W O R L D
H E A L T H
REGIONAL
ORGANIZATION
SOUTH
OFFICE
- EAST
REGIOllAL COMIIITT3I:
Thirty-ninth Session
Agenda iten 22
DRAFT
FINAL REPORT OF THE THIRTY-NINTH SESSION OF
THE REGIONAL COMMITTEE FOR SOUTH-EAST ASIA
CHIANG MAI, THAILAND
9-1 5 September 1986
FOR
ASIA
CONTENTS
Page
1
INTRODUCTION
PART
I
- RESOLUTIONS
3
(To be i n s e r t e d i n t h e f i n a l v e r s i o n )
PART
I1
- DISCUSSION ON THE THIRTY-EIGHTH ANNUAL REPORT
OF THE XEGIONAL DIRECTOR
PART I11
-
PART
- DISCUSSION ON OTHER MATTERS
IV
EXAMINATION OF THE PROPOSED PROGRAMME BUDGET
FOR 1988-1989
1.
R e g i o n a l Programme Budget p o l i c y
2,
Technical Iliscussions
3.
Review of D r a f t P r o v i s i o n a l Agenda o f t h e
Seventy-ninth S e s s i o n of t h e E x e c u t i v e Board
and of t h e F o r t i e t h world Healtll Assembly
-
4.
E i n h t h G e n e r a l P r o q r a m e of Work
5,
Rlood and Blood P r o d u c t s
15
6.
S p e c i a l Proqra~iimef o r Research and T r a i n i n q i n
T r o p i c a l Diseases
15
S p e c i a l I'roqramne of R e s e a r c h , Development and
Research T r a i n i n 9 i n Human Renrod3iction
embers shin of t h e P o l i c v and C o o r d i n a t i o n
Adviscry Cornn~ittee
15
7.
8.
9.
Pronress Report
14
14
-
~~lonqovernmental
Organizations
R e q i o n a l and N a t i o n a l L e v e l s
~ : n v i r o n ~ n e n t atli e a l t h Hazards
- Relations
at
16
16
SEA/RC39/24
Page ii
Page
lo.
11.
12.
s e l e c t i o n of a S u b j e c t f o r t h e T e c h n i c a l
D i s c u s s i o n s t o he h e l d d u r i n q t h e F o r t i e t h
S e s s i o n of t h e R e q i o n a l Committee
17
C o n s i d e r a t i o n of R e s o l u t i o n s of R e g i o n a l I n t e r e s t
Adopted by t h e world H e a l t h Assenhly and t h e
z x e c u t i v e Board
17
T i r e and P l a c e of F o r t h c o m i n ~S e s s i o n s of t h e
R e g i o n a l Committee
17
INTRODUCTION
The T h i r t y - n i n t h S e s s i o n of t h e Reqional COI-riittee f o r South-East Asia
was h e l d a t C h i a n s klai, T h a i l a n d , from 9 t o 15 !;entenher 1986.
I t was
a t t e n d e d by r e p r e s e n t a t i v e s from t h e 11 Member S t a t e r , of t h e Reqion,t:he
United l l a t i o n s Development Programme, United i l a t i ~ n sC h i l d r e n ' s Fund,
Food
and A g r i c u l t u r e O r r ~ a n i z a t i o i lo f t h e United i l a t i o n n , United :<ation:; Fund f o r
P o p u l a t i o n A c t i v i t i e s , I l n i t e d N a t i o n s Economic Coirmission f o r Asia and t h e
P a c i f i c , I n t e r n a t i o n a l Fcanl; f o r R e c o n s t r u c t i o n and Develonment, a s $1-11 a s
from 2 i n t e r q o v e r n m e n t a l o r g a n i z a t i o n s , 27 norioovernmental o r g a n i z a t i o n . s
h a v i n g o f f i c i a l r e l a t i o n s w i t h !4UO,and by 6 o b s e r v e r s from b i l a t e r a l and
voluntary agencies.
The s e s s i o n was d e c l a r e d open by t h e Vice-Chairman of t h e t h i r t v - e i q h t h
s e s s i o n , D r U t h a i Sudsukh, and was i n a l l q u r a t e d hv t h e i3eputy Priroe i l i n i s t e r
o f T h a i l a n d , HOE. rlr Rhichai R a t t a k u l , who d e l i v e r e d a n a d d r e s s .
The
i n a u g u r a l s e s s i o n was a d d r e s s e d hy t h e g e g i o n a l Director, who a l s o r e a d a
messaqe from t h e D i r e c t o r - G e n e r a l
of 1r'HO. The Governor of Chianq ) * a i , Pir
Ciiaiya P h u n s i r i w a n g s e , welcorded t h e d e l e g a t e s ,
A
Sub-committee
on
C r e d e n t i a l s was
appointed,
c o n s i s t i n q of
r e p r e s e n t a t i v e s from Bhutan, I n d o n e s i a and rlepal, The r e p r e s e n t a t i v e from
Yilhva, was e l e c t e d Chairman o f t h e Suh-committtee,
I n d o n e s i a , D r Su:rono
which h e l d one m e e t i n g and p r e s e n t e d i t s r e p o r t (SKA/RC39/21), b a s e d on
which t h e Recjional Committee reco(jnized t h e v a l i d i t y of t h e c r e d e n t i a l s
p r e s e n t e d by a l l t h e r e p r e s e n t a t i v e s .
The R e g i o n a l Committee a p p o i n t e d t h e followirlg o f f i c e - h e a r e r s :
Chairman: D r U t h a i Sudsukh ( T h a i l a n d )
Vice-chairman: D r Abdul Samad Ahdullah ~ : l . i a l d i v e s )
The Committee reviewed t h e d r a f t p r o v i s i o n ' t l agenda of t h e s e v e n t y s e v e n t h s e s s i o n of t h e Xxecutfve Roard a n 6 of t h e F o r t i e t h 1,Iorld H e a l t h
(SEA/RC39/16
and C o r r . 1 ) and t h e n a d o p t e d i t s agenda and
Assembly
s u p p l e m e n t a r y agenda (SEA/RC39/1 and ~ d d , l ) . I t t?stablis!'ied a S u h - C o m i t t e r !
on Programme Budget c o n s i s t i n q of r e p r e s e n t a t i v e s from a l l P.lemhr?r S t a t e s and
a d o p t e d i t s terms of r e f e r e n c e (SEA/EC39/.?). Und~?rt.hr chairnanshi:,
of h . l r
P O P . Chauhan ( I n d i a ) , t h e Sub-committee h e l d t h r r c n e e t i m y and s u b m i t t e d a
r e p o r t (SEA/RC39/22),
which was e n d o r s e d by t h e
Regional
So~laittee
( r e s o l u t i o n SEA/RC39/R4),
The Y r g i o n a l C o m n l i t t e ~e l e c t e d ' r i g . Nohd, H ~ d a y e t u l l a h ( B a n g l a d e s h ) a s
Chairman o f t h e t e c h n i c a l d i s c u s s i o n s on " I n t e g r a t e d ~ w p r o a c ht o m a t e r n a l
and c h i l d h e a l t h c a r e i n t h e c o n t e x t of primar.f h e a l t h c a r e " , and a d o p t e d
t h e agenda f o r t h e s e d i s c u s s i o n s (SEA/R.C39/5 3nd i d d . 1 ) . The c o n c l u s i o n s and
recommendations a r i s i n g o u t o f t h e s e d i s c u s s i o w , w!lich
wer? h e l d on 11
September 1986, were l a t e r p r e s e n t e d
(SEA/RC39/23)
to
the
Regional
Committee, which e n d o r s e d t h e recommendations and a d o p t e d a r e s o l u t i o n
(SEA/RC39/R5).
The C o m m i t t ~ ed e c i d e d t o hold t e c h n i c a l d i s c u s s i o n s on t h e s u b j e c t of
" I n f o r m a t i o n and e d u c a t i o n f o r h e a l t h i n s u p p o r t of Fif?alth f o r A l l by t h e
Year 2000" d u r r n g its f o r t i e t h s e s s i o n ,
A
Sub-committee
on d r a f t r e s o l u t i o n s was formed, c o n s i s t i n o of
r e p r e s e n t a t i v e s from Bhutan, I n d i a , I n d o n e s i a , Mongolia and Thailand. I n t h e
c o u r s e of seven p l e n a r y meetinqs t h e P.erjiona1 Cocmittee adopted n i n e
r e s o l u t i o n s , which have been i s s u e d s e n a r a t e l y i n t h e r e s o l u t i o n series,
The R e g i o n a l Committee nominated S r i Lanka on t h e J o i n t C o o r d i n a t i n g
of t h e S p e c i a l Programme f o r Research and T r a i n i n g i n T r o p i c a l
Diseases. I t nominated Bangladesh, I n d o n e s i a and Nepal t o t h e P o l i c y and
C o o r d i n a t i o n Advisory Committee of t h e S p e c i a l Programmr of Research,
Development 2nd Research T r a i n i n q i n HUmn Reproduction,
Board
The Committee d e c i d e d t o h o l d i t s f o r t i e t h s e s s i o n i n t h e Democratic
P e o p l e ' s R e p u b l i c of Korea and notar? w i t h a p p r e c i a t i o n t h e i n v i t a t i o n s of
t h e Royal Government of Bhutan and t h e Government of I n d o n e s i a t o h o s t t h e
f o r t y - f i r s t and forty-second s e s s i o n s i n 1988 and 1989 r e s p e c t i v e l y .
P a r t s 11, I11 and I V of t h i s r e p o r t a r e
Committee's d i s c u s s i o n s on i m p o r t a n t m a t t e r s .
d e v o t e d t o summaries of
the
SEA/HC39/2/
Paqe 3
PART I
RESOLUTIONS
The resolutions adopted by the Reqional Committee are ,+.?in,: issued i n R
a separate resolution s e r i e s (SEA/P.C~~/R-)
and wrll be incorporated i n the
f i n a l version of the report.
PART I1
DISCUSSION ON THE THIRTY-EIGHTH ANNUAL REPORT
OF THE REGIONAL DIRECTOR
I n t r o d u c i n g h i s Annual Report f o r t h e periorl 1 J u l v 1905 t o 30 J u n e
1986, t h e R e g i o n a l D i r e c t o r s a i d t h a t t h e riember S t a t e s had made a c o n c e r t e d
e f f o r t t o c o n s o l i c l a t e t h e q a i n s a c h i e v e d s o f a r i n t h e i r HF' e f f o r t s and t o
r e c t i f y t h e weaknesses observed i n t h e n a t i o n a l development e f f o r t s . S e v e r a l
o f them had a t t e m p t e d t o i n c o r p o r a t e t h e v i t a l components of HFA s t r a t e g i e s
L O
i ~ p o r t a n t develonments
into
t h e i r n a t i o n a l development
plans,
were:
(1)
t h e implementation of t h e new m a n a q e r i a l p r o c e s s throimh t h e
s t r e n q t h e n i n q of government-TJHO c o o r d i n a t i o n mechanisms a t t h e c o u n t r y l e v e l
w i t h t e c h n i c a l s u p p o r t provided by m u l t i - d i s c i n l i n a r y c o u n t r y teams from t h e
Regional O f f i c e , and ( 2 ) t h e development of a R e q i o n a l Programme Mudget
Policy,
which provided a framework - . i i t h i n which WHO'S c o l l a b o r a t i v e
programme could be f o r m u l a t e d and implemented i n a c c o r d a n c e w i t h t h e needs
of t h e Countries.
I n an a t t e m p t t o meet t h e a c u t e s h o r t a q e of' a d e q u a t e h e a l t h manpower
due t o t h e l a c k of c o o r d i n a t i o n between t h e p r o j e c t i o n of s u p p l y and
demand, which was a major c o n s t r a i n t i n d e v e l o n i n g an e f f e c t i v e h e a l t h
system i n f r a s t r u c t u r e , governments were now r e o r i e n t i n g manpower develovment
a c c o r d i n g t o t h e h e a l t h s e r v i c e s manpower development (HSMD) concept.
I n t h e f i e l d of m a t e r n a l and c h i l d h e a l t h , a d e q u a t e m a t e r n a l and
c h i l d h e a l t h and f a m i l y p l a n n i n g s e r v i c e s were h e i n q provided i n t h e form of
Resides s t r e n ~ t h e n i n g conventional
MCH
an
i n t e g r a t e d PICH package.
programmes, h e a l t h s e r v i c e s r e s e a r c h and s t u d i e s on e:)idemioloqy, p e r i n a t a l
m o r b i d i t y and m o r t a l i t y and low b i r t h w e i g h t were b e i n q conducted.
The n u t r i t i o n c e l l s s e t up i n t h e m i n i s t r i e s of h e a l t h i n e i g h t
c o u n t r i e s had been monitoring t h e n u t r i t i o n l e v e l s of t h e p o p u l a t i o n by
c o n c e n t r a t i n g on t h e p u h l i c h e a l t h a s p e c t and had developed a p p r o o r i a t e
programmes t o t a c k l e n u t r i t i o n a l d e f i c i e n c y d i s e a s e s . WHO s u p p o r t e d t h e s e
e f f o r t s through t h e s t r e n q t h e n i n q of n a t i o n a l c a p a b i l i t i e s , n u t r i t i o n a l
s u r v e i l l a n c e , t r a i n i n g , and t h e implementation of nrogramnes.
Under t h e I n t e r n a t i o n a l D r i n k i n g l l a t e r Supplv and S a n i t a t i o n Decade,
governments had heen t r y i n g t o d e v e l o p d r i n k i n g w a t e r s u p p l y and s a n i t a t i o n
f a c i l i t i e s b u t t h e coverage a c h i e v e d s o f a r was f a r h ~ l o w t h e s t i p u l a t e d
t a r g e t s . WHO had p r o v i d e d s u p p o r t through t h e t r a i n i n u of manpower,
programme p l a n n i n g and r e s o u r c e m o b i l i z a t i o n ,
The O r g a n i z a t i o n had !>een c o o p e r a t i n g w i t h t h e
qovernments
in
formulating
n a t i o n a l druq p o l i c i e s and i n d e v e l o p i n g e f f e c t i v e d r u q
management systems i n o r d e r t o e n s u r e t h e a v a i l a b i l i t y of e s s e n t i a l d r u g s
of a s s u r e d q u a l i t y . l i o s t of t h e c o u n t r i e s had p r e p a r e d lists of e s s e n t i a l
d r u g s and were i n t r o d u c i n g p r a g m a t i c d r u g p o l i c y and management systems.
SJ:A/RC39/24
Page 5
I n r e q a r d t o communicable d i s e a s e s , which c o n t i n u e d t o c o n t r i b u t e t o
h i g h m o r b i d i t y and m o r t a l i t y i n t h e Reqion, a l l t h e c o u n t r i e s were
implementing t.he Expanded Prooramme on Immunization by i n t e i j r a t i n g i t w i t h
primary h e a l t h c a r e s e r v i c e s . dHO had heen p r o v i d i n g t e c h n i c a l s u p p o r t i n
e v a l u a t i n q t h e q u a l i t y and potency of l o c a l l y produced v a c c i n e s
znd,
j o i n t l y w i t h UZJICEF, had been making a c c e l e r a t e d e f f o r t s f o r u n i v e r s a l c h i l d
immunization.
The programste had a l r e a d y made a s t r o n q impact i n a few
countries.
R e a l i z i n g t h e importance of o r a l r e h y d r a t i o r t h e r a p y i n t h e e f f e c t i v e
c o n t r o l of d i a r r h o e a 1 d i s e a s e s , governments had a d o p t e d ORS and proper d i e t
along
with
health
education a s
a
short-term
strateqy for
the
c o n t r o l of d i a r r h o e a l d i s e a s e s , and improvement c f e n v i r o n m e n t a l measures t o
e l i m i n a t e t h e s o u r c e of i n f e c t i o n , a s a long-term s t r a t e u y .
USAID, Ui.IICFF
and WHO had provided v a l u a b l e s u p p o r t i n r e g a r d t o t r a i n i n g , ORS p r o d u c t i o n ,
p l a n n i n g , m o n i t o r i n a and e v a l u a t i o n ,
The i n t r o d u c t i o n of m u l t i - d r u q regimens f o r t u b e r c u l o s i s and l e o r o s y
had h e l p e d i n overconling t h e p r o b l e n ~of r e s i s t a n c e of t h e e t i o l o g i c a l a g e n t
t o t h e a v a i l a b l e d r u g s and r e d u c i n g t h e d u r a t i o n of t r e a t m e n t . However,
owing t o t h e deep-rooted s o c i a l stigma a t t a c h e d t o l e p r o s y , c a s e - d e t e c t i o n
and c a s e - h o l d i n g c o n t i n u e d t o be a prohlem. WHO was c o l l a b o r a t i n q w i t h t h e
countries
i n e v o l v i n g d i a q n o s t i c f a c i l i t i e s , p r o c u r i n g d r u q s and i n
monitori.ng and e v a l u a t i n g t h e a c t i v i t i e s .
I n r e g a r d t o m a l a r i a , t h e prohlem of v e c t o r r e s i s t a n c e t o i n s e c t i c i d e s
were
and p a r a s i t e r e s i s t a n c e t o d r u g s p e r s i s t e d , an? t h e c o u n t r i e s
concentratinq
on
epidemiological surveillance,
an i n t e g r a t e d v e c t o r
c o n t r o l methodoloqy, i n c l u d i n g b i o e n v i r o n m e n t a l measures, d r u g r e s e a r c h , and
manpower t r a i n i n g i n t e g r a t e d w i t h t h e h a s i c h e a l t h s e r v i c e s i n f r a s t r u c t u r e .
The m a l a r i a problem, however, was a major concern i n t h e Region.
S e v e r a l c o u n t r i e s had launched primary e y e c a r e prcqrammes f o r t h e
p r e v e n t i o n of b l i n d n e s s , t h e emphasls b e i n q on t h e t r e a t m e n t of c a t a r a c t ,
which c o n s t i t u t e d 50 p e r c e n t of c a s e s of v i s i o n a r y d e f e c t s . "YO had heen
p r o v i d i n g t e c h n i c a l and f i n a n c i a l s u p p o r t ,
The i n c i d e n c e of c a n c e r , c a r d i o v a s c u l a r d i s e a s e s and mental d i s o r d e r s
Many c o u n t r i e s had i n t r o d u c e d h e a l t h
had heen r i s i n q i n t h e Heqion.
l e g i s l a t i o n t o c o n t r o l t h e u s e of t o b a c c o , k2HO's c o l l a b o r a t i v e a c t i v i t i e s i n
t h i s f i e l d c o n s i s t e d of e p i d e m i o l o g i c a l s u r v e y s , t r a i n i n g of manpower, and
p l a n n i n g , m o n i t o r i n g and e v a l u a t i o n of c o n t r o l proqrammes.
I n t h e f i e l d of r e s e a r c h , t h e South-East. Asia Advisory Committee on
H e a l t h Research ( e a r l i e r c a l l e d t h e South-East Asia h d v i s o r y Committee on
Medical R e s e a r c h ) had d e f i n e d t h e r e s e a r c h needs i n s u p p o r t of t h e h e a l t h f o r - a l l e f f o r t s by t h e c o u n t r i e s OF t h e r e q i o n and p r o v i d e d guidance i n
c o o r d i n a t i n g r e s e a r c h programmes a t t h e c o u n t r y l e v e l . S t e p s were a l s o b e i n g
t a k e n t o implement t h e r e s e a r c h r e s u l t s i n h e a l t h programmes.
In conclusion, t h e Regional D i r e c t o r expressed h i s admiration f o r t h e
f i r m commitment of t h e Member C o u n t r i e s t o t h e g o a l of wealth For A l l by t h e
SEA/RC39/24
Page 6
Year 2000. He was c o n f i d e n t t h a t , with t h i s commitment, tlember S t a t e s would
be a b l e to achieve an i n c r e a s i n g l y b e t t e r s t a t e of h e a l t h f o r t h e i r
peoples.
I n i t s d i s c u s s i o n on t h e annual r e p o r t , t h e Regional Committee noted
with s a t i s f a c t i o n t h a t t h e j o i n t government-WHO c o o r d i n a t i n g mechanism cias
proving
t o be extremely u s e f u l i n t h e e f f i c i e n t management of WHO
c o l l a b o r a t i v e a c t i v i t i e s a t the country l e v e l . This mechanisn woulr? r e q u i r e
f u r t h e r s t r e a m l i n i n g i n t h e l i u h t of t h e a p p l i c a t i o n of t h e Regional
Programme Budget p o l i c y f o r the most optimum use of WHO resources i n
c o u n t r i e s with support, a s required, from a l l l e v e l s of t h e Organization. I n
t h i s regard, t h e Comlnittee noted with i n t e r e s t t h e establishment of country
support teams (CST) i n t h e Regional O f f i c e i n r e s m c t of some c o u n t r i e s t o
provide timely and coherent support t o t h e c o u n t r i e s . The Committee f e l t
t h a t the f u l l b e n e f i t s of known h e a l t h technoloqies were not reaching the
people i n s p i t e of an expanded h e a l t h i n f r a s t r u c t u r e hecause of an
inadequate managerial process. I t recommended t h a t medical and o t h e r h e a l t h
p r o f e s s i o n a l s should be s e n s i t i z e d t o t h e need f o r good management p r a c t i c e s
through a p p r o p r i a t e o r i e n t a t i o n and t r a i n i n q courses,
I n view of c u r r e n t economic d i f f i c u l t i e s , t h e Committee recognized t h e
need
for
b e t t e r coordination of a l l e x t e r n a l a s s i s t a n c e t o h e a l t h
development programmes. Such coordination was b e s t e f f e c t e d by s t r o n g
n a t l o n a l mechanisms, and WHO could a s s i s t i n b r i n g i n g t o g e t h e r t h e n a t i o n a l
coordinators and e x t e r n a l agencies and provide r e l e v a n t information and
t e c h n i c a l support.
The Committee a l s o s t r e s s e d t h a t with t h e prospect of l i t t l e o r no
i n c r e a s e i n t h e a l l o c a t i o n of resources t o t h e h e a l t h s e c t o r a t t h e country
l e v e l , t h e need f o r t h e sound management of h e a l t h s e r v i c e s became a l l t h e
more important.
While a p p r e c i a t i n q t h e study by WHO on the h e a l t h consequences of
nuclear war, t h e Committee f e l t t h a t the p r e s e n t l e v e l of support under t h e
hoerqency Relief Programme should be stepped up.
The Committee welcomed t h e r e c e n t emphasis of WHO support t o the
development of epidemiological s e r v i c e s and recommended t h a t t h i s support he
f u r t h e r strengthened t o include t r a i n i n q i n f i e l d epidemiology. I t a l s o
considered t h a t t h e review, updating and e f f e c t i v e implementation of
e x i s t i n g h e a l t h laws was e s s e n t i a l .
I n d i s c u s s i n g t h e o r g a n i z a t i o n of h e a l t h systems based on primary
h e a l t h c a r e , t h e Committee f e l t t h a t a number of measures such a s community
involvement, i n t e r s e c t o r a l coordination, and r e o r i e n t a t i o n of t h e a t t i t u d e s
of h e a l t h workers of a l l c a t e g o r i e s were e s s e n t i a l i f primary h e a l t h c a r e
was t o be e f f e c t i v e l y implenented. F u r t h e r , a r i g h t understanding of t h e
concept of h e a l t h f o r a l l and primary h e a l t h c a r e , which was s t i l l lacking
among h e a l t h p r o f e s s i o n a l s , t h e p u b l i c i n qeneral, t h e media and p o l i t i c a l
l e a d e r s , was e s s e n t i a l .
SZA/RC39/24
Page 7
The Committee a l s o noted t h e s u c c e s s f u l a p p l . ~ c a t i o nof t h e c o n c e n t of
community s e l f - r e l i a n c e and co~nmunityhoalttl f i n a n c i n g i n t h e implementation
of primary h e a l t h c a r e find t h a t some c o u n t r i e s v e r e d e v e l o p i n q z c r i t i c a l
mass of h e a l t h - f o r - a l l l r ~ a d e r sa t t h e centr;,l and n i d d l e l e v e l s .
I n i t s d i s c u s s i o n on h e a l t h manpower developrlent, t h e Comnii t t e e noted
w i t h concern t h e c o n t i n u i n q i n h a l a n c e t ~ e t w r e nt h e l e v e l of p r o d u c t i o n and
a c t u a l need i n c e r t a i r ~c a t e g o r i e s , I t wai; f e l t n e c e s s a r y t o p e r s e v e r e w i t h
t h e r e o r i e n t a t i o n of m e J i c a l e<lucation t o primary h e a l t h c a r e and a d j u s t t h e
o u t p u t of d i f f e r e n t c a t e g o r i e s of h e a l t h workers a c c o r d i n g t o t h e r e a l
needs.
The Conunitt?e p o i n t e d t o t h e need f o r a c a r e f u l r e v i e w of t h e e n t i r n
of h e a l t h manpower a s a n i n t e g r a t e d packaqe, even w h i l e s c r u t i n i z i n g
one p a r t i c u l a r c a t e g o r y , and f o r m o n i t o r i n g t h e s i t u a t i o n c l o s e l y .
area
AS t o t h e u s e of t?HO f e l l o w s h i p s f o r h e a l t h nanpower development,
the
Conunittee f e l t t h a t s a n e of t h e d i f f i c t ~ l t i e s nirrht be r e s o l v e d by t h e
a d o p t i o n , by Member S t a t e s , of a more f l e x i t l e approach i n r e g a r d t o
e x i s t i n g r e q u i r e m e n t s f o r a c c e p t a n c e by t r a i n i n q i n s t i t u t i o n s , i n a s p i r i t
of b i l a t e r a l c o o p e r a t i o n .
The R e g i o n a l C o n n i t t e e f e l t t h a t i n c r e a s e d emphasis s h o u l d b e l a i d on
t h e i n t e g r a t i o n of h e a l t h e d u c a t i o n w i t h o t h e r components of t h e h e a l t h
system, and t h a t e v e r y h e a l t h worker s h o u l d f u n c t i o n a s a h e a l t h e d u c a t o r a s
w e l l , To e n s u r e t h e r e l e v a n c e and u s e f u l n e s s of t r a i n i n g i n h e a l t h
e d u c a t i o n , h e a l t h p e r s o n n e l should be t r a i n e d i n c o n d i t i o n s s i m i l a r t o t h o s e
of t h e i r work environment.
The Committee, notifiq t.hat t h e r e s e a r c h and d e v e l o p n e n t e f f o r t s of t h e
Region were focused on t h e a t t a i n m e n t of t h e g o a l of h e a l t h f o r a l l , f e l t
t h e need f o r governments t o s t r e n q t h e n f u r t h e r t h e i r n a t i o n a l r e s e a r c h
promotion and development e f f o r t s , The meetinq of t h e d i r e c t o r s of medical
r e s e a r c h c o u n c i l s and a n a l o q o ~ ~bso d i e s was seen a s a p o s s i b l e forram t o
c o n s i d n r t h i s i s s u e f u r t h e r . The Committee a g r e e d on t h e importance of
health
s e r v i c e s r e s e a r c h , h e a l t h h e h a v i o u r r e s e a r c h and t r a n s f e r of
t e c h n o l o g y , and t h e s e were s e e n i n t h e c o n t e x t of i n t e g r a t e d a c t i v i t i e s
focused on t h e b e s t o p t i o n s f o r h e a l t h dev~lopfi1en+,based on primary h e a l t h
care,
The Committee noted t h e s u p p o r t provided t o r e s e a r c h p r o j e c t s and
o f h e r f a c e t s of t h e r ~ s e a r c hproqramrne. and recommended t h a t emphasis be
l a i d on i n s t i t u t i o n a l s t r e n p t h e n i n g and
t h e development of r e s e a r c h
manpower. There was a need t o d e v e l o p s t r a t e q i e s t o a t t r a c t s c i e n t i s t s t o
u n d e r t a k e r e s e a r c h i n g e n e r a l and t h o s e r e l a t e d t o h e a l t h systems i n
particular.
The C o m i t t e e noted t h e c o m ~ l e x i t y i n the? t r a i n i n g of s c i e n t i s t s f o r
h e a l t h s e r v i c e s r e s e a r c h and s t r e s s e d t h e need f o r t h e d i s s e m i n a t i o n and
b e t t e r u t i l i z a t i o n of r e s e a r c h r e s r l l t s . I n t h i s regard., t h e C o r m i t t e e
s t r e s s e d t h e d e s i r a h i l i t y of p r i n c i p a l i n v e s t i ( j a t 0 r s sublnittinrj p r o g r e s s
r e p o r t s and f i n a l r e p o r t s p r o n p t l y .
The importance of n u t r i t i o n , a s p a r t of the nrimary h e a l t h c a r e
package, i n improving t h e s t a t e of h e a l t h of the people was emaphasized by
t h e Regional Committee, which took note of the f a c t t h a t g o i t r e c o n t r o l
programmes were beino launched i n s e v e r a l c o u n t r i e s . I i u t r i t i o n a f anaemia
caused
by i r o n d e f i c i e n c y a s well a s hy c a l o r i e m a l n u t r i t i o n w e r e
highlighted a s problems p r e v a l e n t i n t h e Region which needed a t t e n t i o n .
Support was a l s o needcd f o r measures a g a i n s t vitamin A d e f i c i e n c y and
n u t r i t i o n a l filindness, which a f f l i c t e d l a r q e s e c t i o n s of t h e population b u t
were preventable.
In t h e a r e a of maternal and c h i l d h e a l t h c a r e , th? Reqional Committee
s t r e s s e d the importance of h e a l t h education t o encourage mothers t o use
a v a i l a b l e h e a l t h c a r e s e r v i c e s and f a c i l i t i e s . I t was e v i d e n t t h a t a l l the
c o u n t r i e s were according high p r i o r i t y t o maternal and c h i l a h e a l t h and,
where a p p l i c a b l e , t o family planning, and were making every e f f o r t t o
i n t e g r a t e i t s various elements i n t o t h e nrimary h e a l t h c a r e package.qhe r o l e
played by UNICEF i n t h e s e e f f o r t s was a p p r e c i a t e d and th* need f o r f u r t h e r
c o l l a b o r a t i o n with UUICEF and o t h e r United Nations and h i l a t e r a l agencies
was emphasized.
While notinq t h a t Member S t a t e s were makinq s t e a d y progress i n
implementing a c t i v i t i e s r e l a t i n g t o t h e I n t e r n a t i o n a l Drinking Water Supply
and S a n i t a t i o n Decade, t h e Committee f e l t t h a t much more e f f o r t s were
required i n both these a r e a s t o achieve t h e o b j e c t i v e s of t h e Decade. I t was
p a r t i c u l a r l y concerned t h a t progress i n t h e a r e a of s a n i t a t i o n was laqqinq
behind, and urged t h e Organization t o l a y incraased emphasis on these
aspects.
I n regard t o food s a f e t y , t h e Committee noted t h a t t h e implementation
of t h e programme was weak, Takinq i n t o account t h e i n t e r s e c t o r a l n a t u r e of
t h i s programme and i t s importance i n t h e c o u n t r i e s of t h e Region. t h e
Regional Committee urged t h e Organization t o provide g r e a t e r s u n w r t i n
strengtheninq t h e i n f r a s t r u c t u r e f o r food s a f e t y .
The shortaqe of l a b o r a t o r y d i a g n o s t i c reagents i n t h e c o u n t r i e s of t h e
Region was noted hy t h e Committee, which urged t h e Organization to t a k e
a p p r o p r i a t e and e f f e c t i v e s t e p s t o a t t a i n t h e g o a l of r e g i o n a l s e l f s u f f i c i e n c y i n t h e i r production.
I t noted t h a t expenditure on drugs comprised a major share of the
h e a l t h budgets i n t h e c o u n t r i e s and t h a t t h e i n d i s c r i m i n a t e use of drugs
a l s o l e d t o i a t r o g e n i c d i s e a s e s . 'The committee commended Ranqladesh on
e n a c t i n g a n a t i o n a l p o l i c y on e s s e n t i a l drugs, and noted with s a t i s f a c t i o n
the
e f f o r t s betrig made f o r
i t s implementation, While n o t i n g
with
s a t i s f a c t i o n t h a t s e v e r a l c o u n t r i e s had formulated drug p o l i c i e s and
management, t h e Committee urged Is!!HO t o provide increased support towards t h e
formulation and i n p l e n e n t a t i o n of drug p o l i c i e s , improvement of good
manufacturing p r a c t i c e s (GMP), improved q u a l i t y c o n t r o l f a c i l i t i e s and f o r
b e t t e r d i s t r i b u t i o n systems t o ensure t h e a v a i l a b i l i t y of e s s e n t i a l drugs of
assured q u a l i t y a t consumer p o i n t s . Several d e l e q a t e s a l s o emphasized t h e
need t o make t h e l a t e s t technoloqv f o r t h e production of druga a v a i l a b l e t o
SE?+/RC39/24
Paqe 9
d e v e l o p i n g c o u n t r i e s . I.!HO was r e q u e s t e d t o . a s s i s t i n f e a s i b i l i t y s t u d i e s f o r
t h e p r o d u c t i o n of raw m a t e r i a l s and z l s o h e l p i n some a s p e c t s of drurl
pricing policies,
Urging t h a t t h e q o a l of r e g i o n a l s e l f - s u f f i c i e n c y i n v a c c i n e p r o d u c t i o n
should be pursued,
t h e Xsgional Cnmmittee c a l l e d f o r WHO s u p p o r t t o
strengthen r e q i o n a l production f a c i l i t i e s / l n h o r a t o r i e s s o t h a t these u n i t s
n o t o n l y met t h e i r n a t i o n a l r e q u i r e m e n t s h u t were l l s o a b l e t o c a t e r t o t h e
needs of n e i g h h o u r i n g countries. For a c h i e v i n g t h i s ,
the
Comaittee
recognized t h e need f o r a more r e a l i s t i c e s t i m a t i o n of t h e c o u n t r i e s '
vaccine requirements,
The Regional Committee endorsed t h e recommendation of t h e Ranqlades!~
d e l e g a t i o n t o s t r e n g t h e n t h e Regional O f f i c e f o r e f f e c t i v e s u p p o r t t o t h e
e s s e n t i a l d r u g s programme, t o e s t a 1 , l i s h a r e q i o n a l 3ruq i n f o r m a t i o n c e n t r e
and t o a s s i s t c o u n t r i e s i n improving q u a l i t y c o n t r o l .
The Reqional Committee a l s o f e l t t h a t t h e r e ,v~asa need t c s t r e n q t h e n
t r a i n i n g programmes f o r l a b o r a t o r y t e c h n i c i a n s , and wanted WHO t o make a n
assessment of t h e c o s t - e f f e c t i v e n e s s
of b a s i c r a d i o l o g i c a l s e r v i c e s (RRS)
equipment and d i s s e m i n a t e t h e i n f o r m a t i o n t o t h e c o u n t r i e s .
I n t h e f i e l d of t r a d i t i o n a l medicine, t h e Committee d e s i r e d ?rester
a t t e n t i o n t o be p a i d t o t h e t r a i n i n q and u t i l i z a t i o n of t r a d i t i o n a l
p r a c t i t i o n e r s w i t h i n t h e o v e r a l l nlanpower p o l i c y .
I n view of t h e i n c r e a s i n c j
Committee emphasized t h e need t o
a l s o s t r e s s e d t h e need t o t a k e
community e d u c a t i o n , I n t h i s a r e a ,
w i t h nongovernmental o r q a n i z a t i o n s ,
r a t e of a c c i d e l t s i n t h e Region, t h e
s t r e n q t h e n r e h a b i l i t a t i o n proqrammes. I t
n r e v e n t i v e measures through s c h o o l and
t h e r e was scope f o r u r e a t e r c o l l a b o r a t i o n
The Regional Committee, w h i l e a p p r e c i a t i n q t h e a s s i s t a n c e provided by
WHO and UNICEF f o r immunization programmes, noted tinat immunization coveraqe
in
most c o u n t r i e s was n o t y e t a d e q u a t e .
The Committee noted w i t h
a p p r e c i a t i o n t h e i n t e y r a t i o n of E P I , A R I and CDD ixoqrammes w i t h 1lCH as an
" i n t e g r a t e d package" i n a number of c o u n t r i e s u t i l i z i n q t h e e x i s t i n q
i n f r a s t r u c t u r e , and f e l t t h a t t h i s had no d o u b t y i e l d e d encouraginq r e s u l t s .
P o l i t i c a l conlmitment t o t h i s protjramme a t t h e h i g h e s t 1 e v e . l ~ of t h e
government was q u i t e e v i d e n t i n a l l c o u n t r i e s ,
The e e q i o n a l Committee
emphasized t h a t g r e a t e r s u p p o r t wo111d have t o be : x o v i d e d f o r t h e f u r t h e r
a c c e l e r a t i o n of immunization a c t i v i t i e s i f t h e goi'ls of t h i s proarainme y e r e
t o be met w i t h i n t h e s p e c i f i e d time-frame.
A s r e g a r d s v e c t o r c o n t r o l , t h e Cosoaittee was concerned o v e r t h e
i n s u f f i c i e n t s u p ~ l yof i n s e c t i c i d e s , I t recommendecl t h a t t h e r e should be an
i n t e g r a t e d approach t o v e c t o r c o n t r o l i n v o l v i n q community p a r t i c i p a t i o n and
environmental
interventions.
The Committee a l s o noted t h a t i n most
c o u n t r i e s t h e numher of t r a i n e d workers i n t h e f i e l P f e l l s h o r t of
r e q u i r e m e n t s and t h a t , t h e r e f o r e , t h e r e was a need t o s t r e n g t h e n t r a i n i n g
programmes f o r e p i d e m i o l o q i s t s , n l a l a r i o l o g i s t s and e n t o m o l o g i s t s a t n a t i o n a l
and r e g i o n a l l e v e l s .
SEA/RC39/24
Page 10
Resurgence of malaria continued t o cause concern t o s e v e r a l c o u n t r i e s
i n t h e Rrqion. The t e c h n i c a l problem of vector r e s i s t a n c e t o i n s e c t i c i a e s
and p a r a s i t e r e s i s t a n c e t o drugs and p a r t i c u l a r l y t h e menace of r e s i s t a n t
falciparum p e r s i s t e d , The Committee noted t h a t t h e d i s e a s e continuer1 t o
defy a l l e f f o r t s a t containment and i t , t h e r e f o r e , r e l t t h a t it was time t o
evolve new s t r a t e g i e s f o r i t s e f f e c t i v e c o n t r o l . I n view of t h e i n c r e a s i n g
r e s e r v a t i o n s on t h e use of i n s e c t i c i d e s , i t was recommended t h a t WHO should
advocate more widely t h e i r proper use.
While noting t h a t d i a r r h o e a 1 d i s e a s e s were responsible f o r high i n f a n t
m o r t a l i t y i n s e v e r a l c o u n t r i e s of t h e Reqion, the Cornnittee emphasized t h e
need f o r t h e t r a i n i n y of mothers and h e a l t h worlrers i n t h e pto~peruse of
ORS.
I t recommended t h a t t h e epidemioloqical s u r v e i l l a n c e mechanism should
be strengthened and l a b o r a t o r y d i a g n o s t i c f a c i l i t i e s improved.
A s reqards a c u t e r e s p i r a t o r y i n f e c t i o n s ,
tho Regional
Committee
emphasized t h e need t o educate mothers and t r a i n a l l h e a l t h workers t o hc
a b l e t o a s s e s s t h e s e v e r i t y of A R I f o r a p p r o p r i a t e case manaqement. WHO was
requested t o h e l p e s t a b l i s h c l o s e linkages between A R I , b:PI
and CDP
programmes, within the E1CH package.
The Regional C o r n i t t e e noted t h a t , d e s p i t e the f a c t t h a t t u b e r c u l o s i s
c o n t r o l programmes had been o p e r a t i n q f o r long i n most c o u n t r i e s , t h e
I t was of t h e view t h a t WHO
d i s e a s e continued t o be a major h e a l t h problem.
should promote t h e i n t e g r a t i o n of tuberculosis c o n t r o l a c t i v i t i e s i n t o b a s i c
h e a l t h s e r v i c e s and s h o ~ i l dprovide g r e a t e r support f o r case-detection and
case-holding.
While noting the proqress made i n t h e prevention and c o n t r o l of r a b i e s ,
t h e Regional Committee f e l t t h a t t h e r e was a need t o promote more e f f e c t i v e
i n t e r s e c t o r a l c o l l a b o r a t i o n and ensure an adequate supply of vaccines of
assured q u a l i t y and s a f e t y .
The Committee noted the s t e p s taken by t h e c o u n t r i e s and '.THO i n regard
t o the impendiny r i s k of acquired immuno-deficiency syndrome (AIDS) i n the
Region.
While a p p r e c i a t i n g WHO'S e f f o r t s i n t h ~ sf i e l d , i t f e l t t h a t t h e
countries
should
give greater
attention
t o health
education and
surveillance.
The Committee noted
e s p e c i a l l y i n Thailand.
with
concern
the
rising
incidence
The Committee f e l t t h a t t h e pro(!rammc a g a i n s t deafness
a t t e n t i o n . I t was of the view t h a t 1,JHO should provide
c o u n t r i e s i n promotir~qprogrammes on tobacco and h e a l t h ,
of
DHF,
needed q r e a t e r
a lead t o the
The Regional Coi:mLttee
f e l t t h a t t h e exchange of v a l i d and u s e f u l
information was an a r e a which should receive q r e a t e r attention.
I t wanted
WHO t o provide a s s i s t a n c e t o t h e countries i n the p u b l i c a t i o n of
technical
l i t e r a t u r e and i t s t r a n s l a t i o n i n t o l o c a l lanquaqes.
The Regional Committee adopted a r e s o l u t i o n auorovinq t h e annual r e p o r t
(SEA/RC39/R3).
PART I11
EXAMINATION OF THE PROPOSED P R O G W E BUDGET FOR 1988-1989
'Phe Sub-committee on Progri>mnte Budget incllldert r e : > r e s e n t a t i v e s from a l l
Member S t a t e s . I t met on 9 and 11 September 1986 and s u b m i t t e d i t s r e p o r t t o
t h e R e g i o n a l Committee (SEA/RC39/22),
The Sub-Committee n o t e d t h a t t h e proposed Froqramme Budget f o r 19331989 had heen p r e p a r e d i n c o n f o r n i t v w i t h t h e S e v e ~ t hG e n e r a l Programme o f
Work c o v e r i n g t h e p e r i o d 1984-1989 and t h e mediun-term proqranme f o r t h e
same p e r i o d , w i t h t h e R e g i o n a l Proqramme Rudget P o l i c y , w i t h s p e c i f i c
recommendations made hy t h e R e q i o n a l Committee a t i t s p r e c e d i n g s e s s i o n s ,
and t h a t i t r e f l e c t e d n a t i o n a l and r ~ q i o n a lp r i o r i t i e s ,
I n a c c o r d a n c e w i t h i t s terms o f r e f e r e n c e , t h e Suh-Committee ersmined
t h e working p a p e r s r e l a t i n g t o t h e r e v i e w o f i m p l e m e n t a t i o n of programmes
d u r i n g t h e biennium 1984-19C5 and d u r i n q t h e f i r s t s i x months of t h e
biennium 1986-1987, t h e e n v i s a g e d p a t t e r n o f i n v e s t m e n t ( b y proqramme) and
a c t u a l e x p e n d i t u r e p a t t e r n s riuring t h e p r e c e d i n q and ongoinq b i e n n i a ,
p r o g r e s s made i n t h e j o i n t rjovern:ncnt/b~lJ@e v a l u a t i o n o f a r n - i o r i t y proqmpime
i n t h e Member S t a t e s , t h e proposed Proqramne Rudqet f o r 1988-1989. Thc SuhCommittee was i n i o r m e d of t h e r ) o s s i b i l i t y of reduced f u n d i n q i n 1986-1937
and p o s s i b l y i n 1988-1989 a s w e l l , 1t e n d o r s e d t h e c o n c l u s i o n s of t h e CCPDM
i n t h e c o u r s e o f i t s own r e v i e w s of t h e i m p l e m e n t a t i o n of prooranmes ard
a l s o made s e v e r a l o b s e r v a t i o n s of i t s own, d e t a i l s of which may he found i n
t h e f u l l r e p o r t of t h e Sub-committee,
I n K e ~ ~ l ~ SEA/RC39/R4
t i ~ n
t h e P.eqiona1 Committee approved tll:? r e p o r t of
t h e Sub-committee on Programme Hudqet and r e q u e s t e d t h e R e g i o n a l D i r e c t o r t o
t r a n s m i t t h e proposed Proqramne Rudget a s contain*:! i n document STA/RC39/3
t o t h e D i r e c t o r - G e n e r a l f o r i n c l u s i o n i n t h e nronosed Proqramme Qudget f o r
1988-1989.
SEA/RC39/24
Page 12
PART I V
DISCUSSION ON OTHER MATTERS
1.
R e g i o n a l Programme Budget P o l i c y
The Regional Committee noted t h a t t h e proposed r e q i o n a l proqramne
budget p o l i c y a s c o n t a i n e d i n document SEA/RC39/14 was i n l i n e w i t h t h e
recommendations made l,y i t s t h i r t y - e i g h t h s e s s i o n ,
The a i m of t h e r e g i o n a l programme hudget p o l i c y was t o e n s u r e t h e
o p t i m a l u s e of WHO'S r e s o u r c e s a t a l l o r g a n i z a t i o n a l l e v e l s and, i n
p a r t i c u l a r , t o h e l p t h e Member S t a t e s i n u s i n g 't'HO r e s o u r c e s t o t h e i r h e a l t h
development and f o r t h e i m p l + ? n e n t a t i o n of t h e s t r a t e q i e s f o r h e a l t h f o r a l l ,
The p o l i c y would i n c r e a s e t h e s p i r i t of ~ a r t n e r s h i nbetween t h e nlember
S t a t e s and t h e O r g a n i z a t i o n i n s t r e n g t h e n i n g t h e i r c a p a b i l i t v t o d e v e l o p and
manage t h e c o l l a b o r a t i v e progranime,
The Committee endorsed t h e r e g i o n a l proqrarine hudqet
e v e n t u a l submission t o t h e F o r t i e t h World h e a l t h Assembly,
2.
policy
for
Technical Discussions
During t h e t h i r t y - n i n t h s e s s i o n of t h e R e s i o n a l Committee, t e c h n i c a l
d i s c u s s i o n s were h e l d on t h e s u h j e c t of i n t e q r a t e d anproach t o m a t e r n a l and
child
h e a l t h c a r e i n t h e context. of primarv h e a l t h c a r e (document
SEA/RC39/13).
The d i s c u s s i o n s were o r q a n i z e d i n o r d e r t o review t h e p r e s e n t
s i t u a t i o n as r e g a r d s t h e i n t e q r a t n d approach t o m a t e r n a l and c h i l d h e a l t h
c a r e i n t h e c o n t e x t of rmimary h e a l t h c a r e i n t h e r 4 e ~ h e rC o u n t r i e s o f t h e
Begion, t o s t u d y t h e c r i t i c a l i s s ~ l a sr e l a t e d t o t h e p r o c e s s of i n t e q r a t i o n ,
and t o d e v e l o p m a n a q e r i a l o p t i o n s t o i n t e q r a t e t h o s e h e a l t h a c t i o n s r e q u i r e d
f o r t h e improvement of t h e h e a l t h c a r e of n o t h e r s and c h i l d r e n i n t o a n
i n t e q r a t e d packaqe of s e r v i c e s towards a c h i e v i n g t h e g o a l of h e a l t h f o r a l l .
'I'he f o l l o w i n ? recommendations a r i s i n q o u t of t h e d i s c u s s i o n s (document
SEH/RC39/23) were endorsed nv t h e Regiolral Committee:
( 1 ) Platernal and c h i l d h e a l t h i s concerned w i t h t h e p r o c e s s of qrowth
and development, t h e p r o c e s s t o improve human q u ; i l i t y from one q e n e r a t i o n t o
t h e o t h e r , and i s an i m p o r t a n t c o n t r i b u t o r t o human development from i t s
i n c e p t i o n . I t forms t h e h a s i s f o r a conprnhensive framework of m a t e r n a l and
c h i l d h e a l t h c a r e t h a t i n c l u d e s a l l a c t i v i t i e s aimed at: t h ? imnrovement of
h e a l t h of mothers and c h i l d r e n , i . e . , c ~ a t e r n a l h e a l t h c s r e , c h i l d h e a l t h
c a r e , family planning, n u t r i t i o n , in~munization,d i a r r h o e a 1 d i s e a s e c o n t r o l ,
a c u t e r e s p i r a t o r y i n f e c t i o n s , s c h o o l h e a l t h and r e p r o d u c t i v e h e a l t h of
a d o l e s c e n t s , and r e l a t e d a c t i v i t i e s ,
SCI?/RC39/24
Page 13
( 2 ) The i s s u e of i n t e q r a t i o n of m a t e r n a l and c h i l d h e a l t h , i n c l u d i n q
f a m i l y p l a n n i n g programmes, can he looked unon f r o ? t h r e e dimensions:
( a ) I n t e g r a t i o n of h e a l t h i n t e r v e n t i o n s w i t h i n m a t e r n a l and chilcl
h e a l t h care a t f a m i l y and cormunity l e v e l s (comhlned a c t i o n of
v a r i o u s MCR componer.ts);
(h) I n t e g r a t i o n of MCH/FP proqrammes a t v a r i o u s l e v e l s of
the health
c a r e s y s t e m , b a s e d on primarv h e a l t h c a r e ( f i r s t l e v e l , r e f e r r a l
l e v e l , e.g., a t h o s p i t a l , d i s t r i c t l e v e l , e t c . ) ;
(c)
I n t e g r a t i o n of MCli/FP a c t i v i t i e s of v a r i o u s development s e c t o r s .
I n o r d e r t o enhance e f f i c i e n c y , i t i s recornended
programmes aim a t tte above a s p e c t s of i n t e g r a t i o n .
that
MCH/FP
( 3 ) I n d e v e l o p i n ? a n o p e r a t i o n a l framework f o r t h e i n t e g r a t i o n Of
m a t e r n a l and c h i l d h e a l t h w i t h i n p r i m a r y h e a l t h c a r e , m a t e r n a l and c h i l d
h e a l t h c a r e ( i n i t s b r o a d e r s e n s e ) s h o u l d becon!? a n i n t e g r a l p a r t o f a
comprehensive h e a l t h system i n each c o u n t r y , To e n a b l e t h i s t o m a t e r i a l i z e ,
e q u i t y , community
t h e b a s i c p r i n c i p l e s of p r i m a r y h e a l t h c a r e , i . e . ,
involvement, a p p r o p r i a t e technology and i n t e r s e c t o r a l a c t i o n r e l a t e d t o t h e
improvement of t h e h e a l t h of mother- and c h i l d r e n , s h o u l d h e i n c o r p o r a t e d
and implemented. Each l e v e l of c a r e , from t h e hone U F J t o t h e h i q h e s t
r e f e r r a l l e v e l , shoiild be equipped an? s u p p l i e d w i t h n e c e s s a r y r e s o u r c e s and
c a p a b i l i t y t o conduct p r o p e r c a r e f o r mothers &:id c h i l d r e n , w i t h balanced
emphasis and r e s o u r c e a l l o c a t i o n t o v a r i o u s components.
'
A s r e g a r d s community involvement,
s t e p s have t o he t a k e n t o a o h i e v e
community s e l f - r e l i a n c e , t h r o u g h community o r q m i z a t i o n , community f i n a n c i n g
and community manpower development.
A h i g h l e v e l of p o l i t i c a l
comnitment, ICC a c t i v i t i e s i n a r e p e t i t i v e
and e s c a l a t i v e manner and t h e s t r e n g t l ~ e n i n g of community o r q a n i z a t i o n
(women's o r g a n i z a t i o n s i n p a r t i c u l a r ) a r e nrime e f f o r t s t o encourage
community movement towards c o ~ m u n i t ys e l f - r e l i a n c e ,
(a)
A short-term
(a)
I n p l e m e n t a t i o n of i n t e r s e c t o r a l a c t i o n s t o h e l p improve t h e h e a l t h
of mothers and c h i l d r e n a s an i m p o r t a n t c o n t r i b u t o r t o human
development;
(bl
U n i v e r s a l coveraqe by i n c r e a s i n q t h e
and
a c c e s s i h ~ l i t y of h e a l t h c a r
children;
(c)
A c t i v e p a r t i c i p a t i . , n of nonyov&rnmrntal, i n c l u d i n y professi.ona1,
o r g a n i z a t i o n s , e s p e c i a l l y women's o r q a n i z a t i o n s . i n f o s t e r i n g t h e
w e l f a r e of w~menand c h i l d r e n ; and
programme i,e l i e v e l o p d t o a t t a i n t h e f o l l o w i n g :
availability, affordahilit~
s e r v i c e s f o r n-others and
SEA/RC39/24
Page 14
(d)
Dissemination of i n f o r m a t i o n on a p p r o p r i a t e technology i n m a t e r n a l
and c h i l d h e a l t h among community workers, an4 t h e i r t r a i n i n g i n
t h e u s e of technoloqy.
(5)
A long-term prograrcme be d i r e c t e d t o a c h i e v e t h o f o l l o w i n g :
(a)
I n c r e a s e d a c c e p t a n c e of m a t e r n a l and c h i l d c a r e ,
leadino t o
community s e l f - r e l i a n t a c t i v i t i e s t o improve t h e h e a l t h of mothers
and c h i l d r e n ;
(b)
I n c l u s i o n of a c t i v i t i e s t o improve mother and
r e l a t e d s e c t o r a l proqrammes; and
c h i l d welfare
in
( c ) Reduction of i n f a n t m o r t a l i t y r a t e , m a t e r n a l m o r t a l i t y r a t e and
improvement of t h e i n d i c a t o r s of m a t e r n a l and c h r l d h e a l t h .
A
resolution
recommendations.
3.
(SEA/RC39/R5)
was
adopted
in
support
of
these
Review o f D r a f t P r o v i s i o n a l Agenda of Lie Seventy-ninth S e s s i o n
o f t h e Executive Board and of t h e F o r t i e t h World H e a l t h Assembly
The Regional Committee took n o t e of t h e d r a f t p r o v i s i o n a l agendas of
t h e s e v e n t y - n i n t h s e s s i o n of t h e Executive Board and t h e F o r t i e t h 'lorld
Health Assembly and, p a r t i c u l a r l y , of t h e s t ~ h j e c tf o r t e c h n i c a l d i s c u s s i o n s
a t t h e F o r t i e t h 'ilorld Health Assembly, t i t l e d "Economic S u p p o r t t o l l a t i o n a l
Healtfl-for-All S t r a t e f q i e s "
.
4.
E i g h t h G e n e r a l Programme of Work
-
P r o g r e s s Report
The Committee noted t h a t , t h e 8 t h General Programr,le of liork c o v e r i n q t h e
p e r i o d 1990-1995 was b e i n g f o r ~ u l a t e di n c l o s e c o n s u l t a t i o n w i t h t h e lilemher
S t a t e s . The 8 t h General Prorjrame of Work would b a s i c a l l y have t h e s a v e
s t r u c t u r e a s t h e 7 t h General Programme. On t h e h a s i s of t h e c o n t r i b u t i o n s
from t h e d i f f e r e n t r e ~ i o n s , ririo h e a d q u a r t e r s would be p r e p a r i n g t h e 8 t h
General Programne, which would bt? s u b m i t t e d t o t h e !Jorld Health lssernbly i n
May 1987.
The Committet? noted t h a t document SEA/RC39/6 c o n t a i n e d i n f o r n a t i o n on
t a r g e t s and t h e approaches f o r I'dMD c o l l a b o r a t i o n a t c o u n t r y and r e q i o n a l
l e v e l s , w i t h a n i n d i c a t i o n of s u p p o r t t h a t might he needed from t h e o l o b a l
l e v e l , f o r t h e v a r i o u s programme a c t i v i t i e s . The srophasis of t h e 8 t h General
Programme
o f work
woulr) be
on s t r e n q t h e n i n g
the health
systems
i n f r a s t r u c t u r e of t h e c o u n t r i e s f o r t h e i n t e q r a t e d d e l i v e r y of h e a l t h
programmes.
The Reqional Committee endorsed t h e r e q i o n a l c o n t r i h u t i o n t o t h e
C ~ n e r a lProgramme a s contalnr-rl i n docutnent SEP/RC39/t-,
8th
5,
Blood and Blood P r o d u c t s
The Regional Committee noted and d i s c u s s e d t h e s i t u a t i o n r e q a r d i n n
blood and blood p r o d u c t s a s d e s c r i b e d i n docu~nent.SEA/RC39/7. The Committee
emphasized t h e need t o s t r e n g t h e n blood t r a n s f u s i o n s e r v i c e s i n a l l
c o u n t r i e s and r e q u e s t e d WHO t o p r o v i d e t e c h n i c a l s u p p o r t f o r manpower
development and f o r t h e p r e p a r a t i o n of blood connonents and f r a c t i o n s .
I t adopted a r e s o l u t i o n i n t h i s r e g a r d (SEA/?C39/R6).
6.
S p e c i a l Programme f o r Research and T r a i n i n g i n T r o p i c a l Diseases
(1)
R e p o r t on J o i n t C o o r d i n a t i n g Board (JCB)
I n d i a and Burma had r e p r e s e n t e d t h e Reqion a t t h e Ninth meeting of t h e
J o i n t C o o r d i n a t i n q Board h e l d i n Geneva i n August 1986. The member frotn
I n d i a on t h e JCH r e p o r t e d on Q e h a l f of t h e r e g i o n a l r e p r e s e n t a t i v e s on t h e
t e c h n i c a l p r e s e n t a t i o n , t h e d i s c u s s i o n on d e s i q n a t e d f u n d s and t h e d e c i s i o n s
t a k e n t h e r e o n , a s w e l l a s on t h e a c t i v i t i e s of t h e s c i e n t i f i c and T e c h n i c a l
Advisory Board.
(2)
Nomination of a member i n p l a c e of Burma
whose term e x p i r e s on 31 December 1986
On t h e p r o p o s a l of Bhutan, seconded hy Nepal, t h e Reqional Committee
unanimously nominated S r i Lanka a s a memher of t h e j o i n t C o o r d i n a t i n g Roard
f o r t h r e e y e a r s e f f e c t i v e 1 J a n u a r y 1937.
7.
S p e c i a l Programme of Research, Development and Research
T r a i n i n g i n Human Reproduction
Membership of t h e P o l i c y
and C o o r d i n a t i o n Advisory Committee
-
The Regional Committee was informed t h a t t h e S p e c i a l Programme of
Research, Development and Research T r a i n i n g i n Human Reproduction had
e s t a b l i s h e d a P o l i c y and C o o r d i n a t i o n Advisorv Committee (PCAC), an a d v i s o r y
body t o t h e D i r e c t o r - G e n e r a l , t o make recommendations on m a t t e r s r e l a t e d t o
t h e p o l i c i e s , s t r a t e q i e s , f i n a n c i n g , o v e r a l l o r q a n i z a t i o n , management and
impact of t h e Proqramme.
The a t t e n t i o n of t h e Reqional Committee was drawn t o t h e f a c t t h a t
among t h e members of t h e PCAC were t h o s e t o be s e l e c t e d by t h e Regional
Con~mittee. I t was a l s o informed t h a t t h e menhership of t h e PCAC would be f o r
a periorl of t h r e e y e a r s b u t a t p r e s e n t t h e s e l e c t i o n would be on a s t a g g e r e d
b a s i s , i.e.,
one member would complete t h e tenilre i n December 1986, t h e
o t h e r i n December 1987, t h e t h i r d i n December 1988, and t h e f o u r t h i n
Decrmher 1989,
SiA/RC39/24
Page 16
The R e q i ~ n a lCo.,~mittees e l e c t e d t h e f o l l o w i n q c o u n t r i e s t o t h e PCAC:
Bangladesh: t o s e r v e on t h e Committee up t o 31 Decemher 1986, and t h e n
a g a i n from 1 J a n u a r y 1987 t o 31 December 1989.
Nepal: t o s e r v e on t h e Committee up t o 31 Decemher 15187.
I n d o n e s i a : t o s e r v e on t h e Committee up t o 31 December 1988.
8,
Nongovernmental o r g a n i z a t i o n s
and n a t i o n a l l e v e l s
-
relations a t regional
The R r y i o n a l Committee r e c o g n i z e d t h e i m p o r t a n t r o l e nongovernmental
o r g a n i z a t i o n s were p l a y i n g and t h e i r e f f o r t s c o r p l e m e n t i n g government
programmes. They were p a r t i c u l a r l y u s e f u l by v i r t u e of t h e i r independence,
m o b i l i t y , d i v e r s i t y and g r e a t e r o u t r e a c h t o t h e people. They c o u l d be
c o n s i d e r e d a s n a t i o n a l a s s e t s and a s ii p a r t of t h e n a t i o n a l system.
The Committee f e l t , however, t h a t t h e r e s h o u l d b e a n e f f i c i e n t
mechanism t o c o o r d i n a t e t h e a c t i v i t i e s of t h e I!C-0s w i t h t h o s e of t h e
qovernments, and among t h e IJGOs themselves. S t r e s n was l a i d on t h e need t o
channel t h e r e s o u r c e s p r o v i d e d hy t h e donor a q e n c i e s t o n a t i o n a l MGOs
through t h e n a t i o n a l qovernments concerned. The Reqional Committee a l s o f e l t
t h a t WHO should e n t e r t a i n r e q u e s t s f o r a s s i s t a n c e from n a t i o n a l FlGOs o n l y i f
such r e q u e s t s were c h a n n e l l e d t h r o u q h t h e government. S i m i l a r l y , WHO s h o u l d
c o n s u l t t h e qovernments h e f o r c i t t o d : any d e c i s i o n s r e q a r d i n g t h e NGOs.
The Regional Committee a g r e e d w i t h s e c t i o n 5 of t h e new t e x t of
h u t t o s u g g e s t t o VHO
p r i n c i p l e s iAnnex 1 t o document SEA/RC39/10),
h e a d q u a r t e r s and t o t h e Executive Board t h e a d d i t i o n of a c l a u s e , " t h i s
o p e r a t i o n should he c l e a r e d and c o o r d i n a t e d by t h e qovernment mechanism'' t o
s e c t i o n 5.1.
A r e s o l u t i o n was adopted i n t h i s c o n n e c t i o n (SCA/RC39/Q7).
9.
Environmental h e a l t h h a z a r d s
The Reqional Co:~~mitteed i s c u s s e d t h e paper SFA/RC39/19 and noted t h a t
chemical and n u c l e a r a c c i d e n t s had b o t h immediate and lonq-term e f f e c t s on
h e a l t h and had t h e r e f o r e t o be prevented.
I t e m p h a s i z ~ d t h e need t o
e s t a b l i s h a nodal p o i n t i n governments t o d e a l e f f e c t i v e l y w i t h t h i s
problem.
Governments s h o u l d c r e a t e g r e a t e r p u b l i c awareness, d i s s e m i n a t e
a p p r o p r i a t e i n f o r m a t i o n on t h e t o x i c e f f e c t s of hazardous c h e m i c a l s and
r a d i o a c t i v e m a t e r i a l s , and s h o u l d t a k e p r e v e n t i v e s a f e t y measures t o
minimize t h e o c c u r r e n c e of such a c c i d e n t s . The r o l e of MGOs i n t h e s e a s p e c t s
was emphasized.
While
multiagency
appreciating
tile
co~plex, sensitive,
nlultisectoral
and
n a t u r e of t h i s problem, t h e Reqional Committee urqed WHO t o
Sl?A/RC39/24
Page 17
p r o v i d e g u i d e l i n e s t c c o u n t r i e s f o r d e v e l o p i n q n a t i o n a l p l a n s and c o n t r o l
nechanisms i n t b i s a r e a ; t o d i s s e m i n a t ? i n f o r n a t i o n on t h e i l l - e f f e c t s of
t o x i c c h e m i c a l s and r a d i o a c t i v e m a t e r i a l s , and a s s i s t i n e s t a b l i s h i n q
s u r v e i l l a n c e and m o n i t o r i n g systems f o r e a r l y warninq.
10,
S e l e c t i o n of a s u b j e c t f o r t h e t e c h n i c a l d i s c u s s i o n s
t o be h e l d d u r i n g t h e f o r t i e t h s e s s i o n of t h e
Regional Committee
The Reqional Comilittee d e c i d e d t o hold t e c h n i c a l d i s c u s s i o n s on t h e
s u b j e c t of " I n f o r m a t i o n and Education on H e a l t h i n S u p p o r t of H e a l t h f o r &ll
by
t h e Year 2000" d u r i n g i t s f o r t i e t h s e s s i o n i n 1987 ( r e s o l u t i o n
SEA/RC39/R2).
11.
C o n s i d e r a t i o n of R e s o l u t i o n s of R e g i o n a l I n t e r e s t Adopted
by t h e World H e a l t h Assembly and t h e Executive Board
F o u r t e e n r e s o l u t i o n s of r e g i o n a l i n t e r e s t adopted by t h e T h i r t y - n i n t h
World H e a l t h Assembly and e i q h t by t h e s e v e n t y - s e v e n t h s e s s i o n of t h e
Executive Board were brouqht t o t h e a t t e n t i o n of t h e Reqional Committee.
These were noted.
12.
Time and p l a c e of forthcoming s e s s i o n s of t h e R e g i o n a l Committee
The R e q i o n a l Committee d e c i d e d t o h o l d i t s f o r t i e t h s e s s i o n i n t h e
Democratic P e o p l e ' s Republic of Korea i n 1987 and noted w i t h a p p r e c i a t i o n
t h e i n v i t a t i o n s of t h e Royal Government of Bhutan and t h e Government o f
I n d o n e s i a t o h o l d i n t h e i r c o u n t r i e s r e s w c t i v e l v i n 1988 and 1909, t h e
f o r t y - f i r s t and f o r t y - s e c o n d s e s s i o n s ( r e s o l u t i o n SEA/RC39/?<1),