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

t ... , r WORLD HEALTH ORGA~"ZATION -. REGIONAL COMMITTEE FOR THE WESTERN PACIFIC TWENTIETH SESSION Manila, 23-30 September 1969 REPORT OF THE IEGIONAL COMMITTEE SUMMARY RECORDS OFTH! PLENARY SESSIONS November 1969 .. WORLD HEALTH ORGANIZATION REGIONAL COMMITI'EE FOR THE WESTERN PACIFIC TWENl'IEl'H SESSION Manila. 23-30 September 1969 REPORT OF THE REGIONAL COMMI'l'l'EE SUMMARY RECORDS OF THE PLENARY SESSIONS November 1969 NOTE The twentieth session of the Regional Committee for the Western Pacific was held in the WHO Conference Hall, from 23 to 30 September 1969, under the chairmanship of Medecin-General J. Rondet (France), with Dr Phouy Sunthorn (Laos) as Vice- ChairnJan. Dr C.H. Gurd (United Kingdom) and Dr Diego Hora Silva Ferreira (Portugal) were the Rapporteurs. The Regional Committee met on 23. 24, 25, 29 and 30 September. Technical Discussions were held on 26, 27 and 29 September. The Report of the Committee will be found in Part I of this document on pages 1-96, the summary records of the plenary sessions in Part II on pages 103-218. The Sub-Committee on Programme and Budget met on 25 September. The report of the Sub-Committee will be found on pages 35-72. -ii- .,,::/ PARr I CONl'ENl'S ~ INrR.ODUcrION ........................................................... 1 I ANNUAL REPORT OF THE REGIONAL DIRECTOR covmum THE PERIOD 1 JULy 1968 TO 30 J1Jl.lE 1969 •.......•.•.....•.•.•.....••.••...•..•.•.••...•.. 2 II PROPOSED PROGRAMME AND BUDGET FOR 1971 ••••••••••••••••••••••• 6 III arllE!lt rvlP.'I'J:1ERS .................................................. . IV 1 Resolutions of regional interest adopted by the Twenty-seoond World Health A ssenlbly •••..••.•••••••••••••.•.•.••.••.•••••••• 7 2 Health aspeots of population dynamios: Aotion taken in relation to resolution WPR/RC19.R8 adopted by the Committee at its nineteenth session ••.•••••••••••••••••••••••••••••• 9 3 Filariasis oontrol: a progress report •••••••••••••••••• 4 The epidemiology and prevention of aooidents ••••••••••• 5 Training of national health personnel .................................. 6 Teohnioal Disoussions ................................................................ 7 Reports reoeived from governments on the progress of their health activities •••••••••••••••••••• RESOWrIONS ADOPTED BY THE COMMI'r:cE:E ............................................... WPR/RC20.Rl Long-term planning in the field of heal th, biennial programming and improvement of the evaluation 10 11 12 13 14 16 process ....................................................................... 16 WPR/RC20.R2 WPR/RC20.R3 WPR/RC20.R4 WPR/RC20.R5 Technioal Discussions ....................................... Modifioations made to the 1969 and 1970 programme and budget estimates ............... Proposed programme and budget estimates 18 18 for 1971 .............•.••..•..•............ 19 Programme evaluation ••••••••••••••••••.••.• 19 -iv- • • r , CONl'ENI'S WPR,'RC20 .R6 Annual Report of the Regional Director ••••.••.••. It • • • • • • • • • • • • • • • • • • • • • • • 20 WPR,'RC20.R7 Health aspeots of population dyrl.aJn1 os ••••••••••••••••••••••••••••••••••• 21 WPR,'RC20.R8 The epidemiology and prevention of accidents ••••••••••••••••••••••••••••••• 21 WPR,'RC20 .R9 Training of national health personnel •••••• 22 WPR,'RC20. R10 Twenty-first and twenty-seoond sessions of the Regional Committee ••••••••• 23 WPR,'RC20. Rll Adoption of the report ••••••••••••••••••••• 23 WPR,'RC20.Rl2 Resolution of appreoiation ••••••••••••••••• 24 ANNEXES 1 AGE~A ••••••••••••••••••••••• t ••••••••••••••••••••• It ••••••••• 25 2 LIST OF REPRESDll'AT~ •••••••••••••••••••••••••••••••••••••• 3 REPORT OF THE SUB-COMMITfEE ON 4 5 PRO~ A!ID WIXl::Er ••••••••••••••••••••••••••••••••••••••••• 35 FINAL REPORT OF THE TECHNICAL DISCUSSIONS ON THE PLANNING AND ORGANIZATION OF A NATIONAL EPIDEMIOLOGICAL SERVICE ••••••••••••••••••••••••••••• LIST OF OOCtJrt1ENl'S •••••••••••••••••••••••••••••••••••••••••••• -v- 73 93 • .. (WPR/RC20/13 ) INI'RODUCTION The twentieth session of the Regional Committee for the Western Pacific was held in Manila from 23 to 30 September 1969. The meeting was attended by representatives of all Member states in the Region, with the exception of Singapore, and of the Member states responsible for territories in the Region. Representatives of the United Nations and UNICEF, ~~e United Nations Development Programme, the International Committee of Military Medicine and Pharmacy, the South Pacific Commission and thirteen non-governmental organizations in official relations with WHO were also present. Mr Milton P. Siegel, Representative of the Director-General, attended the session. The Committee eleated the following officers: Chairman Vice-Chairman Rapporteurs in English in French Medecin-General J. Rondet (France) Dr Phouy Sunthorn (Laos) Dr C.H. Gum (United Kingdom) Dr Diego Hora Silva Ferreira (Portugal) Formal statements were made by the representatives of the United Nations and UNICEF, the United Nations Development Programme, the South Pacific Commission, and eleven non-governmental organizations in official relations with WHO. 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 coun~ries: Australia, China, France (Chairman), Japan, New Zealand, Republic of Korea, the United Kingdom and Viet-Nam. Repre- sentatives of Laos, Malaysia, Philippines, Portugal, United states of America and Western Samoa also partiCipated in the meetings. Further detailG are given in Part II and Annex 3 of this report. 2 REGIONAL COMMl'I1'EE: 'lWEm'IErH SESSION The Committee noted that no invitation had been recelved for the twenty-first and twenty-second sessions of the Regional Committee. It was agreed that, if an invitation were received for either session following the meeting, the Regional Director should be authorized to accept it on behalf of the Regional Committee. If no invitation were received, the meetings would be held at regional headquarters (see resolution WPR(RC20.R10). In the course of seven plenary sessions, the Comm1 tree adopted twelve resolutions which are set out in Part IV. PART I. ANNUAL REFORI' OF THE REGIONAL DIRE(,"llOR COVERING THE PERIOD 1 JULy 1968 TO 30 JUNE 1969 In introducing the Annual Report, the ~egional Direotor stated that, although there had been little change in the health situation in the Western Pacific Region during the period under review, certain trends could be noted which might have an effect on long-term regional health planning. These were: (1) the increaSing importance of cardiovascular diseases and cancer as causes of death in some countries; (2) the rise in road accidents and in problems connected with water and air pollution as a result of the rapid urbanization and industrial growth taking place in many countries; (3) the attention being given to the establishment of health insurance and social security schemes as a result of the growing demand for health services. He then drew attention to the following major developments during the period under review: (1) The more comprehensive approach to the development of health programmes, which included the co-ordination of all WHO-assisted projects. Master plans of operation ~ now been prepared for three countries and two territories. # • / : REPORT OF THE REGIONAL COMMITTEE (2) The new approach to health planning being undertaken in Malaysia, where a study of the current patterns of the organization and administration of the local health services and a review and assessment of the eXisting methods and practices used in the delivery of such services in the light of present and future demands were being made. The information thus collected would enable the planners to decide how best to improve the health services at a cost commensurate with avail- able financial resources. (3) The expansion of the regional national health planning training programme, which had two components: organization of regional courses and inter-country meetings, and national training. (4) The emphasis placed on the establishment of multi- disciplinary training programmes for all health workers. (5) The joint meetings which had been held between countries to co-ordinate their antimalaria activities, the first being the Fourth Inter-territorial Malaria Conference for the South- West Pacific held in Kundiawa, Papua and New Guinea, in May, and the second, the Technical Meeting on Malaria for the riparian countries of the Lower Mekong Development Scheme held in Vien- tiane, Laos, in June. (6) The establishment of a WHO-sponsored Japanese encephalitis vector biology and control unit in Seoul, the Republic of Korea, with a SUb-unit in Taipei, China. (7) The field trials being conducted in Singapore on the problems involved in the case-finding, treatment and preven- tion of tuberculosis. (8) The increase in the provision of assistance to appraise the economic and financial aspects of the development of ~njor urban sewerage schemes. (9) The special attention being given to the strengthening of the family planning component of all existing maternal and child health projects. 3 4 The Regional Director then referred to two happenings outside of the period covered by the Annual Report. The first was the donation of freeze-dried smallpox vaccine to the WHO Special Aocount by the Government of New Zealand; the second. the selection of the port of AuCkland as one of the pilot centres for studies of the health of seafarers. The Committee reviewed the Report. chapter by chapter. During the discussion on the problems of communicable disease control. reference was made to the trials being conducted in Singapore on problems of case-finding. treatment and prevention of tuberculosis. It was noted that one of the studies in progress was the collection of information on the prevalence of initial drug resistance. These trials had been started because drugs were being used extenSively and sometimes indiscriminately by many practitioners and many patients coming to government clinics had already received inade~ate amounts, sometimes unknowingly. end had developed resistance. It was hoped that the studies being undertaken would provide information on the extent of this problem. and that all governments in the Region undertaking tuberculosis control programmes would benefit from the results. Reference was made to the fact that since 1966. no ,case of smallpox had been reported in the Region. The hope was expressed that governments would continue to maintain vigilance against this disease. The difficulties in undertaking applied nutrition pilot projects , were mentioned. It was noted that one of the problems was that assistance from FAO usually had to be provided under the United Nations Development Programme and that in some countries the national co-ordinating body had not given a very high priority to such projects. Without FAO assistance it was not possible to provide the comprehensive approach required to undertake a successful applied nutrition project. • REPORT OF THE REGIONAL COMMITl'EE The Committee noted with interest the operational studies in public health practice which were being carried out in Malaysia with the assistance of WHO. It was hoped that this new approach would permit WHO to arrive at new and better definitions of needs, demand, and of the utilization of health services, and that eventually this would have an impact on education and training curricula. Health practice research was considered an important adjunct to national health planning. 5 TIle Committee noted with satisfaction the work being done to assist individual countries to evolve health plans which were realistic in terms of the health needs and the available financial resources of the countries concerned. The programme outlined in the chapter on organization of medical care was commended as it emphasized the importance of a comprehensive co-ordinated programme for the delivery of health and medical services. When reviewing the chapter on maternal and child health, a representative expressed disappointment that there was little mention in the Report of the tremendous amount of activity in the Region in connexion with family planning, population studies and the health aspects of population dynamics. He hoped that WHO would give due recognition to what was taking place in the Region to improve the health and l-relfare of mothers and children through family p1a.nn1ng. Reference was made to the WHO travelling seminar on medical education which had taken place during the period under review. This had been highly spoken of by the deans of the medical schools in Australia who had stated that they had benefitted greatly from the diSCUSSions. Attention was also drawn to the report on the Conference of Directors of Schools of Public Health from the African, Eastern Mediterranean, South-East Asia and Western Pacific Regions of WHO held in Manila in 1967. It was considered that one of the important recommendations of this conference was that made in connexion with the establishment of an association of schools of public health in 6 REGIONAL CQIlMITl'EE:TWENTIEl'H SESSION the four regions and possibly a federation of associations :of schools of public health around the world. Administrators of healilh programmes should also be aware of the first Directory of Schools of IlUblic Health published by WHO in 1968. It was suggested that schools ot public health should promote the concept of involving the medical I schools in health planning, in community health services and in the establishment of management techniques in medical and health facilities. The importance of schools of public health and schools of mediqine adjusting their curricula to meet the changing needs of the nation, communities and societies was also emphasized. The Committee adopted a resolution noting the considerable progress being made in the control of comnunicable diseases wi thin '4l!e Region, but recognizing at the same time the new problems posed by the rising I incidence within the Region of such diseases as cancer and the cardio- vascular diseases, and by the increase in road accidents and air and water pollution. It endorsed the more scientific approach being used in national health planning through health practice researQh and requested the Regional Director to find ways and means of stimulating regional co-operation in these fields (see resolution WPR/RC20.R6). PART II. PROPOSED PROGRAMME AND BUDGE!' FOR 1971 The Sub-Committee on Programme and Budget (established in accord- ance with resolution WP/RC7.R7 adopted by the Committee at, its seventh session) held two meetings. The Regional Committee reviewed the proposals for 1971 in the light of the findings and observations of the Sub-Committee. It adopted two resolutions, one noting the modifications made to the 1969 and 1970 pro- gramme and budget estimates (see resolution WPR/RC20.R3), ~ the other requesting the Regional Director to transmit the programme' and budget estimates for 1971 to the Director-General for his consideration for inclusion in his proposed programme and budget for 1971 (see resolution REPOR!' OF THE REGIONAL COMMITrEE 7 wPR/RC20.R4). . It adopted a further resolution empba.$izing,. the need for re-evaluation of WHO assistance to Member countries to ensure that maximum health benefits were achieved for the funds invested (see resolution WPR/RC20.R5). 1 The report of the Sub-Col!lllittee is contained in Annex 3. PART III. 0'ffiER MATTERS Reso1utions of regional interest adopted by the Twenty-second World Health Assembly (Document WPR/RC20/4) The attention of the COI!IIIittee was drawn to six resolutions of regional interest adopted by the Twenty-second World Health Assembly. These covered: Fluoridation and Dental Health (WHA22.30) Smallpox Eradication Programme (WHA22.34) Re-examination of the Global Strategy of Malaria Eradication (WHA22.39) Diseases under Surveillance: Louse-borne Typhus, Louse- borne Relapsing Fever, Viral Influenza, Paralytio Polio- myelitis (WHA22.47) Diseases under Surveillance: Malaria (WHA22.48) Long-term Planning in the Field of Health, Biennial Programming and Improvement of the Evaluation Process (WHA22.53) The Committee studied at some length resolution WHA22.53 and noted that in the context of long-term planning there was now a need to start preparing for the formulation of the Fifth General Progral!llle of Work for a Specific Period which, according to the approved revised procedure, was, in the first instance, to be elaborated at the country level on the basis of consultations between WHO and individual governments. It noted that during the coming year staff of the Regional Office would consult with government authorities on their national plans, needs and intentions. The regional offices would then build up aggregated regional plans which would be submitted for the consideration and approval of the regional committees at their 1970 meetings prior to their being 8 REGIONAL COMMI'I'l'EE: 'lWENTIE'l'H SESSION forwarded to headquarters. The review of eaoh regional coDlm1ttee would provide basic material for the global General Progr8llJDe of Work ! which would be consolidated at headquarters and would be submitted to the forty-eighth session of the Executive Board, which, in aooordance with Article 28(g) of the Constitution, would propose a programme to the Twenty-fourth World Health Assembly in May 1971. The Committee noted fUrther that the Director-General planned to request the Exeoutive Board at its next session to reoommend to the Health Assembly that the present programne of work, the Fourth General Programme of Work, be extended for one year. If this proposal was accepted, the Fifth General Programne of Work for a Speoifio Period would begin with the year 1973 rather than the year 1972. The attention of the Committee was drawn to the faot that as the deoision of the Assembly had only been taken in July, this preoluded the inoorporation in the regional programme and budget estimates for 1971 of the projections for the year 1972 as there had not been enough time for the Regional Offioes to assemble the information for presenta- ! tion to the Regional Committees. However, it was the intention of the Direotor-General to include a projection for the year 1972 lin his programme and budget estimates for 1971 on a world basis. The Regional Committees next year, when they oonsidered the regional prQgramme and budget estimates for 1972, would be provided with information covering the projeotions for 1973. The discussion oentred mainly on the procedure used to prepare the annual programme and budget and the part played by the Regional Cormn1 ttee. The attention of the Comm1 ttee was drawn to Artiole 55 of the WHO Constitution which gave the Direotor-General full authority to submit the annual programme and budget estimates. The Direotor-General con- sulted with his senior advisers with regard to what oollectively they believed was the appropriate size of aotivity that the Or~zation could implement, taking into consideration the ability of the governments oonoerned to carry out and finance the programme. Each Regional Direotor • '- - 9 was then given a provisional allocation as to the amount of funds which might be used as an order of magnitude in developing the programme for the Region for the second ensuing budgetary year. Consultations were then held with governments in the Region and the regional progranme developed on the basis of these consultations with governments. It was noted further that the Regional Committees had a great deal to say in connexion with the regional progranme by virtue of the fact that the Director-General had requested them to give him advice and recommendations in advance before he finalized his proposals for the annual programme and budget estimates. During the discussion the importance of long-term planning and the evaluation of projects to assess their effectiveness was emphasized. The Committee adopted a resolution listing certain aspects which might be considered when making recommendations in connexion with long-term planning in the field of health and the establishment of a new General Programme of Work (see resolution WPRVRC20.Rl). 2 Health aSpects of population dynamiCS: Action taken in relation to resolution WPR!RCl9.R8 adopted by the Committee at its nine- teenth session (Document WPR/RC20!S) The Committee reviewed document W~C20/S Which summarized the developments which had taken place during the past year and the regional plans for the future. The Committee noted that the Organization was now in the process of developing the necessary technical resources and skills within the structure of WHO. This was being done by means of Short-term training progranmes which included practical experience and on-the-spot reviews of large-scale progranmes in different countries. The Regional Director mentioned some of the activities which WHO was prepared to undertake although additional funds would be needed if these were to be developed. These included the introduction or development of family planning in the following progranmes: basic 10 REGIONAL COMl'-1I'ITEE: 'NEm'IEI'H SESSION health services, maternal and child health, public health ~dministra­ tion, nursing, health education, education and training projects for health professionals (medical schools, schools of public health, nursing schools, schools for health auxiliaries, etc.). Activities might also be included in vital and health statistics, health plan- ning and evaluation projects. The library services in the Regional Office could be strengthened to provide more information on family planning to the staff or other interested persons. In the field of research and training, WHO might assist in the establishment of a regional institute for family planning and health. During the discussion which followed, further information was presented by the Representatives of Cambodia, Japan, MalaYSia, Papua and New Guinea, the Philippines, Republic of Viet-Nam and Western Samoa on the attitudes of their governments to family planning. Reference was made to the pioneering efforts of volun~ary agencies, such as the International Planned Parenthood Federation, the Population Council, the Ford and Rockefeller Foundations, and the international efforts of governments such as those of Sweden, Germany, Japan and the United States of America. The need was stressed for WHO to continue to co-operate t~ith these various agencies and foundations, as well as with the United Nations, ECAFE and UNICEF. The Coromi ttee expressed its satisfaction '"lith the action taken since its last meeting but urged the Regional Director to seek ways to develop further family planning activities which might be requested by any government. It also expressed the hope that additional resources would be provided to WHO, including assistance from the United Nations Trust Fund for Population Activities, so that activities in this field could be expanded (see resolution WPR/RC20.R7). 3 Filariasis control: a progress report (Document WPR/RC20/6) The Committee reviewed document WPR/RC20/6 \'Ihich summarized the various developments which had taken place within the Region since 1966. / REFORI' OF THE REGIONAL COMMITmE The Regional Director drew the attention of governments with a filariasis problem to the following activities which might be included in their control programmes: (1) co-ordinated chemotherapeutic and vector control operations combined with a rigorous quantitative assessment of transmission rates, based mainly on a reduction in infective vectors and a concomitant reduction in microfilarial incidence and intensity, and the prevention of new cases in young children; (2) information on the comparative effects of diethyloarba- mazine on B. malayi and W. bancrofti in all areas where they co-exist; (3) the collection of adequate quantitative information on the incidence of clinical manifestations, their relation to micro- filaraemia, and the development of complications; (4) the testing of immunological surveillance in a selected popUlation for correlation with miorofilaraemia, clinical syndromes, and negative individuals. Further information was presented by Representatives on the situation in Japan, Papua and New Guinea, the Philippines and Western Samoa. 11 4 The epidemiology and prevention of accidents (Document WPRjRC2017) The Committee noted that in 1966 the Nineteenth World Health Assembly had adopted resolution WHA19.36 requesting the Director- General to consider the possibility of WHO playing a more active role in the field of traffic accidents. This resolution was important because of the world-wide increase in accidental death and disability and the fact that traffic accidents represented a major cause of this increase. By adopting this resolution, the Assembly had drawn atten- tion to the medical and human aspects of the problem and recognized that the health authorities had duties and responsibilities in this field. v 12 The Regional Director asked the representatives for thbir views on the problem as it obtained in their respective countries!, on the importance that they felt it merited in the list of their priorities, on whether they considered it more adequate to limit initial preventive action to traffic accidents, particularly the human aspects, or whether they deemed it administratively more convenient to deal with the total accident prevention concept. He also asked for their views, on the role which WHO might play in any such progranmes. During the discussion which followed, a number of Representatives spoke of the growing increase in morbidity and mortality from accidents, and stated that this had become a cause of national concern. It was agreed that the health authorities had certain responsibilities, such as the establishment of emergency medical care facilities throughout the country, the setting up of trauma clinics, and, possibly most important of all, in the field of health education. The Conmittee considered that accident control was a wide problem with many aspects and a number of government departments and other agencies were involved in this matter. It was suggested that WHO could assist by the collection and analysis of statistical data and in providing information to governments and making suitable recom- mendations for preventive measures when requested. It was further suggested that the topic might be considered for the Technical Discussions held 1n connexion with a future session of the Committee (see resolution WPR/RC20.R8). 5 Training of national health personnel (Document WPR!RC20/8) The Committee noted that this item had been placed on the agenda as a result of a resolution adopted by the Twenty-first World Health Assembly (WHA21.20) recommending that Ivlember States should give increasing attention to the training of professional and a~iliary health perscnnel. The Assembly had suggested that the Regional Committees at their meetings in 1969 should undertake an analysis ./- REPORI' OF THE REGIONAL COMMI'I'J.'EE 13 of the problems of training professional and auxiliar.1 health personnel. The views and conclusions of the Regional Committee would be submitted to the Executive Board at its forty-fifth session and the matter would be discussed fUrther during-the Twenty-third World Health Assembly. The Committee reviewed the document which ~d been prepared and which contained simple guidelines which might be used to collect some basic information. It also mentioned some of the problems which were commonly met, particularly in the developing countries in the Region. During the discussion which followed a number of Representatives spoke of the difficulties encountered because of shortage of health personnel. This problem was compounded by the exodus of professional workers to other countries where working conditions and salaries were better. It was agreed that the possibility of providing medical assistants and nurSing aides in place of qualified medical officers and nurses warranted study. The Committee endorsed the suggesti9n5 made in the report on the type of information which might be collected and recognized that this was a most important subject. It considered, however, that there was insufficient time to collect accurate data to study the question in detail before the forty-fifth session of the Executive Board. It adopted a resolution recommending that Member countries should be invited to collect the necessar.1 data which should be analyzed and made the subject of a seminar, or alternatively, referred -for consi- deration to an expert committee. It requested the Regional Director to transmit to the Director-General the working paper, summar.1 records and the resolution for the information of the Executive Board (see resolution WPR/RC20.R9). 6 Technical Discussions 6.1 Designation of Chairman At its eleventh seSSion, the Regional Committee adopted a resolution (WP/RCll.Rll) recommending that the Chairman of the 14 Technical Discussions should be appointed well in advance of the meeting. Following consultations between the Regional Direotor and the Chairman of the Regional Committee, Dr 1. Shigematsu, Chief1, Department of Epidemiology, Institute of Public Health, Tokyo, Japan, was selected for this office. 6.2 Organization The theme of the Technical Discussions was "The Planning and Organization of a National Epidemiological Service". The first session consisted of introductory statements and an explanation of the procedures and techniques to be used in ,the Tech- nical Discussions. The participants were then divided intQ three groups which met separately and conducted a free discussion in accordance with the guidelines and references provided. The third session was again a plenary one at which a ~ummary report was considered and an evaluation made of the discussions. The report of the Technical Discussions appears in Annex 4. 6.3 Selection of topic for the Technical Discussions in 1270 The Conmittee selected "Health Manpower in Developing Countries: Problems and Needs" as the subject for the Technical Discussions in 1970 (see resolution WPR/RC20.R2). 7 Reports received from governments on the progress of their health activities The Chairman acknowledged the following reports presented to the Committee: (1) AUSTRALIA - Report on national health activities, 1968-69; (2) CAMBODIA - Brief report on public health activities, 1968-1969; (3) CHINA - Country report for 1969; (4) FIJI - Brief report on public health activities~ 1968: (5) GIIBERT AND ELLICE ISIANDS - Medical Department Annual Report for the year ended 31 December 1968; T REPORT OF THE REGIONAL COMMITI'EE (6) HONG KONG - Brief report on health activities during 1968; (7) JAPAN - Report on the progress of health activities for the fiscal year 1968 (April 1968 - March 1969); (8) IAOS - Cholera in Savannakhet; Smallpox campaign in Laos; Antimalaria Service in Laos; Activities of the Maternal and Child Health Service; Activities of the Tuberculosis Service; Orthopaedics in Laos; Activities of the Hospital Statistics Service; (9) MAIAYSIA - Brief report on the progress of health activities, 1968; (10) NEW CALEDONIA AND ITS DEPENDENCIES - Brief report on health activities, 1968-1969; 15 (11) NEW ZEAIAND - Report on progress of health activities, 1968; (12) PAPUA AND NEW GUINEA - Annual Report, 1968-69; Hospital disease statistics, 1964-67; (13) PHILIPPINES - Brief report on health activities, 1968-1969; (14) REPUBLIC OF KOREA - Brief report on health situation in 1968; (15) TIMOR - Brief report on the public health services in 1968; (16) VIET-NAM - Brief report on national health activities in Viet-Nam, 1968. The following additional reports were presented: (1) HONG KONG - Report on the outbreak of cholera, July 1969; (2) SINGAPORE - Report on the immunization programme in 1968. 16 'lWENTIEl'H SESSION WPR/RC20.Rl PARI' TV. RESOWTIONS ADOPTED BY THE COMMI'ITEE LONG-TERM PIANNING IN THE FIELD OF HEALTH, BIENNIAL PROGRAMMING AND IMPROVEMENT OF THE EVAWATION PROCESS '!he Regional Committee, Having considered resolution WHA22.53, adopted by the Twenty- second World Health Assembly on !!Long-term Planning in the Field of Health, Biennial Programming, and Improvement of the Evaluation Process!!; and Having heard a report from the Representative of the Director-General on how this would affect the prepara~ion of the Fifth General Programme of Work and future programming, 1. NOTES with satisfaction that future programme and budget estimates \'1111 include a projection for an additional !year; 2. NOTES further that Member States will be asked to send to WHO their observations and recommendations on questions of long- term planning in the field of health and the establisbment of a new general programme of work of WHO for 1972-1976, or for 1973- 1977; 3. RECOMMENDS that Member States within the Region Should take into consideration, when preparing the above recOl1!llendations, the following points: (1) the establishment of a functional relationship between existing or future national health plans and the new General Programme of Work of \'ffiO; (2) the following major programme activities as suitable breakdowns in the preparation of the new General Programme of Work: (a) the preventive and health promotion se~ices, including communicable disease control, environmental ;; REPORT OF THE REGIONAL COMMI'ITEE health, family planning, and the control of non- communicable diseases; (b) strengthening of health services, including national health planning, manpower studies, public administration and the organization of medical care; (c) the development of education and training curri- cula consistent with the details of the health plan and of educational facilities commensurate with man- power requirements. (3) the feasibility of bringing out trends in these major programme activities that would help in defining the fields in which WHO assistance would be required; (4) the feasibility of aggregating these trends into regional plans; 4. RECOMMENDS further that, when considering the question of long-term health planning, Member States should also take into consideration the following: (1) the integration of national health plans with socio- economic plans; (2) the machinery for planning in the health field; (3) the definition of the responsibilities of the health sector in areas of multi-responsibility; (4) the establishment of priOrities and targets, man- power requirements and training, and budgetary and other financial provisions; (5) procedures for the continuous evaluation and, if necessary, modification of the plan; 5. REQUESTS the Regional Director to consult with Member States on their needs for the future and to submit to the next 17 18 REGIONAL CCl'o1MI'ITEE: 'lWENTIBTH SESSION session of the Committee a regional plan, based on th~ proposals received from governments; 6. RECOGNIZES the need to retain sufficient flexibility within the plan to enable the Regional Director to make any adjustments found to be necessary. Sixth meeting, 29 September 1969 WPR/RC20.R2 TECHNICAL DISCUSSIONS The Regional Committee, Having considered the topics suggested by the Government of France and the Regional Director for the Technical Discussions during the twenty-first session of the Committee, DECIDES that the subject for the Technical D1sc~sions in 1970 shall be "Health Manpower in Developing Countries: Problems and Needs". wPR/RC20.R3 Sixth meeting, 29 Sept~ber 1969 MODIFICATIONS MADE TO THE 1969 AND 1970 PROGRAMME AND BUDGEn' ESTIMATES The Regional Committee, I Having examined the report presented by the Regional Director at the request of the Regional Committee at hs nine- teenth session, on the modifications made to the 1969 and 1970 1 regular programme and budget estimates, TAKES NOTE of the changes made; ~cument WPR/RC20/P&B/2, Proposed Programme and Budset Estimates for 1971. • REPORT OF THE REGIONAL CCM1I'!TEE II Having considered the revisions requested by governments 1 to the Supplementary List and those brought forward during the meeting; 2 REQUESTS the Regional Director to consider the Supple- mentary List revised accordingly. Sixth meeting, 29 September 1969 WPR/RC20.R4 PROPOSED PROGRAMME AND BUDGET ESTIMATES FOR 1971 The Regional Conunittee, Having examined the proposed programme and budget estimates for 1971, including the Voluntary Fund for Health Promotion and the Supplementary List,3 and the report of the SUb-Committee;2 REQUESTS the Regional Director to transmit the proposals as amended during the twentieth session of the Committee to the Director-General for his consideration for inclusion in his proposed programme and budget for 1971. Sixth meeting, 29 September 1969 WPR/RC20.R5 PROGRAMl'4E EVALUATION The Regional Committee, Having considered resolution WHA22.53 on long-term planning in the field of health, biennial programming, and improvement of the evaluation process, 1 Document WPR/RC20/P&B/3, ReviSions Requested by Governments to the Supplementary List. 2 Document WPR/RC20/11, Report of the Sub-Committee on Programme and Budget. 3Document WPR/RC20/2. 19 20 L BELIEVES there is need for re-evaluation of WHO assistanoe to Member countries to ensure that maximum health benefits are achieved for the funds invested; 2. APPRECIATES the extent of the task of the Regional Director, the Regional Advisers, and the Country Representative! in assessing the needs and deoiding the best methods of oonduoting country programmes: 3. ~UESTS the Regional Director to include in the Agenda for future Committee meetings, reports by governments on the progress of ourrent programmes receiving WHO assistance. Sixth meeting, 29 September 1969 WPR/RC20.R6 ANNUAL REPORT OF THE REGIONAL DmECTOR The Regional Committee, Having oonsidered the Nineteenth Annual Report of the Regional Direotor: Noting the oonsiderable progress being made in the control of oommunicable diseases within the Region but at the same time, Reoognizing the new problems posed by the inoreasing incidence within the Region of such diseases as cancer and the cardiovasoular diseases, road aocidents and the increasing prevalence of air and water pollution; Noting with satisfaction the work being done by WHO to assist individual oountries to evolve health plans which are realistio in terms of the health needs and the available financial resources of the countries concerned, a.'1d Reoognizing with satisfaction the trend towards a more soientifio approach in national health planning through health practice research, REPORT OF THE REGIONAL COMMI'l'I'EE 1. COMMENDS the Regional Director on the presentation and content of the Report; 2. THANKS the regional office and WHO field staff for the part they have played in the programme of work as outlined in the Report; 21 3. ~UESTS the Regional Director to find ways and means of stimulating regional co-operation in the field of health practice research and national health planning. Sixth meeting, 29 September 1969 WPR/RC20.R7 HEALTH ASPECTS OF POPULATION DYNAMICS The Regional Committee, Having considered the report submitted by the Regional Director on the health aspects of population dynamics and the information presented during the meeting, 1. EXPRESSES its satisfaction with the action taken since the nineteenth session of the Regional Committee but urges the Regional Director to seek ways to develop further family planning activities which may be requested by any government; 2. NOTES with approval the efforts made to promote family planning activities within basic health service programmes; 3. EXPRESSES the hope that additional resources will be provided to WHO, including assistance from the United Nations Trust Fund for Population Activities. Sixth meeting, 29 September 1969 WPR/RC20.R8 THE EPIDEMIOLOGY' AND PREVENTION OF ACCIDEm'S The Regional Committee, 22 Having considered the provisions of resolution wHA19.36 of the Nineteenth World Health Assembly; and Having considered the report presented by the Regional Director to the Regional Committee on the epidemiology and prevention of accidents, 1. BELIEVES that accident control is a wide problem with many aspects, and that WHO can assist by the collection and analysiS of statistical data and in providing information to governments and making suitable recommendations for preventive measures when requested; 2. SUGGESTS that the topic might be considered for the Technical Discussions held in connexion with a future session of the Committee. Sixth meeting, 29 September 1969 WPR/RC20.R9 TRAINING OF NATIONAL HEALTH PERSONNEL The Regional Committee, Having noted resolution WHA2l.20 adopted by the Twenty- first World Health Assembly requesting the Regional Committee to undertake an analysis of the problems of training professional and auxiliary personnel; and Having considered the report submitted by the Re~onal Director on the training of national health personnel, 1. ENDORSES the suggestions made in the report on the type of information which might be collected; 2. RECOGNIZES the urgency and the importance of the subject; 3. CONSIDERS there has been insufficient time to collect accurate data: -' REPORT OF THE REGIONAL CCf.1MI'I'l'EE 4. RECOMMENDS that Member countries should be invited to coll.ot the necessary data which should be analyzed and made the subject of a seminar or, al ternati vely, referred for consideration to an expert committee; 5. REQUESTS the Regional Director to transmit to the Director- General the working paper, the summary records and this resolution for the information of the Executive Board. Sixth meeting, 29 September 1969 wPR/RC20.RlO TWENTY-FIRST AND TWEN'lY-SECOND SESSIONS OF THE REGIONAL COMMITI'EE '!he Regional Committee 1. NOTES that no invitation has been received for the twenty- first and twenty-second sessions of the Regional Committee; 2. AUTHORIZES the Regional Director to accept, on behalf of the Regional Committee, any such invitation which may be extended and to inform all Member governments at the earliest possible date; 3. DECIDES that if no invitation is received for the twenty- first and twenty-second sessions, these will be held at regional headquarters in Manila. Sixth meeting, 29 Setptember 1969 WPR/RC20.Rll ADOPTION OF THE REPORT The Regional Committee, Having considered the draft report of the twentieth session of the Committee, ADOPTS the report. Seventh meeting, 30 September 1969 24 wPR/RC20.R12 RESOLUTION OF APPRECIATION The Regional Committee EXPHESSES its appreciation and thanks to: (1) the First Lady of the Phil1ppines and her Adviser on Community Services. for having invited the Representatives and the Secretariat to a concert at the Cultural Center; (2) the Director, Regional Health Office No.3, Department of Health, Ph1lippines, for having arranged an interesting field visit to Rizal Province; (3) the Chairman and other officers of the Committee; (4) the Chairman of the Technical Discussions, the plenary session rapporteurs. and the chairmen and rapporteurs of the discussion groups; (5) the representatives of the United Nations aqd United , Nations Children' s FUnd, the United Nations Developnent Programme. the South Pacific Commission, and the!non- governmental organizations Who made statements; (6) Mr Milton P. Siegel, Representative of the Director- General, for the honour of his visit and his invaluable advice; (7) the Regional Director and the Secretariat for their work in connexion with the meeting. Seventh meeting, 30 September 1969 REPORT OF THE REGIONAL COMMITTEE 25 ANNEX 1 AGENDA 1 Opening of the session 2 Address by retiring Chairman 3 Address by the Director-General 4 Election of new officers:. Chairman, Vice-Chairman and Rapporteurs 5 Address by incoming Chairman 6 Adoption of the agenda 7 Technical Discussions Statement by the Chairman of the Technical Discussions 8 Proposed programme and budget estimates for the financial year 1 January - 31 December 1971 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 9 Acknowledgement by the Chairman of brief reports received from governments on the progress of their health activities 10 Report of the Regional Director 11 Resolutions of regional interest adopted by the Twenty-second World Health Assembly 12 Health aspects of population dynamics: Action taken in relation to resolution WPRjRC19.R8 adopted by the Committee at its nineteenth session 13 Filariasis control: a progress report 14 The epidemiology and prevention of accidents 15 Training of national health personnel 16 Statements by representatives of the United Nations and Specialized Agencies, of intergovernmental and non-governmental organizations in official relations with vlHO 26 17 Selection of topic for the Technical Discussions during the twenty-first session of the Regional Committee 18 Report by the Chairman of the Technical Discussions 19 Time. place and duration of the twenty-first and twenty-second sessions of the Regional Committee 20 Adoption of the draft report of the Committee 21 Adjournment r AUSTRALIA AUSTRALIE CAMBODIA CAMBODGE CHINA CHINE REPORT OF THE REGIONAL COMMI'I'I'EE LIST OF REPRESENTATIVES LISTE DES REPRESENTANI'S I. REPRESENTATIVES OF MEMBER STATES REPRESENTANTS DES El'ATS MFlmRFS Dr J. S. Boxall Director of International Health Department of Health Canberra Dr R.T. Taureka Regional Health Officer New Guinea Highlands Papua and New Guinea Mr P. W. Carroll Third Secretary Australian Embassy Manila Dr Phav Sany Inspecteur general de la Sante et Professeur de ped1atr1e Ecole de Medecine Phnom-Penh ANNEX 2 ANNEXE 2 27 (Chief Representative) (Chef de delegation) (Alternate/Suppleant) (Alternate/Suppleant) Dr C.K. Chang (Chief Representative) Director (Chef de delegation) Department of Health Administration Ministry of Interior Dr T.Y. Lee Deputy Commissioner of Health Taiwan Provincial Health Department (Alternate/Suppleant) l 28 REGIONAL COMMITI'EE: TWENTIETH SESSION CHINA (continued) Dr Y. Hsiung (Alternate/Suppleant) CHINE (suite) ~eputy Director of Health Taipei City Health Department FRANCE Medecin-General J. Rondet (Chief Representative) Directeur de la Sante et de (Chef de delegation) l'Hygiene publique de Nouvelle-Caledonie la r Medecin-Colonel E. Poyet (Alternate/Suppleant) Directeur du Service de Sante de la Polynesie fran~aise JAPAN Dr K. Kanami tsu (Chief Representative) " JAPON Director (Chef de delegation) Environmental Sanitation Bureau Ministry of Health and Welfare Dr I. Shigematsu (Alternate/Suppleant) Chief Department of Epidemiology Institute of Public Health Ministry of Health and Welfare Mr M. Yamasaki (Alternate/Suppleant) First Secretary Embassy of Japan in the Republic of the Philippines Dr M. Oike (;,Uerna tel JUI;plee.nt ) Assistant Chief General Affairs Section Medical Affairs Bureau Ministry of Health and Welfare Mr N. Maekawa (Adviser/Conseiller) Second Secretary Embassy of Japan in the Republic of the Philippines IAOS Dr Phouy Sunthorn (Chief Representative) Directeur des Affaires (Chef de delegation) administrativfls Dr Thongphet Phetsiriseng (Alternate/Suppleant) Directeur du Service d'hygiene ~ et de medecine preventive '- MAIAYSIA MAIAISIE NEW ZEAIAND NOUVEU.E-ZEIANDE PHILIPPINES REPORT OF THE REGIONAL COMMITl'EE 29 Dr Raja Ahmad Noordin Deputy Director (Health) Ministry of Health Kuala Lumpur Dr Abdul Khalid bin Sahan Senior Medical Officer of Health Selangor State Kuala Lumpur Dr C.O. Innis Principal Medical Officer (Health) Sabah Dr W. Murphy (Chief Representative) (Chef de delegation) (Alternate/Suppleant) (Alternate/Suppleant) Deputy Director of Public Health Department of Health Dr C.S. Gatmaitan Undersecretary for Health and Medical Services Department of Health Dr A.N. Acosta Medical Adviser Department of Health Dr J. Valera Chief Division of Epidemiology Department of Health Dr L. Carlota Director Bureau of Health Services Department of Health Dr G. Balbin Director Regional Health Office No. 3 Department of Health Dr J. Almonte Chief Field Health Operations Department of Health (Chief Representative) (Chef de delegation) (Alternate/Suppleant) (Alternate/Suppleant) (Alternate/Suppleant) (Alternate/Suppleant) (Adviser/Conseiller) 30 PHILIPPINES (continued) (suite) POR'IUGAL REPUBLIC OF KOREA REPUBLIQ,UE DE COREE UNITED KINGDOM ROYAUME-UNI Dr T. Gomez Chief Office of Health Education and Personnel Training Department of Health Dr P. Rigonan Chief (Adviser/Conseiller) (Adviser/Conseiller) Division of Hospital Standards and Administration Department of Health Dr F. Gomez (Adviser/Conseiller) Supervising Statistician Disease Intelligence Center Department of Health Dr Diego Hora Silva Ferreira Chef des Services de sante Macao Dr Sung-Hee Rhee Chief of Training National Institute of Health Mr Sae-Hoon Ahn Second Secretary Korean Embassy Manila Dr C.H. Gurd Director of Medical Services for Fiji and Inspector-General of the South Pacific Health Service Dr P.H. Teng Director of Medical and Health Services Government of Hong Kong Miss H. Upton Third Secretary in the British Embassy Manila (Chief Representative) (Chef de delegation) (Alternate/Suppleant) (Chief Representative) (Chef de delegation) (Alternate/Supple ant) (Adviser/Conseiller) UNITED STATES OF AMERICA ETATS-UNIS D'AME:RIQUE VIET-NAM WESTERN SAMOA SAMOO-OCCIDENTAL UNITED NATIONS NATIONS UNIES II. REPORT OF THE REGIONAL COMMITl'EE Dr R.K.C. Lee Professor School of Public Health University of Hawaii Honolulu Dr J. L. Stookard Research Coordination Technioal Assistance Bureau United States Agency for International Development Washington (Chief Representative) (Chef de delegation) (Alternate/Suppleant) Dr J.P. Keeve (Adviser/Conseiller) Chief Public Health Adviser United States Agency for International Development Manila Dr Truong Minh Cao Directeur general adjoint de la Sante (Chief Representative) (Chef de delegation) Dr Dang Quoc Phu (Alternate/Suppleant) Chef du Service de medecine preventive Dr J .C. Thieme Director of Health Health Department FlEPRE'SENTATIVES OF THE UNITED NATIONS AND SPECIALIZED AGENCIES REPRESENTANrS DES NATIONS UNIE3 ET DES INSTITUTIONS SPECIALISEE8 Mr A.E. Meager UNICEF Representative in the Philippines 32 REGIONAL COMMIT1'EE: TWENTIEI'H SESSION UNITED NATIONS CHIIDREN'S FUND FONDS DES NATIONS UNIES POUR L'ENFANCE UNITED NATIONS DEVELOPMENT PROGRAMME PROGRAMME DES NATIONS UNIES POUR LE DEVELOPPEMENI' Mr A.E. Meager UNICEF Representative in the Philippines Mr A.J. Joseph Resident Representative of the United Nations Development Programme in the Philippines III. REPRESENTATIVES OF OTHER INTER- GOVERNMENTAL ORGANIZATIONS REPRESENTANTS D' AUTRES ORGANISA- TIONS INTERGOUVERNEMENTALES INTERNATIONAL COMMITrEE OF MILITARY MEDICINE AND PHARMACY COMrl'E INTERNATIONAL DE MEDEClNE ET DE PHARMACIE MILITAIRES SOUTH PACIFIC COMMISSION COMMISSION DU PACIFIQUE SUD Brigadier General E.S. Filart, MC Surgeon General Armed Forces of the Philippines Member of the International Committee of Military Medicine and Pharnlacy Dr G. Loison Directeur de Programme (Sante) Commission du Pacifique Sud Nouvelle-Caledonie IV. REPRESENTATIVES OF NON- GOVERNJVIEN.rAL ORGANIZATIONS REPRESENl'ANTS DES ORGANISA- TIONS NON GOUVERNEMENTALES INTERNATIONAL COUNCIL ON ALCOHOL AND ADDICTIONS CONSEIL INTERNATIONAL SUR LES PROBLEMES DE L' ALCOOLISME ET DES TOXICOMANIES Dr R. Seaborn President of the Foundation for Research and Treatment of Alcoholism of Australia INTERNATICNAL DENl'AL FEDERATION FEDERATION DENl'AIRE INTERNATIONALE INTERNATIONAL UNION FOR HEALTH EWCATION UNION INrERNATIONALE POUR L'EWCATION SANITAIRE INl'ERNATIONAL FEDERATION OF GYNECOLOGY AND OBSTEl'RICS FEDERATION INl'ERNATIONALE DE GYNECOLOQIE EI' D' OBSTETRIQ.UE Dr B. Earbors Institute of Hygiene University of the Philippines Dr F. Herrera Chief Division of Health Education and Personnel Training Department of Health Manila Dr J. Villanueva Professor of Obstetrics University of the Philippines 33 THE WORLD MEDICAL ASSOCIATION, INC. Dr A.Z. Romualdez L'ASSOCIATION MEDICALE MONDIALE, INC. Secretary General 'Ihe World Medical ASSOCiation, Inc. Manila MEDICAL WOMEN'S INTERNATIONAL ASSOCIATION ASSOCIATION INTERNATIONALE DES FEMMES MEDECINS WORLD FEDERATION FOR MENTAL HEALTH FEDERATION MONDIALE POUR IA SANTE MEm'ALE INl'ERNATIONAL COMMITl'EE OF CATHOLIC NURSES COOTE INTERNATIONAL CATHOLIQ.UE DES INFIRMIERES EI' ASSISTANl'ES MEDICO-SOCIALES INrERNATIONAL UNION OF NUTRITIONAL SCIENCES UNION INl'ERNATIONALE DES SCIENCES DE IA NUTRITION Dr H. BaJa-Panlilio National Corresponding Secretary of the Philippine Medical Women's Association to MWIA Dr E. Aldaba-Lim Philippine Psychological Corporation Mrs M. Ordonez Vice-President of CICIAMS for Asia, President of the Catholic Nurses' Guild of the Philippines Dr C. Ll. Intengan National Science Development Board Q.uezon City REGIONAL COMMI'lTEE: 'lWENl'IEl'H SESSION PERMANENT COMMISSION AND INTERNATIONAL ASSOCIATION ON OCCUPATIONAL HEALTH COMMISSION PERMANENTE ET ASSOCIATION INTERNATIONALE POUR IA MEDECINE ru TRAVAIL WORID FEDERATION OF OCCUPATIONAL THERAPISTS FEDERATION MONDIALE DES ERGOl'HERAPEUTES INTERNATIONAL PIANNED PARENTHOOD FEDERATION FEDERATION INTERNATIONALE POUR LE PIANNING FAMILIAL LEAGUE OF RED CROSS SOCIETIES LIGUE DES SOCIETES DE IA CROIX-ROUGE Dr M.V. Olympia, Jr. Civil Aeronautics .Adm1n1strat1'on Manila International Airport Mrs C.M. Abad Occupational Therapy Association of the Philippine$ Professor S. Matsumoto Department of Obstetrics/Gynaecclogy Gunma University, School of Medicine Japan Dr R. Apelo President Planned Parenthood Movement in the Philippines Philippine General Hospital Dr V. Galvez Assistant Secretary General The Philippine National Red Cross REPORT OF THE REGIONAL CQ\1MITI'EE ANNEX 3 REPORT OF THE SUB-COMMITI'EE ON PROGRAMME AND BtJDGEI' 1 INTRODUCTION 1.1 At its seventh session, the Regional Committee, in resolution \'1P~VRC7 .R7,. decided "that the establishment of a sub-committee on programme and budget, consisting of six members plus the Chairman 35 of the Regional Committee, should become a routine activity of the Regional Committee"; and recommended that "the membership of . this sub-committee be rotated among the Representatives of various members, subject to the provision that any Representative desiring to be a member of the sub-committee should be entitled to participate". The Sub-Committee on Programme and Budget met on 25 September 1969, tmder the chairmanship of Medecin-General J. Rondet. The a'ttendance was as follows: Members in accordance with the principle of rotation: Australia China France Japan New Zealand Republic of Korea Un1 ted Kingdom Viet-Nam Dr J.S. Boxall Dr R.T. Taureka Mr P.W. Carroll Dr C.K. Chang Dr T.Y. Lee Medecin-Colonel E. Poyet Dr K. Kanami tsu Dr M. Yamasaki Dr M. Oike r1r N. Maekawa Dr W .t1urphy Dr Sung-Hee Rhee Dr C.H. Gurd Miss H. Upton Dr Truong Minh Cae Dr Dang Quoc Phu 36 REGIONAL COMMI'ITEE: TWENTIETH SESSION Other members of the Committee also in attendance were: Laos Malaysia Philippines Portugal United States of America Western Samoa Dr Phouy Sunthorn Dr Thongphet Phetsiriseng Dr Raja Ahmad Noordin Dr C.O. Innis Dr P. Rigonan Dr Diego Hora Silva Ferreira Dr R.K.C. Lee Dr J.L. Stockard Dr J. P. Keeve Dr J .C. Thieme The Representatives of the United Nations Development Programme, the International Dental Federation, the International Committee of Catholic Nurses and the League of Red Cross Societies also attended. Dr D.R. Thomson, Director of Health Services, acted as Secretary. Mr Milton P. Siegel, Representative of the Director-General, and the Regional Director also attended the meeting. In the course of its meeting, the Sub-Committee examined the proposed programme and budget estimates in accordance with the guide- lines given on page 53. In addition, it had before it two other documents: WPR/RC20/P&B/2, which summarized the changes that had taken place in the 1969 and 1970 estimates since the nineteenth session of the Regional Committee, and WPR/RC20/P&B/3, "Revisions Requested by Governments to the Supplementary List Annexed to the Regional Programme and Budget Estimates for 1970 contained in document WPR/RC19/2". 2 GENERAL PRINCIPLES AND PROCEDURES The Sub-Committee noted that the introductory notes on pages 1 and 2 of WPR/RC20/2 had been expanded to include some considerations of the programming cycle of the Organization. 2.1 Changes made to the 1969 and 1970 approved programne and budget estimates The Sub-Committee reviewed the information submitted by the Regional Director (document WPR/RC20/P&B/2), which had been prepared in response to requests by members of the Regional Committee to be provided with additional information on changes occurring in the programne and budget of the Organization since the time when the Regional Committee last had the opportunity of being presented with these proposals. The document compared figures that appeared last year in the regional programme and budget estimates with those for the same year that were included in this year's document. In addi- tion, it contained the following info11OOation: (a) a comparison between the revised budget for 1969 which was presented last year and the operational estimates as of 25 May 1969, by which time there (b) was a much closer appreciation of the possibilities of implementation of the programme (see pages 55-60). a comparison between the original 1970 programme and budget estimates that had been presented to the Committee last year and a revision which had been arrived at according to the best knowledge at the present time of what the situation might be in 1970 (see pages 61-65). Attention was drawn to the fact whereby there was comparison not only in money but also in man-months and fellowship months of the changes made to the 1970 programme and budget estimates (see pages 61-65), so that a more precise idea of the impact on programme would be obtained, in addition to information on budgetary changes. 37 The Sub-Committee noted that some of the latter had had to be made as a result of decisions taken recently by the World Health Assembly, REGIONAL COMMIT1'EE: TWENTIETH SESSION during which the Director-General had put up some proposals for additional funds to cover unexpected expenditures that ¢ould not be foreseen when the budgets for 1959 and 1970 were under preparation. This unexpected expenditure concerned decisions of the General Assembly of the United Nations on the levels of salaries of international staff, similar decisions on.the levels of salaries of general service st~ff in Geneva and an emergency situation that had occurred in Equatorial Guinea. In the discussion of the supplementary estimates for 1969, the Assembly had agreed to the proposals made by the Director-General on ho;~ to finance these additional estimates. The impact on the budget tor the Western Pacific Region had been the deletion of a provision for fellowships for Japan in the amount of $10 000. This change had been agreed to by the delegate of Japan who had participated in the discussions at the World Health Assembly. A revised allocation for 1969 had been received from the Director-General to meet the increased costs of the salaries of international staff arising from changes in their salary scale. As the World Health Assembly had approved an effective working budget level for 1970 that was lower than that proposed by the Director- General, some adjustments had to be made in the proposals for 1970 reflected in document WPRjRC20/2. The commencement of the inter-country project on the training of anaesthetists (pages 268'-269, of the document) would be deferred. This represented a decrease in 1970 in the order of $10 850. 2.2 Preparation of the programme and budget estimates The Sub-Committee noted that when the programme proposals contained in document WPRjRC20/2 were being built up the constitutional objectives of WHO were kept in mind. Consideration was also given to the Fourth General Programme of vlork for a Specific Period, which would end in 1971. Throughout the history of WHO, the contents of the General Programme of Work had hardly changed. There had been spme refining of objectives, perhaps some changes in emphasis, but the main trends were .~ REPORT OF THE REGIONAL COMIlITTI'EE the same: strengthening of health services, fighting against communicable and non.·communicable diseases, improving environmental health, promoting education and training. More recently, there had been some emphasis on co-ordination of programme, particularly at the national level. The priorities of the Fourth General Programme of Work had, in fact, been endorsed by the Regional Committee at its sixteenth session. In addition, there was quite a long series of resolutions of the Regional Committee which were used as a guide in building up the annual programme. The most recent of these had emerged from a discussion on long-term planning during the nineteenth session, in which, in addition to the global priorities decided by the World Health Assembly, the Regional Committee had emphasized certain elements that it felt were particularly interesting for the Region. The Sub-Committee session was the second phase of a joint effort of governments and the Regional Office to build up the programme. It followed continuing consultations that had been held by the \{HO Representatives, not only with the health authorities of countries in the Region but also with other bodies such as planning authorities, economic ministries, co-ordinating bodies, and, of course, the Resident Representatives of the United Nations Development Programme. In the present proposals for 1971 the major subject heading of public health administration ~las considerably emphasized. This rather broad label could be made to include practically any activity of the Organization. But major subject headings could be misleading. The form of presentation of the Organization's programme and budget had been decided by a succession of World Health Assemblies and could not be changed without additional decisions of ifJnO's governing bodies. At a time when vmo was emphasizing integrated projects, for eA~ple, when it insisted that family planning should be integrated into maternal and child health, that maternal and child health should be part of 40 general public health services, that disease control pro~ammes should be carried out through the general health services rather than specialized entities, decreases in the major subject headings for specialized programmes did not necessarily reflect a decrease in the effort given to these programmes, but rather an effort towards their integration. The Sub-Committee's attention was also drawn to the operational studies in public health practice sponsored and undertaken by the Government of Malaysia with WHO's assistance. This research was intended to lead to better definitions of the need and demand for health care, of the utilization of health services. It was hoped, eventually to arrive at new definitions of the types and numbers of staff that the Government would need in order to provide the most effective service to the people. The studies in Malaysia were being conducted in co-operation with WHO's Division of Research in Epidemio- logy and Communications Science. This was a very welcome development and it was hoped that it could be extended to other, similar, projects in the future. The Representative of the United Kingdom expressed his apprecia- tion of the documentation submitted this year to the Sub-Committee, as his delegation was one of those that had last year requested this extra information. He asked whether it would be possible to include in the opening pages, after the summaries for the Regiorlal Office, the Regional Advisers and the \OlliO Representatives, a summary of the country programmes, in much the same format as provided for the Regional Office, showing the individual allocations to various countries I and then another page giving a summary of the inter-country programmes by maj or subject heading. The United Kingdom Government was a very strong supporter of WHO and wished to assist finanCially and in every other possible way, but it was rather concerned about the rather large magnitud, of the increases '_.-... REPORT OF mE REGIONAL COMMI'ITEE 41 year by year. In this respect, it was happy to see that the increase in . the budget for 1971 over 1970 was projected at 9.2% whereas that between 1969 and 1970 was budgeted at 9.6%. It was the main concern of the United Kingdom delegation to see that whatever money was allocated was invested in health programmes which would provide the greatest possible health dividends for the money invested. He noted with interest the statement of the Representative of the Director-General that dUring the recent opening of the United Nations General Assembly, "many speakers had indicated that the stage had been reached, after more than twenty years (it was actually twenty-four years since the Charter of the United Nations was approved in San Francisco) where it had become necessary to take a new look at the structure created in the post-war world and to review the Charter of the United Nations with particular emphasis on its responsibility for the maintenance of peace and security. Reference also had been made to reviewing the functions of the Economic and Social Council. These suggestions for a review of the United Nations Charter are not new, as similar suggestions had been mentioned at a number of the recent sessions of the General Assembly. For its part, WHO felt that one must always take a look at the current Circumstances, see what work was being carried out and take whatever remedial action was necessary in order to make such improvements as were required". The countries themselves should also be called upon to evaluate the programmes that they were requesting, particularly with regard to fello\'fships. Assurance should be g:i ven that requests for fellowships represented a real need, that the people being given extra training would come back to provide advancement along the line of the national health programme and that they would not find themselves balked by the absence of a job so that they tended to get diSinterested, leading them to swell the brain drain. The Secretary said that the information requested by the Represen- tative of the United Kingdom would be incorporated in the documentation prepared for the Committee in the futUre. 42 REGIONAL COMMI'ITEE: TWENTIErH SESSION Although evaluation of WHO-assisted projects shou14 primarily be a function of the recipient governments, the Regional Off~ce had instituted for some months now a review mechanism of the different programmes for which the Regional Advisers had technical responsiblli ty • In this exercise, WHO's current activities were constantly revi~ed to see what improvements were required, whether projects should be continued, dis- continued or carried out in a different way. A considerable amount of importance was attached in the Regional Office to this regular review of activities. The Representative of Australia asked what principles were being followed in the difficult task of allocating funds and quoted as an example the award of fellowships. The Secretary said that WHO had tried to promote the establishment of national fellowship co-ordination cormnittees within the countries receiving aid. The purpose of this was to ensure that the requests which were sent to WHO represented government priorities and did not duplicate requests made to other organizations and that the subject matter and object of the fellowship were closely related to the health plans of the country in question. Not all countries had such committees and this was where a WHO representative had an important role to play, as he was able to have continuous and informal discussions with govern- ment representatives. The Regional Office relied heavily on the opinion of the WHO representative as to whether proposals for fellowships had a particular justification. The Representative of the United States of America congratulated the Secretariat on the additional documentation which it had submitted. This gave a clear picture of the changes which had taken place. He asked whether in future it could be prepared in sufficlent time so that it could be seen by the main offices of Member States which could then eValuate the contents fully. The Secretary agreed that in future all documentation relating to the programme and budget estimates should be distributed 1n advance of the meeting. - -'-... --- -'~ REPOR!' OF THE REGIONAL COMMI'ITEE 43 The Representative of the United States of America asked whether special problems, the size of population and stage of economic develop- ment were taken into consideration when considering requests for assistance. The Secretary said that a Programme Committee, consisting of the· Director of Health Services, the Assistant Directors of Health Services, the Chief, Administration and Finance, and the Budget Officer. had been set up in the office which looked at proposals coming from countries and proposed priorities to the Regional Director. One of the criteria was whether the requests were compatible with a national long-term plan for the development of health services. In many countries, however, there was no long-term health plan. In such cases, requests for assistance had to be reconciled with the factors cited by the Representative of the United States of America. The Regional Office had to deal with countries and territories with very different ecologies and economies and great variations in stages of development. It had to consider the needs of countries that were very highly evolved in their economic development and of those which, for the time being, did not appear to have any prospects of development. When a country's need was great, WHO tried to do everything possible for that country, using the resolutions of the World Health Assembly and the Executive Board as guides. The Twentieth World Health Assembly had, in fact, adopted a resolution (WHA20.50), recommending that WHO should be more flexible in its assistance to developing countries. Another factor in considering requests for assistance was the capacity of the country to absorb the assistance given and the availability of national counterpart staff who could be trained. The Representative of the United States of America stated that his delegation was greatly concerned with the continuing increase in the WHO budget over the past twenty years. The annual increase continued to be over 9%. His Government would not be able to support the increased budget proposed. In view of the extraordinary changes and development in medical sciences, technology, transportation, communication and decision-making processes, it believed that WHO should reassess its administration and 44 REGIONAL COMMrl'rD: '1WEN'1'IETH SESSION procedures. His delegation felt that the Regional Comm~ttee had the responsibility of advising the Regional Director on thi~ continuing increase in budget. Some items could be cut down, sU9~as inter- country programmes and even posts in the Regional Office. The Regional Director should re-examine the organization and staffing of the Regional Office in order to use its resources more effectively. The Representative of France supported the statements made by the Representatives of the United Kingdom and the United States of America regarding the constant increase in the WHO budget in the course of the past years. The 9.2% increase proposed for 1971 went beyond the limit of 6% recommended by certain governments. His Government would not be able to support the increased budget proposed. 3 ~UESTS AFFEOl'ING THE 1970 PROGRAMME AND :stJI)(JEr ESTIMATES The Representative of Malaysia requested the addition of a public health administrator to the strengthening of health se~ices and train- ing of health personnel project (Malaysia 0035) in 1979. The reason for this was that the one WHO medical officer attached to the project was fully involved in health practice research and, in the meantime, there were pressing needs involving the strengthening of basic health services. His Government was willing to make certain adjustments to meet this request. These were as follows: the deletion of the senior public health nurse educator under the Institute of Public Health (pages 118-119); the reduction in the number of consultant months for the mental health project from four to three, and the reduction in the number of con- sultant months for the health education project from three to two and a-half. 4 REVIE.W OF THE PROPOSED PROG1WIJr.1E AND BJDGEl' ESTIMA.TES FOR 1971 4.1 SpeCifiC comments The Sub-Committee noted that the total regular bQdget proposal for 1971 was $5 973 600 compared with $5 470 000 for 1970. This was an increase of $503 600, or 9.2%, over 1970. For 1969 the total shown in document WPR/RC20/2 was $4 850 964. It was noted that this did not reflect the additional' funds approved by REPORT OF THE REGIONAL COMMITTEE the World Health Assembly to meet the increased costs of professionally graded staff which amounted to $142 000. Based on the adjusted figure of $4 992 964, the increase from 1969 to 1970 was $471 0)6, or 9.6%. It was noted that there were no major changes in presentation or in the major subject headings between the estimates in document WPR/RC20/2, and last year's document, WPR/RC19!2. Attention was called, however, to a change in detail in the item "Regional office temporary staff" (page 11). Contrary to previous years, this item showed all estimated costs of temporary general service staff, general service overtime, as well as of temporary language staff. These costs had previously been allocated to established posts. No increase was estimated between 1969 and 1971. The change followed a headquarters requirement. 4.2 Regional Office (pages 4-11) The Sub-Committee noted that the 1969 total of $597 000 had been increased by $17 000 to cover the additional costs of professionally graded staff, making a revised total of $614 000. It was noted further that the regular budget and other funds, mainly under the United Nations Development Programme (UNDP), administered by the Regional Office, represented 9.9%, 10.9% and 11.6% for the years 1969, 1970 and 1971, respectively. The increased percentage in 1970 and 1971 reflected the tapering off and completion of the Region's two Special Fund projects (in China and the Philippines) and the reduced Technical ASSistance funds presently oommitted. The reduction between 1969 and 1971 was in excess of $600 000. Attention was drawn to the possibility of additional UNDP funds becoming available to the Region in 1970 and 1971. The Representative of the United States of America referred to last year '.s discussions on percentages of the budget for regional offices. He wondered why there was such a great variation among the regional offices. In view of the greater mobility now possible because of improved means of transportation, communication and information systems, one would expect to see in the years ahead a reorganization of the staffing pattern of the Regional Office and Regional Advisers. 46 REGIONAL COMMITI'EE: 'lWENTIEl'H SESSION Mr Siegel, Representative of the Director-General, said that it was unwise to make a comparison because every regional office in WHO varied somewhat. Costs would differ because of the difference in size and geography involved. This was clearly the case with regard. to travel. The costs of travel in the Western Pacific Region were higher than those of other regions covering smaller geographical areas. Another important factor that created differences between the costs of regional offices was the rather large differences in some cases in the salary scales of general services staff, which scales are established on an inter-agency basis, i.e., the agencies that comprised the United Nations system. The salary scales for general services staff are established in relationship with the best prevailing rates in the duty stations concerned. 4.3 Regional Advisers and \mO Representatives (pages 12-19) The Representative of the United States of America asked for information on the post of second Education and Training Adviser and the type of qualifications required. The Secretary said that, for some years now, the programme in the field of education and training had continuously increased. There was in particular a very heavy fellowship load, which had become clearly too much for a single professional staff member to handle. At this particular time when there was need to devote attention to the problems of medical education and their relation to national health plans and manpower plans, it was felt that a full-time senior officer was required to concentrate on this problem. The type of person required should have had much experience in medical education in developing countries and be interested in new integrated methods of teaching medicine. It would be recalled that the Director-General had stressed, during the last meeting of the Regional Committee, the fact that WHO was currently facing a crucial period in the development of medical education. It was absolutely essential that educational methods used in schools in the Region be tailored to the needs of the countries rather than to the traditions of other nations, which was largely now the case. The Adviser referred to would, therefore, be a medical educator. REPORT QF '1HE REGIONALCOMMITI'EE 47 4.4 Field activities, including inter-country projects (pages 20-274) The Representative of the United States of America drew attention to the number of inter-country projects proposed and asked what the criteria were for limiting such projects. He noted also that WHO was supporting a number of projects to strengthen teaching institutions and he was concerned with the possible loss of investment if the manpower trained did not remain within the country. The Secretary said that suggestions for inter-country programmes emanated from the WHO technical staff, the WHO representatives and Member governments. The proposals were examined against the background of priorities already mentioned. If it was thought that the proposal had merit, the interest of countries and territories in the activity was then sought. Their opinion was the determining factor as to whether or not a proposal was included. The question of the brain drain was, indeed, a delicate one. He thought it was an example of the conflicting interests within a country of government departments concerned with health and those concerned with economic development. There were countries in the Region where the health planners were desirous of promoting certain activities but where economic planners were against it. As a health organization, WHO could exert very little influence on the economic policy of a country at a given time and any attempt to do so would be resented. The Regional Director said that he had discussed the question of the brain drain with a Minister of Health, who had asked him what he could do to alleviate this problem. The Regional Director had suggested that a health manpower survey be undertaken in order to determine present and future needs and resources. Once these needs had been met, then a country would be in a position to allow its trained personnel to take up posts abroad. Referring to the loss of investment in trained staff raised by the Representative of the United States of America, the Regional Director said that a condition set by the Organization when awarding 48 REGIONAL COMMITTEE: TWENl'IEl'H SESSION fellowships was that the fellows returned to theirrespect~ve countries for a minimum of three years. This condition was unfortunately not always enforced. The Representative of the United Kingdom referred to the filariasis control advisory services projeot listed on page 238 and asked whether funds could be made available for staff in neighbouring countries to visit Western Samoa and see what was being done in the fiElld. The Secretary said that what was required was a Small,. provision of possibly two fellowship months. This would be added to the Supplementary List attached to the 1971 programme and budget proposals. The Representative of Viet-Nam referred to the orthopaedics and rehabilitation project (Viet-Nam 0042) mentioned on page 216 of document WPRjRC20/2. During disoussions with the Regional Director at the World Health Assembly in Boston, the Minister of Health had und~rstood that difficulties would be encountered in recruiting a homogeneous team. There were also problems on the side of the Government, spch as delays in the oompletion of the hospital establishments which were an integral part of the project. His delegation now requested that this partioular project be postponed and that the funds earmarked for it should be used to add to the provisions for the National Institute of Public Health (Viet-Nam 0038), whioh was more important and which needed funds in great quantity. 4.5 Consideration of the Supplementary List annexed to the regional programme and budget estimates for 1971 oontained in document WPR,t!l.C20/2 (pages 308-332) Referring to his previous remarks in connexion with 1970, the Representative of Malaysia requested the addition of a public health administrator for the strengthening of health services and training of health personnel project (Malaysia 0035), to provide continuity of this activity. He stated further that it had not been possible to finance the continuation of the post of entomologist for the malaria eradication programme in Sarawak (Malaysia 0043) under the Technical Assistance component of the United Nations Development Programme beyond the end of 1970. He requested that the post be added to the Supplementary List 49 attached to the 1971 programme and budget estimates. The holder of this post would be stationed in \'lest Io1alaysia but would be responsible for the entomological aspects of the programmes in both East and West Malaysia. The Sub-Committee noted that the Goverrunent of Portugal had requested two nursing fellowships for Timor. The Representative of Viet-N~~ asked for information on the procedure followed in implementing items in the Supplementary List. The Secretary informed the Sub-Committee that the Programme Committee, to which he had already referred, met monthly. The amount of funds that had become available as a result of delays in the recruit- ment of field staff, or in the reoeipt of submission of fellowship applioations by governments or as a result of requests from governments to postpone the implementation of projects until a later date were reviewed by the Committee. The additional government requests appearing in the Supplementary List were then studied and the same priorities used in connexion with the regular programme were followed in selecting items for implementation. 4.6 Revisions requested by governments to the Supplementary List annexed to the regional programme and budget estimates for 1970 contained in document WPR/RC19/2 (Doctwent WPRjRC20/P&B/3) Attention was drawn to the fact that a number of reviSions had been requested by goverrunents to the Supplementary List annexed to the 1970 programme and budget estimates (document WPRjRC19/2). These requests were tor implementation early in 1970 before the World Health Assembly could approve any future supplementary list, such as that attached to the 1971 proposals. They were being brought to the notice of the Sub-Committee since they constituted programme changes \~ich would take effect during 1970. The Representative of Laos requested the provision of two two- year fellowships, one in preventive medicine and the other in 50 REGIONAL CG1MI'ITEE: 'lWENTIEl'H SESSION neuro-psychiatry in 1970, and suggested that these be adqed to the document under consideration. The Representative of Malaysia requested that six c~nsultant months should be added to the Supplementary List in 1970 to enable a sociologist, an economist and other consultants in special fields to assist in the further planning and development of the strengthening of health services and training of health personnel project (Malaysia 0035). A three-month fellowship was also requested under the same project. This would permit the head of the Division of Planning and Research, which had recently been established, to study health plan- ning. It was hoped that this might be awarded from savings in 1969. The Representative of the United Kingdom asked for the addition of a nine-month fellowship to permit a physician to study diseases of the chest. The justification for this fellowship was that Fiji was experiencing a considerable decrease in the incidence of tuberculosis and would have to start to reorientate tuberculosis physicians to the wider field of chest diseases. It was likely that a tuberculosis hospital would be closed at the end of 1970. The Government wished to start the reorientation programme as soon as possible. The Representative of France stated that French Polynesia had requested a health education fellowship in 1970. This'should be included among the revisions requested by governments to the 1970 Supplementary List. The Representative of Cambodia requested that a paediatrician! nutritionist should be added to the list as assistance was required in the strengthening of the child health services. Pages 67-71 contain the revisions requested by governments to the Supplementary List annexed'to the regional programme and budget estimates for 1970 contained in document WPR/RC19/2, including those broUght forward during the meeting. BEPORT OF 'lEE REGIONAL COMl-1ITl'EE 5 OTHER MATl'ERS DISCUSSED 5.1 SUpplies and equipment The Representative of the United Kingdom asked for information on the policy of WHO in connexion with the provision of supplies and equipment, as all too often there was a great need for these and governments were unable to provide them. As an example, he cited the fact that UNICEF was not able to provide drugs, such as diethyl- carbamazine, for mass filariasis campaigns. In a case such as this, he wondered whether WHO could assist. 51 The Secretary said that the UNICEF/WHO Joint Committee on Health Policy had authorized WHO to proceed in partnership with UNICEF in a pilot project on filariasis control in Western Samoa. UNICEF had provided the equipment and supplies required. The results of the pilot project would be reported to the Joint Committee which, in turn, would make reconmendations to the UNICEF Executive Board. There was no guarantee that UNICEF would agree to support mass filariasis control campaigns. If it did not, the possibility of WHO supplying the drugs required could then be considered in the light of resolution WHA20.50 on the policy governing assistance to the developing countries. This resolution had mentioned, among other things, material assistance to the programmes of developing countries provided that the budget was not increased for this purpose. WHO had, in fact, already supplied some drugs to the pilot project. 5.2 Evaluation The Sub-Committee considered a draft resolution submitted by the Representative of Australia on the need for re-evaluation of WHO assistance to Member countries to ensure that maximum health benefits were achieved for the funds invested. This was endorsed by the Representatives of the United Kingdom and the United States of America. 52 REGIONAL COMMITl'EE: TWENrIETH SESSION Following discussion, it was agreed that this draft resolution should be submitted to the main Committee and that the text should be preceded by a preambular reference to resolution WHA22.53 on "Long- term Planning in the Field of Health, Biennial Programming and Improve- ment of the Evaluation Process". "-- 1 2 3 REPORT OF THE REGIONAL COMMITTEE SUGGESTED GUIDELINES FOR THE SUB-COMMITI'EE ON PROGRAMME AND ruDGET 53/54 Introduction by the Director of Health Services of the proposed programme and budget estimates for the financial year 1 January - 31 December 1971 (Document WPR/RC20/2) Any general observations Review of the proposed prograrrme and budget estimates 3.1 Summaries (pp. 2-3) 3.2 Regional Office (pp. 4-11) 3.3 Regional Advisers and WHO Representatives (pp. 12-19) 3.4 Field activities, including inter-country projects (pp. 20-274) 3.5 Special Accounts (pp. 278-306) 3.6 Consideration of the 1971 Supplementary List (pp. 308-332) 3.7 Revisions requested by governments to the Supplementary List annexed to the regional programme and budget estimates for 1970 contained in document WPR/RC19/2 (Document WPR/RC20/P&B/3) 4 Consideration of a draft resolution for submission to the main Committee REPORT OF THE REGIONAL COMMI",,·;.;;;Tl'~EE=-_________ 5:;o;;.5 I. COMPARISON OF 1969 REVISED AND OPERATIONAL BUIXlET ESTIMATES (See explanatory notes on following pages) Changes in 1969 Revised 1969 oper~onal operational budget budget budge. (reductions in I t e m WPRLRC19L2 WPRLRC20L2 brackets) US:p US$ US$ REGIONAL OFFICE 598 600 597 000 ( 1 600) FIELD ACTIVITIES Malaria 694 960 685 000 ( 9 960) Tuberculosis 263 211 280 881 17 670 Venereal diseases and -'--- 46 142 76 590 30 448 treponema.tose s . Bacterial diseases 32 827 4 325 (28 502) Parasitic diseases 22 934 52 416 29 482 Virus diseases 1.9 163 50 320 1 157 Smallpox 15 573 15 000 ( 573) Leprosy 16 247 25 518 9 271 Conununicable diseases - general activities 278 602 279 282 680 Environmental health 308 2.17 370 101 61 884 Public health administration 1 102 977 1 026 922 (76 055) Nursing 279 877 236 356 (43 521) Health education 101 351 94 681 ( 6 670) Dental health 44 415 30 000 (14 415) Social and occupational health 10 900 12 300 1 400 Maternal and child health 186 036 157 853 (28 183) Mental health 45 295 47 117 1 822 Nutri tion 195 396 204 591 9 195 Radiation health 10 400 4 170 ( 6 230) Education and training 498 561 479 104 (19 457) Biology, pharmacology and toxicology 16 100 10 950 ( 5 150) Chronic and degenerative diseases 25 520 18 400 ( 7 120) Vital and health statistics 92 971 92 087 ( 884) Sub-total 4 337 675 4 253 964 (83 711) Less - delays in filling new posts {SO 675) 80 675 Total - FIELD ACTIVITIES 4 257 000 4 253 964 ( 3 036) Total - WESTERN PACIFIC 4 855 600 4 850 964 ( 4 636) ======== ======== ==== };/ Prepared as of May 25, 1969. ,4 REGIONAL COMMI'n'EE: TWENTIETH SESSION Summarized below are modifications to the 1969 programme (WPR/RC20!2) as of 25 1-1ay 1969 as compared l'lith the 1969 programme reviewed by the Regional Committee last year (WPR!RC19!2). MALARIA Additions: British Solomon Islands Protectorate 0501 (formerly 0002), laboratory technician post. Cambodia 0501, supplies. Laos 0504, sanitarian post (originally programmed for 1970) and local costs. Malaysia 0043, supplies. Republic of Korea 0013, operational studies and local costs. Reductions: WPRO 0143, 6 consultant months. T'JBERCULOSIS Various, fellowships advanced to 1968 and recruitment delays. Additions: WPRO 0075, supplies and 1 consultant month. WPRO 0155, participant costs. Reductions: Philippines 0504 (formerly 0069), 6 consultant months (advanced to 1968). VENEREAL DISEASES AND TREPONEMATOSES Additions: Various, fellowships advanced to 1968 and recruitment delays. Cambodia 0504, 2 consultant months. China 0001, 3 consultant months. Viet-Nam 0026, supplies. BACTERIAL DISEASES Additions: Cambodia 0025. freight on vaccine. Malaysia 0075. freight on vaccine. .... '- , REPORI' OF THE REGIONAL COMMITl'EE 57 BACTERIAL DISEASES (continued) Reduction: Gilbert and Ellioe Islands 0008, project reclassified as Communicable Diseases - General Activities, after deleting posts of medical officer (epidemiologist) and laborat~ry adviser and replacing by medical officer (bac'teriologist) • PARASITIC DISEASES Additions: Western Samoa 0501 (formerly 0007), entomologist post, WPRO 0080, 6 consultant months, supplies and temporary advisers. Reduction: Various, recruitment delays. VIRUS DISEASES Addition: WPRO 0158. supplies. Reduction: WPRO 0158, 6 consultant months, participant costs and temporary staff. LEPROSY Addition: China 0045, leprologist post extended. Reduction: Various, fellowships advanced to 1968. COMMUNICABLE DISEASES - GENERAL ACTIVITIES Additions: Cambodia 0505, 4 consultant months. China 0046, 4 consultant months. China 0200, 2 fellowship months. Gilbert and Ellice Islands 0008, project reclassified from Bacterial Diseases. Republic of Korea 0033, 1 consultant month. Viet-Nam 0014, supplies. WPRO 0137, supplies and general service secretary post. REGIONAL COMMI'ITEE: TWENTIEI'H SESSION COMMUNICABLE DISEASES - GENERAL ACTIVITIES (continued) Reduction: Various, fellowships advanced to 1968 and recruitment delays. ENVIRONMENTAL HEALTH Additions: Reduction: Cambodia 0024, supplies. Japan 0026, 2 consultant months. Malaysia 0041, sanitary engineer post. Republic of Korea 0029, 3 fellowship months. Singapore 0200, 12 fellowship months. WPRO 0168, vector control cOurse. WPRO 0169, 13 consultant months. WPRO 0200, 32 fellowship months. Various, fellowships advanced to 1968 and recruitment delays. f:JBLIC HEALTH ADMINISTRATION Additions: China 0049, supplies. China 0057, supplies. f.1alaysia 0035, scientist post, 3 consultant months and supplies. New Hebrides 0500. public health nurse post for 12 months. Republic of Korea 0025. supplies. Republic of Korea 0034, 1 consultant month. Republic of Korea 0035, 3 consultant months. Tonga 0009, 3 fellowship months. Viet-Nam 0018, 12 fellowship months. Western Samoa 0500 (formerly 0012), medical records officer post. WPRO 0159, participant costs. Reductions: f.1alaysia 0035, sanitarian post. Republic of Korea 0035, medical officer (hospital administrator) post. Tonga 0009, medical records officer post. Various, fellowships advanced to 1968 and recruitment delays. NURSING Additions: Reduction: HEALTH EDUCATION Addition: Reduction: DENTAL HEALTH Additions: Reduction: REPORT OF THE REGIONAL COMMITTEE China 0055, nursing post (originally programmed for 1970) and 4 fellowship months. China 0200, 12 fellowship months. 59 Various, fellowships advanced to 1968 and recruitment delays. Republic of Korea 0200, 12 fellowship months. Various, fellowships advanced to 1968 and recruitment delays. Viet-Nam 0035, 3 consultant months. WPRO 0160, 2 consultant months. Various, fellowships advanced to 1968. SOCIAL AND OCCUPATIONAL HF..ALTH Addition: New Caledonia 0200, 1 fellowship month. MATERNAL AND CHILD HEALTH Reductions: ~lENTAL HEALTH Reduction: NUTRITION Additions: Republic of Korea OOO}, 4 consultant months. Various, fellowships advanced to 1968 and recruitment delays. Various, fellowships advanced to 1968. Cambodia 0511, 6 fellowship months extension. WPRO 0148, secretary post and duty travel. 60 REGIONAL COMMITl'EE: TWENTIEI'H SESSION NUTRITION (continued) Reductions: WPRO 0148, 36 fello~lship months. RADIATION HEALTH Various, fellowships advanced to 1968 and recruitment delays. Reductions: Singapore DOl}, 2 consultant months. Various, fellowships advanced to 1968. EDUCATION AND TRAI1rrNG Additions: Reduction: Laos 0015, lecturer in preventive medicine post for 12 months and lecturer in histopathology post for 12 months. Philippines 0091, 27 fello~lship montha. Republic of Korea 0041, 4 consultant months, 12 fello\,Tship months fu'1d grant. Singapore 0011, 6 consultant months. Singapore 0200, 6 fellowship months. Viet-Nam 00}8, 1 fellowship month. vlPRO 0200, }2 fellowship months. Various, felloHships advanced to 1968 and recruitment delays. BIOLOGY, PHARMACOLOGY AND TOXICOLOGY Reduction: Various, fellowships advanced to 1968. CHRONIC AND DEGENERATIVE DISEASES Reduction: VariOUS, fellowships advanced to 1968. VITAL AND HEALTH STATISTICS Reduction: Various, fellowships advanced to 1968 amd recruitment delays. ,/ . \ j. REFORI' OF THlj: REGIONAL COMMITl'EE II. OOMPARISON OF uno OWINAL AND REVISED BUDGET ESTIMATES (See explluWoryDOtU OIl following pages) 61 Item i::;;::::;_~=j~~_;:~_j~~~~-E~~l¥;~d:E~l i 1970 ! HY70 R i 1970 ! UYlO Rl 1970 f 1970 R i us$OOO ! uS$OOO i Us$ i Regional Office .. :.... . .. ·······r=······f·························r········_··········r··························r···_······_·········r··········~~:······r········~·~······r·-·-~;·~~~·· ........ ) i Field Activities Malaria .! Tuberculosis ! Venereal diseases and treponematoses Ilactedal diseases Parasitic diseases Virus diseases Smallpox Leprosy Veterinary public health Communicable diseases: 276 120 24 12 6 12 General activities 102 Environmental health 156 Public health administration i 344 Nursine 84 Health education 12 Dental health 12 Social and occupational health Maternal and child health Mental health Nutrition Radiation health Education and trainine Biology. pharmacology and toxicol0Q' Chronic and degenerative diseases Vital and health statistics Sub-total less delays in filling ne\t posts Total - FIElD AC1'IVITIES 12 12 120 170 24 1498 1498 Total - \vESTERN PACIFIC 1 498 I 264 120 24 144 156 372 84 12 12 - j 12 12 99 - I 168 24 1527 1527 12 9 6 6 9 4 G 7 3ll 26 46 6 6 12 6 4 19 71 4 298 298 1527 298 12 4 6 9 4 9 3 24 17 42 6 6 12 10 ·1 13 68 4 253 253 253 88 30 6 5 15 4 18 167 221 240 35 114 18 31 16 84 6 564 6 21 1689 1689 1689 74 21 6 5 15 4 18 164 231 204 35 11<> 689 266 50 30 11 17 16 35 30 329 423 1271 270 94 52 18 29 31 83 16 45 39 247 6 3 488 648 16 3 - i 21 94 1526 4735 1526 4618 . i 709 298 64 46 10 15 24 21 375 436 13SS 258 92 48 27 105 40 216 3 596 11 ·l868 4773 1526 5301 5470 20025 31905 13 &15 (29892) 35466 2125 ( 585) ( 11476) ( 9554) 45 716 122·18 So; 767 (12227) ( 1654) ( '* 715) ( 1,aO) 22794 ( 5050) (30868) ( 680) ( 51445) 8170 15491 132996 21674 154 670 168400 1 . ~---- === =::::= == -- ==== L~" ... ,. .. .................. , .." .., ................... ".... .. ... · .... h ....... ·" •• "'" i .• ,." ........ " ...... ". ."".t .... "" .. '"'' .. " ...... "j ........ " ............... "j. '" ..................... ~ .... ~ .... , ......... , .... , ""~ ... , .............. " ..... , .". ==== === ======= f . ....... , ......... , ...................... j ..................................... .1 Note that 1970 columns shO\~ 1970 original estimates (WI'R/RC19/2) and 1970 R columns show 1970 revised estimates (Wm/RC20/2). 62 REGIONAL COMMI'l'I'EE: TWENTIEl'H SESSION Summarized below are modifications to the 1970 progr~e (WPR/RC20/2) as compared with the 1970 programme reviewed by the Regional Committee last year (WPR/RC19/2). MALARIA Additions: British Solomon Islands Protectorate 0501 (formerly 0002), laboratory technician post for 12 months. Laos 0504, local costs. New Hebrides 0502 (formerly 0005), supplies. Reductions: Laos 0504, malariologist post for 12 months. TUBERCULOSIS Malaysia 0043. malariologist post for 12 months. New Hebrides 0502 (formerly 0005), 2 fellowships for 4 months each. Papua and Nei"l Guinea 0200, 2 fello"iships for 3 months each. Addition: Philippines 0504 (formerly 0069), statistician post for 12 months. Reductions: Philippines 0504 (formerly 0069), public ,health nurse post for 12 months, 5 consultant months, 1 fello .. lship for 6 months and 1 for 3 months. BACTERIAL DISEASES Reductions: Gilbert and Ellice Islands OO~~, medical officer post for 6 months, laboratory adviser post for 6 months and 6 consultant months. (Project reclassified as Communicable Diseases - General Activities) PARASITIC DISEASES Addition: i-lestern Samoa 0501 (formerly 0007), epidemiologist post for 6 months and entomologist post for 12 months. . '- .. REPORT OF THE REGIONAL COMMI'ITEE LEPROSY Addition: Republic of Korea 0004, 3 consultant months. Reduction: Republic of Korea 0004, leprosy adviser post for 12 months. VETERINARY PUBLIC HEALTH Reduction: WPRO 0175, 4 oonsultant months. COMMUNICABLE DISEASES - GENERAL ACTIVITIES Additions: Reduction: Cambodia 0505, statistician post for 12 months. China 0046, virologist post for 12 months. Gilbert and Ellice Islands 0008, medical officer post for 12 months. (Project classified as Baoterial Diseases in original 1970 estimates) WPRO 0137, general ser'lice secretaI"'J post for 12 months. China 0046, medical laboratory tutor post for 6 months and 15 consultant months. ENVIRONMENTAL HEALTH Addition: Malaysia 0041, sanitaI"'J engineer post for 12 months. Reductions: Malaysia 0041, sanitarian post for 12 months. Ryukyu Islands 0200, 1 fellowship for 3 months. Viet-N~n 0033, 9 oonsultant months. PUBLIC HEALTH AJ:XIUNISTRATION Additions: rn.alaysia 0035, scientist post for 12 months and public health nurse post for 12 months. Malaysia 0082, tutor in microbiology post for 12 months and 1 fellm'lship for 6 months and 1 for 4. months. (Project classified as Education and Training in original 1970 estimates) 64 PUBLIC HEALTH AI'rm-rrSTRATION (continued) Additions (continued): New Hebrides 0500, public health nurse post for 12 months. Philippines 0500 (formerly 0088), medical officer post for 12 months. public health nurSe post for- 12 months and sanitarian post for 12 months. Republic of Korea 0034, public health administrator post for 4 months (continuation of post for full year) . Republic of Korea 0035, 12 consultant mdnths. Viet-Nam 0018, non-medical technologist post for 12 months. Reductions: Malaysia 0035, sanitarian post for 12 months. NURSING Addition: Reduction: Malaysia 0076, 4 consultant months. Philippines 0040, 3 consultant months. Philippines 0088, 6 consultant months. Philippines 0106, 3 consultant months. Republic of Korea 0035, medical officer post for 12 months. Viet-Nam 0042, nurse anaesthesiologist post for 12 months, nurse (post-operative care) post for 12 months and 2 physiotherapist posts for 12 months each. Republic of Korea 0021, nurse educator post for 12 months. Trust Territory of the Pacific Islands 0001, public health nurse educator post for 12 months and 3 fellowships for 12 months each. MATERNAL AND CHIID HEALTH Addition: WPRO 0181, regional course, including 4 consultant months. (Project classified as Education and Training in original 1970 estimates) "' ,. ·Y - - .. _ I ~- " - .... - REPORT OF THE REGIONAL COMMI'rrEE 65/66 NUTRITION Addition: Laos 0511, 1 fellowship for 12 months. Reductions: Cambodia 0511, public health nutritionist post for 12 months. Laos 0511, 6 consultant months. "iPRO 0148, public health nutritionist post for 9 months, 1 fellowship for 12 months and 5 fello~/ships for 9 months each. EDUCATION AND TRAINING Additions: Laos 0015, lecturer in preventive medicine post for 12 months and lecturer in histopathology for 12 months. Republic of Korea 0041, grant. ~~yu Islands 0003, 16 consult&~t months. V1et-Nam 00)8, sanitarian post for 12 months. Reductions: Laos 0015, 13 consultant months. Malaysia 0082. tutor in microbiology post for l2 months, 1 fellowship for 6 months and 1 for 4 months. (Project reclassified as Public Health Administration) ~ Islands 0003. 3 lecturer posts for a total of 16 months. V1et-Nam 00)8. vector control technician post for 12 months. liPRO 0162, 2 fellowships for 12 months each and ::> :::'a llOl'fships for 6 months each. WPRO 0180, 4 fellowships for 6 months each. (Proj0c't reclassified as Biology, Pharmacology al1.d Toxicology) ~IPElO 0181, re<.;ionul course including 6 consultant months. (Project reclassified as Iv"Jaternal and Child Health) ]3IOLOGY t PHARMACOLOGY AND TOXICOLOGY Addition: WPRO 0180, 4 fellowships for 2-1/2 months each. (Pt-oject classified as Education and Training in original 1970 estimates) REPORT OF 'ruE REGIONAL COMMITTEE REVISIONS REQUESTED BY GOVERNMENTS TO 'ruE SUPPLEMENTARY LIST ANNEXED TO THE REGIONAL PROGRAMME AND BUDGET ESTIMATES FOR 1970 CONTAINED IN DOCUMENT WPR/RC19/2, INCWDING 'llIOSE BROUGHT FORWARD DURING THE MEETING CAMBODIA 67 MATERNAL AND CHILD HEALTH Advisory Services Cambodia 0509 A paediatric nutritionist to lecture in paediatrics and to advise the Ministry of Health in connexion with the development of paediatric and nutritional services in the rural areas ($18 000). Total - CAMBODIA: CHINA VENEREAL DISEASES AND TREPONEMATOSES Venereal Disease Control $18 000 ==== China 0001 Two six-month fellowships in venereal disease laboratory techniques ($8500) • LEPROSY Leprosy Control A leprologist (continued for six months) ($14 675). COMMUNICABLE DISEASES - GENERAL ACTIVITIES Communicable Disease Control Centre China 0045 China 0046 Additional requirement - two twelve-month fellowships, one for study of laboratory techniques in biologics and the other for a Master of Public Health degree ($16800). Total - CHINA: $39 975 ===== 68 TUBERCULOSIS Fellowships FIJI Fiji 0200 A nine-month fellowship to permit a physician to study diseases of the chest ($4700). HEALTH EDUCATION Fellowships Total - FIJI: FRENCH POLYNESIA An eighteen-month fellowship ($11 100). $4700 === French Polynesia 0200 Total - FRENCH POLYNESIA: $11 100 MAI.ARIA Malaria Control IAOS Laos 0504 Additional requirement - a three-month fellowship for a medical officer and two three-month fellowships for technicians ($}6oo) PUBLIC HEALTH AJl.1INISTRATION Advisory Services Laos 0501 Additional requirement - a public health nurse to assist the national maternal and child health services programme ($17 840). Health Laboratory Services Laos 0599 Additional requirement - supplies and equipment ($12000). EDUCATION AND TRAINING Fellowships Laos 0200 Two two-year fellowships, one in preventive medicine 'and the other in neuro-psychiatry ($15 600). REPORl' OF THE REGIONAL COMMITrEE vrrAL AND HEALTH STATISTICS Advisory Services IAOS (continued) 69 Laos 0512 Additional requirement - supplies and equipment ($500). Total - IAOS: $49 540 ===== MAIAYSIA MALARIA Eradication Programme, West Malaysia Malaysia 0020 Additional requirement - supplies and equipment ($42 000). PUBLIC HEAL'Jll All'{[NISTRATION Strengthening of Health Services and Training of Health Personnel Malaysia 0035 Additional requirements - six consultant months to enable a socio- logist, an economist and other consultants in special fields to assist in the further planning and development of the project ($10800); a three-month fellowship to permit the head of the Division of Planning and Research, which has recently been estab11shed, to study health planning ($3500). EDUCATION AND TRAINING UniverSity of Malaya Malaysia 0040 Additional requirement - three months for a nurse consultant ($5400) • TUBERCULOSIS Tuberculosis Control Total - MAIAYSIA: PHILIPPINES $61 700 ===-- Philippines 0504 Additional requirement - a three-month and a six-month fellowship ($8600) • 70 PHILIPPINES (continued) PUBLIC HEALTH AtMINISTRATION General Health Services Development Philippines 0500 Additional requirement - three consultant months in p~d1atric nutrition ($5400). Total - PHILIPPINES: $14 000 ==== snmAPORE NURSING Nursing Administration and Practice Singapore 0004 A nurse educator (continued from 1969) ($16770). Total - SINGAPORE: $16 770 =;:;:::===== TRUST TERRITORY OF THE PACIFIC ISIANDS PUBLIC HEALTH AJl'IIINISI'RATION Fellowships Trust Terri tOry of the Pacific Islands 0200 Two three-month fellowships in public health administration ($3900). EDUCATION AND TRAINING FellowShips Trust Territory of the Pacific Islands 0200 Two three-month fellowships in clinical mediCine ($3300). Total - TRUST TERRITORY OF THE PACIFIC ISIANDS: $7 200 ==== ........ --- REPORT OF 'mE REGIONAL COl4Vll'l'l'EE PUBLIC HEAIJrH AmtINISTRATION Hospital Administration VIEI'-NAM 71/72 Viet-Nam 0015 Additional requirement - two consultant months ($3600). Total - VIEI'-NAM: $ 3600 === $226 585 ====-== _ r 1 SUBJEOl' FINAL REPORT OF THE TECHNICAL DISCUSSIONS ON THE PIANNING AND ORGANIZATION OF A NATIONAL EPIDEMIOLOGICAL SERVICE ANNEX 4 "The Plarming and Organization of a National Epidemiological Service" was the subject selected for the Technical Discussions in accordance with resolution WPR/RC19.R5 adopted during the nineteenth session of the Regional Committee for the Western Pacific Region. 2 PIANNING AND PREPARATION FOR THE DISCUSSIONS 73 Advanced planning included preliminary correspondence between the Chairman of the Technical Discussions and the Secretariat. Participants were requested to familiarize themselves with the organization, functions and activities of the epidemiological service in their own country or territory. Working documents and other background materials are listed on page 83. 3 ORGANIZATION OF DISCUSSIONS The Technical Discussions opened with a plenary session. 'lhis was followed by meetings in three discussion groups and a concluding plenary session which adopted the Technical Discussions report. The Chairman of the Technical Discussions was Dr Itsuzo Shigematsu (Japan). Dr J.L. Stockard (United States of America) and Dr Truong Minh Cac (Viet-Nam) were elected rapporteurs of the plenary sessions. The discussion groups were chaired by Dr J .S. Boxall (Australia) for Group A, Dr W. Murphy (Ne\1 Zealand) for Group B and Dr G. I.oison (South Pacific Commission) for Group C; their respective rapporteurs were Dr P.B. Teng (United Kingdom), Dr Raja Ahmad Noordin (Malaysia) and Dr Dang Quoc Phu (Viet-Nam). A list of group discussion officers and members is given on pages 85-91. 14 REGIONAL CG1MI'lTEE: TWENTIETH SESSION 4 FIRST PLENARY SESSION The Chairman in his opening remarks noted that, although epidemio- logical services still hold a place of leadership in pub11c health, considerable improvement in the planning and organization of these ser- vices is needed in many countries. Success can be achieved only if the services are well developed, include all of the essential public health disciplines and are staffed by capable personnel. The Regional Adviser in Communicable Diseases in reviewing the epidemiological situation in the Western Pacific Region called atten- tion to variations among the countries and territories with regard to completeness of registration, accuracy of diagnoses and the lists of notifiable diseases. The incidence of communicable diseases is considerably higher in the less developed nations and te~itories than in the developed ones. Today, because of communicable disease control programmes, life expectancy has increased. This is particularly evident in the developed nations where these programmes have been highly success- ful and where a relative :increase has occurred in the :inc,idence of chronic non-communicable diseases. Although some of the attention of epidemiological services might fruitfully be directed toward non- infectious disease problems, it was felt that several reasons existed for according the highest priority to the epidemiology of communicable diseases throughout the Region. Sharp reductions in the incidence of preventable or easily cured communicable diseases in the developed countries have induced a public disinterest in the highly successful disease control programmes. The incidence of infections, such as venereal disease, is increasing because persons at risk often have misplaced confidence in obtaining a rapid cure with antibiotic drugs. In addition, a number of micro-organisms now are developing resistance to the antibiotics. Although the prevention of many communicable diseases by immunization has been brought to a high level of efficiency, the benefits of these scientific accomplishments have not yet been fully realized in some areas. By contrast, methods for preventing chronic non-communicable diseases have not yet been sufficiently , . REPORT OF THE REGIONAL COMMI'lTEE 75 developed. Accordingly, far fewer benefits can be expected at present from investments in chronic non-communicable disease control programmes ~an would accrue from the same investment in communicable disease control projects, utilizing preventive measures of proved value. In order to approach the communicable disease problems of the Western Pacific Region most effectively, a policy, a plan and an organization flexible enough to adjust to changes are required. Com- patible and complete data suitable for measurement of progress and programme evaluation are also needed. The Chairman indicated that to be successful, epidemiological services must have: (1) services directly implementing counter- measures against communicable diseases and (2) indirect or informa- tional activities to support the direct services. Epidemiological surveillance constitutes the basis for recognition of the problem, and the planning, implementation and evaluation of control measures. Surveillance is a responsibility of all persons concerned with the health of the public. A good surveillance organization extends from the private physician to the headquarters of the international organizations. Data collection, particularly of morbidity and mortality reports, for statistical analysis, epidemiological interpretation, and the rapid dissemination of results are essential for maintaining epidemio- logical surveillance. It was noted that even under the best circumstances, under- reporting of diseases exists. In Japan, it had been useful to supple- ment routine morbidity reporting with surveys of population groups. For example, checking absenteeism in schools during epidemics of highly communicable diseases, such as influenza, provides valuable information. Immunological surveys also are used to follow the level of population antibody response to selected diseases. The immunological surveys facilitate also the implementation and eva- luation of immunization programmes. 76 REGIONAL coMM!TrEtE:· TWENTIETH SESSION In some countries, the absence of legislation has been disadvanta- geous to epidemiological services since this has made it difficult to obtain the co-operation of laboratories and hospitals in the reporting of epidemiological data. The Chairman also observed the need for adequate ari:l capable personnel to serve as epidemiologists, microbiologists, statisticians and laboratory technicians in the epidemiological services. He felt that recruitment of well-trained people was possible·pBrticularly in the presence of a good national policy concerning the wo~k of the epidemiological service. The Director, Division of Comnun1cable Diseases, WHO, emphasized that different nations have widely different requirements to be ful- filled by a national epidemiological service. Factors influencing the organization include the existing level of development of health services, available material and human resources, cultural background of the people and the spectrum of prevalent diseases. The prinCipal public health problems throughout tropical regions are the infectious diseases. Some occur only in man while others are transmitted to man from a variety of domestic and wild animal life. The epidemiological service, therefore, must be prepared, to deal with all factors in the environment which contribute to the transmission of infection. Effective control and prevention of communicable diseases can be achieved only by a multi-disciplinary approach including i specialists in epidemiology, medical microbiology, entomology , health statistics, sanitary engineering, veterinary health, and miscellaneous laboratory and field personnel. I Each discipline requires an adequate continuous source of appro- priate supplies, equipment and funding. At the national level, ideally, there should be a central institute with a public health laboratory capable of res~Ond1ng to '. . REPORT OF THE REGIONAL COMMITl'EE 77 the epidemiological problems in the country. The institute would investigate and control epidemics, organize and direct epidemiological surveillance, perform routine diagnostic and specialized laboratory services, train personnel in the public health disciplines, participate in studies of specific diseases, collect, process and disseminate epidemiological information and co-operate with other ' established insti tutions when such services cannot be provided wi thin the institute. Public health operational efficiency is dependent largely upon a staff of qualified, dedicated, career personnel in an organization which can identi~ populations at risk of specific diseases and assure that staff and materials for disease control programmes are provided. Such efficiency can be achieved by modern epidemiological services only to the extent that the epidemiolOgical approach, using modern micro- biological laboratory, statistical, logistical and maintenance methods, is employed. Once a well-developed national epidemiolOgical ser\'ice has been established, public health authorities can receive valuable assistance in determining policy, preparing budgets and directing operational programmes. Data of high quality can assist the establishment of programme priorities by revealing more clearly the relative importance of multitude of human illnesses. Budget requirements can be determined more reliably when predictions of the range and trends of disease inci- dence are reasonably well defined and the geographic areas most likely to be affected are known. Implementation of disease control programmes is facilitated by an active epidemiological service which detects the occurrence of, and locates,individual cases and groups of cases of preventable diseases. The manifestation of changing disease patterns or absence of expected results signals the need for a control programme readjustment. Field investigations by trained epidemiologists should be undertaken to determine the reasons for the programme failure, whether it is to deal with an introduction of disease from abroad, or to control an endemic disease wi thin the country. Used in this manner the epidemiological service provides a disease control REGIONAL CCl\1MITl'EE: 'lWENl'IEl'H SESSION programme evaluation. Therefore, continuous epidemiological surveil- lance should continue also when the stage of successful elimination of a disease as a public health problem is reached. Considering the stages of development of health services and availability of manpower and material resources, the building and strengthening of epidemiological services at national level should proceed through a series of steps. The first step in the development of epidemiological services is the creation of an epidemiological unit at the ministry of health under the direction of a qualified epidemio- logist. This should utilize the existing microbiological laboratories and statistical services available in the country. In the extreme situation of islands with small populations where the creation of microbiological laboratories would be uneconomical, modern means of communication and transport will facilitate laboratory investigation as this could be provided through bilateral or international assistance outside the country. Depending upon the size of the country, the need for an epidemiological unit and a microbiological laboratory at regional or provincial levels and eventually at district level is necessary. Further development of epidemiological services in the country should make full use of modern medical microbiological laboratories which are community oriented and simultaneously pr~vide diagnostic services for the hospitals. The central microbiological laboratory or insti- tute should provide to the peripheral laboratories, methodological guidance and necessary reference diagnostic materials (reference sera, antigens, strains, etc.) and training facilities for the laboratory personnel. In the next stage, the participation of other scientific disciplines or services are essential (vector biology and control, environmental health, food hygiene, veterinary public health, etc.). In conclusion, the epidemiological services can be considered good only if, depending on eXisting personnel and material resources, they are able to deal successfully with major and preventable diseases. , '-'-?.!'- REPOR!' OF THE REGIONAL COlfir'!TEE 5 GROUP DISCUSSIONS The Technical Discussion groups considered the following points: (1) What is a good epidemiological service? The following definition was proposed: A good epidemiological service means the successful application of scientific methodology to the study and control of diseases, dis- ability, and death. (2) Components and elements of an epidemiological service 79 It was generally recognized that the essential components of an epidemiological service should include morbidity and mortality report- ing; statistical services; and microbiological laboratories. In addi- tion, the groups felt that a number of other elements could well be included. These were research, legislation, health education, emphasis on epidemiology in medical education, and, especially, con- tinuous surveillance by means of the dissemination of information. Considerable attention was given to the desirability of enlisting the assistance of non-governmental professional personnel and the public through an information service appropriate to the target audience. The component elements of a good epidemiological service would utilize complex equipment and quantities of high quality supplies and it was considered essential that provision be made for an adequate logistics and maintenance service. (3) Minimal requirement and elementary source needed when means are limited It was recognized that the minimal requirement for satisfactory service could vary from place to place depending upon the local situa- tion with respect to personnel and material. In those situations where abundant supplies of those elements of an epidemiological service were available, the minimum requirement might be larger tl:1an in one where only limited staff and materials could be brought into use. It was, 80 however, generally agreed that under all circumstances a c~ntral epidemiological unit and a system for the collection and analysis of data were mandatory. (4) Staffing, supervision and training It was considered that the epidemiological unit should be headed by a trained epidemiologist. He should be supported by existing field staff whose services should be made available by the peripheral medical officer of health. Considering the recent tremendous progress in biologyiand the application of mathematical methods, modern epidemiological surveil- lance methodology requires that there be adequate training and re-training of epidemiologists. The epidemiologist should have a medical qualification, with specialization or a diploma in epidemio- logy. It was felt that sufficient attention should be given to training in epidemiology and community-oriented microbiology at medical schools. It was also felt that training in epidemiology should be emphasized and available also for other professional and auxiliary health personnel and should correspond to the health problems of the countru. The supporting role of health education in the control and pre- vention of communicable diseases was also recognized. In order to have an effective epidemiological programme in solving the important communicable disease problems, it was thought that the workers should adopt an attitude of multi-disciplinary approach. To achieve this, there should be co-operation WIi th mutual respect for others on the team. All health personnel needed should be co-opted from other governmental and non-governmental organizations. The epidemiologist should have full administrative and material support and under special circumstances could also be vested wlthstatutory .powers. The work of the central epidemiological unit should not be under- stood as consisting only of administrative activities but should involve , I ... - the oontinuous methodological guidance of the peripheral services, information feedbaoks and field investigations of epidemics or other communicable disease problems (mobile teams). (5) Most effective way and administrative structure to assure co-ordination between government and non-governmental organizations 81 The initial step in the development of an administrative structure which will assure co-ordination between the government and non- governmental organizations is an inventory of all available resources within the nation or territory. This should include the personnel, materials and scientific facilities of the government and the non- governmental organizations. Once the inventory has revealed the resources whioh may fruit- fully be co-ordinated with the work of the epidemiological service, liaison should be established by the central epidemiological unit. In order to obtain the full partioipation of useful resources not directly inoorporated within the epidemiological services, it is important to have as the responsible liaison person someone who exhibits qualities of outstanding leadership. It was stressed that the continuous evaluation of control and preventive measures should be an integral part of surveillance. 6 SECOND PLENARY SESSION In what way can WHO best assist or participate in promoting epidemiological services? The paper presented by the Director, Division of Communicable Diseases, WHO, outlines five ways in whioh the Organization is assisting Member countries to promote epidemiologioal services. These are as follows: (1) providing technical advice in building-up and strengthening epidemiological, public health laboratory and statistical services; (2) giving technioal advice in the planning, implementation and evaluation of specific diseases oontrol and prevention programmes; 82 REGIONAL COMMl'rl'EE:.' 'l'WENrIE'lH SFSSION (3) providing training facilities (courses, seminars) and individual training grants; (4) facilitating the standardization and international compar- ability of laboratory results by providing methodological advice and reference laboratory material (sera, reference strains, antigens, etc.) through the network of WHO Reference Centres; (5) participating in surveillance activities at national and international levels by providing methodological advice and/or means for the collection, transport and storage of biological material (blood, sera, eto.) for investigation by the WHO Serum Referenoe Bank. WHO is also providing, on the request of countries.emergenoy aid in epidemics. The participants stressed the importanoe of: (1) identifying the strengths and defioienoies of epidemio- logioal services in the oountries and territories whioh comprise the Western Pacific Region: (2) Member governments oo-operating to aohieve greater oompar- ability in lists of notifiable diseases, registration of deaths, reports of morbidity and the standardization of diagnostio laboratory procedures. The usefulness of WHO providing teams for special field sUl"lTeys was emphasized. The possibility of governments reporting to the Regional Committee on the epidemiological situation within their oountry and on what they were doing to improve their epidemiological servioes was also mentioned. .. . ... REPORT OF THE REGIONAL C<J.1Ml'ITEE 83/84 LIST OF WOR.1{ING PAPERS AND BACKGROUND MATERIALS WPR/RC20/TDI WPR/RC20/TD2 WPR/RC20/TD3 WPR/RC20/TD3 Add.l Rev.l WPR/RC20/TD4 Rev.1 WPR/RC20/TD5 WPR/RC20/TOO \VPR/RC20/TD7 WPR/RC20/TD8 Technical Discussions Progra~e Procedures and Techniques for the Technical Discussions Guidelines for Technical Discussions Topics for Technical Discussions General Remarks on the Epidemiological Situation in the Western Pacific Region by Dr B. Velimirovic, WHO Regional Commu- nicable Disease Adviser, Office for the Western Pacific BaSic Consideration on the Organization and Planning of Epidemiological Services at Country Level by Dr K. Raska, Director, Division of Cormnunicable D5.seases, Geneva The Practical Aspects of Planning and Organization of a National Epidemiological Service by Dr Itsuzo Shigematsu, Chief, Department of Epidemiology, Institute of Public Health, Tokyo, Japan Discussion Group Memberships Evaluation Questionnaire REPORT OF THE REGIONAL COMMITI'EE 85 LIST OF OFFICERS AND ~ TECHNICAL DISCUSSIONS BUREAU ET MEMBRES DES DISCUSSIONS TECHNIQUES GENERAL CHAIRMAN Dr Itsuzo Shigematsu Japan PRESIDENT Chief Japon Department of Epidemiology ~,,~ Institute of Public Health Ministry of Health and Welfare ENGLISH RAPPORTEUR Dr J.L. Stockard United States RAPPORTEUR DE Research Coordination of America LANGUE ANGLAISE Technical Assistance Bureau Etats-Unis United States Agency for D'Amerique '" International Development Washington FRENCH RAPPORTEUR Dr Truong Minh Cac Viet-Nam RAPPORTEUR DE Directeur general adjoint LANGUE FRANCAISE de la Sante DISCUSSION GROUP A GROUPE DE DISCUSSION A CHAIRMAN Dr J .S. Boxall Australia PRESIDENT Director of International Health Australie Department of Health l Canberra ~ RAPPORTEUR Dr P.H. Teng United Kingdom Director of Medical and Royaume-Uni Health Services Government of Hong Kong MEMBERS Dr T.Y. Lee China MEMBRES Deputy Commissioner of Health Chine Taiwan Provincial Health Department Dr K. Kanamitsu Japan Director Japon Environmental Sanitation Bureau Ministry of Health and Welfare Mr N. Maekawa Japan Second Secretary Japon "to, Embassy of Japan in the Republic of the Philippines 86 MEMBERS Dr Abdul Khal:Ld bin Sahan Malaysia MlHmES Senior Medical Offioer of Health Mala1$ie Selanger State Kuala IA.unpur Dr C.S. Gatma1tan Philippines Undersecretary for Health and Medical Services Department of Health " Dr J. Valera Philippines Chief Division of Epidemiology , Department of Health Dr T. Gomez Philippines Chief Office of Health Education and Personnel Training Department of Health Dr Sung-Hee Rhee Republic of Korea Chief of Training Republique de Coree National Institute of Health "' Dr R.K. C. Lee United States Professor of America School of Public Health Etats .. Unis University of Ha~ D'Amerique Dr J.P. Keeve United States • Chief Public Health Adviser of America United States Agency for Etats-Unis International Development D'Amel'ique Manila Mr A.E. Meager United Nations UNICEF Representative Children's FUnd in the Philippines Fonds des Nations Unies pour l'Enfanoe Brigadier General E.S. Filart, M.C. International Surgeon General Committee of Armed Forces of the Philippines Mil1~ar.y Med1cine Member of the International and Pharmacy Cormni ttee of Mil! tary Medic1ne Comite international and Pharmacy de Medecine et de Pharmacie mtl1taires REPORT OF THE REGIONAL c:or.m:'l"l'EE 87 MIHmRB Dr R. Seaborn International Counoil on MEMBRES President of the Foundation Aloohol and Addiotions for Research and Treatment Conseil international sur of Alcoholism of Australia les Problemes de L'Alooolisme et des Toxicomanies Dr B. Barbers International Dental Institute of Hygiene Federation 1 f-/ University of the Philippines Federation dentaire internationale Dr J. Villanueva International Federation of Professor of Obstetrics Gynecology and Obstetrios University of the Philippines Federation internationale J de Gynecologie et ~ D'Obstetrique Dr E. Aldaba-Lim World Federation for Philippine Psyohological Mental Health Corporation Federation mondiale pour la Sante mentale Dr C. Ll. Intengan International Union of National Science Development Nutritional Sciences Board Union internationale des Quezon City Soiences de la Nutrition Dr V. Galvez League of Red Cross Assistant Secretary General Sooieties The Philippine National Ligue des Sooietas de J Red Cross la Croix-Rouge ~ .. DISCUSSION GROUP B GROUPE DE DISCUSSION B CHAIRMAN Dr W. Murphy New Zealand .. ..Ir PRESIDENT Deputy Director of Public Nouvelle-Zelande Health Department of Health RAPPORmJR Dr Raja Ahmad Noordin Malaysia Deputy Director (Health) Malaisie Ministry of Health Kuala Lumpur MmJIBERS Dr R. T. Taureka Australia MEMBRES Regional Health Officer Australie • -.,. - New Guinea Highlands Papua and New Guinea 88 REGIONAL COMMI'I'I'EE: 'l'WENTlJmf SESSION Dr C .K. Chang China Director Chine Department of Health Administration Ministry of Interior Mr M. Yamasaki First Secretary Embassy of Japan in the Republic of the Philippines Dr A.N. Acosta Medical Adviser Department of Health Dr G. Balbin Director Regional Health Office No. 3 Department of Health Dr P. Rigonan Chief Division of Hospital Standards and Administration Department of Health Mr Sae-Hoon Ahn Second Secretary Korean Embassy Manila Dr C.H. Gurd Director of Medical Services for Fiji and Inspector-General of the South Pacific Health Service Miss H. Upton Third Secretary in the British Embassy Manila Dr J .L. Stockard Research Coordination Technical Assistance Bureau United States Agency for International Development Washington Japan Japon Philippines Philippines Philippines Republic of Korea Republique de Coree Uni ted KingdOlll Royaume-Uni United Kingdom Royaume-Uni United states of America Etats-Unis D'Amerique • t .... CHAIRMAN PRESIDENT Dr J .C. Thieme Director of Health Health Department Dr F. Herrera Chief Division of Health Education and Personnel Training Department of Health Manila Mr A.J. Joseph Resident Representative of the United Nations Development Programme in the Philippines Dr A. Z. Romualde z Secretary General The World Medical Association, Inc. Manila Mrs M. Ordonez Vice-President of CICIAMS for Asia, President of the CatholiC Nurses' Guild of the Philippines Dr M.V. Olympia, Jr. Civil Aeronautics Administration Manila International Airport Dr R. Apelo President Planned Parenthood Movement in the Philippines Philippine General Hospital Western Samoa Samoa-Occidental International Union for Health Education Union internationale pour l'Education sanitaire United Nations Develop- ment Progr8.llllle Programme des Nations Unies pour 1e Deve1oppe- ment The World Medical Association, Inc. International Committee of Catholic Nurses Com1te international catholique des Infirmieres et Assistantes medico- sociales Permanent Commission and International Association on Occupational Health Commission permanente et ASSOCiation internationale pour la Medecine du Travail International Planned Parenthood Federation Federation internationale pour le Planning familial DISCUSSION GROUP C GROUPE DE DISCUSSION C Dr G. Loison Directeur de Programme (Sante) Commission du Pacifique sud Nouvelle-Caledonie South Pacific CommiSSion Commission du Pacifique sud 90 REGIONAL OOM'>UTl'EE: '1WENTIETH SESSION RAPPORTEUR Dr Dang Quoc Phu Viet-Nam Chef du Service de Medecine preventive MEMBERS Mr P. W. Carroll Australia MEMBRES Third Secretary Australie Australian Embassy Manila Dr Phav Sany Cambodia Inspecteur general de la Cambodge Sante et Professeur de pediatrie Ecole de Medecine Phnom-Penh Medecin-Colonel E. Poyet France ( Directeur du Service de Sante de la Polynesie fran~aise Medecin-General J. Rondet France Directeur de la sante et de l'Hygiene publique de la Nouvelle-Caledonie Dr Y. Hsiung China Deputy Director of Health Chine Taipei City Health Department Dr M. Oike Japan Assistant Chief Japon General Affairs Section • Medical Affairs Bureau Ministry of Health and Welfare Dr Phouy Sunthorn Laos Directeur des Affaires administratives ~ . Dr Thongphet Phetsiriseng Laos Directeur du Service d'hygiene et de medecine preventive Dr C.O. Innis Malaysia Principal Medical Officer Malaisie (Health) Sabah Dr L. Carlota Philippines Director • Bureau of Health Services Department of Health Dr J. Almonte Chief Field Health Operations Department of Health 91/92 Philipp1nes Dr F. Gomez Philippines Supervising Statistician Disease Intelligence Center Department of Health Dr Diego Hora Silva Ferreira Portugal Chef des Services de sante Macao Dr Truong Minh Cac Directeur general adjoint de la Sante Dr H. BaJa-Panlilio National Corresponding Secretary of the Philippine Medical Women's Association to MWIA Mrs C.M. Abad Occupational Therapy Assooiation of the Philippines Professor S. Matsumoto Department of Obstetrics/Gynaecology Gunma UniverSity School of Medicine Japan Viet-Nam Medical Women's Inter- national Association Assooiation internationale des Femmes Medecins World Federation of Occupational Therapists Federation mondiale des Ergotherapeutes International Planned Parenthood Federation Federation internationale pour le Planning familial J , ",( . ~ REPORT OF THE REGIONAL COMMITI'EE 93 WPR/RC20/1 WPR/RC20/1-a WPRjRC20/2 WPR/RC20/3 and Corr.1 WPRjRC20/4 WPR/RC20/5 WPR/RC20/6 WPR/RC20/7 WPR/RC20/8 WPR/RC20/9 WPR/RC20/9 Add.1 WPR/RC20/10 WPR/RC20/11 WPR/RC20/12 WPR/RC20/13 ANNEX 5 LIST OF DOCUMENTS Agenda Annotated agenda Proposed programme and budget estimates for the financial year 1 January - 31 December 1971 Nineteenth Annual Report of the Regional Director to the Regional Committee for the Western Pacific Resolutions of regional interest adopted by the Twenty-second World Health Assembly Health aspects of population dynamics Filariasis control: a progress report The epidemiology and prevention of accidents Training of national health personnel Selection of topic for the Technical Discussions during the twenty-first session of the Regional Committee Selection of topic for the Technical Discussions during the twenty-first session of the Regional Committee (Items proposed by the Government of France) List of representatives (see Annex 2 of document WPR/RC20/l3) Report of the Sub-Committee on Programme and Budget (see Annex 3 of document WPR/RC20/l3) Final report of the Technical Discussions on the planning and organization of a national epidemiological service (see Annex 4 of document WPR/RC20/l3) Report of the twentieth session of the Regional Committee for the Western Pacific WPR/RC20/SR,!.1 WPR/RC20/SR/2 WPR/RC20/SR/3 wPR/RC20/SR/4 WPR/RC20/SR/5 WPR/RC20/SR/6 WPR/RC20/sR/7 WPR/RC20/P&B!l WPR/RC20/P&:B/2 WPR/RC20/P&:B/3 REGIONAL· CQ.fIII'ITEE: TWENTIE'lH SESSION Summary reoord of the first meeting - 23 September 1969 SunInary reoord of the seoond meeting - 23 September 1969 Summary reoord of the third meeting - 24 September 1969 Summary reoord of the fourth meeting - 24 September 1969 SUJIIIIarY reoord of the fifth meeting - 25 September 1969 Summary reoord of the sixth meeting - 29 September 1969 Summary reoord of the seventh meeting - 30 September 1969 Suggested guidelines for the Sub-Committee on Programme and Budget (see page 53 of dooument WPR/RC20/13) Proposed programme and budget estimates for 1971 (see pages 55-65 of dooument WPR/RC20/13) Revisions requested by governments to the Supplementary List annexed to the regional programme and budget estimates ·for 1970 oontained in document WPR/RC19/2. inoluding those brought·forward during the meeting (see pages 67-71 of dooument WPR/RC20/13) WPR/RC20/TDl Teohnioal D1scussions programme WPR/RC20/TD2 Prooedures and teohniques for the Teohnioal Disoussions WPR/RC20/TD3 and Add.1 Guidelines for the Technical Discussions WPR/RC20/TD4 Rev. 1 General remarks on the epidemiological Situation in the Western PacifiC Region ... --'" . - WPR/RC20/TD5 WPR/RC20/TD6 WPR/RC20/TD7 WPR/RC20/mS (unnumbered) REPORI' OF THE REGIONAL OOMMI'I'I'EE 95/96 Basic considerations on the organization and planning of epidemiological services at country level The practical aspects of planning and organiza- tion of a national epidemiological service Discussion group memberships Individual evaluation questionnaire Brief reports received from governments on the progress of their health activities (see Part III, section 7 of document WPR/RC20/l3, for list of reports received)