Final report of the thirteenth session of the Regional Committee for the Western Pacific

• -t WORLD HEALTH ORGANIZATION REGIONAL COlOOTTEE FOR THE WESTERN PACIFIC THIRTEENTH SESSION Manila, 20 to 25 September 1962 REPORT OF THE REGIONAL COMMI:TTEE MINUTES OF THE PLENARY SESSION MINUTES OF THE SUB-COMMITTEE ON PROGRAMME AND BUDGET MANILA October 1962 NCIl'E The thirteenth session of the Regional Committee for the • Western Pacific was held in the WHO Conference Hall, Manila, from 20-25 September 1962, under the chairmanship of Dr. F.Q. Du~ue, with Dr. D.J.M. MacKenzie, as Vice-Chairman. Dr. R.G.T. Ii=wis and Dr. Tiao Singkeo were the Rapporteurs. The Regional Committee met on 20, 22 and 25 September. The 21st and 24th September were devoted to the Technical Discussions. The report of the Committee will be found in Part I of this document on pages 1-50, the minutes of the plenary sessions in Part lIon pages 59-155, and the minutes • of the Sub-Committee on Programme and Budget, which met on 21 and 24 September, will be found in Part III, pa~s 159-177. -ii- I II III IV .- __ ..,.-r' CONTENTS INTRODUCTION •••••••••••••••••••••••••••••••••••••••••••••••••••• ANNUAL REPORT OF THE REGIONAL DIRECTOR 4 ••••••••• • •• ••••••••••••• PROPOSED PROGRAMME AND BUDGET ESTIMATES FOR 1964 •••••••••••••••••..••••••••••••••••••••.••••.••••••••••. Ol'lIER ~S DISCUSSED ••••••••••••••••••••••••••••••••••••••••• 1 2 3 Facilities for education and training of health personnel in the Western Pacific Region •••••••.••••••••••••••••••••••••••••••••••••• Programme planning in connection with short-term consultantships ••••••••••••••••••••••••••••••••• Management of cholera El Tor ••••••••••••••••••••••••••••••• 4 Resolutions of regional interest adopted by the twenty-ninth and thirtieth sessions of the Executive Board and the Fifteenth World Health Assembly •••••••••••••••••••••••••••••••••••••• 5 Amendments to the Rules of Procedure of the Regional Committee ..................................... OTlIER BUSmESS •••••••••••••••••••••••••••••••••••••••••••••••••• 1 Progress reports from governments on 1 2 5 6 6 6 7 8 10 11 health activities •••.•••••••••••••••.•.•.•.•••..•.•.••••..• 11 2 Teclmical Discussions ••••••••••••••.••••••••••••••••••••••• 12 2.1 Designation of Chairman ••••••••••••••••••••••••••••••• 12 2.2 Organization ........................................... 12 2.3 Eva.:Luation............................................ 13 2.4 Selection of subject for the Technical Discussions in 1963 ••••••••••••••••••••••••••••••••••• 13 -iv- ~ .. v 'f~ "',.- !. t:- CONTENTS RESOLUTIONS ADOPTED BY THE COMMITTEE •••••••••••••••••••••••••••• 13 WP!RC13.Rl WP!RC13.R2 WP!RC13.R3 WP!RC13.R4 WP!RC13.R5 WP!RC13.R6 WP!RC13.R7 WPjRC13.R8 WP/RC13.R9 WPjRC13. RlO Annual Report of the Regional Director ••••••••••• 13 Education and training ••••••••••••••••••••••••••• 14 Amendments to the Rules of Procedure of the Regional Committee •••••••••••••••••••••••• 14 Programme planning in connection with short-term consultantships •••••••••••••••••• 17 Mana~ment of cholera El Tor ••••••••••••••••••••• 18 Proposed programme and budget estimates for 1964 ••••••••••••••••••••••••••••••• 19 Technical Discussions •••••••••••••••••••••••••••• 20 Time, place and duration of fourteenth and fifteenth sessions of the Regional Comrni ttee ......................................... 20 Adoption of the Report ••••••••••••••••••••••••••• 21 Resolution of appreciation ••••••••••••••••••••••• 21 ANNEXES 1 Agenda ..................................................... . 23 2 3 4 5 List of representatives .....•......•..•....••.••.••...••.•. Report of the Sub-Committee on Programme 8.Ild Budget ...•.........•.••....•......•..••••••.• Technical. Discussions ...................................... . List of documents ......................................... . -v- 33 41 51 ..... - --" (WP/RCl3/l3 Rev.l) REPORI' OF THE REGIONAL COMMITTEE INTRODUCTION The thirteenth session of the Regional Committee for the Western Pacific was formally opened at the WHO Conference Hall by His Excellency the President of the Philippines, Mr. Diosdaclo Macapagal, in the presence of the Honourable Secretary of Health, Dr. Francisco Q. Duq,ue, and members of the diplomatic corps. The session lasted from 20 to 25 September 1962. The meeting was attended by representatives of all Member States in the Region, except Cambodia, and of the Member States responsible for territories in the Region, except the Netherlands. Representatives of the United Nations, the Technical Assistance Board, UNICEF, the South Pacific COmmission, the International Committee of Military Medicine and Pharmacy and of sixteen non-governmental organizations in official rela.tions 'With WHO 'Were also present. Dr. M.G. Candau, Director-General, attended the meeting. The Committee elected the follOwing officers: Chairman Vice-Chairman Ra.pporteurs in English in French Dr. F. Q. Duq,ue (Philippine s ) Dr. D. J. M. MacKenzie ( United Kingdom) Dr. R.G. T. lewis (New Zealand) Dr. Tiao Singkeo (Laos) Formal statements 'Were made by the representatives of the Technical Assistance Board, UNICEF, the South Pacific Commission and twelve non- governmental organizations in official relations with WHO. 2 REGIONAL COMMITrEE: THIRTEENTH SESSION The agenda is given in Annex 1 and the list of representatives in Annex 2. At its first plenary session the Committee established a Sub-Committee on Programme and Budget, composed of representatives of the following countries: Australia, France, Korea, Laos, Philippines, Portugal, Western Samoa and the United States of America. The Sub-Committee held two meetings, following Which it submitted a report to the main Committee. Further details are given in Part II and Annex 3 of this report. The Committee also established a Sub-Committee on Amend.ments to the Rules of Procedure, composed of representatives of Japan, Malaya, United Kingdom (Chairman) and Viet Nam. Further details are given in Part III. The fourteenth session of the Committee will be held in Port M>resby, Papua, with the Government of Australia as host. In accordance with the principle of rotation l the fifteenth session of the Committee will be held in Manila (see resolution WP/RC13.R8). In the course of five plenary sessions, the Committee adopted ten resolutions which are set out in Part V. PART I. ANNUAL REPORT OF THE REGIONAL DIRECTOR The Regional Director in presenting his annual report made specific reference to certain aspects which he considered deserved special mention. The recent outbreaks of cholera El Tor were a potent reminder to governments that much still needed to be done in the field of communicable disease control. Health administrations should critically review their -~ REPORT OF THE REGIONAL COMMrITEE preparedness and machinery for dealing 'With large-scale outbreaks of epidemic diseases, so that the occurrence of a few cases of cholera, of smallpox, or of any other communicable disease, might be controlled before they had time to attain epidemic proportions. The answer to this problem did not, of course, lie with communicable disease control alone - increased attention would have to be paid to environmental health, including the provision of a safe and adequate water supply, improved refuse disposal, and effective control of vectors. The important relationship which existed between health on the one hand, and economic and social development on the other, had. been mentioned on many occasions during meetings of the World Health Assembly, the Executive Board and the Regional Committee. Because of this relationship, it was one of the responsibilities of the health authorities to take all necessary measures to ensure that the economic life of the country did not suffer as a result of epidemic outbreaks of communicable diseases. It was also their responsibility to ensure that other government departments were fully aware of the importance of the promotion of health in relation to any national social and economic development plan, so that adequate funds and personnel were made available to support the programme. The Committee was informed that malaria eradication programmes were now in operation in China (Taiwan), North Borneo, Philippines, the ~ Islands and Sarawak. It was hoped that by 1964 a further three, and possibly five, would have been converted to malaria eradication. The programme in China (Taiwan) continued to be the most advanced one in the Region and the accomplishment of eradication was already in sight. He emphasized again a point which had been brought to the attention of the RegionalCommi ttee 4 REGIONAL COMMITl'EE: THIRTEENTH SESSION on a number of occasio~s - that was, unless the necessary personnel, funds and logistic support were given in an efficient manner to all malaria programmes until the final phase was reached, the gains achieved and the money spent would have been frittered away. A sense of growing success and confidence must not lead to the slightest relaxation of vigilance. Tuberculosis was still rated as an important public health problem in most of the countries in the Region. A number of national pilot area projects had been started with a view to finding ways in which the advances made in the prevention and treatment of tuberculosis could best be applied in different epidemiological and socio-economic conditions. The experience obtained was being used in the development of national programmes aimed at the elimination of tuberculosis as a public health problem, and progress to date was encouraging. The Regional Director then referred to the importance of preparing a national public health plan, co-ordinated with related plans in the social and economic field. This had been among the proposals made by the Executive Board in connection with the participation of governments in the United Nations Development Decade. The first step would involve a study and investigation of health needs, the available personnel, equipment and buildings, with a view to determining the priorities for action and formulating precise proposals aimed at the orderly development of a long-term programme. He emphasized the importance of this approach in all developing countries. The problem of supplying an adequate number of well-trained professional and auxiliary staff still remained a crucial one in many countries. However, gradual improvements could be discerned and the number of fellowships .. REPORT OF THE REGIONAL COMMITTEE 5 awarded in various fields of health during the period under review had considerably increased. The Committee reviewed the annual report chapter by chapter. A number of representatives expressed appreciation of the assistance received from WHO during the past year as this had greatly facilitated the development of health activities. Reference was made to the fact that progress in the field of communicable diseases had been overshadowed by the large-scale outbreaks of cholera El Tor. The Committee noted with satisfaction that this was now a quarantinable disease in terms of the International Sanitary Regulations. The Committee adopted resolution WP/RC1;.Rl. PART II. PROPOSED PROGRAMME AND BUDGET ESTIMATES FOR 1964 The Sub-Committee on Programme and Budget (established in accordance with resolution WP/RC7.R7 adopted by the Committee at its seventh session) held two meetings, during which it made a detailed examination of the proposed programme and budget estimates in the Western Pacific Region. The discussion was broken down into: (1) proposed programme and budget estimates for 1964 regular programme; (2) supplementary list of projects; (3) Expanded Programme of Technical Assistance; (4) Malaria Eradication SpeCial Account; and (5) Special Account for the COmmunity Water Supply Programme. The report of the Sub-Committee, which is contained in Annex ;, was considered and accepted by the main Committee (see resolution WP/RC13.R6). 6 REGIONAL COMMITTEE: THIRrEENTH SESSION PART III. arHE:R MATrERS DISCUSSED 1 rsonnel in the The Committee considered a report prepared by the Regional Director on the facilities for education and training of health personnel within the Region. Attention was drawn to the various resolutions adopted at previous sessions of the Committee emphasizing the importance of intra-regional training. Although a certain percentage of the fellowship requests each year were for placement within the Region, it was considered that these requests, particularly those at post-basic level, were not as many as they might be, one of the reasons for this being possibly the relative lack of information about the regional facilities available. The document presented to the Committee contained preliminary information on regional training centres and institutions which accepted foreign students. It was suggested that it might be useful if governments 'WOuld submit full information on such programmes to the Regional Director, so that the information could then be consolidated and distributed to ~mber governments in the Region (see resolution WP/RC13.R2). 2 in connection with short-term consultantshi s The Committee considered a report presented by the Regional Director which contained certain proposals which he felt might increase the value of short-term consultantships. Following discussion, the Committee agreed that the attention of governments should be drawn to the importance of providing the Organization with fully documented information covering the terms of reference of the consultant and the problems involved, to the value of making appropriate arrangements in advance and of prOviding a counterpart 1 REPORT OF THE REGIONAL COMMI'r'l'EE to assist the visiting consultant. The Regional Director was requested to ensure that the short-term consultants received all available background information prior to their assignment (see resolution WP/RCl3.R4). 3 Management of cholera El Tor (Documents WP/RCl3/7 and Add.l) This item was placed on the agenda at the request of the Government of 7 the Philippines. A paper on the patho-physiology of cholera, prepared by Captain R.A. Phillips, Commanding Officer, United states Naval Medical Research Unit No. 2 (NAMRU-2) in Taiwan, was discussed. An account was also presented of the work being done in the Philippines by NAMRU-2 in co-operation with the Department of Health, with a view to obtaining further information on the treatment, and possibly the prevention, of the disease. patients in one of the hospitals in Mmila were being studied and treated and the activities in operation were designed to discover how the intestinal cells would handle various ions. It was hoped that instead of giving a patient three different intravenous solutions, it would be possible to give them only sodium chloride intravenously, the other requirements being given by mouth, thereby considerably simplifying the treatment of the disease. At the moment there were twenty members of the NAMRU staff working on one patient. The situation would, of course, be different when there was one medical officer handling twenty patients and Captain Phillips and his associates were, therefore, trying to find out whether this could be applied in an epidemic situation. Emphasis was placed on the need for further research in cholera, as almost uothing was known of the epidemiology of the disease and how it spread from one place to another. A number of representatives gave brief reports on the outbrewcs of cholera El Tor in their countries. 8 REGIONAL COMMI'I'l'EE: THIRrEENTH SESSION The Regional Director was asked to collect information on all the studies presently in operation, and on any future developments in this field, and to transmit this information to ~mber States in the Region. Information was also presented to the Committee on the way in which inter-country agreements under Article 104 of the International Sanitary Regulations could be reached, and emphasis placed on the fact that they must not conflict with the principal Articles contained in these Regulations (see resolution WP/RC13.R5). 4 Resolutions of regional interest adopted by the twenty-ninth and thirtieth sessions of the Executive Board and the Fifteenth World Health Assembly (Document WP!RC13!5) The attention of the Committee was drawn to the following resolutions contained in document WP/RC13/5: (1) Admission of New ~mbers: Western Samoa (resolution WHAl5.l6); (2) Continued Assistance to Newly Independent States (resolution (3) Smallpox Eradication Programme (resolution WHAl5.53); (4) Developments in Activities Assisted Jointly with UNICEF (resolution WHAl5.54); (5) Decisions of the United Nations, Specialized Agencies and the International Atomic Energy Agency Affecting WHO's Activities: World Food Programme (resolution WHAl5.56); (6) Decisions of the United Nations, ~ecialized Agencies and the International Atomic Energy Agency Affecting WHO's Activities: United Nations Development Decade (resolution v1HAJ.5. 58); • REPORT OF THE REGIONAL COMMITTEE (7) Decentralization of the United Nations Activities (resolution EB30.R23) ; (8) Report on Development of Malaria Eradication Programme (resolution WHA15.l9); (9) Development of Malaria Eradication Programme: Acceleration of the Programme from Continued Voluntary Contributions (resolution WHA15. 20); (10) MaJ.aria Eradication Special Account (resolution WHA15.34); (11) Financing of the Malaria Eradication Programme: Criteria to be Used in Determining Eligibility for Credits Towards the Payment of Contributions (resolution WHA15.35); (12) MaJ.aria Eradication Postage stamps (resolution WHA15.47). The discussion centred around the following two resolutions: (1) resolution WHAl5.22, Continued Assistance to Newly Independent states, and (2) resolution WHA15.l9, Report on Development of Malaria Eradication Programme. The representative of Western Samoa referred to the fact that the Director-General had been authorized by the World Health Assembly to accelerate assistance to newly independent States, with particular emphasis on national health planning and related training, the expansion of medical 9 education and the strengthening of national staff. The Government of Western Samoa had submitted a proposal to the Regional Director in the form of a ten-year programme of assistance, commencing 1964, and it was hoped that full consideration would be given to this request. 10 REGIONAL COMMr'ITEE: THIRI'EENTH SESSION The representative of the United Kingdom, speaking for North Borneo, outlined the various steps which had. been taken before his country had. embarked on a malaria eradication programme. Pre-eradication studies and surveys were essential, as in this way the programme was built up and ~lemented systematically so that his Government was able to look forward. with greater confidence to the success of eradication. 5 of the Re onal Committee The SUb-COmmittee on Amendments to the Rules of Procedure, established at the first plenary session, held one meeting. It noted that the proposed revisions were to bring the Rules of Procedure of the Regional Committee for the western Pacific into line with those of the World Health Assembly and other regional committees, and decided to recommend their adoption. It further recommended that the Secretariat should be requested to rearrange the Rules of Procedure in proper sequence, incorporating the amendments as adopted, and pointed out that the Regional Committee should, in this connection, recognize that the numbering as recorded in the resolution would sustain certain consequential amendments. It also suggested that the Secretariat should be requested to issue the revised Rules of Procedure in the form of a booklet. The recommendations of the Sub-Committee were accepted unanimously (see resolution WP/RC13.R3). .f ~ .~ ~ REPORT OF THE :REGIONAL COMMITTEE PARI' IV. OTHER BUSINESS 1 Progress reports from gpvernments on health activities The Chairman acknowledged the following reports which had. been transmitted to the Regional Director: (1) AUSTRALIA - Report of the Director-General of Health, 1 July 1960 - 30 June 1961; (2) BRUNEI - Report on the progress of health activities, 1961-1962; 11 (3) CAMBODIA - Report on the progress of health activities, 1961-1962; (4) HONG KONG - Report on the progress of health activities, 1961- 1962; (5) JAPAN - A brief report on public health administration in Japan, January 1961 - July 1962; (6) l-'f..ALAYA - Report on the progress of health activities, 1960-1961; (7) NETHERLANDS NEW GUINEA - Report on the progress of health activities, 1961; ( 8) (9) (10) (11) (12) (13) (14) (15) NEW ZEALAND - Report on the progress of health activities, 1961- 1962; NORTH BORNEO - Report on the progress of health activities, 1961; PHILIPPINES - Report on the progress of health activities, 1961; SARAWAK - Madical and Health Departzoont Annual Report, 1961; SINGAPORE - Report on the progress of health activities during the year 1961-1962; TIMOR - Report on the progress of health activities, 1961; VIET NAM - Report on the progress of health activities, 1961; WESTERN SAMOA - Report on progress of health activities, 1962. 12 REGIONAL COMMITTEE: THIRTEENTH SESSION 2 Technical Discussions 2.1 Designation of Chairman At its eleventh session, the Regional Committee adopted a resolution (WP/RCl1.Rll) recommending that the Chairman of the Technical Discussions should be appointed well in advance of the meeting. Following consultations between the Regional Director and the Chairman of the Regional COmmittee, Dr. Michael J. Flynn, M.B.B.S., D.P.H., Chief Medical Officer, Metropolitan Water, Sewerage and. Drainage Board, Sydney, Austral.ia, was selected for this office. 2.2 Organization The theme of the Technical. Discussions was "The Role of the Health Services in the Improvement of Community Water Supplies" and three working papers were prepared covering the following subjects: (1) The role of health services in the improvement of community water supplies, by Dr. M.J. Flynn; (2) The role of health services in the improvement of community water supplies, by Mr. R.N. Clark; (3) The relative functions of public health and public works agencies, by Mr. C. W. IO.assen. The first session consisted of an introductory statement by the Chairman, a panel presentation of the subject and an open discussion. In the second session, after introductory remarks by the Chairman, the participants were divided into sub-groups which met separately and conducted a free discussion in accordance with guidelines and references provided. The third session was again a plenary session at which the reports prepared REPORT OF THE REGIONAL COMMrTTEE by the sub-groups were presented, the views and opinions expressed were consolidated, and conclusions drawn. Full details are contained in the report of the Technical Discussions which appears in Annex 4. 2 • .3 Evaluation 13 Of the completed questionnaires received, all twenty-seven assessed the choice of the topic as timely; seven participants rated the Technical Discussions as excellent and nineteen as reasonably good; eight said they had gained many new ideas or concepts, and eighteen as gaining some. 2.4 Selection of subject for the Technical Discussions in 196.3 The Connnittee selected "The Role of the Local Health Services in Leprosy Control lJ as the subject for the Technical Discussions in 196.3 (see resolution WP/RC13.R7) • PART V. RESOLUrIONS ADOPTED BY THE COMMITTEE Wp / RC1.3. Rl ANNUAL REPORT OF THE REGIONAL DIRECTOR The Regional COmmittee, Having reviewed the Twelfth Annual Report of the Regional Director which covered the period 1 July 1961 to .30 June 1962,1 1. NOTES with satisfaction the manner in which the programme was planned and carried out; 2. NOTES with satisfaction that cholera El Tor has been included among the quarantinable diseases; 1 Unpublished document WP/RCl.3/2. 14 3. COMMENDS the Regional Director and his staff for the work accomplished; 4. ADOPl'S the report. WPR Handb.Res., 3rd ed., 2.2.12 Third meeting" 22 September 1962 WP/RC13.R2 EDUCATION AND TRAINlNG The Regional COmmittee, Having studied the report of the Regional Director on the facilities available within the Western Pacific Region for the education and training 1 of professional and auxiliary health personnel, 1. REITERATES the importance of awarding fellowships for study within the Region; 2. URGES the governments with suitable training programmes for foreign students to submit full information on such programmes; 3. REQUESTS the Regional Director to prepare a consolidated statement for distribution to ~mber goverrments in the Region. WPR Handb.Res., 3rd ed., 1. 7.3 Third meeting, 22 September 1962 WP/RC13.R3 AMENDMENTS TO THE RULES OF PROCEDURE OF THE REGIONAL COMMITrEE The Regional Committee, Considering that it is desirable to revise the Rules of Procedure of the Regional Committee to bring them into line with the recently revised Rules of Procedure of the World Health Assembly, ADOPTS the following amendments: ~npUblished documant WP/RCl3/8. REPORT OF THE REGIONAL COMMITTEE Rule 11 Revise as follows: "In addition to exercising the powers which are conferred upon him elsewhere by these Rules, the Chairman shall declare the opening and closing of each meeting of the Committee, shall direct the discussions, ensure observance of these Rules, accord the right to speak, put questions and announce decisions. He shall rule on points of order, and, subject to these Rules, shall control the proceedings at any meeting and shall maintain order thereat. The Chairman may, in the course of the discussion of any item, propose to the Committee the limitation of the time to be allowed to each speaker or the closure of the list of speakers." Rule 25 Immediately following this rule, insert a new rule as follows: Rule 25 (bis) No representative may address the Committee without having previously obtained the permission of the Chairman. The Chairman shall call upon speakers in the order in which they signify their desire to speak. The Chairman may call a speaker to order if his remarks are not relevant to the subject under discussion. Rule 27 Delete this rule entirely. Rule 33 Immediately following this rule, insert a new rule as follows: 15 16 REGIONAL CO~: THIRTEENTH SESSION Rule 33 (bis) Subject to Rule 33, any motion calling for a decision on the competence of the Committee to adopt a proposal submitted to it shall be put to the vote before a vote is taken on the proposal in question. Rule 35 Revise as follows: ''When an amendment to a proposal is moved, the amendment shall be voted on first. When two or more amendments to a proposal are moved, the Committee shall first vote on the amendment deemed by the Chairman to be furthest removed in substance from the original proposal and then on the amendment next removed therefrom, and so on, until all the amendments have been put to the vote. Where, however, the adoption of one amendment necessarily implies the rejection of another amendment, the latter amendment shall not be put to the vote. If one or more amendments are adopted, the amended proposal. shall then be voted upon. "A motion is considered an amendment to a proposal, if it merely adds to, deletes from, or revises part of that proposal. A motion which constitutes a substitution for a proposal shall be considered as a proposal." Rule 44 Immediately follOwing this rule, insert a new rule as follows: Rule 44 (bis) After the Chairman has announced the beginning of voting, no representative shall interrupt the voting except on a point of order in connexion with the actual conduct of voting. REFORr OF THE REGIONAL COMMITTEE 17 Rule 46 Delete the footnote and add a new second paragraph as follows: "A decision under this rule by the Cormni ttee whether or not to vote by secret ballot may only be tal(en by a show of hands; if the Committee has decided to vote on a particular question by secret ballot, no other mode of voting may be requested or decided upon." WPR Handb.Res., 3rd ed., 5.3.2 Third meeting, 22 September 1962 WP/RC13.R4 PROGRAMME PLANNING IN CONNECTION WITH SHORr-TERM CONSULTANTS HIPS The Regional Committee, Realizing the importance of well-prepared planning in connection with short-term consultantships, 1. DRAWS the attention of governments: (1) to the importance of providing the Organization with fully documented information covering the terms of reference of the consultant and the problems involved; (2) to the value of making appropriate arrangements in advance and providing a counterpart to assist the visiting consultant; and 2. REQUESTS the Regional Director to ensure that short.term consultants receive all available background information prior to their assignment. WPR Handb.Res., 3rd ed., 1.1.2 Third meeting, 22 September 1962 18 REGIONAL COMMI'I'.rEE: THIRTEENTH SESSION WP/RCI3.R5 MANAGEMENT OF CHOLERA EL TOR I The Regional Committee, Having considered with interest the report presented on the patho-physiology of choleral and on the work being done by the United States Naval Medical Research Unit No. 2 in co-operation with the Government of the Philippines, 1. EXPRESSES its appreciation to the Governments of the Philippines and the United states of America for having made this information available; 2. EMPHASIZES the importance of further research being carried out in relation to cholera El Tor; 3. REQUESTS the Regional Director to collect information on all the studies presently :!.n operation, and on any future developments in this field, and to transmit this information to Member States in the Region; II Having noted the statement presented by the Regional Director on the conclusion of bilateral or multilateral. arrangements under Article 104 of the International Sanitary Regulations,2 UNDERLINES the importance of an early exchange of information, under Article 104 of the International Sanitary Regulations, particularly with regard to the imposition of quarantine restrictions in respect of cholera El Tor. WPR Handb.Res., 3rd ed., 1.3.3 (1) ~pUblished document WP/RC13/7. 2unpublished document WP/RC13/7 Add.l. Fourth meeting, 25 September 1962 , -- .r I REPORT OF THE REGIONAL COMMITTEE 19 PROPOSED PROGRAMME AND BUDGET ESTIMATES FOR 1964 The Regional COmmittee, Having examined the programme and budget estimates proposed for the itlestern Pacific Region in 19641 and the report of the Sub-CoImnittee on Programme and Budget,2 1. ENDORSES the proposed progr~ under the regular budget and those proposed to be financed from the Malaria Eradication Special Account and the Special Account for the Community Water Supply Programme; 2. NOTES the progra.nJIJle proposed to be financed under the Expanded Programme of Tectnical Assistance; 3. AGREES that the follOwing inter-country programmes are important and should be undertaken in 1964: Seminar on the control of communicable diseases Inter-country leprosy consultant, south Pacific Seminar on composting of organic wastes; II Having studied the supplementary list of projects, which were requested by governments, including those brought forward during the meeting, which could not be accommodated within the regional allocations for 1963 and 1964, 1. BELIEVES that these projects should be considered part of the regional programme; 2. REQUESTS the Regional Director to implement as many of the projects in the supplementary list as possible, as and when funds are available; lunpublished documents WP/RC13/3 and Rev.l. ~ublished document WP/RC13/11 Rev.l. 20 REGIONAL COMMItTEE: THIRTEENTH SESSION III REQUESTS the Regional Director to transmit the proposals to the Director-General for his consideration for inclusion in his proposed programme and budget for 1964. WPR Handb.Res., 3rd ed., 3.1.12 Fourth meeting, 25 September 1962 WP/RCl3.R7 TECHNICAL DISCUSSIONS The Regional Committee I 1. NOTES the report on the Technical Discussionsjl 2. EXPRESSES its appreciation to Dr. Michael J. Flynn for having so ably served as Chairman, and to the other experts who served as members of the Panelj II Having considered the topics proposed for the Technical Discussions in 1963,2 DECIDES that the subject shall be ''The Role of the Local Health Services in leprosy Control ". WPR Handb.Res., 3rd ed., 5.4.2 (10) Fifth meeting, 25 September 1962 WP/RC13.R8 TIME, PlACE AND DURATION OF FOURTEENTH AND FIFTEENTH SESSIONS OF THE REGIONAL COMMITTEE The Regional Committee 1. CONFIRMS that the fourteenth session 'Will be held in Port Moresby, Papua, in early September 1963j and 2. DECIDES that the fifteenth session will be held in Mmila in accordance 'With the policy that every second year the meeting should be held at regional headquarters. WPR Handb.Res., 3rd ed., 5. 2.13 ~pUb1iShed document WP/RC13/12 Rev.1. 2UnpUb1ished document WP/RC13/6. Fifth meeting, 25 September 1962 r - REPORT OF THE: REGIONAL COMMITTEE 21 WP/RC13.R9 ADOPTION OF THE: REFORI' The Regional Committee Having considered the draft report on the thirteenth session of the COmmittee, ADOPTS the report. Fifth meeting, 25 September 1962 WP/RC13.RlO RESOLUTION OF APPRECIATION The Regional Committee EXPRESSES its appreciation and thanks to: (1) The Government and people of the Philippines for having invited the Regional Committee to hold its thirteenth session in Manila; (2) His Excellency the President for having formally opened the se ssion; (3) the Acting Secretary of Foreign Affairs for the hospitality offered; ( 4) the Secretary of Health and his staff for the excellent arrangements made for the meeting and the hospitality extended; ( 5) the General Manager and staff of the Philippine National Waterworks and Sewerage Authority for having kindly arranged a visit to the Balara Water Treatment Plant; (6) the Chairman, other officers of the Committee and the Chairman of the Technical Discussions; (7) the representatives of the Technical Assistance Board, the United Nations Children's Fund, the South Pacific COmmission, 22 REGIONAL COMMITrEE: THIRTEENTH SESSION and the non-governmental. organizations who made statements; ( 8) the Director-General for the honour of his visit and his invaluable advice; (9) the Regional Director and the Secretariat for their work in connection with the meeting. Fourth meeting, 25 September 1962 y. .:.-.-- \ 1 ' r -" REPORT OF THE REGIONAL COMMITTEE AGENDA 1 Opening of the session 2 Address by retiring Chairman 3 Address by the Director-General ANNEX 1 (WP/RC13/l Rev.l - 6 August 1962) 4 Election of new officers: Chairman, Vice-Cha.irman and Rapporteurs 5 Address by inCOming Chairman 6 Adoption of the agenda 7 Technical Discussions 8 9 10 II 12 13 7.1 statement by the Chairman 7.2 Acceptance of the Progra.nn:ne for Technical Discussions Proposed progra.nmte and budget estimates for the financial year 1 January - 31 December 1964 8.1 Establishment of the Sub-Committee on Programme and Budget 8.2 Consideration of the report presented by the Sub-Committee on Programme and Budget Acknowledgements by the Chairman of brief reports received from governments on the progress of their health activities Report of the Regional Director Facilities available within the Western Pacific Region for education and training of health personnel Programme planning in connection with short-term consultant ships Mmagement of Cholera El Tor: item proposed by the Government of the Phlli:p:pine s 24 REGIONAL COMMITTEE: THIRrEImTH SESSION 14 Resolutions of regional interest adopted by the twenty-ninth and thirtieth sessions of the Executive Board and the Fifteenth World Hea.lth Assembly 15 Amendments to the Rules of Procedure of the RegionaJ. Committee 16 Selection of topic for the Technical Discussions during the fourteenth session of the Regional Committee 17 Consideration of the report presented by the Technical Discussions Group 18 Time 1 place and duration of fourteenth and fifteenth sessions of the Regional Committee 19 Other business 20 Adoption of the draft report of the Committee 21 Adjournment 1 I '1 r,~ ~ 1 AUSTRALIA AUSTRALIE CHINA CHINE FRANCE REPORl' OF THE REGIONAL COMMITJ.'EE LIST OF REPRESENTATIVES LISTES DES REPRESENTANTS 25 ANNEX 2 I. REPRESENTATIVES OF MEMBER STATES REPRESENTANTS DES ETATS MEMBRES Dr. H.E. Downes Assistant Director-General of Health Department of Health Canberra, Australia Dr. M. J. Flynn Chief Medical Officer Metropolitan Water, Sewerage and Drainage Board Sydney, Australia Mr. D.Sadleir Second Secretary Australian Embassy Manila Dr. J. J. Saave Department of Publ~c Health Papua and New Guinea Dr. C.J. Ross-Smith General Secretary of the Australian Medical Association Australia Dr. C.K. Chang Director (Chief Representative) (Chef de delegation) (Alternate/Suppleant) (Alternate/Suppleant) (Alternate/SUppleant) (Alternate/Suppleant) Department of Health Administration Ministry of Interior Taiwan, Republic of China Medecin-Colonel L. Caillard Directeur de la sante publique de la Nouvelle-CaLedonie Noumea, Nouvelle-CaLedonie 26 REGIONAL COMMrI'rEE: THIRTEENTH SESSION I r ~ JAPAN Dr. N. Tate bayashi (Chief Representative) JAPON Director (Chef de delegation) Division of Health and Welfare statistics Minister's Secretariat Mtnistry of Health and Welfare .« " "" Tokyo, Japan Mr'. K. Watanabe (Alternate/Suppleant) Assistant Liaison Otticer International Affairs Minister's Secretariat Ministry of Health and Welfare Tokyo, Japan Mr'. H. Okazaki (Alternate/SUpp1eant) Third Secretary Embassy of Japan in the Philippines Manila Dr. R. Nakahara (Adviser/Conseiller) Chief Communicable Disease Control Section Public Health Bureau Mtnister's Secretariat MLnistry of Health and Welfare Tokyo, Japan KOREA D:tt. Sang Tae Han (Chief Representative) COREE Chief (Chef de delegation) EPidemic Prevention Section Ministry of Health and Social Affairs Seoul, Korea Mr'. Koo Sup Yang (Alternate/Suppleant) Second Secretary and Consul Embassy of the Republic of Korea in the philippines Manila LAOS Dr. Tiao Singkeo (Chief Representative) Mtnistere de la sante publique (Chef de delegation) et des Affaires sociales Vientiane, Laos Dr. Phouy Phouttasak (Alternate/Suppleant) Medecin provincial Luang Prabang, Laos MALAYA tw:AISIE NEW ZEALAND NOUVELLE .. ZEW·j1>E PHILIPPmES REPORT OF THE REGIONAL COMMrTTEE Dr. L.W. Jayesuria Deputy Director' ~dica.l and. Hea.lth Services Federation of Malaya Mr. K. K. Chong Water Engineer Public Works Department Federation of Malaya Mr. F. W. Crowley Assistant Director (Water Supply) Public Works Department Federation of Malaya Dr. R.G.T. ~wis Deputy Director-General of Health Department of Health Wellington, New Zealand Dr. F.Q. Duque Secretary of Hea.lth Department of Health Manila Dr. A.H. Cruz Director of Health Services Department of Hea.lth Manila Mr. J.C. Perlas Manager National Waterworks and Se~rage Authority Manila Dr. E.L. Villegas ~dical Officer-In-Charge of International Health Affairs Department of Health Manila (Chief Representative) (Chef de delegation) (Alternate/SUppleant) (Al.ternate/SUpp16ant) (Chief Representative) (Chef de delegation) (Alternate/Suppleant) (Al.ternate/Suppleant) (Alternate/SUppleant) Mr. B. Brillantes (Adviser/ ConseUler) Chief Division of Environmental Sanitation Mulila 28 PHILIPPINES (continued) PORTUGAL UNITED KINGDOM ROYAUME-UNI UNITED STATES OF AMERICA mATS-UNIS D'AMERIQUE REGIONAL COMMrrm: THIRrEENTH SESSION Mr. M. Tana Chief Provincial, City and Mm1cipal Department National Waterworks and Sewerage Authority M:l.nila Dr. JOse de Paiva Martins Chief of Health Services Province of Macao Dr. D.J.M. MacKenzie Director of Medical and Health Services Hong Kong Dr. E. Christiansen Acting Deputy Director of Medical Services Jesselton, North Borneo Dr. C.H. Gurd Director of Medical Services Suva, Fiji Dr. M.A. Rozalla Assistant Director of Medical Services Kuching, Sarawak Dr. H. DeLien Officer In Charge United States Quarantine Station Hong Kong (Adviser/Conseiller) (Chief Representative) (Chef de fuUegation) (Alternate/Suppleant) (Alternate/Suppleant) (Alternate/Suppleant) (Chief Representative) (Chef de delegation) Dr. L. Floria (Alternate/Suppleant) Chief Health Division United States ~ncy for International Development Manila captain R.A. Phillips (Adviser/ConseUler) Medical Corps, United States Navy Commandjng Officer United States Naval Medical Research Unit No. 2 Taiwan, China r-- _._ VIEr NAN VIEr-NAM WESTERN SAMOA SAMOA OCCIDENTAL UNITED NATIONS NATIONS UNIES REPORT OF THE F.EGIONAL COMMITrEE Dr. I.e-Cuu-Truong Directeur general de la sante et des :aepitaux Salgon, Viet-Nam Dr. Nguyen-Binh-Nghien Chef Service Hygiene Publique Saigon, Viet-N~ Dr. J. C. Thieme Director of Health Health Department We stern Samoa (Chief Representative) (Chef de delegation) (Alternate/Suppleant) II. REPRESENTATIVES OF THE: UNITED NATIONS AND SPECIALIZED AGENCIES REPRESENTANTS DES NATIONS UNIES ET DES INSTITUTIONS SPECIALISEES Mr. P. Edwards UNICEF Resident Representative Manila (Chief Representative) (Chef de delegation) Mt'. R. Pacheco (Alternate/Suppleant) Information Officer United Nations Information Centre for the Philippines Manila TECHNICAL ASSISTANCE BOARD BUREAU DE L'ASSISTANCE TECHNIQUE Mr. A.H. MacKenzie Resident Representative of the Technical Assistance Board UNITED NATIONS CHILDREN'S FUND ' FONDS DES NATIONS UNIES POUR L'ENFANCE in the Philippines Manila Mr. P. Edwards UNICEF Resident Repre sentati ve Manila Dr. A. Mmgay-Angara UNICEF Programme Officer Manila (Chief Representative) (Chef de delegation) (Alternate/Suppleant) 30 REGIONAL COMMITTEE: THIRTEENTH SESSION III. REPRESENTATIVES OF OTHER INTER- GOVERNMENTAL ORGANIZATIONS AND ~F NON-GOVERNMENTAL ORGANIZATIONS REPRESENTANTS D'AUTRES ORGANISATIONS INTER-GOWERNEMENTALES ET NON- GOUVERNEMENTALES INTERNATIONAL COMMrTTEE OF MILITARY MEDICINE AND PHARMACY COMITE INTERNATIONAL DE MEDECINE ET DE PHARMACIE MILITAIRES INTERNATIONAL ASSOCIATION FOR THE PREVENTION OF BLINDNESS ASSOCIATION INTERNATIONALE DE PROPHYLAXIE DE LA CECITE IHTERNATIONAL COMMITTEE OF CATHOLIC NURSES COMITE INTERNATIONAL CATHOLIQUE DES INFIRMIERES ET ASSISTANTES MEDICO-SOCIALES INTERNATIONAL COMITTEE OF THE RED CROSS COMITE INTERNATIONAl, DE LA CROIX-ROUGE INTERNATIONAL COUNCIL OF NURSES CONSEIL INTERNATIONAL DES INFIRMIERES INTERNATIONAL DENTAL FEDERATION FEDERATION DENTAIRE INTERNATIONALE Colonel B.T. Sayoc, Medical Corps Deputy Surgeon-General Armed Forces of the Philippines General Headquarters Camp Mlrphy, Que zon City Dr. S.P. Lopez Executive Director Philippine Society for the P::>:-evention of Blindness, Inc. Manila Mrs. C.T. Maceda University of sto. Tomas Hospital Manila Mis s O. M. Boado San Juan de Dios Hospital Manila Mr. J.W • .Mittner International Committee of the Red Cross (Philippines) M3.kati, Rizal VIS. T.G. Villarica, R.N. First Vice-President Filipino Nurses' Association Manila Dr. B.B. Erana Office of the Secretary-General Asian-Pacific Dental Federation (Feaeration of National Dental Organizations in Asia and the Pacific) Manila Doctors Hospital Manila " REPORr OF THE REGIONAL COMMITTEE 31 INTERNATIONAL FEDERATION OF GYNECOLOGY AND OBSTETRICS FEDERATION INTERNATIONALE DE GYNECOLOGIE ET D'OBSTETRIQUE INTERNATIONAL FEDERATION OF SURGICAL COLLEGES FEDERATION INTERNATIONALE DES COLLEGES DE CHIRURGIE L~ERNATIONAL HOSPITAL FEDERATION FEDERATION INTERNATIONALE DES HOPITAUX mTER~ATIONAL PAEDIATRIC ASSOCIATION ASSOCIATION INTERNATIONALE DE PEDIATRIE mTERNATIONAL SOCIETY FOR THE REHABILITATION OF THE DISABLED INTERNATIONAL SOCIETY OF BLOOD TRANSFUSION SOCIETE INTERNATIONALE DE TRANSFUSION SANGUINE LEAGUE OF RED CROSS SOCIETIES LIGUE DES SOCIETES DE IA CROIX-ROUGE Professor R. Apelo President Philippines Obstetrical and Gynecological Society Manila Dr. R.L. Alfonso, F.P.C.S. President Philippine College of Surgeons Mmila Dr. P. Recio, F.P.C.S. Philippine College of Surgeons Manila Dr. G.L. del Castillo Member (AJ.ternate/ Supp16ant) Council of Management of the International Hospital Federation Caloocan City Dr. Fe del MUndo Director The Children's Memorial Hospital Quezon City Dr. D.J. Tablan Philippine Foundation for the Rehabilitation of the Disabled Philippine National Red Cross Building Manila Dr. G.C. Caridad Member International Society of Blood Transfusion Philippine National Red Cross Manila Dr. B.C. Fontanilla Member Board of Governors Philippine National Red Cross Manila 32 REGIONAL COMMl'l'I'EE: THIRl'EENTH SESSION LEAGUE OF RED CROSS SOCIm'IES LIGUE DES SOCImES DE IA CROIX-ROUGE (continued) MEDICAL WOMEN'S :mTERNATIONAL ASSOCIATION ASSOCIATION INTERNATIONALE DES FEMMES MEDECINS SOUTH PACIFIC COMMISSION COMMISSION DU PACIFIQUE SUD WORLD CONFEDERATION FOR PHYSICAL THERAPY CONFEDERATION MONDIALE DE PHYSIOTHERAPIE WORLD FEDERATION FOR MENTAL HEALTH FEDERATION MONDIALE POUR LA SANTE MENTALE WORLD FEDERATION OF OCCUPATIONAL THERAPISTS FEDERATION MONDIALE DES ERGOTHERAPEUTES WORLD MEDICAL ASSOCIATION ASSOCIATION MEDICALE MONDIALE WORLD VErERANS FEDERATION FEDERATION MONDIALE DES ANCIENS COMBATTANTS Dr. T. Calasanz Manager Philippine NationaJ. Red Cross Manila Dr. T. Gomez Vice-President Philippine Medic~ Women I s Association Manila Dr. G. Loison Executive Officer for HeaJ.th South Pacific Commission New CaJ.edonia Mr. A. Savellano Head Therapist Physiotherapy Department National Orthopedic HospitaJ. Mandaluyong, Rizal Professor W.S. Perfecto Member Executive Board World Federation for ~ntal Health, and President Catholic Educational Association of the Philippines Manila Mrs. C.A. Floro Registered Occupational Therapist ~mber Philippine Mental HeaJ.th Association Manila Dr. B.R. Roa. President Philippine Medical Association Manila Dr. A.M. Inocentes Chief of Rehabilitation and Consultant Orthopedic Surgeon Physiotherapy Department National orthopedic Hospital Mandaluyong, Rizal REPORT OF THE REGIONAL COMMITrEE 33 ANNEX 3 REPORT OF THE SUB-COMMITrEE ON PROGRAMME: AND BUDGET ~ 1 INTRODUCTION The Sub-Committee on Programme and Budget, composed of representatives of Australia, France, Korea, Laos, Portugal, Western Samoa and the United States of America, met on the afternoon of 21 September 1962, under the chairmanship of Dr. F.Q. Du~ue. It discussed the following items: (i) Proposed programme and budget estimates for 1964 regular programme; (ii) Malaria Eradication Special Account; (iii) Supplementary list of projects; (iv) Expanded Programme of Technical Assistance; (v) Special Account for the Community Water Supply Programme. Representatives of Japan, Malaya, New Zealand, Philippines, the United Kingdom, Viet Nam, and two of the non-governmental organizations in official relations with WHO also attended. 2 RElI.ARKS BY THE SECRETARY The Secretary opened the session with a statement on the overall proposals which totalled $3 629 367. He pointed out that the 1964 regular proposals represented an increase of $283 508 over 1963 and that the full amount had been applied to activities directly related to provision of assistance to Member governments while the Regional Office proposals showed a slight decrease. Under Regional Advisers, an increase of $45 283 was proposed mainly relating to statutory increases and the prOvision of second advisers in communicable diseases and nursing to assist with the increasing volume of activities in these fields. There was a slight increase in the provision for WHO Representatives prinCipally due to expected increased office rentals. REGIONAL COMMITl'EE: THIRTEENTH SESSION The Secretar,y stated that the 1964 regular budget contained 105 projects, of which 91 were country and 14 inter-country projects. Eighty per cent. of the proposals related to continuing and 20 per cent. to new projects. Included were 101 fellowships, 33 of which were for study within the Region. Comments were made on areas of particular e~hasis and details were provided on the inter-country and regional proposals. It was mentioned that because of budgetary limitations certain requests had. had. to be included in the supplementery list for i~lementation subject to availability of funds. Reference was made to the fact that, due to limitations on individual governments target amounts, certain health activities under the Technical Assistance programne ha.d. had. to be restricted and mOdified; and some requests had bee~ made under special categories for which the allocation of funds by the Technical Assistance Board was uncertain. The seriousness of this situation, and its implications on future health activities, was stressed. The attention of the Sub-Committee was also drawn to the resolution adopted by the Regional Committee at its twelfth session, e~hasizing the i~ortant relationship of health to the economic and social development of developing countries, and urging l:.ealth authorities to ensure that the contribution which public health makes to economic and social development was made clear to national planning cOmITittees. l The malaria eradication activities were briefly summarized and the Sub-Committee v.'as informed that five countries in the Region, China (Taiwan), North Borneo, Philippines, Ryukyu Islands and Sarawak, had. full malaria eradication programmes in operation, and that by 1964 it was expected that similar programmes would be start~d in another four or five countries. The possibility of acceleration of the malaria eradication programme, in lResoluticn WP!RC12.R5, WPR Handbook of Resolutions and Decisions, 1962, 3rd ed., 3.1.1 (12). Y • REPORT OF THE REGIONAL COMMITTEE 35 accordance with resolution WHAl5.20 of the Fifteenth World Health Assembly, was mentioned, and it was stated that preliminary discussions were being undertaken with the governments concerned. Brief reference was made to the proposal under the Community Water Supply Special Account and to the fact that discussions were in progress with Headquarters on the ~ .~ possibility' of additional activities under this fund. 3 DISCUSSION for 1964 re The Sub-Committee decided to discuss the regular programme item by item. The repre sentati ve of Korea gave details of the revisions to be made to the 1964 projects proposed for Korea, in order that sufficient funds were made available to support its rural health project. The proposed revisions were noted. The representative of Australia stated that his Government felt that an increase of 15 per cent. in the regular budget, compared to 8 to 10 per cent. in recent years, was not justified by normal expansion of activities. He did not now wish to propose budget cuts, but stated that his Government reserved its right to return to the question at ._the next World Health Assembly. I The detailed proposals for Regional Office, Regional Advisers and WHO Representatives were examined. The Chairman commented on the salaries of general service staff and made some comparisons between the salaries of lower ~ graded clerical staff and regional advisers. The Secretary explained that the advisers' salaries were established by Headquarters, while general service scales were based on the best prevailing salaries in the area concerned. Thus the local salary scale for Manila had been based on a survey of better paying commercial firms, agencies and diplomatic services, and the scale was reviewed REGIONAL COMMITTEE: THIRI'EENTH SESSION from time to time. The Chairman, speaking for his country, again pointed out the discrepancy between clerical salaries and those of Senior Regional Advisers and requested that cognizance be taken of his observations for possible influence when salary scales were re-examined. The representative of Australia noted that the Regional Advisers were very senior medical specialists, who were required to deal with the senior medical staff of the sixteen M:!m.ber governments of the Region, the largest geographical region in WHO, and considering their duties and responsibilities, felt that there was no valid basis of comparison between their salaries and those of the clerical staff. During discussions of the Regional Office estimates, it was noted that the slight decrease in costs was due to reduced home leave and not to staff cuts or other economies which might have affected the efficiency or capacity of the Regional Office to a.dm1nister the 15 per cent. higher regular budget in 1964. Questions were raised on the functions and differences between Regional Advisers and WHO Representatives and the required information was provided. The proposals for projects were then examined on a country basis. A summary was prepared giving details of the regular budget proposals by activity and country. Decision: The Sub-Committee decided to recommend approval of the proposals under the regular budget. 3.2 Malaria Eradication special Account (Documents WP/RC13/3 and Rev.l) The Sub-Committee examined the proposals, including the revision to the Brunei project contained in document WP/RC13/3 Rev.l. There were no . . REPORT OF THE REGIONAL COMMITTEE 37 specific comments and the Sub-Committee expressed approval of the proposals. Decision: The Sub-Committee decided to recommend approval of the proposals under the Malaria Eradication Special Account. 3.3 SUpplementary list of projects (Documents WP/RC13/3 and Rev.l) The Sub-Committee noted the additional request of the Government of ~ '"' Singapore contained in the revision document. The proposed projects were examined individually on a country basis. It -was noted that the revised total of the supplementary list became $940 308. There were no particular comments on any of the projects. Decision: The Sub-Committee decided to report to the plenary session its satisfaction with the supplementary list of projects as amended. 3.4 Expanded Programme of Technical Assistance (Documents WP/RCl3/3 and Rev.l) The Sub-Committee took note of the various revisions, based on final Government requests, to the programmes of the British Solomon Islands Protectorate, North Borneo, Sarawak and Tonga under Category I, and to the inclusion of two additional Category II projects by the Government of Viet Nam. The individual projects were examined country by country; and note -was taken of the three inter-country projects proposed under Category I, a seminar on the control of communicable diseases, an inter-country leprosy consultant, and a seminar on compo sting of organic wastes. Decision: The Sub-Committee noted the programme proposed to be financed under the .Expanded Programme of Technical Assistance and agreed to the inclusion of the suggested inter-country projects. REGIONAL COMMITTEE: THIRTEENTH SESSION The Sub-Committee took note of the project proposed for 1964. 3.6 Final recommendation The representative of the United States of America returned to the question of the proposed regular programme and budget and requested additional information on the total proposals. It was stated that there was a 15.13 per cent. increase in the 1964 proposals over those of 1963, the amounts being $2 157 005 and $1 873 497, respectively. The representative stated, on behalf of his Government, that he felt the increases reasonable and accordingly his delegation was prepared to support a resolution authorizing the Regional Director to transmit the budget proposals to the Director-General for his consideration for inclusion in the overall budget for 1964. Decision: The Sub-Committee decided to recommend to the Regional Committee that it adopt a resolution approving the proposed programme and budget and authorizing the Regional Director to transmit the proposals to the Director-General for his considera- tion for inclusion in his proposed prograwne and budget for 1964, I ....,.- REPORT OF THE REGIONAL COMMITTEE 39 APPENDIX ANALYSIS OF PROPOSED PROGRAMME AND BUDGET ESTIMATES REGULAR FUNDS (FIELD ACTIVITIES) SUMMARY i 19b) I US$ Regional Committee Meeting costs (Appropriation Section 3) .. 7 000 Regional office costs (Appropriation Sections 5 and 7) ........ 445 576 Field activities (Appropriation Sections 4 and 7) ............. 1 471 822 TOl'AL ......................................................................... ~=~~~=~~~ ANALYSIS OF FIELD ACTIVITIES FOR 1963 , Continuing I ! i New Projects ProJects I ! , I us$ % i US$ % a I , i V.alaria •••••••.••••••.••••••• 1 44 336 3.01 ! - - ,.'fuberc1llosis ................................ 125 160 8·50 I 2 800 0.19 Venereal diseases and I t 'I treponematoses ....................... 88 934 6.041 - - II • Bacterial diseases .................... - - i 38 250 2.60 j Parasitic diseases t ................... - 1:36 1 - -! Virus diseases ........................... 20 038 6 800 0.46 leprosy ................................... - - I 13 700 0.93 I Public health administration • 318 703 21.66 I 126 758 8.61 j Vital and health statistics •• 61 204 4.16 2 400 0.16 ~ Dental health •••••••••..•••.. 6 000 0.40 8 760 0.60 ; Nursing ........................................ 106 725 7. 25 52 661 3·58 . Social and occupational health 3 200 0.22 - - Health education •••.••.••••• '. 38 718 2.63 10 800 0.74 , Maternal and child health ••.• 67 692 4.60 22 429 1.52 Mental health •••••••••••••••• 46 042 3.13 1 1 700 0.12 Nutrition ................ ,. .. -............. 36 008 2.45 - - Radiation and isotopes ........... - - I - -Environmental health •••••••.• 103 405 7.02 i 2 000 0.14 Education and training ••••••• 80 682 19 750 1.34 1964 uS$ 7 000 443 202 1 730 848 ~=~~~-~~~ Total us$ % 44 336 3.01 127 960 8.69 -88 934 6.04 38 250 2.60 - - 26 838 1.82 13 700 0·93 445 461 30.27 63.604 4.32 14 760 1.00 159 386 10.83 3200 0.22 49 518 3.37 90 121 6.12 47 742 3.25 36 008 2.45 - - 105 405 7.,16 100 432 6.82 5·48 I other activities •••••••••.••• 9 800 0.61. I 6400 0.43 I 16 200 1.10 TDrAL ............... 11 156 647 78.58 I 315 208 21.42 !=~~!=~~~ 100.00 j========= , ======= ------===== ' ----- 40 REGIONAL COMMI'PI'EE: THIRTEENTH SESSION ANALYSIS OF FIELD ACTIVITIES FOR 1964 Continuing New Projects Total Pro.1ects US$ 0; US&> 'fa ~ % MaJ..ar1a •••••••••••••••••••••• 47 782 2.76 - - 47 782 2.76 Tuberculosis ........•........ 118 391 6.84 39 400 2 .. 28 157 791 9.12 Venereal diseases and treponematoses ••••••••••••• 85 862 4.96 2500 0.14 88 362 5.10 Bacterial diseases ••••••••••• .. .. .. .. .. - Parasitic diseases ••••••••••• .. .. .. - .. .. Virus diseases ••••••••••••••• 25 644 1.48 4 200 0.24 29844 1.72 leprosy ...................... .. .. 2 500 0.14 2500 0.14 Public health administration • 389 06;- 22.48 122 058 7·05 511.123 29·53 Vital and health statistics •• 67 258 3.89 - .. 67 258 3.89 Dental health •••••••••••••••• 29 110 1.68 3 650 0.21 32 760 1.89 Nursing ...•.................. 167 150 9.66 10 200 0·59 177 350 10.25 Social and occupational health .. .. 20100 1.16 20 100 1.16 Health education ••••••••••••• 41 712 2.41 35 121 2.03 76 833 4.44 Maternal and child health •••• 93 394 5·40 II 800 0.68 105 194 6.08 ~ntal health •••••••••••••••• 56 594 3.27 5 000 0.29 61 594 3.56 Nutrition ••..•..••••..••..••. 37 551 2.17 35 800 2.07 73 351 4.24 Radiation and isotopes ••••••• .. - 5 800 0.33 5800 0.33 Environmental health ••••••••• 121 562 7·02 10400 0.60 131 962 7.62 Education and training ••••••• 99 144 5 73 33 700 1.95 132 844 7.68 Other activities ••••••••••••• 8400 0.42 .. .. 8 400 0.42 TOI'AL ••••••••••••••• 1 388 619 80.24 342 229 19.76 1 730 848 100.00 ========= ===== ======= ===== ========= ====== REPORT OF THE REGIONAL COMMITTEE 41 ANNEX 4 TECHNICAL DISCUSSIONS 1 SUBJECT The subject of t~e technical discussions as decided by the Committee at its twelfth session was liThe Role of the Health Services in the Improvement of Conmmnity Water Supplies 11. 2 ORGANIZATION OF THE DISCUSSIONS The first session consisted of an introductory~tatement by the Chairman, a panel presentation of the subject and an open discussion. In the second session, after introductory remarks by the Chairman, the participants were divided into sub-groups which met separately and conducted a free discussion in accordance with guidelines and references provided. The third session was a.cain a plenary session in which the reports prepared by the sub-groups were presented and commented on. 3 FIRS~ SESSION In his introductory statement, w::~ch opened the first session, the Cha.1rman summarized the references provided and briefly stated his views on the assigned subjects. Tbp. 1;nportance of adequate, convenient and pure water supply to the heelth of tb.'3 public was universally recognized. The interest of the health serriccs in good water supply was also universally accepted, and so was J",he necessity for a co-operative approach to this problem. Satisfactory pre gress in this field required team 'WOrk among representatives of mpny disciplines, including particularly the medical or public health officer and the engineer. Agencies concerned 'With public water supply and heel. th should be mutually supportive and should maintain 42 REGIONAL COMMITrEE: THIRTEENTH SESSION the closest liaison. However, the proper relationship of the health agency and the water supply authority, where this was different from the health agency, was not generally agreed and neither was the relative role of the medical and engineering professions within these agencies. In the panel discussion these areas of agreement and disagreement were confirmed. Each panel member spoke of the need for co-operation between engineers and. medical officers and other professions in the prOvision and . maintenance of adequate and. wholesome public water supplies. Examples were cited by panel members from conditions existing in countries in the Region. In one country the public works department had entire responsibility for the public water supply. It assessed the need, designed, presented requests for appropriations, constructed and supervised the operation of public water supplies. The public health department was kept informed of the results of bacteriological and chemical examinations of the water shOwing its quality and was given the opportunity to comment, an ~ortunity of which it seldom availed itself. In the view of this water authority, there was no real necessity for a larger role in community water supply for the health department. In t..nother country of the Region in which responsibility for design, construction and operation of water supplies was given to a national water authority, there was a somewhat closer liaison with the health department, which maintained water analysis laboratories and collected and examined its own samples of community and private water supplies. Any deterioration in quality which might appear from these analyses then became the subject of discussion between the national water agency and the health department. The health department, however, had no authority to order any changes made. REPOR!' OF THE REGIONAL COMMITTEE In still another country, as explained by a panel member, the public works department again acted as a central water agency and was responsible for design, construction and operation of water works in urban areas. Water analyses were performed by a separate institute which reported both to the water agency and the health department. For these urban areas, the water agency and the health department consulted in regard to priorities ~- in construction and the support of the health department was actively sought for appropriations for water works. The health department played an active, even the primary, role in the water supply of rural and other areas having too small a concentration of population or inadequate economic resources presently to support a piped water supply. In these areas the health department attempted to obtain improvement of individual water supplies and to raise water standards generally through the activities of its sanitary agents. In. yet another country cited, the public water supplies were generally the primary responsibilities of local government bodies who obtained advice and support in design and construction from the national public works authority. In this country the health department had recently taken the initiative in grading all the public water supplies. The grades were given by a team, which usually included both medical and engineering officers, and were in many instances considerably lower than had been expected by the local government bodies Owning and operating various water supplies. This grading, and the publication of its results, was expected to result in are-assessment of the water supplies by their owners and a marked improvement in the quality of water supplied. In this country the health department was now en.g;>loying public health engineers, the better to operate such surveillance activities in water supply and in other fields of environmental health. REGIONAL COMMITTEE: THIRTEENTH SESSION After the conclusion of the panel presentation, remarks from the floor confirmed that there were large discrepancies among the various countries of the Region in methods of controlling and operating public water supplies and that there was considerable variation in the role of the health department in this field. In one country of the Region the public health department had set and enforced standards, not only for the quality of water, but also for treatment facilities. In this country no water supply could be constructed or operated without a permit from the minister of health if the water supply served more than 20 000 persons. Ev~n for those water supplies serving less than 20 000 persons, for which permits were granted by the prefectural government and not by the ministry of health directly, the ministry of health standards prevailed. In considering whether to grant penni ts, a thorough review of the engineering plans was made by engineers of the health department staff. Health department engineers inspected the proposed water catchment areas and a thorough investigation was made before a permit was granted. In this country, after the plans had. been approved by the health departzoont, construction of the larger 'WOrks was usually performed by the central government ministry of construction. In summarizing the discussion at the first session, the Chairman remarked that all were agreed that good water was the responsibility of the government, that the provision of this water was a very complex problem, that an extensive system of checks on water quality was required and that these checks should be both internal and external in regard to the agency operating the water supply. It was not agreed as to whether the health department should provide the external checks required, or, if it did, it was not agreed as to what force the health department's observations and opinions should have. REPORT OF THE REGIONAL COMMITTEE 45 4 SECOND SESSION After receiving the instructions of the Chairman, participants divided themselves among four sub-groups which met independently. Each group selected a chairman and a rapporteur and prepared a report on the subject, liThe Role of the Health Services in the Improvement of Community Water Supplies ". In each report, and among the various reports, the differences of opinion previously noted again appeared. 5 THIRD SESSION In the third session the reports of the four discussion groups were presented and discussed. Based on the reports, and the discussion at this session, the following conclusions were reached: (1) The health department has a moral responsibility in regard to the health aspects of public water supplies. This moral responsibility is derived from the department's general responsibility for public health. (2) The preparation of standards for drinking water should be a legal responsibility of the health department. This responsibility should be exerted in co-operation with the water authorities. (3) All certifications as to the safety of water should be made by the health department. (4) The review of the sanitary aspects of plans for proposed water supplies is a proper health department function. Whenever this sanitary review involved engineering 'WOrk of any complexity, it should be performed by competent engineers on the staff of the health department. 46 REGIONAL COMMITI'EE: THIRTEENTH SESSION It is also proper for the health department to follow the progress of preliminary engineering investigation and design work for proposed water supplies. In some countries, the requirement of approval of engineering plans by the health department, before construction can begin, has been satisfactorily applied. These countries have competent specialized engineering sections within their health services. (5) The health department should have at least an advisory role in goveri~nt decisions un subsidies and loans for water st:pply. In one country of the Region, the health department exercises direct control of such subsidies and loans with good results. (6) The preparation of both short- and long-range plans for community water supplies at both n~~ional and local levels is very i!l1j?ortant. The health department should be represented at a high level on bodies preparing such plans. (7) The regular surveillance of the sanitary quality of water supplies, including the inspection of those operations of water works which might affect the sanitary quality of water, is considered to be very important. This surveillance and inspection should be provided both by the agency operating the water supplies and by another agency external to the operating agency. The health department was the logical external auditing agency and in some countries satisfactorily performed this function. The independent collection and J. r '-<. REPORT OF THE REGIONAL COMMITTEE analysis of samples of water were necessary for the proper performance of its function by the external auditing agency. (8) It is necessary continually to collect, to compile and to evaluate data on water used by the public and the effect of its use upon the public health. In certain instances, such as for data regarding the incidence of water-borne diseases, the collection, compilation and evaluation of these data is primarily a function of the health service. In other instances, the collection, compilation and evaluation of such data could better be done by the health department in co-operation with the water agency, the census or another department. Examples of work better performed co-operatively were the assessment of the sanitary quality of existing supplies and the determination of priorities for the improvement of proposed supplies. (9) The health department should sponsor and be ready to assist with training and with education for water supply purposes, including: (a) pre-service and in-service training of health inspectors, sanitarians and public health engineers; (b) short courses, seminars and symposia on public health aspects of community water supplies; (c) education of the public, and ~f public officials, in regard to water supplies. Especially in rural areas, this education should frequently be done through teachers and schools. In many countries this education of the public, and of officials, 47 48 REGIONAL COMMITTEE: THIRTEENTH SESSION in regard to water supply is the most valuable fUnction that the health services can perform in this field. (10) In order that rapid progress be made in the provision of adequate and good water to the public, it is necessary that members of the medical and engineering professions concerned with this field should respect and should co-operate with each other. (11) Increased efforts should be made to accelerate the provision of adequate and safe community water supplies. Wherever adequate progress in this field is not being made and whenever other agencies cannot be induced to take on this work, the health department should atte~t it. This conclusion particularly applies to water supply problems in rural areas in developing countries. (12) The fluoridation of community water supplies is frequently advantageous. Fluoridation, however, should not take precedence over more i~ortant water needs, such as those for adequate quantity and good quality. (13) Finally, the gro~p concluded that the system of effecting community water supply work by a national organization set up for this purpoiie would have advantages in many countries. Such a national water works authority should be responsible to an appropriate minister and should be administered by a board upon which the health department was represented, along with other interested departments, such as the public works and the finance departments. The health department REPORT OF THE REGIONAL COMMITTEE should be prepared to co-operate with such a national authority if such were set up, as should this national authority with the health department. 49/59 WP/RC13/1 Rev.l WP/RC13/1-a WP/RC13/2 and Corr.l WP/RC13/3 and Rev.l WP/RC13/4 WP/RC13/5 WP/RC13/6 and Add.l WP/RC13/7 WP/RC13/7 Add.l WP/RC13/8 WP/RC13/9 and Add.l WP/RC13/10, corr.l and Add.l WP/RC13/11 Bev.l WP/RC13/12 Rev.l WP/RC13/13 Rev.l REPORT OF THE: REGIONAL COMMITTEE ANNEX 5 LIST OF DOCUMENTS Agenda Annotated agenda Twelfth Annual Report of the Regional Director to the Regional Committee for the western pacific Proposed programme and budget estimates for the financial year 1 January - 31 December 1964 Programme planning in connection with short- term consultantships Resolutions of regional interest adopted by the twenty-ninth and thirtieth sessions of the Executive Board and the Fifteenth World Health Assembly Selection of Technical Discussion topics for the fourteenth (1963) session of the Regional Committee The patho-physiology of cholera Arrangements under Article 104 of the International Sanitary Regulations Facilities for education and training of health personnel in the western Pacific Region Amendments to the Rules of Procedure of the Regional Committee for the western Pacific List of representatives Report of the Sub-Committee on Programme and Budget Report of the Technical Discussions 51 Report of the thirteenth session of the Regional Committee for the western Pacific REGIONAL COMKr'ITEE: THIRTEENTH SESSION WP/RC13/Min/l Rev. 1 WP/RC13/Min/2 Rev. 1 WP/RC13/Min/3 Rev. 1 WP/RC13/Min/4 Rev. 1 WP/RC13/Min/5 Rev. 1 WP/RC13/P&:I3/1 WP/RC13/P&:I3/2 WP/RCl3/P&:I3/Min/l Rev.l WP/RC13/P&:I3/Min/2 Rev.l WP/RCl3/TDl WP/RC13/TD2 WP/RCl3/TD3 WP/RC13/TD4 WP/RC13/TD5 WP/RC13/TD6 WP/RCl3/TD7 WP/RC13/TD8 WP/RCl3/TD9 Minutes of the First Meeting - 20 September 1962 Minutes of the Second Meeting - 20 September 1962 Minutes of the Third Meeting - 22 September 1962 Minutes of the Fourth Meeting - 25 september 1962 Minutes of the Fifth Meeting - 25 September 1962 SUb-Committee on Programme and Budget agenda Analysis of proposed programme and budget estimates - regular funds (field activities) Minutes of the First ~eting of the Sub-Committee on Programme and Budget - 21 September 1962 Minutes of the Second Meeting of the Sub-Committee on programme and Budget - 24 September 1962. Procedures and techniques for the Technical Discussions Suggested schedule for Technical Discussions at the Regional Committee Meeting Guidelines for the Technical Discussions The role of health services in the improvement of community water supplies - by Dr. M.J. Flynn The role of health services in the improvement of community water supplies - by Mr. R.N. Clark The relative functions of public health and public works agencies - by Mr. C.W. Klassen Individual evaluation questionnaire for the Technical Discussions Discussion group memberships Discussion group reports · Agenda Item No. 1 2 3 4 5 6 7 8 8.1 842 9 10 11 12 13 CONTENTS Opening of the session ............................. Address by retiring Chairman •••••••.•••••••••••••••• Address by the Director-General •••••••••••••••••••• Election of new officers: Chairman, Vice- Chairman and Rapporteurs ••••••••••••••••.••••••••••• Address by incoming Chairman ••••••••••••••••••••••• Adoption of the Agenda ••••••••••••••••••••••••••••• Technical Discussions •••••••••••••••••••••••••••••• nesignation of Chairman •••••••••••••••••••••••••• Acceptance of the Programme for 66 66, 110 III 68 68 69 69, 70 Technical Discussions •••••••••••••••••••••••••••• 70 Proposed programme and budget estimates for the financial year 1 January - 31 De ceznber 1964 ................. ' .•................ Establishment of the Sub-Committee 159-177 on Programme and Budget ••••••.••••••••••••••••••• 70 Consideration of the report presented by the Sub-C0romittee on Programme and Budget ...•..............•.............•...... Acknowledgement by the Chairman of brief reports received from governments on the progress of their health activities •••••••••••••••• Report of the Regional Director .••••••••••••••••••• Facilities avai}.able within the Western Pacific Region for education and training of health personnel ............................... . Programme planning in connection with short-term consultantships ••••••••••••••••••••••••• Management of cholera E1 Tor ••••••••••••••••••••••• -55- 144 70, 144 86, 114 104, 114 114, 139 120, 144 CONTENTS Agenda Item No. ~ 14 Resolutions of regional interest adopted by the twenty-ninth and thirtieth sessions of the Executive Board and the Fifteenth World 1JeaJ. th Assembly .................................... 134 15 Amendments to the Rules of Procedure of 16 17 the Regional Committee ••••••••••••••••••••••••••••• Selection of topic for the Technical Discussions during the fourteenth session of the Regional Committee •••••••••••••••••• Consideration of the report presented by the Technical Discussions Group ••••••••••••••••• 71) 138 18 Time, place and duration of fourteenth and fifteenth sessions of the Regional ColIDlli ttee •••••••••••••••••••••••••••••••••••••••••• 19 Other business statements by representatives of the United Nations and its Specialized Agencies: Representative of the United Nations Children r s .Fi.md .....•...............•........• 11 Representative of the Technical AssistaIlce .Fi.md ..•............................ 72 Statements by representatives of other inter-governmental organizations and non-governmental organizations in official relations with WHO: Representative of the International Association for the Prevention of Blindne ss ..................................... 76 Representative of the International Committee of Catholic Nurses •••••••••••••••••• 150 Representative of the International Council of Nurses ••••••••••••••••••••••••••••• 103 Agenda Item No. CONTENTS other business (continued) Representative of the International Dental Federation ..• ~ •....•.....••.•.....•.•.. 79 Representative of the International Federation of Surgical Colleges ••••••••••••••• 100 Representative of the International Hospital Federation ••••••••••••••••••••••••••. 100 Representative of the International Paediatric Association •••••••••••••••••••••••• 77 Representative of the International Society for Rehabilitation of the Disabled ........•..........•.................. 80 Representative of the League of Red Cross Societies ••••••••••••••••••••••••••• 78 Representative of the South Pacific Commission •••• fl. • • • • • • • • • • • • • • • • • • • • •.• • • • • • • • • • 74 Representative of the World Federation for Mental Health ...................... Representative of the World Federation 101 of Occupational Therapists •••••••••••••••••••• 77 Representative of the World Veterans Federation .•................................... 149 Resolution of appreciation ••••••••••••••••••••••• 150 20 Adoption of the draft report of the CoIDIni t te e •••••••••••••••••••••••••••••••••••••••••• 154 21 Adj ourIlIIlent •••••••••••••.•.••.••••••••••••••••••••• -57- ~ :'!"'" 1 2 3 4 5 6 7 8 9 10 II 12 13 (WP/RC13/Min/l Rev.l) MINUTES OF THE FIRST MEETING WHO Conference Hall Thursday, 20 September 1962 at 9.00 a.m. CHAIRMAN: Dr F.Q. DUQUE CONTENTS OJ;>ening ceremonies ••••••••••••••••••.•.•••.•.••••••....••••••••.• 62 Opening of the session ••••••••••••••••••••••••••••••••••••••••••• 66 Address by the retiring Chairman ••••••••••••••••••••••••••••••••• 66 Election of new officers ••••••••••••••••••••••••••••••••••••••••• 68 Address by incoming Chairman ••••••••••••••••••••••••••••••••••••• 68 Adoption of the Agenda ••..••.......•...•.•••..•••.•••.•••••••.••• 69 statement by the Chairman of the Technical. Discussions ••••••••••• 69 Acceptance of the Programme for Technical Discussions ............ 70 Establishment of the Sub-Committee on Programme and Btldge t •••••••••••••••. e e-. • e • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • e • • • 70 Acknowledgement by the Chairman of brief reports received from governments on the progress of their heal.th activities ... e·e ••••• e e ••.•.•••••••••••••••••••••••• 4! •••• e ••• Amendments to the Rules of Procedure of the Regional Comm:l ttee ....................................................... . Statements by representatives of the United Nations Children's Fund and the Technical Assistance Board ••••••••••••••• statements by representatives of other inter-governmental organizations and non-governmental organizations in official. relations with WHO •••••••••••••••••••••••••••••••••••••• -59- 70 71 71 60 REGIONAL COMMr!'!'EE: THIRTEENTH SESSION First Maet1ng Thursday, 20 September 1962 at 9.00 a.m. PRESENT I. Representatives of Mamber States AUSTRALIA Dr. H.E. Downes Dr. MoJ. Flynn Mr. D. Sadleir Dr. J.J. Saave Dr. C.J. Ross-Smith FRANCE M9decin-Colonel L. Caillard JAPAN Dr. N. TatebB¥BShi Mr. K. Watanabe Mr. H. Okazaki KOREA Dr;. Sang Tae Han Mr. Koo SUp Yang lAOS Dr. Tiao Singkeo Dr. Phouy Phouttasak. MALAYA Dr. L.W. Ja:yesuria Mr. K.K. Chong Mr. F.W. Crowley NEW ZEALAND Dr. R. G. T. lewis PHILIPPINES Dr. F.Q. Duque Dr. A.H. Cruz Mr. J.C. Perlas Dr. E.L. Villegas Mr. B. Brillantes Mr. M. Tana POrrnJGAL Dr. Jose de Paiva Martins UNITED KINGDOM Dr. D.J.M. M9.cKenzie Dr. E. Christiansen Dr. C.H. Gurd Dr. M.A. Rozalla UNITED STATES OF AMERICA Dr. H. DeLien Dr. L. Florio Dr. le-CUu-Truong Dr. Nguyen .. Binh-Nghien WESTERN SAMOA Dr. J.C. Thieme MINUTES OF THE FIRST MEErING 61 :t II. Representatives of the United Nations and specialized Agencies UNITED NATIONS and Mr. P. Edwards UNITED NATIONS CHILDREN'S FUND TECHNICAL ASSISTANCE BOARD Mr. A.H. Mackenzie -( III. ReEresentatives of other inter-s~vernmental orsanizations and of non-governmental orsanizations INTERNATIONAL COMMITTEE OF Colonel B.T. Sayec MILITARY MlSDIClNE AND PHARMACY ~ INTERNATIONAL ASSOCIATION FOR Dr. S.P. Lopez , THE PREVENTION OF BLINDNESS INTERNATIONAL COMMITTEE Mrs. C.T. Maceda OF CATHOLIC NURSES INTERNATIONAL COMMITTEE Mr. J.W. Mittner OF THE RED CROSS INTERNATIONAL COUNCIL Mrs. T. G. VilJarica OF NURSES INTERNATIONAL DENTAL Dr. B.B. Erana FEDERATION INTERNATIONAL FEDERATION Dr. R.L. Alfonso OF SURGICAL COLLEGES INTERNATIONAL PAEDIATRIC Dr. Fe del MUndo ASSOCIATION INTERNATIONAL SOCIETY FOR THE Dr. D.J. Tablan REHABILITATION OF THE DISABLED ~r" LEAGUE OF RED CROSS Dr. B. C. Fontanilla SOCIETIES MEDICAL WOMEN'S INTERNATIONAL Dr. T. Gomez ASSOCIATION SOUTH PACIFIC COMMISSION Dr. G. Loison ~" WORLD CONFEDERATION FOR Mr. A. Savellano PHYSICAL THERAPY WORLD FEDERATION OF Mrs. C.A. Floro OCCUPATIONAL THERAPISTS WORLD VETERANS FEDERATION Dr. A.M. Inocentes IV. WHO Secretariat SECRETARY Dr. I. C. Fang, Regional Director 62 REGIONAL COMMITTEE: THIRTEENTH SESSION 1 OPENING CEREMONIES 1.1 Address of welcome by the Secretary of Health of the Philippines On behalf of the 27 000 health workers of his country, Dr DUQUE, Secretary of Health of the Philippines, welcomed the delegates to the thirteenth session of the WHO 1<Testern Pacific Region and hoped that their stay would be pleasant and enjoyable. As Secretary of Health, he looked forward to meeting them personally and discussing with them common health problems and their solutions. These meetings with men responsible for the health, not only of their own people, but also of that of the Region and the world as a whole, were occasions to be wished for and were always welcomed by the Department of }~ealth, S:ince health was never a static business and no country could be isolated from the benefits of good health or remain free from the hazards of disease and ill health, these exchanges of information assumed greater meaning and significance. He was certain that all would mutually benefit from this year's discussions, as they had benefitted from the deliberations of p:::'evious sessions and from the guidance of the World Health Organization. He paid tribute to the President of the Philippines who had a paramount interest in promoting the health and Vlelfo.re of the people and had always extended valuable assistance to the Department of Health in the solution of the country's many health problems. The thirteenth session prOmised great accomplishments, as it was expressive of the well-programmed and diversified activities of the World Health Organization which were aimed not only at solving common health problems but also at bringing all into "one world of highest health". MINUTES OF THE FIRST MEETING 1. 2 Address by the Director-General As the Director-General was unable to be present at the opening session, .~ his place was taken by the Regional Director. The REGIONAL DIRECTOR conveyed the cordial greetings of the Director- General and his regret at being unable to attend the opening session. The Director-General was, however, expected to arrive in Manila on Friday and would remain until the end of the meeting. He was deeply conscious of the significance the President of the Philippines had attached to this occasion by honouring the Committee with his presence. On behalf of the Director- General, he expressed to the President, and through him, to the people of the Philippines, the deep-felt gratitude of the World Health Organization for the most generous way in which they had undertaken the task of being host to the Regional Office for the Western Pacific. It was well in keeping with the great interest shown by the Government of the Philippines in the welfare and happiness of the peoples of the Pacific, that the Regional COmmittee, over a decade ago, had selected Manila as the site for the Regional Office. Subsequently, matching leadership with generosity, the Government had made available not only the land required but had given also a very substantial donation to the building in which the Committee was gathered. During the years that the Organization had been guest of the Philippine Government, it had received the utmost conSideration, sincere co-operation and assistance from all the government departments with which it had dealt. He assured the President that the Organization would provide the fullest possible assistance to the Administration in its endeavours to build for better health and prosperity for every Filipino. 64 REGIONAL COMMITTEE: THIRTEENTH SESSION 1.3 Inaugural address by His Excellency, the President of the Philippines Mr MACAPAGAL, President of the Philippines, welcomed the representatives of the sixteen ~mber nations to the thirteenth session of the Regional Committee and extended his best 'Wishes for a successful and fruitful meeting and an enjoyable stay in the Philippines. He was particularly happy to welcome into the fold of the Western Pacific Region a new nation which had achieved its independence early this year - Western Samoa.·- To the representative of Western Samoa he extended his felicitations and best 'Wishes. The Philippines was a nation that believed in freedom and was a strong adherent of the United Nations, of which it was a co-founder, and of world agencies promoting the uplift of mankind. Despite financial difficulties the country had recently subscribed to United Nations bonds for its maintenance. In view of its belief in the value of health, the Philippine Government had always been keenly interested in the activities of the World Health Organization and would always uphold and support the Organization's undertakings in any part of the world. The President greeted the men and women of WHO who had. left the comforts and security of their countries to offer their help that others might profit by their experience and training. His country was proud to have contributed its share to that army of dedicated international workers. The most direct and potent contribution any country could make towards the attainment of international health was, however, to promote the health of its own people. The health authorities in the Philippines, under the energetic leadership of the Secretary of Health, would do their utmost to achieve this objective. The President then referred to the accelerated programme of malaria eradication in the world. There was also a problem of malaria in the .;: MINUTES OF THE FIRST MEETING 65 Philippines and the Government had increasingly appropriated funds to pursue a malaria campaign which, it was hoped, would eradicate the disease within the next few years. He paid tribute to WHO for the assistance it had given in formulating the campaign. He also thanked the Organization for having made it possible for the Government to secure the much-needed vaccines and the technical knowledge required to contain the spread of the cholera El Tor T epidemic in the late summer of last year, and for the very valuable technical guidance and the generous fellowship awards received. This assistance had been a valuable factor in the improvement of health conditions during the last decade. Economic development was a prerequisite of political stability, health was a prerequisite of economic development. From an economic point of view, the motivation, skill and health of the people were inter-related. ~rovement in one of these three attributes tended to improve the others. Because of this inter-relationship, he had, therefore, given full support to the Secretary of Health in his efforts to eradicate malaria and other communicable diseases, as well as to attain the highest level of health for the people, as it was recognized that this was a vital factor in the success of his Administration's five-year socio-economic programme. An aspect of the Organization I s work that lceenly interested his Government was the improvement of the cormnunity water supply. The Philippines, with a rural population of about 80 per cent., would certainly make great strides towards the control of many water-borne diseases if safe water were made available to all homes. The discussions of the Committee on this subject would therefore be followed with great interest. The world was torn by an ideological strife that dissipated the resources and energies of nations. In conferences to promote man IS 66 REGIONAL COMMITTEE: THIRTEENTH SESSION health, governments were, however, striving to perfect modes for the prolongation of life. Man's true welfare and destiny would, therefore, be resolved in their endeavours. As the course of human health advanced and the tenure and opportunity for man to enjoy life were enhanced, the time would come when the healthier and saner minds of healthier and happier men of all nations would collectively demand that the madness of mankind's fratricidal strife be ended, so that all nations and all men could labour in universal brotherhood, not for strife and death, but for health and life. The President then declared the thirteenth session of the Regional Committee officially in session. The meeting was adjourned at 9.35 a.m. and res'UIlEd at 10.10 a.m. 2 OPENING OF THE SESSION: Item 1 of the provisional Agenda In the absence of the retiring Chairman, Dr Turbott (New Zealand), and the retiring Vice-Chairman, Dr Valencia (Philippines), the REGIONAL DIRECTOR, in his capacity as SECRETARY, took the Chair. 3 ADDRESS BY THE RETIRING CHAIRMAN (read by the Secretary): Item 2 of the provisional Agenda Dr TURBOTT stated that the opening of the thirteenth session of the Committee brought him regret but also pleasure. It brought regret because he was unable to be present personally and pleasure in that he could send a message of welcome and good wishes. New Zealand had always been a firm believer in the value of the World Health Organization and it had been a / great privilege ••• ~ ,- MINUTES OF THE FIRST MEETING great privilege to have the Committee meet in Wellington last year, as this had provided an opportunity for his country to dem:mstrate its support of the ideals of the Organization. He then referred to more recent events, and stated he was happy to see the emphasis the Regional Director had placed on the importance of .M:!mber governments combining their efforts with international agencies in long-term programmes, in order to ensure maximum achievements. He also welcomed the increasing awareness of the need to create and expand rural health services. woking back over the past there was a tendency to gaze with wonder at the results gained in combatting communicable diseases. Yaws had retreated before penicillin, the mosquito was being ldlled with insect spraying and transmission of the parasite interrupted with effective drugs. The Region was participating in the "greatest venture in public health the world has ever seen" and was united in striving for eradication of smallpox and in accepting the challenge of leprosy, of tuberculosis. The task ahead was immense, but the future prOmised further achievements, as it was the united efforts of all, the concerted action which had followed past meetings that had resulted in success. The joint planning which would follow the present meeting was the earnest of success in meeting unsolved and new challenges. Health authorities could gaze with pride on what had been accomplished in the short regional history but much remained to be done. Poverty, disease and ignorance still flourished, basic needs in creating better national health were still unmet, pure water was conspicuous by its absence in the majority of the communities in the Region. The Technical Discussions would show how vital a part pure water played in health and would reveal ways and means to further the provision of this essential check to cholera, dysentery, typhoid and other gastro- intestinal diseases. 68 REGIONAL COMMITTEE: THIRTEENTH SESSION In closing, Dr Turbott expressed the hope that the present meeting of the Committee would play its part in furthering the common dream of conquering ill-health and bringing happiness and prosperity to every one of its Member nations. 4 ELECTION OF NEW OFFICERS: Item 4 of the provisional Agenda Dr TATEBAYASHI (Japan) nominated Dr Duque (Philippines) as Chairman; this was seconded by Dr HAN (Korea). Decision: Dr Duque was elected unanimously. Dr DOWNES (Australia) nominated Dr MacKenzie (United Kingdom) as Vice- Chairman; this was seconded by Dr JAYESURIA (Malaya). Decision: Dr MacKenzie was elected unanimously. Dr THIEME (Western Samoa) nominated Dr Lewis (New Zealand) as Rapporteur for the English language; this was seconded by Dr VILLEGAS (Philippines). Dr MARTJ[NS (Portugal) nominated Dr Tiao Singkeo (Laos) as Rapporteur , for the French language; this was seconded by MBdecin-Colonel CAILLARD (France). Decision: Dr Lewis and Dr. Tiao Singkeo were unanimously elected Rapporteurs. 5 ADDRESS BY INCOMING CHAIR~: Item 5 of the provisional Agenda The CHAIRMAN requested that his address should be postponed until Saturday morning. (See minutes of the third meeting, section 1.) MINUTES OF THE FIRST ME:m'ING 6 ADOPTION OF THE AGENDA: Item 6 of the provisional Agenda (Docu.ment WP/RC13/l Rev.l) The CHAIRMAN then moved the adoption of the provisional Agenda. Decision: The agenda was adopted. 7 STATEMENT BY THE CHAIffif.AN OF THE TECHNICAL DISCUSSIONS: Item 7.1 of the Agenda The CHAIRMAN announced that in accordance with the resolution adopted by the Regional Committee at its twelfth session, the Regional Director, in consultation with the Chairman of the Regional COmmittee, had selected Dr. MLchael J. Flynn, M.B.B.S., D.P.H., Chief Medical Officer, lvetropolitan Water, Sevrerage and Drainage Board, Sydney, Australia, as Chairman of the Technical Discussions~ At the request of the Chairman, Dr FLYNN, Chairman of the Technical Discussions, presented the proposed arrangements for this year's Technical 69 Discussions. As already Imown, the theme was ''The Role of the Health Services in the Improvement of Community Water Supplies ", which had been selected by the Regional Committee at its tvrelfth session. Three sessions had been set aside for the discussions, Friday morning, MPnday morning and afternoon. In addition, there would be a special field session on Saturday afternoon, consisting of a visit to the Balara Water Treatment Plant of the Manila Metropolitan Water System. (For consideration of the report on the Technical Discussions, see minutes of the fourth meeting, section 6.) 70 REGIONAL COMMITTEE: THIRI'EENTH SESSION 8 ACCEPTANCE OF THE PROGRAMME FOR TECHNICAL DISCUSSIONS: Item 7. 2 of the Agenda (Document WP/RC13/TD2) The CHAIRYAN referred to the programme in document WP/RC13/TD2 and asked the Committee for comments. Decision: The programme for the Technical Discussions was accepted. 9 ESTABLISHMENT OF THE SUB-COMMITTEE ON PROGRAMME AND BUDGET: Item 8.1 of the Agenda In accordance with the principle of rotation, it was agreed that the membership should be composed of representatives of Australia" France, Korea, Laos, Portugal, Western Samoa and the United States of America. It was also agreed that the Sub-Committee 'WOuld meet at 2.30 p.m. on Friday, 21 September, and that, if necessary, discussions 'WOuld continue at 4.00 p.m. on Saturday, 22 September. (For consideration of the report of the Sub-Committee on Programme and Budget, see minute s of the fourth meeting, section 4.) 10 ACKNOWLEDGEMENT BY 'I'HE CHAIRlv1'.AN OF BRIEF REPORTS RECEIVED FROM GOVERNMENTS ON THE PROGRESS OF THEIR HEALTH ACTIVITIES: Item 9 of the Agenda The CHAIRVAN stated that progress reports on health activities had been received from Brunei, Federation of Malaya, Hong Kong, Japan, Netherlands New Guinea, New Zealand, North Borneo, Singapore, Timor, Viet Nam and Western Samoa. In addition, annual reports had been received from Australia, Japan and Sarawak. (For additional reports acknowledged, see minutes of the fourth meeting, section 1.) MINUTES OF THE FIRST MEETmG 11 AMENDMENTS TO THE RULES OF PROCEDURE OF THE REGIONAL COMMITTEE: Item 15 of the Agenda (Documents WP/RC13/9 and Add.l) 11.1 Establishment of the Sub-Committee on Rules of Procedure In accordance with Rule 51 of the Rules of Procedure of the Regional Committee, a Sub-Committee on Rules of Procedure was established. It was agreed that membership should be composed of representatives of Japan, 71 LAIo '7C • Malaya, the United Kingdom and Viet Nam. The representative of the United Kingdom was appointed Chairman. It was also agreed that the SUb- Committee would meet at 2.30 p.m. on Friday, 21 September. (For consideration of recommendations of the Sub-Committee on Rules of Procedure and adoption of resolution, see minutes of the third meeting, section 7.) 12 STATEME:NTS BY REPRESENTATIVES OF THE UNITED NATIONS CHILDREN'S FUND AND THE TECHNICAL ASSISTANCE BOARD At the invitation of the CHAIIWlIN, the following representatives presented statements. 12.1 Representative of the United Nations Children's Fund Mr EDWARDS extended greetings on behalf of the United Nations Chd~n's Fund and the Director of the Asia Regional Office. There bad occurred some significant changes in the UNICEF programme as a result of recent action by its Executive Board. In the June 1961 session, a number of decisions bad been made which broadened the basis of service and increased the flexibility of UNICEF's approach to children's problems. New possibilities for UNICEF aid bad thus been opened in the fields of education, vocational training, guidance and social services, and greater attention bad been given to the 72 REGIONAL COMMITrEE: THIRTEENTH SESSION needs of youths as 'Well as of young children. All these continued to-have a medical and health aspect that would involve the continuing interest and participation of WHO. Many of these programmes would also involve other United Nations agencies, such as UNESCO, ILO, the Bureau of Social Affairs and FAO. He expressed appreciation of the excellent working relationship that existed between WHO and UNICEF in the Western Pacific Region and stated that UNICEF was particularly interested in the topic of the Technical Discussions. He hoped that representatives would provide effective guidance in dealing with this problem. 12.2 Representative of the Technical Assistance Board Mr MACKENZIE transmitted the personal greetings of the Executive Chairman of the Technical Assistance Board and the Managing Director of the Special Fund, both of whom wished the Committee every success in its deliberations. He then referred to some of the developments in connection with the Technical Assistance programme which might be of interest to the Committee. In 1960, for the first time since Technical Assistance was born in 1950, two-year instead of year-to-year programming was introduced. In 1962, for the first time, project planning was started, that was to say, projects were negotiated for as long as four years on a financial basis. This planning in depth and setting up individual projects on a firm financial basis for as much as four years, with possible negotiation for as long as six years, was a radical change and a noteworthy one, in view of the Development Decade. .. Y- MINUTES OF THE FIRST MEETING 73 In the deliberations of the General Assembly of the United Nations and in the Economic and Social Council, public health and health matters had been given due stress in the many discussions that went on covering the objectives of the Development Decade. In one of the discussions of the Economic and Social Council, it had been stated that the widening of man's horizons through education and training and the lifting of his vitality through better health ~ were not only essential pre-conditions of development, they were also among its major objectives. In the past it had been stated that health matters and health projects were not always given due weight and certainly not sufficient finance in the Technical Assistance programme and in those programmes of assistance financed by the United Nations. He felt that in the Development Decade this situation would change for the better. He then presented a comparison of the amounts made available in 1961- 1962 compared with 1963-1964. In the first period the overall country targets for the sixteen countries in the Western Pacific Region totalled $5 428 000. Of this amount, the approved programme for WHO amounted to $1 244 000 in round figures. This was approximately 22.9 per cent. of the total. In 1963- :~. 1964 the overall targets were reduced from $5 428 000 to $5 281 000, while the requests in the WHO field rose to $1 462 000, or 27.69 per cent. of the overall figures. To date the Special Fund programmes approved in the sixteen countries of the Region totalled 13.5 million dollars. In the Philippines, there were 74 REGIONAL COMMITTEE: THIRTEENTH SESSION three projects either approved or under negotiation which had direct relation to nutrition and an increase in the standard of living, Dairy Research Training Institute, Soil Fertility, and Deep-Sea Fishery Research Institute. In closing, Mr Ms.ckenzie thanked the Regional Director for the office facilities and accommodation he had provided the Technical Assistance Board. The collaboration thus enjoyed was symbolic of the close working relationships between their two bodies. 13 STATEMENTS BY REPRESENTATIVES OF OTHER INTER-GOVERNMENTAL ORGANIZATIONS AND NON-GOVERNMENTAL ORGANIZATIONS IN OFFICIAL RELATIONS WITH WHO 13.1 Representative of the South Pacific Commission Dr LOISON stated that although he had not attended the Regional Committee for seven years, he noted that the relations between WHO and. the Commission had. remained cordial and useful. During these seven years he had worked in the Congo in close relation with the WHO Regional Office. When he had joined the South Pacific Commission eight months ago, he had found that his assistant had previously worked with WHO and that the Commission1s health education officer was leaving to take up the post of adviser to the Regional Office for Africa. All this emphasized the friendly exchange of services between the two organizations which it was hoped would serve as a basis for continuing help in the future. The WHO Representative in Sydney had. continued to act as a very good liaison officer between the two organizations and the Commission had been glad to welcome him as an observer at its recent Conference ~ in Pago Pagp. This year relations had. been even closer as the joint refresher course on integrated rural health in Western Samoa had been directed by Dr. W. Norman-Taylor, the South Pacific Commission Public Health Officer. .. MINUTES OF THE FIRST MEErmG 75 The Commission hoped to participate regularly in other courses organized by WHO, and also to give substantial assistance to all training courses for medical staff and personnel working in allied subjects, since this was one of its main fields of activity. The long awaited co-operative project between the two organizations, the maternal and child health survey in the South Pacific, was now in operation. This was a field in which the Commission and the South Pacific territorial governments were very interested and it was planned to organize a technical meeting on maternal and child health in rural communities early in 1963. It was hoped that WHO would send a consultant. During the past year the main Commission activity had been health education. One of its health education officers had acted as adviser in the planning of the malaria eradication campaign in the British Solomon Islands Protectorate and this assistance would probably continue. The services of WHO were increasingly in demand in the South Pacific area but it was not the policy of the Commission to undertake the kind of services which WHO provided. However, because of its more intimate knowledge of the area and its problems and the fact that it could respond to demands more rapidly than WHO, as its administrative system was more flexible, the Commission hoped to be able to assist both WHO and the territories in achieving maximum benefit. Some activities could be undertaken by the territories themselves and others by WHO, between these two ranges the Commission had many opportunities to act. The task was indeed enormous and for this reason he was happy to see how . .»!.. perfectly the two organizations co-operated. REGIONAL COMMITTEE: THIRTEENTH SESSION 13.2 Representative of the International Association for the Prevention of Blindness Dr LOPEZ stated that the Philippine Society for the Prevention of Blindness was organized in April 1959, under the sponsorship of the Ophthalmological Society of the Philippines, with the main purpose of eliminating all possible causes of preventable or curable blindness. Its first activity had been to gather basic statistics on blindness through the help of the Bureau of Health and the Statistics Department of the National Economic Council. The preliminary findings revealed that there was about one blind person for every four hundred Filipinos, that more than fifty per cent. of the cases -were preventable and more than seventy per cent. curable. The most common causes of preventable blindness -were injuries, infections and infectious diseases, malnutrition, glaucoma, and systemic diseases such as diabetes, hypertension, etc. Using these data as a starting point, the Socjety had undertaken a mass visual screening programme of public-school children in Manila and surrounding areas, with the help of volunteer doctors, school nurses, optometrists, etc. Free eyeglasses had been given to indigent children through the establislwlent of an Indigent Eyeglass Bank, which is in turn aided by civic organizations such as the Manila Lions, donations from private schools, etc., and a glaucoma screening project had been organized for the general population. Much emphasis had been placed on health education through the medium of newspapers, radiO, television, distribution of leaflets, movie film documentaries, etc. Research work was also being carried out, in co-operation with the National Institute of Nutrition, on the nutritional aspects of blindness among the p.oor and a brochure on food rich in essential eye vitamins had been prepared. The Society had participated in World Health -cr- • < , .r . -. .): MINUTES OF THE FIRST MEETING Day by arranging for publicity to be given, on the radio and on television, to health slogans on sight. 77 In closing, Dr Lopez referred to the growing problems of blindness and suggested that a permanent section on blindness prevention should be created within WHO, that the Organization should send a representative to the International Congress to be held in New Delhi next December, and that it should sponsor a seminar on blindness for all Asian countries every three years. He also proposed that UNICEF might give assistance in this field because of the many cases of preventable blindness among children. 13.3 Representative of the International Paediatric Association Dr DEL MUNDO transmitted the greetings of the International Paediatric Association, now assembled in Lisbon, portugal, for its Tenth Paediatric Congress. The subject of the Technical Discussions during the present session of the Regional Committee was of great interest to paediatricians. Many diseases during childhood were still traceable to inadequate and unsafe water supplies, and any move towards the amelioration of these conditions, especially in the developing countries, would go a long way towards the improvement of the general health of the people. The International Paediatric Association looked forward to the day when the results of the Technical Discussions would have a significant effect on the life of the people in the Western Pacific Region • 13.4 Representative of the Wor1 d Federation of Occupational Therapists Mrs FLORO presented the greetings and best wishes of the World Federation of Occupational Therapists. Membership of the Federation now stood at more 78 REGIONAL COMMl'I'I'EE: THIRTEENTH SESSION than 6000 strong with over thirty countries represented. Next month, the Third International Congress of the World Federation of Occupational Therapists would convene in Pennsylvania, United States of America, with the fitting theme: "Cultural Patterns Affecting Rehabilitation". This meeting would afford a valuable opportunity for a dynamic exchange of professional concepts and techniques in the realm of rehabilitation. The School of Allied Medical Professions with its Departments of Occupational and Physical Therapy had started activities at the College of Medicine, the University of the Philippines last June. WHO had played an important and. indispensable part in the implementation of this programme, which would give a tremendous impetus to the expanding rehabilitation services in the country by m.a.king available the much needed personnel. 13.5 Representative of the League of Red Cross Societies Dr FONTANILLA referred to the theme of the Technical Discussions for the present session of the Regional Committee which he considered particularly appropriate. The importance of clean, sanitary and potable water in the control of water-borne diseases and the role played by health services in this connection were fully recognized. In the Philippines, the morbidity and mortality rates resulting from poor community water supplies still had to be lowered. The Red Cross had certainly a part to play in the programme to improve water supplies and he wished to pledge its facilities and resources in the hope that a solution to the problem would soon be found. .. MINUTES OF THE FIRST MEETING 79 13.6 Representative of the International Dental Federation Dr ERANA stated that the national associations of the International ~ Dental Federation and the Asian-Pacific Dental Federation had followed with great interest the Technical Discussions on dental health during the twelfth session of the Regional Committee. It was noted that the regional plan for dental health involved five phases, the first of which would be directed to the planning of a national dental health programme for each 1vember country and territory. Dental caries ranked high as a public health problem in the area and it was impossible for a very limited number of trained personnel to render dental care in a rapidly growing population. It seemed, therefore, that the way to deal with dental caries as a public health problem would be to resort to mass prevention. The topic of the Technical Discussions during the present session was considered a fitting sequel to that of last year in view of the fact that the most effective means of preventing dental caries ,- was intimately associated with the improvement of communal drinking water l .r supplies. The fluoridation of drinlting water as a measure to reduce the incidence of dental caries was a very important step forward, towards which the health services could direct their efforts in an all-inclusive programme to promote the general health through an improved water supply system. Since 1945, when it was first demonstrated that a 50 per cent. reduction in the incidence of dental caries followed the fluoridation of the drinking water supply in Grand Rapids, Michigan, other stUdies had been carried out with similar results. These studies had established quite firmly that a method of controlling tooth decay was available which could be used inexpensively and safely. 80 REGIONAL COMMITrEE: THIRTEmTH SESSION He wished, therefore, to propose that during the second phase of the regional plan, when epidemiological surveys were to be carried out, stUdies should be concomittantly conducted on the fluoride content of the drinking water in various localities with a view to improving and promoting dental health in the area. If this were done, much of the burden that accompanied the collection of data involved in plans to provide protection against dental caries, through fluoridation of the communal drinking water supplies, would be lessened. It was quite apparent that even the most ambitious programme for the treatment of dental caries would at best meet a fraction of the needs of the population in each Member country, because, although the increase in population proceeded at a tremendous rate, the preparation of trained personnel was a slow and time-consuming process. Any activities designed to improve community water supplies should also include, wherever possible, a programme of fluoridation. 13.7 Representative of the International Society for Rehabilitation of the Disabled Dr TABLAN stated that the SOCiety had always worked closely with the World Health Organization. In many instances it had been instrumental in bringing rehabilitation needs throughout the world to the attention of WHO. It had encouraged the establishment of local training programmes, as well as fellowship aid for phySicians and paramedical personnel and technicians from countries where trained assistance was most needed. The SOCiety had also co-operated with WHO in sponsoring and planning conferences and seminars and had acted on a consultative basis on matters concerning all phases of rehabilitation. Support for the programme of WHO was not its only activity. J '"'- MINUTES OF THE FIRST MEETING 81/82 It also assisted voluntary member organizations in more than fifty countries. For example, in December 1962 the Philippine branch would jointly sponsor the Second Pan Pacific Rehabilitation Conference with the Philippine Foundation for the Rehabilitation of Disabled, Inc. The CHAIRMAN thanked the representatives who had presented speeches. (For additional statements presented, see minutes of the second and fourth meetings, sections 2 and 8.1 respectively.) The meeting adjourned at 11.20 a.m. , .. (WP!RC13/Min!2 Rev.l) MINUTES OF THE SECOND MEE:l.'ING WHO conference Hall Thursd~, 20 September 1962 at 2.30 p.m. CHAIRMAN: Dr F.Q. DUQUE CONTENTS 1 Report of the Regional Director ••••••••••••••••••••••••••••••••• 2 statements by representatives of non-governmental organizations in official relations with WHO .............. -••••••• 3 Facilities available within the Western Pacific Region for education and training of health 86 100 personnel •••••.••.••..•••••••••••••••••••••••••••••••••••.•••••• 104. -83- REGIONAL COMMITTEE: THIRTEENTH SESSION Second Meeting Thursday, 20 september 1962 at 2.30 p.m. PRESENT I. Representat1 ves of Member states AUSTRALIA Dr. H.E. Downes Dr. M.J. Flynn Dr. J.J. Saave Dr. C.J. Ross-Smith FRANCE Medec1n-Colonel L. caillard JAPAN Dr. N. Tatebayashi Mr. K. watanabe Mr. H. Okazaki KOREA Dr. Sang Tae Han Mr. Koo sup Yang LAOS Dr. Tiao Singkeo Dr. Phouy Phouttasak MALAYA Dr. L.W. Jayesuria Mr. K.K. Chong -. Mr. F.W. crowley NEW ZEALAND Dr. R.G.T. Lewis PHILIPPINES Dr. F.Q. DUque Dr. A.H. Cruz Dr. E.L. Villegas Mr. B. Brillantes PORI'UGAL Dr. Jose de Paiva Martins UNITED KINGDOM Dr. D.J.M. MacKenzie Dr. E. Christiansen Dr. C.H. Gurd Dr. M.A. Rozalla UNITED Sl'ATES OF AMERICA Dr. H. !)eLien VIRr NAM Dr. Le-cuu-Truong Dr. Nguyen-Binh-Nghien WESTERN SAMOA Dr. J.C. Thieme ., MINUTES OF THE SECOND MEETING II. Representatives of the United Nations and Specialized ~ncies UNITED NATIONS TECHNICAL ASSISTANCE BOARD UNITED NATIONS CHILDREN I S FUND Mr. P. Edwards Mr. R. Pacheco Mr. A.H. Mackenzie Mr. P. Edwards III. Representatives of other inter-governmental organizations and of non-governmental organizations INTERNATIONAL COMMITTEE OF MILITARY HEDICINE AND PHARMACY INTERNATIONAL ASSOCIATION FOR THE PREVENTION OF BLINDNESS !NTERNATIONAL COMMITTEE OF, CATHOLIC NURSES INTERNATIONAL COUNCIL OF NURSES INTERNATIONAL FEDERATION OF SURGICAL COLLEGES INTERNATIONAL HOSPITAL FEDERATION INTERNATIONAL PAEDIATRIC ASSOCIATION LEAGUE OF RED CROSS SOCIETIES SOUTH PACIFIC COMMISSION WORLD CONFEDERATION FOR PHYSICAL THERAPY WORLD FEDERATION FOR MENTAL HEALTH IV. WHO Secretariat SECRETARY Colonel B.T. Sayoc Dr. S.P. Lopez Mrs. C.T. Maceda Mrs. T.G. Villarica Dr. R. L. Alfonso Dr. G.L. del Castillo Dr. Fe del MUndo Dr. B. C. Fontanilla Dr. G. Loison Mr. A. Save llano Professor W.S. Perfecto Dr. I.C. Fang, Regional Director REGIONAL COMMITTEE: THIRI'EENTH SESSIDN 1 REPORT OF THE REGIONAL DIRECTOR: Item 10 of the Agenda (Documents WP/RC15/5 and corr.l) The REGIONAL DIRECTOR welcomed the representative of Western Samoa, Dr. Thieme, who had attended last year's meeting in Wellington as a member of the New Zealand Delegation, but who now participated for the first time as representative of a new Member state. He also expressed regret that the Cambodian and Dutch Governments were unable to send representatives. In introducing the Annual Report for the period 1 JUly 1961 to 50 June 1962, he referred specifically to certain aspects which he consi- dered deserved special mention. Although yaws had almost been eradicated as a result of the very efficient follow-up campaigns which had been continued in the countries and territories from which WHO assistance had been withdrawn, communicable diseases in general still represented a major problem. The recent outbreaks of cholera were a very potent reminder to all governments that much still needed to be done in the field of communicable disease control. The ad ~ meeting on the exchange of information on El Tor vibrio paracholera, held in Manila last April, had provided an opportunity for partiCipants to discuss matters such as diagnOSis, epidemiology, prevention and control, treatment, research and inter-country co-ordination. An interesting point which had come out in the discussions was that the groups which had responded best to the inoculation campaigns were those who were least at risk. This emphasized the urgent need for a more realistic type of health education which would be effective in population groups with, as yet, little under_ standing of the true meaning of health care. Of particular note during the outbreaks had been the ready assistance given by countries, agencies "' ;r- MINUTES OF THE SECOND MEETING 87 and airline companies - this was perhaps symptomatic of the changing attitude to health - an epidemic of any kind attracted international attention and as a result of the rapid means of air transport now available, assistance in the form. of drugs and vaccine could be quiclQy flo'WIl in. However, the aeroplane which had brought important aid so rapidly at the time of the cholera epidemic might also bring in potential cases of disease. In the years ahead health administrations should critically review their preparedness and machinery for dealing with large-scale outbreaks of epidemic diseases, so that the occurrence of a few cases of cholera, of smallpox, or of any other communicable disease, might be controlled before they had time to attain epidemic proportions. The answer to this problem did not, of course, lie with communicable disease control alone - increased attention would have to be paid to environmental health, including the prOvision of a safe and adequate water supply, improved refuse disposal, and effective control of vectors. In some countries of the Region this programme represented a gigantic ente~rise but there was no escape from their obligations to improve the health of the people. The important relationship which existed between health on the one hand, and economic and social development on the other, had been mentioned on many occasions during meetings of the World Health Assembly, the Executive Board and the Regional Committee. Because of this relationship, it was one of the responsibilities of the health authorities to take all necessary measures to ensure that the economic life of the country did not suffer as a result of epidemic outbreaks of communicable diseases. It was also their responsibility to ensure that other government departments were fully aware of the importance of the promotion of health in relation to any national social and economic development plan, so that adequate funds and personnel were made available to support the programme. 88 REGIONAL COMMITTEE: THIRTEENTH SESSION The Regional Director then referred to the different types of malaria programmes being carried out in the Region and stated that malaria eradication programmes were now in operation in China (Taiwan), North Borneo, Philippines, the Ryukyu Islands and Sarawak. By 1964 a further three, and possibly five, would have been converted to malaria "eradication. The programme in China (Taiwan) continued to be the most advanced one in the Region and the accomplishment of eradication was already in Sight. He emphasized again a point which had been brought to the attention of the Regional Committee on a number of occasions - that was, unless the necessary personnel, funds and logistic support were given in an efficient manner to all malaria programmes until the final phase was reached, the gains achieved and the money spent would have been frittered away. A sense of grOwing success and confidence must not lead to the slightest relaxation of vigilance. The global malaria eradication programme was one of the most 8mbi tious endeavours that health authorities had ever undertaken - much had been achieved in Africa, in the Middle East, in South America and in Asia. He called for the support of all concerned to ensure that as much, if not more, was achieved in the western Pacific Region. Tuberculosis was still rated as an important public health problem in most of the countries in the Region. A number of national pilot area projects had been started with a view to finding ways in which the advances made in the prevention and treatment of tuberculosis could best be applied in different epidemiological and socio-economic conditions. The regional tuberculosis advisory team had assisted a number of governments to carry out a tuberculosis prevalence survey, to train BeG assessment workers, to prepare protocols for epidemiological studies in tuberculosis and to develop MINUTES OF THE SECOND MffiErING case-finding methods suited to local conditions. The experience obtained was being used in the development of national programmes aimed at the eltmination of tuberculosis as a public health problem, and progress to date was encouraging. The next point raised by the Regional Director was in relation to the preparation of a national public health plan, co-ordinated with related plans in the social and economic field, Which had been among the proposals made by the Executive Board in connection with the participation of governments in the United Nations Development Decade. The first step would involve a study and investigation of health needs, the available personnel, equipment and buildings, with a view to determining the priorities for action and formulating precise proposals aimed at the orderly development of a long-term programme. A national public health plan would also help international and other outside agencies to concentrate assistance on nationally established priorities. ~£t year he had referred to the health survey carried out in Malaya - this was the first activity of its kind in the Region and the Government was now using the consultant's report as a guide to future planning. A second survey had recently been completed in Korea and he had been impressed with the speed and the efficiency with Which the Korean Government had followed up the proposals made by the survey group. It would not seem unreasonable to emphasize to all developing countries the importance of this approach, which was a natural preliminary to long-term programming. The problem of supplying an adequate number of well-trained professional and auxiliary staff still remained a crucial one in a number of countries. However, gradual improvements could be discerned; in many cases international assistance had played an important part by providing the much needed 90 REGIONAL COMMI'I'rEE: THIRTEENTH SESSION post-graduate training of the teaching staff, by organizing in-service training courses and stimulating activity through the medium of seminars, conferences and study groups. The number of fellowships awarded in various fields of health during the period under review had also considerably increased. Although many problems still remained unsolved and activities in some fields might not have advanced as quickly as all would wish, the progress made during the past year, progress ~ich had taken place despite unsettled internal conditions in a number of areas, should not be underestimated. Each year there was a more vigorous approach to the task ahead, an increasing understanding that international assistance supplemented, but did not replace, national activities, and more earnest efforts to improve the health of all peoples in the Region. On the suggestion of the CHAIRMAN, the Report was discussed section by section. Introduction (pages vii-X) Dr THIEME (western samoa) thanked the Regional Director for the reference on page x to the independence of his country, western Samoa, and its membership in the World Health Organization. Part II, section 1: public Health Services (pages ~13-2l) - Dr CHRISTIANSEN (united Kingdom) expressed his thanks for the two reports on cholera, one produced by Captain R.A. Phillips and the other, the report of the meeting on the exchange of information on El Tor vibrio MINUTES OF THE SECOND MEETING 91 paracholera. Early this year, North Borneo had been faced for the first time with an outbreak. of paracholera El Tor and by immediate and early action the Government had been able to check its spread. The outbreak. had occurred primarily in the areas on the east coast of North Borneo and the reports quoted produced considerable food for thought. He wished to raise several pOints in connection with cholera El Tor, a subject which was very close to the hearts of health authorities at the present time, particularly its relation to public health. Firstly, the possibility of producing diagnostic serum had been mentioned; he wondered whether and how soon this could be done in the field of diagnosis, with a view to identifying the carrier cases. It seemed that the present possibility depended on the isolation of the organism in the stool. Diagnostic serum given by injection would save a great deal of embarrassment and time. Secondly, he wished to know how soon it would be possible to establish a specific vaccine in the prophylaxis of this condition. Thirdly, he pOinted out that there did not seem to be any uniform and definite quarantine period; it might be worthwhile to give this some consideration. Fourthly, in the nutrition education section of the report, it was indicated that people in the lower socio-economic group, where they tended to be lacking in proteins and Vitamins A and C, were more prone to the infection. On the other hand, people with a better standard of nutrition and a higher level of education, were less susceptible to exposure to this disease. He wondered whether research groups might be able to help isolate, among carrier cases, the nidus of the El Tor vibrio in not only the gall bladder but also in the appendix. As the appendix often harboured the entamoeba histolytica, it might well be the nidus of infection in the carrier. Lastly, Dr Christiansen pointed out that there seemed as yet to be no 92 REGIONAL COMMITI'EE: THIRTEENTH SESSION standardized terminology for the El Tor infection, although he noted that the question was to be studied at a cor~erence dealing with terminology. Mention had been made of vibrio cholera Asiatica, enteritis choleriformis El Tor and vibrio comma. El Tor - all these terms were very complicated and confusing, particularly to students of medicine. It wouil.d be much easier to group all of these together as vibrio cholera Asiatica and vibrio cholera El Tor. The CHAIRMAN suggested that as this subject would be fully discussed under Item 13 on the Agenda, a reply to the questions raised might be given at that time. Dr HAN (Korea) stated that his delegation had read the Annual Report with much interest. He wished to thank the Regional Director and his staff for the interest and concern they had.shown in the improvement of the health situation in Korea, especially during a time when other foreign aid was diminishing. Since 1953 when a health survey had been carried out in Korea by a joint WHO and UNKRA team, much progress had been made. However, in May-July of this year, a second survey had been carried out by WHO and ~ a United states Agency for International Development (USAID) team to assess the current situation. The team had submitted recommendations for a long- range health programme and the r~vernment had already taken the first steps to implement these recommendations. A pilot project would be established in a health province with a view to consolidating foreign aid activities and developing a sound health programme. The recommendations of the WHO/USAID team had served as a useful guide in the planning of this project and it was hoped that the Regional Office would continue to provide the technical advisory assistance required. r' . y • o 1.: / - -' MINUTES OF THE SECOND MEETING 93 Dr DUQUE (Philippines) thanked the Regional Director for the assistance provided in connection with the national seminar on hospital administration held earlier this year. The hospital administrators, most of them chiefs of government and private hospitals, who had participated, had greatly appreciated the opportunity to gain new knowledge in this field. Section 3: Environmental Health (pages 26-27) Dr HAN (Korea) stated that his Government had requested a short-term consultant on environmental sanitation to review and analyze the adminis- trative, technical and financial aspects of the community water supply in the City of Seoul, which served an estimated three million population. The Government was ready to receive this consultant at any time. Section 4.1: Assistance to Educational Institutions (pages 27-30) Dr THIEME (Western Samoa) referred to page 29 of the Report where mention was made of the School of Medicine in Fiji and expressed the gratitude of his Government for the training provided to its medical and health personnel. He also thanked the Organization for the help given to the school. Section 2.2: Mental Health (pages 22-23) Dr TRUONG (Viet Nam) first wished to congratulate the Regional Director for the way he had presented his report which showed the progress in the Region. Referring to the section on mental health, he stated that his Government was aware of the importance of mental health and for this 94 REGIONAL COMMITTEE: THIRTEENTH SESSION reason it had requested WHO to provide advisory services in this field in the form of two consultants. One consultant had completed his assignment. Unfortunately, in the course of an accident the second expert had died, and he 'Wished to express his country's deep 8~athy for this loss. The expert had sacrificed herself for the welfare of humanity, she had been much liked by the Vietnamese people and had given much help to his country. Section 4: Education and Training (pages 27-32) Dr TRUONG (Viet Nam) then stated that the problem of finding experts to teach in medical schools existed in many countries of the Region. The question of education and training, and the instruction of medical students had been discussed during the World Health Assembly and the Chief of the Vietnamese delegation had made certain practical suggestions. This matter had been followed-up with the Regional Director who had referred the entire question to WHO Headquarters. He wished, however, to emphasize again the importance of this matter and the belief of his Government that fellowships should be awarded to those who wished to become teachers, so that following training they could take up positions in medical schools in their own country. The Minister of Health of Viet Nam would be a member of the relevant Expert Committee dealing with this problem and it was hoped that a solution might be found in the near future. Dr JAYESURIA (Malaya) expressed appreciation of the services and assistance rendered by WHO and other international organizations to his country. A WHO expert on mental health had spent a few months in Malaya surveying mental health services. His report had been received and was MINUTES OF THE SECOND MEETING 95 now under study. It was hoped that the Government would be able to implement many, if not all, of the recommendations made. Section 5,: Malaria (pages 32-36) Dr HAN (Korea) stated that the malaria project in Korea had been started some years ago and was still in the pre-eradication phase. Much had been done to train national staff with the abil.e assistance of the WHO team stationed in Korea. The most outstanding results of the work so far were the confirmation of the malaria vector in Korea as Anopheles sinensis and the discovery of malaria foci. Spraying operations would start next year. section 6: Communicable Diseases (pages 36-48) Dr MacKENZIE (united Kingdom), on behalf of the United Kingdom delegation, congratulated the Regional Director on his comprehensive report. The encouraging progress reported in the field of communicable diseases had, of course, been overshadowed this year because of the large-scale outbreaks of cholera El Tor. The meeting on El Tor vibrio paracholera, held under the aegis of the western Pacific Regional Office in Manila, had proved most valuable and all those who had attended felt that it had served a useful purpose. He was glad to note that cholera El Tor was now a quarantinable disease in terms of the International Sanitary Regulations. He felt confident that this decision was welcomed by all countries in the Region. Section 6.1: Cholera, Diphtheria, Pertussis and Tetanus (pages 36-37) Dr TRUONG (Viet Nam) stated that his Government had launched a mass immunization campaign against diphtheria, pertussis and tetanus and that 96 REGIONAL COMMITTEE: THIRTEENTH SESSION since the beginning of the campaign last January, 450 000 doses of vaccine had been a.dl!linistered to children between two months to six years of age. In some developing countries, the question of vaccination was mainly a matter of health education and this aspect should be given full consideration in any communicable disease control programme. It was realized that the question of vaccination depended also on the quality of vaccines. One should be in a position to assess how children or individuals reacted to the vaccines but difficulties had arisen. He asked whether WHO could help his Government to find ways and means to discover antibodies in already vaccinated children, in order to assess the value of the vaccine. Section 6.3.2: Yaws (pages 42-43) Dr CRUZ (Philippines) thanked the Organization for the technical guidance it had given and UNICEF for the support received, which had led to the successful conclusion of the yaws control programme in the Philippines. A WHO assessment team was now operating in the province of Leyte after completing 5000 serological survey tests in the province of Samar, and in accordance ~th the commitments of his Government, the provinces of Cotabato (Region 8) and Capiz, Aklan (Regional 5) would also soon be covered. Part II, Section 6.2: Tuberculosis (pages 37-41) Dr HAN (Korea) stated that the number of tuberculosis patients in Korea. was approximately 800 000, and that about 3 per cent. of the total population were suffering from this disease. Tuberculosis was, therefore, considered one of the most significant public health problems. For the effective control of the disea.se, the Government had established a health MINUTES OF THE: SECOND MEETING 97 network comprising 182 health centres and 1000 public doctors who were assigned by the Government to look after an estimated population of about ten to fifteen thousand people in the rural areas. After training, they were given the primary responsibility of case finding and accurate diagnosis of tuberculosis. During the first half of 1962, about 100 000 patients had been registered and given treatment on a dOmiciliary basis. A team of WHO experts had played an important role by advising the Government not only in connection with the pilot area project in Seoul but also in the nation-wide programme. section 6.6: Leprosy (pages 47-48) Leprosy was also an important problem in Korea. The estimated number of cases amounted to 100 000, 22 000 of whom had been treated in leprosaria, colonies or out-patient clinics. A survey conducted last year had revealed that 60 per cent. or more of the patients were non-infectious and had labour power. The Government had adopted a policy of ambulatory treatment of non-infectious cases, and all concerned had been discharged and sent back to their communities. A resettlement project had been initiated last year under the Government's Five-Year programme. The people in general were, however, still afraid of this disease and health education activities would have to be intensified. The WHO expert assigned to Korea had played an important role in solving this problem. Part III, section 5: public Health Administration, Philippines (pages 59-61) Dr CRUZ (Philippines), referring to paragraph (c) Redefinition of functions of rural health units, stated that the rural health units in 98 REGIONAL COMMITrEE: THIRTEENTH SESSION the Philippines had been established in 1954 and it was now necessary to redefine their services. In accordance ~th the policy of the Secretary of Health, more emphasis was being focussed on the improvement of environmental sanitation as a means of improving the general. health pattern of the country. This trend was evident in the various requests for assistance which were being submitted by his Government to WHO and UNICEF, the progress of which would be reported in due time. With regard to paragraph (f) "Difficult areas ", it was fully realized that there ~re areas where the situation demanded special. consideration. This problem had been the subject of a discussion by the heads of the assessment team, who had agreed to recommend to the Secretary of Health the establishment of so-called "itinerant" teams in the difficult areas. Section 6: Health Laboratory Services, Viet Nam (pages 61-64) Dr TRUONG (Viet Nam) thanked the Regional Director for the very qualified expert provided his Government to study the laboratory situation in Viet Nam. The expert's report covered the general planning and organization of a laboratory and the assistance which might be requested from UNICEF to enable the Pasteur Institutes of Saigon and Dalat to produce the vaccine locally. It was envisaged that the locally produced vaccines would become available as from 1964. Until then, the vaccine would continue to be supplied through American assistance. The national vaccination programme was expanding not only in Saigon-Cholon but allover the country. In clOSing, Dr. Truong thanked UNICEF for the assistance given to his country and in particular for the assistance his Government hoped to receive in order to vaccinate 200 000 children per year. MINUTES OF THE SECOND MEmING Part IV: Western Samoa 3: Tuberculosis Control (page 83) Dr THIEME (Western Samoa) asked that the last line of the text should be corrected. BCG vaccination was not being given in his country because of the low infection rate. Korea 15: National Institute for Public Health Training (page 76) 99 Dr HAN (Korea) stated that it was planned to start a rural health project in 1963, thereby strengthening the training of health workers. The WHO public health administrator was at the moment assisting the Government in its programme of training at the National Institute for Public Health but it was expected that his role would be greater in the future as the project's work expanded and increased. Dr DeLIEN (United States of America), on behalf of his delegation, thanked the Regional Director for his report which provided evidence of the effectiveness of the work of WHO in the Western Pacific Region during the past year. The representatives also wished to express their appreCiation of the recognition given to the role of associated agencies engaged in health assistance throughout the Western Pacific. The CHAI~AN proposed the adoption of the Twelfth Annual Report of the Regional Director, and asked the Rapporteurs to prepare an appropriate resolution. It was so agreed. (For adoption of resolution, see minutes of the third meeting, section 3.) 100 REGIONAL COMMITTEE: THIRTEENTH SESSION 2 STATEMENTS BY REPRESENTATIVES OF NON-GOVERNMENTAL ORGANIZATIONS IN OFFICIAL RELATIONS WITH WHO (continued from the first meeting, section 13) At the invitation of the CHAIRMAN, the following representatives presented statements. 2.1 Representative of the International Hospital Federation Dr CASTILLO stated that the International Hespi tal Federation, whose membership included almost all the national hospital associations throughout the world, had now undertaken a programme of regionalization. This was in conformity with the Federation's desire to off~r and make available to all members its services, co-operation and individual assistance. The Americas had already been regionalized and a similar area was now being organized in south-east Asia. The theme of the Technical Discussions this year was not only necessary but timely because of the recent epidemics that had suddenly plagued the Region. He assured the Committee that whatever resolutions, conclusions and recommendations were accepted during the discussions would be implemented to the fullest extent by the Federation. 2.2 Representative of the International Federation of Surgical Colleges Dr ALFONSO stated that the Federation had been inaugurated in Stockholm in July 1958 and had been accepted into official relations with WHO in March 1960. It had now thirty-one chapters in almost los many nations. Its objectives were: the improvement of surgical practice throughout the world, the establishment of close relations among approved surgical colleges and institutions, the maintenance of high standards of medical education, training and research, the unification of surgery in all its specialties, the support of clinical and scientific congresses of appropriate surgical organizations, and the promotion of understanding among the surgeons of all nations. The Federation intended to implement these t MINUTES OF THE SECOND MEETING 101 objectives through surgical missions, training of surgeons, surgical research and the exchange of young surgeons. 2.3 Representative of the World Federation for Mental Health Professor PERFECTO referred to the fact that the World Federation for Mental Health had been established in 1948 at the suggestion of the Director-General of WHO and the Director-General of UNESCO, both of whom had felt that there was need for an international body of voluntary societies concerned with mental health, which would have consultative relationship with their organizations. They had also suggested that this new grouping should be wider than any that had existed up to that time. In consequence, psychologists, teachers, the clergy, SOCiologists, anthropologists and nurses had all played an intimate role in formulating the general policies of the Federation and partiCipating in its activities. During the fourteen years of its life, the Federation had grown from representation in twenty-one countries to a much more effective representation in forty-five countries, with a subsequent increase in activities. The Interim Commission of vffiO had re~uested the Feder.ation to propose a skeleton programme of activities for its mental health section. Looking back, it was interesting to see that every single recommendation made at that time, either to WHO or to national mental health SOCieties, had been implemented either fully or in part. The work of the Federation had been closely co-ordinated with that of WHO, so that there had been practically no wasteful duplication of effort at any time, although there had certainly been growing evidence of the fact that there was still far more to be achieved that WHO could do, either by itself, or with the help of the voluntary associations who were dedicated to these tasks. There had been log REGIONAL COMMtT'rEE: THIRTEENTH SESSION remarkable improvemen~ in the whole approach to the care of the mentally sick in institutions and in countries in nearly every part of the world, although there were still black spots in quite a number of places. His own country provided an illustration of the great change that could be brought about by the introduction of modern concepts of care and treatment and an improvement in the outlook towards mental illness in general. The Federation could have done much more had it not been for the tremendous difficulties in raising funds. WHO had a steady income but he understood that the allocation of funds to mental health had been the lowest made to any section of WHO's work. Since the Organization was dedicated to the physical, mental and social well-being of all peoples, this was unfortunate. The organization of the World Mental Health Year had demonstrated very clearly how great the needs were. Central programmes of research, which had been originally planned, could not be financed, but the national programmes of surveying and improving the quality of existing work and the activities which had been started had resulted in the establish- ment of well over 400 new projects, some of them technical and scientific and some promotional. Although there had been considerable advances in the Western pacific Region, much remained to be done and the experience and the help of the Federation were available to assist Member governments to stimulate further activities in this field. The SECRErARY stated that he did not wish to contradict Professor Perfecto, but mental health had always received a high priority in WHO. The amount of money allocated to any field was, however, decided by the number and size of requests made by Member goveI'I'llOOnts. In 1964 in the Western Pacific Region, the amount provided for assistance to m:ntal -. ! MINUTES OF THE SECOND MEETING 103 health was 3.56 per cent. of the total allocated to field projects. This proved to be much more than that spent on other fields such as virus diseases, 1.72 per cent., dental health, 1.89 per cent. and social and occupational disease, 1.16 per cent. Professor Perfecto could, therefore, rest assured that the important field of mental health was not being neglected and would always receive the highest priority whenever requests ~re received from Member governments. 2.4 Representative of the International Council of Nurses Mrs VILLARICA stated that the International Council of Nurses was a central governing body consisting of about eighty-four Member nations whose headquarters was in London. Recently the Secretary-General of the Council, Miss Helen Nussbaum, had accepted the invitation of the Director-General to serve as a member of the WHO Expert Advisory Panel on Nursing. Nurses the "WOrld over had a part to play in the improvement of community water supply as they had direct contact with the people. They had to travel throughout the country, make inspections and observe the health practices of families, especially those who belonged to the lower- than-average standard. It had been in such roles that nurses had become the apostles of sanitary health care and the ambassadors of community health centres in implementing plans and programmes which had been dedicated to the general community. The poorer classes were reluctant to go to the centres, and unless the nurses contacted them in their homes, modern health care would never benefit this group of people. Hospi tal nursing and the contact of the nurses with their patients and families afforded an opportunity to teach the people concerned about community health care, 104 REGIONAL COMMITTEE: THIRTEENTH SESSION to enlist their co-operation in Illatters such as the conservation of water, the need to follow health rules covering the disinfection, chlorination or fluoridation of water. These ideas often met with hostile opposition but the nurses had explained the advantages of. such processes so that community co-operation had been attained,.... As teachers, and direct examples, they had. been the potent erythrocytes that distributed the oxygen of good living to every part and parcel of the eommuni ty organism. She hoped that whatever the meeting might approve in regard to nursing would be implemented and promised the full support of the nursing profession in whatever was planned for the future. (For additional statements presented, see minutes of the fourth meeting, section 8.1.) 3 FACILITIES AVAILABLE WITHlN THE WESTERN PACIFIC REGION FOR EDUCATION AND TRAlNING OF HEALTH PERSONNEL: Item 11 of the Agenda (Document WP/RC13/8) The SECRETARY, referring to document WP/RC13/8, pointed out that the Regional Committee had, on a number of occasions, emphasized the importance of training within the Region. It was felt that requests for this type of fellowship were not as many as they might be, possibly because of the lack of information on the facilities available. The document represented a preliminary communication on some of the regional. training institutes and centres which accepted foreigh students. He hoped that the representatives present would ensure that the Regional Office was provided with the fullest possible information, so that complete documentation might be sent to all M:!mber States. , I MINUTES OF THE SECOND MEETING 105/106 The Committee reviewed the document and in the absence of any remarks, the CHkTRMAN requested the Rapporteurs to draft a resolution for adoption at the next session, bearing in mind the pOints made in the document. It was so agreed. (For adoption of resolution, see minutes of the third meeting, section 3.) The meeting adjourned at 4.35 p.m. (WP/RC13/Min/3 Rev.l) MINUTES OF THE THIRD MEETING ~1H0 Conference Hall Saturday, 22 September 1962 at 9.00 a.m. later Dr F. Q. DUQUE Dr D.J.M. MacKENZIE (Vice-Chairman) CHAIRMAN: CONTENTS 1 Address by the Cllairman ..........•..•.........................•. 2 Address by the Director-General .••.••••.•.••••.••••••••••.•••••• 3 Consideration of draft resolutions ••••••••••.•••••••.••••.•••••• 4 Programme planning in connection with short-term consul taIlt ships ........................... e· ••••••••••••••••••••• 5 ~agement of cholera El Tor ................................... . 6 Resolutions of regional interest adopted by the twenty-ninth and thirtieth sessions of the Executive Board and the Fifteenth World 110 111 114 114 120 Health As sembly ................................................. 134 7 Amendments to the Rules of Procedures of the Regional Committee (continued) ••••.••••••••••••••••••••••••••••• 138 8 Consideration of draft resolution on programme planning in connection with short-term consultantships (resumed) ••••••••••••••••.•••••••.•••••••••••••• 139 -107- loB Third Meeting Saturday, 22 september 1962 at 9.00 a.m. PRESENT I. Representatives of Member states AUS'rRALtA Dr. H.E. Downes Dr. M.J. Flynn '" Mr. D. Sadleir 74. Dr. C.J. Ross.Smith CHINA Dr. C.K. Chang FRANCE Medecin-Colonel L. Caillard JAPAN Dr. N. Tatebayashi Mr. K. Watanabe Mr. H. Okazaki ~ KOREA Dr. sang Tae Han Mr. Koo Sup Yang LAOS Dr. Tiao Singkeo Dr. Phouy Phouttasak MALAYA Dr. L.W. Jayesuria -,..,. Mr. K.K. Chong Mr. F.W. Crowley NEW ZEAIAND Dr. R.G.T. Lewis ,.( PHILIPPINES Dr. F.Q. Duque ", Dr. A.H. Cruz .. Mr. J.C. Perlas Dr. E.L. Villegas Mr. B. Brillantes Mr. M. Tana PORl'UGAL Dr. Jose de Paiva Martins UNITED KINGDOM Dr. D.J.M. MacKenzie .-., Dr. E. Christiansen Dr. C.H. Gurd Dr. M.A. Rozalia UNITED srATES OF AMERICA Dr. H. DeLien Captain R.A. Phillips Dr. Le-Cuu-Truong Dr. Nguyen..J3inh-Nghien ~ .. MINUTES OF THE ;I'HIRD MEErING WESTERN SAMOA Dr. J.C. Thieme II. Representatives of the United Nations and Specialized Agencies UNITED NATI ONS CHILDREN I S FUND Dr. A. Mangay-Angara III. Representatives of other inter-governmental organizations and of non-governmental organizations INTERNATIONAL COMMITTEE OF MILITARY MEDICINE AND PHARMACY INTERNATIONAL ASSOCIATION FOR THE PREVENTION OF BLINDNESS INTERNATIONAL COMl-!ITTEE OF CATHOLI C NURSES INTERNATIONAL COMMITTEE OF THE RED CROSS INTERNATIONAL COUNCIL OF NURSES INTERNATIONAL FEDERATION OF GYNECOLOGY AND OBSTETRICS INTERNATIONAL FE DE RAT I ON OF SURGICAL COLLEGES INTERNATIONAL HOSPITAL FEDERATION INTERNATIONAL PAEDIATRI C ASSOCIATION LEAGUE OF RED CROSS SOCIETIES SOUTH PACIFIC COMMISSION WORLD VETERANS FEDERATION IV. WHO Secretariat DIRECTOR~GENERAL Colonel B.T. Sayoc Dr. S.P. Lopez Mrs.C.T. Maceda Miss O.M. Boado Mr. J.W. Mittner Mrs. T.G. Villarica Professor R. Apelo Dr. R.L. Alfonso Dr. G.L. del Castillo Dr. Fe del Mundo Dr. B.C. Fontanilla Dr. G. Loison Dr. A.M. Inocentes Dr. M. G. Candau 109 SECRETARY Dr. I.C. Fang, Regional Director llO REGIONAL COMMl'PI'EE: THIRTEENTH SESSION 1 ADDRESS BY THE CHAIRMAN: Item 5 of the Agenda (continued from the first meeting, section 5) The CHAIRMAN thanked the representatives of the Regional Committee for electing him. This was also a great honour to his Government and he accepted the assignment with full realization of the responsibilities that went with it. He extended a warm. welcome to Dr Candau, the Director-General, on behalf of President Diosdado Macapagal and the people of the Republic of the Philippines. Dr Candau's visit to the Philippines and his attendance at the Regional Committee meeting 'Were proof of his deep and abiding concern for the health and welfare of the peoples of the Western Pacific Region and everyone was greatly honoured by his presence. The meeting provided an opportunity for gpvernment authorities to assess the work of WHO, to review what had been done in the different countries of the Region, and to determine how to obtain the highest level of health for their people. This would only be achieved if the menace of the communicable diseases could be reduced. These diseases still constituted the leading causes of morbidity and mortality in many countries in the Region and it would seem that the problem would remain for many years if accelerated progI'BmllEs of eradication were not undertaken. The desired measures might prove contrary to the religion, habits, customs and traditions of the people, but they had to be taken if only to assure for them the health which they vitally needed if they were to lead a fuller and a more productive life. Health information and education would play a major role in changing the attitudes of people and technical knowledge was, of course, essential. The first step had been taken and every effort should be made to follow this up. The health problems that confronted neighbouring countries were the concern of all. The Organ1- zation had provided assistance in the recent efforts to control cholera El Tor which had af'fected the Philippines and several neighbouring countries. .... , MINUTES OF THE THIRD MEETING 111 A new threat was the recurrence of smallpox which was now present in countries in the outer fringes of the Region; this new nenace could easily become worldwide unless immediate measures were taken. Once again, WHO was called upon to resolve this problem and all the representatives present had to assume the responsibility for preventing the spread of the disease in their own countries. Greater efforts were required to improve the health status of ~ all countries and ensure that they were freed from the scourge of communicable diseases which sapped the vitality of the people. The eradication of communicable diseases was, he believed, the challenge of the 1960s. Unless achieved soon, greater problems would arise, as new types of diseases and disease conditions, brought about by the hazards of modern living and their entry into the age of the space and atom, 'WOuld be added to the age-Old communicable diseases. 2 ADDRESS BY THE DIRECTOR-GENERAL: Item 3 of the Agenda Dr CANDAU, Director-General, thanked the Chairman for his kind words of welcome and said that it was a pleasure and honour to be present at the thirteenth session of the Regional Committee. The regional committees played a very important part in the life of the World Health Organization as this type of meeting provided the members of each region a special opportunity for a more detailed discussion of the problems of different countries, for analyzing what had been done in the past and considering plans of action for the future. In the World Health Assembly, programmes were discussed on a 'WOrldwide basis and since around 117 countries were involved it was not possible to discuss them in detail. 112 REGIONAL COMMITTEE: THIRTEENTH SESSION Dr Candau then referred to two pOints on the Committee's agenda which deserved special mention. The first was the subject of the Technical Discussions, the theme of which, "The Role of the Health Services in the Improvement of Community Water Supplies", was considered particularly appropriate for discussion in a regional committee meeting. Whether by coincidence or not, the same subject had been discussed in the meeting of the Regional Committee for South-East Asia. He considered that this was an important subject which would have to be discussed by practically all the regional committees. Progress in the field of health depended to a large extent on good environmental sanitation, and among the many measures required to improve environmental sanitation, the most important one was the question of water supply. He knew that this problem was not an easy one to solve, but it was not so difficult as had previously been considered. The people should understand that the provision of water was a service, like the provision of electricity or gas, which had to be paid for, and financial arrangements would have to be made so that more communities could be provided with a water supply. The second point on the Committee's agenda which was considered of great importance from the worldwide and regional points of view was the question of facilities for education and training of health personnel. Today, with a great number of nations newly independent, or becoming independent, it had become quite clear that nothing could be done to solve their problems unless they had properly trained staff for their health services and governments were stimulated to giving increased attention to the problem of education and training of health personnel. The services of expatriate staff were extremely important as a temporary solution, but the only permanent one was the training • MOOJTES OF THE THIRD MEETI'ING 113 of the local people and more attention had to be paid to this matter. It was recognized that the training of doctors, nurses, sanitary engineers, etc., took a long time and that governments, in general, preferred to train auxiliary personnel who were exceedingly useful provided they worked under the super- vision of fully trained staff. No country could afford today to depend entirely on foreigners; local people had to be trained and in the next few years more and more attention would have to be given to this problem. To send young men to study for six or seven years in an environment totally different from their own resulted in many problems, as they were at an age when the question of adjustment was most difficult, and there was the added risk that they would return to their own countries as foreigners. He felt this was an exceedingly important point to be remembered when considering the problems of training personnel. The ideal solution was, of course, the development of national educational institutions, and different ways would have to be worked out to improve local training facilities. Although this was a big problem for countries in the western Pacific Region, it was an even greater one in other regions of the world. The number of new countries in Africa facing this situation had posed a tremendous challenge to WHO. The Secretary of Health had mentioned the importance of communicable disease control. This was one of the main problems faced by the Region at the moment. Although a special type of service to contend with communicable diseases was justifiable at the beginning, the final solution was the improvement of the general health services of the country. After the attack phase was completed, communicable disease control work had to be continued by a permanent health service and personnel adequately trained were required to man such a service. 114 REGIONAL COMMl'l"l'EE: T:HIRrEENTH SESSION In closing, Dr Candau stated that in the field of health it was possible to build up good co-operation with other countries in the world. He believed that WHO had shown that countries c'Juld work together regardless of political ideals, religion and cultural background. He firmly believed that if the world were healthier, it would also be a more peaceful one. 3 CONSIDERATION OF DRAFT RESOLUTIONS (continued from the second meeting, sections 1 and 3) The Committee considered the following draft resolutions presented by Dr LEWIS (New Zealand), Rapporteur. 3.1 WP/RC13/WP/l - Annual Report of the Regional Director 3.2 WP/RC13/WP/2 - Education and Training Decision: Both resolutions were unanimously adopted (see resolutions WP/RC13.Rl and WP/RC13.R2). 4 PROGRAMME PLANNING IN CONNECTION WITH SHORT-TERM CONSULTANTSInPS: Item 12 of the Agenda (Docunent WP/RC13/4) The CHAI~AN invited the Secretary to present the item. The SECRETARY stated that it had been felt for some time that considerably more benefit would be obtained by governments from the services of short-term consultants if more detailed planning were carried out prior to their arrival. The document before the Committee contained some proposals which might strengthen such assignments. Dr TRUONG (Viet Nam) said that his country had, on several occasions, received WHO short-term consultants and the work they had performed had been most satisfactory. They had not seemed to encounter any great .. MrNUTES OF THE THIRD MEEl'nm liS difficulties in the performance of their duties and the necessary support had been provided. He wondered whether the item which had just been presented for discussion was a purely regional question. He was under the impression that when a short-term consultant went to a country, his services had been requested by the Government for a specific mission and there were signed agreements or plans of operation stipulating exactly what his duties were. It was fully agreed that in order to make the nssignments more profitable, all the necessary reports and documents should be made available to the consultant before his arrival. Referring to-sub-paragraph 2 of the document, he enquired whether the Committee mentioned therein was also supposed to linplement the recommendations made by the consultant. As the consultants were in the country only for a short period, were the recommen- dations to be implemented before or after the submission of their reports? Dr DeLIEN (United states of America) suggested that it might be preferable to let each country determine how it would handle a short-term consultant rather than establish a recommendation from the Committee. The SECRETARY stated that while it was true that in some countries the consultants had been well utilized, there were other instances where they had not been so effectively used. The idea behind the proposal was to remind governments that short-term consultants were usually very busy people and it was only possible to obtain their services for a short period. Therefore, if adequate preparations were made before their arrival, their work could be immediately started. It was not intended that the recommendations made by the consultants should be implemented immediately. They might, however, be discussed by the national committee to see whether they were realistic, whether U6 REGIONAL COMMITTEE: THIRTEENTH SESSION they were feasible or whether there were difficulties which the consultant had not foreseen. Dr THIEME (Western samoa) observed that the only new departure from established procedures appeared to be the creation of a committee which would follow up the expert I s work. An arrangement similar to this, but on a very informal baSis, already existed in Western Samoa. It would not be very difficult to form a cOmmittee, and therefore, his Government accepted the proposals in the document. Dr GURD (united Kingdom) believed that the plan as outlined in the document was very desirable. In his country, consultants had arrived and preparations had been deficient. He felt that the arrangements suggested would be to the advantage of both the Organization and the government concerned. Dr TRUONG asked whether similar committees had been set up in other regions. The SECRETARY replied that recently the Organization had provided a short.term consultant to the Government of Korea in connection with its health survey and planning. Six months before the arrival of the consultant, the Government had organized a fact-finding committee which had carried out a survey of health activities. A wealth of information was available on the arrival of the consultant and this had helped him considerably. FUrthermore, before the consultant left the country, his report and recom- mendations were discussed with the committee, and after his departure the Government had immediately taken steps to implement some of the recommendations. It was this particular instance that had inspired the Regional Office to suggest that if every government were to adopt this procedure, the services MINUl'ES OF Tm: THIRD MEETING 117 of consultants would be more effective. Dr TRUONG stated that he was not against the proposals in the document. He agreed that full information should be made available to consultants before arrival in the country of assignment. All he wished to know was whether the countries of other regions had organized such committees. His Government had created an unofficial body which met from time to time to discuss various problems but it was not a formal committee. The SECRETARY said that he did not know whether the other regions had this kind of arrangement but he had thought that it might be something for the Region to consider. The proposals made by the Secretariat were not intended to be mandatory, they had been prepared as a basis for discussion. The committee was not meant to be official or permanent, it was merely suggested as a means whereby the consultant could be assisted in executing his work and a forum where the realism and feasibility of his recommendations could be discussed. Dr DeLIEN considered that it was not possible to state categorically what a country should do in this particular instance, and he was not sure that the establishment of a committee would be suitable for every country. There might be some other type of organization, a department or an epidemiological group within the Department of Health, which would provide the necessary information and assist the consultant. The committee had its value but he did not believe that it had the universal sanctity which many attributed to it. It might be rather presumptuous to suggest to the countries how they were to make their preparations, but one might suggest that they provided the assistance required. 118 REGIONAL COMMITTEE: THIRTEENTH SESSION Dr HAN (Korea) stated that his Government had had several visits from short-term consultants. The most beneficial one had been the consultant in public health administration to whom the Secretary had referred earlier in the discussion. There might be several ways to prepare for the visits of a short-term consultant, either through the appointment of a committee or the provision of several counterparts. However, he believed that the services of a consultant whose time was limited to a few months could be better utilized if the suggestions contained in the draft resolution appearing in document WP/RC13/4 were followed. His delegation wished, therefore, to propose that the draft resolution should be adopted. M3decin-Colonel CAILLARD (France) said that his Government fully agreed that it was necessary to provide consultants with all the necessary information to enable them to perform their mission. Nevertheless, for territories that had only a very small population such as his own, it would be rather difficult to set up a cOmmittee, as there might not be more than one specialist in a particular field. He felt,therefore, that the word IIcommittee" might not be the right term and that this part of the resolution could perhaps be re-worded in a brOader manner. Dr MacKENZIE (United Kingdom) proposed that the 'WOrd "body" or "agency II might be used instead, or that the resolution might be re-worded bearing in mind the fact that there would always be an exchange of letter between the Organization and the government concerned whenever short-term consultants were appointed to carry out specific tasks. The SECREl'ARY asked whether the Committee might wish to consider replacing the 'WOrds '~o the value of establishing a committee" by '~o the value of making arrangements in advance II. -t ..... - MINUTES OF THE THIRD MEETING 119 Dr DeLIEN suggested that the resolution might be re-worded along the lines of I~O establish an appropriate instrument to assist the visiting consultant ". He knew of situations where the individual responsible for the assistance to be developed was not a committee man and who had a competent staff to do the work. There was no question whatever that in this particular instance a committee had no value • The CHAIRMAN asked the Director-General if he had. any suggestions to make. The DlRECTOR-GENERAL realized that the obligation for establishing a committee in many countries was difficult as often only one person was involved. He believed that Dr DeLien's suggestion that appropriate arrange- ments be made to set up such an instrument might cope with the situation. What was really important was not the committee but the counterpart officer who would work with the consultant and be responsible for any implementation of his recommendations. He suggested that perhaps a working party might be appOinted to redraft with the Rapporteur the resolution, which could be presented again at a later time. The CHAIRMAN referred to page 1 of the document WP/RC13/4 Which stated liThe Government shall establish a committee, with the counterpart officer as secretary, to assist the visiting consultant in dealing with problems involved and also to undertake the implementation of the recommendations made by the consultant. II This would therefore mean that should the government choose to establish a committee of two, the secretary would be expected to work with the consultant. 120 REGIONAL COltMr'ITEE: THIRTEENTH SESSION Dr TRUONG drew attention to paragraph 1.(2} of the resolution which read "to the value of establishing £. committee, with the counterpart officer as secretary, to assist the visiting consultant ", and suggested that a counterpart be appointed to provide all the necessary information with possible assistance of other people. The SECRETARY proposed that consideration might be given to incorporating the suggestions made by Dr DeLien and Dr Truong so that the statement would then read ''DRAWS the attention of governments to the value of establishing an appropriate instrument and appointing a counterpart officer to assist the visiting consultant. " Dr DeLIEN felt that the word "appoint" sounded somewhat dictatorial and suggested that ''providing'' would be more appropriate. The CHAIRMAN asked the Rapporteurs to revise the text of the draft resolution in accordance with the discussions so that the Committee could review the matter again. (For adoption of resolution, see section 8 belOW.) At this point Dr MacKENZIE (United Kingdom), Vice Chairman, took over the Chair. 5 MANAGEMENT OF CHOLERA EL TOR: Item 13 of the Agenda (Documents WP/RC13/7 and Add.l) The Secretary was invited to present this item. The SECRETARY said that the Government of the Philippines had requested that this item should be placed on the agenda. A paper on the patho-pby'siology .. MINUTES OF TIm THIRD MElETnm of cholera prepared by Captain R.A. Phillips, Commanding Officer, United States Naval M:dical Research Unit No. 2 in Taiwan, had already been distributed. He suggested that Captain Phillips should be invited to present this paper and also to give a short statement of the work being done in the Philippines by NAMRU 2, in co-operation with the Department of Health. l2l The attention of the Committee was also drawn to document WP/RC13/1 Add.l which referred to the arrangements under Article 104 of the International Sanitary Regulations. Captain PHILLIPS (United States of America) said he would like first to acknowledge the support they had received in their studies. This had been a joint venture, and he was merely a rapporteur of the studies which had been conducted by the Navy, the governments, their colleagues -- technicians and nurses -- in the countries of Egypt, Pakistan, Thailand, Taiwan and the Philippines where they had worked in the past few years. Despite the studies made by Schmidt of the Hamburg epidemic in 1850, when he had pointed out the very low protein content in the cholera stool and stated that one would not be dealing with the transudate, and the studies that Dr Goodpasture had made at the San Lazaro Hospital on the 1923 epidemic, in which he had performed autopsies on patients within a few minutes of death and pointed out that there was no sloughing of the intestinal tract, it was still generally believed, until a few years ago, that one was in fact dealing with a disease in which the cholera vibrio attacked the mucosa of the intestinal tract causing death and sloughing of the mucosal cells. This could no longer be considered as the aetiology of the diarrhoea found in cholera. Studies on the protein content of the cholera stool had been repeated in the Egyptian epidemic 122 REGIONAL COMMI'I'l!EE: THIRTEENTH SESSION in 1947 and it was found that the concentration was about 0.1 gmper cent. on the average. This was not a t!"ansudate inasmuch as a transudate should have 1-1/2 to 2 per cent. of protein in the stool, and so they searched for other possible mechanisms of the disease. The transudate classical theory in cholera was again studied by Dr Gangarosa of the Walter Reed, in collaboration with the NAMRU group in Ban~tok in 1959, and he had taken snippets of intestinal mucosa with a tube passed down into the intestine and could find in none of these instances, any evidence of loss of mucosal integrity. .... The coup de grace was delivered actually by Dr Gordon in the same year. He used polyvinyl- pyrrolidone which was not attacked by intestinal bacteria and tagged it with iodine 131. He found that when this was g1 ven intravenously to cholera patients there was no greater polyvinylpyrrolidone content in the stool of cholera patients per unit time than there was in the stool of normal indi viduals. That effectively ruled out the idea that one was dealing with a damaged mucosa that would leak protein as a tranSUdate. captain Phillips added that they had been interested in the studies conducted by Visscher in 1944 on dogs in which the movement of large volumes of electrolyte solutions from plasma to gut lumen and .from gut lumen to plasma in normal dogs was determined with the use of isotopes. If these studies were transposed to maIl, it would mean that in a 50-kilO man, a total of 20 to 80 litres of fluid would pass from his plasma. into the gut lumen and back again in 24 hours, so that the next flux was zero. He had also demonstrated, and this had been verified by others, that the mechanism of this movement back from the lumen of the bowel into the plasma was by means of the active transport of sodium ion, and the sodium ion was ''pumped'' into the plasma, and carried along with it water to maintain neutrality or isotonicity and also chloride ion and bicarbonate ion. In 1959 studies had MINU'l'ES OF THE THIRD MEETING 123 been started in Bangkok to determine if this was the pattern involved in the disease and they had been able to find, with considerable regularity, a sodium pump inhibitor in the stools of cholera patients. He believed that all they had done and all that had been done in the past seemed to verify that they were dealing in essence with an inhibitor vf the active transport of the sodium ion and the fluid which normally poured into the gut was not reabsorbed. It was interesting to note that cholera seemed to be a self-limited disease of about three to five days and that the mucosal cells turned over in just that period of time. It appeared that they were dealing with a pOisoned cell so far as the sodium activity was concerned, and when the new cells were formed that was the end of the disease. Why one had the low attack rate, or in other words, why one person in 2000, one in 50 000 or one in 200 only acquired the disease, was an unanswered question. Based on the studies of Dr Gangarosa, it was believed that from the appearance of the intestinal mucosa, one was dealing with patients who had some lCLnd of nutritional deficiency. However, other people also had a similar deficiency and apparently did not acquire the disease. There seemed to be two or three factors involved, but any rate there was physiological evidence of what was happening to a certain extent and it was hoped, therefore, to be able to obtain further information on the treatment, and perhaps, prevention of the disease. On request of the Secretary of Health of the Philippines, the group had arrived at the end of June of this year, and had decided to see how the intestinal cells would handle various ions. They studied patients in Pavilion 8 of San Lazaro Hospital, utilizing rectal and urethral catheters and measured the collected hourly stool and urine, and the arterial blood samples every two hours. 124 REGIONAL COMMITTEE: THIRTEENTH SESSION The patients were maintained in a steady state with an intravenous infusion of sodium, potassium,chloride and bicarbonate ions, and after usually a four-hour period, or for as long as was required to get the patient into a steady state, they stopped the intravenous solution and gave them the same solution or different solutions by mouth. They found very quickly that under these circumstances the patient could not handle the sodium ion, it went right on out, taking chloride and water with it. On the other hand, he could absorb potassium ion and bicarbonate ion, and could absorb them in large amounts and sufficient amounts, so that he did not waste any more of his body stores of potassium and bicarbonate ions. In fact one could even treat the acidosis of the patient with this cholera cocktail. This was rather important as far as treatment of the disease was concerned, because, as was known, the patient required three intravenous solutions -- sodium chloride, potassium chloride and sodium bicarbonate. The sodium bicarbonate put up in solution had to be refrigerated or it would be transformed into sodium carbonate, and giving that intravenously would be disastrous. In the tropics there was inadequate refrigeration for intravenous fluids so that if potassium and sodium bicarbonate could be given by mouth, it meant- that instead of three intravenous solutions, only one, sodium chloride, was now required, thereby considerably simplifying the treatment of the disease, if this could be put into practice. In the studies just reported, there were twenty of the NAMRU staff working on one patient. This was quite different to the situation where one physician was handling twenty patients. They were now trying to find out whether this could be applied in an epidemic situation. There were two other interesting points that had come out of their study. MINUTES OF THE THIRD MEHrING 125 The cholera stool from patient to patient was surprisingly uniform in its electrolyte composition, the sodium ion was about 150, the chloride around 100, potassium around 10, and bicarbonate ion around 50. This was one of the reasons why it was easy to apply rule of thumb treatment to these patients. No matter what the patient was given by mouth, the individual would end up with about the same output through the rectum. In other words, if the patients were given water by mouth, the body would add to it in going through the intestinal tract, sodium chloride, potassium and bicarbonate ions in the concentration added if water had not been given or if a solution of the same composition as the stool of the patient had been given. This was exceedingly important because if a cholera patient were allowed to drink water in the amounts he wanted, the sodium, chloride, bicarbonate and potassium stores would be depleted in a very short space of time, and on the basis of the studies carried out it had been estimated that if a patient were allowed 400-500 cc of water per hour, he would be dead in eight hours. Cholera wa~ one of the diseases that had caused or could cause economic havoc. If a patient acquired the disease and could get to a hospital or treatment centre where there were adequate doctors and nurses and saline solutions, etc., within three hours of the onset of the disease, there would be no deaths in the uncomplicated cases. This statement, however, would not hold for those cases which had diabetes, a bad heart, or bad kidneys. The only reason people were worried about cholera was because people died. If there were adequate treatment facilities, he was sure that the concern about cholera and the quarantine of cholera would vanish. He felt that at some time the question of quarantine regulations would have to be reconsidered by WHO. He urged that further research should be undertaken on cholera, 126 REGIONAL COMMITTEE: THIRTEENTH SESSION as almost nothing was known of the epidemiology of the disease and how it spread from one place to another. If reports on the cost caused by cholera were considered -- a~ this statement was based on a report in a newspaper in Taiwan -- the cost of an epidemic which continued for five-six months in terms of loss of exports could be as high as two hundred million dollars in one year and if this were multiplied with the loss sustained by other countries which also had the disease, a lot of research could be done with a fraction of this sum. The VICE-CHAIRMAN thanked Captain Phillips for his interesting presentation of the item on cholera, and said the paper was now open for discussion. Dr CHRISTIANSEN (United Kingdom) congratulated Captain Phillips on his able presentation. Two days ago he had mentioned certain points of issue in relation to this subject. His Government had followed developments with interest since, for the first time, cholera El Tor had appeared on the east coast of North Borneo early this year. They had expected and anticipated its arrival, waiting for the first case to appear when the various neighbouring countries were faced with the problem and the infection. It had given them much food for thought and action and they had started very quickly on the preventive as well as the curative side. Within a short period of time, by the rapid organization of prophylactic and preventive squads, inoculation programmes had been carried out on the east and west coasts and then in the interior, covering over 75 per cent. of the population within a very short space of time. He wanted to record his appreciation and thanks to the neighbouring countries of Hong Kong and Sarawak, particularly the Directors of Medical Services, and also to Australia for flying in vaccine .. lIDruTES OF THE THIRD MEETING 127 to boost the stock. This particular subject provided great food for thought, as it was complicating and confusing and was still baffling most of those interested. Much had been discovered and learned, particularly on tne theory of sodium pumping inhibition. There was, however, still need for further research, and the six points mentioned in a previous meeting might be a part of the research work that was still being conducted. These six pOints were: (1) Had a diagnostic serum been discovered in the field of preventive medicine and if not, was there any knowledge of foreseeing how soon this would be possible? Diagnostic serum would be easier and less time-consuming by way of a skin test, such as tuberculin testing, thereby avoiding the embarrassment of the rectal swab and loss of time taken before organisms could be identified in the laboratory. (2) Was the final production of a specific vaccine being approached? This would be a tremendous advance in medicine and in public health, if, and as soon as, this vaccine could be established and made available • (3) up to the present time there had been no unified and authorized ~uarantine period for cholera El Tor. He felt that a final definite ~uarantine period should be established. ( 4) The reports available to the Committee had revealed that the lower socio-economic group was more prone to this infection. Associated with this was the ~ue stion of protein and vitamins A and C, there by sho'fing the need for consideration of the nutritional standard coupled with a higher • educational standard. He felt that in addition to the availability of a well-balanced protein intake, and ade~uate intake of vitamins A and C to maintain the physiological tissues at par, the possibility of using vitamin Bl might be considered. Vitamin Bl increased tissue tone generally 128 REGIONAL COMMrTTEEl: THIRTEENTH SESSION and it might be presumed that in the lower socio-economic group the intake of vitamin Bl orally in food in the natural form might be lacking. He felt that vitamin Bl , by increasing the body tissue tone, might playa very active part indeed in preventing the onset of the infection within the intestines. There was room for research in the field of vitamin Ei' It might, of course, be contended that an adequate intake of vitamin Ei might predispose to the possibility of a carrier state. ( 5) It was know that in certain infections the gall bladder and appendix had been the nidus of infection among carriers. It was also know that the appendix had been harbouring entamoeba histolytica and also the bacillus typhus among carriers. Here would be needed the co-operation of the surgeon so that after an appendectomy, the appendix could be delivered to the research team for further investigation. (6) There did not appear to be any conclusive acceptance of a nomenclature for vibrio cholera El Tor. Various terminologies had been used such as "vibrio cholera Asiatica", "vibrio comma El Tor" and "enteritis choleriformis El Tor ". It might be worthwhile to consider and to recommend to a higher authority, which was due to meet, the adoption of a nomenclature of vibrio cholera Asiatica on the one hand, and vibrio cholera El Tor on the other, for the sake of simplicity. Dr CHANG (China) gave a brief report of the recent outbreak of cholera in Tai'wan. The first case had occurred on 17 July on the west coast and mid-part of the island and the last case was confirmed on 4 September. There was a total of 383 cases with 24 deaths. On 19 September the area had been declared free from cholera infection. During the epidemic, preventive and control measures had been instituted and treatment suggested MINUTES OF THE THIRD MEETING 129 by captain Phillips had been used. He thanked WHO, UNICEF, NAMRU-2 and the Governments of Japan and the Philippines for their help. He believed the epidemic was now over and most of the data were now under collection, tabulation, and analysis. One of the challenging problems was the carrier. This problem had been greater in the first 40 days and about 15 000 people had been examined, most of them being contacts, and among them were found 290 carriers which constituted a percentage of 1.49 per cent. The VICE-CHAIRMAN enquired if these carriers were actual contacts of cases or whether they were drawn from the general sample of the population. Dr CHANG said that the figures mentioned were up to the end of August and most of them were from contacts of patients. All the family members were examined whenever a case was found. Dr CRUZ (Philippines) said that in the management of cholera cases registered in the Philippines, there were no difficulties in places where there were hospital facilities. The rural areas, however, where around 80 per cent. of the people resided and where cholera cases were registered, offered some problems, but these were overcome by the policy set by the present Secretary of Health,wherein the rural health units personnel consisting of medical officers, public health nurses, midwives and sanitary inspectors should be provided with saline solution for immediate administration to the patients while in trans~t to the nearest hydration centres or hospitals. In this way they had been able to save life and lower the fatality rate. The hydration centres, which had been established by regional health directors and public health workers in areas far from the prOvincial hospitals, had served as a clearing place where patients could be given 130 REGIONAL COMMITTEE: THIRTEENTH SESSION better management and care. Referring to the question raised by the Chairman as to whether the carriers isolated in China were contacts of actual cases, Dr Cruz said that according to Somiatno of Indonesia, about 4 per 1000 population were positive and were called "casual carriers". This was a new terminology and it meant that carriers were not only among those who were actual contacts of cases but also were among the general population. The Disease Intelligence Centre in the Philippines had found that the "casual carrier" rate was as high as 11 per cent. Dr ROZALLA (United Kingdom) reported that the cholera outbreak in Sarawak during 1961 had started on 12 July and the country waS declared free of infection on 19 October. During the outbreak there was a total of 301 cases, with 70 deaths, the latter occurring chiefly 1.1 the rural areas. Although Sarawak had been declared free of infection, it had continued to maintain a close watch on immigrants and visitors. No mass vaccination of the population had been carried out since October 1961. There was now a large population of about 10 to 15 thousand persons within easy reach of the main town of Kuching, in whom vaccination had not been carried out for nearly a year and, as they were living in a previously infected local area, it was thought that this was an opportunity for some research on the question of carriers and the carrier state of the population. Unfortunately, Sarawak had its limitations and was unable to carry out this research. He thought that the representatives attending this session, the Organization, and possibly Captain Phillips, would be interested to know that his country had the material but not the means to carry out such research. Dr TRUONG (Viet Nam) said that he had listened with great interest to the discussions on the subject and thanked those participating in the ... i~ "1- - . ~"'- MrNUrES OF THE THIRD MEETING 131 discussions which concerned all the countries in the Western Pacific Region. WHO should undertake all measures, from the :management point of view, to collect the studies undertaken in different countries and to send to governments all the reports which were being prepared so that they could be fully informed of the development of the epidemic. He al.so asked that the discussion should be reported as fully as possible in the minutes so that the document could be studied very carefully. The VICE-CHAIRMAN assured Dr Truong that his remarks would be given due attention. Dr JAYESURIA (Malaya) stated that he would greatly appreciate it if any further information on the progress of research on cholera El Tor could be made available to the Government of the Federation of Mllaya. His country had been fortunate as so far cholera El Tor had not touched its shores, but the Government had been impressing on its health staff the importance of being prepared and to watch out for any cases of gastro-intestinal upset which might be the beginning of cholera El Tor. He asked that all information available and any other information produced in the near future could be distributed as early as possible through the WHO Regional Office. Dr MARTINS (portugal) said that there had been two cholera cases in M3.cao last year. This year, they had vaccinated 99 per cent. of the population and happily they had not had one case. The subject of carriers was a very important matter. Many people in the lower social level had been investigated and so far carriers had not been encountered in Macao. The VICE-CHAIRMAN gave a brief resume of the situation in Hong Kong. The last confirmed bacteriological case was on 8 November 1961 at the end REGIONAL COMMI'l'TEE: THIRTEENTH SESSION of the outbreak last year and routine sampling of night soil, water supplies and any other vehicle of infection had. from then onwards continued. The first positive culture of the vibrio was picked up from the first case on 23 August, since which time either one or t'WO further cases had. been found. at roughly a week's interval. The total as of yesterday was nine cases, eight of which had been bacteriologically confirmed and the ninth was a clinical case, the clinician was certain it was cholera but it was repeatedly negative on culture. A mass vaccination campaign had been carried out in March and April of this year and only achieved 53 per cent. of the population on an average, but did succeed in getting between 80 per cent. and 90 per cent., and in some cases better, among the people considered to be most at risk, the boat people living on the water and the people in the new territories. The sampling of night soil had continued throughout this time and over a week ago, the first positive culture was discovered from the communal night soil in a tanker in Kowloon. Having picked this up it had been decided to sample night soil from all the tankers in the urban area, that was in Kowloon and on Hong Kong Island, and it was found that within the next two days there were five districts infected in Kowloon, and by the end of the week and the time he left Hong Kong, nine districts were infected and most of Hong Kong Island waterfront. However, despite this widespread appearance of vibrios, as yet the tally of cases had not risen as sharply as it had been expected. They had picked up one non- agglutinable vibrio culture from a case of gastro-enteritis and had also started picking up an occasional non-a.gglutinable vibrio from the night soil. captain PHILLIPS referred to the treatment of patients in remote areas. A patient with cholera. who was twelve hours away from a treatment centre was likely to be just as dead as a patient with acute appendicitis. (- MINUTES OF THE THIRD MEETING 133 :ct: On the question of vaccine evaluation, if there was a treatment centre with adequate saline, doctors and nurses, one could draw a ring three hours away from that treatment centre, and all people in that area could be considered as experimental subjects with no ethical or moral question involved because they would all be treated properly as soon as they were brought in. In that way, half of the individuals could be given cholera vaccine and the other half typhoid vaccine, and one could set up an adequate vaccine evaluation study, although this would present difficulties. Witt an attack rate of one " in 2000, it meant that to get a hundred cases, an estimated 200 000 people should be studied. As to the question of terminology, the patient could not tell the difference between the El Tor vibrio and the Asiatic cholera vibrio. captain Phillips believed that so far as present thinking and knowledge was concerned, we might as well call it cholera, because the implication had been that E1Tor cholera was a milder disease and he assured the representatives that it was not. .Any person weighing 50 kilos, with the vibrio El Tor in his intestinal tract, who put out 80 litres of stool in the course of the disease had a pretty severe illness. Finally, insofar as diagnosis was concerned, he considered that any individual who put out more than three litres of stool .~. in twenty-four hours had cholera. The VICE-CHAIRMAN said that there was one death in the nine cases he had mentioned earlier, the individual was moribund on admission to the hospital and died before treatment could be started. Regarding the carrier state, all contacts of cases had been isolated and four contact carriers only had been uncovered, all of whom were related to the first case. At the time he had left Hong Kong, there had been no further contact carriers picked up from any of the subsequent cases. 134 REGIONAL COMMITTEE: THIRTEENTH SESSION The attention of the Committee was then drawn to document WP/RC13/7 Add..l, Arrangements under Article 104 of the International Sanitary Regulations. The VICE-CHAIRMAN said that this paper followed on the meeting held in Mmila to discuss cholera El Tor, during which it had been recommended that consideration should be given to reaching inter-country agreements under Article 104 of the International Sanitary Regulations. The Regional Office had said that it would be very happy to help with the framing up of such agreements and that it would ask the Director-General for authority to give such advice when help was required by any country contemplating this measure. The paper before the Committee gave guidance on how such inter-country agreements could be reached, bearing in mind that they must not conflict with the principal regulations and the articles contained in the International Sanitary Regulations. There being no further comments, the Vice-Chairman asked the Rapporteurs, in conjunction with the Secretariat, to present a draft resolution for consideration of the Committee at its next plenary session. (For adoption of resolution, see minutes of the fourth meeting, section 3.) 6 RESOLUTIONS OF REGIONAL INTEREST ADOPTED BY THE TWENTY-NDJTH AND THIRTIETH SESSIONS OF THE EXECUTIVE BOARD AND THE FIFTEENTH WORLD HEALTH ASSEMBLY: Item 14 of the Agenda (Document WP/RC13/5) The SECRETARY stated that document WP/RC13/5 contained the resolutions of regional interest adopted by the twenty-ninth and thirtieth sessions of the Executive Board and the Fifteenth World Health Assembly. A note had been added in connection with specific resolutions. He wished to stress -'" MINUTES OF THE THIRD mErING the importance of resolution WHAl5.l9 on page 9, "Report on Development of Malaria Eradication Programme", and in particular, the text on page 10, on the relationship between malaria eradication activities and public health services. Dr THIEME (Western Samoa) stated that two resolutions of regional 135 interest adopted by the twenty-ninth and thirtieth sessions of the Executive Board and the Fifteenth World Health Assembly most directly concerned Western Samoa: resolution WHA15.16 - "Admission (\f New Members: Western Samoa." and resolution WHAl5.22 - "Continued Assistance to Newly Independent states". The first one had already been acknowledged; the second was an important new landmark in WHO assistance to his country. This resolution provided that assistance to newly independent states should be accelerated along the lines recommended by the Director-General in his report, and authorized the Director- General to implement programmes for the countries concerned, concentrating on national health planning and related training, expanding the medical education and training of national staff, and providing operational assistance. The primary objective was assistance to newly independent states in the basic training and higher education of the national staff. The establishment of a Special Account to be part of the Voluntary Fund for Health Promotion was authorized. In a letter from the Regional Director, it had been suggested that Western Samoa might request assistance from the Organization in a long-range programme in the field of education and training in medicine and public health. In a subsequent letter, the Regional Director had set out a form in which a ten-year programme for assistance commencing 1964 might be submitted. It appeared, however, that the establishment of the new account, even though it was merely a voluntary fund, was designed to direct the greater part of WHO REGIONAL COMMITTEE: THIRrEENTH SESSION assistance to the newly independent African states, not recognizing the Asian and Latin American countries. Western Samoa had received assistance from the Organization for many years and would need a much lesser amount than other countries. It was the only country in the Western Pacific falling strictly under the category of newly independent and emerging States, and would appreciate having the Regional Director's support of its request of assistance over a ten-year period. With the country's population increasing rapidly and its health services needing considerable expansion every year to keep pace with population growth and with limited financial resources, the Government was presently faced with difficulties. However, a little money was available for the development of these services and if, in accordance with th~ resolution, WHO could see its way clear to accelerating assistance in the training of national medical and public health personnel, additional funds might possibly be released in the future. The SECRETARY confirmed that he had very recent'.y received the request from the Government of Western Samoa. While he was not in a position at this time to make any cOmmitments, as the request had to be presented to WHO +. Headquarters, he assured the representative of Western Samoa that the Regional ~ . Office would give this request its sympathetic consideration, within its capabilities and financial resources. The DIRECTOR-GENERAL expressed his appreciation of the statement made by the representative of Western Samoa and his great pleasure in seeing him attend, for the first time, a meeting of the Regional Committee for the Western Pacific. The resolution was quite clear in defining assistance for all newly independent countries, not only those in Africa but also those in, tor example, the ~r1cas and the Western Pacific. Regard1Qg the Special ~ccount for MINUTES OF THE THIRD MEETING 131 Accelerated Assistance to Newly Independent and Emerging States, he explained that the Account had been established but there were as yet no funds in it. This type of meeting provided the opportunity for seeing two sides of the picture: the Organization's desire to serve and the need for resources. Dr CHRISTIANSEN (United Kingdom) conveyed the gratitude of his Government to the Regional Director and his advisory staff and also to UNICEF for the assistance they were providing to his country's malaria eradication programme. In 1955 North Borneo had begun its pre-eradication programme and during the years that followed survey work was carried out consistently under the guidance of the Regional Office. In early 1961 the Government felt sufficiently confident to draw up an eradication programme, which covered not only the pre-eradication stage but also the present eradication stage, the consolidation stage and the maintenance stage which it was hoped to reach by 1968. Dr Christiansen emphasized the necessity of a pre-eradication survey before launching an eradication programme. With the results of the pre-eradication studies, his Government was able to look forward with greater COnfidence to the success of eradication, which had been built up and implemented systematically. The headquarters for the malaria eradication programme in North Borneo was at a hill station called Keningau and it was here that the WHO staff, who served as advisers on a colony-wide basis, were based. The administration itself emanated from the head office of the Director of Medical and Health Services in Jesselton. There was a full integration of the WHO staff and that of the Government, and the co-ordination and co-operation existing among them were excellent, as shown by the monthly meetings of the senior malaria staff conferences where the progress of the eradication programme was reported and difficulties thrashed out. In turn, the 138 REGIONAL COMMITTEE: THIRTEENTH SESSION Government was doing its best to carry out the advice given by the Regional Office and by the WHO advisers in the field. The VICE-CHAIRMAN thanked Dr Christiansen for his remarks. There being no further comments, the VICE-CHAIRMAN proposed that the Committee take note of the resolutions given in document WP/RC13/5. It was so agreed. 7 AMENDMENTS TO THE RULES OF PROCEDURE OF THE REGIONAL COMMITTEE: Item 15 of the Agenda (Documents WP/RC13/9 and Add.l) (continued from the first meeting, section 11) The VICE-CHAIRY.AN explained that this item dealt with the report of the Sub-Committee on Rules of Procedure. As Chairman of this Sub-Committee, he made the following report: The Sub-Committee had met at 2.30 p.m. on Friday, 21 September 1962 with the follOwing members: Dr Jayesuria (~aya), Dr Truong (Viet Nam) and Mr Okazaki (Japan). Having considered documents WP/RC13/9 and WP/RC13/9 Add.l, it resolved to recommend to the Regional Committee the adoption of the resolution contained in WP/RC13/WP/3. It further recommended that the Regional Committee should request the Secretariat to rearrange the rules in proper sequence, incorporating the amendments now adopted. It was pointed out that the Regional Committee should, in this connection, recognize that the numbering, as recorded in the resolution, would sustain certain consequential amendments. The Secretariat should also be requested to issue the revised Rules of Procedure in the form of a booklet. The draft resolution was then presented to the Committee for consideration. 'I- -I -"t- MINUTES OF THE THIRD MEETING Decision: In the absence of any comments or objections, the recommendations of the Sub-Committee were accepted and the draft resolution was unanimously adopted (see resolution WP/RC13.R3). 139/140 8 CONSIDERATION OF DRAFT RESOLUTION ON PROGRAMME PLANNING IN CONNECTION WITH SHORT-TERM CONSULTANTSHIPS (re surned from section 4 above) The VICE-CHAIRMAN referred to draft resolution WP/RC13/WP/4 which had been distributed to the Committee and asked for comments. There being no comments, he proposed that the resolution should be adopted. Decision: The draft resolution was unanimously adopted (see resolution WP/RC13.R4). The meeting adjourned at 12.00 noon. 1 2 3 4 (WP/RC13/Min/4 Rev.l) MINUTES OF THE FOURTH MEETING WHO Conference Hall Tuesday, 25 September 1962 at 9.00 a.m. CHAIRMAN: Dr F.Q. DUQUE CONTENTS Acknowledgement by the Chairman of additional brief reported received from governments on the progress of their health activities (continued) ••.••••••••••••••••••••••• Message from the Government of Cambodia •••••••••••••.••••••••••• Consideration of the draft resolution on the management of cholera El Tor (continued) •••••••••••••••••••••••• Consideration of the report presented by the Sub-Committee on Programme and Budget ( cent inued) ............ ,. .................................................................................... .. 144 144 144 144 5 Selection of topic for the Technical Discussions during the fourteenth session of the Regional 6 7 8 ColIlInittee ........................................................................................................... 145 Consideration of the report presented by the Technical Discussion Group •.•••.•••••••••••••••••••••••••••••••• Time, place and duration 0f fourteenth and fifteenth sessions of the Regional Committee •••••••••••••.•••••••••••••••• Other business ................................................................................................ .. 8.1 Statements by representatives of the non- governmental organizations in official 147 148 149 relations with WHO (continued) ••••••••••••••.•••••••••••••• 149 8.2 Resolution of AppreCiation ••••.••.•••.••..••••••••••••••••• 150 -141- 142 REGIONAL COMMI'rJ:EE: THIRTEENTH SESSION .. . Fourth ~eting Xuesdalz 25 September 1962 at 9.00 a.m. PRESENT I. Representatives of Mamber States AUSTRALIA Dr. H.E. Downes Dr. M.J. Flynn Dr. J.J. Saave Dr. C.J. Ross-Smith CHINA Dr. C.K. Chang FRANCE Medecin-Colonel L. Caillard JAP~ Dr. N. Tateba.ya.shi Mr. K. Wa.tanabe Mr. H. Okazaki Dr. R. Naka.ha.ra KOREA Dr. Sang Too Han Mr. Koo Sup Yang LAOS Dr. Tiao SinglteO Dr. Phouy Phouttasa.k ...., 'tf.ALAYA Dr. L.W. Ja.yesuria Mr. K.K. Chong Mr. F.W. Crowley NEW ZEALAND Dr. R.G.T. ~'Wis PHILIPPINES Dl. F.Q. Duque --( Dr. A.H. Cruz Mr. J.C. Perlas Dr. E. L. Ville 6as Mr. B~ BrUlantes Mr. Me Tana Dr. J. de Paiva Mu-tins "'1 .,- PORTUGAL UNITED KINGDOM Dr. E. Christiansen Dr. C.H. Gurd Dr. Me A. Rozalla UNITES STATES OF .AMERICA Dr. H. DeLien VIET NAM Dr. ~-Cuu-Truong Dr. Nguyen~Binh-Ngbien WESTERN SAMOA Dr. J.C. Thieme '. MINUTES OF THE FOURTH MEETING II. Representatives of the United Nations and Specialized Agencies UNITED NATIONS CHILDREN'S FUND Dr. A. Mangay-Angara III. Representatives of other·inter~governmental organizations and of non-governmental organizations INTERNATIONAL ASSOCIATION FOR THE PREVENTION OF BLINDNESS INTERNATIONAL COMMr'ITEE OF CATHOLIC NURSES INTERNATIONAL COUNCIL OF NURSES INTERNATIONAL HOSPITAL FEDERATION INTERNATIONAL PAEDIATRIC ASSOCIATION INTERNATIONAL SOCIETY FOR THE REHABILITATION OF THE DISABLED LEAGUE OF RED CROSS SOCIETIES SOUTH PACIFIC COMMISSION WORLD CONFEDERATION FOR PHYSICAL THERAPY WORLD FEDERATION OF OCCUPATIONAL THERAPISTS WORLD VETERANS FEDERATION IV. WHO Secretariat DIRECTOR-GENERAL Dr. S.P. Lopez Mrs. C.T. Maceda Mrs. T. G. Villarica Dr. G.L. del Castillo Dr. Fe del Mundo Dr. D.J. Tablan Dr. B.C. Fontanilla Dr. G. Loison Mr. A. Save llano Mrs. C.A. Floro Dr. A.M. Inocentes Dr. M. G. Candau 143 SECRETARY Dr. I.C. Fang, Regional Director 144 REGIONAL COMMITTEE: THIRTmNTH SESSION 1 ACKNOWLEDGEMENT BY THE CHAIRMAN OF ADDITIONAL BRIEF REPORTS RECEIVED FROM GOVERNMENTS ON THE PROGRESS OF THEIR HEALTH ACTIVITIES: Item 9 of' the Agenda (continued f'rom the f'irst meeting, section 10) The CHAI~ acknowledged receipt of' progress reports on health activities from the Governments of Cambodia and the Philippines. 2 MESSAGE FROM THE GOVERNMI!lNT OF CAMBODIA The CHAIRMAN announced that the Government of Cambodia had sent a telegram expressing its regret at not being able to participate in the present session and extending its very best wishes to all Member States in the Region. 3 CONSIDERATION OF THE DRAFT RESOLUTION ON THE MANAGEMENT OF CHOLERA EL TOR (continued from the third meeting, section 5) Dr LEWIS (New Zealand), Rapporteur, read draft resolution WP/RC13/WP/6 to the Committee. Decision: There being no comments, the draft resolution was adopted (see resolution WP/RC13.R5). 4 CONSIDERATION OF THE REPORT PRESENTED BY THE SUB-COMMITTEE ON PROGRAMME AND BUDGET: Item 8.2 of' the Agenda (Document WP/RC13/ll) (continued from the first meeting, section 9) On behalf of the Sub-Committee on Programme and Budget, the CHAIRMAN presented the draft report and said that, if approved, the document would become an annex to the report of' the Regional Committee. He then asked for comments. Dr DeLIEN (United States of America) stated that he had previously given his comments. His delegation was pleased with the budget proposals, MINUTES OF THE FOURTH MEETING which were considered reasonable, and would now recommend their adoption. The SECRETARY presented draft resolution WP/RC13/WP/5 on the proposed programme and budget estimates for 1964. Decision: In the absence of other comments, the draft report and the draft resolution were adopted (see resolution WP/RC13.R6). 5 SELECTION OF TOPIC FOR THE TECHNICAL DISCUSSIONS DURING THE FOURTEENTH SESSION OF THE REGIONAL COMMITTEE: Item 16 of the Agenda (Documents WP/RC13/6 and Add.l) The SECRETARY said that document WP/RC13/6 contained suggestions of the Secretariat as to the topics which might be considered for the Technical Discussions in 1963. In order to facilitate a decision, the subjects selected for the Technical Discussions during past years had been listed in the addendum to the document. Dr TRUONG (Viet Nam) stated that the three topics suggested were interesting, but his delegation preferred topic 3: liThe Role of Local Health Services in Leprosy Control II. Leprosy was a world problem and it occurred in many countries in this region. The millions of people suffering from the disease, those cured and those being treated, emphasized its importance. At the Regional Committee meetings in 1960 and 1961, attention had been drawn by several representatives to the problem of leprosy and it had even been suggested that this might be selected as the theme for World Health Day or for the Technical Discussions. It might now be the time to review this problem from the level of the local health services, considering both social and technical aspects. His delegation strongly supported tp~t this topic should be taken up at the next Technical Discussions. 146 REGIONAL COMMI'I'I:EE: THIRTEENTH SESSION Dr HAN (Korea) shared the views expressed by the representative of Viet Nam and stated that in Korea, as previously mentioned, leprosy was still one of the major health problems. The national law covering the management of leprosy patients was now being revised. This would provide that patients would not be segregated but would receive treatment at home and only those with deformities and requiring special care would be accommodated in the leprosaria. The local health services 'WOuld play a very important role in case-finding, treatment and follow-up of patients, especially now that the health network in Korea had just been completed. Health education would also have its part. He believed that an exchange of knowledge and experience on this subject would bring about an early solution to the problem. Dr SMVE (Australia) associated his delegation with the statements made by the previous speakers. While document WP/RC13/6 described the topic adequately, he emphasized that in the less privileged and developing countries of tbe legion, particularly in Papua and New Guinea, Hansen's disease was of ~ecial socio-medical importance and presented a considerable community health problem. Discussions on the role of the local health services in the domiciliary treatment of the disease would definitely be of great value. Dr JAYESURIA (Malaya) supported the recommendations of the representatives of Viet Nam, Korea and Australia. Hansen's disease was still a big problem in M3J.aya. There were persons who were still reluctant to come forward early for treatment and who preferred to remain in hiding. If detected early enough, many of them could have been given effective treatment. The Ministry of Health was drafting new legislation to replace the old leprosy enactment which placed too great an emphasis on segregation. The new law would allow .. , '- MINUTES OF THE FOURTH MElETDI'G 147 greater freedom of movement and liberty to the non-infective cases and would include domiciliary treatmen~ Decision: The Committee agreed that "The Role of the local Health Services in Leprosy Control" should be the topic of the Technical Discussions at the fourteenth session of the Regional Committee (see resolution WP/RC13.R7). 6 CONSIDERATION OF THE REPORT PRESENTED BY THE TECHNICAL DISCUSSION GROUP: Item 17 of the Agenda (Document WP/RC13/l2 Rev.l) (continued from the first meeting, section 7) In presenting the report, Dr FLYNN, Chairman of the Technical Discussions, said that most of the representatives came from countries with either too much or too little water. With population explosion, it was anticipated that in the next thirty-five years the population would be increased by 100 per cent. and it was quite possible that as a result, water demands would be increased by more than 1000 per cent. For this reason, the representatives involved in the Technical Discussions had been vitally concerned with the role of the health services in the provision of adequate and pure water for rapidly expanding communities. The report of the Technical Discussion group , r-/ represented the various shades of opinions, agreements and disagreements, particularly on the public health policies followed in various countries. It might not possibly satisfy every representative in all its details, but it was certainly the best that could be prepared in the time available. The group -t_ felt that the attention of governments must be focussed on the needs for pure water and, consequently, the Technical Discussions report stressed the role of health services in this particular aspect, and suggested lines of co-operation which might be fully established between the various agencies • working in this field. 148 REGIONAL COMMt'1'1'EE: . THIRTEENTH SESSION Dr Flynn paid tribute to the work of the Secretariat during the Technical Discussions and also thanked the representatives for their interest, support and kindness, all of which had made his assigruoont so pleasant and satisfying. The CHAIRMAN invited the Committee to comment on the report. He also announced that the evaluation questionnaires covering the Technical Discussions should be completed and handed to the Secretariat. There being no further comments, the Chairman proposed that the Committee note the report. It was so agreed. 7 TIME, PLACE AND DURATION OF FOURTEENTH AND FIFTEENTH SESSIONS OF THE REGIONAL COMMr'l'l'EE: Item 18 of the Agenda The SECRETARY stated that the Committee at its tenth session had accepted the invitation of the Australian Government to hold its fourteenth session in Port l>t>resby. FollOwing discussions with the Government, it was proposed that the dates of the meeting should be early September 1963. unless the Committee decided otherwise, the fifteenth session would be held in ManUa, in accordance with past procedure that every second year the meeting would be held at regional headquarters. Dr SAAVE (Australia) 1 on behalf of the Australian delegation, stated that his Government looked forward to acting as host during the fourteenth session of the Regional Committee. He assured the Committee that everything possible would be done to meet all the requirements in connection with the meeting. - . • " , :C, , -- MINUTES OF THE FOURTH MEETING There being no further comments in relation to the fourteenth and fifteenth sessions, the CHAI~AN asked the Rapporteurs to prepare an appropriate resolution. It was so agreed. (For adoption of resolution, see minutes of the fifth meeting, section 1.2.) Dr HAN (Korea) referred to resolution WP/RC12.Rll adopted by the Committee at its twelfth session, in particular to sub-paragraph 2 of section 4. He wished to remind the Committee that the Government of Korea would act as host during the sixteenth session, which would be held in Seoul. 8 OTHER BUSINESS: Item 19 of the Agenda 8.1 Statements b Re resentatives of the Non-Governmental Or anizations in Official Relations with WHO continued from the first and second meetings, sections 13 and 2 respectively) At the invitation of the CHAIRMAN, the following representatives presented statements: 8.1.1 Representative of the World Veterans Federation Dr INOCENTES stated that rehabilitation projects in south-east Asia had received new impetus through the vitalizing efforts of WHO and the World Veterans Federation. The award of fellowships in physical medicine, in physical therapy, in orthopaedics, the assignment of experts in physical therapy, and the support of the School of Allied Medical Professions in the Philippines represented some of the assistance given. The Federation looked forward to enlarging this area of common endeavour with WHO, as the importance of rehabilitation, econOmically as well as altrUistically, was fast gaining the attention of all peoples in this part of the world. 150 REGIONAL COMMITTEE: THIRTEENTH SESSION 8.1.2 Representative of the International Committee of Catholic Nurses Mrs MACEDA stated that the Catholic Nurses' Guild of the Philippines had been established in several hospitals 'With an initial membership of around six hundred. The original purpose had been to establish the Guild in hospitals conducted by Sisters alone, but it now covered government hospitals where Sisters were not found. In 1957 the National Central Board was formed, the officers being appointed by His Excellency, the Papal Nuncio, from among those recommended by the hospital committees. The Central Board functioned as the highest governing body of the Guild throughout the Philippines. To carry out its objective effectively the Central Board had established several archdiocesan boards - a conglomeration of four or more hospital local branches - the most active of which was the Cebu Archdiocesan Board. The archdiocesan board of Manila had lately been reorganized to carry out projects pertinent to nurses and nursing work. A statement was then given of the various activities carried out by the Guild, which now c~unted more than one thousand 1\1lJy fledged members and was a recognized member of the International Committee of Catholic Nurses and Medical Social Assistants. 8.2 Resolution of Apprec~ation Dr THIEME (Western Samoa) sponsored a resolution of appreciation. Decision: The draft resolution was adopted (see resolution WP!RC13.RlO) • The meeting adjourned at 9.50 e..m. - . .. (WP/RCl3/M1n/5 Rev.l) MINUTES OF THE FIFTH MEETING WHO Conference Hall Tuesday, 25 September 1962 at 4.30 p.m. CHAIRlvf.AN: Dr F. Q. DUQUE CONTENTS '. l Consideration of draft resolutions •••.••••••••••••••••.••••••••• 2 Adoption of the draft report of the Committee ••••••••••••••••••• 3 Adjournment ....................................................... -l5l- 152 REGIONAL COMMrTrEE: THIRTEENTH SESSIOtr Fifth Meeting, Tuesday, 25 September 1962 at 4.45 p.m. ., ~. I. Representati ves of Member states AUSTRALIA Dr. H.E. Downes .' r-~. D. sadleir Dr. J.J. Saave Dr. C.J. Ross-Smith CHINA Dr. C.K. Chang FRANCE Medecin-Colonel L. Caillard JAPAN Dr. N. Tatebayashi Mr. K. vlatanabe Mr. H. Okazaki Dr. R. Nakahara KOREA Dr. sang Tae Han Mr. Koo Sup yang LAOS Dr. Tj.ao Singkeo «- • Dr. Phouy Phouttasak MALAYA Dr. L. vi. Jayesuria Mr. K .- Chong NEW ZEALAND Dr. R.G.r:t'. LewiS PHILIPPINES Dr. F.Q. Dl.:que Dr. A.H. Cruz Mr. J.C. Perlas Dr. E.L. Villegas l{r. B. Brillantes Mr. H. Tana UNITED KINGDOM Dr. E. Christiansen ~ Dr. C.lI. Gurd :Jr. !VT ./1.. Rozalla t - ..... MINUTES OF THE FIFTH MEETING UNITED STATES OF AMERI CA Dr. H. DeI1en VIETNAM Dr. Le-Cuu-Truong Dr. Nguyen-Binh-Nghien WESTERN SAMOA Dr. J.C. Thieme II. Representatives of other inter-governmental organizations and of non-governmental organizations . INTERNATIONAL ASSOCIATION FOR THE PREVENTION OF BLINDNESS SOUJ:H PACIFIC COMMISSION Dr. S.P. Lopez Dr. G. 1Oison 153 III. WHO Secretariat Dr. I.C. Fang, Regional Director SECRETARY 154 REGIONAL COMMITI'EE: THIRTEENTH SESSION 1 CONSIDERATION OF DRAFT RESOLUTIONS (continued from the fourth meeting, sections 6 and 7) 1.1 Technical Discussions (draft resolution WP/RC13/WP/7) 1.2 Dr LEWIS (New Zealand), Rapporteur, read the draft resolution. Decision: The Committee having no comments to make, the resolution was adopted (see resolution WP/RC13.R7). of The draft resolution was read by the RAPPORTEUR. Decision: This resolution was adopted (see resolution WP/RC13.R8). 2 ADOPrION OF THE DRAFT REPORT OF THE COMMITTEE: Item 20 of the Agenda (Document WP/RC13/l3 Rev.l) The CHAIRMAN presented the draft report of the Regional Committee, which ~ , was reviewed section by section. Decision: In the absence of comments, the report was adopted (see resolution vlPjRC13.B9). 3 ADJOURNMENT: Item 21 of the Agenda In closing, the CHAIRMAN conveyed to all representatives his deep appreciation of their collaboration and assistance, which had made this session very fruitful and which had been very helpful in his task as Chairman. He also thanked the Regional Director and his staff for their .. MINUl'ES OF THE FIFTH MEETING kind assistance which had made his assignment a most pleasant one. Once more, he e~ressed his Government's pleasure in having had the honour of acting as host for this meeting and he wished everyone a safe and pleasant journey home. He then declared the thirteenth session of the WHO Regional Committee for the Western Pacific closed. The meeting adjourned at 4.55 p.m • .. 1 2 3 4 5 (WP/RC13/p&B/Mln/l Rev.l) MINUTES OF THE FIRST MEETING OF THE SUB-COMMITTEE ON PROGRAMME AND BUDGET WHO Conference Hall Friday, 21 September 1962 at 2.30 p.m. CHAIffiHAN: Dr F. Q. DUQUE CONTENTS Proposed programme and budget estimates for the financial year 1 January - 31 December 1964 ................. Proposed programme and budget estimates for 1964 regular prograzmne •....••................................... Inter-country and MESA programmes ••.•••••••••••••••••••••••••••• Supplementary list of projects •••••••••••••••••••••••••••••••••• Expanded Programme of Technical Assistance ...................... 162 166 171 172 172 6 Special Account for the Community Water Stlpply Prograzmne .•....•.....•....••.........•..•.......•........ 173 7 Other business ................................................. . 174 -159- / 160 I. REGIONAL COMMITTEE: THIRTEENTH SESSION First Meeting Friday, 21 SeEtember 1962 at 2.30 p.m. PRESENT Representatives of Member states AUSTRALIA Dr. H. E. Downes Mr. D. Sadleir Dr. J.J. Saave FRANCE Medecin-Co1one1 L. Caillard JAPAN Mr. K. Watanabe KOREA Dr. Sang Tae Han Mr. Koo Sup Yang LAOS Dr. Tiao Singkeo Dr. Phouy Phouttasak MALAYA Dr. L.W. Jayesuria NEW ZEALAND Dr. R.G.T. Lewis PHILIPPINES Dr. F.Q. Duque Dr. E.L. Villegas PORTUGAL Dr. J. de Paiva Martins UNITED KINGDOM Dr. D.J.M. MacKenzie Dr. E. Christiansen Dr. C.H. Gurd Dr. Me A. Rozal1a UNITED STATES OF AMERICA Dr. H. DeLien VIET NAM Dr. Nguyen-Binh-Nghien WESTERN SAMOA Dr. J.C. Thieme .. .~ , ... • PROGRAMME AND BUDGET: FIRST MEETnm II. Representatives of other inter-governmental organizations and of non-governmental organizations INTERNATIONAL COUNCIL OF NURSES LEAGUE OF RED CROSS SOCIETIES III. WHO Secretariat SECRETARY (later) Mrs. T.G. Villarica Dr. B.C. Fontanilla Dr. I.C. Fang, Regional Director Dr. F.J. Dy, Director of Health Services 161 162 REGIONAL COMMI'l'l'EE: THIRrEENTH SESSION . 1 PROPOSED PROGRAMME: AND BUDGJlrr1 ESTIMATES FOR THE FINANCIAL YEAR 1 JANUARY - 31 DECEMBER 1964 (Documents WP/RCl3/3 and Rev.l) The SECRETARY stated that in 1964 increases were proposed under both regular and MESA funds. The regular budget showed a net increase of $283 508, over 1963, consisting of a $285 882 increase under Field Activities and a decrease of $2374 for the Regional Office. The full 1964 increase had, therefore, been applied to activities directly connected with assistance to Member governments, while provision for administrative and housekeeping expenditure had been maintained at the minimum required to operate an effective regional headquarters. The Regional Office decrease was principally attributable to uneven distribution of home leave between the two years. The proposed increase under Regional Advisers of $45 283 was mainly in respect of statutory increases and provision for two new adviser posts, one in communicable diseases and the other in nursing, required to assist with the large volume of activities in these fields. The combined provision for communicable diseases and nursing activities amounted to approximately 17~ of the total field activities budget in 1964. The net increase of $1534 under WHO Representatives was to cover expected increased office rentals. The proposed regular programme for 1964 had been based on government requests, taking into] a:ccmmt continuing commitments and the criteria for regional programme priorities previously established. From the summary of Field Activities on page 2 it would be seen that the 1964 proposals totalled $1 713 803, representing an increase of $285 882 (2CJ1,) over the corresponding figure for 1963. One hundred and five projects, under 18 different major subject headings, were proposed, compared to 92 in 1963. Included in the 1964 regular progra.IllllE were 101 fellowstips, of which 33 were for study within the Region. • .. • -~ PROGRAMME AND BUDGET: FIRST MEETING The analysis of the regular programme contained in document WP/RC13/P&J3/2 provided information on proposed expenditure under the twenty different major subject headings. It would be noted that continuing projects accounted for approximately 8CYjo of the proposals while new projects took approximately 20%. Continued emphasis was laid on education and training, public health administration, campaigns against various communicable diseases, and projects for the st.re.D.g.t.ben Of nursing, maternal and child health, and environmental health services. The analysis showed that the largest individual percentage of funds continued to be budgeted for public health administration, with 29.53% of the total, followed by nursing with 10.25%. Full weight had been given to recommendations of previous Regional Committee meetings for projects benefiting more than one country. Thus, various region-wide activities were proposed, including a regional tuberculosis advisory team, an inter-country treponematoses team, a tuberculosis refresher course for assistant medical officers in the South Pacific Island Territories, a tuberculosis conference, a seminar on national health planning, a seminar to improve nutritional standards at the village level, and an epidemiological survey of dental diseases. Due to budgetary limitations, it had been necessary to relegate certain requests to the supplementary list, for possible implementation as and when funds were available. Details were contained in the green pages of the regional budget document. Requests not received in sufficient time for inclusion in the original document had been included in document WP/RC13/3 Rev.l The 1964 Technical Assistance programme was based on requests of Member governments to the Technical Assistance Board for the biennium 1963/1964. The final request of the United Kingdom had not been received in sufficient time for inclusion in the document and the additional information had, therefore, been included in document WP/RC13/3 Rev.l. 164 REGIOI::AL COMMITTEE: THIRTEENTH SESSION . Due to limitations of the target amounts available to governments for their overall Technical Assistance activities during the biennium, some requests covering health activities had been restricted or modified. In certain cases it had not been possible to include full prOvision for continuing components under Category I. other governments had included part of their Category I requests under special categories such as "Category I .. (Special)/II" and. "High Priority Project", or requested special considera.tion -, from the Technical Assistance Board Executive Chairman's planning reserve. As the Technical Assistance Board's action on such exceptional requests had. not been Imo'WIl at the time when the document was printed, such proposals had been included under Category II. In some cases WHO assistance might have to be withdrawn before the government was prepared to take over the 'WOrk, certain projects would have to be carried out on a. reduced scale, while the continuation of others depended on supplementary funds from the Technical Assistance Board, or possible up-grading from Category II. The Secretary stressed the seriousness of this situation and its implications on the effective continuation and growth of health programmes financed under this fund. Present Technical Assistance country programming procedures and the exclusion of the a,ency sub-total within the country allocation made it imperative that the health authorities should be represented on the national co-ordinating bodies responsible for the planning and allocation of Technical Assistance funds. He reminded the Committee of the resolution it had adopted at its last session emphasizing this point and stated that unless this was done, there was little which the Regional Office could do to assist. In 1964 a slight increase was proposed in connection with . projects under the M:I.laria Eradication Special Account and additional. PROGRA..fI.1ME] AND BUDGET: FIRST MEETING activities were also proposed under regular and Technical Assistance funds. At the time of printing, certain projects, or components of projects, were still being discussed witll the governments concerned and these had not, therefore, been included in the original document, but were contained in document vTP/RC13/3 Rev.l. The Secretary then referred "GO the discussions taking place with various governments in connection with the possible acceleration of the malaria eradication programme. Following consideration of the report of the Director- General, the Fifteenth "i'Torld Health Assembly had adopted resolution WHAl5.20, which re'luested the Director-General "to implement the activities in the report insofar as they conform to the accepted principles of assistance by the Organization and to the e~ent to which financial resources became available in the l{'l,.! "-ria :6radic3.tion $pecial Account (MESA) and suitable staff is forthcoming". As planning and discussions with various governments on this additional assistance were still in the preliminary stage, no information • was presented in the b~dget document. Tee expanded activities would, of course, be dependent on the development of plans of operation with the governments concer::1ect, taking ~_nto account the overall financial resources available for the occp.ler8;tc:d :.?rogra.:u,l~. The ~rograrr.me u:r_cl.cr t1:2 ::Jj)ecial Account for Community Water Supply was restricted due to fir..cncial limitatiOliS end in 1964 only one inter-country project, the provision of consultalJ.t services to assist governments in the organization of ,{ater supply I'rogrammes, was proposed. The possibility of addition?~ activities under this fund was being discussed with Head'luarters. 166 REGIONAL COMMITTEE: THIRrEENTH SESSION The CHAIRMAN asked for questions or comments. 2 PROPOSED PROGRAM.m AND BUDGE:r ESTIMATES FOR 1964 REGULAR PROGRAMME (Document WP/RC13/3, pages 1-139) Country Programmes (pages l8-11B) Dr HAN (Korea) stated that as he had mentioned previously a rural health services project would be initiated next year. As this project was of paramount significance, his Government 'Wished to make revisions to the proposed regular programxoo and budget for 1964 for Korea as follows: to defer to a later year - Korea 17, epidemiologist for 1963 and 1964; to transfer to the supplementary list - Korea 200 - dental health fellowship, Korea 200 - industrial and occupational health fellowship,. Korea 3 - short- term consultant in maternal and child health, Korea 24 - short-term .. consulta.nt in radiation and isotopes. The funds thus saved 'WOuld be used to cover the services of the experts and the fellowship programme for the rural hea.lth services project in 1964. The CHAIRMAN confirmed that the proposed revisions would be made. Dr DOWNES (Austral.ia) said that the Government of the Commonwealth of Australia 'Wished him to say that an increase in the regular budget of l5~, compared to an average of B-10% in earlier years, was not justified by normal expansion of activities. It did not, however, 'Wish at this time to suggest particular points at which cuts in the budget might be nade. His Govern.n:ent reserved its right to return to this quest:Lon at -the -next Worl.d Health Assembly. ..... ' .. PROGRA1+1E AND BUDGET: FIRST MEETING,. The SECREI'ARY suggested that the Committee might review the budget for the Regional Office first, after which it might go through the proposed programme country by country. It was so agreed. Regional Office (pages 3-8) The CHAIRMAN requested some information regarding the salary of certain general services staff, in particular the salaries of the mail clerk and supply clerk listed on page 7. The SECRETARY explained that the Organization had established at the very beginning, and reviewed from time to time, salary scales both for international and local staff. It was imperative for the regional offices to follow the established salary scales. Dr THIEME (Western Samoa) noted that the cost of the Regional Office y7 was less than that for the year before, following a rise from 4-5% for the period 1962-1963. The decrease in the 1964 estimates appeared to result from lower costs in sending staff on home leave compared to the estimated costs in 1963. It was gratifying to note that the decrease did not result from a reduction in the number of staff members or any other economy which might affect the efficiency of the Regional Office or its capacity to administer the 15% higher budget in 1964. The proposed programme and budget for the Regional Office, ;pages 3-8, was a;p;proved by the Sub-Committee. 168 REGIONAL COMMITI'EEl: THIRTEENTH SESSION Regional Advisers (pages 9-12) Dr DeLIEN' (United States of Aloorica) asked for information on the difference between the Regional Advisers and WHO Representatives. For new and uninitiated delegates who might have the same problem as he" it might be desirable if an explanation were included in the future proposed programme and budget estimates. The SECRETARY stated that the Regional. Office maintained a certain number of advisers who were highly qualified and advised governments in specific technical fields. At present there were thirteen such advisers in the Regional Office. Referring to the WHO Repre sentati ve s, he explained the WHO policy of decentraliza.tion. There were six Regional Offices and these were again further decentralized into smaller units. In the Western Pacific, there were five WHO Representatives, namely, one in Sydney who took care of the South Pacific, one in Singapore who was responsible for Brunei, MUaya, North Borneo, Sarawak and Singapore, one in 9aigon for Viet Nam. and Laos, one in Cambodia, and one in Taipei for Taiwan, Japan, Hong Kong, lfAcao, Guam, Ryukyu Islands and the United states Trust Territory of the Pacific Islands. The WHO Representatives maintained close conta.ct with governments, between the govenm:ents and the field staff, and between the governments and the Regional Office in Manila. They were all public health aijmi ni strators, who surveyed the needs of the countries concerned and assisted the governments to determine their problems and to formula.te their requests for assistance to WHO. Dr DOWNES (Australia), in reply to a question raised by Dr. DeL1en, said that the expanswnJof the- regional budget in -the past , • PROGRAMME AND BUDGET: FIRST MEETING had been somewhere around 8-10%. It had been noted in the budget document that the increase for 1964 was 15% or slightly over. The CHAIRMAN referred to the difference in emoluments of the salaries of the regional advisers and asked for information on this point. The SECRETARY explained that this depended on various factors, including the years of service with the Organization. The CHAIRMAN stated that he had noted that there was a wide gap between the salaries of the clerl\.s compared to the salaries received by the regional advisers. Speaking for his own country, he felt that the clerical staff should be given 0. raise. He had noted that the clerlm received very little salary, i.e., from $963 to $2000 a year, while the regional advisers received $12 000 a year. He suggested that the salary of the clerical staff should be raised to a minimum of $2000 per year. The proportion of salaries for the Y advisers and clerks presented a very wide gap and this should be narrowed down. He asked the Committee to take cognizance of this observation which might also influence their thinking, as "Well as the planners in Geneva, and suggested that the distribution of salaries should be re-examined. The SECRETARY pointed out that the local salary scales "Were established on the basis of the best prevailing rates which "Were determined after a survey had been made of a number of different organizations, including banks, oil companies, embassies and other offices in Manila. There "Were no WHO sta.ff members on the local salary scale at a starting salary of j?1950 and after a period of ten years this would become "f2730. For Grade MJ, the starting salary was "f6550 which went up to t;025 after ten years of service. 170 REGIONAL COMMI'rrEE: THIRrEENTH SESSION Dr DOWNES (Australia) stated that he had. come from what was called a devel.oped country where there were experts in many fields comparable to that of the WHO regional. advisers. It was probably difficult for the Secretary, who was also the Regional Director, to defend the salary scale of his regional a.d.visers. In Australia, these regional advisers 'Were regarded as senior specialists. The Western Pacific Region covered geographically the largest area among the six regional offices of WHO. The regional advisers, or senior specialists, were expected to travel about this vast region and to talk at the same level as the senior consultants in the sixteen countries in the Region. In many cases they were at a higher level than the specialists in the countries concerned. It was an understatement to call them regional advisers and to compare their duties and responsibilities 'With those of the cl.erical staff. They should be placed in the category of the most senior specialists. The CHAIRMAN said tho.t in the Department of Health, a senior specialist usually received f700 per month while the ordinary clerks received about ;180 to f220 per month which was approximately 1/6 that of the senior executive. Although this was a thought-provoking idea which might interest the Committee, he was not trying to push the matter. He felt, however, that' the small- salaried starf should be given a better deal. The proposed. programme and budget for the Regional Advisers, pages 9-12, was approved by the Sub-Committee. - PROGRAMME AND BtrJGNr: FIRST MEETING 111 WHO Representatives (pages 13-16) Mr WATANABE (Japan) said that he had no particular connnents to ma.lce but would like to know whether the term "vlHO Representatives" covered the former posts designated as I1WHO Area Representatives II. He noted that reference vre.s also made to the post of "Country Liaison Officer" and asked where such a post could be located in the budget. The SECRETARY explained that the designation ''WHo Representative II had. been established by WHO Headquarters and replaced the other designations used in different regions, such as area representatives, zonal representatives, etc. "Country Liaison Officer" was the title given to a public health administrator assigned to a country who performed duties outside his normal ones. This was not an established post and was, therefore, not included in the budget. In reply to a question by the Chairman, the Secretary explained that all the country projects listed in the programme and budget had been included at the request of governments. As there were no further comments on the country programmes, this section of the programme and budget J pages 18-118, was approved by the Sub-Committee. 3 INTER-COUNTRY AND HESA PROGRAMMES (Doc1.lIOOnt WP/RC13/3, pages 119-163) _~ In the absence of questions or remarks, these prosrammes,. ;pages 119- 163,: were awroved by the Sub-Committee • • Dr DeLIEN (United States of America) suggested that it might be helpful to have a summary statement giving the totals for 1962-1963 and 1964 for Regional Advisers, villO Representatives, Country Programmes, etc. 172 REGIONAL COMMITrEE: THIR'fl:ENTH SESSION The CHAIRMAN asked the Secreta.r1at to produce the required inf'ormation. The meeting vms a.c:.journed at 4.05 p.m. and resumed at 4.15 p.m. Dr DY, Director of Health Services, then took over the functions of Secretary. 4 SUPPLEMe:NTARY LIST OF PROJECTS (Document WP/RC13/3, pages 184-204) The SECRETARY drew attention to document WP/RC13/3 Rev.l which included changes made after the printing of the 1964 budget document. On page one of this document an a.d.ditional project had been included, Singapore 9, Public Health Administration, Hospital records, 'Which provided for an expert costing $14 271. The total figure for Singapore would, therefore, be $27 871. There being no other comments, the, SUPPlementary lis~, pages 184- 204, was approved by the Sub-ComIni ttee. 5 EXPANDED PROGRAMME OF TECHNICAL ASSISTANCE (Document WP/RC13/3, pages 1-139, and Annex A, pa.ges 168-182) The SECRETARY explained that,as some government requests under the Expanded Programme of Technical Assistance had been received rather late, it vms not possible to include them in the document. Based on information received a few days ago, a revision (document WP/RC13/3 Rev.1) had. been prepared, incorporating the various changes which had. to be made. He then referred to page 20, second column, which indicated the costs of Technical Assistance activities. Under British Solomon Islands Protectorate - Malaria, the • • PROGRAMME AND BUDGET: FIRST MEETING 173 figure had been changed to $17 350 in 1962, $35 200 in 1963, and $14 800 in 1964. On page 80, under North Borneo - Malaria, the figure for 1962 should be changed to $50 300, for 1963 it should be $43 462 and for 1964, $35 538. On the same page, under Nursing, the figures for 1963 and 1964 should be deleted, as the requests had been relegated to category II. The totals for North Borneo would, therefore, be $50 300 in 1962, $43 462 in 1963 and $35 538 I- in 1964. On page 98, under Sarawak - M:l.laria, the figures should be $40 485 for 1963 and $50 759 for 1964. On page 106, Tonga - Environmental health, information had been received that no provision for the continuation of this project had been included in the United Kingdom Government's requests under the Technical Assistance. The project had, therefore, been deleted. On page 174, under Viet rram, Fellowships - Viet Nam 201 should be added under M3.ternal and child health with the figure of $4000 under category II. Viet-Nam 23 - Nutrition advisory services, $19 170 should also be added under category II. The figures under Category I remained unchanged. There being no comments on the Technical Assistance budget, this section was approved by the Sub-Committee. 6 SPECIAL ACCOUNT FOR THE COMMUNITY WATER SUPPLY PROGRAMME (Document WP/RC13/3, pages 165-167) The SUb-Committee took note of the inter-country programme for 1964 indicated in this part of the budget • 174 REGIONAL COMMI'l'rEE: THIRTEENTH SESSION 7 OTHER BUSINESS Dr DeLIEN (United States of America) asked what, in general, was the total increase in the 1964 budget over that approved for 1963. The SECREl'ARY replied that there was an increase of $283 508, or 15.l3~, the amount approved for 1963 being $1 873 497 and that proposed for 1964, $2 157 005. These totals included both the Regional Office and Field Activities. Dr DeLIEN said that he was satisfied with the explanation given. He believed that the increases were reasonable and his delegation, therefore, was ready to support a resolution authorizing the Regional Director to transmit the budget proposals to the Director-General. The SECRETARY recalled that earlier in the afternoon the representative of the United States of America had requested a summary of the various expenditures incurred in 1962, 1963 and 1964. This information was now ready and would be distributed to the members of the Sub-Committee. As the Sub-Committee had no other comments to offer, the CHAI~AN announced that a report would be drafted and submitted to the plenary session for consideration. It was so agreed. (For consideration of draft report and draft resolution, see minutes of the second meeting.) The meeting adjourned at 5.00 p.m. 1 2 • (WP/RC13/p&13/Vdn/2 Rev.l) MINUTES OF THE SECOND MEETING OF THE SUB-COMMITTEE ON PROGRAMME AND BUDGET WHO Conference Hall Monday, 24 September 1962 at 11.45 a.m. CHAIRMAN: Dr D.J.M. MacKENZIE (Vice-Chairman) CONTENTS Consideration of the draft report of the Sub-Committee on programme and budget (continued) Consideration of draft resolution on the proposed programme and budget estimates ............... for 1964 ....................................................... . -175- 177 177 REGIONAL COMMITTEE: THIRTEENTH SESSION Second Meeting Monday, 24 September 1962 at 11.45 a.m. PRESENT I. Repre sent at i ves of Member States AUsrRALIA Dr. H.E. Downes FRANCE Medecin-Colonel L. Caillard JAPAN Mr. K. Watanabe KOREA Dr. sang Tae Han Mr. Koo Sup yang IAOS Dr. Tiao Singkeo ... Dr. Phouy Phouttasak MAIAYA Dr. L.W. Jayesuria Mr. K.K. Chong NEW ZEAIAND Dr. R.G.T. Lewis PHILIPPINES Dr. E.L. Villegas PORTUGAL Dr. Jose de Paiva Martins UNITED KINGDOM Dr. D.J.M. MacKenzie Dr. E. Christiansen Dr. C.H. Gurd UNITED STATES OF AMERI CA Dr. H. DeLien Captain R.A. Phillips VIETNAM Dr. Nguyen-Binh.Nghien WESTERN SAMOA Dr. J.C. Thieme II. WHO Secretariat .. SECRETARY Dr. I.C. Fang, Regional Director PROGRAMME AND BUDGET: SECOND MEErING 177 1 CONSIDERATION OF THE DRAFT REPORT OF THE SUB-COMMITTEE ON PROGRAMME AND BUDGET (DOcument WP/RC13/11 Rev.l) (continued from the first meeting) The CHAIRMAN presented the draft report of the Sub-Committee on Programme and Budget. He drew attention to the second paragraph under "Introduction" on page 1 and asked that Viet Nam be added to the list of countries mentioned. The sentence would, therefore, read: "Representatives 1_ of Japan, Malaya, New Zealand, Philippines, the United Kingdom, Viet Nam and two of the non-governmental organizations in official relations with WHO also attended." Dr DeLIEN (United States of America) referred to paragraph 3.6 on page 6 and suggested that the phrase "for his consideration for" be added to the end of line 8, the sentence to read: "The representative stated, on behalf of his Government, that he felt the increases reasonable and accordingly his delegation was prepared to support a resolution authorizing the Regional Director to transmit the budget proposals to the Director-General for his consideration for inclusion in the overall budget for 1964." Decision: There being no further comments, the Sub-Committee approved the draft report, as amended, for presentation to the plenary session of the Regional Committee. 2 CONSIDERATION OF DRAFT RESOLUTION ON THE PROPOSED PROGRAMME AND BUDGET ESTIMATES FOR 1964 ~. The CHAIRMAN invited the Sub-Committee's comments on draft resolution • WP/RC13/WP/5 • Decision: In the absence of comments, it was agreed that the draft resolution be submitted to the main Committee for consideration at its plenary session. The meeting adjourned at 11.50 a.m.