenda of the Meeting of Health Ministers of the Region. � Studies on tobacco-related mortality and morbidity have to be undertaken to assess the effectiveness of interventions. Trends in tobacco consumption need to be regularly monitored by the Member countries. � Measures for demand reduction such as education on the harmful effects of tobacco use should be included in school curricula. This includes a complete ban on advertising, promotion and sponsorship of all tobacco products. � There is a need to strengthen the measures concerning tobacco dependence and cessation. � The importance of continuous advocacy and leadership by the national coordination mechanism to enhance and sustain the multisectoral collaboration was highlighted. � Tobacco control cannot be a stand-alone agenda. Efforts need to be integrated with those of health promotion and control of noncommunicable diseases, diet, physical activity and other related issues. � It has been noted that there is evidence-based information on economic aspects of tobacco taxation and efforts to increase tax on tobacco products should be made in close consultation with the Ministry of Finance. Report of the ACM to Review Technical Matters to be discussed at the 61st Session of the RC Page 4 Recommendations Action by Member States (1) To encourage implementation of the six-point MPOWER policy package as advocated in the WHO Report on the Global Tobacco Epidemic 2008; (2) To establish/strengthen national coordinating mechanisms and national regulatory authorities with provision of adequate resources to implement the WHO FCTC; (3) To take an active part in the development of guidelines for implementation of various provisions of the Framework Convention as well as in the negotiations on the protocols to the Framework Convention; (4) To organize national forums and consultative meetings of key stakeholders including civil society organizations in order to review various innovative financing options, including the use of dedicated taxation from tobacco to implement activities for promoting health. Action by WHO/SEARO (1) To continue strengthening its Tobacco-Free Initiative programme; to support Member countries in implementing national tobacco control programmes in accordance with the WHO FCTC, and to help implement the Framework Convention and its protocols effectively; (2) To continue to mobilize resources to support tobacco control efforts in the Region. 2.2. Managing human resources for accelerating reduction of maternal and neonatal mortalities (agenda item 2.2) Introduction The Secretariat stated that community-based health providers for maternal and newborn health (MNH) in some countries of the Region are often insufficient in numbers, as well as in their midwifery skills. As a result, there is limited access to skilled care at birth, especially for marginalized communities. Also, specialists are very limited in number and are usually Report of the ACM to Review Technical Matters to be discussed at the 61st Session of the RC Page 5 concentrated in urban areas. The lack of and inequity in access to skilled care at birth, emergency obstetric care and management of newborn problems hamper the efforts to reduce maternal and neonatal mortality as targeted in MDGs 4 and 5. To address these challenges, it is proposed that all Member countries in the Region strengthen national databases on human resources for MNH; develop a long-term national plan to address the gaps of human resources for MNH by category and ensure adequate resources and effective implementation; strengthen human resource management for MNH services; and work with partners, nongovernmental organizations and stakeholders in developing a clear policy and plan on skilled birth attendants. Besides those actions at the policy level, other actions are also needed at the entry level for preparing the workforce; at the workforce level for enhancing performance; and at the exit level for managing attrition. WHO is to advocate for increased investment in human resources for MNH and to work with Member countries in addressing the key challenges. Discussion points � The issues and challenges of human resources for MNH at policy, entry, workforce and exit levels are well recognized by all Member countries. This needs to be backed up with referral services for women with obstetric complications and newborns with problems. � It was recognized that the duration of education for skilled birth attendant (SBA) varies among Member countries. However, in the long- term, strengthening of midwifery pre-service education should be given adequate attention. Competency-based training in midwifery needs to be ensured both in pre-service and in-service midwifery training. � The private sector, professional organizations and society should be encouraged to collaborate with the government in addressing the shortage of SBAs. � The need for SBAs can be fulfilled in a phased manner along with the efforts to strengthen training in midwifery. � With the shifting role of traditional birth attendants (TBAs) to the sociocultural aspect of maternal and newborn health care in some countries of the Region, it is also important that SBAs develop a good partnership with them. Report of the ACM to Review Technical Matters to be discussed at the 61st Session of the RC Page 6 � There are disparities of access to skilled care at birth within countries because of geographic difficulties, remoteness and areas of conflict. Policies on placement, special allowance and rewards for SBAs assigned in these areas have been implemented to some extent. The problem remains in retention of health workforce in the underserved areas. Therefore, innovative measures need to be implemented by central or local government to address this issue. � The use of evidence-based standards, guidelines and tools in this area would help countries to move forward. Also, research to analyse and monitor the magnitude of investment in human resources and its impact on MNH outcomes would provide direction in addressing the issues. Recommendations Action by Member States (1) Identify innovative strategies and actions to address the issues and challenges of human resources for MNH at policy, entry, workforce and exit levels, taking into account the sociocultural context in countries; (2) Build common understanding on the training of skilled birth attendants (SBA) and utilize evidence-based information on the impact of socio-cultural factors on MNH; (3) Arrange training for the existing health workers to meet the needs of birth attendants of the Member countries as interim measures, as required; (4) Provide more attention to key areas of MNH, i.e. newborn health and its dependence on maternal health, maternal nutrition and breastfeeding, post-partum haemorrhage, etc., and ensure that such aspects are included in training of SBAs for MNH; (5) Utilize community-based health workers and volunteers in providing psychosocial support to mothers and families along with other public health interventions. Report of the ACM to Review Technical Matters to be discussed at the 61st Session of the RC Page 7 Action by WHO/SEARO (1) Provide country-specific guidance in managing health workforce in MNH and advocate for relevant policy issues; (2) Collaborate and coordinate with other UN agencies and development partners in addressing the issues and challenges of human resources and other MNH programme issues to foster the implementation of actions in an integrated manner; (3) Promote the use and implementation of evidence-based policies, standards and tools for improving human resources for MNH. 2.3. Responding to emerging and re-emerging vector-borne diseases (agenda item 2.3) Introduction The Member countries of the South-East Asia Region are burdened with diverse vector-borne human diseases, especially malaria, dengue/dengue haemorrhagic fever, lymphatic filariasis, visceral leishmaniasis (kala-azar), Japanese encephalitis, chikungunya, rodent-borne viruses and arboviruses which continue to pose serious threats to human health, with considerable health and socio-economic impact. Also at the global level, a serious threat has emerged by new, emerging and re emerging vector-borne infectious diseases. The Region has experienced a gradual increase in outbreaks of dengue, malaria and other vector-borne diseases. These diseases are closely associated with climatic conditions, although response patterns vary. Some other diseases may be more prevalent in the Region as a result of global warming and climate change. Higher temperatures, in combination with conducive patterns of rainfall and surface water, will prolong transmission seasons in some endemic locations. In other locations, global climate changes may decrease transmission through reduced rainfall or temperatures that are generally too high for transmission. In all such situations, the actual health impacts of changes in potential vector-borne diseases transmission will be strongly determined by how effective the public health system infrastructure is. Deforestation, poor water management, migration and lifestyle changes are other important factors related to vector-borne disease transmission. Report of the ACM to Review Technical Matters to be discussed at the 61st Session of the RC Page 8 The enhanced visibility of emerging and re-emerging vector-borne disease control and application of strategies would require sustained high- level political commitment. WHO will continue extending support to Member countries to strengthen their vector-borne disease control and elimination programmes to culminate in the achievement of the Millennium Development Goals related to vector-borne disease control and elimination targets, through implementation of a comprehensive regional strategy. Discussion points � Control of vector-borne disease is making good progress in all Member countries. However, disease surveillance systems need to be further strengthened. � There is a need to strengthen capacity in medical entomology through training at country and regional levels. Entomological studies are also essential for dengue and other vector-borne diseases. � The health impact of global warming and climate change are felt in many Member countries. Member countries reported Japanese encephalitis, dengue haemorrhagic fever, malaria and kala-azar in previously non-reporting areas. It is noted that dengue is now spreading from urban to rural areas. � Vector-borne diseases are problems at several international borders. There is a need to strengthen the cross-border collaboration, especially with neighbouring countries in SEA and other regions. Intercountry informal dialogue will also be important. � Dengue is one of the major public health problems and is increasing in the South-East Asia Region. Paediatric vaccine development is an important area to be accelerated. � Private sector involvement in vector-borne disease control and case management is very important. There are good examples of private- public partnerships and community involvement. � Needs-based comprehensive health education in schools about VBDs was emphasized. � Importance of non-health sector involvement, for example in the area of animal health, was highlighted. Report of the ACM to Review Technical Matters to be discussed at the 61st Session of the RC Page 9 � The contribution of the Global Fund and WHO was acknowledged. To make the maximum use of the fund, training and research in the area of vector-borne diseases needs to be addressed. � A Strategic Plan in Collaboration with WPRO and partners through Asia Pacific Dengue Partnerships (APDP) should be implemented in the SEA Region. Recommendations Action by Member States (1) To accelerate the development and implementation of national vector-borne disease control programmes that are consistent with the regional strategy for vector-borne disease control; (2) To promote intersectoral collaboration and coordination with other ministries, such as environment, education, tourism, rural development and agriculture for the implementation of vector-borne disease control programmes; (3) To enhance intercountry cooperation through multicountry activities (MCAs) to establish and strengthen linkages between researchers and academic institutions; (4) To strengthen internal and cross-border surveillance to assess the burden of vector-borne diseases; (5) To scale up effective interventions to prevent emergence of drug- resistant malaria in Member countries; (6) To implement kala-azar and lymphatic filariasis elimination programmes to achieve the regional target; (7) To incorporate Japanese encephalitis immunization programmes into the Expanded Programme on Immunization (EPI), where appropriate; (8) To implement and monitor an effective integrated vector management programme; (9) To explore the use of global funds available for malaria for a collective response to other vector-borne diseases. Report of the ACM to Review Technical Matters to be discussed at the 61st Session of the RC Page 10 Action by WHO/SEARO (1) To provide educational training, technical support and advocacy for the mobilization of additional financial resources for strengthening the vector-borne disease control programme; (2) To collaborate with the Regional Office for the Western Pacific in implementation of strategic plan for the prevention and control of dengue in the Asia-Pacific region; (3) To provide technical support to accelerate development of paediatric dengue vaccine; (4) To support Member countries in assessing the disease burden and transmission pattern through disease and vector surveillance, including drug resistance monitoring; (5) To strengthen intersectoral collaboration between Member countries and stakeholders to share information concerning prevention and control of vector-borne diseases; (6) To support Member countries in establishing pharmacovigilance for kala-azar and malaria; (7) To promote operational research as a key priority in the area of vector-borne disease management; (8) To develop a regional strategic plan and guidelines for the management of chikungunya. 2.4. Public health approach to combating HIV/AIDS (agenda item 2.4) Introduction The HIV epidemic continues to take its toll in the SEA Region. Member countries in the SEA Region have demonstrated that implementing an effective response is feasible, both to halt and reverse epidemics and to provide services to those in need. To date, efforts to scale up HIV/AIDS programmes have involved a variety of different service delivery models, guidelines and tools for multiple HIV/AIDS interventions. Countries seeking to scale up HIV/AIDS health services to achieve universal access will benefit by adopting a service delivery model that brings together the best of these approaches and will help to compensate for the significant health systems challenges that many of them face. Report of the ACM to Review Technical Matters to be discussed at the 61st Session of the RC Page 11 WHO promotes a public health approach to the delivery of health services for HIV/AIDS, drawing upon the successful experiences of other health programmes. The four steps of the approach are: (1) Define the problem and the risk factors; (2) Find out what works to control the disease; (3) Scale up effective interventions in a wide range of settings; and (4) Monitor/evaluate the impact and cost-effectiveness of these interventions. The key lessons for a public health approach to HIV include: (1) The health sector’s role is central in the overall national response to the epidemic; (2) A scaled-up integrated package of prevention, treatment, care and support services is necessary to halt and reverse the epidemic and mitigate its impact; (3) Implementing a scaled-up response to the HIV epidemic requires effective programme management, trained human resources and robust health systems. Discussion points � Member countries shared their experiences in the implementation of the public health approach and highlighted the policies, strategies and interventions that were being pursued. Representatives felt that sharing of experiences is very important to provide peer support. � HIV/AIDS interventions should be based on prevalence rates as well as on incidence rates, if possible. � Though the health sector has the major role and therefore spearheads the public health approach, other sectors have to play their roles as well; this issue should be considered at the highest levels (e.g. parliament). � Scaling up interventions is a problem in Member countries because of many constraints such as the cost of ARVs, poor infrastructure and lack of understanding of clear policies and strategies. Drug resistance will complicate matters further. There is a need to re-emphasize the Report of the ACM to Review Technical Matters to be discussed at the 61st Session of the RC Page 12 policies and strategies that exist and use the resources available from the Global Fund to scale up interventions. � In scaling up interventions, not only traditional priority groups (sex workers, injecting drug users and men who have sex with men) should be given priority, but also prisoners. Prevention of mother-to-child transmission (PMTCT) should be prioritized given the stage of the epidemic and the tremendous impact that it will have. Rehabilitation facilities for intravenous drug users need to be operational. Operational research is also an important area. � Successful interventions, such as the 100% condom use, need to be reviewed and re-emphasized so that interventions can be adapted for implementation over time. Further market surveys to ensure quality of condoms should be sustained. � With many players active in the field of HIV/AIDS work, WHO’s role should be clear so that there is no confusion and overlap. � Cross-border cooperation and collaboration is an important area in combating HIV/AIDS. Other means, such as informal meetings focused at the local level, also should be considered. Involvement of regional organizations like ASEAN and SAARC should be continued. Recommendations Action by Member States (1) Under the overall multisectoral approach to combating HIV/AIDS, the public health approach and role of health sector should be further strengthened in all Member States by: � Reviewing and updating strategic information, including HIV/STI surveillance and research; � Scaling up appropriate HIV prevention in relevant population groups to have the desired impact on the epidemic and to meet the MDG goals by strengthening health systems using the available resources; � Expanding antiretroviral (ARV) treatment, giving priority to prevention of mother-to-child transmission and TB/HIV interventions; and Report of the ACM to Review Technical Matters to be discussed at the 61st Session of the RC Page 13 � Conducting programme reviews to measure progress, identify challenges and use the opportunity for advocacy at the country level. (2) Strengthen cross-border collaboration and develop effective coordinating mechanism to combat HIV/AIDS. Action by WHO/SEARO (1) To facilitate and support cross-border coordination and collaboration to discuss innovative mechanisms for control of HIV/AIDS, TB and vector-borne diseases; and (2) Continue the support that is required by Member States in the health sector response to HIV/AIDS. 2.5. Regional Initiative on Environment and Health (agenda item 2.5) Introduction The Secretariat introduced the topic by informing that the WHO Global Strategy for Health and Environment, endorsed by the World Health Assembly in 1993, was followed by the SEA Region Regional Initiative on Environment and Health. To implement it, a Regional Strategic Plan for Health Environment was developed in 1995 and National Environment and Health Action Plans (NEHAPs) were identified as the operational backbone for this initiative. By 2004, nine SEA Region countries had NEHAPs. Key areas reflected in the NEHAPs were unsafe water and poor sanitation, the need for management of hazardous wastes, outdoor and indoor air pollution and challenges posed by occupational health, chemical safety and food safety. Boosted by the regional initiative SEA Region countries have achieved significant successes in sanitation and water supply coverage, in developing national capacities and legislation for the management of hazardous chemicals and of health care wastes and in increasing food safety. Yet, more could have been done with more resources. As an example, the Secretariat highlighted that the current burden of disease due to poor water supply and sanitation in the Region is estimated by WHO to be close to 8.5% of the total disease burden. However, the 2008-2009 WHO SEA Region budget allocation for environment and health activities is only 2% of the total budget used in the Region. Report of the ACM to Review Technical Matters to be discussed at the 61st Session of the RC Page 14 The Secretariat stressed the need for more investment to address the environmental factors affecting health. The Secretariat briefed the committee on the Regional Ministerial Forum for Environment and Health (RMFEH), whose first meeting was held in Bangkok in August 2007, and on its six technical working groups assigned to implement the Ministers’ Plan of Action for Environment and Health. Current membership of RMFEH constitutes only ASEAN countries and thus only Indonesia, Myanmar and Thailand are from the SEA Region. The RMFEH recommended the use of NEHAPs as the main national reference document. The Secretariat said that WHO would be able to support countries in this process. Discussion points � All Member countries confirmed the health significance of environmental factors, including global warming and climate change; � All noted that so far, environmental health has been neglected and there is an urgent need for an increased budget allocation to this area; � All committee members agreed that there was an urgent need to develop/ update the existing NEHAPs and to ensure that they are fully endorsed by national authorities. � Sri Lanka shared several success stories of collaborative multisectoral activities (integrated pest and vector management together with Ministry of Agriculture, promoting healthy settings projects in schools with Ministry of Education and NGOs, developing environmental safety regulations with the Ministry of Environment); � Thailand stressed that the NEHAPs’ implementation has come along and recommended streamlining regional action with the activities of the Regional Ministerial Forum for Environment and Health. Recommendations Action by Member States (1) Increase financial resources for better environmental health; (2) Develop/update NEHAPs, including emerging environmental health issues; Report of the ACM to Review Technical Matters to be discussed at the 61st Session of the RC Page 15 (3) Promote active participation of the private sector and of NGOs in environmental health programmes and compile success stories; (4) Promote healthy public policies; (5) Collaborate with the technical working groups of the Regional Ministerial Forum for Environment and Health. Action by WHO/SEARO (1) Assist Member countries in the review of NEHAPs; (2) Support Member countries to identify and address environmental factors and mitigate the adverse health effects; (3) Support research to assess risk factors and health impacts of global warming and climate change; (4) Provide technical support and capacity building for health impact assessments, strategies for healthy public policies and the sound management of hazardous substances, including health-care waste. 2.6 UN reform process and health partnerships: Progress and developments (agenda item 2.6) Introduction The Secretariat addressed three interrelated issues: UN reform; harmonization and alignment; and health partnerships. Recognizing that the Sixtieth Regional Committee for WHO’s South- East Asia Region deliberated on UN reform and its impact at country level, the update focused on three ongoing processes: (1) the intergovernmental negotiation on the Report of the UN Secretary-General’s High-Level Panel on UN System-wide Coherence; (2) the triennial comprehensive policy review of operational activities for development of the UN system (2007) and UN General Assembly Resolution 62/208 on the review; and (3) developments in the UN system at the global, regional and country levels. It was emphasized that the lessons from “Delivering as One” pilot initiative and the “New United Nations Development Assistance Framework (UNDAF)” process would continue to influence the work WHO does in support of Member countries. In relation to UN reform, WHO’s focus Report of the ACM to Review Technical Matters to be discussed at the 61st Session of the RC Page 16 remains the participation in the “Delivering as One” pilot countries and the UN Resident Coordination system; the Country Cooperation Strategy as its primary contribution to UNDAF process; building country office capacity to better support Member countries; and improving its efficiency and effectiveness to better serve Member countries. The secretariat also presented the work WHO is doing in building capacity for harmonization and alignment of development activities. In light of the increased number and importance of health partnerships, the meeting was briefed on the work done by WHO to streamline its engagement in health partnerships. Discussion points � UN reform is a continuous process that targets efficiency to maximize benefits for Member countries. � UN reform is complex and requires comprehensive analysis of its benefit for health outcomes at the country level. � Participants acknowledged that the importance of national leadership and ownership; that “no one size fits all”; and lessons from other countries should all be considered while pursuing any change for the UN at the country level. � Recognizing the respective mandates, roles and unique expertise of all UN funds, programmes and specialized agencies is essential for UN to work together. The need for WHO to coordination and work with other UN agencies/partnerships is apparent. � WHO’s leadership and mandate, its role as a directing and coordinating authority on international health and technical advisor for national authorities and its technical competence were appreciated. However, it was felt that its role should not diminish as a consequence of any UN reform. � The new UNDAF which is replacing the “Delivering as One” pilot is expected to provide greater consensus and better coordination among agencies at the country level. � UNDAF is an important tool to align and harmonize all UN agencies, working in line with national priorities. WHO should support countries in building capacity for engagement in UNDAF. Report of the ACM to Review Technical Matters to be discussed at the 61st Session of the RC Page 17 � The Country Cooperation Strategy is a useful guide for WHO’s work with countries and as WHO’s contribution to UNDAF. � There is a need for partnership management with External Development Partners and UN agencies in order to align and harmonize their support in health at the country level in line with the Paris Declaration. � Harmonization and alignment are areas where the WHO Regional Office and country offices could provide the necessary technical support and build national capacity. � WHO supports UN reform and cooperates fully while maintaining its own identity as a specialized agency; its leadership role in the health sector; its constitutional provisions; and its other roles to ensure maximum benefits and direct support to the Member States. Recommendations Action by Member States (1) To individually and collectively analyse how best they can move ahead for better coordination of external development partners and UN reform based on lessons learnt from other regions and countries. Action by WHO/SEARO (1) To continue cooperating in UN reform in line with WHO’s global policy to maximize the benefit for the health sector while maintaining its identity as a specialized agency for health; (2) To conduct and present an analysis to assist Member States’ engagement in UN reform; (3) To provide appropriate technical support to Member countries when necessary in elaborating/defining UNDAF; (4) To provide training to increase capacity in harmonization and alignment to Member countries, WHO country teams and partners; (5) To report updated information to the Regional Committee based on the outcome of the ongoing process; (6) To use the Country Cooperation Strategy as WHO’s contribution to UNDAF. Report of the ACM to Review Technical Matters to be discussed at the 61st Session of the RC Page 18 3. Technical Discussions: Selection of a subject for the Technical Discussions to be held prior to the Sixty-second session of the Regional Committee (agenda item 3) Introduction The Secretariat stated that the purpose of this agenda item was to provide a forum for an in-depth and wide-ranging review of various issues relating to the subject that were of regional interest (SEA RC5/R3). The discussions on this subject would also provide an opportunity for determining strengths, weaknesses and usefulness of the related WHO collaborative programmes, which could therefore be reinforced and further strengthened as necessary. The outcome of the discussions would also enable WHO to reorient, modify and appropriately plan its programmes. This would ensure relevant and necessary support to countries in the technical areas concerned. The working paper enumerated the subjects that have come up for technical discussion since 1994. The Secretariat put forward five subjects for consideration, based on the discussions at previous sessions of the Regional Committee, high-level policy meetings, such as Health Ministers’ Meetings, Health Secretaries’ Meetings, etc., and also based on the contemporary importance and relevance of the subjects to the Region. � Education and ethics in the rational use of medicines � Injury prevention and safety promotion � Tobacco control: meeting the obligations of the WHO FCTC � Intersectoral collaboration for control of zoonotic diseases � Reducing health effects of climate change Discussion points � Myanmar proposed the topic of reducing the health effects of climate change, since it affects the health status of people through increasing disease, malnutrition and death. � Developing countries, small islands and local communities are especially vulnerable to climate change because they are least able to prepare for and to adapt to its consequences. Report of the ACM to Review Technical Matters to be discussed at the 61st Session of the RC Page 19 � Other Member countries supported the topic of climate change with modification of the title. The subject of climate change for Technical Discussions should be rephrased as “Protecting human health from climate change”, to avoid any political connotations that might involve other sectors beyond health. � Reducing the health effects of climate change should include the adverse effects of noncommunicable diseases and injuries as well as communicable diseases. � Thailand proposed “Rational use of medicine” as a technical discussion topic since concrete recommendations could be made and implemented in the Region; the proposal was endorsed by Timor- Leste. � Bangladesh proposed “The role of education and ethics in health issues”. Recommendation (1) The ACM unanimously recommends that the Sixty-first Regional Committee endorse the topic on “Protecting human health from climate change” as a subject for technical discussion to be held prior to the Sixty-second session of the Regional Committee. 4. Governing bodies (agenda item 4) 4.1 Review of the decisions and resolutions of the Sixty-first World Health Assembly and the 122 nd and 123 rd sessions of the WHO Executive Board (agenda item 4.1) Introduction Introducing the agenda item, the Secretariat stated that the working paper highlighted the following most significant and relevant decisions and resolutions emanating from the Sixty-first World Health Assembly: � Poliomyelitis: Mechanism for management of potential risk to eradication (WHA61.1) Report of the ACM to Review Technical Matters to be discussed at the 61st Session of the RC Page 20 � Implementation of International Health regulations (2005) (WHA61.2) � Global Immunization Strategy (WHA61.15) � Health of migrants (WHA61.17) � Climate change and health (WHA61.19) � Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property (WHA61.21) � Monitoring achievement of the health-related MDGs (WHA61.18) � Infant and young child nutrition (WHA61.20) � Prevention and control of noncommunicable diseases: Implementation of global strategy (WHA61.14) � Strategies to reduce the harmful use of alcohol (WHA61.4) These decisions and resolutions are particularly relevant to the South- East Asia Region, have obvious and immediate implications for the Region, they would merit follow-up action, both by Member countries of the Region as well as WHO at the Regional Office and country levels. Highlights from the operative paragraphs of selected decisions/resolutions, as well as the regional implications of each decision and/or resolution, as applicable, and actions proposed for Member countries and WHO, were presented. The ACM then considered the resolutions/decisions and made the following observations and recommendations: Discussion points � The ACM noted regional implications and actions taken and proposed as contained in the working paper. � Member countries were requested to provide inputs to the Regional Office on the implementing the resolution WHA61.21 (Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property). This topic should be taken into consideration in the proposed regional consultation on counterfeit drugs. Report of the ACM to Review Technical Matters to be discussed at the 61st Session of the RC Page 21 Recommendations Action by WHO/SEARO (1) To provide support to Member countries to implement the resolutions that have regional implications, and particularly resolution WHA61.21 “Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property”; (2) The ten selected resolutions of the Sixty-first World Health Assembly will be submitted to the Sixty-first Session of the Regional Committee for review, consideration and noting as appropriate. 4.2 Review of the draft provisional agendas of the 124th session of the WHO Executive Board and the Sixty-second World Health Assembly (agenda item 4.2) Introduction The Secretariat introduced the draft provisional agenda of the 124th session of the Executive Board (EB). This will be submitted to the forthcoming Sixty- first session of the Regional Committee; Member countries may propose the inclusion of any additional item to the agenda of EB 124. As per Rule 8 of the Rules of Procedures of the Executive Board, any proposal from a Member State to include an item on the agenda should reach the Director-General not later than 12 weeks after circulation of the draft provisional agenda or 10 weeks before the commencement of the session of the EB, whichever is earlier. The proposals should therefore reach the Director-General by 12 September 2008. The criteria endorsed by the board for inclusion of proposed additional items are: � Proposals that address a global public-health issue, or � involve a new subject within the scope of WHO, or � represent a significant public-health burden. Furthermore, in accordance with Rule 9 of the Rules of Procedure of the Executive Board, as amended by the Board at its 122 nd session (EB122.R8), “… any proposal for inclusion on the agenda of any item under Report of the ACM to Review Technical Matters to be discussed at the 61st Session of the RC Page 22 (c), (d), (e) and (f) above shall be accompanied by an explanatory memorandum…” Resolution EB 122.R8 and Rule 9 of the Rules of Procedure of the Executive Board were attached to the working paper for easy reference. Following receipt of proposals, the Director-General will draw up the provisional agenda in consultation with officers of the EB. The provisional agenda will be annotated and explain any deferral or exclusion of proposals made, and dispatched to Member States eight weeks before the 124 th session of the EB. The ACM noted the draft provisional agenda of the 124th session of the Executive Board. Discussion points � Delegates from Thailand presented to the ACM the concept note proposing the topic “Capacity Building to Support Roles of Private Sector in Health are”, requesting that this item be included as an agenda item at the 124th EB. � In the spirit of regional solidarity, it is important to get a single regional voice on this issue to support at the EB. The members of the EB from SEA Region would be expected to take a lead role in ensuring this agenda item is included in the Agenda of the 124th EB as well as the following World Health Assembly in May 2009. Recommendations Action by Member States and WHO/SEARO (1) To review and provide further inputs for the concept paper drafted by Thailand on proposed inclusion of an item on “Capacity Building to Support Roles of Private Sector in Health Care” in the agenda for the 124th session of the Executive Board; (2) Upon receipt of inputs from the Member countries of the SEA Region, Thailand on behalf of the Region, should officially submit the proposal to the Director-General’s Office, WHO/HQ, Geneva before 12 September 2008. Report of the ACM to Review Technical Matters to be discussed at the 61st Session of the RC Page 23 5. Follow-up on selected resolutions/decisions of the last three years (agenda item 5) 5.1 South-East Asia Regional Health Emergency Fund (agenda item 5.1) Introduction The Secretariat introduced the topic with the following points: � The South-East Asia Regional Health Emergency Fund (SEARHEF) was established through Resolution SEA/RC60/R7 to provide immediate financial assistance to Member countries for meeting their health requirements following an emergency. � US$ 1 000 000 were approved and allocated in January 2008 under the Regular Budget for the 2008-2009 biennium. A contribution of US$ 100 000 was received for the Fund from the Royal Thai Government in October 2007. � With SEARHEF, the immediate needs of populations affected by the Cyclone Nargis in Myanmar (May 2008) and floods in Sri Lanka (June 2008), were met. � Efforts are being made to mobilize resources through voluntary contributions from partner agencies to enhance the Fund. For oversight and governance of SEARHEF, a Working Group in which each of the Member countries of the Region is represented has been established; the first meeting is scheduled for 5 July 2008. Discussion points � Vulnerability of the countries in the Region to natural hazards such as earthquakes, floods, volcanic eruptions and other projected severe weather events due to climate change highlights the need for SEARHEF. � Appreciation was expressed by delegates for the creation and the operationalization of SEARHEF in recent emergencies of Cyclone Nargis in Myanmar and flash floods in Sri Lanka. Report of the ACM to Review Technical Matters to be discussed at the 61st Session of the RC Page 24 � Mechanisms for the proper management of the fund and regular review of policies to ensure optimal use of funds should be in place. � There is a need for the fund to be revolving, so that it becomes a sustainable mechanism to support emergencies in Member States. � It was explained that the process involved for Assessed Contribution portion of SEARHEF to be carried over to subsequent bienniums should be discussed at the SPPDM in the budget appropriations agenda. The recommendations of the SPPDM can then be considered by the Regional Committee, which will in turn be submitted to the EB/PBAC and for approval by WHA under the budget appropriation. Recommendations Action by Member States (1) Continue to support further development and management of SEARHEF through active participation in the meetings of the Working Group and other statutory meetings of WHO; (2) Advocate and support the process at appropriate forums for SEARHEF to become revolving. Action by WHO/SEARO (1) Through the appropriate steps and channels, support the request of Member countries for SEARHEF to be revolving; (2) Support improvement of the policies, principles and guidelines as per suggestions of the Working Group of SEARHEF. 5.2 Challenges in Polio Eradication (agenda item 5.2) Introduction At its 60th session, the Regional Committee adopted resolution SEA/RC60/R8, urging Member countries to strengthen their immunization programmes to ensure the highest coverage and the highest standard of surveillance for vaccine-preventable diseases, and requested the Regional Director to support Member States in this endeavour. It also required WHO Report of the ACM to Review Technical Matters to be discussed at the 61st Session of the RC Page 25 to report on the progress made in polio eradication to the Regional Committee on an annual basis until polio-free status is achieved for the Region. Since the Regional Committee meeting, the Member countries and the Regional Office have made concerted efforts to eradicate polio in the Region. The number of cases of P1 subtype polio has been the lowest ever in Western Uttar Pradesh India, with multiple rounds of monovalent oral polio vaccine (mOPV1). However, the deliberate focus on eradicating P1 subtype led to a surge of P3 subtype in Bihar. Fortunately, aggressive use of P3 in the last few months of 2007 and early 2008 has shown a rapid containment of the large outbreak of P3 subtype polio cases in Bihar. It is generally agreed among experts that India is on track to eliminate P1 subtype polio in 2008, and then focus on eradicating subtype P3 in 2009. Acute flaccid paralysis (AFP) surveillance indicators are generally very high, especially in the countries with active circulation of polio now or in the recent past. For the first time, as shown by immunological study, polio endemic areas of India appear to have attained population immunity levels similar to those of the polio-free areas. All the countries that were reinfected following importation in the recent past have been able to stop transmission. However, in spite of progress, the Region has not yet been able to reach polio-free status, and WHO recognizes multiple risks to polio eradication as stated in sixty-first World Health Assembly resolution 61.1. Appropriate management of these risks is essential for attaining and sustaining polio-free status. Although there has been improvement in routine immunization coverage in almost all countries, Bangladesh, India and Indonesia remain among the top 10 countries of the world where most unimmunized children live. In India, particularly, routine immunization is a major challenge in the very states (Uttar Pradesh and Bihar) where polio continues to remain endemic. Therefore, enhanced efforts are needed to reach the millions of children that still do not have access to even routine immunization, let alone new vaccines. The challenge for the Region is to strengthen routine immunization programme so that the costly gains of polio eradication can be sustained. Report of the ACM to Review Technical Matters to be discussed at the 61st Session of the RC Page 26 Discussion points � That there are more than 13 million children with no access to routine immunization in the Region is a matter of great concern. Member countries are encouraged to accelerate efforts to enhance coverage to achieve a national coverage of at least 80% or higher with all antigens at the district level. � It is suggested that expert consultations are needed to explore cost implications of the use of inactivated polio vaccine (IPV) in the post- eradication era and to define a strategic framework and guidance for countries for OPV cessation. � Although India is the only endemic country for polio in the Region, all other countries are at risk of importation from other parts of the world as well. Therefore, for an effective maintenance of polio-free status, all polio-free countries are encouraged to ensure the highest quality AFP surveillance possible. Further, high routine immunization coverage must be achieved in order to sustain the gains of polio eradication. � Several Member countries emphasized the importance and need for synchronized control activities, particularly along border areas. � The Regional Director highlighted the need to work together to eradicate polio and confirmed that polio eradication is the highest operational priority for WHO-SEARO. Recommendations Action by Member States (1) Scale up routine OPV coverage in countries where OPV3 coverage is still less than 80%; (2) High-quality surveillance for acute flaccid paralysis (AFP) must be maintained, including in countries that are polio-free. Action by WHO/SEARO (1) Enhance support to Member States to eradicate poliomyelitis where it is still endemic, and to sustain polio-free status in countries that have already eradicated polio; Report of the ACM to Review Technical Matters to be discussed at the 61st Session of the RC Page 27 (2) Provide technical guidance to Member States on OPV cessation and future options to maintain population immunity against polio including the possibility of IPV use and its cost implications on national programmes. 5.3. International migration of health personnel: A challenge for health systems in developing countries (agenda item 5.3) Introduction The Secretariat introduced the topic on “International migration of the health workforce” and emphasized that it is a challenge for the Member countries as it impedes the momentum of strengthening health systems. In response to Regional Committee Resolution SEA/RC60/R9 and to sustain the health workforce (HWF), the Regional Office is developing tools to assess and explore the pattern of migration and categories of health workforce that migrate from and to the Region. It is also developing a database for health workforce in the SEA Region that will include the yearly output of health workforce, as well as the proportion that migrates and its categories. The health workforce database will contribute towards evidence- based crafting of policies and strategies for health workforce retention and setting up of forums for discussion and exploration to develop a regional code of practice for the ethical recruitment of health workers. This will enable government-to-government exchange of the health workforce without incapacitating the health system in the country of origin, and aid collaboration with Global Alliance for Health Workforce, World Trade Organization, Asia Pacific Action Alliance for HRH, International Organization for Migration, Organization for Economic Cooperation and Development for technical and policy dialogue. Discussion points � Internal (rural to urban areas, and from public sector to private sector) and external migration of health workforce challenges the health system. There is a strong need for a regional coordination mechanism to monitor migrations. Report of the ACM to Review Technical Matters to be discussed at the 61st Session of the RC Page 28 � Improving working conditions, better compensation packages, professional and psychosocial support and career opportunities are needed to retain health workforce in the system. However, translation into action is important. � It was noted that some countries of the SEA Region do benefit from the international migration of health workforce as recipient countries. � Member countries proposed that WHO organize a conference for Member countries of the Region to share experiences in mitigating the negative impact of the international migration of health personnel. � It is acknowledged that migration of health personnel can have a positive impact on the transfer of knowledge and technology. � The issue of health professionals not working in the profession should also be taken into account. Recommendations Action by Member States (1) Assess the health workforce migration pattern and identify “push” and “pull” factors specific to the country; (2) Conduct research with regard to migration trends, numbers, types and movements; (3) Institute mechanisms for motivation of health workforce and develop appropriate incentive systems to retain them. Action by WHO/SEARO (1) Develop tools to monitor the HWF migration into and out of the Region; (2) Develop health workforce database in the Region and also develop policy dialogue, information-sharing and collaboration with partners; (3) Organize a forum for HWF migration and regulatory mechanisms; (4) Convene a regional consultation to share experience on HWF migration; (5) Facilitate the study of HWF movement within the countries of the Region. Report of the ACM to Review Technical Matters to be discussed at the 61st Session of the RC Page 29 5.4 Regional Strategy for Health Promotion (agenda item 5.4) Introduction The WHO Regional Committee, in resolution SEA/RC59/R4, on the “Regional Strategy for Health Promotion”, urged Member States to strengthen capacity for planning, coordination, management and implementation of comprehensive and multisectoral health promotion policies and programmes. It also urged them to document evidence of effective health promotion interventions at national and local levels in order to facilitate development of effective policies, as well as to adopt alternative, innovative and sustainable sources of financing for health promotion activities with a firm institutional base for management. The Regional Committee also requested the Regional Director to strengthen the capacity for health promotion across the Organization in the Region to provide better support for Member States. It also requested a report on the progress of the implementation of the Regional Strategy to the Sixty-first Session of the Regional Committee in 2008. The document SEA/ACM/Meet.1/5.4 highlighted the action undertaken and the progress made on implementation of the resolution under eight strategic directions specified in the Regional Strategy for Health Promotion: (1) infrastructure for coordination and management; (2) capacity building; (3) regulation and legislation; (4) partnerships, alliances and networks; (5) evidence for health promotion; (6) policy advocacy and social mobilization; (7) health promotion financing; and (8) management of change. Discussion points � Delegates agree on the importance of strengthening health promotion across the Organization and within countries. � Challenges in health promotion identified include: − The role of institutions of learning involved in health promotion training was considered important in strengthening health promotion capacity at all levels. − Evidence gathering and sharing of experiences, including social and behavioural research to identify factors associated with specific health behaviors and outcomes. Report of the ACM to Review Technical Matters to be discussed at the 61st Session of the RC Page 30 − Innovative financing of health promotion, including the use of a dedicated tax such as the Thai Health Promotion Foundation. − Countering aggressive marketing campaigns by the concerned industries through legislation, policies and communication. � The need for a multisectoral approach, with the emphasis on applying the “healthy settings” approach, was highlighted, in order to integrate health promotion into all vertical and horizontal interventions. Recommendations Action by Member States (1) Collect, analyse and disseminate the evidence-based effective health promotion interventions to influence healthy public policies and intervention programmes; (2) Identify sustainable mechanisms for financing health promotion activities. Action by WHO/SEARO (1) Support Member countries to conduct health promotion programme planning, monitoring and evaluation, and operational research, including on social and behavioural factors that influence health outcomes; (2) Report regularly on the progress of implementation of the Regional Strategy for Health Promotion in the appropriate forums. 5.5 Update on scaling up prevention and control of chronic noncommunicable diseases and alcohol consumption control (agenda item 5.5) Part A: Scaling up prevention and control of chronic noncommunicable diseases Introduction The Sixtieth session of the Regional Committee through resolution SEA/RC60/R4, endorsed the Regional Framework for Prevention and Report of the ACM to Review Technical Matters to be discussed at the 61st Session of the RC Page 31 Control of Noncommunicable Diseases (NCDs) and urged Member States to initiate appropriate steps to formulate, update and strengthen national policies, strategies and programmes, and also to establish suitable infrastructure and appropriate funding mechanisms for integrated prevention and control of NCDs. The resolution also requested the Regional Director to provide technical assistance to Member countries; to mobilize necessary resources for developing their capacity to implement national policies, strategies and programmes for integrated prevention and control of NCDs; and to facilitate and coordinate international support of development partners. The resolution requested the Regional Director to report to the Sixty-third session of the Regional Committee in 2010 on the progress achieved in implementing the regional framework. Document SEA/ACM/Meet.1/5.5 provided an update on action to implement the resolution and the framework, with particular focus on (i) progress in developing national NCD policies, plans and programmes; (ii) WHO technical assistance in capacity building; and (iii) promotion of collaboration and networking in the area of NCD prevention and control. Discussion points � Member countries expressed profound concern over the growing health, economic and social burden of NCDs in the Region and emphasized the need to apply a public health approach based on principles of health promotion and disease prevention, with appropriate emphasis on identification and action-oriented surveillance of major modifiable risk factors. � Several countries of the Region reveal a growing commitment to prevent and control NCDs as demonstrated in new national policies or other high level commitments developed, strengthened coordinating mechanisms, enhanced public health infrastructure and increased financial investments. � As determinants of NCDs and their risk factors largely lie outside the reach of health sector, multisectoral approaches are being applied in the Region in formulating new national policies and plans for prevention and control of NCDs. � National capacity for development and implementation of NCD prevention and control policies, plans and programmes is limited and Report of the ACM to Review Technical Matters to be discussed at the 61st Session of the RC Page 32 requires further technical assistance from WHO, as well as support of other developmental partners. � Member States are strengthening their efforts to establish effective national networking mechanisms for prevention and control of NCDs. Recommendations Action by Member States (1) To develop and update national plans of action and allocate appropriate resources for surveillance, prevention and control of NCDs in line with the Regional Framework for Prevention and Control of NCDs; (2) To contribute to implementation of the Action Plan for the Global Strategy for the Prevention and Control of NCDs endorsed by the Sixty-first World Health Assembly. Action by WHO/SEARO (1) To provide technical support to Member countries in building their capacity for developing, implementing, monitoring and evaluating national multisectoral programmes for integrated prevention and control of NCDs. Part B: Alcohol consumption control Introduction The Fifty-ninth session of the WHO Regional Committee for South-East Asia, under resolution SEA/RC59/R8, requested the Regional Director to support Member States in building and strengthening institutional capacities for developing: information systems, policies, action plans, programmes, guidelines and monitoring/evaluation of programmes on prevention of harm from alcohol use; to hold a biennial regional forum of key partners from Members States and other international partners to share progress, experiences and lessons on alcohol control programmes, and to report on the progress on the implementation of the Alcohol Consumption Control – Policy Options to the Sixty-first session of the Regional Committee in 2008. Report of the ACM to Review Technical Matters to be discussed at the 61st Session of the RC Page 33 Document SEA/ACM/Meet.1/5.5 provided an update on action undertaken on implementation of the resolution. Discussion points � The proposal made by India at the Sixty-first World Health Assembly on adoption of “World No Alcohol Day” needs to be followed up and presented at the Regional Committee for its consideration. � Strategies to control harm from alcohol use should be based on a global strategy and include regional and national cultural aspects. � To create awareness of the issue is desirable. However, more concrete action is needed to initiate global actions for adoption of international strategies such as a framework convention for alcohol control, based on (but not similar to) the WHO Framework Convention for Tobacco Control. This should also be discussed at the Ministers’ Forum or Regional Committee to have strong political commitments. � Whereas tobacco use leads to many health problems (e.g. lung cancer, myocardial infarction, etc.), alcohol use leads to similar health effects and also creates social problems, which could then lead to further negative results such as injury and violence. Recommendations Action by Member States (1) Develop and update national plans of action and allocate appropriate resources for programmes addressing the reduction of harmful use of alcohol; (2) Actively engage in developing a Draft Regional Strategy on Harmful Use of Alcohol based on all evidence and best practices in order to support and complement national public health policies. Action by WHO/SEARO (1) Continue to support Member States in promoting the adoption of “World No Alcohol Day” by the World Health Assembly; (2) Develop a regional strategy to move forward in the direction of a framework convention on alcohol control. Report of the ACM to Review Technical Matters to be discussed at the 61st Session of the RC Page 34 6. Reports by Country Representatives on their attendance at the Meetings of the Coordinating Bodies of WHO’s Global Programmes (agenda item 6) 6.1 UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases: Joint Coordinating Board (JCB) (agenda item 6.1) Introduction The Thirty-first meeting of the Joint Coordinating Board (JCB) was held in Rio de Janeiro, Brazil, from 16 to 18 June 2008. Dr Gado Tshering, representative from Bhutan presented the report on the deliberations of the JCB meeting on behalf of representatives from the SEA Region. The ACM noted the report. 6.2 UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction: Policy and Coordination Committee (PCC) (agenda item 6.2) Introduction The Twenty-first Meeting of the Policy and Coordination Committee of the UNDP/UNFPA/WHO/World Bank Special Programme for Research, Development and Research Training in Human Reproduction, was held in Buenos Aires, Argentina on 23-25 June 2008. Dr Abul Kalam Azad, representative from Bangladesh, presented the report on the deliberations of the Policy Coordination Committee (PCC) meeting on behalf of representatives from the SEA Region. The ACM noted the report. Report of the ACM to Review Technical Matters to be discussed at the 61st Session of the RC Page 35 7. Agenda items to be discussed in the Health Ministers’ Meeting (agenda item 7) 7.1 Millennium Development Goals (agenda item 7.1) Introduction The Fifty-fifth World Health Assembly (WHA) in 2002 reaffirmed its commitment to the UN Millennium Declaration and the related Millennium Development Goals (MDGs) through Resolution WHA 55.19. The Twenty- second Meeting of Ministers of Health of countries of the South-East Asia Region in September 2004 reviewed the progress made towards achieving MDGs in the Region and made recommendations to Member countries to identify specific challenges and develop appropriate intervention programmes. A High-Level Forum on the MDGs in Asia and the Pacific met in Tokyo in June 2005 and reviewed the progress made and challenges faced by Member countries. The Fifty-eighth World Health Assembly in May 2005 requested Member States to reaffirm the MDGs as critical for health development, and to develop nationally relevant “roadmaps” that incorporate the actions as a guide to accelerating progress towards achieving health-related MDGs. The Sixty-first World Health Assembly adopted a resolution on monitoring of the achievements of the health- related Millennium Development Goals. Discussion points � The current progress on some health-related MDGs shows the need for accelerated actions to achieve the goals by 2015. � The need to have disaggregated data to assess disparity/inequity by geography, age groups, sex and income/wealth. � Not all information is available from routine or institution-based health information systems. Some must be obtained from population-based surveys that are not possible to conduct on an annual basis. � Multisectoral and multidisciplinary approaches are required to achieve the MDGs. Report of the ACM to Review Technical Matters to be discussed at the 61st Session of the RC Page 36 � Delegates felt the need to bring up the issue in the next HMM for sustaining achievements beyond 2015. � Timor-Leste requested WHO to support the strengthening of their health information system and desired strong commitment from WHO. � There is a need to promote implementation of an essential health care package and for more investment on health. The commitment of developed countries to donate 0.7% of their GDP as overseas development assistance (ODA) to developing countries should be adhered to. � Economic sanctions impact negatively on resource-constrained countries, thereby making it difficult for them to get assistance from the donors, such as Global Fund for HIV/AIDS, tuberculosis and malaria (GFATM). Thus, these sanctions affect the ability of these countries to achieve health-related MDGs. � There is a need to have efficient and effective health systems with provision of sufficient well-trained health workforce and equitable financing schemes that protect the poor. Recommendations Action by Member States (1) Sustain high-level political commitment on strengthening the health systems, using revitalized PHC approach; (2) Allocate more resources to implement focused interventions to accelerate the progress towards achieving health-related MDGs; (3) Foster multisectoral and multidisciplinary approaches considering that health is strongly influenced by social determinants; (4) Generate additional or disaggregated information to enable measurement of inequity across social determinants; (5) Countries which have achieved MDGs already or reached indicators that of developed countries must ensure and sustain the achievement. Report of the ACM to Review Technical Matters to be discussed at the 61st Session of the RC Page 37 Action by WHO/SEARO (1) Monitor and report the progress routinely; (2) Convene an expert group meeting on MDGs; (3) Establish a South-East Asia Regional Task Force on health-related MDGs to review the progress annually and make recommendations for action; (4) Assist Member countries in strengthening their health systems, including health information systems. 7.2 Climate change and health (agenda item 7.2) Introduction The health risks posed by climate change are global and difficult to reverse. Recent changes in climate in the South-East Asia (SEA) Region have had diverse impacts on health. Populations considered to be at greatest risk from climate change and related health hazards are those living on islands, mountainous regions, water-stressed areas, mega cities and coastal areas. Low-income groups and those suffering from malnutrition, with poor education and weak infrastructures, will have most difficulty adapting. Mountain communities are particularly vulnerable, due to high exposure to hazards, remoteness, poor infrastructure and marginalization. Most countries in the South-East Asia Region have set up national expert committees, often under the direct supervision of prime ministers, to formulate national plans for mitigation and adaptation to climate change. The active participation of the health sector, however, needs to be improved. Based on the specific request from the Ministers of Health at the 25th Meeting in August 2007 in Thimphu, Bhutan, SEARO supported four national workshops on human health and climate change in Bangladesh, India, Indonesia and Nepal in November and December 2007. Further, in December 2007 SEARO with WPRO organized a regional workshop of representatives of 32 Member countries in Bali, Indonesia. The outcome was a regional framework for an action plan to protect human health from the effects of climate change. The goal of the plan is to build capacity and strengthen health systems. Report of the ACM to Review Technical Matters to be discussed at the 61st Session of the RC Page 38 SEA Region countries now need to implement the regional framework through national action plans. Discussion points � All countries agreed on the fact that global warming and climate change pose the greatest threat to human health and biggest challenge ever to the health sector. Climate change will bring about increases in the disease burden related to malnutrition, respiratory and cardiovascular conditions from excessive air pollution and heat, unsafe water and food. The occurrence of malaria, dengue and other vector- borne diseases will probably rise. More frequent and more intense weather events, the most recent example being cyclone Nargis in Myanmar, will cause injuries and deaths and have dramatic impacts on mental health due to psychosocial stress. � All countries agreed on the implementation of WHA Resolution 61.19 and of the regional framework to protect human health from the effects of climate change, noting that failure to adapt now will be costly in terms of disease, health-care expenditure and lost productivity. � Bangladesh, Maldives and Sri Lanka pointed out the importance of increasing the knowledge of health professionals in this area and called for support in capacity building. The Secretariat informed that it is currently preparing a training package. � Bhutan, Indonesia, Myanmar and Nepal stressed the need for more awareness and advocacy work. All countries and the Secretariat were urged to engage more proactively with other sectors and processes dealing with climate change mitigation and adaptation to highlight its link to human health. � Indonesia and Nepal stated that mitigating the effects of climate change can have direct and immediate health benefits. � Nepal and Sri Lanka referred to the benefits in working with others in terms of efficiency and funding opportunities. � The Secretariat informed that its work in this area is multisectoral by definition. It is providing inputs to India for the working group preparing the section on human health to be included as part of the Report of the ACM to Review Technical Matters to be discussed at the 61st Session of the RC Page 39 national action plan on climate change. The Secretariat is also participating in a planned seminar in Thailand and a multisectoral workshop in Bangladesh in August 2008. � Bhutan, India and Thailand called for taking the discussion towards more concrete public health interventions that would mitigate the impacts of climate change on health. The Secretariat was asked to prepare the background documents for the Regional Committee in this perspective. Recommendations Action by Member States (1) Increase financial support to strengthen health programmes that are already addressing climate-sensitive diseases and environmental health; (2) Develop and ensure swift implementation of integrated national action plans focussing on concrete public health interventions that would mitigate the impacts of climate change on health; (3) Collaborate with other sectors and stakeholders and actively participate in ongoing processes that are addressing climate change issues to streamline health concerns at national, regional and global levels, including United Nations Framework Convention on Climate Change. Action by WHO/SEARO (1) Support SEA Region countries in increasing awareness and collecting evidence-based data of the health consequences of climate change; (2) Finalize the regional training package for health professionals on climate change and human health by the end of 2008 and promote its use; (3) Support SEA Region countries in the formulation of national action plans, with a focus on concrete public health interventions, and conduct research work to that end. Report of the ACM to Review Technical Matters to be discussed at the 61st Session of the RC Page 40 8. Other agenda items (agenda item 8) 8.1 Geographical rotation of Director-General (agenda item 8.1) Introduction The Secretariat provided an overview of the issue of geographical rotation of Director-General, explaining that it was one of the subjects of the Executive Board’s discussion at its 122nd session held in January 2008. The Board requested regional committees to discuss the issue and reach a consensus that would guide the Board in its deliberation at its 124th session in January 2009. This issue has been included in the agenda of the Sixty- first Session of the Regional Committee for South-East Asia for its guidance. Discussion points � Member countries support taking forward the issue of regional rotation of the Director-General and agreed that the issue should be discussed at the Regional Committee. Recommendations Action by Member States (1) Brief the delegates for the Regional Committee to prepare for discussions on this issue at the Sixty-first Session of the Regional Committee. Action by WHO/SEARO (1) Introduce the issue at the Sixty-first Session of the Regional Committee. 8.2 Equitable geographical distribution of the membership of the Executive Board (agenda item 8.2) Introduction The Secretariat introduced the topic by informing the ACM that the increased representation of the South-East Asia (SEA) Region on the WHO Executive Board was discussed at various forums at the regional level. Report of the ACM to Review Technical Matters to be discussed at the 61st Session of the RC Page 41 The Sixtieth Session of the WHO Regional Committee urged Member countries to actively support this process. This agenda was taken up by the ACM to generate discussion among Member countries on the issue. The views of the ACM would be submitted to the Sixty-first Session of the Regional Committee for consideration. Discussion points � Given the deferral of the issue from the agenda of the 122nd session of the Executive Board, a strategy on how to support the Member States in presenting their case was needed to get the issue on the agenda for the 124th session of the Executive Board. � It was agreed that more consultation was required to come up with a strategy in support of advancing this issue. Recommendations Action by Member States (1) Member States are to identify participants from both health and foreign ministries for a regional consultation to be held in August, focusing on identifying a proper mix of participants with technical health and diplomatic experience, who may act in the future as the main focal points for the regional Member States in taking this issue forward. Action by WHO/SEARO (1) SEARO is to convene a Regional Consultation on Expansion of Executive Board Membership for the SEA Region to outline the regional strategy to move forward, to include participants from both health and foreign ministries of all interested Member States. The consultation should be held in time to present findings to the Sixty- first Regional Committee. Report of the ACM to Review Technical Matters to be discussed at the 61st Session of the RC Page 42 Additional Agenda items During the course of discussions the following two additional agenda items were also taken up for discussion in the ACM: 1. Pandemic influenza preparedness: Sharing of influenza viruses and access to vaccines and other benefits Introduction As part of Global Surveillance of influenza Network (GSIN), all National Influenza Centers (NICs) share viruses with WHO Collaborating Centers which regularly conduct risk assessment for the purpose of new vaccine formulation and designing diagnostic reagents. However, with the current epidemic of avian H5N1 in the Region and numerous confirmed human cases, one Member country has expressed concern that virus sharing should be linked with fair and equitable access to vaccines and be governed by transparent and standard terms and conditions for shipping. This had led to a temporary halt in the 50-year practice of freely sharing viral isolates routinely under GSIN, and prompted WHO and Member States to re- examine the current practice. A series of steps have been taken by WHO and Member States to resolve this standoff. After several intergovernmental meetings (IGMs), an IGM ‘Chair’s Text’ has been developed, for which comments are invited from Member States by 27 July 2008. Discussion points � Viral and benefit-sharing are issues that affect all Member countries which must understand the implications of the “Chair’s text.” While certain countries of the Region have been more actively involved in the issue, others need technical inputs to provide meaningful feedback on the “Chair’s text” as required by the tight deadline. � Member countries agreed to share interventions and explore the possibility of having a regional position. This could be done through electronic communications with coordination by SEARO to meet the deadline. Report of the ACM to Review Technical Matters to be discussed at the 61st Session of the RC Page 43 � Major challenges raised by the issue of viral sharing include questions of: (1) What process should be used for sharing the virus and related material; (2) Who will share in the benefits of the vaccine; and (3) Can the virus-providing country share the patent with the patent holder (in many cases the vaccine producer)? � The threat of an avian influenza outbreak, or other pandemic outbreak, is serious for the Region. There must be discussions about creating a mechanism for seamlessly sharing information between SEARO countries in the event of a pandemic outbreak. Recommendations Action by Member States (1) Review the “Chair’s text” and provide comments by 27 July 2008. Action by WHO/SEARO (1) Provide Member countries inputs on technical implications in the “Chair’s text”; (2) Facilitate collaboration, if possible, on reaching a regional stand to the “Chair’s text” through a consultative meeting; (3) To include in the Sixty-first Regional Committee agenda pandemic influenza preparedness and the progress of the intergovernmental meeting. 2. Counterfeit medical products Introduction This agenda item was proposed by India as an item for the Regional Committee. The Secretariat introduced the agenda item by providing a brief background, current status and future issues regarding counterfeit drugs. The committee was informed that WHO had addressed the quality of medicines since its inception. WHA resolutions 41.16 (1988) and WHA 47.13 (1994) concerned these issues. Report of the ACM to Review Technical Matters to be discussed at the 61st Session of the RC Page 44 An information paper (A61.16) was presented in the World Health Assembly in May 2008 and a resolution was proposed which was vigorously discussed. Ultimately, the item was referred to the sixty-second World Health Assembly through the Executive Board. The major issue relates to the definition of counterfeit medicine. The previous WHO definition dates from 1992. A new definition was proposed in the International Medical Products Anti-Counterfeiting Taskforce (IMPACT) meeting. The differences in these two definitions need to be looked into, in terms of their impact on public health. Discussion points � Member States agreed that the issue of counterfeit medicines merits the attention of the Region, but expressed concern that the possible implications of the proposed resolution are not fully understood. � The magnitude of the problem in the SEA Region and elsewhere is not really known and should be assessed. � It was pointed out that a clear distinction exists, and should be made, between counterfeit and substandard medicines. � Reference was made also to the “LDC exemption”, which allows WTO Members that are least-developed countries (LDCs) to defer the implementation of patents in the pharmaceutical sector until 2016. � It was proposed that the Regional Office organize a meeting for all Member countries, in order to clarify the implications of the proposed resolution on counterfeit medical products. The appropriate officials and experts from all countries of the Region should participate. The meeting is to be held end July 2008. Recommendations Action by Member States (1) Draft terms of reference for the envisaged meeting; (2) Review and suggest improvement in the definition of counterfeit medicines; Report of the ACM to Review Technical Matters to be discussed at the 61st Session of the RC Page 45 (3) Analyse at the national level the possible implications of the proposed Executive Board resolution on counterfeit medical products. Action by WHO/SEARO (1) Organize a meeting of Member States, in order to facilitate clarification of the issues including the definition of the counterfeit medicines; (2) Assist in revitalizing regional and global networking in sharing information on counterfeit medicines; (3) Provide technical support in identifying different definitions of counterfeit medicines. Adoption of report The Meeting of the Advisory Committee (ACM) reviewed the draft report of the meeting item by item, concentrating on the discussions and observations made by Members, and the recommendations arrived at on each agenda item, and adopted it with some modifications. Closure In his concluding remarks, Dr Samlee Plianbangchang, Regional Director, thanked all the distinguished participants for their deliberations. He expressed his particular appreciation to the Chairperson, H.E. Professor Mya Oo, and the Co-Chairperson, Dr Gado Tshering, for the effective manner in which they chaired the meeting. Dr Samlee also thanked Dr Sopida Chavanichkul and other members of the drafting group for their excellent report. He appreciated the practical recommendations made by the committee and assured the members that the Regional Office would take urgent action to implement all the recommendations made by the committee. The Chairperson, H.E. Professor Mya Oo, thanked all the distinguished participants for their deliberations and active participation in the meeting. He then declared the meeting closed. Report of the ACM to Review Technical Matters to be discussed at the 61st Session of the RC Page 46 Annex 1 Agenda 1. Opening session 2. Technical matters: 2.1 Tobacco Control: Progress and plans for implementing FCTC 2.2 Managing human resources for accelerating reduction of maternal and neonatal mortalities 2.3 Responding to emerging and re-emerging vector-borne diseases 2.4 Public health approach to combating HIV/AIDS 2.5 Regional Initiative on Environment and Health 2.6 UN reform process and health partnerships: Progress and developments 3. Technical discussions: Selection of a subject for the Technical Discussions to be held prior to the Sixty-second Session of the Regional Committee 4. Governing Bodies: 4.1 Review of the decisions and resolutions of the Sixty-first World Health Assembly and the 122nd and 123rd sessions of the WHO Executive Board (1) Poliomyelitis: mechanism for management of potential risks to eradication (WHA61.1) (2) Implementation of IHR (2005) (WHA61.2) (3) Global immunization strategy (WHA61.15) (4) Health of migrants (WHA61.17) (5) Climate change and health (WHA61.19) (6) Public health, innovation and intellectual property: Global strategy and plan of action (WHA61.21) (7) Monitoring of the achievement of the health-related MDGs (WHA61.18) (8) Infant and young Child nutrition (WHA61.20) Report of the ACM to Review Technical Matters to be discussed at the 61st Session of the RC Page 47 (9) Prevention and control of noncommunicable diseases: Implementation of the global strategy (WHA61.14) (10) Strategies to reduce the harmful use of alcohol (WHA61.4) 4.2 Review of the draft provisional agendas of the 124th session of the WHO Executive Board and the Sixty-second World Health Assembly 5. Follow-up action on selected resolutions/decisions of the last three years: 5.1 South-East Asia Regional Health Emergency Fund 5.2 Challenges in polio eradication 5.3 International migration of health personnel: A challenge for health systems in developing countries 5.4 Regional Strategy for Health Promotion 5.5 Update on scaling up prevention and control of chronic noncommunicable diseases and alcohol consumption control 6. Reports by country representatives on their attendance at the meeting of the coordinating bodies of WHO’s global programmes, i.e. 6.1 UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases: Joint Coordinating Board (JCB) 6.2 UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction: Policy and Coordination Committee (PCC) 7. Agenda items to be discussed in the Health Ministers’ Meeting* 7.1 Millennium Development Goals 7.2 Climate change and health 8. Other agenda items 8.1 Geographical rotation of Director-General 8.2 Equitable geographical distribution of the membership of the Executive Board 9. Concluding session *exact titles of the agenda items are being finalized. Report of the ACM to Review Technical Matters to be discussed at the 61st Session of the RC Page 48 Annex 2 List of participants Bangladesh Mr Abul Kalam Azad Additional Secretary Ministry of Health and Family Welfare Prof (Dr) Khondhaker Md. Shefyetullah Director (Medical Education) Directorate-General of Health Services Ministry of Health and Family Welfare Bhutan Dr Gado Tshering Secretary Ministry of Health Mr Sonam Dorji Chief Planning Officer Planning and Policy Division Ministry of Health DPR Korea Mr Kim Chang Min Vice Director Department of International Organizations Ministry of Foreign Affairs Dr Pak Tong Chol WHO Desk Officer Ministry of Public Health India Mr Vineet Chawdhry Joint Secretary (IH) Ministry of Health and Family Welfare Dr Sharat Chauhan Deputy Secretary (IH) Ministry of Health and Family Welfare Mr K. Srinidhi Section Officer (IH) Ministry of Health and Family Welfare Indonesia Dr Yusharmen Harun Director Non-communicable Diseases Control Ministry of Health Dr Widiyarti Chief Regional and Bilateral Sub-Division Bureau of Planning and Budgeting Ministry of Health Maldives Ms Aminath Rasheeda Executive Director Department of Public Health Ministry of Health Ms Mariyam Suzana Ministry of Health Myanmar H.E. Professor Mya Oo Deputy Minister Ministry of Health Dr Win Myint Deputy Director General (Medical Care) Department of Health Ministry of Health Dr Soe Lwin Nyein Director (Epidemiology) Department of Health Ministry of Health Dr Ko Ko Naing Deputy Director International Health Division Ministry of Health Report of the ACM to Review Technical Matters to be discussed at the 61st Session of the RC Page 49 Nepal Dr Dirgha Singh Bam Officiating Secretary Ministry of Health and Population Dr Laxmi Bikram Thapa Director Epidemiology and Disease Control Division Ministry of Health and Population Sri Lanka Dr H A P Kahandaliyanage Secretary Ministry of Healthcare and Nutrition Dr S.M. Samarage Deputy Director General (Planning) Ministry of Healthcare and Nutrition Thailand Dr Sopida Chavanichkul Director Bureau of International Health Ministry of Public Health Dr Phusit Prakongsai Senior Health Technical Officer International Health Policy Programme Ministry of Public Health Pol. Maj. Suriwan Thaiprayoon Plan and Policy Analyst Bureau of International Health Ministry of Public Health Timor-Leste Mr Agapito da Silva Soares Director-General Ministry of Health Mr Marcelo Amaral Head Health Policy Office Ministry of Health WHO Secretariat Secretaries of the meeting Dr Poonam Khetrapal Singh Deputy Regional Director Dr Myint Htwe Director, Programme Management Members Mr J.J. Kobza Director, Administration and Finance Dr Than Sein Director Department of Noncommunicable Diseases and Mental Health Dr Abdul Sattar Yoosuf Director Department of Sustainable Development and Healthy Environments Dr Jai P. Narain Director Department of Communicable Diseases Dr Dini Latief Director Department of Family and Community Health Dr N. Kumara Rai Acting Director Department of Health Systems Development Dr R.M. Brooks Coordinator Programme Planning and Coordination Dr William L. Aldis Coordinator Health Policy and Research Dr Sangay Thinley Coordinator HIV/AIDS, Tuberculosis and Other Communicable Diseases Dr Chusak Prasittisuk Coordinator Communicable Diseases Control Dr Khalilur Rahman Coordinator Tobacco Control Dr Lin Aung Programme Development Officer Programme Planning and Coordination Dr Yonas Tegegn Strategic Alliance and Partnerships Officer Report of the ACM to Review Technical Matters to be discussed at the 61st Session of the RC Page 50 Dr Rui Paulo De Jesus Sustainable Health Policy Officer Dr Pem Namgyal Regional Adviser Immunization and Vaccine Development Dr Khanchit Limpakarnjanarat Regional Adviser Communicable Diseases Surveillance and Response Dr Ilsa Sri Laraswati Nelwan Regional Adviser Health Systems Mr Alexander von Hildebrand Regional Adviser Food and Chemical Safety Dr Sunil Senanayake Regional Adviser Health Situation and Trend Assessment Dr Kunal Bagchi Regional Adviser Nutrition for Health and Development Dr Jerzy Leowski Regional Adivser Noncommunicable Diseases Dr Vijay Chandra Regional Adviser Mental Health and Substance Abuse Dr Davison Munodawafa Regional Adivser Health Promotion and Education Dr Ardi Kaptiningsih Regional Adviser Reproductive Health Dr Roderico Ofrin Technical Officer (Ag. Regional Adviser) Emergency and Humanitarian Action Ms Laksami Suebsaeng Technical Officer (Ag. Regional Adviser) HIV/AIDS Ms Catherina Timmermans Technical Officer Intellectual Property Rights and Trade & Health Dr Hla Hla Aye Temporary International Professional Human Resources for Health Mr T.R. Swaminathan Programme Planning and Coordination Unit Mr R.K. Arora Programme Planning and Coordination Unit This publication is a report of the Meeting of the Advisory Committee (ACM) to Review Technical Matters to be Discussed at the Sixty-first Session of the Regional Committee (30 June – 3 July 2008). Delegates from Member countries in the South-East Asia Region reviewed the working papers to be discussed at the Sixty-first Session of the WHO Regional Committee for South-East Asia to be held in September 2008. During the meeting, various staff members at the Regional Office made brief presentations and responded to issues considered during the discussions. For each agenda item, delegates prepared comments and recommendations for consideration by the Sixty-First Session of the Regional Committee. Regional Office for South-East Asia World Health House, Indraprastha Estate Mahatma Gandhi Marg, New Delhi-110002, India