EM/RC24A/3 page 10

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EXECUTIVE BOARD Fifty-fifth Session

Provisional agenda item 5.5.1

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十 e 、 〉 . 一

1 � � i t ^ л - с � -

IMPLEMENTATION OF RESOLUTION WHA7.33

In 1974, only Subcommittee A of the Regional Committee for th© Eastern Mediterranean held its session, pursuant to the provisions of resolution WHA7.33.1 Subcommittee В did not meet.

Paragraph 2(9) of resolution WHA7.33 provides that : Mif for any reason one or other of the subcommittees should be unable to meet on the date and at the place notified, the other subcommittee *s opinions shall be forwarded to th© Director-General".

The Director-General has, therefore, the honour to present to the Executive Board the report on the 1974 session of Subcommittee A.2

1 Handbook of Resolutions and Decisions, Vol. I, 1948-1972, p. 334

2 Document EM/RC24A/3

ANNEX

\V Г, R . 3 �» t A L T H ^ ORGANISATION MOSvJDIAl E O R G A N I Z A T I O N У V DE LA SANTÉ

REGIONAL OFFICc Ю Й T H� � ^ � — ^{L t} �―xfcAU KtGiONAL DL I-

lA > Î ^ N MtDirCkR^NEAN •"•……•-- ’ MÉDITERRANÉE ORIF),T �.

RtGIObiAL COMMITTEE FOR THE EM/RC2 4 A / 3

t,/\bTERN MLDITERRANEAN 1 3 S e p t e m b e r 1 9 7 4 1974 Session

SUB-COMMITT£b Л a g e n d a I t e m 1 3

REPORT OF SUB-COMMITTEE A OF THE

1974 SESSION OF THE

REGIONAL COMMITTEE FOR THE EASTERN MEDITERRANEAN

EM/RC2 4 A / 3

G e n e r a l

Opening of the Session E l e c t i o n o f u t r i c e r s

I n a u g u r a l Address

Address by the Governor of Alexandria Address by the Regional Director

ndoption of the Agenda

PART I I RLPOR'lS AMD STATEMENTS

1. Annual Report of the Regional Director

2 . S t a t e m e n t s anu R e p o r t s by R e p r e s e n t a t i v e s and Observers of organizations and Agencies

PART 1 1 1 SUB-DIVISION ON PROGRAMME�

1. Appointinent. of Sue-Division

2 . P r o p o s e d Proqramme and B u d g e t E s t i m a t e s f o r 1 9 7 6 / 7 7 f o r t h e E a s t e r n M e d i t e r r a n e a n R e g i o n 3 . P l a c e o f S a n i t a t i o n i n t h e C o n t r o l o f G a s t r o -

Inte."Linal Diseases

PART IV TE^bi.iCAx, DISCUSSIONS

1 . R a t i o n a l i t y in S u p p l y , C o n t r o l and U t i l i z a t i o n of Drugs

PART V OTHER MATTERS

1 . R e s o l u t i o n s o f R e g i o n a l I n t e r e s t Adopted by t h e T w e n t y - S e v e n t h World H e a l t h Assembly and t h e E x e c u t i v e B o a r d a t i t s F i f t y - T h i r d and F i f t y - F o u r t h S e s s i o n s

2 . Review o f t h e F i f t h G e n e r a l Programme o f Work C o v e r i n g a S p e c i f i c P e r i o d ( 1 9 7 3 - 1 9 7 7 )

3 . Working Group on T e c h n i c a l C o - o p e r a t i o n Among D e v e l o p i n g C o u n t r i e s

4 . A d o p t i o n o f t h e R e p o r t 5 . C l o s u r e o f t h e S e s s i o n PART VI RESOLUTIONS

ANNEX I SUB-COMMITTEE A OF THE REGIONAL COMMITTEE FOR THE EASTERN MEDITERRANEAN, 1974 SESSION

TABLE OF CONTENTS

PART I INTRCOULl'�ON

Page

1 1 1 1 2 3 3

4 4 4 9 13 13 13 15 16 16 17

17 18 18 18 19

1

2 3 4 5 о 7

ANNEX I I LIST OF REPRESENTATIVES, ALTERNATES, ADVISERS AND OBSERVERS TO SUB-COMMITTEE A

page 10

PART I

INTRODUCTION

1 . GENERAL

1974 Sub-Committee A of the Regional Committee for the Eastern Mediterranean at i t s Session met in the Regional Office for the Eastern Mediterranean Region of the World Health Organization, Alexandria, Arab Republic of Egypt, from 10 to 13 September Three plenary meetings were held and the Sub-Division on Programme took place on

Thursday, 12 September. Technical Discussions on "Rationality in supply, control and u t i l i z a t i o n of drugs" took place on Friday, 13 September.

The following S t a t e s were represented : Afghanistan

Bahrain Cyprus Egypt Ethiopia France Iran Iraq Jordan Kuwait Lebanon

Libyan Arab Republic Oman

Pakistan Qatar

Saudi Arabia Somalia

Sudan

Syrian Arab Republic Tunisia

United Arab Emirates Yemen

All Member S t a t e s represented exercised their r i g h t of vote in Sub-Committee A.

The United Nations Development Programme, the United Nations Children's Fund, the United Nations Relief and Works Agency for P a l e s t i n e Refugees and the Food and Agriculture Organization were represented•

Representatives or observers from eighteen inter-governmental, non-governmental and national Organizations were p r e s e n t í .

2 • OPENING OF THE SESSION (Agenda item 1)

The opening session was held a t the WHO Regional O f f i c e .

Dr H. Morshed ( I r a n ) , Vice-Chairman of Sub-Committee A of the 1973 Session of the Regional Committee for the Eastern Mediterranean declared the

1974 Session open, wishing i t every success in i t s d e l i b e r a t i o n s . He thanked the Government of the Arab Republic of Egypt for t h e i r h o s p i t a l i t y .

3 . ELECTION OF OFFICERS (Agenda item 2)

The Sub-Committee elected i t s Officers as follows:

1 See: L i s t of Representatives, Alternates, Advisers and Observers to Sub-Committee A, Annex I I

EM/RC24A/3

Chairman : Dr Ahmed Kamel Mazen (Egypt)

Vice-Chairmen : Professor Mohammed Ibrahim Azeem (Afghanistan) Dr E l i a s Hayek (Lebanon)

Chairman of Sub-Division

on Programme: Dr Hashem Abdel Ghaffar (Saudi Arabia) Chairman of Technical

Discussions : Dr Abdullah Al-Rifai (Kuwait) 4• INAUGURAL ADDRESS

Dr Ahmed Kamel Mazen, F i r s t Under-Secretary of Health, Ministry of Public Health, Egypt, on behalf of H.E. the Minister of Public Health, Arab Republic of Egypt, inaugurated the Meeting of Sub-Committee A of the 1974 Session of

the WHO Regional Committee for the Eastern Mediterranean.

He expressed the r e g r e t of the Minister a t his unavoidable absence due to o f f i - c i a l duties and had the honour to present his address.

The Minister welcomed a l l those taking part in the Meeting to what they should consider as their homeland• He r e c a l l e d that 1974 marked the s i l v e r anniversary of the WHO Regional Office for the Eastern Mediterranean, Egypt having been among the f i r s t ten of the Arab s i s t e r countries which joined the Region in 1949. He welcomed the i n v i t a t i o n to the Palestine Liberation Organization to take i t s r i g h t f u l place in the Meeting and thus contribute to the health development of the Palestinian people•

In evaluating the l a s t quarter of a century, he concluded that an appreciable and e f f e c t i v e improvement in health had been achieved in the Region. Now, Member S t a t e s were being called on to r e a c t by p o s i t i v e co-operation in r a i s i n g health standards. He suggested that they unify in formulating s t r a t e g i c health develop- ment plans 9 which would give WHO f l e x i b i l i t y and the p o t e n t i a l i t y to e s t a b l i s h for the various countries: health development problemsf t h e i r order of p r i o r i t y , and c o u n t r i e s1 a b i l i t y and p o t e n t i a l i t y to overcome t h e i r problems•

Among these problems, he pointed to d e f i c i e n c i e s in and lack of equipment ⁹ absence of r e l i a b l e s t a t i s t i c s and shortage of qualified health personnel•

Religion had never been an obstacle to development in the Region. Since the October War⁹ the p o l i t i c a l climate had been characterized by a search for peace and r e s p e c t for international law. I t was recognized that the use of force was a grave hazard to a culture and i t s development. Love, friendship, f r a t e r n i t y and peace were the i d e a l s , although i t was recognized that defence was also e s s e n t i a l •

Referring to the Regional D i r e c t o r ' s expressed thanks to Egypt for having granted h o s p i t a l i t y to the Regional Office for twenty-five years, he assured Heads of Member States that Egypt should be considered as part of t h e i r homeland whose wish to offer i t s p o t e n t i a l i t i e s to the development of h e a l t h .

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5 . ADDRESS BY THE GOVERNOR OF ALEXANDRIA

Abdel Tavab Hudeib, Governor of Alexandria> welcomed p a r t i c i p a n t s to the Meeting, on behalf of the people of Alexandria, who considered i t an honour to have an i n t e r n a t i o n a l gathering• He admired the e f f o r t expended in holding such a meeting, which promoted health - the basis of l i f e for humanity. He r e c a l l e d the

importance of the adage f,a sound mind in a sound body", which rule was upheld by those present through t h e i r meetings and seminars• He was sure that t h e i r God-given knowledge would be used for the good of mankind • He assured the Meeting t h a t the f a c i l i t i e s of Alexandria were at i t s disposal and wished those present every success and a pleasant s t a y .

6 . ADDRESS BY THE REGIONAL DIRECTOR

Dr A.H, Taba, Regional Director, on behalf of the World Health Organization, welcomed those present to the annual session of Sub-Connnittee A of the Regional Committee for the Eastern Mediterranean.

He extended warm and sincere thanks to the Government of the Arab Republic of Egypt for t h e i r h o s p i t a l i t y in hosting the Regional Office and the c o r d i a l r e l a t i o n s which e x i s t with the a u t h o r i t i e s in a l l matters•

He pointed out that the importance of t h i s Region l a y , not only in i t s r o l e within the f i e l d of health but because i t contained within i t s e l f so many of the most challenging problems which face the world a t t h i s time. Although i t embraced a singularly diverse group of countries, i t was useful to remember to discuss together the many common problems. Nevertheless, the solutions in each country should s u i t i t s own p a r t i c u l a r needs.

I t was not simply that some countries were r i c h and some l e s s r i c h , and that some had reached a stage of s o c i a l and economic development f a r advanced above o t h e r s . Also, in t h i s fast-moving region at the cross roads of so many c u l t u r e s , there were some completely new phenomena. For example, the degree of wealth

possessed by a country was no longer d i r e c t l y r e l a t e d to i t s stage of s o c i a l develop- ment. The a b i l i t y of the health s e r v i c e s of countries of the Eastern Mediterranean Region to respond to the true needs of t h e i r populations was as much a problem in the wealthiest as in the economically l e s s fortunate member c o u n t r i e s .

WHO had a continuing and healthy process of assessing i t s achievements and r e - examining ways to provide assistance to Che Member States• While there had been great successes in the f i r s t twenty-five years of e x i s t e n c e , the problems which r e - mained were greater than those which had been solved• For example ⁹ the most elemen- tary health and medical services were s t i l l beyond the reach of a vast proportion in most c o u n t r i e s .

Experiments were being conducted, notably s e v e r a l in t h i s Region, to find new ways of developing health systems t r u l y responsive to the a c t u a l needs of the people.

Ways to design and guide such health s e r v i c e s as s c i e n t i f i c a l l y as possible, and prepare those who w i l l roan them, were being studied •

EM/RC24A/3 page 10

The shortage of health manpower and the inadequacy of i t s d i s t r i b u t i o n , with over-production of some health personnel, and gross under-production of others, was common to every country of the Region. I t was disturbing that many of those being trained were much l e s s aware than they should be of the r e a l i t y of t h e i r c o u n t r i e s ' health problems. Doctors and nurses, and many other groups as well, continued to be prepared along l i n e s developed long ago to meet the needs of quite d i f f e r e n t p l a c e s , times and circumstances. Too l i t t l e training took into account advances in educational science or an understanding of how communities changed and grew.

Properly designed education and training of health personnel was an over-riding p r i o r i t y .

He r e f e r r e d to the c l o s e and intimate r e l a t i o n s between t h i s Office and the countries served, as a r e s u l t of which there was no question of WHO ever attempting to impose ideas in the Region from the outside•

Each year there were many opportunities for a constant dialogue : at the WHO Assembly, the Executive Board and t h i s Annual Meeting views were exchanged with every country on what should be done, when and how. He himself, and his technical colleagues, v i s i t e d the countries to review and evaluate the progress of j o i n t work with the health a u t h o r i t i e s • And daily there was a constant flow of correspondence between t h i s Office and the Governments. This sense of continuing and f r u i t f u l contact was cherished and thanks were due to Governments for t h e i r support and en- couragement •

At the meeting of the Regional Committee each year, when a l l concerned were gathered together, he looked forward to receiving c o l l e c t i v e guidance on a c t i v i t i e s and to sharing in d e t a i l suggestions for j o i n t future c o l l a b o r a t i o n .

1 • ADOPTION OF THE AGENDA (Agenda item 3 , Document EM/RC24A/1, R e v . l , Resolution EM/RC24A/R.1)

The provisional agenda was adopted as presented.

PART I I

REPORTS AND STATEMENTS

1 . ANNUAL REPORT OF THE REGIONAL DIRECTOR (Agenda item 5 , Document EM/RC24/2, Resolution EM/RC24A/R.2)

Introducing his Report, the Regional Director r e c a l l e d that the Regional Office for the Eastern Mediterranean opened in i t s present premises on 1 July 1949• Soon a f t e r the establishment of the Regional O f f i c e , and p e r i o d i c a l l y ever since, the Region has suffered floods, famines and wars, a l l f a c t o r s that impede, and even s e t back socio-economic progress of which the development of health s e r v i c e s i s an i n - d i v i s i b l e p a r t . Nevertheless, considerable gains had been made in the development of health s e r v i c e s in the Member Countries of the Region and in the health s t a t u s of t h e i r populations. The geographical s i t u a t i o n of the Region a t the cross roads of so many c u l t u r e s added to the challenges which i t had to face and the likelihood of events which might hamper progress. Nevertheless there were many causes for pride and s a t i s f a c t i o n . He pointed to the table on page i i i of the Introduction to his Report which summarized progress made in the past twenty-five years, outstanding

page 10 among which were the achievements towards the e r a d i c a t i o n of smallpox and malaria

and the Increased number of t r a i n i n g i n s t i t u t i o n s and a v a i l a b l e health personnel.

Medical schools alone, as could be seen from the r e p o r t , had increased from 12 to 4 9 , and even since the r e p o r t was published two new schools had been opened. A similar massive i n c r e a s e In such other t r a i n i n g i n s t i t u t i o n s as dental schools, pharmacy s c h o o l s , nursing schools and t r a i n i n g programmes for many d i f f e r e n t c a t e - g o r i e s of a u x i l i a r y and middle l e v e l personnel had been seen. Development of health s e r v i c e i n f r a s t r u c t u r e had been s t r i k i n g , but remained uneven, d i f f e r e n c e s being found even within individual c o u n t r i e s . However, s t i l l g r e a t e r a t t e n t i o n was c a l l e d f o r , p a r t i c u l a r l y in r u r a l and other under-privileged a r e a s .

The regional programme follows the General Programme of Work of the Organization covering a s p e c i f i c period, and the d i r e c t i v e s of the Regional Committee. A sepa- r a t e document reviewing progress in the F i f t h General Programme of Work ( 1 9 7 3 - 7 7 ) would be discussed under Agenda item 7 ( b ) .

Most countries now had a n a t i o n a l health plan, the preparation of which had in s e v e r a l cases been a s s i s t e d by WHO. In other Instances those responsible for health planning had been trained through WHO fellowships within or outside the Region -

notably through a j o i n t course a t the School of Public Health, Teheran, I r a n , and the High I n s t i t u t e of Public Health, Alexandria, Egypt. Exchange of v i s i t s between health planners among the countries of the Region, to study and compare the d i f f e r e n t methods employed was another useful means of a s s i s t a n c e . M i n i s t r i e s of Health

should a l s o take advantage of qualified persons in U n i v e r s i t i e s and Health I n s t i t u t e s to a s s i s t them in t h e i r planning.

Lack of trained manpower was a problem common to a l l c o u n t r i e s , even where f i n a n c i a l resources were a v a i l a b l e . To make the most of a v a i l a b l e manpower, a s s i s t - ance in the management, evaluation and implementation of programmes was a v a i l a b l e , for example in the formulation of country health programmes• A management survey of health training programmes in the Yemen Arab Republic had been c a r r i e d out; the United Arab Emirates were a s s i s t e d in preparing t h e i r f i r s t health p l a n ; the Govern- ment of Iran was being a s s i s t e d in i n v e s t i g a t i n g new approaches to find the best means of delivery of health care； a seminar held in Cairo in October 1973 had given senior health administrators the opportunity to discuss and review modern management techniques.

Some communicable diseases were s t i l l prevalent in the Region, such as m a l a r i a . Here the progress made could be c l e a r l y seen from figures 1 and 2 , but nevertheless the disease s t i l l recurred and in two countries the incidence had i n c r e a s e d . A number of countries had succeeded in achieving t o t a l e r a d i c a t i o n ; in some others

transmission was reduced to near zero and c o n t r o l programmes had been introduced where e r a d i c a t i o n was not f e a s i b l e . The c o s t of malaria operations s t i l l involved Governments in considerable expenditure and the World Health Assembly had asked the Executive Board to review the matter (Resolution WHA 2 7 . 5 1 ) .

From figures 3 and 4 the g r a t i f y i n g r e s u l t s of the smallpox e r a d i c a t i o n p r o - gramme were evident. Only in Ethiopia and Pakistan was the disease s t i l l endemic•

The WHO team in Pakistan had r e c e n t l y informed him t h a t e r a d i c a t i o n was expected to be achieved there by end-September 1974, while mid-1975 should also see e r a d i c a - tion in E t h i o p i a .

EM/RC24A/3 page 10

Cerebrospinal meningitis was s t i l l a problem in many c o u n t r i e s , but e s p e c i a l l y in the Sudan. Recently, a breakthrough had been achieved with development of a new polysaccharide A vaccine. T r i a l s in the Sudan and Egypt had so f a r given promising r e s u l t s and the vaccine may prove a s u c c e s s f u l weapon against the d i s e a s e .

The important r o l e of laboratory s e r v i c e s in medical c a r e , epidemiological a c t i v i t i e s , and s u r v e i l l a n c e , was r e a l i z e d . To strengthen these s e r v i c e s , support for the t r a i n i n g of personnel a t a l l l e v e l s had been provided, about 11 per cent of the t o t a l fellowships awarded in the l a s t twenty-five years being devoted to t r a i n - ing of laboratory personnel alone. Training courses were established in countries of the Region.

The infant mortality r a t e had dropped considerably over the l a s t twenty-five y e a r s , in both the l e s s e r and more developed countries within the Region, but was s t i l l g r e a t e r than in developed countries outside the Eastern Mediterranean Region.

Thanks were p a r t i c u l a r l y due to UNICEF for the a s s i s t a n c e they continued to give to work in the area of maternal and child health in the Region. WHO continued to make a v a i l a b l e the l a t e s t advances in t h i s f i e l d and, for t h i s purpose, various meetings had been held: a Seminar on School Health Services in Baghdad, I r a q , was held in March 1974 and another seminar on Provision of Health Services for the P r e - school Child, Mogadishu, Somalia， in July 1974. At the same time, WHO continued to a s s i s t countries with the health aspects of family planning in accordance with i t s o f f i c i a l mandate from the World Health Assembly. Egypt, I r a n , Pakistan and Tunisia have adopted a family planning policy giving p r i o r i t y to population c o n t r o l , while other countries advise mothers on such a s p e c t s as family spacing through maternal and child health centres• UNFPA a s s i s t a n c e contributed g r e a t l y to the programme.

The important topic of q u a l i t y c o n t r o l and r a t i o n a l i t y in the use of drugs would be expounded f u l l y as p a r t of the Technical Discussions.

Once more the need for r e l i a b l e health s t a t i s t i c s in any planning or evaluatory a c t i v i t i e s was s t r e s s e d . S t a t i s t i c a l personnel b e n e f i t t e d from WHO fellowships and t r a i n i n g courses were r e c e i v i n g a s s i s t a n c e . Medical care in the Region suffered from the inadequate quality of medical r e c o r d s . To overcome t h i s , countries were a s s i s t e d in establishing or strengthening t h e i r h o s p i t a l record systems and, in October 1974, a course for medical records o f f i c e r s leading to a diploma would commence a t the High I n s t i t u t e of Public Health, Alexandria, Egypt.

The Regional Director took the opportunity to r e f e r to a document prepared by the Regional Office based on s t a t i s t i c s a v a i l a b l e from Governments themselves ⁹ as well as from a v a r i e t y of United Nations sources, and asked Representatives to supply any needed amendments to the d a t a . He s t r e s s e d that the method of compilation and c o l l e c t i o n must conform to i n t e r n a t i o n a l standards for the data t o be acceptable ^#

In the f i e l d of mental h e a l t h , there had been a g r e a t change in a t t i t u d e s . In s p i t e of some continuing r e s i s t a n c e , i n c a r c e r a t i o n in c u s t o d i a l i n s t i t u t i o n s was gradually giving way to i n t e g r a t i o n of p s y c h i a t r i c c a r e in general h o s p i t a l s , and an increased emphasis on community c a r e of the mentally i l l . The p s y c h i a t r i c a s p e c t s of crime and j u v e n i l e delinquency, dependence on alcohol and other drugs, and d i f f i c u l t i e s a t school and a t work were f a c e t s of the mental health problem in d i f f e r e n t c o u n t r i e s . A universal shortage of manpower a t a l l l e v e l s hindered development of programmes.

page 10 The promotion of environmental health and s a n i t a t i o n was an expensive e n t e r -

p r i s e , which might not always receive due p r i o r i t y in the a l l o c a t i o n of r e s o u r c e s . I t should be realized that many i n t e r n a t i o n a l agencies, such as UNDP, UNICEF, IBRD and regional banks such as the African Development Bank and the Asian Development Bank, were potential sources of funds, in addition to b i l a t e r a l a s s i s t a n c e . WHO would be glad to help In preparing well formulated requests for such a s s i s t a n c e and eventually in implementing the programmes. In s p i t e of the progress achieved so f a r , i t had been estimated t h a t , by 1980, 54 per cent of urban and 94 per cent of the r u r a l population of the Region would s t i l l be lacking e s s e n t i a l water and s a n i t a - tion s e r v i c e s .

Education and training a t a l l l e v e l s had always been a p r i o r i t y for WHO, a s s i s t - ance in the past to health manpower development accounting for approximately one- third of the t o t a l budget.

The number of medical schools in the Region had increased considerably, the l a t e s t t o t a l being f i f t y - o n e , some of which were unfortunately premature. WHO had always recommended the need for elaborate and detailed planning before opening a new medical school. In Kuwait for example, t h i s advice had been followed and the

school w i l l open only in two y e a r s ' time, although f i n a n c i a l resources have been available for some time•

Whereas in the past emphasis was on the preparation of high l e v e l personnel, there was now an Increasing i n t e r e s t in developing the middle and lower l e v e l s of health personnel. The training of "medical assistants1 1 and other t e c h n i c a l and a u x i l i a r y personnel was receiving much more a t t e n t i o n in order to c o r r e c t the im- balance in the available manpower supply.

The l a s t two years had witnessed great a t t e n t i o n to teacher t r a i n i n g . The Regional Teacher Training Centre, Pahlavi University, Shiraz, contributed through a s e r i e s of national, regional and o n - s i t e workshops• The a p p l i c a t i o n of modern concepts of educational science to the a r t of medical teaching and e s p e c i a l l y the use of audio-visual aids was expounded• The Centre produced a quarterly publica- tion, e n t i t l e d "The Learner" which was distributed to health professional educators through the Region• The University of Alexandria w i l l open a c e n t r e s p e c i f i c a l l y concerned with the educational process which i t i s hoped w i l l serve a l l Egypt•

A meeting in Teheran in 1962 emphasized the aims of medical education as being both s c i e n t i f i c and s o c i a l . This was followed by a s e r i e s of meetings : in 1963 in Alexandria, 1967 in Baghdad, 1968 in Khartoum, 1970 in Teheran and 1972 in

Alexandria. During the Khartoum meeting the Association of Medical Schools of the Middle East was e s t a b l i s h e d . These meetings discussed p a r t i c u l a r l y the relevance of c u r r i c u l a to the needs of countries served. As a part of the concern to define the r o l e of the physician in t h i s Region, a workshop on the Needs for Research in Medical Education was held in 1974 in Alexandria•

In t h i s context, a continuing problem which should be mentioned, to which a solution had not yet been found, was the "brain drain" of qualified health personnel who leave their own countries, depriving them of much needed s e r v i c e s .

Nursing s t i l l remained e s s e n t i a l l y a weak element in the Region, and a complex problem to which a solution had yet to be found. To improve the l e v e l of nursing

EM/RC24A/3 page 10

care and t r a i n nurses to provide the s e r v i c e s needed by p a t i e n t s and communities, a s e r i e s of meetings had been held a t which the problem was discussed by senior nurses from various c o u n t r i e s . An i n t e r e s t i n g experiment in Egypt was the opening of 130 new secondary t e c h n i c a l nursing schools for the t r a i n i n g of l a r g e numbers of nurses,

the f i r s t batch of whom would complete t r a i n i n g next y e a r . The programme was being followed with i n t e r e s t by WHO.

Fellowships had always been and would continue to be a major f i e l d of a c t i v i t y , accounting for about US $ 2 m i l l i o n l a s t year alone ( f i g u r e s 5, 6, 7 and 8 showed development of the programme over the years)•

The Regional D i r e c t o r thanked the Governments of Egypt, Kuwait and Saudi Arabia wno had each financed the production of the Arabic v e r s i o n of "World Health¹¹ for one y e a r , and the Government of Libya who had financed two y e a r s . Money was now a v a i l a b l e for two y e a r s1 production. The f i r s t issue in P e r s i a n had a l s o been produced, sponsored e n t i r e l y by the Government of I r a n .

He r e f e r r e d to the Resolution EM/RC23A/R.5 submitted by the Government of Lebanon to the Twenty-third Session regarding the health conditions of inhabitants of Occupied T e r r i t o r i e s in the Middle E a s t , and informed the Meeting that a r e p o r t had been submitted to the Assembly by the WHO team on i t s f i r s t v i s i t to a l l the c o u n t r i e s concerned, except I s r a e l , in May 1 9 7 4 . A r e p o r t on the second s i m i l a r v i s i t in August was awaited. The Resolution EM/RC23A/R.4 submitted by the Govern- ment of Egypt regarding f u r t h e r d e c e n t r a l i z a t i o n of WHO a c t i v i t i e s had been presented by him to the Executive Board. With regard to the Resolutions EM/RC23A/R.8 and EM/RC23A/R.9 submitted by the Government of I r a n , he had s o l i c i t e d voluntary c o n t r i b u t i o n s from c o u n t r i e s , t h i s a c t i o n being in accordance with a r t i c l e 50 ( f ) of the WHO C o n s t i t u t i o n . He estimated t h a t approximately US $ 25 million could be absorbed to promote the programme in the next f i v e y e a r s . Such funds could be

devoted t o a v a r i e t y of a c t i v i t i e s including aid required as a r e s u l t of emergencies, such as t h a t at present being given to Cyprus.

He drew the a t t e n t i o n of Representatives to the l a s t three and a - h a l f pages of the I n t r o d u c t i o n to h i s Report, which in e f f e c t summarized the main p o i n t s , and assured them t h a t t h e i r comments would be welcomed.

He wished t o thank a l l the member Governments for t h e i r c l o s e and intimate c o l - l a b o r a t i o n with the Regional Office and f i e l d s t a f f .

In the ensuing d i s c u s s i o n s , Representatives thanked the Regional D i r e c t o r for h i s e x c e l l e n t Report and his l u c i d p r e s e n t a t i o n . The information on progress in the l a s t t w e n t y - f i v e years was p a r t i c u l a r l y a p p r e c i a t e d .

Several R e p r e s e n t a t i v e s expressed t h e i r s a t i s f a c t i o n a t the progress achieved over the years and t h e i r continued support of WHO's e f f o r t s to improve health condi- t i o n s in the Region. The concept of g r e a t e r c o l l a b o r a t i o n between c o u n t r i e s was welcomed and, in t h i s c o n t e x t , i t was f e l t t h a t while the " b r a i n - d r a i n " caused by

q u a l i f i e d health personnel working outside the Region was a serious problem, as some c o u n t r i e s could not match the i n c e n t i v e s o f f e r e d abroad, the employment of such personnel in another country of the same Region, whose l a c k was g r e a t e r , could be considered as d e s i r a b l e r e g i o n a l c o l l a b o r a t i o n . I t was f e l t t h a t the "Health Development Bank" and "Regional Co-operative" suggested by the Regional D i r e c t o r

page 10 should be considered in order to make best use of resources on a regional b a s i s ,

since disease has never been limited by f r o n t i e r s . In addition, they could be p a r t i c u l a r l y useful in emergency s i t u a t i o n s # The Regional Director was asked to continue to study these proposals•

The apparent decrease in the portion of the UNDP Indicative Planning Figure devoted to the health s e c t o r since introduction of the Country Programming system was r e g r e t t e d . In reply to a request that WHO might present a resolution in t h i s respect to the UNDP, the Regional Director emphasized that i t was the r e s p o n s i b i l i t y of countries themselves to e s t a b l i s h p r i o r i t i e s and decide how the Country Programme was devised. He r e i t e r a t e d his often expressed advice that health ministries should ensure that they are strongly represented in planning bodies, so that a f a i r propor- tion of resources may be a l l o c a t e d to h e a l t h . He urged that the impact of improved health, for example of working population, on the socio-economic s t a t u s of a country be f u l l y explained.

Several Representatives outlined recent health developments in t h e i r c o u n t r i e s . The Representative of Egypt extended an i n v i t a t i o n to anyone who f e l t i t might be beneficial to v i s i t one of the new secondary nursing schools. The Representative of Sudan offered to provide co-operation to s i s t e r countries who could benefit from the experience with the cerebrospinal meningitis polysaccharide A vaccine t r i a l .

The health of inhabitants of Occupied T e r r i t o r i e s was a matter of considerable concern； i t was stated that in s p i t e of resolutions passed conditions continued to d e t e r i o r a t e . Increased a t t e n t i o n to t h i s problem was urged.

In s p i t e of successful e f f o r t s in control of communicable diseases, some, such as schistosomiasis, s t i l l remained a major problem as most of the countries were mainly a g r i c u l t u r a l . I t was mentioned that the large Euphrates Dam p r o j e c t might entrain epidemiological d i f f i c u l t i e s , for which WHO a s s i s t a n c e would be necessary.

The lack of health education as a f a c t o r inhibiting control of communicable diseases was mentioned•

The need for further d e c e n t r a l i z a t i o n , which i s in accordance with WHO'S policy, was also mentioned•

2 • STATEMENTS AND REPORTS BY REPRESENTATIVES AÑD^QBSERVERS OF ORGMTZATIQNS AND AGENCIES

(Agenda item 8, Resolution ЕМДСТЗА/ИТЗ)

The Representative of the United Nations Relief and Works Agency for Palestine Refugees conveyed the greetings of the Commissioner-General of UNRWA to the Meeting and thanked WHO for t h e i r i n v i t a t i o n to be represented.

UNRWA1s valued collaboration with WHO dated back to 1950 and a continuing cordial and close relationship bound the two organizations together. The Agency was thankful for the technical guidance, supervision and a s s i s t a n c e which i t

continued to r e c e i v e from WHO Headquarters to the Agency's health programme. He personally thanked the Regional Director and his s t a f f for t h e i r unfailing co- operation with UNRWA1 s Department of Health.

E M / R C 2 4 A / 3

page 10

UNRWA entered the twenty-fifth year of operations on 1 May 1974, providing e s s e n t i a l r e l i e f , education and health s e r v i c e s for e l i g i b l e P a l e s t i n e refugees, presently t o t a l l i n g 1 583 646, r e g i s t e r e d with them.

He outlined -the health programme for the e l i g i b l e refugees, including environ- mental s a n i t a t i o n services for some 629 000 refugees l i v i n g in the s i x t y - t h r e e UNRWA- serviced refugee camps• UNRWA endeavoured within i t s limited resources to maintain health s e r v i c e s comparable with those provided by the Arab host governments a t public expense to t h e i r c i t i z e n s • Great importance was attached to community education in h e a l t h i e r habits and p r a c t i c e s in daily l i f e .

In s p i t e of temporary disruptions r e s u l t i n g from h o s t i l i t i e s mainly in Syria in October 1973 and in South Lebanon in May and June 1973, the health s e r v i c e s operated smoothly. Emergency health and r e l i e f s e r v i c e s and f a c i l i t i e s were expeditiously provided by the Agency to the affected camps • No cases of cholera or other

quarantinable disease were reported during the period and almost a l l the Important

n o t i f i a b l e diseases continued to show a s a t i s f a c t o r y trend. <

Three health centre premises, WHO supplementary feeding c e n t r e s , two c l i n i c a l l a b o r a t o r i e s and two specialized c l i n i c s (one each for diabetes and for rheumatic d i s e a s e s ) were established• Environmental s a n i t a t i o n in the camps had been improved

through UNRWA-assisted refugee s e l f - h e l p schemes, e s p e c i a l l y for construction of p r i v a t e l a t r i n e s , sewerage and surface drains•

A s p e c i a l contribution of US $ 7 . 9 million by the European Economic Community for the c o s t of the preparatory cycle of education, and an emergency contribution of US $ 4 . 2 million by the United States Government .towards the c o s t of the elementary c y c l e of education in the l a s t four months of 1974, eliminated the budgetary d e f i c i t for 1974 and thereby averted the Impending t h r e a t of reduction in the Agency's pro- gramme . However, UNRWA was s t i l l extremely apprehensive about 1975, when expenditure was estimated a t US $ 109 million, mainly as a r e s u l t of the high p r i c e of flour and l o c a l i n f l a t i o n . The foreseen d e f i c i t of US $ 39 million was of a d i f f e r e n t order of magnitude from any in the past and again exposed the refugees to the t h r e a t of reductions in services•

UNRWA¹ � present mandate would expire on 30 June 1975. I t was hoped that when renewal vas considered by the United Nations General Assembly a t i t s next session, a b e t t e r method of financing UNRWA^f8 programes in future would be sought such as would allow UNRWA to concentrate on the delivery of e s s e n t i a l s e r v i c e s t o the Palestine refugees Instead of engaging in fund raising•

He thanked governments⁹ inter-governmental organizations⁹ voluntary agencies, philanthropic bodies and individuals who, through t h e i r general or designated

c o n t r i b u t i o n s , made possible the continuation and Improvement of the health programme for the P a l e s t i n e refugees•

The Representative of the United Nations Development Progranme .stated that c o - operation with WHO had become increasingly g r e a t e r 9 p a r t i c u l a r l y since UNDP I n s t i t u - t i o n a l i z e d the long-term country programing system two years ago.

He s t a t e d that In the Five-Year UNDP Country Prograome for Egypt, the health s e c t o r represented about US $ 2 . 3 million or 6 per cent of the t o t a l UNDP programme, a l l being executed or to be executed by WHO,

p a g e 10

He outlined the present and proposed a s s i s t a n c e to the health s e c t o r in Egypt in the two main areas of research, control and training in b i o l o g i c a l substances and in the training of a u x i l i a r y health personnel.

He pointed out that there had been an unusual i n c r e a s e in the UNDP contribution in 1970/1971 in the Region, due to l a r g e - s c a l e water supply and training p r o j e c t s . As a r e s u l t , by c o n t r a s t there might appear to have been a reduction in subsequent years9 but t h i s was not a r e a l decrease.

For example, in Egypt the Country Programme for 1973/1977 was about US $ 2 m i l l i o n , an increase of 130 per cent over the previous f i v e - y e a r period.

He would not f a i l to report to UNDP Headquarters the comments of the meeting.

He had three suggestions to make:

(a) to impress on co-ordinating organizations that the Government i s responsible for assigning p r i o r i t i e s ,

(b) as the UNDP was increasingly approving integrated p r o j e c t s , a health component might be included, for example, in a g r i c u l t u r a l , i n d u s t r i a l and s c i e n t i f i c p r o j e c t s ,

(c) advantage might be taken of the system of annually reviewing Country Programmes.

He mentioned the regular and systematic co-operation between UNDP and the WHO Regional Office• He referred to the Inclusion in the agenda of d e l i b e r a t i o n s of the Working Group on Technical Co-operation among Developing Countries which was s e t up by the Governing Council of the UNDP a t i t s January 1973 session, a healthy sign of WHO's dynamism in constantly adapting i t s e l f to changing needs of the World.

The Representative of the United Nations C h i l d r e n� Fund r e f e r r e d to c o l l a b o r a - tion with WHO which always offered challenging opportunities for stimulating j o i n t a c t i o n .

The Regional Director had pointed out that the problems which remain unsolved were s t i l l s i z a b l e . In t h i s anniversary y e a rr he extended to the Regional Director and to his e x c e l l e n t team of advisers, administrators and country r e p r e s e n t a t i v e s , UNICEF's very sincere wishes for success in dealing with these problems•

About 50 per cent of UNICEF¹s programme expenditures were to-day consecrated to basic health s e r v i c e s , including MCH, water supply and other child health programmes•

During the current year, in f a c t , UNICEF supplies and equipment were being provided in some ninety countries to 22 000 r u r a l centres and subcentres, 1 500 urban MCH c e n t r e s , d i s t r i c t and r e f e r r a l hospitals and maternity homes. At the same time, training stipends were being granted to more than 21 000 health workers.

Achievements over the past few years had been f a i r l y impressive, but b a s i c health s e r v i c e s in the r u r a l areas of developing countries were s t i l l limited in extent and of uneven q u a l i t y . Not enough a t t e n t i o n was being accorded to the d i f f e r e n t ways to reach the child and improve his h e a l t h , including the use of a u x i l i a r y health workers, of personnel and s e r v i c e s outside the t r a d i t i o n a l health s t r u c t u r e and involvement of the community in the delivery system. WHO and UNICEF

EM/RC24A/3 page 10

were c u r r e n t l y undertaking an extensive study on a l t e r n a t i v e approaches, for review by the UNICEF Executive Board during i t s session scheduled for Spring 1975.

He mentioned the plight of children affected by the present economic and

f i n a n c i a l disequilibrium which tended to c r e a t e g r e a t e r d i s p a r i t i e s among the develop- ing c o u n t r i e s . Faced with problems which seriously threatened the v i a b i l i t y of t h e i r economy, many of these countries might cut back budgets for the s o c i a l f i e l d s , including health s e r v i c e s . These countries would need greatly increased external aid i f s e r v i c e s for children were to be maintained. In t h i s connexion, the UNICEF Executive Board this year adopted a decision e n t i t l e d "Declaration of an Emergency for Children in Developing countries as a r e s u l t of the Current Economic C r i s i s " .

The Representative of the Organization of African Unity f e l t that his p a r t i c i p a - tion for the f i r s t time in the work of the WHO Eastern Mediterranean Region, since an agreement was signed in 1969, marked a step forward in co-operation. He noted with s a t i s f a c t i o n the e f f e c t i v e e f f o r t s of WHO in the s i x OAU Members belonging to the Region, and paid a t r i b u t e to the Regional Director and his colleagues for their achievements • The Division of Health of OAU was directed by three doctors, whose mission was to implement the resolutions of the Organization regarding h e a l t h , n u t r i -

tion and hygiene. He welcomed the co-operation of WHO and other organizations and a g e n c i e s . Even ten years a f t e r freedom from colonization, e f f o r t s to improve health were hampered by a lack of manpower and equipment, but he was optimistic about the

f u t u r e . Peace and s e c u r i t y were the sine qua non for progress and with these i t was hoped to eliminate a l l t r a c e s of former domination.

The Representative of the World Federation of Medical Education stated that the Federation was composed of a s s o c i a t i o n s i n t e r e s t e d in medical education, such as the American and European Medical Associations, the African Association of Medical

Colleges and the Association of Medical Schools of the Middle E a s t . A c t i v i t i e s had s t a r t e d two years ago and the f i r s t assembly was held recently in Stockholm. WHO'S e f f o r t s in promoting medical education, and p a r t i c u l a r l y those of the Regional

D i r e c t o r , were appreciated.

The Representative of the International Dental Federation mentioned the d i f f i c u l t y in identifying common problems in a narrow f i e l d such as dental health

when Member Countries were a t such d i f f e r e n t stages of development. Epidemiological studies of the pattern and d i s t r i b u t i o n of dental diseases were lacking in the Region and dental needs of each country had not yet been assessed, making i t d i f f i c u l t to plan dental manpower, dental education and training programmes, and suitable organ- i z a t i o n a l patterns for the delivery of dental c a r e .

The dentist/population r a t i o differed widely; in most countries d e n t i s t s were s c a r c e and nearly a l l s e t t l e d in l a r g e towns• In r u r a l areas a t present s e r v i c e s were s t i l l prlmitve. The main concern of the e x i s t i n g dental s e r v i c e s was the s a t i s f a c t i o n of the present demand for dental care rather than planning or a p r e - ventive approach to dental d i s e a s e .

The d e n t i s t should be s o c i a l l y - o r i e n t e d and community"fliinded, and be able to a s s i s t in planning, Implementing and evaluating dental health progranmee.

To solve dental health problems, there would be a need for aid to research c e n t r e s , fellowships and other training a c t i v i t i e s , development of studies on

page 10

f l u o r i d a t i o n , s o c i o l o g i c a l studies and group meetings and perhaps the appointment of a regional dental consultant•

The Representative of the International Federation of Sports Medicine i n t r o - duced his organization, which had been founded in 1928; and outlined i t s o b j e c t i v e s . He noted items of conmpn i n t e r e s t in the agenda; notably the Technical Discussions on the subject of drugs - doping c o n t r o l , psychotropic drugs and anabolic s t e r o i d s being constant problems connected with sports medicine •

Air pollution p a r t i c u l a r l y affected a t h l e t e s , whose r e s p i r a t o r y volume when engaged In sports was 100-180 l i t r e s pmr minute compared with the average of eight l i t r e s .

PART I I I

SUB-DIVISION ON PROGRAMME

1 . APPOINTMENT OF SUB-DIVISION (Agenda

In conformity with Rule 14 of the Rules of Procedure ⁹ a Sub-Division was e s t a b - lished of the Sub-Cosmittee as a whole under the Chairmanship of H.E. Dr Hashem Abdel-Ghaffar (Saudi Arabia) . The Proposed Programme and Budget E s t l n a t e s for 1976/1977 for the Eastern Mediterranean Region (Agenda item 8) and Technical Matters

(Agenda item 9) were referred to the Sub-Division.

2 . PROPOSED PROGRAMME AND BUDGET ESTIMATES F g F " i 9 7 6 / 7 7 FOR THE EASTERN MEDITERRANEAN REGION (Agenda item 8, EM/RC24/3, Resolution

EM/RC23A/R.8)

Introducing the document on the Programme and Budget, the Regional Director drew a t t e n t i o n to the Assembly Resolution WHA 26.38 on the feasiblHity of introduc- ing a biennial programme and budget. In conformity with t h i s resolution the present document had been prepared to cover the biennium 1976/77.

The decision to prepare a biennial budget was welcomed, as i t tended to stream- l i n e the work of the Organization and economized on the time required for the prepara tion and review of the programe proposals. As in previous years, the programme proposals had been prepared in c l o s e consultation with the individual governments.

The Regional Director proposed, and the sub-division agreed, t h a t , a s in the p a s t , questions and comments on individual country programmes should be of a general or policy I n t e r e s t and that s p e c i f i c d e t a i l s or suggestions for changes in a country's progranme would be discussed outside the Session between the country Representatives concerned and the Regional Director and his s t a f f •

The Regional Director invited governments to review the country progranne s t a t e - ments contained in the document； a number of these statements had been cleared with the governments concerned» but some had been prepared by the Regional Office to the best of knowledge, without the possiULity of consultation with th« Government.

Representatives vere invited to inform the Regional Office, e i t h e r verbally or in writing, of any necessary changes•

EM/RC24A/3 page 10

The Regular Hudget Estimates amounted tentatively to about US $ 12 760 000 in

�9 7 6 and US $ �j 470 000 in 1977, compared with US $ 12 080 000 in 1975 and US $ 11 160 000 in 19/4 . Thus, in �У 7 Ь t h e r e was an i n c r e a s e of about 5 . 6 4 per cent over 1975, whilst for 1977 a f u r t h e r i n c r e a s e of approximately 5 . 5 per cent was foreseen. Considering the world-wide inflationary t r e n d s , the percentage increases foreseen were r e l a t i v e l y modest and were a t best s u f f i c i e n t to maintain the l e v e l of the present programme without expansion. The t o t a l amounts a v a i l a b l e from other sources of funds - UNDP, UNFPA and Funds-in-Trust - were tentative but there was a definite decrease particularly under UNDP. However, the budgetary period covered by the documeriL extended beyond the programme c y c l e f o r which country programmes had been approved by and i t was t h e r e f o r e hoped t h a t a d d i t i o n a l p r o j e c t s , not l i s t e d in the document, would become a v a i l a b l e under UNDP. UNFPA a s s i s t a n c e was con-

c e n t r a t e d in four countries of the Region which had family planning programmes, but other c o u n t r i e s were a l s o benefiting from UNFPA funds.

The main portion of the 1976/77 i n c r e a s e in the Regular Budget would being used for i n c r e a s i n g f i e l d a c t i v i t i e s , i . e . about 90 per c e n t .

Under the a l l o c a t i o n for Regional Office and Regional Advisers, no i n c r e a s e s in the number of posts had been proposed for 1976 and 1977, although there would be some minor changes in the composition of the p o s t s , in view of changes in needs and emphasis. For example, a health economics adviser and an adviser on c a r d i o v a s c u l a r d i s e a s e were being introduced against the d e l e t i o n of the posts of MCH and ТВ

a d v i s e r s . No provision had been made for changes in the number of WHO Represent- a t i v e s due to l i m i t a t i o n s of funds and as no request for a d d i t i o n a l WHO Represent- a t i v e posts had been received ； t h i s question could, however, be reviewed next year as he s t i l l hoped to i n c r e a s e the coverage of c o u n t r i e s or groups of c o u n t r i e s by WHO R e p r e s e n t a t i v e s .

The three l a r g e s t main headings for 1976 and 1977 remained Health Manpower Development； Disease Prevention and Control； and Strengthening of Health S e r v i c e s . These three Appropriation Sections accounted for about 75 per cent of the e n t i r e 1976 and 1977 Regular Budget E s t i m a t e s . Most of the individual country p r o j e c t s under the Regular budget provided, in addition to advisory a s s i s t a n c e , for f e l l o w - ships and supplies or both. P a r t i c u l a r l y in the c o u n t r i e s which, under United Nations terminology, belong to the twenty-five l e a s t developed of the developing c o u n t r i e s , provision had been made for some l o c a l c o s t components for supplementing n a t i o n a l s a l a r i e s , e s p e c i a l l y in order to provide i n c e n t i v e s for f i e l d work, or to defray some e s s e n t i a l cost of maintenance and r e p a i r of equipment.

The Regional Director r e f e r r e d to the i n t e r - c o u n t r y programme which included a c t i v i t i e s undertaken for the b e n e f i t of a l l c o u n t r i e s or groups of c o u n t r i e s , such as t r a i n i n g courses, seminars, but a l s o t e c h n i c a l advisory s e r v i c e s i f more than one country benefited from the a c t i v i t i e s .

In concluding, the Regional D i r e c t o r emphasized that the programme as r e f l e c t e d in the document followed the evolution of needs and t r e n d s . As Governments were able to r e s o l v e the communicable disease problems l a r g e l y from t h e i r own r e s o u r c e s , the trend towards reducing the a l l o c a t i o n for communicable disease continued enabling the Organization t o give more emphasis to other programmes such as mental health and c a r d i o v a s c u l a r d i s e a s e s .

page 10 Representatives congratulated the Regional Director on his c l e a r and comprehen- sive p r e s e n t a t i o n of the Programme and Budget P r o p o s a l s . Appreciation was e x - pressed of the f l e x i b l e way in which WHO provided a s s i s t a n c e , always in keeping with evolving needs of c o u n t r i e s .

In reply to concern expressed a t the r a t h e r nominal i n c r e a s e in the t o t a l Regular Budget a l l o c a t i o n and proposed the provision of extra-budgetary funds t o expand the Regular programme， the Regional Director r e f e r r e d to h i s e f f o r t s t o obtain additional regional appropriations from the governments of the Region in accordance with A r t i c l e 50 ( f ) of the WHO C o n s t i t u t i o n .

He further explained that the decrease in the a l l o c a t i o n s for mycobacterial diseases and drug c o n t r o l should not be taken too l i t e r a l l y , as they might be i n - fluenced by changes in individual p r o j e c t s and did not r e f l e c t a general t r e n d .

One Representative requested that consideration be given to s e t t i n g up a Regional Consultative Committee or Board to harmonize n a t i o n a l health plans and t o help in preparing a consolidated regional health programme, as well as to advise on i n t e r - c o u n t r y programmes in f i e l d s such as nursing, a u x i l i a r y health t r a i n i n g and environmental p o l l u t i o n . In r e p l y , the Regional Director explained the procedure by which the Regional Programme and Budget Proposals were prepared through continuous c o n s u l t a t i o n with the governments, were reviewed by the Regional Committee and the Executive Board and u l t i m a t e l y approved by the World Health Assembly• The question of the Consultative Committee or Board could be studied f u r t h e r , although i t might be d i f f i c u l t to find a b e t t e r forum that the Regional Committee for t h a t purpose.

One Representative r e f e r r e d to the example of h i s country where, f o r many y e a r s⁹ a l a r g e portion of WHO ^fs country a c t i v i t i e s had been financed through Funds-in-Trust arrangements • tie expressed the hope t h a t those c o u n t r i e s which were in a more

fortunate f i n a n c i a l position would a l s o finance WHO-assisted p r o j e c t s from Funds-in- Trust and thus leave more WHO funds a v a i l a b l e for the l e s s f o r t u n a t e c o u n t r i e s • In welcoming t h i s suggestion, the Regional D i r e c t o r a l s o i n v i t e d those c o u n t r i e s with b i l a t e r a l a s s i s t a n c e programmes in the f i e l d of health t o consider the p o s s i b i l i t y of channelling t h i s a s s i s t a n c e through WHO.

Regarding the future of the global Smallpox E r a d i c a t i o n Programme a f t e r 1976, the Regional Director gave an assurance t h a t even a f t e r

from t h i s Region, s u r v e i l l a n c e a c t i v i t i e s would have t o would be made a v a i l a b l e for t h i s purpose •

e r a d i c a t i o n of smallpox continue and t h a t funds

The d r a f t r e s o l u t i o n on the Proposed Programme and Budget Estimates for 1 9 7 6 / 7 7 adopted unanimously.

3 . PLACE OF SANITATION IW THE CONTROL OF GASTRO-INTESTINAL DISEASES~(Document

EM/RC24/4, Resolution EM/RC24A/R.9)

The i n t e n t i o n of the discussion was to determine the e f f i c a c y of c o n t r o l methods to analyze the b e n e f i t s derived from them and t h e c o n s t r a i n t s . He s t a t e d t h a t ,

although there was a tendency for communicable d i s e a s e s t o d e c r e a s e , in the world and in t h i s Region, g a s t r o - i n t e s t i n a l d i s e a s e s were the most d i f f i c u l t to c o n t r o l and e r a d i c a t e . The best combination of f a c t o r s to t h i s end had to be e s t a b l i s h e d •

EM/RC24A/3 page 10

The main elements required were : proper liquid and solid waste disposal, a pure water supply, control of i n s e c t s and other v e c t o r s , and health education; but no

single solution to the problem e x i s t s .

The r o l e of the environment had been p a r t i c u l a r l y demonstrated when cholera spread from the former endemic areas and followed an epidemiological pattern linked to d i f f e r e n t e c o l o g i c a l s i t u a t i o n s . Cholera when introduced in Africa took two forms: a lagunar one, which became quickly endemic and in which water played a part； and a second violent explosive type in the savanna and sahelian b e l t , which caused many deaths during a duration of a few weeks • The second type was not t r a n s - mitted by water. When transmission of g a s t r o - i n t e s t i n a l infections such as cholera, i s by human c o n t a c t , the c a r r i e r s are very d i f f i c u l t to detect and s t e r i l i z e .

Representatives mentioned that water supplies in countries were mostly the

r e s p o n s i b i l i t y of ministries other than the ministry of health. While well-qualified engineers were most concerned with providing a constant supply of water to as many inhabitants as possible, they were not always so concerned with the quality of the water provided. I t was suggested that a council or a board might be created in c o u n t r i e s , with the minister of health as co-ordinator, to ensure that the water supplied was pure and i t was emphasized that the r o l e of the minister of health was to maintain a constant surveillance and monitoring of the quality of the water supply•

While i t was agreed that improved sanitation was necessary in the control of disease 9 the cost of environmental health programmes was a stumbling block, which was aggravated by the use of foregin engineers who designed elaborate and c o s t l y schemes : t h i s problem deserved recognition. I t was further f e l t that the import- ance of immunization programmes should not be ignored. With regard to a suggestion that a c o s t / b e n e f i t study might be undertaken of inputs to environmental sanitation programmes as against t r a d i t i o n a l methods of c o n t r o l , i t was explained that these s t u d i e s , while i n t e r e s t i n g , were d i f f i c u l t in that they compared long- and short-term investment, systems which employed many workers against those which employed few, and those which required much investment against those which required l i t t l e , not f o r g e t t i n g unpredictable f a c t o r s which might intervene during the studies•

A resolution was adopted in conformity with the discussions and the Regional Director was asked to continue to provide a s s i s t a n c e to Member States in assessing the prevalence of g a s t r o - i n t e s t i n a l diseases and in planning and implementing control programmes, taking into account the relevant socio-economic f a c t o r s .

PART IV

TECHNICAL DISCUSSIONS 1• RATIONALITY IN SUPPLY f CONTROL y AND UTILIZATION

OF DRUGS (Agenda item 11, Document EM/RC24/Tech >Disc , / 1 , Resolution EM/RC24A/R.10)

The Technical Discussions on "Rationality in Supply, Control and U t i l i z a t i o n of Drugs" were held on Friday, 13 September 1974, under the chairmanship of Dr Abdullah A l - R i f a i (Kuwait).

page 10 The paper submitted by the Regional Director formed the background to the s u b j e c t .

PART V

OTHER MATTERS

1• RESOLUTIONS OF REGIONAL INTEREST ADOPTED BY THE TWLixTY-SEVENTH WORLD HEA¿^~ASSEMBLY AND THE EXECUTIVE BOARD AT ITS FIFTY-THIRD^AI^D F I F T Y -

FOURTH SESSIONS (Agenda item 7 (a^^'Wc'UiiSt EM7RC24/5, Resolutions EM/RC24A/R.4 and EM/RC24A/5)

The Sub-Committee reviewed the Resolutions included in Document EM/RC24/5.

In connexion with Resolution WHA 27 .42, the Representative of UNWRA c i r c u l a t e d a statement c l a r i f y i n g c e r t a i n points in documents A27/WP/10 and A27/WP/14.

Representatives commented on resolutions dealing with assistance to l e a s t developed countries (WHA 2 7 . 3 4 ) and malaria (WHA 2 7 . 5 1 ) . A resolution was adopted on the health conditions of inhabitants of Occupied Arab T e r r i t o r i e s (WHA 2 7 . 4 2 ) . The Regional Director emphasized the increasing f l e x i b i l i t y of WHO a s s i s t a n c e ; the use of nationals wherever possible instead of international experts and t h e i r en- couragement by granting subsidies, the g r e a t e r supply of equipment, the assignment of consultants instead of long-term s t a f f where s u i t a b l e , and the granting of fellowships to nationals to study within t h e i r own countries when great distances from t h e i r home town were involved. The object was to serve countries with maximum e f f e c t and b e n e f i t .

2• REVIEW OF THE FIFTH GENERAL PROGRAMME OF WORK COVERING A SPECIFIC PERIOD ( 1 9 7 3 - 1 9 7 7 ) (AgeHda"

item 7 ( b ) , Document EM/RC24/6, Resolution EM/RC24/R.6)

The purpose of the item was to e n l i s t Member S t a t e s1 p a r t i c i p a t i o n in a review of the implementation of the General Programme ( O f f i c i a l Records No. 193) . The comments of the Sub-Committee would be used in the preparation of the Sixth General Programme of Work.

I t was f e l t that because of lack of data in c o u n t r i e s , the programme had to be of a general nature, too s p e c i f i c a programme could lead to poor Implementation•

The difference In p r i o r i t i e s in countries was stressed and i t was suggested that a group of WHO experts survey new p r o j e c t s a f t e r the F i f t h Programme has been in opera- tion somewhat longer. The Impact of the General Programme In some countries was questioned, the majority of established p r o j e c t s have continued to be extended•

I t was f e l t that as development of human resources and environmental health are general p r i o r i t i e s , they could not be more s p e c i f i c a l l y defined; but WHO might

a e e i�t countries in studies of t h e i r individual p r i o r i t i e s and co-ordinate those studies already undertaken•