SECTION I I MINUTES OF THE SESSION - WHO | World ...

SECTION I I

MINUTES OF THE SESSION

CONTENTS BASED ON THE AGENDA

Agenda item No.

1 Opening of the session

Pages

47

2 Sub-Committee on Credentials

2.1 Appointment of the Sub-Committee 50 2.2 Approval of the report of the Sub-committee 50,114

3 Election of Chairman and Vice-chairman 50

4 Adoption of provisional agenda 50

5 Appointment of Sub-Committee on Programme Budget and adoption of its terms of reference

6 Adoption of agenda and election of Chairman for the technical discussions

7 Thirtieth Annual Report of the Regional Director 51

8 Resolutions of regional interest adopted by the 74,75,81,82, World Health Assembly 97,99,108,110,

115,120,127

9 Charter for Health Development 136

10 Technical discussions - Expanded Programme on Immunization"*

11 Proposed regional programme budget estimates for 1980 and 1981

11.1 Consideration of the report of the Sub-committee on Programme Budget

12 Consideration of the recommendations arising out of the technical discussions

13 Cooperation with non-health sectors in national health development (item proposed by the Government of Mongolia)

14 Importance of field studies on the ecology and control of vectors of human diseases and of training of medical entomologists in South-East Asia (item proposed by the Government of Indonesia)

*Held in conjunction with but not as a part of the regular proceedings of the Regional Committee.

Agenda item No.

15 Food fortification (item proposed by the Government of Indonesia)

16 Selection of a subject for the technical discussions at the thirty-second session of the Regional Committee

17 Time and place of the thirty-second session of the Regional Committee

Pages

115

18 Adoption of the final report of the thirty-first session of the Regional Committee 146

19 Adjournment 146

SUPPLEMENTARY AGENDA

1 National sample surveys for assessment of leprosy cases, their detection, chemotherapy, physical and vocational rehabilitation, immunology and epidemiology (item proposed by the Government of India)

2 The control and treatment of intestinal bacterial and parasitic infections in tropical countries (item proposed by the Government of India)

3 Cardiomyopathy and the incidence of rheumatic heart diseases and their complications in the tropics (item proposed by the Government of India)

4 Identification and epidemiology of cancer in South-East Asian countries (item proposed by the Government of India)

5 Technical cooperation among developing countries (TCDC) in the South-East Asia Region (item proposed by the Government of India)

6 Study of WHO'S structures in the light of its Eunc t ions

7 Establishment of a Regional Medical Library and an Information Centre for South-East Asia at the National Medical Library, New Delhi (item proposed by the Government of India)

SUNWARY MINUTES*

F i r s t Meeting, 22 August 1978. 9.00 a.m.

TABLE OF CONTENTS

1 Opening of t h e s e s s i o n

2 Address by t h e F i r s t Vice-Chairman of the Council of M i n i s t e r s

3 Address by t h e M i n i s t e r of Health

4 Message from t h e Direc tor-Genera l of WHO

5 Address by the Regional D i r e c t o r

6 Sta tement by t h e Represen ta t ive o f UNDP

7 Vote of thanks

8 Appointment of t h e Sub-committee on C r e d e n t i a l s

9 Closure o f the Inaugura l Meeting

10 Approval of t h e Report of t h e Sub-Committee on C r e d e n t i a l s

11 E l e c t i o n of Chairman and Vice-Chairman

12 Adoption of t h e P r o v i s i o n a l and Supplementary Agenda

1 3 Appointment o f t h e Sub-committee on Programme Budget and Adoption o f Its Terms o f Reference

14 Adoption of Agenda, and E l e c t i o n of Chairman, f o r t h e Techn ica l Discuss ions

15 T h i r t i e t h Annual Repor t of t h e Regional D i r e c t o r

16 Adjournment

ANNEXES

1 Text of Inaugura l Address by the F i r s t Vice-Chairman o f t h e Council of ? l i n i s t e r s of the Mongolian P e o p l e ' s Republic

2 Text of t h e Address by t h e M i n i s t e r of Heal th of Mongolia

3 Message from t h e Direc tor-Genera l of WHO

* O r i g i n a l l y i s s u e d as document SEA/RC31/Min.l, on 22 August 1978.

4 6

4 Text of Address by the Regional Director 62

5 Text of Statement by the Representative of the United Nations Development Programme, Ulan Bator

6 Text of the Regional Director's Speech introducing his Annual Report

MINUTES OF THE FIRST MEETING 47

1 Opening of t h e s e s s i o n ( i tem 1 of t h e Agenda)

The t h i r t y - f i r s t s e s s i o n of t h e Regional Committee was opened by DR PRAKORB TUCHINDA ( t h e outgoing Chairman). He welcomed Mr T. Ragcha, F i r s t Vice-Chairman of t h e Council of M i n i s t e r s of t h e Mongolian Peop le ' s Republ ic , D r Nyam-Osor, Minister of Heal th , Mongolian P e o p l e ' s Republic, the d e l e g a t e s , t h e r e p r e s e n t a t i v e of t h e United Nations Development Programme, and gues t s . On beha l f of t h e Regional Committee, he thanked t h e Government of Mongolia f o r h o s t i n g t h e s e s s i o n i n Ulan Bator.

He no ted t h a t remarkable progress had been made by t h e c o u n t r i e s of t h e Region in t h e p a s t t h r e e decades i n t h e i r q u e s t f o r b e t t e r h e a l t h f o r t h e i r peop les . He made p a r t i c u l a r r e f e r e n c e t o t h e s p i r i t of cooperat ion and c o l l a b o r a t i o n between WHO and i ts Member S t a t e s , which had made t h e e r a d i c a t i o n of smallpox p o s s i b l e . Paying s p e c i a l t r i b u t e t o t h e Regional D i r e c t o r f o r h i s p a r t i n promoting t h e p rogress of h e a l t h development i n t h e Region, h e s a i d t h a t h e was conf iden t t h a t , through cont inued cooperat ion among Member c o u n t r i e s and w i t h t h e suppor t of WHO a s w e l l a s UNDP and UNICEF, t h e enormous h e a l t h problems conf ron t ing t h e c o u n t r i e s of t h e Region, p a r t i c u l a r l y in t h e f i e l d s of c o m u n i c a b l e d i s e a s e s , environmental h e a l t h and primary h e a l t h c a r e , would be s u c c e s s f u l l y t a c k l e d . The Regional Conunittee would assume in i n c r e a s i n g l y important r o l e in t h e work of t h e Organizat ion and i n p rov id ing o p p o r t u n i t i e s f o r promoting t e c h n i c a l coopera t ion among developing c o u n t r i e s .

2 Address by t h e F i r s t Vice-Chairman of t h e Council of M i n i s t e r s

MR T . RAGCHA, F i r s t Vice-Chairman of t h e Counci l of M i n i s t e r s , Mongolian Peop le ' s Republic, welcomed t h e r e p r e s e n t a t i v e s of t h e Member S t a t e s of t h e WHO South-East Asia Region.

He s a i d t h a t t h e problem of p rov id ing b e t t e r h e a l t h t ranscended n a t i o n a l boundar ies and had become a common concern of t h e inter- n a t i o n a l community. Any set-back t o t h i s p rocess i n one country would a f f e c t t h e o t h e r s . There fo re , i t became impera t ive f o r t h e Member S t a t e s of t h e Region n o t only t o s t r e n g t h e n mutual t e c h n i c a l cooperat ion among themselves, b u t a l s o t o i n c r e a s e t h e i r c o l l a b o r a t i v e e f f o r t s w i t h t h e World Heal th Organizat ion.

Descr ib ing b r i e f l y t h e p rogress made by h i s government i n t h e f i e l d of h e a l t h , he expressed h i s government's a p p r e c i a t i o n of t h e cooperat ion and a s s i s t a n c e rece ived from WHO ( f o r f u l l t e x t of address , s e e Annex 1 ) .

3 Address by t h e M i n i s t e r of Heal th

DR NYAM-OSOR welcomed t h e r e p r e s e n t a t i v e s of t h e Member S t a t e s of WHO'S South-East As ia Region and thanked Mr Ragcha f o r h i s address . He s a i d t h a t t h e Organ iza t ion had , d u r i n g t h e p a s t t h r e e decades, achieved r e c o g n i t i o n as a r e s u l t of i ts e f f o r t s towards p r o t e c t i n g t h e h e a l t h of mankind. WHO was p l a y i n g an a c t i v e r o l e in s t r e n g t h e n i n g u n i v e r s a l peace through t h e promotion of h e a l t h . H e was happy t o n o t e t h e v a r i o u s i n n o v a t i v e measures adopted by t h e Regional Committee. In f a c t , WHO l a r g e l y depended on t h e i n i t i a t i v e s of i ts Member S t a t e s .

4 8 MINUTES OF THE FIRST MEETING

Outlining the s teps taken by h i s government t o implement various a c t i v i t i e s with the Organization, he r e i t e r a t e d h i s country's support to the Sixth General Programme of Work. He was apprec ia t ive of the Organization's e f f o r t s in achieving slnallpox eradica t ion and hoped t h a t the problems s t i l l confronting the Region would be tackled with renewed energy and resources.

The Minister then out l ined some of the achievements of h i s country i n the f i e l d of heal th, and referred with appreciat ion to the continuing col laborat ion with WHO and other United Nations' agencies such as UNDP, UNFPA and UNICEF.

In conclusion, he expressed the hope t h a t the present session of the Regional Committee would contr ibute grea t ly t o the cause of hea l th i n the Region, and wished the del iberat ions success ( fo r f u l l t e x t of address, see Annex 2).

4 Message from the Director-General of WHO

The REGIONAL DIRECTOR read a message from Dr H. Mahler, Director- General of the World Health Organization. I n h i s message. Dr Mahler reca l led the appeal which he had made t o the p o l i t i c a l leaders of the world following the Th i r ty - f i r s t World Health Assembly t o accord higher p r i o r i t y to hea l th and, through i t , t o promote development and world peace. This was the beginning of what he now ca l led the " p o l i t i c a l s t ruggle for health". In May 1977, the Th i r t i e th World Health Assembly had defined the t a rge t f o r governments and f o r WHO f o r the coming decades as the attainment by a l l c i t izen6 of the World by the year 2000 of a l eve l of hea l th t h a t would permit them to lead s o c i a l l y and economically productive l i v e s . The blueprint he had out l ined a t the Regional Committee l a s t year contained p r i o r i t y programmes and mechanisms f o r ensuring t h a t the most appropriate programmes i n each country were properly iden t i f i ed and implemented. He sa id t h a t governments must now make an unequivocal p o l i t i c a l commitment, including l e g i s l a t i o n a s necessary, t o introduce hea l th reforms t h a t were e s s e n t i a l i f hea l th development was to become a r e a l i t y . Social heal th goals appropriate to the country, including p r i o r i t y programmes, had to be iden t i f i ed and formulated with c l ea r object ives using appropriate technology.

Systematic managerial ac t ion fo r hea l th had t o be taken, with in t e r - na t ional support. In t h i s context he re fer red t o the re-examination of the Organization's s t r u c t u r e which he had already s e t i n motion and concluded by appealing t o the Regional Committee t o i n i t i a t e s imi l a r ac t ion a t the Regional l e v e l ( f o r f u l l t e x t of the message, see Annex 3).

5 Address by the Regional Director

The REGIONAL DIRECTOR thanked, on behalf of WHO and the Regional Committee fo r South-East Asia, the Government of the Mongolian People's Republic f o r i t s i n v i t a t i o n t o hold the t h i r t y - f i r s t sess ion of the Regional Committee i n Ulan Bator.

Referring t o the work done by the Organization during the pas t three decades, he s a i d t h a t the s ingu la r achievement of smallpox eradica t ion

MINUTES OF THE FIRST MEETING 4 9

had generated hope and optimism among the people t o expect s imi l a r breakthroughs in respec t of some o ther diseases, which should be possible with the wider appl ica t ion of hea l th planning and management and e f f i c i e n t follow-up of the na t iona l hea l th serv ices . The introduction of the primary hea l th care approach had ushered i n a new e r a of comnnmity pa r t i c ipa t ion and involvement, extending hea l th care to r u r a l a reas and urban slums, and h e a l t h manpower development was being reoriented t o ensure grea ter s o c i a l relevance of t r a in ing p r o g r a m s . The provision of proper water supply and s a n i t a t i o n , however, remained the weakest l i n k i n the chain of hea l th development. In view of such formidable challenges, the Organization's e f f o r t s were being d i rec ted towards f u l f i l l i n g e f f ec t ive ly i ts mandate of technical cooperation with i ts Member S ta t e s , which ro l e , he sa id , had been made e a s i e r by the growing awareness of t h e magnitude of hea l th problems and the increasing comitrnent of governments t o improving the qua l i ty of l i f e of t h e i r peoples. The present sess ion was an h i s t o r i c one i n t h a t i t marked t h i r t y years of the Organization's f r u i t f u l col laborat ion with i t s Member S ta t e s i n the Region.Referring to the Health Charter , which was before the Committee, he sa id t h a t i t s adoption would be the harbinger of an accelerated pace of hea l th development in the countr ies of t h i s region. It had i n i t a seed t h a t could grow i n t o a mighty movement f o r the s o c i a l and economic development of the countr ies of South-East Asia.

I n conclusion, he sa id t h a t a book, "A Decade of Health Development", had been brought out t o comernorate the Organization's t h i r t y years of serv ice t o the Region, and hoped t h a t i t would cont r ibute t o a grea ter appreciat ion of t h e problems confronted by and the e f f o r t s t h a t had been made to tackle them f o r improving the hea l th of the peoples of the Region ( f o r f u l l t e x t of address, s ee Annex 4 ) .

6 Statement by the representa t ive of UNDP

MR BUKHTOYAROV (Resident Representative, United Nations Development Programme) s t a t e d t h a t the pas t year had been a successful one, in which the most important s i n g l e achievement had been the e radica t ion of smallpox from the e n t i r e South-East Asia Region. He r e fe r r ed t o the close cooperation between WHO and UNDP i n development programmes i n Mongolia, p a r t i c u l a r l y the successful f inancing and execution of two large-scale p ro jec t s , of ass i s tance to t h e S t a t e Medical I n s t i t u t e and the production of BruceZZa vaccine.

He a l s o r e fe r r ed t o Mongolia's Sixth National Five-Year Plan, which paid the g r e a t e s t a t t e n t i o n t o the hea l th needs of the population, the p r i o r i t y a reas being hea l th and medical care , expanded coverage of t h e r u r a l population and f u r t h e r extension of the maternal and ch i ld hea l th serv ices . In support of the na t iona l plan i n the f i e l d of maternal and chi ld hea l th serv ices , a WHOfUNFPA projec t on Epidemiological Studies of Population Growth was already in operat ion, exemplifying t h e f r u i t f u l cooperation between the Mongolian Government and the United Nations agencies, which he was confident would continue i n the fu ture ( f o r f u l l t e x t of s tatement , see Annex 5 ) .

7 Vote of Thanks

DR JAMBAA (Vice-Minister of Health, Mongolia) expressed h i s g ra t i t ude t o the Regional Committee f o r having accepted the i n v i t a t i o n

5 0 MINLITES OF THE FIRST MEETING

of the Government of Mongolia t o hold its present sess ion in Ulan Bator. He then thanked the F i r s t Vice-chairman of the Council o f Ministers of Mongolia f o r inaugurat ing the sess ion and f o r h i s i n sp i r ing address, and the Minister of Public Health f o r making valuable proposals a s a guide fo r fu r the r j o i n t col laborat ion between h i s government and WHO. He requested the Chairman to convey t o D r Mahler t h e i r appreciat ion of h i s thought-provoking message, thanked the Regional Director f o r h i s s t imula t ing address and t h e Resident Representative of UNDP i n Ulan Bator f o r h i s message of greet ings.

8 Appointment of Sub-committee on Credentials (item 2.1)

The CHAIRMAN proposed, and i t was agreed, t h a t the representa t ives of Burma, Nepal and S r i Lanka should cons t i t u t e the Sub-Committee on Credentials .

9 Closure of the l n a u ~ u r a l Meeting

The inaugural sess ion was then adjourned.

10 Approval of the Report of the Sub-committee on Credentials (item 2.2)

DR JOSHI (Nepal), who had been e lec ted Chairman of the Sub-committee on Credentials , read out the repor t of the Sub-committee (document SEA/RC31/22) recommending recognit ion of the v a l i d i t y of t h e c redent ia l s presented by the representa t ives of Burma, Democratic People's Republic of Korea, India , Indonesia, Maldives, Mongolia. Nepal, S r i Lanka and Thailand, and s t a t e d t h a t there was no representa t ive from Bangladesh. This r epor t was adopted.

11 Elect ion of Chairman and Vice-Chairman (item 3)

DR SANKARAN (India) proposed the name of D r Jambaa (Mongolia) f o r the o f f i c e of Chairman. DR HERAT (Sr i Lanka), seconded the proposal. The Committee unanimously e l ec t ed D r Jambaa (Mongolia) as Chairman.

DR JAMBAA, on taking the cha i r , thanked the de legates , on behalf of a l l the hea l th workers of h i s country and on h i s own behalf , f o r the honour bestowed on him and h i s country by e l e c t i n g him Chairman. The Regional Committee was an exce l l en t forum f o r exchanging ideas and a r r i v i n g a t decisions t h a t would have an impact on the hea l th of the people of the Region, which accounted f o r one-fourth of the t o t a l world population, and he hoped t h a t t h e de l ibera t ions a t t h e sess ion would be f r u i t f u l .

DR PRAKORB (Thailand), seconded by DR JOSHI (Nepal), proposed the name of D r Sankaran, Representative of India , f o r the o f f i c e of Vice- Chairman. This proposal was unanimously accepted.

12 Adoption of the Provisional and Supplementary Agenda (item 4 )

The REGIONAL DIRECTOR explained t h a t s i x items had been proposed by the Government of India and one i tem by t h e S e c r e t a r i a t , a t the behest of the Director-General of WHO, based on the reso lu t ion adopted by the


Th i r ty - f i r s t World Health Assembly (WHA31.27). These items cons t i tu ted the supplementary agenda (document SEA/RC31/1 Add.1). The Committee adopted the provisional agenda (SEA/RC31/1) and the supplementary agenda (SEA/RC31/1 Add.1).

1 3 Appointment of the Sub-committee on Prograrmne Budget and Adoption of Its Terms of Reference (item 5)

The REGIONAL DIRECTOR explained t h a t the programme budget being proposed a t the cur rent sess ion covered t h e biennium 1980-1981 and the format in which i t was presented d i f f e red from t h a t of the previous years . It was therefore important t h a t the Sub-Committee be composed of representa t ives from as many count r ies as possible . The suggestion was accepted, and the Committee then approved the terms of reference of the Sub-committee as out l ined i n document SEA/RC31/4.

14 Adoption of the Agenda, and Elect ion of Chairman, f o r the Technical Discussions (item 6)

On the proposal of DR SOEBEKTI (Indonesia), seconded by MR DID1 (Maldives), D r Nadda (Thailand) was e l ec t ed Chairman of t h e technica l discussions. The proposed agenda f o r the technica l discussions (SEA/RC31/5) was then adopted.

15 Th i r t i e th Annual Report of the Regional Director (i tem 7)

The REGIONAL DIRECTOR, present ing h i s r epor t , s a i d t h a t t h e Organi- zat ion having completed three decades of co l labora t ion with its Member S ta t e s in hea l th development, should now take s tock and plan t o meet the challenges ahead. The Th i r ty - f i r s t World Health Assembly had requested ( reso lu t ion WHA31.27) the Director-General t o re-examine the Organization's s t r u c t u r e i n the l i g h t of its funct ions; the aim of the re-examination w a s t o ensure the promotion of in tegra ted ac t ion a t a l l operat ional l eve l s .

Though the re were a number of problems which t h e count r ies of t h i s region had to face , considerable progress had been made. Health planning had taken root in most of the count r ies , e i t h e r through country hea l th programing o r through na t iona l planning processes. A common problem, however, w a s the need t o develop funct ional ly adequate na t iona l hea l th information systems which were v i t a l f o r the planning, management and evaluat ion of hea l th programmes. Also there was the need f o r c lose funct ional l i n k s between na t iona l information systems and the Organization's i n t e r n a l system f o r providing information support t o the formulation of co l labora t ive programmes.

Despite t h e growing investment in hea l th se rv ices and a s teady expansion of t h e i r i n f r a s t r u c t u r e , coverage continued t o be l imi ted . The innovative experiments c a r r i e d out s o f a r in t h i s f i e l d had shown the a v a i l a b i l i t y of s i g n i f i c a n t a l t e r n a t i v e approaches, such as primary hea l th care , f o r f u l f i l l i n g the bas i c h e a l t h needs of the community. The mobilization of the resources required from i n t e r n a l and ex te rna l agencies was poss ib le only i f there were unqual if ied commitment on the p a r t of governments to t h i s cause.


There had been g rea t e r awareness i n t h e count r ies of t h e need f o r o r i en t ing t r a in ing progranrmes of a l l categories of hea l th personnel towards the needs of the hea l th serv ices .

In the a rea of medical research the re had been a s i g n i f i c a n t change i n t h e approach with t h e establishment of the Regional Advisory C o d t t e e on Medical Research.

To f a c i l i t a t e technica l cooperation among developing countr ies , it w a s proposed t o c o l l e c t information on expe r t i s e and f a c i l i t i e s f o r t r a in ing avai lab le in d i f f e r e n t f i e l d s .

He s t a t e d t h a t n ine out of the t en countr ies in the Region had indica ted t h e i r acceptance of the d r a f t of the Health Charter, which had been conceived f o r the purpose of providing an e f f e c t i v e mechanism f o r solving p r i o r i t y h e a l t h problems on the bas i s of mutual cooperation and col laborat ion. He emphasized the need f o r the Regional C o d t t e e t o be more and more closely involved in the work of the Organization and t o assume a forward-looking approach with a two-way communication with the various governing bodies of the Organization ( f o r f u l l t e x t of t h i s presenta t ion , s ee Annex 6 ) .

The CHAIRMAN congratulated the Regional Director on h i s exce l len t Annual Report and fo r h ighl ight ing some of the important i s sues r e l a t i n g t o the work of WHO.

MR VOHRA (India) f e l i c i t a t e d the Regional Director f o r h i s l u c i d report . A point which the Regional Director had not gone i n t o i n d e t a i l bu t on which h i s country would l i k e t o congratulate him w a s the outstanding achievement of working out unanimously agreed parameters and c r i t e r i a f o r the a l loca t ion of resources on a systematic and s c i e n t i f i c bas i s . Much progress had been made in the del ivery of UNDP-funded progr-s i n h i s country and the re was exce l l en t cooperation and coordination among h i s government, WHO and o ther i n t e r n a t i o n a l agencies. Referr ing t o the understanding reached regarding t h e a l loca t ion of resources, he s t a t e d tha t one could advance a s t e p f u r t h e r i f the inter-country programme was a l so prepared on the bas i s of regional p r i o r i t i e s and objec t ives . He f e l t t h a t the Region could a l so be very proud of t h e e radica t ion and cont ro l of f a t a l diseases.

DR JADAMEAA (Mongolia), welcoming the delegates from various countr ies and the representa t ives of i n t e r n a t i o n a l agencies t o the meeting and congratulat ing the Regional Director on h i s comprehensive repor t , s t a t e d t h a t h i s government noted with s a t i s f a c t i o n t h a t WHO w a s giving more importwce to the development of technica l cooperation. p a r t i c u l a r l y in the f i e l d of s t rengthening of na t iona l hea l th serv ices of the least developed among the developing count r ies of the Region. The h i s t o r i c achievement of smallpox e rad ica t ion had been poss ib le because of the well coordinated and cooperative e f f o r t s of Member count r ies and WHO. I f the governments could successfu l ly implement the b a s i c provisions of WHO'S S ix th General Programme of Work by improving the organiza t ional , adminis t ra t ive and planning machinery, grea ter success would be possible in implementing the objec t ives of m e d i m t e r m programmes.


H i s government had i n i t i a t e d seve ra l measures f o r the s trengthening of na t iona l hea l th ca re , such a s the establishment of a complete and independent system of primary and spec ia l ized medical care and the provision of hea l th care t o the r u r a l a reas . In order t o meet the growing needs of the population, however, grea ter a t t e n t i o n was being given to fu r the r expanding cooperation with WHO and other United Nations spec ia l ized agencies on s p e c i f i c hea l th matters , i n addi t ion t o implementing comprehensive economic and s o c i a l development programmes in which hea l th serv ices a l s o received p r i o r i t y . Development of hea l th se rv ices i n Mongolia faced c e r t a i n d i f f i c u l t i e s such as high population growth, the huge area over which they were d i s t r ibu ted , l o g i s t i c d i f f i c u l t i e s and the inadequacy of organizat ional and management s k i l l s . Resources were needed to adapt medical care serv ices t o these s p e c i f i c condit ions, including the provision of mobile hea l th teams with s p e c i a l equipment i n addit ion t o the permanently es tab l i shed heal th cent res f o r the r u r a l population.

Referring t o the need f o r s e t t i n g up i n h i s country a factory f o r the production of b io log ica l s f o r diagnost ic , cu ra t ive , preventive and cont ro l purposes, he s a i d t h a t the economic j u s t i f i c a t i o n f o r making f u l l use of its capacity could not be worked out , which l ed t o the f a c t t h a t the medical s e rv ice t i m e per person was r a the r long and the cos t of medical care per person was qu i t e high as compared t o countr ies which were l e s s sparse ly populated. In view of t h i s s i t u a t i o n , i t was imperative t o promote in t e rna t iona l and b i l a t e r a l cooperation i n order t o achieve the goal of providing hea l th care i n the r u r a l a reas . In t h i s regard the s p e c i f i c condition of every country should be taken i n t o account while a l loca t ing in t e rna t iona l resources f o r na t iona l development programmes.

Though considerable success had been achieved in the f i e l d of maternal and chi ld hea l th , i n f a n t mor ta l i ty s t i l l posed a problem. HLs government had therefore i n i t i a t e d a comprehensive programme of s o c i a l , economic and hea l th a c t i v i t i e s f o r t h e plan period 1979-1985 t o check t h i s problem, and i n t h i s the United Nations agencies would have an important r o l e t o play. F ina l ly , he s t a t e d t h a t , a s hea l th was an important f a c t o r i n a na t ion ' s socio-economic, c u l t u r a l and educat ional development programme, the pa r t i c ipa t ion of a l l s ec to r s of the na t iona l economy was of s p e c i a l s igni f icance .

DR PRAKORB (Thailand) congratulated the Chairman and the Vice-chairman on t h e i r e l ec t ion , and the Regional Director f o r h i s exce l l en t and comprehensive Annual Report. He was glad t o note t h a t the Report, a p a r t from highl ight ing the regional accomplishments in the f i e l d of hea l th during the previous year , emphasized the new concept of hea l th development as out l ined in the World Health Assembly reso lu t ion on "Managerial process f o r hea l th development" (WHA31.43). He w a s apprec ia t ive of WHO'S v i t a l col laborat ion with h i s government i n seve ra l hea l th programmes.

DR AUNG THEIN (Burma) associated himself with the sentiments expressed by h i s fellow representa t ives i n congratulat ing the Regional Director on h i s comprehensive repor t .

DR JOSH1 (Nepal) a l so congratulated the Chairman and the Vice-chairman on t h e i r e l ec t ion . He conveyed h i s thanks t o the outgoing chairman

54 MINUTES OF THE FIRST MEETING

f o r h i s r o l e and congratulated t h e Regional Direc tor on h i s exce l l en t report .

DR HO MYONG HUN (Democratic People's Republic of Korea), congratulat ing the Chairman and the Vice-Chairman on t h e i r e l e c t i o n , thanked t h e Regional Director f o r h i s u n t i r i n g e f f o r t s over the pas t year t o develop hea l th work i n the Region and f o r h i s exce l l en t repor t . He conveyed h i s government's appreciat ion t o the Government of Mongolia f o r the exce l l en t preparat ions made f o r the Regional C o d t t e e .

The successfu l e radica t ion of smallpox proved t h a t the work in t h e Region was progressing according t o the a sp i r a t ions and demands of the Member S ta t e s and the objec t ives of the WHO Const i tut ion.

Af ter reviewing t h e r e s u l t s of the Six-Year National Economic Plan, h i s government had embarked upon a Seven-Year Plan (197fJ-1984). During the Six-Year Plan, the number of h o s p i t a l s and beds had increased by 2.8 times and 1.5 times respec t ive ly and the output of drugs and medical apparatus by more than 2.3 and 7.2 times respec t ive ly . The average l i f e span had increased every year and the mor ta l i ty r a t e had been reduced t o one-fourth of the pre- l ibera t ion f igure . The average l i f e span was now 73 years (70 f o r males and 76 f o r females). The col labora t ive e f f o r t s between h i s government and WHO i n the f i e l d of cancer and cardiovascular d iseases had made steady progress. He thanked WHO f o r the ass i s tance provided to h i s country, pa r t i cu la r ly i n the provision of fellowships and supplies .

DR HERAT (Sr i Lanka), conveying h i s govemment's f r iendly greet ings t o the people of Mongolia and t o fellow delegates , thanked the Government of Mongolia f o r hos t ing the Regional Committee, and congratulated the Regional Director f o r the exce l l en t work done during the year. He a l s o congratulated the representa t ives who had been e l ec t ed t o various o f f i c e s .

MR AHMED ALI D I D 1 (Maldives) a l s o congratulated the Chairman and the Vice-Chairman on t h e i r e l e c t i o n , and the Regional Direc tor on h i s comprehensive repor t . He took the opportunity to convey h i s government's thanks p a r t i c u l a r l y t o the Governments of Ind ia , S r i Lanka and Bangla- desh f o r t h e i r support and he lp during t h e recent cholera epidemic i n Maldives.

DR SOEBEKTI (Indonesia) congratulated t h e RegionalDirec tor on h i s exce l len t Annual Report, t o *ich he would have some more information t o add under the sec t ion on mental hea l th . The CHAIRMAN s a i d t h a t t h e Regional Director would no doubt make a note of these a t the appropri- a t e place in the minutes. Planning competency in h i s corntry had developed very well . The hea l th manpower development capacity i n Indonesia was now adequate; they now had the problem of making i t more appropriate . Primary hea l th care a c t i v i t i e s were developing slowly but s t e a d i l y , and he hoped f o r more progress a f t e r the Alma Ata Conference. Thanks t o t h e l a r g e inputs from WHO through one of the country p ro jec t s , planning i n the h e a l t h sec to r was very thorough and had contr ibuted g rea t ly t o the t h i r d five-year plan of the country. As a r e s u l t of WHO a s s i s t ance , the planning u n i t i n the Health Ministry had become one of the s t ronges t u n i t s in the country. I n Lndonesia, p r i o r i t y was now given to environmental hea l th , fo r which the President of Indonesia had appointed a minis te r , and the problem w a s now being tackled in ter -sec tora l ly .

16 Adjournment

The meeting was then adjourned.


Annex 1

INAUGURAL ADDRESS BY THE FIRST VICE-CHAIRMAN OF THE COUNCIL OF MINISTERS OF THE MONGOLIAN PEOPLE'S REPUBLIC

On behalf of the Government of t h e Mongolian People's Republic, I would l i k e t o b id a warm welcome and extend s ince re gree t ings t o all of you, dis t inguished delegates and guests , who have come t o p a r t i c i p a t e in the Th i r ty - f i r s t Session of the World Health Organization Regional Committee f o r South-East Asia, hosted by my Government.

The World Health Organization Regional Committee f o r South-East Asia is holding i ts t h i r t y - f i r s t sess ion a t a unique moment, f o r it coincides with the 30th anniversary of the foundation of the World Health Organiza- t i o n and the f i r s t year of r e a l i z a t i o n of the Sixth General Progr- of Work adopted by the World Health Assembly.

Eleven years have elapsed s ince the 20th sess ion of the World Health Organization Regional Committee f o r South-East Asia w a s he ld in t h i s country f o r the f i r s t time.

In our age, the age of the communication boom and of increased inter- course among na t ions , t h e problem of pro tec t ion of human hea l th trans- cends na t iona l boundaries and becomes a cormmn concern of t h e inter- na t iona l community. A f a i l u r e in one country in the f i e l d of disease prevention may a f f e c t any o ther country. Therefore, i t becomes increasingly imperative f o r na t iona l governments t o coordinate t h e i r indiv idual e f f o r t s in the f i e l d of hea l th pro tec t ion , t o develop c lose r cooperation between themselves and t o p a r t i c i p a t e ac t ive ly in t h e work of the World Health Organization.

In pu r su i t thereof the Government of the Mongolian People's Republic has always given i ts a c t i v e support t o t h e development and expansion of f r u i t f u l cooperation, both on an inter-governmental bas i s and in the framework of i n t e rna t iona l organizat ions.

On the morrow of the v ic tory of the people's revolut ion in 1921, the Government of t h e Mongolian People's Republic took charge of t h e publ ic hea l th of the country a s one of its p r i o r i t y tasks and began t o develop af resh the medical s e rv ice , f r e e of charge. Our people take a leg i t imate pr ide in t h e i r achievements made over the pas t 57 years in the f i e l d of hea l th pro tec t ion and improvement of l i v i n g and c u l t u r a l standards.

A t present the Mongolian People's Republic's h e a l t h pro tec t ion expenditure accounts f o r about 10 per cent of the s t a t e budget.

The r u r a l population in our country is f u l l y provided with spec ia l ized medical s e rv ice by the rapeu t i s t s , obs t e t r i c i ans , surgeons and paedia t r ic ians , and the urban population with highly q u a l i f i e d medical care.

The Government of t h e Mongolian People's Republic has i d e n t i f i e d s p e c i f i c goals t o promote f u r t h e r and develop t h e hea l th pro tec t ion a c t i v i t i e s in t h e country. These goals have found t h e i r c l e a r expression in the Sixth


Five-yearplan for the development o f t h e na t iona l economy and cu l tu re of our country f o r 1976-1980 and they a r e being achieved through successive measures.

One of the c l e a r examples t o t h i s e f f e c t is the "Health Law of the Mongolian People's Republic" adopted by t h e Regular Session of t h e Great People's Khural i n June 1977.

The Government of the Mongolian People's Republic highly apprec ia tes the World Health Organization as one of the pres t ig ious in t e rna t iona l organizat ions cont r ibut ing t o the success of the multi-faceted endeavours of our Government in t h e f i e l d of hea l th pro tec t ion . Since i t s admission t o the World Health Organization in 1962, t h e Government of the Mongolian People's Republic has been engaged in close cooperation with the World Health Organization.

I a v a i l myself of t h i s pleasant opportunity t o express our profound g ra t i t ude t o WHO and its Regional Off ice f o r South-East Asia f o r t h e i r cooperation with and ass i s tance t o our Government i n r ea l i z ing the supreme goal of our Government t o f u r t h e r the humane and noble cause of safeguarding the hea l th and welfare of i ts people.

In our hrrmble opinion, such an in tegra ted soci-economic approach is needed i f we a re t o achieve pos i t i ve r e s u l t s in our e f f o r t s in hea l th pro tec t ion , be it on a na t iona l , reg ional , o r world sca l e .

We a re deeply conscious of the f a c t t h a t long-last ing peace is one of the p r inc ipa l p re requ i s i t e s f o r a h e a l t h i e r and happier l i f e of the people of any country. Hence, we th ink t h a t WHO, its Regional Office and a l l peace-loving Member S ta t e s of our region a re ca l l ed upon t o b r ing t h e i r worthy cont r ibut ion t o the r e a l i z a t i o n of t h e construct ive and r e a l i s t i c i n i t i a t i v e s aimed a t curbing the arms race and fu r the r deepening in t e rna t iona l detente and making i t i r r e v e r s i b l e .

I would l i k e t o express my f i rm conviction t h a t the Th i r ty - f i r s t sess ion of the World Health Organization Regional C o m i t t e e f o r South-East Asia w i l l successfu l ly dea l with the goals before i t and cont r ibute t o the humane and noble cause of promoting the hea l th pro tec t ion of the peoples of i t s Member S ta tes .

In conclusion, may I wish complete success t o t h e work of t h e Thirty- f i r s t sess ion of the WHO Regional Committee f o r South-East Asia, and t o a l l of you, dis t inguished delegates and guests , a very pleasant s t a y i n our country.


Annex 2

TEXT OF THE ADDRESS BY THE MINISTER OF HEALTH OF MONGOLIA

On behalf of the Ministry of Public Health of the Mongolian People's Republic, the thousands of medical workers of the Mongolian Health Service and i n my own name I extend t o a l l of you our warm greet ings on the occasion of the convening of the Th i r ty - f i r s t Session of the WHO Regional Committee for South-East Asia in Ulan Bator.

I express my profound g ra t i t ude t o Comrade T . Ragcha, F i r s t Vice-Chairman of the Council of Ministers of the Mongolian People's Republic, f o r h i s eloquent statement presented from the high rostrum of t h i s forum on the a c t i v i t i e s of the WHO and f o r the cooperative arrangements t h a t a r e being made by the Organization and my Government.

It gives me a grea t pleasure to note t h a t the World Health Organization, which had taken i ts o r ig in from the objec t ive need f o r world-wide combination and coordination of e f f o r t s of na t ions toward the protect ion of mankind's h e a l t h , has become f o r these three decades a highly p res t i - gious in t e rna t iona l organizat ion, playing an increasingly a c t i v e r o l e i n s t rengthening universal peace and i n promoting the noble and humane cause of t h e hea l th and welfare of Man.

Relying on the ac t ive pa r t i c ipa t ion and cooperation of its Member S ta t e s , as well a s on the tremendous innovations and achievements i n the f i e l d of medicine, the WHO, f o r t h i s comparatively shor t span of time, has been engaged i n an a c t i v e search f o r s t reamlining i t s pol icy and performance and has accomplished much.

Actions and achievements of WHO l a r g e l y depend on i n i t i a t i v e s of the Member S ta t e s , on the scope and magnitude of t h e i r cooperation with WHO, a s wel l as on the r i g h t s e l ec t ion of p r i o r i t y tasks of na t iona l h e a l t h systems. I n t h i s connexion I am pleased t o no te the commendable i n i t i a t i v e s and construct ive measures by the WHO Regional Committee f o r South-East Asia.

The Government of the Mongolian People's Republic has always given i t s a c t i v e support t o the dynamic pol icy and progranrme of WHO. To t h i s e f f e c t the representa t ives of our Government have repeatedly expressed themselves a t the World Health Assemblies and sess ions of the Regional Committee. Comrade T. Ragcha, F i r s t Vice-Chairman of the Council of Ministers, has j u s t s t a t e d my Government's pol icy towards WHO. We f u l l y support the b a s i c provisions of the Sixth General Programme of Work of WHO and a r e applying them to our work, formulating and following appropr ia te technology f o r hea l th .

The Government and people of Mongolia highly apprec ia te the e radica t ion of smallpox through the j o i n t e f f o r t s of WHO and its Member S ta t e s a s one of the tremendous achievements h i c h has far-reaching s igni f icance not only fo r t h e pro tec t ion of human hea l th but a l s o f o r o ther a reas of current concern.


However, there is no room f o r complacency. Our region is s t i l l confronted with such maladies a s high morbidity and mor ta l i ty r a t e s of c e r t a i n preventable communicable d iseases , slow decrease of morbidity and mortal i ty r a t e s of childhood and maternal d iseases , malar ia , hunger and malnutr i t ion. This c l e a r l y shows us what problems we have t o t ack le f i r s t and where t o concentrate our energy and resources. In t h i s , our cooperation has a decis ive r o l e t o play.

Two years ago the Mongolian hea l th serv ice celebrated the 55th anniversary of i t s foundation as a na t iona l event. Comrade Yu Tsedenbal, President of t h e Great People's Khural of the Mongolian People's Republic, having assessed the main indices of hea l th se rv ice coverage of our country, pinpointed our p r i o r i t y tasks. These tasks a re connected with the fundamental improvement i n the operat ional e f f ic iency of the hea l th and hygiene serv ice , and increas ing the a v a i l a b i l i t y of spec ia l ized medical care t o t h e population. I n order t o achieve those tasks the Government of the Mongolian People's Republic is carrying out a programre of broad measures. The programme provides f o r the s e t t i n g up of provinc ia l and in ter -provinc ia l spec ia l ized medical cent res , s t rengthening d i s t r i c t and i n t e r - d i s t r i c t h o s p i t a l s , gradual t r a n s i t i o n to an ove ra l l dispensary system, and extension of out-pat ient and po lyc l in i c serv ices . I n addi t ion the programme a l s o embraces measures t o expand t h e serv ices of s t a t iona ry and mobile medical teams and t o provide the r u r a l population with the regular serv ices of physicians.

A t present every 10 000 of the population has 101.4 h o s p i t a l beds, 20.5 doctors and 72.3 fe ldshers . So the doctor-patient r a t i o is I t o 483. and one c i t i z e n receives medical care 8.2 times per year.

Ten per cen t .o f the s t a t e budget goes t o hea l th pro tec t ion of the population and the annual per cap i t a budgetary a l loca t ion is 162 tugr iks (or $53). These a r e the r e a l r e s u l t s of t h e socio-economic pol icy of our Party and Government.

Over many years the Mongolian people's Republic has been cooperating with WHO and o ther kindred organizat ions of t h e United Nations system such as UNDP, UNFPA and UNICEF in the f i e l d of hea l th protect ion.

With the cooperation of WHO, the Mongolian People's Republic is implementing over 10 pro jec ts and doing a f r u i t f u l job in such areas a s t r a i n i n g of na t iona l medical cadres, advanced t r a in ing , appl ica t ion of the l a t e s t achievements in the f i e l d of medicine and the s trengthening of t h e mater ia l b a s i s of preventive serv ices .

With g rea t s a t i s f a c t i o n I would l i k e t o mention t h a t i n the p a s t ten years about 300 of our doctors went abroad on WHO fellowships f o r advanced t ra in ing . about 10 consul tants came every year t o our country t o work i n the important f i e l d of public hea l th pro tec t ion and t o provide much valuable advice and recommendations.

I would l i k e t o s t a t e here t h a t our cooperation with WHO brings its worthy contr ibut ion to our endeavour to meet adequately the growing hea l th


pro tec t ion requirements of our country's population as wel l as the challenges t h a t come from t h e s p e c i f i c condit ions such a s t h e vastness of our land, its severe weather conditions and the shortage of cadres.

M r Chairman,

There is a Mongolian proverb which says:

"without debt you a r e r i c h without d isease you a r e happy ..."

A l l of us, and in f a c t every c i v i l i z e d human being of our p lane t , a r e deeply conscious t h a t t h e f i rm foundations of happiness are peace, f r iendship and detente. And hea l th , happiness and cheers a r e all but f r u i t s of peace.

Before concluding I would l i k e t o read a passage from a poem by Dashdorjiin Natsagdorj, who was the veteran of our revolut ion and a grea t humanist, i n which he g l o r i f i e d hea l th :

"Happiness, happiness, happiness It may be of d i f f e r e n t o r ig in on t h i s e a r t h But the happiness of being hea l thy Is the r e a l happiness.. . "

While expressing once again my confidence t h a t t h i s sess ion w i l l make a g rea t cont r ibut ion t o the noble cause of pro tec t ing t h e h e a l t h of t h e peoples of our region may I wish every success t o t h e t h i r t y - f i r s t sess ion of the WHO Regional Committee f o r South-East Asia.

I wish you, dis t inguished delegates , l a d i e s and gentlemen, a very pleasant s t a y in our country and kindly ask you t o make use of your s t ay t o ge t b e t t e r fami l ia r ized with our people's f r i end ly sentiments, h o s p i t a l i t y and t h e i r accomplishments and aspi ra t ions .

Thank you.

60 MINUTES OF TEE FIRST MEETING

h e x 3

MESSAGE FROH TIIE DIRECTOR-GENERAL OF MHO

A t the Thirty-first World Health Assembly in May th i s year I launched an appeal to the po l i t i ca l leaders of the world to accord higher pr ior i ty to health and, through health, t o promote development and peace. This w a s the begianing of what I shall now c a l l the "pol i t ical struggle for health". The great sanitary r e f o m of the l a t t e r half of the nineteenth century, which provided the industrial izing countries with clean water and safe sewage, and which did so much to promote health in these countries, were brought about by vigorous po l i t i ca l action. The great health reforms which WHO has launched in the l a t t e r half of the twentieth century w i l l have to be brought about too by vigorous po l i t i ca l action.

We have a main social target for the coming decades. In May 1977. the Thirt ieth World Health Assembly defined it for governments and for WBO as the attainment by a l l the cit izens of the world by the year 2000 of a level of health that w i l l permit them to lead socially and economically productive l ives. The struggle for health is aimed a t at taining that target. To gain acceptance of our target and to release the massive social energy required to a t ta in it , po l i t i ca l struggle is inevitable. We w i l l have to rack our brains to devise the best ways of launching th i s po l i t i ca l struggle for health and keeping up its momentum. I sha l l l e t you have my ideas; they are based on a deep sense of urgency; the time for action is now.

In my address to you l a s t year, I sketched a blue-print for at taining an acceptable leve l of health for all by the year 2000. The time is long overdue to convert th is , or any other suitable blue-print, in to a world- wide plan of action i n which the countries of South-East Asia w i l l have to play the i r f u l l part. I divided the blue-print in to pr ior i ty programmes and mechanisms for ensuring that the most appropriate programmes in each country are properly identified and delivered. I cannot s t r e s s suff ic ient ly action i n countries, for that is where i t is most effective. Governments must make an unequivocal po l i t i ca l commitment, including legis la t ion as required, to introduce the health reforms that a r e eskential if health development is to become a rea l i ty . Social health goals appropriate to the country have to be defined. Pr ior i ty programmes have to be identified and formulated with clear-cut objectives aimed a t at taining the defined social health goals. For each programme g p r o p r i a t e technology has to be selected or devised that is sc ien t i f ica l ly sound, socially acceptable and economically feasible. All programPles, whatever the i r degree of priori ty. have to be integrated in to a general health system, s t a r t i ng with primary health care and ensuring the support of the r e s t of the system. Health workers of a l l categories h a w to be oriented socially t o serve people by providing them with the services planned for them, and have to be trained technically to th i s end.

Systematic managerial action f o r health also has to be taken. 'Ihis includes such ac t iv i t i e s as country health programming, national health programme budgeting, health progranme formulation, the translation of these programmes into ins t i tu t iona l and service requirements, the delivery


of programmes through these i n s t i t u t i o n s and se rv ices , hea l th progranrmes evaluat ion and information support. In addi t ion , the s o c i a l r ea l i za t ion of s o c i a l goals has t o be kept firmly in mind t o a t t a i n l a s t i n g r e su l t s . By t h a t , I mean the pa r t i c ipa t ion of an enlightened public i n the development and cont ro l of their heal th system. So I re turn t o the theme of s o c i a l ac t ion fo r hea l th and t o the need to e s t a b l i s h and implement plans of ac t ion throughout t h e world t h a t w i l l ensure an acceptable l e v e l of hea l th f o r a l l .

In t e rna t iona l ac t ion f o r hea l th is required t o support na t iona l ac t ion , but never t o supplant i t . On the bas i s of na t iona l plans of ac t ion , WHO w i l l bu i ld up regional and global plans of ac t ion . These w i l l be c r u c i a l f o r the s t r a t egy being developed by WHO'S Executive Board f o r a t t a i n i n g an acceptable l e v e l of hea l th f o r a l l by t h e year 2000. They w i l l a l so be c r u c i a l f o r the contr ibut ion of hea l th t o t h e New In te rna t iona l Economic Order and i t s conversion i n t o a genuine i n t e r n a t i o n a l development order.

Following my speech t o the Th i r ty - f i r s t World Health Assembly, I have addressed personal l e t t e r s t o a number of t h e world's l eade r s , asking them t o make the most of the r e l a t i v e l y non-controversial nature of h e a l t h a sp i r a t ions i n order t o promote s o c i a l and economic development and, through t h i s development, world peace. I have a l s o addressed all Y f n i s t e r s of Health, asking them t o approach t h e i r Head of S ta t e and t h e i r colleagues i n government who have an i n t e r e s t i n development and peace.

The Th i r ty - f i r s t World Health Assembly adopted a reso lu t ion in which i t requested me to re-examine the Organization's s t r u c t u r e s i n the l i g h t of i ts funct ions with a view t o ensuring t h a t a c t i v i t i e s a t a l l opera t ional l e v e l s promote in tegra ted ac t ion . Together with the Regional Directors I have already s e t t h a t study in motion, and I hope you w i l l launch it i n your region a t t h i s sess ion of the Regional Committee, and t h a t you w i l l ensure wide consul tat ions with the governments i n the region.

I am now turning to you, representa t ives of t h e countr ies of the Region of South-East Asia, t o do your utmost t o ensure the urgent in t roduct ion of the widespread hea l th reforms t h a t a r e required across the Region and the establishment of na t iona l and regional plans of ac t ion f o r heal th. The obs tac les you w i l l have t o face only underline the need t o mobilize co l l ec t ive se l f - r e l i ance i n t h e s t rugg le f o r s o c i a l and economic development. M r Chairman, honourable representa t ives , t h e pu r su i t of hea l th is a v i t a l component of t h a t s t ruggle . Pursue i t with fervour!


Annex 4

TEXT OF ADDRESS BY THE REGIONAL DIRECTOR

We a r e indeed very g r a t e f u l t o you, Your Excellency, f o r being with us t h i s morning t o inaugurate the 31st sess ion of the WHO Regional Committee f o r South-East Asia, desp i t e your press ing pre-occupation with du t i e s of S ta te . I thank you f o r the kind words you s a i d about WHO and espec ia l ly its South-East Asia Region. We g rea t ly apprec ia te your in sp i r ing address, which w i l l guide us in our de l ibera t ions . To you, Mr Minister of Health, we a r e g ra t e fu l f o r your address and f o r the exce l l en t arrangements made f o r t h i s sess ion of the Regional Committee.

I wish t o take t h i s opportunity t o welcome most co rd ia l ly t h e dis t inguished representa t ives from Member S t a t e s , and t h e representa t ives of i n t e r - na t iona l agencies and governmental and non-governmental organizations.

I a l s o wish t o express our s ince re appreciat ion of the kind i n v i t a t i o n extended by your Government t o t h e Regional Committee t o hold t h i s sess ion in the c i t y of Ulan Bator, the c a p i t a l of your g rea t country. Mongolia is remarkable in many respects . Its vas t p la teau of one-and- a-half mi l l ion square kilometres in the h e a r t of Asia is g i rd led by mountains which include both green meadows and the famous Gobi deser t . Ihe severe con t ra s t s of your cont inenta l climate have made Mongolia the homeland of one of the s t u r d i e s t and most courageous of Asia 's peoples.

Adapting t o the extreme moods of na ture , your people have inhe r i t ed a s t rength , hardiness and resourcefulness , and above a l l , an indomitable pioneering s p i r i t which is a g rea t i n s p i r a t i o n t o us a l l .

Indeed, Your Excellency, today, when near ly a b i l l i o n people who re s ide i n the countr ies of the South-East Asia Region a r e faced with formidable problems of d isease , we could derive s t rength from t h e pioneering s p i r i t and resourcefulness t h a t have made your land and people grea t .

M r Chairman, l a d i e s and gentlemen, a s we look back over th ree decades of the Organization's work and take s tock of what has been achieved and what remains t o be done, we r e a l i z e t h a t we a r e t r u l y a t a cross-roads. The glorioue conquest of smallpox - u n t i l recent ly a k i l l e r disease of major proportions - has generated a new surge of hope and optimism and t h e people a re expecting a s imi l a r breakthrough i n respect of some o t h e r diseases. The ca re fu l planning, e f f i c i e n t management and cons is ten t follow-up which went i n t o t h e smallpox e rad ica t ion campaign show promise of being extended t o t h e whole hea l th sec to r . Health planning and management, which the Organization promoted from small beginnings some t en years ago, is now being applied on a wide s c a l e i n the form of country hea l th programing o r o t h e r na t iona l hea l th planning processes. Ihis is enabling count r ies t o achieve g r e a t e r e f f i c i ency i n the management of t h e i r hea l th se rv ices and make use of t h e ava i l ab le resources. With the r e a l i z a t i o n of the l i m i t a t i o n s of e x i s t i n g hea l th se rv ices , the advent of the primary hea l th care approach is ushering in a new e r a of community pa r t i c ipa t ion and involvement which w i l l extend h e a l t h ca re t o the vas t under-served populations i n r u r a l a reas and urban slums. Health manpower development, which in most count r ies of the Region had been based on


western models, of ten divorced from t h e r e a l i t i e s and needs of our own communities, i s being re-oriented t o ensure g rea t e r s o c i a l relevance of t r a i n i n g programmes. A good beginning has been made i n promoting problem- or ien ted research t o tackle the manifold challenges i n the f i e l d of hea l th care. It is t rue tha t the provision of proper water supply and s a n i t a t i o n remains the weakest l i n k i n the chain of hea l th development; but even here considerable progress has been achieved i n defining t h e magnitude of the problem. Active s t e p s a r e a l so being taken to mobilize the necessary resources fo r the implementation of t h i s g igant ic undertaking.

In the face of such formidable challenges, the World Health Organization i t s e l f is being re-oriented t o f u l f i l more e f f e c t i v e l y its mandate of technica l cooperation with i t s Member S ta t e s . I n t h i s increasingly co l labora t ive r o l e , i t i s considerably helped by t h e growing awareness of the magnitude of hea l th problems and the g rea t e r commitment of governments t o improve the qua l i ty of l i f e of t h e i r peoples. The new programme budgeting is an example of one of the s t e p s being taken t o he lp promote meaningful technica l cooperation with Member S ta t e s . Other far-reaching changes a re being brought about i n the s t r u c t u r e of the Organization a t a l l l e v e l s so t h a t i t may e f f e c t i v e l y f u l f i l its cons t i tu t iona l function.

In t h i s important endeavour we count upon your cooperation and guidance t o evolve mechanisms by which t h e Organization can b e s t respond t o t h e needs and problems of Member S ta t e s .

I would l i k e to point out he re , Mr Chairman, t h a t t h i s session of the Regional Committee is an h i s t o r i c one and, as I s a i d e a r l i e r , marks t h i r t y years of the Organization's f r u i t f u l col laborat ion with Member S ta t e s i n the Region. Before you, f o r adoption, is a Health Charter which could open up a new v i s t a i n the sphere of cooperation and collaboration f o r hea l th development. I be l ieve t h a t the Health Charter , with i t s r inging proclamation of some of the b a s i c tene ts of hea l th development, and with the unqual if ied commitment of our governments t o t h i s cause, w i l l t r u l y be the harbinger of an accelerated pace of hea l th development i n the countr ies of t h i s region. I t has i n i t a seed t h a t could grow i n t o a mighty movement f o r the s o c i a l and economic development of the count r ies of South-East Asia.

In conclusion, M r Chairman, I am pleased t o take the opportunity of t h i s h i s t o r i c occasion to present a book, "A Decade of Health Development", which has been published t o comemorate the Organization's t h i r t y years of s e rv ice . Copies of the book w i l l be d i s t r ibu ted shor t ly . A s our Director-General, D r Halfdan Mahler, says i n h i s preface t o t h e book, "To look forward with v i s ion , it is wise t o glance back with percept ion, not t o be bound by what we have done before , nor to blame ourselves o r our predecessors, but t o l ea rn lessons i n order t o bu i ld a s t a b l e r and h e a l t h i e r future." I hope t h a t t h i s bcok w i l l cont r ibute in a small way t o a g rea t e r appreciat ion of the problems t h a t confront t h i s region and the e f f o r t s t h a t have been made t o tackle them for improving t h e hea i th of the peoples of our countr ies .

Thus, while the challenges before u s a r e formidable and numerous, there a re exc i t ing developments from which we can der ive hope, optimism and courage.


Mr Chairman, Your Excellencies, ladies and gentlemen, I am confident that the discussions during the coming week w i l l take us yet another step nearer to our goal of the attainment of health for a l l by the end of the century.

Thank you, Mr Chairman.


Annex 5

TEXT OF STATEMENT BY THE REPRESENTATIVE OF THE UNITED NATIONS DEVELOPMENT PROGRAMME, ULAN BATOR

I am g r a t e f u l f o r t h i s opportunity t o address the t h i r t y - f i r s t session of the WHO Regional Comaittee f o r South-East Asia. I would l i k e t o convey the regards o f M r Morse, the Administrator of t h e United Nations Development Programme, on whose behalf I am represent ing UNDP a t t h i s important reg ional sess ion .

A s you a r e aware, t h e last year was a successfu l one i f w e take the Region as a whole. While there is i n some areas s t i l l room f o r improvement in the way of reaching t h e standards comparable t o those i n some developed count r ies , there w a s nevertheless a s e r i e s of achievements marking the l a s t year .

The most important s ing le achievement was the o f f i c i a l dec lara t ion of the complete e radica t ion of smallpox from the e n t i r e South-East Asia Region. A l l p a r t i e s who have pa r t i c ipa t ed i n t h i s tremendous e f f o r t should be commended f o r the results obtained, which did not only e l iminate a dangerous disease but demonstrated a l s o t h a t concerted undertakings of the countr ies involved can r e s u l t in s i g n i f i c a n t achievements. I am convinced t h a t t h i s unique example w i l l increase the morale i n the f i g h t aga ins t o the r d iseases such a s malaria , leprosy and childhood d iseases which s t i l l continue t o endanger the l i v e s of a l a r g e p a r t of the inhabi tan ts of t h i s region.

As f a r a s UNDP's cooperation with WHO i n Mongolia is concerned, I would l i k e t o inform the d is t inguished delegates t h a t cooperation in t h i s f i e l d has a t r a d i t i o n of more than t en years when p ro jec t s such as tuberculosis con t ro l , hea l th laboratory serv ices , environmental h e a l t h and maternal and ch i ld h e a l t h were launched.

Today, the cooperation between UNDP and WHO continues i n a highly success- f u l manner with t h e f inancing and execution of two large-scale pro jec ts .

One renders a s s i s t ance t o t h e S t a t e Medical I n s t i t u t e and has a budget of 1.1 mil l ion do l l a r s . The main long-range objec t ive of t h i s p ro jec t is t o assist t h e Government of Mongolia in improving i t s medical education system with a view t o a t t a i n i n g a higher s tandard of medical care and hea l th p rac t i ce f o r the whole population.

The second p ro jec t is, desp i t e its r e l a t i v e l y small budget, one of the most successfu l in the Region and he lps t o e l iminate b ruce l los i s i n g o a t s and sheep. During the f i r s t t h ree years. 6.5 mi l l ion animals were vaccinated and t h i s year about 5.5 mi l l ion w i l l be inoculated, one mi l l ion more than the number planned. The long-range objec t ives of t h e p ro jec t a r e se l f - su f f i c i en ty i n the production of b ruce l l a vaccines and the v i r t u a l e radica t ion of the d isease , maintaining a brucel la-free s t a t u s i n Mongolia. The pro jec t is the b igges t undertaking i n the Region i n b ruce l los i s prevention, and it can be r e a l i s t i c a l l y expected t h a t long- range objec t ives w i l l be met. This is a l l the more s o a s the Mongolian Government pays h ighes t a t t e n t i o n t o t h e hea l th needs of i ts population

66 MINUTES OF TWE FIRST MEETING

which can a l s o be seen from the cur rent National Sixth Five-Year Plan, which foresees the following i n the f i e l d of hea l th , among o the r things:

- the improvement of t h e qua l i ty of hea l th and medical care ,

- the expansion of the coverage of the r u r a l population with both primary and f u l l y q u a l i f i e d h e a l t h ca re , and

- the expansion of the dispensary serv ices and fu r the r expansion of the maternal and ch i ld hea l th serv ices .

This l a t t e r objec t ive is now concretely a WHO/UNFPA projec t ca l l ed "Epidemiological surveys", whereby ten model maternal and ch i ld hea l th se rv ice d i s t r i c t s a re t o be es tab l i shed i n an e f f o r t t o reduce fu r the r the maternal morbidity and mor ta l i ty r a t e s . It is planned t h a t by 1981 one paedia t r ic ian should not serve more than 900 chi ldren. The ove ra l l doctor-population r a t i o is now about 22 per 10 000 and is improving fu r the r .

These examples have demonstrated in b r i e f how f r u i t f u l the t r i l a t e r a l cooperation between the Mongolian Government, WHO and UNDP has been i n the pas t and how successfu l i t is a t present . May I express my hope t h a t t h i s w i l l continue to be the case a l s o i n the fu tu re in t h e b e s t i n t e r e s t s of the people we a r e pr iv i leged t o serve.

Mr Chairman, dis t inguished representa t ives , may I wish t h i s Committee. on behalf of t h e Administrator of UNDP and on my own behal f , an i n t e r e s t - ing se s s ion , f r u i t f u l discussions and new achievements in t h e f i e l d of hea l th .

Thank you f o r your a t t e n t i o n .


Annex 6

TEXT OF THE REGIONAL DIRECTOR'S SPEECH INTRODUCING HIS ANNUAL REPORT

I have g rea t pleasure i n present ing my annual repor t t o you f o r the year 1977-78. The Organization has now completed 30 years of c lose collabo- r a t ion with i t s Member S ta t e s in hea l th development, and a f t e r these three decades, you w i l l agree tha t i t is time f o r us t o look back, t o take s tock of things, and to plan t o meet the challenges ahead. We a re t ru ly a t a cross-roads. M r Chairman. It i s therefore s i g n i f i c a n t t h a t the Th i r ty - f i r s t World Health Assembly, which considered t h e Executive Board's organiza t ional study on WHO'S r o l e a t the country l e v e l , requested the Director-General, through resolu t ion WHA31.27, t o re- examine the organizat ion 's s t r u c t u r e i n the l i g h t of i t s functions. This re-examination is t o be aimed a t ensuring t h a t a c t i v i t i e s a t a l l opera t ional l e v e l s promote in tegra ted ac t ion . The Director-General is required t o r epor t t o the 65th sess ion of the Executive Board t o be held i n January 1980. It is therefore important now f o r the Regional Committee t o conduct the study i n close consul tat ion with a l l Member S ta t e s and with a l l the ser iousness i t merits. The Director-General has prepared a background paper f o r t h i s purpose, which forms an important item of your agenda, t h a t is , document SEA/RC31/14 (supplementary agenda item No. 6 ) . I s h a l l focus on some of the important i s sues r e l a t e d t o t h i s subjec t when t h e item is considered. Suff ice it t o comment here t h a t the fu tu re working of the Organization w i l l be profoundly influenced by the conclusions t h a t you a r r i v e a t . The Director-General has summarized the b a s i c i s sues in h i s background paper. I quote: "If hea l th is important f o r development and WHO cons i s t s of Member S ta t e s cooperating among them- se lves in the s p i r i t of t h e Const i tut ion t o a t t a i n an acceptable l e v e l of hea l th f o r t h e i r people, it follows t h a t WHO is equal ly important both f o r hea l th and f o r development". Based on t h i s premise, the key question is: "Which way and t o what ex tent governments want WHO and what kind of WHO they want?" This s tudy, therefore , w i l l focus on b a s i c i ssues such as the meaning and scope of technical cooperation i n the context of the prevai l ing hea l th s i t u a t i o n i n the Member countr ies of the Region. Some s t r u c t u r a l changes may be necessary a t the f i e l d and programe coordination l e v e l s in the countr ies and i n the Regional Office. I f we a re t o a t t a i n our s o c i a l goal of hea l th f o r a l l by t h e year 2000 and t o use hea l th a s a l eve r f o r s o c i a l and economic development and as a platform f o r peace, we w i l l have t o give ca re fu l considerat ion to these v i t a l quest ions. I am s u r e I can count on your c loses t cooperation and guidance in t h i s matter.

Looking back, M r Chairman, when the Organization came i n t o existence, hea l th development, p a r t i c u l a r l y in countr ies such a s those in our Region, was in a very unsa t i s fac tory s t a t e . Major k i l l e r d iseases such as smallpox, plague, malar ia , tuberculos is , and many o thers wrought havoc on the population. The qua l i ty of l i f e of the people was unenviable. With most of the countr ies of the Region under co lonia l r u l e , manpower development was geared more towards supporting and strengthening the administrat ive s t r u c t u r e s r a the r than to the hea l th care of the vas t under-served populations. Although some of these formidable problems s t i l l continue t o plague us, we have made considerable progress i n hea l th

68 MINOTES OF THE FIRST MEETING

development. We have indeed reason t o be g r a t i f i e d by the headway made i n the increase i n l i f e expectancy, decrease i n death r a t e and p a r t i c u l a r l y in fan t mor ta l i ty , increase i n the number of r u r a l h e a l t h cent res and h o s p i t a l beds and in many o ther a reas . Smallpox, a major d isease which only a few years ago was responsible f o r a heavy t o l l of human l i v e s and which disabled and d is f igured mi l l ions , today l i e s vanquished. This is t r u l y a milestone in man's constant s t rugg le t o conquer k i l l e r diseases. Likewise, the cont ro l of plague, yaws, and kala-azar has been a major achievement. Even with other d iseases such a s malaria, tuberculosis and leprosy, there has been s i g n i f i c a n t progress, desp i t e many setbacks and continuing problems. Our Region has p a r t i c u l a r reason to be proud t h a t hea l th planning has taken root in most of its countr ies , e i t h e r through country hea l th programing or through na t iona l planning processes, based on s imi l a r management pr inc ip les . This has enabled the governments t o u t i l i z e the ava i l ab le resources more purposefully and t o d i r e c t the a c t i v i t i e s of t h e i r hea l th serv ices towards grea ter e f f ic iency and increased coverage of the populations.

An important problem t h a t is commonly faced by most countr ies of the Region r e l a t e s t o the development of a funct ional ly adequate na t i ana l hea l th information system. M r Chairman, as you w i l l agree, information is the very l i f e l i n e of hea l th development. It is v i t a l i n the planning, management and evaluat ion of hea l th programmes. Although information systems of some s o r t a r e funct ioning i n Member countr ies with varying degrees of development, with the increas ing demand on the hea l th serv ices due t o the manifold challenges i n the f i e l d , the need f o r improving e x i s t i n g na t iona l hea l th information systems is becoming more and more evident. As you a r e aware, t h e T h i r t y - f i r s t World Health Assembly, in its resolu t ion WHA31.20, while urging Member S ta t e s t o develop o r s t rengthen t h e i r hea l th information systems, requested the Director-General t o develop p r inc ip l e s f o r na t iona l hea l th information systems i n c lose co l labora t ion with Member S ta t e s . I am happy t o repor t t h a t considerable spade work has already been done in t h i s region i n t h i s very important f i e l d . For a number of years , we have s t rongly f e l t the need f o r c lose funct ional l i n k s between na t iona l information systems and the Organization's i n t e r n a l system fo r providing information support t o t h e formulation, management and evaluat ion of i t s col labora t ive programmes. Our experience i n t h i s f i e l d , having been based on t h e c l o s e s t co l labora t ion with na t iona l hea l th a u t h o r i t i e s i n preparing country p r o f i l e s , w i l l be extremely usefu l i n drawing up, on the request of Member S t a t e s , co l labora t ive p r o g r a m s f o r the development of na t iona l hea l th information systems.

Notwithstanding t h i s g ra t i fy ing progress, t h e f a c t remains t h a t we a r e s t i l l a t a point i n hea l th development where the vas t majori ty of people i n the count r ies of our Region, p a r t i c u l a r l y those in r u r a l a reas and the urban poor, do not have access t o even minimal hea l th care ; a l s o , the qua l i ty of l i f e continues t o be of a s tandard which is unsa t i s fac tory . Despite the growing investment in hea l th se rv ices and a s teady expansion of t h e i r i n f r a s t ruc tu re , the l imi t a t ions of t h e i r coverage have not been overcome. Many pioneering, innovative experiments have been ca r r i ed out during the l a s t decade i n many p a r t s of the world, and notably i n many count r ies of our Region. These have shown t h a t there a r e s i g n i f i c a n t a l t e r n a t i v e approaches f o r f u l f i l l i n g the b a s i c hea l th needs of the community, and i t i s g ra t i fy ing t h a t many of our count r ies have been adopting such methods f o r providing hea l th care t o t h e i r peoples. These


a r e based on the concept of primary h e a l t h care , which in turn r e s t s on the twin p r inc ip l e s of community pa r t i c ipa t ion and i n t e r s e c t o r a l coordination. It i s designed t o s t imula te the process of all-round c o m ~ m i t y development s o a s t o improve t h e qua l i ty of l i f e of the people, using hea l th ca re as an ent ry poin t . It i s an approach which aims a t br inging hea l th care t o the people, which is a r eve r sa l of the conventional approach of providing medical care t o those who v i s i t hea l th c l i n i c s o r hosp i t a l s . Here the key person is the primary hea l th worker, chosen and guided by the community and technica l ly supported by the hea l th serv ices through l o g i s t i c and r e f e r r a l serv ices . Simple as t h i s profound concept sounds, i t s e f f e c t i v e implementation, which involves an e f f o r t of g igan t i c proportions, is aimed a t improving the l i v e s of almost a b i l l i o n people who l i v e in t h i s region. This task, which involves improving the h e a l t h h a b i t s of the people, providing simple medical care and preventive serv ices and ensuring the provision of food, housing, water and san i t a t ion , w i l l r equi re enormous resources. The mobilization of such resources, from i n t e r n a l and ex te rna l agencies, is only poss ib le with the t o t a l and unqual if ied co~mnitment of the governments to t h i s cause. A s you a r e aware, only two weeks from now the In t e rna t iona l Conference on Primary Health Care w i l l be held a t Alma Ata (USSR), where some of you w i l l be represent ing your Governments. High-powered delegat ions a re being sen t t o t h i s conference by almost a l l countr ies of the world. This conference is aimed a t securing such a commitment from them. It w i l l be followed by a s e r i e s of i n i t i a t i v e s both a t the na t iona l and the in t e rna t iona l l e v e l t o mobilize the much-needed resources f o r the implementation of the p r o g r a m s drawn up by Member S ta t e s . I may mention here t h a t a donor's meeting w i l l be he ld i n the Regional Office i n 1979 t o discuss the question of resource mobilization f o r primary hea l th care programmes i n t h i s region.

Since the advent of independence in many count r ies of the Region in the l a t e f o r t i e s , hea l th manpower development has made steady progress. There has been a growing awareness in our count r ies of the need f o r o r i e n t a t i n g t r a i n i n g programmes of a l l ca tegor ies of h e a l t h personnel towards the needs of the hea l th serv ices . The task has not been easy, q d i n t h i s important undertaking we s t i l l face many problems, but we can c e r t a i n l y der ive grea t encouragement from the progress already made i n the Region. This involves such d iverse a reas a s c r i t i c a l s tud ie s of manpower s i t u a t i o n s , pro jec t ions of manpower requirements, r eo r i en ta t ion of cu r r i cu la , mult iple hea l th profess ional t r a i n i n g programmes, in tegra ted teaching and evaluat ion. The growing number of reg ional fellowships, almost amounting t o a t h i r d of the t o t a l , is a r e f l e c t i o n of the increasing a v a i l a b i l i t y of expe r t i s e and centres of excel lence within t h i s region.

Another a rea which gives us some cause f o r s a t i s f a c t i o n is medical research. A s you a r e aware, there has recent ly been a s i g n i f i c a n t change i n our approach t o medical research. I n t h e past, medical research was unfortunately of ten divorced from the problems and needs i n t h e hea l th f i e l d and was l a rge ly r e p e t i t i v e , ins t i tu t ion-based , and confined t o e l i t e academicians. The bulk of research consis ted of c l i n i c a l t r i a l s t o evaluate the use of pharmaceutical preparat ions. A l l t h i s is f a s t changing. The recent ly es tab l i shed Regional Advisory Committee on Medical Research has drawn up a list of p r i o r i t y problems and has cons t i tu ted a number of research study groups, which have formulated coherent programmes in these a reas . These e f f o r t s a r e geared towards the c rea t ion of na t iona l c a p a b i l i t i e s i n research s o as t o achieve se l f - r e l i ance within the Region.

70 MINUTES OF W E FIRST MEETING

I have no doubt t h a t in the coming years such research w i l l malce an increas ing contr ibut ion t o solving some of t h e problems t h a t we a r e encountering today. I n t h i s f i e l d of research and t r a i n i n g the re is ample scope f o r technica l cooperation among developing count r ies (TCDC).

The concept of technica l cooperation among developing countr ies is no t , of course, new. The remarkable progress already made by developing countr ies s i n c e the Second World War has been primari ly due t o the exchange of technology. It is but l o g i c a l t h a t w e i n t h i s region, with our c lose h i s t o r i c a l and c u l t u r a l t i e s , geographical proximity and s imi l a r socio-economic background, should share c a p a b i l i t i e s and s k i l l s s o as t o enhance individual and co l l ec t ive se l f - r e l i ance .

You w i l l r e c a l l t h a t the Regional Committee a t its t h i r t i e t h sess ion last year adopted a reso lu t ion (SEA/RC30/R10) emphasizing the p r inc ip l e s of TCDC. In pursuance of t h i s reso lu t ion , I requested the WHO Representatives (who a r e now ca l l ed WHO Programme Coordinators) t o obtain information in regard t o a reas i n which t h e count r ies of t h e South-East Asia Region could a s s i s t each other . Based on the information co l l ec t ed , we propose t o publish a d i r ec to ry l i s t i n g d e t a i l s of scholarships f o r t r a i n i n g awarded by governments b i l a t e r a l l y and through inter-governmental agencies such as the Colombo Plan, the Association of South-East Asian Nations (ASEAN), and the South-East Asia Ministers of Education Organization (SEAMEO). I would be glad i f the dis t inguished representa t ives could inform us of o the r common areas t o which such cooperation could be extended.

An outstanding example of TCDC was the cooperation some of the countr ies of the Region extended t o the Government of Maldives during the recent outbreak of cholera in t h a t country. India, S r i Lanka and Bangladesh provided timely he lp t o meet the emergency.

Technical cooperation should be undertaken mainly a t t h e country l e v e l on the i n i t i a t i v e and under the d i r ec t ion of the governments concerned, although i t should a l s o include e s s e n t i a l support at t h e regional and global l eve l s . I f technica l cooperation is t o be responsive t o t h e needs o f , and oppor tuni t ies ava i l ab le i n , the count r ies , then these needs and oppor tuni t ies should be i d e n t i f i e d by the countr ies themselves. I would emphasize, therefore , t h a t f o r WHO, t echnica l cooperation means not only the Organization's cooperation with count r ies but a l s o the fos t e r ing of cooperation among the countr ies themselves, so t h a t a l a s t i n g impact is made on hea l th development. As such, technica l cooperation is p a r t of a wider process of hea l th development, with WHO playing an e s s e n t i a l technical and coordinat ing r o l e t o ensure t h a t co l labora t ion among countr ies w i l l enable them t o achieve indiv idual and c o l l e c t i v e s e l f - re l iance .

Another important development t o which I should l i k e t o make a reference here r e l a t e s t o t h e Health Charter . M r Chairman, I am happy t o repor t t ha t we have come t o t h e end of t h e tunnel t h i s year i n t h i s important undertaking. Although it has taken us almost ten years , I f e e l very happy indeed t h a t we a r e on the threshold of adopting a Charter f o r Health Development f o r t h i s region, which w i l l be instrumental i n mobilizing the necessary resources, both i n t e r n a l and ex te rna l , t o meet the stupendous

MINUTES OF THE FIRST MEETING 7 1 / 7 2

hea l th problems facing our countr ies . For m e , personal ly, t h i s is a dream come t rue . I am happy t h a t n ine out of our ten countr ies have indicated t h e i r acceptance of the d r a f t of t h e Charter, which w i l l be submitted t o you during t h i s sess ion f o r your approval. The proposed Health Charter has been conceived with a view t o providing an e f f ec t ive mechanism through which the countr ies of the Region can plan and work together fo r solving p r i o r i t y hea l th problems on t h e bas i s of mutual cooperation and col labora t ion , deriving insp i r a t ion and s t rength from one another 's knowledge, experience and support. In t h i s context, the bene f i t s of the Charter a r e manifold. I s h a l l r eve r t t o t h i s subject when I present the d r a f t Charter t o you under agenda i t e m 9 .

Mr Chairman, I have taken some t i m e t o explain to you and to the dis t inguished representa t ives some of the important developments which have reached t h e i r culmination t h i s year. We a r e meeting a t a c ruc ia l t i m e - a t a time when the Organization is undergoing a process of inten- s ive in t rospec t ion t o enable i t to respond adequately t o the c a l l of i t s Hember S ta t e s , who a re facing formidable problems,. I n t h i s process, the ro l e of the Regional Committees is assuming ever-increasing importance. It has become necessary t h a t your Committee should assume a foward- looking approach with a two-way communication with the various governing bodies of the Organization. An important proposal f o r the funct ional synchronization of the working of the Regional C o d i t t e e , of t h e Executive Board and the World Health Assembly i s on the anv i l . A s the outgoing Chairman has r igh t ly emphasized, the Regional Committee should be more and more closely involved i n the work of the Organization. A r t i c l e 50 of the Const i tut ion provides fo r the Regional C o d t t e e s to tender advice to the Organization on in t e rna t iona l hea l th matters which have wider than regional s igni f icance . This is a funct ion which the Regional Corni t tees in general have not exercised s o f a r . While considering the organizat ional study t h a t I r e fe r r ed t o , I am su re you w i l l a l so pay a t t e n t i o n to t h i s point along with o thers .

M r Chairman, l ad ie s and gentlemen, the i s sues before you t h i s year a re numerous and important. Some of them a re of momentous s igni f icance . Your contr ibut ions, therefore , besides guiding us i n our fu tu re work i n t h i s region, may indeed be of global s igni f icance .

Thank you, Mr Chairman.

SUMMARY MINUTES*

Second Meeting, 22 August 1978, 2.30 p.m.

TABLE OF CONTENTS

1 Annual Report of the Regional Director

2 Adjournment

*Originally issued as document SEA/RC31/Min.2, on 23 August 1978.

7 4 MINUTES OF THE SECOND MEETING

1 Annual Report of the Renional Director (item 7) (cont'd)

Part I - General Review of Activities Planning and Development of Health Services (pp.1-14) Resolutions of Regional Interest Adopted by the World Health Assembly WHA31.11, WHA31.12, WHA31.20. WHA31.43 (item 8) (document SEA/RC31/12)

DR GAITONDE (India) congratulated the Regional Director on his excellent survey of the progress made in the field of health in the Region, as presented in his Annual Report. His country fully subscribed to the view that a good system of health planning was essential for the development of health services. As a result of efforts made in the field of health manpower development through successive five-year plans, India today had more than 150 000 practitioners of modern medicine, and more than 250 000 practitioners of traditional systems of medicine. Despite this progress, it had been found that most of the resources were being spent on institutional training and on the 20% of the population which lived in urban areas, leaving vast rural populations, constituting 80% of the total, out of the ambit of the country's health care prograrmnes. Therefore, in the new five-year plan that was being drawn up, corrective measures had been taken to ensure that the fruits of health development came within the reach of the rural communities.

Previously, there had been a number of vertical programmes which operated independently of each other. In the current five-year plan, whichhadadoptedarolling system of planning, it had been decided to have multipurpose health workers who would deliver health care in a coordinated manner. These workers were being trained in multi- faceted health care delivery systems and would constitute the last link in the health service infrastructure.

The need for rural-based health care was being met by the development of community health workers, a concept through which it was aimed to bring health care to the very doorstep of the rural communities. Thib: type of personnel would help the communities in the promotion of health and the prevention of comunicable diseases. Under this programme, which had started in 1977, it was planned to provide one male and one female worker, usually a traditional midwife known as a dai, for every one thousand population. - A notable feature of the Sixth Five-Year Plan was that the outlay for health had been increased by almost 70% over that of the previous plan; also a kind of "performance budgetting" had been applied in the health sector under which allocations would be made on the basis of a continuous evaluation of performance.

DR JOSH1 (Nepal) said that his country depended mostly on paramedical workers such as auxiliary health workers and assistant nurse midwives, serving in health posts, which were the backbone of the country's health care delivery system, serving 80% of the population. The plan now was to have junior auxiliary health workers (four to each health post) and village health volunteers. There were at present 483 health

MINUTES OF THE SECOND MEETING 71

posts, and by 1980 it was proposed to have about 700 health posts spread throughout the country. At the same time hospital services were not being ignored. A beginning had been made in training necessary health manpower in the Institute of Medicine, set up with assistance from WHO, which would train a new category of personnel known as community physicians; the first group of 20 candidates had been admitted to the four-year course.

DR BERAT (Sri Lanka) said that in Sri La& a programme had been started to train community health workers who would work as assistants to midwives, who had so far been the chief grsssroots- level workers. It took eighteen months to train a midwife whereas the community health worker would be trained in three months. With the assistance of agencies such as UNICEF, it was proposed to train 6000 such workers during the next three years. These trainees would not be government employees and as such salary and overhead costs would be avoided, but they would be given an expense allowance of Re 150 a month and would also have a better prospect of being selected in due course for training as midwives in government service. These workers would provide the present missing link between the midwives and the rural people.

DR PRAKORB (Thailand), referring to the country health programming exercise undertaken in Thailand in 1975, said that this had evolved new strategies in health development resulting in new forms of technical cooperation with WHO, such as the establishment of the Boyal Thai Government/WHO Coordinating Committee. This Committee had been involved in the planning, management, monitoring and evaluation of health activities at the country level. Country health programming was a dynamic process which needed further development, and in this connexion his country looked forward to further collaboration with WHO. Some of the other improvements which had resulted from the exercise were better planning and management, conduct of national seminars in health management, and closer collaboration with all the related sectors, resulting in integrated rural development.

Primary Health Care (pp. 14-18) Resolutions of Regional Interest Adopted by the World Health Assembly - WHA31.34 (item 8) (document S~A/Rc31/12)

DR GAITONDE (India) said that during the Sixth Five-Year Plan, a new concept of community health worker had been evolved and it was planned to train during 1978 about 90 000 workers who would serve a population of almost 80 to 90 million in about 80 000 villages in India. The new concept envisaged the involvement of the community in helping itself. The community health workers would be given training for two to three months and would serve as the link between the population and the health services. Their training was aimed at equipping them basically in the concept of preventive and promotive health care and also to identify communities at risk and help in the collection of bio-statistics. They would have small kits which would enable them to give medical care for common ailments and they would provide health education to the population, particularly with respect to sanitation, hygiene, protected water supply and nutrition, apart from being trained

7 6 MINUTES OF THE SECOND MEETING

in the referral system. The success of this programme depended on the selection and training of the community health worker from the community itself.

Another concept was the one under which a female worker would be chosen to work along with the male worker. The traditional midwives, known as 9, who enjoyed the confidence of the community, were being trained as female community health workers, thereby serving as a good link between the community and the referral system. The system worked very well and he requested the representatives from other countries to enlighten him on their experiences, particularly in regard to the training methods adopted by them.

DR JOSH1 (Nepal) observed that in Nepal the aim was to provide minimum health care to the maximum number of people. The concept of health care should be based on what the community could afford; for those who were too poor to pay for the services, health care should be provided free of charge.

DR GAITONDE (India) referred to three manuals which had been prepared in India for the training of primary health care workers, cornunity health workers and multipurpose workers, as well as to the numerous audio-visual aids used in those training programmes.

DR SOEBEKTI (Indonesia) said that his country was deliberately proceeding slowly in the matter of training voluntary workers. Volunteers from the rural community were being trained in limited numbers end no monetary incentives were being provided to them by the Government. The selection of volunteers differed from area to area, keeping in view the fact that those who were selected had a regular income of their own thereby ensuring their long stay as volunteers. They would never become government employees; if they ever eventually received payment for their health work this would be made by the communities themselves. Another activity in this sphere was the development of health insurance into which payments were made by the villagers. Already more than 200 villages were developing these programmes. There were pilot projects for the training of the volunteers in six provinces. There was no standardized training programme: in some areas it was continuous, in others it was intermittent. The main concern was to keep the programme going through continuous supervision and guidance so that evaluation and monitoring could be done by the members of the community themselves.

DR PRAKORB (Thailand) said that in Thailand also primary health care was the main strategy for providing health services to the entire rural population. With the cooperation of WHO and UNICEF as well as other international and bilateral agencies, the primary health care programmes and projects in Thailand had been well developed. In preparation for the International Conference on Primary Health Careat Alma Ata, anational dialogueonprimary health care had been initiated last year to discuss its concept, scope and relevant approaches. The dialogue had brought out the fact that primary health care should be consistent with everyday life and should be connected with other development services such as agriculture and education; it should be

MINUTES OF THE SECOND MEETING 7 7

supported by referral and strengthened communication systems, and should use local resources and appropriate technology. Also, it should be implemented in an integrated manner with the full participation of the people so as to suit the local needs and identify local problems. The dialogue had proved a success, and coordinated programmes and projects for primary health care had already been started. He thanked WHO and UNICEF for their cooperation, which had contributed substantially to the successes in the field of primary health care.

DR JOSH1 (Nepal) wanted to know the difference between a basic health service worker and a primary health care worker.

MR VOHRA (India) called attention to the vast potential of practitioners of traditional medicine in many countries of the Region which could be used for providing primary health care. In India the Sixth Five-Year Plan included a 500% incraaae in the budgetary allocation for the scientific development and advancement of traditional systems of medicine. Referring to the forthcoming International Conference on Primary Health Care at Alma Ata, USSR, he hoped to learn there what had been achieved in other countries in this vital field.

The REGIONAL DIRECTOR said that primary health care was one of the most important issues in developing countries. National meetings on this subject had been held in the various Member countries, followed by an inter-country meeting organized in the Regional Office. A report containing the recommendations made at this regional meeting as well as a summary of the discussions that had taken place at the national dialogues had been sent to the Director-General of WE0 for presentation at the Alma Ata Conference. He mentioned that a consultant appointed by WHO to study this subject had found that in India alone there were 60-70 experimental primary health care projects. Similarly there were a large number of experimental projects in other countries. There were interesting experiments going on in many countries of the Region on alternative strategies for the delivery of health care.

Referring to the point raised by the representative from Nepal as to the difference between a basic health worker and a p r h r y health care worker, he said that a primary health worker was usually selected by and worked for the community, whereas a basic health worker was an employee of the government, which trained him and paid for his services and thus he might not be selected by the conrmunity itself. One major difference was that in the work of the primary health care worker there was considerable community participation and a multi- sectoral approach. If, however, the basic health worker was selected from the community and given adequate training, it would amount to the same thing. In most countries the basic health worker was giveh training for six months to two years, depending on the type of work he was required to do. The shorter period of training of the primary health care worker, ranging from 2 to 3 months in different countries, enabled them to provide mostly preventive and promotive rather than curative health care. It was gratifying to note that all the countries of the Region were interested in delivering primary health

18 MINUTES OF THE SECOND MEETING

care to as many people in the rural areas as possible, and he hoped that the political decisions to be taken after the Alma Ata Conference would enable this work to be carried out more effectively. Primary health care was an approach to help the community to help itself by having immediate preventive, promotive, rehabilitative and curative care. In this, the primary health care workers would have to have the official health services, without which they could not carry out their work.

The CHAIRMAN said that he believed the deliberations at the Alma Ata Conference would be very important to the Region.

The VICE-CHAIRMAN, speaking as the representative from India,presented to the Chairman a set of manuals for community health workers, primary health care workers and multipurpose workers as well as the audio- visual aids used in their training. He said that several evaluations had been conducted on the progress of the community health worker scheme, which had now been operating for nine months, and it was found that there was a general acceptance of the philosophy of this type of worker. Many teething troubles in implementing this massive programme had been found, but these were being identified and rectified. In this connexion, it was important to make the health professionals accept fully the philosophy of the delivery of medical care through paramedical personnel.

The REGIONAL DIRECTOR, responding to the point raised by the representative from India on the utilization of practitioners of traditional systems of medicine, said that both the World Health Assembly and the Executive Board had adopted resolutions to the effect that,wherever possible, action should be initiated for using this source of manpower for the delivery of primary health care. In several countries of the Region efforts were being made to make use of this large group of people and bring them into the mainstream of health care delivery. As far as the training of these practitioners was concerned, some governments felt that such training should not be combined with that for western medicine. In countries such as Nepal, the Government was trying to integrate both the systems of medicine. The Institute of Medicine in Kathmandu had undertaken to train eleven different categories of workers, i.e., middle level and auxiliaries, and one such category was the practitioner of traditional medicine. After training, the workers were assigned as interns to the hospitals where the western system of medicine was in vogue, and thereafter they were sent to the health posts to provide simple medical care to the community and refer cases as necessary.

DR JADAMBAA (Mongolia) described the development of primary health care in his country since independence in 1921. Health care had initially been provided to the rural community through the scheme of "bag-nurses", who were assigned to jobs after a three-month training. Later the rural communities were being served by feldshers, who had been trained for 2 to 5 years. Simultaneously a planning system was set up for health manpower. Mongolia now had four categories of medical personnel, starting with the feldshers in the rural areas, which were now also being served by mobile health teams. This system needed strong administrative and organizational support.


He took the opportunity to convey his government's thanks to the representative from India for providing a very interesting set of manuals on primary health care, which would be useful to his country.

Family Health (pp.18-20)

DR JOSH1 (Nepal) said that there had been improvement with regard to family health services in Nepal, with the Population Planning Division having been placed directly under the Prime Minister. The family planning programme had come directly under the Minister of Health. With assistance from WHO, 15 medical officers had received training in "minilap" techniques. The Government would also soon expand the programme of vasectomy as well.

DR HERAT (Sri Lanka) said that, in his country, family planning was a component of the family health programme. The stress was on the mother's health. The mother could be advised to delay the next pregnancy in the interest of her own health and that of her child. Immunization, nutrition and maternal and child health and health education were included in the family health programme. Such an approach was more acceptable to the community than a family planning programme per se.

DR GAITONDE (India) said that in India the Ministry of Health and Family Planning had been renamed the Ministry of Health and Family Welfare, which implied a significant change in the approach of the Government to family planning. The new concept was to provide maternal counselling, welfare of the child and family planning counselling through educational methods. The programme also laid emphasis on the nutritional state of the child and also involved the expanded programme on immunization. Whereas the stress in the past had been on one or two methods, at present it was not only on the provision of various methods of family planning but also on the type that was suitable and acceptable to the family concerned. Educational methods based on tradition and local culture were being used that would be easily understood by the rural population.

DR U THAN WIN (Burma) said that, after country health programming, the People's Health Programme, which had begun in April 1978, included a family health programme. This involved the training of 300awiliary midwives for six months in township hospitals and they were now providing family health services in their own villages; currently, another three hundred were being trained. In addition to them, training was provided to "self-supported midwives" and reorientation training was also given to lady health visitors and midwives.

DR JADAMBAA (Mongolia) pointed out that family health was very closely linked with the socio-economic measures of any country. Realizing this relationship, a number of measures had been adopted in Mongolia to safeguard and improve the working conditions of women. He referred to the protection given to women and children under a new labour legislation. He stated that, during the period 1964-1973, the number of creches had increased by 2.4 times, polyclinics, women's consultation clinics, etc., by 4.5 times and obstetric and gynaecology


clinics by 2.1 times. Nonetheless, there were a number of areas chat required improvement, and in order to achieve this, continued collaboration with WHO and other United Nations agencies such as UNDP and UNICEF was required.

DR SAlVKARAN (India), elaborating the statement made by Dr Gaitonde, said that India was the first country in the Region to evolve a national family planning policy. Despite the setbacks encountered by the programme recently, it was felt that the programme now was on the right path - more oriented towards delivering good family welfare services at the local level. The programme as constituted, however, did not cover a large population of the country. Studies were being carried out on infant mortality, perinatal mortality, neonatal mortality, etc. With assistance from WHO, UNICEF and other international agencies, the "balvadi" programme was an important component in providing nutrition to children.

Research in reproductive biology was being carried out in the country primarily through funds made available by WHO amounting to about $6 million during the previous few years. Many institutions and research workers were involved in this programme, and it was hoped that in the near future the research might lead to an anti-fertility vaccine, both for males and females. The Central Drug Research Institute, located in Lucknow, was carrying out experiments on a large number of herbs for family planning which could be more acceptable to the villagers, who were accustomed to herbal medicines.

DR PRAKORB (Thailand) said that the family health programme in Thailand consisted of two main components, namely, maternal and child health and family planning. After initiation of the family planning programme in 1971, the population growth rate had been reduced from 3.3 to 2.5 per year. During the Fourth Five-Year Economic Development Plan (1977-1981) the target was to reduce the growth rate from 2.5 to 2.1 by 1981. The emphasis was on sterili- zation of both sexes and on population education. In order to achieve more efficient implementation, efforts were being made to coordinate the work of voluntary organizations and to provide inter-sectoral training.

Nursing (pp.20-24)

DR AUNG THEIN (Burma) said that the nursing curriculum in Burma was now community-oriented. There was no problem of urban concentration because the nurses were selected from rural areas and were sent back to the areas after training.

DR JOSH1 (Nepal) said that, with assistance from WHO, a post-basic training programme of two years' duration in nursing had been in operation. Since there was an interval between the first and second year's training, there had been a number of drop-outs among the trainees and it was now proposed to make the training continuous.

DR SANKARAN (India) said that nursing education in India consisted of two levels: namely, post-matriculation and post-intermediate programmes, the latter leading ultimately to a master's or even a


doctoral degree in nursing. Adequate expertise had been developed in this field; however, the drop-out rate of around 25% was a matter of concern. Another important feature was that the training programme had not kept pace with the need and had not focused attention on the nurseldoctor ratio. With the development of programmes for training auxiliary nurse-midwives and other paramedical personnel, however, it was hoped that many of the existing deficiencies would be overcome. He said that India was grateful to WHO for the assistance provided in developing expertise in specialized fields such as rehabilitation, orthopaedics, thoracic surgery and intensive care. His country now had the necessary infrastructure and was capable of further diversify- ing nursing education to provide for better nursing care.

Health Education (pp.24-27) (Resolutions of Regional Interest Adopted by the World Health Assembly (document SEA/RC31/12) - WHA31.42) The Health Assembly resolution on "Education of People in Community Health" was noted.

Nutrition (pp.27-29) (Resolutions of Regional Interest Adopted by the World Health Assembly (document-SEA/RC~~/~~) - WHAj1.47). DR SAMLEE (Thailand) said that considerable progress had been made in Thailand in the field of nutrition, thanks to WHO assistance, and this included the organization of an inter-regional Seminar on Nutritional Anaemia in which UNICEF and US AID had also participated. WHO also supported a training programme in clinical nutrition for 30 medical officers and nurses. Plans were being developed for the local preparation of nutrition supplements using local products and technology and minimizing logistic problems.

DR HERAT (Sri Lanka) said that nutrition in Sri Lanka had predominantly been dependent on paediatricians for the past 20 or 25 years. Malnutrition was, however, still prevalent. The Government had now established a national nutrition policy and a National Nutrition Committee. He hoped that, with WHO assistance, it would be possible to ensure, in the not too distant future, that mothers and children did not suffer from protein-energy malnutrition.

DR SANKARAN (India) stated that this subject was of vital importance to India. Sixty per cent of the population was at risk from malnutrition. The Government had put into operation certain basic and fundamental policies to provide the minimum needs to a large section of the population. CARE and UNICEF had helped with the I, minimum needs" programme. The situation was, however, still far from satisfactory despite first rate research work that had been carried out and the fact that the country had some excellent nutritionists.

DR JOSH1 (Nepal) stated that Nepal had not been able to do much in this field although there was a programme of nutrition education by radio. The nutrition unit had now come under the Planning Commission and he hoped that some headway would be made. Iodine deficiency was


an important problem in the north of the country. Iodized salt imported from India was being used. The country had to be self- reliant, however, and iodine injections would also now be used in the northern part of the country initially with the help of UNICEF and the Government of Belgium.

The REGIONAL DIRECTOR mentioned some of the efforts of the Regional Office in helping the countries to combat malnutrition. It had cooperated with the governments, particularly those of India, Indonesia, Maldives, Sri Lanka and Thailand in designing the technical components of IBRD, UNICEF, WFP and FAO-assisted projects on nutrition and food fortification. A nutrition study on patterns of breast- feeding was under way. In Thailand an operational research programme was being carried out with WHO and IPPF assistance. In India, the Regional Office was cooperating in the training course for state nutrition officers at the National Institute of Nutrition.

In the spirit of TCDC, India and Indonesia had established a cooperative programme to solve research problems related to the enrichment of salt with iron as a prophylaxis against anaemia.

Medical Care (p.29) (Resolutions of Regional Interest Adopted by the World Health Assembly (document SEA/~c31/12) - WHA31.32 and WHA31.33)

The World Health Assembly resolutions on the subjects of "Action Programme on Essential Drugs" and "Drug Policies and Management: Medicinal Plants" were noted.

Rehabilitation (p.30) Traditional Medicine (pp. 30-31)

DR GAITONDE (India), referring to medical care, stated that, though successive plans in India had laid emphasis on the problem of preventive and promotive health care, the provision of medical care had not been neglected. The entire medical care system had a pyramidal structure, so that quite a few of the 106 medical colleges had developed into centres of excellence in particular specialties. As these centres were found to be concentrating their training on institutional care, it had been decided to involve medical colleges in the training programmes in rural health care.

With the increasing bed strength of district hospitals it was now intended that they too should develop certain specialties such as paediatrics, obstetrics and gynaecology, ophthalmology and ENT. A rural hospital scheme was also being developed to provide referral services for primary health centres, one in every 4 of which would be upgraded. Thus India was developing its medical care system in such a way that beds would be available to the communities in the rural levels.

DR JOSH1 (Nepal) stated that 16 types of ayurvedic medicines had been supplied to 64 integrated health posts. An evaluation carried out with assisthnce from WHO revealed this to be quite effective and that

MINUTES OF THE SECOND MEETING 8 3 / 8 4

the workers in these health posts wanted more ayurvedic medicines to be supplied and requested some training in ayurvedic medicine. The Government intended to provide these medicines and arrange for the training.

2 Adjournment


SUMMARY MINUTES*

Third Meeting, 23 August 1978, 9.00 a.m.

TABLE OF CONTENTS

1 Statement by the Representative of UNICEF


3 Adjournment

ANNEXES

1 Text of the Statement by the Representative of UNICEF

2 Additional Information on Mental Health i n Indonesia

*original ly issued as document SEA/RC31/Min.3, on 24 August 1978.

8 6 MINUTES OF THE THIRD MEETING

I n the absence of the Chairman, the VICE-CHAIRMAN took the Chair and welcomed Professor J. S u l i a n t i Saroso, from Indonesia, and the representa t ives of UNICEF t o t h e meeting.

1 Statement by the Representative of UNICEF

A s the representa t ive of UNICEF had not been able t o be present a t the inaugural meeting, the Chairman invi ted him t o make a statement on behalf of UNICEF.

(At t h i s s t age , t h e CHAIRMAN took the chair . )

MR GLAN DAVIES (Regional Direc tor , UNICEF, New Delhi) s t a t e d t h a t the r e l a t i o n s between WHO and UNICEF, extending over three decades of f r u i t f u l co l labora t ion , were perhaps c lose r and more int imate than those between any o ther two United Nations agencies. This cooperation was reinforced by the ex is tence of a Jo in t WHOfUNICEF Committee on Health Policy, which advised the respec t ive Executive Boards on col labora t ion in various f i e l d s . The most recent example of t h i s j o i n t en te rp r i se was the co-sponsorship of the forthcoming In ter - na t iona l Conference on Primary Health Care a t Alma A t a . He conveyed the greet ings of the Executive Director of UNICEF a s an expression of warm goodwill and an assurance of continuing t h i s c lose co l labora t ion .

Referr ing t o the designat ion of 1979 a s t h e In t e rna t iona l Year of the Child, he s t a t e d t h a t i f a marked acce lera t ion in the provision and development of s e rv ices fo r ch i ldren was witnessed in 1979 and sustained up t o t h e end of the century, the year would have been a landmark in achieving WHO'S s o c i a l t a r g e t of h e a l t h f o r a l l by the year 2000. Items on the agenda of t h i s session such a s the Health Charter, the Expanded Programme on Immlarization and n u t r i t i o n were very re levant t o the aims and objec t ives of t h e In t e rna t iona l Year of the Child ( f o r f u l l t e x t of statement, s e e Annex 1 ) .

2 Annual Report of t h e Regional Director ( i tem 7) (cont 'd)

The REGIONAL DIRECTOR re fe r r ed t o t h e minutes of t h e f i r s t meeting t h a t had been c i r cu la t ed t h a t morning (document SEA/RC31/Mln.l) and asked t h e representa t ives t o i n s e r t a sentence which had been in- adver ten t ly omitted from the t e x t of the minutes. On page 8, in the l a s t paragraph before the Adjournment, a f t e r the f i r s t sentence of the in tervent ion of D r Soebekti , the following sentence should be inser ted : "The CHAIRMAN s a i d t h a t the Regional Direc tor would no doubt make a note of these add i t iona l i tems of information a t t h e appropriate place i n the minutes".

Rehabi l i ta t ion (p. 30)

DR SANKARAN (India) s t a t e d t h a t i n the p a s t f i v e years , there had been a spur t of growth i n the f i e l d of physical medicine and r e h a b i l i t a t i o n i n India. Rehabi l i ta t ion included vocat ional and funct ional rehabi l i - t a t ion , r e h a b i l i t a t i o n of the physical ly and v i sua l ly handicapped a s

MINUTES OF THE THIRD MEETING 87

as w e l l a s those mentally handicapped. With a s s i s t ance from in ter - na t iona l agencies and the United S ta t e s Government, a major a r t i f i c i a l l i m b fac tory had been es tab l i shed at Kanpur f o r the production and d i s t r i b u t i o n of o r t h o t i c and p ros the t i c appliances on a l a rge sca l e . I n order t o make ava i l ab le these appliances a l l over t h e country and t o ensure t h e i r maximum u t i l i z a t i o n , a National I n s t i t u t e of Orthot ic and P ros the t i c Training had been set up in Orissa Sta te . This i n s t i t u t e had developed s t r a t e g i e s f o r the t r a n s f e r of appropriate technology t o r u r a l a reas and a l so provided t h e necessary inf ra- s t r u c t u r e f o r the t r a i n i n g of personnel in the f i e l d of physical r e h a b i l i t a t i o n .

PROFESSOR SULUlEPTI (Indonesia) s a i d t h a t in Indonesia cent res f o r r e h a b i l i t a t i o n had o r ig ina l ly been loca ted only in hosp i t a l s . Now, as a r e s u l t of a d i s a b i l i t y survey ca r r i ed out by a similar pro jec t , the Government would l i k e t o have the r e h a b i l i t a t i o n progr- w r e conrmunity-oriented as p a r t of primary hea l th care. The objec t ive was two-fold: t o promote r e h a b i l i t a t i o n of disabled persons outs ide the hosp i t a l s , and t o devise measures t o prevent d i s a b i l i t y , f o r example, i n a reas prone t o accidents , e spec ia l ly due t o f a l l s from palm t r e e s , a gadget had been devised t o prevent t h i s .

The d i s a b i l i t y survey had been going on f o r a nrrmber of years and i t was hoped t o have the f indings next year. A preliminary ana lys is had revealed t h a t one of the major a reas of chronic d i s a b i l i t y was in the f i e l d of denta l hea l th , and therefore plans were under way f o r s t a r t - i ng a programme t o f ind a so lu t ion t o these disorders . She hoped t h a t the proposed inter-country seminar on r e h a b i l i t a t i o n would be he ld in Indonesia l a t e r t h i s year a s scheduled.

Tradi t ional Medicine (pp. 30-31)

DR KWON SUNG YON (DPR Korea) s a i d t h a t he was happy t o note t h a t e f f o r t s were being made in t h e count r ies of t h e Region f o r the development of t r a d i t i o n a l systems of medicine. I n DPRK, the system was being widely used in conjunction with w d e r n medicine, and its apvl ica t ion i n t h e hea l th serv ices was a l s o being encouraged. Care was taken t o s e e t h a t the non-sc ient i f ic aspec ts of t h e system were not put i n t o p rac t i ce . Extensive research work was being ca r r i ed out a t the I n s t i t u t e of T rad i t iona l Medicine. Also, some h o s p i t a l s were spec ia l i z ing in t r a d i t i o n a l medicine. He hoped t h a t the Regional Office would increase st i l l f u r t h e r its e f f o r t s t o encourage the use of t r a d i t i o n a l medicine i n the Region.

DR GAITONDE (India) expressed h i s s a t i s f a c t i o n a t the importance at tached t o t r a d i t i o n a l systems of medicine by WHO. Such systems had been in vogue in h i s country f o r centur ies , p a r t i c u l a r l y the Ayurveda, Unani and Siddha systems. More than 50 per cent of the r u r a l population continued t o derive bene f i t s from p r a c t i t i o n e r s of t r a d i t i o n a l medicine, and in s p i t e of an expansion of t h e modem drug industry

88 MINUTES OF THE THIRD MEETING

not more than 40% of t h e population made use of these drugs. The Government had l a i d g rea t emphasis on t h e development of t r a d i t i o n a l systems of medicine i n its F i f t h and Six th Five-Year Plans, which included the t r a i n i n g of personnel, p a r t i c u l a r l y i n the f i e l d s of Ayurveda, Unani and Siddha, and the increas ing employment of p rac t i t i one r s of t r a d i t i o n a l medicine both a t the primary hea l th cent res and i n d i s t r i c t hosp i t a l s . The pharmaceutical industry was a l s o being encouraged t o manufacture t r a d i t i o n a l drugs.

A separa te Council had been cons t i tu ted f o r t r a d i t i o n a l medicine and research i n t o the system had been receiving increas ing support. A concept had been developed whereby composite u n i t s , including a team with an Ayurveda physician, an a l lopa th ic physician, a phamcognoc i s t , a pharmacologist and a phytochemist, had been es tab l i shed t o inves t iga t e seve ra l d i f f e r e n t drugs, p a r t i c u l a r l y in ayurvedic medicine. H i s government was g r a t e f u l t o WHO f o r sponsoring t h e research p ro jec t on the e f f i cacy of ayurvedic treatment of rheumatoid a r t h r i t i s with ICMR col labora t ion in Coimbatore. He f e l t t h a t WHO should go fu r the r i n encouraging the t r a d i t i o n a l s y s t e m and compile a l ist of lredicinal herbs used i n the various countr ies of the Region s o t h a t each country 's experience could b e of mutual b e n e f i t .

DR HERAT ( S r i Lanka) s t a t e d t h a t i n h i s country the re were 1 8 000 Ayurveds, of whom 10 000 were r eg i s t e red and 8 000 unregistered. The l a t t e r group was expected t o be r eg i s t e red soon. A l a rge p a r t of the population depended on the p r a c t i t i o n e r s of Ayurveda f o r f i r s t consul tat ions. For example, in r u r a l a r eas , a pregnant mother usually made the f i r s t v i s i t t o an ayurvedic p r a c t i t i o n e r . Real izing t h i s f a c t , the Family Health Bureau e n l i s t e d t h e cooperation of these p rac t i t i one r s i n the implementation of t h e family hea l th programme. The Bureau assoc ia ted i t s e l f with the t r a i n i n g of ayurvedic p r a c t i t i o n e r s i n family hea l th i n order t o obtain t h e i r support serv ices . It had now been found t h a t these p r a c t i t i o n e r s would l i k e t o have t r a i n i n g in simple s u r g i c a l methods such a s vasectomy, although the present curriculum fo r the t r a i n i n g of ayurvedic p r a c t i t i o n e r s d id n o t include in s t ruc t ions i n surgery. He w a s n o t su re whether the medical council of h i s country would agree t o introducing this subjec t i n t o the curriculum. He would l i k e t o know the experience of o ther countr ies i n t h i s regard.

DR JOSH1 (Nepal) mentioned t h a t in Nepal there were two thousand p r a c t i t i o n e r s of Ayurveda, 82 ayurvedic d ispensar ies and a 150-bed ayurvedic hosp i t a l . I n order t o assess the e f f icacy of ayurvedic medicine, a board had been cons t i tu ted cons is t ing of physicians of both ayurvedic and modem s y s t e m . The p r a c t i t i o n e r s of modem medicine on this board would p a r t i c i p a t e i n organizing research i n order t o determine the e f f icacy of ayurvedic drugs.

Recently. the Government of Ind ia had provided a professor , under b i l a t e r a l arrangement, t o assist Nepal in improving the ayurvedic system. I n c lose co l labora t ion with the Department of Health, a p ro jec t formulation was being attempted; various types of su rg ica l in te rvent ions were being introduced i n t o the ayurvedic p rac t i ce , and d e f i n i t e conclusions a s to t h e e f f i cacy of t h i s procedure would be known only a f t e r the p ro jec t formulation was completed.


DR U AUNG THEIN (Burma) s t a t e d t h a t h i s government was encouraging the t r a d i t i o n a l systems of medicine, and the Ministry of Health was now responsible f o r the u n i t concerned with this. I n addi t ion t o the ex i s t ing d ispensar ies of t r a d i t i o n a l medicine, it was planned to e s t a b l i s h ten new dispensar ies every year . A teaching hosp i t a l and school of t r a d i t i o n a l medicine was operat ing i n Mandalay where t h i r t y t r a inees followed a three- e a r diploma course. Tradi t ional medicine was one of the subjec ts included i n the c u r r i c u l m f o r community hea l th workers. The subjec t of t r a d i t i o n a l medicine was a l s o being introduced i n t o the t r a i n i n g of medical a u x i l i a r i e s .

DR GAITONDE ( India) , na r ra t ing the experience of h i s country i n exposing ayurvedic p r a c t i t i o n e r s t o modern medicine, explained t h a t India had passed through a very d i f f i c u l t phase with regard t o the in tegra ted t r a in ing of ayurvedic physicians. I n the in tegra ted medical col leges, where ayurvedic physicians were t ra ined , bas i c science subjec ts of modern medicine such as physiology, biochemistry and surgery had a l s o been taught. Af ter a few years i t had been r ea l i zed , however, t h a t those who had been t ra ined i n these co l leges of ten gave up p rac t i s ing Ayurveda and turned t o p rac t i s ing modern medicine. As a r e s u l t of t h i s experience, the curriculum had now been completely revised, and there were no in tegra ted col leges i n the country but only separa te col leges devoted s o l e l y t o t r a d i t i o n a l systems of medicine.

The REGIONAL DIRECTOR, replying t o the request of D r S u l i a n t i t h a t the inter-country seminar on the Community Aspects of Rehabi l i ta t ion be he ld i n her country, assured her t h a t t h e Seminar would be he ld i n Indonesia. He hoped t h a t the meeting, being an inter-country one, would be useful not only t o Indonesia but a l s o t o the other countr ies of the Region.

He was happy t h a t a useful discussion had taken place on t r a d i t i o n a l medicine. He was encouraged by t h e f a c t t h a t s o many of the representa t ives , including t h e delegate from DPRK, had r e f e r r e d t o t h i s sub jec t , and t h i s would ce r t a in ly a c t a s a stimulus f o r fu r the r ac t ion . A consul tant was scheduled t o v i s i t the countr ies i n the Region shor t ly t o carry out a survey of manpower and other f a c i l i t i e s ava i lab le i n t h i s f i e l d . Based on the information gathered, i t was proposed t o have a meeting on t r a d i t i o n a l medicine i n the ea r ly p a r t of 1979 t o acce le ra t e the process of t h e development of t r a d i t i o n a l medicine programmes.

An i n t e r e s t i n g question had been ra ised by the delegate from S r i Lanka a s t o whether p r a c t i t i o n e r s of t r a d i t i o n a l medicine should be allowed t o carry out s u r g i c a l in te rvent ions - espec ia l ly vasectomies. There was a t l e a s t one country i n the Region t h a t allowed t h i s prac t ice . I n Bangladesh, a u x i l i a r i e s were successful ly t ra ined f o r a period of three months i n order t o car ry out tubectomies.

It was, of course, f o r the count r ies themselves t o decide whether t o impart t r a i n i n g i n s u r g i c a l procedures t o p r a c t i t i o n e r s of t r a d i t i o n a l medicine - p a r t i c u l a r l y i n the l i g h t of t h e experience of India , where the ayurvedic p r a c t i t i o n e r s given t r a i n i n g i n the modern system had given up t h e i r p r a c t i c e of t r a d i t i o n a l medicine and switched over t o the western system.

90 KINUTES OF TBE THIRD MEETING

Mental Health (pp. 32-33) Drug Dependence (pp. 34) Medical Stores Management (pp. 34-35)

DR SANKAWN (India) s a i d t h a t h i s government appreciated WHO'S e f f o r t s i n the f i e l d of mental hea l th , including the development of a medium- term programme. Based on t h i s p r o g r a m , the Government had taken concrete s t e p s t o i d e n t i f y mental hea l th problems. The MTP included comprehensive l e g i s l a t i o n f o r mental hea l th (which w a s under considerat ion by the Parliament), t h e development of spec ia l ized cent res of higher education in the f i e l d , and the s trengthening of departments of psychiatry and of c l i n i c a l and s o c i a l medicine. A s p e c i a l programme f o r t h e r e h a b i l i t a t i o n of the mentally retarded. including a proper assessment of mental r e t a rda t ion , would be launched during the next year . Also, some of the cent res i n India had undertaken col labora t ive s tud ie s i n a reas such a s depressive disorders . The National I n s t i t u t e of Mental Health and Neurosciences a t Bangalore was a cen t r e of excel lence and t h e Department of Psychiatry of the Post-graduate I n s t i t u t e of Medical Education and Research a t Chandigarh was designated as a WHO Collaborat ing Centre in Mental Health.

DR GAITONDE (India) s a i d t h a t t h e magnitude of the problem of drug dependence remained t o be assessed i n India. There were two groups of addic ts - some r e l i g i o u s s e c t s who were addicted t o drugs such a s opium and cannabis, and young univers i ty s tudents . The long-term e f f e c t of drug in t ake had n o t y e t been evaluated. There was a l s o a need f o r epidemiological s tud ie s in t h i s area. He expressed h i s g r a t i f i c a t i o n f o r t h e a s s i s t ance provided by WHO, p a r t i c u l a r l y i n respec t of t r a i n i n g in t h e epidemiology of drug abuse, including its prevention. The Government had recent ly appointed a committee under the chairmanship of the Director-General of the Indian Council of Medical Research t o study t h e measures which needed t o be adopted f o r t h e con t ro l and prevention of drug dependence. It was a l s o proposed t o c o n s t i t u t e a na t iona l c o d t t e e to dea l with t h i s problem. He suggested t h a t before drug dependence assumed alarming proport ions, WHO should pay increased a t t e n t i o n t o t h i s problem, including f i n a n c i a l inputs , p a r t i c u l a r l y in order t o assess its ex ten t among young students .

PROFESSOR SULIANTI (Indonesia) s a i d t h a t she was happy t o r epor t t h a t the programme on mental h e a l t h in Indonesia had moved away from t h e h o s p i t a l s t o t h e community so t h a t i t became a community mental hea l th p r o g r a m . Surveys had been undertaken t o a s ses s t h e ex tent of dis- a b i l i t y due t o meatal d isorders . She observed t h a t a request had been submitted t o WHO f o r t h e a l l o c a t i o n of add i t iona l funds t o augment the ava i l ab le resources f o r making t h e programme r e a l l y community-oriented, and hoped t h a t t h e response would be favourable.

DR SOEBERTI (Indonesia) provided information add i t iona l t o t h a t a lready contained in the Annual Report (see Annex 2) .

DR HERAT ( S r i Lanka) s a i d t h a t t h e main problem i n the f i e l d of medical s t o r e s management in h i s country was the system of procurement of medicines from dea le r s who submitted the lowest quotation. As was normally t h e case, t h i s procedure was o f t en unsa t i s fac tory because of


the f a c t t h a t cheap drugs were not necessar i ly good and o f t en the bes t ones were not cheap. He wondered whether some recommendations could be made by WHO f o r s tandardizing t h e procurement of drug suppl ies so t h a t governments could take appropriate ac t ion t o procure the b e s t drugs even i f i t meant grea ter a l loca t ion of funds.

DR JOSH1 (Nepal) s a id t h a t in Nepal t he re was a c e n t r a l s t o r e which supplied the hea l th posts and hosp i t a l s on a year ly bas is . Owing t o various reasons, including d i f f i c u l t t e r r a i n and l ack of t ranspor t and communications, e spec ia l ly during t h e monsoon, t h e suppl ies did not reach t h e i r des t ina t ions i n time. Also, the annual suppl ies frequently were exhausted in s i x months. Since procurement procedures o f t en r e su l t ed i n delay, drugs were i n s h o r t supply. With a s s i s t ance from UNDP of about USS1.8 mi l l ion , i t was proposed t o develop t h e manufacture of standardized medicines in Nepal. This proposal would enable buffer s tocks t o be kept l o c a l l y in order t o maintain continuous supply of drugs t o remote a reas .

DR AUNG THEIN (Burma) s t a t e d t h a t , with t h e cooperation of various in t e rna t iona l agencies, t h e problem of drug dependence was be ing tackled wel l in Burma through hea l th education and community pa r t i c ipa t ion . Also, more in-service courses f o r physicians and nurses were proposed to be held during 1978179.

DR PRAKORB (Thailand) s a i d t h a t , with WHO'S cooperation, there was already a p ro jec t in operat ion in one of the a reas in North-East Thailand i n order t o f ind out the need f o r mental h e a l t h serv ices . The r e s u l t s s o f a r obtained showed a considerable unmet need. Furthermore, mental hea l th serv ices s o f a r had been l imi t ed t o p a t i e n t s in psych ia t r i c hosp i t a l s , bu t i t was now proposed t o i n t e g r a t e these serv ices i n t o the general hea l th serv ices . Physicians from provinc ia l h o s p i t a l s were being t ra ined t o take care of mental i l l n e s s more e f f ec t ive ly .

As f o r the treatment of drug addic t ion , t h e f i r s t n a t i o n a l programme had been formulated in 1959 and implemented with the twin objec t ive of expanding the f a c i l i t i e s and developing s u i t a b l e manpower. It had been est imated t h a t t he re were 600 000 persons addicted t o narcot ics i n Thailand, the most vulnerable group being adolescents . Several technica l and adminis t ra t ive problems had been encountered in the implementation of the programme. I n order t o a l l e v i a t e some of these, it had been decided t h a t , under t h e Fourth Five-Year Development Plan, the preventive aspect would be the r e spons ib i l i t y of t h e Ministry af Education while the Ministry of Public Health would take care of the medical aspect of the p r o g r a m .

DR SANKAFWi (India) s a id t h a t medical s t o r e s management in India was not q u i t e s a t i s f a c t o r y desp i t e the country's long experience in t h i s regard. The f i r s t medical s t o r e had been es tab l i shed i n Karnal in 1912 primari ly t o c a t e r t o the needs of t h e armed forces. The present network of medical s t o r e s served not only the Government-run hosp i t a l s but a l s o a t times of na tu ra l calamit ies . The areas r equ i r ing considerable improvement in the management of medical s t o r e s were inventory control , the se l ec t ion of the r i g h t qua l i ty of drugs and proper de l ivery systems. A t p resent , therefore , inventory con t ro l was being es tab l i shed , with

9 2 MINUTES OF THE THIRD MEETING

the holding of rol l ing stocks, and a l l aspects of medical stores management were being reviewed on the basis of modern concepts of stores maaagement. He said that he would welcome any suggestions for the improvement of medical s tores management, part icularly from the other countries of the Region and also from international bodies.

The REGIONAL DIRECTOR thought that the discussions that had taken place on mental health, drug dependence and medical s tores management were very interest ing and, although there was a lack of f a c i l i t i e s in some areas, f a c i l i t i e s were available in some others.

With regard to mental health, he referred to the designation of the Department of Psychiatry of the Post-graduate In s t i t u t e in Chandigarh as a WHO Collaborating Centre, and said that the f a c i l i t i e s available a t the Ins t i tu te as well as a t the National Ins t i tu te of Mental Health and Neurosciences a t Bangalore would be available to the other countries in the Region. Based on the reconrmendations of a recent meeting which had been attended mostly by public health personnel and socialworkers, including a few psychiatrists , he would shortly be convening a meeting of an advisory group to advise him from t i m e t o time on future programre needs.

In reply to the request made by Professor Sul iant i , he said that the Organization would be quite prepared to a s s i s t in the proposed survey i n Indonesia for the development of a community mental health prog-.

He f e l t that there was considerable in te res t i n the subject of drug dependence, and it was a potential area for TCDC, since border surveillance was the most important way to prevent the smuggling of drugs.

With regard to the question of psychotropic drugs, raised by the Indian delegate, he referred to the studies being carried out i n Bombay with financial assistance from WHO Headquarters. With assistance from the United Nations Fund for Drug Abuse Control, a progr- had been in i t i a ted two years ago in Thailand. As f a r as Burma was concerned, a programme had already been finalized and should go into operation as the agreement had already been signed. With regard t o drug abuse among students, several studies were already under way not only in th i s region but a lso outside. WHO would be prepared to provide whatever assistance was possible to tackle th i s growing problem.

In reply to the comuents made by the delegates from India and S r i Lanka on medical stores management, he said that a t the request of the Government of S r i Lanka a consultant had vis i ted that country recently and made recommendations with regard to the procurement, storage and distribution of drugs and medical supplies. As fa r as the procurement of drugs was concerned, it was for the governments t o decide whether to buy the cheapest drugs or the best drugs. I n th i s connexion, a WHO expert committee on drugs had drawn up a list of 200 drugs that could be used by any country in the hospital or outside, and some countries had i n fact reduced the number further to 50 or 60 on an experimental basis. With regard to the UNLlP project on ayurvedic drugs in Nepal, for which WHO would be the executing agency, a team of experts from WHO Headquarters and UNICEF had vis i ted Nepal in the early par t of

94 MINUTES OF TIIE THIRD MEETING

a medium-term p r o g r a m f o r the t r a i n i n g of epidemiologists in the countr ies of the Region with a view t o s trengthening the e x i s t i n g na t iona l i n s t i t u t i o n s i n epidemiology and a l so f o r introducing new epidemiological methods. The meeting would be attended by representa- t i v e s from Bangladesh, Burma, India , Indonesia, Nepal. S r i tanka and Thailand. A consul tant r ec ru i t ed f o r t h e meeting had already v i s i t e d the count r ies of the Region and had prepared a r epor t f o r presentat ion a t the meeting. The meeting was a l s o expected t o be attended by WIIO s t a f f from both Headquarters and t h e Regional Office as well a s by experts from t h e Centre f o r Disease Control CCDC), Atlanta, USA. CDC had a l so agreed t o provide one of t h e i r s t a f f f o r a longer term. It was hoped t h a t a v i ab le method would be developed a t t h i s m e t i n g based on the experiences of various countr ies .

Although there had been a dearth of epidemiologists a l l over t h e world, the f a c t remained t h a t even t h e few qua l i f i ed epidemiologists avai l - ab le were not being u t i l i z e d fu l ly .

The Haffkine I n s t i t u t e in India had recent ly es tab l i shed a c l i n i c a l research u n i t a t the Kasturba Infec t ious Hospital i n Bombay, with the objec t ive of carrying the bene f i t s of c l i n i c a l research t o the community . It w a s hoped t h a t the consul tant proposed t o be assigned t o Indonesia would make appropriate recommendations f o r developing a s u i t a b l e method f o r epidemiological surve i l lance .

With regard t o the d i f f i c u l t i e s in the EPI r e fe r r ed t o by D r Jada&aa, the REGIONAL DIRECTOR sa id t h a t these problems would no doubt be discussed during the technica l discussions on t h e expanded p r o g r a m on immunization. He assured the representa t ive from Mongolia, however, t h a t WHO was maintaining t h e c loses t co l labora t ion with UNICEF, bu t fo r whose ass i s tance i t would not be poss ib le t o car ry out t h e EPI.

Malaria (pp. 38-44)

DR SANKARAN s t a t e d t h a t India had had the p r iv i l ege of being t h e co- sponsor of the World Health Assembly reso lu t ion on malaria cont ro l (WHA31.45) i n May 1978. He was happy t o no te s ince then t h a t , as a r e s u l t of in tens ive prophylact ic measures taken by t h e Government, there had i n f a c t been a decrease of 1 .8 mi l l ion in the incidence of malaria in h i s country from 6.5 mi l l ion cases l a s t year . Another important aspec t was the malaria research programme, which had received a "shot in the arm" a s a r e s u l t of t h e National Workshop on t h e Methodology of Applied Research in Malaria which had been he ld in Bangalore i n Ju ly 1978. He h ighl ighted t h e r e c o m n d a t i o n s made by t h i s workshop. The resurgence of malaria had made applied research in t h i s f i e l d a p r i o r i t y matter.

One of the problems was the paucity of t ra ined manpower. Strengthening and development of i n s t i t u t i o n s fo r t r a i n i n g and in-service t r a in ing were highl ighted i n these recommendations.

DR JOSH1 (Nepal) s a i d t h a t the malaria s i t u a t i o n i n Nepal was not a s bad as i n some of t h e neighbouring countr ies . The number of cases was

MINUTES OF THE THIRD MEETING 9 5

going down, but the number of imported cases was increasing, among which there were P.falciparum cases, and a few of them were r e s i s t a n t t o 4-aminoquinolines. The number of imported cases was mainly because of the movement of labour from neighbouring count r ies i n t o Nepal and vice versa. Thanks t o good cooperation among the o f f i c i a l s of both Nepal and India i t was poss ib le t o hold two border conferences, a t which the dates f o r DDT spraying were f ixed and a l s o relevant information on malaria was exchanged.

DR U THAN W I N (Burma) s a i d t h a t , a s in other countr ies of the Region, malaria continued t o be a matter of ser ious concern t o Burma. It was noted t h a t the main t h r u s t of the WHO co l labora t ive programme was on t r a i n i n g and applied f i e l d research f o r the con t ro l of malaria. It was f e l t , however, t h a t more emphasis was needed on t r a i n i n g and consul tat ion a t the na t iona l l eve l . The non-avai labi l i ty of i n sec t i - c ides and ant i-malarials continued t o be major cons t ra in ts in the cont ro l of the disease i n many countr ies . Since malaria cont ro l required increased use of i n sec t i c ides and ant i-malarials , he requested WHO t o in t ens i fy e f f o r t s t o procure these. He thanked WHO and UNICEF fo r t h e i r a s s i s t ance t o h i s country in malaria cont ro l .

DE HEMT ( S r i Lanka) thanked WHO f o r the advice and ass i s tance given t o S r i Lanka in its f i g h t aga ins t malaria. Gemming o r gem prospecting, a growing business in S r i Lanka, had proved t o be a r e a l hidden enemy i n t h i s respec t . Most of the prospectors were i l l i c i t diggers; they dug up ea r th and moved away leaving shallow pools which col lec ted water. The spraying teams were not aware of t h e loca t ion of these pools, which bred mosquitoes. He wondered whether WHO would be able t o provide some advice on how t o tackle t h e s i t u a t i o n .

DR NADDA (Thailand) s a i d t h a t the malaria s i t u a t i o n in Thailand had de ter iora ted s ince 1972, but now the trend was l e v e l l i n g off o r even s l i g h t l y improving. But the s i t u a t i o n i n t h e south of the country was ser ious ly de ter iora t ing . A number of f ac to r s , both technica l and administrat ive, were involved, such a s r e s i s t ance on the p a r t of pa ras i t e s and vectors and l imi t a t ion of f inanc ia l resources. The Department of Communicable Disease Control assigned a high p r i o r i t y t o the problem and had increased the f inanc ia l a l loca t ion t o malaria cont ro l , even though t h a t meant decreasing the a l loca t ion f o r other d iseases . He thanked WHO f o r the cooperation and col labora t ion provided i n f i e l d research, b io log ica l con t ro l and epidemiological determination of r e s i s t ance of vec tors and pa ras i t e s . There had been r e s i s t ance t o the spraying of DDT in the southern p a r t of the country; to overcome the r e s i s t ance emulsion spraying was introduced i n place of water- suspension sprays. This r e su l t ed in grea ter acceptance of spraying, but a l s o esca la ted the spraying cos ts . Another approach introduced was the u t i l i z a t i o n of malaria volunteers and malaria communicators, and t h i s had yielded encouraging r e s u l t s in reducing the ex tent of r e fusa l of i n sec t i c ide spraying. He hoped t h a t with WHO ass is tance t o research, b e t t e r a l t e r n a t i v e s would become ava i l ab le t o cont ro l the disease. He thanked UNICEF f o r a s s i s t ance with the purchase of DDT.

DR GUNOWISESO (Indonesia) s t a t e d t h a t a j o i n t Government/US AID/WHO con t ro l programme was being implemented i n the i s l ands of Java and Ba l i , and the programme was going on smoothly with the incidence coming down. The malaria programme i n Indonesia was col labora t ing with other departments, such a s ag r i cu l tu re , f inance, community development and


transmigration, and there would be a c o r n i t t e e t o dea l with t h e country 's progranrme f o r cont ro l of t h e vectors . It was planned t o expand the programme t o o ther i s l ands and therefore the problem of manpower requirement would have to be surmounted. Manpower would be needed t o cover twenty-six provinces i n the expanded programme. It would become necessary t o hold consul tat ions with o ther agencies f o r the s trengthening of organiza t ional personnel, and he hoped t h a t a s s i s t ance would be forthcoming f o r the purpose, espec ia l ly from WHO.

The REGIONAL DIRECTOR sa id t h a t a f t e r the e radica t ion of smallpox, malar ia had become enemy number one. He Sta ted t h a t the workshop r e fe r r ed t o by the representa t ive from India was important and if any other Member country desired t o have copies of t h e repor t of t h i s workshop, i t could be made ava i l ab le a f t e r the Government of India had cleared i t . Referr ing to t h e observations of t h e delegate from Burma on the question of obtaining drug suppl ies , he sa id t h a t t h i s was a problem faced by many count r ies of the Region, and WHO, through the good o f f i c e s of UNICEF, had been able t o provide some ass is tance . He thought t h a t M r Glan Davies, UNICEF Regional Director f o r the South Central Asia Region, who was present a t the meeting, might be able t o say how UNICEF could a s s i s t fu r the r . Referring to the observations of the delegate from S r i Lanka, he s a i d t h a t t h i s was one country which had completely given up the use of DDT because the vector had developed res i s tance . Malathion was being used in i t s place. Experience of some of the Lat in American count r ies and a l s o some s t a t e s in India had shown t h a t the vector developed r e s i s t ance t o t h i s i n sec t i c ide within two o r three years , and i f t h i s happened then there would be no o the r so lu t ion , except t h e hope t h a t a f t e r the discontinuat ion of DDT f o r a period of f i v e years , the vector might no more be r e s i s t a n t to i t . Regarding the problem of P.falciparum res is tance , re fer red t o by various delegates , he sa id t h a t the Regional Office was supporting a research p r o g r a m in t h i s a rea ; a research study group had met in February 1977; a consul ta t ion meeting on malaria and its research aspec ts had been held i n October 1977 and a t r a i n i n g course on in v i t r o t e s t i n g f o r P.falciparum res i s t ance had been held in Bangkok. WHO ass i s tance had a l s o included the a l loca t ion of funds f o r p ro jec t s in Bangladesh, Ind ia , Nepal and Thailand f o r research in l imi t ed areas. This sub jec t had a l s o been discussed a t g rea t length during the l a s t meetings of t h e Executive Board and the World Health Assembly. The Regional Office was qu i t e prepared t o be involved in research a c t i v i t i e s and would l i k e the na t iona l personnel t o undertake some such a c t i v i t i e s . It might be ab le t o he lp with operat ional research a s was already being done i n India .

MR DAVIES (UNICEF) sa id t h a t , sub jec t t o t h e UNICEF budgetary a l loca t ion to t h e country concerned, UNICEF ass i s t ance could be made ava i l ab le a s follows: supplementary suppl ies of ant i -malarials which were beyond the country's resources, machinery required f o r l o c a l t a b l e t t i n g of drugs, procurement of suppl ies a t competitive r a t e s on a reimbursement bas i s and, f i n a l l y , on the recommendation of WHO, machinery fo r e s t ab l i sh ing l o c a l production cent res of an t i -malar ia l s and laboratory suppl ies , including equipment f o r i den t i fy ing pa ras i t e s and vectors .

MINUTES OF THE THIRD MEETING 9 7

Tuberculosis (pp. 44-45)

DR JOSHI (Nepal) s a i d t h a t the prevalence of tuberculos is had been thought t o be 1.1% but , according t o a recent survey, i t had been found t o be 0.5% only. BCG vaccinat ion and case-finding had been completed i n 65 out of a t o t a l of 75 d i s t r i c t s . There was a plan t o cover t h e remaining 10 d i s t r i c t s too. Supplies of BCG vaccine were ava i l ab le t o the required extent . Drugs had, however, been i n shor t supply. He would request UNICEF f o r suppl ies , including f i r s t - l i n e an t i - tuberculos is drugs.

MR DAVIES (UNICEF) s t a t e d t h a t in p r inc ip l e such suppl ies could be made but the request would need t o be made t o the UNICEF Representative in Nepal.

Diseases sub jec t t o the In t e rna t iona l Health Begulations (pp. 46-49) Resolutions of Regional I n t e r e s t adopted by t h e World Health Assembly (document SEA/RC31/12 - WHA31.4 and WHA31.54) Control and Treatment of I n t e s t i n a l Bac te r i a l and P a r a s i t i c Diseases (document SEA/RC31/16) (Supplementary Agenda item 2)

DR GAITONDE (India) introduced item 2 of t h e supplementary agenda and s a i d t h a t almost 80% of the chi ldren in r u r a l a reas in Ind ia suf fered from i n t e s t i n a l , p a r a s i t i c and b a c t e r i a l i n fec t ions , and such infec t ions in the adu l t population l e d t o physical incapaci ty and l o s s of manpower product ivi ty. He f e l t t h a t the p i c t u r e in the other count r ies might n o t be very d i f f e ren t . There was a need f o r f i e l d surveys and the s trengthening of laboratory serv ices . Also the re w a s a need t o evolve a cont ro l programme which would include epidemiological research and opera t ional research f o r the de tec t ion and treatment of cases. It was a l s o necessary t o have constant su rve i l l ance , improvement of environmental s a n i t a t i o n and hea l th education, which was most important. He suggested t h a t WHO should formulate a s p e c i a l programme f o r the con t ro l of these infec t ions .

DR GUNOWISESO (Indonesia) s t a t e d t h a t the epidemic form of gastro- e n t e r i t i s was very important and s tud ie s had shown an incidence of 20/100 000. Morbidity s t u d i e s showed t h a t 40% of deaths in t h e age group below 5 years were due t o diarrhoea1 diseases. A rehydrat ion programme using o r a l e l e c t r o l y t e s had been introduced, d i s t r i b u t i n g e l e c t r o l y t e s through every l e v e l of t h e hea l th serv ices and other agents. The i n s t a b i l i t y of the o r a l e l e c t r o l y t e , its p roh ib i t ive cos t and l imi t ed a v a i l a b i l i t y , however, presented problems.

DR JOSHI (Nepal) r e fe r r ed t o t h e recent outbreak of cholera in Kathmandu Valley and thanked UNICEF f o r t h e a s s i s t ance provided f o r t h e production of o r a l rehydration e l e c t r o l y t e s . P l a s t i c bags were no longer used as containers of o r a l rehydration f l u i d because of the r e s u l t i n g reduction in potency a f t e r some t i m e . Ins tead aluminium f o i l was being used thereby ensuring r e t en t ion of potency fo r a much longer time. He added t h a t the mor ta l i ty r a t e due t o these in fec t ions was n m not very high in Nepal (5 o r 6 deaths out of 3000 cases) .

DR THAN WIN (Burma) s a i d t h a t diarrhoea1 d iseases , e spec ia l ly in chi ldren , were a wel l recognized publ ic hea l th problem in count r ies of t h e Region. H e welcomed the research endeavours i n i t i a t e d both


a t the regional and global l e v e l s and a l s o appreciated the e f f o r t s t o make o r a l rehydration f l u i d ava i l ab le i n s u f f i c i e n t quan t i t i e s at the l o c a l l eve l .

He added t h a t Burma was the only country i n the Region with endemic f o c i of plague, which posed a t h r e a t t o neighbouring countr ies . Thus, the problem should concern WHO s o t h a t concerted ac t ion t o meet t h i s p o t e n t i a l r i s k could be promoted.

DR SULULNTI SAROSO (Indonesia), r e f e r r i n g t o t h e proposal made by the delegate from India t h a t the C o m i t t e e pass a reso lu t ion on t h i s sub jec t , s t a t e d t h a t , though i n t e s t i n a l i n fec t ions were rampant in the Region, i t would be b e t t e r t o consider the subjec t under two separa te sub jec t s , a s the ac t ions t o be taken f o r the prevention and cure of b a c t e r i a l infec t ions and p a r a s i t i c i n fec t ions would be d i f f e ren t . In p a r a s i t i c d iseases , personal and environmental hygiene was important and environmental s a n i t a t i o n and hea l th education would play a s i g n i f i c a n t ro le . I n b a c t e r i a l i n fec t ions , dehydration posed a ser ious problem and hence a good rehydration programe with appropriate technology should be formulated. She suggested, therefore , t h a t regarding b a c t e r i a l d iseases the Committee r e i t e r a t e the reso lu t ion passed by the T h i r t y - f i r s t World Health Asseubly on diarrhoea1 d iseases con t ro l (WHA31.44), in which t h e Director-General had been requested t o accord high p r i o r i t y t o research a c t i v i t i e s f o r t h e fu r the r development of simple, e f f e c t i v e and inexpensive methods of treatment, prevention and con t ro l o f d iar rhoeal d iseases in a reas having varying kinds of hea l th se rv ice f a c i l i t i e s . A separa te reso lu t ion might be passed on p a r a s i t i c i n t e s t i n a l i n fec t ions .

The REGIONAL DIRECTOR sa id t h a t diarrhoea1 d iseases cons t i t u t ed an extremely important subjec t and a s such the global Advisory Committee on Medical Research had, a t i ts meeting in June t h i s year , recommended t o t h e Director-General the formulation of a global p r o g r a m on t h i s subjec t . The Regional ACMR had a l so recognized t h i s subjec t a s one of the p r i o r i t y a reas f o r research and the research s tudy group, which met in February l a s t yea r , had i d e n t i f i e d 20 areas , including some of those mentioned in t h e paper presented by the Government of India ; 8 of these 20 areas had been considered a s high p r i o r i t y a reas by the RACMR. The Regional Office had ca l l ed on Governments t o forward t h e i r proposals f o r research. He s t a t e d t h a t a consul ta t ive meeting on t h i s sub jec t was planned f o r December 1978, a t which time t h e views expressed by the delegates , e spec ia l ly with regard t o t h e promotion of o r a l e l e c t r o l y t e s , would be brought t o t h e no t i ce of t h e pa r t i c ipan t s . He thanked the delegate from Indonesia f o r h e r suggestion f o r separa t ing i n t e s t i n a l p a r a s i t i c i n fec t ions from b a c t e r i a l i n fec t ions , and h e r suggestion might be taken i n t o considerat ion by t h e sub-committee on reso lu t ions which would be formed l a t e r .

The VICE-CHAIRMAN, speaking a s the representa t ive of India , s a i d s u i t a b l e amendments would be made i n the d r a f t reso lu t ion tak ing i n t o considerat ion the views expressed by t h e delegates .


Bacterial Diseases Leprosy (pp. 49-51) Sexually Transmitted Diseases (pp. 51-52) Diphtheria, Pertussis and Tetanus (p. 52) Meningococcal Meningitis (p. 52)

Resolutions of Regional Interes t Adopted by the Zhirty-first World Health Assembly (item 8 of the Agenda) (WtlA31.57)

National sample surveys for assessment of leprosy cases, the i r detection, chemotherapy, physical and vocational rehabi l i ta t ion, imunology and e p i d d o l o g y (item 1 of the Supplementary Agenda)

The VICE-CHAIRMAN, speaking as the representative of India, presented the paper on leprosy prepared by the Government of India, and said that i n India there were about 3.2 million leprosy cases, most of whlch were infective. A national leprosy control progr- had been in operation. Since there were other countries i n the Region having a similar problem it was f e l t , however, tha t the experience could be shared. I f the target of health for a l l by the year 2000 was to be achieved, the countries of t h i s region had a gigantic task in th i s venture alone.

DR U THAN WIN (Burma), referring t o document SEA/RC31/15, sa id that each country had i ts own pr ior i ty with regard t o leprosy control programmes. National sample surveys might be useful as f a r as India was concerned, but other countries might not be in the s ~ m e position a s India was. Burma, fo r example, had already carried out national sample surveys. The countries might wish t o se lec t the i r own method of case-finding to s u i t the local si tuation.

DR JOSH1 (Nepal) said that the leprosy control project in Nepal was functioning sa t i s fac tor i ly in regard t o case-finding among the school population. The country had two leprosaria, one in Kathmandu and the other i n Western Nepal. The conditions in these ios t i tu t ions were unsatisfactory . The REGIONAL DIRECTOR sta ted that leprosy was one of the pr io r i ty areas ident i f ied by the Regional ACMR. The Researkh Study Group had met in order to formulate programmes of research in leprosy. Already f i e ld studies were under way i n India and Burma with regard t o the imPmmology and effectiveness of various drugs. The findings of the studies were awaited before a decision as to the most sui table method to be followed could be taken. In the WHO Headquarters Tropical Diseases Research (TDR) programme also leprosy had been included as one of the s i x diseases for research. WHO Headquarters had been approached to provide some funds t o support regional e f fo r t s in th i s f i e ld .

DR SAWKMWl (India) was happy tha t the TDR programme of WHO Headquarters as also the Regional ACMR had shown v i t a l in te res t in leprosy research. The problem of drug resistance and drug control had been prevalent t o a greater extent in h i s country. In the l i gh t of the observations maAo hv fellov r e~ re sen t a t i ve s , he said that he would not pursue h i s

MINUTES OF THE THIRD MEETING 1pL

Annex 1


PROFESSOR SULIANTI (Indonesia) thought t h a t a reso lu t ion on the subjec t might have d i f f e r e n t implicat ions f o r d i f f e r e n t countr ies . It might, on the o ther hand, be usefu l t o make a request t o t h e TDR programme t o develop a proper method f o r carrying out na t iona l sample surveys. Perhaps t h e TDR programme might be i n a pos i t i on t o he lp with the preparat ion of a WHO monograph on the subjec t f o r the use of t h e countr ies .

The REGIONAL DIRECTOR s a i d t h a t t h e WHO TDR programme would be sending a team i n September to discuss with t h e governments of the Region the research p o t e n t i a l f o r t h i s programme. They could be approached a t t h a t time t o develop a s u i t a b l e method, a s suggested by the representa t ive from Indonesia. The Regional Office and WHO Head- qua r t e r s had already been col labora t ing with India and Indonesia in f i e l d surveys.

Meningococcal Meningitis (p.52)

DR JADAMBAA (Mongolia) s a i d t h a t s t u d i e s had been c a r r i e d o u t on t h e epidemiological c h a r a c t e r i s t i c s of meningococcal i n fec t ions i n Mongolia i n 1974-1977 with a s s i s t ance from WHO. The in fec t ion had been r eg i s t e red in the country i n 1951 a s a sporadic one, bu t it had gradually increased u n t i l 1969 when t h e morbidity r a t e had exceeded the na t iona l average by 3-4 times.

Bacter io logica l s tud ie s had revealed t h a t the predominant types of meningococcus were Neisseria meningit idis types A and C and p a r t i a l l y B. On t h i s b a s i s , mass vaccinat ion of ch i ldren with antimeningococcal vaccine A, C and AtC had been ca r r i ed out i n 1974. During t h e years 1974-1978, an anti-meningococcal mobile team had made 72 v i s i t s t o meningococcal f o c i and had i n i t i a t e d s p e c i f i c measures f o r el iminat ing the in fec t ious f o c i . As a r e s u l t of these measures, there had been a gradual decrease i n t h e in fec t ion s ince 1974.

The REGIONAL DIRECTOR s t a t e d t h a t WHO had been happy t o be associated with the e f f o r t s of the Government of Mongolia i n tackl ing the problem of meningococcal meningitis.

3 Adjournment



Annex 1

TEXT OF THE STATEMENT BY THE REPRESENTATIVE OF UNICEF

Thank you very much for allowing me th i s opportunity to avai l of a privilege miesed on account of my delayed a r r iva l yesterday.

Within the United Nations family the relationships between WHO and UNICEF are perhaps closer and more intimate than those between any other two United Nations Organizations. These relationships extend over 30 years representing three decades of f r u i t f u l collaboration. The linkage between our organizations is reinforced by the existence and l ively ac t iv i ty of our WHO/ONICEP Joint Health Policy Committee, which advises our respective Executive Boards,and whose recommendations provide the bases for our cooperation in various f ie lds and sectors. We are jointly engaged in programmes in most M e r States and our most recent major joint enterprise is co-sponsorship of the forthcoming International Conference on Primary Health Core to be held in Alma Ata. Hence it is not as a routine formality that 1 convey to th i s session of the WE0 Regional C o d t t e e the greetings of Mr Llenry Labouisse, Executive Director, UNICEF. He hopes h i s greetings v i l l be received as an expression of warmest goodvill and an earnest of continuing close cooperation. He sends h i s best wishes for a productive session.

M r Chi- , th i s session of the Regional Committee w i l l be its l a s t before the International Year of the Child, and 1979 - the designnted year - is rapidly bearing down upon us. We a l l must assume additional c d t m e n t s on behalf of those we classify in our documents as "the most vulnerable" - "the under-served" - "the unreached".

And health v i l l have pivotal significance - whatever the other measures undertaken on behalf of the child.

1979 v i l l be significant only i f we w i t a e s s a marked acceleration in the provision and development of services for children. With th i s acceleration sustained to the end of the century, 1979 should also be a benchmark in plot t ing WBO's approach to its social target of health for all by 2000.

The Committee has on i ts agenda items very relevant to some of the r e q u i r e ments of the International Year of the Child, 1979. e.g.:

(a) plans for an Expanded Programne on Immunization;

(b) the concepts of inter-regional cooperation and mobilization of resources embodied in the proposed Health Charter, and

(c) the demands for more research in the nutr i t ion f i e ld to combat nutr i t ional deficiencies by, for instance, food for t i f icat ion.

In a l l spheres of l i f e and l iving, things have grown more complex with the year.


The dramatic, pub l i c i ty -a t t r ac t ing , v e r t i c a l campaigns of y e s t e r year a r e over - the task of t h e h e a l t h administrat ion is now with problems more complicated and i n t r a c t a b l e with developing an appropriate i n f r a s t r u c t u r e having t h e capacity f o r combined cu ra t ive and preventive operat ions and of somehow motivating publ ic pa r t i c ipa t ion .

While f inanc ia l resources a r e important, they a r e not t h e be a l l and end a l l . Is i t not t h e case, a s the EPI paper suggests , t h a t t h e need of the hour - the key t o success - l ies in organizat ion; in t h e adoption of the appropriate s t r a t e g i e s and t a c t i c s - thus t o maximize t h e product ivi ty of e x i s t i n g resources of money and manpower and t o ensure most p r o f i t a b l e investment of any a v a i l a b l e new resources.

It is in t h i s context, M r Chairman. I think t h a t within the t i t le Ditector- General - whether applying t o the WHO o r t o t h e technica l heads ofNat ional Health Departments, t h e word G e n e r a l i s t h e opera t ive one, the required a t t r i b u t e s and q u a l i t i e s a r e more those of t h e General - r a t h e r than Director because i t i s e s s e n t i a l l y a General 's job to :

devise s t r a t e g i e s determine t a c t i c s , and deploy h i s resources

f o r the b a t t l e t o be waged.

I wish the Generals, t h e Colonels and Lieutenants who are amongst us a l l success in the b a t t l e s f o r hea l th t h a t they have t o wage.

MINUTES OF THE THIRD MEETING 103/104

Annex 2

ADDITIONAL INFORMATION ON MENTAL HEALTH I N rn0NBSIA

On page 33 of Annual Report

In Indonesia, a consul tant was assigned t o assist the Direc tora te of Mental Health in organizing a na t iona l workshop on comuni ty mental hea l th . Two consul tants had e a r l i e r been assigned t o a c t as resource persons i n a na t iona l workshop on psych ia t r i c epidemiology. The Regional Adviser on Mental Health and the consul tant on comuni ty mental hea l th v i s i t e d cent res in Java, Bal i and Sumatra. On these i s lands and in Kalimantan and Sulawesi, comprehensive community mental hea l th serv ices a r e being developed through the e x i s t i n g hea l th cent re system. Already 100 hea l th cent res can provide such mental hea l th serv ices . This number w i l l increase as more hea l th cent res a r e expected t o be included i n t h e " In tegra t ion Projec t on Mental Health in Health Centres". Psych ia t r i s t s s t a t ioned in nearby mental hosp i t a l s carry out consul tat ion v i s i t s t o these hea l th cent res and arrange fo r on-the-spot t r a i n i n g of t h e hea l th cent re personnel (doctors, nurses and o ther s t a f f ) .

On page 141

Other h e a l t h matters of rap id ly increas ing importance a r e mental hea l th problems (psychoses, neuroses, psychosomatic diseases.etc .) , mental r e t a rda t ion , drug abuse and addic t ion , and juvenile delinquency (espec ia l ly in the b i g c i t i e s of J aka r t a and Surabaya).

On page 142

A t the r u r a l l e v e l , mental hea l th serv ices a r e provided through more than 100 hea l th cent res throughout the country, which a r e being served through consul ta t ion v i s i t s of p s y c h i a t r i s t s s t a t ioned in nearby mental hosp i t a l s . The development of such community-oriented mental hea l th se rv ices w i l l continue and is being supported by WHO through a country pro jec t . It i s envisaged t h a t in the fu tu re more hea l th cent res w i l l provide such mental hea l th serv ices s ince new hea l th cent res w i l l i n t e g r a t e such serv ices in t h e i r regular opera t ional procedures. The "Integrat ion Projec t of Mental Health in Health Centres" has l a i d the foundation f o r a mechanism f o r t h e s t r u c t u r i n g of such procedures.

The core s t rength of t h i s i n t eg ra t ion p ro jec t lies i n the f a c t t h a t the h e a l t h cent re doctors a r e being t r a ined personally t o gain progressive knowledge i n public hea l th psychiatry and expe r t i s e t o meet the increasing demand of t h e publ ic f o r medical a t t e n t i o n t o mental hea l th problems, and t h a t no p s y c h i a t r i s t s w i l l be permanently assigned t o these hea l th cent res ; they serve only on a t r ans i to ry b a s i s a s s p e c i f i c a l l y requested by both the Provinc ia l Chief of Health Service and the hea l th cent re doctors.

SUMMARY M L t w m S *

Fourth Meeting. 23 August 1978. 2.30 p.m.

TABLE OF CONTENTS

1 Arr iva l of Representative of Bangladesh

2 Annual Report of the Regional Direc tor

3 Announcement

4 Approval of the Second Report of t h e Sub-Committee on Credentials

5 Appointment of Sub-Committee on Resolutions


7 Adjournment

*Originally issued as document SEA/RC31/Mln.4, on 24 August 1978.

106 MINUTES OF THE FOURTH MEETING

1 Arr iva l of Representative of Bangladesh

The C H A W welcomed the representa t ive from Bangladesh, DR MOBARAK HUSSAIN, who had j u s t a r r ived from Dacca.

2 Annual Report of the Regional Direc tor (item 7) (cont'd)

Vira l , Chlamydial, R icke t t s i a1 and Related Diseases (pp. 52-54)

DR GAITONDE (Lndia), speaking on t h e pol iomyel i t i s s i t u a t i o n in h i s country, s t a t e d that ,a l though the o v e r a l l incidence w a s recorded rs two per 100 000, the d isease was p a r t i c u l a r l y seen in the urban area . He f e l t t h a t t he re was an upward t rend of t h e d isease in t h e co~mt ry . I n India there was considerable under-registrat ion of the disease. About 95% of cases occurred among chi ldren under the age of 5 years and therefore , epidemiologically speaking, t h e d isease was i n f a n t i l e pol iomyel i t i s . Vaccination aga ins t the d isease was n o t a na t iona l p r o g r a m in India , though o r a l vaccine was given in urban areas . Research on enteroviruses was being ca r r i ed out a t t h e Haffkine I n s t i t u t e , with p a r t i c u l a r emphasis on the pol iovi rus ; i r ~ addi t ion , research was a l s o under way i n some other units under t h e aegis of t h e Indian Council of Medical Research. It had been poss ib le to set up a p r o g r a m of production of l i v e po l io vaccine a t t h e Hafflrine I n s t i t u t e . There was, however, much more to be done in the f i e l d of pol io - p a r t i c u l a r l y the epidemiological aspec ts , and t h e evaluat ion of t h e e f f i cacy of the o r a l vaccine. More extensive s tud ie s were needed in t h i s sphere. Studies ca r r i ed out a t the Haffkine I n s t i t u t e and t h e All-India I n s t i t u t e of Medical Sciences in New Delhi had revealed t h a t where o r a l vaccinat ion was ca r r i ed out t h e sero-conversion rate was not very high; therefore there was a need f o r evaluat ing o r a l versus parentera l vaccinat ion. He suggested t h a t WHO might therefore like t o convene a meeting t o discuss t h i s .

PROFESSOR SULIANTI (Indonesia) , r e c a l l i n g one of t h e statements made by the l a t e D r Payne, ADG. WHO, t h a t where the i n f a n t mor ta l i ty w a s more than 80 per 1000 l i v e b i r t h s there was no need f o r pol io vaccinat ion, wondered whether t h a t statement could be considered t o be s t i l l v a l i d i n the l i g h t of experience gained s o f a r .

DR THAN W I N (Burma) s a i d t h a t dengue haemorrhagic fever was a hea l th problem of grea t importance t o h i s country. H e welcomed the e f f o r t s of s c i e n t i s t s to produce a vaccine aga ins t the d isease but t h i s would s t i l l take some time. It was f e l t , therefore , t h a t the emphasis should continue t o be on vector cont ro l , and WHO should fu r the r expand its e f f o r t s in t h i s regard.

DR HERAT ( S r i Lanka) thanked both WHO and UNICEF f o r t h e i r ass i s tance . which enabled h i s country t o expand its EPI programme, i t was expected t h a t the coverage of the EPI programme would increase t o 80% by 1981.

DR GAITONDE (India) , speaking on v i r a l h e p a t i t b , s a i d t h a t t h i s disease was becoming an increas ing problem in India. There had been a number of explosive epidemics of h e p a t i t i s - possibly of v i r a l h e p a t i t i s type A. Recently the re had been a major epidemic in Bombay and i t was fe l t necessary t o develop a surve i l lance programme, f o r which WHO a s s i s t ance

MINUTES OF TEE FOUBTll WETIIJG 107

would be greatly welcomed. Hepatitis B was also a special problem. It had been found that 30% of the patients admitted t o the Infactious Disease Eospital in Bombay had type B hepat i t is . lhrn urs rl.0 a need to develop diagnostic k i t s - particularly where tr8nsfuaioll s e r v i u o were available.

DR JOSH1 (Nepal) s ta ted that trachoma was cawing concern t o h i s country and the disease was rampant among certain tr ibes. It wan pl-d that the problem would be tackled under the progr- for the pmventioa and control of blindness. Two of the national s ta f f had been sent to Japan for training.

MR D I D 1 (Maldives) mentioned thpt there w a s no special EPI p r o g r l s in h i s country, but a l l the h d z a t i o n s were carried out by the Public Health Division and the MCE c l in ics in Hale tmder tAe YBD- assisted project "Leprosy and Tuberculosis Control Progr-".

DR NADDA (Thailand) said that in h i s country dengue haemorrhagic fcver was one of the more serious diseases, and it affected mostly p r r school children. Nineteen hundred and seventy-sepen happcned t o be the worst year, with the number of reported canes going up to 38 768. Though i t was expected that in 1978, 70% of the number of c u u of 1977 would occur up to July, i t had turned out b t rhc actual amber of cases w a s l ess , thus indicating a downward trend, though no colltrol measures had been taken. There w a s a vector control project in operation with the objective of integrating control ac t iv i t i - of malaria and dengue haemorrhagic fever and other vector-borne d b u m s , but t h i s expectation had not yet rmterialized b e c a w of lack of resources.

PROPESSOR SULIANTI (Indonesia), referring to the section on dengue haemorrhagic fever, said that i t dealt more vi th vaccine developaant rather than other measures of direct significance in control programea such as the need for vector control in relation to th i s diseane.

The REGIONAL DIRECTOR, replying to the suggestion made by D r Gaitonde, said that i f i t was the wish of the Regional Comaittee that a seminar on the efficacy of the oral polio vaccine should be organized, th i s could be done. Referring to the discussions on dengue haemorrhagic fever, he said that three countries in the Region, viz., Burma, Indonesia and Thailand, were affected, Thailand being the country most affected. Dengue haemorrhagic fever w a s one of the diseases which had been identified as a pr ior i ty for research by the Regional Advisory C o d t t e e on Medical Research. A study group had met three t h and had made certain suggestions. Since a vaccine against the d i s u s e was s t i l l f a r away, it was f e l t that the present e f for t s could be directed towards vector control as well, as suggested by r o e speakers. A research project on vector control, supported by WBO Headquarters, was in operation in Indonesia: in addition, there were country projects operating in Burma and S r i Lanka. Ae regards the inter-regional project in Indonesia, continuation of th i s project would depcad on the outcome of the discussions planned to be held in October, when a team would be v i s i t ing Indonesia and the Regional Office.


Replying t o the question r a i sed by Professor S u l i a n t i whether an i n f a n t mor ta l i ty r a t e of 80 per 1000 l i v e b i r t h s w a s an ind ica t ion f o r undertaking a po l io immunization programme, he s a i d t h a t he had no p a r t i c u l a r answer t o t h i s . He thought t h a t D r Henderson from WtlO Headquarters, who was present a t the meeting, might be ab le t o throw some l i g h t on t h i s question. He f e l t , however, t h a t the above proposi t ion was based on the hypothesis t h a t where the in fan t mor ta l i ty r a t e was high there were a l s o gas t ro i n t e s t i n a l infec t ions , and a s such it in t e r f e red with immunization i n such cases. This was only a surmise.

DR HENDERSON (WHO Headquarters) s a i d , i n reply t o t h e query from the delegate from Indonesia, t h a t an i n f a n t mor ta l i ty r a t e of 80 deaths per 1000 l i v e b i r t h s had frequently been regarded as a "threshold", above which pol io immunization campaigns had not been urged. Such high i n f a n t mor ta l i ty r a t e s were general ly associated wlth an e a r l y age of f i r s t i n fec t ion with pol io v i rus , when p a r a l y t i c a t t a c k r a t e s were low. Recent s tud ie s in Ghana and o ther developing countr ies , including Indonesia, had however, revealed t h a t para lys is caused by pol io was a s ign i f i can t problem, even in areas with infant mor ta l i ty r a t e s above 80. Therefore, WtlO w a s recommending t h a t each country study its own problem, and decide on t h e p r i o r i t y f o r the in t roduct ion of pol io vaccine based on i t s own f indings.

Referring t o the point r a i sed by t h e delegate from India regarding the e f f icacy of o r a l versus parentera l pol io vaccine, he s a i d t h a t t h i s was a question of world-wide concern. Professors Salk and Sabin, in addi t ion t o many o thers , were cont r ibut ing t h e i r energies t o studying t h i s problem. They might be i n a pos i t ion t o have some b e t t e r information on these two vaccines in the next 12 t o 18 months, and therefore an inter-country seminar t o d iscuss t h i s sub jec t might be premature a t t h i s juncture.

Expanded Programme on Immunization (pp. 54-56) (Resolutions of Regional I n t e r e s t Adopted by the Thir ty-Firs t World Health Assembly (Agenda item 8)- document SEA/RC31/12 - WHA31.53)

The CHAIRMAN drew the a t t e n t i o n of t h e delegates t o t h e f a c t t h a t t h i s item was scheduled t o be taken up a s the subjec t f o r the technical discussions.

PROFESSOR SULUWTI (Indonesia) s a id t h a t s ince she would not be ab le t o a t t end the technica l discussions because of her r e s p o n s i b i l i t i e s as Chairman of the Programme Budget Sub-Coannittee meeting taking p lace a t the same time, she would l i k e t o seek a c l a r i f i c a t i o n a s t o what should be the c r i t e r i a and standard f o r q u a l i t y cont ro l of pe r tus s i s vaccine, s ince the re seemed t o be va r i a t ions between t h e c r i t e r i a l a i d down by WHO and the standard being adopted by some of the manufacturers.

DR JOSH1 (Nepal) s a i d t h a t with a s s i s t ance from WBO and UNICEF, the expanded programme on immunization w a s j u s t being e t a r t e d in Nepal. Shortage of vaccine on account of suppl ies not being received on time had been a problem. There were a l s o p a r t i c u l a r problems in Nepal such a s the establishment and maintenance of the cold chain and of l o g i s t i c s .

MINUTES OF THE FOURTH MEETING 109

He s a i d he would welcome any information a s t o whether any breakthrough had been possible i n regard t o cold chain technology.

DR HENDERSON (WHO Headquarters), in reply t o the poin t r a i sed by Professor Su l i an t i , s a id t h a t the d i f f i c u l t y was in p a r t due t o lack of consensus on what should cons t i t u t e a proper s tandard f o r the pe r tus s i s vaccine. Using current s tandards, d i f f e r e n t labora tor ies had d i f f i c u l t y in agreeing on the r e s u l t s of t e s t i n g a given vaccine. With pertussis,compared with other vaccines the margin between l e v e l s of potency and tox ic i ty was r a t h e r narrow. Balancing potency and t o x i c i t y remained a d i f f i c u l t problem, and work was under way t o resolve t h i s . WHO Headquarters had convened a meeting on t h i s t op ic during the pas t year and another meeting was scheduled t o be held in November 1978 a t the National I n s t i t u t e of Health in Washington, D.C. It was hoped t h a t t h i s problem would be solved in t h e next few years .

The REGIONAL DIRECTOR, r e f e r r i n g t o the point r a i sed by t h e delegates from Mongolia and Nepal regarding the establishment of t h e cold chain and its maintenance, s a id t h a t t h i s was an important problem f o r many of the count r ies of the Region. Transport of vaccine from one place to another sometimes took severa l days. Apart from the work t h a t had been done i n t h e Western count r ies with regard t o developing cold boxes, a considerable amount of experimentation had been done in two o r th ree countr ies of the Region. He f e l t t h a t t he re had been some breakthrough already, i n t h a t cold boxes had been developed which would p ro tec t the vaccines f o r a period of a t l e a s t 8 days. The problem with t h i s and o ther boxes, however, had been t h a t they were too heavy t o be ca r r i ed by one person i n addi t ion t o h i s k i t . This point would, he hoped, be taken up f o r considerat ion during the forthcoming technical discussions a t t h e Regional Committee.

PROFESSOR SULIANTI (Indonesia) s a i d t h a t i n Indonesia there was already a p i l o t pro jec t i n operat ion f o r the cont ro l of schistosomiasis with WHO col labora t ion , and s tud ie s had been undertaken t o e s t ab l i sh the epidemiology of the disease. She requested WHO'S co l labora t ion again i n the cont ro l programe by providing an agro-engineer. The disease was not widespread i n Indonesia but was confined t o only two areas in Central Sulawesi. I f these two areas were brought under cont ro l , t h i s disease would not become a publ ic h e a l t h problem.

DR GAITONDE (India) s a id t h a t schistosomiasis was not a public hea l th problem i n India and there was only a small focus in a t i ny v i l l a g e of 900 people, some 200 km south of Bombay. Though the s p e c i f i c vector s n a i l did n o t occur i n t h a t a rea , there was s t i l l some transmission of Schistosoma haematobium. As such, i t was an epidemiological r idd le and he requested WHO a s s i s t ance in conducting s t u d i e s i n t h e a rea in order t o solve the problem.

DR SANKARAN (India) described the s t r u c t u r e of the f i l a r i a s i s cont ro l programme in India. There were 148 f i l a r i a s i s con t ro l un i t s , 17 survey u n i t s and 143 c l i n i c s in operat ion, covering about 23 mi l l i on population mainly in urban areas . Unfortunately, vec tor con t ro l in those areas had n o t been adequately followed up. With regard t o le ishmaniasis , recent ly there had been a spread of t h e d isease , both dormant and systemic, in 1 3 d i s t r i c t s of Bihar and in some adjoining S ta t e s . He thanked the


various in t e rna t iona l agencies f o r t h e i r assistance in t h e provision of antimony compound f o r the treatment of cases of le ishmaniasis , and hoped i t would be control led f u l l y before t h e onset of t h e period of transmission, which commenced i n the l a t t e r p a r t of t h e year.

The REGIONAL DIRECTOR, r e f e r r i n g t o t h e request made by t h e delegate from Indonesia f o r a s s i s t ance i n schistosomiasis cont ro l , s a i d that WHO would be w i l l i n g t o provide t h e serv ices of an agro-engineer. Similar ly t h e Organization would be prepared t o be r s soc ia t ed with India in solv ing t h e problem of schistosomiaoio near Bombay. With regard to f i l a r i a s i s , he s t a t e d t h a t t h i s was o m of the six d b e a s u , included in the Prograrnue of Tropical D i s c a s u B u s r r c h (TDIL). A meeting had been he ld in Malaysia under t h e auspices of thc Wutern P a c i f i c Regional Off ice and a suggestion had a l s o been made that both Regions could j o i n t l y hold a meeting t o consider the research aspec ts of f i l a r i a s i s . While agreeing t h a t f i l a r i a s i s deserved more a t t e n t i o n than a t present , he r e fe r r ed to t h e e f f o r t s being audc by the Nat ional I n s t i t u t e of Comunicable Diseasea, Delhi, in t h a t d i r ec t ion and s a i d t h a t WBO would be prepared t o render whatever a s s i s t ance w a s required. He brought t o the a t t e n t i o n of the Committee the po in t t h a t i f there was j o i n t co l labora t ion between t h i s region and the Western P a d f i c Region in t h i s programme more a s s i s t ance could be extended from the Headquarters TDR. Referr ing t o the incidence of leishmrmiasis in some p a r t s of Bihar, he s a i d t h a t WBO was a b l e t o arrange f o r the supply of antimony compound. As enough expe r t i s e was ava i l ab le loca l ly , it had not been considered necessary t o provide any consul tant s e rv ices from outside.

Veterinary Public Health (57-61) (Resolutions of Regional I n t e r e s t Adopted by t h e Th i r ty - f i r s t World Health Asseubly (Agenda item 8) - document SEA/RC31/12 - WHA31.48)

DR JOSH1 (Nepal) s t a t e d t h a t recent ly there had been a severe outbreak of rab ies in Nepal, t o contain which ant i - rab ies vaccine had bean procured from France and the USSR. Arrangements were being made f o r the l o c a l production of the vaccine with WE0 ass is tance . There were some problems with p a r t s of the equipment supplied. As soon as the machinery imported fo r t h e purpose w a s i n s t a l l e d , production would commence.

DR GAITONDE (India) s t a t e d t h a t an t i - rab ies vaccine was produced in India i n s e v e r a l l abora to r i e s , the major type being t h e sheep-brain vaccine, i nac t iva t ed by phenol. Recently, hwever , beta-propiolactone (BPL) inac t iva ted vaccine had been produced a s a b e t t e r s u b s t i t u t e . bu t i t posed a b i g problem owing t o t h e d i f f i c u l t y of procuring BPL. In view of the low iuonunogenicity and the possible incidence of neurological complications, a s wel l a s t h e f a c t t h a t rab ies s t i l l posed a public hea l th problem not only in India bu t in o the r countr ies a s wel l , there was a need t o develop a t i s s u e c u l t u r e vaccine. Such a vaccine had already been developed in t h e USA and marketed, and he wondered whether it would be poss ib le f o r WHO t o give a s s i s t ance t o India in t h e production of a s i m i l a r t i s s u e c u l t u r e vaccine.


The immunology of both b a c t e r i a l and p a r a s i t i c d iseases was a s s d g increasing s igni f icance and therefore there was a need t o develop departments of immunology, a t l e a s t in nat iondl institutes. There was a l s o a s h o r t supply of immunological reagents and he sought WHO ass i s t ance both in the development of t r a i n i n g prograuma im immunology and in the provision of reagents.

PROFESSOR SULIANTI (Indonesia) invi ted the a t t e n t i o n of t h e Comictee t o paragraph 3 on page 60 of the Annual Report, wherein a reference had been made t o the i n s t i t u t i o n s in Bogor and Ci lo to as having po ten t i a l f o r t r a in ing both na t iona l and in t e rna t iona l personnel. The l a t t e r a t t r i b u t e might r a l s e expectat ions and she thought t h a t it would be b e t t e r n o t t o r e f e r t o it a s y e t .

The REGIONAL DIRECTOR, r e f e r r i n g t o the point made by t h e delegate from Nepal concerning the damaged machinery f o r the production of ant i - rab ies vaccine, s a id that, though there had been some delay in the a r r i v a l of the equipment, the Regional Office was under the impression t h a t it had been received i n the country and merely awaited i n e t a l l a t i o n . He promised t o see what could be done t o expedite del ivery of the necessary spa re pa r t s . With regard t o the request made by the delegate from India f o r ass i s tance in the production of t i s s u c cu l tu re vaccine, he s t a t e d t h a t in t h e f i r s t ins tance t h e services of a s p e c i a l i s t could be made ava i l ab le t o the Government of India t o look i n t o this matter and advise them as t o how they might proceed fu r the r . Concerning a s s i s t ance in t r a i n i n g programmes in immunology and the provision of reagents , WHO would be prepared t o assist the Indian Government in ge t t ing reagents from abroad.

H e noted the poin ts made by the delegate from Indonesia regarding the t r a i n i n g programmes a t the i n s t i t u t e s a t Bogor and Ciloto, bu t hoped t h a t i t would be possible within a year o r s o t o accept i n t e rna t iona l persoanel a t these t r a i n i n g programmes. The necessary co r rec t ioa would be made t o paragraph 2 on page 60.

Disease Prevention and Control - Non-Comounicable Diseaaes

Cancer (pp. 62-64) Cardiovascular Diseases (pp. 64-65) B l i n d n e s s (pp. 65-67)

Cardiomyopathy and the incidence of rheumatic h e a r t d iseases and t h e i r complications in the t rop ic s ( i t e m 3 of the Supplementary Agenda) (document SEA/RC31/17)

I d e n t i f i c a t i o n and epidemiology of cancer in South-East Asian Countries ( i t e m 4 of t h e Suppleuentary Agenda) (documeat SEAIRC31118)

The VICE-CHAIRMAN, speaking a s the representa t ive from India, introduced the paper prepared by t h e Government of India (document SEA/RC31/17), and sa id that WHO had helped their government in the study of rheumatic h e a r t d iseases in a h o s p i t a l population and a l s o in t h e conduct of a survey by the Indian Council of Medical Research f o r 100 000 chi ldren in the upper, middle and lauer Facaue brackets . %is survey had shown t h a t t h i s d isease was highly prevalent in the lower socio-economic

112 MINUTES OF THE FOURTH PIEETING

group, the prevalence varying from 6-12/1000 population. 'his high incidence demanded an ilnmediate penici l l in prophylaxis progr- subsidized by the Government. While data on cardiomyopathy i n India were not readily available, in Kerala State, where the incidence of endomyocardial f ib ros i s w a s high, the incidence of cardiomyopathy mi&t be as high as 52, which might probably be due to dietary habits. There were a number of cases of "heart block" reported in Calcutta, which might be owing to the presence of an acid in the vegetable o i l . A study on cardiomyopathy conducted in Chandigarh showed that out of 5600 autopsies conducted, 1600 had revealed cardiac diseases. 300 of which were rheumatic heart disease, 210 myocardial infarction a d 49 cardiomyopathies. In view of these significant findings in various parts of India, th is subject would seem to be of concern t o Member countries of the Region and should form a programme of WHO study.

PROFESSOR SLnIANT.1 (Indonesia) said that epidemiological research in cancer needed adequate information support and diagnostic f ac i l i t i e s . In view of the incidence ra te of cancer cases and the paucity of f a c i l i t i e s , she wondered whether it might not be bet ter a t t h i s stage to concentrate on hospital follow up, so that , over the years, useful comparisons could be drawn. In Indonesia, it waa not possible to conduct a population survey, but they were a t the moment engaged in developing a cancer registry where, on the advice of a WE0 consultant, at tention w a s concentrated on only certain types of more prevalent cancer such as cancer of the breast and uterus.

DR PRAKORB (Thailand) said that cancer was one of the important public health problems i n Thailand. Services could be properly rendered only in big inst i tut ions , such as university hospitals and the National Cancer Ins t i tu te . With WHO assistance, a plan of action had been prepared to develop a medimterm and a long-term cancer control progranme. Plans were also available for registration of cases and for the development of training cmd demonstration in the cancer control progr-. It was proposed to strengthen the National Cancer Ins t i tu te with a view t o developing patterns for cancer services and research. Cardiovascular diseases were responsible for many deaths and much disabi l i ty . Also, rheumatic hear t diseases were prevalent among children, and cardiomyopathy affected the middle-aged and the old. With WHO assistance, a medium-term programnie for cardiovascular diseases had also been developed. The ac t iv i t i es were being expanded into regional hospitals in the f i r s t instance and l a t e r in to provincial hospitals.

DR SANHARAN (India), introducing the paper on ident i f icat ion and epidemiology of cancer (doc-t SEA/RC31/18), sa id that the commonest cancer among males in India was that of the mouth and pharynx (excluding the nasopharynx), and among females, cancer of the uterine cervix. Both types affected largely the lower socio-economic groups and were intimately related to the i r habits and unhygienic l iving conditions, not to the i r nu t r i t iona l s t a t e . In Bombay c i ty , where c igaret te smoking was common and the population cosmopolitan, cancer of the posterior one third of the tongue w a s found to be commorr, whereas i n places where tobacco chewing vas practised, cheek cancers predominated. In some other parts of the country cancer of the anterior two thirds of the tongue was found to be frequent. Palata l


cancer was a l s o prevalent i n some areas . It had been found t h a t 80 per cent of the hosp i t a l cases of cancer were i n an advanced s tage of the d isease even a t f i r s t v i s i t , whereas 80 per cent of the cancers detected i n r u r a l surveys were i n the very ea r ly s tages . India was, however, in a for tunate pos i t ion i n regard t o the anatomical s i t u a t i o n and b io log ica l behaviours of i t s common cancers. On the other hand t h i s s i t u a t i o n had been neut ra l ized by the ignorance, the poverty and the sheer s i z e of the population, and i n addi t ion by the lack of communication and the absence of a cohesive na t ional cancer de tec t ion prograrmne. What was needed, therefore , was a v iable method t o cont ro l and, i f poss ib le , t o cure t h i s disease. A l a rge p r o g r a m was in operat ion in Bombay f o r the purpose of e a r l y de tec t ion and i d e n t i f i c a t i o n of the type of cancer cases.

DR JADAMBAA (Mongolia) s a id t h a t u n t i l recent ly h i s country had been carrying out hospi tal-oriented cont ro l of cancer. It had been found t h a t preventive measures such a s e a r l y de tec t ion and diagnosis would he lp g rea t ly the b e t t e r treatment of cases. It was proposed t o cover the e n t i r e r u r a l a reas through preventive medical check-ups within 3 or 4 years , a s t h i s method was found t o be the most e f f e c t i v e measure fo r cont ro l l ing cancer.

The REGIONAL DIRECTOR sa id t h a t both in the developed and developing countr ies cardiovascular diseases and cancer now received grea ter a t t e n t i o n . WHO would be happy t o be associated with t h e countr ies ' e f f o r t s i n determining p r i o r i t i e s i n t h i s area of non-communicable diseases. It should, however, be remembered t h a t the regional budget from the Regular funds was l imi ted , and therefore any addi t ional f inanc ia l a s s i s t ance would have t o be found from other sources.

Some of the count r ies i n the Region had ca r r i ed out country hea l th programming exerc ises or o ther s imi l a r a c t i v i t i e s , and i n the l i g h t of these i t was up to the countr ies themselves t o determine what t h e i r p r i o r i t i e s would be and how the problems could be tackled.

DR HUSSAIN (Bangladesh) agreed t h a t the countr ies should be more concerned about deciding t h e i r own p r i o r i t i e s .

PROFESSOR SULIANTI (Indonesia) sa id t h a t some of the medium-term programmes of WHO d e a l t with those d iseases which might not be p r i o r i t y a reas i n the countr ies of t h i s region, f o r example, mental hea l th , cardiovascular d iseases , cancer and the prevention of blindness. Yet no medium-term programmes had been prepared so f a r f o r diarrhoea1 d iseases or vector-borne diseases. As f a r as Indonesia was concerned, these e f f o r t s a t medium-term programming were exerc ises in co l l ec t ing proper da ta on which l a t e r t o determine the country's p r i o r i t i e s .

The REGIONAL DIRECTOR, i n reply to a query from D r Joshi (Nepal) as t o what the pol icy of WHO was in regard t o i n i t i a t i v e s from b i l a t e r a l agencies in promoting p a r t i c u l a r hea l th programnes in Member countr ies . s a id t h a t i f a government accepted an o f f e r from a donor country WE0 should not be involved when such a s s i s t ance was withdrawn. WE0 would support only programmes of a p r i o r i t y na tu re whether financed by WE0 o r b i l a t e r a l agencies, and he then underlined the coordinat ing r o l e of WHO.

114 MINUTES OF THJ3 FOURTH MEETING

The Regional Director a l s o agreed with the point r a i sed by PROFESSOR SULIAWTI, and added t h a t the m e d i w t e r m programmes took some time t o be drawn up and in c e r t a i n cases a considerable p a r t of the progrume period might have elapsed by t h e time a progranme was f ina l i zed . Nevertheless, t h e programmes, i f developed, might be extremely usefu l f o r t h e Seventh General Progranrme of Work. fle assured the representa- t i v e s t h a t he would draw the a t t e n t i o n of t h e Director-General t o the poin ts r a i sed in t h i s discussion.

DR SANKARAN (India) assured the meeting t h a t the paper presented by h i s government had in no way been influenced by o thers . The epidemiological p i c tu re emerging from t h e s t u d i e s undertaken suggested t h a t it would be worthwhile t o carry out fu r the r inves t iga t ions .

Rheumatic h e a r t d iseases were becoming a major problem in t h e country and s ince these could be prevented by proper prophylaxis, and thus the morbidity reduced, it had been thought t o be an important subjec t t o be brought t o the a t t e n t i o n of t h e Regional Committee.

3 Anuouncement

The CHAIIlMAN announced t h a t the Sub-committee on Credentials would meet during the t e a break t o consider the c reden t i a l s of the representa t ive of Bangladesh.

4 Approval of the Second Report of t h e S u b - C o d t t e e on Credentials

DR JOSH1 (Nepal), Chairman of the S u b - C o d t t e e on Credentials , read out the second repor t of t h e Sub-committee (document SEA/RC31/22 Add.1) recommending recognition of the v a l i d i t y of the c reden t i a l s presented by the representa t ive of Bangladesh. This r epor t was adopted.

5 Appointment of Sub-committee on Resolutions

The CHAIRMAN suggested t h a t the representa t ives of India , Indonesia, Mongolia. Nepal and Thailand c o n s t i t u t e the Sub-Committee on Resolutions. Any o the r representa t ive who wished could, o f course, p a r t i c i p a t e i n the work of t h i s sub-committee. This was agreed to by the Committee.

6 Annual Report of the Regional Director (i tem 7 ) (continued)

DR AUNG THEIN (Burma) suggested t h a t t h e e x i s t i n g two-tier system f o r qua l i ty con t ro l of b io log ica l s should be supplemented by a t h i r d t i e r - a t the na t iona l l e v e l .

DR S A W ( Ind ia ) , r e f e r r i n g t o the sub-section "Microbiology of Cross Infec t ions i n Hospitals", s a id t h a t the subjec t of c ross in fec t ion in h o s p i t a l s had engaged the s p e c i a l a t t e n t i o n of t h e c e n t r a l and s t a t e governments in h i s country. A workshop on the subjec t had made a number of reconrmendations such a s checking of s t e r i l i z a t i o n procedures and proper use of s t e r i l e techniques. As a r e s u l t of t h e workshop, the Government of India had published a document f o r c i r cu la t ion t o a l l the hosp i t a l s having more than one hundred beds suggesting t h a t they i n i t i a t e a programme of h o s p i t a l s t e r i l i z a t i o n . It proposed t h e s e t t i n g up of c o d t t e e s on h o s p i t a l infec t ions and hosp i t a l morbidity and mor ta l i ty to keep a c lose check on hosp i t a l infec t ions .


DR GAITONDE (India) s t a t e d t h a t there was an urgent need t o develop instrumentation which would be s u i t e d t o the laboratory inves t iga t ions in the Region. There had been no progress in t h e f i e l d of biomedical engineering f o r a number of years and therefore he suggested t h a t a beginning be made in developing a programme of biomedical engineering t o t r a i n profess ionals t o i n i t i a t e f u r t h e r improvements in laboratory instrumentation technology.

He s t r e s sed t h a t no laboratory da ta could be r e l i e d upon unless the methods had been standardized, and congratulated WHO on s t a r t i n g a progr- of s tandardiza t ion of laboratory inves t iga t ion methods. There was a need f o r continuing t h i s programme and involving more l abora to r i e s - p a r t i c u l a r l y those t h a t were d i r e c t l y concerned with the inves t iga t ion of programmes f o r hea l th care de l ivery . The Government of India was planning t o e s t a b l i s h a c e n t r a l laboratory f o r qual i ty cont ro l of vaccines. This was one area which was in need of strengthening.

The second area t h a t needed strengthening was qua l i ty cont ro l of pharmaceuticals and b io log ica l products. India had a f a i r l y large- s ized pharmaceutical industry with an annual turnover of more than one thousand mi l l ion rupees. H i s government had recent ly announced a new drug pol icy. There was a need f o r the development of a f a i r l y high grade technology f o r the qua l i ty cont ro l of pharmaceutical products. He looked forward t o technica l co l labora t ion and cooperation with other countr ies which would no doubt be mutually bene f i c i a l .

DR JADAMBAA (Mongolia) s a id t h a t because of the vastness of h i s country, hea l th laboratory serv ices needed rapid laboratory t e s t s , espec ia l ly in the remote places. A second important requirement was fo r co l labora t ion between ve ter inary and hea l th laboratory serv ices which would he lp to economize on the resources.

Environmental Health (pp. 72-75) Occupational Health (pp. 75-76) Radiation Health (pp. 76-78) Hazards t o Man from Pes t ic ides (p. 78) Food Safety Programmes (p. 78) (Resolutions of Regional I n t e r e s t Adopted by the T h i r t y - f i r s t World Health Assembly (Agenda item 8) - document s ~ ~ / R C 3 1 / 1 2 - WHA31.40, WHA31.48)

Food f o r t i f i c a t i o n (item proposed by the Government of Indonesia (document SEA/RC31/10) (agenda item 15))

DR SOEBEKTI (Indonesia), introducing the document on the subjec t of food f o r t i f i c a t i o n , s a id t h a t during the pas t two years severa l countr ies of t h i s region had s t a r t e d t h e i r own programmes fo r f o r t i - f i c a t i o n of food-stuffs according to t h e i r needs. Though there had been some s tud ie s undertaken in Indonesia, only f o r t i f i c a t i o n of s a l t with iodine had been s t a r t e d . It had a l so been decided t o f o r t i f y wheat f lou r . It would be cos t ly t o undertake s p e c i a l campaigns o r crash programmes f o r food f o r t i f i c a t i o n . Apart from the technica l n u t r i t i o n a l point of view, o ther aspects required a t t e n t i o n such a s production, the process of f o r t i f i c a t i o n , packaging, decrease in the


s t a b i l i t y of t h e f o r t i f i e d f o o d s t u f f s by t h e t ime they reached t h e consumers, a p roper d i s t r i b u t i o n sys tem, p r i c e c o n t r o l , inter- m i n i s t e r i a l coord ina t ion of t h e e f f o r t s , and t h e l e g a l q u e s t i o n s involved. S ince t h e programme o f f o r t i f i c a t i o n had a l r e a d y been undertaken i n some o t h e r c o u n t r i e s of the Region, h e would welcome a n exchange of views on t h e exper iences i n t h i s f i e l d . It might a l s o be d e s i r a b l e t o e o r g a n i z e an in te r -coun t ry seminar o r e s t a b l i s h a TCDC programme.

The REGIONAL DIRECTOR s a i d t h a t t h e paper p resen ted had brought o u t some i n t e r e s t i n g problems. I n developing c o u n t r i e s one of t h e most important problems was p r o t e i n energy m a l n u t r i t i o n . The f o r t i f i c a t i o n of sa l t w i t h i o d i n e had been t r i e d o u t s u c c e s s f u l l y i n t h e c a s e of g o i t r e c o n t r o l ; s i m i l a r a t t empts had been made i n Bhutan, Burma, I n d i a , Nepal and Thailand. The s u c c e s s of f o r t i f i c a t i o n of s u g a r wi th v i tamin A s t i l l remained t o be seen from t h e s t u d i e s b e i n g c a r r i e d o u t i n C e n t r a l America. The f e a s i h i l i t y and u s e f u l n e s s of f o r t i f i c a t i o n w i t h i r o n remained t e c h n i c a l l y d e b a t a b l e . Research s t u d i e s had been c a r r i e d o u t i n Burma, I n d i a and Thailand. The a d d i t i o n o f i r o n t o common s a l t had been t r i e d i n I n d i a and Indones ia . Fel lowships had been awarded t o a person f o r working a t t h e Na t iona l I n s t i t u t e of N u t r i t i o n i n Hyderabad. F o r t i f i c a t i o n w i t h amino a c i d s was b e l i e v e d t o be n o t s o u s e f u l . F o r t i f i c a t i o n w i t h p r o t e i n c o n c e n t r a t e s was a c o s t l y p roposa l and might be a d v i s a b l e f o r b e i n g t r i e d i n l i m i t e d groups and f e e d i n g programmes. I r o n f o r t i f i e d f o o d s t u f f s , i n c l u d i n g i t s d i f f e r e n t types and l e v e l s , were b e i n g t r i e d ou t f o r sa feguard ing t h e h e a l t h of pregnant mothers i n Burma. I n view of t h e i n c r e a s i n g i n t e r e s t b e i n g shown by d i f f e r e n t c o u n t r i e s of t h e Region i n t h e s u b j e c t of f o r t i f i c a t i o n of f o o d s t u f f s , h e s a i d t h a t WHO would be g lad t o c o l l a b o r a t e i n t h e s e a c t i v i t i e s .

Heal th S t a t i s t i c s (pp. 79-80)

PROFESSOR SULIANTI ( Indones ia ) f e l t t h a t a h e a l t h in fo rmat ion system was n o t a q u e s t i o n of mere s t a t i s t i c s , b u t t h a t of management i n f o r - mat ion, which cou ld h e l p e s t a b l i s h h e a l t h i n d i c a t o r s f o r adequate p lanning and e v a l u a t i o n . She sugges ted , t h e r e f o r e , t h a t i n f u t u r e r e p o r t s in fo rmat ion systems be desc r ibed s e p a r a t e l y and n o t w i t h i n the framework of h e a l t h s t a t i s t i c s .

DR JOSH1 (Nepal) s t a t e d t h a t d e s p i t e t h e d i f f i c u l t i e s i n t h e d e l i v e r y of h e a l t h c a r e because of t h e t e r r a i n and l i m i t e d m a t e r i a l and manpower resources , the h i g h e s t importance was b e i n g a t t a c h e d t o h e a l t h in fo rmat ion sys tems development i n h i s country . He agreed w i t h t h e Regional D i r e c t o r ' s comment t h a t in fo rmat ion was t h e l i f e l i n e of h e a l t h development and f e l t t h a t in fo rmat ion sys tems, i f developed w i t h s p e c i a l e f f o r t s , could make h e a l t h s e r v i c e s work b e t t e r and more e f f i c i e n t l y . Las t y e a r , wi th t h e a s s i s t a n c e of WHO, Nepal had prepared a country pro- f i l e according t o t h e newly o r i e n t e d WHO in fo rmat ion system. He r e f e r r e d t o t h e paper on n a t i o n a l h e a l t h in fo rmat ion systems (document SEAIHIIZ) which had been c i r c u l a t e d a t a meeting convenedbyWH0 Headquar ters r e c e n t l y t o d i s c u s s t h e q u e s t i o n o f n a t i o n a l h e a l t h in fo rmat ion sys tems. He appre- c i a t e d t h e c l e a r p r e s e n t a t i o n i n t h e paper and t h e p r e c i s e manner i n which i t desc r ibed t h e i n t e r - r e l a t i o n between t h e WHO in format ion system and

MINUTES OF THE FOURTH MEETING 1 1 7

na t iona l information systems. The paper was an extremely useful document f o r planners, decis ion makers, managers and workers a t a l l l eve l s . He described the co l labora t ive work i n t h i s f i e l d as a powerful method of s t imula t ing and strengthening na t iona l and organizat ional information systems. He requested the Regional Office to continue with i t s ass i s tance i n fu r the r r e f in ing and improving na t iona l information systems, as i t j u s t could not be a one-time exerc ise .

DR SANKLUh' (India) r e fe r r ed to t h e discussions a t the l a s t World Health Assembly, when i t had been pointed out by him t h a t the information system outl ined in one of the lead documents c i r cu la t ed a t t h a t t ime would not be prac t icable in the countr ies of the South- East Asia Region. What was required was a system or ien ta ted t o the needs of the developing economies of the countr ies of the Region. Since the l a s t World Health Assembly and the t h i r t i e t h session of the Regional Committee, e f f o r t s had been made to introduce a new impetus i n t o the Central Health In t e l l i gence Bureau, h i c h would ul t imately become a monitoring system f o r t h e planning and implementation of hea l th information serv ices i n India. It had been decided t h a t there should be a cen t r a l hea l th information system which would be s t a t i s t i c a l l y based and b u i l t on the same l i n e s a s the family welfare progralmne, on a hor izonta l s t r a t i f i e d bas i s using the multipurpose hea l th workers, the primary hea l th workers and the chain of echelons t h a t l ed to the centre . It w a s planned to l i n k t h i s with a na t iona l computer gr id giving access t o hea l th r e l a t ed information i n other s ec to r s , such as ag r i cu l tu re . F ina l ly , he f e l t t h a t the excel lent paper r e fe r r ed t o would be of grea t use, pa r t i cu la r ly i n the f i e l d of management planning and execution of hea l th pro jec ts i n India.

DR PRAKORB (Thailand) sa id t h a t following t h e na t ional hea l th programming and formulation in 1976, a na t iona l hea l th information system i n Thailand had been developed from the o r i g i n a l hea l th s t a t i s t i c a l serv ices . The pro jec t on hea l th planning, management and information systems was an i n t e g r a l p a r t of the current na t ional hea l th development plan. A s a p a r t of the hea l th information system, a sub-system was in the process of development to deal with information a t the primary hea l th care l e v e l with a view to using i t as a tool fo r monitoring and cont ro l l ing t h e undertakings of the scheme and as an input i n t o the ove ra l l hea l th information system. He thanked WHO fo r i t s ass i s tance i n t h i s f i e l d and a l so congra tu l a~ed the author of the comprehensive document re fer red to by previous speakers.

DR HERAT ( S r i Lanka) s a i d t h a t the document was exce l len t . In order to carry out h i s work any progranrme o f f i c e r should have the f a c i l i t y of devising h i s own monitoring system. He should a l s o decide on the method and type of data co l l ec t ion . I f these were taken i n t o account while developing an information system i t would be very he lp fu l to the p r o g r m e managers.

The REGIONAL DIRECTOR was happy t h a t , while the sec t ion on hea l th s t a t i s t i c s was being discussed, almost every representa t ive had spoken about hea l th information systems which showed the importance the Member S ta t e s at tached to t h i s subjec t . He was a l s o happy t h a t the representa t ives found the background paper on na t iona l hea l th information

118 MINUTES OF 'IIE FOURTH MEETING

systems informative and useful . He s a i d t h a t this paper, which brought out the bas i c p r inc ip l e s of na t iona l hea l th information systems and t h e i r l inkage with the WHO Information Systems Progranune, had been prepared a t the personal request of the Director-General. Since the paper was highly appreciated by the representa t ives , he was prepared t o send copies t o Member S ta t e s .

He sa id t h a t the South-East Asia Region had every reason t o be proud of having played a leading p a r t in the development of WHO Information Systems and in strengthening na t iona l hea l th information systems; with the recent reor ien ta t ion of t h e WHO Information Systems Programme. c l e a r l inkages had been es tab l i shed between these. He then described the progress the Regional Office had made in the preparat ion of p ro jec t p r o f i l e s , programme p r o f i l e s and country p ro f i l e s . The South- East A s i a Region had ca r r i ed out country p r o f i l e exerc ises in Indonesia (1976). Thailand (1977) and Nepal (1978). He was happy t h a t a t the request of Mongolia, a s imi l a r exerc ise would be conducted following t h i s s e s s ion of the Regional Committee. He w a s a l s o happy t h a t the representa t ive of Nepal, who had played a leading r o l e in the preparat ion of t h e Nepal country p r o f i l e , would be associated with t h i s exerc ise , which he thought w a s an exce l len t example of technical cooperation among developing countr ies . It was a l s o planned t o conduct a country p r o f i l e exerc ise in S r i Lanka shor t ly . One of the s i g n i f i c a n t aspec ts of these exerc ises had been the c lose involvement of na t iona l s t a f f a t the h ighes t l e v e l .

H e r eca l l ed t h a t WHO had been ac t ive ly involved with Member S ta tes in developing na t iona l hea l th information systems. I n order t o s t imula te t h i s a c t i v i t y fu r the r , the Regional Office w a s organizing a meeting in December 1978 to evolve s t r a t e g i e s f o r improving and strengthening na t iona l hea l th information systems i n the Region. He hoped t h a t t h i s meeting would be attended by high l e v e l na t iona l administrators , information s p e c i a l i s t s , heads of s t a t i s t i c a l and epidemiological un i t s , e t c .

Development of Health Manpower (pp. 80-93)

Establishment of Regional Medical L ib ram and Information Centre f o r South-East Asia a t the National Medical Library, New Delhi (S i~pplementar~ Agenda item 7) (document S E A / R C ~ ~ / ~ ~ )

DR SANKARAN (India) , r e f e r r i n g t o document SEA/RC31/20, s t a t e d t h a t h i s country had es tab l i shed a na t iona l medical l i b r a r y i n New Delhi. It was hoped t h a t t h i s l i b r a r y could be expanded s o as t o be of mutual he lp t o a l l the Member S t a t e s in the Region. It w a s no t intended t h a t t h i s should be "THE" regional medical l i b r a r y fo r the e n t i r e Region. What w a s intended was a network of l i b r a r i e s and information centres f o r the whole of the Region, l inked t o each other . The l i b r a r y had the necessary i n f r a s t r u c t u r e , documentation and a f a i r amount of medical l i t e r a t u r e co l l ec t ed over the pas t 100 years. He f e l t t h a t t h i s l i b r a r y could become the f i r s t l i n k in a chain of medical l i b r a r i e s o r an information cent re t h a t might be developed by WHO f o r the purpose of disseminating information t o the countr ies of the Region.


DR HERAT ( S r i Lanka), appreciat ing the proposal made by t h e represen- t a t i v e from India, s a id tha t i t was important, however, f i r s t t o have a good na t iona l l i b r a r y i n each country between which l inks could eventual ly be es tab l i shed . WHO might co l labora te in the fu r the r development of each na t iona l centre so tha t any linkage with the Indian l i b r a r y could be s a t i s f a c t o r i l y es tab l i shed .

PROFESSOR SULIANTI (Indonesia) thanked the representa t ive from India f o r drawing the a t t en t ion of the Committee t o t h e existence of the National Medical Library in New Delhi. It was necessary t o have good l i b r a r i e s t o serve the countr ies . The i n i t i a l e f f o r t should, however, be to e s t ab l i sh o r s t rengthen the na t iona l l i b r a r i e s and the rea f t e r l inkages with the Indian counterpart could be brought about. She considered t h a t , though the idea of s e t t i n g up a Regional Library was good, the cos t involved would be enormous. I f the WHO Regional Office could serve as a s o r t of c lear ing house not only f o r the countr ies of the Region but a l so fo r the cent res in the o ther Regions, it mi&t be usefu l , and a l so a cheaper proposi t ion.

DR JOSH1 (Nepal) s t a t e d tha t hea l th a s s i s t a n t s were being t ra ined f o r three years a f t e r they had had general education up t o the eighth c l a s s . The I n s t i t u t e of Medicine, which was giving a one-year course, was taking i n only mat r icu la tes . As the mat r icu la tes came almost exclusively from urban areas ( there being no high schools i n the v i l l ages ) they would not go t o work i n r u r a l a reas . He wondered whether i t was the pol icy of WHO t o r e c r u i t high school graduates only f o r t r a in ing as hea l th a s s i s t a n t s .

DR GAITONDE (India) sa id tha t community-oriented medical education was a new experiment i n h i s country. The number of medical col leges had increased from 28 in 1947 t o 106 i n 1978. There were a l s o post- graduate medical i n s t i t u t i o n s teaching various medical s p e c i a l t i e s . It was, however, f e l t t h a t the t r a i n i n g given t o medical graduates was not su i t ed t o t h e i r tasks of serv ing the community. It was, therefore , f e l t t h a t t he re was need f o r a complete re-orientat ion of the programe. The Government had launched a new programme, which envisaged the planning of undergraduate medical s tudents i n the primary hea l th cent res f o r a sho r t period during t h e i r t ra in ing .

DR HUSSAIN (Bangladesh) s t a t e d t h a t every country must have i t s own na t iona l l i b r a r y which should function a l s o as a documentation cent re fo r providing more information. Thereafter one could s e t up a regional l i b r a r y . He sa id i t should be possible t o procure ass i s tance from b i l a t e r a l and in t e rna t iona l agencies f o r e s t ab l i sh ing such l i b r a r i e s . As regards hea l th manpower, it had been mentioned t h a t t h e medical graduate was not s u i t a b l e to serve i n the r u r a l a reas . In Bangladesh, a cadre of v i l l age doctors had been crea ted , and the Government proposed t o appoint such a doctor t o each of t h e 65 000 v i l l ages . This would be a community-supported programme and the Government had already s t a r t e d two schools, and would s e t up 250 schools in the course of the next s i x years . With t h i s cadre of manpower, Bangladesh would have three cadres of hea l th personnel, besides t h e paramedical and aux i l i a ry s t a f f , namely medical graduates and post-graduates, medical a s s i s t a n t s a t the middle l e v e l and the v i l l a g e doctor a t the grass-roots l e v e l .


PROFESSOR SULIANTI (Indonesia) asked whether, s ince every country had expressed an i n t e r e s t in the establishment of l i b r a r y se rv ices , the inter-country progr- could not be u t i l i z e d t o provide guidance i n the development of such serv ices , f o r example, through fellowships.

DR AUNG THEIN (Burma) agreed with the suggestion t h a t the development of na t iona l medical l i b r a r i e s should precede the s e t t i n g up of a regional network.

The REGIONAL DIRECTOR noted t h a t most of the countr ies were in t e re s t ed i n developing na t iona l medical l i b r a r i e s , and thought t h a t f o r t h i s purpose a l s o a s s i s t ance from t h e b i g l i b r a r i e s , such a s the one i n India , could be obtained. The Chief of the Library Service a t WHO Headquarters had v i s i t e d recent ly some countr ies of the Region t o iden t i fy l i b r a r i e s s u i t a b l e f o r development as a regional l i b r a r y . He had found t h a t i n Thailand a l s o the re was a very good l i b r a r y . The serv ices of these l i b r a r i e s already e x i s t i n g i n the Region could be made use of in developing na t iona l l i b r a r i e s . He welcomed the suggestion of Professor S u l i a n t i t o use the inter-country programme f o r t h i s purpose and suggested t h a t t h i s might be considered by the Sub-committee on Programme Budget a t t h i s sess ion . A t the moment, the count r ies could ask f o r MEDLINE serv ices and requests received by the Regional Office had been forwarded t o WHO Headquarters f o r providing such serv ices without payment.

Research Promotion and Development (pp. 94-96) Resolutions of Regional I n t e r e s t adopted by the Th i r ty - f i r s t

World Health Assembly (item 8 of t h e Agenda) (WHA31.35)

DR KO KO (Director , Programme Management), h ighl ight ing the events t h a t had taken p lace i n the f i e l d of research promotion and development during t h e pas t year, s t a t e d t h a t biomedical and hea l th serv ices research had been given very c lose a t t e n t i o n in the Region. The research programme had been i n i t i a t e d in 1976 using a s seed money a sum of US$60 000 from the Regional Direc tor ' s Development Fund. The programme had been progressing very w e l l . A sum of US52.25 mi l l ion had been proposed f o r 1980-1981 fo r inter-country a c t i v i t i e s under the Regular budget, i n addi t ion t o t h e proposals made under the country programmes and extra-budgetary resources made ava i l ab le f o r t h i s purpose. The Regional Advisory Committee on Medical Research had met four times s i n c e its establishment and had i d e n t i f i e d regional p r i o r i t i e s , f o r which study groups had been cons t i tu ted . During 1978, three new research study groups would be organized. The recommendations made by these study groups were endorsed by t h e RACMR, and a s a r e s u l t s eve ra l research a c t i v i t i e s had been undertaken i n countr ies - on subjec ts such a s drug r e s i s t ance of P.falciparum, applied research in malaria and drug ef fec t iveness and immunology in leprosy. Action had a l so been i n i t i a t e d fo r conducting research on the development of a denguelhaemorrhagic fever vaccine and the charac ter iza t ion of arbovirus infec t ions . The Health Services Research Working Group developed a de ta i l ed work plan a f t e r co l l ec t ing information on on-going a c t i v i t i e s and a f t e r i den t i fy ing p r i o r i t y a reas f o r research.

In c e r t a i n a reas , such as hea l th serv ices research, diarrhoea1 d iseases and n u t r i t i o n , t h e South-East Asia Region was taking a leading r o l e in the development of regional programmes which would spearhed the development of global programmes. The WHO global Advisory Committee on


Medical Research had accepted t h a t the p r o g r a m of hea l th serv ices research should be developed from the regions and within indiv idual count r ies , and t h a t t h e c e n t r a l mechanism should provide consul tant support , t echnica l guidance and budgetary resources. The Committee had a l s o proposed t o develop regional programmes on diarrhoea1 d iseases a s a f i r s t s t e p towards the development of a global programme. The Regional Office w a s preparing a regional research and ac t ion programme on n u t r i t i o n t o be implemented soon. This programme a l so would be a bas i s f o r the formulation of the global programme.

One of the main a c t i v i t i e s i n the f i e l d of research was the development of medium and long-term programmes f o r research promotion and development in response t o the r e so lu t ions adopted a t the World Health Assembly and as recommended by the RACMR and endorsed by the Regional Committee; t h i s programme aimed a t the formulation of na t iona l research programmes a t country l e v e l , and na t iona l meetings f o r t h i s purpose had already been held in Bangladesh, Indonesia,and Thailand, and one would be he ld i n S r i Lanka shor t ly . In o ther countr ies , such a s Burma, India and Nepal, the na t iona l a u t h o r i t i e s concerned with research were developing na t iona l research plans using the es tab l i shed machinery fo r research administrat ion.

The REGIONAL DIRECTOR r e fe r r ed t o the Specia l Programme f o r Research and Training i n Tropical Diseases which had been es tab l i shed by Headquarters and s a i d t h a t he had been requested by the Director- General t o br ing up t h i s matter a t the Regional Committee. The Tropical Diseases Research programme (TDR) was a global programme of in t e rna t iona l technical cooperation i n i t i a t e d by WHO and co-sponsored by UNDP and the World Bank. The two major object ives of TDR i n summary were (a) research and development f o r b e t t e r t oo l s t o cont ro l t r o p i c a l d iseases , and (b) t r a in ing and strengthening of i n s t i t u t i o n s t o increase the research capabi l i ty of t r o p i c a l countr ies . The programme was cur rent ly concerned with s i x major t r o p i c a l diseases: malaria, schistosomiasis , f i l a r i a s i s , trypanosomiasis, leprosy and leishmaniasis.

A t a meeting of the cooperating p a r t i e s of the TDR, held i n February 1978 in Geneva, representa t ives from th i r ty - f ive governments and other organizat ions cooperating i n the programme and the three co-sponsors had considered the s c i e n t i f i c and technica l progress, t h e adminis- t r a t i v e and technica l s t r u c t u r e s proposed f o r TDR and t h e i r formal establ ishment , and a programme budget f o r 1978 and the f inanc ia l s i t u a t i o n . The cooperating p a r t i e s were those governments contr ibut ing to t h i s Special Programme; those governments providing technica l and/ o r s c i e n t i f i c support to the TDR and those governments whose countr ies were d i r e c t l y a f f ec t ed by the diseases dea l t with by the Special Programme and those inter-governmental and other non-profit making organizat ions cont r ibut ing t o Special Programme resources o r providing technica l and/or s c i e n t i f i c support t o TDR.

From the South-East Asia Region, three s c i e n t i s t s had pa r t i c ipa t ed i n t h i s meeting. The cooperating p a r t i e s had, a t t h i s meeting, endorsed the "Memorandum of Understanding on the Administrative and Technical S t ruc tures of the Special Programme fo r Research and Training in Tropical Diseases". This memorandum of understanding described the funct ions, composition and working of the mechanism fo r the operation


of TDR. In the memorandum it had a l s o been agreed t o e s t a b l i s h a J o i n t Coordinating Board (JCB) f o r the purpose of coordinating the r e s p o n s i b i l i t i e s of the p a r t i e s cooperating in TDR.

The REGIONAL DIRECTOR sa id t h a t he had addressed a l e t t e r t o the governments of the Region on 10 July 1978 t o which relevant excerpts from the Memorandum of Agreement had been at tached. The J C B would cons i s t of 30 members which would include twelve government represen- t a t i v e s se l ec t ed by the WHO Regional Committees from among those countr ies d i r e c t l y a f f ec t ed by d iseases dea l t with by TDR. He therefore requested the Regional Committee t o s e l e c t two governments which the Director-General could then approach f o r the nomination of representa t ives t o t h e J C B . One point t h a t should be kept i n mind i n s e l e c t i n g the count r ies was the requirement t h a t the Members should be "from among those countr ies d i r e c t l y a f f ec t ed by the d iseases d e a l t with by the Special P r o g r a m , o r from among those providing technical o r s c i e n t i f i c support t o t h e Special Programme".

To ensure continui ty of membership, i t had been suggested t h a t the tenure of representa t ives should be , i n the f i r s t ins tance , three years f o r one and two f o r the other . Subsequent appointments o r reappointments would be f o r three years each.

DR PRAKORB (Thailand) proposed t h a t Burma and India be se l ec t ed t o nominate representa t ives on the J C B .

PROFESSOR SULIANTI (Indonesia) enquired whether there were any guide- l i n e s f o r the nomination and whether the vot ing should be by s e c r e t b a l l o t . The Committee should perhaps be given some time t o consider t h i s quest ion.

The CHAIRMAN suggested t h a t the Regional Committee could adopt its own procedures f o r t h e purpose.

The REGIONAL DIRECTOR again r e fe r r ed to h i s l e t t e r dated 10 Ju ly 1978 addressed t o governments. The Regional Committee had been requested t o nominate two governments from the Region t o nominate representa t ives on the JCB. No procedures had been l a i d down f o r the purpose and the Committee could follow i t s own procedure. I f i t was considered necessary by t h i s Committee, the s e l e c t i o n could be postponed t o Friday.

MR SUPTHLPT (Director , Support Programme) read out excerpts from the l e t t e r dated 10 July 1978 r e fe r r ed to by the Regional Direc tor . In t h i s l e t t e r Member S ta t e s had been asked t o i n s t r u c t t h e i r represen- t a t i v e s t o the Regional Committee on t h i s matter. He added t h a t , according t o t h e Rules of Procedure of the Regional Committee, the s e l e c t i o n could be e i t h e r under Rule 42 (voting by show of hands) o r under Rule 46 (vot ing by s e c r e t b a l l o t ) .

PROFESSOR SULIANTI (Indonesia) pointed out t h a t the matter had not been included in the agenda of the Regional Committee and therefore the Indonesian delegat ion had not received any b r i e f i n g on t h i s question.

The REGIONAL DIRECTOR s a i d t h a t a s a w r i t t e n communication had already been s e n t t o governments on t h i s sub jec t , i t had been f e l t t h a t there was no need t o include t h i s sub jec t as a separa te agenda item. I f i t


was considered necessary, however, the matter could be taken up l a t e r in the sess ion o r even a t the next sess ion of the Regional Committee; but t h i s might r e s u l t i n the Region los ing i t s representat ion on t h e J C B f o r one year .

MR VOHRA (India) confirmed t h a t the Government of India had received the wr i t t en communication r e fe r r ed t o from the Regional Office. Ee therefore f e l t t h a t there was no need t o delay the nomination.

DR HERAT (S r i Lanka) seconded the proposal.

The CHAIRMAN asked whether the proposal made by the representa t ive of Thailand was acceptable. He then declared t h a t i n the absence of fu r the r comments, India and Burma, as proposed by the representa t ive from Thailand, were nominated by the Regional Committee as members of the J o i n t Coordinating Board.

Par t I11 - A c t i v i t i e s Undertaken by Governments with the Help of WHO (pp. 119-207)

The CHAIRMAN suggested t h a t s ince t h i s p a r t consis ted of l is ts of p ro jec t s , and these pro jec ts would be sc ru t in i zed by the Sub-cornittee on Programme Budget, the Committee might not wish t o consider t h i s i n d e t a i l a t t h i s point . However, i f t h e members wished t o make any s p e c i f i c observations, they could do so.

Approval of the Report

DR SANKARAN (India) moved t h a t the whole repor t be adopted. This proposal was seconded by DR AUNG THEIN (Burma)

7 Adjournment


Fifth Meeting. 25 August 1978, 9.30 a.m.

TABLE OF CONTENTS

1 Regional Director's Annual Report

2 Tenure of Members in the Joint Coordinating Board of the TDR Programme

3 Periodicity of the Regional Director's Report

4 Resolutions of Regional Interest Adopted at the Thirty-first World Health Assembly

5 Study of WHO'S Structures in the Light of its Functions

6 Cooperation with Non-health Sectors in National Health Development

7 Importance of Field Studies on the Ecology and Control of Vectors of Human Diseases and the Training of Medical Entomologists in South-East Asia

8 Charter for Health Development

9 Selection of a Subject for the Technical Discussions at the Thirty-second Session

10 Time and Place of Thirty-second Session

11 Adjournment

*Originally issued as document SEA/RC31/Min.5. on 26 August 1978.

126 MINUTES OF THE FIFTH MEETING

In the absence of the Chairman, the VICE-CHAIRMAN took the Chair.

1 Regional Director's Annual Report (item 7 of the Agenda) (cont'd)

The REGIONAL DIRECTOR thanked the delegates for the constructive comments they had made on his Annual Report, which he said would guide him to a very great extent in the future work of the Organization as a whole and of the South-East Asia Region in particular. He said that the "Donors' Meeting on Ptimary Health Care Programmes in South-East Asia", to which he had referred earlier, would be held from 9 to 13 July 1979. Representatives of the potential donors, including USAID, would be present at this meeting. It had been agreed that representatives from Pakistan and Afghanistan (Eastern Mediterranean Region) would also attend the meeting. The donors would like to know the needs of the countries in some selected priority areas. Since the meeting would be a logical sequel to the International Conference on Primary Health Care to be held at Alma Ata, he anticipated that the conclusions and recommendations of the Alma Aea Conference would form a basis for the discussions at the donors' meeting.

2 Tenure of Members of the Joint Coordinating Board of the TDR Programme

The REGIONAL DIRECTOR also brought to the attention of the Committee that it would need to decide on the tenure of the two members of the Joint Coordinating Board of the TDR from this region, i.e., which country should serve for three years and which for two years. By drawing lots the Committee decided that Burma would nominate a member of the Board for three years and India for two years.

DR SULIANTI (Indonesia), recalling earlier discussions on the subject, emphasized the need for deciding on the functions and responsibilities of the two members.

The REGIONAL DIRECTOR stated that the functions and responsibilities had been described in the Memorandum of Understanding but the Regional Committee had the right to decide on how the two members should report to the Regional Committee. He added that he would bring to the attention of the Director-General the discussion on this matter in the Regional Committee.

3 Periodicity of the Regional Director's Report

The REGIONAL DIRECTOR then brought to the Committee's attention the fact that WHO Headquarters and other Regional Offices were bringing out a more extensive report covering a period of two years in non- budget years and a brief report covering the activities over a cwelve- month period in the year when the progrannne budget document was submitted to the Committee. He therefore proposed that the Committee might consider this and decide whether this region should follow the same practice.

PROFESSOR SULIANTI (Indonesia) said that the Regional Committee should look into this question keeping in mind the necessity and usefulness of the Annual Report. In the Health Assembly, the Programme Budget was

MINUTES OF TH!Z FIFTH MEETING 127

examined in detail but the report of the Director-General was not gone into in depth at the plenary session. On the other hand, in the Regional Cornittee for South-East Asia, the Regional Director's Annual Report was discussed in greater detail, and this discussion enabled the Member countries to keep themselves abreast of the activities going on in the Region. She wondered whether it would be adequate to have this opportunity once in two years only. In such a case the information contained in the Regional Director's Annual Report would not be of topical interest. The programme budget was discussed by a Sub-Committee in one day, but the Annual Report was discussed in the plenary for a longer period. If the report was to be submitted once in two years, then the Regional Committee might need to adopt a different procedure for the examination of the prograrne and review of the report.

MR VOHRA (India) also supported the suggestion that the present practice of having a report every year should continue. Most organizations brought out annual reports for the purpose of "stock taking". The Regional Director's Annual Report helped both governments and the Organization to review the progress made during the previous year.

DR HUSSAIN (Bangladesh) supported the views expressed by the delegates from India and Indonesia.

DR JOSH1 (Nepal) felt, however, that it would be better to fall in line with the Headquarters' practice.

DR JADAMBAA (Mongolia) mentioned that the Annual Report of the Regional Director provided an opportunity to Member States to discuss the activities that had taken place during the year, while the Assembly did not go into such depth in regard to the Director-General's report. He would, therefore, like to support the proposal made by the delegates from India and Indonesia.

After requesting further comments the CtIAIRMAN announced that the general consensus of the Committee was that the present practice by which the Regional Director presented a detailed report annually should be continued.

4 Resolutions of Regional Interest Adopted by the Thirty-first World Health Assembly (item 8 of the Agenda) (WHA 31.41)

(Technical Cooperation Among Developing Countries (TCDC) in the South-East Asia Region) (item 5 of the Supplementary Agenda) (document SEA/RC31/19)

DR GAITONDE (India), presenting the paper on the subject prepared by the Government of India (document SEA/RC31/19), said that it was recognized that health was an integral component of overall development programmes for which a proper mechanism of cooperation should be created at regional and inter-regional levels. Referring to the World Health Assembly resolution WHA31.41, he said that India was now in a position to offer technical expertise to the other Member countries of the Region in almost all branches of medical science, including public


heal th. It would be des i r ab le f o r the count r ies t o meet and iden t i fy possible a reas of regional cooperation. He then out l ined the f a c i l i - t i e s ava i l ab le i n India which were l i s t e d i n the paper.

DR PRAKORB (Thailand), commending the document presented by the Government of India , s a id t h a t technica l cooperation among the Member S ta t e s of the Region had already been taking place. It was, however, useful to br ing t h i s matter t o the a t t e n t i o n of the Regional Committee i n order to s t rengthen t h i s cooperation.

PROFESSOR SULIANTI (Indonesia), supporting the p r inc ip l e s of TCDC i n t h i s region, r eca l l ed t h a t World Health Assembly reso lu t ion WHA31.41 invi ted the Regional Committees t o discuss and re inforce t h i s subject with a view to promoting hea l th care, and t o s e t up appropriate regional and in ter - reg ional mechanisms f o r developing and strengthening TCDC i n hea l th . TCDC was already taking place i n t h i s region. Therefore she suggested t h a t the Committee d iscuss the question of s e t t i n g up a mechanism through which TCDC i n the Region could be fu r the r strengthened.

DR U THAiY W I N (Burma) f e l t t h a t TCDC i n the Region was a very important a c t i v i t y i n which WHO was playing e s s e n t i a l l y a s c i e n t i f i c , technical and coordinat ing r o l e . He supported the proposals contained i n the document presented by the Government of India .

DR HERAT ( S r i Lanka) sa id t h a t the p r inc ip l e s of TCDC were of grea t i n t e r e s t t o h i s government. S r i Lanka was already having such coopera- t i on with i t s neighbours. It would be usefu l t o have documented information on t h e technical cooperation ava i l ab le i n the count r ies of the Region a s well a s on what was required by them.

DR JOSH1 (Nepal) supported t h e proposals of the Government of India.

DR HUSSAIN (Bangladesh) supported the need f o r evolving a mechanism by the Regional Office so t h a t the r ec ip i en t coun t r i e s would be ab le t o know more about the type of f a c i l i t i e s ava i l ab le within the Region.

DR SANKARAN (India) said t h a t the concept of TCDCwas i n t h e nature of a two-way t r a f f i c . India would l i k e t o know more about the f a c i l i t i e s ava i l ab le i n the o ther count r ies so a s t o know where i t s own personnel could be sent f o r the necessary t r a in ing .

DR JADAMBAA (Mongolia), supporting the paper presented by the Government of India , said t h a t a mechanism should be es tab l i shed i n the Regional Office because i t knew which country needed what and where it was ava i lab le . It should serve a s a foca l point fo r t h i s a c t i v i t y .

The REGIONAL DIRECTOR sa id he was happy t o note t h e g rea t i n t e r e s t evinced by t h e count r ies of t h e Region i n t h e concept of TCDC. He welcomed the i n i t i a t i v e of the Indian Government i n l i s t i n g the a reas i n which expe r t i s e and t r a i n i n g f a c i l i t i e s were ava i lab le i n t h a t country. Similar f a c i l i t i e s and exper t i se were no doubt ava i l ab le i n other count r ies a s well . He requested the delegates t o ask t h e i r governments t o provide the Regional Office with information on such f a c i l i t i e s i n t h e i r count r ies , so t h a t the information thus co l lec ted

MINUTES OF THE FIFTH MEETING 129

could be issued in the form of a directory. The Regional Office was prepared to act as the focal point so that if any country wanted to know where facilities were available in a particular subject, the information could be made available to it. The Regional Office could also make arrangements for fellowships within the Region. He thought that the first thing to do was to prepare a directory. He intended to follow up on this soon after returning to Delhi. He said that he would nominate a person in the Regional Office to be the focal point so that all communications could be addressed to him.

The CHAIRMAN said that this was a very encouraging development, and South-East Asia was probably the first Region to take the necessary steps for fostering technical cooperation among its Member countries and was well ahead of the other regions.

5 Study of WHO's Structures in the Light of its Functions (Supplementary Agenda item 6) (document SEA/RC31/14)

The REGIONAL DIRECTOR, introducing the document on the subject (SEA/RC31/14), said that the paper prepared by the Director-General was an important one. It related to the study of the Organization's structure as recommended by the Thirty-first World Health Assembly (resolution WHA31.27). The study had been recommended in order to ensure that the activities of the Organization at all operational levels promoted integrated action.

What factors impeded the progress of health development in the countries of the Region and, in particular, what were the causes of the relatively low impact of WHO's collaborative programmes with Member States, were some of the fundamental questions the answers to which would explain why the pace of health development in general had been relatively slow. Other questions raised in the background paper included the strengthening of the Regional Committees, matters related to the regional office structure, the work of WHO programme coordinators' offices, and TCDC.

He said that full advantage had not always been taken of the Organization's role of international coordination on health matters and of technical cooperation with Member States. There were instances in which the Organization's constitutional role as a technical coordinating agency had been obscured as a result of mere requests for supplies and equipment. Such instances had, however, been few and far between as far as the South-East Asia Region was concerned. The Regional Committee might consider measures to minimize or even eliminate practices which compromised WHO'S basic role of coordination.

In the past, the concept of technical cooperation had sometimes been confused with technical assistance. WHO had either passively acceded to governments' requests or had imposed its own vertical type of projects, with little or no impact on the growth of relevant programmes in the Region. The outmoded donor/recipient approach had, however,now yielded place to real cooperation among Member States and WHO as complementary partners. As regards the WHO programme coordinators, a shift in the emphasis of their role from a representational one to one of greater technical coordination might become apparent. In this connexion, a significant issue that would need consideration was the use of national health personnel as project managers and eventually as programme coordinators.


As a result of the proposed studies the role of the regional committees would assume greater importance, with their deliberations having added dimensions. Emanating from the study would be the need for evolving effective steps to promote and implement TCDC in the Region.

The Regional Director emphasized that a critical and intensive introspection would be essential if the future work of the Organization were to meet successfully the challenges confronting health care. It was a matter for satisfaction that this region had initiated action in such fields as country health programming, national health information systems, TCDC, medium-term programming, allocation of resources, the use of national project managers in WHO collaborative programmes, and the setting up of government/WHO coordinating comittees. In view of such innovative approaches adopted by the Region, some of the self- critical conclusions outlined in the document under discussion might not apply to this region.

He urged that any changes resulting from this study of the Organization's structure by the Regional Committee should not be mere changes for the sake of change but should be geared to ensuring that the Region's interests would be better served by the Organization. In order to enable the Regional Committee to consider the momentous issues raised in the Director-General's paper, he said that he would recommend the appointment of a sub-committee consisting of five countries to study the entire issue in depth and prepare a report. The Director-General had provided guidelines for the terms of reference of this committee which included: (1) conducting the study in the Region together with the Regional Director on behalf of the Regional Comittee, (2) ensuring adequate consultations with the governments on the basis of the Director-General's background paper, (3) monitoring the progress of the study in the Region, (4) preparing a report to the 1979 session of the Regional Comittee, and (5) preparing a final regional report to enable the Director-General to submit his global report to the January 1980 session of the Executive Board.

The Regional Director further stated that, once the report of the sub- committee was received, he would convene a meeting of the representatives of all Member States to consider it before submission to the Regional Committee in 1979. He said that the Regional Office would extend the necessary help to the Member States in completing the study. He hoped that the conclusions arising out of the study in this region would greatly influence the working of the Organization in the future.

The CHAIRMAN, elaborating on the statement made by the Regional Director, said that it was a rare privilege for him to chair a meeting which was considering such an important and vital subject. He requested the Regional Director to convey his sincere thanks to the Director- General on his soul-searching and soul-stirring document. A task had been assigned by the Director-General to the countries of the Region. From the point of view of the countries of this region, he highlighted the main points raised in the document.

The Director-General, in his usual masterly way, had described the problems, vicissitudes, trials and tribulations the Organization was facing. WHO, an organization which was meant to direct, motivate and


guide and ultimately influence the policies of nations toward the betterment of their health care services for the largest number of their population, was becoming a programme-oriented body for promoting avenues of research and service to answer the problems of a few who did not in any way need such help. Much of the Organization's resources and energywere being used up for consultants, fellowships and supplies in areas and fields not identified by the Member countries but, in a number of cases, recommended by experts.

In order to stem the trend, the Executive Board and the World Health Assembly had authorized the Director-General to study the Organization's structure in the light of its functions. The Director-general had pointed out in the document that no changes in the Constitution of WHO were indicated as desirable or necessary. What was being envisaged was structural changes without in any way changing the basic function of the Organization, since WHO'S function had been described in the Constitution as a "role of directingandcoordinating international health work and of technical cooperation with Member States".

It had also been pointed out by the Director-General that the strengthening of regional arrangements had resulted in regional solidarity, but had sown the seeds of global fragility, which might lead to a global policy too far withdrawn from the national reality and vice versa. Such an isolation and a phenomenon of retro-active guidance had resulted in this mood of introspection,micro-optimal use of allocated resources and a divergency between governments, regional offices and Headquarters. Most fortunately, this was not true of this region, thanks to the superhuman effort of the Regional Director; the collaborating spirit of friendship between Member countries and the Regional Office could be described as exemplary. The malady did, however, exist and needed to be arrested. This could be done only if intelligent, meaningful and inter-regional collaborative steps were taken.

In the document, technical cooperation had been spelt out as a meaningful dialogue between the Organization and the Member States leading to the maximum use of available resources which was, however, a far cry from the present day "ad hocism".

The proposed changes in the concept were far-reaching and should not be left as hopes. It was necessary to reorganize the WHO structure to improve the effectiveness and efficiency of the Organization. The document before the Regional Committee contained proposals that needed critical analysis and required a thorough review. In view of the importance of the subject, he, as the Chairman, proposed to nominate Burma, Indonesia, Nepal, Sri Lanka and Thailand to constitute the proposed committee to review the background paper of the Director- General to study the basic organizational pattern of the Organization, and to prepare a document for the next session of the Regional Cornittee.

DR U AUNG THEIN (Burma), while thanking the Chairman for nominating his country to the committee, suggested that since Burma had already been nominated for the JCB of the TDR, India might be nominated for this committee in its place.


DR JOSH1 (Nepal) supported the proposal of B u m .

PROFESSOR SULlANTI (Indonesia) said that, as the Indian Government had already been selected to nominate a representative to the JCB of the TDR, it might be advantageous if some other country, such as Bangladesh or Mongolia, could be nominated to the sub-cornittee on the organizational study.

DR HERAT (Sri Lanka) thanked the Chairman for nominating his country to the sub-committee, and seconded the proposal of theIndonesian delegate, since he felt that participation in the sub-committee should be broad based.

PROFESSOR SULIANTI (Indonesia) said that the "Study of WHO'S Structures in the Light of its Functions", which had been suggested by the Director- General, was very important and opportune. What had previously been known as WHO assistance was now recognized as WHO collaboration. The concept of health activities had also undergone a change in that it had already been realized that the health of a population could not be achieved with only health activities. It would be important to study the responsibilities of the Regional Office and of the WHO programe coordinators in the countries, who would not only have to deal with the Ministry of Health but act as catalysts in discussions with other sectors and with bilateral agencies. WHO being one entity, there was also a need to strike a balance in matters of anationa1,regional and global character. In addition to the Executive Board's organizational study of WHO at the country level, another study had also been made a year ago which looked into the national, regional and Headquarters programing. In conclusion, she thanked the Chairman for nominating Indonesia to this committee.

The REGIONAL DIRECTOR thanked the Chairman for his illuminating address. which contained some critical but relevant remarks about the way in which theorganization was functioning and should function. Since the proposed study was a very important one he suggested that the proposed sub- cornittee should have representation from all the ten Member countries of this region. If this was agreed, he said, he would like to convene a meeting and invite all the Member countries to be represented. He had originally intended organizing a meeting of the countries as he had informed the representatives in his introductory remarks on the Annual Report.

The CHAIRMAN asked for the views of the delegates on the suggestion of the Regional Director. In the absence of any reraarks, he stated that the Regional Director's suggestion was acceptable to the Committee.

6 Cooperation with Non-health Sectors in National Health Development (item 13 of the agenda) (document SEA/RC31/11)

DR JADAMBAA (Mongolia), presenting the paper on this subject (document SEA/RC31/11), said that the attainment of the main objectives of any national public health system could not be achieved without the active and informed participation of all non-health sectors. The importance of this matter had been repeatedly stressed by the World Health Assembly and the Executive Board mainly within the framework of national health planning. Much had been done during recent years to strengthen inter- sectoral contacts. His government would like to suggest to the other


governments t h a t there should be an exchange of ideas and experience regarding the work of t h e respec t ive na t iona l a u t h o r i t i e s f o r mutual bene f i t . The in t e r - sec to ra l partnership i n hea l th i n h i s country was regulated by general l e g i s l a t i o n and hea l th l e g i s l a t i o n . It could not , however, be assumed t h a t l e g i s l a t i o n would be automatical ly transformed i n t o ac t ion . For example, though there was a comprehensive ve ter inary h e a l t h se rv ice i n h i s country wi th a s o l i d labora tory component, the professional contact between the public hea l th department and t h i s department had not been optimal. On the o ther hand, there was very c lose cooperation between the Ministry of Health and the Ministry of Transport, which had recent ly b u i l t a hosp i t a l fo r its own workers. Three hundred somon cooperative and s t a t e farms had t h e i r own maternity homes and provided t ranspor t f o r physicians and fe ldshers t o reach p a t i e n t s and t ake mothers home a f t e r de l ive r i e s . tle suggested t h a t a reso lu t ion might be adopted by the Regional Committee s t r e s s ing the importance of cooperation with non-health sec to r s i n improving the hea l th of the people.

MR VOHRA (India) observed t h a t the paper presented by the delegate from Mongolia c l e a r l y showed the anxiety of theMongolian People's Republic t o achieve not only t h e objec t ives set by WHO bu t a l s o t o ensure the development of all-round good hea l th . Referring t o t h e various resolu- t i ons t h a t had been passed i n the pas t and were being considered a t the cur rent sess ion of the Regional Committee, he f e l t t h a t passing reso lu t ions from time t o time i n i s o l a t i o n and i n a piecemeal manner would not be e f f e c t i v e i n solving hea l th problems. He therefore suggested t h a t comprehensive reso lu t ion urging cooperation i n hea l th matters from a l l o ther branches of governmental funct ioning be adopted by the Regional Committee.

DR SOEBEKTI (Indonesia), expressing h i s apprec ia t ion of t h e paper presented by the Mongolian delegate, s t a t e d t h a t p r i o r i t y must be given t o o the r f i e l d s of development which would i n t h e long run support hea l th objec t ives . I f the community were t o be helped i n a l l respec ts , coordination among decision-makers i n t h e government machinery would be necessary. Also, t he re was a need t o recognize the r o l e played by r e l i g i o u s leaders and s o c i a l workers. Laws and regula t ions alone would not automatical ly r e s u l t i n appropriate act ion; what was required was f o r the decision-makers i n min i s t r i e s of hea l th t o be w i l l i n g t o make personal approaches t o t h e i r col leagues i n o ther s ec to r s . Such approaches should, however, be followed up a t various leve ls .

DR JOSH1 (Nepal) sa id t h a t he would support the proposal t o pass a r e so lu t ion s t r e s s i n g t h e importance of cooperation with non-health sec to r s .

DR HERAT ( S r i Lanka) s a i d he wholeheartedly endorsed t h e Mongolian proposal. Cooperation of o ther departments was absolutely necessary a s the hea l th sec to r could not function i n i s o l a t i o n i f all t h e serv ices necessary f o r the people were t o be provided. In addi t ion , there should be c l e a r l y defined coordination between the a c t i v i t i e s of the hea l th and other sec tors .

DR KWON SUNG YON (DPRK) sa id t h a t cooperation wi th MU-health s e c t o r s in na t iona l hea l th development, a s described by t h e de legate from Wngolia ,


was of the utmost importance, as public health was closely connected with various sectors of the national economy. Health programmes could prove successful only if they were organized as national and social activities with the involvement of non-health sectors. In the DPRK much emphasis was laid on such collaboration. Health workers had helped to create a sense of awareness among the other personnel on the need for voluntary participation in health work. The existing state laws and regulations had empowered the health authorities to provide guidance and exercise necessary control over the role of the other sectors in the field of health. For example: labour laws required industrial undertakings to ensure a safe and healthy working environment; the law on the nursing and rearing of children required crcches to maintain hygienic conditions and provide physical exercise and appropriate medical support, and land laws forbade the discharge of pollutants. The powers for supervision and guidance in all these areas were vested in the sanitation control institutions. He supported the need for ensuring the cooperation of the non-health sectors in national health development, and said he was in agreement with the proposal of the delegate from Mongolia.

MR VOHRA (India) said that the Comittee could perhaps follow, to the extent necessary, Article 8, sub-clause 2 of Chapter 5 of the Charter for Health Development, the working of which already embodied the proposal made by the Government of Mongolia.

DR THAN WIN (Burma) supported the views expressed by the various delegates on seeking the cooperation of the non-health sector, since this would be indispensable if the target of health for all by the year 2000 was to be achieved.

DR HUSSAIN (Bangladesh), supporting the proposal made by Mongolia, said that health had become a multidisciplinary subject, especially in the fields of nutrition, water supply and information and public relations. The Government of Bangladesh had, therefore, established development boards at the divisional, district and thana levels to review the operation of health services. They were also responsible for the implementation of various other services.

The CHAIRMAN requested the delegate from Mongolia to forward a formal resolution on this subject to the Resolutions Sub-committee for consideration, taking into account the views expressed by the various delegates. Clarifying the point made by Mr Vohra from India, he said that the entire health problem should be studied as a whole and not piecemeal. Speaking as the representative from India, he was pleased to endorse a resolution on this matter from the point of view of inter- sectoral cooperation in the health field, which had been referred to in the Charter for Health Development. It might be discussed further when that item was taken up for consideration.

7 Importance of Field Studies on the Ecology and Control of Vectors of Human Diseases and the Training of Medical Entomologists South-East Asia (item 14 of the ~~enda) (document SEA/RC31/9)

PROFESSOR SULIANTI (Indonesia), introducing the paper prepared by her government on the subject (document SEA/RC31/9), said that in many


countries of the Region vector-borne diseases such as malaria and dengue haemorrhagic fever (DHF) had been recognized as public health problems. Though a number of drugs were available for the treatment of some of these diseases, the best preventive measure was still interruption of the transmission of the disease by reducing contact between the vector and the human host. It would take a long time before an effective vaccine against these diseases was developed and produced for use by the health services. Though the importance of vector control had been stressed during the discussion on the Regional Director's Annual Report, theIndonesiandelegation would like WHO to pay greater attention and give top priority to field studies on the ecology and control of vectors of human diseases and to the training of medical entomologists. For example, in the inter-country programmes of research on DHF and malaria, the research was largely directed towards therapeutic trials on immunology and virology and few studies on vector control were envisaged. It would be necessary to extend this research to cover studies on vector populations so that an appropriate technology for vector control could be developed, especially for use in the context of primary health care. Greater attention should be given to research into bioenvironmental methods of vector control, to which a reference had been made at a previous session of the Regional Committee. She concluded by saying that a formal resolution would be sent to the Resolutions Sub-Committee for consideration.

DR GAITONDE (India), endorsing the views expressed by the representative from Indonesia, said that the study of the ecology and dynamics of transmission of diseases through vectors should receive priority consideration. As a matter of fact, in India an institute of vector control had been established with assistance from WHO. At present the training of entomologists was mainly a function of the science colleges and it was,therefore, necessary to see that their training programmes were directed towards the training of medical entomologists. To that extent there was a need for input of resources.

DR HUSSAIN (Bangladesh) supported the views expressed by the representative from Indonesia and mentioned that, realizing the importance of this subject, the Government of Bangladesh had established, on the recommendations of WHO and with assistance from UNDP, an institute for epidemiology, disease control and research, which had various components, including field research and training for medical entomologists.

DR JOSH1 (Nepal) said that as malaria posed a serious problem in his country and in neighbouring countries, field studies on the ecology and control of vector diseases assumed greater significance and hence he would support the views of the Indonesian delegate.

DR JADAMBAA (Mongolia) said that,though vector-borne diseases were not a major public health problem in his country, he would support the proposal made by Indonesia in view of its importance to the Region as a whole.

The CHAIRMAN recalled that, at the meeting on malaria research held recently in Bangalore (India), to which he had referred earlier, the subject of vector control had been thoroughly discussed. The Vector Control Unit at Pondicherry had presented its inputs at this meeting.


8 Charter f o r Health Development (item 9 of the Agenda) (document SEA/RC31/6)

Introducing the r epor t of the meeting on the Charter f o r Health Develop- ment,held i n New Delhi from 1 t o 3 March 1978 (document SEA/RC31/6), the REGIONAL DIRECTOR s t a t e d t h a t the working group which had approved the d r a f t of t h e Charter had recommended t h a t the Regional Office should have the d r a f t of the Charter examined by the l e g a l exper ts a t WHO Headquarters, and t h a t an a r t i c l e should be included t o provide fo r any fu tu re amendments t o the e x i s t i n g provisions. He reported t h a t the Legal Unit a t WHO Headquarters had found t h a t , a s the Charter had been e s s e n t i a l l y conceived not a s a l e g a l instrument but a s a dec lara t ion of general aims and p r inc ip l e s which the count r ies concerned were adopting f o r themselves, i t was not necessary to change A r t i c l e 11 nor t o add an amending c lause . Any amendments could be adopted i n the same manner a s the o r i g i n a l Charter i t s e l f - by the Regional Committee.

He took the opportunity t o thank the Member S t a t e s f o r t h e i r s p i r i t of cooperation and mutual understanding shown i n t h e f i n a l i z a t i o n of the Charter , which was an indica t ion of t h e i r concern and sense of urgency f o r solving common p r i o r i t y problems through concerted e f f o r t s . He r e i t e r a t e d t h a t the Charter was not a panacea fo r a l l t h a t a i l ed hea l th development i n t h e Region, but i t c e r t a i n l y could br ing bene f i t s to Member S ta t e s .

The adoption of the Charter by the Regional Committee, the Regional Director continued, would provide a s t rong cormitment a t the declsion- making l e v e l of each government vis-a-vis na t ional p r i o r i t i e s for the hea l th sec to r . It would a l s o provide an instrument fo r f o s t e r i n g continued technica l cooperation among the countr ies of the Region i n tha t the mutual exchange of accumulated knowledge and experience among the count r ies would be f a c i l i t a t e d through the implementation of the Charter leading t o c o l l e c t i v e se l f - r e l i ance . The mobilization of ex te rna l resources would improve with the adoption of the Charter. He r e i t e r a t e d t h a t t h e p r inc ip l e s of the Charter had been conceived i n complete harmony keeping i n view the p r i o r i t i e s of the Region, and the Member S t a t e s would be f r e e t o p a r t i c i p a t e i n any programme under the Charter.

Once the Charter had been accepted by t h e Regional Committee, the Director-General and t h e Regional Director would v i s i t the Member countr ies t o ge t the Charter signed a t the highest p o l i t i c a l l e v e l so tha t i t could become an instrument fo r heal th development i n the Region.

DR SANKARAN (India) believed t h a t the Charter , when f i n a l l y adopted, would be a pace-set ter f o r hea l th development i n the Region, and t h a t it would serve a s an example t o be emulated by other Regions.

MR VOHRA ( India) , appreciat ing the luc id exposi t ion of the p r inc ip l e s of the Charter by the Regional Direc tor , sa id t h a t a good dea l of spade work had been done i n the d ra f t ing of t h i s important document by the count r ies of the Region. A s i g n i f i c a n t point t o bear i n mind was t h a t i t d id not impose any obl iga t ion on t h e p a r t of the Member S t a t e s . To the ex tent t h a t a Member country would l i k e to u t i l i z e i t , however, the Charter had an enabling p o t e n t i a l f o r providing so lu t ions t o the

MINUTES OF TNE FIFTH MEETING 137

re levant hea l th problems. He pleaded t h a t the Regional Committee formally endorse the Charter so t h a t the Regional Director would be i n a pos i t i on t o i n i t i a t e fu r the r ac t ion in the matter .

DR HUSSAIN (Bangladesh) described the Charter a s an exhaustive document. He f e l t , however, t h a t the f inanc ia l aspects of hea l th serv ice de l ivery could have been s p e l t out . I n the l e a s t developed count r ies , hea l th care was provided f r e e of charge but reached the ,, haves" and not the "have nots", because the funds a t the disposal of t h e na t iona l governments were not s u f f i c i e n t t o meet the e n t i r e needs

DR PRAKORB (Thailand) said t h a t h i s government had s tudied the Charter with g rea t a t t e n t i o n . Taking i n t o account the l imi ted resources ava i l ab le and the g rea t demands t h a t were made on these resources, i t was f e l t t h a t a cha r t e r of t h i s nature would be of considerable help. He therefore expressed apprec ia t ion of the e f f o r t s made by the group t h a t had draf ted t h e document, and supported t h e Charter on behalf of h i s government.

PROFESSOR SULIANTI (Indonesia) sa id t h a t her government endorsed the Charter i n p r inc ip l e . She sought c l a r i f i c a t i o n on c e r t a i n points .

Referring t o A r t i c l e 8, clause (8) on page 7 of the document, which d e a l t with d isease prevention and con t ro l , she sa id t h a t t h e r e was no mention of vec to rcon t ro1 ,ye t there was emphasis on immunization, which had been included i n Ar t i c l e 8 clause (12) on page 8, where i t r i g h t l y belonged t o family hea l th programmes. She hoped t h a t t h i s emphasis on one aspect of cont ro l would not exclude other aspects from bene f i t t i ng from programmes which might be i n i t i a t e d through the Charter . Similar ly t h e spec i f i c mention of the de l ivery of hea l th serv ices i n A r t i c l e 8 , c lause (15) on page 8 , should not exclude research i n other subjec ts .

DR JOSH1 (Nepal) endorsed t h e Charter.

DR JADAMBAA (Mongolia) requested c e r t a i n c l a r i f i c a t i o n s . Regarding A r t i c l e 9 he wondered whether governments were expected t o s e t up a spec ia l mechanism f o r implementing the Charter . Regarding A r t i c l e 8, c lause ( 6 ) , on page 7 , c a l l i n g f o r the use of t r a d i t i o n a l medicine, he sa id t h a t i n h i s country t r a d i t i o n a l medicine was not encouraged and he hoped t h i s c lause i n t h e Charter did not imply t h a t h i s government should include t r a d i t i o n a l medicine.

DR HERAT ( S r i Lanka) sa id t h a t h i s government endorsed the d r a f t cha r t e r without any reserva t ions .

The REGIONAL DIRECTOR, i n rep ly t o the various poin ts ra i sed by the de legates , sa id t h a t the d r a f t was the outcome of a meeting attended by representa t ives of nine count r ies - not a document draf ted by the WHO Regional Office. I t thus r e f l ec t ed the viewpoints of the Member S ta t e s . He emphasized t h a t the proposed Charter was a dec lara t ion of p r inc ip l e s and was not binding on any government. Since the document was only a dec lara t ion of the p o l i t i c a l a sp i r a t ions of i t s s igna to r i e s each country could pursue i t s own p o l i c i e s and procedures i n r e l a t i o n to the Charter 's provisions.


The meeting on the Charter for Health Development mentioned above had spent three days in arriving at a draft that would be acceptable to all shades of opinion. The Charter was perhaps the first of its kind in the field of health in the entire world, the Charter of Punta del Este being a social document containing only a section devoted to health.

The CHAIRMAN drew the attention of the delegates to the list of participants (Annex 4 of document SEA/RC31/6) and pointed out that the participants were senior responsible officials and had represented various ministries including planning and finance. As mentioned by the Regional Director, the draft was not binding on any of the signatory governments, but only expressed their political aspirations to better the health of their populations.

DR JADAMBAA (Mongolia) clarified that his government fully agreed with the main principles of the Charter and he did not wish to propose any changes in the provisions, since it had been explained that governments need implement only those provisions of the Charter which fitted in with their own policies.

DR HUSSAIN (Bangladesh) said that the present system of providing health services continued to benefit mostly the richer sections of society. He suggested that a WHO consultant be assigned to study the various systems of financing health programmes in order to assess their respective values.

The CHAIRMAN intervened to draw the attention of the delegates to Article 7 of the Charter dealing with resources, adding that it should be the endeavour of governments to allocate maximum inputs to the health sector consistent with national resources. He said he was confident that the Charter would help achieve an increased allocation to the health sector.

DR SOEBEKTI (Indonesia) said that he wished to have a clarification as to who would sign the Charter. The articles of the Charter were not exclusively within the purview of the Ministry of Health. Also, if the Charter was not to be binding on governments, would potential donors accept the validity of the Charter?

The REGIONAL DIRECTOR said, in answer to the question from the delegate from Indonesia, that the Charter was meant to be signed by Heads of State or Prime Ministers. If it were to be a political declaration, it should be signed at the highest level. Cove-nts might or might not use the Charter, or use only some parts of it. If they felt that they could promote their health activities without using the Charter, they were, of course, free to do so.

The CHAIRMAN said that even after its adoption by the Regional Cornittee, the Charter would be thoroughly scrutinized by the ministry of law and other departments concerned. It might be forwarded to governments with the recommendation that it be signed.

As to the suggestion made by the delegate from Bangladesh to appoint a consultant to look into different methods of financing health services, he felt this was a very good one, and hoped that the Regional Director would look into this. He then invited further comments.


MR VOHRA ( Ind ia ) po in ted o u t t h a t t h e C h a r t e r was t h e product of a group c o n s i s t i n g of r e p r e s e n t a t i v e s from Member S t a t e s . H e f e l t t h a t t h e Regional Committee should n o t on ly approve t h e Char te r b u t a l s o make a p o s i t i v e recommendation t h a t i t be s igned by governments.

PROFESSOR SULIANTI ( Indones ia ) s a i d t h a t she would l i k e t o be c l e a r i n h e r unders tand ing t h a t i f t h e Char te rwere t o be s igned by t h e P r e s i d e n t , i t had y e t t o be submit ted t o h i s o f f i c e f o r c l e a r a n c e .

The CHAIRMAN, i n t h e absence o f any f u r t h e r comments, dec la red t h a t t h e consensus of t h e Regional Committee w a s t o endorse t h e Char te r and recommend t o governments t h a t i t be s igned by t h e Head of S t a t e o r t h e Head of t h e Government.

9 S e l e c t i o n o i a Sub jec t f o r t h e Technical&scuss ions -- a t t h e Thirty-second Sess ion of t h e Regional Committee ( i tem 16) - PROFESSOR SULIANTI ( I n d o n e s i a ) , r e f e r r i n g t o t h e s u b j e c t s mentioned i n document ~ ~ A l R C 3 1 1 8 , s a i d t h a t t h e r e w a s no recognized t r a d i t i o n a l system of medicine i n Indones ia , though t r a d i t i o n a l medic ines were widely used. She proposed, t h e r e f o r e , t h e combined s u b j e c t of t r a d i t i o n a l medicines w i t h drug p o l i c y , i n t h e c o n t e x t of primary h e a l t h c a r e .

DR GAITONDE ( I n d i a ) s a i d t h a t w h i l e he suppor ted P r o f e s s o r S u l i a n t i ' s p roposa l , t h e emphasis should be on d rug p o l i c y , and t h e r e f o r e suggested t h e s u b j e c t "Drug p o l i c y , i n c l u d i n g t r a d i t i o n a l medic ines , i n t h e c o n t e x t of primary h e a l t h care".

DR JOSH1 (Nepal) and DR HERAT ( S r i Lanka) suppor ted t h e p roposa l of t h e d e l e g a t e from I n d i a .

Th i s sugges t ion was unanimously agreed , and t h e Committee s e l e c t e d t h e s u b j e c t "Drug p o l i c y , i n c l u d i n g t r a d i t i o n a l medic ines , i n t h e con tex t of primary h e a l t h care" f o r t h e t e c h n i c a l d i s c u s s i o n s at t h e t h i r t y - second s e s s i o n .

1 0 Time and P lace of t h e Thirty-second Sess ion of t h e Regional Couimittee ( i t e m 17)

The REGIONAL DIRECTOR r e p o r t e d t h a t s i n c e no i n v i t a t i o n from any government had been received, t h e th i r ty - second s e s s i o n would au to - m a t i c a l l y be he ld i n t h e Regional O f f i c e i n New Delhi some t ime i n September 1979.

11 Adjournment


SLMMARY MINUTES*

Sixth Meeting, 25 August 1978, 2.30 p.m.

TABLE OF CONTENTS

1 Proposed Regional Programme Budget Estimates for 1980 and 1981 and Consideration of the Report of the Sub-cormnittee on Prograrmne Budget

2 Consideration of the Recommendations Arising out of the Technical Discussions

3 Consideration of Other Draft Resolutions

4 Adjournment

*Originally issued as document SEA/RC31/Min.6, on 26 August 1978.

142 MINUTES OF THE SIXTH MEETING

1 Proposed Regional Programme Budget Estimates for 1980 and 1981 and Consideration of the Report of the Sub-committee on Programme Budget (items 11 and 11.1 of the Agenda)

The REGIONAL DIRECTOR said that the proposed programme budget for the financial years 1980-1981, in which the new procedures for budgeting at the country level had been followed, as spelt out in World Health Assembly resolution WHA30.23, had been prepared in close collaboration between the national authorities and WHO. As a result, the programme budget document showed only programme allocations and the detailed project planning and budgeting within the framework of the present programme proposals would be finalized early next year and submitted to the Regional Committee at its next session.

PROFESSOR SULIANTI (Indonesia), Chairman of the Sub-committee on Programme Budget, said that the Sub-committee had had very fruitful discussions on the programme budget proposals which had been dram up in close consultation with governments, and thanked the Regional Director and the members of the secretariat for the excellent working papers presented to the Sub-committee. She then read out the Sub- committee's report, which was presented to the Regional committee (document SEA/RC31/23).

As there were no comments, the Chairman declared that the report of the Sub-committee on Programme Budget had been approved.

2 Consideration of the Recommendations Arising out of the Technical Discussions (item 12 of the Agenda)

At the invitation of the Chairman, DR NADDA (Thailand), Chairman of the technical discussions, presented the report on the technical discussions (document SEA/RC31/24). He said the fruitful discussions had been summarized in the report and the major conclusions had been further summarized in a draft resolution presented to the Committee with the report.

PROFESSOR SULIANTI (Indonesia) proposed and DR JOSH1 (Nepal) seconded that the draft resolution submitted by the Chairman of the technical discussions be adopted. The draft resolution was adopted with a minor change.

DR HENDERSON (WHO Headquarters) said he had been impressed with the high quality of the technical discussions and wished to thank the secretariat for the excellent work done in bringing out the report and the resolution.

3 Consideration of Other Draft Resolutions

Resolutions on the following subjects which had been prepared by the Sub-committee on Resolutions were adopted with a few changes:

1. Proposed Regional Programme Budget for 1980 and 1981 (SEA/RC31/R2)

2. Thirtieth Annual Report of the Regional Director (SEA/RC31/R3)

MINUTES OF THE SIXTH MEETING 1431144

3 . Development and Coordination of Biomedical and Health Services Research (SEA/RC31/R4)

4. Control and Treatment of Intestinal Parasitic Infections (SEAIRC31lR5)

5. Vector-Borne Disease Control (SEAIRC31fR6)

6. Technical Cooperation Among Developing Countries (TCDC) (SEA/RC31/R7)

7 . Cooperation with Non-health Sectors in National Health Development (SEA/RC31/RB)

8. Charter for Health Development (SEA/RC~~/R~)

9. Time and Place of the Thirty-second Session (SEA/RC3:/R10)

10. Selection of Topic for the Technical Discussions in 1979 (SEA/RC31/R11)

4 Adjourment


SUMMARY MINUTES*

Seventh Meeting, 28 August 1978, 9.30 a.m.

TABLE OF CONTENTS

1 Adoption of the Final Report

2 Resolution of Thanks

3 Adjournment

*Originally issued as document SEA/RC31/Min.7, on 5 September 1978.

146 MINUTES OF THE SEVENTH MEETING

1 Adoption of the Final Report (item 18)

The draft report and its addendum (document SEA/RC31/25 and Add.l), which had been circulated earlier, were adopted with the following corrections suggested by the Regional Director:

Introduction

On page iv, para 2, line 2, omit the words: "consisting of the representatives of all the countries".

PART I1

On page 7, para 1, line 1, for "a regional network of libraries", read "a network of national libraries". - PART IV

On page 10, para 1, line 2, replace the word "extensive" with the word "inexpensive".

2 Resolution of Thanks

DR SANKARAN (India) moved a resolution expressing appreciation to the Government of Mongolia for the excellent arrangements made and warm hospitality shown, and to the Regional Director and his staff for their contribution to the success of the session.

PROFESSOR SULIANTI (Indonesia) seconded the resolution, but suggested that the word "participants" in operative paragraph 1 be changed to "delegates", as she wishedit tobe quite clear that the representatives and alternates from the various governmentswere fullyandindividually appreciative of the facilities provided by the Government and people of the Mongolian People's Republic.

After some discussion, the Committee agreed that "participants" was a comprehensive word and need not be changed, but to remove any possible misunderstanding the phrase would be reworded as "all participants, and the members of the WHO secretariat". The resolution was adopted with this change (SEA/RC31/R12).

3 Adjourment (item 19 of the Agenda)

DR PRAKORB (Thailand) expressed his thanks to the Government of the Mongolian People's Republic for hosting this session in the peaceful city of Ulan Bator and to the Minister of Public Health, his First Deputy and the staff concerned for the warm welcome and hospitality extended to the delegates whichhad made their stay pleasant and enjoy- able. He also wished to thank the Regional Director his remarkable leadership and his staff for their contribution to the success of the session. He also expressed his appreciation to the Chairman and the Vice-Chairman for ably conducting the business of the meeting, and to the guides who had been very helpful.

MINUTES OF THE SEVENTH MEETING 147

DR HERAT (Sri Lanka) also thanked the people and the Government of the Mongolian People's Republic for the warm and generous hospitality extended to the delegates during their stay, which they would cherish in their memories for a long time. He also expressed his gratitude to the Chairman and the Vice-Chairman for very ably conducting the meeting, and thanked the Regional Director and his staff. He said that he would be leaving this country with cherished memories and friends. Addressing his colleagues, he said that meetings such as this provided an opportunity to know each other and understand each other's views and to realize that all belonged to the one family of the human race.

DR SOEBEKTI (Indonesia) stated that his delegation wished to congratulate the Regional Director and his staff for their successful contribution to the meeting and thanked the Chairman and the Vice- Chairman for their smooth conduct of the deliberations. Finally, he wished to thank the Mongolian Government for their warm hospitality, which experience would stay in their memories for a long time.

DR KWON SUNG YON (DPRK) said how much his delegation had appreciated this session of the Regional Committee being held in the Capital of this brotherly socialist country. He stated that the able leadership and performance of the Chairman had brought the meeting to its fruitful conclusion. He thanked the Vice-Chairman and the Chairmen of the technical discussions and the Programe Budget Sub-committee for ably conducting their respective deliberations. He also thanked the Government of the Mongolian People's Republic, and especially the Minister of Public Health, for the excellent arrangements made for the meeting and for their warm hospitality, and the Regional Director and his staff for their hard work. He was pleased that all subjects had been discussed in conformity with the interests of the Member States and in a friendly atmosphere. His government would now make every effort to implement the decisions taken. Finally he wished every one a safe journey home.

DR JOSH1 (Nepal) thanked the Chairman and the Vice-Chairman of the Regional Committee as well as the Chairmen of the technical discussions and the Sub-Comittee on Programme Budget for ably conducting the discussions. He also expressed appreciation to the WHO Secretarldi, both visible and invisible, for their excellent work in bringing out the report in time, and the interpreters and guides for their assistance. Finally, he wished to thank the Government of the Mongolian People's Republic for their wonderful hospitality, which had made them all feel at home.

DR U AUNG THEIN (Burma) conveyed, on behalf of his goverment, his sincere thanks to the Mongolian People's Republic, the Regional Director and his staff for their concerted efforts in making the Regional Committee session a fruitful and successful one. He had been impressed at the remarkable achievements made by the Member States in the field of health through continued cooperation and collaboration among them, and with support from WHO, UNDP, UNICEF and other agencies. He was confident that, under the able leadership of the Regional Director, and through the cooperation of the Member countries of the Region, the target of "health for all by the year2000"


would be reached. He conveyed his appreciation to the Government of Mongolia for making excellent arrangements, which had made their stay pleasant. Referring to the memorable visits to the country's historical and cultural places, he once again expressed his thanks to the Government for their hospitality and friendliness. He also thanked the Chairman and the Vice-Chairman for their untiring efforts in conducting the business of the session successfully.

DR WSSAIN (Bangladesh) expressed his gratitude to the Government of Mongolia for their hospitality and the excellent arrangements made for the Regional Committee. The session, which had been an instructive one, had offered an excellent opportunity to the Member States to exchange their ideas and experiences. He thanked the representatives of the Member States for their cooperation and understanding and for the valuable contributions made to the success of the session. He also conveyed his thanks to the Chairman and the Vice-Chairman, and his appreciation to the Regional Director for his leadership.

DR SANKARAN (India) said that the Regional Committee represented the hopes and aspirations of a billion people. It afforded an opportunity to discuss the health problem existing in the Member States and come to a consensus in regard to the delivery of better health care. He hoped that the Member States would make efforts to implement the decisions made at this session, particularly with regard to specialized programmes such as the expanded programme on immunization.

The session had taken stock of the Region's accomplishments and its failures, the role of the regional organization and that of the Organization as a whole. On behalf of his government, he conveyed to the Mongolian People's Republic his thanks for their having hosted this most important and impressive session. He also thanked the host Government for arranging instructive and educative visits to health centres, and for their hospitality.

He paid special tribute to the Regional Director and his staff for work well accomplished, for the targets well achieved, and for having laid out so well the targets for the future. He also complimented his fellow representatives for their role, and particularly the friendly atmosphere in which all worked together.

He had been particularly impressed by the enormous progress made by the Government of Mongolia in the health field.

MR GLAN DAVIES (UNICEF) wished to associate himself with the sentiments expressed by earlier speakers. He thanked the Government of Mongolia for the services and facilities offered, which enabled them to consider priority health matters, particularly the expanded programme on immunization. He conveyed his heart-felt appreciation to the Mongolian People's Republic for making his visit and stay inMongolia a memorable one, and he wished them every success in their future endeavours.

DR LADNYI (Assistant Director-General, WHO Headquarters) thanked the Government of the Mongolian People's Republic for the warm hospitality extended and the excellent arrangements made for the Regional Committee. He also thanked all the participants in the session for

MINUTES OF THE SEVENTH MEETING 149

their contribution to the deliberations on the expanded programme on immunization. He felt that the expertise of this region would certainly be of benefit not only to the countries of South-East Asia but also to countries in other regions. He was happy to note the achievements made by Mongolia in the prevention and control of many communicable diseases.

The REGIONAL DIRECTOR said he was overwhelmed by a sense of gratitude. The session was one of the most constructive and productive ones, and the deliberations were for him a most stimulating experience. A number of resolutions on several important topics had been adopted. He was happy to note that the members were showing increasing interest in the promotion of research. Further progress in this direction depended on energetic efforts at the country level. He was glad that this Regional Committee had taken the first steps toward studying the question of restructuring the Organization in the light of its functions. He expressed his appreciation to the Chairman for the way in which he had conducted the session and the Chairman's interpreter for his help in this matter. He thanked the Vice-Chairman for ably steering the discussions in the absence of the Chairman. He was also grateful to the Chairman of the technical discussions and the Chairman of the Sub- committee on Programme Budget for conducting their respective sessions. He hoped that the technical discussions on EPI would provide the much needed fillip to the programmes in the Region. He thanked the Resident Representative of UNDP for his statement at the inaugural session, and the UNICEF Regional Director also for his preliminary statement and useful interventions. He requested the Chairman to convey to the First Vice-Chairman of the Council of Ministers of the Mongolian People's Republic, Mr Ragchaa, his deep sense of gratitude for his inaugural address and to the Minister of Public Health, Dr Nyam-Osor, for his inspiring address. He was extremely grateful to the Government of the Mongolian People's Republic for organizing such memorable field visits. On behalf of the participants and the WHO secretariat he thanked the Government once again for the excellent arrangements made for the thirty-first sessionofthe Regional Committee. Finally, he wished all the delegates and other participants bon voyage.

The CHAIRMAN, on behalf of the Government of the Mongolian People's Republic and his delegation, expressed his sincere thanks to the representatives for electing him as Chairman of the thirty-first session of the Regional Committee. He was grateful to them for their generous compliments and to the Regional Director for the kind words expressed by him. Even though he had to communicate through an interpreter, he had been able to conduct the deliberations smoothly entirely because of the wholehearted cooperation, understanding and support extended by all of them.

The Chairman said that he had been much impressed by the keen interest shown by all the representatives during the discussions, and congratulated them on their depth of knowledge and experience of the health problems of the countries. This had led to a positive exchange of views during the session. He thanked the Vice-Chairman and the Chairmen of the technical discussions and the Programme Budget Sub- committee for ably conducting the discussions. He thanked the Regional Director for his able interventions, and also for the patience


and understanding shown by him throughout the session. This session was fortunate in that it had in Dr Gunaratne a health statesman of extraordinary ability, insight, maturity and leadership.

The thirty-first session had many important issues to consider, including the study of the Organization's structure in the light of its functions. He said he was much gratified to observe the spirit of "give and take" and mutual cooperation that permeated the entire session, which had laid down a strong foundation of technical cooperation among developing countries and for regional self-reliance and self-sufficiency. Thanking all the participants for the compliments paid to his country, its people and its leaders, he said that his country considered it a privilege to have hosted the thirty- first session of the Regional Cornittee.

Finally, he wished all delegates a very happy return home and declared the session closed. At the conclusion of the session, the Chairman, who is also the Mongolian First Deputy Minister of Public Health, announced that the Council of the State Medical Institute of the Mongolian People's Republic had decided to confer upon Dr Gunaratne the degree of Doctor of Medicine honoris causa at a function later in the day.

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