WORLD HEALTH ORGANIZATION

Transcription

1 WORLD HEALTH ORGANIZATION REGIONAL COMMITTEE FOR THE WESTERN PACIFIC TWENTY-SEVENTH SESSION Manila, 6-10 September 1976 REPORT OF THE REGIONAL COMMITTEE SUMMARY RECOltnS OF THE PLENARY SESSIONS MANILA October 1976

2 WORLD HEALTH ORGANIZATION REGIONAL COMMITTEE FOR THE WESTERN PACIFIC -- ; - -TWENTY-SEVENTH SESSIdN'-" Manila, 6-10 September '10/76 -- ' 1\ I ( I, I REPORT OF THE REGIONAL COMMITTEE SUMMARY RECORI:S OF THE PLENARY SESSIONS I ( I t I \r I ~ I- I I, MANILA October 1976

3 NOTE The twenty-seventh session of the Regiona~Committee for the Western Pacific was held at the WHO Conference Hall, Manila, from 6 to 10 September under the Chairmanship of Mr J.S. Singh (Fiji), with Dr C. Evans (Australia) and Dr Tran Ngoc Dang (Socialist Republic of Viet Nam) were the Rapporteurs. The Regional Committee met on 6, 7, 8 and 10 September. The report of the Committee will be found in Part I of this document on pages 1-66; the summary records of the plenary sessions in Part II on pages The Sub-Committee on Programme and Budget met on 7 and 9 September. The report of the Sub-Committee will be found in Part I of this document on pages > f -11-

4 " I~ PART I REPORT OF. THE REGIONAL COMMlTTEE I I',! ( I 1 -~

5 CONTENTS IN'rRODUC'l'ION ' It It It.,It. _... _. '. 1 I. ANNUAL REPORT OF THE REGIONAL DIREcrOR COVERING THE PERIOD 1 JULY 1975 TO 30 JUNE II. REVIEW OF THE PROGRAMME BUOOET Introducti-on... 1t,1t. 2 Defini tion of the term "Technical Cooperation" ~. 6 3 Review of budget performance direct servic.es to governments of the Region by programme. by country or area and by project... "",,. II " " " " " " " " " 7 4 Modifications to the 1977 programme budget. ' 8 5 Review of.the proposed programme budget estimates for 19r8 and lr.;l79."... "... "."""""""""""".~.""""""""... ". 8 6 Consideration of tentative projections for 1980 and 1981 ".""."""""... """".",,.,,.-."""""".,, """... """,,... "." II 7 Resolutions ".. ".".""""""""""."""""""._.""",,"",,.. "0...,... \' 11 II~ ~ <J'I'Iim MA~ms ""."... " """ "".""""".".",,.,,.,,""""""",, Resolutions of regional interest adopted.by the Twenty-ninth World Health Assembly and the Executive Board at its fifty-seventh and fifty-eighth sessions Allocation and management of WHO's resources at regional and country level Special assistance to Democratic Kampuchea, the ~o People's Democratic Republic and the Socialist Republic Of Viet Nam... t WHO's role in the development and coordination of biomedical research: greater involvement of the regions in research ~ Alcoholism and other qependence problems The regional environmental health programme: regional centre for environmental health sciences v-

6 CONTENTS Importance of core programmes for child health. wi th particular emphasis on staff training through fellowships..... Progress in nutritional surveillance Preparation of a fifth regional programme of work covering a specific period ( inclusive) Method of work of the Regional Committee Time and place of the twenty-eighth and twenty-ninth s~essionsof the Regional Committee Selection of topic for the Technical Presentation during the twenty-eighth session of the Regional <;;omml tt~~ "... "... ",... ~ ' 13 Reports received~from governments on the progress of their health activities ','" , 29 IV; RESOWTIONS ADOPTED BY THE REGIONAL COMMITl'EE 30 WPR/RC27~Rl Allocation and management of WHO's resources at regional and country level... '" WPR/Rc27. R2 WPR/Rc27 R3 WPR/RC27.R4 WPR/RC27.R5 WPR/RC27.R6 WPR/RC27.R7 Annual report of the Regional Director Special assistance to Democratic Kampuchea. the Lao People's Democratic Republic and the Socialist Republic of Viet Nam Resolutions of regional interest adopted by the Twenty-ninth World Health Assembly and the Executive Board at its fiftyseventh and fifty-eighth sessions Alcohol and other dependence problems Regional centre for environmental health s'ciences..... Frequency qf meetings of the Regional Cornmi ttee...!... ~ vi-

7 CONTENTS WPR;RC27.R8 WPR;RC27.R9 WPR;RC27.RIO WPR;RC27.Rll Annual reporting by the Regional Director WHO's role in the development and coordination of biomedical research: greater involvement of the regions in research..... Core programmes for child health, with particular emphasis on staff training' Progress in nutritional surveillance WPR;RC27.R12 Topic of Technical Presentation in r WPR;RC27.R13 WPR;RC27.R14 WPR;RC27.R15 WPR;RC27.R16 WPR/RC27.R17 WPR/RC27.R18 WPR/RC27.R19 WPR;RC27.R20 WPR/RC27.R21 Twenty-eighth and twenty-ninth sessions of the Regional Comm1 ttee Sixth general programme of work covering a specific period: principal and detailed object1 yes Preparation of a regional programme of work Sub-Committee on the general programme of work Sixth general programme of work covering a specific period: priorities for in-depth studies.. 42 Technical Cooperation..... Budget performance direct services to governments Revisions made to the 1977 programme budget es tima tes Proposed programme budget estimates for 19r8 and 19r WPR/RC27.R22 WPR/RC27.R23 Tentative projections of the budget estimates for 1980 and 1981 Expression of sympathy ,- -vl1-

8 CONTEN'IS WPR/RC27 R24 WPR/RC27.R25 Adoption of the report ;. Resolution of appreciation List of non-governmental organizations whose representatives made statements to the Regional Committee. Agenda..... List of representatives.... '..... Working Group to examine regional action in connexion with the Sixth General Programme of Work (terms of reference) List of documents.. " "... " " " vii1-

9 (WPR/RC27!16 ) INTRODUCTION The twenty-seventh session of the Regional Committee for the Western Pacific was held in Manila from 6 to 10 September The Committee expressed to the Government and People of the People's Republic of China its deepest sympathy for the death of their esteemed leader, Chairman Mao Tse-tung. The meeting was attended by Representatives of Australia, China, Fiji, Japan, Lao People's Democratic Republic, Malaysia, New Zealand, Papua New Guinea, Philippines, Republic of Korea, Singapore, Socialist Republic of Viet Nam and Western Samoa, and of the Member States responsible for territories or areas in the Region. Representatives of the United Nations Development Programme, UNICEF, and the International Labour Organisation, the Asian Development Bank, the South Pacific Commission and 28 non-governmental organizations in official relations with WHO were also present. The Committee elected the following officers: Chairman Vice-Chairman Mr J.S. Singh (Fiji) Mr E. Robin Safitoa (Papua New Guinea) Rapporteurs in English in French Dr C. Evans (Australia) Dr Tran Ngoc Dang (Socialist Republic of Viet Nam) Formal statements were made by the Representatives of the United Nations Development Programme, UNICEF, the International Labour Organisation, the South Pacific Commission and the non-governmental organizations listed in Annex 1. The agenda appears in Annex 2 and the list of representatives in Annex 3. At its first plenary session, the Committee established a Sub-Committee on Programme and Budget, composed of Representatives of the following countries: Fiji, Lao People's Democratic Republic, Papua New Guinea, Philippines, Portugal, Singapore, Socialist Republic of Viet Nam, Uni ted States of America and Western Sarnoa. During the discussion on Item 16 of the Agenda, Preparation of a Fifth Regional Programme of Work covering a Specific Period ( inclusive), the Committee established a working group to examine regional action in connexion with the Sixth General Programme of Work

10 2 REGIONAL COMKrTIEE: 'lwenty-seventh SESSION covering a Specific Period ( inclusive) consisting in Representatives of Australia, Fiji, Malaysia, Philippines and Western Samoa (see also Section 9). One of the Working Group's recommendations, Which was subsequently adopted by the Regional Committee, was that a Sub-Committee be established to review the implementation of the General Programme of Work covering a specific period in the Western Pacific Region (see resolution WPR/Rc27.R16). In the course of six.plenary sessions, the Committee adopted 25 resolutions which are set out in Part IV. PART I. ANNUAL REPORT OF THE REGIONAL DIRECTOR COVERING THE PERIOD 1 JULy 1975 TO 30 JUNE 1976 The Committee Joined the Regional Director in welcoming to the Regional Committee the Representatives of Papua New Guinea, formerly an Associate Member of the Organization, and the reunified Socialist Republic of Viet Nam. The Committee noted that, during the year, some progress had been made in.promoting the primary health care concept; for example in Western Samoa, where preliminary discussions had taken place on the formulation of a country health programme and the development of a primary health care system. Governments were being encouraged to examine the problems involved, and the resources needed, to implement expanded programmes of immunization. Important factors in implementing such programmes were the necessity to have a strong political commitment on the part of the government concerned and the administrative backing to ensure a continuing operation. Adequate supplies of vaccine, and properly oriented health workers, were also of major importance. The Committee was interested to hear that the diminishing number of requests to WHO for cooperation in developing health personnel seemed to indicate that some countries were now able to undertake their own training programmes from national resources, though one area in which the Organization was still able to cooperate, was in the provision of consultants in specialized fields to give refresher training, as had been done in the Trust Territory of the Pacific Islands for two consecutive years. It noted that health laboratory technology remained a field in which shortage of trained manpower constituted a major constraint. It also noted that the Regional Teacher Training Centre in Sydney had been able to continue its programme through workshops and national courses and now offered a Master's degree in health personnel education; the first course having commenced in July 1975.

11 REPORT OF THE REGIONAL COMMI'l'lEE 3 A milestone in the development of the regional programme had been the establishment of a Regional Advisory Committee on Medical Research, which held its first meeting in June In view of the distress1ng increase in cancer, cardiovascular diseases and other chronic diseases, it was commendable that one of the priority areas for regional research activities recommended by the Regional Advisory Committee on Medical Research was that of the cardiovascular diseases. Other priority areas for research were: the development of strategies for health service research; family health; environmental health; and parasitism and other communicable diseases. The Committee joined with the Regional Director in conveying to the Japan Shipbuilding Industry Foundation deep appreciation for its second generous donation to WHO. Note was taken of the extent to which the Organization was becoming dependent on extrabudgetary resources to implement many of the Health Assembly's resolutions. Representatives were interested to note that four "country health information profiles", had already been cleared by the Governments concerned. They were compiled from various government, WHO and United Nations sources, and" could be consulted 1n the Conference Hall. Prior to the open1ng of discussion, the Representative of Australia announced that the Government of Australia would make available to WHO, in the financial year 1976/1977, A$ as part of Australia's aid programme to the Socialist Republic of Viet Nam. The contribution was intended for the tuberculosis control programme. Representati ves of thirteen Member States took part in the ensuimg discussion. The Committee noted the importanae attached by most countries in the Region to the concept of primary health care, through which disease control programmes could be extended to remote areas; and the emphasis placed on community participation as well as on-the-spot training of primary health care workers. It listened with interest to descriptions of the functions of the barefoot doctor in the People's Republic of China and of the primary health care system 1n the Socialist Republic of Viet Nam. It noted the role still to be played in certain areas by the district medical officer and the traditional doctor. The Committee also noted with interest, statements on the health situation in the Lao People's Democratic Republic, New Zealand and the Republic of Korea. As well as health problems connected with the affluent society, several Representatives mentioned those connected with the aged, stressing the necessity to make provision for them in the health services and for closer study of the diseases connected with old age.

12 4 REGIONAL COMMIT'lEE: 'IWENTY-SEVENTH SESSION Linked with this was the need to give attention in the Region, to the control at chronic diseases such as cancer and cardiovasoular diseases. The Committee noted with approval the suooessful progressive development of a health management information system in Malaysia; an example from whioh workers in other oountries or areas could learn. The perennial problem faoed by reoipient countries in placing fellows, because of late nominations, was again drawn to the attention of the Committee. It was felt that there existed a need to make a reassessment of the fellowship programme. The Committee noted with oonoern the increasing problem of malnutrition in Fiji caused by the urbanization of rural populations, and approved the action being taken to alleviate it. Mention was made of the planned filariasis research project in Western Samoa and also of the continuing effort needed to trace and treat all cases of the disease in the country. Finally the Committee noted the impact made on the programme in the Region by the UNDP liquidity crisis and heard with interest a statement made by the UNDP Resident Representative in the Philippines. The Committee adopted a resolution noting the programme that had been planned and oarried out during the period under review and commending the Regional Director and his staff on the work accomplished (see resolution WPR/Rc27. R2). PART II. REVIEW OF THE PROGRAMME BUDGET, Introduction At its seventh session, the Regional Committee, in resolution WPR/RC7.R7, deoided "that the establishment of a sub-committee on programme and budget, consisting of six members plus the Chairman of the Regional Committee, should become a routine activity of the Regional Commi ttee"; and recommended that "the membership of this sub-codlri ttee 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". At its twenty-first session, the membership of the Sub-Committee was increased to halfl the Members in the Region. 1 "Half the Members" me~s that half an odd number would be the next higher full number - e.g., one half of 17 is 9

13 REPORT OF THE REGIONAL COMMITmE 5 The Sub-Committee on Programme and Budget met on TUesday afternoon, 7 September, and considered its draft report on Thursday morning, 9 September, under the chairmanship of Mr J.S. Singh. The attendance was as follows: Members in accordance with the principle of rotation: Fiji Lao People's Democratic Republic Malaysia Papua New Guinea Philippines Portugal Singapore Socialist Republic of Viet Nam United States of America Western Samoa Mr J.S. Singh (Chairman) Dr J.B. Senilagakali Dr Keo Phimphachanh Tan Sri Datuk (Dr) Abdul Majid Ismail Dr Mehar Singh Gill Mr ann bin Kayat Mr E. Robin Safitoa Dr K. Wari Dr J. Sumpaico Dr F. Aguilar Dr Leonel dos Remedios Dr Leong Kwok Wah Dr Tran Ngoc Dang Dr Nguyen Van Trong Mr Nguyen Hong Quang Dr J.C. King Dr Solia Tapeni Faaiuaso Other members of the Committee also in attendance were: Australia China Japan New Zealand Dr C. Evans Dr Chen Hai-feng Dr Chin Hsiang-kuan Dr Huang YU-hsiang Mr TSao YUng-lin Mr L1 Ching Hsiu Dr A. Tanaka Dr H. Shinozaki Mr T. Yano Dr B.W. Christmas

14 6 REGIONAL COMMITTEE: ~-seventh SESSION Republic of Korea Uni ted Kingdom Dr Kyong Shik Chang Mr Moo Geun Jeon Dr J.A.B. Nicholson The Regional Director attended. Dr Hesselvik, Director of Health Services, acted as Secretary. was assisted by Miss Newton, Chief, Administration and Finance. He The Sub-Committee had before it the following documents: WPR/RC27/2 and Corr.l WPR/RC27/2 Rev.l WPR/RC27/2 Rev.2 WPR/RC27/p&B/l WPR/RC27/p&B/2 WPR/Rc27/p&B/3 WPR,/RC27/p&B/4 WPR/Rc27/p&B/5 Proposed programme budget estimates for the financial years 1978 and 1979 Proposed revision to the programme budget, 1977, Proposed revision to the programme budget, , Suggested guidelines for the Sub Committee on Programme and Budget Budget performance direct services to governments of the Region by programme, by country or area and by project Proposed programme budget estimates for the financial years 1978 and 1979 Tentative projections for Proposed programme budget 1977, 1978 and distribution of costs of intercountry programmes (Regular Budget) 2 Dafini tion of the term "Technical Cooperation II On the initiative of the Representative of Australia, the Sub Committee commenced its deliberations by considering the implications of the intention of the World Health Organization to change the term "technical assistance", used hitherto, to "technical cooperation".l Resolution WHA29.4B, adopted by the Twenty-ninth World Health Assembly, requested the Director-General to "reorient the working of the Organization wi th a view to ensuring that allocations of the Regular Budget reach the level of at least 6~ in real terms towards technical cooperation and 1 See WHO Official Records, No. 231, 1976, Part II, page 128, paragraph 15.

15 REPORT OF THE REGIONAL COMMITmE 7 provision of services by 1980".1 It had thus become imperative clearly to define the term "technical cooperation" if misunderstandings and controversy were not to arise. In an endeavour to arrive at a suitable definition of the term, the Sub-Committee considered that the activities of WHO could be divided into three categories: (i) (i1) those in which it cooperated directly with Member States, such as the provision of supplies and equipment; educational activities; the provision of advisory services; WHO Representatives and Regional Advisers; those in which it cooperated indirectly with Member States, which still should be termed technical cooperation, such as collection and dissemination of information and of epidemiological data, including that published in the Weekly Epidemiological Record; development of skills, techniques and strategies for the use of Member States; Expert Advisory Panels and Expert Committees; general planning activities; attendance of Representatives of Member States at the World Health Assembly, the Executive Board and the Regional COmmittee; (iii) those which could not be termed technical cooperation, such as the maintenance of Headquarters and Regional Office buildings and administration and finance services. Thus the Sub-Committee recommended that the definition of the term technical cooperation might be "Any activity of WHO, particularly if jointly developed by WHO and a Member State or Member States, which increases the capability of the Member State(s) to carry out its own programmes within the health field. Such an activity should be mutually conceived and/or mutually agreed to by WHO and Member states". It decided to submit a draft resolution to the Regional Committee which was subsequently adopted (see resolution WPR/RC27.R18). 3 Dr Hesselvik, Secretary, drew attention to Annex 1 of document WPR/RC27/p&:B/2 which showed the revised Regular Budget, as agreed by the Regional Committee at its twenty-fifth session, the obligations incurred and the percentage of implementation of the different parts of the programme. Difference.s between the revised programme and actual 1 See WHO Official Records, No. 233, 1976, Part I, page 31.

16 8 REGIONAL COMMI'l"IEE: 'IWENTY-sEVENTH SESSION implementation resulted mainly from changes in government requests and priorities. from unexpected delays in the recruitment of staff and from other causes beyond the control of the Regional Director, such as the situation that developed in Democratic Kampuchea and in the Socialist Republic of Viet Nam, where the planned programme had had to be drastically curtailed. The Sub-Committee noted, from Annex 1. that the rate of 'programme implementation in 1975 was 94.84% as expressed in monetary terms. However. because of increased costs of staff, consultants and fellowships. the rate of delivery in man-months was considerably lower. The Sub-Committee further noted the details contained in Annexes 2-6 of services provided to individual countries or areas, including those provided from the intercountry programme and those provided by Regional Advisers and WHO Representatives. 4 The Secretary drew the attention of the Sub-Committee to paragraph 4, page 4 of document WPR/RC27/P&:B/3 and to Annex 1 of the same document. The Director-General had been able to make an additional allocation of US$ to help the least developed countries in the Region. Other changes were mostly the result of extension or deletion of posts or fellowships and changes in programme requested by governments. 5 and 5.1 General observations The Sub-Committee noted that the proposed programme budget estimates for had been prepared from government requests, taking into consideration the tentative budgetary allocations provided by the Director-General, under which the totality of the regular programme budget proposals had had to be accommodated, using as a guideline the Sixth General Programme of Work covering a specific period ( ) adopted by the TWenty-ninth World Health Assembly and other recommendations of the Regional Committee, the Executive Board and the World Health Assembly. Again the proposals were being presented for a biennium and with information for 1976 and the revised budget for As usual. Dooument WPR/Rc27/2 attempted to depict the total programme to be exeouted in the Region with who involvement and thus included activities funded from sources other than the WHO Regular Budget. While information on other sources of funds always tended to be speculative, because of different programme cycles and different requesting procedures, the current financial situation of the United

17 REPORT OF THE REGIONAL COMMITIEE 9 Nations Development Programme was such that the information on funding from that source from 1977 to 1979 was even more uncertain than usual. The Sub-Committee noted that the actual or proposed annual growth, from 1976 to 1979, was about ~ and the proposed level for 1979 was approximately US$ 13 million. The Sub-Committee noted some innovations. Following a suggestion by the Director-General, provision for a Regional Director's Development Programme had been included. ~s was intended to finarlce collaborative activities with Governments which it was not possible to foresee at the time the estimates were developed. For the first time also a specific, although modest, provision for staff development and training had been included, though the major part of this programme was being supported from the Headquarters budget. In keeping with the emphasis placed by the TWenty-eighth World Health Assembly on primary health care,l and recoliidendations of the Executive,Board at its fifty-seventh session and the TWenty-ninth World Health Assembly. on the convening of a Conference on Primary Health Care in the USSR in 1978,2 provision had been made for an intercountry team and for regional meetings on the promotion of primary health care (Intercountry programme PH: 001). The TWenty-ninth World Health Assembly, in resolution WHA29.24, had again emphasized the necessity to help Democratic Kampuchea, the Lao People's Democratic Republic, and the Socialist Republic of Viet Nam. 3 The Regional Director had included as much provision as possible in the Regular Budget for these countries. It was noted that no contact had yet been made with Democratic Kampuchea, in spite of repeated efforts, although it was hoped that eventually it would be established. As soon as this was the case, projects would be developed, as they were requested by the Government, within the proposed budgetary frame. Document WPR/RC27/2 Rev.2 had been issued following the unification of the Democratic Republic of Viet Nam and the Republic of South Viet Nam into one whole, the Socialist Republic of Viet Nam and showed the consolidated proposed programme budget. The Sub-Committee noted document WPRjRC27/2 Rev.l prepared following resolution WHA29.48 adopted by the TWenty-ninth World Health Assembly, which requested that an increasing proportion of the regular programme budget should be reoriented towards technical cooperation and provision of services to Governments and that all avoidable and non-essential expenditure on establishment and administration be curtailed.4 The Regional Director had listed in the document the cuts 1 Resolution WHA28.88, WHO Official Records, No. 226, 1975, pp Resolutions EB57.R27, WHO Official Records, No. 231, 1976, p. 19 and WHA29.l9, WHO Official Records, No. 233, 1976, Part I, p Resolution WHA29.24, WHO Official Records, No. 233, 1976, Part I, p Resolution WHA29.48, WHO Official Records, No. 233, 1976, Part I, pp

18 10 REGIONAL COMMITTEE: TNENTY-SEVENTH SESSION whioh would be made in the Regional Office staff to comply with the resolution. The money thus released would mainly be added to the Regional Director's Development Programme. It was noted however that. should the workload increase, some of the posts might have to be re-establ1shed. The Sub-Committee noted further that if the twenty-eighth session of the Regional Committee was held in Tokyo, with the Government of Japan agreeing to bear the additional cost, the amount of US$ shown as the cost of organizational meetings in 1977, on page 2 of Document WPR/RC27/2, would be reduced by some US$ in accordance with the spirit of resolution WHA In this way the expected shortfall of US$ in the provision from the United Nations Development Programme for the Regional Teacher Training Centre in Sydney (Intercountry programme HMO 007) could be partly met. The Representative of the United States of America, in supporting the emphasis placed on health planning, primary health care, nutrition, health manpower development and communicable disease control, expressed oonoern that a high proportion of funds for health manpower development were earmarked for medical schools. This was not consistent with increasing WHO emphasis on the training of auxiliary personnel. He onoe again expressed support for an increase in intercountry aotivities instead of the more costly small country programmes. In view of the characteristics of the developing countries in the Region the Representative of Papua New Guinea supported the emphasis plaoed by the Representative of the United States of America on primary health care inoluding the training and support of auxiliary personnel. In reply to a query from the Representative of Portugal, the Director of Health Services said that note had been taken of the Government of Portugal's earlier expression of interest in participants from Macao attending two intercountry courses planned for Governments could, of course, indicate at any time their interest in taking part in planned intercountry activities. The Sub-Committee noted with interest an account of the sohistosomiasis prevention and control programme in the People's Republio of China. 5.2 Consideration of the "List of Proposals" (Document WPR/Rc27/2, Annex Dr, pages 334 to 345) The Sub-Committee noted the number of proposals for large projects which had emerged primarily as a result of the efforts to assist the Sooialist Republic of Viet Nam and the Lao People's Democratio Republic, which obviously could not be finanoed within the WHO Regular Budget and for which outside financing had to be sought. Documents WPR/RC27/5, Add.l and Add.2, which contained the Regional Director's report on the efforts of WHO in this direction, had been disoussed by the Regional Committee.

19 REPORT OF THE REGIONAL COMMITIEE 5.3 The Sub-Committee noted that requests totalling US$ in 1978 and US$ in 1979 had had to be placed in the List of Additional Projects. They could not be accommodated in the budget estimates because of limitation of funds. although they were. technically valid. The Regional Director would naturally do his best to accommodate these requests. to the extent that savings became available. If they were considered to be urgent. governments should review whether some other parts of the WHO services provided to them deserved lesser priority and could be relinquished. The followingadd1tional request for assistance in 1978 and 1979 was presented during the meeting of the Sub-Committee: Philippines CVD Cardiovascular diseases (epidemiology) Consultant for three months in 1978 and three months in Intercountry programmes (Document WPR/RC27/p&:B/5) The. Sub-Committee noted Document WPR/RC27/p&:B/5 which showed the distribution of costs of intercountry programmes apportioned by country or area for and The Sub-Committee noted that the tentative projections had been prepared in response to the World Health Assembly resolution dealing inter alia with biennial programming (resolution WHA22.53).1 For this purpose. the Director-General provided each Region with a tentative allocation for the two years succeeding the programme budget years under review. The tentative allocation for the years 1980 and 1981 for this Region was US$ and US$ respectively. 7 Resolutions The Committee adopted the following resolutions in connexion with the programme budget: (1) Technical cooperation (WPR/RC27.Rl8); (2) Budget performance Direct services to governments (WPR/RC27. R19 ) ; 1 Resolution WHA WHO Official Records. No pp

20 REGIONAL C<Mt1I'l'IEE: 'lwenty -SEVENTH BESSION (3) Revisions made to the 1977 programme budget estimates (WPR/RC27 R20 ) ; (4) Proposed programme budget estimates for 1978 and 1979 (WPR/RC27.R2l); (5) Tentative projections of the budget estimates for 1980 and 1981 (WPR/RC27.R22). PART III. OTHER MA '!"mrs 1 Resolutions of regional interest adopted by the TWenty-ninth World Health Assembl and the Executive Board at its fift - seventh and fifty-eighth sessions Documents WPR C27 and Add.l) The Committee considered the following resolutions: (1) Sixth General Programme of Work covering a Specific Period (resolution WHA29.20); (2) Psychosocial factors and health (resolution WHA29.21); (3) Report on the world health situation (resolutions WHA29.22 and EB57.R46); (4) Real Estate Fund (resolution WHA29.28); (5) Voluntary Fund for Health Promotion (resolutions WHA29.31 and EB58.Rlo); (6) Organizational study on the planning for and impact of extrabudgetary resources on WHO's programmes and policy (resolution WHA29.32); (7) Coordination with the United Nations system - general matters: UNDP-supported activities - financial situation (resolutions WHA29.42 and EB57.R49); (8) Coordination with the United Nations system: general matters (resolution EB57.R48); (9) Coordination with the United Nations system (general matters): technical cooperation among developing countries (resolution EB57.R50); (10) International Women's Year (resolution WHA29.43); (11) WHO's human health and environment programme (resolution WHA29.45);

21 REPORT OF THE REGIONAL COltKI'rIEE 13 (12) Health aspects of human settlements (resolution WHA29. 46); (13) Community water supply and excreta disposal (resolution WHA29.47); (14) Programme budget policy (resolution WHA29.48); (15) Cardiovascular diseases (resolution WHA29.49); (16) Occupational health programme (resolution WHA29.57); (17) Schistosomiasis (resolution WHA29.58); (18) Mycotic infections (resolution WHA29.59); (19) Expanded programme on immunization (resolution WHA29.63); (20) Rheumatic diseases (resolution WHA29.66); (21) The need for laboratory animals for the control of biological products and the establishment of breeding colonies (nonhuman primates) (resolution WHA29.67); (22) Disability prevention and rehabilitation (resolution WHA29.68); (23) Leprosy control (resolution WHA29.70); (24) Health manpower development (resolution WHA29.72); (25) Development of the antimalaria programme (resolutions WHA29.73 and EB57.R26); (26) Promotion of national health services and health technology relating to primary health care and rural development (resolutions WHA29.l9. WHA29.74 and EB57.R27); (27) Development of programme evaluation in WHO (resolution EB57.Rl7); (28) Report by the representatives of the Executive Board at the Twenty-ninth World Health Assembly: Method of work of the Executive Board in relation to programme development (resolution EB58.Rll). (See resolution WPR/Rc27.R4)

22 14 REGIONAL COMMI'l"1EE: 'lwenty-seventh SESSION A summary of the comments made on specific resolutions is given below. 1.1 Report on the world health situation (resolutions WHA29.22 and EB57.R46) The Representative of the United Kingdom spoke to resolution WHA He remarked that the report was a sobering review of the situation, particularly in respect of progress in the field of tuberculosis and the near-disaster situation with regard to malaria. 1.2 Voluntary Fund for Health Promotion (resolutions WHA29.31 and EB58.RlO) The Representative of the United Kingdom spoke to these resolutions. He said that the Government of the United Kingdom's attitude was that, if a programrnewas worth carrying out, it should receive priority for support from Regular Budget funds. Nevertheless, the Government had made a contribution of some US$ over 3 years towards the Smallpox Eradication Programme and was currently providing funds and experts to the Special Programme for Research and Training in Tropical Diseases. He believed that the Government of the United Kingdom might be providing tangible evidence of support for the Expanded Programme on Immunization in the near future, and it was, of course, interested in the programme for community water supply. 1.3 Coordination with the United Nations system - seneral matters: UNDP-supported activities - financial situation (resolutions WHA29.42 and EB57.R49) The Representative of the United Kingdom spoke to these resolutions. He said that the Government of the United Kingdom, through its Ministry of Overseas Development, was considering sympathetically more than one of the problems created by that situation. 1.4 Coordination with the United Nations system (general matters): technical cooperation among developing countries (resolution EB57.R50) TWo Representatives spoke to this resolution. The Representative of the People's Republic of China said that, in resolution EB57.R50 mention had been made of resolution WHA He also referred to resolution WHA29.45 'WHO's human health and environment progradllle", 1n which mention had been made of resolution WHA The Chinese delegation had categorically stated its position on resolutions WHA28.63 and WHA28.75 during the TWenty-eighth World Health Assembly and did not wish to reiterate it. l The Representative of the United Kingdom said that the whole aim of development programmes was to attain national self-reliance or perhaps even regional self-reliance. His government was sympathetic to 1. See WHO Official Records No. 227, 1975, pages 305, 309, 490, 491 and 639.

23 REPORT OF THE REGIONAL COMMITIEE 15 that a1m; it might, for example, be interested in a project for the training of auxiliaries, and possibly in assisting training abroad for a particular project in band. That policy was now under consideration. 1.5 International Women's Year (resolution WHA29.43) The Representative of the United Kingdom spoke to this resolution. He commented that, although health was a field in which the place of women was beyond dispute, there was not one woman sitting at the meeting table at that moment. 1.6 WHO's human health and environment programme (resolution WHA29.45) See under 1.4 above. 1.7 Community water supply and excreta disposal (resolution WHA29.47) The Representative of the United Kingdom spoke to this resolution. He thought it essential that Member states gave high priority to community water supply and excreta disposal and saw health ministries as taking a leading role and convincing other ministries of the importance of safe water and proper sanitary disposal. The Committee noted that under this resolution, specific action was requested on the part of regional committees in the year Programme budget policy (resolution WHA29.48) The Representative of the United Kingdom spoke to this resolution. He said that his government understood the wish of other Member States to see more tangible results from work done in their countries and the Director-General and his Secretariat were working towards that end. The transfer of technology from the developed to the developing countries was desirable, provided that a proper balance in the allocation of the Organization's resources was maintained. 1.9 OCCUpational health programme (resolution WHA29.57) The Committee noted that this resolution called for discussion of the subject by regional committees in 1977 or " 1.10 Mycotic infections (resolution WHA29.59) The Representative of the United Kingdom spoke to this resolution. He remarked that mycotic infections were arousing increased interest but that as yet very little reliable knowledge existed on morbidity from those conditions, for instance on systemic morbidity. The Government of the United Kingdom supported research in that field.

24 16 REGIONAL COMm'l"I'EE: 'lwenty-seventh SESSION The Representative of the Philippines spoke to this resolution. He stated that an immunization programme had been launched in the Philippines in 1976, involving both vaccine production and implementation by field units. Assistance was being provided by WHO, UNICEF and the Netherlands. but it was hoped that after five years the Government would be able to proceed with the progranme USing national resources only The need for laboratory animals for the control of biological products and the establishment of breeding colonies nonhuman primates) (resolution WHA29. 7 The Representative of the United Kingdom spoke to this resolution. He pointed out that the Government of the United Kingdom was setting up breeding facilities for experimental animals, using marmosets which were easier to breed than rhesus monkeys Leprosy control (resolution WHA29.70) Two Representatives spoke to this resolution. The Representative of western Samoa expressed the Government of Western Samoa's gratitude to WHO and to UNICEF for their technicai and material assistance to the leprosy survey conducted in The United States of America had also provided valuable support by assigning staff to the survey. The Representative of Papua New Guinea voiced his appreciation of the substantial contribution made by the Japanese Shipbuilding Industry Foundation to leprosy control in Papua New Guinea Health manpower development (resolution WHA29.72) The Committee noted that this resolution called for a medium-term health manpower development programme to be established at country level and discussed by regional committees in 1977; and that it was proposed to start. early in to assemble the necessary information. hopefully through a series of country visits from Regional Office staff. 1.lS Promotion of national health services and health technology relating to primary health care and rural development (resolutions WHA29.74 and EBS7. R27 ) The Committee noted that resolution WHA29.l9. which referred to the International Conference on Primary Health Care planned for was related to these two resolutions. It also noted the outline provided of action already taken to promote primary health care in the Region. and plans for the future.

25 REPORT OF THE REGIONAL COMMITIEE 17 The Representative of the United Kingdom spoke to these resolutions. He stated that the Government of the United Kingdom was developing a new aid strategy, placing emphasis on coordination, to improve primary health care for the least privileged population groups. Training of personnel should be adjusted to the specific needs and resources of each country, and self-reliance should be encouraged. Accordingly, it was important to train as many categories of health personnel as possible in national or regional institutions, rather than in countries with different problems Development of programme evaluation in WHO (resolution EB57.Rl7) The Representative of Australia spoke to this resolution. He stressed that evaluation should be built into all programmes, and welcomed the fact that it was built into the Sixth General Programme of Work covering a Specific Period Report by the representatives of the Executive Board at the Twentyninth World Health Assembl: Method of work of the Executive Board in relation to programme development (resolution EB.Rll) The Representative of Australia spoke to this resolution. He pointed out that the purpose of the resolution was to give the Executive Board a more active role in managing the activities of the Organization. Any move to increase the responsibilities of the Board should be supported, as that would mean an increase in the involvement of all Member States. 2 Allocation and management of WHO's resources at regional and country level (Document WPR/RC27/4) The committee reviewed detailed proposals presented by the Regional Director for a further development in the programme budgeting procedure, based on the concept of programming by objectives and budgeting by programmes. If the regional committees approved the proposals put forward, a new form of budget presentation would be introduced in the proposed programme budget for In 1978, instead of a document containing proposals for projects down to the last detail, such as document WPR/RC27/2 (Proposed programme budget estimates for the financial years 1978 and 1979) which it was considering at the present session, the Committee would have before it a summary in the form of narrative country programme statements, setting out broad programme trends, objectives and modes of action, with a planning figure for each country or area broken down by major programmes or areas of cooperation. The formal programming would have been carried out in the countries themselves earlier in It would not be until the year immediately preceding the operating period, that the broad programme proposals would be cast in detailed terms of human resources, supplies, equipment, etc. Plans of operation for specific activities would have been developed with national authorities and

26 18 REGIONAL COMMITmE: 'ntienty-seventh SESSION discussed in the intervening period and dialogue with national authorities would continue during the operating period as part of the process of ongoing management and evaluation. In general, the Committee welcomed the new form of programme budgeting and the programme-oriented approach as a wise innovation, though some reservations were expressed: The Representative of Australia said that, since some projects continued from one biennium to the next, it was important to know a~ an early stage what they were to cost in the future so that remaining resources could be made available for new projects. He also expressed concern that the new system might lessen WHO's accountability. The Representatives of Malaysia and Papua New Guinea both emphasized the -need to make allowance for the differing budgetary cycles of Member States, necessitating closer collaboration in budgetary matters between governments and WHO. It was noted, however, that flexibility was intended to be one of the main features of the new system. The Representative of the United States of America, in welcoming the distinction made between cooperation and assistance, and the emphasis on the former as WHO's rightful role, hoped that the narrative country programme statements would be clear and concise. In noting that details of projects would not be listed, he said that such information would eventually be needed in order to permit evaluation; to protect against excessive expenditure, breakdowns of allocations for personnel, fellowships, etc would also be needed. The initial broad programme areas should be gradually refined during two years of discussion with governments so as to develop specific projects with precise costing. The Representative of the United Kingdom said it would be wrong to think that, because of these new innovations, the functions of WHO Headquarters would ultimately be dispersed; there were always important functions for it to carry out, such as coordination of global programmes and some important technical cooperation programmes. In this connexion it might be worthwhile to point out that about 28% of WHO's staff was stationed at its Headquarters, compared to about ~ of FAO's and 8~ of UNESCO's at their Headquarters. The Committee noted that an important outcome of the new system would be the more orderly development of medium-term programming, which was in accordance with the expressed wishes of the Executive Board. By late 1977, examples of medium-term programmes should have become available, starting with that being developed for health manpower development. Reassurance was received on the matter of accountability. The Regional Director would report to the Committee after project details had been developed within the broad programme areas that had already

27 REPORT OF THE REGIONAL COMMITlEE 19 been considered by the Committee under the new system. It was traditional for the Regional Director to make available to the Committee all the information it required for evaluation purposes and this would continue under the new system. In noting that the same subject was under consideration in 1976 by all the regional committees of the Organization and, with their reactions, would be submitted to the Executive Board and thereafter to the World Health Assembly, the Committee adopted a resolution endorsing the new procedures and the form of budget presentation outlined in document WPR/Rc27 /4 to be introduced in the proposed programme budget for (see resolutionwpr/rc27.rl). 3 Special assistance to Democratic Kampuchea, the Lao People's Democratic Republic and the Socialist Re ublic of Viet Nam (Documents WPR C27 5, Add.l and Add.2 The Committee reviewed three reports issued under this item of the Agenda: (1) a brief statement on the steps taken to implement resolutions of the Twenty-eighth World Health Assembly and the twenty-sixth session of the Regional Committee, together with the report of a special meeting on assistance to Viet Nam, held in Manila on 30 and 31 March 1976, as a first step towards stimulating extrabudgetary assistance from Member States; (2) a description of the accelerated action taken with regard to assistance to the Socialist Republic of Viet Nam since the adoption of resolution WHA29.24 by the World Health Assembly, which had happily resulted in several positive responses; (3) an outline of programmes meriting special assistance in the Lao People's Democratic Republic which had recently been formulated with the Government. The Committee expressed its appreciation to all Member States that had indicated their willingness to assist the three stricken countries in reconstructing their health services. Announcements had been made during the present session of contributions by the Governments of Australia to the Socialist Republic of Viet Nam and of Canada to the Lao People's Democratic Republic. Other governments, both within and outside the Region, had already announced their intention to make donations. The Committee noted with appreciation that the Government of France was continuing bilateral assistance to the Socialist Republic of Viet Nam; as was the Government of New Zealand. The discussions on this item ended with the Representative of the Socialist Republic of Viet Nam expressing his Government's thanks to WHO for assisting in formulating details of the priority programmes for assistance and taking the first'steps to seek such assistance; and to all Member States that had offered to contribute to the effort being undertaken. The Committee adopted a resolution expressing its appreciation to all Member States that had already announced voluntary contributions and appealing to others to assist in the exceptional operations being

28 20 REGIONAL COf/IMIT1EE: 'lwenty-seventh SESSION undertaken in the Lao People's Democratic Republic and the Socialist Republic of Viet Nam. It requested the Regional Director to assist the Director-General in his efforts to provide all forms of assistance in the most expeditious, efficacious and flexible manner (see resolution WPR,lRc27. R3 ) 4 WHO's role in the development and coordination of biomedical involvement of the re ions in research The Committee noted that three major steps had been taken in implementation of resolution WPR,/RC26.RlO adopted by the Committee at its twenty-sixth session: (1) a post of adviser in biomedical research had been established in the Regional Office and a suitable candidate was being sought; (2) a group composed of the Chairman of the Headquarters Advisory Committee on Medical Research, Dr Scrimshaw, a Headquarters staff member who was an authority on parasitic and tropical diseases, Dr Buck, and Dr Reyes from the Regional Office, had travelled in the Region to study the feasibility of designating an institute in a country of the Region a WHO regional centre for research and training in tropical diseases; and (3) the first meeting of the Regional Advisory Committee on Medical Research (RACMR) had taken place in Manila. The Committee noted the summaries of the recommendations arising from both the feasibility study and the meeting of the Regional Advisory Committee on Medical Research. The enthusiasm and support encountered for establishing priority areas for regional research programmes had been very encouraging. The Committee gave its support to the Regional Director's efforts to strengthen the role of research in the Region: in particular to (1) the establishment of three task forces for the development of regional research programmes - on health services, on parasitic and other communicable diseases, and on cardiovascular diseases - in order to develop comprehensive proposals for research programmes; (2) the proposal to designate the Institute for Medical Research, Kuala Lumpur, Malaysia as a WHO regional centre for research and training in tropical diseases; and (3) the development of close cooperation with the multidisciplinary programme of operational research in the Republic of Korea. It also supported in principle the proposals to establish research on the control of~. japonicum in the Philippines and other research activities but wished to await the detailed plans to be prepared by the three task forces before final approval was given. 1 The Delegation of the People's Republic of China stated that it wished to enter a reservation on this last recommendation.

29 -, REPORT OF THE REGIONAL COMMITIEE 21 The Representative of Malaysia indicated that the Government of Malaysia would do all it could to ensure that the Institute for Medical Research, Kuala Lumpur became a centre of excellence for basic medical research on tropical infectious diseases in the Region, and the Representative of the Republic of Korea welcomed the establishment of close collaboration and exchange of information between Member States and the Korea Health Development Institute. Following a suggestion by the Representative of Western Samoa that an institute in the South Pacific area might carry out a programme of training and research similar to that of the Centre in Kuala Lumpur,' the Committee noted that a filariasis research programme was to be launched in Western Samoa which would certainly benefit other Member States having the same health problem. As with many research activities it comprised a training aspect. It was understood, however, that certain disease conditions were not present in Malaysia and research on them might have to be carried out elsewhere. The Committee also noted the possibility of expanding the research activities in filariasis and fish food poisoning in which WHO was already cooperating in Frenoh Polynesia. The Committee heard with interest of the innovative "open-door" type of research des~ribed by the Representative of China. It noted that the Government of the Socialist Republic of Viet Nam was building up the Institute of Hygiene, Ho Chi Minh Ville which, among. its activities, would be able to undertake research and training of health workers for the Region. In answer to queries as to what sources of funds would be utilized for the various researoh programmes, it was explained that provision had been made under the Regular Budget for the posts of the adviser and his secretary and for the memben of the RACMR to attend its sessions. It was also hoped to finance the preliminary meetings of the task forces which would formulate detailed plans for aotivities requiring extrabudgetary resources. The Committee adopted a resolution indicating its support of the recommendations resulting from the feasibility study for the designation of a research and training centre and those of the Regional Advisory Committee on Medical Research; requesting the three task forces thus established to develop estimated budgets for future researoh and administrative overheads for review by the Regional Advisory Committee on Medical Research and presentation to the Regional Committee; and requesting the Regional Director to continue to seek extra budgetary funds to help in financing research activities (see resolution WPR/RC27. R9 )

30 22 REGIONAL COMMITIEE: 'lwenty-seventh SESSION 5 Alcoholism and other dependence problems (Document WPR/RC27/8 and Corr.l) The Committee recalled that at its twenty-sixth session a number of representatives had expressed the view that, while problems resulting from drug dependence and from alcoholism were similar, they were neverth'eless distinct and should be considered separately. Indeed in many parts of the Region alcoholism was considered to be the greater problem. With the appointment of an adviser under an intercountry project the regional programme in prevention and control of drug abuse was already being intensified. Resolution WPR/RC26/Rll had requested the Regional Director to include the subject of alcoholism as a separate item on the Agenda of the twenty-seventh session. The Committee therefore had before it a report on the present situation in the Region, compiled with material obtained through a questionnaire. The information obtained was interesting. For example, traffic accidents, though they were not a result of alcohol dependence per ~, were considered to be one of the major consequences of excessive drinking. The Committee noted, incidentally, that the WHO programme on health aspects of traffic accidents, for which the Regional Office for Europe was responsible, would include a study of the interaction of alcohol and drugs with road traffic accidents. The Representatives of Australia, Fiji, Japan, New Zealand, Papua New Guinea and the Philippines all bore witness to increases in prevalence of alcoholism, particularly among young people, though the seriousness of the problem differed in varying degrees, depending on the situation in each country; for example in the Philippines the problem was moderate at present but increasing. In Malaysia, dependence on dangerous narcotic drugs was a greater problem for the time being. A number of countries were implementing strong measures to combat the problem. The Committee felt that emphasis should be placed on developing existing means for collecting, processing and publishing available data and for the regular ad hoc collection of statistics. This could be done at less cost, and often to greater benefit, than by introducing new procedures and new collections of statistics and material. The development of training programmes was a central issue in the control of alcoholism. The skillful use of control measures offered the greatest hope of quick containment of health problems related to alcohol and drugs. It was suggested therefore that encouragement be given to further studies and research, with built-in means of evaluation, to produce meaningful results. The Committee adopted a resolution recognizing that the increasing consumption of alcohol was of major concern in many countries or areas of the Region, but that lack of basic information on the extent and characteristics of the problem was a serious hindrance to establishing

31 REPORT OF THE REGIONAL COMMITrEE 23 adequate preventive and remedical measures; urging Member States to promote increased awareness of the problem and to give priority to setting up data collection and monitoring systems which would be comparable on an intercountry basis, and to developing test programmes, programme evaluation and staff training; requesting the Regional Director to cooperate with Member States in giving full attention to the seriousness of alcohol related problems within the context of overall health (see resolution WPR/RC27 R5 ) 6 The regional environmental health programme: regional centre for environmental health sciences (Document WPR/RC27/9) The Committee considered the justification provided as background to a proposal that a regional centre for environmental health sciences, similar to the one in Lima, Peru, be established in the Western Pacific Region. Lacking in the Region were: facilities for intensive training courses on different aspects of environmental health for professionals and technicians; basic data and data on progress in the field of environmental health; criteria and standardized methods applicable to the Region; applied research activities aimed at developing autochthonous technology where only limited resources were available; and a regional forum where scientists could exchange experience. The Committee considered a proposal that a study be carried out by a consultant on the feasibility of establishing such a centre, and the terms of reference proposed for the consultant. While agreeing with the principles behind the proposal, Representatives advocated caution in undertaking an activity that could very well be carried out with existing mechanisms; this particularly when the Director-General had just been asked by the World Health Assembly to ensure that by 1980 at least 60% of the Regular Budget was spent on "technical cooperation". For example, the provision of adequate water supplies and basic sanitation merited priority over the establishment of a centre for environmental health sciences. The Committee requested therefore that the proposed feasibility study first be carried out and that among its terms of reference the foll0wing be included: definition of the needs in the Region which such a centre might meet; indication of alternative methods of meeting those needs, including the use of existing facilities; compilation of a comprehensive analysis of the cost of each alternative; review of the experience at the Lima Centre;

32 24 REGIONAL COMMITmE: 'lwenty-seventh SESSION consideration of the advisability and efficiency of having many disciplines (e.g. physicists, chemists, engineers, microbiologists) together in one Institute. Noting that the study might need several consultants to review the technical and financial implications of establishing a Centre, the Representative of Japan said that his Government would readily provide the services of its own experts. The Representative of France informed the Committee that the Government of France, while taking a deep interest in environmental health, did not support the proposal, since it was already pledged to contribute US$ annually for five years to the United Nations Environmental Programme and considered that optimal use of data from existing centres in the Region would provide all the information required. The Committee adopted a resolution recognizing the importance of the activities in which such a Centre would be engaged; agreeing that it was desirable to make the fullest possible use of technical expertise available in the Region and to consider the creation of an institution responsive to regional policies and needs; agreeing with the proposal to conduct in early 1977 a study on the feasibility of establishing a Regional Centre; authorizing the Regional Director to engage the services of consultants with terms of reference to be established in accordance with the views expressed by the Committee at its present session; requesting the Regional Director to report to the Committee at its twenty-eighth session on the findings and recommendations of the feasibility study (see resolution WPR/RC27.R6). 7 Importance of core programmes for child health, with particular emphasis on staff training through fellowships The Committee noted that the future of any country depended on its children, who were entitled to very high priority in health care. It was well known that in some Member States more than 45% of the population was under 15 years of age, and there was a danger that uncontrolled growth would create such an excess of dependants over wage-earners and providers that social and economic development would slow down or come to a standstill; at the same time there would be increasing demands on the health services, probably beyond their capacity to cope with. The Representative of the United Kingdom, who introduced the subject, said that his Government believed it was preferable to concentrate cooperation in certain specific fields, and attached great importance to paediatrics, especially community paediatrics. There should be emphasis on programmes in maternal and child health, and also in nutrition, with particular attention to the importance of breast-feeding, the prevention of malnutrition, and the reduction of nutritional hazards associated with deficient hygiene. Associated programmes to improve child health included those for the prevention and control of communicable diseases, including common intestinal infections, and health education programmes.

33 REPORT OF THE REGIONAL COMMIT'lEE 25 In all those activities very much would depend on training and retraining. The British Council had called upon its overseas representatives to encourage governments to seek a greater proportion of fellowships in subjects related to child health. A number of specialized institutions in the United Kingdom could offer training in tropical paediatrics (i.e. those paediatric conditions and problems that occurred specifically or with greater frequency in a tropical environment). Seven representatives spoke of the great need for training in every aspect of child health, particularly of low-level health workers. In the Western Pacific Region it was not only the diseases specific to tropical areas that caused most damage but the lethal and handicapping diseases prevalent throughout the world. Maternal and child health were inseparable from primary health care. The Committee adopted a resolution urging Member States to continue their endeavours to meet the needs of children through intensifying the role of adequately trained staff, of all disciplines and at all levels, in promoting activities for improving the outcome of pregnancy and controlling the prevalence of diseases and factors which bear on the psychosocial development of children; requesting the Regional Director to continue to give all possible assistance to Member States encountering problems in the training of health staff to enable them to promote activities benefitting children (resolution WPR/Rc27.RlO). 8 Progress in nutritional surveillance The Committee noted that a recent Joint FAOjUNICEF/WHO Expert Committee on the Methodology of Nutritional Surveillance of which Dr Solon, a member of the Philippine delegation to the present session of the Regional Committee, had been a member, had produced guidelines on the development of nutritional surveillance systems,l. The Expert Committee had noted that famines generally occurred in areas where the nutritional situation was chronically poor. It was important that surveillance aimed at forecasting famines should make use of a wide range of information - not merely clinical and dietary information but also agricultural, economic and meteorological data. The Expert Committee had recommended making maximum use of existing data; for example, if data recorded by maternal and child health services on growth and nutritional status were analysed more closely they could provide early pointers to changes in the nutritional situation. The basic idea underlying the proposed surveillance programme was to identify the nature and extent of nutritional problems not only in the Western Pacific Region but also in other Regions, where they were sometimes worse. Chronic malnutrition, for example, could rapidly lead to famine in cases of food shortages. The first step was to gather knowledge on a wide scale so as to be able to intervene if necessary. 1 WHO Technical Report Series, No. 593, 1976.

34 26 REGIONAL COMMI'I'IEE: 'lwenty-seventh SESSION The Representative of the United Kingdom, who introduced the subject, said that not enough was known of the methodology of surveillance, which needed to be adapted to the resources and conditions of different countries or areas; a flexible approach was essential. In general, clinical data tended to show only the after-effects of food shortages, and for early warning it would be necessary to rely on experts in agriculture and economics. Any surveillance would therefore need to be coordinated through a central national agency for nutritional planning and policy. The Committee heard a statement, read by a Representative of the Philippines, on nutritional surveillance in the Philippines, where the main purpose of the programme was the identification of nutritional problem areas so that remedial measures could be instituted. Over three million children had been weighed, and malnutrition of the first, second and third degrees among them had been quantified. The Committee adopted a resolution noting that malnutrition persists, even when national economic indicators improve; urging Member States to develop simple nutritional surveillance systems which will provide data on deprived groups, in order to facilitate medium and long-term planning and to predict deterioration in nutritional status so that rapid preventive action can be taken; requesting the Regional Director to assist Member. States in developing and validating surveillance systems suited to the resources of individual countries and based on minimal data. (see resolutipn WPR/RC27.Rll). 9 The Committee recalled that, at its twenty-sixth session, it had decided to wait until its present session to consider whether it wished to prepare a fifth regional programme of work covering the period , or whether the Sixth General Programme of Work for the same period, adopted by the Health Assembly in May 1976, was a sufficient guide to deliver the programme of the Region.1 At the twenty-sixth session, when the Committee considered the draft of the Sixth General Programme of Work, it allocated priorities to each principal and detailed objective. In the final Programme adopted by the Health Assembly these objectives had been somewhat reworded or amplified, and in some cases their order had been changed. They remained, however; essentially the same, except for four which were new. The Committee therefore had to decide the following: (1) whether it agreed that all except four of the objectives of the final Sixth General Programme of Work remained essentially the same and therefore retained the same regional priority as those contained in the draft which was before the Committee in 1975; (2) the priorities, for the regional programme, of the four new objectives; (3) the necessity, or otherwise, to prepare a fifth regional programme of work. 1 Resolution WHA29.20, WHO Official Records, No. 233, 1976, pp

35 REPORT OF THE REGIONAL COMMI'.MEE 27 After the Representative of Australia had referred to resolution WHA29.20; in particular to operative paragraph 2(b),.and suggested that regional committees could.play an important role in assisting the Executive Board by indicating which sections of the Programme should be given high priority for in-depth study, the Committee decided to appoint a working group, consisting of the Representatives of Australia, Fiji, Malaysia, Philippines and Western Samoa, to consider the whole question. The Working Group subsequently presented a draft of its terms of reference to the Committee, which were accepted with slight amendment (see Annex 4). The report of the Working Group was presented to the Committee on Friday, 10 september. After having reviewed the report the Committee adopted four resolutions: (1) allocating priorities to the four new objectives contained in the Sixth General Programme of Work covering a Specific Period ( inclusive) (see resolution WPR/RC27.R14); (2) deciding that elaboration of a separate programme of work for the Western Pacific Region would serve no useful purpose, since the Sixth General Programme of Work constituted a sufficient guide for the delivery of the WHO programme in the Region (see resolution WPR/RC27. RlS ) ; (3) establishing a Sub-Committee, with membership to be rotated annually, consisting initially of the Chief Representatives of Australia, Fiji, Malaysia and the Philippines; to review, analyse and make. recommendations on the development and implementation of the WHO General Programme of Work as it affects the Western Pacific Region (see resolution WPR/RC27.R16); (4) requesting the Regional Director to recommend to the Executive Board (a) three programme areas, having priori ty in the Western Pacific Region, for in-depth study by the Executive Board: primary health care; prevention and control of cardiovascular diseases; nutrition; (b) that stress be laid on the desirability of the Executive Board selecting topics which might evoke a deeper appreciation of the changing role and wider involvement of WHO in the development process, as well as forge closer links with other organizations in efforts towards socioeconomic development (see resolution WPR/Rc27.R17). 10 Method of work of the Regional 10.1 Frequency of meetings of the Regional Committee (Document WPR/Rc27/1l Rev.l) The Committee reviewed a report presented by the Regional Director on the implications of changing the sessions of the Regional Committee to a biennial sequence.

36 28 REGIONAL COMMI'l'IEE: 'lwenty-seventh SESSION It noted the arguments for and against the proposal, including the fact that amendments to Articles 34 and 55 of the WHO Constitution had not yet entered into force and therefore the World Health Assembly ztill had to consider the budgetary and financial aspects of the biennial programme budget annually. Word had just been received from WHO Headquarters that on 26 August 1976, 75 Member States had accepted the proposed amendments; 23 more acceptances were still required. The Committee decided to maintain the status ~ for the time being and to review the question again if and when the required number of acceptances to amend Articles 34 and 55 were received and the World Health Assembly adopted biennial budgeting. In reply to comments of the Representative of Malaysia, who wished to continue meeting annually, and the Representative of Western Samoa, who asked what the position of the Regional Committee would be if the World Health Assembly amended the Constitution, it was explained that Rules 4 and 5 of the Rules of Procedure of the Regional Committee for the Western Pacific allowed for the Committee to hold sessions as often as it wished. It had been the practice for the Committee to meet annually but it was free to change the frequency of its sessions if it so desired. The Committee adopted a resolution deciding to maintain annual sessions until further consideration of the subject at a future session (see resolution WPR/Rc27.R7) Annual reporting by the Regional Director (Document WPR/RC27/l2 and Corr.l) The Committee noted that, in 1977, the Director-General would present to the World Health Assembly, as background material for its consideration of the proposed programme budget for 1978 and 1979, a short report covering significant matters and developments in In 1978, he would publish and present to the Health Assembly a comprehensive report on the work of WHO in 1976 and that is, the years covered by the present biennial programme budget. He would also discontinue publishing a report on individual projects. The decision to adopt that new cycle had been taken in order to relate reporting by the Director General to biennial programme budgeting and to the new concept of programming by objectives and budgeting by programmes. The Committee noted the report which described the background to the Health Assembly's decision in detail. It decided that the Regional Committee should follow a similar cycle; remembering that the proposed biennial programme budget estimates were considered by the Committee in the year before they were considered by the Health Assembly and that the cycle of reporting to the Regional Committee would therefore have to be: a comprehensive report in odd-numbered years and a short report in evennumbered years.

37 REPORT OF THE REGIONAL COMMITmE 29 The Committee adopted a resolution authorizing the Regional Director to: issue in even-numbered years, beginning in 1978, a short report covering significant matters and developments during the preceding year from 1 July to 30 June; in odd-numbered years, beginning in a comprehensive report on the work of WHO during the preceding two years from 1 July to 30 June; and beginning in discontinue publishing a report on individual projects on the understanding that the Regional Director will make available to members of the Regional Committee, on request, full information on any project (see resolution WPR/RC27.R8). 11 Time and place of the twenty-eighth and twenty-ninth sessions of the Regional Committee The Committee accepted with appreciation the invitation of the Government of Japan, confirmed by its Representative to the Regional Committee, to hold its twenty-eighth session in Tokyo provided a satisfactory agreement was concluded by 31 March Because of increased pressure on the Secretariat when a meeting was held outside Manila it agreed that the dates should be 6 to 12 September The Committee also accepted with pleasure the offer of the Government of the Philippines to act as host to the twenty-ninth session, which would be held in Manila. The Committee adopted a resolution conveying its appreciation to the Governments of Japan and the Republic of the Philippines (see resolution WPRjRC27.R13). 12 Selection of topic for the Technical Presentation during the twenty-eighth session of the Regional Committee (Document WPR/RC27!13) The Committee selected "National drug policies and management" as the topic of the Technical Presentation during the twenty-eighth session" of the Regional Committee (see resolution WPRjRC27.R12). 13 Reports received from governments on the progress of their health activities The Chairman acknowledged the following reports presented to the Committee: (1) AUSTRALJA - Report on national health activities, 1975/76; (2) FIJI - Brief report on health activities; (3) FRENCH POLYNESIA - Rapport succinct sur les activites sanitaires (1975); (4) HONG KONG - Brief report on progress of health activities, 1975;

38 30 REGIONAL COMMITIEE: 'lwenty-seventh SESSION (5) JAPAN - Report on the progress of health activities (1976); (6) MACAO - Brief report on the progress of health activities, 1975; (7) MALAYSIA - Brief report on the progress of health activities; (8) NEW ZEALAND - Brief report on the progress of health activities, 1975/76; (9) PAPUA NEW GUINEA - Brief report on the progress of health' activities during the last 12 months; (10) PHILIPPINES - State of health, 1975; (11) REPUBLIC OF KOREA - Report on the progress of health activities; (12) SOCIALIST REPUBLIC OF VIET NAM - Rapport succinct sur la situation sanitaire en PART IV. RESOIlJTIONS ADOP'lE) BY THE REGIONAL COMMITIEE WPR/RC2?:.Rl ALLOCATION AND MANAGEMENT OF WHO'S RESOURCES AT REGIONAL AND COUN'ffiY revel The Regional Committee, Having considered the report of the Regional Director on the development of programme budgeting and management of WHO's resources at country level,l Stressing the importance of a programme-oriented approach to the collaborative planning and implementation of WHO technical cooperation at country level, 1. ENDORSES the programme budgeting procedures and the form of budget presentation outlined in the report; and 2 RECOMMENDS to the Executive Board that the proposed programme budgeting procedures be adopted with effect from the forthcoming progra/lllle budget cycle and that the proposed form of budget presentation be introduced in the proposed programme budget for Second meeting, 6 September Document WPR/Rc27 /4.

39 REPORT OF THE REGIONAL COMMITmE WPR/RC27.R2 ANNtJAL REPORT OF THE REGIONAL DIRECTOR The Regional Committee, Having reviewed the Report of the Regional Director on the work of the World Health Organization in the Western Pacific Region during the period 1 July 1975 to 30 June 1976,1 1. NOTES with satisfaction the manner in which the programme was planned and carried out; and 2., COMMENDS the Regional Director and his staff for the work accomplished. Third meeting, 7 September 1976 WPR/RC27.R3 SPECIAL ASSISTAM::E TO DEMOCRATIC KAMPUCHEA, THE LAO PEOPIE '5 DEMOCRATIC REPUBLIC AND THE SOCIALIST REPUBLIC OF VIET NAM The Regional Committee, Having considered resolution waa29.24 adopted by the Twenty-ninth World Health Assembly, 1. NOTES the Report on the Special Meeting on ASSistance to the Democratic Republic of Viet Nam and the Republic of South Viet Nam and the success achieved by the WHO Preparatory Mission;2 2. NOTES, further, the details of the special assistance request,d by the Government of the Lao People's Democratic Republic; 3 3. EXPRESSES its appreciation of the interest shown by some Member States, in making voluntary contributions for operations in the now unified Socialist Republ1c of Viet Nam, including the contributions by the Governments of Australia and Canada announced at the present session; 4. APPEAIS to other Member States to lii$ke voluntary contributions for these exceptional operations in the Lao People's Democratic Republic and the Socialist Republic of Viet Nam; 1 Document WPR/RC27/3 and Corr.1. 2 Documents WPR/RC27/5 and WPR/RC27/5 Add.l. 3 Document WPR/RC27/5 Add.2.

40 22 REGIONAL COMMITrEE: MNT'f-SEVENTHSESSION 5. REQUES~ the Regional Director to continue to assist the Director General in his efforts to provide all forms of assistance to the three countries concerned in the most expeditious, efficacious and flexible manner. Third meeting, 7 September 1976 WPR/RC27.R4 RESOLU'ITONS OF REGIONAL IN'IEREST ADOPTED BY THE ':twenty NINTH WORLD HEALTH ASSEMBLY AND THE EXECUTIVE B()ARD AT I~ FIFTY-SEVENTH AND FIFTY-EIGHTH SESSIONS The Regional Committee TAKES note of the following resolutions adopted by the TWentyninth World Health Assembly and the Executive Board at its fiftyseventh. 'and' f1ftj'-eighth sessions: WHA Sixth General Programme of Work covering a Specific Period WHA Psychosocial factors and health :WHA Report on the world health situation EB57.R46 WHA Real Estate Fund WHA Voluntary Fund for Health Promotion EB58.R10 WHA Organizational study on the planning for and impact of extrabudgetary resources on WHO's programmes and poiicy WHA Coordination with the United Nations system.. general.,:. EB57.R49 matters: UNDP-supported acti vi ties - financial situation EB57.R48 - Coordination with the UIiitedNations system: matters general EB57.R50 - Coordination with the United Nations system (general matters): technical cooperation among developing countries

41 REPORT OF THE REGIONAL COMMITIEE 33 WHA International Women's Year WHA WHO's human health and environment programme WHA Health aspects of human settlements WHA Community water supply and excreta disposal WHA Programme budget policy WHA Cardiovascular diseases WHA Occupational health programme ~29,,58 - Schistosomiasis WHA Mycotic infections.. WHA Expanded programme on immunization WHA Rheumatic.diseases WHA The need for laboratory animals for the control of biological products and the establishment of breeding colonies (nonhuman primates) WHA Disability prevention and rehabilitation WHA Leprosy control WHA Health manpower development WHA Development of the antimalaria programme EB57.R26 WHA29 l9 WHA29.74 EB57.R27 - Promotion of national health services and health technology relating to primary health care and rural development EB57.Rl7 - Development of programme evaluation in WHO EB58.Rll - Report by the representatives of the Executive Board at the Twenty-ninth World Health Assembly: Method of work of the Executive Board in relation to programme development Third meeting, 7 September 1976

42 REGIONAL COMMI'ITEE: 'lwenty-seventh SESSION WPR/RC27.R5 AICOHOL AND OTHER DEPEND~E PROBIEMS The Regional Committee, Having considered the progress report provided by the Regional Director in connexion with resolution WPR/RC26.Rll on the abovementioned subject,l 1. NOTES with satisfaction the activities already undertaken and proposed by WHO; 2. RECOGNIZES that the increasing consumption of alcohol is a major problem in many countries or areas of the Region, but that lack of basic information on the extent and characteristics of the problem is a serious hindrance to establishing adequate preventive and remedial measures; 3. URGES Member States to promote increased awareness of the problem and to give priority to setting up data collection and monitoring systems which will be comparable on an intercountry basis, and to developing test programmes, programme evaluation and staff training; 4. REQUES'15 the Regional Director to cooperate with Member States in giving full attention to the seriousness of alcohol related problems within the context of overall health; 5. THANKS the Regional Director for his report. Fourth meeting, 8 September 1976 WPR/RC27.R6 REGIONAL CENTRE FOR ENVIRONMENTAL HEALTH SCIENCES The Regional Committee, Having studied the proposal submitted by the Regional Director in document WPR/Rc27/9 on the establishment of a Regional Centre for Environmental Health Sciences,2 1. RECOGNIZES the importance of the acti vi ties in which such a Centre would be engaged; 2. AGREES that it is desirable to make the fullest possible use of technical expertise available in the Region and to consider the creation of an institution responsive to regional policies and needs; 1 Document WPR/RC27 18 apd Corr.l.

43 REPORT OF THE REGIONAL COMMITIEE AGREES further with the proposal to conduct in early 1977 a study on the feasibility of establishing a Regional 'Centre.; 4. AUTHORIZES the Regional Director to engage the services of consultants with terms of reference to be established in accordance with the views expressed by the Committee at its present session; 5. REQUESTS the Regional Director to report to the Committee at its twenty-eighth session on the findings and recommendations of.the feasibility study. Fourth,meeting, 8 September olPR/RC27. R7 FREQUENCY OF MEETINGS OF THE REGIONAL COMMITIEE The Regional Committee, Having considered the report of the Regional Director on frequency of meetings of the Regional Committee, prepared in response to resolution lojpr/rc26.r15; " Having been informed that. the amendments to Articlef:i 34 and 55 of the Constitution, which are expected to result in full biennial programme-budgeting for the OrganiZation, have not yet entered into force; Believing that a coordinated approach to the f:iubject would be preferable to having each regional committee deal with it separately; DECIDES to maintain annual sessions until further consideration of the subject at a future session. Fourth meeting, 8 September o1PR/Rc27.R8 ANNUAL REPORTING BY THE REGIONAL.DIRECTOR The Regi.onalC:':omml ttee, Having considered the report of the Regional Director on the subject of annual reporting by him,2 1 Document WPR/RC27/ll Rev.l. 2 Document WPR/RC27/12 and Corr.l.

44 36 REGIONAL COMMIT'mE: 'lwe}fl'y-seventh SESSION 1. CONSIDERS it desirable that the reports of the Regional Director to the Regional Committee should harmonize with those of the Director General to the World Health Assembly; 2. AUTHORIZES the Regional Director to: (1) issue in even-numbered years, beginning in 1978, a short report covering significant matters and developments during the preceding year from 1 July to 30 June; (2) issue in odd-numbered years, beginning in 1979, a comprehensive report on the work of WHO during the preceding two years from 1 July to 30 June; (3) beginning in 1977, discontinue publishing a report on individual projects on the understanding that the Regional Director will make available to members of the Regional Committee, on request, full information on any project. Fourth meeting, 8 September 1976 WPR/Rc27.R9 WHO I S ROrE IN THE DEVELOPMENT AND COORDINATION OF momedical RESEARCH: GREA'lER INVOLVEMENT OF THE REGIONS IN RESEARCH The Regional Committee, Having considered the progress report provided by the Regional Director on the greater involvement of the Western Pacific Region in the development and coordination of biomedical research, 1 1. THANKS the Regional Director for his report; 2. NO'mS with satisfaction: (1) the recent establishment of a post of regional adviser in biomedical research; (2) the creation of the Regional Advisory Committee on Medical Research; (3) the recommendations resulting from the feasibility study for the designation of a WHO regional centre, or centres, for research and training in tropical diseases, including the effects of malnutrition; 1 Document WPR/RC2'j' /7.

45 - REPORT OF THE REGIONAL COMmT'lEE APPROVES the recommendations of the experts carrying out. the feasibility study and, subsequently, those of the Regional Advisory Committee on Medical Research that: (1) the Institute for Medical Research, KU$la Lumpur, Malaysia, be strengthened, and eventually designated a WHO regional centre for research and training in tropical diseases; (2) close cooperation be developed with the multi-disciplinary programme of operational research in the Republic of Korea; and (3) three task forces be established to advise on the development of regional research programmes in health services, in parasitic and other communicable diseases and in cardiovascular diseases; 4. REAIJZEB that additional fund,s w111 be required to implement the above-mentioned recommendations; 5. REQUESTS the Regional Director: (1) to take the neoessary steps, as far as funds become available, to implement the decisions reflected in paragraph 3 above; (2) to request the three task forces to develop estimated budgets for future research and administrative overheads, for review by the Regional Advisory Committee on Medical Research and presentation to the Regional Committee; (3) to continue approaching Member states, foundations and voluntary agencies for contributions to help in financing the resear.ch aetivi ties; (4) to study further the setting up of a multi-disciplinary research programme on schistosomiasis in the Philippines and to report thereon to the Regional Committee at its next session; 6. REQUESTS Member States and voluntary agencies to make funds and other forms of cooperation available for research activities in the Region. Fifth meeting, 10 September 1976

46 REGIONAL COMMI.T'lEE: 'MN'lY-SEVENTH SESSION WPR/RC27 RIO CORE PROGRAMMES FOR CHIIDHEALTH" WITH PARTICULAR EMPHASIS ON STAFF 'maining The Regional Committee, Having considered the statement of the Representative of the United Kingdom on the importance of core programmes for child health, with particular emphasis on staff training; Reiterating the importance for child health of nutrition. particularly nutritional hygiene, communicable diseases and health education; Appreciating the interest of Member States of the Region in the needs and problems of childhood, in particular those relating to prevalent pathology and to influences on the psychosocial development of children; 1. NO'lES with satisfaction the efforts of WHO and other United Nations agencies, in part1cularunicef; 2. URGES Member States to continue their endeavours to meet the needs of children through intensifying the role of adequately trained staff, of all disciplines and at all levels, in promoting activities for improving the outcome of pregnancy and controlling the prevalence of diseases and factors which bear on the psychosocial development of children; 3. REQUESTS the Regional Director to continue to give all possible assistance to Member States encountering problems in the training of health staff to enable them to promote activities benefitting children. Fifth meeting, 10 September 1976 WPR/RC27. Rll PROGRESS IN NUTRITIONAL SURVEILLANCE The Regional Committee, Having considered the statement of the Representative of the United Kingdom on the need to develop national systems for nutritional surveillance; Having heard with interest of the steps being taken in certain countries and areas of the Region; 1. NOTES that malnutrition persists, even when national economic indicators improve;

47 2. URGES Mellber states to develop simple nutritional surveillance systemswhieb will pr.ovide data on, deprived groups in order to, ' facilitate medium and long.. term planning and to predict deterioration in nutritional status so that rapid preventive action can be taken; 3. REQUESTS the Regional Director to assist Member States in developing and validating surveillance systems suited to the resources of individual countries and based on minimal data. Fifth IIIHtinl. 10 Septeaber WPR/RC27.Rl2 TOPIC OF 'lechnical PRESENTATION IN 1977 '!he Regional C<DI1 ttee. Having.considered the topics sugpateci b1 the Regional Director for the Technical Presentation during the twent1-eighth session of the Committee, 1. DECIDES that the subject for the Technical Presentation in 1977 shall be "NatIonal drug policies and management". Fifth meeting, 10 September 1976 WPR/RC27 Rl3 'twenty-eighth AND 'lwenty-ninth SESSIONS OF THE REGIONAL CClIIMI'rlEE 'nle Regional COIIIIIIi ttee 1. EXPRESSES its appreciation to - the Government of Japan for confirming its offer to act as host to the twenty-eighth session of the Regional Committee; 2. CONFIRJIIS that the twenty-eighth session will be held in TokJO. rca 6 to 12 September 1977, provided. a satisfactory agreement is concluded between the Government and WHO by 31 March 1977; 3. EXPRESSES its appreciation to the Government of the Republic of the Philippines for its offer to act as host during the twenty-ninth session which will be held in Manila; 1 Document WPR,/RC27/1.3.

48 40 REGIONAL COMMITIEE:' 'IWENTY..sEvENTH SESSION 4. ACCEP'IS the kind offer of the Government of the Republic of the Philippines, noting th~ft it will be confirmed formally in the near future. Fifth meeting, 10 September 1976 WPR/RC27.R14 SIXTH GENERAL PROGRAMME OF WORK COVERING A SPECIFIC PERIOD: PRINCIPAL AND DETAIIED OBJECTIVES The Regional Committee, Having noted resolution WHA29.20 adopted by the Twenty-ninth World Health Assembly; Recalling resolution WPR/RC26.R12, which indicated an order of priority for the regional programme to the principal and detahed. objectives of the draft of the Sixth General programme of Work covering a specific period ( inclusive); 1. NOTES that, with the exception of four detailed objectives which are new, the principal and detailed objectives of the Sixth General Programme of Work approved by the World Health Assembly remain essentially th~ same as those contained in the draft, despite some rewording. amplification and rearrangement; 2. REAFFIRMS that the priorities indicated in resolution WPR/RC26.R12 remain valid; 3. ACCORDS the following priorities for the regional programme to the four new objectives: Section A. 3.1 To reduce maternal. perinatal. infant and childhood mortality and morbidity. and to promote reproductive health and the physical and psycho-social development of the child and adolescent wi thin the family context; 3.2 To collaborate with countries in the development and strengthening of the family health component of health services, including family planning and welfare; Priority A Priority A

49 REPORT OF THE REGIONAL COMMIT'lEE 41 Section B. 7.1 To projllote closer cooperation between all services concerned with health promotion and to integrate them into a single system where appropriate; 1.6 To develop and apply chemical, biological, genetic and other means of control, of disease vectors, intermediate hosts and reservoirs of pathogenic agents, with due regard to safety for man and the environment. Priority B Priority B Fifth meeting, 10 September 1976 WPR/Rc27.Rl5 PREPARATION OF A REGIONAL PROGRAMME OF WORK 'lberegi.onal Committee, Having considered the information provided by the Regional Director regarding the necessity or otherwise to prepare a Fifth Regional Programme of Work covering a Specific Period ( inclusive);l Having, by its resolutions WPR/RC26.R12 and WPR/Rc27.R14, accorded regional priorities to the principal and detailed objectives of the Sixth General Programme of Work covering a Specific Period ( inclusi ve); CONSIDERS that the elaboration of a separate programme of work for the Western Pacific Region "ill serve no useful purpose, since the Sixth General Programme of Work covering a Specific Period ( inclusive) constitutes a sufficient guide for the delivery of the WHO programme in the Region. Fifth meeting, 10 September Document WPR/RC27/10.

50 42 REGIONAL COMl([TlEE: 'IWENTY-SEVENTH SESSION WPR/Rc27.Rl6 SUB-COMMITIEE ON THE GENERAL PROGRAMME OF WORK The Regional Committee, Having noted the report of the Working Group on the application of the General Programme of Work within the Western Pacific Region,l 1. DECIDES to establish a sub-committee with membership to be rotated annually, to review, analyze and make recommendations on the development and implementation of the General Programme of Work as it affects the Western Pacific Region; 2. REQUESTS the Regional Director to take appropriate action, including the provision of necessary budget, to enable the Sub-Committee on the General Programme of Work to be established; 3. DECIDES that the Sub-Committee at the twenty-eighth session of the Regional Committee will be composed of the Chief Representatives of Australia, Fiji, Malaysia and the Philippines. Fifth meeting, 10 September 1976 WPR/RC27.R17 SIXTH GENERAL PROGRAMME OF WORK COVERING A SPECIFIC PERIOD: PRIORITIES FOR IN-DEPTH STUDIES The Regional Committee, Having noted the report of the Working Group on the application of the Sixth General Programme of Work within the Western Pacific Region;l Referring particularly to operative paragraph 2(b) of resolution WHA29.20 adopted by the Twenty-ninth World Health Assembly; REQUESTS the Regional Director to transmit to the Director-General for the consideration of the Executive Board the following recommendations: (1) that the programme areas listed below, of high priority within the Western Pacific Region, are suitable for in-depth study by the Executive Board: (a) primary health care, 1 ' Document WPR/RC27/Working Paper/2.

51 REPORT OF THE REGIONAL COMMITlEE 43 (b) prevention and control of communicable diseases, (0) nutrition; (2) that stress be laid on the desirability of the Executive Board selecting topics which may evoke a deeper appreciation of the changing role and wider involvement of WHO in the development process, as well as the forging of closer links with other organizations in efforts towards socioeconomic development. Fifth meeting, 10 September 1976 WPR/RC27.R18 'IECHNICAL COOPERATION The Regional Committee, Having considered the nature of technical cooperation in connexion with the review of the Proposed Programme Budget Estimates for 1978/1979; Being convinced that a common definition, and acceptance of. the term "technical cooperation" should be used throughout the Organization; COMMENDS to the Executive Board the definition and explanation of technical cooperation set forth in the statement attached as Annex 1. Sixth meeting. 10 September 1976 ANNEX 1 'lechnical COOPERATION Technical cooperation may be described as: Any activity of WHO. particularly if jointly developed by WHO and a Member State(s). which increases the capability of the Member State(s) to carry out its own programmes within the health field. Such an activity should be mutually conceived and/or mutually agreed to by WHO and Member States. Any acti vi ty which achieves this result could be said to be of direct benefit to that Member State. 1. Activities conferring direct benefit include: (1) the provision of supplies or equipment;

52 44 REGIONAL COMMI'l"lEE: 'lwenty-seventh SESSION (2) the increase in local skills in a Member State by means of training programmes, (a) (b) conducted in the country itself, conducted abroad - these could be WHO fellowships for study abroad. or participation in interregional and regional seminars and workshops; (3) advisory services to specific programmes of Governments of Member States by means of WHO short-term consultants and regional and Headquarters permanent staff. aoting in an advisory oapacity; (4) the WHO country representatives. 2. Activities oonferring an indirect benefit should also be included as technical cooperation. Activities oonferring an indirect benefit include: (1) the information-gathering services of WHO and its activities as an information clearing house; (2) epidemiologioal advice and informat1on. including the Weekly Epidemiological Record; (3) the evolution of skills and techniques and strategies which. developed within WHO. are available for use if required by various Member States; (4) Expert Committees and Expert Advisory Panels; (5) general planning activities of WHO; (6) attendance of delegates at World Health Assemblies. Executive Boards and Regional Committee meetings; (7) general coordination by WHO of health activities and WHO's activities in bilateral and multilateral aid programmes; (8) development and support of research programmes. 3. Expenses NOT usually included under the heading of "Technical Cooperation" are-those of a purely administrative nature; such as: (1) maintenance of Headquarter~ and Regional Offices; (2) salaries of maintenance staff; (3) salaries of finance and administrative staff at Headquarters and in Regional Offioes.

53 REPORT OF THE REGIONAL COMMITTEE 45 WPR/RC27.Rl9 BUDGET PERFORMANCE 1975 ~ DIRECT SERVICES 'ro GOVERNMEN'I5 The Regional Committee 1. NOTES the report of the Regional Director on budget performance for the financial year 1975,1 and 2. REQUES'I5 the Regional Director to make reports of a similar nature to future sessions of the Regional Committee. Sixth meeting, 10 September 1976 WPR/RC27.R20 REVISIONS MADE TO THE 1977 PROGRAMME BUDGET ESTIMATES The Regional Committee, Having examined the report presented by the Regional Director on the revisions made to the 1977 regular programme budget estimates,2 TAKES NOm of the changes made. Sixth meeting, 10 September 1976 WPR/RC27 R21 PROPOSED PROGRAMME BUDGET ESTIMATES FOR 1978 AND 1979 The Regional Committee, Having examined the proposed programme budget estimates for 1978 and 1979 to be financed from the Regular Budget and other sources of funds, and those included in the List of Additional Projects,3 1. NOTES with appreciation the detailed information on consultant and fellowship provisions contained in Annexes VI and VII of document WPR/Rc27/2; 1 Document WPR/RC27/p&B/2. 2 Documents WPR/RC27/2, WPR/RC27/2 Rev.l and Rev.2 and WPR/RC27/P&B/3. 3 Documents WPR/RC27/2, WPR/RC27/2 Rev.l and Rev.2.

54 46 REGIONAL COMMIT'lEE: 'lwenty~seventh SESSION 2. NO'!'ES further the list of proposals for implementation when additional funds become available from extrabudgetary sources, contained in Annex IV of document WPR/RC27/2; 3. CONSIDERS the List of Additional Projects and the list of proposals for implementation if funds become available as part of the regional programme; 4. REQUESTS the Regional Director to transmit the proposals to the Director-General for consideration and inclusion in his proposed programme budget for 1978 and Sixth meeting, 10 September 1976 WPR/Rc27.R22 'lentative PROJECTIONS OF THE mdget ESTIMA'lES FOR 1980 AND 1981 The Regional Committee, Having examined the tentative projections of the programme budget estimates for 1980 and 1981, for the western Pacific Region, presented by the Regional Director,l REQUESTS the Regional Director to transmit these tentative projections to the Director-General. Sixth meeting, 10 September 1976 WPR/RC27.R23 EXPRESSION OF SYMPATHY The Regional Committee EXPRESSES its deepest condolences to the Government and People of the People's Republic of China on the death of their esteemed leader, Chairman Mao Tse-tung. Fifth meeting, 10 September Documents WPR/RC27/2 and WPRjRC27/p&B/4.

55 REPORT OF THE REGIONAL COMMI'I'lEE 47/48 WPR/RC27.R24 ADOPTrON OF THE REPORT '!he Regional Committee. Having considered the draft report of the twenty-seventh session of the Regional Committee,l ADOPTS the report. Sixth meeting, 10 September 1976 WPR/RC27.R25 RESOWTION OF APPRECIATION '!he Regional Committee EXPRESSES its appreciation and thanks to: (1) the Chaiman and other officers of the COJlllllittee; (2) Dr Chin Hsiang-Kuan and Dr K. Newell for making the Technical Presentation on "Primary Health Care"; (3) the representatives of the United Nations Development Programme, the United Nations Children's Fund, the International Labour Organisation, the South Pacific Commission and the non-governmental organizations for their statements; (4) the Regional Director and the Secretariat for their work in connexion with the meeting. Sixth meeting, 10 September Document WPR/RC27/l6.

56 REPORT OF. THE REGIONAL COMMIT'lEE 49 ANNEX 1 LIST OF NON-GOVERNMENTAL ORGANIZATIONS WHOSE REPRESENTATIVES MADE STA'IEMEN'lS 'ro THE REGIONAL COMMITlEE ~ade Representatives of the following non-governmental organizations state~nts to the Committee: WORlD FEDERATION OF SOCIETIES OF ANAESTHESIOLOGISTS IN'lERNATIONAL UNION OF ARCHL'IEC'lS WORlD FEDERATION OF THE DEAF IN'lERNATIONAL DENTAL FEDERATION IN'IERNATIONAL UNION FOR HEALTH EDUCATION CHRISTIAN MEDICAL COMMISSION MEDICAL WOMEN'S IN'IERNATIONAL ASSOCIATION IN'lERNATIONAL COMMITlEE OF CATHOLIC NURSES IN'lERNATIONAL COUNCIL OF NURSES WOrlLD FEDERATION OF OCCUPATIONAL THERAPISTS IN'IERNATIONAL PIANNED PARENTHOOD FEDERATION IN'IERNATIONAL SOCIETY OF RADIOGRAPHERS AND RADIOLOGICAL 'IECHNICIANS IN'lERNATIONAL SOCIETY OF RADIOWGY LEAGUE OF RED CROSS SOCIETIES REHABILITATION IN'lERNATIONAL IN'IERNATIONAL IEAGUE AGAINST RHEUMATISM COUNCIL FOR IN'IERNATIONAL ORGANIZATIONS OF MEDICAL SCIE~ES IN'IERNATIONAL COUNCIL ON SOCIAL WELFARE INTERNATIONAL COLLEGE OF SURGEONS

57 50 INTERNATIONAL ORGANIZATION AGAINST TRACHOMA WORLD VE'lERANS FEDERATION WORID FEDERATION OF UNI'IED NATIONS ASSOCIATIONS

58 L REPORT OF THE. REGIONAIt COl!llTlEE.. ANNEX 2 AGENDA 1 Opening of the session 2 /peletei! 3 LDeleteii 4 Election of new officers: Chairman, Vice-Chairman and Rapporteurs 5 Address by incoming Chairman 6 Adoption of the agenda 7 Proposed Programme Budget Estimates and Establishment of the Sub-Committee on Programme and Budget 7.2 Consideration of the report presented by the Sub-COlllll1 ttea on Programme and Budpt 8 Acknowledgement by the Chairman of brief report$ received from governments on the progress of their health activities 9 Report of the ~egi0j?8l Director 10 Allocation and management of WHO's resources at regional and country level 11 SpeCial assistance to Democratic Kampuchea, the Lao People's Democratic Republic. and the Socialist Republic of Viet Ham 12 Resolutions of regional interest adopted by the TWenty-ninth World Health Assembly and the Executive Board at ita fifty-seventh and fifty-eighth sessions 13 WHO's role in the development and coordination of biomedical researqh: greater involvement of the Regions in research (resolution WPR/RC26.RIO) 14 Alcoholism (resolution WPR/RC26.Rll) 15 '!he Regional Environmental Health Progra.e: Regional centre for environmental health sciences 16 Preparation of a Fifth Regional Programme of Work covering a Specific Period ( inclusive) (resolution WPR/RC26.R12)

59 52 REGIONAL CQ!fi1"iEE'.:~-SEWNTH SESSION, 17 MethOd of work of the Regional COI1IIIi ttee 17.1 Frequency of meetings of the Regional Committee (resolution WPR/RC26.R15)., 17.2 Annual reporting by the Regional Director 18 Statements of representatives of the United Nations, the Specialized Agencies. of intergovernmental and non~governmental organizations in official relations with WHO 19 Selection of topic for the Technical Presentation during the twenty 'eighth session "of the Regiona-1COIIIIIi ttee 20 Time and place of the twenty-eighth and twenty-ninth sesslons of the Regional Committee 21 Adoption of the draft report of the COIIIIIittee 22 Closure of the session Supplementary agenda item 1 Supplementary agenda item 2 The importance of core programmes for child health, with particular emphasis on staff training through fellowships Progress in nutritional surveillance 4.'. -...

60 REPORT, OFoTHE BEGIONAL COMMITlEE. C.l, ~ t ANNEX 3 'A:NNEXE3 UST OF REPRESENTAT.[VES ',US'lE DES REPRESENTANTS, ;'. I. REPRESENTATIVES OF MEM8ERSTATES REPRESENT ANTS. DES ETA~ MEMBERS ' A~~j:.J:A AUS'mALIE _ ~. ~.",,'pr C. Evans, Deputy Director-General of He,lilth Department of Health (Chief Representative) (Chef de la delegation) f '-,~ Mr K. Boreham, ' ;',First Secretary Australian Embassy in Manila, (Alternate/Suppleant) CHINA CHINE,... Dr Chen Hai-feng: Director Department of EducaUon and' Scientific Research Ministry of Health Dr Chin Hsiang-man Bl».'efoot Doctor "Lo"yuan People's CollllllUrte Chang Yang County Hupei Province (Chief Representative) (Chef de la delegation), ' (Alternate/Suppleant),Dr. Huang Yu-hsiang" Jiang-zhenColllllUne Hospital Chuansha County (Alternate/Suppleant).:.. Mr Tsao Yung-lin,,~>, B1.Weau of Foreign Relations Ministry of Health, ' (Adviser/Conseiller) Mr L1 Ching Hs1-u\' Bureau of Foreign Relat10ns Ministry of Health (Adviser IConseiller) FIJI FIDJI,-'. Mr J.S. Singh Minister for Health, (Chief Representative) (Chef de la delegation) Dr J.B. Senilagakali Director of Curative Medical Services (Alternate/Suppleant)

61 54 REGIONAL COfVIMlTlEE: lwnty-seventh SESSION FRANCE JAPAN JAPON lao PEPPIE' S. DEMOCRATIC REPUBLIC REPUBLIQUE DEMOCRATIQUE POPULAIRE LAO MAlAYSIA MAIAISIE Dr. P. Leproux Medecin-chef du Centre de lutte contre la tuberculose de la Polynesie fran~aise Dr A. Tanaka Director-General Statistics and Information Department Minister's Secretariat Ministry of Health and Welfare DII H. Shinozaki Deputy Director International Affairs Division Minister's Secretariat Ministry of Health and Welfare Mr T. Yano Second Secretary Embassy of Japan in Manila Dr Keo Phimphachanb Chef de Cabinet du Secr~taire d'etat a la Sante publique Tan Sri Datuk (Dr) Abdul Majid Ismail Director-General of Health Ministry of Health Dr Mehar Singh Gill Deputy Director of Health Services Ministry of Health Mr Onn bin Kayat Principal Assistant Secretary (International Health) Ministry of Health Mr Mohammed Daud YUsoff. Third Secretary Embassy of Malaysia in Manila (Chief Representative) (Chef de la delegation) (Alternate/Suppleant) (Adviser/Conseiller) (Chief Representative) (Chef de la delegation) (Alternatej,Suppleant) (Alternate/suppleant) (Adviser/Conseiller)..

62 REPORT OF THE REGIONAL comm!'r1ee 55 NEW ZEALAND NOUVELIE-ZELANDE PAPUA NEW GUINEA PAPOUASIE NOUVElLE-GUINEE PHILIPPINES Dr B. W. Christmas Deputy Director-General of Health (Public Health) Department of Health Mr E. Robin Safitoa Secretary for Health Department of Health Dr K. Wari Assistant Secretary TUberculosis Control Department of Health Dr J. Sumpaico Director Bureau of Research and Laboratories Department of Heal th Dr J.J. Dizon Director Bureau of Health Services Department of Health Dr E. Fernando Director.. Regional Health Office No. 4 Department of Health Dr F. Solon Executive Director National Nutrition Council Dr F. Aguilar Executive Director Project Management Staff Department of Health Dr F. Bayan Director National Family Planning Programme Department of Health Dr T. Gomez Director National Nutrition Service Department of Health (Chief Representative) (Chef de 1a delegation) (Alternate/Suppleant) (Chief Representative) (Chef de la delegation) (Alternate~uppleant) (Alternate~uppleant) (Alternate/Supp1eant) (Alternate/Suppleapt) (Al ternate/supplean t) (Alternate/Suppleant)

63 REGIONAL COMMlTIEE; 'lwenty- SEVENTH SESSION PHILIPPINES (continued) (suite) Dr L. Manapsal Medical Adviser Department of Health Dr A.M. Angara Chief Division of Maternal and Child Health Department of Health (AI ternate/suppleant) (Alternate/Suppleant) POR'IlJGAL Dr Leonel dos Remedios Madecin-inspecteur Chef du Bureau Provincial des Services de Sante et d'assistance de Macau REPUBLIC OF KOREA REPUBLIQUE DE COREE Dr Kyong Shik Chang Director Bureau of Medical Affairs Ministry of Health and Social Affairs Mr Se Lin Huh First Secretary Embassy of the Republic of Korea in Manila (Chief Representative) (Chef de la delegation) (Alternate/Suppleant) Mr Moo Geun Jeon International Affairs Officer Ministry of Health and Social Affairs (Alternate/Suppleant) -- SINGAPORE SINGAPOUR SOCIALIST REPUBLIC OF VIET NAM REPUBLIQUE SOCIALIS'lE DU VIET NAM Dr Leong Kwok Wah Medical Superintendent Middleton Hospital Dr Tran Ngoc Dang Head Prophylactic and Curative Department Ministry of Health Dr Nguyen Van Trong Director Department of External Relations Ministry of Health Mr Nguyen Hong Quang Ministry of Foreign Affairs (Chief Representative) (Chef de la delegat10n) (Alternate/Suppleant) (Alternate/Suppleeant)

64 REPORT OF THE REGIONAL COMMITI'EE 57 UNITED KINGDOM ROYAUME-UNI UNI'lED STATES OF AMERICA ETATS-UNIS D'AMERIQUE WESTERN SAMOA SAMOA-OCCIDENTAL DrJ.A.B. Nicholson Medical Adviser Ministry of Overseas Development London Dr J.C. King Deputy Director Office of International Health Department of Health, Education and Welfare Washington Mr P.L.G. Santos Director of Public Health Terri tory of Guam Dr P. Turner Acting Director of Medical Services American Samoa Mr R.M. Pringle First Secretary American Embassy in Manila Dr Soli a Tapeni Faaiuaso (Chief Representative) (Chef de la delegation) (Adviser/Conseiller). (Adviser /Consel11er r (Adviser/Conseiller) II. REPRESENTATIVES OF THE UNI'lED NATIONS AND REIATED ORGANIZATIONS REPRESENTANTS DE L'ORGANISATION DES NATIONS UNIES ET DES INSTITUTIONS APP AREN'IEES UNI'lED NATIONS CHrIDREN'S FUND FONIlS DES NATIONS UNIES POUR L'ENFANCE Dr Wah Wong UNICEF Area Representative in the Philippines Mr P.W. Bailey UNI'mJ). NATIONS DEVELOPMENT PROGRAMME PROGRAMME DES NATIONS UNIES POUR IE DEVELOPPEMENT Mr D. Bergstrom Resident Representative of the United Nations Development Programme in the Philippines Mr S. Wljayasingha

65 58 REGIONAL COMMI'I'IEE: TWENTY-SEVENTH SESSION, -.p IN'1ERNA TIONAL rabour ORGANISATION ORGANISATION INTERNATIONAIE DU TRAVAIL Mr A. Granger Director ILO Area Office in the Philippines Mr J.M. Duijvestein III. REPRESENTATIVES OF OTHER IN'1ER GOVERNMENTAL ORGANIZATIONS REPRESENTAN'lS D' AU'IRES ORGANISATIONS INTERGOUVERNEMENTAIES ASIAN DEVELOPMENT BANK BANQUE ASIATIQUE DE DEVELOPPEMENl' SOUTH PACIFIC COMMISSION COMISSION.DU PACIFIQUE SUD Mr K.H. Phua Planning Officer Operations Department Asian Development Bank Dr E. Macu Salato Secretary-General South Pacific Commission IV. WORLD FEDERATION OF SOCIETIES OF ANAESTHESIOLOGISTS FEDERATION MONDIAIE DES SOCIETIES D'ANESTHESIOLOGISTES REPRESENTATIVES OF NON-GOVERNMENTAL ORGANIZATIONS REPRESENT ANTS DES ORGANISATIONS NON GOUIJERNEMENTAIES Dr Q. Gomez President, WFSA Director Western Pacific Anesthesiology Center Veterans Memorial Hospital -'. INTEFNATIONAL UNION OF ARCHI'mC'lS UNION IN'mRNATIONAIE DES ARCHI'mC'IES IN'mRNATIONAL SOCIETY' OF BLOOD TRANSFUSION SOCIE'm IN'IERNATIONAIE DE TRANSFUSION SANGUINE WORLD FEDERATION OF THE DEAF FEDERATION MONDIAIE DES SOURDS Mr J. Nakpll, FPI A Philippine Institute of 'Architects Dr G.C. Caridad Regional Councillor for Asia of the International Society of Blood Transfusion Philippine National Red Cross Mrs E.S. Carlos Executive Secretary Philippine Association of the Deaf

66 REPORT. OF THE REGIONALCOMMITJEE 59 IN'IERNATIONAL DENTAL FEDERATION FEDERATION DENTAIRE IN'IERNATIONAIE Dr P. Gonzales Dr R.C. Navia Manila Central University College of Dentistry Dr G.A. Carreon City Hall Dapitan City. -. INTERNATIONAL UNION FOR HEALTH EDUCATION UNION IN'IERNATIONAIE D'EDUCATION POUR LA SAN'IE WORIDFEDERATION FOR.MEDICAL EDUCATION FEDERATION MONDIAIEPOUR L'ENSEIGNEMENT DE LA.MEDECINE IN'IERNATIONAL HOSPITAL FEDERATION FEDERATION IN'lEBNATIONAIE DES HOPITAUX CHRISTIAN MEDICAL COMMISSION COMMISSION MEDICAIE CHRETIENNE THE WORLD MEDICAL ASSOCIATION. INC. L'ASSOCIATIONMEDICAIE MONDIAIE. INC. MEDICAL WOMEN'S IN'IERNATIONAL ASSOCIATION ASSOCIATION INTERNATIONAIE DES FEMME'5 MEDECINS WORLD FEDERATION FOR MENTAL HEALTH FEDERATION MONDIAIE POUR IA SAN'IE MENTAIE WORID FEDERATION OF NUCIEAR MEDICINE AND BIOLOGY. FEDERATIONMONDIAIE DE MEDECINE ET DE BIOLOGIE NUCIEAIRES INTERNATIONAL COMMITJEE OF. CATHOLIC NURSES COMITE IN'IERNATIONALCATHOLIQUE DES INFIRMIERES ET ASSISTAN'IES MEDICO-SOCIAIES Dr F. Herrera Dr J. Cuyegkeng Vice-President World Federation for Medical Education Dr J.P. Caedo. Jr. President Philippine Hospital Association Dr G.H. Viterbo Medical Director Capiz Emmanuel Hospital Roxas City Dr A. Z, Romualdez Dr E. I. Cuyegkeng. President Philippine Medical Women's Association Dr L. IgnaciO Dr L.S. Villadolid Makati Medical center Mrs M.R.Ordonez Division of Nursing Services Manila Health Department

67 60 REGIONAL C()fofI[r'l"lEE: 'l"iienty"'seventh SESSION IN'IERNATIONAL COUNCIL OF NURSES CONSEIL INTERNATIONAL DES INFIRMIERES WORLD FEDERATION OF OCCUPATIONAL THERAPIS'IS FEDERATION MONDIAIE DES ERGOTHERAPEU'1ES INTERNATIONAL PLANNED PARENTHOOD FEDERATION FEDERATION IN'IERNATIONAIE POUR IE PLANNING FAMILIAL Mrs F.M. Valdez President Philippine Nurses Association Miss C. Tablan-Santos Dr R.A. Apelo Department of Obstetrics and Gynecology College of Medicine University of the Philippines INTERNATIONAL SOCIETY OF RADIOGRAPHERS AND RADIOLOGICAL 'lecfinicians ASSOCIATION INTERNATIONAIE DES 'lechniciennes ET'IECHNICIENS DIPLOMES EN EIECTRO-RADIOLOGIE MEDICAIE INTERNATIONAL SOCIETY OF RADIOLOGY SOCIE'lE INTERNATIONAIE DE RADIOLOGIE IEAGUE OF RED CROSS SOCIETIES LIGUE DES SOCIE'mS DE LA CROIX-ROUGE REHABILITATION INTERNATIONAL INTERNATIONAL IEAGUE AGAINST RHEUMATISM LIGUE INTERNATIONAIE CONTRE IE RHUMATISME COUNCIL FOR IN'lERNATIONAL ORGANIZATIONS OF MEDICAL SCIENCES CONSEILDESORGANISATIONS IN'lERNATIONAIES DES SCIENCES MEDICAIES Dr J.B. Catindig Chief, Medical and Services DiviSion, IPPF East and South-East Asia and Oceania Region Mr N.A. Palomo Radiation Health Office Department of Health Dr H. Zialcita Member Philippine College of Radiology Brigadier General P.R. Sotto (Ret.) Member Board of Governors Philippine National Red Cross Mrs C. Floro, President The Philippine Foundation for Rehabilitation of the Disabled Dr T.P. Torralba President Philippine Rheumatism Association Dr A.M. Dalisay Executive Director National Research Council of the Philippines ~..'

68 , " REPORT OF THE REGIONAL COMMI'I'IEE 61 IN'IERNATIONAL COUNCIL ON SOCIAL WELFARE CONSEIL INTERNATIONAL DE L I ACTrON SOCIAIE IN'IERNATIONAL COLIEGE OF SURGEONS COLIEGE INTERNATIONAL DES CHIRURGIENS IN'IERNATIONAL ORGANIZATION AGAINST TRACHOMA ORGANISATION IN'IERNATIONAIE POUR LA IlJ'I"lE CONTRE IE TRACHOME WORID VE'IERANS FEDERATION FEDERATION MONDIAIE DES ANCIENS COMBATTANTS WOR;ID FEDERATION OF UNI'lED NATIONS ASSOCIATIONS FEDERATIQN MONDIAI1i: DES ASSOCIATrONS POUR IES NA TIONS UNIES Brigadier General P.R. Sotto (Ret.) Member Board of Directors Council of Welfare Agenc1es of the Philippines Dr L.D. Martinez Dr H. Velarde, Jr. Director Far East Graduate Course in Ophthalmology Brigadier General P.R. Sotto (Ret.) Veterans Federation of the Philippines Dr N.M. Santiago University of the Philippines Health Service

69 62 REGlONAL COMMITTEE: 'l'tien'iy.;seven'lh SESSION. ANNEX 4 WORKING GROUP TO EXAKINE REGIONAL ACTION IN CONNEXlON WITH THE SIXTH GENERAL PROGRAMME OF WORK COVERING A SPECIFIC PERIOD ( ) Terms of Reference 1. The Working Group should examine and propose -to the Regional Committee possible ways and means of setting up a mechanism whereby the Regional Committee could regularly review the progress made in the Western Pacific Region towards the development and implementation of the Sixth General Programme of Work. 2. The Working Group should report to the Regional Committee which cou'ld then propose to the World Health Assembly and the Executive Board specific programmes which the Comm! ttee considers to be of the highest priority for in-depth studies by the Executive Board. --

70 REPORT OF THE REGIONAL COMMI'l'lEE ANNEX 5 LIST OF DOCUMENl'S WPR,,1tC27/l WPR,,1tc27/1 Add.l WPR/RC27 /l-a WPR/RC27/2 and Corr.l WPR/RC27 /2 Rev. 1 WPR,,1tC27/2 Rev.2 WPR/RC27 /3 and Corr.l WPR/RC27/4 WPR/RC27/5 WPR,,1tC27 /5 Add.l WPR/RC27/5 Add.2 WPR/RC27 16 and Add.l WPR,,1tC27i7 WPR/RC27/8 and Corr.l Agenda Supplementary agenda Annotated ae;enda Proposed programme budget estimates for the financial years 1978 and 1979 Proposed revisions to the programme budget, 1977, Proposed revisions to the programme budget, , Twenty-sixth Annual Report of the Regional Director to the Regional Committee for the Western Pacific Form of presentation of programme budget - development of programme budgeting and management of WHO's resources at country level Special assistance to Cambodia (Democratic Kampuchea), the Democratic Republic of Viet Nam, the Lao People's Democratic Republic and the Republic of South Viet Nam Special assistance programme for the Socialist Republic of Viet Nam Special abbistance to the Lao People's Democratic Republic Resolutions of regional interest adopted by the Twenty-ninth World Health Assembly and the Executive Board at its fifty-seventh and fifty-eighth sessions WHO's role in the development and coordination of biomedical research: greater involvement of the Regions in research Alcohol and other dependence problems

71 64 REGIONAL COMMI'l'lEE: 'lwnty-seventh SESSION WPR/RC27/9 WPR/RC27/10 WPR/RC27/11 Rev.l WPR/RC27/12 and Corr.l WPR/Rc27/13 WPR/RC27/14 Rev.l WPR/Rc27 /15 WPR/RC27 /16 Regional centre for environmental health sciences Preparation of a Fifth Regional Programme of Work covering a Specific Period ( inclusive) Frequency of meetings of the Regional Committee Annual reporting by the Regional Director Selection of topic for the Technical Presentation during the twenty-eighth session of. the Regional COIIIDittee List of representatives (Distributed only to representatives during the meeting. Revised list incorporated in the final report of the. Regional COIIIDittee, pages ) Report of the Sub-Committee on Programme and Budget (Distributed only to representatives during the meeting. Report incorporated in the final report of the Regional Committee, pages ) Report of the twenty-seventh session of the Regional Committee for the Western Pacific WPR/RC27/p&B/l WPR/RC27/p&B/2 WPR/RC27/p&Bj) Suggested guidelines for the Sub-Committee on Programme and Budget Budget performance direct services to governments of the Region by programme, by country or area and by project Proposed programme budget estimates for the financial years 1978 and 1979 WPR/RC27jP&B/4 Tentative projections for WPR/RC27/p&B!5 Proposed programme budget and distribution of costs of intercountry programmes (regular budget) WPR/RC27/I'P/l WPR/RC27/I'P/2 Technical Presentation - Primary health care in the Western Pacific, by Dr K.W. Newell Technical Presentation - Basic health service in the rural areas of China, by Dr Chin Hsiang-kuan

72 REPORT OF THE REGIONAL COMMIT'IEE 65/66 WPRjRC27/SR/1 WPRjRc27 /SR/2 WPR,lRC27 /SR/3 WPR,lRC27/SR/4 WPR,lRc27 /sr/5 WPR,lRC27/SR/6 Summary record of the first meeting - 6 September 1976 Summary record of the second meeting - 6 September 1976 Summary record of the third meeting - 7 September 1976 Summary record of the fourth meeting - 8 September 1976 Summary record of the fifth meeting - 10 September 1976 Summary record of the sixth meeting - 10 September 1976 (Unnumbered) Brief reports received from governments on the progress of their health activities WPR/RC27/Working Paper/l Working Group to examine regional action in connexion with the Sixth General Programme of Work: Proposed Terms of Reference WPR/RC27/Working Paper/2 Report of the Working Group on the Sixth General Programme of Work to the twenty-seventh session of the Regional Committee (Distributed only to representatives during the meeting.)

73 PART II SUMMARY RECORDS OF THE PIENARY SESSIONS

74 CONTENTS Agenda Item No. 1 Opening of the session LDelete.Q/ 3 LDelete.Q/ 4 Election of new officers: Chairman, Vice-Chairman ano and Rapporteurs Andress by incoming Chairman. 6 Adopti on 0 f the agenda... ' Proposed Programme Budget Estimates, 1978 and 1 <] Establishment.of the Sub-Committee on Programme and Budget Consideration of the report presented by the Sub-Committee on Programme and Budget '79, Acknowledgement by the Chairman of brief reports received from governments on the progress of their heal th act! vi ties.... Report of the Regional Director , Allocation and management of WHO's resources at regional and c-ountry level , Special assistance to Democratic Kampuchea, the Lao People's Democratic Republic and the Socialist Republic of Viet Nam.. 100, 113, Resolutions of regional interest adopted by the Twenty-ninth World Health Assembly and the Executive Board at its fifty-seventh and fifty-eighth sessions.... Sixth General Programme of Work covering a Specific Period (resolution WHA29.20) Psychosocial factors and health (resolution WHA29. 21)... ' 102,

75 CONTENTS Agenda Item No. Report on the world health situation (resolutions WHA29.22 and EB57.M6) Real Estate Fund (resolution WHA29.28) Voluntary Fund for Health Promotion (resolutions WHA29.31 and EB58.RIO) Organizational study on the planning for and impact of extrabudgetary resources on WHO's programme and policy (resolution WHA29.32) Coordination with the United Nations system - general matters: UNDP-supported activities - financial situation (resolutions WHA29.42 and EB57.. R49)..... Coordination with the United Nations system: general matters (resolution EB57.R48). Coordination with the United Nations system (general matters): technical cooperation among developing countries (resolution EB57.R50) International \<lornen's Year (resolution WliA29.1~3) WHO's human health and environment programme (resolution WHA29. 45).. Health aspects of human settlements (resolution WHA29. 46)..... Community water supply and excreta disposal (resolution WHA29.47) loj~ Programme budget policy (resolution WHA29.48) Cardiovascular diseases (resolution WHA Occupational health programme (resolution ~A )..... Schistosomiasis (res.lution WHA29.58). Mycotic infections (resolution WHA29.59)

76 CONTENTS N$enda Item No. Expanded programme on immunization (resolution WHA29. 63) Rheumatic diseases (resolution WHA29.66). 105 The need for laboratory animals for the control of biological products and the establishment of breeding colonies (nonhuman primates) (resolution WHA29.67) Disability prevention and rehabilitation (resolution WHA29.68) Leprosy control (resolution WHA29.70) Health manpower development (resolution 'WliA29. 72) 106 Development of the antimalaria programme (resolutions WHA29.73 and EB57.R26) 106 Promotion of national health services and health technology relating to primary health care and rural development (resolutions WHA29.74 and EB57.R27) Development of programme evaluation in WHO (resolution EB57.R17) Report by the representatives of the Executive Board at the Twenty-ninth World Health Assembly: Method of work of the Executive Board in relation to programme development (resolution EB5B.Rll) ' WHO's role in the development and coordination of biomedical research: greater involvement of the Regions in research (resolution WPR/Rc26.RIO)... Alcoholism (resolution WPR/Rc26.Rll) , 135, , The Regional Environmental Health Programme: Regional centre for environmental health sciences E2, Preparation of a Fifth Regional Programme of Work for a Specific Period ( inclusive) (resolution WPR/RC26.R12)... 98, 121,

77 CONTENTS Agenda Item No. 17 Method of work of the Regional Committee 125, 127, Frequency of meetings of the Regional Committee (resolution WPR/RC26.R15) Annual reporting by the Regional Director 18 statements of representatives of the United Nations, the Specialized Agencies, of intergovernmental and non-governmental organizations in official relations wi th WHO." ""." ""." "."."." "."."." 19 Selection of topic for the Technical Presentation during the twenty-eighth session of the Regional Camm1 ttee " """""" ",,,,"""""""""""""""""" 20 Time and place of.the twenty-eighth and twenty-ninth sessions of the Regional Committee Death of Chairman Mao Tse-tung Adoption of the draft report of the Committee.. Resolution of appreciation Closure of the session """"""""""""""""""""""""""""" 125, , , , Suppl. 1 Suppl. 2 The importance of core programmes for child health, with particular emphasis on staff training through fellowships (item proposed by the Government of the United Kingdom) Progress proposed Kingdom) in nutritional surveillance (item by the Government of the United " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " 135, 149 1)8,

78 (WPR/RC27/SR/l) SUMMARY RECORD OF '!'HE FIRST MEETING WHO Conference Hall, Manila Monday, 6 September 1976 at 9.00 a.m. CHAIRMAN: Dr A. Tanaka (Japan) later: Mr J.S. Singh (Fiji) CONrENTS 1 Formal opening of the session by the retiring Vice-Chairman 78 2 Election of new offioers: Chairman, Vice-Chairman aild Rapporteurs '" '" '" '" '" '"... '".... '" '"... '" '"... '" Adoption of the agenda "78 4 Establishment of the Sub-Committee on Progra.nme &lld: Budg'et Ac~ledgement by the Chairman of brief reports reoeived from governments on the progress of their health activities 79 6 Report of the Regional Director 79 7 Allocation and management of WHO's resources at regional and country level... '"

79 74 REGIONAL COMMlT'lEE: 'lwenty-beventh SESSION First Meeting Monday, 6 September 1976 at 9.00 a.m. PRESENT I. Representatives of Member States AUSTRALIA CHINA FIJI Dr C. Evans Mr K. Boreham Dr Chen Hai-feng Dr Chin Hsiang-kuan Dr Huang Yti-hsiang Mr Tsao YUng-lin Mr Li Ching Hsiu Mr J.S. Singh Dr J.B. Senilagakali Dr P. Leproux JAPAN!AO PEOPIE' S DEMOCRATIC REPUBLIC MALAYSIA NEW ZEALAND PAPUA NEW GUINEA PHILIPPINES PORTUGAL REPUBLIC OF KOREA Dr A. Tanaka Dr H. Shinozaki Mr T. Yano Dr Keo Phimphachanh Tan Sri Datuk (Dr) Abdul Majid Ismail Dr Mehar Singh Gill Mr Onn bin Kayat Dr B.W. Christmas Mr E. Robin Safitoa Dr K. Wari Dr J. Sumpaico Dr J.J. Dizon Dr F. Aguilar Dr A.M. Angara Dr Leonel dos Remedios Dr Kyong Shik Chang Mr Se Lin Huh Mr Moo Geun Jeon

80 ,.' SUMMARY RECORD OF THE FIRST MEETING 75 SINGAPORE SOCIALIST REPUBLIC OF VIET NAM UNITED KINGDOM UNITED STATES OF AMERICA WES'lERN SAMOA Dr Leong Kwok Wah Dr Tran Ngoc Dang Dr Nguyen Van Trong Mr Nguyen Hong QUang Dr J.A.B. Nicholson Dr J.C. King Dr Solia Tapeni Faaiuaso II. Representatives of the United Nations and Related Organizations UNI'mD NATIONS CHILDREN'S FUND UNI'mD NATIONS DEVELOPMENT PROGRAMME INTERNATIONAL LABOUR ORGANISATION Mr P. Bailey Mr D. Bergstrom Mr S.Wijayasingha Mr J.M. Duijvestein III. Representatives of Other Intergovernmental Organizations ASIAN DEVELOPMENT BANK SOUTH PACIFIC COMMISSION Mr K.H. Phua Dr E. Macu Salato IV. Representatives of Non-governmental Organizations INTERNATIONAL UNION OF ARCHITECTS INTERNATIONAL SOCIETY OF BLOOD 'IRANSFUSION WORLD FEDERATION OF THE DEAF INTERNATIONAL DEN~L FEDERATION INTERNATIONAL UNION FOR HEALTH EDUCATION WORLD FEDERATION FOR Mf;DICAL EDUCATION Mr J. Nakpil Dr G.C. Caridad Mrs E.S. Carlos Dr P. Gonzales Dr R.C. Navia Dr G.A. Carreon Dr F. Herrera Dr J. Cuyegkeng

81 76 REGIONAL COMMIT'lEE: 'lwen'ly-beventh SESSION, IN'IERNATIONAL HOSPITAL FEDERATION CHRISTiAN MEDICAL COMMISSION THE WORLD MEDICAL ASSOCIATiON, INC. MEDICAL WOMEN'S IN'IERNATIONAL ASSOCIATiON WORLD FEDERATION FOR MENTAL HEALTH Dr J.P. Caedo, Jr. Dr G.H. Viterbo Dr A. Z. Romualdez Dr E. I. Cuyegkeng Dr L. Ignacio WORID FEDERATION OF Dr L.S. Villadolid NUCLEAR MEDICINE AND mology? INTERNATIONAL COMMIT'lEE OF CATHOLIC NURSES INTERNATIONAL Cmm::IL OF NURSES IN'IERNATI ONAL PLANNED PARENTHOOD FEDERATION INTERNATIONAL SOCIETY OF RADIOGRAPHERS AND RADIOLOGICAL TECHNICIANS IEAGUE OF RED CROSS SOCIETIES REHABILITATION INTERNATIONAL INTERNATIONAL IEAGUE AGAINST RHEUMATISM COUNCIL FOR IN'JERNATIONAL ORGANIZATIONS OF MEDICAL SCIENCES IN'IERNATIONAL COUNCIL ON SOCIAL WELFARE IN'IERNATIONAL COLLEGE OF SURGEONS WORID VETERANS FEDERATION Mrs M.R. Ordonez Mrs F.M. Valdez Dr J.B. Catindig Mr N.A. Palomo Brigadier General P.R. Sotto (Ret.) Mrs C. Floro Dr T.P. Torralba Dr A.M. Dal1say Brigadier General P.R. Sotto (Ret.) Dr L.D. Martinez Brigadier General P.R. Sotto (Ret.) '"

82 SUMMARY RECORD OF THE FIRST MEETING 77 Y. WHO Secretariat SECRETARY Dr Francisco J. Dy

83 78 REGIONAL COMMITmE: 'NENTY-SEVENTH SESSION 1 FORMAL OPENING OF THE SESSION BY THE RETIRING VICE-CHAIRMAN: Item 1 of the Provisional Agenda Dr A. TANAKA, retiring Vioe-Chairman. in the absenoe of Dr T.M. McKENDRICK. retiring Chairman, declared the twenty-seventh session of the WHO Regional Committee for the Wiatern Pacific open. 2 EIECTION OF NEW OFFICERS: CHAIRMAN, VICE-CHAIRMAN AND RAPPOR'IEURS: Item 4 of the Provisional Agenda 2.1 Election of Chairman Dr CHRISTMAS (New Zealand) nominated Mr SINGH (Fiji) as Chairman; this was seconded by Dr FAAIUASO (Western Samoa). Decision: Mr SINGH was lmanimously elected. 2.2 Election of Vice-Chairman Dr EVANS (Australia) nominated Mr SAFITOA (Papua New Guinea) as Vice-Chairman; this was seconded by Dr DIZON (Philippines). Decision: Mr SAFITOA was lmanimously elected. 2.3 Election of Rapporteurs Dr MAJID (r~alaysia) nominated Dr EVANS (Australia) as Rapporteur for the English language; this was seconded by Dr KroNG S"HIK CHANG (Republic of Korea). Dr IEPROUX (France) nominated Dr 'IRAN NGOC DANG (Socialist Republic of Viet Nam) as Rapporteur for the French language; this was seconded by Dr PHIMPHACHANH (Lao People's Democratic Republic). Decision: Dr EVANS and Dr TRAN NGOC DANG were lmanimously elected. 3 ADOPTION OF THE AGENDA: Item 6 of the Provisional Agenda (Documents WPR/RC27/l and Add.l) The CHAIRMAN moved the adoption of the Agenda. with the deletion of items 2 and 3. Decision: In the absence of comments. the Agenda was adopted. 4 ESTABLISHMENT OF THE SUB-COMMI TlEE ON PROGRAMME AND ElJDGET: I tern 7.1 of the Agenda In accordance with resolution WPR/RC2l.Rl adopted by the Regional Committee at its twenty-first session, which decided that the membership of the Sub-Committee on Programme and Budget should "consist of half the

84 SUMMARY RECORD OF THE FIRST MEE'ITNG 79 Members in the Region plus the Chairman of the Regional Conuni ttee and that it be rotated among the representatives of various Members, subject to the provision that any representative desiring to participate in the discussion of the Sub-Conunittee should be entitled to do so", it was a5reed that the membership this year would be composed of representatives from Fiji, Lao People's Democratic Republic, Malaysia, Papua New Guinea, Philippines, Portugal, Singapore, Socialist Republic of Viet Nam, United states of America and Western Samoa. It was further agreed that the Sub-Committee would meet at 2.30 p.m. on Tuesday, 7 September and that a further meeting would take place at 9.00 a.m. on Thursday, 9 September. 5 ACKNOWIEDGEMENT BY THE CHAIRMAN OF BRIEF REPORTS RECEIVED FROM GOVERNMENTS ON THE PROGRESS OF THEIR HEALTH AC'ITVITIES: Item 8 of the Agenda The CHAIRMAN acknowledged reports on the progress of health activities received from the following countries or areas: Australia, Fiji, Hong Kong, Japan, Macao, Malaysia, New Zealand, Papua New Guinea, Philippines, Republic of Korea and Socialist Republic of Viet Nam. Reports had been received from the Government of French Polynesia but copies were not available for distribution; the reports were with the WHO Secretariat and could be seen by those interested. 6 REPORT OF THE REGIONAL DIRECTOR: Item 9 of the Agenda (Document WPR/RC27/3 and Corr.l) In introducing the Annual Report, the REGIONAL DIRECTOR welcomed to the Regional Committee the delegations of Papua New Guinea, formerly an Associate Member of the Organization, and the reunified Socialist Republic of Viet Nam. During the year, some progress had been made in promoting the primary health care concept; in Western Samoa, for example, where preliminary discussions had taken place on the formulation of a country health programme and the development of a primary health care system. Governments were being encouraged to examine the problems involved, and the resources needed, to implement expanded programmes on immunization. Important factors in implementing such programmes were the necessity fora strong political commitment on the part of the government and the administrative backing to ensure a continuing operation. Adequate supplies of vaccine, and properly orientated health workers, were also of major importance. It had been gratifying ~o see, from the diminishing number of requests to WHO for cooperation in developing health personnel, that some countries were now able, to undertake their own training programmes from national resources. One area in which the OrganiZation could

85 80 REGIONAL COMMITtEE: 'lwenty-seventh SESSION continue to cooperate was in providing oonsultants in specialized fields to give refresher training, as had been done in the Trust Territory of the Pacific Islands for two consecutive years. Health laboratory technology, however, remained a field in which shortage of trained manpower constituted a major constraint. The Regional Teacher Training Centre in Sydney had continued its programme, through workshops and national courses. It now offered a Master's degree in health personnel education; the first oourse having oommenoedin July The Regional Director did not elaborate on developments during the year in the fields of child health, nutrition, environmental health, or alcoholism and related dependence problems, since the Committee was to discuss those programmes in detail later in the session. A milestone in the development of the regional programme had been the establishment of a Regional Advisory Committee on Medical Research,. which held its first meeting in June In view of the distressing increase in cancer, cardiovascular diseases and other chronic diseases, it was gratifying to note that a priority area for regional research activities recommended by the Regional Advisory Committee on ~dical Research was that of the cardiovascular diseases. Other priority areas for research were: the development of strategies for health service research; family health; environmental health; and parasitic and other communicable diseases. The Director of Health Services had Just returned from a visit to Tokyo to accept, on behalf of WHO, another generous donation from the Japan Shipbuilding Industry Foundation. In reiterating to the Foundation WHO's deep appreciation, the Regional Director reminded Representatives of the extent to which the Organization was becoming dependent on extrabudgetary resources to implement many of the Health Assembly's resolutions. In the Western Pacific Region there was much need of resources to provide special assistance to Democratic Kampuchea, the Lao People's Democratic Republic and the Socialist Republic of Viet Nam, and to implement the recommendations of the Regional Advisory Committee on Medical Researoh. The Regional Director concluded by drawing the attention of Representatives to the "country health information profiles" compiled from various government, WHO and United Nations sources. Those already cleared by the governments concerned were available for Representatives to see in the Conference Hall on request. The CHAIRMAN proposed that, as suggested by the Regional Director, and with the approval of the Committee, the report should be reviewed section by section. He then invited representatives to comment.

86 SUMMARY RECORD OF THE FIRST MEETING 81 Dr EVANS (Australia) referred to pages xviii and 60 of the report, which dealt with aid to the Socialist Republic of Viet Nam. The Government of Australia would make available to vjho, as part of Australia's aid programme to the Socialist Republic of Viet Nam, A$ in the financial year 1976/1977, for the tuberculosi~ eradication programme. In making this contribution, the Government commended the thorough and comprehensive report on health needs in the Socialist Republic of Viet Nam prepared by WHO in conjunction wi th the Vietnamese authorities. This important groundwork had simplified the task of appraisal and of deciding on an appropriate response. Dr MAJID (Malaysia) congratulated the Regional Director on his report. The Delegation of Malaysia endorsed the high priority accorded to primary health care in the Western Pacific Region, based on community participation. Experience in Malaysia had shown that, through primary health care, a larger number of the population benefitted and gained access to the health services, particularly in the remote areas. Thi0 was the basic approach to the development of a national health infrastructure, which would provide the foundation of an integrated national health programme. The success of the national tuberculosis and leprosy control and the environmental sanitation programmes in Malaysia was largely due to the primary health care delivery system, particularly in the rural areas. The development of primary health care services, including those for communicable disease control, family planning, health education and other health needs, should be through the community. Dr Majid strongly supported the views of the Regional Director that staff training and development should be task-orientated. He emphasized that training courses should be very carefully selected in order to j.mprove the competence of staff in the job they were expected to perform. Training should be given in the same work-setting as that of the trainee and, as far as possible, should be undertaken in the Region and not in an alien environment. It had been mentioned that cancer, other chronic diseases, and communicable diseases were on the increase in the Western Pacific Region, especially in the developing countries. The implication seemed to be that there was now a need for closer study of the diseases of old age and of affluent sooieties, to see how large a problem they were. Epidemiological studies related to this problem would only be possible through efficient data collection systems. WHO oould cooperate with countries or areas in the Region in developing such systems in order to establish the right priorities for national health programmes. Dr CHEN HAI-FENG (China) congratulated the officers on their election. The emphasis given in the report to the development of basic health services was to be welcomed. Many third world countries had experiences in that area which were worth sharing. China's policy was based on services to the peasants and workers, with appropriate training of cadres, including barefoot doctors. Dr Huang Yu-hsiang, was a rural medical doctor who had trained barefoot doctors and could give information on the results achieved.

87 82 REGIONAL COMMIT'IEE: 'lwenty-seven'jli SESSION Dr HUANG YU-HSIANG -(China) said that _barefoot doctors were a new type of medical worker, personally supported by Chairman Mao Tse-tung. T.ney were widely appreciated by the masses of poor and lower-middle peasants in the rural areas where, through their work, the health situation had drastically improved and agriaultural production been promoted. Barefoot doctors were mostly selected, upon reoommendation of the masses, from among the youth of poor and lower-middle peasant origin and in some oases from among urban intellectual youth settling in the oountryside. Their training was adapted to local conditions. Since the Great Proletarian Cultural Revolution he and other medical workers in commune hospitals had run 16 courses for barefoot doctors on behalf of the peasants, under the leadership of the party conmittee and the revolutionary collldittee of the commune. The training had three important features. Firstly, political ideological education was given prominence. Barefoot doctors studied the works of Marx, Lenin and Chairman Mao Tse-tung and at the same time peasants who had suffered in the old society were invited to report on past bitterness and present happiness. In that way political consciousness was continuous17_~ilt up. Barefoot doctors were also taught to participate constantly in agricultural labour, receiving their inoome acoording to the collective distribution system. The training encouraged them to maintain a spir1 t of hard struggle and devotion. to keep olose ties with the masses, who we100med them, and to be mentally orientated towards work in the countryside. Secondly, the teaching methods and oontent had been transformed. Barefoot doctors might, for example, be taken to a patient's home for on-the-spot investigation and observation, analysis of a oase and disoussion on methods of prevention, diagnosis and treatment. Traditional Chinese medicine and western medicine were integrated in the teaohing and theory was combined with practice. Practice could be obtained in a commune hospital, or by acoompanying a mobile medioal service or an urban medical team. Refresher training was also given, using various methods, As oompared with traditional medical education, basic and clinioal courses were closely integrated, with collaboration between teachers and students. A lecture on an anatomical system might for instance be followed by an examination of the diseases related to it, the drugs needed, and treatment by traditional and western methods. Good results had been achieved in enabling the barefoot dootors to prevent and treat common diseases, to manage certain aoute cases and even to oonduct operations as for appendioitis, hernia and removal of tumours. Most of the female barefoot doctors oould assist in diffiou1t labour and family planning. Thirdly, with a view to their specialization and overall profioiency, barefoot doctors had been trained to undertake both preventive and therapeutic work in olose oontact with the labouring people, praotising both traditional and western medioine, performing the work of a doctor and a nurse and being

88 SUMMARY RECOJID OF THE FIRST MEETING familiar with the cultivation of medicinal herbs and the preparation of herbal drugs. Some barefoot doctors could extract a tooth under acupuncture anaesthesia and even work out prescription of medicinal herbs for more than ten different illnesses in the form of injections, tablets or syrup. Great importance was attached to the prevention of disease. Barefoot doctors taught hygiene to health aides, sanitation workers and stockbreeders in production teams and mobilized the masses in the Patriotic Health Movement to destroy flies, mosquitos, rats and bedbugs, thus bringing infectious diseases under control. Finally, they gave lectures to worker-peasant-soldier students in medical colleges. With guidance and support at all levels, the barefoot doctors had become a vital force in revolutionizing health in rural areas as well as medical education. Mr BOREHAM (Australia) said that the Australian authorities had. noted two major changes in Part I of the report. A new topic "Research promotion and development" was now in first place and "Family health" had been incorporated in the section on "Strengthening of health services", presumably asa reflection of changed emphasis in WHO's regional priorities. Secondly, with regard to "Strengthening of health services", the Australian authorities would like to see emphasis given to three aspects of primary health care: the need for community involvement in its delivery; the need for the workers to be nominated by the villages served; and the danger of health services being imposed from above. Failure to take those points into account frequently caused rural people to turn to traditional healers instead of government services. Under "Family health" the increasing acceptance of a multidisciplinary integrated approach to meet the health needs of all family members was welcomed. The importance of the contribution of other development-related agencies in that regard should be stressed. Under "Health manpower development", it was of interest to record that during the reporting period the Australian Department of Health had arranged training for 42 fellows sponsored by WHO. However, the authorities faced a perennial problem of placement of fellows, owing to failure to make nominations known in good time. It was felt that there was now a need for reassessment of the fellowship programme. Under "Communicable disease prevention and control" the Regional Director's remarks on the diminishing acceptance of DDT indoor spraying were endorsed but attention was again drawn to the frequent adverse environmental effects of DDT use. With regard to the impact of the liquidity problem of UNDP on the implementation of activities financed by that body, information on the latest position of UNDP funding would be appreciated.

89 84 REGIONAL C<»ftlIT'lEE: 'nienty-seventh SESSION Finally, in view of the relevance of cancer, cardiovascular disorders and chronic diseases to developing countries, as stressed in the report, it seemed surprising that the allocations for those purposes in the proposed budget were so small. The matter would be raised later in discussing the proposed programme budget. Dr FAAIUASO (Western Samoa) congratulated the Regional Director on his report. The tenn "primary health care", as discussed under paragraph 2.2.1, appeared to have come into use over the previous few years but it had long been a basic concept in Western Samoa where participation -of oommunity organizations and women's committees in village health care dated back to the 1920s. I t was gratifying that developllent of primary health care was being given high priority by WHO. The Organization's support in developing a national programme was much appreciated. The WHO/UNICEF Joint Committee on Health Policy study on community involvement in primary health care had also been carried out in Western Samoa during It was a pleasure for Western Samoa to be able to help those two agencies in turn. Hopefully, a Similar study might be conducted in a few years' time to observe the progress made. -, As mentioned on page 5, Western Samoa was interested in ccnmtry health programming, which would contribute substantially to planning of the health services; and it was hoped that WHO assistance might be available for the purpose. Dr SUMPAICO (Philippines) congratulated the Regional Director on his report. Health priorities in the Philippines closely followed those of WHO. Special attention was given to the expansion of primary health care as well as prevention and control of communicable diseases which remained the main public health problems. An expanded programme of immunization had beoome operational. Dr SENILAGAKAL! (Fiji) said it was an honour for his ccnmtry that his Minister for Health had been chosen to act as Chairman of the meeting. Primary health care was a new concept on which more information would be welcome during the meeting. The Representative of Malaysia was to be thanked for mentioning old age. Attention was paid to mothers, children and adults but less to that group. The Government of Fiji laid great stress on the life of the individual tram conception to death. The presentation on barefoot doctors in China had been much appreciated. ~ Fiji's School of Medicine had started the previous century, more or less in the same way, and evolved over the years to such an extent that doctors had been trained above the level of the ccnmtry's needs; and consequently, it had b8en decided to 1975 to so back to the ~ginn1ngs, and to start a course for medical assistants who would provide primary health care in rural areas.

90 SUMMARY RECORD OF THE FIRST MEETING 85 The general standard of health in Fiji was good. However, neighbours' ideas were always welcome. Western Samoa, for instance, was training nurses for extra responsibilities in peripheral areas; more information on the subject could be of benefit to Fiji. Dr MAJID (Malaysia) said that the Ministry of Health of Malaysia, with technical cooperation from WHO, had set up a health management information systems development project with the aim of developing a totally integrated system to satisfy the information needs of the Ministry and cater for its planning and management functions at all echelons. The information system would take the country's situation and environment into account. The project, which was to last two years and would test-run and evaluate the proposed system, consisted of a steering committee and an information systems working group. The former, headed by the Director-General of Health and composed of the heads of technical and-administrative divisions of the Ministry, was responsible for developing the information system, and was being assisted in that task by the working group. The conceptual and systems analysis phases of the project had been completed and the system design phase was in progress. The development phase, of improving on the design by simulating the system, would follow. All those phases would be completed by the end of 1976 and in 1977 the system would be test-run and evaluated. It was expected that the fully tested information system would be available by early 1978 for phased nation-wide implementation. Dr THAN NGOC DANG (Socialist Republic of Viet Nam) described the organization of health services in the Socialist Republic of Viet Nam, based on a wide network of primary care centres extending services to the rural communities, which comprised 80% of the population. Every commune - a commune encompassed several villages - had a nursing and midwifery unit, usually comprising a general care section of five to ten beds, a maternal care section of five beds and a drug section. '!he staff varied according to the density of the population: one or two barefoot doctors, one midwife, two or three nurses. A number of communes already had physicians and most of them possessed a garden where plants were grown for the local production of pharmaceuticals. The rural centres dealt with urgent cases, applied preventive measures, taught the principles of hygiene and engaged in mother and child health activities; they were assisted by voluntary agencies (health workers, hygiene activists, members of the Red Cross). At each district level, there was a multipurpose hospital with 50 to 100 beds; a clinic, with five or six departments, which directed preventive and epidemiological work, control of social diseases, family planning, etc.; a Government pharmaceutical centre, which delivered drugs to the district hospital and to the rural units; and a local section of the Association of Traditional Medicine. Treatment centres and highly specialized institutes at the provincial and central levels completed the network.

91 86 REGIONAL COMMITTEE: TWENTY-SEVENTH SESSION The staff of the commune centres was recruited from local peasant families and trained at the secondary medical school of the province; medical schools of a higher level had commenced to train the first commune doctors. The organization of the rural health network was proving to be a real success, offering living evidence of the concern of the Party and the Government for the working masses. Mr SAFITOA (Papua New Guinea) thanked the delegates for electing him Vice-Chairman and the Regional Director for his comprehensive report. The importance attached by the Government of Papua New Guinea to setting up a comprehensive system of primary health care was reflected in the country's five-year national health plan. Emphasis had been placed on establishing rural health centres, since most of the population lived in rural areas. Centralization in the form of large hospitals had proved to be inefficient, because it was difficult to staff such institutions adequately with the limited resources available. Priority had also been given, in the plan, to the launching of a comprehensive training programme for paramedical workers, whose formal training was considered to be essential if health services were to be extended to the rural population. Dr PHIMPHACHANH (Lao People's Democratic Republic) explained that since the Lao People's Democratic Republic had been proclaimed, on 2 December 1975, the Government had made the utmost effort to heal the wounds caused by thirty years of war, to resettle hundreds of thousands of displaced persons and to remove the sequelae of the conflict. The Delegation of the Lao People's Democratic Republic approved the emphasis the Regional Director had placed on the development of health services, in particular primary health care. It fully endorsed the Regional Director's statements on the training of health workers, and said that country health programming had been a fruitful experience for the country. In conclusion, Dr Phimphachanh thanked Member States and the international organizations for the assistance they had extended to the Lao People's Democratic Republic; cooperation with WHO had proved to be particularly valuable. Dr KYONG SHIK CHANG (Republic of Korea) congratulated the Chairman and other officers on their election and the Regional Director on his report, which the Delegation of the Republic of Korea fully endorsed. The Government appreciated the valuable assistance that WHO had rendered to its major health programmes. In recent years, the Republic of Korea had made rapid strides in the development of its economy. From 1962 to 1975 it had achieved an average rate of economic growth of 9% per year, and had thus become virtually self-supporting. In the fourth five-year economic development plan, covering the period , priority would be given to improving the environment by controlling pollution, extending water supplies, and improving sewage treatment; to strengthening the health services by improving health care to low income groups; and to preventing and controlling disease. The Korean Health Development Institute, founded in 1976, would carry out research and evaluation to develop effective measures and methods of formulating national health policies. The Institute would conduct studies jointly with other research

92 SUMMARY RECORD OF THE FIRST MEETING 87 institutes in the country and abroad, as well as research projects on health care requested by the Government. The Government of the Republic of Korea was grateful for the cooperation WHO had provided in the past, and hoped that such cooperation would continue. The Government would continue to promote international cooperation in public health and other matters affecting its common interests with all other countries or areas in the Western Pacific Region and in the world as a whole. Dr CHRISTMAS (New Zealand) also congratulated the Regional Director on the presentation of his report. Conscious of the problem of specialization in the medical profession, New Zealand had recently introduced a government-financed training scheme to enable young hospital residents to train in approved general practices. A subsidized scheme had been introduced to enable medical practitioners in rural areas to appoint nurses to assist them, and the scheme had recently been extended to urban practitioners in response to their demand for similar services. New Zealand had art aging population. He therefore endorsed the proposal made by the Representative of Malaysia that the aged should be provided for in national health services. The Government of New Zealand also laid great stress on epidemiological surveillance, and he agreed with the Regional Director that there was a need to strengthen and coordinate hospital laboratory services. In New Zealand, grants were being made to hospital laboratories to undertake public health work, and the National Health Institute in Wellington was being developed as a reference laboratory in microbiology, toxicology, and clinical biochemistry. The Institute was modelled on the Center for Disease Control, Atlanta, United States of America, and on the Central Public Health Laboratory, London (Colindale), United Kingdom. As regards the health services as a whole, the Government of New Zealand was aware of the need to develop a forward-looking plan for medical manpower, and a workshop had been held recently to review requirements in medical personnel over the next few years. Following the change of Government in 1975, the theoretical programme for the reshaping of the health services had been reviewed and published as a White Paper. A revision was regarded as an urgent priority and a special health services advisory committee had been set up. The Committee would be assisted by a management services research unit to formulate a new programme that would lead to a more integrated and comprehensive health service. Dr NICHOLSON (United Kingdom) congratulated the Regional Director on his extremely well balanced report, which brought out the right priorities. He agreed with other speakers that emphasis should be placed on primary health care. However, although he fully endorsed the idea that the community should be involved and that community health workers should be nominated by their own villages in view of the undesirability of imposing health services from above, he thought that the importance of the district medical officer as the leader of the district health team

93 88 REGIONAL COMMITmE: 'lwenty-seventh SESSION should not be forgotten, since he played an important role in supervision, teaching, retraining, and referral. The importance of traditional doctors should not be disoounted either, especially where there were manpower and financial constraints. Much could be done, and had been done, in some countries and areas of the Region, by training, and by joint training, tradi tional and western doctors. Dr SENILAGAKALI (Fiji), referring to Part II, page 78, paragraph 3 of the Report, thanked the Regional Director for drawing attention to the fact that malnutrition was a major problem in Fiji. That problem had increased over the past years because of the urbanization of rural' populations. He was gratified that the World Food Programme, in collaboration with the Ministry of Health of Fiji, was to launch a project in 1977 for the free distribution of milk over five years at a cost of US$ 5 million. Furthermore, the United States Agency for International Development, together with the Ministry of Health, was to launch a project in 1977 to combat malnutrition. at a cost of 08$ Dr DOS REMEDIOS (Portugal) stressed that the Government of Portugal attached great importance to the fellowship programme and to intercountry programmes for health manpower development on account of the shortage of heal th personnel in the territories for Which it was responsible. It was intended to request increased assistance of that nature in the future. Mr SAFITOA (Papua New Guinea) expressed appreciation for the eleven projects in which WHO cooperated in Papua New Guinea, and congratulated the Regional Director for placing emphasis on the delivery of basic health care at the grass-roots level. In Papua New Guinea priority was being given to the development of health services for the rural population. Dr FAAIUASO (Western Samoa) commended the special attention paid by the Regional Director to the problem of filariasis. Western Samoa was a pilot area for WHO's activities in filariasis control, and the Organization and UNICEF had devoted considerable resources to control of the disease over the past decade. As noted in the Report, the micro~ filarial rate had recently risen again; one way of reducing it would be to trace and treat all cases, and it was hoped that WHO would cooperate in such efforts. The Government of Western Samoa was prepared to cooperate fully in the planned WHO filariasis research project in Western Samoa. The REGIONAL DIRECTOR, replying to the query by the Representative of Australia about the situation concerning UNDP funds, drew attention to the table on page 65 of his Report, which showed the obligations incurred from UNDP funds up to In 1976 plazmed progr&llllles to a value of 00$ had had to be deleted, while top-priority activities. costing US$ had had to be transferred to the WHO Regular Budget. '.!he total reduction in UNDP funds in the Region was some US$ In 1977, there would be a shortfall of US$ for health manpower teacher training activities. The UNDP Representative in Manila might be able to give further information When he addressed the Committee under Item 18 of the Agenda.

94 SUMMARY RECORD OF THE FIRST MEETING 89 In reply to another question from the Representative of Australia. the Regional Director pointed out that the low priority given in the Region to the control of chronic diseases such as cancer and cardiovascular diseases reflected the wishes of Member States, not those of WHO. He fully agreed that more consideration should be given to that group of diseases. Increased attention to the sexually transmitted diseases and nutrition would also be welcomed. The Regional Director had been gratified to hear from the Representative of Malaysia of the progress made with the health information system in that country. He hoped it would be possible for workers from other countries or areas in the Region to visit Malaysia in order to learn from its example. -"" Finally, he thanked Representatives for their kind comments on the quality of his Report. The fact that he was able to report so positively was largely due to the efforts of the staff of the Region, particularly the project staff. There being no other comments, the CHAIRMAN asked the Rapporteurs to prepare an appropriate resolution. (For consideration of the draft resolution, see the third meeting. section 1.1.) 7 ALLOCATION AND MANAG1!l<'IENT OF WHO I S RESOURCES AT REGIONAL AND COUNrRY level: Item 10 of the Agenda (Document WPR/RC27/4) The REGIONAL DIRECTOR informed the Committee that document WPR/Rc27/4 set out in detail proposals for a further development in the programme budgeting procedure, based on the concept of programming by objectives and budgeting by programmes. If the Committee approved the proposals put forward. a new form of budget presentation would be introduced in the proposed programme budget for In 1978, instead of a document containing proposals for projects down to the last detail, such as document WPR/RC27/2 (Proposed programme budget estimates for the financial years 1978 and 1979) which it was going to consider later in the present meeting, the Committee would have before it a summary in the form of narrative country programme statements, setting out broad programme trends, objectives and modes of action, with a planning figure for each country or area, broken down by major programmes or areas of cooperation. The formal programming would have been carried out in the countries themselves earlier in It would not be until the year immediately preceding the operating period, that the broad programme proposals would be cast in detailed terms of human resources, supplies, equipment, etc. Plans of operation for specific activities would have been developed with national authorities and discussed in the intervening period and dialogue with national authorities would continue during the operating period as part of the process of ongoing management and evaluation. Dr FAAIUASO (Western Samoa) expressed support for the suggested procedure, and noted with satisfaction that WHO was moving from a project-oriented policy towards a programme-oriented policy. He asked for further details on how the individual "country planning figures" would be arrived at.

95 90 REGIONAL COMMI'l"lEE: 'lwenty-seventh SESSION Dr EVANS (Australia) coidented that so. portions of the Ensllah ten of document WPR;RC27/4 were extremely difficult to understand. All in all, however, the document was valuable, and he agreed that the tjpe of planning statement it proposed would be more readily understandable to Representatives. The prosramme-oriented approach was a wise innovation. Nevertheless, as some projects continued from one biennium to the next it was important to know their future cost at an early stage so as to estimate what resources would be available for new projects. There was a danger that the new system might lessen WHO's accountability, and he suggested it might prove advisable for the Regional COlllllittee to set up a working group to conduct surveys in certain programme areas. Otherwise the Delegation ot Australia supported the proposals. Dr K:!OlIO SHIKCHANG.(Republ1c'GfKorea)4eBoribecl the propoaecl form of bi.ldget presentation as real18t1o, and supported the introduction of the new system. Dr MAJID (Malaysia) sa.id he was well aware of the problems faced by WHO in the tnanagement of cooperation at the country level. Mala7l!1ia had been associated with WHO in the developant of the new system of programme budgeting~ After five years otpersistent and strenuouii efforts the project systems analysis exercise had not proved the complete answer, but it had indicated SOllIe new approaches. The Government of Malaysia supported the principle that the WHO programme budget should be based on programming by objectives and budgeting by programmes. Problems of implementation were to be anticipated, but should not prove insurmountable. In practice it would be necessary to make allowance for the budgetary cycles of Member States. which differed from the WHO cycle; Malaysia had an annual cycle within the tramework of a five-year plan. In Malaysia the national health plan was integrated with overall national planning, and was designed to complement and support overall Government policies and objectives. The system that WHO was endeavouring to develop was similar to that currently in use in MalaYsia, and his country would willingly provide assistance or the benefit of its experience in the implementation of the new system. DrPHIMPHACHANH (Lao People's Demooratic Republic) said that the Government of the Lao People IS Democratio Republic had important programmes planned up to First, it was called upon to ensure that the whole population, particularly the working masses and the various ethnic minorities, be granted access to health care based on community health services. Secondly, it planned to undertake drug pro<iuction within tbec~tr7j c~oin& D7 aet~ up labora"tl!lri_. producing both sa.lt and glucose sera, which constituted the basis for the production of pharmaceuticals at industrial level as well as on a small scale.

96 SUMMARY RECORD OF THE FIRST MEETING 91/92 Dr KING (United States of America) congratulated the Regional Director on his forthright approach to long-term country planning and on the proposal to integrate the plans into the WHO budgetary cycle two years in advance. He welcomed the distinction between cooperation and assistance, and the emphasis on the former as WHO's rightful role. It was to be hoped that the "narrative country programme statements" would be clear and of high quality. Some kind of time frame for programmes should be included, as should some indication of the commitment by the country or area concerned to support the programme. -" He noted that it was not intended to show detailed activities and project lists in the proposed programme budgets; however, as programmes proceeded it would be essential to provide such information so as to permit evaluation by the Regional Committee. He urged that at an early stage in pro~amme developmelo~_an indication be given of the expected breakdown of allocations of personnel, fellowships and travel costs by WHO and by the country. That should not reduce flexibility, but would protect against excessive expenditure by WIll of' funds, supplies and equipment. The initial broad programme areas should be gradually refined during two years of discussion with governments so as to develop specific projects with precise costing. (For continuation of discussion, see the second meeting, section 1.) The meeting rose at a.m.

97 (WPR/RC27!SR!2) SUMMARY RECORD OF THE SECOND MEETING WHO Conference Hall, Manila Monday, 6 September 1976 at 2.30 p.m. CHAIRMAN: Mr J.S. Singh (Fiji) CONTENTS 1 2 Allocation and management of WHO's resources at regional and country level (continued) Preparation of a Fifth Regional Programme of Work for a Specific Period ( inclusive) Special assistance to Democratic Kampuchea. the Lao People's Democratic Republic, and the Socialist Republic of Viet Nam Resolutions of regional interest adopted by the TWenty-ninth World Health Assembly and the Executive Board at its fifty-seventh and fifty-eighth sessions Announcement 102 lat

98 94 REGIONAL COMMI'I'IEE: 'lwn'ly-seventh SESSION Second Meeting Monday, 6 September 1976 at 2.30 p.m. PRESENT I. Representatives of Member States AUSTRALIA CID:NA FIJI Dr C. Evans Mr K. Boreham Dr Chen Hai-feng Dr Chin Hsiang-kuan Dr Huang Yu-hsiang Mr Tsao Yung-lin Mr Li Ching Hsiu Mr J.S. Singh Dr J.B. Senilagakali Dr P. Leproux JAPAN LAO PEOPIE'S DEMOCRATIC REPUBLIC MALA'YSIA NEW ZEALAND PAPUA NEW GUINEA PID:LIPPINES PORTUGAL REPUBLIC OF KOREA Dr A. Tanaka Dr H. Shinozaki Mr T. Yano Dr Keo Phimphachanh Tan Sri Datuk: (Dr) Abdul Majid Ismail Dr Mehar Singh Gill Mr Onn bin Kayat Dr B.W. Christmas Mr E. Robin Safitoa Dr K. Wari Dr J. Sumpaico Dr F. Aguilar Dr A.M. Angara Dr Leonel dos Remedios Dr Kyong Shik Chang Mr Se Lin Huh Mr Moo Geun Jeon

99 SUMMARY RECORD OF THE SECOND MEETING 95 SINGAPORE SOCIALIST REPUBLIC OF VIETNAM UNITED KINGDOM UNI'l D STA'lES OF AMERICA WESTERN SAMOA Dr Leong Kwok Wah Dr Tran Ngoc Dang Dr Nguyen Van Trong Mr Nguyen Hong Quang Dr J.A.B. Nicholson Dr J.C. King Dr Solia Tapepi Faaiuaso II. Representatives of Other Intergovernmental Organizations ASIAN DEVELOPMENT BANK SOUTH PACIFIC COMMISSION Mr K.H. Phua Dr E. Macu Salata III. Representatives of Non-governmental Organizations INTERNATIONAL DE~L FEDERATION INTERNATIONAL UNION FOR HEALTH EDUCATION WORID FEDERATION FOR MEDICAL EDUCATION CHRISTIAN MEDICAL COMMISSION IN'lERNATIONAL COMMITIEE OF CATHOLIC NURSES INTERNATIONAL COUNCIL OF NURSES IN'lERNATIONAL SOCIETY OF RADIOGRAPHERS AND RADIOLOGICAL 'lechnicians IN'lERNATIONAL SOCIETY OF RADIOLOGY IEAGUE OF RED CROSS SOCIETIES REHABILITATION IN'lERNATIONAL Dr R.C. Navia Dr F. Herrera Dr J. Cuyegkeng Dr G.H. Viterbo Mrs M.R. Ordonez Mrs F.M. Valdez Mr N.A. Palomo Dr H. Zialcita Brigadier General P.R. Sotto (Ret.) Mrs C. Floro

100 96 REGIONAL COMMI'l"lEE: 'IWENTY-SEVENTH SESSION INTERNATIONAL COUNCIL ON Brigadier General P.R. Sotto (Ret. ) SOCIAL WELFARE WORID VE'IERANS FEDERATION Brigadier General P.R. Sotto (Ret. ) WORID FEDERATION OF UNITED Dr N.M. Santiago NATIONS ASSOCIATIONS ~ IV. WHO Secretariat SECRETARY Dr Francisco J. Dy

101 SUMMARY RECORD OF THE SECOND MEETING 97 1 ALLOCATION AND MANAGEMENT OF WHO'S RESOURCES AT REGIONAL AND COUNTRY IEVEL: Item 10 of the Agenda (Document WPR/RC27/4) (continued from the first meeting, section 7) Dr TANAKA (Japan) congratulated the Representatives of Papua New Guinea on being present at a session of the Regional Committee for the first time since that country had become a full Member of the Organization. He also expressed his Government's deepest sympathy to the Representatives of China and the Philippines for the sufferings the two countries had encountered as a result of the recent earthquakes. The Delegation of Japan supported in principle the proposed programme-oriented approaoh in planning, budgeting and management desoribed in document WPR/RC27/4. This new method was more praotical and would faoilitate the implementation of WHO programmes and oontribute to the effective use of a limited budget. Dr NICHOLSON (United Kingdom) stated that the Government of the United Klngdom recognized the importanoe of ensuring that resouroes were available for technioaloooperation programmes w,nen they were really needed. It would support the proposals contained in document WPR/RC27/-4. It woulcl be wrong however to think that, ultimately, the functions of WHO Headquarters would be dispersed; there were always important functions for it to carry out, such as ooordination of global programmes and some important technical oooperation programmes. In this connexion it might be worthwhile to point out that about 28% of WHO's staff was based in Geneva, compared to about 60% of FAO's in Rome and 8~ of UNESCO's in Paris. Mr SAFITOA (Papua New Guinea) said that the Government of Papua New Guinea supported the programming idea in principle though it had one reservation because of the differing budgetary systems used by individual countries. For instance, in Papua New Guinea the Government operated under a yearly budgeting programme. If the new system were to be adopted, closer collaboration between WHO and governments would be needed. He suggested that some flexibility within the budgeting system should be considered so that changes occurring within government programmes would not necessarily affect the WHO programme. The REGIONAL DIRECTOR replied that the system should be easily able to meet the problem of different government budgeting cycles because one of its features was flexibility. Country planning figures were based on United Nations statistical reports and data from other sources. In allocating them, for each country or area, the Programme Committee of the Regional Office took into account population, crude birth rate, crude death rate, infant mortality, life expectancy at birth, physicians per population, E cap! ta gross national product and also the country or area's demonstrated absorptive capacity. These criteria had been used for a number of years, and no significant change was planned. The more developed and affluent countries would probably want to reduce the amount of technical cooperation they received in financial terms in favour of the less affluent developing countries.

102 REGIONAL COMMIT'lEE: 'l\<ien'ly-seventh SESSION The Regional Director went on to say that the important principle involved was.dialo~e at the country level between WHO staff and governments. With greater involvement of governments, there would be a more orderly development of what was termed "medium-term programming", which was what the Executive Board wished to see. By late 1977 examples of medium-term programming would have been developed, commencing with the health manpower development programme. Miss NEWTON (Chief, Administration and Finance) stated that there should be no concern in the Western Pacific Region regarding WHO's accountability. The Regional Director would report to the Regional Committee after project details had been developed within a programme already considered under the new system. It was traditional for the Regional Director to make all the information it required available to the Committee for evaluation purposes and this would continue under the new system. The only change would be that d.etalls of projects would not be planned three to four years in advance but rather broad analyses of programmes. However, the Regional Committee would see details of. the planned projects at the session following its review of the broad programmes, after they!:\ad been worked out between the government concerned and the WHO Secretariat. The Regional Director added that the same subject was an item on the agenda of all WHO Regional Committees' in 1976; 'ibeir comments would be submitted to the Executive Board, possibly in January 1977, and subsequently to the World Health Assembly. There being no further comments, the Committee decided to consider immediately the draft resolution contained in document WPR/RC27/4. Decision: The draft resolution was adopted (see resolution WPR/RC27. Rl) 2 PREPARATION OF A FIFTH REGIONAL PROGRAMME OF WORK COVERING A SPECIFIC PERIOD ( INCWSIVE): Item 16 of the Agenda (Document WPR/RC27/10) The REGIONAL DIRECTOR stated that the Committee, at its twentysixth session, had decided to wait until its present session to consider whether it wished to prepare a fifth regional programme of work covering the period , or whether the Sixth General Programme of Work for the same period, adopted by the Health Assembly in May 1976, was a sufficient ~ide to deliver the programme of the Region. At the twenty-sixth session, when the Committee considered the draft of the Sixth General Programme of Work, it allocated priorities to each prinoipal and detailed objective. In the final Programme adopted by the Health Assembly these objectives had been somewhat reworded or amplified, and in some oases their order had been changed. Annex 3 of document WPR/RC27/l0 enabled the final objeotives to be oompared to those oontained in the draft. They remained essentially the same exoept for four, which were new. On page 2 of document WPR/RC27 /10, Representatives would find listed the four new objectives to whioh priorities had to be acoorded for the regional programme.

103 SUMMARY RECORD OF THE SECOND MEE'IING 99 The Committee would therefore wish to consider the following: (1) whether it agreed that all except four of the objectives Of the final Sixth General Programme of Work remained essentially the same and therefore retained the same regional priority as those contained in the draft which was before the Committee at its twenty-sixth session in 1975; (2) the priorities, for the regional programme, of the four new objectives; (3) the necessity, or otherwise, to prepare a fifth regional programme of work. Dr FAAIUASO (Western Samoa) said the importance of the item was recognized. From a review of the Sixth General Programme of Work, it seemed that a separate regional programme would serve little purpose. What mattered was for governments to develop their own country health programming on the basis of the objectives in the Sixth General Programme of Work. With regard to the four new objectives it was suggested that for the regional programme, priority A be given to objectives 3.1 and 3.2 (Section A), and priority B to objectives 7.1 (Section A) and 1.6 (Section B). Dr EVANS (Australia) was interested to hear the remarks of the Representative of Western Samoa, which overall had the support of his Delegation, especially with regard to objectives 3.1 and 3.2; objective 7.1 might perhaps be given priority B. The view was also supported that there was no need for a fifth regional programme Since the Sixth General Programme of Work contained sufficient guidance for delivery of programmes in the Region from 1978 tol983. Under resolution WHA29.20 the WHO Executive Board had been asked to study the Sixth General Programme of Work in depth and to evaluate it.l Regional Committees could assist the Board by indicating which sections of the Programme should be given high priority for in-depth study. The role of the Board in carrying out annual reviews of the Programme was strongly supported. It might be useful to set up a small working party to study the matter and report back to the Committee at its present session; nevertheless the Committee should be able to express its views to the Board continuously. That would show that the Region was endeavouring to influence the Board's decisions in a way commensurate with the regional activities and priorities. The working party could also consider the concept of "technical cooperation", which had not been defined in the documents issued. Dr MAJID (Malaysia) strongly supported the proposal of the Delegations of Australia and Western Samoa that a working group be formed. The CHAIRMAN asked the Regional Director to clarify the situation. The REGIONAL DIRECTOR welcomed the proposal to establish a working group, which appeared to be acceptable. However, he wondered whether a decision on the questions he had raised should be postponed until after the working group had submitted its conclusions, or taken straight 1 See WHO Official Records, No. 233, 1976, pp

104 100 REGIONAL COMMI'l'IEE: M:NTY-SEVENTH SESSION away. Also, it would be appreciated if the Representative of Australia were to formulate terms of reference for the working group so that it could be appointed by the Chairman. It could then meet and report to the Committee before adjournment, some time during the week. The CHAIRMAN felt that the meeting should consider the proposals with regard to priorities A and B. Views of Representatives had been heard. It had been proposed that objectives 3.1 and 3.2 might be assigned priority A and objective 7.1 priority B. It should also be decided whether discussion of the matter should be deferred until after appointment of the proposed working group. The views of the meeting were sought. Dr MAJID (Malaysia) was of the opinion that since there was agreement to form a working group, it would be wiser to discuss the priorities of the objectives after hearing the proposals of the working group. Dr CHRISTMAS (New Zealand) supported the recommendation of the Representative of Malaysia. The CHAIRMAN noted that the Committee was in agreement with the proposal to form a working group. It would be composed of members from Australia, Malaysia and Western Samoa. Every assistance from the Secretariat would be available. The REGIONAL DIRECTOR reiterated his suggestion that terms of reference for the working group might be drafted by the Representative. of Australia, Dr Evans, if he agreed. Also, Dr Ferrand, Assistant Director of Health SerVices, was available to render assistance. The time for convening the working group could be decide.d at the end of the afternoon. >. The Committee agreed that the Representative of Australia would draft the terms of reference and convene the working group which would present its report to the Committee later in the session. (For discussion of the terms of reference of the working grou~, see the third meeting, section 5; for consideration of the report of the working group, see the fifth meeting, section 3.) 3 SPECIAL ASSISTANCE TO DEMOCRATIC KAMPUCHEA, THE LAO PEOPIE'SI DEMOCRATIC REPUBLIC, AND THE SOCIALIST REPUBLIC OF VIEr NAM: Item 11 of the Agenda (Documents WPR/RC27/?, Add.l and Add.2) The REGIONAL DIRECTOR drew attention to the three documents issued under this item of the Agenda. Document WPR/RC27/5 briefly stated the steps taken to implement resolutions of the Twenty-eighth World Health Assembly and the twenty-sixth session of the Regional Committee and transmitted to the Committee the report of a special meeting on assistance to Viet Nam, held in Manila on 30 and 31 March 1976 as a first step towards stimulating extrabudgetary assistance from Member States. 1 See also the sixth meeting, section 2.

105 SUMMARY RECORD OF THE SECOND MEETING 101 Document WPR/RC27/5 Add.l described the accelerated action taken with regard to assistance to the Socialist Republic of Viet Nam since the TWenty-ninth World Health Assembly in May 1976, when resolution WHA29.24 was adopted, which had happily resulted in several positive responses. Document WPR/Rc27/5 Add.2 presented to the Committee programmes meriting special assistance in the Lao People's Democratic Republic which had been formulated with the Government over the past two months. The Committee would certainly wish to express its appreciation to Member States that had indicated their willingness to assist the three stricken countries in reconstructing their health services. It might also wish to urge all other Member States having sufficient resources, to make whatever other contributions they could. Dr MAJID (Malaysia) said that his Government sympathized with the heal th problems in the Indochinese States and fully supported the action of the United Nations agencies in rehabilitating the health services. At the special meeting on March 1976, the Government of Malaysia had agreed to contribute M$ in special assistance for the Socialist RepUblic of Viet Nam and the amount had been made available to WHO shortly after. Malaysia had wide experience in tackling health problems such as tuberculosis, malaria, leprosy and yaws and was willing to share its experience with others. Moreover, as Malaysia had established diplomatic relations with the Socialist Republic of Viet Nam and the Lao People's Democratic Republic, it would be pleased to promote bilateral cooperation in addition to the WHO efforts for improvement of health in those countries. Dr IEPROUX (France) stressed the great interest which the Government of France took in the Organization's programme of assistance to the Socialist Republic of Viet Nam. While France did not contribute financially to this international programme, its bilateral assistance in the field of health could be considered complementary to the activities of WHO. For instance, the Government of France continued to supply drugs to. Grall Hospital, which had been taken over by the Vietnamese authorities, and would place four or five specialists at its disposal. Similarly, the French Red Cross had contributed an amount of 00$ to Hocmun Hospital. There being no further coliid.ents, the CHAIRMAN asked the Rapporteurs to prepare an appropriate resolution. (For consideration of the draft resolution, see the third meeting, section 1.2.) Dr NGUYEN VAN TRONG (Socialist Republic of Viet Nam) expressed the gratitude of the Government of the Socialist Republic of Viet Nam to the Director-General, the Regional Director, the WHO experts and Member States for having studied and worked out a special programme of

106 102 REGIONAL COMMITlEE: 'IWENTY-SEVENTH SESSION assistance to Viet Nam. The Programme had initially been prepared for two separate States and had now been approved by the reunified Government; it was hoped it could be carried out without delay so as to solve the urgent health problems of the post-war period. WHO had taken the first steps to solicit the necessary funds. The Representative of the Socialist Republic of Viet Nam wished to convey his Government's appreciation to all Member States that had offered to contribute to the effort undertaken. 4 RESOWTIONS OF REGIONAL INTEREST ADOPTED BY THE 'lwenty-ninrh WORID HEALTH ASSEMBLY AND THE EXECUTIVE BOARD AT ITS FIFTY SEVENTH AND FIFTY-EIGHTH SESSIONS: Item 12 of the Agenda (Documents WPR/RC27/6 and Add.l) The REGIONAL DIRECTOR proposed that resolution WHA29.19 be considered later, together with resolutions WHA29.74 and EB57.R27, since the three were closely related. 4.1 Sixth General Programme of Work covering a Specific Period (Resolution WHA29.20) The REGIONAL DIRECTOR reminded the Committee that it was already discussing the application of the Sixth General Programme of Work to the programme of the Region under the separate agenda item Psychosocial factors and health (Resolution WHA29.2l) The Committee noted the two above-mentioned resolutions without comment. 4.3 Report on the world health situation (Resolutions WHA29.22 and EB57.R46) The REGIONAL DIRECTOR drew attention to operative paragraphs 1 and 2 of resolution WHA Dr NICHOLSON (United Kingdom), referring to resolution WHA29.22, remarked that the report was a sobering review of the situation, particularly in respect of progress in the field of tuberculosis and the near-disaster situation with regard to malaria. 4.4 Real Estate Fund (Resolution WHA29.28) The Committee noted the resolution without comment. 4.5 Voluntary Fund for Health Promotion (Resolutions WHA29.31 and EBSS.RlO) The REGIONAL DIRECTOR drew the Committee's attention to operative paragraphs 2 and 3 of resolution WHA29.31 and operative paragraph 2 of resolution EBSS.RlO.

107 SUMMARY RECORD OF THE SECOND MEETrNG 103 Dr NICHOLSON (United Kingdom) said that the Government of the United Kingdom's attitude had generally been that. if a programme was worth carrying out, it should receive priority for support from Regular Budget funds. Nevertheless, it had made a contribution of some US$ over 3 years towards the Smallpox Eradication Programme and was currently providing funds and experts to the Special Programme for Research and Training on Tropical and Parasitic Diseases. He believed that the Government of the United Kingdom might be providing tangible evidence of support for the Expanded Programme on Immunization in the near future. and it was. of course, interested in the programme for community water supply. 4.6 Organizational study on the planning for and impact of extrabudgetary resources on WHO's programme and policy (resolution WHA29.32) The REGIONAL DIRECTOR drew attention to operative paragraph 3. The Committee noted the resolution without comment. 4.7 Coordination with the United Nations system - general matters: UNDP-supported activities - financial situation (resolutions WHA29.42 and EB57.R49) The REGIONAL DIRECTOR drew attention to operative paragraph 2 of resolution WHA Dr NICHOLSON (United Kingdom) said that the Government of the United Kingdom, through its Ministry of Overseas Development, was considering sympathetically more than one of the problems created by that situation. 1~.8 Coordination with the United Nations system: general matters (resolution EB57.R48) The committee noted the resolution without comment. 4.9 Coordination wi th the United Nations system (general matters): technical cooperation among developing countries (resolution EB57.R50) The REGIONAL DIRECTOR drew attention to operative paragraphs 1 and 3. Dr CHEN HAI-FENG (China) said that, in resolution EB57.R50 and resolution WHA29.45 (see Item 4.11 below). mention had been made of resolutions WHA28.75 and WHA The Chinese delegation had categorically stated its position on those resolutions during the Twenty-eighth World Health Assembly and did not wish to reiterate it.

108 104 REGIONAL COMMITlEE: 'NENTY-SEVENTH SESSION Dr NICHOLSON (United Kingdom) said that the whole aim of development programmes was to attain national self-reliance or perhaps even regional self-reliance. His government was sympathetic to that aim and might, for example, be interested in a project for the training of auxiliaries, and possibly in providing training abroad for a particular project in hand. That policy was now under consideration. ft International Women's Year (resolution WHA29.43) The REGIONAL DIRECTOR drew attention to operative paragraph 1. Dr NICHOLSON (United Kingdom) observed that, although health was a field in which the place of women was beyond dispute, there was not a single woman sitting at the meeting table at that moment WHO's human health and environment programme (resolution WHA29.45)!he REGIONAL DIRECTOR drew attention to operative paragraph Health aspects of human settlements (resolution WHA29.46) The REGIONAL DIRECTOR drew attention to operative paragraph 2. The Committee noted the two above-mentioned resolutions without comment Community water SUpply and excreta disposal (resolution WHA29.47) The REGIONAL DIRECTOR drew attention to operative paragraph 4 and to operative paragraph 5 (4), which requested specific action on the part of regional committees in the year Dr NICHOLSON (United Kingdom) thought it essential that Member States give high priority to that matter and saw health ministries as taking a leading role and convincing other ministries of the importance of safe water and proper sanitary disposal Programme budget policy (resolution WHA29.48) Dr NICHOLSON (United Kingdom) said that his government understood the wish of Member States' representatives to see more tangible results of work done in their countries and the Director-General and his Secretariat were working towards that end. The transfer of technology from the developed to the developing countries was desirable, provided that a proper balance in the allocation of the Organization's resources was maintained Cardiovascular diseases (resolution WHA29.49) The REGIONAL DIRECTOR drew attention to operative paragraph 2.

109 SUMMARY RECORD OF THE SECOND MEETING Occupational health programme (resolution WHA29.57) The REGIONAL DIRECTOR drew attention to operative paragraph 1 and to operative paragraph 3, which called for discussion of the subject by regional committees in 1977 or Schistosomiasis (resolution WHA29.5B) 2. The REGIONAL DIRECTOR drew attention to operative paragraphs 1 and The Committee noted the three above-mentioned resolutions without conunent. infections (resolution WHA29.59) The REGIONAL DIRECTOR drew attention to operative paragraph 1. Dr NICHOISON (United Kingdom) remarked that mycotic infections were arousing increased interest but that as yet very little reliable knowledge existed on morbidity from those conditions, for instance on systemic morbidity. The Government of the United Kingdom supported research in that field Expanded programme on immunization (resolution WHA29.63) The REGIONAL DIRECTOR drew attention to operative paragraph 4. Dr SUMPAICO (Philippines) stated that an immunization programme had been launched in the Philippines in 1976, involving both vaccine production and implementation by field units. Assistance was being provided by WHO, UNICEF and the Netherlands, but it was hoped that after five years the Government would be able to proceed with the programme using national resources only Rheumatic diseases (resolution WHA29.66) The REGIONAL DIRECTOR drew attention to operative paragraph 1. The Committee noted the resolution without comment :!:!!:::...!=~..:.f.:::o.:,.r...;l;a;:.:bo::.:::.:r~a:.:to:.::;r~y~a=:n:;:~:.: ma=:l::s~f~o:;.r_th=e~c:.:o;:;n:.:t=-r~o::.l_o~f;...;b;.;;i~o;.;;l:.:o!"g~ic:;a;;;;;;;l and the establishment of breedin colonies nonhuman (resolution WHA29. 7) Dr NICHOISON (United Kingdom) pointed out that the Government of the United Kingdom was setting up breeding facilities for experimental animals, using marmosets which were easier to breed than rhesus monkeys.

110 106 REGIONAL COMMI'I'1EE: 'lwenty-seventh SESSION 4.22 Disability prevention and rehabilitation (resolution WHA29.68) The REGIONAL DIRECTOR drew attention to operative paragraph 3. The Committee noted the resolution without comment Leprosy control (resolution WHA29.70) Dr FAAIUASO (Western Samoa) expressed the Government of Western Samoa's gratitude to WHO and to UNICEF for their technical and material assistance to the leprosy survey conducted in The United States of America had also provided valuable support by assigning staff to the survey. Mr SAFITOA (Papua New Guinea) voiced his appreciation of the substantial contribution by the Japanese Shipbuilding Industry Foundation for leprosy control in Papua New Guinea Health manpower development (resolution WHA29.72) ~eregional DIRECTOR drew attention to paragraph 2(6) which requested that medium-term health manpower development programmes be established at country level and discussed at the meetings of regional committees in It was proposed to start. early in to assemble the necessary information. hopefully through a series of country visits from Regional Office staff DeVelo~nt of the anti malaria programme (resolutions WHA29.73 and. EB57.R2 ) The REGIONAL DIRECTOR drew attention to operative paragraph 1 of resolution EB57.R26. The Committee noted the two above-mentioned resolutions without comment Promotion of national health services and health technology relating to primary health care and rural development (resolutions WHA29.74 and EB57.R27) The REGIONAL DIRECTOR drew attention to operative paragraphs 2 and 3 of resolutionwha to operative paragraph 2 of resolution EB57.R27. and to paragraph 1 of the related resolution WHA which referred to the forthcoming International Conference on Primary Health Care. Document WPR/RC27/6 Add.l provided an outline of the action already taken to promote primary health care in the Region and plans for the :future.

111 SUMMARY RECORD OF THE SECOND MEETING 197/108 Dr NICHOLSON (United Kingdom) stated that the Government of the United Kingdom was developing a new aid strategy. placing emphasis on coordination. to improve primary health care for the least privileged population groups. Training of personnel should be adjusted to the specific needs and resources of each country, and self-reliance should be encouraged. Accordingly, it was important to train as many categories of health personnel as possible in national or regional institutions, rather than in countries with different problems Development of programme evaluation in WHO (resolution EB57.Rl7) The REGIONAL DIRECTOR drew attention to operative paragraph 3. Mr BOREHAM (Australia) stressed that programme evaluation should be built into all programmes, and welcomed the fact that it was built into the Sixth General Programme of Work Report by the representatives of the Executive Board at the '!'went -ninth World Health Assembl: Method of work of the Executive Board in relation to prograllllle development (resolution EB.Rll The REGIONAL DIRECTOR drew attention to operative paragraph 5. Dr EVANS (Australia) pointed out that the purpose of the resolution was to give the Executive Board a more active role in managing the activities of the Organization. Any move to increase the responsibilities of the Board should be supported. as that would mean an increase in the involvement of all Member States. 5 ANNOUNCEMENT The REGIONAL DIRECTOR outlined the tentative programme of work for the remainder of the session which would be duplicated and distributed to the Committee. The meeting rose at 4.30 p.m.

112 (WPRjRc27/SR/3 ) SUMMARY RECORD OF THE THIRD MEETING WHO Conference Hall, Manila Tuesday,. 7 September 1976 at 9.00a.liI. CHAIRMAN: Mr J.S. Singh (Fiji) CON'IENT.3 1 Consideration of draft resolutions Address by incoming Chairman WHO's role in the development and coordination of biomedical research: greater involvement of the Regions in research Alcoholism and other dependence problems Reconsideration of preparation of a fifth regional programme of work for a specific period ( inclusive) '!he regional environmental health programme: regional centre for environmental health sciences Frequency of meetings of the Regional COll1llli ttee Annual reporting by the Regional Director

113 ;. 110 REGIONAL COMMITlEE: 'IWENTY-8EVENTH SESSION 'lhird Meeting Tuesday. 7 September 1976 at 9.00 a.m. PRESENT I. Representatives of Member States AUSTRALIA CHINA FIJI FRANCE JAPAN LAO PEOPIE' S DEMOCRATIC REPUBLIC MALAYSIA NEW ZEALAND PAPUA NEW GUINEA PHILIPPINES PORTUGAL REPUBLIC OF KOREA SINGAPORE Dr C. Evans Mr K. Boreham Dr Chen Hai-feng Dr Chin Hsiang-kuan Dr Huang Yu-hsiang Mr Tsao Yung-lin Mr Li Ching Hsiu Mr J.S. Singh Dr J.B. Senilagaka1i Dr P. Leproux Dr A. Tanaka Dr H. Shinozaki Mr T. Yano Dr Keo Phimphachanh Tan Sri Datuk (Dr) Abdul Majid Ismail Dr Mehar Singh Gill Mr Onn bin Kayat Dr B.W. Christmas Mr E. Robin Safitoa Dr K. Wari Dr J. Sumpaico Dr A.M. Angara Dr Leone1 dos Remedios Dr Kyong Shik Chang Mr Se Lin Huh Mr Moo Gaun Jeon Dr Leong Kwok Wah

114 SUMMARY RECORD OF THE THIRD MEETING 111 SOCIALIST REPUBLIC OF VIET NAM UNI'lED KINGDOM UNITED STA'lES OF AMERICA WESTERN SAMOA Dr Tran Ngoc Dang Dr Nguyen Van Trang Mr Nguyen Hong Quang Dr J.A.B. Nicholson Dr J.C. King Dr Solia Tapeni Faaiuaso II. Representatives of Other Intergovernmental Organizations SOUTH PACIFIC COMMISSION Dr E. Macu Salato III. Representatives of Non-governmental Organizations WORlD FEDERATION OF THE DEAF INTERNATIONAL DENTAL FEDERATION INTERNATIONAL UNION FOR HEALTH EDUCATION WORID FEDERATION FOR MEDICAL EDUCATION MEDICAL WOMEN'S INTERNATIONAL ASSOCIATION INTERNATIONAL COMMITTEE OF CATHOLIC NURSES INTERNATIONAL COUNCIL OF NURSES WORID FEDERATION OF OCCUPATIONAL THERAPISTS INTERNATIONAL PLANNED PARENTHOOD FEDERATION INTERNATIONAL SOCIETY OF RADIOGRAPHERS AND RADIOLOGICAL 'lechnicians INTERNATIONAL SOCIETY OF RADIOLOGY LEAGUE OF RED CROSS SOCIETIES Mrs E.S. Carlos Dr R.C. Navia Dr F. Herrera Dr J. Cuyegkeng Dr E.I. Cuyegkeng Mrs M.R. Ordonez Mrs F.M. Valdez Miss C. Tablan-Santos Dr J.B. Catindig Mr N.A. Palomo Dr H. Zialci ta Brigadier General P.R. Sotto (Ret.)

115 112 REGIONAL COMMITlEE: 'lwen'ly-seventh SESSION REHABILITATION INTERNATIONAL INTERNATIONAL LEAGUE AGAINST RHEUMATISM Mrs C. Floro Dr T.P. Torralba IN'IERNATIONAL COUNCIL Brigadier General P.R. Sotto (Ret. ), - ON SOCIAL WELFARE WORID VE'IERANS FEDERATION WORID FEDERATION OF UNI'IED NATIONS ASSOCIATION Brigadier General P.R. Sotto (Ret.) Dr N.M. Santiago IV. WHO Secretariat SECRETARY Dr Francisco J. Dy,;:

116 SUMMARY RECORD OF THE THIRD MEETING CONSIDERATION OF DRAFT RESOLUTIONS The Committee considered the following resolutions: 1.1 Annual Report of the Regional Di rector (Document WPR!RC27 iwp /1) Decision: The draft resolution was adopted without comment (see resolution WPRjRc27.R2). 1.2 SpeCial assistance to Democratic Kampuchea, the Lao People's Democratic Republic and the Socialist Republic of Viet Nam (Document WPR/RC27;WP/2) The REGIONAL DIRECTOR announced that the Government of Canada would contribute US$ for assistance to the Lao People's Democratic Republic. The Committee might wish to amend the fourth line of operative paragraph 3 of the draft resolution to read: " Governments of Australia and Canada " Decision: The draft resolution was adopted as amended (see resolution WPR/RC27.R3). 1.3 Resolutions of regional interest adopted by the Twenty-ninth World Health Assembly and the Executive Board at its fiftyseventh and fifty-eighth sessions (Document WPR!RC27 iwp /3) Decision: The draft resolution was adopted without comment (see resolution WPR/RC27.R4). 2 ADDRESS BY INCOMIW CHAIRMAN: Item 5 of the Agenda The CHAIRMAN addressed the meeting. Annex 1. His statement appears in 3 WHO'S ROLE IN THE DEVELOPMmr AND COORDINATION OF BIOMEDICAL RESEARCH: GREATER INVOLVEMENT OF THE REGIONS IN RESEARCH: Item 13 of the Agenda (Document WPR!RC27(7) The REGIONAL DIRECTOR said that three maj or steps had been taken in implementation of resolution wpr/rc26.rlo adopted by the Committee at its twenty-sixth session: (1) a post of adviser in biomedical research had been established in the Regional Office and a suitable candidate was being sought; (2) a group composed of the Chairman of the Headquarters Advisory Committee on Medical Research, Dr Scrimshaw, a Headquarters staff member who was an authority on parasitic and tropical diseases, Dr Buck, and Dr Reyes from the Regional Office, had travelled in the Region to study the feasibility of designating a WHO regional centre for research and training in tropical diseases; and (3) the first meeting of the Regional Advisory Committee on Medical Research (RACMR) had taken place in Manila: Document wpr/rc2717 and its annexes presented summaries of the recommendations arising from both the feasibility study and the meeting of the Regional Advisory Committee on Medical Research. The enthusiasm and support encountered for establishing priority areas for regional

117 114 REGIONAL COMMI T1EE : 'IWENTY-SEVENTH SESSION research had been very encouraging. With the approval of the Committee and provided the necessary extrabudgetary funds could be found, it was hoped soon to establish the three recommended task forces: on health services research; on parasitic and other communicable diseases; and on cardiovascular diseases, in order to develop comprehensive proposals for research programmes. The Committee would wish to consider whether the recommendations arising from the feasibility study and the RACMR were acceptable. Dr KING (United States of America) said that the Government of the United States of America supported the Regional Director's efforts to strengthen the role of medical research in the Region and commended the rapid establishment of a post of adviser in biomedical research and anracmr. In particular, the Government: (1) supported the RACMR recommendation that the Regional Director establish task forces to develop regional plans for research in the areas of health services, parasitic and other communicable diseases, and cardiovascular diseases; supported the recommendation that experts in parasitology and enteric infections be included as members of the RACMR; (2) agreed to the proposal that the Regional Director seek funds for start-up costs, which should nevertheless be kept to a minimum; each task force should develop an estimated budget on future research and administrative overheads, to be reviewed by the RACMR and presented to the Committee at its twenty-eighth session; (3) supported the proposal to designate the Institute for Medical Research, Kuala Lumpur, Malaysia, as a WHO regional research centre, while noting that the United States was already assisting the Institute through the University of California; (4) supported the recommendation to establish close collaboration with the Korea Health Development Institute and recommended that the task force on health services research develop a roster of other institutions in the Region involved in operational health research; (5) recommended that the Committee await submission of the task force plans for research before agreeing to fund research on the control of S. japonicum in the Philippines and urban tropical health in Singapore. Dr King asked whether the Regional Director sought to fund the biomedical research programme from extrabudgetary sources only or also from the Regular Budget. Dr TANAKA (Japan) agreed that it was very important to strengthen coordination and collaboration of research in the Region. The Delegation of Japan supported the proposals in principle but felt that every effort should be made to obtain the necessary funds for setting up the three task forces from the Regular Budget. Dr SUMPAICO (Philippines) strongly supported the RACMR recommendations and welcomed the opportunity to site schistosomiasis

118 SUl4>1ARY RECORD OF THE THrRD MEETING 115 research in the Philippines,.nere the disease had long been a problem. It was hoped that contributions would be available for the purpose. Greater involvement of the regions in research was most welcome. Previously aotivities had been oarried out in collaboration with WHO Headquarters whereas now the Regional Office was participating fuily and coordination was thus facilitated. Dr MAJID (Malaysia) said that the Government of Malaysia supported the RACMR recommendations. It was honoured that the Institute for Medical Research, Kuala Lumpur had been recommended for designation as a WHO regional centre, following an offer made at the twenty-sixth session of the Committee. The Institute was reported to be competent in fields such as parasitology, filariasis, scrub typhus, medical ecology, medical entomology, arbovirus research and bacteriology, human genetics, nutritional biochemistry and community health research. There were deficiences in other areas, as noted by the visiting team, and they would certainly be investigated. The recommendation that detailed plans should be drawn up for establishment of the regional research centre was welcomed. The Government of Malaysia would do all it could to ensure that it became a centre of excellence for basic medical research on tropical infectious diseases in the Region. Dr SENILAGAKAIJ: (FiJi) endorsed the remarks and recommendations made. The Government of Fiji welcomed the designation of a research centre to serve the Region in Kuala Lumpur, which was an excellent site for the purpose. Training of medical personnel to work in the Region should best be undertaken in local institutions. Mr SAFITOA (papua New Guinea) expressed his appreciation of the steps taken. Such research was very important in determining the basis of any health service to enable it to deal with problems encountered. The establishment of the RACMR and its work so far were to be commended. As a new member of WHO, Papua New Guinea would endeavour to support the project in every way possible. Dr FAAIUASO (Western Samoa) wondered, without any bias being intended,.nether a similar programme of training and research might be carried out at an institute in the South Paoific as well as at Kuala Lumpur. Dr LEPROUX (France) said that the Government of France fully endorsed the recommendations of the RACMR. French Polynesia had a Medical Research Institute which had recently been granted scientific recognition by the Institut Pasteur, Paris, with which it was linked by convention. This Institute, which ha4 acquired an appreciable competence in fish food poisoning (ichthyosarcotoxism) and filariasis,

119 116 REGIONAL COMMITIEE: 'MNTY-SEVENTH SESSION had already collaborated with the Organization, and this cooperation with WHO and countries in the Region could usefully expand. Furthermore, French Polynesia, where imports alone accounted for a daily consumption of 5000 calories per person, offered an ideal field for the study of plethoric diseases such as diabetes, hypertension and obesity. Dr CHEN HAI-FENG (China) said that the key issue was who medical research should serve and how. He wished to describe briefly the "open door" research carried out in China. "Open door" hospitals, education and scientific research were innovations arising from the Great Proletarian Cultural Revolution. Now millions of workers, peasants, barefoot doctors and basic-level health workers were participating in the research and excellent progress was being made. China had broken with the old ways and was taking its own road in vigorously developing science and technology Stress was firmly placed on the rural areas. Every effort was made to prevent, control and eliminate common infectious diseases at the basic level. Many research workers had gone from their laboratories to the countryside, factories and mines; to areas afflicted by diseases and rich in herbal medicines. They gave emphasis to prevention, integration of traditional and western medicine, and the destruction of pests. Frontline scientific research bases had been created with a three-in-one combination of worker-peasant-soldier masses, professional personnel and cadres. The research was undertaken together with local barefoot doctors, red doctors, practitioners of traditional medicine and herbal farmers. Some institutes had established links with factories, mines or rural health units in order to conduct studies and training among the people. The research took many forms and the results were promptly disseminated. The "open door" approach had been successfully applied in the development of laser techniques, the fight against cancer and tumours, and the prevention and treatment of schistosomiasis. Research was no longer divorced from politics and the broad masses. --" had been firmly reorientated in serving the workers, peasants and soldiers and joining forces with productive labour. The old situation of instituteand theory-centred research monopolized by a handful of intellectuals had been changed. Research was now carried out on a mass movement basis, with better, speedier and more economical results. - Theoretical research was also done in an "open door" manner, laboratory work being combined with vast experimentation among the broad masses, in both long- and short-term studies. "Open door" research was regarded as an important achievement of the socialist revolution.

120 SUMMARY RECORD OF THE THIRD MEETING 117 Dr TRAN NGOC DANG (Socialist Republic of Viet Nam) expressed the full support of the Delegation of the Socialist Republic of Viet Nam for the recommendations of the RACr.m. WHO had been assisting in building in Viet Nam an Institute of Hygiene for medical study and research, as well as for the training of health workers from the Region. This Institute, established in Ho Chi Minh Ville. had been found undamaged when the present authorities entered the City. Thanks to assistance supplied by Denmark. the Netherlands and New Zealand construction would be completed shortly. Dr KYONG SHIK CHANG (Republic of Korea) said that the Delegation of the Republic of Korea supported the RACMR recommendations and commended the efforts made. The establishment of close collaboration with the Korea Health Development Institute, as proposed, would be a significant step. Through that Institute it was planned to develop a low-cost health care delivery system adapted to the social and cultural background of the country. Technical cooperation by WHO and other United Nations and international agencies would be welcome. At the same time the Government of the Republic of Korea was willing to exchange information on progress made in research at the Institute with other establishments in Member States. Dr DOS REMEDIOS (Portugal) said that although there were no diseases like schistosomiasis in his Territory, the RACr.m recommendation was fully supported. Dr NICHOLSON (United Kingdom) said that the Government of the United Kingdom supported the recommendations in principle, noting that research was needed on specific hazards in terms of their priorities. He wondered whether the funds involved would come only from extrabudgetary sources or also from the Regular Budget. The REGIONAL DIRECTOR, replying to the questions raised, pointed out, with regard to the site of the research and training centre, mentioned by the Representative of Western Samoa, that he had visited the Institute for Medical Research in Kuala Lumpur and had been impressed. He could endorse the recommendation of the feasibility team. However, not all activities would be centred there since the disease conditions for some research were not present in Malaysia; it would therefore have to be conducted elsewhere. A filariasis research programme was to be launched in Western Samoa, which would also benefit other countries and areas having the same health problem. Moreover all research activities had a training aspect. Apart from the training available in connexion with the research in Western Samoa, investigators would be able to train at the centre of excellence in Malaysia and elsewhere. With regard to the major question of the source of funds for the programme in the Region, raised by the Representatives of the United Kingdom and the United states, provision was made in the Regular Budget only for the posts of adviser and his secretary and for the members of the RACMR to attend its sessions. It was also hoped to finance the

121 118 REGIONAL COMMITTEE: TWENTY-SEVENTH SESSION preliminary meetings of the task forces, which should if possible prepare for presentation to the RACMR and the Regional Committee detailed plans and corresponding budgets, for which extrabudgetary resources would be needed. It was hoped that Member States from within, and even from outside, the Region would contribute extrabudgetary funds, without which the research programme would proceed very slowly. It did not seem justifiable for WHO to divert funds from direct technical collaboration with developing countries for the purpose of expanding research activities, which could be very costly. There being no further comments, the CHAIRMAN asked the Rapporteurs to prepare an appropriate resolution. (For consideration of the draft resolution see the fourth meeting, section 1.1, and the fifth meeting, section 2.1). 4 AlCOHOLISM AND OTHER DEPENDENCE PROBIEMS: Item 14 of the Agenda (Document WPR/RC27!8 and Corr.l) '!he REGIONAL DIREC'roR reminded the Committee that at its twentysixth session a number of representatives had expressed the view that, while problems resulting from drug dependence and from alcoholism were similar, they were nevertheless distinct and should be considered separately. Indeed in many parts of the Region alcoholism was considered to be the greater problem. With the appointment of an adviser under an intercountry project the regional programme in prevention and control of drug abuse was already being intensified. Resolution WPR/RC26/Rll had requested the Regional Director to include the subject of alcoholism as a separate item on the Agenda of the Committee's twenty-seventh session. Document WPR/RC27/8 therefore contained a review of the present situation in the Region carried out through circulation of a questionnaire. The information obtained was interesting. For example, traffic accidents, though they were not a result of alcohol dependence per se, were considered to be one of the major consequences of ex~sive drinking. The Regional Director mentioned that the WHO programme on health aspects of traffic accidents, for which the Regional Office for Europe was responsible, would include a study of the interaction of alcohol and drugs with road traffic accidents. Dr EVANS (Australia), commenting on the effect of alcoholism on public health, said that it was a major problem in Australia. It was noted with regret, from the figures given in document WPR/RC27/8, that the consumption of alcohol per person was greater in Australia than anywhere else in the Region. Very little attention had been given in the document to physical control measures, in spite of the fact that the Finnish Foundation for Alcohol Studies, the. WHO Regional Office for Europe, and the Addiction Research Foundation of Ontario, Canada had already produced a publication which demonstrated the major importance of physical measures in controlling alcohol consumption. l 1 Alcohol Control Policies in Public Health Perspective, The Finnish Foundation for Alcohol Studies, 25, Forssa,

122 SUMMARY RECORD OF THE THIRD MEETING 119 The Delegation of Australia endorsed reoommendation (a) for future action but felt that emphasis should be placed on developing means for collecting, processing and publishing available data, and for regular and ad hoc colleotion of statistics. This could be done at less cost, and Of~to greater benefit, than by introducing new procedures and new colleotions of statistics and material. The Government of Australia. had been so concerned with the alcohol problem that the Senate Standing Committee on Social Welfare had requested the Department of Health to produce a position paper. The development of training programmes was a central issue in the control of alcoholism. The skillful use of control measures offered the greatest hope of quick containment of health problems related to alcohol and drugs. It was suggested therefore that encouragement be given to further studies and research, with built-in means of evaluation, to produce meaningful results. Dr TANAKA (Japan) stated that the Delegation of Japan supported the planned future action described in document WPR/RC27/B. He said that as a result of urbanization and industrialization, alcoholism had become an important social problem in Japan. It had spread among the younger generation, the socially high-ranking, and even among women. Ten years ago most patients had been treated in closed mental hospitals but recently open-care treatment had been proved effective. In addition to the care given i'n hospitals, there were voluntary "stop-drinking" organizations throughout the country consisting of cured alooholics. The Ministry of Health and Welfare had given priority in the field of mental health to alcoholism and was planning to undertake intensified research, prevention campaigns, training of health personnel and to assist in the development of voluntary organizations at the oommunity level. Dr CHRISTMAS (New Zealand) stated that the Government of New Zealand shared the concern of the Governments of Australia and Japan, particularly that expressed by the Representative of Japan regarding consumption of alcohol by young people, the results of which were already being reflected in the increased traffic accident rate affecting this age group. There was also evidence that the drinking pattern was increasing among married women. In an effort to deal with the problem, the Government of New Zealand proposed to set up an alcohol advisory council. Intensified health education was directed towards problems associated with drinking and driving. Hospital boards were being encouraged to establish clinics to serve as detoxification centres. In addition to preventive action, the effective development of supportive services merited special attention. The Government of New Zealand relied very much on voluntary organizations. Undoubtedly, trained workers experienced in handling the long-term psychosocial problems of the alcoholic were needed in the Region. Dr MAJID (Malaysia) spoke of the problem of alcoholism in the developed countries of the Western Pacific Region. The ambivalent attitude of a permissive society which. knowing it had been proved a hazard to health, still considered the drinking of alcohol as adding to

123 120 REGIONAL COMMITlEE: 'lwenty-8eventh SESSION social status, contributed to the problem. In developing nations such as Malaysia, the problem was to some extent contained, because of social \sanctions; it was mostly confined to a small section of the adult \popu1ation. The problem of dependence on dangerous narcotic drugs was of prior concern. This did not mean that there was a complacent attitude to the problem of alcoholism. Prevention programmes were still experimental and needed support. Success depended very much on the strength of religious beliefs, the vitality of tradition and culture and the will to exercise social and legal sanctions. The Government of Malaysia, with the cooperation of WHO, intended to implement th~e recommendations for future action that were applicable to the country. InfPrmation on production, distribution, consumption and ill effects attributed to alcohol; absenteeism from work; economic loss incurred; and the occurrence of traffic accidents leading to incapacity, invalidism and death, Were useful guides in the study of the nature and extent of the problem. Dr SENILAGAKALI (Fiji) suggested that the thirteen countries or areas in the Region that had not replied to the questionnaire be urged to do so, since the information obtained would be of benefit to all Member States in the Region. A Royal Commission appointed to assess the crime situation in Fiji had found that alcoholism was increasing, especially among young people. The Government would be reviewing the report of the Commission and it was hoped that drastic decisions would be taken to prevent an increase in the problem. A survey conducted in 1975 revealed that 30% of children suffering from malnutrition in urban areas had parents who drank liquor excessively. Religious organizations were very active in teaching their congregations temperance. The problem of alcoholism in Fiji and possibly also in the other Pacific island territories, was intensified by the tendency for people to get drunk on home-made alcohol. In Fiji, laws had been formulated against this and against consumption of other intoxicating substances. Dr WARI (Papua New Guinea) said it was appropriate that this subject was being discussed separately. While developed countries had expressed concern, developing countries such as Papua New Guinea could not be excluded, because the problem was increasing; mainly as a result of urbanization and migration from rural areas to the towns. The Government of Papua New Guinea supported the idea of planned future action. Certain measures had already been taken, such as restricting drinking hours. On important days liquor was not sold at all and on pay days the hours during which liquor could be sold were limited. Organizations, such as women's groups, were active in combating alcoholism. Dr SUMPAICO (Philippines) said that the problem of alcoholism in the Philippines, at present moderate, was increasing. It was interesting to note the figures given for the Philippines in the table of annual per capita consumption. The Delegation of the Philippines would support any action the Committee might recommend for the future. There being no further comments, the CHAIRMAN asked the Rapporteurs to prepare an appropriate resolution. (For consideration of the draft resolution, see the fourth meeting, section 1.2.)

124 SUMMARY RECORD OF THE THIRD fating RECONSIDERATION OF PREPARATION OF A FIFTH REGIONAL PROGRAMME OF WORK FOR A SPECIFIC PERIOD ( INCLUSIVE):l Item 16 of the Agenda (Documents WPR/RC27/10 and WPR/RC27/Working Paper/1) The CHAIRMAN introduced the working paper, which set out the proposed terms of reference for the Working Group set up to examine regional action in connexion with the WHO Sixth General Programme of Work. Dr KING (United States of America) expressed agreement with the principles of the terms of reference, but felt there was some ambiguity between sections (i) and (ii). The mechanism set up in section (i) seemed to be ignored in section (ii). Dr SUMPAICO (Philippines) asked whether the "highest priority" in section (ii) referred to one programme or several programmes. Dr EVANS (Australia), replying to questions at the suggestion of the REGIONAL DIREC'lDR, explained that section (i) referred to a regular, ongoing process of annual review. Section (ii) referred to specific programmes to be suggested to the Executive Board for study at its next session. Dr CHRISTMAS (New Zealand) supported the proposals as explained by the Representative of Australia. The REGIONAL DlREC'lDR suggested that the reference to the World Health Assembly be removed from section (ii) and that the words "at its next session" be inserted at the end of that section. He also proposed that section (iii) be deleted: the proposal to suggest a definition of "technical cooperation" to the Executive Board was a helpful initiative, but the matter could more appropriately be discussed during the discussion on the programme budget. Enlargement of the Working Group by one or two members might also be considered. Dr MAJID (Malaysia) supported the proposals of the Regional Director. Mr BOREHAM (Australia) said the Delegation of Australia had no objections to the amendments proposed by the Regional Director, provided that the definition of "technical cooperation" were discussed at a later meeting. The CHAIRMAN invited Dr Senilagakali (Fiji) and Dr Sumpaico (Philippines) to join the Working Group. It was so agreed. The REGIONAL DIRECTOR suggested that the Working Group might wish to meet during the morning of Wednesday, 8 September. The Secretariat would provide all possible assistance. (For consideration of the report of the Working Group, see the fifth meeting, section 3.) 1. See also WPR/RC27/SR/2, Section 2.

125 122 REGIONAL COMMI'I'IEE: 'lwenty-seventh SESSION 6 THE REGIONAL ENVIRONMENTAL HEALTH PROGRAMME: REGIONAL CENTRE FOR ENVIRONMENTAL HEALTH SCIENCES: Item 15 of the Agenda (Document WPR/RC27/9) The REGIONAL DIRECTOR informed the Committee that document WPR/RC27/9 provided the Justification for a proposal that a regional centre for environmental health sciences, similar to the one in Lima, Peru, be established in the western Pacific Region. Lacking in the Region were: facilities for intensive training courses on different aspects of environmental health for professionals and technicians; basic data and data on progress in the field of environmental health; criteria and standardized methods applicable to the Region; applied research activities aimed at developing autochthonous technology where only limited resources were available; and a regional forum where scientists could exchange experience... It was proposed, if the Committee agreed, to carry out a study early in 1977 on the feasibility of establishing such a centre. He invited the Committee to indicate whether it supported the proposals in principle. Mr BOREHAM (Australia) stated that the Government of Australia was not opposed to the proposed feasibility study, but wished to raise a number of points for discussion before the proposal was accepted. The proposed terms of reference for the consultant appeared to presuppose the need for such a centre; however. the Government believed that the provision of adequate water supplies and basic sanitation in areas of the Region that lacked them should be given priority over a centre for environmental health sciences. The main reasons advanced in the document for establishing such a centre were to carry out applied research; to collect and disseminate information; and to conduct training courses. With regard to the first two activities, there was already very adequate published research material for dealing with the technical problems related to water supplies, sanitation, food hygiene. and air pollution. As regards training, courses for village health workers were the most urgent need and were best conducted in the trainee I s own country, while senior staff could be trained more economically in existing establishments in the Region. Moreover, the Director~General had been asked by the World Health Assembly to ensure that by 1980 at least 60% of the regular programme budget would be spent on IItechnical cooperation". Before taking any decision it was advisable to clarify whether the proposed centre would come under the heading of IItechnical cooperation", a term that had not yet been defined. To sum up, the Government of Australia was not opposed to the feasibility study, but doubted whether the proposed centre could achieve anything that could not be done equally well by existing mechanisms.

126 SUMMARY RECORD OF THE TllRD MEETING 123 Dr KING (United States of America) said that the Government of the United States of America supported the proposal to conduct a feasibility study, but emphasized the need to await the results of the study before making any assumptions as to whether a regional centre for environmental health sciences should be established. The study should define the needs that the centre might meet; indicate alternative methods of meeting those needs, including the use of existing facilities; and present a comprehensive analysis of the cost of each alternative. The study should also include a review of experience at the Lima Centre. The period of the study should be extended to four months to give sufficient time for analysis. Finally, the Committee should guard against too ready an acceptance of the need to construct a separate building for the proposed centre. Dr TANAKA (Japan) stated that the Government of Japan supported the proposal to set up a regional centre for environmental health sciences. However, several consultants might be needed to study the technical and financial feasibility of the proposal, and his Government would readily provide the services of its own experts. The centre need not necessarily be located in a developing country, but should be set up in the most suitable location as recommended by the consultants. Dr MAJID (Malaysia) said he felt there was a good case for setting up a regional centre, as there were many environmental health problems peculiar to the Region which required more scientific study. There was a need to collect baseline data more systematically, analyse them thoroughly and present them meaningfully. A core of specialist interdisciplinary scientific personnel needed to be trained, while bacteriologists, entomologists, engineers and food technologists should be taught to appreciate the public health aspects of their work. The Delegation of Malaysia therefore supported the proposal to conduct a feasibility study. Dr SUMPAICO (Philippines) supported the proposal that a feasibility study should be setup. The Philippines stood at the threshold of industrial development, which was vital for the country. Therefore, if the feasibility study pointed to the necessity for such a centre, his delegation would support its establishment. Dr LEPROUX (France) informed the Committee that the Government of France, while taking a deep interest in environmental health, was not in favour of establishing the proposed Centre. It had pledged an annual contribution of US$ for a period of five years to the United Nations Environmental Programme and considered that an optimal use of the data received in Geneva from the existing Centres in the Region would provide all the information required. Speaking at the request of the CHAIRMAN, the REGIONAL DIRECTOR thanked the members of the Committee for their pertinent comments, which had provided valuable guidance.

127 124 REGIONAL COMMITmE: 'IWENTY-SEVENTH SESSION Mr GO (Regional Adviser in Environmental Health) said that many of the issues raised by the Representative of Australia would be fully explored in the feasibility study. His concern that a white elephant might be created was understood. He personally was somewhat biased towards problems of the human environment and could not agree that, although the provision of rural water supplies was the first priority, one could ignore the many other environmental problems facing developing countries. It was noteworthy that. simultaneously with the current session of the Regional Committee, the Government of the Philippines was holding a conference on "Science and Human Survival" - thus showing the emphasis that it placed on such problems. Moreover, in among the major health concerns that were emerging in the developing countries, that of the quality of the environment was to be treated as a priority programme area by WHO. As regards the concept of establishing the Centre, he stressed the desirability of promoting collaboration among countries. The proposed Centre would be a forum where nationals of countries or areas in the Region could work together on environmental problems indigenous to the Region. In reply to the comment made by the Representative of Australia that the activities of such a Centre might not be fully appropriate in view of the emphasis that had been placed on technical cooperation in resolution WHA29.48, he said that, in fact, the Centre would encourage technical cooperation. There were many activities, particularly in the field of training, that could be carried out more effectively with the facilities that would be provided by the Centre and that were not currently available. It was unlikely that any country of the Region, apart from the more advanced countries, would be able to set up a national institute dealing with environmental sciences. As had been pointed out by the Representative of Malaysia and other representatives, one of the problems faced by many countries was the lack of data on which policies could be based. The projected centre could fulfil that need more economically than separate national entities. If no immediate action were taken to facilitate the establishment of the Centre, the process might take 20 years. Dr CHRISTMAS (New Zealand) doubted the advisability of bringing so many disciplines together in the same institute, since such a large collection of physicists, chemists, engineers, and microbiologists might embrace a very large organization. The problems of occupational health and air pollution might be dealt with more effectively at one institute and those of food technology in relation to public health at another. Such institutes could then work in collaboration with each other. Mr GO (Regi onal Adviser in Environmental Health) thought that it would be inadvisable to set up different centres to deal with various aspects, for reasons of economy, and because of the benefits to be derived from having persons from different disciplines working together. Many environmental policy issues could not be dealt with by a unisectoral approach. For instance, air pollution involved not only the ministry of health but also economic and social factors such as gain and adverse effects.

128 SUMMARY RECORD OF THE THIRD MEETING 125 The REGIONAL DIRECTOR pointed out that the question raised by the Representative of New Zealand might be one of the topics to be explored in the feasibility study by one or more consultants. Mr BOREHAM (Australia) said that his delegation welcomed the assurance given by the Regional Adviser in Environmental Health that the points raised would be fully discussed in the feasibility study. The REGIONAL DIRECTOR expressed his appreciation of the offer made by the Delegation of Japan, to contribute the services of an environmental health consultant. He presumed that the Committee accepted the offer, without cost to the Organization. It was so agreed. There being no further comments, the CHAIRMAN asked the Rapporteurs to prepare an appropriate resolution. (For consideration of the draft resolution, see the fourth meeting, section 1.3.) 7 FREQUENCY OF MEETINGS OF THE REGIONAL COMMIT'IEE: Item 17.1 of the Agenda (Document WPR/RC27/11 Rev.l) The REGIONAL DIRECTOR referred to document WPR/RC27 III Rev.l, which contained a report on the implications of changing the sessions of the Regional Committee to a biennial sequence. Representatives would have noted the arguments for and against the proposal, including the fact that amendments to Articles 34 and 55 of the WHO Constitution had not yet entered into force and therefore the World Health Assembly still had to consider the budgetary and financial aspects of the biennial programme budget annually. The Committee might therefore feel that it also should review, in the year following its consideration of the proposed biennial programme budget, revisions to the budget proposals for the second year of the biennium. It was up to the Committee to decide whether it wished to change the frequency with which it met immediately, or wait until the matter was considered throughout the Organization, probably when the amendments to Articles 34 and 55 entered into force. The Regional Director went on to say that he had just received a message from WHO Headquarters regarding the proposed amendments to Articles 34 and 55 of the Constitution: by 26 August Member States had accepted the amendments; 23 more acceptances were still required. Dr FAAIUASO (Western samoa) suggested, in the light of the Committee's observations and points 3.5 and 3.6 of document WPR/Rc27/ll Rev.l, that further discussion of the subject be postponed until the amendments to the Constitution had entered into force.

129 126 REGIONAL COMMI'I'IEE: 'J.\oIENTY-SEVENTH SESSION Dr EVANS (Australia) remarked that the matter had been raised by his delegation in Although the reasons advanced at that time in support of biennial sessions still held good, the Regional Director had mentioned certain practical difficulties in his report and in his statement. It might be advisable, therefore, to discuss the possible implementation of such biennial sessions at a later stage. The problems appeared to be that the Regional Committee needed to meet in even-numbered years in order to approve the programme budget; the Government of Japan had offered to act as host to the 1977 session and it would not be reasonable to suspend that session. By 1981, the World Health Assembly would probably have adopted biennial budgeting. His delegation therefore agreed with the suggestion of the Representative of Western Samoa, that discussion of the item should be postponed. Dr MAJID (Malaysia) thought that, for a number of reasons, the current annual sequence of sessions should be. maintained. There was no obvious advantage to countries in changing the existing practice. The financial savings would be largely offset by the need for longer sessions. Most countries planned their national budgets annually and hence their programming activities also were on an annual basis. If the proposed change were accepted, it might upset financial procedures for the allocation of funds to various ministries. It might not be possible for countries to send senior officers to the sessions if they lasted longer. The annual sessions, besides reviewing regional activities, also provided an opportunity for senior health officials to exchange their views on important technical developments, and promoted goodwill and understanding. In the absence of adequate justifications for the new practice, he urged that the proposal to change the frequency not be accepted and that a session of the Regional Committee continue to be held annually. Dr SENILAGAKALr (Fiji) supported the view expressed by the Representative of Malaysia. The Government of Fiji had an annual budget and he foresaw difficulties in providing money for visits of senior officers to the Regional Committee if the meetings were held every second year and lasted longer. 'Ibe. theoretical savings did not justify the prolonged absence of such senior staff from their countries. Dr SUMPAICO (Philippines) proposed that the status quo be preserved until more justifications for holding biennial sessions were forthcoming. Dr DOS REMEDIOS (Portugal) said that his delegation was satisfied with the existing arrangement. Dr mong (Singapore) endorsed the comments made by the Representative of Malaysia. From the point of view of the Government of Singapore, fiscal arrangements would be much easier if meetings continued to be held annually. Dr FAAIUASO (Western Samoa) asked what the position of the Regional Committee would be if the World Health Assembly changed the Constitution as had been proposed.

130 ... - SUMMARY RECORD OF THE THIRD MEETING 127 Miss NEWTON (Chief, Administration and Finance) explained that, under the Rules of Procedure of the Regional Committee for the Western Pacific, which the Committee had adopted in accordance with the constitutional provisions, it could meet as often as it considered necessary. It had been the practice for the Committee to hold annual sessions but it was free to change the frequency of its meetings if it so desired. There being no further comments, the CHAIRMAN asked the Rapporteurs to prepare an appropriate resolution. (For consideration of the draft resolution, see the fourth meeting, section 1.4). 8 ANNUAL REPORTING BY THE REGIONAL DIREC'roR: Item 17.2 of the Agenda (Document WPR/RC27/12 and Corr.l) The REGIONAL DIREC'roR stated that, in 1977, the Director-General would present to the World Health Assembly, as background material for its consideration of the proposed programme budget for 1978 and 1979, a short report covering significant matters and developments in In 1978, he would publish and present to the Health Assembly a comprehensive report on the work of WHO in 1976 and that is, the years covered by the present biennial programme budget. He would also discontinue publishing a report on individual projects. The decision to adopt that new cycle had been taken in order to relate reporting by the Director General to biennial programme budgeting and to the new concept of programming by objectives and budgeting by programmes. Document WPR/RC27/12 described the background to the Health Assembly's decision in detail. Representatives were requested to comment on whether the report of the Regional Director to the Regional Committee should follow a similar cycle; remembering that the proposed biennial programme budget was considered by the Committee in the year before it was considered by the Health Assembly and that the cycle of reporting to the Regional Committee would therefore have to be: a comprehensive report in oddnumbered years and a short report in even-numbered years. Mr BOREHAM (Australia) congratulated the Regional Director on the clarity of the language in the documents before the Committee. The Delegation of Australia supported the proposal that the Regional Director should implement similar changes in the presentation of his report to the Regional Committee as those adopted for the Director General's reports to the World Health Assembly. Thus a comprehensive report would be issued in odd-numbered years and, since in its consideration of the programme budget, the Regional Committee should be able to take a broader view instead of discussing minutiae, a shorter report in even-numbered years. Publication of a report on individual projects should also be discontinued.

131 128 REGIONAL COMMI'PIEE: 'lwenty-seventh SESSION Dr MAJID (Malaysia) said that his delegation agreed with the views expressed by the Representative of Australia and had supported resolution WHA If the Committee decided to hold a session annually, then Malaysia would agree that the Regional Director should publish a comprehensive report every other year and a short report in the intervening year. The Delegation of Malaysia also agreed to the discontinuation of the report on individual projects. There being no further comment, the CHAIRMAN asked the Rapporteurs to prepare an appropriate resolution. (For consideration of the draft resolution, see the fourth meeting, section 1.5.) The meeting rose at 12 noon I..

132 '''''' SUMMARY RECORD OF THE THIRD MEETING 129 ANNEX 1 ADDRESS BY THE INCOMING CHAIRMAN Respected Regional Director, Distinguished Representatives, Representatives of the United Nations, and related organizations and non-governmental organizations, Ladies and Gentlemen, Yesterday when this meeting elected me to this Chair, I stated that I would give a brief address this morning. First of all, let me say how very grateful I am for the great honour you all have bestowed on rrry country, Fiji, and on me personally, as one of the representatives to this meeting. I do thank you all for your confidence in me. Having come from a tiny country; from the remotest part of the Pacific to these large and beautiful islands, and amidst such distinguished and experienced representatives, I find myself unworthy to be so honoured. As this is the first occasion that Fiji is chairing this meeting, I do plead for your close cooperation and assistance in carrying out my duties. You already indicated your willingness to cooperate in no small means yesterday. If there are any shortcomings, you will no doubt bear with me, in the same spirit as elder and more experienced members of a family treat the smaller individuals in the household. May I also take this opportunity to thank most sincerely the fellow Member countries of this Region that successfully supported my country's candidature for the Executive Board of the World Health Organization, at the last World Health Assembly in Geneva. May I also warmly congratulate the Vice-Chairman and the distinguished Rapporteurs on their election. I feel certain of their fullest cooperation. Distinguished Representatives, whilst we meet here to deliberate on matters affecting the health and welfare of people generally, we are not unmindful of the sad and tragic calamities that have recently befallen parts of this very country, where we all have gathered together for this important meeting.

133 130 REGIONAL COMMITmE: 'IWENTY-SEVENTH SESSION On behalf of my Government - I am sure all other distinguished representatives share my sentiments - I wish to convey my heartfelt sympathies and condolences to the Government and the people of the Republic of the Philippines on this major disaster causing loss of thousands of innocent lives and property. We all mourn for the victims of this disaster and do wish the stricken areas a speedy recovery. Finally, distinguished representatives, I pray for God's guidance in our deliberations and with this meeting every success. Thank you.

134 (WPR,/RC27/SR/4 ) SUMMARY RECORD OF THE FOURTH MEETING WHO Conference Hall, Manila Wednesday, 8 September 1976 at 9.00 a.m. CHAIRMAN: Mr J.S. Singh (Fiji) CONTENTS 1 Consideration of draft resolutions Importance of core programmes for child health, with particular emphasis on staff training through fellowships Progress in nutritional surveillance... 4 Selection of topic for the Technical Presentation during the twenty-eighth session of the Regional Conun1 ttee Time and place of the twenty-eighth and twentyninth sessions of the Regional Committee

135 132 REGIONAL COMMITIEE: 'lwenty-seventh SESSION Fourth Meeting Wednesday, 8 September 1976 at 9.00 a.m. PRESENT I. Representatives of Member States AUSTRALIA CHINA FIJI FRANCE JAPAN IAO PEOPIE I S DEMOCRATIC REPUBLIC MALAYSIA NEW ZEALAND PAPUA NEW GUINEA PHILIPPINES PORTUGAL REPUBLIC OF KOREA Dr C. Evans Mr K. Boreham Dr Chen Hai-feng Dr Chin Hsiang-kuan Dr Huang Yu-hsiang Mr Tsao Yung-lin Mr Li Ching Hsiu Mr J.S. Singh Dr J.B. Senilagakal1 Dr P. Leproux Dr A. Tanaka Dr H. Shin ozaki Mr T. Yano Dr Keo Phimphachanh Tan Sri Datuk (Dr) Abdul Majid Ismail Dr Mehar Singh Gill Mr Onn oin Kayat Dr B.W. Christmas Mr E. Robin Safitoa Dr K. Wari Dr J. Sumpaico Dr J.J. Dizon Dr F. Aguilar Dr A.M. Angara Dr Leonel dos Remedios Dr Kyong Shik Chang Mr Se Lin Huh Mr Moo Geun Jeon

136 SUftIofARY RECOJID OF THE FOURTH MEETING SINGAPORE SOCIALIST REPUBLIC OF VIET NAM UNI'mD KINGDOM UNI'mD STA'lES OF AMERICA WES'lERN SAMOA Dr Leong Kwok Wah Dr Tran Ngoc Dang Dr Nguyen Van Trong Mr Nguyen Hong Quang Dr J.A.B. Nicholson Dr J.C. King Dr Solia Tapeni Faaiuaso II. Representatives of other Intergovernmental Organizations SOUTH PACIFIC CCX't1MISSION Dr E. Macu Salato III. Representatives of Non-governmental Organizations IN'lERNATIONAL SOCIETY OF BLOOD 'lransftlsion WORm FEDERATION OF THE DEAF IN'IERNATIONAL DENTAL FEDERATION IN'IERNATIONAL UNION FOR HEALTH EDUCATION WORm FEDERATION FOR MEDICAL EDUCATION MEDICAL WOMEN'S IN'mRNATIONAL ASSOCIATION IN'mRNATIONAL COMIIIi'IEE OF CATHOLIC NURSES ' IN'1ERNATIONAL COONCIL. OF NURSES WORm FEDERA'![ONOF OCCUPATIONAL THERAPISTS IN'IERNATIONAL PIANNED PARENTHOOD FEDERATION IN'lERNATIONAL SOCIETY OF RADIOGRAPHERS AND RADIOLOGICAL 'lechnicians Dr G.C. Car1dad Mrs E.S. Carlos Dr R.C. Navia Dr F. Herrera Dr J. Cuyegkeng Dr E.!. Cuyegkeng Mrs M.R. Ordonez Mrs F.M. Valdez Mrs C. Tablan-Santos Dr J.B. Catindig Mr N.A. Palomo

137 134 REGIONAL COMMI'I'IEE: 'lwenty-seventh SESSION IN'lERNATIONAL SOCIETY OF RADIOLOGY REHABILITATI ON IN'lERNATIONAL Dr H. Z1alc1ta Mrs C. Floro INTERNATIONAL LEAGUE Dr T. P. Torralba -0 AGAINST RHEUMATISM WORID FEDERATION OF UNITED NATIONS ASSOCIATIONS Dr N.M. Sant1ago IV. WHO Secretariat SECRETARY Dr Franc1sco J. Dy

138 .. - SUMMARY RECORD OF THE FOURTH MEETING CONSIDERATION OF DRAFT RESOll1TIONS 1.1 coordination of biomedical the Re ions in research The CHAIRMAN announced that the draft resolution had been withdrawn and would be submitted again at a subsequent meeting. (For consideration of the revised draft resolution, see the fifth meeting, section 2.1.) The Committee considered the following resolutions: 1.2 Alcohol and other dependence problems (Document WPR/Rc27/WP/5) Decision: The draft resolution was adopted (see resolution WPR/Rc27 R5 ). 1.3 Regional Centre for Environmental Health Sciences (Document WPR,lRC27 IWP/6) Decision: The draft resolution was adopted (see resolution WPR/RC2"{.R6) 1.4 FreJRency of meetings of the Regional Committee (Document WPR C2"{ /WP 17) Decision: The draft resolution was adopted (see resolution WPR/RC2"{.R7). 1.5 Annual reporting by the Regional Director (Document WPR,lRC2"{/WP/B) Decision: The draft resolution was adopted (see resolution WPR/RC2"{ R8) 2 IMPORTAN::E OF CORE PROGRAMMES FOR CHILD HEALTH, WITH PARTICULAR EMPHASIS ON STAFF TRAINING THROUGH FELLOWSHIPS: Supplementary Item 1 of the Agenda Dr NICHOISON (United Kingdom), introducing the item which had been proposed by the Government of the United Kingdom, stressed that the future of any country. depended on its children, who were entitled to very high priority in health care. It was well known that in some Member States more than 4~ of the population was under 15 years of age, and there was a danger that uncontrolled growth would create such an excess of dependants over wage-earners and providers that social and economic development would slow down or come to a standstill; at the same time ttlere would!)e'-increasing demands on the health services, probably beyond their capacity to cope with. The Government of the United Kingdom believed it was preferable to concentrate cooperation on certain specific fields, and attached great importance to paediatrics, especially community paediatrics. There should be emphasis on programmes in maternal and child health, and also on nutrition, with particular attention to the importance of breastfeeding, the prevention of malnutrition, and the reduction of nutritional hazards associated with deficient hygiene.

139 136 REGIONAL COMMIT'lEE: 'lwenty-seventh SESSION Associated programmes to improve ohild health included those for the prevention and control of communicable diseases, including common intestinal infections, and health education programmes. In all those activities very much would depend on training and retraining. The British Council had called upon its overseas representatives to encourage governments to seek a greater proportion of fellowships in subjects related to child health. A number of specialized institutions in the United Kingdom could offer training in tropical paediatrics. In reply to a question from the Regional Director, Dr Nicholson said he would define tropical paediatrics as those paediatric conditions and problems that occurred specifically, or with greater frequency, in a tropical environment. Dr FAAIUASO (Western Samoa) commented that as 45-5a;r; of the population of Western Samoa was aged 15 or under, the Government was extremely interested in training in child health care. It would be appreciated if more medical workers could receive training in that field. Dr CHRIS'lMAS (New Zealand) pointed out that in countries where child mortality rates were low there was an increasing need to provide paediatricians and others with guidance and training in the psychosocial needs of the child. Dr TRAN NGOC DANG (Socialist Republic of Viet Nam) said that in the Socialist Republic of Viet Nam much importance was attached to the question of child care, since child mortality, particularly during the first year of age, was still comparatively high. He considered that problems of child psychology and physiopathology deserved particular attention. Dr KACIe-DIMITRI (Regional Adviser in Maternal and Child Health) made a plea for changes in attitudes as well as in terminology in the field of maternal and child health. Within the Region, it was not so much the diseases specific to tropical areas that caused most damage to health but the lethal and handicapping diseases prevalent throughout the world. For example, respiratory diseases were the leading cause of morbidity and death in infants and children of preschool age. Diarrhoeal diseases were the second cause of morbidity in the Region, and were often fatal. It was now within the means of any government to cope with those conditions by oral rehydration, which would prevent death, handicaps, and economic loss. It was also possible to prevent some congenital anomalies and even malignancies, which were' an: ~t cause of death in countries that had achieved low mortality rates. Tuberculosis appeared among the five leading causes of death in only one developed country of the Region, and the problems of malaria and trachoma in young children were less serious than hitherto.

140 SUMMARY RECORD OF THE FOURTH MEETING 131 In making provision for staff training, it was important not to concentrate on physicians and specialists only but to devote much more attention to lower-level staff who could use oral rehydration and who understood the importance of early referral. Dr KING (United States of America) stressed that access to child health was through the mother, who took the leading part in the care of the child. She bore the responsibility, for example, for nutrition, attendance for immunization, improvement of sanitation in the home. There should be more emphasis on preventive health programmes using low-level health workers. Maternal and child health were inseparable from primary health care. Dr MAJID (Malaysia) drew attention to the rural health services set up in Malaysia after Independence, principally to provide family health care. As a result the infant mortality rate had fallen from 72 per 1000 in 1957 to 37 per 1000 in A firm base of primary health care was needed before tackling the specific problems of child health. In' Malaysia it was the practice to train lower-level workers locally and to have senior staff trained abroad. He asked the Representative of the United Kingdom how that oountry's fellowship programme would operate. Dr SENILAGAKALr (Fiji) reported that a paediatrician from Fiji had obtained a diploma in Liverpool under a WHO fellowship. On returning home he had introduced a new system of paediatric care for rural areas, not simply operating from the main hospital but paying regular visits to rural health centres to train rural health workers in various aspects of child health. Dr ANGARA (Phi11ppines) said that in the Phi11ppines over 37% of all deaths occurred in infants and pre-school children; 44% of infant mortality was in children under one month old. The main problem, therefore, was in the first few days or weeks of life, and one of the major causes was low birth weight. Perinatal deaths were arousing increasing concern among paedlatricians and obstetricians. The REGIONAL DIRECTOR said he was glad to note the fellowship facilities offered by the United Kingdom. Dr NICHOLSON (United Kingdom) expressed his appreciation of the interest shown in the item proposed by the Government of the United Kingdom. With regard to the points raised by the Representative of Malaysia, he had been most impressed by the way Malaysia had developed its rural health services since Independence. He explained that his Government provided fellowships in health and related fields in the same way as WHO, though on a stdaller scale. It was now hoped that countries or areas in the Region would seek a greater proportion of fellowships in subjects related to child and community health. The main purpose of the fellowships was to train people who would return home and pass on what they had learned to others, so that all countries would eventually become self-reliant in manpower training. There being no further comments, the CHAIRMAN asked the Rapporteurs to prepare an appropriate resolution. (For consideration of the draft resolution, see the fifth meeting, section 2.2.)

141 138 REGIONAL COMMIT'IEE: 'IWENTY-SEVENTH SESSION 3 PROGRESS IN NUTRITIONAL SURVEILLA~: Supplementary Item 2 of the Agenda Dr NICHOISON (United Kingdom), introducing the item. whioh had been proposed by the Government of the United Kingdom, reoalled that a recent Joint FAO/UNICEF/WHO Expert Committee on the Methodology of Nutritional Surveillance had produced guidelines on the development of nutritional surveillance systems. l Dr Solon, a member of the Philippine delegation to the present session of the Regional Committee, had been a member of that Expert Committee; his work was highly regarded in the United Kingdom, and Dr Nicholson expressed the hope that the Regional Committee would consider how far his successful methods could be applied in other countries or areas of the Region. The Expert Committee had noted that famines generally occurred in areas where the nutritional situation was chronically poor. It was important that surveillance aimed at forecasting famines should make use of a wide range of information - not merely clinical and dietary information but also agricultural, economic and meteorological data. The Expert Committee had recommended making maximum use of existing data; in particular, if data recorded by maternal and child health servioes on growth and nutritional status were analysed more closely they could provide early pointers to changes in the nutritional situation. In devising a surveillance system it would be necessary to select target groups at high risk, in acoordance with the United Kingdom's new strategy of aid for the poorest. Not enough was known of the methodology of surveillance, which needed to be adapted to the resources and conditions of different countries or areas; a flexible approach was essential. In general, clinical data tended to show only the after-effects of food shortages, and for early warning it would be necessary to rely on experts in agriculture and economics. Any surveillance would therefore need to be coordinated through a central national agency for nutritional planning and policy. Dr ANGARA (Philippines) read out a paper prepared by Dr R.F. Florentino, Deputy Executive Director of the Nutrition Center of the Philippines. In July 1976, the National Nutrition Council had invited participants from ASEAN countries to a workshop to develop a common strategy for national nutritional surveillance systems. The workshop had recommended the types of information that should be assembled and a collection system. The Philippine participants were currently working out a pilot scheme to be conducted at provincial level. 1 WHO Technical Report Series, No. 593, 1976.

142 SUMMARY RECORD OF THE FOURTH MEETING 139 The surveillance system would have four objectives: to measure phenomena that indicate the nutritional status of high-risk groups; to monitor the agricultural, socioeconomic and cultural factors that affect nutritional status; to identify nutritional problem areas for remedial action; and to test the feasibility of continuous data gathering in a locality. Within the framework of the Philippine Nutrition Programme, data would be gathered mainly at household and municipal level but also at provincial and national levels; households would be randomly selected, using a special sampling design to ensure representative and longitudinal data. As an example, information on the money value of food consumed would be collected from households twice a year, and birthweight data would be collected from hospitals monthly. Staff involved would include municipal health officers, district school supervisors and Bureau of Agriculture Economics technicians. Agricultural, economic, meteorological and other necessary data would be contributed by the appropriate agencies. Dr CHRISTMAS (New Zealand) asked what were the objectives of the proposed surveillance programme. Dr MAJID (Malaysia) thanked the Representative of the United Kingdom for his presentation on a subject of great importance to the Region. Nutrition and child health were interrelated, and in Malaysia there were many integrated programmes in which the two subjects were dealt with together. The nutrition programme was the only one administered by the Ministries of Health,-Agriculture, and Education, as well as by the Prime Minister's Department. The health of the child depended on its state of nutrition, since much ill health and disease arose out of poor nutri tion. It was intended to extend to the whole country a programme in child nutrition that had been initiated in several areas as a pilot project. WHO had assisted in the project by supplying a consultant. Dr Majid asked whether the intention in carrying out a nutritional surveillance programme was to process data in order to keep the state of nutrition of a particular group under surveillance or to enable countries to cope with nutritional problems arising out of food shortages, calamities, or other circumstances. Dr ANGARA (Philippines) considered the main purpose of the programme to be the identification of nutritional problem areas so that remedial measures could be instituted. In the Philippines, over three million children had been weighed, and malnutrition of the first, second and third degrees among them had been quantified. Dr NICHOLSON (United Kingdom) confirmed that the basic idea underlying the proposed surveillance programme was to identify the nature and extent of nutritional problems not only in the Western Pacific Region but also in other Regions, where they were sometimes worse. He referred particularly to chronic malnutrition, which could rapidly lead to famine