WORLD HEALTH ORGANIZATION · 2016-03-01 · WORLD HEALTH ORGANIZATION REGIONAL COMMITTEE FOR THE...

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WORLD HEALTH ORGANIZATION

REGIONAL COMMITTEE FOR THE WESTERN PACIFIC FORTY-FOURTH SESSION

Manila, 13-17 September 1993

REPORT OF THE REGIONAL COMMITTEE

SUMMARY RECORDS OF THE PLENARY MEETINGS

Manila November 1993

WORLD HEALTH ORGANIZATION

REGIONAL COMMITTEE FOR THE WESTERN PACIFIC

FORTY-FOURTH SESSION

Manila, 13-17 September 1993



Manila November 1993

PREFACE

The forty-fourth session of the Regional Conunittee for the Western Pacific was held in

Manila, from 13 to 17 September 1993. Mr Solomone Naivalu (Fiji) and Dr Ana Perez (Portugal)

were elected Chairman and Vice-Chairman, respectively. Dr Chen Ai Iu (Singapore) and

Dr Michel Germain (France) were the Rapporteurs.

The Regional Conunittee met on 13, 14, 15, 16 and 17 September. The Report of the

Regional Conunittee is in Part I of this document, on pages 1-38; the summary records of the

plenary meetings in Part II, on pages 93-274.

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I

! I I I

CONTENTS

PART I - REPORT OF THE REGIONAL COMMITTEE

INTRODUCTION AND SUMMARY 3

I. REPORT OF THE REGIONAL DIRECTOR COVERING THE PERIOD 1 JULY 1991 TO 30 JUNE 1993 .... ................... .................... 5

II. PROGRAMME BUDGET, 1992-1993: BUDGET PERFORMANCE (INTERIM REPORT) ............................................................................ 7

III. SUB-COMMITTEE OF THE REGIONAL COMMITTEE ON PROGRAMMES AND TECHNICAL COOPERATION: REPORT ON COUNTRY VISITS ............................................................................... 9

IV. OTHER AGENDA ITEMS ...................................................................... 10

1. Annual report on AIDS, including sexually transmitted'diseases ................. 10

2. Eradication of poliomyelitis in the Region: progress report ................. ".... 11

3. Nutrition in the Western Pacific Region, including follow-up of the International Conference on Nutrition ........... ............................... 12

4, Development of health research ...... , ..... , . , .......................... ; .. . . . . . . . . . . . . . 13

5. Public health training in the Western Pacific Region ............... .......... ....... 14

6. Fiji School of Medicine .................................... , ......................... :.... 15

7. Regional strategy on health and environment, including follow-up of the United Nations Conference on Environment and Development (UNCED) ............................................ 16

8. Cholera and diarrhoeal diseases ......................................................... 17

9. Health promotion ........................ , ... , .................................... "........ 18

10. WHO Response to Global Change: Report of the Executive Board Working Group ............................ , ......... ,.............................. 19

11. Correlation of the work of the World Health Assembly, the Executive Board and the Regional Committee .................................... 22

12. Selection of topic for the Technical Discussions in conjunction with the forty-fifth session of the Regional Committee .... ,.,....................... 22

13. Time and place of the forty-fifth and forty-sixth sessions of the Regional Committee . .. . . . . .. .. . . .. .. . . . . . . . .. .. .. . . . . . .. .. .. .. .. .. . .. .. .. .. .. .. .. . 22

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V. RESOLUTIONS ADOPTED BY THE REGIONAL COMMITTEE ................... 23

WPRJRC44.Rl

WPRJRC44.R2

WPRJRC44.R3

WPRJRC44.R4

Nomination of the Regional Director ................................ 23

AIDS and sexually transmitted diseases ............................. 23

Global Programme on AIDS: Membership of the Management Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Eradication of poliomyelitis in the Region . . . . . . . . . . . . . . . . . . . . . . . . . 25

WPRJRC44.R5 Report of the Sub-Committee of the Regional Committee on Programmes and Technical Cooperation: country visits .............................. 27

WPRJRC44.R6 Nutrition in the Western Pacific Region ................. ........... 28

WPRJRC44.R7 Public health training in the Western Pacific Region ............. 29

WPRJRC44.R8 Fiji School of Medicine .................................. .............. 30

WPRJRC44.R9 Regional strategy on health and environment ............ .......... 31

WPRJRC44.RlO WHO Response to Global Change ................................... 32

WPRJRC44.Rll Health promotion........................................................ 34

WPRJRC44.RI2 Forty-fifth and forty-sixth sessions of the Regional Committee ............................................ 35

WPRJRC44.RI3 Cholera and diarrhoeal diseases ..................................... 35

WPRJRC44.R14 Development of health research ...................................... 36

WPRJRC44.R15 Special Programme of Research, Development and Research Training in Human Reproduction: Membership of the Policy and Coordination Committee......... 37

WPRJRC44.R16 Action Programme on Essential Drugs: Membership of the Management Advisory Committee ........... 37

WPRJRC44.R17 Selection of topic for the Technical Discussions in 1994 ........ 38

WPRJRC44.R18 Resolution of Appreciation.................. .................. ......... 38

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ANNEXES

1. REGIONAL COMMITTEE FOR THE WESTERN PACIFIC SUMMARY OF PRELIMINARY VIEWS ON THE REGIONAL IMPLICATIONS OF THE EXECUTIVE BOARD ACTIONS EXECUTIVE BOARD WORKING GROUP REPORT ON THE WHO RESPONSE TO GLOBAL CHANGE ................................................ 39

2. LIST OF NONGOVERNMENTAL ORGANIZATIONS WHOSE REPRESENT A TIVES MADE STATEMENTS TO THE REGIONAL COMMITTEE AND SUBMITTED STATEMENTS FOR CIRCULATION TO MEMBERS ....................................................... 65

3. AGENDA ........................................................................................... 67

4. LIST OF REPRESENTATIVES ............................................................... 71

PART II - SUMMARY RECORDS OF THE PLENARY MEETINGS... ................ ....... 93

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PART I


(wpRlRC44/22)

INTRODUCTION AND SUMMARY

The forty-fourth session of the Regional Committee for the Western Pacific was held in ,

Manila from 13 to 17 September 1993.

The session was attended by representatives from Australia, Brunei Darussalam, Cambodia,

China, Cook Islands, Fiji, Hong Kong, Japan, Kiribati, Lao People's Democratic Republic,

Malaysia, Republic of the Marshall Islands, Federated States of Micronesia, New Zealand, Papua

New Guinea, Philippines, Republic of Korea, Samoa, Singapore, Solomon Islands, Tokelau,

Tonga, Tuvalu, Vanuatu and Viet Nam, and by representatives of France, Portugal, United

Kingdom of Great Britain and Northern Ireland and United States of America as Member States

responsible for areas in the Region.

Representatives of the United Nations Development Programme, the United Nations Office

of the High Commissioner for Refugees, the Asian Development Bank and 38 nongovernmental

organizations in official relations with WHO attended the session.

The Committee elected the following officers:

Chairman: Mr Solomone Naivalu (Fiji)

Vice-Chairman: Dr Ana Perez (Portugal)

Rapporteurs

in English: Dr Chen Ai Ju (Singapore)

in French: Dr Michel Germain (France)

At the second plenary meeting, the Committee went into private session to consider

nominations for the post of Regional Director. The Committee unanimously nominated

Dr Sang Tae Han (Republic of Korea), who was the incumbent Regional Director and sole

candidate. The appointment, for a period of five years beginning I February 1994, is to be

proposed to the Executive Board (see resolution WPRlRC44.Rl).

4 REGIONAL COMMITTEE: FORTY-FOURTH SESSION

The Report of the Regional Director on the work of WHO during the period I July 1991 -

30 June 1993 was presented to the Committee and discussed at its first and second meetings. The

Committee expressed its satisfaction with the manner in which the programmes had been carried

out (see Section I).

At the fifth meeting the Sub-Committee of the Regional Committee on Programmes and

Technical Cooperation reported on its visits to Fiji and the Republic of Korea to review WHO's

collaboration in the field of district health systems (see Section III). The Committee endorsed the

recommendations of the Sub-Committee.

The WHO Response to Global Change: Report of the Executive Board Working Group was

discussed at length during the seventh meeting, and consensus reached on issues to be forwarded

to the Programme Committee of the Executive Board in November 1993. A summary of the

points raised is presented in Annex I. The Sub-Committee of the Regional Committee on

Programmes and Technical Cooperation in the meantime was mandated to carry out a more

detailed study for discussion at the forty-fifth session of the Regional Committee (see Section IV).

At the ninth plenary meeting, it was announced that the Director-General had received

letters from the Permanent Missions of the Portuguese Republic and the People's Republic of

China based in Geneva containing declarations that Macao will participate on its own, but without

voting rights, in activities of the Committee. Macao will have its own name plate until

19 December 1999, after which date it will be Macao, China (see document WPRlRC44/SRl9).

The Committee noted the information.

Malaysia was selected to appoint a member of the Management Committee of the Global

Programme on AIDS (see resolution WPRlRC44.R3).

The Philippines was selected to represent the Region on the Policy and Coordination

Committee of the Special Programme of Research, Development and Research Training in Human

Reproduction (see resolution WPRlRC44.RI5).

Papua New Guinea was selected as the Member State to represent the Region on the

Management Advisory Committee of the Action Programme on Essential Drugs (see resolution

WPRlRC44.RI6).

Oral statements were made by the representatives of 11 nongovernmental organizations.

Written statements were received for circulation from 13 nongovernmental organizations

(see Annex 2).

REPORT OF THE REGIONAL COMMITTEE 5

The Committee appointed Mr Christopher Lovelace (New Zea1an4) as Modefator of m~

Technical Discussions on "Information and communication support for primary health care".

In the course of nine plenary meetings the Committee adopted 18 resolutions, which are set

out in Part V.

The agenda appears as Annex 3 and the list of representatives as Annex 4.

I. REPORT OF THE REGIONAL DIRECTOR COVERING THE PERIOD

1 JULY 1991 TO 30 JUNE 1993 (Documents WPRlRC44/3 and Corr.l)

The Regional Director presented his report for the biennium. A radical improvement in

quality of surveillance and timeliness of reporting was noted in regard to poliomyelitis eradication.

Surveillance figures in 1992 recorded 2037 confirmed poliomyelitis cases, the lowest recorded

annual incidence to date in the Region. In addition to the high routine vaccine coverage,

supplementary poliomyelitis immunization activities have been extended through the mobilization

of substantial funds. The Comminee gratefully acknowledged the contributions by WHO's

partners such as UNICEF, Rotary International, etc.

Currently 35 countries and areas have national AIDS programmes. As at

1 September 1993, the number of reported AIDS cases was 5549. It was noted that the main

challenge facing WHO is to make national programmes as effective as possible and to contain

further spread.

In the second evaluation of health for all by the year 2000, the leading causes of mortality

from infectious diseases were shown to be diarrhoeal diseases and acute respiratory infections.

This requires a continued emphasis on correct case management. There are now 35 diarrhoea

training units in the Region, which have provided over 100 clinical case management courses

during the biennium. By the end of 1992 84% of the population had access to oral rehydration

salts, which was noted to be especially important in view of efforts to increase the preparedness of

countries to deal with the new cholera strain Vibrio cholerae 0139.

The Committee was concerned to learn about the resurgence of malaria and tuberculosis,

which are proving irrepressible. The main focus of activities has been in Cambodia and Viet Nam

following considerable rises in the number of microscopically confirmed cases of malaria. The

development of the Chinese drug Qinghaosu will be significant in that regard.

6 REGIONAL COMMITTEE: FORTY -FOURTH SESSION

The growth of WHO's comprehensive computerized progranune management information

system was noted. The Committee heard that the Regional Office had pioneered the use,

regionwide, oflocal area network technology.

The representatives of six Member States spoke on the report in the course of the general

preliminary review. They expressed appreciation of the report's attractive presentation and its

comprehensiveness as a record of fruitful cooperation with Member States in formulating and

implementing health programmes that are closely linked to the six regional priorities.

The representatives of China and Japan referred to the dramatic changes in the international

political and economic situation which have affected health conditions and widened discrepancies.

The serious economic difficulties in the Region have required major adjustments to programmes.

Through careful management, reduced expenditure and increased external resources, the majority

of priority projects have been implemented. The representative of Japan stressed the need for

continued investment in health in the interests of social and economic development and strongly

urged that a consensus be reached on such investment.

The Committee welcomed Japan's expression of increased support for the AIDS control

problem. Japan will host the Tenth International Conference on AIDS in August 1994.

A number of representatives, including China, Cambodia and Papua New Guinea, described

the serious health problems currently encountered and expressed their appreciation of the close

cooperation of WHO and other agencies in improving the health status of their countries.

The action programmes to combat malaria, including the use of permethrin-impregnated

bednets, in Papua New Guinea and Solomon Islands were noted with interest.

The increasing role played by women in the Organization was observed with satisfaction

and in particular in the Regional Committee itself as exemplified by the number of women in the

delegations and the appointment of the Vice-Chairman.

In its discussion of Chapter 2 of the Report: WHO's general programme development and

management, the Committee took note of the recently published report by the World Bank. 1 The

representatives of Australia, France, Samoa and Tonga observed that this provided WHO with the

opportunity to reaffirm its global role of leadership in the health field. Financial institutions such

as the World Bank and ADB, which had access to funds greatly in excess of those available to

IWorld Development Report 1993 Investing in Health. World Development Indicators. published for the World Bank by

Oxford University Press. USA. June 1993.


WHO, should be encouraged to support the Organization instead of trying to exercise a direct role

in the public health field. Improved collaboration and coordination between WHO and the World

Bank and other intergoverrunental and nongoverrunental organizations were therefore essential.

The representative of Tonga pointed out that the World Bank report would be discussed at a

forthcoming meeting of South Pacific goverrunents in Suva and he hoped that WHO would be

represented at that meeting.

II. PROGRAMME BUDGET, 1992-1993: BUDGET PERFORMANCE (INTERIM REPORT)

(Document WPRJRC44/4)

Expenditures and obligations incurred as at 31 May 1993 amounted to US$ 44 446 200,

resulting in an implementation rate of 78% in dollar terms. The budget is expected to be fully

implemented by the end of the biennium.

Representatives praised the informative and clear presentation of the report. The reasons

for the several modifications to the budget and the rationale behind some re-allocation of resources

were discussed. The Committee noted that a similar exercise may have to be conducted for the

1994-1995 budget, particularly if the Director-General again decides to withhold some part of the

budget.

The representatives of Australia and the United States of America asked for amplification of

the reasons for the 37% increase in support services costs.

The Regional Director's detailed response emphasized that the Regional Office required a

wide range of staff with the technical expertise and experience to advise Member States and that it

was important to distinguish between technical and administrative staff. The support services

represented a very small part of the total budget.

The prioritization exercises were explained, noting that they paved the way for a

restructuring of the Regional Office and its programmes for the future.

The representative of Tonga, noting the budgetary problems faced in 1992-1993, asked for a

realistic analysis of the prospects for the next biennium and beyond.

The Regional Director stated that at the forty-third session of the Regional Committee in

Hong Kong in 1992, he advised that the expected budget shortfall for the 1994-1995 biennium


would be US$ 4.3 million but this was now projected at US$ 9.4 million as a result of recosting

taking into account inflation and other factors. He outlined the measures being taken by the

Secretariat to cut expenditures sharply and manage the expected deficit, including the freezing of

posts. He noted that the projected shortfall did not take into account the possibility of any further

withholding of funds by the Director-General for the next biennium. He also advised that the

instructions for the preparations for the 1996-1997 biennium were not to take any cost increase

factor into account, and further, that 3% of the planning allocation was to be withheld by the

Director-General for allocation at a later date.

The Director-General acknowledged the Regional Director's strong request to use the

withheld 3 % for regional priorities. The Director-General continued that with reference to the

possibility of withholding up to 10% in 1994-1995, it had been necessary to aim for zero or even

negative growth in the budget of the next biennium because of the non-payment of arrears by a

major contributing country. He agreed with a comment by the representative of France on the

need to intensify cooperation with countries in greatest need, noting that the flow of funds from

bilateral and multilateral sources was increasing.

Representatives expressed serious concern over the non-payment by some Member States of

contributions and the resultant withholding of funds by the Director-General. The representatives

of Tonga and Samoa urged major contributors to pay on time. The representative of Papua New

Guinea raised several questions about the contributions from the Region and the implications for

the Region of non-payment.

The Committee heard that contributions still to be paid by eight Member States in the

Region amount to US$ 2 887 000, but that the main problem is with Members outside the Region

that cannot meet their obligations.

The Director-General elaborated on the funding difficulties faced by the other regions and

the problems caused by non-payment of contributions. If non-payment continued, a significant

reduction in WHO's normative function and direct cooperation with Member States might have to

be considered, alternatively, WHO faces complete structural change. However, it is hoped that

the financial situation will be back to normal in one or two years.


III. SUB-COMMITTEE OF THE REGIONAL COMMITTEE ON PROGRAMMES

AND TECHNICAL COOPERATION: REPORT ON COUNTRY VISITS

(Document WPRlRC44/8)

9

The report introduced the visits of the Sub-Committee to Fiji and the Republic of Korea to

review cooperation in the field of district health systems and to observe whether the district health

system approach is really a part of overall health development in those countries. The Committee

was informed that there is a strong link, and an awareness of the importance of integrating and

coordinating the functions of the hospital and public health at the district level. Strong leadership

and clear lines of authority are key elements in the successful working of the system.

The representative of the United States of America endorsed the conclusions and

recommendations of the Sub-Committee, supported by several other representatives. He

commended the efforts made by both countries to conduct effective research projects to further the

development of health systems. He requested further information on how the significant reduction

in infant mortality in Fiji had been achieved. He also suggested that the Regional Director might

wish to examine the validity of primary health care as a model for reducing treatment and

rehabilitation expenditures. The Director, Health Services Development and Planning replied that

the improvement in infant mortality and other health indicators in Fiji was probably attributable to

the general improvement in socioeconomic standards and equitable access to health services.

The representative of Fiji responded to each of the Sub-Committee's recommendations in

turn, noting where steps towards implementation were already under way. The Committee was

assured of Fiji's support for the proposals of the Sub-Committee. Fiji expects to be able to report

good progress in the implementation of the recommendations by the end of the biennium.

An example of a project for the introduction of a district health system in Hong Kong was

described by the representative of Hong Kong. The Committee was also informed by the

representative of Portugal of the progress of Macao's adoption of an integrated health policy based

on primary health care.

The representative of the Republic of Korea recognized the excellent report of the

Sub-Committee which will be of great help in planning the nationwide implementation of district

health systems.

It was noted that the Government of Papua New Guinea is proposing to introduce a new

policy on district hospitals and looks forward to collaboration with WHO on implementation of

policies.

10 REGIONAL COMMI'ITEE: FORTY-FOURTH SESSION

The support of WHO was recognized by the Cambodian representative, who infonned the

Committee that his Government, in collaboration with WHO, had restructured the entire health

system, with resources concentrated on the district level.

The Committee was reminded by the representative of Solomon Islands, supported by the

representative of New Zealand, that a South Pacific island should be visited each year by the

Sub-Committee.

The health systems of Cook Islands, Tokelau and Tuvalu were described to the Committee.

The representative of Tuvalu outlined the country's health policy, which is based on primary

health care with a significant element of community involvement.

The Philippines, Singapore and Solomon Islands will be visited by the Sub-Committee in

1994. The subject for review will be "health and sustainable development - environmental

health" .

The Committee adopted resolution WPRlRC44.R5.

IV. OTHER AGENDA ITEMS

1. Annual report on AIDS. including sexually transmitted diseases

(Document WPRlRC44/5 Rev. 1)

The Committee had before it the annual report on AIDS. This provided a more detailed

review than usual in response to a request for a comprehensive report on the programme. All

Member States have established national AIDS committees. The Regional Office estimates that

between 50 000 and 100 000 people are already infected with HIV in the Region.

The representatives of 23 Member States spoke on this item. They reported on

the incidence and prevalence of the disease and on the measures being taken in their respective

countries to contain the spread of HIV infection and AIDS, including health education and

promotion, media information, condom use, strengthening of HIV surveillance, screening of blood

products and avoidance of needle or syringe sharing.

High-risk groups such as commercial sex workers and injecting drug users are a common

concern. The Committee noted the adoption in Australia of cost-effective measures such as the

funding of sex worker groups so that they can organize themselves and insist on use of condoms,


and the setting up of needle or syringe exchange schemes in major cities for injecting drug users.

The example was given of the expansion of education and intervention programmes for groups at

risk in the Philippines; and in Viet Nam, the organization of programmes to combat drug use and

control prostitution, including provision of rehabilitation measures.

Another concern raised in the course of the discussion was infection among health care

workers. The representative of Hong Kong urged the preparation of up-to-date WHO guidelines

for the national health authorities. Guidelines in other regions recommend that infected health

workers should refrain from invasive procedures. WHO will endeavour to draft global guidelines.

In response to questions raised by the representatives of Australia, New Zealand and the

United States, the Committee was informed that efforts will be made to provide examples of

successful interventions, especially among commercial sex workers and injecting drug users, in the

1994 report to the Committee. Further information will be provided by WHO headquarters.

The Global Programme on AIDS is contracting. The number of staff at regional level will

be reduced. The Committee observed that a continued reduction of resources, and management of

the AIDS programme from headquarters in Geneva might jeopardize the short-term and

medium-term plans of Member States.

The Committee also noted the need to strengthen the surveillance and reporting system. A

study will be conducted on the introduction of new reporting forms and on the type of data to be

included. Also in response to this concern, the new AIDS Surveillance Report is being published

by the Regional Office every six months.

These and other issues raised by representatives were reflected in resolution

WPRlRC44.R2, which the Committee adopted.

2. Eradication of poliomyelitis in the Region: Progress report (Document WPRlRC44I7)

The representatives of 16 Member States commented on this agenda item.

The Committee noted the great progress made towards the goal of poliomyelitis eradication.

The number of reported cases in 1992 fell to 2087, representing a 21 % reduction on the previous

year and the lowest annual total ever reported to the Region. This was due to increased supplies

of vaccine, widespread supplementary immunization activities, improved surveillance and

continued high coverage by the Expanded Programme on Immunization in the Region. The

Committee welcomed the Philippines' initiative in organizing national immunization days and

urged other Member States to emulate that example.

12 REGIONAL COMMITIEE: FORTY-FOURTH SESSION

Appreciation was expressed of the support of several Member States, including Australia,

France, Japan and the United States, as well as of collaborating agencies such as Rotary and the

Agency for Cooperation in International Health in Japan, which have provided or pledged funds

for oral poliovirus vaccine. In view of the critical need for countries to conduct

national immunization days during the months of low transmission in 1993-1994, the need for

continued mobilization of national and international support was emphasized. A continued

shortfall in resources, particularly of poliovirus vaccine supplies was reported by many Member

States.

The Committee recognized the need expressed by the representative of the United States of

America to ensure the potency, safety and efficacy of vaccine. The Regional Director assured the

Committee that due attention would continue to be given to those aspects, although a balance

needed to be maintained between quality on the one hand and affordability on the other. The issue

might be addressed at the Vaccine Development Initiative meeting at Kyoto, Japan, in November

1993.

In reply to a question by the representative of France on the use of the injectable poliovirus

vaccine (IPV) preparation, the Committee was informed that oral poliovirus vaccine was the

vaccine of choice recommended by the EPI Global Advisory Group and would continue to be used

during the poliomyelitis eradication phase.

The Committee adopted resolution WPRlRC44.R4, which reflected the various concerns

noted by representatives.

3. Nutrition in the Western Pacific Region. including follow-up of the International Conference

on Nutrition (Documents WPRlRC44/9 and Add. 1)

The Committee heard reports from 18 countries and areas describing the measures adopted

to prevent and alleviate problems stemming from malnutrition, micronutrient deficiencies and

inappropriate nutrition.

In reviewing the working documents WPRlRC44/9 and Add. 1, the Committee noted that the

total response rate on action taken in the field of infant and young child nutrition and

implementation of the International Code of Marketing of Breast-milk Substitutes was 74 %,

representing 26 countries and areas in the Region. Thirteen governments reported some form of

implementation of the Code. There are now 135 "baby-friendly" hospitals in eight countries.

With respect to the follow-up on the joint F AO/WHO International Conference on Nutrition held

in Rome in December 1992, it was noted that proposals for support in developing national plans


of action had been received from Cambodia, the Lao People's Democratic Republic and Viet Nam.

The representative of the Philippines announced that his Government has also launched a plan of

action.

A number of Member States, in particular those of New Zealand, Singapore, the Republic

of the Marshall Islands, France (for French Polynesia) and Tokelau drew attention to the

increasing burden on the health services due to noncommunicable diseases attributable to dietary

factors. This was particularly notable in New Zealand where, in 1990, one third of all deaths

were considered to be attributable to dietary factors. Ischaemic heart disease is a leading cause of

death followed by cancer. In Singapore likewise, the principal cause of death is noncommunicable

disease related to unhealthy lifestyles and inappropriate diets.

The Committee noted that, to deal with this problem, New Zealand introduced a national

nutrition policy in 1992 and disseminated guidelines to such population groups as adolescents and

old people. Also in 1992, Singapore launched a ten-year healthy lifestyle programme to reduce

the risk of chronic degenerative disease.

The representative of the United States of America referred to the initiatives of USAID in

the fields of nutrition deficiencies and breast-feeding. USAlD intends to promote breast-feeding

as one of the most cost-effective means of improving child survival.

The representative of New Zealand, observing that dairy and meat products contributed

greatly to fat consumption, said that innovative strategies would be needed to involve the food

industry in a multisectoral approach to nutrition action plans. The Committee reflected this

concern and other issues raised by representatives in resolution WPRlRC44.R6.

4. Development of health research (Document WPRlRC44/10)

The Committee reviewed the two main purposes of the programme; to obtain results that

solve problems related to achieving health for all, and to strengthen national research capabilities.

Efforts have been made to promote national research coordination so as to direct research towards

solving priority problems. A more direct focus is needed on studies of priority areas which can

immediately and directly be used to eliminate or reduce the health problems of the people.

The Committee endorsed the observations and recommendations of the Western Pacific

Advisory Committee on Health Research and the directors of health research councils or

analogous bodies at their meeting in August 1992.


Representatives stressed the need to establish a regional information network. The

representative of the Republic of Korea gave an example of a development of such a computerized

system in his country. This was supplemented by the representative of Japan who described

computer networking and its advantages for communications between collaborating centres in the

Region. This was felt to be very promising by the Comtnittee, provided that funds were available.

The important role of the collaborating centres in contributing to research and the transfer

of technology to the developing countries of the Region was discussed. The role of the national

health research councils or analogous bodies in terms of research used by WHO was explored in

discussion initiated by the representative of the United States of America. He sought clarification

of the criteria by which operational research awards were made and the levels of those awards.

He was infonned that the main criterion used was whether the findings would contribute to the

solution of health problems.

The topic of the safety and efficacy of vaccines was raised by the representative of France.

He referred to a report recently published by the World Bank and suggested that WHO should not

subsidize local production of vaccines as it was not efficient to conduct immunization campaigns

with poor quality vaccines. He reminded the Committee of the availability of expertise in the field

of research and training programmes at the Pasteur Institute in New Caledonia and at the Malarde

Institute in French Polynesia.

The status of various health research projects in Brunei Darussalam, Malaysia and Solomon

Islands was mentioned.

WHO hopes in future to publish the research findings of collaborating centres in an official

WHO document and to disseminate this within and outside the Region. Member States were

urged to encourage collaborating centres to produce high quality results.

Resolution WPRJRC44.RI4 was adopted as a result of the Comtnittee's deliberations.

5. Public health training in the Western Pacific Region (Document WPRJRC44/11)

The interim report on public health training resources in the Region, prepared in response

to resolution WPRJRC43.R9, provided a preliminary assessment of postgraduate training

resources. The report highlighted the importance of improving the relevance of training

programmes to regional requirements as well as the need to establish formal links between

institutions. The directory of training institutions in the Western Pacific Region will be

completely revised in 1994 using an extensive cross-indexing format.


The representatives of eight Member States reported on the situation of public health

training in their respective countries and areas. A number of countries depend almost entirely on

external public health training facilities. The major role played by WHO in this area and the

support provided by other countries are thus greatly appreciated.

The Committee welcomed the opportunities for sharing provided by the Asian-Pacific

Academic Consortium for Public Health and other bodies offering scope for inter-related

networking, including the Network of Community-Oriented Educational Institutions for Health

Sciences. It noted that in Australia consortia were currently being developed to link public health

schools. It is hoped that the model can be extended to other countries in due course.

In adopting resolution WPRlRC44.R7, the Committee requested the Regional Director,

inter alia, to enhance the role of the Regional Office as coordinating centre for exchange of

information on public health training and research institutions in the Region and to support the

development of collaborative arrangements among regional institutions in order to maximize

resources.

6. Fiji School of Medicine (Documents WPRlRC44/12 and Corr.l)

The Committee reviewed the report on the Fiji School of Medicine. This was prepared in

response to the request that progress be monitored in implementing the 1989 Plan of Action. This

concerned revitalizing the School as a centre for training health personnel for the Region.

The representative of Fiji reviewed the progress in implementing the plan of action for the

School's redevelopment. This has been a collaborative effort between the School Faculty, the

Ministry of Health, WHO and a task force of medical educationalists and administrators. The first

phase, covering curriculum reform and academic changes, has been implemented and the first

cadre of public health practitioners will graduate at the end of 1993. It is hoped that the School

will enjoy a measure of autonomy through the establishment of an independent council as

controlling body. WHO is cooperating in this respect. The Fiji Ministry of Health is also

accelerating efforts to identify funding from donor agencies for new buildings to house teaching

facilities, offices and student accommodation.

The representative of Fiji assured the Committee of his Ministry's full commitment to the

implementation of the plan of action.

The representatives of Cook Islands, Kiribati, the Federated States of Micronesia, Samoa,

Solomon Islands, Tokelau, Tonga and Tuvalu endorsed the comments of the representative of Fiji,


stressing the importance of the School as a centre of health training in the Pacific. Donor

countries were urged to contribute generously to the School's requirements.

The representative of Samoa stressed the need for solid cooperation between the Fiji School

of Medicine and the Faculty of Medicine at the University of Papua New Guinea. The two levels

of training to be given must provide a balanced approach between public health teaching and

clinical curative teaching.

The Committee adopted resolution WPRlRC44.RB.

7. Regional strategy on health and environment. including follow-up of the United Nations

Conference on Environment and Development <UNCED> (Document WPRlRC44113)

The Committee had before it for review document WPRlRC44/13 which was intended to

serve as a framework to guide health and environment activities over the following six years. It

took note of the new WHO Global Strategy for Health and Environment, endorsed by the

Forty-sixth World Health Assembly in May 1993. The regional strategy calls for a fresh look at

the way traditional activities are handled. Special attention needs to be paid to pinpointing priority

activities based on considerations of significance, timeliness and practicability. The Strategy

should be supported by plans of action addressing each of the priority activity areas identified,

which should be dynamic documents responsive to changing circumstances.

The representatives of eleven Member States spoke on the agenda item, a number of them

providing the Committee with a summary of recent activities and measures adopted in their

respective countries and directed towards arresting or reversing the consequences of environmental

degradation. Those measures included, among others described by Member States, the adoption

of a Green Plan comprising six environmental action programmes in Singapore; the

implementation of an environmental protection plan in the Republic of Korea; the setting up,

inter alia, of the Philippine Council for Sustainable Development in the Philippines; and the

development of a National Contingency Response Plan in Malaysia.

A number of representatives, in particular the Philippines, Portugal and Tonga, emphasized

the magnitude and complexity of environmental health issues and problems. These call for an

intensification of support from the international community for the implementation of national

plans of action within the framework of the regional strategy.

The representative of Japan stressed the importance of effective networking among

organizations and the need to set priorities. The representative of the Philippines also called for

the setting up of a framework for regional cooperation on transboundary issues such as transport


of toxic wastes, export of hazardous or toxic processes and materials and wildlife trade, and the

exploitation of forest resources.

Four representatives (China, Malaysia, Portugal and the Republic of Korea) drew attention

to the deteriorating quality of air and called for stricter air pollution control, particularly as it

relates to motor vehicle emissions.

The Committee was infonned that a final draft of the revised WHO guidelines on drinking

water quality, which are to be published by WHO headquarters, is available in the Secretariat for

consultation by Member States. Collaboration is already being provided for the revision of

national legislation on water quality.

Contributions to the Capacity 21 initiative, developed by UNDP for the plan of action of

Agenda 21 with a proposed budget of some US$ 5 billion, now totalled some US$ 1.2 billion.

The WHO environmental health programme at headquarters has been infonned of the need to

approach UNDP to ensure that at least 10% of those funds are available for health-related projects.

Health officials in Member States should therefore encourage and collaborate with their

counterparts in the environmental field in that regard.

The Committee adopted resolution WPRlRC44.R9 to reflect some of the issues raised in the

discussion.

8. Cholera and diarrhoeal diseases (Documents WPRlRC44/14 and INF.OOC'/l)

The Committee was updated on the. spread of the new strain of cholera, Vibrio cholerae

0139. The progress made by the diarrhoeal disease control programme in the Region, particularly

with regard to increasing access to and use of oral rehydration therapy, the scope of the training

given to health workers, the number of courses conducted, and the undertaking of evaluation

activities was also reviewed.

Representatives of nine countries described the status of diarrhoeal disease control activities

in their countries, and where relevant, the incidence of cholera. The guidelines for cholera control

sent by WHO to Member States have been found useful. The representative of the Lao People's

Democratic Republic asked for these to be translated into the Lao language.

The representatives infonned the Committee of the measures taken in their countries to

prepare for outbreaks of cholera. The representative of Malaysia announced that 20 cases of the


new 0139 strain had just been reported. The representative of China reported that 167 cases due

to Vibrio cholerae 0139 have occurred in Xinjiang Autonomous Region.

The representative of the Philippines suggested that increased political support for the

diarrhoeal diseases programme might result from the cholera epidemic. Measures such as building

safe water and sewnage systems and improving sanitation would be important. She also

suggested that there should be more focused epidemiological studies on transmission and

appropriate control measures.

It was noted by the Committee that a high priority should be given to the prompt reporting

of cholera according to the International Health Regulations (Article 3) in order to promote

international collaboration in the control of the disease.

The Conunittee adopted resolution WPRlRC44.RI3 in response to the issues raised during

its deliberations.

9. Health promotion (Document WPRlRC44fI5)

Health promotion has been recognized as a priority in the Region since 1989. Through

extensive discussions, consensus on an outline for future strategies was reached, and presented to

the Conunittee for endorsement. The Secretariat was commended on having taken the initiative to

strengthen health promotion in the Region.

Representatives from 15 Member States spoke on this agenda item, providing a description

or an update of the status of health promotion activities in their countries.

The Committee agreed that such activities must involve individual and collective

responsibility for health. It is not enough to improve health services; a multisectoral approach to

health and well-being will be necessary both nationally and internationally.

It is the responsibility of the Member States to provide a health promoting environment and

to formulate the national public policies to enable this. The Conunittee noted the difficulties in

finding the right balance between behavioural patterns and the responsibilities at the individual and

collective levels. The need to develop programmes that enable individuals in the different stages

of life to improve their own health and the health of their families was another important issue.

The role of health research in the area of health promotion was observed, in particular as

regards the potential role of the collaborating centres in finding the best ways of developing

lifestyles conducive to health in different age groups.


The Committee commented on the requirement for the health sector to take the initiative in

securing intersectoral commitment. The support of other components of government will be

important in championing health promotion and healthier lifestyles.

In this regard the representative of the United States reminded the Committee of the

resolution on health promotion and protection passed at the forty-ninth session of the Economic

and Social Commission for Asia and the Pacific (ESCAP) in which WHO was invited to present a

paper on the eradication of preventable diseases at the 1994 ESCAP Ministerial Conference.

There was clear support from the Member States during that meeting for the concept of health

promotion in relation to disease control as a component of social and economic development.

Cultural appropriateness of health promotion measures was an issue raised by

representatives of two countries, who noted that respect for the social and cultural structure of the

targeted population is essential.

In this regard the representative of Japan reminded the Committee that an international

forum on the subject of "health and cultural cities" will take place in Nangoku City, Kochi

Prefecture, Japan in November 1993.

Resolution WPRlRC44.Rll was adopted by the Committee.

10. WHO Response to Global Change: Report of the Executive Board Working Group

(Documents WPRlRC44/18 and Add. 1)

The Committee reviewed the process by which the Report of the Executive Board Working

Group and associated documentation from the Programme Committee of the Executive Board came

about, and the initial analysis of its regional implications and requirements for action prepared by

the Secretariat for consideration and discussion by the Committee.

The report highlights the major issues to be confronted if effectiveness and efficiency were

to be improved but does not mention the specific aspects of how to deal with these major issues,

nor the source of the additional resources required to effect them. It was also noted, as an aspect

to be considered, that the report hardly mentions the role of regions, although the

Director-General in his address to the Committee at the opening of the session had been explicit in

his support of a strong role for the regions. The Committee also noted with attention the

reiteration by the Director-General of its prerogative to decide upon its own method of work, and

the request to be active in the reform process. The Committee strongly endorsed the proposal that

the recommendations of the Working Group should be reviewed by the regional committees with

their view being reported to the Executive Board at its ninety-third session in January 1994. The


discussions of the Regional Committee of the Western Pacific will also be presented to the

Programme Committee of the Executive Board in November 1993 before submission to the Board

in January 1994.

Although almost all of the Working Group's report have implications for the Region, it was

felt that not all of the 47 recommended "Executive Board actions" were in areas directly requiring

response by the Region. Of those actions requiring response by the Region, a number involved

issues already being actively addressed by the Region.

Responding to the issue of "compartmentalization" raised in the Working Group Report, the

Committee stressed that regional diversity, as the Director-General had himself noted, was a

strength and a resource. With respect to the Working Group's specific reference to information

systems, it was noted that the Region's experience was proving instructive to other regions.

The representative of Japan remarked that the feasibility of the Working Group's report in

regional terms must be seriously considered, as must the question of how action for change was to

be financed.

The representative of Australia warned that other organizations are waiting to take WHO's

place if it does not perform. He said that WHO must concentrate on results, and that its future is

at stake.

The discussion of the report, though in general supportive of its direction and of the

initiative, centred on certain issues of concern to representatives. Four representatives urged that

particular attention should be paid to clarification of the roles of headquarters and the regional

offices, with decentralization and a proper devolution of responsibilities where regions had a

specific area of concern such as malaria. The key role to be played by the regional office in

suggesting and implementing reform was stressed, with the recognition that WHO must function

as one body throughout the world.

There was strong general agreement that the office of the WHO Representative should be

strengthened to enable informed, substantive decisions to be taken at country level.

It was agreed that the Sub-Committee of the Regional Committee on Programmes and

Technical Cooperation should be the vehicle for further detailed consideration of the many

complex issues raised by the report. The role and method of work of the Regional Committee will

be one such issue.


The Sub-Committee will investigate and elaborate upon the questions raised during the

discussions and report to the Regional Committee in September 1994, prior to the report of the

Regional Committee to the Executive Board Working Group in January 1995. It was also noted

that this timetable allowed the representatives to refer the issues to their governments for further

discussion, so that debate at the next session of the Regional Committee will be meaningful.

Support was expressed for the concept of "zero-based budgeting" with more efficient use of

the resources available to WHO.

Reorganization, better staffing with more qualified personnel recruited from a larger pool of

international experts, and greater use of institutions and centres of excellence such as the WHO

collaborating centres were means discussed by which WHO can exercise its leadership in

international health work.

There was considerable discussion over the nomination and terms of office of the Director

General and regional directors. The representatives of Fiji and Viet Nam supported a limitation of

the terms of appointment of the Director-General and regional directors to two or at most three

terms, for reasons of flexibility and continuity. The representative of Australia urged two terms

only and the use of a search committee for candidates. This was supported by the representatives

of the United States of America and New Zealand, although the latter noted that the idea of a

search committee was only one of several options. The representative of China remarked that the

issue needed careful study. The representative of Tonga drew the Committee's attention to the

fact that any proposed change in the nomination process would oblige the Committee to amend its

Rules of Procedure as established in Article 49 of the Constitution of WHO.

The representative of France suggested that the Sub-Committee should look at the

nomination and terms issue. This was supported by the representatives of Solomon Islands and

Tonga. The latter noted that there was therefore no need to reach a consensus on the matter

immediately. The Committee must have time to consider the many aspects of the question

thoroughly. The representative of Japan challenged the need for change, saying that as there was

no apparent defect in the present system there was no need for change. This was supported by the

representative of Cook Islands. In conclusion it was accepted that the Programme Committee of

the Executive Board should be informed that there was as yet no consensus on this point, which

would be studied further by the Sub-Committee.

There was general agreement that the issues raised in Section 6 of the Regional Committee

document WPRlRC44/18 should be brought to the attention of the Executive Board as a concern in

the Region.


In summing up, the Regional Director noted that the preliminary report of the Regional

Committee will consist of the summary record of the session, with a tabular presentation of the

issues discussed. This will consist of a revision of the table presented as Annex 4 of the working

document WPRlRC44/18.

The Committee agreed to adopt resolution WPRlRC44.RlO as a result of its discussions.

11. Correlation of the work of the World Health Assembly. the Executive Board and the

Regional Committee (Documents WPRlRC44/19 and WPRlRC44/20)

The attention of the Committee was drawn to document WPRlRC44/l9 containing eight

resolutions of relevance to the Region, adopted by the Forty-sixth World Health Assembly.

The Committee also reviewed document WPRlRC44/20 showing the correlation between the

Committee's current agenda and items to be discussed at the ninety-third session of the Executive

Board and the Forty-seventh World Health Assembly.

There were no comments.

12. Selection of topic for the Technical Discussions in conjunction with the forty-fifth session of

the Regional Committee (Document WPRlRC44/21)

The Committee, after reviewing document WPRlRC44/21 , decided to select the topic "Drug

quality assurance" as the subject for the Technical Discussions in conjunction with the forty-fifth

session of the Regional Committee (see resolution WPRlRC44.RI7).

13. Time and place of the forty-fifth and forty-sixth sessions of the Regional Committee

The representative of Malaysia confirmed his Government's invitation to hold the forty-fifth

session of the Regional Committee in Malaysia. The dates for the session will be 19 to

23 September 1994. The forty-sixth session (1995) will be held at regional headquarters in Manila

(see resolution WPRlRC44.RI2).

REPORT OF THE REGIONAL COMMlTIEE 23

V. RESOLUTIONS ADOPTED BY THE REGIONAL COMMITIEE

WPRlRC44.Rl NOMINATION OF THE REGIONAL DIRECTOR

The Regional Committee,

Considering Article 52 of the Constitution; and

In accordance with Rule 51 of its Rules of Procedure;

1. NOMINATES Dr Sang Tae Han as Regional Director for the Western Pacific; and

2. REQUESTS the Director-General to propose to the Executive Board the appointment of Dr Sang Tae Han for a period of five years from 1 February 1994.

Second Meeting, 13 September 1993

WPRlRC44.R2 AIDS AND SEXUALLY TRANSMITIED DISEASES


Having considered the annual report on AIDS, including sexually transmitted diseases;l

Noting the upward trend of HIV infection and AIDS and the high incidence of sexually transmitted diseases in the Region;

Recognizing the need for education on transmission and prevention of HIV and other sexually transmitted diseases in the general population and special population groups;

Considering the individual risk behaviours that promote the spread of HIV infection and AIDS and sexually transmitted diseases;

Appreciating the diversity of cultures, traditions and behaviour patterns indigenous to the Region and their varying effects on the risks of HIV transmission;

Noting with concern the reduction of resources at the country and regional levels;

Noting the importance of the safety of blood and blood products;

1. URGES Member States:

(1) to give stronger political commitment to AIDS and sexually transmitted diseases prevention and control programmes;

1 Document WPRlRC4415.


(2) to increase involvement of other government departments or ministries in the planning and execution of national AIDS and sexually transmitted diseases programmes;

(3) to encourage the active participation of nongoverrunental organizations in planning and implementation of national AIDS and sexually transmitted diseases programmes;

(4) to strengthen surveillance of HN infection and AIDS and sexually transmitted diseases by making reliable and up-to-date data available, and to enhance the safeguarding of patient confidentiality;

(5) to promote scientific studies of sexual behaviours and other sociocultural factors influencing the risks of HIV tr;msmission including cost-benefit studies of specific intervention or control programmes;

(6) to encourage increased exchange of information and experience and to provide additional information needed in the prevention and control of AIDS and sexually transmitted diseases;

(7) to focus socially and culturally relevant initiatives and use of resources to reduce the prevalence of risk activities responsible for HN transmission, such as commercial sex activity, injecting drug use, and the spread of sexually transmitted diseases;

(8) to move progressively towards 100% screening of blood and blood products in the Region;

2. REQUESTS the Regional Director:

(1) to continue technical collaboration with Member States in the prevention and control of AIDS, sexually transmitted diseases and injecting drug use;

(2) to seek an increase in the provision of Global Programme on AIDS resources for optimum implementation of AIDS and sexually transmitted diseases programmes, and for control of injecting drug use in the Region;

(3) to coordinate further with donor agencies to ensure that maximum benefit is gained from all external resources;

(4) to continue to report annually to the Regional Committee on the regional situation of AIDS and other sexually transmitted diseases.

Fifth Meeting, 15 September 1993

WPRlRC44.R3


GLOBAL PROGRAMME ON AIDS: MEMBERSHIP OF THE MANAGEMENT COMMITTEE

The Regional Conunittee,

25

Noting that the tenn of the Republic of Korea as a member of the Global Programme on AIDS Management Conunittee expires on 31 December 1993,1

SELECTS Malaysia as the Member State of the WHO Western Pacific Region whose representative shall be a member of the Global Programme on AIDS Management Conunittee for a period of three years from 1 January 1994 to 31 December 1996.

Fifth Meeting, 15 September 1993

WPRlRC44.R4 ERADICATION OF POLIOMYELITIS IN THE REGION


Recalling resolutions WPRlRC39.RI5, WPRlRC41.R5, WPRlRC42.R3 and WPRlRC43.R3, which call for the eradication of poliomyelitis in the Western Pacific Region by the year 1995, resolution WHA46.33, and the deliberations of the Executive Board in January 1993;

Having considered the progress report of the Regional Director on the eradication of poliomyelitis in the Region;2

Noting the decrease in the number of reported poliomyelitis cases in 1992 to 2087, the lowest ever reported to the Western Pacific Regional Office;

Noting the continued progress towards poliomyelitis eradication made during the last year, with increased supplies of vaccine, widespread supplementary immunization activities, improved surveillance, and continued high Expanded Programme on Immunization coverage in the Region;

Appreciating the increased level of activities for poliomyelitis eradication as countries implemented their national plans of action, in particular the Philippines, where the Government successfully conducted the first national immunization days in the Region;

Recognizing, however, that there continues to be a shortfall of resources, including the supply of poliovirus vaccine, to achieve the 1995 poliomyelitis eradication goal;

Emphasizing the critical need for countries to conduct national immunization days during the months of low transmission in 1993-1994 in all countries where poliomyelitis is still endemic to achieve the 1995 target;

1 Document WPRlRC44/6.

2Document WPRlRC44/7.


1. REAFFIRMS that experience over the last year has continued to show that poliomyelitis eradication in the Western Pacific Region by 1995 is achievable and will serve to further improve routine Expanded Programme on Immunization activities;

2. URGES all Member States reporting poliomyelitis cases:

(1) to conduct national immunization days during the months of low transmission each year until 1995 with proper planning and monitoring of activities;

(2) to implement acute flaccid paralysis surveillance and further improve the timeliness and completeness of reporting, including collection and analysis of stool specimens;

(3) to evaluate systematically poliomyelitis eradication activities, to document achievements and to identify issues hindering further improvement of activities;

(4) to continue to mobilize national and international support for poliomyelitis eradication, particularly for the procurement of oral poliovirus vaccine;

3. URGES also all Member States reporting no poliomyelitis cases:

(1) to remain vigilant for the possible importation of poliomyelitis cases and to develop plans and systems to rapidly detect and control imported or any other cases;

(2) to further increase financial support of poliomyelitis eradication activities for those countries which are still reporting cases, particularly procurement of oral poliovirus vaccine for supplementary immunization;

(3) to follow the recommendations of the EPI Global Advisory Group on the use of injectable poliovirus vaccine;

4. THANKS the many partners who have continued to collaborate in the Expanded Programme on Immunization and the poliomyelitis eradication initiative, particularly UNICEF, the Governments of Australia, Japan, and the United States of America, Rotary International, Rotary Japan and other nongovernmental organizations, and URGES them to continue and intensify their support;


(1) to continue to support Member States in improving their acute flaccid paralysis surveillance systems, conducting properly planned and implemented supplementary immunization activities and systematically evaluating activities;

(2) to continue also, in collaboration with all partners concerned, to mobilize additional resources for poliomyelitis eradication, particularly for vaccine supply;

(3) to share experiences on poliomyelitis eradication with other regions in order to strengthen the interregional poliomyelitis eradication effort;

(4) to report on the safety and efficacy of poliovirus vaccine to the Regional Committee in 1994.

Seventh Meeting, 16 September 1993

WPRlRC44.R5

REPORT OF THE REGIONAL COMMIITEE

REPORT OF THE SUB-COMMIITEE OF THE REGIONAL COMMITTEE ON PROGRAMMES AND TECHNICAL COOPERATION: COUNTRY VISITS


27

Having considered the report of the Sub-Committee on Progranunes and Technical Cooperation on its visits to Fiji and the Republic of Korea to review WHO's collaboration in the field of district health systems, I

1. ENDORSES the recommendations of the Sub-Committee of the Regional Committee on Programmes and Technical Cooperation;


(1) to consolidate and reinforce their efforts to strengthen intermediate or district level health services in support of the primary health care strategy for health for all within the context of their own overall plans for national health development;

(2) to emphasize the provision of a comprehensive range of services of the highest possible quality, including continuing technical and management education opportunities for health staff at intermediate or district levels of their health systems;


(1) to continue to support Member States in their efforts to use the district health system as a key component of their overall health development;

(2) to provide the technical support required to implement the recommendations of the

Sub-Committee;

4. THANKS the Sub-COmmittee for its work;

5. REQUESTS the Sub-Committee, as part of its terms of reference in 1994, to review and analyse the impact of WHO's cooperation with Member States in the field of health and sustainable development - environmental health;

6. DECIDES that the countries to be visited in connection with the review are the Philippines, Singapore and Solomon Islands.


I Document WPRlRC4418.

28 REGIONAL COMMI1TEE: FORTY-FOURTH SESSION

WPRlRC44.R6 NUTRITION IN THE WESTERN PACIFIC REGION


Recalling resolutions WHA31.47, WHA33.32, WHA34.22, WPRlRC26.R9, WPRlRC27.Rll, WPRlRC32.Rll, WPRlRC33.RI6, WPRlRC34.RlB, WHA4S.33, WHA45.34, WHA46.7 and WHA46.17;

Having reviewed the Regional Director's report on nutrition, which incorporates both the two-yearly report on infant and young child nutrition and implementation of the International Code of Marketing of Breast-milk Substitutes and a report on the follow-up to the FAOIWHO International Conference on Nutrition; I

Noting that, notwithstanding the measures taken by Member States to improve infant and young child nutrition and the encouraging reduction in the proportion of malnourished children in the Region, the prevalence of breast-feeding is again declining in a number of countries, and especially in many urban areas;

Recognizing that, despite some encouraging progress by countries in reducing the prevalence of vitamin A deficiency, iodine deficiency disorders and iron deficiency anaemia, these disorders are still significant public health problems in the Region;

Further recognizing that inappropriate diet and overnutrition are problems in some countries of the Region;

Welcoming countries' commitment at the International Conference on Nutrition to work towards the alleviation and prevention of malnutrition and diet-related problems;

1. ENDORSES the World Declaration and Plan of Action for Nutrition adopted by the International Conference on Nutrition;


(I) to strive to eliminate vitamin A deficiency and iodine deficiency disorders as public health problems by the year 2000;

(2) to make every effort to achieve during the remainder of the decade substanti~ reductions in malnutrition, particularly among children, women and the elderly. m iron-deficiency anaemia, in diet-related chronic diseases, in foodborne disorders and in social and other impediments to optimal breast-feeding;

(3) to intensify national efforts to improve infant and young child nutrition, es~cially through suitable measures to give effect to the International Code of Marketmg of Breast-milk Substitutes;

(4) to draw up, or strengthen as appropriate, plans of action specifying national nutritional goals and how they are to be achieved. in line with the obje~tives and major policy guidelines laid down in the Plan of Action adopt~ by th~ International Conference on Nutrition, and the nutritional goals of the Fourth Uruted Nations Development Decade and the World Summit for Children;

I Document WPRlRC44/9.

, I

REPORT OF THE REGIONAL COMMITTEE· 29

(5) to ensure the implementation of plans of action that:

(a) incorporate nutrition objectives in national, social and economic development policies and programmes;

(b) include food and nutrition-related measures in various sectors through governmental mechanisms at all levels, especially district development plans, and in collaboration with nongovernmental organizations and the private sector;

(c) stress community-based action for better nutrition, particularly through sustainable nutrition-related primary health care activities;

3. REQUESTS the Regional Director to support Member States in developing and implementing their national plans of action for better nutrition that emphasize self-reliance, community-based action and, where relevant, the involvement of the food industry.


WPRlRC44.R7 PUBLIC HEALTH TRAINING IN THE WESTERN PACIFIC REGION


Having considered the preliminary report on the assessment of postgraduate training resources in public health in the Region;l

Recalling the discussions held during the various intercountry workshops and conferences between 1989 and 1993;

Noting the continuing need for an effective structure to coordinate regional training activities in public health;

Noting further that public health problems of the Region need to be purposefully tackled while addressing country-specific issues;

Recognizing the major role WHO has played and continues to play in this field;

1. URGES Member States;

(1) to relate public health training curricula in their respective countries more closely to health workforce planning needs;

(2) to encourage public health training institutions within their respective jurisdictions to develop collaborative arrangements with other national and regional institutions so as to enhance training capacities in the Region as a whole;

(3) to provide comprehensive information on public health training institutions for inclusion in the World Directory of Schools of Public Health;




(I) to support further strengthening of regional institutions for training in public health;

(2) to e~ance t~e role of .the Regional Office as the coordinating centre for the exchange of lllformatlOn on publIc health training, and research institutions in the Region;

(3) t~ ~up~ort .the. dev~lopment of co~laborative arrangements among regional public health trallllllg InstitutiOns m order to maxunize regional resources in this area;

(4) to collect and disseminate all available information on practical training opportunities relating to public health available in the Region.


WPRlRC44.R8 FUI SCHOOL OF MEDICINE


Having considered the progress report on the implementation of the development programme for the Fiji School of Medicine;!

Recalling the Declaration of Tokyo in April 1985, and the Declaration of Edinburgh in 1988, calling for new strategies for training medical personnel and for meeting the needs of the changing medical profession;

Noting that the strategies adopted for the revitalization of the Fiji School of Medicine are consistent with the reorientation of health services towards primary health care, and that the aim of the School's curriculum is to train health personnel with skills that are appropriate for the island countries and areas of the Pacific;

Noting further that the School has completely reversed the pattern of student and graduate attrition due to academic failures, and has enhanced clinical competencies;

Anticipating a resurgence in the number and variety of health professionals graduating from the Fiji School of Medicine in the coming years;

Realizing that the development of the School is an ongoing process and that much remains to be accomplished;

1. REGISTERS its appreciation of:

(1) the cooperation extended by the Fiji Government to the revitalization proposal;

(2) the participation of the Pacific countries in the curricular reform activities of the School;

!Documenl WPRlRC44/!2.

REPORT OF THE REGIONAL COMMITfEE 31

(3) the participation of donor countries and agencies in the redevelopment efforts;


(1) to make provisions for the status of the primary care practitioner (PCP) graduates during their one-year field internship in the health services of their home countries;

(2) to facilitate the integration of each year's PCP graduates into the communities selected as internship centres;

(3) to review the status of the individuals undergoing internships, keeping in mind that they can either continue as students, supported by scholarships or undergo in-service training as staff members of the health service;

3. REQUESTS agencies, institutions and governments within and outside the Pacific Basin to sustain support for the innovative approaches of the Fiji School of Medicine as well as for academic reform of the same nature elsewhere in the Pacific;

4. REQUESTS the Regional Director to reinforce WHO's efforts to mobilize and coordinate technical and material support, with emphasis on the needs that have emerged as a result of the developments of the last three years.


WPRlRC44.R9 REGIONAL STRATEGY ON HEALTH AND ENVIRONMENT


Bearing in mind resolution WHA46.20 on the WHO global strategy for health. and environment, and resolutions WHA46.7 and WHA46.17 on issues relating to health and environment;

Having considered the report of the Regional Director on the regional strategy on health and environment; I

. Recognizing the increasingly complex nature of environmental healtQ problems and the assocIated need for better collaboration among organizations involved in issues relating to health the environment and development; ,

Noting the need for a more judicious and strategic use of limited resources in resolving health and environment problems;

1. ENDORSES the Regional Strategy on Health and Environment;


(1) to involve health professionals in discussions on sustainable development and the planning and development decision-making process;

I Document WPRlRC441l3.

32 REGIONAL COMMIITEE: FORTY-FOURTH SESSION

(2) to advocate the central role of health in decision-making about sustainable development;

(3) to id~ntify ~d prioritize. national environmental health-related problems and develop associated natIOnal strategIes and plans on health and environment consistent with WHO's global and regional strategies;

(4 ~ to allocate national resources and external support agency resources in accordance with the approved national strategies and plans;

(5) to se~re funds a~a!l~ble un~er the UNDP's Capacity 21 initiative to support health and environment activIties consistent with national strategies and plans;


(1) to vigorously implement the Regional Strategy on Health and Environment in cooperation with Member States;

(2) to collaborate with Member States in the development of their national health and environment plans, and in their related activities with other agencies such as UNDP.

Ninth Meeting, 17 September 1993

WPR/RC44.RlO WHO RESPONSE TO GLOBAL CHANGE


Recognizing the need for reform of the organization and operations of WHO in response to dynamic global conditions and to ensure WHO's continued leadership in health;

Noting the need for greater accountability and efficiency in the operation and management of WHO's limited resources, as well as the need to more clearly define the impact on health of the resources used;

Having considered. the Report of the Executive Board Working Group on the WHO Response to Global Change; I the background paper2 of the Western Pacific Regional Office Secretariat on the regional implications of the Working Group report; the associated resolution EB92.R2 of the Executive Board and resolution WHA46.16 of the World Health Assembly; and the report of the Programme Committee of the Executive Board in July 1993~

Having discussed these documents as reflected in the summary record of the forty-fourth session of the Regional Committee;

Noting the need to make a preliminary report to the Executive Board in January 1994 as required by resolution EB92.R2;

I Document EB92/4.

2Document WPRlRC44118. 3Document WPRlRC44118 Ad<1.1.

r,


Deciding to study the issues further in order to provide a more detailed report to the Executive Board in January 1995;

1. ENDORSES the spirit, goals and aims of the Report of the Executive Board Working Group on the WHO Response to Global Change;

2. RE-AFFIRMS the essential role of a strong regional office in working effectively with Member States to fulfil the mandate of the Organization and improve the health status of people;

3. COMMITS itself to reviewing its own methods of work consistent with the issues raised by the Executive Board Working Group regarding the methods of work of the World Health Assembly and the Executive Board;

4. REQUESTS the Sub-Committee of the Regional Committee on Programmes and Technical Cooperation:

(1) to review the method of work of the Regional Committee as it relates to the recommendations of the Report;

(2) to further assess the regional implications of the Report of the Executive Board Working Group;

(3) to make recommendations on establishing priorities for implementation of actions with regional implications; and

(4) to prepare a background document to guide discussion of this agenda item by the Regional Committee at its forty-fifth session;


(1) to implement the applicable recommendations of the Executive Board Working Group report, bearing in mind the discussions by the Regional Committee at its forty-fourth session;

(2) to report on the status of implementation to the Regional Committee at its forty-fifth session;

(3) to support the Sub-Committee in carrying out its work as mandated;

(4) to transmit to the Executive Board, through the Director-General, in response to its resolution EB92.R2, a preliminary report which includes the summary record of its discussions of the implications of the recommendations of the Executive Board Working Group report for regional and country activities.



WPRlRC44.Rll HEALTH PROMOTION


Having considered the Regional Director's report on health promotion and on the development of a health promotion progranune;1

Recalling resolution WHA42.44 on health promotion, public information and education for health, and resolutions WHA46.7, WHA46.17 and WHA46.20 on, inter alia, nutrition, health and development and environment issues;

Noting with concern the increase in nonconununicable diseases, especially cardiovascular diseases, injuries and other health risks associated with a wide range of factors, such as urbanization, industrialization, and environmental changes in the course of development;

Recalling that these problems cannot be solved simply by improving the health services and that a multisectoral approach to health and well-being is necessary nationally and internationally;

Recognizing that health promotion is a strategy that responds to these issues;

Emphasizing the principle of individual and collective responsibility for health;


(1) to develop progranunes that enable individuals in the different stages of life to improve their own health and the health of their families;

(2) to facilitate conununity action that contributes to the development of lifestyles and living conditions conducive to health;

(3) to provide a health-promoting environment through the formulation of national public policies;

(4) to ensure support for health goals from relevant government sectors;

(5) to develop a mechanism for intersectoral collaboration that includes nongovernmental organizations and the private sector;


(1) to advocate the concept of individual and conununity responsibility for health;

(2) to facilitate and coordinate the exchange of practical experiences;

(3) to provide technical support to prog~anunes and pr?je~ts that strengthen n~t only individual action for health throughout the different stages In lIfe but also conunumty and government action.


I Document WPRlRC44/15.

REPORT OF THE REGIONAL COMMITIEE 35

WPRlRC44.R12 FORTY-FIFTH AND FORTY-SIXTH SESSIONS OF THE REGIONAL COMMITTEE


1. EXPRESSES its appreciation to the Government of Malaysia for confirming its offer to act as host to the forty-fifth session of the Regional Committee in 1994;

2. CONFIRMS that the forty-fifth session will be held in Malaysia, provided a satisfactory agreement can be concluded between the Government and WHO by 31 March 1994;

3. DECIDES that the dates of the forty-fifth session shall be from 19 to 23 September 1994;

4. DECIDES further that the forty-sixth session of the Regional Committee shall be held at regional headquarters in Manila.


WPRlRC44.R13 CHOLERA AND DIARRHOEAL DISEASES

The Regional Committee

Having considered the Regional Director's report on cholera and diarrhoeal diseases;'

Recalling resolution WPRlRC36.R4 on diarrhoeal disease control;

Bearing in mind resolution WHA44.6 on, inter alia, import restrictions on products from countries affected by cholera;

Noting the progress made by the diarrhoeal diseases control programme in the Region, particularly with regard to increasing access to and use of oral rehydration therapy, the scope of the training given to health workers, the number of courses conducted, and the undertaking of evaluation activities;

Expressing its concern regarding inadequate compliance with the International Health Regulations (Article 3) with regard to reporting of cholera in the Region;

Being concerned about the occurrence of a new strain of cholera (Vibrio cholerae 0139), its rapid spread and potential to cause major outbreaks;


(1) to provide maximum support for the further development of strong, well managed national diarrhoeal diseases control programmes in order to cope with the diarrhoea and cholera problems in the Region;

lDocument WPRlRC441l4.

36 REGIONAL COMMITIEE: FORTY -FOURTH SESSION

(2) to give high priority to prompt reporting of cholera according to the International Health Regulations (Article 3) in order to promote international collaboration in the control of the disease;

(3) not to apply to countries affected by the epidemic restrictions that cannot be justified on public health grounds, in particular as regards importation of products from the countries concerned;


(1) to further strengthen technical collaboration with Member States, particularly in training to enhance correct management of diarrhoea cases at the health facility and the household level; and in the implementation of preventive measures to reduce diarrhoeal diseases;

(2) to reinforce WHO's efforts to mobilize and coordinate technical and financial support for national diarrhoeal diseases control programmes.


WPRJRC44.RI4 DEVELOPMENT OF HEALTH RESEARCH


Having considered the report of the Regional Director on the development of health research;'

Recalling resolution WPRJRC42.R7 on the development of health research;

1. ENDORSES the recommendations of the Western Pacific Advisory Committee on Health Research (WP ACHR) at its fourteenth session;


(1) to establish research priorities based on needs and direct their research efforts towards these priorities;

(2) to concentrate efforts on applied or operational research, the results of which can immediately be utilized to eliminate or reduce their health problems;

(3) to establish a national focal point to coordinate and manage health research activities, if this does not already exist;


(1) to implement the WPACHR recommendations if the relevant resources are available;

'Document WPRlRC441l0.

r I


(2) to continue to support individual and group research training activities;

(3) to establish an effective health research information network involving national health research councils or analogous bodies and WHO Collaborating Centres.

WPRJRC44.RI5


SPECIAL PROGRAMME OF RESEARCH, DEVELOPMENT AND RESEARCH TRAINING IN HUMAN REPRODUCTION: MEMBERSHIP OF THE POLICY AND COORDINATION COMMITTEE


Noting that the period of tenure of the representative of the Government of Papua New Guinea as a member of the Policy and Coordination Committee of the Special Programme of Research, Development and Research Training in Human Reproduction expires on 31 December 1993,1

1. SELECTS the Government of the Philippines to nominate a representative to serve on the Policy and Coordination Committee of the Special Programme of Research, Development and Research Training in Human Reproduction for the period 1 January 1994 - 31 December 1996;

2. THANKS the representative of the Government of Papua New Guinea for serving on the Committee.


WPRJRC44.RI6 ACTION PROGRAMME ON ESSENTIAL DRUGS: MEMBERSHIP OF THE MANAGEMENT ADVISORY COMMITTEE


Noting that the term of Malaysia as a member of the Management Advisory Committee of the Action Programme on Essential Drugs expires on 31 December 1993,2

1. SELECTS Papua New Guinea as the member of the WHO Western Pacific Region whose representative shall be a member of the Management Advisory Committee to serve for a period of three years from 1 January 1994 to 31 December 1996;

2. THANKS the representative of Malaysia for serving on the Committee.

1 Document WPRlRC441l6.

2Document WPRlRC441l 7.



WPRlRC44.RI7 SELECTION OF TOPIC FOR THE TECHNICAL DISCUSSIONS IN 1994


Having considered the topics suggested for the Technical Discussions in conjunction with the forty-fifth session of the Regional Conunittee, l

DECIDES that the subject of the Technical Discussions in 1994 shall be "Drug quality assurance" .


WPRlRC44.RI8 RESOLUTION OF APPRECIATION


EXPRESSES its appreciation and thanks to:

(1) the Chairman and other officers of the Committee;

(2) Mr Lovelace for agreeing to act as Moderator of the Technical Discussions;

(3) the representatives of the nongovernmental organizations for their statements.



REGIONAL COMMITTEE FOR THE WESTERN PACIFIC

SUMMARY OF PRELIMINARY VIEWS ON THE REGIONAL IMPLICATIONS OF THE EXECUTIVE BOARD ACTIONS

EXECUTIVE BOARD WORKING GROUP REPORT ON THE WHO RESPONSE TO GLOBAL CHANGE

Report Section

4.1

Title

Mission of WHO

Number

(I)

(2)

Executive Board Action

Request D-G to make annual assessment of world health status and needs, and recommend WHO priorities for international health action to meet those needs.

Request D-G to analyse and define year 2000 specific objectives and operational targets, measured by precise indicators, and mobilize resources attainment.

to ensure

*No comment by the Regional Committee for the Western Pacific at its forty-fourth session.

RegionallmpJications

If a separate document is envisioned, this will require substantial regional staff resources. This needs serious study to assess resources required. Regional priorities may not always match global priorities; particular attention should be paid to harmonization.

Will require comprehensive review of all programmes, consistent with the priorities established above. WPR is in the process of doing this already (e. g. , environmental health and malaria). This would require considerably intensified effort.

Preliminary Views of the Regional Committee

..

Endorsed global and regional efforts to redefine mission of WHO in realistic, outcome-oriented terms. The Regional Committee supported the idea of taking an objective look at the nature and extent of Western Pacific regional activities in ~ ...

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(3)

(4)


Request D-G, to the extent that targets will not be met, to propose alternative strategies and plans, with budgetary resources required, for 2005, 20 I 0 or other years as appropriate.

Request D-G to study feasibility of organizing international workshops or other forums to develop consensus for changes in strategy for health for all; stress health promotion and disease prevention.

*No comment by the Regional Committee for the Western Pacific at its fony-fourth session.

Regional Implications

No major implications beyond those mentioned above. This logical approach stretches the time frame beyond the year 2000.

It is important that such meetings be well-prepared and designed to produce real consensus. All too often the consensus reached in such meetings is so broad as to be ineffective. Consensus also needs to be developed at regional and country levels to ensure coordination of programme efforts.

Preliminary Views or the Regional Committee

the light of regional priorities. WHO should not promise more than it can deliver, and resources should be focused on regional priority issues.

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Report Section Title

4.2 Governing bodies

4.2.1 WHA

4.2.1.1 WHA resolutions

Number

(5)


To submit to the 1994 WHA a proposed resolution authorizing the EB to establish a routine procedure for prior review of all resolutions proposed to the WHA that have potential impact on the objectives, policy and orientations of WHO, or that have implications in terms of staffing, costs, budgetary resources and! or administrative suppon.

·No comment by the Regional Committee for the Western Pacific at its forty-founh session.


Having a more detailed assessment of resource implications will be helpful to the Region in planning its own work. Staff time may be required to define regional resource implications in some cases. Inclusion of provision for time limit, evaluation and reponing, as appropriate, as integral pan of WHA resolutions will improve programme accountability. Similar approach could be considered at regional level. Meeting this requirement to respond to resolutions that come from the floor during WHA deliberations (e.g., budgetary reform, WHA 46.35) may be a problem.


Endorsed. Will include provision for time limit, evaluation, reponing and resource implications, as appropriate, in regional resolutions.

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4.2.1.2

4.2.2

4.2.2.1

Title

Method of work oftheWHA

EB

EB decisions

Number

(6)

(7)

(8)


Request the D-G to submit to the Board in January 1994 further proposals for improvements in the method of work of the WHA, to focus discussions and realize further economies in the duration and cost of the Health Assembly.

Request the Secretariat to identify clearly in EB documents the issues that require the advice, guidance or decision of the EB.

Ensure that EB discussions genuinely focus on and reach clear conclusions and decisions with respect to all issues concerning health policy, technical, budgetary and financial aspects or other overall supervisory or advisory functions.

"No comment by !he Regional Commi!lee for !he Western Pacific at its forty-fourth session.


No direct implications for Region. Indirectly, "improvements" at WHA level should lead to more effective use of regional resources. Regional Committee should consider these issues in assessing its own method of work.

Already being done at the regional level in Regional Committee documentation.

Have been working consistently on this at Regional Committee sessions over the last few years, particularly with respect to improving transparency of budgetary process.


The Regional Committee suggested shortening of duration of the WHA to one week in non-budget years and nine days in budget years.

"

With reference to securing maximum transparency, accountability and efficient use of WHO's resources, the Regional Committee addressed the question of the appropriateness of regional and country allocations in relation to current needs and capabilities, and suggested that a zero-based budgeting

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Report Section

4.2.2.2

Title

Method of work of the EB

Number

(9)

(10)

(11)


Request the Secretariat to prepare summary records that are more succinct and focus more on conclusions and decisions reached.

The EB should establish subgroups to meet during, and as part of, the EB sessions each year, to review and evaluate specific programmes.

The EB should use the subgroups to advise on • cross-programme· issues such as administration and fmance.

·No comment by the Regional Committee for Ihe Western PacifIC at its fony-foorlh session.


No particular regional implications. Regional Committee documentation has been moving in this direction for some time.

The Sub-Committee of the Regional Committee on Programmes and Technical Cooperation, as well as the Technical Discussions at the Regional Committee, addresses this issue at the regional level. The Regional Committee may wish to enhance· the role of the Sub-Committee in this regard. EB subgroups will likely require substantive input (of information) from the regions.

Same as the above.

Preliminary Views oftbe Regional Committee

approach should be taken with a view to bringing expectations in line with available funding.

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4.2.2.3

Title

Programme Committee of the EB

Number

(12)


The EB should reconsider the need for. and the tenns of reference of the Programme Committee of the EB.

"No comment by the Regional Committee for the Western Pacific at its forty-fourth session.


This EB action has no particular implication for the Region when properly understood. Reconsideration of the need for and terms of reference of the EB/PC is not based on any conclusion that the matters currently brought before the PC are not important. Rather. it is based on a concern that the PC currently may have more responsibilities than it can adequately cope with. and that the EBWG Report suggests the fonnation of other EB subgroups to consider some matters that current! y fall under the PC on a more in-depth basis (e.g.. budget and finance). The creation of such subgroups could make some of the work of the pc. under its existing terms of reference. redundant.


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4.2.2.4 Nomination and terms of office of the D-G and RD

4.2.2.5 Participation of EB members in the work of WHO

Number

(13)

(14)


To form a special ad hoc sub-committee of the EB to consider options for nomination and terms of office of the D-G and RD, including the use of search committees.

To establish a small working group to recommend how to: improve ways in which the board members are designated; improve the selection procedures for the officers of the Board; and achieve more active involvement of all members throughout the year in the work of the Organization.

·No comment by the Regional Committee for the Western PacifIC at its forty-fourth session.


Regional Committee input to ad hoc sub-committee of EB desirable. Use of search committee theoretically attractive, but imponant issues of make-up (i.e., selection of committee members) and method of operation need thorough evaluation. Term of office, duration of term, etc., need consideration.

Current procedure in WPR, including • gentlemen's agreement· regarding representation of UN Security Council permanent members, seems to work well. Including EB members (regional) in Regional Committee delegation has been useful in


Discussed at length but no consensus reached. Referred to Sub-Committee of the Regional Committee on Programmes and Technical Cooperation for review/assessment of all aspects of various mechanisms (e.g., search committee) and subsequent reponing to the Regional Committee at ItS fony-fifth session. The constitutional implications of change were noted.

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Report Section

4.2.2.6

4.2.3

4.2.3.1

Title

EB polling Member State opinions

Regional Committees

Method of work of Regional Committees

Number

(15)

(16)


The EB sh::/Uld conduct, from time to time, surveys of Member States' opinions and perceptions of the work of WHO.

Requesting the regional committees to study their own method of work and report to the EB in January 1995.

* No comment by the Regional Committee for the Western Pacific al its forty-fourth session.


strengthening linkages between EB and Regional Committee. An informal meeting of the Regional Committee members is convened to come to a consensus on the selection of EB members from the Region and officers for the WHA.

Properly conducted surveys could provide useful information for decision-making. Improperly conducted surveys could waste a lot of time and resources. Any such survey should be well thought out.

It would be prudent for the Regional Committee to study its method of work in the context of the issues raised with respect to the WHA.


•

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4.3

4.3.1

Title

Headquarters

Policy determination

Number

(17)


Request the D-G to consider the establishment of a policy development team, utilizing current staff, to orient the long-term vision, policy direction and programme priorities for the health sector and WHO.

• No comment by the Regional Committee for the Western Pacific at its forty-fourth session.


In WPR, current method of work can generally be affirmed, especially as it relates to health policy, budgeting and financial matters. To enhance effectiveness of technical programmes and resource utilization, the Regional Committee may wish to take a closer look at policy development in relation to regional priorities. In this regard, the Sub-Committee could be tasked with reviewing the related issues, and policy development could be included as an agenda item for the forty-fifth session of the Regional Committee.

WPRO Programme Committee and RD's weekly meeting with Programme Directors covers this issue at the regional level.


budgetary and financial matters. Nevertheless, the Sub-Committee on Programmes and Technical Cooperation will review the method of work of the Regional Committee, further assess the regional implications of the Repon of the Executive Board Working Group, prioritize these regional implications in relation to regional priorities, and prepare a background document to guide discussion of this agenda item by the Regional Committee at its forty-fifth session.

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Section Title Number Executive Board Action Regional Implications Regional Committee

.... (18) Request the D-G to WPR has made a special Endorsed, noting

strengthen and develop, with effort to maintain special effort in WPR the RDs, an improved policy consistency with to maintain planning and analysis organizational policy. consistency. [:g capability/system to None of the problems 0 recommend clear priorities implied here are -0 for programme objectives. substantive insofar as Z targets and budgets. WPR is concerned. >

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(19) Request the D-G to propose Same comment as above. • ~ and implement appropriate Regarding management management and information systems, see communication systems, following comment t'l1

t'l1 particularly with the RDs, to (4.3.2) .. achieve the designated § objectives and targets according to the priorities identified . I a

4.3.2 Management

~ information systems (20) Request the D-G to provide a WPR experience/expertise •

detailed analysis of the in management en current status, capability , information systems is ~ compatibility , plans and being shared with other en programmes of existing regions. S management information Z systems throughout the Organization.

• No comment by the Regional Committee for the Western Pacific at its fony-fourth session.


4.4 Regional Offices

4.4.1

4.4.2

Staffing needs and patterns

Technical consultants

Number

(21)

(22)


Request the D-G to review the effectiveness of current WHO procedures and criteria for the development of appropriate staffmg patterns and the selection and recruitment of staff.

Request the D-G, in collaboration with the RDs, to review the practices of providing technical consultation for the Organization and identify changes needed.


An extremely important matter that requires careful examination of a number of issues, includi ng: the appropriate mix of scientists, generalists and programme managers; the issue of post ownership as it relates to recruitment; crossprogramme sharing of staff; staff rotation (particularly from HQ to the field); and the resources required to implement any changes. Personnel procedures will have to be reviewed thoroughly in the light of recommended changes.

Consideration of cost implications extremely important (particularly, increases in consultant fees). More effective utilization of ,expert panel system (including


Endorsed, emphasizing need for assessment of resources required to implement recommended changes. The Regional Committee strongly emphasized the importance of the role of regional offices, and recommended further delegation of authority, particularly in areas where certain regions have a particular interest (e. g. in malaria).

Endorsed, noting need to include examination of Expert Panel and Collaborating Centre potentials and need for consideration of cost implications of all recommendations.

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4.4.3

Title

Communications and collaboration

Number

(23)

(24)


Request the D-G to review the current delegation of authority between headquarters and regional offices and introduce appropriate changes.

The EB should include as part of its working agenda, on a regular basis, meetings with the RDs.



selection/designation process) and collaborating centre staff should be explored.

Current delegation mechanism working well in WPR. From an overall organizational perspective, question is more one of use and practice rather than actual delegation of authority itself.

No particular implications, although it is related to the issue of improving (he linkages between the EB and the Regional Committee (section 4.2.2.5)


Need for pool of consultants recognized.

expanding available

Endorsed, noting that current mechanism has worked reasonably well in the Western Pacific Region. However, the Regional Committee strongly expressed the need for fll rther delegation of authority and devolution of responsibility to the Regional Office and on to country level. The Regional Committee also stressed the need for clarification of roles and responsibilities of the different levels of WHO.

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4.5 Country Offices (WHO Representatives)

4.5.1 WRs' responsibilities

Number

(25)

(26)


Request the O-G to evaluate current and planned country health programmes and determine the profile of skills and qualifications required to select highly qualified WRs.

Request the O-G to develop appropriate procedures for ensuring career development of the WRs.

• No comment by the Regional Committee for the Western PacifIC at its forty-fourth session.


If carried out thoroughly, should lead to selection of WRs who are better equipped to deal effectively with the wide range of issues related to health. At present, most WPR WRs have medical degrees. While medical qualification is desirable, more use could be made of health professionals with other backgrounds. Selection should be based on technical ability , administrative experience, and required professional skills.

If done in a thorough, professional manner, this would help ensure the recruitment and retention of wel\-qualified people. At present, WR's briefing, training and career development are not standardized and there is no clear strategy.


•

The Regional Committee strongly re-affirmed the imponance of WRs' and CLOs' offices for country operations.

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... Also, there is uo clear policy of rotation within or between regions. Consideration should also be given to allocating a ~ percentage of the regional @ budget (e.g., 1%) 0 specifically for staff Z development and training; > early identification of (-

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from among professional ~ staff and putting them on § an appropriate career track; and establishing a maximum period for ttl

ttl posting to a particular .. country of 4-5 years, in ~ conjunction with a

~ comprehensive policy on rotation. -< ,

4.5.2 WRand ~ c: intersectoral ~

coordination (27) Request the D-G to direct the This is a mandate that the Endorsed. -l

== RDs and the WRs to provide RDs and WRs already en the leadership in intersectoral have. The real question is ttl coordination among the UN how to enhance their en en agencies and between major ability to carry out this -0 donors. role, assuming that people Z

with the appropriate skills and qualifications have been selected pursuant to Section 4.5.1 above.

Report Section

4.5.3

Title

Delegation of authority to WRs

Number

(28)


Request the D-G to review, update and standardize the delegations of authority, the country office administrative/management and operating procedures, and the basic operating resources for WR offices.


To be more effective, WRs would need to have: a level of representation consistent with other agencies, especially UNDP; adequate staff; and be supported· with clear, concise and unambiguous programme and policy infonnation.

The current general delegation of authority in WPR is clear and adequate in most cases. The extent to which this delegation is exercised, however, varies considerably from country to country (i.e., WR to WR). If WRs with appropriate skills and qualifications are selected pursuant to Section 4.5.1 above, the implementation of delegation of authority should become more consistent throughout the Region.


Endorsed. (See comment under Section 4.4.1 (21».

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4.5.4

4.5.5

Title

WRs' involvement in policy and technical dialogue

WHO representation in Member States

Number

(29)

(30)


Request the D-G to review the role of the WR and recommend appropriate measures to strengthen the integration of the work of the WR into the policy and strategy development of the Organization.

Request the D-G to inquire among Member States their interest in having alternative funM of WHO representation.

* No comment by the Regional Committee for the Western Pacific at its forty-fourth session.


Twice-a-year meetings with WRs at WPRO are intended to help ensure this kind of involvement. These forums clearly provide the opportunity for substantive input from WRs. WRs may benefit from attending Regional Committee sessions. Notwithstanding the opportunities that exist for involvement, the development of clearer, more concise programme and policy information for WRs would improve the likelihood of actually achieving substantive involvement.

Emphasis of EB action is on developed countries. WRs/CLOs in all countries in WPR not feasible.


Endorsed.

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4.6

4.6.1

4.6.2

Title

Coordination with UN and other agencies

UN structural reforms

Country and global coordination

Number

(31)

(32)


Request the D-G to ensure that the Organization be active in its response to the structural and operatiOnal reforms taking place in the UN and its programmes.

Request the D-G to engage in discussions with appropriate elements of UN leadership to ensure optimal use of UN "unified offices" with UN specialized agency coordinators .



WHO focal point (national staff) at country level important to enhance cooperation and coordination.

Underlying message for national health authorities is that improVed coordination is needed among national agencies in their relationship with UN and other external support agencies.

While "unified offices" offer potential administrative economies, the location of specialized agencies in their counterpart national organizations (e.g., the Ministry !Department of Health in the case of WHO) offers the possibility of improved "service.


Endorsed, indicating the need for commensurate concern at the national level.

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Report Section

4.6.3

4.6.4

Title

WHO coordination of health resources

UN regional standardization

Number

(33)

(34)


Request the D-G to present appropriate information and recommendations to the UN/donor agencies to include disease surveillance, prevention, and control as an integral component of each development project.

Request the D-G to engage in dialogue with the UN Secretariat to study means for reducing differences in regions and operation procedures among UN agencies.



WHO/WPR approach of locating offices in Ministry !Department of Health insofar as possible is preferred.

The major responsibility for advocating, among UN/donor agencies, the integration of health concerns in the development decision-making process must be shouldered by the WR.

Lack of standardization does cause some problems in WPR (e.g., when dealing with ASEAN issues; and issues affecting the Indo-China peninsula) . Much stronger operational and functional linkages could/should be developed among regions and organizations. Geographical standardization may be helpful, but it is not at the heart of cooperation and coordination problems.


Endorsed.

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Report Section

4.7

4.7.1

Title

Budgetary and financial considerations

Extrabudgetary programmes and funding

Number

(35)

(36)


The EB should consider assigning an EB member to sit on the management committee of each major extrabudgetary-funded programme to facilitate coordination and compatibility of policies, decisions and priorities with those of the WHA/EB.

Request the D-G to seek approval from the WHA to have authori ty to assess appropriate overhead rates, up to 35%, for extrabudgetary programmes.

• No comment by the Regional Committee for the Western PacifIC at its forty-fourth session.


A recent example was the difficulty in coordinating the work of a UNFPA regional team with the WHO regional structure.

No particular regional implications. In many cases, this is already done at HQ leveL

The reasonableness of the 35 % request hinges on a number of significant related organizational changes (e.g., a move to seek extrabudgetary funding on a competitive basis; resolution of issues related to quality, cost-effective service; the resolution of probletDS related to stafftng needs


•

•

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!

UI .....

Preliminary Views r Ul Report of the 00

Section Title Number Executive Board Action Regional Implications Regional Committee

... and patterns; etc.). In the absence of the resolution of these related

~ issues, WHO cannot support a 35 % overhead Cl -charge. If this is insisted 0 on, WHO may face Z difficulties at the regional >

t""' level to attract (') extrabudgetary funds. 0 A more rational approach ~ that recognizes the actual -overhead cost of :l implementing activities in ttl the various regions and ttl incorporates these costs in

CB project proposals would be preferable. ~

(37) The EB should establish a This is a good idea in ';< pledging system to secure principle. Again, a great • CB additional funds for priority deal of bureaucratic

~ regular budget programmes. streamlining would be required to make such a system effective. !;I.I

ttl Historically, WHO has !;I.I

been very cautious in its !;I.I -approach to this area. 0 Z

• No comment by the Regional Committee for the Western PacifIC at its fony-fourth session.

Report Section

4.7.2

4.8

4.8.1

Title

Budgetary inputs and outputs

Technical expertise and research

Technical competence

Number

(38)

(39)


The EB requests the D-G to establish budgeting systems/mechanisms to derive the greatest benefit from the process of budgeting by objectives/targets and to facilitate the achievement of priorities and to provide for periodic adjustments of these priorities in accordance with changing health needs.

Request the D-G to improve the personnel procedures to ensure:· technical competence as the primary basis for the selection and recruitment of staff; the design and implementation of appropriate career development and continuing education programmes; and the development of a staff rotation system between headquarters and regions.

* No comment by the Regional Comminee for the Western Pacific at its forty-fourth session.


In 1994-1995, WPR was the only region to fully support H Q priorities with related budgetary increases. The D-G and the RDs have to set aside budget for priority programmes in 1996-1997.

As with the section on Staffing Needs and Patterns (4.4.1) no assessment of increased financial resource requirements is made. Existing rules and regulations allow for selecting and maintaining technically competent people. Unfortunately, in practice, their application is sometimes too heavily influenced by political considerations.


•

Emphasis was placed on the need for examination of the issues of staffing needs and patterns, technical/managerial competence, and technic;iI consultants from a Regional perspective. The Regional Committee reaffirmed its commitment to technical competence

8 ~ ...

~ (g ~ S6 ~ ttl

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VI \0

.....

Report Section

4.8.2

Title

Research initiatives

Number

(40)

(41)


The EB should draw to the attention of the WHA the impact on the quality of staff and on the ability of the Organization to perform its mandated functions due to politically motivated appointments.

With a view to ensuring the best possible use of all resources available to the health sector, the D-G should review and update existinl guidelines and procedures related to WHO collaborating centres and their participation in research initiatives for the Organization.

• No comment by Ibe Regional Commiuee for Ibe Westem Pacific at ill forty-founII session .


Suitability for international service is a criterion which is inextricably linked to technical competence.

Politically motivated appointments may be particularly a problem at other offices of WHO. Political consideratioDS should not be overriding; people can be selected who accomuvvlare political concerns I!!d are technically competent ml!t are suitable for international service.

The forum for accomuvvlating this .. the regional level is the WPACHR and the RPD programme. ThiI approach to Ipplied research seems to be working very well, IIId is a more cost -effective use of resources.


and suitability for international service as the primary criteria for staff selection at all levels. The Regional Committee also discussed expanding the pool of available consultants.

•

EDdorsed, noting that the current approacb to applied research in Western Pacific Rqion is working well aDd is a more cost-effective use of resources.

f ~ ~

g

~ ~

~ trI ~

CB

S a ~ i o z

Report Section

4.8.3

Title

WHO collaborating centres

Number

(42)

(43)


Request the D-G to require every programme to include a budgetary item for conducting basic science or operational research activities.

The EB should establish a small group to determine with the D-G ways to expand the use the centres.

'" No comment by the Regional Committee for the Western Pacific at its forty-fourth session.


It is assumed that the reference to "every programme" refers only to technical programmes. As indicated above, the WPACHR-RPD forums provide for this in WPR. WHO should be involved principally in operational and applied research with relatively little basic research. 1982 Scientific Group on Research Needs for HFAl2000 established regional research priorities which were subsequently endorsed by the WPACHR. Reaffirmed in 1988, these pnontles continue to guide applied research effons in the WPR.

More attention needs to be paid to strengthening the monitoring and evaluation function. If this is done correctly, everything else falls into place. This process is under way in WPR.


'"

Endorsed, emphasizing the importance of the monitoring and evaluation function.

f ....

~ ~ ~ ;! m

~ ~ > r-

I m

0--

Report Section

4.9

Title

Communications

Number

(44)

(45)

(46)


Request the D-G to develop annual plans with each collaborating centre to facilitate the implementation of appropriate international health work, and the evaluation of the capability of the centre to maintain its special designation.

Request the D-G to develop WHO's capability to make greater use of modern communication techniques and methods.

Request the D-G to issue an annual publication which reports on the Organization's efforts and programmes for improving the world health situation.

* No comment by the Regional Committee for the Western Pacific at its forty-fourth session.


In WPR, annual work plans are already required as part of the monitoring and evaluation process.

The greater use of modern communication methods, particularly mass media tools, has significant resource implications which should be thoroughly assessed.

Such a document should be seen as a replacement for or a consolidation of some existing publications rather than as an add-on effort. Consideration should be given to modifying the RD's report to accommodate the region-specific needs of such a global publication.


Endorsed, indicating that this is already being carried out in the Western Pacific Region.

•

•

i ~ ....

~

m o z > t""

~

~

en ·m en en o Z

Report Section

5.2

Title

Conclusions

Number

(47)


The work recommended by the EBWG is the responsibility of the D-G, the EB itself, or a series of working partners who must resolutely pursue the opportunities outlined in this report. However, to ensure continuity, there is an urgent need to devise means for the EB to monitor the work and continue activities, including the potential contribution from the current EBWG members.


No real regional implications apart from the extra documentation required for the EB monitoring function. However, at least one WPR Member State should be represented in this activity (e.g., an EB member from the Region).


Endorsed.

i ...

~

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8 3:

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el

64 REGIONAL COMMITfEE: FORTY-FOURTH SESSION


ANNEX 2

LIST OF NONGOVERNMENTAL ORGANIZATIONS WHOSE REPRESENTATIVES MADE STATEMENTS TO THE REGIONAL

COMMITTEE AND SUBMITTED STATEMENTS FOR CIRCULATION TO MEMBERS

At the invitation of the CHAIRMAN. statements were presented by the following

nongovernmental organizations:

World Federation for Medical Education

International Epidemiological Association

International Union for Health Promotion and Education

International Council of Nurses

World Federation of Occupational Therapists

International Pharmaceutical Federation

World Confederation for Physical Therapy

World Association for Psychosocial Rehabilitation

World Organization of the Scout Movement

International Federation of Sports Medicine

International Union against the Venereal Diseases and the Treponematoses

Statements were received for circulation to Members from the following:

International Association of Cancer Registries

International Union of Pure and Applied Chemistry

International Dental Federation

International League against Epilepsy

World Association of Girl Guides and Girl Scouts

International Association of Medical Laboratory Technologists

Mother and Child International

International Union of Nutritional Sciences

International Federation of Ophthalmological Societies

International Planned Parenthood Federation

International Pediatric Association

World Association for Psychosocial Rehabilitation

World Veterans Federation


ANNEX 3

AGENDA

1. Opening of the session

2. Address by the retiring Chairman

3. Election of new officers: Chairman, Vice-Chairman and Rapporteurs

4. Address by the incoming Chairman

5. Adoption of the agenda

WPRfRC4411 Rev. 1

6. Address by the Director-General

7. Nomination of the Regional Director

WPRfRC44/2

8. Report of the Regional Director

WPRfRC44/3

9. Programme budget, 1992-1993: Budget performance (interim report)

WPRfRC44/4

10. AIDS

10.1 Annual report on AIDS, including sexually transmitted diseases

WPRfRC44/5

10.2 Global Programme on AIDS: Membership of the Management Committee

WPRlRC44/6

11. Eradication of poliomyelitis in the Region: Progress report

WPRfRC4417

12. Sub-Committee of the Regional Committee on Programmes and Technical Cooperation: Report on country visits

WPRfRC44/8


Annex 3

13. Nutrition in the Western Pacific Region, including follow-up of the International Conference on Nutrition

WPRJRC44/9

14. Development of health research

WPRJRC44/10

15. Human resources for health

15.1 Public health training in the Western Pacific Region

WPRJRC44/11

15.2 Fiji School of Medicine

WPRJRC44/12

16. Regional strategy on health and environment, including follow-up of the United Nations Conference on Environment and Development (UNCED)

WPR/RC44/13

17. Cholera and diarrhoeal diseases

WPRJRC44/14

18. Health promotion

WPRJRC44115

19. Special Programme of Research, Development and Research Training in Human Reproduction: Membership of the Policy and Coordination Committee

WPRJRC44116

20. Action Programme on Essential Drugs: Membership of the Management Advisory Committee

WPRJRC44/17

21. WHO Response to Global Change: Report of the Executive Board Working Group

WPRJRC44/18


Annex 3

22. Correlation of the work of the World Health Assembly, the Executive Board and the Regional Committee

22.1 Consideration of resolutions of the Forty-sixth World Health Assembly and the Executive Board at its ninety-first and ninety-second sessions

WPRlRC44/19

22.2 Consideration of the agenda of the ninety-third session of the Executive Board

WPRlRC44/20

23. Selection of topic for the Technical Discussions in conjunction with the forty-fifth session of the Regional Committee

WPRlRC44/21

24. Time and place of the forty-fifth and forty-sixth sessions of the Regional Committee

25. Statements by representatives of the United Nations, the Specialized AgenCies and intergoverrunental and nongoverrunental organizations in official relations with WHO

26. Closure of the session

AUSTRALIA

BRUNEI DARUSSALAM


LIST OF REPRESENTATIVES

I. REPRESENTATIVES OF MEMBERS

Dr Anthony I. Adams Chief Medical Adviser Department of Health, Housing Local Government and Community Services FAX: (616) 285 1994 TEL: (616) 289 8408

Mr LundyKeo Assistant Director International Branch Department of Health, Housing Local Government and Community Services FAX: (616) 285 7087 TEL: (616) 289 8343

Mrs Judith L. Holmes Information Resources Section Information Management Branch Department of Health, Housing, Local Government and Community Services Canberra FAX: (616) 289-7102 TEL: (616) 289 8826 (w); 259 1857 (h)

Dato Paduka Dr Haji Johar Noordin Minister of Health Bandar Seri Begawan FAX: (6732) 40980 TEL: (6732) 226 640, Ext. 100

Dato Paduka Dr Haji Hussain bin Haji Md. Daud Director of Medical and Health Services Ministry of Health Bandar Seri Begawan FAX: (6732) 40980 TEL: (6732) 226 640, Ext. 101

71

ANNEX 4

(Chief Representative)

(Alternate)

(Alternate)


(Alternate)


Annex 4

BRUNEI Dr Haiiah Intan Hj Md Salleh (Alternate) DARUSSALAM Deputy Director of Health (continued) Ministry of Health

Bandar Seri Begawan FAX: (6732) 40980 TEL: (6732) 226 640, Ext. 105

Pengiran Haji Anuar Ismail (Alternate) Administrative Officer Ministry of Health Bandar Seri Begawan FAX: (6732) 40980 TEL: (6732) 226 640, Ext. 115

Dk Haiiah Saadiah Pg Muda Haji Hashim (Alternate) System Analyst Ministry of Health Bandar Seri Begawan FAX: (6732) 40980 TEL: (6732) 226 660

CAMBODIA Dr Hong Sun Huot (Chief Representative) Ministre de la Sante Ministere de la Sante Phnom Penh FAX: (855) 232 6211 TEL: (855) 232 6469

Dr Mam Bun Heng (Alternate) Directeur de la Sante Ministere de la Sante Phnom Penh FAX: (855) 232 6211 TEL: (855) 24033

CHINA Dr He Jiesheng (Chief Representative) Vice-Minister Ministry of Public Health Beijing FAX: (861) 401 4332 TEL: (861) 401 4332

Dr Li Shichuo (Alternate) Director Department of Foreign Affairs Ministry of Public Health Beijing FAX: (861) 401 4332 TEL: (861) 401 4332

CHINA (continued)

COOK ISLANDS


Mr Zhang Yuji Director Department of Social Development State Planning Commission Beijing FAX: (861) 401 4332 TEL: (861) 401 4332

Dr Wang Zhao Deputy Director Department of Health and Epidemic Prevention Ministry of Public Health Beijing FAX: (861) 401 4332 TEL: (861) 401 4332

Dr Li Qingan Deputy Director Department of Hygienic Inspection and Surveillance Ministry of Public Health Beijing FAX: (861) 401 4332 TEL: (861) 401 4332

Mr Wu Guogao Deputy Chief Division of International Organizations Department of Foreign Affairs Ministry of Public Health Beijing FAX: (861) 401 4332 TEL: (861) 401 4332

Dr Qi Qingdong Programme Officer Division of International Organizations Department of Foreign Affairs Ministry of Public Health Beijing FAX: (861) 401 4332 TEL: (861) 401 4332

Mr Ngereteina Puna Minister of Health Ministry of Health Rarotonga FAX: (682) 25664 TEL: (682) 22664

73

Annex 4

(Alternate)

(Alternate)

(Alternate)

(Alternate)

(Adviser)



Annex 4

COOK ISLANDS Dr George Koteka (Alternate) (continued) Secretary of Health

Ministry of Health Rarotonga FAX: (682) 25664 TEL: (682) 22664

Mr Hugh Henry (Alternate) Chairman Cook Islands Health Board Rarotonga FAX: (682) 25420 TEL: (682) 25320

FIJI Mr Solomone Naivalu (Chief Representative) Minister for Health Ministry of Health Tamavua FAX: (679) 306 163 TEL: (679) 306 117

Mr Poseci Bune (Alternate) Permanent Secretary for Health Ministry of Health Tamavua FAX: (679) 306 163 TEL: (679) 306 117

Dr Nacanieli Goneyali (Alternate) Director of Hospital Services Ministry of Health Tamavua FAX: (679) 306 163 TEL: (679) 306 117

FRANCE M. Robert Paouta Naxue (Chief Representative) Membre du Congres de N ouvelle-Caledonie B.P.31 Noumea TEL: 264731


Annex ,4

FRANCE M. Michel Buillard (Alternate) (continued) Ministre de la Sante,

de la Solidarite, de I'Habitat et de la Recherche et Vice-President du Gouvernement de la Polynesie fran\;aise B.P.2551 Papeete, Tahiti FAX: (689) 430 974 TEL: (689) 422 030

Dr Richard Wong Fat (Alternate) Directeur de la Sante publique en Polynesie fran\;aise B.P.611 Papeete, Tahiti FAX: (689) 430 974 TEL: (689) 422 030

Dr M. Germain (Alternate) Medecin inspecteur de la Nouvelle-Caledonie Noumea FAX: (687) 277 346 TEL: (687) 283 454

M. Jean-Louis Durand-Drouhin (Alternate) Sous-Directeur des Relations internationales Ministere des Affaires sociales, de la Sante et de la Ville 1 Place de Fontenoy 75700 Paris FAX: (33 140) 567 243 TEL: (33 140) 567 365

Dr Bernard Montaville (Alternate) Direction de la Cooperation Ministere des Affaires etrangeres 34 rue La Perouse 75775 Paris Cedex 15 FAX: (33 140) 666 877 TEL: (33 140) 667 790

76

Annex 4

HONG KONG

JAPAN

REGIONAL COMMITTEE: FORTY-FOURTH SESSION

Dr Lee Shiu-hung Director of Health Department of Health 9th Floor, Sunning Plaza 10 Hysan Avenue Hong Kong FAX: (852) 576 5166 TEL: (852) 890 0704; (852) 890 0585

Mr Victor Ng Principal Assistant Secretary Health and Welfare Branch 7th Floor, Main Wing Central Government Offices Hong Kong FAX: (852) 576 5166 TEL: (852) 890 0704; (852) 890 0585

Dr Ma Po-ling Consultant (Community Medicine) Department of Health 9th Floor, Sunning Plaza 10 Hysan Avenue Hong Kong FAX: (852) 576 5166 TEL: (852) 890 0704; (852) 8900585

Dr Leung Ting-hung Principal Medical and Health Officer Department of Health 9th Floor, Sunning Plaza 10 Hysan Avenue Hong Kong FAX: (852) 576 5166 TEL: (852) 890 0704; (852) 890 0585

Mr Hirokazu Arai Ambassador Extraordinary and Plenipotentiary Embassy of Japan in the Philippines Makati FAX: (0723) 817 65 62 TEL: (0723) 818 90 11


(Alternate)

(Alternate)

(Alternate)


JAPAN (continued)


Dr Hidesuke Kobayashi Councillor for Science and Technology Minister's Secretariat Ministry of Health and Welfare 1-2-2, Kasumigaseki Chiyoda-ku Tokyo 10045 FAX: (813) 3501 2532 TEL: (813) 3591 8983

Mr Hisato Murayama Minister Embassy of Japan in the Philippines Makati FAX: (0723) 817 6562 TEL: (0723) 818 9011; 852078

Mr Hideyuki Sakai Director International Affairs Division Minister's Secretariat Ministry of Health and Welfare 1-2-2, Kasumigaseki Chiyoda-ku Tokyo 10045 FAX: (813) 3501 2532 TEL: (813) 3591 8983

Mr Isao Saito Director Narcotics Division Ministry of Health and Welfare 1-2-2, Kasumigaseki Chiyoda-ku Tokyo 10045 FAX: (813) 3501 2532 TEL: (813) 3591 8983

Mr Takanori Kitamura Counsellor Embassy of Japan in the Philippines Makati FAX: (0723) 817 6562 TEL: (0723) 8189011; 852078

77

Annex 4

(Alternate)

(Alternate)

(Alternate)

(Alternate)

(Alternate)

78

Annex 4

JAPAN (continued)


Dr Jinichi Suzuki Assistant Director International Affairs Division Minister's Secretariat Ministry of Health and Welfare 1-2-2, Kasumigaseki Chiyoda-ku Tokyo 100-45 FAX: (813) 3501 2532 TEL: (813) 3591 8983

Mr Kousaku Uchida Deputy Director International Affairs Division Minister's Secretariat Ministry of Health and Welfare 1-2-2, Kasumigaseki Chiyoda-ku Tokyo 100-45 FAX: (813) 3501 2532 TEL: (813) 3591 8983

Dr Hiroyuki Doi Deputy Director International Affairs Division Minister's Secretariat Ministry of Health and Welfare 1-2-2, Kasumigaseki Chiyoda-ku Tokyo 100-45 FAX: (813) 3501 2532 TEL: (813) 3591 8983

Dr Etsuro Kashiwagi First Secretary Embassy of Japan in the Philippines Makati FAX: (0723) 817 6562 TEL: (0723)8189011; 852078

Dr Souichi Koike Medical Officer International Affairs Division Minister's Secretariat Ministry of Health and Welfare 1-2-2, Kasumigaseki Chiyoda-ku Tokyo 100-45 FAX: (813) 3501 2532 TEL: (813) 3591 8983

(Adviser)

(Adviser)

(Adviser)

(Adviser)

(Adviser)

,.REPORT OF THE REGIONAL COMMITTEE 79

AQQex4

KIRIBATI Mr Inatoa Tebania (Chief Representative) Minister of Health. Family Planning and Social Welfare P.O. Box 268 Bikenibeu Tarawa FAX: (686) 28152 TEL: (686) 28100

Mr Meita Beiabure (Alternate) Secretary for Health. Family Planning and Social Welfare P.O. Box 268 Bikenibeu Tarawa FAX: (686) 28152 TEL: (686).28100

Dr Kautu Tenaua (Alternate) Senior Medical Officer Ministry of Health. Family Planning and Social Welfare P.O. Box 268 Bikenibeu Tarawa FAX: (686) 28152 TEL: (686) 28100

LAO PEOPLE'S Dr Khamphay Rasmy (Chief Representative) DEMOCRATIC Vice-Ministre REPUBLIC Ministere de la Sante publique

Vientiane FAX: 856219380 TEL: 8563829

MALAYSIA Dato' Lee Kim Sai (Chief Representative) Minister of Health 50590 Kuala Lumpur FAX: (603) 291 1436 TEL: (603) 298 9887

Tan Sri Dato' (Dr) Abu Bakar (Alternate) bin Suleiman Director-General of Health Ministry of Health 50590 Kuala Lunmur FAX: (603) 292 8894 TEL: (603) 292 5196


Annex 4

MALAYSIA Dr Wan Mahmud bin Othman (Alternate) (continued) Director. Vector-borne

Disease Control Progranune 50590 Kuala Lumpur FAX: (603) 293 1590 TEL: (603) 292 4013

Mr Lee Check How (Alternate) Confidential Secretary of the Minister of Health 50590 Kuala Lumpur FAX: (603) 292 8894 TEL: (603) 298 5077

REPUBLIC OF Mr Donald F. Capelle (Chief Representative) THE MARSHALL Secretary of Health and Environment ISLANDS Ministry of Health Services

P.O. Box 16 Majuro 96960 FAX: (11-692) 93432 TEL: (11-692) 93399

Mr Michael Jenkins (Alternate) National Health Planner Ministry of Health Services P.O. Box 16 Majuro 96960 FAX: (11-692) 93432 TEL: (11-692) 93399

FEDERATED Dr Eliuel K. Pretrick (Chief Representative) STATES OF Secretary MICRONESIA Department of Health Services

P.O. Box PS 70 Palikir Pohnpei 96941 FAX: (691) 320 5263 TEL: (691) 3202643/2619/2872

Mr Jeff Benjamin (Alternate) Administrator for Health Care Services Department of Health Services P.O. Box PS 70 Palikir Pohnpei96941 FAX: (691) 3205263 TEL: (691) 3202643/2619/2872

NEW ZEALAND

PAPUA NEW GUINEA

PHILIPPINES

, REPORT OF THE REGIONAL COMMITIEE

Mr Christopher Lovelace Director-General of Health Department of Health p,O, Box 5013 Wellington FAX: (644) 496 2340 TEL: (644) 496 2000

Dr Gillian Durham Chief Executive Public Health Commission p,O, Box 1795 Wellington FAX: (644) 495 2258 TEL: (664) 4952250

Ms Gillian Grew Chief Nursing Advisor Ministry of Health p,O, Box 5013 Wellington FAX: (644) 4962340 TEL: (644) 4962000

Mr Francis Koimanrea Minister for Health Ministry of Health P,O. Box 3991 Boroko. N.C.D. FAX: (675) 250 826 TEL: (675) 251225; 277-501; 277-503

Dr Isaac Ake Secretary for Health Department of Health P.O. Box 3991 Horoko. N.C.D. FAX: (675) 250 826 TEL: (675) 251 225

Dr Juan M. Flavier Secretary of Health Department of Health San Lazaro Compound Sta. Cruz Manila FAX: (632) 711 6055 TEL: (632) 711 6080

81


(Alternate)

(Alternate)


(Alternate)


82

Annex 4

PHILIPPINES (continued)

REGIONAL COMMITTEE: FORTY -FOURTH SESSION

Dr Jaime Z. Galvez-Tan Undersecretary of Health Department of Health San Lazaro Compound Sta. Cruz Manila FAX: (632) 711 6055 TEL: (632) 711 6080

Dr Linda L. Milan Assistant Secretary of Health Department of Health San Lazaro Compound Sta. Cruz Manila FAX: (632) 711 6055 TEL: (632) 711 9502

Dr Carmencita N. Reodica Assistant Secretary of Health Department of Health San Lazaro Compound Sta. Cruz Manila FAX: (632) 711 6055 TEL: (632) 711 6080

Mrs Ma. Rowena Mendoza Sanchez Director for Social, Cultural and Humanitarian Affairs Department of Foreign Affairs Manila FAX: (632) 833 1322 TEL: (632) 831 8874 .

Mrs Remedios V.S. Paulino Officer-in-Charge Foreign Assistance Coordination Service Department of Health San Lazaro Compound Sta. Cruz Manila FAX: (632) 711 6055 TEL: (632) 711 6080

(Alternate)

(Alternate)

(Alternate)

(Adviser)

(Adviser)

PHILIPPINES (continued)

PORTUGAL


Miss FJeurdelys Torres Director, Social Development Staff National Economic and Development Authority Amber Avenue Pasig Metro Manila FAX: (632) 631 3728 TEL: (632) 631 3728

Dr Susan D. Pineda Head Executive Assistant Department of Health San Lazaro Compound Sta. Cruz Manila FAX: (632) 711 6055 TEL: (632) 711 60-80

Mrs Arlene Ruiz Chief, Division of Health, Nutrition and Family Planning Social Development Staff National Economic and Development Authority Amber A venue Pasig Metro Manila FAX: (632) 631 3728 TEL: (632) 631 3758; (632) 631 2189

Dr Ana Maria Basto Perez Secretaire de la Sante et des Affaires sociales Macao TEL: (853) 510 878; 510 879

Dr Joao Larguito Claro Sous-Directeur Departement des Services de Sante Macao TEL: (853) 510 878; 510 879 FAX: (853) 713 105

83

Anaex4

(Adviser)

(Adviser)

(Adviser)


(Alternate)

84

Annex 4

PORTUGAL (continued)

REPUBLIC OF KOREA


Dr Liu Guo-bin Conseiller pour la Sante Macao TEL: (853) 510 878; 510 879

Dr Carlos Manuel Nogueira da Canhota Chef, Cabinet technique des Soins de Sante primaires Macao FAX: (853) 568 859 TEL: (853) 569 034

Dr Maria de Lourdes Silva Chef du Departement de Planification et des Ressources humaines Macao FAX: (853) 710 430 TEL: (853) 390 7123

Mr Chang-Soo Lee Ambassador Extraordinary and Plenipotentiary The Embassy of the Republic of Korea in the Philippines Makati Metro Manila FAX: (632) 817 5845 TEL: (632) 817 5827

Dr Dong-Mo Rhie Director-General Bureau of Public Health Ministry of Health and Social Affairs Seoul Republic of Korea FAX: (02) 504 6418 TEL: (02) 503 7537; 542 3534

Mr Ho-Jin Lee Counsellor Embassy of the Republic of Korea in the Philippines Makati Metro Manila FAX: (632) 817 5845 TEL: (632) 817 5827

(Alternate)

(Alternate)

(Alternate)


(Alternate)

(Alternate)


Annex 4

REPUBLIC OF Mr Doa-Young Cheong (Alternate) KOREA Director (continued) Office of International Cooperation

Ministry of Health and Social Affairs Seoul PAX: (02) 504 6418 TEL: (02) 503 7524

Mr Jeong-In Suh (Alternate) Deputy Director International Organizations Division Ministry of Foreign Affairs Seoul TEL: (02) 720-2336

Dr Sung Woo Lee (Adviser) President Korea Institute for Health and Social Affairs Seoul PAX: (822) 352 9129 TEL: (822) 355 800

Dr Kyu-Sang Cho (Adviser) President Korea Industrial Health Association Seoul PAX: (02) 585 1584 TEL: (02) 522 7544

Dr Young-Soo Shin (Adviser) President Korea Institute of Health Service Management Seoul PAX: (822) 388 8330 TEL: (822) 388 8329

SAMOA Mr Sala Vaimili II (Chief Representative) Minister of Health Apia FAX: (685) 214 40 (Department of Health) TEL: (685) 233 30 (Direct line)

(685) 212 12 (Department line)

Dr George Schuster (Alternate) Director-General of Health Apia PAX: (685) 214 40 (Department of Health) TEL: (685) 233 30 (Direct line)

(685) 212 12 (Department line)


Annex 4

SINGAPORE Dr Chen Ai Ju (Chief Representative) Deputy Director of Medical

Services (Hospitals) Ministry of Health College of Medicine Building 16 College Road Singapore 0316 FAX: (65) 224 1677 TEL: (65) 223 7777

Dr Luisa Lee (Alternate) Chief Executive Officer Woodbridge Hospital Ministry of Health Singapore 0316 FAX: (65) 480 9260 TEL: (65) 480 9302

SOLOMON Mr Nathaniel Waena (Chief Representative) ISLANDS Minister for Health and

Medical Services P.O. Box 349 Honiara FAX: (677) 21608 TEL: (677) 23402

Mr John Musuota (Alternate) Member of Parliament Honiara FAX: (677) 23866 TEL: (677) 22732

Dr Nathan Kere (Alternate) Acting Permanent Secretary Ministry of Health and Medical Services P.O. Box 349 Honiara FAX: (677) 21608 TEL: (677) 23402

TOKELAU Dr Iuta Tinielu (Chief Representative) Director of Health Tokelau FAX: 21761 TEL: 20822; 20823

TONGA

TUVALU

UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND

UNITED STATES OF AMERICA


Dr Sione Tapa Minister of Health Nuku'alofa FAX: (676) 24 291 TEL: (676) 23 200

Mrs A. Homasi Chief of Nursing Ministry of Health and Human Resource Development P.O. Box 36 Funafuti FAX: (688) 832 TEL: (688) 751

Mrs Suialofa Elisaia Higher Executive Officer Ministry of Health and Human Resource Development P.O. Box 36 Funafuti FAX: (688) 832 TEL: (688) 832

Dr Lee Shiu-hung Director of Health Department of Health 9th Floor, Sunning Plaza 10 Hysan Avenue Hong Kong FAX: (852) 576 5166 TEL: (852) 890 0704; (852) 890 0585

Dr Edgar C. Reid Deputy Director for Preventive Health Services Department of Health and Human Services Government of American Samoa Tutuila FAX: (684) 633 5379 TEL: (684) 633 2243/4606

87

Annex 4



(Alternate)



88 REGIONAL COMMIITEE: FORTY -FOURTH SESSION

Annex 4

UNITED STATES OF AMERICA (continued)

VANUATU

Dr Sam Lin Assistant Surgeon-General Special Assistant to the Director Office of International Health United States Public Health Service Department of Health and Human Services Rockville, Marvland FAX: (301) 443 4549 TEL: (301) 4434010

Mr Ignacio Cruz Aguigui Special Assistant to the Governor for Health Office of the Governor Agana Guam FAX: (671) 477 4826 TEL: (671) 472 8931

Ms Ann S. Blackwood Directorate for Health and Transportation Bureau of International Organization Affairs Department of State Washington. D.C. FAX: (202) 647 8902 TEL: (202) 647 1044

Dr Edward Tambisari Minister of Health, Rural Water Supply, Population and Rights of Children Port Vila FAX: (678) 3142 TEL: (678) 22545

Mr Hilson Toaliu Principal Officer Department of Preventive Health and Rural Water Supply Port Vila FAX: (678) 3142 TEL: (678) 22512

(Adviser)

(Adviser)

(Adviser)


(Alternate)


Annex 4

VIETNAM Professeur Nguyen Trong Nhan Ministre de la Sante Hanoi FAX: (844) 264 052 TEL: (844) 253 303

Dr Ngo Van Hop Directeur Departement de la Cooperation internationale Ministere de la Sante Hanoi FAX: (844) 264 052 TEL: (844) 264 050


(Alternate)

II. REPRESENTATIVES OF THE UNITED NATIONS AND RELATED ORGANIZATIONS

UNITED NATIONS DEVELOPMENT PROGRAMME (UNDP)

Mr Kevin McGrath Resident Representative of the United Nations Development Progranune in the Philippines

UNITED NATIONS OFFICE OF THE HIGH COMMISSIONER FOR REFUGEES (UNHCR)

Makati, Metro Manila

Dr Wayne Draper Medical Advisor Office of the High Commissioner for Refugees Philippine Refugee Processing Centre Morong, Bataan

III. REPRESENTATIVE OF AN INTERGOVERNMENTAL ORGANIZATION

ASIAN DEVELOPMENT BANK Ms Jane Thomason Health Specialist Infrastructure Department Education, Health and Population Division (East) Mandaluyong, Metro Manila


Annex 4

IV. REPRESENTATIVES OF NONGOVERNMENTAL ORGANIZATIONS

INTERNATIONAL ASSOCIATION FOR ADOLESCENT HEALTH

WORLD BLIND UNION

INTERNATIONAL ASSOCIATION OF CANCER REGISTRIES

INTERNATIONAL UNION OF PURE AND APPLIED CHEMISTRY

INTERNATIONAL DENTAL FEDERATION

INTERNATIONAL UNION FOR HEALTH PROMOTION AND EDUCATION

WORLD FEDERATION FOR MEDICAL EDUCATION

INTERNATIONAL EPIDEMIOLOGICAL ASSOCIATION

INTERNATIONAL LEAGUE AGAINST EPILEPSY

INTERNATIONAL FEDERATION FOR FAMILY LIFE PROMOTION

INTERNATIONAL FEDERATION OF GYNECOLOGY AND OBSTETRICS

WORLD ASSOCIATION OF GIRL GUIDES AND GIRL SCOUTS

INTERNATIONAL FEDERATION OF HEALTH RECORDS ORGANIZATIONS

WORLD FEDERATION OF HEMOPHILIA

INTERNATIONAL ASSOCIATION OF MEDICAL LABORATORY TECHNOLOGISTS

CHRISTIAN MEDICAL COMMISSION

Professor Perla D. Santos Ocampo

Captain Oscar J. Taleon

Dr A.V. Laudico

Dr Aida Aguinaldo

Dr Sofronio San Juan

Professor Myung Ho Kim

Dr Fernando Sanchez

Dr Jane Baltazar

Dr Anemio T. Ordinario

Mrs Esperanza Dowling

Dr Manuel M. Ramos, Jr

Mrs Milagros Araneta Villasor

Mrs Lourdes L. Palapal

Dr Luz L. Alisangco Gamez

Mr Masamichi Kinomoto Mr Toshihiro Mitsudome

Mrs Pearl Domingo-Flores


MEDICAL WOMEN'S INTERNATIONAL ASSOCIATION

MOTHER AND CHILD INTERNATIONAL

INTERNATIONAL COUNCIL OF NURSES

INTERNATIONAL UNION OF NUTRITIONAL SCIENCES

WORLD FEDERATION OF OCCUPATIONAL THERAPISTS

INTERNATIONAL FEDERATION OF OPHTHALMOLOGICAL SOCIETIES

INTERNATIONAL PLANNED PARENTHOOD FEDERATION

INTERN A TIONAL COUNCIL OF SOCIETIES OF PATHOLOGY

INTERNATIONAL PEDIATRIC ASSOCIATION

INTERNATIONAL PHARMACEUTICAL FEDERATION

INTERNATIONAL FEDERATION OF PHARMACEUTICAL MANUFACTURERS ASSOCIATIONS

WORLD CONFEDERATION FOR PHYSICAL THERAPY

WORLD ASSOCIATION FOR PSYCHOSOCIAL REHABILITATION

INTERNATIONAL COMMITTEE OF THE RED CROSS

WORLD REHABILITATION FUND, INC.

WORLD ORGANIZATION OF THE SCOUT MOVEMENT

INTERNATIONAL FEDERATION OF SPORTS MEDICINE

Dr Fe Canlas-Dizon

Dr Carmelita B. Cuyugan Dr Evangeline G. Suva

Dr Leda Layo-Danao

Dr Corazon Barba

Ms Cynthia V. Isaac .

Dr Romeo V. Fajardo

Mrs Clio Brion Zabala

Dr Jorge C. Peralta

Annex 4

Professor Perla D. Santos Ocampo

Mr John Ware

Mr Edmund B. Tamayo

Mrs Sandra Moore

Dr Antonio Perlas

Dr Didier Soubeyran

Dr Tyrone M. Reyes

Mr Kim Kyu Young Mr Golam Sattar

Dr Teruichi Shimomitsu


Annex 4

WORLD FEDERATION OF UNITED NATIONS ASSOCIATIONS

INTERNATIONAL UNION AGAINST THE VENEREAL DISEASES AND THE TREPONEMATOSES

WORLD VETERANS FEDERATION

INTERNATIONAL ALLIANCE OF WOMEN

INTERNATIONAL COUNCIL OF WOMEN

Dr Liduvina R. Senora Dr Yolanda A. Mangunay

Dr Rosemarie T. Santana-Arciaga

Dr Godofredo Reyes

Ms Liza Largoza-Maza

Dr Guia Najera Ison, MPH

PART II


CONTENTS

PART II - SUMMARY RECORDS OF THE PLENARY MEETINGS

Agenda item no.

1. Opening of the session ................................................................ .

2. Address by the retiring Chairman .................................................. .

3. Election of new officers: Chainnan, Vice-Chairman and Rapporteurs ..... .

4. Address by the incoming Chairman ................................................ .

5. Adoption of the agenda .............................................................. ..

6. Address by the Director-General .................................................. ..

7. Nomination of the Regional Director ............................................. ..

8. Report of the Regional Director

98

98, 111

98

134

99

99, 115

124

99, 125

9. Programme budget, 1992-1993: Budget performance (interim report) ...... 134

10. AIDS................... .................................. .................................. 143

10.1 Annual report on AIDS, including sexually transmitted diseases ......... 143, 154, 170

10.2 Global Programme on AIDS: Membership of the Management Committee ............................................. ,............. 165, 172

11. Eradication of poliomyelitis in the Region: progress report................ 165, 173,214

12. Sub-Committee of the Regional Committee on Programmes and Technical Cooperation: Report on country visits ....................... 179,215

13. Nutrition in the Western Pacific Region, including follow-up of the International Conference on Nutrition ............... .......... ............ 190, 215

14. Development of health research ................................................. 256, 267

15. Human resources for health .. .................... ............ .................... 198

15.1 Public health training in the Western Pacific Region ....................... .

15.2 Fiji School of Medicine .......................................................... .

16. Regional strategy on health and environment, including follow-up of the United Nations Conference on Environment

200, 216

204, 216

and Development (UNCED) ..................................................... 209,217,264

- 95 -

Agenda item no.

17. Cholera and diarrhoeal diseases .................................................. 251. 266

18. Health promotion..... ........ ........ ..... .......... .......... ...................... 242. 265

19. Special Programme of Research. Development and Research Training in Human Reproduction: Membership of the Policy and Coordination Committee..................... 268. 273

20. Action Programme on Essential Drugs: Membership of the Management Advisory Committee....... ............. ... 269. 273

21. WHO Response to Global Change: Report of the Executive Board Working Group .............................................................. 223.236.264

22. Correlation of the work of the World Health Assembly, the Executive Board and the Regional Committee ....... . . . . . . . . . . . . . . . . . . . . . 270

22.1 Consideration of resolutions of the Forty-sixth World Health Assembly and the Executive Board at its ninety-first and ninety-second sessions .............................................................. 270

22.2 Consideration of the agenda of the ninety-third session of the Executive Board ............................................................... .

23. Selection of topic for the Technical Discussions in conjunction with the forty-fifth session of the Regional Committee ..................... .

24. Time and place of the forty-fifth and forty-sixth sessions of the Regional Committee ........................................................... .

25. Statements by representatives of the United Nations. the Specialized Agencies and intergovernmental and nongovernmental organizations in official relations with WHO ................................................... .

26. Closure of the session ............................................................. .

- 96-

271

271, 273

250,265

273

274

1.

2.

3.

4.

5.

6.

7.

(wpRlRC44/SRlI)

SUMMARY RECORD OF THE FIRST MEETING

WHO Conference Hall. Manila Monday. 13 September 1993 at 9 a.m.

CHAIRMAN: Dr Lee Shiu-hung (Hong Kong) later: Mr S. Naivalu (Fiji)

CONTENTS

Opening of the session ......................................................................... .

Address by the retiring Chairman ........................................................... .

Election of new officers: Chairman, Vice-Chairman and Rapporteurs .............. .

Technical Discussions: appointment of a moderator ..................................... .

Adoption of the agenda ........................................................................ .

Address by the Director-General ........................................................... ..

Report of the Regional Director ............................................................. .

- 97 -

98

98

98

99

99

99

99


1. OPENING OF THE SESSION: Item 1 of the Provisional Agenda

Dr LEE Shiu-hung, retiring Chairman, declared the forty-fourth session of the WHO

Regional Committee for the Western Pacific open.

2. ADDRESS BY THE RETIRING CHAIRMAN: Item 2 of the Provisional Agenda

Dr LEE made a statement to the Committee as retiring Chairman (see Annex 1).

3. ELECTION OF NEW OFFICERS: CHAIRMAN, VICE-CHAIRMAN AND

RAPPORTEURS: Item 3 of the Provisional Agenda

3.1 Election of Chairman

Dr LEE Kim Sai (Malaysia) nominated Mr NAIV ALU (Fiji) as Chairman; this was

seconded by Dr TAPA (Tonga).

Decision: Mr NAIV ALU was elected unanimously.

Mr NAIVALU took the chair.

3.2 Election of Vice-Chairman

Mr Chang-Soo LEE (Republic of Korea) nominated Dr Ana PEREZ (Portugal) as

Vice-Chairman; this was seconded by Mr V AIMILI (Samoa).

Decision: Dr Ana PEREZ (Portugal) was elected unanimously.

3.3 Election of Rapporteurs

Dr FLAVIER (Philippines) nominated Dr CHEN Ai Ju (Singapore) as Rapporteur for the

English language; this was seconded by Mr LOVELACE (New Zealand).

Professor NGUYEN TRONG NHAN (Viet Nam) nominated Dr GERMAIN (France) as

Rapporteur for the French language; this was seconded by Dr RASMY (Lao People's

Democratic Republic).

SUMMARY RECORD OF THE FIRST MEETING 99

Decision: Dr CHEN Ai Ju and Dr GERMAIN were elected unanimously.

4. TECHNICAL DISCUSSIONS: APPOINTMENT OF A MODERATOR

The CHAIRMAN moved the appointment of a moderator for the Technical Discussions

and proposed Mr LOVELACE (New Zealand).

Decision: The proposal was adopted unanimously.

5. ADOPTION OF THE AGENDA: Item 5 of the Provisional Agenda

(Document WPRlRC44/1 Rev. 1)

The CHAIRMAN moved the adoption of the Agenda.

Decision: In the absence of comments, the Agenda was adopted.

6. ADDRESS BY THE DIRECTOR-GENERAL: Item 6 of the Agenda

The CHAIRMAN invited Dr Nakajima to address the meeting (see Annex 2 for a copy of

his statement).

7. REPORT OF THE REGIONAL DIRECTOR: Item 8 of the Agenda

(Documents WPRlRC44/3 and Corr.1)

Before introducing his report, the REGIONAL DIRECTOR welcomed Tuvalu as the

newest member of the Region. He was happy to report that planning was already going on for

activities in Tuvalu for the biennium and for 1994-1995. By entering late into the group, it

would benefit from a sharpened focus of response to its health problems.

In presenting his report, the Regional Director said he was reflecting not only on the

previous two years but on the previous four-and-a-half years since he had been given the honour

of serving in that capacity.

He wanted to remind the Committee of a few fundamentals. WHO's primary mandates

were to "act as the directing and co-ordinating authority on international health work" and to


establish and maintain effective collaboration with countries on technical cooperative activities.

Had that been done?

The Constitution stated, among other basic principles, that "the extension to all peoples of

the benefits of medical, psychological and related knowledge is essential to the fullest attainment

of health", and further, that "informed opinion and active co-operation on the part of the public

are of the utmost importance in the improvement of the health of the people". Had those

principles been significantly incorporated in WHO's work?

WHO's role was to coordinate, gather information, analyse it, discuss its implications for

health planning, undertake collaborative work with Member States to implement relevant

activities, and ensure that appropriate technology and skills were available. The report

presented the evidence of those basic elements of WHO's role.

No activity showed those elements working together more clearly than the eradication of

poliomyelitis. As a result of joint efforts with concerned governments and

collaborating agencies, highly effective strategies had been put in place over the previous three

years. The 1992 surveillance figures showed 2081 confirmed poliomyelitis cases, which was

the lowest recorded annual incidence yet. The annual report to be presented later in the session

would discuss that in detail.

Three years before, it had taken up to one year for surveillance reports to reach the

Secretariat. Currently most poliomyelitis surveillance reports reached the Secretariat on a

weekly basis. The quality of surveillance had improved as radically as the timeliness. Four

years before, only a minor proportion of the cases had been investigated clinically or

virologically. Currently more than 55 % of all suspected acute flaccid paralysis cases were

investigated and more than 50% had stool specimens collected for analysis. To be able to do

that, a regional network of laboratories had had to be set up, which was now functioning

efficiently.

While high routine coverage with all vaccines had been maintained for most countries, the

scale and extent of supplementary immunization had also undergone a remarkable change. All

countries except Papua New Guinea and Cambodia were currently conducting extensive

supplementary poliomyelitis immunization activities. Substantial funds had been mobilized to

support vaccine purchase. In the previous three years, an additional ten million US dollars had

been made available, in addition to the other funds supplied by WHO's partners in poliomyelitis

eradication such as UNICEF and Rotary International.


The technology to eradicate poliomyelitis had been available for many years. What had

been needed was to improve management, concentrate the focus and accelerate activities. The

report acknowledged the tremendous success of the Philippines, which had been the

first country in the Region to hold national immunization days. That activity clearly showed

how, with reference to the mandate and principles first mentioned, the combination of "central

coordination and direction" with "informed ... and active co-operation on the part of the public"

helped to bring about "the extension of ... the benefits of medical knowledge" and greater

collaboration on an international scale.

Surveillance, the knowledge of the changing health status of the populations of the

Region, was an increasingly important tool. It was essential, however, to be flexible in

approach, when it transpired that the situation had altered, or that a new factor (such as drug

resistance) changed the picture.

The report described how information, in the sense of both surveillance and informing the

public, had been important in the approaches to HIV infection and AIDS in the Region. That

would also be discussed in detail in the full annual report to be reviewed later in the session. In

the meantime he drew attention particularly to the extent to which WHO's efforts were directed

towards finding out the trends of incidence, the population groups within which the disease

spread, and their behaviour patterns, so that preventive activities were clearly and efficiently

sighted on those areas.

The Global Programme on AIDS had had to work fast. In 1989,20 countries and areas

had reported HIV infections, but far from all of them had had a national AIDS programme.

Currently, 26 countries were reporting HIV infection, but all 35 countries and areas in the

Region had national AIDS programmes. At the end of 1989, the number of reported AIDS

cases had been 2450. Three and a half years later that number had grown to 5524. WHO's

challenge in the years ahead was to make the national programmes as effective as possible, to

contain any further spread, and to ameliorate conditions for those already infected.

The second evaluation of progress towards health for all by the year 2000 published in

1993 shed some interesting light on the shifts that were taking place. Most of the countries and

areas in the Region had either achieved or were close to achieving their set health indicator

targets. All but four countries and areas now had infant mortality rates below the global target

of 50 per 1000 live births. At the other end of the life span, those same four countries had been

the only ones to report average life expectancy of less than the global target of 60 years.


In 1990, data from the Region on the leading causes of mortality from infectious diseases

had shown diarrhoeal diseases in top place, closely followed by acute respiratory infections.

The focus of the programme had thus been on correct case management of diarrhoea and

acute respiratory infections, both at home and at health facilities, as well as on strengthening

preventive interventions.

Training with carefully designed materials had been an important strategy. It had also

been important to make sure that the appropriate treatment materials were available throughout

the Region. WHO's approach had been to teach how to recognize and manage the problem, and

to make sure that adequate supplies of the appropriate remedy were available for them to use.

Training in clinical management had remained the leading element in national CDD

programmes. Seven countries had now established diarrhoea training units, bringing the total to

35 units in the Region. More than 100 clinical case-management training courses had been held

by the units during the biennium.

By the end of 1992, 84% of the population in the developing countries of the Region

(other than China) had had access to oral rehydration salts. That would be especially important

in view of the precautions being taken against the new cholera strain, Vibrio cholerae 0139, and

the efforts to increase the preparedness of countries.

The resurgence of malaria and tuberculosis demonstrated the problems faced and the need

for a flexible approach. There were nine malarious countries in the Region, with a total of

almost 800 000 microscopically confirmed cases reported in 1991, and as many as two million

cases per year believed to go unreported and incompletely treated. The escalating levels of

multidrug resistance in the potentially life-threatening species Plasmodium /alciparum, posed

exceptional challenges to control programmes in the light of increasing population mobility and

the developing tourist industry throughout the Region. Even though a great deal was known

about those diseases, they were proving irrepressible. The right approach to subdue them was

still being sought.

An important meeting on malaria would take place in Kunming, China, in November

1993 to discuss strategy. That meeting followed the World Declaration on the Control of

Malaria in Amsterdam, which had instigated the review of national malaria control programmes

and activities. The main focus of activities (and allocation of external resources) in the Region

had been in Cambodia and Viet Nam, following considerable rises in the numbers of

microscopically confirmed cases. There had been a more than threefold increase in malaria

related mortality in Viet Nam in the previous three years, with over 4600 deaths in 1991. The


development of the Chinese drug Qinghaosu or artemisinin was being strongly supported by

WHO, with the objective of producing two million adult curative doses per annum.

The Regional Director's report on the biennium provided an account of the current status

of the tuberculosis programme and WHO's concerns in relation to the connection with AIDS

and the spread of its highly resistant forms.

He had often stated in the past that the most critical component of the infrastructure

needed for health development was the availability of adequate and appropriate human

resources. In that area, the Fiji School of Medicine, which was also the subject of a working

paper to be discussed later in the session, provided a good example of the targeted approach in

action. The first 28 primary care practitioners from its new medical curriculum would graduate

in December of the current year. After a year of field assignments, most of them would

continue on to the second tier of the programme to eventually become medical doctors.

Other new approaches to relevance in medical education had been the subject of

discussions throughout the Region, including developed countries such as Japan. In the

previous month, the World Conference on Medical Education in Edinburgh, United Kingdom,

had provided a global forum for discussion of similar concerns by representatives of

the Regional Association for Medical Education, supported by WHO. The basic training of

other categories of health workers, such as those of nursing and dental health, was also

undergoing the same changes.

While those activities were aimed at producing the right kind of health personnel for the

future, the Region had also attended to the training needs of those already in service. Distance

education techniques for nurses had been tried out in China and Fiji. Postgraduate

and continuing medical education had been supported in Malaysia and the Republic of Korea.

Making appropriate information available to those who could use it was a central concern.

Getting adequate and accurate regional information was also vital to the planning of response.

The information and communication support required for primary health care was the subject of

Technical Discussions in 1993. He commended representatives on their choice as it was a

particularly timely opportunity to address that issue. It was truly one of the foundation stones

on which successful activities were built.

An achievement of which he was particularly proud was the growth of WHO's own

comprehensive computerized programme management information system. The Regional Office

had been a pioneer in the use of local area network technology. The system that had been


developed was used regionwide to guide the management of WHO's programmes with Member

States. It was complemented by complete office automation in all WHO offices in the Region.

All WHO Representatives and Country Liaison Officers had computers and access to the

regional information system. The centralization that that kind of information access gave was a

strong contributor to WHO's ability to manage programmes efficiently. In 1989 100 sets of

microcomputers had been installed. Now there were 310 in the Region, and the system was

being sought after by other WHO regions.

The matter of distribution of WHO's printed materials had been actively addressed. It

was essential that the printed materials for support to health services were as accessible as

possible, which usually meant that they should be translated and illustrated. Recent publications

such as Health research methodology: a guide for training in research methods answered not

only regional needs but those of other regions as well, having been translated into Chinese and

Croatian. Publications such as Medicinal plants in China and Medicinal plants in Viet Nam, not

only increased the level of knowledge but supported the important area of traditional medicine

as well.

The problems faced in 1989 were not so different from those to be faced in the next five

years. Both environmental health and health promotion were still major concerns and were the

subjects of agenda items. Both were important regional priorities, with newly formulated

strategies to present for the consideration and endorsement of the Committee. Nutrition was

also an agenda item and a central concern of WHO's work. Surveillance, development of

national nutrition policies, and a focus on micronutrient deficiencies had been emphasized, with

a continuing stress on the importance of breast-feeding.

The long-term problems currently being faced in the Region in general remained the

same, such as urbanization, environmental degradation, shifts in the relative importance of

degenerative diseases to communicable diseases, the struggle to provide adequate health

systems, and appropriately trained health personnel to staff them. A crucial concern was health

care financing. The report provided detailed information on all of those, and representatives

were invited to raise their concerns as the report was discussed.

The acceleration of change was a worldwide phenomenon. In a move initiated by WHO

headquarters, especially at the level of the Organization's governing bodies, the Committee

would be diSCUSSing the WHO response to global change. He considered that WHO had not

only made an appropriate and effective response to regional change in the Region but that it had

engineered and shaped change to improve quality of life, to bring better health, and greater

expectations for longer life to the peoples of the Region.


In general terms, he suggested that WHO should not simply respond to problems but

should be able, through much improved surveillance, timely analysis and understanding of the

situation, to work carefully towards forecasting trends in diseases, or disabilities in popUlations,

and plan for how to accommodate the demands of those factors on the health systems and

personnel in the future.

The CHAIRMAN called for comments on the report, section by section, starting with the

Introduction.

Introduction (pages 1-3)

Dr TAPA (Tonga) congratulated the Director-General on his reelection for a second term

of office, and on his inspiring address. Dr Nakajima's origins in the Region enabled him to

display empathy for its health problems.

Welcoming the representative of Tuvalu, Dr Tapa expressed appreciation· of the

increasing role played by women in the Regional Committee.

He congratulated the Regional Director on his comprehensive report: the presentation

was attractive, and the contents were excellent. The few disappointments reported were far

outweighed by the many positive achievements, which should serve as a stepping-stone to

sustainable health development.

His Government was grateful to WHO for its support in dealing with Tonga's health

problems. The Organization was collaborating with other United Nations agencies, Member

States, intergovernmental and nongovernmental organizations and the private sector in a spirit

of friendship and partnership for the achievements of health for all, through global strategies

that had proved their worth as a means of improving the quality of all stages of human life.

Dr HE Jiesheng (China) congratulated the Chairman on his election and expressed thanks

to the Regional Director and his staff for their meticulous preparation of the session.

The report, as a record of fruitful cooperation with Member States in formulating and

implementing health programmes according to priorities and varying conditions in an effort to

attain health for all, had received serious attention and was well appreciated, as were the six

regional priorities established in the period. Those were closely related to successful activities

for the Expanded Programme on Immunization and eradication of poliomyelitis, multidrug

therapy for leprosy, control of diarrhoea and acute respiratory infections, AIDS prevention and


control, health promotion, environmental health, and information system development, as well

as training, including the health workforce planning manual for Pacific island countries.

The progress had been achieved despite serious economic difficulties in the Region

requiring two major adjustments to programmes with most countries, which had threatened the

implementation of certain cooperative activities. Through careful management by the Regional

Director, reducing expenditure and seeking new resources, it had nevertheless been possible to

implement the majority of priority projects. It was hoped that cooperative programmes for the

next biennium could be carried out as scheduled.

Cooperation in China had been reviewed at the recent fifteenth meeting of the

ChinalWHO Joint Coordination Committee. The majority of cooperative programme activities

had been accomplished, including those for primary health care, poliomyelitis eradication,

control of AIDS, diarrhoeal diseases and acute respiratory infections; iodine deficiency

disorders and neonatal tetanus control programmes had been formulated; maternal and child

health had been promoted, as well as the prevention and control of chronic noncomrriunicable

diseases; a health economics network was receiving close attention. All such activities

contributed to health services development and improved health and welfare, furthering the aims

of health for all in China, as well as the goals of the Declaration adopted at the World Summit

for Children.

The Region still faced arduous tasks as the Organization as a whole underwent reform and

adaptation to world change. China was convinced that, under the leadership of Dr Han, the

Regional Office would expand its cooperation with Member States and, taking their specific

conditions into account, formulate and implement more practical programmes towards health

development and health for all.

Dr HONG SUN HUOT (Cambodia) conveyed the greetings of the National Provisional

Government and Dr Mam Bun Heng to all participants.

He congratulated the Regional Director on the report, which described WHO's

involvement in Member States, nowhere more evident than in Cambodia and the rehabilitation

of its health services. The elections organized by the United Nations there had been a success,

and progress had been made in communications between Phnom Penh and the provinces with

the repairing of bridges and roads. However, the problems were far from over, a major one

being lack of funds for salaries to police and the civil service, including employees of the

Ministry of Health.


Besides the need to pay health workers a living wage, their education and training levels

needed to be raised, and health care services supported with regular supplies of equipment and

medicine; otherwise chronic inefficiency and misappropriation of resources would continue to

detract from the benefits of expertise and material support received from a host of agencies as

well as in bilateral aid.

WHO was helping to achieve that end as well as safeguard the health of the population,

and had done so for almost five years, for example, in sanitation and malaria control. He listed

the most important programmes, from management and integration of services and human

resources survey and development to environmental health, mental health and diseases control.

WHO continued to respond efficiently to emergency needs, from schistosomiasis control to

birth spacing. He praised the departing WHO Representative, Dr Jean-Paul Menu, for his

resourceful and selfless devotion to such cooperation.

Cambodia looked forward to exchanging ideas in order to solve remaining problems: the

lack of trained educators, administrators, managers and planners; poor regulation of the private

sector which flourished in the prevailing conditions with the lack of funds for essential drugs

and equipment, for example; uncoordinated training programmes of different agencies; lack of

coordination also of projects for delivery of goods and services, especially to outlying areas;

continuing high rates of mortality and morbidity due to malnutrition, lack of hygiene and

sanitation, and a high maternal mortality rate related to lack of antenatal care and child spacing

options.

The Ministry of Health was reorganizing its own hospital services and building up a

central medical store, establishing an ambulance service. and waging a campaign to clean up the

capital.

Dr KOBAYASHI (Japan) congratulated the Chairman on his election and expressed

appreciation to the Regional Director for his efforts in improving the health status of the Region

during his five years in office.

Commending the report, he observed that the international political and economic

situation was changing dramatically, affecting health conditions and widening discrepancies. In

such conditions, it was important to emphasize the need for continued investment in health to

promote social and economic development; he strongly urged that a consensus should be

reached on such investment.


He particularly commended efforts in the Region for the eradication of poliomyelitis

among other measures for disease control outlined in the report; it should be possible to reach

the 1995 goal with the support of international agencies and voluntary groups, which must be

carefully coordinated.

With reference to the AIDS control programme, Japan was increasing its support through

the Regional Office, and would be host to the Tenth International Conference on AIDS in

August 1994.

Mr V AIMILI (Samoa) congratulated the officers on their election. He also congratulated

the Director-General of WHO on his reappointment, expressing his pride and pleasure in seeing

someone from the Region leading the Organization, and his confidence in Dr Nakajima's ability

to carry out the task.

He expressed appreciation for the cooperation of WHO and other organizations in

implementing programmes in his country, and fully endorsed the report. He wished to highlight

the quality of the Regional Director's leadership, the exemplary use of modem technology and

administrative management, the sound use of resources and the need for solidarity to ensure

programme implementation.

Mr KOIMANREA (Papua New Guinea) joined other speakers in congratulations

to officers on their election and to the Director-General on his reelection. He commended the

Regional Director on his report and expressed appreciation for the cooperation of staff,

including the WHO Representative, who had contributed to improved health status in Papua

New Guinea. He endorsed the report, and looked forward to seeing its recommendations

implemented, having no doubt as to the efficiency of the Regional Director and his staff.

With WHO's technical cooperation - to the value of US$ 4 million, Papua New Guinea

had been able to strengthen various activities, including disease control, disease epidemiology

and health information, family planning, oral health and health service management as well as

laboratory services. It should have eradicated leprosy by the year 2000. Where the malaria

programme was concerned, he had just opened a national symposium on the subject. It was

hoped that a vaccine against malaria would soon be found. The situation with regard to

poliomyelitis had improved greatly.

Regarding his country's future direction, he hoped that WHO would continue its close

cooperation, concentrating on the strengthening of technical programme management support at

provincial, district and community level for rural services; counterpart support to provinces


and in districts where services were most in need; training for programme management at

provincial and district level; mobilization of resources to provide support to services; measures

concentrating on a "basic package" at district and conununity level for water and sanitation.

maternal and child health including prevention of malnutrition and measures for safe

motherhood; better prevention and control of infections through better nutrition and

immunization coverage; and training. particularly for conununityhealth workers. He appealed

to WHO to ensure that staff providing such support and training were experienced.

The meeting rose at 12 noon.


ANNEXl

ADDRESS BY THE RETIRING CHAIRMAN

Dr Nakajima, Dr Han, Distinguished Representatives, Ladies and Gentlemen,

It has been my privilege to serve, since last September, as Chairman of the Regional

Committee of WHO's Western Pacific Region. This was a great honour to me and to my

Government. It has also been a very useful experience personally, in view of the wide-ranging

and important contacts I have made across the Region during the year. This will be of

considerable value to all our respective health departments.

From the global perspective, the World Health Organization is at a critical stage. Recent

developments in the world gave us hope that funds previously used for armaments could be

directed to the social sector, and in particular, to health. Unfortunately, this was not so, as we

are now seeing in many parts of the world. Even though our Region has remained reasonably

unaffected, these changing circumstances have had some impact on our resources. The role of

the Organization in this changed world order has to be reaffirmed and strengthened.

When we look at the health situation in the Region, the picture is a little more comforting.

However, there is no room for complacency as bettering the health and the quality of life of all

peoples is a never-ending task. We are under constant pressure to achieve more.

Distinguished Representatives, you will recall that last year, during the Regional

Committee at its forty-third session in Hong Kong, three of the many important issues we

looked at were the annual report on the progress in eradicating poliomyelitis, options for quality

assurance in health services, and public health training. These issues are still very much in our

minds. It is encouraging to take note that we have continued our advances in areas such as

reduction of infant mortality, and immunization coverage, as well as in communicable diseases

control. The increasing average life expectancy in the Region and the corresponding growth in

lifestyle-related diseases or disabilities, are a new focus for preventive action and concern in this

Region. Economic prosperity is not the same as socioeconomic development. The health

problems which develop as incomes rise and spending power increases are focused in a different

direction. There is a need to direct our efforts to educating people how to lead a healthy

lifestyle, and to spend wisely to protect their health. At the same time, we also have to ensure

adequate health services exist to cater to the degenerative diseases expected.


Annex 1

Our Region is a heterogeneous mixture of affluence and lack of resources. ethnic and

cultural diversities, large and small populations and different forms of government. In some

countries, the health sector is not always given the resources and the attention it deserves and

some governments are struggling to keep their commitments to national economic development.

It is not easy to see the long-term goals of health care as priorities. Nevertheless, it is still

possible for international and regional financial institutions to help these countries before it is

too late. The great efforts of affluent countries, especially those within the Region, to extend a

helping hand either through WHO or bilaterally is a very positive development. I am sure you

will join me in wishing this strong collaborative partnership between countries and with WHO

continues to grow.

In reflecting on successful collaboration, I must pay tribute to nongovernmental

international agencies for their valuable contributions during the year. Their contributions,

particularly in vaccine supply for poliomyelitis eradication, drugs for leprosy or for prevention

of blindness, deserve a special mention on behalf of the millions who benefited. I should like to

take this opportunity to thank them most wannly for their generosity and involvement in

improving the health of the peoples in this Region. It is significant that such support

emphasizes the credibility of the programmes as well as the Organization. A poliomyelitis-free

society by 1995, and leprosy elimination to follow will clearly focus attention on the Western

Pacific Region and its management, and such achievements will bring credit to us all, the

Member States.

It is not my intention to narrate the achievements that we have made individually and

collectively in the past year. Suffice it to say that considerable progress has been made in many

areas, bringing us closer to the goal of health for all by the year 2000.

The problem areas in our Region are complex and deep-rooted. Tuberculosis

and malaria, as two examples, are proving to be more tenacious than we anticipated, and there

is a need to strengthen the strategies to control these diseases. AIDS still threatens; it is

premature to judge the progress of this killer, though the signs are promising that we are

making preventive steps in the right directions. Environmental problems continue to shadow

all progress. Lifestyle issues, chronic degenerative diseases and an aging population prompt us

to look more and more to health promotion efforts for all sectors of society .

We are all aware that WHO and, in particular the Western Pacific Region, has had a

difficult year in terms of financial resources. We have full sympathy with Dr Han, the Regional


Annex I

Director, who had the difficult task of balancing limited financial resources with requirements

for technical or expert scientific advice. Member States fully supported him and I am sure we

will continue this sound and trusting partnership in the years to come. It would be tragic if we

had to sacrifice crucial health programmes for lack of financial resources. In this context, it is

perhaps not inappropriate to enquire boldly whether this Region is receiving its due share of

resources, recognizing its status as the most populous and extensive Region. This Region has a

wonderful track record of spending every cent of its allocation wisely for the improvement of

the health of its peoples. With the considerable problems we face, I am sure you will share my

view that WHO could achieve more, if a greater proportion of funds was made available for the

countries in this Region.

While there will be opportunity later to debate this issue and the need for additional

resources, we must also take steps ourselves to prioritize programmes and target the needy. I

am personally happy to hear of the initiatives being directed to the urban poor. The border

meetings on drug abuse, AIDS, malaria, etc., will continue to have our full support as these

areas of concern and diseases have no geographical boundaries and their effective control

requires joint efforts by neighbouring countries and areas.

The six priority programmes for the Region have made new strides and it is gratifying to

note increased awareness and progress in these areas. In conclusion, looking back over the past

year, we have clearly seen the rewards of increased cooperation in the field of health and its

related concerns.

I have one more pleasant task to perform before we elect the incoming Chairman of the

forty-fourth session of the Regional Conunittee. That is, the honour of extending our

congratulations to Dr Nakajima on his re-election as Director-General of the World Health

Organization. It is our hope that the recognition extended to you, Dr Nakajima, in this new

term of office, may encompass a review of the allocation of funding to this Region, and that you

will extend greater support to the Western Pacific Region during your second term of office.

Before I conclude, let me express my sincere thanks to Dr Han, Regional Director, for

his unfailing support and excellent work in this Region.

114 REGIONAL COMMI'ITEE: FORTY-FOURTH SESSION

Annex 1

To all of you, my fellow distinguished Representatives, let me express my gratitude by

thanking you for the great honour of allowing me to serve as the Chainnan of this august body.

It has been a privilege which I will long cherish.

Thank you and my best wishes to you all.


ANNEX 2

ADDRESS BY THE DIRECTOR-GENERAL

Mr Chairman, Honourable Representatives, Distinguished Colleagues, Ladies and

Gentlemen,

It is a traditional duty, but also a pleasant privilege, for me to meet with you on the

occasion of your Regional Committee and, as I have done over the past five years, provide you

with an update on the evolution of WHO and its global activities.

Political turbulence and financial· crisis, which have hit hard the world over, have also

reached the World Health Organization and the health sectors of most countries. Health has

emerged as a major political issue, as the realization has grown that it is a major social and

economic issue. Public opinion today commonly ranks health as one of its main concerns and

expects governments to live up to their responsibilities in this field. The economic impact of

health has also come to the fore: not only as a line of heavy expenditure in national budgets,

but also as a potential investment into a booming service industry, as an investment in human

beings and the future of our planet and, last but not least, as a prerequisite for sustainable

human development.

As a political issue, health will be a more difficult, sensitive and competitive domain at

the national and international levels, but most of all at the local level. This political

environment, however, also creates new opportunities. We must explore them and make the

most of them to improve the health of all peoples of the world. We must win the battle for the

survival and happiness of humankind. We in WHO must adapt and rise to the challenge with

innovative approaches to health systems and interventions.

WHO's initiatives and activities are on track and will meet their targets. Dracunculiasis

will be eliminated by 1995. Leprosy will be eliminated as a public health problem by the year

2000. We can reasonably expect that poliomyelitis will be eradicated by the year 2000. The

WHO Onchocerciasis Control Progranune has reached its final stage and calls for devolution to

the local level, with international support for land development and human resettlement in the

24 million hectares that have been made oncho-free. Although we are confronted with a serious

cholera pandemic, there has been a striking reduction in case fatality rates throughout the world.

WHO progranunes on Control of Diarrhoeal Diseases and Acute Respiratory Infections have


Annex 2

made steady progress. The Expanded Programme on Immunization has already reached 80%

coverage of the world's children. If sustainability can be achieved, these last three programmes

together will help prevent seven and a half million child deaths per year. The WHO Global

Programme on AIDS continues to strengthen its support to national AIDS programmes, as well

as to research and development efforts.

In carrying out WHO's task, we can trust in the wisdom of our Constitution. The

mission and fundamental principles it proposes for WHO are still relevant today. To all WHO

Member States I have pledged that, during my second mandate as Director-General of WHO, I

will continue to pursue our common goal of Health for All through primary health care.

"Health for All" must remain our common vision - the vision of a world in which all peoples

and individuals can enjoy basic and affordable health care, of acceptable quality.

Peace and sustainable development, equity and democracy are the principles that must

guide health development. There can be no lasting peace without social justice and harmony.

Sustainable human development must be both economic and social. It will be achieved only

when all people, individuals and communities alike, are freely involved and given a chance to

enhance their own potential. It implies the exercise of democracy and respect for human rights.

In WHO programmes, this translates as "community participation", "social justice", and

"equity". These principles are not rhetoric. They must be used as rules for action in a

pragmatic partnership.

The new partnership for health that I called for at the January session of the Executive

Board this year, endorsed by the World Health Assembly in May, expresses my concern for

pragmatism and democracy in health action and cooperation. Through this new partnership, all

social actors will be motivated to share responsibility in the all-out effort required to achieve

Health for All, with universal access to health care and services. Our new partnership for

health will ensure greater effectiveness through collective action or synergy. It will also

emphasize sustainability through the continuing commitment of all actors concerned, within and

beyond the health sector. As health becomes an important domain in the broader realm of

public policy, WHO will foster and take the lead in interdisciplinary, intersectoral and

interagency alliances for health.

To meet the challenges of a changing environment, WHO itself is undertaking a process

of profound internal reform of its structures and working methods. I wish to stress that, to me,

the ultimate purpose of any reform must be to improve the relevance and performance of WHO


AJ1Jlex 2

services at country level. We must be ready and equipped to support countries in developing

their health systems and in implementing health policy reform.

Reform is made necessary worldwide by the interplay between global change and the

epidemiological transition we are going through. The nature and scope of the AIDS pandemic

and the resurgence of communicable diseases such as tuberculosis, malaria and cholera,

constitute public health problems which also have considerable socioeconomic and political

dimensions. Changes in lifestyles, influenced by market structures and marketing practices,

bring with them an increased incidence of noncommunicable diseases and psychosocial problems

such as substance abuse, violence and suicide. Changes in the global environment are creating

serious health problems, in particular a marked increase in respiratory diseases such as asthma.

The economic recession, unemployment, migration, refugees, aging and other demographic

factors, all have a serious impact on health and public policies in developed and developing

countries alike.

The technological and information explosions have profoundly modified health care

practices, the roles and responsibilities of health care professionals and their relations with their

patients who now want to be recognized as constituents and fully-fledged partners. New ethical

and legal issues are raised.

All these changes call for the reform of public policies and, within this framework, the

reform of our health care systems and approaches. They also require a clear redefinition and

distribution of responsibilities for the formulation, coordination and implementation of public

health policies, both at national and international levels. It is in this context that WHO has

undertaken its reform process.

Since the last session of your Regional Committee, the Executive Board Working Group

on the WHO Response to Global Change finalized its report and submitted its recomml!ndations

to the Forty-sixth World Health Assembly and the Executive Board. Acting upon the

resolutions of the Assembly and the Board on this matter, the Secretariat has also bem guided

by the special report of the External Auditor, and the recommendations of the United Nations

Joint Inspection Unit on decentralization.

Having carefully looked into the report of the Working Group and its practical

implications, the Secretariat worked out concrete proposals for the Programme Committee of the

Executive Board which met last July. The Secretariat suggested some regrouping uf the 47


Annex 2

recommendations produced by the Working Group, and identified priorities for action together

with a tentative timetable for their implementation.

The Programme Committee of the Executive Board discussed our proposals and made its

own comments and suggestions which are for your consideration at this session of your

Regional Committee. The Programme Committee is scheduled to meet again in November to

complete its review of the recommendations of the Working Group and their follow-up, taking

into account the views the Regional Committees may wish to express. In particular, it will

consider the terms of reference of the Budget and Finance Committee that has been proposed to

assist the Executive Board.

Within headquarters, the reform process is under way. I am focusing on management, to

streamline decision-making. The permanent dialogue I have initiated with the Regional

Directors will be formalized within a Global Policy Council whose core membership will also

include the Assistant Directors-General and the Director of the International Agency for

Research on Cancer. This Global Policy Council is designed to strengthen the overall

development, coordination, implementation and updating of WHO policies. A Management

Development Committee will be made up of the Assistant Directors-General, Executive

Directors and the Directors of Programme Management from the six WHO regions,

representing the Regional Directors. This Committee will ensure further linkage of programme

and budget management between headquarters and the regional offices. To support the

Director-General for coordination and development of strategies, communication, information

and executive functions, I have set up a Cabinet which will also act as secretariat to the Global

Policy Council and the Management Development Committee.

WHO's work will faU under four main policy directions: integration of health into public

policies; equity and quality; promotion and protection of health; and disease prevention and

control. A revised Classified List of Programmes is being finalized. It will propose six major

programmes and activities. Within the Ninth General Programme of Work, the reorganization

and clustering of activities and expertise will be subordinated to targeted outcomes. Priorities

will be assessed on both a technical and financial basis. Realistic goals and targets will be spelt

out to facilitate regular monitoring and evaluation which, in turn, will serve as the basis for our

biennial programme budget proposals, within the general framework of our Health-for-All

strategy. Following up the recommendations of the Executive Board Working Group, we are

initiating a process to publish yearly assessments of the world health status. Finally, we are

adjusting our financial procedures and administrative structures to keep bureaucracy to a


Annex 2

minimum an9 further strengthen transparency and accountability. Changes are being introduced

to the preparation of the proposed programme budget for 1996-1997.

On all these measures and proposals, I shall report to the Executive Board in January

1994, and to the Forty-seventh World Health Assembly in May 1994.

When the Programme Committee met in July, I stressed that a number of

recommendations for reform could be addressed directly by headquarters, but that Othl~rs, of a

global nature, would have to be taken up in coordination with the whole United Nations system.

And that still others, involving the regional and country levels, had to be jointly addr,::ssed by

WHO headquarters and all WHO regions.

This applies to the review of current methods of delegation of authority between

headquarters and regional offices, as well as between regional and country offices. It also

relates to the redefInition of the functions, training and recruitment procedures for the WHO

country representatives. As a global health network, WHO brings together a wide range of

skills and knowledge. Member States should be able to have full and quick access to WHO's

capabilities, at all levels and wherever they may be located. This could be facilitated, for

example, through greater use of intercountry teams and interregional missions.

While it is the prerogative of the Regional Committees to decide on their own ml:thods of

work, this has implications for the scheduling and harmonization of reform for the whole of

WHO. In fact, any final proposals for improvements in policy planning, analysis capability and

information systems, at any level, will require overall coordination between countries, regions

and headquarters.

Honourable Representatives and Colleagues, I have come to ask for your support and

participation.

I urge you all to be active and full partners in the major reform process that tOi1;ether we

have launched. I request you, as the Regional Committee for the Western Pacific, to set up a

working group along the lines you deem most appropriate, to look into the recol1Ulll~ndations

made at global level, as they apply to your region and countries. Your initial suggestions and

recommendations may then be submitted as an interim report by your Regional Direcl:or to the

WHO Executive Board in January 1994. A fuller report will be considered by the Board in

January 1995.


Annex 2

WHO is the only global health network with a comprehensive approach to health and a

deliberate concern for long-term impact and sustainability. It now numbers 187 Member States.

It has always served all peoples of the world without exception. It has a long-standing tradition

of political neutrality, and of high technical and ethical standards. We must uphold this

tradition while improving our performance and demonstrating our capacity to adapt to our

environment.

On the eve of the twenty-first century, the Asia-Pacific region has created what

is qualified as an "Asian miracle", a successful model to be emulated by all. Hard work and a

lively spirit of enterprise, paralleled by a democratization of the political process, are at the root

of the economic achievements of this region. Indeed, the Western Pacific Region can be proud

of its economic and social take-off. The impetus gained by health development poliCies in the

Region is reflected by the fact that most countries have met, or will soon meet, the health

indicator targets they had set for the year 2000. Even cash-strapped countries have markedly

improved their infrastructure and primary health care coverage. Thus, the Expanded

Programme on Immunization has developed successfully, and work has been continued or

pioneered for the control of diarrhoeal diseases and acute respiratory infections. Altogether, the

Region has made significant headway in controlling leprosy, tuberculosis and poliomyelitis. I

am confident that all of you will want to safeguard such gains and reinforce your leadership in

health development.

Leadership and creativity will certainly be needed to meet all the health and management

challenges of the coming century. Today, both WHO and its Member States are faced with the

prospect of diminishing resources while needs are increasing and diversifying. In this

environment, as your Regional Director, Dr Han, stressed to the Programme Committee last

July, WHO "cannot simply try to do more of the same with less". WHO has to learn to do

things differently so as to do them even better and at a lesser cost, together with its Member

States.

In some countries of the region, overall health-related costs are expected to double over

the next ten years because of the rapidly aging population. It is also estimated that, in these

countries, the number of workers supporting each senior citizen may drop by about 30%.

Meanwhile, the region is still confronted with difficult health problems such as malaria, cholera

and the threat of AIDS with its likely impact on tuberculosis. Furthermore, at this time of rapid

industrialization, I believe it is essential that all of us should keep emphasizing health and safety

issues to decision-makers. In particular, we must impress upon all political and social actors


Annex 2

that economic growth and higher productivity cannot be pursued at the expense of worker

safety. Going against this principle would be counterproductive and, in the end, extremely

costly in terms of both human and financial resources. The same caution must be used in

managing and preventing environmental health hazards.

Let us recall what the President of the Philippines, Mr Fidel Ramos, once said: "In each

country where economic change has been successful, the key has been a national consensus for

change". That consensus for economic change and development will be at risk unless the

health, employment, safety and welfare of all groups of the population are given equal attention.

What applies at the national level must also be defended at the international level.

Personally, I shall continue to stress to the international community that solidarity is our

best investment for security; that solidarity and aid to development must go beyond short-lived

compassion. They imply long-tenn commitments. They must pave the way for the

development and sustainability of health infrastructure. There are no quick-fix solutions to

AIDS, tuberculosis, malaria, cardiovascular diseases, cancer, cholera and malnutrition.

Prevention and treatment of such health problems need long-tenn planning, research, training

and investment of resources, and multisectoral interventions. Health development and

sustainable national economic development are mutually dependent. And both, in tum, are

largely dependent on fair and stable international economic relations.

For vulnerable populations and countries in greatest need, WHO launched a special

initiative for intensified cooperation at the end of 1988. It has earned high regard, not only

among the beneficiaries but also among bilateral and multilateral donors. It is my intention that

this initiative, now a major activity, will be one of our highest priorities in a refonned WHO.

The success of this activity, however, depends on close cooperation between headquarters and

the regions, a key element in our refonn process.

In a world where relations between countries become increasingly complex and

interdependent, strong forces are at work which also drive towards fragmentation. This is a real

and major risk. To be fully effective, our Organization must be one. Diversity is one of the

major assets of the World Health Organization. Our regions are the very substance of that

diversity. Fragmentation, however, would soon spell insignificance, and disintegration.

WHO must be one. Decentralization can and must be reconciled with unity of purpose

and coordination of resources, action and information. Flexibility must be matched by


Annex 2

accountability. WHO structures and progranunes must show internal coherence to maximize

efficiency. They must also be directly relevant and adapted to the needs of our Member States.

Your participation In the current reform process is thus essential. In the end, the contributions

of the Regions will be crucial to the successful outcome of the reform process in WHO.

Our ultimate objective in reforming WHO reaches far beyond strengthening WHO as a

major United Nations development agency. It is nothing less than ensuring the future of global

health cooperation. It is to improve the health, not just of a few, but of all peoples of the world,

including the most vulnerable groups.

Today, contrary to post-Cold War expectations, poor countries are suffering more than

ever. Natural, but also man-made disasters, and wars especially, are producing millions of

casualties and leave millions to suffer unproductive lives in ill health. At the same time, rich

countries, despite their relative difficulties, continue to enjoy improving health and an

environment of peace. It must be our shared moral responsibility to fight suffering

and injustice. Thus, I call for the world to unite for peace through health and development.

Honourable Representatives and Colleagues, I shall look forward to your advice and

recommendations. I thank you for your attention.

SUMMARY RECORD OF THE SECOND MEETING

WHO Conference Hall. Manila Monday. 13 September 1993 at 2.30 p.m.

CHAIRMAN: Mr S. Naivalu (Fiji)

CONTENTS

(wpRlRC44/SRJ2)

1. Nomination of the Regional Director ....................................................... 124

2. Report of the Regional Director (continued) .............................................. 125

- 123 -


1. NOMINATION OF THE REGIONAL DIRECTOR: Item 7 of the Agenda


The meeting was held in private session from 2.30 p.m. to 3.00 p.m. and resumed its work in

public session at 3.10 p.m.

At the request of the CHAIRMAN, Dr CHEN Ai Ju (Singapore), Rapporteur, read out the

resolution that had just been adopted by the Regional Committee in private session:


Considering Article 52 of the Constitution; and

In accordance with Rule 51 of its Rules of Procedure;

1. NOMINATES Dr Sang Tae Han as Regional Director for the Western Pacific; and

2. REQUESTS the Director-General to propose to the Executive Board the appointment of

Dr Sang Tae Han for a period of five years from 1 February 1994.

The CHAIRMAN, congratulating Dr Han on his nomination for a second term of office as

Regional Director, said that he was delighted that Dr Han would lead the Western Pacific Region

during the next five years.

Twenty-seven representatives congratulated Dr Han on his unanimous nomination. In

particular, they expressed their appreciation of the work he had carried out during the past five years

and assured him of their full support and cooperation in the future. Similarly, they congratulated

Dr Nakajima on his reelection as Director-General, and remarked that the two directors would

together successfully lead the Organization forward in improving health in the Region.

Dr HAN replied that he was honoured by the Committee's decision to nominate him as

Regional Director and grateful to the Member States of the Region for the renewed opportunity to be

of service. He thanked WHO staff at both regional and global levels for their support. Recognizing

the importance of WHO's other partners in health development in the Region; the bilateral donor

countries, intergovernmental and nongovernmental organizations, and other private organizations

and agencies, he observed that their generous support had enabled the Organization to carry out its

collaborative programmes with Member States in the Region. He looked forward to continuing and

strengthening that close and valuable partnership.

SUMMARY RECORD OF THE SECOND MEETING 125

Dr Han noted that the health field had seen many changes in the previous years. WHO had

achieved some measure of success in the eradication of selected diseases. The groundwork had been

laid for coordinated, targeted approaches to WHO's regional health priorities. During Dr Han's

first term WHO had been able, with the strong support of Member States, to establish momentum.

Dr Han affirmed that the Organization would move ahead in tackling the challenges to health

development in the Region, and that he would endeavour to fulfil his responsibilities to the best of

his ability.

2. REPORT OF THE REGIONAL DIRECTOR: Item 8 of the Agenda (continued from the first

meeting, section 7) (Documents WPRlRC44/3 and Corr.l)

Mr WAENA (Solomon Islands) recalled the pending issue of the appointment of a country

liaison officer for Solomon Islands, and looked forward to an appointment before too long.

The new Government in Solomon Islands had placed top priority on the field of health

development, and in particular on combating malaria, which was not only a health problem but also

an obstacle to the development of tourism. He therefore called upon WHO to support his

Government in a recently established programme called "People against malaria". The Government

was considering making 1994 the year of the "People against malaria" action programme. This

would involve his Government fighting against malaria jointly with the church, nongovernmental

and voluntary organizations, as well as with multilateral and bilateral aid agencies. The incidence of

malaria had already been reduced with the introduction of permethrin-impregnated bednets. WHO's

contribution had been invaluable.

Another problem in Solomon Islands was the lack of adequately trained human resources. He

expressed his gratitude to the Governments of Fiji and Papua New Guinea for allowing Solomon

Island nationals to be trained in their respective health training institutions. He hoped that that

friendly support would be extended in the future, and also that WHO would provide support so that

the efforts to train health workers could continue.

With regard to population growth, the rate in Solomon Islands was very high at 3.5%

annUally. Although the population as such was not very large, if the increase continued at that rate

there would be very serious difficulties. He therefore looked forward to special support from WHO.

Chapter 1: The Regional Committee (pages 7-10)



Chapter 2: WHO's general programme development and management (pages 11-17)

Dr ADAMS (Australia) commended the report, which augmented the Second Evaluation of

the Implementation of the Global Strategy for Health for All by the Year 2000 discussed at the

previous Health Assembly. With reference to paragraph 2.14, he expressed concern that a recent

report on health development by the World Bank I was somewhat critical of WHO's approach,

although it credited the Organization with help in the preparation of the report. The

report emphasized the need for a public health package and certain critical services. In fact WHO's

approach, focusing on primary health care and public health management was very similar and it

was important to correct any confusion in that regard. Clearly WHO did not have the level of funds

available to the Asian Development Bank or the World Bank and perhaps such institutions should be

encouraged to provide further financial help to WHO rather than seeking to exercise a direct role in

the public health field.

Mr V AIMILI (Samoa) endorsed those comments. It was essential to avoid duplication and

confusion and the financial institutions should be encouraged to support WHO. The Regional

Director should give due attention to that issue.

Dr MONT A VILLE (France) said that the World Bank report had been largely inspired by

WHO, together with UNICEF, and that the Organization should take the opportunity provided by its

presentation to reaffirm its global leadership role in the field of health. As the report showed, the

World Bank was one of the most important sources of funding in the health field, contributing more

than US$ 1 billion per year. Improved collaboration and coordination between WHO and the World

Bank was therefore essential in all the areas covered by the Regional Director's report, in particular

those related to communicable diseases.

Dr TAPA (Tonga) agreed that the World Bank report should be looked at carefully and noted

that it would be discussed at a forthcoming meeting of representatives of South Pacific governments

in Suva. He hoped that WHO would also be represented at that meeting as it was important to

safeguard the interests and leadership role of WHO in health matters in the Region.

Chapters 3-15: (pages 19-164)

There were no specific comments on Chapters 3-15 (pages 19-164).

IWorld Development Repon 1993 Investin~ in Health. World Development Indicators. published for the World Bank by Oxford

University Press, USA, June 1993.


Part II. Review of selected prograuunes (pages 165-193)

There were also no comments on Part II, Review of selected programmes (pages 165-193).

The REGIONAL DIRECTOR said that he had taken full note of the comments made by the

representative of Solomon Islands concerning priorities. It was clear that if small countries spread

their relatively small allocations from WHO over a large number of programmes the resources

available for each would be meagre. It was important to ensure the most effective use of regular

budget allocations. Any Member State which prioritized health and development efforts, focusing

on a limited number of programmes, would have Dr Han's support. He was prepared to

reprogramme so that the major portion of resources might be allocated to the highest priority

programme areas. For instance if Solomon Islands wished to allocate its full regular budget for the

biennium of US$ 1.6 million to malaria, Dr Han was prepared to do so, with any other additional

resources WHO could mobilize. The Regional Office was most willing to discuss the reorientation

of individual country programmes to highest priority areas if both parties agreed.

The World Bank report, mentioned by several speakers, would require careful consideration.

In the past, health and health-related issues had always been left to WHO. Increasingly other actors

were entering the health field. such as the Asian Development Bank, the World Bank, and other

intergovernmental and nongovernmental organizations. In order to achieve the greatest benefits for

the peoples and countries of the world it was essential for all the institutions concerned to work

together rather than to compete with each other. Of course different agencies had different styles of

management, which were reflected in differences in the governing bodies and in their published

reports. However, improved collaboration and coordination of their activities were essential. WHO

was already collaborating successfully in some areas, such as the malaria control programme in the

Lao People's Democratic Republic, where WHO technical expertise was backed by World Bank

funding, and a similar project in Viet Nam. He would make further references to that issue during

consideration of item 21 of the Agenda, WHO Response to Global Change: Report of the Executive

Board Working Group. In his view it was time for WHO to reaffirm its leadership role in the health

field and to take a more proactive and entrepreneurial attitude, approaching others at both the global

and regional levels rather than waiting for them to approach the Organization, as in the past.

He then addressed the Committee on his perspective on the future (see Annex).

The meeting rose at 5.10 p.m.


ANNEX

ADDRESS BY THE REGIONAL DIRECTOR

Mr Chairman, Distinguished Representatives,

I would like to take this opportunity, at the close of our discussion of my report on the

biennium, to speak briefly on the future.

When introducing the Report, I stressed that our response to substantial regional change

has been careful evaluation and structured planning. This is our way forward.

By nominating me to serve another five years as Regional Director, you have shown trust

in my approach. I would like at this time to look ahead to how I propose we should deal with

the next half decade. We cannot just wait for major change to occur and then try to respond.

One of the greatest management challenges is to anticipate changes and their impact, and to

prepare successfully to deal with them.

This may sound straightforward but it is not. For example, in the field of communicable

diseases, how should we use our great store of scientific knowledge? To find a cure for the

disease and administer it effectively? To vaccinate against it? To educate and support

individuals in their behaviour and environment so that they do not put themselves at risk?

The choice of how to use our resources becomes more acute by the year. Our experience

so far shows clearly that, to be most effective, action must be concerted and multilateral. To

marshall these forces, the solution we choose must be the right one.

I propose, in the next five years, to further refine the focus of our efforts in the Region.

We will direct our energies to a series of key issues or priorities. Further, and most

importantly, we will be actively working to increase our role as central coordinator

and manager of resources. In some cases this will be a continuation of what we have started

together during the past four-and-a-half years.

I propose consolidation of our past successes, and a shift forward to a considerably

streamlined agenda. For this I seek your cooperation and support as partners. I am planning a

concentrated process of preparation and development.


Annex

Some of this may lead to quite new advity areas. For example, I have in mind a

reorientation of the regional office and the country-level offices to be more proactive, functional

and issue-oriented. As the Director-General mentioned this morning, the purpose of reform

must be to improve the relevance and performance of WHO services closer to countries. He

strongly emphasized the role of the regions as a key to shape the relevance of WHO structures

and programmes to the needs of the Member States. My staff and I must be able to work with

you, the Member States, in a more responsive, systematic, comprehensive and coordinated way.

The key to this is to focus on how we will meet country needs. This is a concern voiced not

only here but by WHO governing bodies. There is a clear message in the report of the

Executive Board Working Group on the WHO Response to Global Change, which we will

discuss under agenda item 18. This paper has strong implications for our future

modus operandi, and I would urge all Representatives to study it well before our joint

discussions later in the session.

For our Region, I propose to focus WHO's programme resources on priority issues. We

will deploy our forces where impact can be made, sustained and accounted for.

When I look at what the Region will be like at the end of this century, I see a population

somewhat larger, but considerably older. I see a population far more concentrated in larger

cities than it is today, and I see a population struggling to keep the benefits of economic and

social development while minimizing the detrimental effects on the environment. The dominant

diseases will be those heavily influenced by the wide range of behavioural factors which we now

call "lifestyles". Presently we have little or no influence over these changes, and, it might be

argued, even over their outcome. These will be the challenges of the future.

We know that an aging population has increased morbidity, especially chronic illnesses

and degenerative changes. Many of these disabilities can be prevented or at least diminished by

very simple interventions, made, often at a personal level, at earlier stages of life. These

include not smoking, reducing salt intake, regular exercise and eating a healthy diet. These can

reduce the incidence of cardiovascular diseases, respiratory diseases and cancer.

Simple actions for health can start from the first days of life. Breast-feeding is one such

simple measure, which can have significant effects on infant survival and longer-term health of

the child. Yet, the influence of social and economic change, affecting family support, creating

financial pressure for mothers to work are combining to reduce this practice to a senous extent

in the Region.


Annex

We must find ways to be more effective in convincing people to change and to provide

the context in which they can do it. This also applies to many conditions affecting younger

people, for example AIDS and HIV infection. Transmission by the major routes of sexual

contact or voluntary intravenous injection can be entirely prevented by individual behaviour

change. Here we have to confront the obvious question "how successful have we been in

convincing at-risk persons to make the change?". The answer is that we have not been as

successful as we would have hoped. We know we must learn more effective ways to persuade

and convert. Effective communication will be even more important in our future efforts.

The years to come will see continued, probably accelerating change in the Region. The

effect of this is obvious even today. We must plan what we can do now to reduce the future

impact of urban congestion, pollution, the overburdening of health and social services and the

disruption of human lives. It is in these situations that the active support of communities and

governments is crucial to enable individuals to lead healthier lives. Later during this session, I

will present to you my proposed Regional Strategy on Environmental Health. In this proposal I

have emphasized the need to make interventions and design projects that we can really deal

with. In this Strategy I show how we aim at outcomes that are likely to have a significant

impact on human health and to be sustainable. For too long we in the health sector have waited

for others involved in planning to come to us to seek advice. This has not worked. We must

take our expertise, knowledge and advice to them. I mean to do this and urge you to join me.

This brings me to the role of external resources available to you at country level to

develop health programmes and the health system. My aim is to encourage or attract the

maximum possible amount of resources for you to address health priorities. As I have stated to

several donor agencies, I am not seeking funds for WHO execution, but rather trying to match

funding requirements of countries in need with donor agency interests.

I am prepared to put the resources of the Western Pacific Regional Office at your disposal

to develop and achieve this match. Such a partnership of country programme, donor agency

and WHO during planning and perhaps implementation, monitoring and evaluation of

programmes, should achieve satisfactory results. This uses WHO's technical resources more

effectively. One current example is our extensive collaboration with several donors in country

programmes on the critical field of malaria control. Once we have decided on the appropriate

approach, we will make a concerted move forward.


In order to do all these, it is important that we all address the issue of health system

reform in all of our countries. With rapid social, political and economic changes taking place in

so many countries, both developing and developed, the health system of yesterday is no longer

appropriate for today, let alone tomorrow. Financing of health systems is a critical issue in

many countries, but have we really addressed what we are financing? Traditions are

comfortable and reassuring, but can at times develop into major constraints in themselves. We

must have the courage to look at and listen to new ideas, and seriously assess their worth. This

is especially true in the development of human resources for health. In this area we must ensure

that the health workforce of tomorrow is prepared to handle problems which require the use of

advanced management skills and the marketing and communication techniques by which

lifestyles and individual behaviour can be influenced. The health sector has long been

conservative, but we must now take on a leadership role, broaden our horizons and greet the

21st century with well-prepared plans.

In the next five years, it is unlikely that the tremendous pace of change in our

surroundings will slow down. The threats to health we perceive now will not disappear or

diminish. Our best hope is to think very carefully what each country's priority issue should be,

and use that urgent need to link related health activities. I propose that each Member State

should select two or three such issues upon which to concentrate their individual WHO country

programmes. For instance, if a country decides that it will focus on malaria control, related

concerns would encompass nutrition, environmental issues, surveillance techniques, laboratory

skills and clinical management. The government would look at how individuals could be

encouraged and supported to better protect themselves and their families, as well as making sure

that community action and public policy clearly supported the chosen health goals.

If we can achieve these specific goals, within the context of the regional priorities, I think

that we shall have established the disciplines and practices to take us forward into the 21st

century. Perhaps we can even say more. If we can deal thoroughly and effectively with the

problems we have identified, we will not only have managed change, we will have built a legacy

for future generations. Let us work together in the next five years to accomplish this vision,

through careful analysis of needs and concerted application of our many strengths.

Mr Chairman, Distinguished Representatives, let us rise to the challenge of change!

SUMMARY RECORD OF THE THIRD MEETING

WHO Conference Hall, Manila Wednesday. 14 September 1993 at 9 a.m.


CONTENTS

(wpRlRC44/SRl3) ,

1. Address by the incoming Chairman .......................................................... 134

2. Progranune budget, 1992-1993: Budget performance (interim report) ................................................................................... 134

3. AIDS ............................................................................................... 143

3.1 Annual report on AIDS, including sexually transmitted diseases ............... :...... 143

- 133 -


1. ADDRESS BY THE INCOMING CHAIRMAN: Item 4 of the Agenda

The CHAIRMAN addressed the Committee (see Annex).

2. PROGRAMME BUDGET, 1992-1993: BUDGET PERFORMANCE (INTERIM REPORT):

Item 9 of the Agenda (Document WPRlRC44/4)

The REGIONAL DIRECTOR drew attention to document WPRlRC44/4, which contained an

interim report on budget performance during the biennium 1992-1993. The report summarized the

difficulties faced prior to and during implementation stages and the actions taken to resolve the

situation. The various changes in the 1992-1993 regular budget were shown in Annex 1. The

interim financial implementation of the regular programme budget as at 31 May 1993, listed by

major programme and programme, was contained in Annex 2. Annex 3 provided more detailed

remarks on the financial implementation.

The 1992-1993 regular programme budget estimates of US$ 63 90 1 400 referred to in

Annex 1 and itemized in column (1) of Annex 2 were those reviewed by the Regional Committee at

its forty-first session in 1990. Subsequent changes in the regular budget were shown in Annex 1 and

further reflected in Annex 2 under columns 2 and 3. The effect of those changes could be seen in

the resulting adjusted programme budget of US$ 57 140 400.

Annex 2 showed that expenditures and obligations incurred as at 31 May 1993 had amounted

to US$ 44 446 200 (column 7), resulting in an implementation rate of 78% in dollar terms (column

8). The budget was expected to be fully implemented by the end of the biennium.

The interim report was intended to provide information on progress in implementation. It

explained fully the many problems and the measures taken to overcome them. He thanked all the

Member States for their cooperation and understanding.

The final report on budget performance 1992-1993 would be presented to the Committee at its

forty-fifth session in 1994, at which time it was expected that discussion would take place on the

final implementation results. Nevertheless, he would be pleased to answer any questions on the

interim report.

Ms BLACKWOOD (United States of America) expressed appreciation of the manner in which

the interim report on budget performance had been presented. It was very informative, and, she

believed, unique in the WHO system. It showed not only how much of each budget line had been

SUMMARY RECORD OF THE THIRD MEETING 135

implemented or obligated to date, but also gave explanatory comments on variations between the

obligations and the original budget allocations. Several factors outlined in the report revealed that

the Region was operating under constraints not anticipated at the time of adoption of the 1992-1993

programme budget. The financial challenges were a reminder that the Committee needed to make

hard decisions in order to detennine the Region's priorities in the use of scarce resources. It was

hoped that the Secretariat would continue to modify future biennial budgets in ways that would assist

Member States in understanding and making such difficult choices. The United States delegation

would be interested to know how the target activities for reduction had been determined in

consultation with Member States, which had resulted in a reduction of US$ 7.4 million. In addition,

the Regional Director's comment on the significant increase under programme 15 (Support services -

column 5, page 11 of the report) was requested.

Mr KOIMANREA (Papua New Guinea) congratulated the Regional Director on handling the

budget changes both in a financially sound and compassionate manner. The implementation rate of

78% for the adjusted 1992-1993 programme budget was noted with satisfaction. That indicated not

only the Secretariat's ability to utilize funds in a timely manner, but also reflected the increasing

needs of countries in the Region. He welcomed the agreement during the previous day's session to

allow reprogranuning of resources to a few selected areas where the most gains could be achieved.

The Regional Director's vision for a more proactive and entrepreneurial Western Pacific Region had

much to commend it. Health systems needed reform, which should be done in response to changing

social, economic, and political conditions. Health systems, and in particular financial resources,

could be used to achieve the maximum benefits possible. His Government looked forward to a

fuller discussion of the programme budget during the Committee's session in 1994.

Mr KEO (Australia) said that his Government acknowledged the 10.8% reduction in the

1992-1993 programme budget, and recognized the need to accommodate a roll-over deficit of

US$ 1 million for the previous biennium. A uniform reduction of about 12 % throughout the

15 programmes, including support services, would have been expected, but the wide variation of

programme changes during implementation as shown in Annex 2 was a source of concern. For

example, programme 6 (Public information and education for health) had been reduced by 42 %,

while programme 15 (Support services) showed an increase of 37%, which included an increase of

72% in personnel costs. In the interest of transparency and good governance, the Secretariat was

requested to indicate, as a standard budgeting practice for current and future bienniums, the number

of staff allocated against each programme together with their corresponding costs. While

appreciating the difficulties encountered by the Secretariat during implementation of the budget,

national and budgetary realities were such that it was important to adhere to the actual budget

regardless of the amount of the overall deficit before or during implementation. Based on available


documentation, the Regional Director should be complimented on his managerial ability to

implement the biennial activities within the budget. That achievement should be applauded as it

would no longer be possible to support the practice of rolling over the current biennium's deficits to

a future biennium.

Mr Doa-Young CHEONG (Republic of Korea) congratulated the Secretariat on the smooth

implementation of the programme budget for 1992-1993 despite the difficult financial situation. Its

collaboration in such programmes as development of district health management, and

implementation of primary health care was particularly appreciated.

The REGIONAL DIRECTOR thanked the representatives for their expressions of concern

over the financial difficulties that WHO had faced in the implementation of the 1992-1993

programme budget. Likewise, he thanked the Member States for their cooperation and

understanding during the two exercises undertaken in order to adjust the 1992-1993 programme

budget, which had actually been reviewed in 1990. The Director-General had withheld 10% of the

budget allocation for the current biennium as a result of the non-payment by some Member States of

their assessed contributions. Moreover, as agreed with Member States, certain essential activities in

the preceding biennium had had to be carried over to the current biennium. In February 1992,

following a recosting of the various components of the programme budget that had revealed a

deficit, the first budget reduction exercise (referred to as "Priority C" adjustment) had been

undertaken. Although it seemed to be an across-the-board reduction between programmes, a very

critical review of country programmes had been undertaken with the aim of reducing those which

were considered a lower priority. The exercise had resulted in a budget reduction of approximately

21 %-22% spread over country (20%), intercountry (22%) and Regional Office (30%) levels. It had

been hoped that the reduction would result in sufficient savings to allow implementation of the

remaining activities within the reduced budget allocation. Unfortunately, further cost escalations

and improved implementation rates through the use of the regional information system had

necessitated that Member States, through the WHO Representatives and Country Liaison Officers,

again be requested to consider further adjustments (referred to as "Priority X") in the revised

programme budget. That had resulted in a further reduction of US$ 2.9 million. That had proved

insufficient, and a deficit remained of around US$ 1.3 million. It was hoped that that could be

covered by non-implementation of certain activities. However, it was hoped that the lessons learnt

from previous exercises in terms of prioritizing activities could be useful in the implementation of

the 1994-1995 programme budget since in the next three months, consideration might have to be

given to that. That experience would be borne in mind during the formulation of the 1996-1997

programme budget.


In reply to questions from the representatives of Australia and the United States of America

concerning the 37% increase in the operating budget for support services, the REGIONAL

DIRECTOR explained that there had been a general escalation of costs, but the rise had been mainly

due to increased salary costs. The 42 % decrease in the operating budget for public health

information and education for health was largely accounted for by the freezing of posts, in particular

the post of a public information officer. He agreed it was illogical to freeze a vacant post in a high

priority area while retaining staff working in low-priority areas, but he was often compelled to do so

by the staff management policies, which applied throughout the United Nations system. He had

asked the Programme Committee and Senior Staff Selection Committee at the Regional Office to

look into the distribution of posts at the Regional Office and country offices and to consider what

posts might be abolished in the course of the next two bienniums. The freezing of posts was an

interim measure prior to the thorough reorganization of the structure of the Regional Office.

Responding to the Australian representative's question about the ratio between the

staff component of the budget and other programme components, he emphasized that the Regional

Office required a wide range of staff with the expertise and experience to advise Member States.

Permanent staff accounted for 38.8 % of the total budget and short -term consultants for 6.3 % . It

was important to make a distinction between the technical staff and administrative support staff.

Dr TAPA (Tonga), pointing out that resources available for WHO activities in the Region

were constantly dwindling, asked what were the realistic prospects for the next biennium. Perhaps

Member States were making things more difficult for themselves by failing to pay their assessed

contributions in time.

The REGIONAL DIRECTOR assured the representative of Tonga and other representatives

that their comments and concerns would be taken fully into account when planning future

operations. For several bienniums the Region had been obliged to resort to underbudgeting, as it

had been unable to make adequate provision for increases in real costs. He had told the Committee

at its previous session that, despite an improved budgeting process for the 1994-1995 biennium,

there would still be a budget shortfall of US$ 4.3 million at the start of that biennium; and that he

had endeavoured to budget for the actual cost of country programmes, and to confine

underbudgeting to intercountry programmes, the Regional Office and WHO Representatives'

Offices. During the past year further escalation of costs had occurred in many areas. In particular,

Manila had been classified as a hardship duty station, as a result of which Regional Office staff had

to be paid a hardship allowance. The post adjustment at some other duty stations had also been

increased. As a result of those and other developments, it was currently estimated that the budget

shortfall at the start of the next biennium in January 1994 would be US$ 9.4 million. Even that


figure did not take into account the possibility that the Director-General might find it necessary to

withhold further funds in the next biennium. He was accordingly taking measures to cut expenditure

sharply in Manila and in WHO Representatives Offices, by freezing posts and conducting other

cost-cutting exercises in many areas. He hoped that some of the shortfall could be made up by

implementing activities somewhat later than scheduled.

Regarding the programme budget for 1996-1997, he had just received instructions from the

Director-General to prepare that budget without taking any cost increase factor into account. In the

past the real increase in costs in the Region had been of the order of 20%, but it had only been

possible to apply a cost increase factor of about 8 %. It was impossible to foresee what cost increase

factor might be allocated to the Region in 1996-1997 by the governing bodies of WHO. The

Director-General had also instructed that 3% of each region's budget for 1996-1997 should be

withheld at the global level for priority activities. The Regional Director strongly urged that the

funds withheld from the Region be used for priority activities in that Region. The Director-General

acknowledged the Regional Director's wish.

Mr DURAND-DROUHIN (France) reaffirmed his Government's belief in the principle that,

in allocating financial resources, priority should be given to intensified cooperation with countries in

greatest need.

The interim report on budget performance showed clearly where it had been found necessary

to make savings. It would be useful to know what principles or criteria were applied by the

Regional Office in allocating resources to individual countries.

The DIRECTOR-GENERAL said it was not yet clear what the Organization's financial

situation would be in 1994-1995.

He had been obliged to withhold 10 % of regional budgets in the current biennium because a

major contributing country was some two years in arrears in the payment of its contributions. In

budgeting for the next biennium, therefore, he was obliged to aim for zero or even negative growth

and to concentrate more on priority areas.

The decision to withhold 3 % of regional allocations had arisen out of his discussions with the

regional directors and assistant directors-general. Such an across-the-board cut had many pros and

cons, but the majority had felt it was the only way to reorient activities and ensure that funds were

available for priority programmes and countries.

He agreed with the representative of France on the importance of intensified cooperation with

countries in greatest need. That approach was accelerating the flow of resources to such countries,


not just from the WHO regular budget but from all sources of international cooperation in health. It

aimed to reform the countries' health care systems towards primary health care. Many countries of

the Region had benefited from the approach, and the total flow of funds from bilateral and

multilateral sources was increasing. Disbursements by some multilateral agencies were still

conditional on structural adjustment, but it was hoped such constraints would gradually disappear in

the Region.

To sum up, the Organization's financial prospects for 1994-1995 were still no better, but he

hoped the situation would improve as economic recovery got under way in the major contributing

countries.

He shared the Regional Director's concern at the critical situation created by increases in the

salaries and allowances of long-term staff. Under the common system, salary scales and post

adjustment rates were determined by the United Nations; WHO had no control over them, but had

to foot the bill. Moreover, judgements of the ILO Administrative Tribunal were increasingly

favourable to staff who appealed against their conditions of service.

The recommendation not to include a cost increase factor in the 1996-1997 budget at the

present stage emanated from the Executive Board Working Group on Global Change. That

recommendation in tum reflected the resolution on budgetary reform adopted by the Forty-sixth

World Health Assembly, which called for a shorter period between the recommendation and

implementation of the progranune budget. Rather than indicate a "phantom" cost increase two or

three years before implementation, it had been decided to wait at least one more year so as to obtain

a more realistic figure. For similar reasons, it was intended to wait as long as possible before

setting the exchange rates for the United States dollar. Those matters would be discussed by the

Executive Board, possibly within a specially created committee on budget and finance, and by the

World Health Assembly.

The REGIONAL DIRECTOR said that, where the regular budget was concerned, the regional

programme budgeting policy determined in 1986 was applied whereby national and intercountry

programme formulation took into account for each country its population and other biostatistical data

such as birth and death rates as well as health problems and health service infrastructure; the rate of

development, particularly the plight of the least developed countries and countries in special need;

and the capacity of Member States to absorb funds - an important factor, since even in the countries

most in need, if that capacity was low, direct cooperation might not be productive.

Concerning indicative country planning figures. he had to say in the presence of the Director

General that when China had replaced Taiwan as a Member State, the Region had received only


US$ 500 000 more to cope with programmes for a population of some 1000 million; although that

allocation had increased over the years to about US$ 9 million it was still a drop in the ocean

compared with the problems requiring solution. In Cambodia the special situation was involving

WHO in cooperation that exceeded the extra million dollars provided. Indeed many of the least

developed countries were in the Western Pacific Region, and the extrabudgetary funds and suppon

under WHO initiative for intensified cooperation with countries in special need were also brought to

bear for Cambodia, Viet Nam and cenain Pacific island countries, for example.

"Savings" was not a very apt term to describe the measures applied to reallocate resources in

the Region. He preferred the concept of "slippage". Such savings could only be made when, for an

activity that could not be implemented with the resources available, the Regional Office had to rely

on economies in large fellowship provisions, or on funds becoming free owing, for example, to the

inability of a consultant to take up duties, or to the non-implementation of a fellowship due to the

candidate failing a language proficiency test, or when the temporary freezing of a post became

possible.

Dr TAPA (Tonga) thanked the Director-General and the Regional Director for their frank

explanations. The information they provided on the challenges to be faced was essential; he was

convinced that with a proper appreciation of the facts and with the collective wisdom of the Regional

Office and Members of the Region it would be possible to meet the situation. The special needs of

some countries had to be recognized on humanitarian grounds, together with the need for

extrabudgetary suppon to cope with them. Tonga, with its population of some 100 000 and a

minimum assessment of 0.01 % of the budget, relied on such suppon to increase cooperation some

fiftyfold.

He appealed to major contributors to pay on time. WHO had faced up to non-payment

realistically so far, but therepons on status of contributions showed that the list of Members in

arrears was growing.

He had every confidence in WHO's leadership, but all should be aware of the consequences of

continued non-payment.

Mr KOIMANREA (Papua New Guinea) asked in regard to resources contributed to the

regular budget by Member States of the Region, what was their total financial contribution, what

were the consequences for their programmes with WHO in the case of non-payment, and how non

payment by major contributors affected smaller countries or those paying smaller contributions.


Mr V AIMILI (Samoa) associated himself with the remarks of the representative of Tonga:

there was no question of doubting WHO's leadership in financial matters and the World Health

Assembly had confirmed that position, but the situation must be stated clearly in regional terms.

He asked whether an appeal could appropriately be made at regional level for major

contributors to pay on time, since an unequivocal approach was necessary.

He hoped that the Western Pacific Region was not to be treated as a special case. It was

important for responsibilities to be properly recognized and the total budget figure to be covered by

Members' contributions.

Mr WAENA (Solomon Islands) said that when so much was spent on warfare and weapons of

mass destruction it was essential to insist that health and welfare were being neglected and that

proportionally the amount allocated to the good cause promoted by agencies like WHO was minute.

He thanked the Chairman for pointing that out. Major contributors to the budget had a special

responsibility in that regard.

The REGIONAL DIRECTOR, replying to the representative of Papua New Guinea, said that

the contributions of Member States with their seat of government in the Region totalled

US$ 109 million, or 15.18% of all WHO assessments. If the contributions of the United States of

America (US$ 186 million or some 25 %), France (US$ 42.8 million or 6.1 %), the United Kingdom

of Great Britain and Northern Ireland (US$ 33 million, or 4.7%), and Portugal (US$ 1 338000, or

1.18%), were added, some 50% of assessed contributions could be said to come from Members

represented at the session of the WHO Regional Committee for the Western Pacific.

But the question was not only one of non-payment; some countries were in understandable

difficulties, which it was hoped would be relieved so that they could resume normal payment. The

main problem was with Members outside the Region that could not meet their obligations.

Countries that did not pay were eventually subject to the provisions of Article 7 of the WHO

Constitution for suspension of voting privileges and services, applicable at the World Health

Assembly, but not at Regional Committee level.

There was the additional problem of late payment, which could continue for several years

before such provisions became applicable.

Contributions still to be paid in 1993 by eight Member States in the Western Pacific Region

amounted to US$ 2 887 000, and it would be advisable that all contributions due were received

before non-payment by Members in other Regions was criticized.


The implications for smaller contributing countries in the case where larger contributors did

not pay raised the question of priority-setting.

The DIRECTOR-GENERAL said that the Western Pacific Region shared the worst situation

resulting from non-payment by major contributors with the European Region whose Members

contributed over 50% of the total regular budget. In that region the fragmentation of the fonner

USSR and fonner Yugoslavia had resulted in several new Members - and a significant proportion of

the total population of some 1400 million (the largest regional population) - falling into the category

of developing countries. Many of their peoples were among those in greatest need.

All regions indeed had claims to special consideration. In the circumstances he wished to

remind representatives that WHO was one of the most successfully decentralized agencies, also

financially. Over 60 % of the budget went to the regions and - through the regional mechanism - to .

countries for their people in the fonn of technical support and cooperation.

So if a major contributor, say, one which contributed over 10% of the assessed total regular

budget - had not paid its contribution since the second part of 1991, creating a correspondingly large

deficit, and if in addition another country with a large population and responsible for a considerable

proportion of contributions became fragmented, while at the same time yet other countries in the

Middle East and in the Americas, for example, faced serious economic difficulties, representing

some 5% of unpaid contributions, what was to be done? Until 1990 - leaving aside exceptional

non-payment or delayed payment by one or the other major contributors that had resulted in a 25 %

deficit - no such difficulty had had to be faced. It was indeed only after 1987, where WHO could

still count on receiving about 95% of total assessed contributions, that receipts had fallen below 90%

to about 83 %, and the rate of payment was now below 80 % .

If in 1993 the largest contributor did not make the payment which it usually made in October,

the situation would become so serious that a significant reduction in WHO's normative function and

direct technical cooperation with Member States would have to be considered. If the

major contributor did not make its payments, WHO was obliged to face complete structural change.

There were only three choices: either abolish headquarters, abolish the Regional Office, or abolish

technical cooperation with countries. WHO was currently in a borderline situation.

However, he had been assured by major contributors in verbal communications that arrears

would be paid. One such contributor had already made good part of its arrears. Other Members in

arrears had also started to pay. It was hoped that a normal financial situation with

regular contributions from fully-fledged contributors would be re-established in one or two years.


3. AIDS: Item 10 of the Agenda

3.1 Annual report on AIDS, including sexually transmitted diseases:

Item 10.1 of the Agenda (Document WPRlRC44/5 Rev. I)

The REGIONAL DIRECTOR said that for the previous six years, he had presented an annual

report on AIDS, including sexually transmitted diseases, in conformity with resolution

WPRlRC38.R5 of the Regional Committee at its thirty-eighth session. The report presented an

analysis of the scope and trend of the spread of the AIDS epidemic in the Region.

For the current year, in response to a request for a comprehensive report on the progranune. a

more detailed review had been prepared. It presented the epidemiological situation of HlV

infection, AIDS and sexually transmitted diseases in the Region, and the history, development and

future direction of the regional AIDS progranune. The evaluation did not simply present the

statistics of incidence or mortality but drew reasoned and very carefully considered conclusions

about the implications, or omissions of the statistics gathered.

The objective of the report remained, as before, neither to alarm nor to threaten but to inform,

guide and provide a balance in adopting proper prevention and control measures and defining target

areas.

The major factors which facilitated HIV transmission were known. The approaches

to minimize risk behaviour had been discussed and decided upon. All countries in the Region had

established national AIDS committees to oversee the management of national progranunes. Nine of

the 35 countries and areas had not reported any cases of AIDS or HIV infection. None the less,

when the documents before the Committee were prepared, there had been only 5058 cases of AIDS

reported from countries in the Region, whereas, the number of cases was, as at I September 1993,

5549. WHO estimates were that between 50000 and 100 000 people were already infected with

HIV in the Region.

In the knowledge that much had been done to protect peoples from any further damage by the

disease, and with the understanding that so much remained to be done, he urged representatives to

respond to the detailed analysis provided, and discuss the future directions.

Dr LEE Shiu-hung (Hong Kong) congratulated the Regional Director on his comprehensive

report on AIDS, which underlined the need to sustain efforts at both country and international level.

He welcomed the organization during the previous four years of three meetings among health

authorities in the neighbouring areas of China, Hong Kong and Macao on the exchange of


epidemiological information and experiences in the prevention and control of major communicable

diseases, including AIDS, and looked forward to continuing WHO support.

With the rising prevalence of HIV, it was not surprising that some health care workers were

infected with the disease. That was becoming an increasing concern in view of the need to strike a

balance between the public's concern for safeguarding the health of people receiving treatment from

infected health care workers and the need to protect the rights and privacy of those workers. He

urged WHO to prepare up-to-date guidelines on HIV infection among health care workers for

national health authorities.

The Government of Hong Kong fully supported WHO's Global Programme on AIDS, and

was happy to collaborate in activities, including the holding of seminars or training courses in Hong

Kong for health-related workers from other countries and areas. Furthermore, it had recently

established an AIDS Trust Fund with a government contribution equivalent to US$ 45 million. Its

purpose was to award payments to haemophiliacs infected through blood transfusion or blood

products prior to the introduction of blood screening and heat-treated products in 1985; to fund

community projects for medical and social support services to HIV-infected persons; and to

strengthen Hong Kong's public health education programmes which would promote public

awareness and remove prejudice.

Mr SAITO (Japan), recognizing the need for urgent action to stem the explosive spread of

HIV infection in Asia, recommended several lines of action for the Global Programme on AIDS in

the Western Pacific. It should endeavour to determine the cost-effectiveness of HIV/AIDS

interventions; it should transfer rapidly to country level the knowledge gained from successful

prevention and care interventions; it should set up a task force for the regional programme on

AIDS; and it should expand its support to nongovernmental organizations through provision of

technical support at country level.

The Japanese Government had pledged to maintain technical and financial support for the

Global Programme on AIDS, especially in the Western Pacific, and in August 1994 it was to host

the Tenth International Conference on AIDS. It was essential to ensure participation by the Region

in the Conference, which would help to raise awareness of the spread of HIV infection and promote

prevention and care. Japan hoped to receive the support and collaboration of Member States and

WHO in that activity.

Mr LOVELACE (New Zealand), noting the inadequacy of reporting in some countries with

respect to incidence, prevalence and trends associated with the AIDS pandemic, asked what steps

might be taken at regional level to encourage higher quality reporting of information. With regard


to such groups as commercial sex workers and injecting drug users, he asked what type of

programme might be developed at regional level or encf)uraged at country level to impFove the flow

of information to those vulnerable populations.

Dr CLARO (Portugal), updating the figures provided in Table 2, page 4 of document

WPRlRC44/5 Rev. 1, said that as at June 1993, five people had been diagnosed with AIDS. of whom

three had died. Forty-one people had been diagnosed as HIV positive. 31 of whom were women.

Two-thirds of the group had been infected through heterosexual transmission. and only one person

through blood transfusion.

The policy for AIDS prevention and control in Macao was based on respect and protection of

human rights, and several practical measures had been adopted in relation to confidentiality. health

care. drug users and immigration. Health education. communication and information on AIDS had

been promoted through the media. Special attention had been paid to such higher risk groups as

teenagers, both students and those out of school. blood donors and commercial sex workers.

Condom use had also been promoted. HlV surveillance had been strengthened. Blood

was screened. and pregnant women, prisoners. and police force applicants had been tested. Drug

users were tested on a voluntary basis. All results were HIV-negative. Immigrant workers in

various entertainment facilities were tested every three months and permission to reside and work in

Macao depended on the results. Local workers in the same activities were also being tested.

Official channels had been established with Zhuhai for the exchange of information. and it was

hoped that such collaboration could be extended elsewhere. Since most of the information was in

Portuguese. he asked whether WHO could cooperate in the work of translation. His Government

very much appreciated WHO support in the form of educational materials in various languages and

training for staff.

Dr REODICA (Philippines). noting the gradual increase in the number of AIDS cases in the

Region and the presence of many factors contributing to the spread of AIDS, urged WHO to give

top priority to the Global Programme on AIDS.

A total of 103 AIDS cases had been reported in the Philippines as at June 1993. of whom 69

had died. The male to female ratio for HIV infection was 1: I. and the mode of transmission was

primarily heterosexual. Prevalence of HlV infection was estimated at between 5000 and 30 000

cases; it was hoped that the sentinel surveillance programme recently introduced would soon

provide a more accurate picture. Knowledge. attitude and practice surveys were currently being

conducted among injecting drug users so that education and intervention programmes could be

launched. Many of the HIV-positive females were sex workers, and infection rates were rising fast.


The national AIDS progranune, institutionally located within the Department of Health, had

initially focused on preventing sexual transmission and on protecting the blood supply; its current

thrust was to prevent injecting drug users from sharing needles and syringes. Management of the

progranune was being decentralized, and training was being provided for administrative and medical

staff. Local AIDS councils were being set up, comprising local officials and staff of

nongovernmental organizations. The recent integration of control of sexually transmitted diseases in

the AIDS progranune would orient activities towards the prevention of such diseases among the

general population and the use of social hygiene clinics for prevention and education activities on

both AIDS and sexually transmitted diseases.

The new AIDS communication strategy targeted more specifically policy-makers, health

professionals, religious leaders, teachers and entertainers. Education and intervention progranunes

for groups at risk were being expanded, with the strong participation of nongovernmental

organizations and the private sector. The Government staunchly advocated the right of people with

HIV -infection to an economically productive life through non-discrimination at the workplace and

the provision of an alternative livelihood for sex workers. Congress had given the Department of

Health a free hand in drafting a comprehensive bill on AIDS/HIV prevention.

The multisectoral National AIDS Council had been set up to oversee the Philippines response

to the threat of AIDS. A national conference would be held in December to coincide with World

AIDS Day - National AIDS Awareness Month.

Dr CHEN Ai Ju (Singapore) said that the provision of technical know-how and expertise by

WHO was very much appreciated. As the disease was evolving rapidly, the efforts made to keep

Member States informed of epidemiological changes and possible treatment and prevention measures

were most important.

In Singapore 190 cases had been recorded, most of which were transmitted through casual sex

with commercial sex workers. The national AIDS control progranune was therefore multipronged,

the greatest emphasis being placed on educating the public, reaching out to high-risk groups,

strengthening control of sexually transmitted diseases, and protecting the national blood supply.

Singapore had successfully protected the blood supply and raised public awareness of the disease and

its modes of transmission. It was now focusing on enhancing personal responsibility and modifying

behaviour. It looked forward to further collaboration with WHO and to learning from the

experience of other Member States.

Dr ADAMS (Australia) reported that since the previous Regional Committee session the

national five-year strategy had been evaluated, and the Australian Government had recently agreed


to maintain it. The evaluation indicated that in Australia, as in some other countries in the Region,

the epidemic seemed to be plateauing. He hoped that sufficient measures were now in place to

control the spread of the virus.

The evaluation concluded that the most cost-effective measures taken in the early days of the

epidemic were perhaps the funding of sex worker groups, providing them a small amount of money

so that they could organize themselves and insist that all their clients used condoms. As a result, no

sex worker in Australia had been infected with HIV through sexual contact during the entire

epidemic. The other cost-effective intervention, which took some courage on the part of politicians,

was the setting up of needle and syringe exchange schemes in the major cities to prevent the spread

of the virus among injecting drug users.

He was fairly confident that the measures in place would continue to contain the epidemic.

However, there was no room for complacency as a new generation of children was now reaching

sexual maturity. He endorsed the request of the representative of New Zealand for the presentation,

possibly at the 1994 Regional Committee session, of specific examples of successful interventions,

particularly programmes related to sex workers and injecting drug users.

Mr ZHANG Yuji (China) said that in China the situation concerning AIDS and sexually

transmitted diseases was basically that same as that depicted in the report. A total of 1106 cases of

HIV infection and 14 cases of AIDS had been reported. HIV infection in China was concentrated in

border and coastal areas and large cities; occurred mostly among young and middle-aged people;

and affected a range of population groups, but mostly farmers and injecting drug users. The rate of

infection from sexual contact was rising fast. Cases of sexually transmitted diseases were also

growing rapidly.

The Chinese Government attached great importance to the prevention and control of AIDS

and sexually transmitted diseases. It had established a reliable reporting and surveillance network

which was operating efficiently. The medium-term prevention and control programme, formulated

by the Government in cooperation with WHO, was progressing smoothly. With WHO's support

China had promoted and strengthened AIDS information, education and surveillance. A joint

ChinalWHO review of the national AIDS prevention and control programme would be held in

October 1993 and he looked forward to further cooperation with the Organization in order to prevent

the spread of AIDS in China.

The meeting rose at noon.


ANNEX

ADDRESS BY THE INCOMING CHAIRMAN

Distinguished Representatives, Director-General, Regional Director, Representatives of

Specialized Agencies of the United Nations and Nongovernmental Organizations, Ladies and

Gentlemen,

I wish to thank the Committee for nominating me as Chairman of the forty-fourth session

of the Regional Committee for the Western Pacific. I fully recognize the honour bestowed on

me, and even more so, on my country, Fiji. I also thank you on behalf of the Vice-Chairman

and Rapporteurs whose support I will be counting on during the deliberations of this session.

As my first task as Chairman, I wish to congratulate Dr S. T. Han on his nomination.

The unanimous vote of the Regional Committee speaks for itself. His experienced leadership

and guidance are going to be highly valued in the crucial years ahead.

May I also take this opportunity as Chairman of this session to join the other

Distinguished Representatives in wishing Dr Nakajima success during his second term

as Director-General of the World Health Organization. I fully support the sentiments expressed

by my predecessor, Dr Lee.

The next year will be one of particular challenge to WHO as it competes . for resources,

deals with new directions and new structures and yet continues to address the multiple health

problems of the world. When summing up our discussion on the Regional Director's report,

Dr S.T. Han has given.a clear idea of how he proposes to rise to many of these challenges.

The decade of the nineties wd tile cel1tury t(l come are often referred to as the era of Asia

and the Pacific. While it is true that economic development in this Region has been faster than

in other parts of the world, and will hopefully continue at the current rate, the health problems

not only remain but multiply. In this Region, there is still unnecessary loss of life from

infectious diseases and the manifestation of poverty, there is increasing morbidity due

to environmental degradation and accidental injury, and there is, in almost all countries, an

increase of incidence of diseases of lifestyle largely due to increasing longevity and affluence.


Annex

Many of our small island nations have their own unique problems because of their

smallness in size, limited resources, unstable economies and fragile ecosystems. These

problems may be better addressed if they are appreciated and respected by the bigger and more

affluent countries in view of continuing collaboration and cooperation.

It has been observed that one of the truly Significant health-for-all achievements in the

Region has been the ability to manage change on the basis of clearly fonnulated policies. What

is now required is to incorporate the issues of targeting more precisely into national policies.

We must learn to focus on priorities to improve efficiency of health care.

In the Western Pacific Region, more countries are going through significant social change

which results in evolving health system structures. Most notable among these is the

decentralization of responsibility for decisions and resources utilization. Consequently, we

would expect that the new health policies will reflect the emerging priority health issues we

face. This applies to the larger countries as well as to the smaller island countries in the south.

The service structure that will evolve in each country will be characterized by more local

responsibility with regard to operational decisions. Many of these structures will be less formal

and will link partners involved, which include the government, the private sector, the

nongovernmental organizations and the community.

This evolution is necessary. It will need vision and foresight on the part of the

governments also. The views expressed by the Regional Director for WHO provide a clear

direction to follow. We share his hopes and plans for the future and will be working to realize

this in each of our countries. I consider this the basic essence of partnership we all have been

talking about.

On a personal note, I know how hard WHO has worked on this in Fiji. the classical

example being the 1l7-year old institution of the Fiji School of Medicine. Dr Han, we are

always grateful for your personal efforts in this context.

Distinguished Representatives. on the agenda of this session are many major issues,

which require careful consideration and clear decision by the Regional Committee. We have a

busy week and a great responsibility before us.


Annex

I am sure we will tackle these issues in the usual business-like fashion for which the

Western Pacific Regional Committee is well-known. Let me thank you all in advance for your

cooperation and indulgence. I hope all of us will have a fruitful forty-fourth session and an

enjoyable stay in Manila.

Thank you.

SUMMARY RECORD OF THE FOURTH MEETING

WHO Conference Hall. Manila Tuesday. 14 September 1993 at 2.30 p.m.


CONTENTS

(wpRlRC44/SRl4)

1. AIDS (continued) ................................................................................ 154

1.1 Annual report on AIDS, including sexually transmitted diseases (continued) .................................................................... J....... 154

1.2 Global Programme on AIDS: Membership of the Management Committee ............................................................ 165

2. Eradication of poliomyelitis in the Region: Progress report ............................ 165

- 153-


AIDS: Item 10 of the Agenda

Annual report on AIDS. including sexually transmitted diseases: Item 10.1 of the Agenda

(Document WPRlRC44/5 Rev. 1) (continued)

Dr Dong-Mo RHIE (Republic of Korea) commended Member States and WHO on their

IDS prevention and control efforts in the Region. Only by cooperating with each other would

ember States cope with the problems involved. With WHO support, the Republic of Korea

ould continue to cooperate with other Member States in that area.

In the period from the first identification of HIV infection in the Republic of Korea in

ecember 1985 to 31 July 1993 more than 260 cases had been recorded, of which 247 were

nder supervision. The mode of transmission was shifting from sexual contact overseas to

To combat the situation his Government had passed an AIDS Prevention Act, established

National AIDS Committee and encouraged the active participation of nongovernmental

rganizations. Continuous education was being provided through the broadcasting media,

amphlets, school education and counselling centres. In addition all blood supplies had been

s reened for antibodies to HIV since 1987, mandatory testing for high-risk groups was being

i plemented and management of infected people, through monthly checks and free distribution

f AZT, had been initiated. AIDS patients were admitted to designated hospitals with a

overnment subsidy.

He thanked the Member States and the Regional Office for their close collaboration in

IV infection and AIDS prevention activities in the Region.

Mr TEBANIA (Kiribati) said that of the two HIV cases in Kiribati listed in Table 2 of the

egional Director's report, one had died some months earlier. No further cases had been

His Government, through the Ministry of Health, was making every effort to monitor the

'tuation closely and was encouraging prevention activities at all levels. He hoped that WHO

ould continue to give its full support so that the disease could be contained both in the Region

d the world at large.

SUMMARY RECORD OF THE FOURTH MEETING 155

Dr WONG FAT (France) commended the high quality of the report provided. It

indicated that the AIDS pandemic in the Region was at an early stage compared with other parts

of the world. However, a substantial increase in cases was to be expected by the year 2000. As

the report indicated, there was still a high level of risk factors for transmission of the disease.

These were linked to the prevalence of communicable diseases, the sexual behaviour of the

population and the prevailing drug use situation. There was, therefore, a need to strengthen

control activities, particularly in view of the likely increase in commercial activities and tourism

and the opening of new areas to tourism in the Region.

France would support all efforts by the Regional Office to provide information, especially

on monitoring, surveillance and epidemiological activities. France was following the situation

in the Region closely and envisaged the provision of human resources support to Member

States. He reaffirmed France's commitment to the principles laid down in the areas of

confidentiality of medical information and the prevention of discriminatory measures against

those found to be seropositive.

Professor NGUYEN TRONG NHAN (Viet Nam) commended the Regional Director on

his report. HIV infection was becoming an increasingly important problem in Viet Nam, with

the number of cases increasing rapidly week by week. As at 13 August 1993 some 765 cases

had been recorded from 21 provinces, of which 680 were Vietnamese nationals. The majority

of cases were from high-risk groups such as injecting drug users (88%), sex workers and people

with sexually transmitted diseases. There had recently been ten deaths from AIDS in Ho Chi

Minh City and the southern provinces.

In 1990 the Government had established a national interministerial AIDS Committee for

AIDS prevention and control made up of 14 ministries and with representation from other

government agencies. Provincial committees had also been established in 19 provinces. For

surveillance purposes there were 17 sentinel provinces. Eleven blood transfusion centres had

been equipped with laboratories for serodiagnostic testing. In the first six months of 1993,

20 790 blood samples had been tested, of which 566 had proved positive. That represented a

considerable increase over the previous years and the Government had therefore increased the

budget from 700 million dong in 1991-1992 to 10 billion dong in 1993 (excluding contributions

from provincial authorities). In addition health education activities for AIDS prevention had

been intensified. Surveys had indicated that 41 % of the population were now aware of the risks

of AIDS compared to 5% in 1990. Viet Nam was following WHO policy concerning

confidentiality for affected cases, which required that they were fully aware of the dangers and

were willing to act responsibly towards others in the community. The Government


had organized two other programmes to support AIDS prevention: (1) to combat drug use by

encouraging farmers to replace drug crops with useful medicinal plants and by establishing

rehabilitation centres for drug addicts; and (2) for the control of prostitution by developing

information tools, rehabilitation measures and measures to improve the status of sex workers.

Despite the results achieved a number of obstacles remained, particularly of a financial

nature. It was hoped that international organizations, particularly WHO, would provide

increased support in the future for AIDS prevention and control activities.

Mr AGUIGUI (United States of America) welcomed the comprehensive report prepared

by the Regional Director, which represented an outstanding response to the Regional

Committee's request at its previous session. The information provided was comprehensive,

focused and well-written. The data would be of great use to the Committee in making

recommendations for the future.

Much had been accomplished since the spread of the AIDS pandemic to the Region. All

countries had established national AIDS committees to oversee the management of national

programmes and increasing numbers of separate AIDS units to monitor daily operations were

being set up. Multisectoral approaches, seldom seen as a response to health issues, had been

initiated and were being put to good use. Those activities demonstrated the recognition by

Member States of the threat posed by HIV and AIDS to the peoples of the Region. However,

the threat would grow if the resources mobilized to stop the spread of the disease proved

insufficient. The report indicated that WHO had redistributed its resources for the AIDS

programme by increasing support for national activities at the expense of regional activities.

The shift in emphasis towards support for local responsibility for national programmes and local

development of strategies that took into account social, religious and cultural influences was

appropriate and to be welcomed.

The Regional Director's introduction to the report advocated a philosophy and attitude

that represented a first line of attack against HIV infection and AIDS. The opportunity now

existed for the Region to limit the spread and damage of the disease, although, as the Regional

Director had said, that would require a special kind of courage and openness.

The Regional Director was encouraging Member States to learn from the experiences in

other parts of the world, to examine all the factors that could contribute to the spread of HIV

infection, to avoid the consequences of complacency and inaction and to unite in a determination

to implement the necessary protective measures. The Regional Director had suggested that the

report could serve as a catalyst for action. His delegation endorsed those views.


The United States of America was paying particular attention to rates of HIV infection

and AIDS in its territories and protectorates in the Region. Guam, with a population

approaching 140 000 had the fourth highest rates of HIV infection and AIDS after Australia,

French Polynesia and New Caledonia.

One of the fundamental aims of AIDS education and prevention was the achievement of

more responsible lifestyles through changes in attitude and individual behaviour.

Guam was making increasing efforts to identify high-risk populations and was in the

process of enacting local legislation that would guarantee confidentiality of testing and strictly

prohibit discrimination against people infected with HIV. However there was a dearth of

medical resources on the island for the treatment of full-blown AIDS cases.

The Regional Director had recommended a number of directions to be pursued

by Member States. Approaches that were successful elsewhere had to be assessed, shared and

adapted to different social and cultural conditions, and properly supported during the

implementation. He requested the Regional Director to provide the Committee with specific

details of successful programmes being conducted on behalf of high-risk populations as cited in

the report. Attention should also be given to unsuccessful efforts to limit the spread of infection

in countries with high rates of HIV infection and AIDS since as much could be learnt from

mistakes as from successes.

If the philosophy of the report was fully accepted, the Region could be successful in

finding the special courage and openness to limit the spread of the disease.

Dr HONG SUN HUOT (Cambodia) commended the Regional Director on his excellent

report.

Testing for HIV had commenced in 1991 in Cambodia and the first seropositive cases had

been detected among voluntary blood donors in the same year. As of July 1993 a total of 136

Cambodians had tested positive for antibodies to HIV. WHO estimated that 1000-2000

Cambodians might be seropositive. The main mode of transmission was sexual and

transmission through blood was potentially significant. Small surveys conducted in 1992 had

indicated rates of HIV infection of 9.17% in sex workers and 4.50% in sexually transmitted

disease cases. AIDS was a great potential threat to Cambodia. The establishment of a National

AIDS Committee to develop a national AIDS plan and coordinate AIDS activities had been of

great importance in reducing that threat. WHO had been instrumental in the development of a

five-year national AIDS prevention and control plan and an AIDS adviser had been working in


the country for the past 18 months drawing attention to the disease and its possible impact.

AIDS was now an important factor in all Ministry of Health policy decisions throughout the

health sector.

Cambodia appreciated WHO's prompt response of support for the programme and looked

forward to collaborating with and learning from other countries in the Region.

Mr BUNE (Fiji) said that since the registration of the first AIDS case diagnosed in the

country in 1989, Fiji had detected 17 cases of HIV infection and six had since died. In 1989, in

collaboration with WHO, the Ministry of Health had developed a short-term plan which had

been implemented in 1990. That had been followed by a three-year medium-term plan which

was currently in the third year of implementation. The main thrust of the two plans was

education to increase awareness about HIV infection and AIDS. In addition, handbooks on

treatment and counselling guidelines had been developed and distributed to health care workers

and a mass media campaign using radio, brochures, posters, etc., had been launched. Initially,

a multisectoral National Advisory Committee on AIDS (NACA) chaired by the Minister of

Health had been formed in 1988 to spearhead implementation of the plans. In 1992 NACA had

been restrucrured and now involved only a core of professional experts whose main role was to

make policies and advise the Government on HIV-related issues. At the national level NACA

was supported by four subcommittees dealing with clinical aspects, blood transfusion,

epidemiology and sexually transmitted diseases, and information, education, communication and

counselling. Efforts were currently under way to strengthen community outreach programmes

with the formation of divisional AIDS committees and a nongovernmental AIDS Task Force.

Several training programmes in the form of workshops and seminars had been organized around

the country.

Another major development was the setting up of testing facilities in major urban and

selected rural centres. All donated blood was now screened for HIV antibodies and clients

tested received pre-test and post-test counselling from staff who had received some basic

inservice training. So far 18 test centres had been set up and it was hoped to expand the

service, depending on the availability of trained laboratory technicians.

Efforts over the past five years had concentrated on the promotion of awareness in the

public and health care workers. It was time to review what had been achieved and focus

attention on specific targeted groups and services. Strengthening of street outreach activities

would be high on the agenda for meeting the demand for such services. Hopefully the review

would result in the setting up of a three- to five-year national plan to address the epidemic in

Fiji.


He joined previous speakers in commending the Regional Director on the comprehensive

report he had prepared for the Committee.

Dr PRETRICK (Federated States of Micronesia) welcomed the excellent report under

discussion.

AIDS prevention and control activities had commenced in the Federated States of

Micronesia in late 1987, supported by a three-year grant from the United States Department of

Health and Human Services, through the Centers for Disease Control and Prevention (CDC),

Atlanta, Georgia, with the establishment of a National AIDS Task Force and the recruitment

and appointment of one national and four state AIDS coordinators.

Collaboration with WHO had commenced with the formulation and subsequent approval

and funding of a short-term prevention and control plan in 1989-1990. A three-year medium

term plan had been formulated in 1990 with subsequent approval and funding in 1991.

Implementation was now in the third year. The activities carried out between 1 August 1991

and December 1993 had been clearly laid out in the workplan under three main headings:

health education, surveillance and control, and support for laboratory supplies and equipment.

The prevalence of HIV infection in the country was not known. Two cases of AIDS had

been reported but there were currently no documented seropositive cases. . Since the

confirmation of the first AIDS case diagnosed in 1989, an intensive campaign had been mounted

in collaboration with the departments of health services of the four States, WHO and CDC. The

campaign had involved a set of educational programmes for the public, government and

nongovernmental sectors. The main thrust of the national AIDS prevention and control

programme was health promotion through the mass media and other educational media.

The Federated States of Micronesia was making great efforts to minimize the spread of

HIV infection through the adoption of appropriate health education programmes, including

counselling and testing services, aimed at reducing behaviours related to HIV transmission. It

was hoped that continued technical and other support would be received for those endeavours.

Dr RASMY (Lao People's Democratic Republic) joined previous speakers in

commending the report which was comprehensive yet concise.

His Government had commenced AIDS control in November 1988 with the establishment

of a National AIDS Control Committee. AIDS prevention now formed an integral part of the

activities of the Ministry of Health, which in collaboration with other ministries and government

agencies, controlled and coordinated efforts countrywide.


In May 1989 a short-term AIDS prevention and control plan had been formulated and

successfully implemented. In April 1991 a medium-term plan had been formulated; activities

had been extended to the provincial level and would in due course cover the entire country.

Control activities included the dissemination of basic information concerning HIV

infection and AIDS using all means available (lectures, seminars, the press, radio, television,

etc.) with the aim of helping the community to understand the disease and so prevent the spread

of the epidemic.

So far 9421 blood samples from different groups in the population (blood donors,

refugees, etc.,) had been tested - 20 had been found to be seropositive. One case of AIDS had

been detected and the person concerned had since died.

The HIV infection and AIDS situation in South-East Asia was becoming alarming with a

substantial increase in incidence in neighbouring countries. Furthermore the opening up of the

country, infrastructural development and the construction of a bridge linking Thailand with the

Lao People's Democratic Republic might lead to an increase in the introduction of AIDS and

sexually transmitted diseases to the latter.

WHO had been the main contributor of technical and financial support in the

implementation of prevention and control activities. UNDP had pledged a contribution of

US$ 100 000 for the restructuring of the National Committee and the revision of the

programme. A nongovernmental organization, Care Australia was providing support amounting

to US$ 32 000 for the organization of five training seminars. The Save the Children Fund of

the United Kingdom and the Shell company had proposed support for the National Committee

for the production of educational materials and had provided US$ 3000. A further US$ 28 000

had been contributed by Norwegian aid agencies.

The main obstacles to the implementation of prevention and control activities were the

delay in approval of the necessary funds, poor coordination between the different institutions

concerned, and the lack of full-time staff.

A survey of more than 4000 individuals had indicated 22 cases of various sexually

transmitted diseases. He gave details of the numbers of cases and their distribution by age, sex

and profession.

Mr HENRY (Cook Islands), commending the Regional Director's report, said no cases of

HIV infection or AIDS had so far been reported in his country. In 1991 the Government had

decided to set up a Health Board of which he was Chairman. The Board's first task had been to


approve the budget for an AIDS education programme in schools and on radio and television.

Such a programme was difficult to carry out, for it conflicted with the customs and the religious

and moral values of the population, but the Ministry of Education and nongovernmental

organizations had provided much valuable support. Emphasis had been placed on promoting

frankness and adult attitudes towards education on HIV infection and AIDS, and as a result

schoolchildren were now speaking openly about AIDS and the use of condoms.

The President of the House of Chiefs had recently expressed her concern to him at

imported videos containing explicit sex scenes which were influencing the traditional way of

life.

Dr TAPA (Tonga) told the Committee that a third death from AIDS had occurred since

the preparation of the Regional Director's comprehensive report. The only female known to be

infected with HIV was a married woman with two children, thought to have been infected by

her husband.

His Government was collaborating with the Global Programme on AIDS in implementing

a medium-term plan, and was strongly committed to supporting all measures for controlling

AIDS, both nationally and regionally.

Dr ABU BAKAR (Malaysia), expressing appreciation of the Regional Director's report,

said the AIDS control programme in his country received strong Government support and was

adequately funded. The incidence of HIV infection and AIDS was still increasing. The pattern

remained broadly the same, with the majority of cases occurring in injecting drug users, but

there appeared to be a slight increase among heterosexuals and commercial sex workers.

The national AIDS control programme was developing strategies to modify people's

behaviour, but faced serious challenges in getting those strategies accepted and implemented in

an essentially conservative society. It was encouraged by the Australian experience and would

welcome the opportunity to learn from the experience of other countries. He was grateful for

WHO's cooperation and support in developing his country's programme. There was a need to

strengthen collective efforts in the areas of training, information exchange and research.

Mr WAENA (Solomon Islands) said his Government placed high priority on the control

of sexually transmitted diseases, especially AIDS. The national AIDS prevention policy

developed in 1988 advocated intensive education on preventive methods and the screening of

blood. So far no cases of HIV infection or AIDS had been detected, although hundreds of

samples had been tested in 1992. His Government would continue to do all its slender


resources permitted to prevent AIDS, and hoped it could count on support from the Regional

Office if necessary. He concluded by complimenting the Regional Director on his well

presented and professional report.

Mr KOIMANREA (Papua New Guinea) updated some of the figures in the Regional

Director's report: up to 30 June 1993 139 cases of HIV infection had been detected, mainly in

the 16-30-year-old age group, and 31 people had died from AIDS. His Government was

concerned at the rate at which other sexually transmitted diseases were spreading. If HIV

infection and AIDS followed the same pattern, the results could be catastrophic. The

Department of Public of Health had conducted several public awareness programmes, the most

recent of which had been targeted at politicians and influential members of the community. At

present 97% of blood transfusions were screened for HIV, and it was planned to raise that

figure to 100% by 1995.

His country's most important strategy for AIDS prevention was information, education

and communication. There was an urgent need for specialists to teach the relevant techniques

and skills to health and community workers and to the staff of nongovernmental organizations.

His Govermnent supported WHO's activities so far and endorsed the approaches suggested for

the future.

Mrs HOMASI (Tuvalu) joined in the commendation of the Regional Director's

comprehensive report. There were no reported cases of HIV infection in Tuvalu, but the

country was vulnerable as many of its citizens were seamen who travelled all over the world.

Support was needed in drawing up policy guidelines for health workers and in strengthening

preventive activities. The national AIDS committee was already very active in AIDS

prevention.

The REGIONAL DIRECTOR pointed out that his report had been issued as a printed

brochure, with substantial print runs in English and French, and Member States were invited to

request additional copies.

He thanked representatives for their contributions to the debate, which would serve as a

valuable guide for future planning. He greatly appreciated their concern and their commitment.

He told the representative of Hong Kong that no guidelines on HIV-infected health

workers had been prepared by WHO. Fortunately HIV infection in health workers was not yet

a problem in the Region. Guidelines issued by countries in other regions where it was a

problem recommended that infected health workers should not perform invasive procedures.


Another sensitive issue was whether the patient should be informed that a health worker was

infected. WHO would endeavour to draft global guidelines on such issues.

The figures on HIV infection and AIDS contained in his report were those received up to

1 June 1993 and did not reflect data supplied later, such as those received from Macao on

13 August. There was a need to strengthen the surveillance and reporting system so that

accurate and up-to-date information was available at all times. In the past headquarters had

published monthly figures for AIDS cases, but had recently decided to publish those figures

only half-yearly. Representatives had received the first issue of the AIDS Surveillance Report,

to be published by the Regional Office every six months, and he would be grateful for their

comments and suggestions for improvement. New reporting forms and definition of data that

need to be reported had been introduced and would be assessed. The Regional Office was

prepared to provide Member States with consultants to help streamline their reporting systems.

It needed the cooperation of Member States, for only with full knowledge of the facts could

effective action be taken to control the epidemic.

The Regional Office had recently conducted a study of epidemiological trends in different

risk groups, based on a relatively small number of cases. From 1990 to 1992, HIV infection

rate had increased by 65% among homosexuals and bisexuals, by 210% among heterosexuals,

and by 160% among injecting drug users. The sharp rise in transmission to heterosexuals

showed that the virus was entering the general population, probably as a result of the activities

of commercial sex workers and other high-risk groups. The increase in incidence· among

injecting drug users was particularly high in countries such as China and Malaysia.

A week previously UNDP and the Asian Development Bank had sponsored a meeting in

Manila on the economic aspects of AIDS. WHO had been represented at the meeting and had

agreed to participate with intergovernmental agencies in studies on the cost-effectiveness of

AIDS prevention and control programmes.

The Regional Director woulq Iltudy carefully the four specific proposals made by Japan,

including the organization of a task force for the regional programme on AIDS.

In response to the representative of New Zealand, he drew attention to the data on

commercial sex workers contained in Table 3 of the document under discussion. He believed

there was a need to develop peer education and client education. Since prostitution was illegal

in virtually all countries of the Region, it was preferable to approach commercial sex workers

through nongovernmental organizations rather than governmental agencies. The same applied

to injecting drug users.

164 REGIONAL COMMITfEE: FORTY -FOURTH SESSION

He would like to see an exchange of experience about such activities. The Western

Pacific could learn from and apply the experience gained in other regions. In addition, valuable

experience within the Region should be fully exploited and exchanged. Knowledge of sexually

transmitted diseases among sex workers and their clients was particularly important because

those groups were more vulnerable. One example of activities carried out in the Region was the

organization of a workshop on AIDS control among commercial sex workers, in which

representatives of that group participated.

In reply to the request of the representative of Portugal for support in the translation of

AIDS materials, he stressed that the Regional Office would encourage the translation of worthy

educational material into any of the vernacular languages spoken in the Member States. The

Regional Office wished to encourage such initiatives. It was prepared to support any Member

State for that purpose because translation would make the materials more useful. They had to

be produced in a form that could be understood by such groups as commercial sex workers.

Referring to the request of the representative of the United States of America for

examples of successful interventions, he said that efforts would be made to provide such

information in next year's report.

The representative of the United States of America had also asked for information on

successes and failures. A total of some 5500 AIDS cases had been reported in the Region out of

a global figure of roughly 700 000. Thus AIDS cases in the Region represented less than 1 % of

the global figure. About 92 % of the reported cases reported had occurred in three countries:

Australia, Japan and New Zealand. Australia and New Zealand therefore had more experience

in AIDS prevention and control, and much could be learned from such successful initiatives as

the syringe exchange scheme. He did not refer to Japan because in that country it was mostly

blood transfusion recipients who had been infected. Another good example was the school

AIDS education programme mentioned by the representative of the Cook Islands. Further

information would be provided by headquarters which was attempting to document successful

interventions worldwide. With regard to failures, it was still too early to provide details.

The Regional Director advised the Committee that the budget for the Global Programme

on AIDS was contracting. The Management Committee of the Global Programme on AIDS had

therefore decided to reduce the number of staff at regional level. In the Region two vacant posts

had been abolished in compliance with its wishes. However, if the reduction of resources

continued, and if headquarters should wish to handle the AIDS programme on a global basis

from Geneva, there would be grave consequences for the Region. Activities should be carried

out at country level and regional backstopping should be strengthened. He would plead the


cause of the Region at headquarters, along with other regional directors who had expressed

strong reservations to both the Director-General and the Executive Director in charge of the

Global Progranune on AIDS. He hoped that there would be no further reduction in human and

financial resources, which would jeopardize the short- term and medium-term plans of the

Member States themselves.

1.2 Global Progranune on AIDS: Membership of the Management Committee: Item 10.2 of

the Agenda (Docwnent WPRlRC44/6)

The REGIONAL DIRECTOR said that the Management Committee of the Global

Progranune on AIDS was an advisory body to the Director-General of WHO. It provided

advice on WHO's management of the Global Progranune on AIDS (GPA), in particular on

matters relating to the policy, strategy, financing, monitoring and evaluation of the Progranune.

It represented the interests of intergovernmental organizations and others collaborating with

WHO in the implementation of the Global AIDS Strategy. It was composed of representatives

of countries which contributed to the GPA general budget, the six intergovernmental

organizations contributing to the implementation of WHO's Global Strategy, the Chairman of

the Advisory Council on HIV and AIDS, and two government representatives from each of

WHO's six regions selected by the respective regional committees for three-year terms.

The current members from the Region were Fiji and the Republic of Korea. The term of

office of the latter would expire on 31 December 1993. At the forty-fourth session,

the Regional Committee was invited to select a new member whose term would start

on 1 January 1994 and end on 31 December 1996. To replace the Republic of Korea, the

Committee might wish to consider Malaysia.

The CHAIRMAN, noting that there were no comments, took it that the Committee agreed

that Malaysia should be selected to provide a representative to the Management Committee of

the Global Progranune on AIDS. He requested the Rapporteurs to prepare an appropriate draft

resolution.

2. ERADICATION OF POLIOMYELITIS IN THE REGION: PROGRESS REPORT:

Item 11 of the Agenda (Docwnent WPRlRC44I7)

The REGIONAL DIRECTOR observed that, since the previous session of the

Committee, great progress had been made towards the goal of eradicating poliomyelitis in the

Region by 1995.


He was pleased to report that the number of reported poliomyelitis cases in the Region

had fallen to 2087, which was a 21 % reduction from the previous year and the lowest annual

total ever reported to the Regional Office.

In China and Viet Nam, which reported most of the Region's cases, the numbers of cases

had been successfully reduced by 29% and 9% respectively.

Countries that were still burdened by poliomyelitis cases had responded to the resolution

of the Regional Committee in 1992 and had maximized the use of their limited supplies of oral

poliovirus vaccine to conduct supplementary immunization activities as extensively as possible.

The national immunization days held in the Philippines, the first country in the Region to

conduct supplementary immunization on a national scale, had been a great success. The

campaign had been entitled "Ceasefire for Children" and the Government of the Philippines

deserved congratulations on successfully immunizing over 90% of the nation's children under

five years of age with oral poliovirus vaccine during the two rounds of activities in 1993.

China, the Lao People's Democratic Republic and Viet Nam had also held large-scale

immunization days, but had been obliged to reduce the area covered and the target age for

supplementary immunization from under five to under four or even under three years because of

limited funds for the purchase of vaccine supplies. None the less he noted with satisfaction that

China would be holding national immunization days on 5 December 1993 and 5 January 1994.

Surveillance, another key strategy of poliomyelitis eradication, had greatly improved,

both in quality and timeliness. More than 50% of suspected poliomyelitis cases were currently

being fully investigated. That included collecting and analysing specimens in national and

regional laboratories, which was now being carried out by all countries reporting poliomyelitis

cases. That was a great improvement since 1991, when only two countries had been doing so.

At the previous session of the Committee, a special plea to Member States for funding for

poliovirus vaccine had been made, especially from those countries that could afford to provide

additional funds.

He was very grateful for the support of several Member States such as Australia, France,

Japan and the United States and collaborating agencies such as Rotary and the Agency for

Cooperation in International Health in Japan, which had already provided, or pledged, funds for

oral poliovirus vaccine for poliomyelitis eradication. There were also signs that the amount of

vaccine provided would be further increased in the future.


At the same time the commitment of the poliomyelitis-endemic countries had also grown,

and that had been reflected in the increased provision of national resources for the poliomyelitis

eradication initiative.

Transmission of poliomyelitis was now at its lowest level; the tremendous commitment

of governments and the large scale of immunization activities now taking place were evident.

The opportunity to forge ahead must not be missed. One thing was certain: if they failed to

mobilize enough vaccine, the disease would rebound and outbreaks would occur again. It

would then be more costly to control the situation.

WHO had the technology and the commitment, but there was still not enough vaccine.

Only two more years remained to the 1995 goal. Member States and WHO were engaged

in an initiative that would rid the world of poliomyelitis forever. They must show that they

were equal to that great public health challenge and spare no effort in their united drive to

eradicate the crippling disease.

Dr WANG Zhao (China) noted that in 1992 the incidence of poliomyelitis in China

accounted for three-fifths of the total figure for the Region. The total number of cases reported

in 1992 - 1191 - represented a reduction of 39% compared with 1991. Infants under the age

of 36 months accounted for 88 % of the cases. Infection was spread by the wild poliovirus

because of the low vaccination rate.

In 1992, 186 million doses of vaccine were administered during the intensified campaign

of the expanded programme on immunization, in addition to the 105 million doses administered

in 1991. The key to ensuring poliomyelitis eradication was administration of a booster

vaccination to children under the age of four, and of three doses to non-immunized children.

Otherwise the number of susceptible children might provoke a new epidemic which would delay

achievement of the goal of poliomyelitis eradication both in the Western Pacific and at global

level, and ultimately would represent a higher cost to China and to other countries. The

Ministry of Public Health had therefore decided to declare a national immunization day at the

end of 1993 in order to intensify poliomyelitis vaccination. With the support of international

and nongovernmental organizations China was endeavouring to find a solution to the shortage of

vaccines and of financial resources.

Dr HONG SUN HUOT (Cambodia) noted that the progress report highlighted the

situation in Cambodia, one of the six remaining poliomyelitis-endemic countries in the Region.

Although its vaccination coverage was low, Cambodia wished to assure neighbouring countries


that it was working hard to catch up and intended to comply fully with regional objectives, with

the strong technical and financial support of the international cOllUTIunity.

He pointed out that the expanded progranune on illUTIunization, launched in 1986 with the

support of UNICEF, had only recently reached all provinces. In 1992 national coverage was

40 % for three doses of oral poliovaccine, but only 6 % for two doses of tetanus toxoid for

pregnant women. National BCG coverage was 55%, although it rose to over 80% in some

provinces.

Nevertheless, vaccine preventable diseases remained a serious problem. In 1992, 146

cases of poliomyelitis and 2759 cases of measles had been reported. However, those figures

were underestimated as surveillance had not yet been fully developed. The Ministry of Health

was making great efforts to increase coverage by ensuring access to regular illUTIunization

sessions throughout the country. It was also improving disease surveillance.

Cambodia was currently working with WHO advisers to plan further activities to achieve

maximum oral poliovaccine coverage. A series of national and provincial illUTIunization days

were to be held in 1994. The Government of Cambodia and he personally were cOllUTIitted to

the regional initiatives for poliomyelitis eradication, the elimination of neonatal tetanus, and the

control of measles.


SUMMARY RECORD OF THE FIFTH MEETING

WHO Conference Hall. Manila Wednesday. 15 September 1993 at 9 a.m.


CONTENTS

(WPRlRC44/SRl5)

1. Consideration of draft resolutions ............................................................ 170

1.1 AIDS and sexually transmitted diseases ............................................. 170 1.2 Global Programme on AIDS: Membership of the

Management Committee ................................................................ 172

2. Eradication of poliomyelitis in the Region: Progress report (continued) ............. 173

3. Sub-Committee of the Regional Committee on Programmes and Technical Cooperation: Report on country visits ......................................... 179

- 169-


1. CONSIDERATION OF DRAFT RESOLUTIONS

The Conunittee considered the following draft resolutions:

1.1 AIDS and sexually transmitted diseases

(Document WPRlRC44/Conf. Paper No.1)

Mr SAITO (Japan) said that, although drug abuse was a problem worldwide, its

significance in HIV transmission varied from country to country. He therefore proposed that

operative paragraph 1 (7) be amended to read as follows: "to focus socially and culturally

relevant initiatives ... "

Mr LOVELACE (New Zealand), noting the absence of any specific reference to the

security of the blood supply, which his Government believed was a vital consideration in HIV

transmission, proposed the following amendments: (I) to add as a last preambular paragraph,

"Noting the importance of the safety of the entire blood supply; and (2) to add as operative

paragraph 1 (8) "to progressively move towards 100% screening of the entire blood supply in

the Region" .

Referring to operative paragraph 2 (2), he wondered whether it was appropriate to

request the Regional Director to seek an increase in resources without the Conunittee having

first clearly defined what those resources would be directed to.

Dr MONT A VILLE (France) proposed that the phrase "strengthening of confidentiality

and surveillance" be included in operative paragraph I (4). He also proposed that operative

paragraph 1 (7) should refer to the emphasis being given at country level to activities on

prevention and information.

Dr TAPA (Tonga), noting the adding of the words "until deemed unnecessary" on

operative paragraph 2 (4), said that it was the prerogative of the Regional Conunittee to

determine the periodicity of the reporting or to discontinue it and therefore those words should

be deleted.

The REGIONAL DIRECTOR read out the proposed amendments to ensure that the

Secretariat had understood the meaning and spirit of the proposals.

(1) At the end of the preambular paragraph, "noting the importance of safety of

blood and blood products;" should be added.

SUMMARY RECORD OF THE FIFTH MEETING 171

(2) On operative paragraph 1 (4), the word "and confidentiality" would be added

after the word "surveillance", if the Committee so agreed, as the Secretariat would like

to stress the surveillance aspect, but include confidentiality.

(3) On operative paragraph 1 (7), the phrase "for infonnation and prevention"

would be included.

(4) On the last operative paragraph, under 1 (8), "to move progressively towards

100% screening of blood and blood products in the Region;" would be added.

(5) To delete the last three words on the draft resolution, "until deemed

unnecessary" .

(6) The words "socially and culturally relevant" would be inserted after "focus"

under operative paragraph 1 (7), as proposed by the representative from Japan.

Professor NGUYEN TRONG NHAN (Viet Nam) said thaI since AIDS was linked to the

drug problems in several regions, he proposed that in operative paragraphs 2 (1) and (2), the

words "and drug abuse" should be added after "sexually transmitted diseases" .

The REGIONAL DIRECTOR remarked that drug abuse was a very important aspect of

AIDS and HIV infection, as important as sexually transmitted diseases. Therefore, the

amendment would read" ... control of AIDS, sexually transmitted diseases and drug abuse", if

the Committee so wished.

Mr AGUIGUI (United States of America), while supporting the proposed amendments

of the representative from Japan on operative paragraph I (7), sought clarification on the

insertion of the words "for information and prevention" as previously proposed by the

representative from France. Pending clarification, he proposed the following amendment, "to

focus socially and culturally relevant initiatives and use of resources to reduce the prevalence of

risk activities responsible for ... "

Dr MONTA VILLE (France), explaining the amendment proposed earlier by France,

said that it was desirable to emphasize the need for additional information, besides what was

routinely provided, on the infection itself.

Dr ADAMS (Australia) proposed that the United States amendment to operative

paragraph 2 (1) and 2 (2) should be made more specific by referring to "injecting drug use".


Mr SAITO (Japan) supported the United States amendment to paragraph 1 (7),

substituting "to reduce the prevalence of" for the word "on" before "risk activities".

The REGIONAL DIRECTOR again read out the proposed amendments, suggesting that

the United States amendment concerning additional information would be best accommodated in

operative paragraph 1 (6), which would then read:

(6) to encourage increased exchange of information and experience, and to provide

also additional information needed in the prevention and control of AIDS and sexually

transmitted diseases;

Paragraph 1 (7) would read: "to focus socially and culturally relevant initiatives and

use of resources to reduce the prevalence of risk activities responsible for HIV transmission,

such as commercial sex activity, injecting drug use, and the spread of sexually transmitted

diseases" .

Paragraphs 2 (1) and 2 (2) WOUld, by virtue of the United States amendment, completed

by the Australian proposal, refer to AIDS, sexually transmitted diseases and injecting drug use.

Paragraph 2 (2) would need a slight editorial adjustment so that it was clear it referred

to ... "optimum implementation of AIDS and sexually transmitted diseases programmes, and for

control of injecting drug use in the Region;" .

It was so agreed.

Decision: The resolution, as amended, was adopted (see resolution WPRlRC44.R2).

1.2 Global Programme on AIDS: Membership of the Management Committee


Decision: The resolution was adopted (see resolution WPRlRC44.R3).


2. ERADICATION OF POLIOMYELITIS IN THE REGION: PROGRESS REPORT:

Item 11 of the Agenda (Document WPRlRC44I7) (continued from the fourth meeting,

section 2)

Dr ABU BAKAR (Malaysia) said that his country had been free of the disease from

1986 until 1991, when three cases had been reported which had all been traced to sources of

infection outside the country.

A comprehensive national eradication programme had been drawn up incorporating

surveillance for acute flaccid paralysis, which was among the diseases regularly monitored.

Immunization coverage for all doses of poliovirus vaccine was about 90%, and the current

strategy was to concentrate on non-immunized and high-risk groups.

He requested information on the magnitude of the shortfall in vaccine supplies indicated

in the report.

Mr SAKAI (Japan) congratulated the Secretariat on the strong leadership permitting

marked progress in the initiative to eradicate poliomyelitis by 1995. Eradication programmes

had received continuous support since 1988; since 1990 there had been technical cooperation

between Japan and some countries, where considerable reduction in incidence had been found.

It had participated in the Technical Advisory Group since its first meeting in Tokyo in 1991,

where the focus was on preparation of guidelines and strategy for eradication. In the previous

two meetings more specific issues had been discussed and solutions proposed, including the

financial aspects of meeting the vaccine shortage. Through the collaboration of various agencies

and donors it would be possible to have immunization days during the coming winter.

Now that the regional programme was entering the crucial stage requiring accelerated

action, Japan wished to work closely with WHO and other Member States to ensure its success.

Dr MONTAVILLE (France), fully supporting the programme, and referring also to the

vaccine supply shortage, said that resolution WHA46.33 of the Health Assembly, which France

endorsed, did not specify which method of immunization should be preferred. Immunization

with live poliovirus vaccine should only be resorted to in the absence of safer options where the

particular conditions were carefully considered, and expert advice should be available in such

cases.

Dr MILAN (Philippines) expressed concern over the vaccine shortfall in conditions

where the technology and political will were present to carry out the programme. She endorsed


the policy that included immunization days, and the policy guidelines drawn up by the

Secretariat.

The programme in the Philippines owed its initial success to clear directives; mass

activities for mobilization and advocacy; an appropriate communications strategy; active

involvement of the community and community leaders; strong political support at the highest

level; and financial support from donors and cooperating agencies, particularly WHO,

UNICEF, AIDAB, CIDA, US AID and Rotary International.

Japan had indicated that it might be able to provide poliovirus vaccine for the second

round of national immunization days in February and March 1994.

The remaining challenges included: maintenance of the high coverage with oral

poliovirus vaccine (OPV) and local support for the programme with the recent decentralization

of services; reaching remote areas with OPV; ensuring the supply not only of vaccine but of

needles, syringes and cold-chain equipment.

She endorsed the Regional Director's appeals for support to win the fight against

poliomyelitis.

Professor NGUYEN TRONG NHAN (Viet Nam) said that since 1985, with the

cooperation of WHO, UNICEF, Rotary International and other international and

nongovernmental organizations, his country had successfully carried out its expanded

programme on immunization, exceeding 80% coverage of infants under one year in the last four

years. Poliomyelitis had been reduced by 70%, but there were still 553 cases in 1992. Its

eradication would require 36 million more doses for children under five years each year. Only

part of this could be supplied by national production. Production of 16 million doses had been

planned in 1993.

A first round of national immunization days were planned in November, and second

round in December 1993, for all children under five, involving 250000 staff and volunteers in

60000 health centres - the largest mass immunization campaign ever organized.

In order to attain the hoped-for goal by 1995, Viet Nam would need the cooperation of

international organizations and countries for vaccine supplies and cold-chain equipment, with

WHO as the main agency.

Dr DURHAM (New Zealand) noted the importance attached in the report to the

maintenance of surveillance and plans of action in countries free from poliomyelitis. The last


endemic case in New Zealand had occurred in 1977; there had been one imported case in 1990.

Her country's experience was that as first-hand knowledge of the effects of the disease became

more remote, reports of adverse reactions to immunization acquired greater importance in the

community and might affect coverage.

She requested WHO to comment regularly on the safety and efficacy of poliomyelitis

and other vaccines in its reports.

Dr PRETRICK (Federated States of Micronesia) said that 50 % of the widely dispersed

rural population of his country's more than 65 inhabited islands (1.2 million square miles) were

under twenty years old, while 17% were under five years. Since the poliomyelitis outbreak in

the early 1960s no cases of paralytic poliomyelitis had been reported, but vaccine coverage was

not as high as could be wished. Only about 70% of children had received three doses of oral

poliovirus vaccine by the age of two years; by the age of five coverage rose to 80%-90%.

After the lesson of the 1960s and outbreaks of other diseases like tuberculosis, mumps

and measles, Micronesia remained dedicated to integrated preventive measures and the

eradication of poliomyelitis.

Dr RASMY (Lao People's Democratic Republic) said that his country's eradication

programme, which was part of the Expanded Programme on Immunization had achieved

remarkable progress since its inception in 1989, although immunization coverage remained quite

low at barely 27 %. Nine cases of acute flaccid paralysis had been reported in 1992, five of

. them being confirmed as poliomyelitis.

Since the creation of the National Committee for the Mother and Child in 1992 and the

adoption in June 1993 of a resolution on the subject, the Expanded Programme on Immunization

and poliomyelitis eradication programme had been given high priority in the socioeconomic

development plan running until 1996, and efforts were being redoubled. Immunization

coverage was to reach 80%. The President of the Republic had himself taken charge of a

campaign in eight provinces, and the Minister of Health was the focal point for equipment, staff

and programme management. National days had been organized in 48 out of 129 districts in 17

provinces in November and December 1992, and 77% of the target population of children under

five years had been immunized.

The cold-chain had been imprOVed in over 20 districts using gas refrigeration. Training

according to the WHO module had been completed throughout the country for 1200 vaccinators

for mobile teams and centres.


Coverage with three doses of OPV had reached 26 % in 1990, 22 % in 1991 and 27 % in

1992.

The campaign was still dependent on increased cooperation, like that of UNICEF, and

vaccine supplies. Other weaknesses included poor public health infrastructure, inadequate cold

chain equipment and health education, and problems of access to remote mountain villages,

especially in the six-month-long rainy season.

Two more national days were planned in 100 districts in 1994, with WHO and Japanese

support. The surveillance system was to be extended to all provinces and districts, dispensaries

were to be rehabilitated and community involvement, emphasizing women's groups, increased.

The Lao People's Democratic Republic looked forward to greater collaboration with

international governmental and nongovernmental organizations.

Dr LIN (United States of America) commended the Regional Director on the

informative and timely document, and complimented him on the continued efforts to accelerate

poliomyelitis eradication. He also congratulated Member States on their efforts to reduce

incidence of the disease to its lowest point thus far, and urged them to follow the Philippines'

example in organizing national immunization days in accordance with resolution

WPRJRC43.R3. He believed the Region could be the next to achieve eradication.

Noting with concern the low EPI coverage in some countries, he asked for information

on particular activities to be targeted, and urged that Member States be encouraged to ensure

that they remained free of poliomyelitis by such means as national immunization days. If

sufficient supplies of vaccines were not forthcoming, commitment and know-how would be of

no avail; 50% to 100% more vaccines were required to supplement the routine immunization

measures. Quality assurance was also vital to ensure potency, safety and efficacy. The

Regional Director was requested to study the means of maintaining the highest standards in that

regard, and to be firm in ensuring cooperation with Member States with a view to the goal of

eradication.

Mr WAENA (Solomon Islands) said that, while there had been no cases of acute flaccid

paralysis in his country, he recognized the need to maintain high levels of immunization and

efficient cold-chain services. His country would need support for the necessary measures and in

ensuring the supply of vaccine. He reiterated his country's commitment to the goal of

eradication.


Dr SCHUSTER (Samoa) commended the report. Significant headway had been made

and progress would no doubt continue under the intensified effort of national programmes with

immunization days. WHO's cooperation was essential, particularly to ensure supplies of

vaccine so that all eligible children were reached. Samoa had been free of poliomyelitis for ten

years, and would continue surveillance to ensure that it remained so.

Dr Haji JOHAR (Brunei Darussalam) said that his country had been free of

poliomyelitis since 1986. It supported the goal of eradication, but was concerned about the risk

represented by guest workers and their dependants from areas where compulsory immunization

in infancy was no longer considered necessary or was not possible. Surveillance was thus the

primary preoccupation, although full immunization coverage was provided throughout the

country. The technical and advisory support of WHO was much appreciated.

Dr TAPA (Tonga) said that countries of the Region should not waver in their

determination to achieve eradication, in which Tonga assured them of its moral support; and he

urged others that could afford to do so to give more than moral support; in particular vaccines

and equipment, in an effort of solidarity to att.ain the goal.

Mrs HOMASI (Tuvalu) said that there were currently no cases of poliomyelitis in

Tuvalu but that that situation might change in the future unless the cold-chain and transport of

vaccines to the widely dispersed islands were improved. She urged WHO to help in that regard.

Dr OMI (Regional Adviser, Expanded Programme on Immunization), replying to the

representative of Malaysia on vaccine requirements, said that, despite encouraging support from

the international community, there was still a shortfall of oral poliovirus vaccine (OPV) for the

conduct of immunization days in countries reporting poliomyelitis. Total vaccine requirements

for both routine and supplementary immunization activities had been calculated on the

assumption that: (1) routine immunization included three or four doses for 100% of infants

(45% in the case of the Lao People's Democratic Republic); (2) supplementary immunization

included both immediate outbreak response immunization around cases and national

immunization days; (3) two doses would be given to all children under five years of age (under

four years in China) on immunization days; (4) two doses would be given to all children under

five years in communities around cases in outbreak response immunization; and (5) the cost of

improved imported OPV was nine cents per dose and that of locally produced vaccine in China

was two cents per dose. Based on those assumptions the requirement for 1993 totalled 491

million doses of which 412 million had already been committed by national governments or

external support agencies. That left a shortfall of 79 million doses, costing US$ 3.6 million.


The costs of regional shortfalls for 1994 and 1995 totalled US$ 7.1 million and US$ 7.6 million

respectively.

In reply to the representative of France the report of the Thirteenth Global Advisory

Group on the Expanded Programme of Immunization (document WHO/EPI/GM/9.3) stated that

OPV was the vaccine of choice for poliomyelitis eradication. There had been no change in

policy since then. The rationale for that policy was as follows. Firstly, OPV was the only

vaccine shown to displace circulating wild poliovirus and was therefore the vaccine of choice to

assure community protection in countries where poliomyelitis was still endemic. Secondly.

OPV was easy to administer in oral drop form and could be safely given by volunteer health

workers; syringes and needles were not needed. which reduced logistical requirements.

Thirdly. at nine cents per dose OPV was much less expensive than injectable inactivated

poliovirus vaccine (IPV) at 75 cents per dose. The Global Advisory Group would be

considering making a recommendation for the use of IPV in industrialized countries with high

standards of sanitation and no known circulation of wild poliovirus. and where vaccine cost was

not an issue. However, the vaccine of choice during poliomyelitis outbreaks would still be the

oral vaccine.

The REGIONAL DIRECTOR added that through 1995 the total vaccine requirement

was 1484 million doses while the total amount available was 795 million doses, leaving a

shortfall costing around US$ 18.3 million.

As he had mentioned at the previous meeting. a number of governments and agencies

were making contributions in that area and their generous support was greatly appreciated.

Rotary International had been supporting China and would be discussing further collaboration at

a meeting to be held in the Regional Office immediately following the current Regional

Committee session. Japan had agreed to provide US$ 6 million over the next three years for

vaccine procurement in China. He hoped that Japan would be able to offer further help as its

economy improved. In addition Australia and other Member States were providing vaccines.

As Dr Omi had said, OPV was the vaccine of choice as recommended by the Global

Advisory Group. That Group represented the best technical expertise available in the world and

its advice should guide regional policy. He was not discarding the use of IPV but suggested that

it might be considered for use jointly with OPV or during the vigilance and maintenance phase

that would be necessary following poliomyelitis eradication.

He agreed that safeguarding the efficacy and safety of vaccines was essential and

assured the Committee that WHO would continue to give due attention to those aspects.


However, excessive emphasis on improving quality might force up the price of vaccines. It was

important to find an appropriate balance between efficacy and safety on the one hand and

affordability on the other. He hoped that the issue would be addressed at the Vaccine

Development Initiative meeting, which he hoped to attend with the Director-General at Kyoto in

November 1993.

The CHAIRMAN requested the Rapporteurs to prepare an appropriate draft resolution.

3. SUB-COMMITTEE OF THE REGIONAL COMMITTEE ON PROGRAMMES AND

TECHNICAL COOPERATION: REPORT ON COUNTRY VISITS: [tern 12 of the

Agenda (Document WPRlRC44/8)

Dr MILAN (Philippines), introducing the report of the Sub-Committee, said that item

(5) of the Sub-Committee's terms of reference was "To undertake country visits to review and

analyse the impact of WHO's cooperation with Member States". In June 1993. four of the Sub

Committee members had visited Fiji and the Republic of Korea to review cooperation in the

field of district health systems. The Sub-Committee had then met as a whole in Manila to

discuss their findings.

The purpose of the country visits in 1993 had been to observe whether the district health

system approach was really a part of overall health development in those countries.

The members had noted that in Fiji and the Republic of Korea, there was a very strong

link between the development of district health systems and overall health development. A

number of features of that development would be of interest to most Member States.

There was a marked awareness of the importance of integrating and coordinating the

functions of the hospital and public health at the district level. Though it was progressing

differently in each country, that most essential feature of a viable district health system provided

valuable lessons which could be shared.

In both countries, it had been very clear how much the dynamic management and

leadership of the district health system had contributed to its success. The countries had been

aware of that fact and had been addressing the question of how strengthening management

within the district could be institutionalized throughout the health system.

Closely aligned to strong leadership at the district had been the awareness that more

authority must be provided to those managers to make operational decisions.


High priority had been placed on continuous education and training at the district level.

That reflected the perceived value of their human resources and the need to be able to respond

quickly and effectively to the changing needs of a district health system.

Details of the Sub-Committee's findings and recommendations were set out in the

report.

The country visits had taken place from 14 to 25 June. Excellent progranunes had been

prepared. On behalf of the Sub-Committee, Dr Milan expressed her sincere gratitude to the

Member States concerned for their hospitality and full cooperation in the assignment.

With regard to the future work of the Sub-Committee, it was proposed that the subject

for review in 1994 should be "health and sustainable development - environmental health", and

that, subject to the agreement of their governments, the countries to be visited should be the

Philippines and Singapore.

Dr LIN (United States of America) commended the Sub-Committee on its work. He

also commended Fiji and the Republic of Korea on their progress in improving the organization

and management of the health systems reviewed.

He had particularly noted the comments in the report about involvement of

local government in the administration of district health activities, greater integration of the

private sector into health services delivery, and the importance of the efforts to strengthen the

capabilities and authority of district managers for assuring the quality of both management and

delivery of health services.

Placing responsibility for managing and monitoring health care services close to the

people being served and involving community leaders in decisions affecting those services were

two principles of "community-oriented primary care" that motivated efforts for improving

access to and containing the costs of health care. He noted that those principles were already

being incorporated into the systems of both countries visited.

He commended the efforts being made by the two countries to conduct effective

research projects to further the development of health systems. The conduct of such research

was becoming more widely understood and utilized in the United States of America. It was

becoming paramount to evaluate the quality as well as the outcome of health services in order to

contain costs while maintaining the highest possible standards of patient care.


He endorsed the Sub-Committee's recommendations to the two Member States and

suggested that all Member States should examine them for applicability to their own district

health systems. His delegation acknowledged the common features of district health systems in

countries in the Region and also respected those features that were unique to each. The

presentation and discussion of the Sub-Committee's report provided an excellent opportunity to

exchange relevant technology and other information, enabling Member States to learn and grow

through each other's efforts.

He requested further information as to how the significant reduction in infant mortality

in Fiji, from 40 to 20 per 1000 live births over a period of 15 years, had been achieved, in

particular in relation to the fact that 95 % of primary health care was provided in government

health facilities.

The report stated that projected health expenditure in the Republic of Korea had risen

from 5.6 % in 1988 to 6.4 % in 1990. However, the proportions of those percentages devoted to

primary health care were not indicated. The report also noted that through government efforts

since 1987, the proportion of primary health care physicians had risen by 30%-40%. Assuming

that primary health care had been accepted as the entry point for health care promotion and

disease prevention, it would be helpful to know whether an increase in the number of primary

health care physicians had a significant effect on national health care costs after a period of

several years. Although the relative costs for primary health care training and services could be

expected to increase, aggregate health costs (primarily expended on treatment and rehabilitation

rather than prevention) could be expected to decline over the same period. It might therefore be

helpful for the Regional Director to compare total national health expenditures with those

specifically for primary health care where there had been a significant increase in the numbers

of primary health care specialists, in order to examine the validity of primary health care as a

model for reducing treatment and rehabilitation expenditures.

He suggested that, where possible, Sub-Committee recommendations should be made in

the context of the national plans of action developed in accordance with the WHO health-for-all

strategy. Such an approach would provide a consistent framework against which a Member

State could evaluate its progress in implementing both the recommendations and the strategy.

In conclusion he endorsed the Sub-Committee's support for decentralized decision

making and empowerment of health systems at the operational level and encouraged the

Regional Director to continue to support Member States in the area under discussion.


Dr TAPA (Tonga) thanked the Chairman of the Sub-Committee for her introduction to

the Sub-Committeee's excellent report. The findings, particularly those on Fiji, were of some

relevance to the development of district health systems in Tonga. He endorsed the conclusions

and recommendations contained in sections 2.2 and 2.3 of the. report which might also be of

relevance to other Member States in the Region.

He supported the subject proposed for the 1994 country visits, "Health and sustainable

development - environmental health" and the two countries suggested, the Philippines and

Singapore, subject to the agreement of their Governments.

Mr BUNE (Fiji) expressed appreciation for the Sub-Committee's visit to Fiji. He

commended the Regional Committee's initiative in that regard and hoped that such visits would

continue.

The Sub-Committee's conclusions and recommendations in respect of Fiji reflected the

views and concerns and some of the possible solutions expressed by Ministry of Health officials

during the visit.

The decentralization called for in recommendation (1) had been proposed by his

Ministry in 1987-1988, following an exercise undertaken with WHO support, but owing to

budgetary constraints at that time it had not been approved. It was hoped that the policy could

be introduced within the next 12 months.

Recommendation (2) concerning district health planning and the training of district

health staff in planning and management also involved the decentralization policy. A health

planning unit had been established with support from the United Kingdom and two advisers

from that country were helping the unit in drawing up a national health plan which it was hoped

to complete in the next 12 months.

Reorientation of staff and role clarification called for in recommendation (3) were also

being tackled within the decentralization policy and through a job evaluation exercise. Training

would be considered further under item 15.2 of the agenda, Fiji School of Medicine. In the

School's new two-tier curriculum the first tier would cover epidemiology, public health,

occupational health, health education and health management, and the second would deal with

health planning and economics, with the aim of enhancing the managerial capabilities of future

medical personnel.

The issue of health financing, covered in recommendation (4), was being considered by

the health planning unit, and cost-recovery had been addressed at a recent workshop sponsored


by USAID. The World Bank study of health policy priorities in South Pacific countries referred

to at an earlier meeting had also addressed the issue. Fiji was still providing free medical

services, which was a great strain on the budget. Cost-recovery would be a priority over the

next five years and it was hoped that government approval for implementation would be given

within 12 months.

Fiji had already taken steps to implement recommendation (5) on intersectoral

collaboration and there was now a regular forum for discussion and planning between the health

and finance sectors and the Public Service Commission.

Fiji accepted recommendation (6) on continuing and in-service training and was taking

steps to implement it with the support of the health planning unit.

Fiji also accepted recommendation (7), which called for a comprehensive human

resources policy, and had discussed it with the visiting team.

Fiji had noted recommendation (8) on standards of care which were the subject of

continuous review. He thanked the Regional Director for the opportunity to visit the Republic

of Korea immediately prior to the Regional Committee session to share their experiences in that

regard. It was hoped that WHO could collaborate so as to improve standards.

With regard to recommendation (9) on community involvement, he quoted from the

report of a recent World Bank study: Fiji had been most successful in grafting primary health

care facilities on to existing hospital-based systems, with spending on rural health services

averaging over 10% of recurrent health outlays in the 1980s. Fiji's achievements could be seen

in the utilization figures: 3.1 outpatients visits per person per year to government facilities.

Village committees were supporting 12 nursing stations, and some 3000 village health workers

had been given a six-week training course by the Government to enable them to provide primary

health care services. Such workers were supported by the village leadership, either by

contributions in kind or by small cash payments.

Fiji accepted recommendation (10) on WHO collaboration, and looked to WHO for

budgetary support in implementing it.

He assured the Committee that Fiji expected to be able to report good progress in

implementing the Sub-Committee's recommendations by the end of the biennium. Fiji also

supported the proposals of the Sub-Committee concerning the subject for review in 1994 and the

countries to be visited in 1994.


Dr MA Po-Ling (Hong Kong) described a test project for the introduction of a district

health system in an urban setting, the Kwun Tong District of Hong Kong, in December 1991.

The aim was to develop a primary health care system that would permit the delivery of the

services most relevant to the community's needs, through a team approach involving all health

care providers within the district and the participation of the community. All six government

health institutions in the district level had been grouped together to form a network, managed by

a multidisciplinary district management committee. That committee had already coordinated

improvements in services provided by the general outpatient clinic and family health centres.

To facilitate community participation, a multisectoral district health committee had been set up

in March 1992. By enhancing the role of the community in identifying health needs and

implementing health programmes, that committee could channel community resources towards

health promotion and disease prevention services in the district. During its brief period of

existence the district health service had already proved its value in enlisting community

participation in health and in improving cooperation between clinics and hospitals and between

the public and private sectors.

He congratulated the Sub-Committee on its work and looked forward to further

opportunities for exchanging information and sharing experience.

Dr NOGUEIRA DA CANHOT A (Portugal) told the Committee that Macao had adopted

an integrated health policy based on primary health care in 1985. The entire population had

access to primary health care free of charge, while hospital care was free for certain risk groups.

Under the integrated system, all medical staff at health centres were on hospital duty once a

week and were thus able to benefit from contact with specialists. A central computerized

information system linked hospitals and health centres. Through such coordination of

resources, Macao's health system was able to provide a comprehensive range of health services

for the population.

Mr Jeong-In SUH (Republic of Korea) expressed his Government's gratitude for the

Sub-Committee's visit and for its excellent report. The findings and recommendations of the

Sub-Committee would be of great help in planning the nationwide implementation of district

health services. Thanks were also due to the Secretariat for their support and cooperation in

developing district health services in the Republic of Korea.

Mr KOIMANREA (Papua New Guinea) said that the concept of district health systems

had long been neglected in his country. but the new Government was endeavouring to rectify

that. He himself came from a rural area, and as Minister of Health had decided to introduce a

new policy on district hospitals. He endorsed the views of the representative of Fiji and hoped


he would be able to visit that country to learn from its eXPllrience. His GoverJlffient agreed with

the recommendations of the Sub-Committee, 1.00ked forward to increased collaboration within

the Region, and hoped that WHO would prov!de support in the implementation of policies.

Dr HONG SUN HUOT (Cambodia) said his Government supported the growing

emphasis on district health systems in the Region. He drew attention to the contributions of

WHO and other international agencies to the development of national policies and plans and the

strengthening of health systems management in Cambodia. WHO had been working with the

Cambodian health administration for nearly two years, helping to restructure the entire health

system.

Under the new health system provincial departments of health would concentrate most

resources at the district level, with a clear mandate to promote, implement and support primary

health care in the villages. Basic medical care would be available from district and subdistrict

hospitals, dispensaries and mobile teams, and serious cases could be referred to provincial

hospitals. Public health centres would be set up in each district, supported by a network of

public health posts at commune and village level. Mobile teams would visit rural communities

to perform immunizations and provide antenatal care and health education. National

programmes, such as those for the control of malaria and tuberculosis, would gradually be

integrated with district-level activities.

A choice between public and private health services would be encouraged, but quality

must be maintained in both sectors. Private services must be seen as complementing public

services, not replacing them. A programme of supervision and inspection of both types of

services was to be introduced.

He congratulated the Sub-Committee on its work and proposed that it should visit

Cambodia in the near future. A suitable subject for review, where collaboration had been under

way for a considerable period of time, would be tile planning and management of malaria

control.

Mr WAENA (Solomon Islands) thanked the Sub-Committee for its findings and

recommendations, expressing particular interest in those concerning Fiji. He would support a

draft resolution adopting the recommendations of the Sub-Committee. The subject proposed for

review in 1994, "WHO's collaboration in the field of health and sustainable development -

environmental health", was of great importance to his country. There was an urgent need to

protect the environment and make it safer and cleaner.


He stressed that the Sub-Committee should visit a South Pacific country each year as

well as an Asian country. For the small island nations of the Pacific, global warming

represented a serious threat, and it was important that the Regional Committee should address

their unique situation. Furthermore, such countries were at risk from unplanned development,

for which multinational companies were often to blame. For example, the activities of logging

companies had produced disastrous effects in his own country.

Unlike Fiji, Solomon Islands had a decentralized health system, whereby the provincial

authorities were empowered to take policy decisions, but his country was willing to learn from

the experience of Fiji and was grateful for its support.

Mr HENRY (Cook Islands), thanking the Secretariat for its support to Cook Islands,

said the experience gained by his country's Secretary of Health as a member of the Sub

Committee had proved invaluable to the Health Board and the national health services. The

Sub-Committee had produced an excellent report, and its recommendations regarding Fiji were

of particular relevance to Cook Islands.

His country had had district health services since 1901, for each of the 12 inhabited

islands duplicated the services available on the main island. Communications were now

becoming easier with the use of satellites. Many of the Sub-Committee's recommendations

concerning Fiji had already been put into effect in Cook Islands. The Health Board had

complete control over its financial resources and had been delegated decision-making powers

previously held by the Cabinet. The main task assigned to the Health Board, to make the health

services self-sufficient, was wellnigh impossible, but some progress towards it had been made

by involving the commercial sector, the community, traditional leaders, nongovernmental

organizations and youth movements in producing a district health scheme understood by all.

Mrs HOMASI (Tuvalu) commended the Sub-Committee's report. She felt the

Committee would appreciate some general information on the health situation and health system

of the Region's newest Member State. During the past decade, health and education had

accounted for 27 % of recurrent expenditure and 20 % of externally funded development

expenditure. However, it was no easy matter to ensure adequate health services in a country

consisting of nine scattered islands.

The Government's health policy was based on primary health care, with a significant

level of community involvement. In 1984 a national primary health care committee had been

established. The greatest constraints on the provision of better health services were the shortage

of doctors and dentists and the excessive centralization of medical resources on the main island


of Funafuti, aggravated by the difficulties of referring patients to the 3D-bed hospital there from

the outlying islands.

The overall health situation was relatively good for a least developed country. The

universal child immunization standards had been achieved, but there was still a high incidence

of respiratory infections, diarrhoeal diseases, conjunctivitis, influenza and food poisoning, and a

significant number of cases of dengue, tuberculosis, hepatitis, measles and meningitis. In 1990

there had been a severe outbreak of cholera, with a 20% attack rate, which had been attributed

to contaminated water sources and poor personal hygiene. Average life expectancy had been

estimated in 1986 at 57 years for males and 60 years for females, over 10 years below the

average for the Pacific region. The pattern of morbidity indicated that life expectancy could be

extended through improved community health care, better access to safe water and sanitation

facilities, and health education.

Tuvalu had always been self-sufficient in food, with ample supplies of coconuts, fish

and vegetables. However, increasing consumption of imported foods low in fibre and high in

carbohydrates was leading to increased incidence of diabetes and cardiovascular diseases. Lack

of fresh fruit and vegetables in the diet was resulting in vitamin and mineral deficiencies.

The country's health administration had recently been reorganized and a Department of

Health created in the Ministry of Health and Human Resource Development. The Department

of Health was subdivided into three functional units: public health services, curative services,

and nursing services. The second national development plan called for wider health

responsibilities for each island council and for greater community involvement in the promotion

of primary health care and environmental health.

Given the constraints of a small and scattered island population with limited resources,

the results achieved so far in the health sector were reasonably encouraging. The major

problems facing the country in its efforts to improve the people's health concerned the health

workforce population growth (population density already exceeded 300 persons per km 2),

environmental health, communicable diseases, and management of health services.

Health expenditure accounted for 7.7% of gross national product, of which 30% was

devoted to primary health care. One of the greatest obstacles to achieving the goal of health for

all by the year 2000 was the shortage of functional management systems and the inadequacy of

Iilanagement skills.


Tuvalu had been collaborating with WHO since 1982 and she believed that full

membership would strengthen that partnership. Her Government was pleased with the outcome

of the recent WHO mission to Tuvalu, whose findings and recommendations offered a mutual

opportunity for greater collaboration in the great cause of health for all.

Dr TINIELU (Tokelau) thanked the Sub-Committee for its report. Fiji was a useful

model for other Pacific island states, and most of the recommendations concerning that country

applied also to Tokelau.

Dr DURHAM (New Zealand) supported the proposal by the representative of Solomon

Islands that the Sub-Committee should visit a South Pacific country each year.

Dr ROMUALDEZ (Director, Health Services Development and Planning), replying to

the representative of the United States of America, suggested that the remarkable improvement

in the infant mortality rate and other health indicators in Fiji was probably due largely to the

general improvement in socioeconomic standards and equitable access to health services.

The health system of the Republic of Korea was at a transitional stage, having adopted

universal health insurance as recently as 1989. It was difficult to analyse in detail the resources

devoted to primary health care on the one hand and hospital facilities on the other. The country

had established a very strong health services research capability in various institutions, and the

Secretariat was working closely with those institutions, in the conviction that developments in

the Republic of Korea would be helpful to other countries of the Region undergoing similar

changes.

The REGIONAL DIRECTOR invited the Committee to accept the Sub-Committee's

proposal concerning the subject for review in 1994: WHO's collaboration in the field of health

and sustainable development. He suggested that, as several representatives had urged, a South

Pacific country be added to the list of countries to be visited. Solomon Islands would be an

appropriate choice.


The meeting rose at 12: 15 p.m.

SUMMARY RECORD OF THE SIXTH MEETING

WHO Conference Hall. Manila Wednesday. 15 September 1993 at 2.30 p.m.

CHAIRMAN: Dr Ana Maria Basto Perez (Portugal)

CONTENTS

1. Nutrition in the Western Pacific Region. including follow-up

(WPRlRC44ISRl6)

of the International Conference on Nutrition ............................................... 190

2. Human resources for health ..................... .............................................. 200

2.1 Public health training in the Western Pacific Region ............................. 200 2.2 Fiji School of Medicine .................. ............ .................................. 204

3. Regional strategy on health and environment. including follow-up of the United Nations Conference on Environment and Development (UNCED) ......................................................................................... 209

- 189-


1. NUTRITION IN THE WESTERN PACIFIC REGION, INCLUDING FOLLOW-UP OF

THE INTERNATIONAL CONFERENCE ON NUTRITION: Item 13 of the Agenda

(Documents WPRlRC44J9 and Add.l)

The REGIONAL DIRECTOR said that the report encompassed three important aspects

of nutrition activities in the Region. In addition to the biennial report to the Conunittee on

action taken in the field of infant and young child nutrition and the implementation of the

International Code of Marketing of Breast-milk Substitutes, two other items were being

presented.

Section 2 of the working document had noted that, as of 9 June 1993, 24 countries had

reported to WHO. Since then there had been responses from two more countries, Cambodia

and Singapore, giving a total response rate of 74% or 26 of all countries and areas in the

Region.

With the report from Singapore, there were currently 13 instead of 12 governments

reporting some form of implementation of the International Code of Marketing of Breast-milk

Substitutes. It also increased the number of institutions designated as "baby-friendly". That

initiative was now active in Singapore where the Government reported having one accredited

hospital. The working document had reported 133 such hospitals in six countries. With one

hospital in Malaysia also awarded in August 1993, there were now 135 "baby-friendly"

hospitals in eight countries.

The joint Food and Agriculture Organization and World Health Organization

International Conference on Nutrition had been held in December 1992 in Rome, attended by

159 member countries of the two organizations. One of the major aims of the Conference had

been to raise awareness of the nutritional problems affecting all countries in different ways and

to greater or lesser degrees. However, it was emphasized that the Conference had not been an

end in itself but a catalyst for future action. The plans for follow up, which were evolving in

the Region, would be described.

Following the printing of the document, proposals had been received from Cambodia,

the Lao People's Democratic Republic and Viet Nam for support in developing national plans of

action in nutrition.

The document before the Conunittee presented a review of existing nutrition activities

and an analysis of how the follow-up activities to the International Conference on Nutrition

SUMMARY RECORD OF THE SIXTH MEETING 191

follow-up activities would complement those. An information folder on the status of nutrition

in the Region had been provided. One of the encouraging things to be noted was that there were

indeed real signs of progress and improvement in nutrition in the Region.

Ms GREW (New Zealand), congratulating the Regional Director on his report, said that

nutrition was a public health issue for New Zealand. In 1990 one-third of all deaths were

believed to have been attributable to dietary factors. Ischaemic heart disease was the leading

cause of death, followed by cancer; incidence of bowel cancer was one of the highest in the

world.

New Zealand endorsed the categorization of countries for the purposes of funding, as

outlined on page 12, paragraph 3.2 of document WPRlRC44/9, and would place itself in

category (iii), among the countries developing or revising a national nutrition policy. A

national nutrition policy had been introduced in 1992, nutrition guidelines had been

disseminated for such population groups as adolescents and older people, and work had

commenced on a national plan of action.

Her Government considered that countries in category (iii) would face a challenge as

they moved from policy to action to implementation. In New Zealand, for example, dairy and

meat products contributed greatly to both the economy and the fat consumption of the

popUlation. Innovative strategies would be required in order to involve major food industri~s

with large domestic and export markets in the Region in a multisectoral approach to nutrition

action plans. New Zealand urged the Regional Director to provide support and guidance for

endeavours to involve such industries in the formulation and implementation of action plans

aimed at improving nutritional status in the Region.

Dr Dong-Mo RHIE (Republic of Korea), congratulating the Organization on the success

of the International Conference on Nutrition and action taken to implement the International

Code of Marketing of Breast-milk SUbstituteS, said lhllt th(lse activities were important steps in

the process of strengthening the commitment and action needed to prevent and alleviate

nutritional problems.

His country had experienced nutritional problems stemming from food shortages, but

these had been overcome with the improvement of the economy. Nevertheless, there was still

concern about undernutrition, overnutrition, and inappropriate nutrition. His Government was

implementing programmes geared to improving health and preventing disease through

compensation of nutritional deficiency and control of weight. It had drawn up national dietary

guidelines, monitored dietary trends, set up a nutrition information system, promoted breast-


feeding and school lunches, and banned the advertising of breast-milk substitutes in the media.

In addition, the number of "baby-friendly" hospitals was increasing thanks to collaboration

between citizen's groups and the Government.

Dr LEE (Singapore) observed that although nutrient deficiencies were rare in Singapore

the country was not free from nutritional problems. The principal cause of death was

noncommunicable diseases related to unhealthy lifestyles and inappropriate diets. The national

health policy for·the 1990s therefore gave priority to health promotion through health education

and better nutrition. Her Government had drawn up a national plan of action for nutrition as

part of the health promotion programme. A food and nutrition department had been established

to plan, coordinate and implement nutrition policies, programmes and activities. It planned to

create a demand for and supply of healthier food choices through public education and creation

of an environment conducive to such choices. That would be done by both encouraging the

supply of healthy food and ensuring healthy catering practices, as many people ate their meals

outside the home.

Unhealthy diets were also a target of Singapore's ten-year healthy lifestyle programme

launched in 1992, which aimed at reducing the risk factors of chronic degenerative diseases. By

the year 2000 the Government hoped to achieve specific nutrition-related goals, including

reduction in obesity and the average blood cholesterol level, and healthier eating practices and

diets. She affirmed that nutrition policies and programmes to improve the health and well-being

of the population were firmly set on the national agenda.

Dr HONG SUN HUOT (Cambodia) pointed out that Cambodia was one of the 13 most

nutritionally vulnerable countries in the world, the only one in that category in the Region. His

Government, including the ministries of health and agriculture, were aware that many people,

especially women and children, were suffering from undernutrition and micronutrient

deficiencies, and was taking steps to improve the situation. It was to prepare an intersectoral

policy and national plan with the collaboration of the WHO regional adviser on nutrition. An

intersectoral workshop was to be held to start formulating provincial nutrition strategies in

cooperating with WHO and nongovernmental organizations. Additional technical and financial

resources would be needed in order to develop nutrition programmes.

Dr NOGUEIRA DA CANHOT A (Portugal) said that data on micronutrient deficiency

was not yet available in Macao. A nutrition survey was to be undertaken shortly so that

problems could be identified.


Priority in all activities was given to children and pregnant women. As only 30% of

mothers breast-fed their babies, measures had been taken to promote breast-feeding, including

training of health workers, education on infant feeding for all pregnant women, and use of the

media to provide information on the benefits of breast-feeding. Education was also provided on

healthy food during pregnancy. Various educational materials had been produced, including a

guide on healthy food during pregnancy, and booklets on infant nutrition and healthy food for

children. In collaboration with the Department of Education, nutrition education had been

promoted in nurseries, kindergartens and primary schools.

Dr TEBANIA (Kiribati) said that a food and nutrition committee had been established in

Kiribati to help solve nutrition-related problems. School programmes on food and nutrition had

been revitalized and local nongovernmental organizations had been encouraged to conduct food

and nutrition workshops for communities and young people out of school.

With regard to vitamin A deficiency, a number of bodies, including the Department of

Agriculture, the University of the South Pacific and UNICEF, were tackling the problem. He

was glad to report that the figure of 10% given in Table 1 of document WPRlRC44/9 for the

prevalence of Bitot's spots had now dropped to 2%. Although high compared with WHO

norms, it indicated the effectiveness of activities. The reduction had been achieved through

enhanced awareness and understanding derived from food and nutrition training programmes.

The Government of Kiribati had just approved a food and nutrition policy to guide further

efforts.

Mr CAPELLE (Marshall Islands) commended the report on nutrition in the Western

Pacific Region, which he found informative and well organized.

The Ministry of Health and Development faced many obstacles to the provision of

health care to all citizens of the Marshall Islands. One was the prevalence of nutrition-related

morbidity, mortality and disability. A study undertaken jointly with UNICEF in 1991 indicated

a high percentage of malnourished children. Reviews conducted by the Asian Development

Bank and the World Bank in 1993 confirmed that preventable, nutrition-related conditions were

the leading cause of morbidity and mortality among adults.

The Ministry had formulated a national nutrition policy and had established a nutrition

council to foster intersectoral collaboration in such areas as policy development, programme

inonitoring, and the coordination of international aid. All activities were carried out within the

framework of community-based primary health care, which received the highest priority.

194 REGIONAL COMMmEE: FORTY -FOURTH SESSION

The Ministry had also mobilized local and international funds to host an annual national

conference on maternal and child health. The conference had focused on preventable nutrition

related diseases, disability and death. It had been attended by members of local communities,

such as women's leaders, traditional leaders, educators and other key figures from the main

urban centres and rural communities. The event had been organized entirely by and for

Marshallese people and conducted in the Marshallese language.

The Marshall Islands was seeking information that would guide its development. It

needed to set up mechanisms to assess problems, identify shortcomings, and document progress,

and would welcome any support WHO could provide in that respect.

Dr GALVEZ-TAN (Philippines) reported that vitamin A, iron and iodine deficiencies

were common in the Philippines among children and women. Iodine deficiency disorders were

alarmingly high among pregnant and lactating mothers. Only 12% of mothers were exclusively

breast-feeding up to six months. The Government had therefore launched a plan of action for

nutrition involving local government, nongovernmental organizations, the private sector and

communities. It aimed at eliminating vitamin A deficiency and iodine deficiency disorders by

1995 and reducing iron deficiency anaemia. Micronutrient supplementation would be given to

targeted high-risk groups as a short-term measure, and food fortification, including iodized salt

and dietary diversification, would form the basis of a long-term solution. The President of the

Philippines had declared the Government's commitment to eliminating micronutrient

malnutrition when he had launched the campaigns entitled Fortification for Iodine Deficiency

Elimination and Fortified Vitamin Rice in June 1993.

During the second Philippine national immunization day, a massive effort had been

made to reach young children with high-dose vitamin A capsules. On a single day, 84% of all

Filipino children under five years old had received a capsule. Encouraged by that success, the

Government was to hold a nationwide micronutrient day on 16 October. Every child aged

between one and four years would receive one vitamin A capsule, and every pregnant woman

would be given one iodized oil capsule and a packet of vegetable seeds or cuttings. The

initiative was interagency and multisectoral; in particular, the Department of Agriculture was to

provide seeds, seedlings or cuttings of plants rich in vitamins A and C and iron.

A total of 103 hospitals had been declared "baby-friendly", and by 1995 all government

hospitals and most private institutions should be taking part in that initiative. After signing the

International Code of Marketing of Breast-milk Substitutes in 1986, the Government was paying

special attention to monitoring, especially of advertising and of the sponsorship by infant

formula companies of continuing medical education.


Based on experience in national nutrition programmes, he recommended that the

Secretariat should undertake the following:

- vigorously pursue the baby/mother "friendly" initiative in hospitals throughout the

Region, so that all babies born in those locations would have the best possible start in life;

- build upon the experience of national immunization days to launch "national

micronutrient days". Such action WOUld, in the short run, greatly decrease vitamin A, iodine,

and iron deficiency and, in the long term enhance public awareness of "hidden hunger";

- actively involve Member States in the Region, in partnership with the private sector,

in enforcing the International Code of Marketing of Breast-milk Substitutes and thus improving

the nutritional status of infants throughout the Region.

Dr AKE (Papua New Guinea) pointed out that in Papua New Guinea the forms of

malnutrition varied widely throughout the country, and the causes of malnutrition differed from

one area to another. Thus each affected area had to be assessed and strategies formulated to

meet individual needs. In addition few data were available on most nutritional problems, and

the public was poorly informed.

His Government had established a national nutrition strategy and plan along three main

lines. The first was to focus on local needs, following a local approach to tackling nutritional

problems. The second was to set up food and nutrition surveillance, which called for

cooperation between government ministries and nongovernmental organizations. The third was

to adopt a new communication strategy - nutrition messages would be transmitted to the public

in simple and easily understandable forms.

Close collaboration existed with the Department of Education, and all primary and

secondary schools currently included nutrition in the health components of their curricula.

Breast-feeding was still the norm in his country, but a decline had been observed in

urban areas, especially for working mothers. The public service therefore allowed mothers to

take time off work to breast-feed. All hospitals could be considered as "baby-friendly", as all

the criteria were met.

Papua New Guinea planned to carry out a survey within the next two years in order to

update knowledge on the nutritional status. That would provide the information on which to

base the 1996-2000 health plan on nutrition. The Government would also be strengthening

monitoring and evaluation.


Mr BUILLARD (France) said that noncommunicable diseases related to dietary habits

were on the increase in French Polynesia, representing a danger to the territory's

health structure and increasing the cost of services. A medium-term programme had been

drawn up, and a workshop on lifestyles and eating habits was to be organized in 1993; it was

hoped to involve all sectors and to increase awareness among the population at large and among

politicians .

He thanked the cooperating agencies for their support.

Dr TINIELU (Tokelau) congratulated the Vice-Chairman on her election, and the

Director-General on his reappointment at the Health Assembly.

Indiscriminate eating, i.e., consumption of food without awareness of or attention to the

content and consequences, led to diseases that were becoming an increasing burden on the health

services of countries like his own, where cardiovascular diseases accounted for 30 % - 35 % of

deaths.

Although the role of micronutrients was not always clear - for example, iron deficiency

anaemia in children was usually but not always a factor of diet - and only clinical observation

could detect vitamin A deficiency - his Government was disseminating all relevant information

to improve dietary habits in accordance with recommendations of the International Conference

on Nutrition. Efforts were also being made to render local natural foods more palatable where

indicated, to discourage the use of unhealthy substitutes, to encourage home gardening, to

enrich soil for local food production, and in particular to encourage breast-feeding of infants by

such measures as increased maternity leave.

Tokelau proposed to employ community nutritionists or dieticians to advise and

demonstrate to the community appropriate recipes for local and imported foodstuffs.

Dr ADAMS (Australia) stressed the importance of a balanced nutrient policy. It would

seem contradictory, for example, to encourage households to use salt, even iodized, at the same

time as discouraging the use of fats because of the risk in terms of hypertension and

cardiovascular disease.

Dr QI Qingdong (China) commended the report as a comprehensive account of activities

for follow-up to the International Conference on Nutrition.

The Chinese Government had publicized the results of that Conference, reporting

thereon to the State Council and OIganizing meetings with representatives of the State Planning


Commission, industrial and agricultural bodies, statistical bodies, consumer groups and the

Women's Federation to brief them and prepare for the formulation of a national plan of action.

The State Planning Commission proposed to incorporate it in China's Ninth Five-Year Plan.

A National Advisory Committee on Food and Nutrition had been established in June

1993 to support the State Council and responsible departments in studies of important aspects

such as food development and nutrition improvement; to advise' on directives and draft

legislation, policies and programmes for the State Council and central departments; to publicize

scientific findings; to provide training; and to promote and guide activities for food and

nutrition.

The national plan of action was to be formulated with reference to Chinese policy

documents for the 1990s and the World Declaration and Plan of Action by staff of the relevant

departments such as those for health, agriculture and commerce. A first draft based on a

framework drawn up in June was planned for completion by the end of 1993 for review by the

State Council.

It was also planned to hold a national training course on nutrition improvement in mid

December with leaders of the appropriate departments, where the draft plan of action would also

be discussed. A high-level meeting would be held on control of iodine deficiency disorders in

September 1993 in Beijing to devise strategies and plan for international cooperation, set up

networks for surveillance, nutrition education, and review of food hygiene legislation as well as

preparation of a "Nutrition Law".

Dr TAPA (Tonga) commended the comprehensive report and the document on the

nutrition situation in the Region.

Obesity and noncommunicable diseases resulting from poor or inappropriate nutrition

caused avoidable mortality and morbidity. The prospects for child nutrition were better because

of the emphasis on breast-feeding and the introduction of the "baby-friendly" hospital initiative,

which affected two hospitals out of four in Tonga. The International Code of Marketing of

Breast-milk Substitutes was followed as a recommendation.

Three qualified nutritionists - two of them trained thanks to WHO fellowships - were

working in nutrition education, general nutrition and diet in schools, among the general

population and its special vulnerable groups in Tonga.

198 REGIONAL COMMITIBE: FORTY-FOURTH SESSION

UNICEF and WHO were also to be thanked for their cooperation in a current nutrition

project. His Government remained committed and would give high priority to the regional

nutrition programme.

Dr LIN (United States of America) joined others in praising the comprehensive

documentation, and the Secretariat follow-up to the International Conference.

At that Conference a major initiative of USAID on "Opportunities for micronutrient

intervention" was launched with a view to reducing specific nutritional deficiencies both through

action in countries and support of competent international agencies.

Programmes to alleviate serious nutritional disorders were under way in various

countries, and USAID had a number of programmes in the Region focusing on vitamin A

deficiency - both prevalence surveys and action to encourage home gardening, nutrition

education and supplementation.

He wished to emphasize that breast milk was the only source of complete nutrition for

normal infants; mothers should be encouraged to breast-feed for at least six months.

Breast-feeding was well known for its benefits to children and mothers in tenns also of infant

nutrition, the infant's first immunization, in birth-spacing, and in promotion of maternal health

at low cost.

Nationally, a goal of the United States of America was to increase the proportion of

breast-feeding mothers to 75% at hospital discharge and to 50% at six months. Internationally,

USAID had undertaken to promote breast-feeding as a worldwide objective as one of the most

cost-effective means of improving child survival and had adopted a related strategy as part of its

child survival initiatives.

Professor NGUYEN HONG NHAN (Viet Nam) said that a study of calorie intake

showed that a quarter of Vietnamese families suffered from insufficient energy intake.

Protein malnutrition studies based on weight-for-age in 1988 had indicated that 41.8%

of children were malnourished, and animal protein accounted for only 20% of intake compared

with an average total intake of 33%.

Low birth weight affected 14% of newborn infants, and many women had a too-low

weight in pregnancy. Vitamin A deficiency caused xerophthalmia in 0.72% of a large sample of

children under five years of age.


Viet Nam was combating malnutrition through a plan of action to the year 2000 to

create an information network, reduce prevalence of malnutrition in children under five to 30 %,

increase the average weight during pregnancy, reduce low birth weight incidence to 10%,

eradicate blindness caused by vitamin A deficiency. reduce goitre due to iodine deficiency by

50%, and ensure an average daily calorie intake of 2100 kilocalories.

The cooperation of international governmental and nongovernmental organizations was

earnestly sought for those measures.

Mr WAENA (Solomon Islands) said that his country had conducted a national nutrition

survey in 1989 which showed that although marasmus and kwashiorkor, for example, were not

prevalent, there were unacceptable levels of malnutrition connected with weaning; the risk

caused by adoption of processed-food diets was especially present in urban areas, and the

national programme for maternal and child health was tackling the problem with the. help of two

nutritionists, as well as promoting health education.

Although breast-feeding was widely practised, the increasing employment of women

constituted a potential threat inspite of the proviSion of an hour in the mornings and afternoons

for those with infants to feed. Bottle-feeding was contrary to policy in hospitals and

institutions. No breast-milk substitutes were imported, the other method of feeding being by

cup and spoon using expressed milk. It was intended to keep it that way.

Mr PUNA (Cook Islands) said that the report gave much food for thought with no

"junk".

Cook Islands, which followed the principle that small was beautiful, had relatively

manageable problems. He thanked WHO, UNICEF. UNFPA, SPC, SPAF and the

New Zealand Research Foundation for sponsoring the family lifestyles programme and USAID

for sponsoring a vitamin deficiency study in the northern group of islands which found no

sufferers.

Bringing up to date figures given in the WHO document. he said that the infant

mortality rate for the Cook Islands was down to 9 per 1000 live births. "Westernization" where

it referred to habits related to fastfood must be combated together with other causes of

malnutrition in order to preserve physical. mental and social health.

Ministers .of health and of finance were making a concerted effort to adjust attitudes.

School lunch services were a good starting point to ensure a healthy diet for children.

Nongovernmental organizations were very cooperative in that field, particularly the


Cook Islands Welfare Association (bringing together mothers and district nurses) and the family

alliance.

The eradication of nutritional diseases should be seen as a realizable aim. His country's

Food Act could be made available to others in the Region on request.

He suggested regional cooperation for the detennination of maternity leave

requirements. Premises must be provided for breastfeeding mothers that could also

accommodate education for mothers.

Finally, he urged health authorities to provide a good example where nutrition and

exercise were concerned.

2. HUMAN RESOURCES FOR HEALTH: Item 15 of the Agenda

2.1 Public health training in the Western Pacific Region: Item 15.1 of the Agenda

(Document WPRJRC44/11)

The REGIONAL DIRECTOR recalled that at its forty-third session the Regional

Committee had discussed the topic of public health training in the Region. The Committee had

agreed with the Australian representative, who had introduced the topic, on the vital importance

of public health training in the development of human resources to meet regional health needs of

the future. The Secretariat had been requested to initiate action towards the development of

mechanisms for cooperation among training institutions in the Region to maximize the Region's

capabilities in that area.

The interim report provided a preliminary assessment of postgraduate trammg

resources. It highlighted the need to improve the relevance to regional needs of training

programmes and their content, and the need to establish fonnal links between institutions. A

new index to the existing directory of training institutions in the Western Pacific had been

developed and would be the basis for updating the Directory in 1994. Discussion of the report

was expected to elicit advice on further action needed to strengthen public health training in the

Region.

Members of the Committee had therefore been provided with a copy of the 1992

Directory of Training Institutions in the Western Pacific, as well as an index to postbasic and

postgraduate training for use with the Directory. The index was an initial attempt to design


more "user-friendly" packages of information on available training opportunities in the Region.

It was planned to completely revise the en~ire Directory in 1994 using an extensive cross

indexing format similar to the drug reference manuals used by physicians.

It had been noted that the listing in the current directory was incomplete with one

country's institutions forming almost 80% of the listing. He requested Member States to

collaborate closely with the Secretariat in the revision of the Directory by providing accurate

and complete information on their training activities.

Dr ADAMS (Australia) said that he had been heartened by the reception of Australia's

proposal at the previous session of the Regional Committee and thanked the Regional Director

and the Secretariat for the progress made. Hopefully the momentum would be maintained. He

also thanked the regional training centre in Australia for the workshop organized recently and

recommended study of its report.

Within Australia it was proving possible to renew funding for all public health training

centres; the latest budget showed welcome government support for public health training.

Consortia were currently being developed to link public health schools so as to build strengths

and it was hoped that that model could be extended to other countries in the Region in due

course. WHO support in that regard was greatly appreciated.

Dr DE LOURDES SILVA (Portugal) welcomed the review of public health training in

the Region. It was most useful for Macao, where training resources were not currently

available, in selecting suitable institutions for its staff. Macao had made great efforts to

strengthen human resources development, particularly through the training of local health

personnel, to ensure continuing provision of health services beyond 1999. During the past year

considerable progress had been achieved: 30 medical graduates had completed an 18-month

general internship programme for professional options and 40 doctors were attending a

complementary internship programme for specialization options. Since July 1993 another 25,

mostly graduates from Jioan Medical University in Guangdong, China, had started a new

general internship programme with a duration of 24 months. During 1993 the Macao Technical

School had trained 16 general nurses, 38 specialized nurses of whom 15 were in community

health, and 41 technicians for diagnostic and therapeutic services.

Macao's continuing education programme was progressing successfully with the

organization of in-service training and refresher courses and workshops, including one on

hospital administration and planning and management for human resources for health. Study

tours and technical visits had also been supported to ensure study in and exchange of


experiences with other countries and areas. The support provided by WHO and various

countries and areas, especially China and HO:1g Kong was greatly appreciated. In 1992-1993,

11 WHO fellowships had been granted for the training of local health professionals.

Owing to the shortage of local health personnel, human resource development would be

a long-term task for Macao and greater efforts were needed. It was hoped that countries and

areas in the Region and WHO would continue to provide support in the future.

Dr HONG SUN HUOT (Cambodia) said that Cambodia had a joint faculty for

medicine, pharmacy and dental care whose main task was the training of health professionals.

Training in public health was therefore related to this school and to other health institutions in

the country, including centres for hygiene and epidemiology, malaria, tuberculosis, leprosy, etc.

There was no specific public health school. One reason for that was the need to ensure that

future doctors" and other health professionals all received a broad grounding in public health.

The faculty was currently considering offering 300 hours of public health training in each of the

six years of medical training, representing 25 % of the course. Postgraduate training had started

on a small-scale with public health modules for public health trainers from the faculty and other

institutions and for supervisors and trainers at the level of provincial health services. In

addition negotiations were under way with a Philippine nongovernmental organization (ADRA)

concerning the organization of another training module leading eventually to a postgraduate

diploma for public health practitioners in Cambodia.

External funding, especially that received from Thailand and China, had been greatly

appreciated. It was felt that it should be used primarily for the training of future public health

trainers and researchers as it as essential to strengthen local capabilities.

Cambodia was ready to share its experiences in postgraduate training with interested

countries through the exchange of training modules. Exchange of examiners would also be

useful. Member States in the Region might also be interested to learn more about Cambodia's

medical school. Cambodia would be grateful for support, in the form of educational materials

or visits from trainers, in the further development of future trainers. It was essential to provide

all health professionals with a base of public health knowledge as a first step towards the

development of public health specialists.

Dr MONTA VILLE (France), welcoming the report, hoped that francophone countries

would participate in public health training. In New Caledonia for example there were skills and

achievements that would be of interest to others in the South Pacific.


Dr REID (United States of America) welcomed the report as a first step in addressing

the appropriateness and relevance of postgraduate training in the Region. It had established

both baseline parameters and areas requiring further study and support.

The United States territories in the Region had health problems that were similar to

those of many other developing countries, both within and outside the Region. The United

States of America was providi.ng financial support to its territories and training for

their personnel at United States institutions. Other developed countries in the Region with

established institutions were also providing training opportunities. In recent years WHO had

provided considerable support to American Samoa in the organization of training workshops,

etc. However, existing cadres of trained personnel were getting older and new younger and

more dynamic staff were needed. The help received from the United States of America, WHO

and other donors was therefore greatly appreciated and it was hoped that it would bear fruit in

due course.

Mr WAENA (Solomon Islands) welcomed the report as the Solomon Islands placed top

priority on the training of qualified health workers for the delivery of health services to its

scattered islands. Emphasis was given to the training of doctors and specialists to replace

doctors from overseas. Training in public health was also considered essential as health

services needed advice from health managers, epidemiologists, anthropologists, health

economists health educationalists, environmental specialists, etc. Although training had started

on a small scale, many of the training opportunities were located in the northern hemisphere far

from the Region, which sometimes had adverse consequences on family life. Opportunities

within the Region were insufficient to meet demands. He was encouraged to learn that Australia

was setting up public health schools which would hopefully increase regional opportunities.

He endorsed the conclusions and recommendations for future activities contained in the

report.

Dr Haji HUSSAIN (Brunei Darussalam) said that his country depended entirely on

external public health training facilities and therefore welcomed the opportunities for sharing

provided by the Asian-Pacific Consortium for Public Health and the Network for

Community-Oriented Educational Institutions for Health Sciences.

In addition to the lack of training facilities there was also a shortage of public health

trainers and even candidates. There were only four local doctors with a postgraduate training in

public health and they were occupying the top executive posts in the Ministry of Health. One

other doctor was currently undergoing public health training in Singapore.


Since the discontinuation of the Royal Society of Health diploma course for health

inspectors, inspectorate staff had been trained in South Australia. However, current prospects

in that field did not attract students.

Postgraduate studies in public health, nutrition, and biomedical and laboratory sciences

were undertaken mostly in the United Kingdom. The short-term on-the-job training, mostly in

industrial health and safety, offered by Japan was greatly appreciated. Current priorities were

for training in environmental health, occupational health, epidemiology, community health and

public health practice.

Dr PRETRICK (Federated States of Micronesia) commended the report and endorsed its

conclusions and recommendations.

Postgraduate training for his country's citizens was usually undertaken at the University

of Hawaii, School of Public Health. The University had put in place several programmes

designed to help students from disadvantaged backgrounds to qualify for admission to its public

health master's course. One such programme was the Health Career Opportunity Program at

the college in Pohnpei. In recent years the University of Hawaii had developed a graduate

certificate in public health to meet the needs of interested groups, such as health practitioners.

The first group of seven students from the Federated States of Micronesia would receive

certificates in August 1993, and more would complete the programme in 1995. The enrolment

and completion rates for the programme had been satisfactory and all States had sent

participants. The programme provided a means for ensuring continuous enrolment in the future

at the University of Hawaii School of Public Health.

His Government was aware of the broad range of opportunities available within the

Region and strongly encouraged utilization of the institutions in the Region by its citizens.

The CHAIRMAN requested the Rapporteurs to prepare an appropriate resolution.

2.2 Fiji School of Medicine: Item 15.2 of the Agenda (Documents WPRJRC44/12

and Corr.l)

The REGIONAL DIRECTOR said that, during its forty-first session in 1990,

the Committee had requested him to monitor progress in implementing the 1989 Plan of Action

for revitalizing the Fiji School of Medicine as a centre for training health personnel for the

Region. It had also requested a report on the findings within three years of the date of the

resolution.


The report under consideration complied with that mandate. It also coincided with the year

when the first graduates of the School's ne" problem-based medical course (first tier) would

emerge.

The report took note of a renewed optimism arising from the initial success of the new

medical curriculum, exemplified by a significant reduction in student failure rates, and by a

marked increase in interest among the island States in the Region in all the curricular offerings

of the Fiji School of Medicine. In effect, the redevelopment work at the School had opened up

new avenues for closer coordination of medical training in the Region. For example, an

integrated primary care worker's programme recently implemented in Kiribati would soon

qualify graduates for entry into the second tier (hospital-based) of the new medical course in

Fiji. Similarly, the University of Hawaii-Manoa's Pacific Basin Medical Officers Training

Program (PBMOTP) and the Fiji School of Medicine were seriously looking at setting up a

department of postgraduate training. Parallel developments were thus occurring at many levels

within the Fiji School of Medicine itself, and among related health training institutions in the

Region.

On the issue of the autonomous organizational structure for the School of Medicine, a

paper for submission to the Cabinet of the Fiji Government had been discussed between the

Minister of Health and the Council of the Fiji School of Medicine. He understood that the

representative from Fiji would be able to give further details on that matter.

Mr W AENA (Solomon Islands) said that the item under discussion was of great interest

to the Solomon Islands which had greatly benefited from the training of its personnel at the Fiji

School of Medicine for many years.

His Government's health policy emphasized conununity health, so that the School's new

curriculum was most appropriate. Students were being introduced to problem-based and

student-centred learning, in addition to being exposed to health problems in the community,

which motivated them to learn by themselves, ask important questions and find solutions. Such

skills were not addressed in conventional courses yet they were most relevant for personnel who

would, on their return, have to work alone in rural areas providing both health care and

management.

Six students were currently undergoing training at the School and, thanks to the

generosity of the Fiji Government, it was proposed to send four more each year.


The changes being made at the School were not easy and required support from the

international community in the form of provision of educational and other materials and

sponsorship of students. Recipient countries should also support the School where possible. He

hoped that WHO would continue to collaborate with the School so as to strengthen and develop

its programmes.

Mr BUNE (Fiji) said that Regional Director's report summarized the progress made in

redeveloping the Fiji School of Medicine and restructuring its curricula and academic

programmes in the past five years. He expressed his Government's appreciation to the Regional

Committee and WHO for the financial and technical support which had made the changes

possible. Representatives would recall that, at its thirty-ninth session, the Regional Committee

had endorsed the representative of Fiji's plea for WHO support in revitalizing the School in

order to prevent its collapse and closure, which had seemed imminent at the time. The School

had not only survived but had taken on a new lease of life as a vibrant and innovative health

training institution at the forefront of medical education. The plan of action for the

redevelopment had been a collaborative effort undertaken by the Faculty of the School and

Ministry of Health officials with the support and guidance of WHO and a task force of medical

educationalists and administrators commissioned by WHO in early 1989. The three-stage plan

had been ratified by the Cabinet in August 1989.

As the report indicated, the first phase, curricular reform and academic changes, had

been implemented and the first cadre of health care workers to be designated public health

practitioners would graduate by the end of 1993. It was both fitting and pleasing that the

Regional Director had agreed to present the diplomas at the graduating ceremony. However

much remained to be done to fully implement remaining two phases of the plan of action. The

first was the desire of donor countries and WHO for the School to enjoy a measure of autonomy

through the establishment of an independent council as the controlling body. WHO

had appointed short-term consultants to explore mechanisms for implementation, draw up

appropriate legal documents, and define the operational steps required. Documents were in the

process of being submitted to the Fiji Government, which stood ready to examine them. In the

meantime the Ministry of Health was accelerating efforts to identify and consolidate support

from relative donor agencies to provide funding for new buildings to house teaching facilities,

offices and student accommodation. The Ministry of Health had already submitted an outline

plan for the project to the Central Planning Office in accordance with the recommendations of

the short-term consultants.


The Fiji Government assured the Regional Committee, the Regional Director and the

other 16 island countries which depended on the School for the development of human resources

for health, that the Ministry of Health was fully committed to the implementation of the plan of

action. It would continue to collaborate with WHO to ensure that the 107-year-old institution

remained the dominant force in training and education of health care workers in the Pacific

Basin.

Dr TAPA (Tonga) expressed great pleasure at the Regional Director's report. He had

attended the session of the Regional Committee which had adopted resolution WPRlRC41. R 1,

in response to the impassioned plea to the Regional Director and Member States to come

forward and revitalize the Fiji School of Medicine, an historical institution .. As a graduate of

the School himself he welcomed the successful implementation of the first phase of the plan of

action and the forthcoming graduation of the first students to benefit.

Although much remained to be done, the future of the institution now seemed assured as

an important training centre for the Pacific islands. Tonga would continue to send students to

the School. He urged the Secretariat, in the Regional Office and at headquarters, and other

agencies to continue their support to the School. Like the Expanded Programme on

Immunization, the revitalization of the Fiji School of Medicine was another shining example of

international collaboration in the health field.

Dr PRETRICK (Federated Sates of Micronesia) said that the Government of the former

Trust Territory of the Pacific Islands had started sending students to the Fiji School of Medicine

in 1951 and graduates had formed the core of the medical personnel in the area until very

recently. A critical shortage of staff had developed as it became increasingly difficult for

students to gain admission. The Pacific Basin Medical Officers Training Program located in

Pohnpei in the Federated States of Micronesia had been developed to counter that shortage. By

the year 2000 at least 89 medical officers would have completed the course, resulting in at least

76 Micronesians appropriately qualified to meet the health care needs of the Pacific islands. By

early 1997 all the students would have completed five-year training programmes. Following the

closure of the Programme in aboUl the year 2000, future medical officer training for

Micronesian citizens would have to be undertaken at the Fiji School of Medicine. With the

rapid increase in population and the near retirement of senior medical officers in his country,

the demand for doctors would become critical by about the year 2015. He therefore strongly

supported efforts to revitalize the School. It was also hoped that the Fiji School of Medicine

would provide postgraduate training for current Program graduates.


His Government respected the goal of the School - the training of highly qualified

medial officers capable of providing medical care services to their own people - and he urged

WHO to continue its collaboration with that institution.

Dr SCHUSTER (Samoa) observed there were two medical schools in the Region to

which most of the Pacific island nations had long sent their graduates and postgraduates: the

Fiji School of Medicine and the Faculty of Medicine in the University of Papua New Guinea.

Most of the benefits currently enjoyed had stemmed from training provided .there before

students starting graduating from schools elsewhere.

It was important to ensure that the two levels of training that were now going to be

given would provide a balanced approach between public health teaching and clinical curative

teaching. Countries had been criticized for spending too much money on costly clinical curative

services rather than investing in low-cost but highly cost-effective preventive public health

programmes. The Fiji School of Medicine would serve the countries in that respect.

He urged donor countries to contribute generously to the School's requirements.

However, he stressed that donations should not be made on a competitive basis, which might

encourage the two schools to compete for financing. Rather, donors should ensure that there

was solid collaboration and cooperation between the schools.

Mr TEBANIA (Kiribati) endorsed the views expressed by previous speakers. His

Government fully agreed with the report on the Fiji School of Medicine. Efforts were under

way to link the programme of the Kiribati medical assistants school to the primary

care practitioners course at the Fiji School of Medicine. That link should be operative by the

end of 1994.

Dr TINIELU (Tokelau) expressed his agreement with the support to be provided to the

Fiji School of Medicine, which was an important source of health personnel to other areas of the

Western Pacific.

Mt HENRY (Cook Islands) observed that both the Fiji School of Medicine and the

University of the South Pacific played an important part in the development of human resources.

Many of the qualified health professionals of Cook Islands were working in Australia and New

Zealand where they had been trained. When they came back to their country they had a

different cultural outlook. He stressed that the Fiji School of Medicine and the University of

the South Pacific should be used to train people of the Pacific because they would learn in the

Pacific way. They would return to the country where they began their education wiser, better


qualified and able to apply their knowledge for the benefit of their people, rather than coming

back with the education of another culture. He did not wish to be derogatory, but to emphasize

that the Pacific countries did loose qualified people. It was therefore important to the Pacific to

maintain the Fiji School of Medicine, the Medical Faculty at the University of Papua New

Guinea, and the University of the South Pacific.

Mrs HOMASI (Tuvalu) expressed her full support for the betterment and improvement

of the Fiji School of Medicine. The School had long been Tuvalu's main institution for training

their health personnel. She joined other countries of the Region in thanking Fiji for acting as a

big brother, an approach that was appreciated in Tuvalu.

4. REGIONAL STRATEGY ON HEALTH AND ENVIRONMENT, INCLUDING

FOLLOW-UP OF THE UNITED NATIONS CONFERENCE ON ENVIRONMENT

AND DEVELOPMENT (UNCED): Item 16 of the Agenda (Document

WPRlRC44/13)

The REGIONAL DIRECTOR said that in recent years, the environmental health

problems of the Region had become more prominent and widespread. In confronting those

problems, it had become increasingly evident how complex the interdependence was among the

health, social and physical aspects of the environment, as well as between the public and private

sectors. Although that interdependence was not fully understood, it was clear that a healthy

environment could not be achieved by addressing health alone. At the same time, it should be

recognized that WHO had some limitations. Activities must be selected judiciously, and that

was something that must be worked at and planned for.

Document WPRlRC44/13 was intended to serve as the framework to guide health and

environment activities over the following six years. It had grown out of the work of the 1991

Regional Consultative Group on Health and Environment. In addition, it complemented and

was responsive to: Agenda 21 of the 1992 United Nations Conference on Environment and

Development; the recommendations of the 1991-92 WHO Commission on Health and

Environment; and the new WHO Global Strategy for Health and Environment, endorsed by the

Forty-Sixth World Health Assembly in May 1993.

The Strategy called for a fresh look at the way traditional activities were handled.

Special attention needed to be paid to pinpointing priority activities based on considerations of

significance, timeliness and practicability. It must be backed up by plans of action addressing

each of the identified priority activity areas. Such plans of action must be dynamic documents,


responsive to changing circumstances. Some of the plans had already been developed by WHO

in collaboration with the Member States. More needed to be developed at the national and local

levels by Member States in collaboration with WHO. Such plans must reflect the priority

concerns and those concerns to which key decision-makers were committed. Taken together,

the Strategy and associated plans of action were intended to answer the questions posed at the

Technical Discussions held in conjunction with the fony-third session of the Regional

Committee in Hong Kong in 1992, on the topic "Healthy urban environment". Those questions

were: What was to be done with what was available; How could they achieve a greater impact;

and How could WHO best enhance Member States' effons to resolve priority environmental

health problems?

Successful implementation of the Strategy required improved collaboration among

national and external suppon agencies involved in health, environment and development

activities. It also required that WHO health professionals make themselves pan of discussions

on sustainable development. They could not wait to be invited. More imponantly, it involved a

renewed sense ofpannership between Member States and WHO. That must be "their Strategy",

if it was to succeed.

Dr PINEDA (Philippines), commending the Regional Director's timely and relevant

report, expressed appreciation of WHO's pannership in tackling complex and often politically

sensitive issues concerning health and the environment. She hoped the Regional Director would

continue his resolute effons to ensure national action to arrest the consequences of irreversible

environmental degradation in the Region.

The Philippines had responded to the challenges of health and environmental issues in a

number of ways. First, it had set up the Philippine Council for Sustainable Development on

which eleven government agencies and some nongovernmental organizations were represented.

The Council had recently identified shonfalls in resources for water supply projects, air

pollution monitoring and development of a hospital waste management system. Secondly, the

Health Depanment panicipated in the Pollution Adjudication Board. Thirdly, it had

strengthened the Inter-Agency Committee on Environmental Health which addressed emerging

and continuing problems. Founhly, the Health Depanment had adopted a radical approach to

integrating health and development issues into plans and programmes, with considerable

success.

Regional field offices had been organized into HEAD (Health, Environment And

Development) zones, grouped together according to ecological systems or bioregions. The

HEAD zones had made pioneering effons to bring development issues such as industry, trade,


energy and agriculture into health sector discussions, with a view to making risk reduction a key

parameter for health interventions. A framework for continuing collaboration by the major

development sectors was being constructed, in order to address the health aspects of water

resource utilization, industrial expansion, pesticide use, biodiversity and food safety. It was

imperative to set up a framework for regional cooperation on transboundary issues such as

transit of toxic wastes, export of hazardous or toxic processes and materials and wildlife trade

and the exploitation of forest resources. It was high time for the health sector of the Region to

unite in condemning practices that adversely affected individual Member States and the entire

interdependent ecosystem of the Region.

Dr CHEN Ai Ju (Singapore) expressed her appreciation of the Regional Director's

informative report. Her Government supported the regional strategy and plans focusing on

priority activities with maximum impact. She urged the Regional Director to support the efforts

of Member States to incorporate health and environment measures into national plans for

sustainable development.

In Singapore a Green Plan had been drawn up, which set out the environmental goals

for making Singapore a "green city" by the year 2000. The Plan contained six action

programmes: environmental education, environmental technology, resource conservation,

environmental noise, clean technology and nature conservation. Those new programmes would

complement existing activities concerned with solid wastes and waste water management,

control of hazardous substances and environmental management. Singapore had long

recognized the need for sustainable development and endeavoured to maintain a balance between

environmental protection and industrial development in its pursuit of economic growth. Great

emphasis was also placed on food safety and hygiene.

Mr Jeong-In SUH (Republic of Korea) thanked the Regional Director for his timely

report. Since the United Nations Conference on Environment and Development in 1992 the

Republic of Korea had drawn up and implemented an environmental protection plan in order to

tackle various global environmental issues. It had introduced legislation on environmental

impact assessment and combated air pollution by promoting the use of cleaner fuels. Vigorous

efforts had been made to increase public awareness of the importance of recycling.

The Republic of Korea intended to participate in regional environmental cooperation

projects such as the North-west Pacific Action Plan for the prevention of marine pollution, and

would incorporate environmental factors into its industrial policy with a view to achieving

sustainable development. His Government would continuously contribute to the efforts of the

world community to preserve the global environment.


Dr REID (United States of America) commended the emphasis of the repon on local

involvement. response to urgent needs combined wIth sustainable long-term plans. promotion of

change in attitudes. and intersectoral cooperation. The United States National Institute of

Health contributed to. the latter through its collaboration with the UNEPfILO/WHO

International Progranune on Chemical Safety and the Pacific Basin Consonium for Hazardous

Waste Research. He suggested regional contacts should be established with these bodies. as

well as the development of an interdisciplinary approach to environmental health activities.

covering occupational health and maternal and child health. statistics and epidemiology

inter alia. The same opponunities should be given to health professionals as to social and

economic development expens and politicians.

He requested that the environmental health concerns of Member States in the Region

should be clearly determined as a basis for cooperation. enhancing data collection and project

outcome. and that the Secretariat make its services available for that process. Workshops or

environmental data analysis for panicular purposes of environmental epidemiology could be

\ helpful.

Finally. he encouraged the Regional Director to establish a system for the recording of

achievements in that field to ensure that the methods used were appropriate.


(wpRlRC44/SRl7)

SUMMARY RECORD OF THE SEVENTH MEETING

WHO Conference Hall. Manila Thursday. 16 Sg>tember 1993 at 8.30 a.m.

CHAIRMAN: Mr S. NaivaJu (Fiji)

CONTENTS

~

1. Consideration of draft resolutions ....... ......................... ............................ 214

1.1 Eradication of poliomyelitis in the Region .......................................... 214 1.2 Report of the Sub-Committee of the Regional Committee on

Programmes and Technical Cooperation: Country visits ..... '" ......... .... ... 215 1.3 Nutrition in the Western Pacific Region ................ .................. .......... 215 1.4 Public health training in the Western Pacific Region ............................. 216 1.5 Fiji School of Medicine ............ .............................................. ...... 216

2. Regional strategy on health and environment, including follow-up of the United Nations Conference on Environment and Development (UNCED) (continued) ................. ........... ............. .... ........... ... ................. ............ 217

3. WHO Response to Global Change: Report of the Executive Board Working Group .................................................................................. 223

- 213 -



The Committee considered the following draft resolutions:

1.1 Eradication of poliomyelitis in the Region (Document WPRlRC44/Conf. Paper No.3)

Dr DURHAM (New Zealand) proposed an additional operative paragraph 5 (4) to provide

for a report on the safety and efficacy of poliovirus vaccine to the Regional Committee in 1994.

Dr MONTAVILLE (France) proposed that the final phrase of operative paragraph 3 (1)

include a reference to "any other cases".

Dr LIN (United States of America) suggested that the proposed amendment to paragraph

3 (I) might read: "to rapidly detect and control imported or any other cases".

Dr MONTA VILLE (France) further proposed, with respect to those countries wishing to

avail themselves of that possibility, the inclusion of a new operative paragraph 3 (3) to provide

for the use of an injectable preparation.

Dr ADAMS (Australia) objected that the decision on the appropriate vaccine was best left

to a global expert group.

The REGIONAL DIRECTOR concurred. The oral vaccine had proved most effective,

and a change to an injectable vaccine would have implications for countries outside the Region.

The Secretariat would like to be guided by the recommendations of the Global Advisory Group,

which were transmitted to it through headquarters.

Dr MONTAVILLE (France) suggested that the proposed operative paragraph 3 (3)

should include a reference to the advice of the EPI Global Advisory Group on the use of an

injectable preparation.

In reply to a question from Dr TAPA (Tonga), the REGIONAL DIRECTOR explained

that the Global Advisory Group made recommendations to the Director-General, who made the

final policy decision.

Dr TAPA (Tonga) said he was unhappy with the implication in operative paragraph 2 (1)

that immunization should cease in 1995, since the global target was eradication by the year

2000. He would prefer a more flexible wording.

SUMMARY RECORD OF THE SEVENTH MEETING 215

The REGIONAL DIRECTOR explained that the date 1995 referred only to the national

immunization days to prevent local outbreaks. It would probably be necessary to continue

immunization activities well beyond that date.

Dr LI Shichuo (China) pointed out that paragraph 4 should include an expression of

thanks to the various organizations mentioned therein that had supported poliomyelitis

eradication activities in his country.

The REGIONAL DIRECTOR said that editorial changes would be made to accommodate

the various wishes of the representatives.

Decision: The draft resolution, as amended, was adopted (see resolution

WPRlRC44.R4).

1.2 Report of the Sub-Committee of the Regional Committee on Programmes and Technical

Cooperation: Country visits (Document WPRlRC44/Conf. Paper No.4)

Dr SCHUSTER (Samoa) proposed that in operative paragraph 2 (2) the phrase "of the

highest possible quality" be inserted after "comprehensive range of services".

Dr LIN (United States of America) commented that, in the view of his delegation, Sub

Committee recommendations after country visits should be made in the context of national plans

of action for achieving health for all.

The REGIONAL DIRECTOR said the draft resolution would be amended to reflect the

above comments.


WPRlRC44.R5).

1.3 Nutrition in the Western Pacific Region (Document WPRlRC44/Conf. Paper No.5)

Dr DURHAM (New Zealand) proposed that the last line of operative paragraph 3 be

amended to read: "self-reliance, community-based action and, where relevant, the involvement

of the food industry".


It was so agreed.


WPRlRC44.R6).

1.4 Public health training in the Western Pacific Region


Dr MONT A VILLE (France) suggested that operative paragraph 1 (3) should include a

reference to other training opportunities for public health.

The REGIONAL DIRECTOR pointed out that the World Directory of Schools of Public

Health was a headquarters publication and covered only training institutions specifically

concerned with public health. He felt it would be preferable to insert a new operative paragraph

2 (4): "to collect and disseminate all available information on practical training opportunities

relating to public health available in the Region" .

It was so agreed.


WPRlRC44.R7).

1.5 Fiji School of Medicine (Document WPRlRC44/Conf. Paper No.7)

Dr DURHAM (New Zealand) requested clarification of operative paragraph 2 (1).

In reply, the REGIONAL DIRECTOR said that the Secretariat was concerned that during

their one-year field internship in their own country - after the first tier of training - primary care

practitioner graduates should be appropriately employed as health personnel by their

Governments. Another aspect of their status was the proper arrangement of tutorial

supervision, so as to enhance their field training.

Dr DURHAM (New Zealand) proposed that the operative paragraph concerned be

amended to reflect more clearly the need for recognition of the status of trainees by their home

countries during the period of field internship.

Dr REID (United States of America) proposed that the fourth preambular paragraph be

amended by replacing the word "wastage" with "and graduate attrition".


The REGIONAL DIRECTOR suggested that in addition to the amendment just proposed,

operative paragraph 2(1) be amended by replacing the words "their respective health services"

with "the health services of their home countries" to meet the concerns of the representll1ive of

New Zealand.


WPRlRC44.R8).

2. REGIONAL STRATEGY ON HEALTH AND ENVIRONMENT, INCLUDING

FOLLOW-UP OF THE UNITED NATIONS CONFERENCE ON ENVIRONMENT

AND DEVELOPMENT (UNCED): Item 16 of the Agenda (Document WPRlRC44/13)

(continued from the sixth meeting, section 3)

Dr LI Qingan (China) endorsed the concepts contained in the Regional Director's report

and welcomed the emphasis placed on traditional activities utilizing simple methods for the

protection of the environment that were both feasible and practical for developing countries.

The control of motor vehicle emissions, covered in section 4.6 of the report, was of great

importance in China where, since the policy of reform and opening up of the country, there had

been a rapid increase in the number of vehicles in many cities. In Beijing, for example, in 1992

alone the number of vehicles had doubled, with more than 200 taxi companies starting up. Most

Chinese people did not own private cars. In his view the number of private cars should not be

used in future as an indicator of social development, as the use of public transport should be

encouraged.

Section 4.7 on coal use took China as an example for the indoor and groundwater

pollution caused by the use of coal. However. in most of China there was no natural gas supply

so that coal was the major energy source. WHO was currently promoting technology transfer

involving appropriate fluoride removal methods in individual households and communities.

Traditional methods such as the installation of chimneys and renovation of stoves were also

being employed.

Urban health development (section 4.8) demanded multisectoral cooperation. Public

authorities should ensure that activities were coordinated.

Having developed a sound strategy. the next step was to determine how to put it into

practice. China was following guiding principles for the simultaneous programming of

construction and urban development on the one hand and environmental protection on the other.


It was also developing legislation to safeguard the environment. The health sector was

responsible for health-related aspects, such as the establishment of a hygiene

surveillance system, improvement of health legislation and regulations, and the monitoring of

drinking water, food safety, occupational health, and sanitation in public places in accordance

with health-for-all strategies.

Mr HENRY (Cook Islands) commended the report and endorsed the proposed regional

objectives and goals and the priority activities highlighted. Cook Islands would be interested to

see what benefits would accrue to small island states.

His country's main concerns were related to tourism development and economic

advancement projects. It was essential that environmental impact assessment reports were

submitted for all such projects. Tourism was the main source of income, and in 1989 a

commission had been appointed to draw up a ten-year plan for its development. With their

fragile environments, small island countries were extremely vulnerable and there was potential

for dramatic change in a very short time, for example as a result of contamination of the water

supply. Support was needed to help his country fulfil its health-for-aU commitments relating to

the environment.

Cook Islands had designated the current week "Clean Up the World Week" and many

special events had been organized, involving schoolchildren especially. Public employees had

been given a one-day holiday to be devoted to cleaning up their villages. The message, coming

from children particularly, was that destruction of the environment would mean destruction of

the people. He proposed that a World Environment Day be designated so that activities similar

to those organized around World Health Day would be encouraged worldwide.

Dr ADAMS (Australia) said that the item under discussion was of such importance that it

should be retained on the agenda of the Regional Committee for the time being and for as long

as was deemed necessary in the future.

Australia had put in place a number of initiatives to predict, prevent or minimize the

impact of technology on ecosystems and water, air and other environmental resources.

Australia was ready and willing to collaborate with other Member States in the implementation

of regional strategies to prevent further degradation of the environment.

The Secretariat might wish to consider whether it was feasible to draw up a plan of action

for environmental health for the Region as a whole.


Dr ABU BAKAR (Malaysia) welcomed the report and endorsed the goals, objectives and

strategies outlined, which were of great relevance to Malaysia.

Over the next few years Malaysia would be giving priority to traditional areas of

environmental health: community water supply and sanitation in rural and urban areas, and

control of environmental health hazards. The Government had privatized the provision of toxic

and hazardous waste collection, treatment and disposal; the first treatment plant would become

operational in 1994. Similar services for dealing with clinical waste were in the process of

being privatized.

The Ministry of Health was currently collaborating with the Environmental Health Centre

in Kuala Lumpur in developing a national contingency response plan to cope with accidents or

pollution of public water supply sources.

One of the new areas of importance was the assessment of the impact of development on

health. It was now mandatory in Malaysia for an environmental impact assessment to be carried

out prior to the implementation of any significant project. However, there was a need to

include a health component in such exercises in a meaningful way. There was also a need to

improve databases for environmental monitoring and disease surveillance and the relevant

parameters and indicators.

Malaysia's current drinking-water quality surveillance programme was based on the 1988

WHO guidelines. A review of the programme would be undertaken following publication of the

new WHO guidelines later in 1993. In order to strengthen the response mechanisms within the

programme and to ensure a reduction in violation rates, a quality assurance programme using

specific indicators had been initiated which focused attention on systems with poorer

performance using specific indicators.

Malaysia was also giving priority to the control of motor vehicle emissions, indoor air

quality and urban environmental health and to human resources development for public health

engineers, health officers and health inspectors.

Dr CLARO (Portugal) endorsed the regional strategy on health and environment and the

priority areas outlined in the report.

Macao was highly urbanized with one of the highest population densities in the world.

Furthermore, it was located in the Pearl River delta, an area of rapid industrialization. There

was an urgent need to assess the health impact of the latter and it was hoped that a long.term


comprehensive environmental health plan could be developed with support from the

Environmental Health Centre and in close collaboration with China and Hong Kong.

Air pollution control, particularly motor vehicle emission control was of high priority.

An air quality monitoring programme had been developed since 1988. Data collected showed

that air quality was deteriorating.

Drinking water quality, assessed under EC standards using WHO recommended

methodology, was considered good but the estuarine waters surrounding Macao were becoming

heavily polluted. Macao was grateful for the support received from the Environmental Health

Centre in undertaking a review of the situation. Construction of a wastewater treatment plant

had started. The British Council had sponsored an international workshop on the development

of strategies for pollution control in the Pearl River delta, with European Commission support,

which had been held in Guangdong, Hong Kong and Macao in February 1993. The three

parties had subsequently organized a working group to develop a joint action plan for the area.

Food safety was of importance. particularly in view of the high level of tourism and the

many restaurants and street food vendors in the city. The limited staff were endeavouring to

carry out inspection and food quality surveillance and it was hoped that WHO could provide

support for the training of food inspectors.

Industrial noise control legislation had been published in July 1993 in the Government

Gazette. Scientific knowledge and technical know-how would be needed for its enforcement

and WHO support was requested in that area also.

The complexity of environmental health issues was such that Member States would

require support from the international community. Macao was ready and willing to collaborate

with WHO and other countries in the Region in that area.

Dr KERE (Solomon Islands), commending the report, said the importance given to health

and the environment by Solomon Islands had been reflected in the earlier discussion, during

consideration of item 12 of the agenda, on the selection of countries to be visited, and was also

reflected in the country's current activities for health promotion, a subject to be discussed under

item 18 of the agenda.

Dr TAPA (Tonga) commended the report and recalled that Tonga had started its

collaboration in the area under discussion with UNICEF and WHO in 1958. The programme.

which was still continuing, concentrated on water supplies and sanitation in villages and

schools.


The Government of Australia had assisted Tonga by preparing a 20-year master plan for

the period 1990-2010 for water supply, and implementation was under way.

As the report indicated, environmental health problems had increased both in magnitude

and complexity. Tonga endorsed the regional strategy, and the eight priorities described in the

report, and had noted the future activities outlined.

He urged other Member States, other United Nations agencies and WHO to continue their

support for the implementation of national plans of action within the regional strategy.

Mr UCHIDA (Japan) congratulated the Regional Director on his leadership role in

developing the regional strategy outlined in the report before the Committee.

Japan had supported WHO activities related to the strategy, including the establishment of

the WHO Commission on Health and Environment, WHO's active participation in UNCED and

its preparatory processes, the development of the WHO Global Strategy for Health and

Environment endorsed by the Health Assembly in resolution WHA46.20 and regional meetings

for the preparation of the report before the Committee.

Implementation of the global strategy at the regional and country level was extremely

important. He endorsed the emphasis on networking more effectively among organizations, as

outlined in section 3 of the report, and the need to set priorities.

Japan was interested in the outcome of the activities outlined in connection with assessing

the impact of environmental health and wished to use that information in implementing its

overseas projects for solid waste and treatment disposal. It was hoped that Japan's experience

would be taken into account and reflected in the environmental health impact guideline to be

elaborated.

His Government had participated in the preparation of the new WHO guidelines on

drinking-water quality to be published shortly. Japan would be implementing revised national

standards based on the new guidelines later in 1993 and would be happy to support WHO in

promoting the guidelines in the Region.

The inclusion of safety of chemicals and toxic and hazardous wastes as a priority activity

(section 4.7 of the report) was an important element of the global strategy and Agenda 21, as

'shown by the endorsement of the expansion of IPCS. He urged the Secretariat to develop

project proposals on chemical safety and relevant human resources to be funded from UNDP's

Capacity 21 progranune. Such projects should make more effective use of IPCS information.


The REGIONAL DIRECTOR welcomed the valuable and constructive comments made

by representatives.

In relation to the comments made by the representatives of Australia and the United States

of America, he said that the report outlined a general strategy. The next step was to elaborate

the strategy further. The Secretariat had started by identifying the specific environmental

concerns most relevant to each Member State; the most common were covered by the priority

activities outlined in the report. The aim was to draw up a profile for each country as a basis

for the development, in collaboration with Member States, of national plans of action.

In reply to the representative of Cook Islands he said that activities for World Health

Day, 7 April, were frequently extended beyond the day itself, as determined by Member States

themselves. The United Nations agency with responsibility for environmental matters, UNEP,

had now designated 5 June as World Environment Day. WHO was willing to collaborate in

health-related activities associated with that day.

The representatives of Malaysia and Japan had referred to the revised WHO guidelines on

drinking-water quality to be published by headquarters shortly. A final draft was available in

the Secretariat for consultation by interested Member States prior to the official publication.

Collaboration based on the revised guidelines was already being provided, for example in Fiji,

for the revision of national legislation on water quality.

Japan had expressed interest in collaboration with WHO and would be invited to

participate in a meeting on environmental impact assessment, to be held at the Environmental

Health Centre in November 1993.

Following UNCED, UNDP had developed the Capacity 21 project for implementation of

the plan of action of Agenda 21, with a proposed budget of some US$ 5 billion. Contributions

totalling some US$ 1.2 billion had been received so far. He had discussed with the Executive

Director of the environmental health programme at WHO headquarters the need to approach

UNDP to ensure that at least 10% of that large sum would be devoted to health-related projects

coordinated by WHO. He urged health officials in Member States to pressure their counterparts

in the environmental field in that regard. WHO and Member States should work together to

mobilize the necessary resources.



3. WHO RESPONSE TO GLOBAL CHANGE: REPORT OF THE EXECUTIVE BOARD

WORKING GROUP: Item 21 of the Agenda (Documents WPRlRC44/18 and Add.l)

The CHAIRMAN invited the Regional Director to introduce the item.

The REGIONAL DIRECTOR said that, at the eighty-ninth session of the Executive

Board in January 1992, much of the discussion had focused on the profound political, economic

and social changes that were affecting the world, and the fact that WHO must respond to such

changes in new and more practicable ways if it was to remain effective in international health

work. Based on those discussions, it had been proposed that the Board should consider setting

up a small sub-committee to take a broad look, in cooperation with the Secretariat, at the

Organization and the leadership it should provide in a changing world; the Director-General's

new health policy orientations; and the Ninth General Programme of Work.

In so doing, it had been suggested that the Board should take into account the roles of and

relationships between United Nations agencies, nongovernmental organizations, Member States

and others. It had also been proposed that particular emphasis be given to scrutinizing

management and organization, and priorities.

Based on those suggestions and subsequent discussion, the Board had decided to convene

a working group on the WHO response to global change. The group had been instructed to

make preliminary recommendations to the Board's Programme Committee in August 1992 and,

through it, to submit final recommendations to the Board at its ninety-first session in January

1993, regarding the Organization's structure, role and mission; its coordinating role with other

agencies and organizations; the orientation and preparation of the Ninth General Programme of

Work; and the technical quality of programmes.

A preparatory group had been set up by the Board to refine the general terms of reference

and to develop a work plan for the working group. The Working Group itself had been formed

by the Board at its ninetieth session in May 1992, and had subsequently met three times in 1992

and twice in 1993. The final report of the Working Group, before the Committee (Annex 1 to

document WPRlRC44/l8) had been submitted to the Board at its ninety-second session, after

discussion at the Forty-sixth Health Assembly in May 1993.

The report of the Working Group on the WHO Response to Global Change clearly

reflected the fact that profound changes - political, economic and social - were affecting the

world, and that WHO must respond to them in order to remain effective in international health

work.


The report reviewed the Organization's structure and approach. It highlighted the major

issues to be confronted if effectiveness and efficiency were to be improved. Unfortunately, the

specific aspects of how to deal with those major issues were not mentioned, nor the source of

the additional resources that would be required to bring about "profound change". The report

also hardly mentioned the role of regions - an area that the Committee would surely wish to

consider carefully. It was not his intention to impose views on the Regional Committee, but he

had wondered whether the omission was a signal to Member States to pay careful attention to

the role of the regions, to articulate what that role was, and what resources were needed. The

Director-General, in his statement on the opening day of the session, had been explicit in his

support of a strong role for the regions. It was reassuring to note that the regions were

considered to be "the very substance of that diversity" which was "one of the major assets of the

World Health Organization". The reiteration of the prerogative of the Committee to decide

upon its own method of work and request to be active in the reform process, was a valuable and

timely recognition of the key role that it was to play in shaping the relevance of WHO structures

and programmes to the needs of Member States.

There was great interest in the document and what it might mean for the future of WHO.

The Programme Committee of the Executive Board had spent considerable time at its Iuly 1993

meeting focusing on the Director-General's emerging timetable and workplans for

implementation of the Working Group's recommendations; establishing priorities for early

implementation, particularly those related to the work of the Executive Board; and determining

its own appropriate follow-up mechanisms. The results of the Programme Committee's

deliberations had been provided to the Committee as an addendum (document WPRlRC44/18

Add.l) to the background prepared for that agenda item. Essentially, the Programme

Committee had reviewed the recommendations and prioritized them as follows:

recommendations already being implemented;

recommendations on which a report would be presented at the Executive Board in

Ianuary 1994; and

recommendations to be implemented during the course of 1994-1995.

The Committee had noted that many recommendations required implementation at country

and regional levels, and strongly endorsed the proposal that the recommendations of the

Working Group should be reviewed by the regional committees with their views being reported

to the Executive Board at its ninety-third session in January 1994.


The Secretariat had thoroughly reviewed the report of the Working Group in preparing

the background paper before the Conunittee. While it had tried to indicate which areas might

be of greater concern to the Region, that was in no way intended to unduly influence the

Conunittee's discussions and he hoped that representatives would see fit to examine the report

carefully and discuss its implications for the Region. \

Although it might be said that, in one way or another, almost all of the Working Group's

report had significant implications for the regions, 33 of the 47 recommended "Executive Board

actions" were in areas directly requiring response by the Western Pacific Region. Of those 33

actions, 17 involved issues currently being actively addressed by the Region, some of which

had more significant regional implications than others.

As an example, with respect to the action which requested the Director-General to analyse

and define specific objectives and operational targets for the year 2000, the Secretariat was

already in the process of doing that in programmes dealing with the reduction in maternal

mortality; the eradication of poliomyelitis; the elimination of leprosy as a public health

problem; malaria control; and environmental health. Another recommended "Board actiop"

focused on influencing other United Nations and external support agencies to include and

support the consideration of health as an integral component of development. Over the past

year or so, the Secretariat had been quite active with the Asian Development Bank, the World

Bank, UNDP, Rotary International and several other bilateral external support agencies in

successfully developing collaborative initiatives. Good results had been achieved.

Without seeking to prejudice or limit discussions in any way, he wished briefly to

highlight a few additional issues considered to be very significant from the Secretariat's

perspective.

Section 3 of the report, "WHO - Present Organization and Operation". pertinently pointed

out that WHO must maintain health sector leadership, but did not indicate how that should be

achieved. It highlighted the need to improve the competence, proficiency and capacity of staff

and advisers but did not address the question of the resources required to bring that about.

Financial constraints were noted only in the context of extrabudgetary resources. The section

also introduced the problem of the "seven WHOs" - headquarters and the six regional offices. It

appropriately noted that WHO must avoid compartmentalization and fragmentation between

headquarters, regions and countries. None the less, he observed that the Region still felt itself

to be an integral part of the Organization and that its diversity, which the Director-General

himself recognized, was a strength and a resource.


The WHO regions differed considerably with respect to needs, resources, and

approaches. There were three issues that were of immediate importance to the Western Pacific

Region.

First, while recognizing that "compartmentalization" could occur, the Western Pacific

Region had worked very hard to diffuse such situations. Where that type of problem existed,

whether at the leadership or technical operations level, it tended to be attributable to the

personalities involved rather than to the organizational structure. In the Region, that problem

had been dealt with in programmes such as AIDS, environmental health, immunization,

information systems, and malaria. With respect to the Working Group report's specific

reference to information systems, the Region's experience was proving instructive to other

regions.

Secondly, the Western Pacific Region had, for the most part, been able to harmonize

policy and budgetary considerations among the groups mentioned, particularly over the last few

years. Considerable efforts had been made to ensure consistency between budget allocation and

the specification of priority programme areas.

Thirdly, with reference to what the report described as a financial drain on regular budget

programmes which must subsidize extrabudgetary administrative activities, until WHO started

to operate on a competitive basis, as for instance, with the private sector, it was in no position

to request full administrative support cost recovery on a percentage basis from extrabudgetary

donors. A more realistic approach that built WHO's actual support and implementation costs

into programmes was more pragmatic. Indeed, given the fact that no real increase in regular

budget funding could be anticipated, it was essential.

A larger question, not stated explicitly in the report, but clearly reflected in what was

written, concerned de-emphasizing the role of regional offices and equipping headquarters to

deal more directly with a strengthened country representative.

That unspoken question shaped a great deal of the report. Though it might sound

reasonable in theory, with the added allure of sounding cost-effective, he considered such a step

would not, ultimately, be realistic. Headquarters' current understanding of regional and

national problems was insufficient. That lack could not be met simply by reviewing mission

reports and making two-week visits to the field. On the other hand, he fully understood and

accepted that, at the regional level, the Organization must improve its operations and


effectiveness. In that context, the Committee might wish to raise the questions: Had the Region

and the regional Secretariat done a good job? Could WHO be more responsive to country needs

in the Region if the countries and areas were managed from headquarters?

Subsection 4.2, Governing Bodies, concerned the World Health Assembly, the Executive

Board, and the regional committees. The temptation would be for regional committees to focus

only on the subsection devoted directly to them. He recommended that representatives be

guided by the issues raised in the subsections on the World Health Assembly and the Executive

Board in examining their own methods of work. Many of the issues, such as consideration of

the cost implications, time-limits and reporting associated with resolutions, were equally

relevant at the regional level. In carrying out that examination, the Regional Committee might

wish to prioritize its activities like the Programme Committee of the Executive Board, and use

the Sub-Committee on Programmes and Technical Cooperation in assessing selected issues. A

careful consideration of a revised set of terms of reference for the Sub-Committee would be

needed, to ensure that that body was clearly directed for that very important task.

The areas of special attention in Subsection 4.4, "Regional Offices", had been considered

quite appropriate by the regional Secretariat: staffing needs and patterns (using the most

appropriate level of technical staft); technical consultants (expansion of the population from

which to choose); and communications and collaboration (using modern technology and

avoiding duplication of effort among agencies, particularly United Nations agencies). However,

the absence in that section of the report (perhaps more than in any other) of any reference to the

increased financial resources required to bring about the necessary changes, was a matter for

concern, which must be addressed from a regional perspective in some fashion. For example,

by keeping consulting fees at a relatively low level, compared with other external support

agencies, the pool of available consultants from which a choice could be made would be

reduced. That implied that, at times, the Secretariat might have to be more responsive to a

consultant's availability and perhaps less responsive to a country's needs with respect to the

timing of the implementation of a particular activity. He urged representatives to consider that

type of issue, and to confront the long-term implications squarely.

Subsection 4.5, "Country offices (WHO Representatives)", highlighted an area in which

there was general agreement, namely, the need to strengthen the office of the WHO

Representative and, for that matter, in the Region, the Country Liaison Officer. It

was consistent with the growing trend among external support agencies to try to be more

responsive to country needs by taking informed, substantive decisions at the country level.

Related to that idea was the need for increased delegation of authority and an emphasis on


resolving intersectoral and interagency coordination issues at the country level rather than at

disparate organization headquarters levels. A review of the profile of skills and qualifications

required of highly qualified country representatives (WRs) was suggested. Such a review, if

carried out thoroughly, could go a long way toward helping ensure the selection of WRs who

were better equipped to deal effectively with the wide range of issues related to health.

Those issues and the many others raised in the Working Group's report reflected a spirit

of enquiry that was to be applauded and endorsed. Radical change was being considered, and

many aspects of the Organization had been opened to question and review. It was essential that

the Committee be intimately involved in that process, and that its discussion of the issues should

reflect a clear commitment to that involvement.

He added that the Regional Committee's discussion would be reported in a preliminary

way to the Executive Board's Programme Committee in November 1993 before a final report

was drawn up for submission to the Board itself at its ninety-third session in January 1994.

The CHAIRMAN invited the Committee to discuss the document section by section.

Dr DOl (Japan) commended the Regional Director on the well-prepared documentation,

which presented very clearly the regional implications of the Working Group's report.

Dr Nakamura of Japan had been a member of the Programme Committee of the Executive

Board when it considered in July 1993 the 47 recommendations of the Working Group, which

had been classified according to the recommended priority for action. The Programme

Committee would meet again in November to consider the response to the Working Group's

recommendations, together with the terms of reference for a budget and finance committee

proposed by the Health Assembly in resolution WHA46.35 on budgetary reform.

At the July meeting of the Programme Committee the Regional Director had expressed

his concern about the lack of specific indications for action on the major issues and

the resources that would be required to bring about profound change. Japan agreed with those

expressions of concern; the feasibility of the Working Group's report in regional terms must be

seriously considered, as must the question of how action for change was to be financed.

Dr ADAMS (Australia) said that he felt it was no exaggeration to state that WHO's future

was at stake. Thus far people's expectations of WHO had been met, but now other

organizations were waiting to take its place if it was found wanting. If pride in being associated

with WHO was to be upheld, it would be necessary to ensure that WHO remained vibrantly


active as the supreme organization for health in the world, responsive to changing priorities,

flexible, accountable and open in its administration. It must concentrate on results.

The role of headquarters and regional offices must, in particular, be clarified, with proper

devolution of responsibilities; the administrative and financial aspects of some special

programmes seemed thus far to have passed the regions by.

Attention should be given to the terms of appointment of the Director-General and

regional directors: Australia would favour a limit of two terms of office and the use of search

committees for candidates, which had proved effective in the appointment of the Director of

International Agency for Research on Cancer.

The means of designation of collaborating centres should be examined critically, and

methods for increasing the pool of consultants available for work with WHO should be

considered as the Regional Director had suggested.

It would be hard to finalize pragmatic recommendations in the short time remaining for

the Regional Committee; he suggested that the Subcommittee on Programmes and Technical

Cooperation might be called upon to help with that task in a special session during the next few

weeks.

Dr LI Shichuo (China) regarded the item as a particularly important one. The world was

undergoing profound political, economic, social changes as well as changes in science and

technology, including health. In response to those changes, many countries, including those in

the United Nations system, were preparing and implementing reform. Although the approaches

were different, encouraging results had been achieved in varying degrees. Reform was the trend

of the times - a healthy trend in the process of world development.

WHO had set up a Working Group on the WHO Response to Global Change in 1992.

The initiative had been a good one and the work done was outstanding. The Executive Board

member from China had participated actively in the Working Group. The cooperation of the

Director-General and the regional directors, Assistant Directors-General and the staff of the

WHO secretariat had been crucial to its work. The World Health Assembly had made positive

comments.

The report of the Working Group touched upon many major issues relating to WHO's

reform, and some suggestions were constructive and feasible. None the less. because of the

complexity and difficulty of the task, the varied conditions in each region and country. and the

limited size of the Working Group, it had not been possible to make recommendations which


applied specifically to each country and region. Some needed to be further discussed.

However, this was an important starting point for WHO's reform and it reflected the conunon

aspiration of Member States for more effecti\'e work by WHO.

He felt decentralization would be the general trend of reform. Headquarters, regional

offices and Member States were irreplaceable; their roles should be coordinated and

strengthened. It was gratifying to note that WHO had already started its reform. The Regional

Office's working efficiency had been spoken of highly by the Member States. As part of the

process of reform, more studies should be carried out on such subjects as improvement within

the Region, how to do better and more efficient work and how to maintain the high profile. He

noted with satisfaction that the Regional Office secretariat had made a sununary of the regional

implications of the report by the Working Group with objective and feasible conunents on each

of the 47 reconunendations of the Executive Board. The Chinese delegation hoped that with the

concerted efforts of the Regional Office and Member States, the reform in the Region could be

carried out firmly and practically.

Mr BUNE (Fiji) said that his delegation had studied the Report of the Executive Board

Working Group with great interest. He believed that reform of the structure and organization of

WHO in response to the profound changes taking place was long overdue. He suggested that

the Regional Conunittee should review its own method of work and effectiveness. The

Sub-Conunittee on Progranunes and Technical Cooperation might be requested to carry out such

a review on behalf of the Conunittee.

With regard to reconunendation (1) on the adequacy of regular budget funding levels

(document WPRlRC44I1S, page 15), he endorsed the zero-based budgeting approach as a way

to ensure that the Organization operated within its means. He similarly supported

reconunendations (2) to (5). He fully endorsed reconunendation (6) relating to the functions and

operations of WHO Representatives. Choice of WHO Representatives was a crucial matter, and

the process of selecting officials with the most appropriate skills and qualifications should be

thoroughly examined, together with opportunities for their training and career advancement.

There should be further delegation of powers from headquarters to regional offices, and from

regional offices to WHO Representatives - a particularly important matter for the scattered

islands in the Pacific ..

Referring to the nomination and terms of office of the Director-General and the regional

directors, he stressed that health development called for perseverance and continuity. It was

based on building up cooperative relations. Frequent changes of the chief executives would

cause discontinuity and disruption. However, accountability to Member States was important,


so there had to be some flexibility in the duration of tenus of office. Two or three tenus of five

years might be an appropriate length of ser.vice for the Director-General and the regional

directors.

He firmly believed that the momentum to achieve health for all by the year 2000 must be

maintained, a prerequisite being continuity and stability of the regional offices, their

administrative structure, and programming capabilities.

Mr LOVELACE (New Zealand) recognized that the report offered an outstanding

opponunity for WHO to build upon past success and ensure its continuing leadership

in international health work. He strongly supported the report's emphasis on greater clarity and

well-defined goals, increased accountability of WHO structures, and better coordination of

global and regional initiatives. He endorsed the suggestion that the report should be reviewed

by a sub-committee of the Regional Committee.

Ms BLACKWOOD (United States of America) expressed her support for the refonus

outlined in the report of the Working Group, which would help WHO to respond

more effectively and efficiently to change. Implementation of the recommendations would help

to assure WHO's leadership in international health work. The regional offices should playa

key role in refonus and undertake the changes needed to ensure that WHO functioned as one

body throughout the world. She urged the Regional Director to request headquaners to start the

reform process, and to give full attention to implementing the recommendations in the Region.

Dr Dong-Mo RHIE (Republic of Korea), commended the report and its excellent analysis

of the regional implications. He supported the rationale behind a working group to examine

response to change. Human beings survived by adapting to change; so should the Organization.

However, changes should be made smoothly so as to maintain the continuity of health work.

Dr NGO V AN HOP (Viet Nam), referring to the Report of the Executive Board Working

Group (document WPRlRC44/18, Annex I), submitted a number of suggestions. With regard

to the method of work of the Health Assembly (paragraph 4.2.1.2) he believed that the duration

of the Assembly could be reduced to one week in non-budget years and to nine days in budget

years by improving the quality of the general debate. Discussion could concentrate on specific

points communicated to the participants beforehand. Each country could send in advance a

report on its state of health for distribution to participants instead of presenting them in the

general debate.


Concerning the nomination and terms of office of the Director-General and regional

directors (paragraph 4.2.2.4), continuity was important for the successful work of the regional

directors. Two, or exceptionally three, terms of office were appropriate.

On the topic of communications and collaboration (paragraph 4.4.3), where the regions

had a specific area of interest, malaria for example, headquarters should devolve responsibility

for that area to the Region.

He favoured strengthening the office of the WHO Representative in the countries

(paragraph 4.5), suggesting that the post of administrative officer should be filled by local staff.

Nationals would be more familiar with their country's administrative procedures and their

salaries would be lower than those of international staff. This would be a saving.

Mr DURAND-DROUHlN (France) said that his Government considered it absolutely

necessary for WHO to adapt rapidly to the major changes taking place. The Executive Board

Working Group on the WHO Response to Global Change had done stimulating work. He was

satisfied with the report and felt that the recommendations should be followed up.

In order to improve WHO's efficiency in health work, the Organization should aim for

greater transparency in budgetary and financial matters and in the functioning of the

Organization. Better coordination of activities both within the United Nations system and with

other partners in the international community was also desirable, as his delegation had made

clear during the meeting of the Regional Committee for Europe in Athens. Problems that arose

had to be solved. so that WHO could maintain its credibility and means of action as leader in

health and health policy.

Regional offices and the regional committees had a significant role to play. Since WHO

was a single b04y difficulties could only be overcome by involving all in it. The Regional

Committee had a responsibility in that process; it therefore had to be rigorous.

He endorsed the suggestion that a review of the method of work of the Regional

Committee should be placed on the agenda of its forty-fifth session in 1994. In order to

improve the efficiency of WHO in the Region, that review should cover the progress of reform

as it related to the Region. In particular, it should look at the nomination and terms of office of

the Regional Director, personnel matters, and the role and responsibilities of WHO

Representatives.


Dr MILAN (Philippines) expressed her appreciation of the Executive Board's initiative to

examine WHO's response to change. Such an initiative ensured that the Organization would

adapt to new realities. Given the importance of the subject each issue should be carefully

studied. For example, what was actually obtaining in the Region and in Member States? What

action did the Committee wish to take? What were the cost implications of that action? She felt

that the time allowed was insufficient to deal with matters thoroughly, and therefore endorsed

the suggestion that a sub-committee should deal with each question systematically.

In general teons she agreed with the analysis, conclusions and recommendations

presented in the report.

Dr TAPA (Tonga) pointed out that WHO's Constitution contained a chapter on regional

arrangements which specifically concerned the Regional Committee, the Regional Office and the

offices of WHO Representatives. The Committee should bear that in mind. His Government

had views on the regional implications of the Working Group's report, but in order to do justice

to the task in hand, he agreed with other speakers that the report should be reviewed by another

body. Time constraints prevented the Committee from examining the list of implications

contained in Annex 4 of the report, such as those stemming from the proposal to use search

committees for the nomination of Regional Directors. Since the Committee had just nominated

the Regional Director, who would be in office for five years, was there a need to give an

opinion on a search committee immediately? He felt that that could be done during the next

four years. There had been no complaints about the method of nominating the previous four

Regional Directors. If a search committee were to be set up, how would the members be

selected? What factors might influence them? There were two sides to most questions, and the

Committee would not be able to examine all aspects thoroughly.

He fully supported the suggestion that a sub-committee of the Regional Committee should

examine the report, and would trust its collective wisdom. The Committee was required to

report to the Executive Board in four months' time, but it had more important matters to deal

with, directly connected with its constitutional authority. It should take its time, study the

report carefully, and report at a later date.

Mr WAENA (Solomon Islands) fully endorsed the views of the previous speaker.

Because of the far-reaching implications of the proposals contained in the Working Group's

report, particularly for small island States, he was not in a position to surmise the position of

his Government. It would wish to consider those implications closely. Governments should be

given the opportunity to reflect upon the issues raised in the report and present their views later,


possibly at the Regional Committee in 1994, when they would be able to make a meaningful

contribution.

The REGIONAL DIRECTOR, noting the suggestion that the Working Group's report

should be reviewed by a sub-committee, pointed out that the Committee would have to consider

the timeframe for reporting back to the Executive Board. An initial report was required by

November, to be completed by January 1994. If a sub-committee were to review the regional

implications, it would have to submit its conclusions to the Regional Committee, unless those

were accepted a priori. Some representatives had expressed their difficulty in giving concrete

and detailed views at the current session. If the Committee felt that it should report at a later

date, that opinion should be transmitted to the Executive Board. Possibly the Executive Board

had wished to see changes put into effect rapidly. On his side he assured the Committee that

any recommendation considered to be constructive would be implemented without delay. As he

had mentioned, he had already started to take action on the 17 areas which had more relevant

implications for the Region and would pursue that course vigorously.

The meeting rose at noon.

SUMMARY RECORD OF THE EIGHTH MEETING

WHO Conference Hall, Manila Thursday, 16 September 1993 at 2.30 p.m.


CONTENTS

1. WHO Response to Global Change: Report of the Executive Board

(wpRlRC44/SRl8)

Working Group (continued) ................................................................... 236

- 235 -


1. WHO RESPONSE TO GLOBAL CHANGE: REPORT OF THE EXECUTIVE BOARD

WORKING GROUP: Item 21 of the Agenda (Documents WPRJRC44/18 and Add. 1)

(continued from the seventh meeting, section 3)

Dr SCHUSTER (Samoa) endorsed the opinions expressed by other representatives. He

asked for clarification on the timing of the Regional Committee's report to the Executive Board:

must the report be prepared at the present session, or could it be finalized at the forty-fifth

session?

The REGIONAL DIRECTOR replied that if the matter was delegated to a sub-committee

with instructions to report back to the Regional Committee in 1994, the report would not reach

the Executive Board until January 1995. Alternatively, the sub-committee could be delegated

full authority to submit the report on behalf of the Regional Committee. The five other regional

committees were likely to submit their views to the Programme Committee of the Executive

Board in November, and he felt it was important that the Region should not lag behind in

presenting its own views. He suggested that the Regional Committee should endeavour to reach

a consensus on a number of major issues at its present session. Its standpoint on those issues

could be submitted as a preliminary measure to the Programme Committee of the Executive

Board in November. A sub-committee could also be set up to look into the regional

implications of the proposed Executive Board actions more thoroughly and report to the

Regional Committee in 1994. The whole, detailed reaction of the Regional Committee could

then be given to the Executive Board in January 1995.

Dr TAPA (Tonga) said he felt the recommendations contained in section 6. of document

WPRJRC44/18 could be transmitted to the Executive Board as the preliminary views of the

Regional Committee, but not necessarily as its final standpoint. He believed that the

Sub-Committee on Programmes and Technical Cooperation should be mandated to conduct a

detailed analysis and make recommendations so that the Committee could then decide on its

definitive standpoint in 1994 and forward its decisions in 1995.

Mr WAENA (Solomon Islands) endorsed the views of the representative of Tonga.

Mr LOVELACE (New Zealand), Professor NGUYEN TRONG NHAN (Viet Nam),

Dr RASMY (Lao People's Democratic Republic), Mr DURAND-DROUHIN (France) and

Dr TAPA (Tonga) expressed support for the Regional Director's suggestion.

SUMMARY RECORD OF THE EIGHTH MEETING 237

Ms BLACKWOOD (United States of America) urged the Regional Committee to support

the option of a search committee, put forware in section 4.2.2.4 of the report of the Executive

Board Working Group, as a method for obtaining nominations for the posts of Director-General

and regional director. Now would be a good time to introduce such a policy as it could not

imply criticism of anyone currently in office.

Dr DOl (Japan) asked for clarification of the purpose of this proposal. He could see no

defect in the present system. He seconded the proposal of the representative of Tonga.

Mr LOVELACE (New Zealand) noted that section 4.2.1.1 was strongly supported by his

country. Concerning item 4.2.2, he would echo the comments of the representatives of the

United States of America and Australia. He emphasized that the requirement to maintain a

strong and effective regional committee and regional office should be an essential component of

the initial response.

Mr DURAND-DROUHIN (France) said it was important that the Regional Committee's

report to the Executive Board should contain its carefully considered views on the, method of

work of the regional committees and on coordination with the United Nations and other

agencies.

Mr LOVELACE (New Zealand) supported the comments made by the representative of

France.

Dr TAPA (Tonga) pointed out that, in accordance with Article 49 of the Constitution of

WHO, the Regional Committee had adopted its own Rules of Procedure, which set out the

arrangements for nomination of the Regional Director. The proposed change in the nomination

process would oblige the Committee to amend its Rules of Procedure.

The REGIONAL DIRECTOR summarized the areas in which consensus was apparently

being reached, namely, the decentralization of authority to the regional office, the method of

work to be considered by the sub-committee; the strengthening of the office of the WHO

representative; and the coordination of health resources, He noted that the only area where the

representatives were not in accord was on the issue of the nomination and terms of office of the

Director-General and regional directors.

Mr HENRY (Cook Islands) agreed with the comments of the representatives of Japan and

Tonga on the nomination process, and insisted that the Region should maintain its own

procedures which had worked well.


Dr LI Shichuo (China) expressed agreement with the Regional Director's suggestion.

The issue of nominations for the posts of Director-General and regional directors required

careful study. He was in full agreement with the summary of the points of consensus made by

the Regional Director.

Dr ADAMS (Australia) agreed with the previous remark of the representative of China.

He explained, as an example, that a search committee could look for about 12 candidates and

submit its views and recommendations to the Regional Committee. It was essential that the

most important health posts in the world should be filled by the right people.

Mr LOVELACE (New Zealand) pointed out that the idea of a search committee had been

put forward in the Working Group report as only one of several options to be considered, not as

a specific proposal.

Mr WAENA (Solomon Islands) urged representatives to reach consensus on the issues

and suggested that the Committee defer discussion on more difficult or substantial issues. He

agreed with the representative of Japan on the nomination issue.

Dr TAPA (Tonga) said that if the Committee was unable to reach consensus on a

particular issue, it should state that to the Executive Board.

Mr BUNE (Fiji) wondered whether the Executive Board would be prepared to wait until

the Regional Committee reached a consensus before taking a decision.

Dr TAPA (Tonga) suggested that, since the Executive Board had asked for the views of

regional committees, the Regional Committee for the Western Pacific should report on those

aspects of the Working Group's recommendations on which it reached consensus and should

also report the diverse views expressed on other points that required further study.

It was so agreed.

The REGIONAL DIRECTOR, taking the comments in the order in which they had been

made, summarized the various views presented as follows:

All representatives accepted the need for reform and approved the spirit in which the

Working Group had made its report. However, the manner and means of implementation of

recommendations for action required thorough review, which the Regional Committee entrusted

to its Sub-Committee on Programmes and Technical Cooperation for final decision by the

Regional Committee itself.


The Regional Committee had expressed consensus on the need for clarification of the

respective roles and responsibilities at different levels of the Organization, at headquarters,

regional office and WHO Representative offices. In addition, it was generally agreed that

proper delegation of authority to the regional and country level was an important consideration

for the future. The WHO Representatives' offices in particular should be strengthened.

In order for WHO to properly exercise leadership in international health, its structure

should be strengthened by reorganization, better staffing with more highly qualified personnel

recruited from a larger pool of international experts, and greater utilization of institutions and

centres of excellence, such as the WHO collaborating centres.

Support had been expressed for the concept of "zero-based budgeting", but with more

efficient use of the resources available to WHO.

The role and method of work of the Regional Committee was one of the subjects to be

referred to the Sub-Committee.

Concerning the method of selection of the Director-General and regional directors, the

Regional Committee, after long and serious debate, had not reached any clear consensus. It had

therefore referred the matter to the Sub-Committee which would in turn report to the Regional

Committee. The Committee would then submit its findings to the Executive Board in 1995.

The recommendation of the Working Group on prior review of resolutions proposed to

the Executive Board and Health Assembly had been found acceptable.

Drawing attention to the table in Annex 4 to document WPRlRC44/18, he proposed that a

further column be added in which the Regional Committee's preliminary views would be

incorporated to form part of the report to the session of the Programme Committee of the

Executive Board in November 1993.

In reply to Dr TAPA (Tonga) be confirmed that the revised table containing these

preliminary views and the summary record of the debate would be forwarded to headquarters

for submission to the governing bodies. They would also be sent to the representatives for their

information, together with the Report of the Regional Committee.

It was so agreed.

The Chairman asked the Rapporteurs to prepare an appropriate resolution.

(WPRIRC44/SRl8, continued)

SUMMARY RECORD OF THE EIGHTH MEETING (continued)

WHO Conference Hall. Manila Thursday. 16 SqJtember 1993 at 4.10 p.m.

. . CHAIRMAN: Mr S. Naivalu (Fiji)

CONTENTS

1. Health promotion ."."".".""" .. """ .. """""""." ....... "",,",,.,, ..... ,,........ 242

2. Tim~ and place ~fthe forty-fifth and forty-sixth sessions ~f the . RegIOnal Comnuttee .. " " " .................................. :. . . . . .. . .. .... .. .. .. . . . . . . . .. . . . . . 250

3. Cholera and diarrhoeal diseases 251 ,

4. Development of health research . ........................................................ \ ... . 256

- 241 -


1. HEALTH PROMOTION: Item 18 of the Agenda (Document WPRJRC44/15)

Introducing document WPRJRC44/15, the REGIONAL DIRECTOR said that, since

health promotion had been recognized in 1989 as a priority area, there had been extensive

collaboration in the Region in the preparation of the programme outline. Reflecting

the knowledge that a wide, multisectoral approach to health and well-being was necessary,

involvement by the Member States had been diverse.

Though the concepts and strategies were wide-ranging, the outlined programme had a

truly regional approach.

The health promotion programme recognized that people needed to take responsibility for

health throughout their lives and make full use of their physical, mental and social capacities.

Health and well-being would be primarily achieved by the people themselves. To enable

individuals to realize improved health status. there must be a supportive environment, both in

the community and in public policy. The development of health-supportive policies which

reduced risks in the physical. economic and social environment required coordinated action by

many sectors. The programme recognized that health problems transcended national frontiers.

that health promotion aimed at equity. and that health was a fundamental factor in development.

The resulting strategies for future action had been formulated at several working groups

and meetings of experts. The meetings had culminated in the WHO Working Group on Health

Promotion Planning in Singapore in March 1993. which had been kindly arranged and chaired

by the Permanent Secretary of Health Dr Kwa Soon Bee. The Working Group had reviewed the

programme outline and stressed the balance between individual, community and government

action as the main strategic component.

By the end of the century the Region would have changed considerably. Its population

would have increased in number and average age. The peoples would be concentrated in larger

cities, striving to maintain some degree of freshness in their environments.

The dominant diseases would be strongly influenced by lifestyles. Those were one of the

targets of WHO's health promotion plans. The disabilities and difficulties of an aging

population could be prevented or at least reduced by simple interventions. People would be

encouraged to develop, as early as possible. healthy behaviour patterns and healthy lifestyles.

That included breast-feeding infants, regular exercise, appropriate dietary patterns, not

smoking, reducing salt intake and so on.


Ways had to be found to be more effective in convincing people to change their habits

and their ways of life, and the context or environment in which they could do it must be

provided. The key role that individual behaviour change played in the prevention of HIV

transmission was already known. The major transmission routes of sexual contact or injecting

drug use were obvious targets for educational activities within the health promotion sphere.

That was just one example of the areas in which the active support of governments and

communities was absolutely essential to enable individuals to lead healthier lives.

The Committee should therefore consider the document very carefully, and consider what

steps might be taken to foster the growth and development of that most essential programme and

policy area.

WHO had outlined its proposal for action. He was convinced that it could prepare

successfully for joint efforts to enable every country, community and person to achieve· better

health and better lives.

Dr DOl (Japan), described a new aspect of health promotion and public health action in

Japan. The cultural aspect was important, he said, and described the emerging "health culture".

Culturally adapted projects were increasingly found in his country, for example, involving

communities in the design of premises for healthy living and other community action for health.

Related projects launched by the Ministry of Health and Welfare were for "comfortable

social life", healthy life promotion and the design of social environments for children, the

handicapped and the elderly, as well as promotion of voluntary work, day care services for the

mentally disabled living at home, and waste reduction and recycling.

The emphasis on health and culture was expected to encourage community action and gain

the support of government, local authorities, and the private sector. It was proposed that health

authorities should contribute to city planning. An international symposium on the subject was

to be held in Kochi City, Japan, in November 1993 and the results would be reported to the

Regional Committee in 1994.

Dr LI Shichuo (China) said that health promotion was an important component of the

health service, and one of the Region's six priorities. The targets for 1995 were noted and had

China's full support; the programme would be stressed in WHO's Ninth General Programme of

Work.

Health promotion was an applied science, not limited to dissemination of information

since it fostered a sense of health. Much could be achieved at little cost, but it must be directed


at influencing the entire life span and involve all sectors. China placed great emphasis on

people's involvement in measures for their own health, and had encouraged "cooperative

mother" groups, for example. Much remained to be done to accommodate the great variations

in conditions of its population in different regions. He urged WHO to develop models for

health promotion in countries and to mobilize the necessary resources.

Dr CHEN Ai Ju (Singapore), commending the Secretariat's initiative in strengthening

health promotion, said that, since the 1960s when her country's effons in that domain were

related mainly to communicable disease prevention and environmental health, the concept had

evolved so that healthy lifestyles were now promoted in a bid to prevent noncommunicable

diseases and change the traditional pattern based on the patient/doctor model.

Over the last ten years the Ministry of Health had conducted campaigns on proper

nutrition and exercise, and non-smoking, as well as stress management. The health education

programme and health policy had political support.

In 1992 a ten-year "healthy lifestyles" project had been launched with annual themes for a

month-long campaign. It relied on multisectoral suppon and community panicipation, with

government voluntary organizations and professional bodies providing skills, training and a

supportive environment. In 1993 the emphasis was on physical activity.

There was also a "trim and fit" scheme for schools, a workplace health promotion

programme, and numerous other initiatives for the elderly, housewives and the general

population, concentrating on healthy living rather than disease. Monality and morbidity

statistics and special surveys were used to monitor the programme and evaluate results.

Political commitment was a key feature.

Dr DURHAM (New Zealand) congratulated the Regional Director on the repon. Her

country's programme was based on the concepts of individual responsibility for health and

collective responsibility for health policy and a supportive environment for healthy choices.

Those concepts should permeate health action and related programmes focusing on the whole

life cycle.

New Zealand's approach, based on a public opinion survey, favoured specific goals in the

promotion of a social and physical environment to protect public health. The activities listed in

section 6 of the document should include a balance of aspects that relied on individual and

collective responsibility. and it was recommended that some specifically regional environmental


approaches be incorporated to complement the "healthy cities" and "healthy schools"

approaches.

Dr REODICA (Philippines) also commended the report, which reflected the Region's

philosophy and action. The Philippines also applied the life-cycle concept of community and

individual action for health, and had much experience with campaigns to mobilize the

population for such causes as immunization and nutrition.

It was recognized that, while "points of service" for health still offered the main

opportunity for health messages, much could now be done with well-directed involvement of the

media.

Mr TEBANIA (Kiribati) said that, since his country had become a Member of WHO the

Government had designated 9 May as National Health Day with the objective of promoting,

strengthening and sustaining the primary health care activities that were implemented

throughout the islands with WHO support. The 1993 National Health Day had included a

keynote address by the President, reiterating the Government's commitment to primary health

care strategies and health-for-all goals through equity, intersectoral cooperation, community

commitment and national self-reliance. The President had also expressed his appreciation of all

the support provided by WHO.

With the aim of increasing public awareness and encouraging the outer islands to compete

with each other, awards for the cleanest and healthiest island, the most active in supporting

primary health care, the most successful health district, the cleanest ward in the Tungaru Central

Hospital and the most active health worker had been presented during the celebrations.

The main island, South Tarawa, provided a large number of sporting facilities which were

well used, indicating the healthy lifestyle activities being pursued there. The April 1992 issue

of the Regional Office magazine "Health and Development" had reported Kiribati health

promotion activities under the heading " A Leap for Health - Kiribati Ministry of

Health Promotes Fitness at the Workplace". With continued support from WHO, Kiribati

would spare no effort to make each of the 33 islands in Kiribati "a healthy island".

Dr CLARO (Portugal) said that, as in other countries or areas in the Region, mortality

and morbidity, particularly from communicable diseases, had declined in Macao and

iife-expectancy was increasing as a result of the improvement in socioeconomic status and

well-being. The infant mortality rate had dropped to 7.5 per 1000 live births. However,

lifestyle-related diseases were increasing and cardiovascular disease had become the principal


cause of death. To meet the new challenges the Government had started a number of health

promotion activities through health education, environmental measures, community and

organization development, nutrition and regulatory activities, aimed at changing individual

behaviour, community, society, the environment and the health systems.

Health education was a core component of health promotion and various educational

activities had been organized for specific population groups. A community-based diabetes

control programme had been developed which included education regarding diabetes and its

control.

Environmental measures had been taken, as outlined earlier during discussion of item 16

of the agenda.

Community and organization involvement was important for the success of health

promotion and Macao had implemented several measures in that regard.

Current increases in the availability of a wide variety of food and reduction in physical

exercise could lead to poor nutrition because of inadequate or incorrect food choices and poor

physical fitness. Nutrition education was promoted by health professionals in health centres,

schools and neighbourhoods.

Health promotion activities were relatively new in Macao and it was hoped that

collaboration with WHO and other Member States would be strengthened, particularly in the

areas of training and information exchange.

Dr MONT A VILLE (France) said that health promotion was an important matter

involving a balance between behavioural patterns and responsibilities at the individual and

collective level, which in some areas could be difficult to achieve. The report referred to a

number of activities such as nutrition, AIDS, lifestyle-related diseases and the Healthy Cities

concept, which France supported. While interventions aimed at adults were needed, it was

perhaps more cost-effective to focus on children and adolescents in an educational setting.

Health research was needed in the area of health promotion to determine the best ways of

achieving sustainable and effective lifestyle changes. WHO collaborating centres might be

useful in that regard.

Dr LIN (United States of America) welcomed the report, commended the

activities undertaken by the Secretariat and endorsed the actions proposed. Health protection

required the exercise of individual and shared responsibilities. The achievement of an

appropriate agenda depended heavily on changes in individual attitudes and behaviour.


However, it also required national and local approaches through legislation, regulations and

social sanctions to achieve healthier places in which to live, and effective disease prevention.

Finally, it required the health sector to take the initiative in securing intersectoral commitment

and the support of other components of government in championing health promotion and

healthier lifestyles. It was time for the health sector to convince other sectors of the long-term

benefits of health promotion to their own sectors. Expenditures on childhood vaccines would

result in the eventual eradication of the respective diseases and their disabling legacies, thus

reducing subsequent expenditure on treatment and rehabilitation. The health sector could not

succeed alone; intersectoral education and cooperation were essential.

For example, at its forty-ninth session, the Economic and Social Commission for Asia

and the Pacific (ESCAP) had adopted a resolution sponsored by the United States of America on

health promotion and protection. Although the session had focused on economic and social

development, Member States had supported the concept of health promotion in relation to the

eradication of poliomyelitis, education on and prevention of HIV infection and AIDS, and

reduction of unhealthy activities such as the use of tobacco, alcohol and illicit drugs. They had

understood their individual responsibilities to themselves, their families and their communities

and had recognized the future economic gains to their respective countries in releasing resources

previously required for treatment and rehabilitation. The resolution invited WHO to present a

paper on the eradication of preventable diseases at the 1994 ESCAP Ministerial Conference in

preparation for the World Summit for Social Development.

The United States of America was fully committed to the health promotion programme in

the Region.

Dr ABU BAKAR (Malaysia) commended the report and supported the action plan

proposed. Malaysia had launched a healthy lifestyles campaign in 1991, concentrating on

healthy diet and food safety, which had been well received by the public. The enthusiasm

generated was most encouraging. The campaign was part of the Government's approach to

improving the quality of the family and promoting a caring society. Malaysia was currently

considering how to set targets related to behaviour change and requested WHO's collaboration.

Mr CAPELLE (Republic of the Marshall Islands) said that the Republic of the Marshall

Islands strongly supported regional efforts in the area of health promotion.

While the process of development brought obvious benefits, the resulting changes in

patterns of choices and lifestyles could have a negative impact on health that was only just being


recognized by the people. The consequences were especially critical for the young, who made

up the major part of the population. His country recognized the urgency of addressing that

issue.

It was important to target health promotion activities at that age group so as to influence

young people in their formative years before lifestyle patterns became established. The

Ministry of Health and Environment was implementing an innovative health promotion strategy

involving young people who were selected to join health education touring groups promoting

healthier lifestyles throughout the country. He expressed appreciation of the resources made

available by WHO.

Mr HENRY (Cook Islands) commended the report. Cook Islands had implemented a

number of health promotion initiatives with the support of WHO aimed at various population

groups. The activities for mothers and babies were centred on the clinics in the public health

service which had been running since 1945, and methodologies were updated every few years.

Youth programmes were implemented in youth clubs, sports clubs and colleges, mainly through

volunteers. With the support of commercial sponsorship, programmes aimed at adults to reduce

smoking, improve diet and encourage family planning were publicized by television, which was

now reaching the outer islands. Access to the elderly was through hospitals or home visits.

The Ministry was making every effort to encourage the involvement and participation of

the community. Centralization of the administration of health promotion was under way and

support was being given to relevant nongovernmental organizations with office accommodation

and equipment. Hospitals and clinics were inspected regularly to ensure a high standard of

hygiene.

It was hoped that health promotion would lead to disease reduction in due course. In the

meantime, there were a number of obstacles to effective treatment, one of which was the

difficulty in procuring essential drugs. During the previous session of the South Pacific Forum,

the Prime Ministers of the smallest states had discussed the need to collaborate so as to achieve

cost benefits through bulk purchasing. Any support in that regard would be greatly appreciated.

Dr Haji HUSSAIN (Brunei Darussalam) commended the Regional Director on his report.

In addition to ensuring equity of health for all in the country, the national health policy

drawn up by his Ministry of Health called for the intensification of programmes to support and


promote a cleaner environment and the adoption of healthy lifestyles. Health promotion

activities had been actively pursued in recent years.

Health promotion in Brunei Darussalam relied heavily on the primary health care concept

and collaboration with other ministries and nongov~rnmental organizations to support

programme activities. Other ministries and nongovernmental agencies also conducted health

promotion programmes from time to time, often in coru;ultation with the Ministry of Health.

Brunei Darussalam was a Malay Muslim State and health promotion strategies called for

respect for the natural, social and cultural structure of the targeted population. For example,

programmes with sexual overtones had to be tailored to suit local expectations.

Health promotion had been undertaken on the areas of AIDS, nutrition, cardiovascular

diseases, road safety, home and industrial accidents, occupational health, tobacco and health,

etc.

Brunei Darussalam was also planning collaborative activities and joint projects with other

Member States in the Region in a number of areas.

Mrs HOMASI (Tuvalu) said that health promotion in Tuvalu was very similar to that in

Cook Islands. Nongovernmental organizations participated in health promotion pr,ogrammes as

well as in programmes on health education, family planning, and awareness-raising. The

national bank had banned smoking on its premises. In primary schools children were taught

how to brush their teeth.

Health promotion needed to be strengthened in the area of health materials. Tuvalu

produced few materials aside from radio programmes, which were the principal means of

communicating messages to the outer islands. She endorsed the comments of the representative

of Cook Islands on economies in the procurement of essential drugs.

Mr WAENA (Solomon Islands) said that his country was reviewing such activities as

logging, which had caused permanent environmental damage. He hoped that, when the Sub

Committee visited Solomon Islands, it would take note of what was happening, and cooperate

with the Government in drawing up appropriate policies that might alleviate environmental

damage. Moreover, the type of investor that came to Solomon Islands, apparently to help the

economy, were those who invested in such areas as tobacco products, which represented a

health hazard to local communities.


The REGIONAL DIRECTOR, referring to bulk purchasing of drugs in the G5 countries

in the South Pacific, explained that a project based in Apia had been cooperating with small

Member States in the Pacific in pharmaceutical management. including procurement of essential

drugs. That project had even prepared information for the smaller countries on where the

cheapest good quality medicine could be obtained. Unfortunately, when the incumbent left last

year. the post had had to be frozen because of financial difficulties. He assured the G5

countries that he would respond to any requests for support and was prepared to provide

"helping hands" if needed.

The CHAIRMAN, noting that there were no further comments, requested the Rapporteurs

to draw up an appropriate resolution.

2. TIME AND PLACE OF THE FORTY-FIFTH AND FORTY-SIXTH SESSIONS OF

THE REGIONAL COMMITTEE: Item 24 of the Agenda

The REGIONAL DIRECTOR invited the representative of Malaysia to inform the

Committee about the situation regarding the invitation of his Government to hold the forty-fifth

session of the Committee in Malaysia.

Dr ABU BAKAR (Malaysia) informed the Committee that last year his country had

offered to host its meeting in 1994. Preparations were already under way and he expected to

sign shortly the memorandum of understanding as stipulated in resolution WPRlRC43.R13. He

looked forward to welcoming all representatives at the meeting next year.

The REGIONAL DIRECTOR thanked the representative of Malaysia and suggested that

the dates of the Committee's forty-fifth session should be from 19 to 23 September 1994,

provided those dates were suitable to the Government of Malaysia. Efforts were made to

coordinate the dates of all six regional committees. firstly, to enable the Director-General to

attend at least part of all of them, and secondly, to allow enough time for the discussions of all

the regional committees to be reflected in the documentation for the Executive Board meeting in

January.

The forty-sixth session. in 1995, would be held at the WHO regional headquarters in

Manila.

The Chairman asked the Rapporteurs to draw up an appropriate resolution.

SUMMARY RECORD OF THE EIGHTH MEETING

3. CHOLERA AND DIARRHOEAL DISEASES: Item 17 of the Agenda

(Documents WPRlRC44/14 and INF.DOC.lI)

251

The REGIONAL DIRECTOR said that document WPRlRC44/14 provided a summary of

the regional cholera and diarrhoeal diseases control activities.

Diarrhoeal diseases, including cholera, represented a major cause of morbidity and

mortality in most developing countries. Globally, an estimated 1000 million episodes and 3.3

million deaths due to diarrhoea occurred annually among children under five years of age.

Appropriate treatment, in particular the use of oral rehydration therapy averted an estimated

1 million diarrhoea deaths each year.

The WHO diarrhoeal diseases control programme, which had been initiated in 1978, had

as its specific objectives the reduction of diarrhoea-associated mortality, morbidity and

malnutrition among infants and young children in developing countries.

Twenty-two countries in the Region in which diarrhoea was a public health problem had

now developed national control programmes in collaboration with WHO.

Cholera was already endemic in many countries. In 1992, a total of 7249 cholera cases

and 247 deaths had been reported by eleven countries in the Region. That was about four times

the number of reported cases in 1991 and about twice as many as in 1990. An ominous new

development was the identification of a new serogroup of Vibrio cholerae, namely

V. cholerae 0139. The new serogroup had first been reported on the Indian subcontinent in

March 1993 and had spread further to Asian countries. The first cases of cholera due to

V. cholerae 0139 in the Region had been reported in China in May 1993.

The illness caused by the new organism was both clinically and epidemiologically

indistinguishable from that caused by V. cholerae 01. Populations living in areas where cholera

regularly occurred appeared to lack immunity to the new serogroup, which might explain the

present large, unexpected outbreaks.

The cholera caused by the new strain was likely to spread. Current WHO guidelines for

cholera control, which remained valid for that new cholera, should be applied vigorously.

The situation clearly indicated the need for Member States to be constantly alert and able

to respond to cholera outbreaks with adequate control measures. A strong national programme

for the control of diarrhoeal diseases was the most important way to improve the state of

preparedness of countries affected or threatened by outbreaks of cholera. When health workers


were trained in the case management of acute diarrhoeal diseases and supplies were available.

countries were able to respond most effectively to possible cholera outbreaks.

An informed public was much more likely to understand and support rational and

effective control measures. WHO had widely disseminated current information on cholera.

Proper rational preparation and education helped to prevent major outbreaks, and minimize

avoidable loss of life. When an outbreak did occur, making the proper response was very

important to the continued smooth functioning of the country. A proper response included

prompt reporting of cholera cases, organization of surveillance, and implementation of control

measures. Timely reporting of cholera cases was of the greatest importance in order to promote

international collaboration in the control of cholera. Inadequate preparation could result in an

escalation of domestic problems as international tourism and exports of seafood and agricultural

products suffered, and there was domestic fear and sometimes panic.

There were strong links between health and larger development issues. To effectively

prevent and control diarrhoea and cholera, sustained improvements in water and sanitation

facilities, housing, personal and domestic hygiene and other environmental conditions were

required. Those issues must be addressed by the Member States if the long-term objectives of

the programme were to be achieved and sustained.

In the future, high priority should be given to further strengthening the national

diarrhoeal diseases control programmes, especially if the goals of reducing childhood morbidity

by 25% and mortality by 50% by the year 2000, as endorsed at the World Summit for Children

in 1990, were to be achieved. That would have the additional benefit of providing cholera

control, as that was best achieved by having the strongest possible national diarrhoeal diseases

control programmes. A principal task for the future would be continuing to provide advice to

health officials on the implementation of control activities. To gain public awareness and

cooperation, health education on prevention and treatment of cholera would be encouraged.

Countries were strongly encouraged to report suspected or confirmed cases of cholera

promptly to WHO as required by the International Health Regulations. Although no country

had objected to the requirement. compliance with the regulations had been less than optimal.

There were still problems with reporting of inaccuracy, delays and incomplete data.

Improved surveillance would be made a high priority, and support would be given to

Member States for prompt reporting of cholera.


Dr RASMY (Lao People's Democratic Republic) infonned the Committee that in

May 1993 there had been an outbreak of diarrhoea in 18 villages in southern Lao. A total of

452 cases were recorded, with 31 deaths. Microbiological tests confinned the serogroup to be

Vibrio cholerae 01. A cholera outbreak had occurred in a neighbouring province, with 801

cases and 98 deaths - a fatality rate of 12.2 %. The strain involved had not yet been confinned.

The Ministry of Health and local authorities had taken a number of measures to control the

epidemic.

WHO had recently infonned the Ministry of Health that a new strain - 0139 - had

emerged, and had sent guidelines which were very useful in the effons to control the spread of

the disease. He requested WHO's cooperation in the translation of those guidelines into the Lao

language, which would be extremely helpful for health workers in the field, and in the supply of

oral rehydration salts and appropriate drugs.

Dr WANG Zhao (China) reponed that China had revised its national programme on

diarrhoea control, and that for 15 provinces, autonomous regions and municipalities had

fonnulated their programmes. The target was a 20% reduction in diarrhoea incidence. Effons

were geared towards strengthening public education, reducing abuse of antibiotics and

promoting the use of oral rehydration salts.

An outbreak of diarrhoea clinically resembling cholera had occurred in southern China in

May, with 167 recorded cases and four deaths. The epidemic was caused by the serogroup

Vibrio cholera 0139. The pathogen was sensitive to tetracycline, chloramphenicol, doxycycline

and neomycin, but resistant to trimethoprim-sulfamethoxazole. Comprehensive measures had

been taken to protect water supplies and to sterilize drinking water. Research was being carried

out and epidemic surveillance had been strengthened throughout the country to prevent the

spread of the epidemic. No new cases had been reponed since September.

Dr HONG SUN HUOT (Cambodia) said that cholera epidemics were rather frequent in

Cambodia; at least eight major outbreaks had been declared by the Ministry of Health since

1980. More than 2100 cases had been reponed from all areas during the last three years. The

mortality rates was 12 % on average. The pathogen had been confinned as Vibrio cholerae

serotype Ogawa. The Ministry of Health was taking public health measures for the prompt

control of the outbreaks. The National Centre for Hygiene and Epidemiology was providing

technical support to affected provinces, investigating outbreaks, training local staff in case

management and implementation of preventive measures, and promoting health education at

community level. Collaboration with nongovernmental organizations in the field was

particularly effective. Mass educational health campaigns using all available media had been


conducted during the last outbreaks. The Ministry of Health had recently developed a national

cholera warning system in order to improve surveillance and the effectiveness of interventions.

Dr ABU BAKAR (Malaysia) reported that Malaysia was still experiencing

sporadic outbreaks of cholera and other diarrhoeal diseases in certain areas. A national plan of

action had been implemented to counter changing disease trends. Research findings and disease

management had been incorporated into the health personnel training. Health messages targeted

at specific people in high-risk areas and workplaces had been modified in order to promote

changes in behaviour and practices. High priority had been given to encouraging notifying

stations to report cholera cases promptly, to improve surveillance, and to take urgent control

measures. Health authorities were particularly vigilant for imported strains, especially the

non-O 1 strain of Vibrio cholerae from the Indian sub-continent. Unfortunately, 20 cases has

just been reported. The sources appeared to have been a non-licensed food handler in contact

with the sub-continent. With the number of people arriving from abroad he thought that it

would not be possible to prevent that kind of contact.

Dr PRETRICK (Federated States of Micronesia) said that diarrhoeal diseases were the

second most commonly reported illness among all age groups in the Federated States of

Micronesia. In 1992, 6% of the population was reported as having suffered a diarrhoeal illness,

although that figure was understated. Although outbreaks of cholera had occurred in the

country in 1982 and 1990, and some level of endemic cholera existed in Chuuk State, no further

cases had been reported. All health care workers had been trained in the use of oral rehydration

salts.

His Government was taking the necessary steps to establish a diarrhoeal diseases

programme and to ensure further training of primary health workers and community members in

the early recognition and appropriate treatment of those diseases.

Dr NGO V AN HOP (Viet Nam) commended the report on cholera. The national control

programme for diarrhoeal diseases and cholera had been established in 1982 with projects in

four provinces, and currently covered approximately 90% of the target population. It was being

implemented in 8407 communes (83%) involving about 8.5 million children under five years

old with a coverage rate of 90%. Although the programme had reached 90% of the

target popUlation, compared with 84% in 1990, the quality of implementation varied from

province to province and was far from optimal in mountainous areas. In 1992, four million

sachets of oral rehydration salts had been distributed to the provinces. Most of the cholera cases

had occurred in the southern provinces. Although the new strain Vibrio cholerae 0139 had not

so far occurred, the collaboration of WHO would be required in such an event.


Dr TINIELU (Tokelau) wished to emphasize that the regional disease. surveillanclt

programme for notification and early dissemination of information to Member States was' a very

important first line of defence in the Region. particularly in his area.

Dr REODICA (Philippines) commended the document and fully agreed with the major

points highlighted concerning cholera control through the diarrhoeal diseases centrol

programme; the use of oral rehydration therapy; the ineffectiveness of available vaccines; the

marginal effectiveness of antimicrobial chemotherapy; and the importance of surveillance and

reporting in targeting and evaluating interventions.

In 1988. a national epidemic sentinel surveillance system had been established. with eight

sentinel sites for the monitoring of 14 diseases of epidemic potential. including cholera. In

1991. that system had recorded 533 cholera cases compared with 996 in 1990. The 46%

decrease could be attributed to the ban on the consumption of mussels during. the rainy season

because of the red tide alert. The geographical distribution of cholera in 1992 showed that two

provinces had recorded the highest number of cases; affecting,mostly children under ten years of

age. Case fatality rates for 1990 and 1991 had been low. signifying that C3$es had been

promptly and adequately managed. At the San Lazaro Hospital sentinel site. tttere had been no

deaths among admitted cases in 1992. Strengthening of the national diarrhoeal diseases control

programme had been the cornerstone of the improvement of the cholera situation, A national

cholera task force had been created at the peripheral level for effective implement;ttion of the

WHO guidelines. She suggested that cholera be used as an issue to fuel.PQlitical sUpPort for the

diarrhoeal diseases control programme. building safer water· and sewerage systems and

improving sanitation. and that there should be more focused epidemiological studies on

transmission and appropriate control measures.

Regarding section 6 of the document, future action could include specific preventi,ve

measures Member States might take. such as the improvement of food and water vendor

sanitation. and water and sewage systems.

The Government would appreciate receiving a regular update .. 0(10 the incidence of the

0139 cholera serotype.;

Dr MONTAVILLE (France) expressed his delegation's appreciation of the report which

drew the attention of the Committee to the magnitude of the epidemic in the Region. The

control of diarrhoeal diseases was an important issue that involved prevention through the

upgrading of water and sanitation services. Through the .European Community. Fr/lIlce had

provided experts to a number of Latin American countries and similarly coItaporated with


Member States in Polynesia and the South Pacific. For example, an intercountry meeting in the

South Pacific had been held in Vanuatu.

The REGIONAL DIRECTOR assured Member States that updated information on cholera

outbreaks including the new serotype 0139 would be provided as part of the regional

surveillance system.

He fully supported a request from the Lao People's Democratic Republic to have the

WHO guidelines on cholera control translated into the vernacular and requested further details.

The Chairman asked the Rapporteurs to prepare an appropriate resolution.

4. DEVELOPMENT OF HEALTH RESEARCH: Item 14 of the Agenda


The REGIONAL DIRECTOR said that document WPRlRC441l0 provided information

on the main activities performed by the regional research promotion and development

programme. The programme had two closely related purposes: firstly to obtain results that

could solve problems related to achieving health for all and secondly, to strengthen national

research capacities. In that context, efforts had been made to promote national

research coordination so as to direct research towards solving priority problems. Although the

development of national research coordination mechanisms differed considerably between

countries, there had been increasing interest in that effort.

In 1990 the Regional Office had commissioned a study to provide information on the

outcome of WHO research support mechanisms throughout the 1980s. The findings

had indicated that research grants definitely benefited the individual researchers. However, it

was less clear to what extent the studies had resulted in improvement in the health programmes

of the country as a whole.

WHO had continued to provide grants for research and for research training promoting

research activities within WHO's six regional priority areas. For the future, and in order to use

limited funds most wisely, there should be a more direct focus on studies on priority areas

which could immediately and directly be utilized to eliminate or reduce the health problems of

the people.

The document presented the observations and recommendations made by the Western

Pacific AdviSOry Committee on Health Research and the directors of health research councils or


analogous bodies at their meeting in August 1992. He hoped that the Conunittee would endorse

them and comment further on the report. In view of the long-term nature of the effects of health

research, he hoped that discussion of the future directions and priorities of WHO's research

programme would also be of interest to the Committee, so as to provide guidance for its work in

the next bienniwn.

Mr Jeong-In SUH (Republic of Korea) expressed appreciation of WHO's activities in

health research promotion and development. There was a need to establish a regional

information network. In his country, a research project on the development of district health

management information systems had been launched to provide a model for such information

systems using a computerized information system of various district health institutions and

computer-based communication channels. The project was being carried out by two interrelated

working groups: a health services group responsible for the analysis of information associated

with the execution and management of various service programmes of health centres and sub

centres and a computer programme group developing computerized information systems on the

basis of the results of the health services group's analyses. The system was being tested in

several project sites using computers provided to ten health centres as an initial step in

developing satisfactory systems for health centres and sub-centres.

Mr AGUIGUI (United States of America) thanked the Regional Director for his overview

of activities in the Region on health research and congratulated him on the publication of the

WHO manual Health research methodology: a guide/or training in research methods l , which

would help broaden the Region's knowledge of the fundamentals of research design and

methodology.

Noting the initiative taken by WHO collaborating centres in Australia in 1991 to discuss

the contributions of collaborating centres to research and to the transfer of technology to the

developing countries of the Region, he said that the importance of the transfer of new

technology derived from research could not be overemphasized. As an example, the outcome of

a study being conducted in the Federated States of Micronesia to analyse ground water quality at

varying distances and directions from pour-flush latrines would help similar developing

countries with increasing populations in infrastructure planning and assessment of

environmental health care needs.

lWHO Regional Publications· Western Pacific Education in Action Series No.5, 1992, Manila.


The implementation of the general and topical recommendations found in Annex 3 of the

working document would serve to strengthen the processes for decision-making and acceptance

of research proposals at a time when there was great interest, but limited fiscal and personnel

resources for the programme. He noted in particular the recommendation to develop a strategic

health plan for health research in the Region for the next five years, to be accompanied by the

determination of specific targets.

He sought the Regional Director's comments on whether the Regional Office saw the

establishment of focal centres as a prerequisite to receiving WHO support for research and

research training grants. If, as a matter of consistency and national accountability for health

research activities, the focal centres had served their respective countries in providing local

coordination and oversight of health research priorities and WHO-supported health research,

then Member States with focal centres should not only have a designated point of contact for the

Regional Office, but also a recognized single advocate for the Member States on those matters.

He also sought clarification of the criteria by which operational research awards were

made, when a clearly indicated outcome of the research was a marketable product such as a

vaccine, diagnostic reagent or medical device. He also queried the levels of awards made for

that category of operational research during the reporting period.

The momentum gained on behalf of the Region's health research programme was notable

and not to be taken lightly. The additional development of the proposed strategic framework

within which future research directions could be aligned, and support prioritized, would

certainly add to the stature gained thus far.

Dr MONT AVILLE (France) stressed that priority should be given to malaria.

Coordination of research studies should be done on two levels - regional and global levels,

together with other organizations such as the South Pacific Commission. Referring to the report

published recently by the World Bank, he said two elements should be emphasized. Firstly, the

Bank had provided mechanisms for coordination of research in the health field along the same

lines as those for agriculture and environment. Secondly, the report had revealed that the

World Bank had been following a strategy completely opposed to that of WHO. The Bank had

suggested that WHO should stop subsidizing local production of vaccines based on the criteria

of quality control standards, indicating that doing immunization campaigns with poor quality

vaccines meant a substantial loss in time, efficiency and money. France, together with the

Regional Office, wished to uphold quality control of vaccines specifically for BCG in Viet Nam

and suggested that the issue of safety and efficacy of vaccines could be presented for discussion.


Referring to health research in the Region, he said there should be more information on

research and training progranunes. Expertise along those lines was available at the Pasteur

Institute in New Caledonia and at the Malarde Institute in French Polynesia.

Dr DOl (Japan) stressed the importance of communication among collaborating centres

scattered throughout the Region. Through a new device called computer networking, using

work stations, all collaborating centres working in the same field would be able to exchange

information, expertise and ideas. WHO headquarters had already established a networking

system through Internet, a commercial system, and therefore could access almost all work

stations in the world. To establish the networking system did not require investments of

millions of dollars. All that would be required were telephone lines and MODEM with

practically no installation costs. Noting that management of information would be facilitated by

the use of technology, he said Japan would support the establishment of inter-collaborating

centre networking in the Region.

Dr Haji HUSSAIN (Brunei Darussalam) commending the Regional Director on the

report, said his country recognized the importance of health research, especially operational or

applied research. Development of health research in Brunei Darussalam was still in its infancy,

mainly owing to lack of trained manpower in that field. However, efforts had been continually

made to enhance national capabilities to carry out health research. A workshop on principles of

research design and methods had been held recently in collaboration with WHO to acquaint

medical staff and auxiliary health workers with the principles of health research. He was glad

to report that many of the recommendations of the workshop had been implemented.

A research project on the prevalence of congenital hyperthyroidism in Brunei Darussalam

had been started in 1990. Up to 1992, among 17 552 newborn babies that had been screened,

six cases of congenital hyperthyroidism had been detected, an incidence rate of 1 in 2925 live

births. Screening for congenital hypothyroidism had been routinely done for all newborns in

the country.

A collaborative study on the status of community nutrition had been planned with the

Institute for Medical Research in Kuala Lumpur, Malaysia.

The medical and health libraries had been updated to provide information support

facilities for research.

Brunei Darussalam would welcome the establishment of an effective regional information

network with WHO collaboration to enhance national research capabilities in health.


Mr WAENA (Solomon Islands) said that his Government considered health research

essential in order to make their programmt' strategies effective, affordable and sustainable

within the country's available resources. Research findings from other countries, while being

equally important, would need to be carefully evaluated with respect to their applicability and

adaptability to the existing local situation. Having that in mind, his Government had therefore

encouraged applied or operational field research as part of its health policy since 1988. To

support that policy, the Medical Training and Research Institute had been established in Honiara

in that same year. His Government believed that research, if it were to serve its purpose, had to

be directly related to the priority needs of the country. Malaria being one of them, research

activities had been focused on the use of impregnated bednets. As a result, that effective and

affordable method of controlling the disease had gained wide acceptance among the country's

population. Given the current momentum of activities, and with the required support, it was

projected that impregnated bednets would be used throughout the country by 1994. Experience

proved that research findings based on local conditions were vital in allowing decision makers

the choice of the most effective and efficient alternatives. He therefore requested WHO, subject

to funding availability, to provide support to the activities of the Medical Training and Research

Institute. His request was made in the spirit of the recommendation made by the Western

Pacific Advisory Committee on Health Research.

Referring to the research activities being carried out in the Region, the REGIONAL

DIRECTOR agreed that a significant amount of work was being done; however, funding

limitations remained a constraint. With regard to the question raised by the representative of

the United States, "focal centres" seemed to be an ambiguous tenn. If what was meant was

national health research councils or analogous bodies or regional reference centres

where research activities were being undertaken, WHO did not nonnally provide support, but

only used their research findings. It had been WHO's policy to encourage operational research

rather than basic research. Support for the latter should ideally come from WHO headquarters,

which had better access to resources. Research on vaccine development was one example.

Although a few activities had been undertaken in that area within the Region, the

funds provided averaged only US$20 000-US$30 000, which was quite low for that type of

undertaking.

The main criteria used in the Region in evaluating research proposals for funding was

whether the findings would contribute to the immediate solution of health problems. The two

types of research grants were (I) those submitted by individuals; and (2) studies specified by

the Regional Office and commissioned to individuals or institutions. Both types underwent


critical review by the Regional Research Development Committee. comprising Programme

Directors and headed by the Director. Programme Management.

He agreed that research training was an important pan of health research. However. in

view of funding constraints. the duration of training should be limited to a few months and

placements made in research institutions within the Region where possible.

With regard to the issue raised by the representative of Japan. the greatest number of

collaborating centres in the Region was in Australia (40). China (64) and Japan (49). The

existing linkages and networking activities among those institutions would continue to

be promoted. The heads of those centres had met to discuss ways in which they could be more

useful in their role as WHO collaborating centres. He said that networking development using

the modem technology available was very promising provided that funds were available.

He hoped that in the future. the research findings of collaborating centres would be

published in an official WHO document and disseminated as information for countries within

and outside the Region. However. he expressed some concern that the results of research

studies performed by most centres were so far too varied in quality for publication. He

therefore urged Member States to encourage the collaborating centres to produce high quality

results.

The CHAIRMAN requested the Rapponeurs to prepare a suitable draft resolution.


1.

2.

3.

4.

5.

SUMMARY RECORD OF THE NINTH MEETING

WHO Conference Hall! Manila Friday, 17 September 1993 at 8.30 a.m.


CONTENTS

(WPRlRC44ISRl9)

Consideration of draft resolutions ............................................................ 264

Announcement on Macao ...................................................................... 267

Special Programme of Research, Research Development and Research Training in Human Reproduction: Membership of the Policy and Coordination Committee ......................................................... 268

Action Programme on Essential Drugs: Membership of the Management Advisory Committee ........................................................... 269

Correlation of the work of the World Health Assembly, the Executive Board and the Regional Committee .......................................................... 270

5.1 Consideration of resolutions of the Forty-sixth World Health ,,\ssembly and the ~xecutive Board at its ninety-first and mnety-second sessIOns .................................................................. 270

5.2 Consideration of the agenda of the ninety-third session of the Executive Board ... ......... ..... ............. ........................................... 271

6. Selection of topic for the Technical Discussions in conjunction with the forty-fifth session of the Regional Committee ............................ ............. 271

7. Consideration of draft resolutions (resumed) ., ......................... .................... 273

8. Statements by representatives of the United Nations, the Specialized Agencies. and intergovernmental and nongovernmental organizations in official relations with WHO ................................................................... 273

9. Resolution of appreciation ..................................................................... 273

10. Closure of the session .......................................................................... 274

- 263 -



The Committee considered the following draft resolutions:

1.1 Regional strategy on health and environment (Document WPRlRC44/Conf. Paper No.8)

Mr UCHIDA (Japan) proposed the addition of the words "and in their related activities

for UNDP's Capacity 21" at the end of operative paragraph 3 (2). He agreed to the

REGIONAL DIRECTOR's suggestion that the amendment be worded in more general terms:

"and in their related activities with other agencies such as UNDP".


WPRlRC44.R9.)

l.2 WHO Response to Global Change (Document WPRlRC44/Conf. Paper No.9)

Ms BLACKWOOD (United States of America) proposed three amendments:

- at the end of operative paragraph 4 (I), add: "as it relates to the recommendations of

the Report";

- in operative paragraph 4 (3), replace "to establish priorities" by "to make

recommendations on establishing priorities";

- in operative paragraph 6 (1), delete "the spirit of" .

Dr DURHAM (New Zealand) proposed the insertion, at the end of the first preambular

paragraph, of the words "and to ensure WHO's continued leadership in health". In the second

preambular paragraph she proposed the addition of the words "and efficiency" after

"accountability" .

Mr DURAND-DROUHlN (France) expressed his support for the amendments proposed

by the representative of New Zealand, and proposed the insertion of the words "operation and"

before "management" in the second preambular paragraph. He also proposed a new preambular

paragraph, "Noting the need to increase the efficiency of WHO", but later withdrew that

proposal as it duplicated the second proposal made by the representative of New Zealand.

Finally, he proposed the deletion of the words "the spirit of" in the first operative paragraph.

SUMMARY RECORD OF THE NINTH MEETING 265

Dr NGO VAN HOP (Viet Nam) and Dr TAPA (Tonga) :strc;mgly opposed the final

amendment proposed by the representative of France. The word "spirit' must remain.

The Regional Committee accepted a compromise proposal put forward, by

Ms BLACKWOOD (United States of America) to amend the first part of the first operative

paragraph as follows: "ENDORSES the spirit, goals and aims of the Report".

The REGIONAL DIRECTOR suggested that operative paragraph 5 be converted into

subparagraph (4) of operative paragraph 6. The beginning of the paragraph would then need to

be reworded as follows: "to transmit to the Executive Board, through the Director-General, in

response to resolution EB92.R2, a preliminary report ... ". Operative paragraph 6 would then

become operative paragraph 5.


WPRJRC44.RlO).

1.3 Health promotion (Document WPRJRC44/Conf.Paper No. 10)

Dr LIN (United States of America), referring to the fourth preambular paragraph, which

mentioned "a multisectoral approach to health and well-being", asked whether from a

procedural point of view it would be possible to expand the sense of the phrase by introducing

an example such as resolution ESCAP/49.I, which he had quoted during the discussion on the

item.

The REGIONAL DIRECTOR suggested that the addition of the words "nat~onally and

internationally" at the end of the paragraph might meet Dr Lin's requirement.

Dr LIN (United States of America) agreed.

The draft resolution. as amended. was adopted (see resolution WPRJRC44.RII).

1.4 Forty-fifth and forty-sixth sessions of the Regional Committee

(Document WPRJRC44/Conf. Paper No. 11)

The draft resolution was adopted (see resolution WPRJRC44.RI2).


1.5 Cholera and diarrhoeal diseases (Document WPRJRC44/Conf. Paper No. 12)

Dr CHEN Ai Ju (Singapore) proposed that the main clause of operative paragraph 1 be

amended to read, simply:

"I. URGES Member States:'

It was so agreed.

Mr KEO (Australia) said that if operative paragraph I (3) made more specific reference to

the health reasons for import restrictions he would have difficulty in accepting it.

Dr REID (United States of America) agreed.

The REGIONAL DIRECTOR, referring to the third preambular paragraph, said that

resolution WHA44.6, in its operative paragraph S, referred to "epidemic restrictions that cannot

be justified on public health grounds" .

Article 23 of the International Health Regulations stated that "The health measures

permitted by these Regulations are the maximum measures applicable to international traffic,

which a State may require ... ".

Some Member States had expressed reservations about certain of the Regulations.

He suggested that the words "on public health grounds" might be added to the end of

paragraph 1 (3), which would replace the reference to "diarrhoeal diseases as a public health

problem" which would be deleted by the Singapore representative's amendment.

Mr KEO (Australia) favoured deletion of operative paragraph 1 (3), the simple reference

to resolution WHA44.6 in the preamble being sufficient in his view.

Ms GREW (New Zealand) preferred the deletion also of the third preambular paragraph.

Dr TAPA (Tonga), supported by Dr NGO V AN HOP (Viet Nam) and by Mr WAENA

(Solomon Islands), urged that operative paragraph I (3) be maintained as it was of particular

relevance to the situation of some South Pacific island countries.

The REGIONAL DIRECTOR suggested that inclusion of the full text of operative

paragraph 5 of resolution WHA44.6 might solve the problem.


At the request of Ms GREW (New Zealand), he read the text:

"5. URGES Member States not to apply to countries affected by the epidemic

restrictions that cannot be justified on public health grounds, in particular as regards

importation of products from the countries concerned;"

It was agreed to maintain the third preambular paragraph of the draft resolution of the

Regional Committee and to replace operative paragraph I (3) with that quotation.

The draft resolution. as amended. was adopted (see resolution WPRlRC44.RI3).

1.6 Development of health research (Document WPRlRC44/Conf. Paper No. 13)

The draft resolution was adopted (see resolution WPRlRC44.R14).

2. ANNOUNCEMENT ON MACAO

The REGIONAL DIRECTOR said that he was pleased to announce that the

Director-General had received letters from the Permanent Missions of the Portuguese Republic

and the People's Republic of China based in Geneva, containing declarations that Macao was to

participate on its own in the activities of the Regional Committee for the Western Pacific.

In accordance with Article 47 of the Constitution and paragraph 3 of resolution

WHA2.103, Macao would have all rights other than the right to vote in plenary meetings and in

subdivisions dealing with finance or constitutional matters.

In future, Macao would have its own name plate "MACAO" until 19 December 1999,

after which date it would become "MACAO, CHINA".

Document WPRlRC44/INF.DOC.l2 provided further details.

Dr Ana PEREZ (Portugal) expressed her country's pleasure and thanked the Regional

Director and Member States on behalf of her Government for their support of the measures that

had led to the decision to accept Macao more fully into the Region's family. A representative

from Macao had for many years attended sessions of the Regional Committee as a member of

the Poriuguese delegation. Macao could now participate more fully in the work of WHO and

contribute to the attainment of health for all by the year 2000.


Dr HE Jiesheng (China) associated herself with the remarks of the representative of

Portugal, noting that Macao would be represented as Macao, China from 1999, and expressed

pleasure at the settlement of the matter to the satisfaction of all concerned. She congratulated

colleagues from Macao, encouraging them to participate in efforts for health for all by the year

2000.

Mr Jeong-In SUH (Republic of Korea) extended the congratulations of his Government to

Macao.

3. SPECIAL PROGRAMME OF RESEARCH, DEVELOPMENT AND RESEARCH

TRAINING IN HUMAN REPRODUCTION: MEMBERSHIP OF THE POLICY AND

COORDINATION COMMITTEE: Item 19 of the Agenda (Document WPRJRC44/16)

The REGIONAL DIRECTOR, introducing the item at the invitation of the CHAIRMAN.

said that the Policy and Coordination Committee (PCC) was the governing body of the Special

Programme of Research, Development and Research Training in Human Reproduction. It was

composed of four categories of members from the various Member States with a total of 32

members. One of the categories. category (2), had 14 members. Three memberships were

allocated to the Western Pacific Region. Those members were to be elected by the Regional

Committee according to population distribution and regional needs for three-year terms. In

electing members, due consideration should be given to a country's financial or technical

support for the Special Programme, and its interest in that field, as reflected by national policies

and programmes.

The three current category 2 members were Papua New Guinea, Fiji and Viet Nam. The

period of tenure of the member from Papua New Guinea was due to expire on

31 December 1993.

In order to maintain the full representation of the Region on the Policy and Coordination

Committee, the Committee was requested to select one Member State to nominate a member

whose three-year term would start on 1 January 1994. The Regional Committee might wish to

consider the Philippines.

The nomination was approved.

The next meeting of the Policy and Coordination Committee would be held from 23 to

2S June 1994.

SUMMARY RECORD OF THE NINTH MEETING

Dr REODICA (Philippines) expressed her country's gratitude for the nomination.

The CHAIRMAN asked the Rapporteurs to prepare a draft resolution.

4. ACTION PROGRAMME ON ESSENTIAL DRUGS: MEMBERSHIP OF THE

MANAGEMENT ADVISORY COMMITTEE: Item 20 of the Agenda


269

The REGIONAL DIRECTOR, introducing the item at the invitation of the CHAIRMAN,

said that the Action Programme on Essential Drugs had created the Management Advisory

Committee in 1989 to replace the Meeting of Interested Parties. The Committee acted as an

advisory body to the Director-General on matters related to the policy, strategy, financing,

management, monitoring and evaluation of WHO's Action Programme on Essential Drugs.

The Management Advisory Committee met once a year or more often if so proposed by

either its Chairman or the Director-General.

The membership of the Committee included two Member States from each of WHO's six

regions, selected by their respective regional committees for a three-year term from among

those Member States with which the Action Programme was collaborating.

With respect to regional representation, the Committee had adopted a system by which

four of the twelve regional members were replaced each year.

China and Malaysia were currently the Member States from the Western Pacific Region

whose representatives served on the Management Advisory Committee. The term of office of

Malaysia would end on 31 December 1993. To maintain a staggered membership with a

three-year cycle, the Committee must select one Member State to replace Malaysia in

representing the Region on the Management Advisory Committee. The selected Member State

would serve for three years from 1 January 1994 to 31 December 1996.

The Committee might wish to consider Papua New Guinea as the representative, which

would provide a satisfactory balance of membership among representatives of States in the

southern and northern parts of the Region.

Mr KEO (Australia) and Dr TAPA (Tonga) supported the nomination.

Mr Y AMANDI (Papua New Guinea) expressed gratitude for the nomination.

Papua New Guinea would do its best to carry out its duties.


The CHAIRMAN asked the Rapporteurs to prepare a draft resolution.

5. CORRELATION OF THE WORK OF THE WORLD HEALTH ASSEMBLY, THE

EXECUTIVE BOARD AND THE REGIONAL COMMITTEE: Item 22 of the Agenda

5.1 Consideration of resolutions of the Forty-sixth World Health Assembly and the Executive

Board at its ninety-first and ninety-second sessions: Item 22.1 of the Agenda


The REGIONAL DIRECTOR, introducing the item at the invitation of the CHAIRMAN,

said that document WPRlRC441l9 referred to resolutions adopted by the World Health

Assembly in May 1993, that were of significance to the Region. It commented on their

implications and provided some information on relevant activities. The resolutions themselves

were attached to the document. Other resolutions adopted by the Health Assembly that needed

to be brought to the attention of the Committee were related to other items on the agenda and

were included in the documentation on those items.

The attention of the Committee was drawn particularly to those operative paragraphs

pertaining to activities that Member States in the Region could undertake to implement the

resolutions .

As time was short, the Regional Committee might consider the resolutions together.

It was so agreed.

5.1.1 Resolution WHA46.6 - Emergency and humanitarian relief operations

5.1.2 Resolution WHA46.18 - Maternal and child health and family planning for health

5.1.3 Resolution WHA46.19 - Nonproprietary names for pharmaceutical substances

5.1.4 Resolution WHA46.24 - Recruitment of international staff in WHO: Employment

and participation of women


5.1.5 Resolution WHA46.27 - Collaboration within the United Nations system:

International Year of the Family (1994)

5.1.6 Resolution WHA46.31 - Dengue prevention and control

5.1. 7 Resolution WHA46. 32 - Control of malaria

5.1.8 Resolution WHA46.36 - Tuberculosis programme


5.2 Consideration of the agenda of the ninety-third session of the Executive Board: Item 22.2

of the Agenda (Document WPRfRC44/20)

The REGIONAL DIRECTOR said that document WPRlRC44/20 showed the correlation

between the Committee's current agenda and items to be discussed at the forthcoming sessions

of the Executive Board and the World Health Assembly. The full draft provisional agendas

were shown in Annexes 2 and 3.


6. SELECTION OF TOPIC FOR THE TECHNICAL DISCUSSIONS IN CONJUNCTION

WITH THE FORTY-FIFTH SESSION OF THE REGIONAL COMMITTEE: Item 23 of

the Agenda (Document WPRfRC44I2I)

The REGIONAL DIRECTOR announced that, after the closure of the session, the

Technical Discussions would be held on the topic "Information and communication support for

primary health care".

In the meantime, the Committee should select a topic for the Technical Discussions to be

held in conjunction with the forty-fifth session. Document WPRlRC44/20 contained three

proposals for the Committee's consideration: (I) Accident prevention; (2) Drug quality

assurance; and (3) Regional disease surveillance.

The Committee was of course free to propose alternative topics. Since the document had

been prepared, there had been a recent development in an area which the Committee had agreed


was of high priority for the Region. That was the area of human resources for health.

specifically the education of medical professional~, a topic last discussed at the thirty-seventh

session in 1986.

In August 1993. the World Federation of Medical Education had convened a World

Summit on Medical Education in Edinburgh, United Kingdom. The Regional Office had

supported the attendance of the Executive Council of the Association for Medical Education in

the Western Pacific Region as well as WHO regional staff at the conference. The results of the

summit - outline proposals for major changes in the orientation and content of medical

curricula - would be the subject of a regional meeting in September 1994.

In view of that and considering the importance of the subject. the Committee might wish

to consider also the topic of "Medical education in the Western Pacific Region - mandate for

change" for the Technical Discussions in conjunction with the forty-fifth session of the Regional

Committee.

Ms GREW (New Zealand) expressed a preference for the first topic. "Accident

prevention" .

Dr MONT A VILLE (France) said that given the dangers of inadequate quality control of

drugs in the Region and worldwide and the increase in marketing of substandard drugs the

second topic. "Drug quality assurance" would be most appropriate.

Dr CLARO (Portugal) said that although all three topics were of importance he would

also favour the second topic.

Dr DOl (Japan). Dr REODICA (Philippines). Professor NGYUEN TRONG NHAN

(Viet Nam). Dr RASMY (Lao People's Democratic Republic) Dr HONG SUN HUOT

(Cambodia) and Dr PRETRICK (Federated States of Micronesia) also favoured that topic.

Dr Haji HUSSAIN (Brunei Darussalam) said that he would prefer the selection of the

topic "Medical education in the Western Pacific Region - mandate for change" mentioned by the

Regional Director.

Mrs HOMASI (Tuvalu) said that she would support the selection of either the second

topic. "Drug quality assurance" or the topic of "Medical education in the

Western Pacific Region".


Decision: "Drug quality assurance" was selected as the topic for the Technical

Discussions to be held in conjunction with the forty-fifth session of the Regional

Committee.

7 . CONSIDERATION OF DRAFT RESOLUTIONS (resumed)

7. 1 Special Programme of Research. Development and Research Training in Human

Reproduction: Membership of the Policy and Coordination Committee

(Document WPRlRC44/Conf. Paper No. 14)

Decision: The draft resolution was adopted (see resolution WPRlRC44.RI5).

7.2 Action Programme on Essential Drugs: Membership of the Management Advisory

Committee (Document WPRlRC44/Conf. Paper No. IS)


7.3 Selection of topic for the Technical Discussions in 1994

(Document WPRlRC44/Conf. Paper No. 16)


8. STATEMENTS BY REPRESENTATIVES OF THE UNITED NATIONS, THE

SPECIALIZED AGENCIES, AND INTERGOVERNMENTAL AND

NONGOVERNMENTAL ORGANIZATIONS IN OFFICIAL RELATIONS WITH

WHO: Item 25 of the Agenda

At the invitation of the CHAIRMAN, statements were presented by the following

nongovernmental organizations:

World Federation for Medical Education

International Epidemiological Association


9. RESOLUTION OF APPRECIATION

Mr W AENA (Solomon Islands), on behalf of the other representatives, thanked the

Regional Director and the Secretariat for ensuring that the deliberations of the forty-fourth

session of the Regional Committee had been conducted in a smooth, efficient and professional

manner. The representatives had come from various countries far and wide, great and small,

industrialized and developing but the common denominator which united all of them was their

wish to provide good health to the people of the Region. He then presented a draft resolution of

appreciation.

Decision: The draft resolution was adopted (see resolution WPRfRC44.RI8).

10. CLOSURE OF THE SESSION: Item 26 of the Agenda

The CHAIRMAN announced that in accordance with set procedures, the draft report of

the session would be sent to all representatives for their approval.

The REGIONAL DIRECTOR presented the Chairman with a gavel set in commemoration

of his chairmanship of the forty-fourth session of the Regional Committee.

The CHAIRMAN thanked the Regional Director and the Secretariat, the other officers,

the representatives and the nongovernmental organizations for their support, contribution and

encouragement. His colleagues would continue to lend their full support to the Regional

Director and WHO staff in the years ahead. After wishing the other representatives good health

and a safe journey home, he declared the forty-fourth session of the Regional Committee closed.

The meeting closed at 11.20 a.m.

WORLD HEALTH ORGANIZATION · 2016-03-01 · WORLD HEALTH ORGANIZATION REGIONAL COMMITTEE FOR THE...

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