report of the thirty-sixth session of the regional
TRANSCRIPT
REGIONAL COMMITTEE FOR THE EASTERN MEDITERRANEAN
EM.IRC36/21-E October.1989
THIRTY-SIXTH SESSION ORIGINAL: 1\RABIC
REPORT OF THE THIRTY-SIXTH SESSION
OF THE REGIONAL COMMITTEE FOR
THE EASTERN.MEDITERRANEAN
Teheran, Islamic Republic of Iran, 30 September - 4 October 1989
WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR THE EASTERN MEDITERRANEAN
1989
C WHO EMRO 1989
The issue of this document does not constitute formal publication and all rights are reserved by the World Health organization. It may be abstracted or reproduced or translated for purposes connected with the constitutional functions and obligations of the Organization, but not for sale or for use in ·
conjunction with commercial purposes.
Printed by YKI in Alexandria
1989
TABLE OF CONTENTS
I. INTRODUCTION · · · - · · · · · · · · · · · · - - ·
It. OPENING MEETING AND PROCEDURAL MATl'ERS
II-l.
11-2.
II-3.
II-4. II-5. 11-6.
II-7.
Message from H.E. the President of the Islamic Republic of Iran • • • • • • •
Address by H.E. the Minister of Health and Medical Education of the Islamic Republic of Iran
Introductory speech by the Director-General • • • Address by the Regional Director . Election of officers • • • • • • • • • • Adoption of the agenda • • • •· • • • • • Address by the Director-General
III. REPORTS AND STATEMENTS
III-1.
III-2.
IIl-3.
Biennial Report of the Regional Director for the Eastern Mediterranean to the Thirty-sixth Session of the Regional Committee • • • • • • • • • • •
Summary of points raised by representatives • • • • Statements by observers • • • • • • • • • • • • • •
IV. BUDGETARY AND PROGRAMME MATTERS
IV-1.
IV-2.
Changes to the programme budget for the financial period 1990-1991 • • • • • • • Report on the Joint Government/WHO Programme Review Missions, 1989 • • • • • • • • • • • •
V. TECHNICAL MAT'l'ERS
V-1. V-2. V-3. V-4.
v-s.
V-6.
V-7.
V-8.
V-9.
Technical paper: Viral hepatitis . • • • • • • • • • • • Technical paper: oral health • • . • • • • • • • • • . • Progress report: Acquired immunodeficiency syndrome (AIDS) Progress report: Poliomyelitis eradication in
the Eastern Mediterranean Region • • • • • • • • • • Report on progress of WHO-sponsored research activities in
the Eastern Mediterranean Region . • • • • Report on the tuberculosis situation in
the Eastern Mediterranean Region • • • • • • Report on the Regional programme for
emergency preparedness • • • • • • • • • • Monitoring progress in the implementation of
Health for All strategies • • • • • • • • Progress report: Health systems research as part of
the managerial process in support of the strategy for Health for J\11 . . . . ... � . . ... . . . . . . . . . . .
l
2
J
3
3
5
6
6
8
10 11
14
14
17
18
19
21
23
24
26
28
30
CONTENTS
VI. TECHNICAL DISCUSSIONS
VI-1. VI-2.
Healthy lifestyles • • • • • • • • • • • subjects of technical discussions and
technical papers in 1992 and 1993 • • •
. .
VII. OTHER MATrERS
VII-1.
vu-2.
VII-3.
VII-4.
VII-5. VII-6.
VII-7.
Reports of the Regional Consultative committee • • • • Resolutions and decisions of Regional interest adopted
by the Forty-second World Health Assembly and by the Executive Board at its Eighty-third and Eighty-fourth Sessions • • • • • • •
Progress report: WHO's public image and advocacy for Health for All • • • • • •
Special programme for research and training in tropical diseases - Nomination of a member from the Eastern Mediterranean Region to the Joint Coordinating Board • • • • • • • • • • • • • • • • • •
Progress report: Regional Office accommodation • • Interim report on leadership development programme in
international health . • • • • • • • • • • Rescheduling the meetings of the WHO governing bodies •
VIII. CLOSING SESSION
VIII-1.
VIII-2.
VIII-3.
Place and date of the Thirty-seventh the Regional Committee, 1990 .
Adoption of the Report Closing • • . • • • • • • • • •
Session of the
IX. RESOLUTIONS AND DECISIONS
IX-1. IX-2.
Resolutions Decisions
ANNEXES
Annex I Annex II
Annex IU Annex IV Annex V
Agenda • • • • • • • • • • • • • • • • List of representatives, alternates,
advisers, observers and secretariat • • • • Address by Dr Hussein A. Gezairy, Regional Director . Address by Dr Hiroshi Nakajima, Director-General Final list of documents • . • • • • • • • • • • • •
32
33
35
37
39
40 40
40
41
43
43 43
45 59
63
65
74
80 88
EM/RC36/21-E page 1
I. INTRODUCTION
The Thirty-sixth Session of the Regional Committee for the Eastern Mediterranean was held at the lsteghlal Hotel, Teheran, Islamic Republic of Iran, from 30 September to 4 October 1989. The Technical Discussions on •Healthy Lifestyles• were held on 2 OCtober 1989. The opening day was attended by Dr Hiroshi Nakajima, Director-General of the World Health Organization.
The following Member States were represented:
Afghanistan, Republic of cyprus Democratic Yemen Iran, Islamic Republic of Kuwait Lebanon Libyan Arab Jamahiriya
oman Pakistan Qatar Somalia Syrian Arab Republic Tunisia United Arab Emirates
The Session was also attended by observers from the United Nations Children's Fund (UNICEF), the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), the Organization of l\frican Unity (OAU), and Palestine, as well as by observers from non-governmental and national organizations.
EM/RC36/21-E page 2
II. OPENING MEETING AND PROCEDURAL MA"rr'ERS
The proceedings began with the national anthem of the Islamlc Republic of Iran'and a recitation £rom the Holy Qur'an.
II-1. MESSAGE FROM H.E. THE PRESIDENT OF THE ISLAMIC REPUBLiq.OF IRAN (Agenda item 1)
Dr H. Habibi, First Vice-President of the Islamic Republic of Iran, delivered a message from His Eminence Hujjatul Islam Aly Akbar Hashmi Rafsanjani, President of the Republic, to the Thirty-sixth Session of the Regional Committee.
Referring to the Constitution of the Islamic Republic of Iran, and its recognition that health care and treatment are basic necessities of the population, he said that, as a general policy, his government had given greater priority to prevention rather than to curative services. To this end, and with the aim of establishing social justice, health services had been provided to all classes of society. particularly to those living in underserved villages and underprivileged populations. High priority had been given to safe drinking water, environmental conservation and child immunization, with road construction, the establishment of primary schools and high schools and the development of a Primary Health care (PHC) network, including 8000 health houses having been built since the Revolution. Emphasis had also been placed on the development of water supply and sanitation in rural areas, and millions of people now had access to electricity and a telephone network.
The development of preventive, curative and rehabilitative health services, together with equitable distribution of health resources, and the special attention given to the underprivileged populations with a view to improving their health status, had resulted in the reduction of the infant mortality rate from 115 per 1000 before the Revolution, to 45 per 1000 at present.
In reference to the continued production and use of chemical weapons in the world, the need for WHO to extend its efforts against these dangers to health was stressed.
He concluded with the expectation that this session would result in important steps being taken towards upgrading health in the Region, particularly among its deprived communities. He thanked the international organizations, particularly WHO, for their support in health matters and wished success to all in their deliberations.
EM/RC36/21-E page 3
II-2. ADDRESS BY H.E. THE MINISTER OF HEALTH AND MEDICAL EDUCATION OF THE ISLAMIC REPUBLIC OF IRAN
His Excellency Dr Iraj Pazel, Minister of Health and Medical Education of the Islamic Republic of Iran, welcomed the ministers and representatives attending the Thirty-sixth Session of the Regional Committee for the Eastern Mediterranean. He stated tha� he was confident that the Committee would find appropriate solutions to existing problems of the Region, and that the exertions of collective endeavours would safeguard the health and welfare of the Member States' populations .
All Member states, he said, had agreed upon Health for All (HFA) policy and strategy. However, the results of monitoring the HFA Global Strategy showed that certain countries were still lagging behind in implementing it. He added that this noble strategy could be attainable only if the world was free from hunger and injustice.
He affirmed that the Islamic Republic of Iran fully supported the development of a health system based on primary health care, and that there had been improvements in the country's health network since 1985.
The integration of medical education into the Ministry of Health in October 1985 had also caused great health manpower development. In addition, the training of local health technicians was expected to make rural health centres more effective, and the national mass campaign for children's health had made community participation and intersectoral coordination easier and more feasible.
He then reviewed the achievements realized in the Islamic Republic of Iran in the fields of child immunization, provision of safe drinking water in rural areas, and coverage of mothers and children by prenatal and child care programmes. The pharmaceutical industry had been nationalized, and 90 percent of pharmaceuticals distributed were being produced locally. Also, the new drug policy had improved self-sufficiency and drug quality control.
He ended by expressing his thanks to the Director-General and the Regional Director for the support given to his country, and the efforts exerted by WHO to safeguard the health of every human being.
II-3. INTRODUCTORY SPEECH BY THE DIRECTOR-GENERAL
Dr Hiroshi Nakajima, Director-General of the world Health Organization, thanked the host country for its hospitality towards the Regional Committee's delegations and for the excellent preparations made and facilities offered. He was gratified by the progress achieved by the Islamic Republic of Iran and steps taken by the Revolution, especially in the health field, and admired the progress he noted in the health facilities he had visited with Dr Gezairy, Regional Director .
11-4. ADDRESS BY THE REGIONAL DIRECTOR
Dr Hussein A. Gezairy, Regional Director, welcomed all participants to the Thirty-sixth session of the Regional Committee, and expressed his appreciation for the presence of Dr Hiroshi Nakajima, Director-General, at the meeting.
EMIRC36/21-E page 4
Dr Gezairy drew attention to the conflict and suffering still afflicting many of the Region's populations in the form of armed strife, or the heroic struggle against cruel oppression as in the tntefadeh, or natural catastrophe and its aftermath of refugee problems, or famine. The consequent adversities in the health sphere sometimes seemed to be inseparable, and it was necessary to marshal all our resources with the greatest care if millions of sufferers were to be returned to health.
Against this solemn background must be set the importance ·of man's realization that all races inhabit one planet and rely on it for survival. The divers environmental issues of prime concern throughout the world serve only to emphasize world health problems. All our resources should be deployed to ensure world survival.
The Regional Director referred to some budgetary changes for the forthcoming biennium, to the Resolutions and Decisions of Regional interest adopted by the· Forty-second World Health Assembly, to two meetings of the Regional consultative committee held during the past year and to the Jolnt Programme Review Missions. Reports on all these topics had been placed before the representatives for discussion.
Turning to technical items on the agenda, Dr Gezairy referred to the status of the Regionwide onslaught against AIDS. As there was no known cure as of yet, greater emphasis than that which WHO normally placed on prevention had to be exerted. This had been done by multi pronged endeavours, foremost among which were health education and communication. Some noteworthy efforts had been made by national authorities and WHO, including the adaptation of initiatives used elsewhere. It was apparent from the beginning of this crisis, however, that the type of health message used in •permissive• societies would not be applicable in the Region, therefore guidance on this subject had to be •modified" to be culturally acceptable.
Another scourge that because of its dire effects had, at times, received almost as much publicity as AIDS was poliomyelitis, and a WHO initiative to achieve polio eradication by the year 2000 had recently been launched.
Research was an area that impinged on every programme, and WHO EMRO encouraged research efforts in this Region, especially those geared towards the afflictions to which EMR was especially prone, as well as to health systems research (HSR).
The Regional Committee last year had made a request for a situation analysis on tuberculosis in the Region. The disease was still a serious public health problem, which although not beyond control, does not lend itself to the concept of eradication. It requires the provision o f medical tools, particularly those leading to early diagnosis and treatment that facilitate compliance of patients.
He referred to Emergency Preparedness and Response, a relatively new area of EMRO activity, but necessary in view of the divers forms of disaster that had struck so many Member States. These could not be foreseen, but the machinery to deal with them could be brought into existence with the application of foresight.
Health for All (HFA) progress continued to need monitoring; without this tool, we could not hope to plot our position or take required action against
EM/RC36/21-E page 5
shortfalls . A study had been performed to identify Regional targets, and this would help to keep all our countries on course towards the main objective.
Another prominent HFA aspect was advocacy. lt was increasingly realized that for this to be effective, WHO's public image needed to be high-profiled and ever reliable.
Dr Gezairy mentioned viral hepatitis as a and the focus of medical and epidemiological Region, where the question of vaccination inclusion in EPI was being considered.
subject of increasing concern, attention, especially in this against hepatitis B and its
oral health was at last receiving the importance it merited. In the past, the label of "dental health" s_eemed to imply that only teeth were involved! Now, with the emphasis on oral hygiene, as well as dental hygiene, and stomatology, the scope has been properly widened.
Then he came to the subject of "Healthy Lifestyles", stating that the way we live was part of our health/disease picture, and that it lay largely in our own hands whether we were to be well or sick.
Dr Gezairy went on to say that we should not neglect to emphasize the significant contribution that Islam had made to healthy living, as described in the paper on "Healthy Lifestyles", and especially focused upon in the Amman Declaration annexed to it.
Another matter for discussion was the Leadership Development Programme in International Health. Great importance had been placed on this drive, and that by and large, it was going along according to schedule.
Other matters included Regional Office accommodation. It went without saying that unless suitably accommodated, the office would not be able to function properly, and this would affect our contributions towards the goal of health Regionwide.
The rescheduling of meetings of WHO Governing Bodies was also something that concerned the smoother and more efficient running of our Organization, and would require the delegates' very careful consideration.
In concluding his address, the Regional Director said that he looked forward to the frank and thought-provoking exchange of views that was always characteristic of Regional Committee meetings.
After a short break, and in view of the absence of the Chairman and Vice-Chairman of the Thirty-fifth Session of the Regional Committee, the Thirty-sixth session was opened by the Regional Director.
11-5. ELECTION OF OFFICERS (Agenda item 2: decision 1)
The Regional Committee elected the following officers:
Chairman: H . E. Dr Iraj Fazel (Islamic Republic of Iran)
Vice-chairmen: H.E. Dr Saeed Sharaf Badr (Democratic Yemen) Dr Mustafa Mohamed El Zaidi (Libyan 1\.rab Jamahiriya) (H.E. Dr Saeed Sharaf Badr was designated First ViceChairman, in accordance with Rule of Procedure No. 13).
EMIRC36/21-E page 6
For the Technical Discussions, the Committee elected as
Chairman: Dr Imdad Hussain Baloch (Pakistan)
11-6. ADOPTION OF THE AGENDA (Agenda item 3, document EM/RC36/l Rev.2: decision 2)
The Regional Committee adopted the Provisional Agenda without change (EM/RC36/l Rev 2) (Annex 1).
II-7. ADDRESS BY THE DIRECTOR-GENERAL
Dr Hiroshi Nakajima expressed his pleasure in attending the Thirty-sixth Session of the Regional committee for the Eastern Mediterranean, stating that while last year he had shared with the Committee his thoughts about changes for WHO to respond better to changing health, social and economic conditions, today he would- like to extend that line of thinking to the year 2000 and beyond.
He urged that a balanced view be taken, saying that a basic principle of the WHO Constitution was the fundamental right of every human being to lead a socially and economically productive life. As a health organization, we must place health realities above political and economic realities, while recognizing their interrelationship.
The world picture was far from bleak, he said. A new spirit of openness was emerging among many countries. There was greater willingness to enter into dialogue and greater respect for the validity of different systems and viewpoints. There were opportunities for resolving intercountry and internal conflicts that had international repercussions. Initiatives were under way for the reduction of armaments, yielding enormous potential savings of resources. Welcome efforts were being made to reduce the debt crisis in many countries. These trends could serve the cause of human health, and social and economic development to the year 2000 and beyond.
At the same time, we were confronted with conflicting trends . Industrial and economic development was raising the economic and political aspirations of the population, but failing to take into account the fragile ecosystem of our planet on which depends the future health, safety and existence of mankind.
It was our hope, he added, that economic development would narrow the gap between rich and poor, but too often it had widened it. 'tihile we had made progress in some areas, we still had a long way to go to reach our goal of social equity with sustainable development. WHO has a mandate to address this challenge, for even its constitution recognizes that unequal development in different countries is a danger to the promotion of health and control of disease.
He stated that for WHO to promote health successfully, we had to be able to deal with the full range of social, economic and environmental issues that bear on health development . That was his reason for a study of the interdependence of the world economy and health development, and the reason for convening a high-level technical expert c01nrntssion on health and the environment, the results of which would shape our future work and contribute to the United Nations Conference on Environment and Development in 1992.
EM/RC36/21-E page 7
Since good nutrition is essential to human welfare, WHO was proposing to co-sponsor, with the Food and Agriculture Organization, an international conference on nutrition, to anticipate new problems and strategic solutions for the future.
The 1990s has been designated the International Decade for Natural Disasters Reduction. In response to resolution WHA42.16, he decided to strengthen the Organization's response to emergency situations by establishing a new Emergency Relief Operations Programme in Geneva. This programme would respond in a timely, flexible and effective manner to requests reflecting the evolving needs of countries and Regional Offices.
He went on to say that the role of WHO was not just to relieve poverty and the immediate conditions of ill health, it was to bring about long-term, sustainable health development.
In response to several resolutions of the World Health Assembly, WHO's programmes of international cooperation and strengthening of health services, in consultation with the Regional Offices and countries concerned, were helping to develop new approaches to economic adjustment, improve resource allocations and rationalize the financing of health care. Mobilization of additional resources on behalf of programmes, at all levels of the organization, was being intensified.
He said he would like to see mutually supportive relations among all Regions and programmes of WHO. Experience showed that no disease or condition of ill health could be dealt with in isolation from other health and social issues.
He appealed to everyone to spare our Organization and the world Health Assembly from political issues that were not directly related to international health work. tt was in this context that he would welcome your views on the proposal to reschedule future sessions of the World Health Assembly, and consequently of the Executive Board and the Regional committee.
EM/RC36/21-E page B
III. REPORTS AND STATEMENTS
III-1. BIENNIAL REPORT OF THE REGIONAL DIRECTOR FOR THE EASTERN MEDITERRANEAN TO THE THIRTY-SIXTH SESSION OF THE REGIONAL COMMITTEE (Agenda item 4, document EM/RC36/2: resolution EM/RC36/R.1)
Or Hussein A. Gezairy, Regional Director, in presenting his Biennial Report for the period 1 July 1987 to 30 June 1989, pointed out that a tradition had evolved whereby every year the Report had a special theme. This year he had chosen that of •communication•. Communication was becoming more and more fundamental to the EMR/EMRO pattern of work. He stressed that every chance that presented itself to get our •information for health• across should be seized. A striking instance of this was •exploiting•· the schoolchild in the most beneficial way, so that he or she would transmit health knowledge gained in school to parents and families.
In this connection, he drew attention to a new initiative launched by WHO, together with UNESCO and UNICEF, concerning a publication called •Facts for Life•: 1t was supported by a video film and the aim was to inform and mobilize the public about vital health matters. He expressed the hope that governments would give this initiative the full support it needed.
Another area where governments, particularly Ministries of Health, could be more effective communication-wise was in the greater use of the media.
He pointed out that every year, a somewhat sombre tone was taken as the financial situation was discussed. Although the constraints had not gone away, we were successfully living with them. This was due to the proper mix of husbandry, prudence and rational use of available resources as directed by our Governing Bodies. Towards that end, we were giving highest emphasis and priority to close consultation and dialogue with our Member States.
In this connection, WHO Representatives not only acted as virtual ambassadors, but they smoothed the way for WHO work in a limitless arena. Yet another most essential element lay in the Joint Programme Review Missions. Here, too, was a means by which we and Member States kept a finger on the pulse of what was happening in our programmes. An invaluable "twin• of this exercise were visits to the Regional Office by senior national officials, who were far from being restricted to the health sector. These visits enhanced the intersectorality we a ll believed in, and they also provided an opportunity for learning, for the officials as well as ourselves, which was a very productive exercise.
Now was the time to begin twenty-first century work, he said, and indeed we were doing just that. In all WHO programmes, whether they had actual target dates such as HFA/2000, Polio Eradication by 2000, the earlier dates of universal child immunization, the International Drinking Water supply and Sanitation Decade, etc., we must focus our attention and work beyond target aspects.
F.M/RC36/21-E page 9
With the future in view, we entered into the drive for HFA Leadership Development in International Health, and this was well under way. Action started early this year in the Regional Office when the traininq programme got off to a good start. Closely akin to this enterprise were the concepts of integrated social development. basic minimum needs (BMN) and quality of life.
He went on to say that we in EMRO were especially concerned with the most vulnerable groups. of these, women and children came first to mind. This was because of the iniquitous rates of maternal and infant mortality, which were still far from ideal in our Region. Among our very important approaches to correcting these wrongs were to provide a trained birth attendant for every village. This, he said, would bring about greater health benefits than even building a hospital in every inhabited area.
Vulnerable groups included increasingly adolescents who were of ten the prey of harmful pressures, as well as •senior citizens• who were frequently cast aside in some •developed• countries as having outlived their usefulness, but not within EMR countries. The mentally ill, too. were sometimes cruelly exposed, and we had to remedy this, and we were, in fact, doing so.
Health manpower must be fully and adequately prepared for the new century. There had been for a very long t ime an imbalance between hea 1th manpower needs and what was actually produced. In rectifying this, proper planning was utterly essential; hence, the •three-pronged approach" in our Health Manpower Development (HMO) Programme: planning, production and management.
our HMO Programme was full of dynamic initiatives, he said, such as the task-oriented, community-based curriculum pioneered at Gezira, Sudan. 'i'hts had become accepted practice Regionally and beyond. Also, our Educational Development Centres continued to play vital roles, including the one ln Teheran, which was being replicated elsewhere in the Islamic Republic of Iran.
Research represented an area where WHO EMRO was particularly active. The type of health research considered most vital nowadays was health systems research. The EM/Advisory Committee on Health Research (ACHR) was our leading Regional body in this domain; prominent subjects of its attention recently had been AIDS, diarrhoeal diseases, accident prevention and nutrition.
This brought the Regional Director to an area where we were involved tn redressing two extremes: famine on the one hand and •malnutrition of affluence• on the other. The former was an outrage that he heartily wished we could do more to alleviate, while the latter was a spin-off from developedcountry lifestyles •.
Another research topic--accident prevention--had gained in attention at Regional committee meetings. In EMR much interest was now focused on this and on related necessary safety measures.
"Emergency preparedness• came under our •coordination• umbrella, involving collaboration with many other UN bodies. as well as bilateral agencies and non-governmental organizations.
l\mong our communication endeavours was our Programme for Health and Biomedical Information (HBI). Under its aegis, an investigatory t eam visited
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four EMR countries to look into the situation regarding WHO publications, which form a major aspect of our communication work . we hope to reach and benefit wider and wider audiences .
In its twelfth meeting in Cyprus , 25-26 September 1989 , the Regional consultative committee d iscussed WHO health and biomedical strategy for the 1990s in EMR .
He also referred t o the major section of the Biennial Report dealing w ith Disease Prevention and Control , particulary to vaccinating all the world's children against the s ix EPI target diseases by 1990 , and the progress achieved in this connection due to acceleration efforts. Part of our EPI programme dealt with poliomyelitis , and the new goal of •Eradication by 2000•. This was indeed ambitious, but not unrealistically so , he said.
In EMRO's war against malaria, setbacks were sometimes experienced. This was so lately ·when cases increased tn a few Member States due to various factors. Weapons used against this disease continued to include increased training and community involvement .
AIDS has been a great preoccupation of WHO EMRO . Here again , it was realized that it was not just the illness we must deal with, but the psychosocial behavioural patterns involved in its spread.
A recent development was the invasion of the Region by the screw-worm fly � WHO and FAO together were combating this.
Viral hepatitis was another area requiring increased EMRO attention, and a new programme had been set up. Hepatitis B vaccination in EPI programmes was also being envisaged .
runong non-communicable diseases . cancer was still claiming a severe toll in EMR. cancer registries were one of the most useful combative measures. So , of course , was the anti-smoking campaign to which we remained dedicated .
Smoking and other unhealthy lifestyles also provoked cardiovascular diseases which had increased, ironically, as affluence had increased worldwide : EMR had not escaped this trend. H�alth education was a vital tool used by WHO and so was research and helping to strengthen national resources.
runong the serious, but largely preventable conditions affecting m illions Regionwide were blindness and visual impairment, which remained persistent problems . He stressed that we had by no means neglected deafness and other types of handicap 9 which we were striving to redress with emphasis on community-based rehabilitation.
He then turned to environmental health that constituted a very large and extremely important segment of our activity , and in which we were forced to be as multisectoral as possible, as well as farsighted.
In concluding his statement , the Regional Director mentioned the •Healthy Cities" concept . which he hoped wou ld become increasingly an EMR reality, strongly counteracting the harmful effects of urbanizat ion .
III-2 . SUMMARY OF POitJTS RAISED BY REPRESENTATIVES
Th� representatives of the Member States congratulated the Minister of Health and Medical Education of the Islamic Republic of Iran for having been
EMIRC36/21-E page 11
elected Chairman of the Thirty-s ixth sess ion of the Regional Commit tee , and wished him success in the execut ion of his task. They praised the new heal th phi losophy expressed in the message of the Director-General , Dr Hiroshi Nakaj ima , to the Regional Commit t e e . They also comp limented the Biennial Report of the Regional Director on the act iv ities of the Regiona l Office for the Eastern Mediterranean , emphas izing that it was comprehensive and included some very important and vital items , namely: healthy lifestyles , communication, environment and pol lut ion , health education , immunizat ion , 1\IDS , ant i-smoking act ivit ies , and the HFA Strategy . Some representat ives lis ted the achievements realized by their countries in these a reas , and commended the support and ass istance provided to them in these respect s by WHO EMRO. Some of the representatives whose countries are current ly suffer ing from social problems or economical dif ficulties requested some essent ial resources to meet basic needs in the- health sector . Some referred to the severe conditions imposed on the Palestinians since the 1 nte£adeh and the cruel treatment they were receiv ing by the occupying forces , s tressing the consequent negative impact on the health s ituat ion o f these people . They called upon WHO to intervene with a view to protecting the health o f Palestinians in the occupied Terr itories .
The Director-General thanked the representat ives of the Member States for their appreciat ion o f the message he delivered to the Regional committee , and promised that the Organization would spare no effor t to meet the dif ferent requests for assis tance made by the representat ives .
The Regional Director thanked the representat ives for their appreciation of his Report , and praised the measures and procedures t aken by thei r countries i n different fields of act ivities . He added that their appreciat ion of the endeavours made by the Reg ional Office would motivate i t to exert more efforts so as to be worthy of such appreciation and praise in the future .
III-3 . STATEMENTS BY OBSERVERS
Palestine
Dr E . S . Tarawela , Representative of Pales t ine , discussed the deteriorat ing economic and socia l conditions of Palestinians living in the occupied Territories , as well as the unacceptable and savage pract ices that Israel i authorities were pursuing in these Territor ies , with the aim of destroying the infrast ructure of the Palest inian soc iety. These practices included the taking ove r of land , usurpat ion of water resources , estab lishment of Israe l i set t lement s , the des t ruct ion of basic structures in agriculture , indust ry and economics , the impos ition of group penalt ies , cur fews , the danger. of moving about : the c losing o f schools and universit ies , and the prohibition of a l ternative forms of educat ion such as home s tudy .
The Special commit tee o f experts established by the World Health 1\ssemb ly s tated that no real commitment to improve health could be made in the light of condit ions prevailing in the occupied Terr itorie s , as the occupy ing authorities hindered the development of basic health s tructures and manpower . several hospitals and health centres had been closed and the number of health personnel had been reduced .
Since the begining of the intefadeh on 8 December 1987 , further deteriorat ion of the health situation has occurred . EVen hospitals had not been spared : they �ad been raided , doctors and nurses attacked and arrested ,
EM/RC36/21- E page 12
ambulances forbidden to carry the wounded and injured. and there had been assaults made inside hospitals as well.
The Representative of Palestine then expressed his appreciation for the assistance provided by WHO and by other international organizations, saying that he was expecting to receive more.
united Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA)
Dr R. Cook, Director of Health, UNRVA, thanked WHO for the opportunity to discuss some current concerns for the welfare and health of the Palestinian people in exile and in the occupied Territories.
He congratulated the Regional Director on his Biennial Report, saying it was one of the most interesting and wide-ranging in its scope of all the reports of its kind . He also thanked the Director-General and the Regional Director for their greatly increased technical support which, he added, was far greater in value than its mere monetary cost .
UNRWA has been aiding Palestinian refugees since 1948 . who now mnnber over 2 million, scattered throughout Lebanon, Syrian Arab Republic, Jordan, the West Bank and Gaza . Some 40\ of them still live in very basic, crowded camps . successors to the tents of 1949.
Since the beginning of UNRWA, WHO has been responsible for technical direction of the UNRWA Health Programme , which has developed very much as a primary health care programme. lt has to its credit some notable innovations, including pioneering oral rehydration . the use of growth charts, comprehensive immunization and nutrition rehabilitation centres . Modernising its programme to meet changing needs, UNRWA has steadily increased its oral health service, its care for diabetics, expansion o f its maternal health programme, development of a comprehensive mental health care programme, and preparation of a nutrition survey. 1t has also been conducting a feasibility study concerning a possible UNRWA hospital in Gaza.
Dr cook reiterated UNRWA ' s great concern over ( 1) the misuse of tear gas : (11) the frequent deliberate beatings resulting in bone fractures : (iii) the high proportion of injured and child fatalities; and ( iv ) the use and damage caused by "high velocity" ammunition . Also, interference with ambulances and physical abuse of the drivers and patients was strongly protested by UNRWA.
UNRWA has implemented a number of measures to combat such problems , such as employing Refugee Affairs officers, and clinics were remaining open in the evening, and some of them round-the-clock . A team of WHO specialists in trauma care had visited the Occupied Territories, and their recommendations were now being implemented . They included aid to NGO hospitals to improve their casualty facilities, provision of physiotherapy units and ambulances, and training of staff in advanced first aid, with emergency resuscitation apparatus, etc . , being made available at all UNRWA health centres.
All these emergency measures required funding and the generous support of Member States is still much needed .
EM/RC36/21-E page 13
united Nations Children' s Fund (UNICEF)
Mr Richard Reid , Regional Director , UNICEF, said that more children under five had died in EMR from dehydration caused by diarrhoea and from pneumonia than from all forms of cancers in all age groups . However, morbidity and mortality had declined 1.n the Region, and a number of countries had infant mortality rates that had fal!en to under 50 per 1000 live births , but i f the population rate continued to increase, this would likely reverse.
By the year 2030 , the aggregate population of the Region was expected to increase to between 900 million and one billion, treble its current number, while oil production will have effectively ceased .
Childspacing remained an issue ; saying that babies born with a 24-30 month interval were not only , on average , larger and healthier, but brighter as well - compared with 12-18 month spacing .
oral rehydration therapy and antibiotics should be exploited more fully, he said . Primary health care could often be placed in the hands of t rained community health workers, who were not only more cost-effective , but could carry out the same duties as • traditional• doctors, in many cases .
He cited the Islamic Republic of Iran as having developed a disciplined corps of camnunity health workers that would be considered to be the best of all ground-level PHC elements .
He concluded by saying UNICEF would focus on three areas during the next decade: (i) the girl child ; ( 11 ) childbearing , including reducing maternal mortality ; and (iii) children in war or conflict conditions .
Organization of African unity (OAU)
Mr wawa o. Leba, Representative of the OAU, expressed OAU ' s gratitude for the WHO/UNICEF collaborative programmes, developed for Third World countries in general, and for Africa and OAU in particular.
He stated that a strategy for African development was adopted in 1985 , in Lusaka, which supports primary health care services and helps to accelerate the attainment of HFA/2000.
He then listed activities undertaken l;>Y the OAU in the context of certain WHO AFRO specific programmes, namely:
( 1) Emergency preparedness to cope with disasters in Africa ;
( 11) Establishment of a special Health FUnd for Africa; and
( 111) Coordination of global activities for AIDS control.
He also described another programme conducted by WHO/UNICEF/OAU related to child survival, protection and development .
As regards research , the OAU Scientific Commission , in Lagos , Nigeria , was conducting studies on AIDS.
EM/RC36/21-E page 14
IV. BUOOETARY rum PROORAMME MA'ITERS
IV-1. CHANGES TO THE PROGRAMME BUOOET FOR THE FINANCIAL PERIOD 1990- 1991 (Agenda item S, document EMIRC36/3)
Mr R. Helmholz, Director, support ' Programme, informed the Regional Committee that an additional allocation to the Regional Budget for the WHO Arabic Programme, and adjustments vis-a-vis cost increases, together with the use of a more realistic U.S. dollar exchange rate for the Egyptian pound led to a revised Regional Budget of US$67 376 000 . These adjustments affected only the Regional/intercountry components ; country totals remained the same.
Discussions
In response to a question, Dr Gezairy , Regional Director, provided further information concerning the continued devaluation of the main currency of expenditure of the Regional Office, and the consequent need for the use of a more current rate of exchange in calculating the u . s . dollar value of the Regional/intercountry component of the budget. The use of the casual income facility to deal with the effects of currency fluctuations of the main currencies of expenditure of Regional Offices was also explained.
lV-2. REPORT ON THE JOINT GOVERNMENT/WHO PROGRAMME REVIEW MISSIONS, 1989 (Agenda item 8, document EMIRC36/6: resolution EM/RC36/R.5)
The report was presented by Dr Orner Sulieman, Regional Adviser on Health Programme Development, who stated that the fourth round of Joint Government/ WHO Programme Review Missions ( JPRMs) had been completed in April 1989, and assessment had been made of progress achieved in implementing Health for All by the Year 2000 (HFA/2000) Global Strategy and reviewing the implementation of collaborative WHO programmes . Based on the outcome of this, reprogramming for the 1988/89 biennium and budgeting for the 1990/91 biennium had been performed.
As a result of this round of JPRMs, new programmes in a few countries were created. Such programmes included Quality of Life Programmes or Basic Minimum Needs (BMN) ; Leadership Development Programme; Implementation of the Action-Oriented School Health curriculum ; Emergency Preparedness ; Development of the Healthy Cities Programme; Healthy Public Policies Programmes ; and the Development of National Networks of Peripheral Libraries.
The emphasis on ensuring that a greater share of WHO resources be spP.nt at the peripheral level continued to be respected.
JPRMs had created the opportunity, at times, for national officials responsible for various programmes to meet and d iscuss the need for intrasectoral coordination in support of Health for All and primary health care policies.
EMIRC36/21-E page 15
It was realized during this last round of JPRMs that there was a need to update HFA s trategies. a process which EMRO is now doing.
Some problems were encountered during the last round of JPRMs. �lthough preparatory wc,rk had been initiated four to eight months earlier, it had not been completed in time in some countries. There was also the need to improve health information systems, Rnd it was felt necessary that programme managers should update their programme profiles.
National team members, in some instances, were not available during the entire mission period, and except in six countries, the team did not have representation from sectors other than in health. Because more importance had been given to the budgetary exercise , WHO was misunderstood, on occasion, in some quarters that had measured its usefulness according to the dollar value of the country allocation.
It was important to remember that WHO had invested millions of dollars in obtaining appropriate updated technologies and in assisting countries in developing effective policies, strategies and managerial systems.
Proposals relating to improving the JPRM process were received from national and international officers . Emphasis was on national managers collecting and updating information on their prograrmnes and clearing it by decision-makers in their own countries, prior to presenting it to JPRM team members .
Team members should consist of people who had broad experience and knowledge related to 'WHO systems and Health for All policies and strategies.
Reports of JPRMs should be widely distributed and used as briefing and planning documents.
Some quarters proposed that the review team should discuss country priorities and the most appropriate programmes to meet those priorities. The teams' proposals and recommendations would then be discussed in EMRO where the budgetary exercise would be performed.
Discussions
one of the representatives suggested that the word •mission• be replaced by •team• or •committee•, and called upon the Regional Office to intesify the training provided to national health personnel in the fields of planning, follow-up and evaluation of health programmes. He also agreed to involving non-medical personnel undertaking activities of great relevance to the health sector in the JPRM team.
A second representative requested that the national team in the JPRM be headed by the senior official responsible for elaborating the national health plan, and that this team include among its members, responsible officials who would have participated in the elaboration of the national comprehensive development plan. He added that it was not possible to f ix a certain period for JPRMs that wc,uld apply for all countries, and that each country should decide on the period it considers suitable, in collaboation with WHO. He also put forward a proposal concerning the involvement of nationals from other countries in the JPRM teams and stressed the importance of the experience that would be thus acquired. He also supported the integration of programmes with a view to achieving homogeneity.
EM/RC36/21- E page 16
A third representative stated that it was difficult to convince the policy-makers in his country that the activities of the JPRM were not restricted to budgetary exercises and that the role of such missions was essentially to plan and evaluate health programmes. He called for expediting the integration of vertical programmes, and extending the scope of thP.ir activities ; and agreed that it was important to exchange experiences by means of involving nationals in the missions sent to other countries.
A fourth representative assured that the possible unavailability of nationals in JPRM meetings was not due to their indifference, but to other serious commitments .
Dr Omer Sulieman commented on the points raised by the representatives saying that the assessment of the last round of JPRMs on the part of the Regional Office was definitely positive, that the cooperation of countries, in general, was commendable. However, there was still scope for improvement.
He assured the representatives that the Regional Office would implement all proposals and requests made, to the best of its ability, emphasizing, in particular, the exchange of experiences through the involvement of nationals from different countries in the JPRMs. He also maintained that it was important that nationals acquire such experience before joining any JPRM team. He added that he was confident the Regional Director would pay suitable attention to this subject.
EM/RC36/21-E page 17
V. TECHNICAL MA'rl'ERS
V-1 . TECHNICAL PAPER: VIRAL HEPATITIS (Agenda item 17 (a ) , document EM/RC36/15 : resolution EM/RC36/R. 3 )
D r M.H . Wahdan, Director, Disease Prevention and Control, presented the paper on the situation of viral hepatitis in the EMR, which 1s an increasingly serious public health problem, not only in the Region, but in the world as a whole.
The various types of viral hepatitis were presented, and their main epidemiological features clarified.
Detailed presentations were made in relation to hepatitis B, in view of its serious sequelae and the fact that an effective vaccine against it was . . · available . This vaccine, if used on a large scale, could change the epidemiological pattern and reduce, to a large extent, the unpleasant symptoms of this infection.
The prospects of production of a hepatitis B vaccine and an immunization strategy for the Region were also discussed.
The presentation also covered proposed Regional p lans that include essential strategies for strengthening national and Regional plans, particularly in relation to vaccination policies.
Discussions
one representative urged the Organization to provide Member States with lists of vaccine-producing companies and l ists of their products. Another asked for the strengthening of national blood banks, while a third requested WHO ' s support for his country in the field of hepatitis vaccination, together with the necessary information to help it in its control . A fourth requested the organization' s col laboration in studying all aspects . of the disease, while another representative referred to the high cost of vaccine production and importation, expressing the hope that WHO would provide the necessary support for vaccine production. One representative said that his ·country already had the laboratory facilities necessary for the antigen and antibody identification, but there was a need for trained manpower in this respect. He requested the Organization to provide training for technicians in this field.
Commenting on the discussions, Dr Wahdan said that EPI/EMRO had produced a publication on hepatitis . immunization strategies that contained information countries required. Copies of this publication would be sent to Member states. Dr Wahdan urged countries to try to purchase drugs and vaccines in bulk . in order to lower prices. In countries that had the capability to produce vaccine locally, production should be linked with a national hepatitis immunization plan. The Organization stood ready to provide countries with the necessary support and advice in the various technical aspects involved.
EM/RC36/21-E page 18
V-2. TECHNICAL PAPER : ORAL HEALTH (Agenda item 17 (b ) . document EM/RC36/16 : resolution EMIRC36/R. 14)
Officer at the WHO Regional Demonstration Oral Health (DTRC) in Damascus, Syrian Arab
Dr S .A. Hussein , WHO Dental Training and Research Centre for Republic, presented the paper. periodontal disease were th� two unfortunately. prevalence of both many countries of the Region, incriminating factor.
He pointed out that dental caries and major oral health problems in the EMR. these disorders were on the increase in with poor oral hygiene as the main
The Regional oral Health Programme, developed within the framework of the health c�re system, had the primary objective of assisting Member States to improve the oral health status of their population in order to achieve an acceptable level of oral health by the year 2000. As a prerequisite for this objective, Member States were being assisted to develop a national integrated plan for oral health within the framework of the national health - plan, with clearly defined measurable goals .
oral health care services in EMR countries were at different stages of development . The main concern of existing services was to satisfy the current •curative• demand, which does not comply with the philosophy of a •preventive• approach . such curative-oriented oral health services, leading to more tooth extractions, undermined further the oral health status of the population . The thrust of the Regional strategy was the introduction of oral disease preventive measures, improvement of oral hygiene and oral health education of the public. An essential component of this strategy was the development and utilization of oral health manpower. It was obvious that an urgent need was the development of curricula relevant to the needs of EMR countries .
The establishment of the Demonstration , Training and Research Centre for oral Health (DTRC ) in Damascus , in 1982, a fully equipped and highly competent centre, was to coordinate efforts of WHO and Member States to improve o ral health of the Region 's people . The Centre ' s main approaches are trainl.ng, research and demonstration. A Regional Workshop on oral Health, organized by the DTRC in 1986 , was a major milestone in sensitizing Member States regarding the urgent need for an oral health programme within the framework of each of their health care systems.
Discussions
One representative referred to his country' s achievements in the area of oral health development . He said that oral health care services had been integrated into primary health care services this year , and were being developed in the direction of prevention and control rather than of extraction. He also mentioned the problem of employing dentists in rural areas and the d ifficulty in attracting them to work in rural health centres .
The Representativ� of the Executive Director of the International Dental Federation , Teheran, spoke about thP. measures which should be taken to prevent transmission of hepatitis B and AIDS infection from patients to dental care providers and vice versa . He recommended that authorities should continue health education at the pre-school and school-age levels with a view to promoting dental health , and that due consideration should also be given to geriatric dental care . Dentists should be aware of the epidemiology and oral manifestations of HIV infection. Epidemiology, attention to lifestyle,
EM/RCJ6/21-E page 19
and surveillance should be taught at dental schools. He proposed that a full-time dentist with a public health background be appointed at each WHO Regional Office , in order to improve communication between dentists and health officials, and promote dental health.
He suggested that oral health survey manuals, and WHO recording forms for the documentation of HIV/AIDS cases be distributed to all dentists in the Region, and urged that data on the rate of decayed, filled or missing (DFM) teeth and on periodontal disease, be collected, tabulated and recorded in every country of the Region, through random sampling in different age groups. Different genetic, environmental , religious , and socioeconomic factors must be taken into consideration when collecting the necessary samples .
Dr S .A . Hussein commented saying that he hoped assistant dentists would be appointed in the rural areas before dentists were. He also stated that he approved the recommendations and proposals made by the Executive Director of the International Dental Federation.
V-3 . PROGRESS REPORT: ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS) (Agenda item 9 , document EM/RC36/7 : resolution EM/RC36/R.2)
Dr M.H. Wahdan, Director, Disease Prevention and Control, presented a report to the Regional committee on progress made on AIDS in the EMR and on implementing Regional Committee resolutions.
As regards national programme support, considerable effort- had been made in programme formulation. Six countries had finalized the preparation of their medium-tenn plans . and collaboration was under way in another 12, to be completed before the end of 1989. It was hoped that by early 1990 , all Member States would have formulated their medium-term plans for prevention and control of human immunodeficiency virus (HIV) infection, which would cover the period up till the early 1990s.
Details about intercountry meetings and workshops and training courses in support of national programmes were also presented. Much had been achieved through these activities in various aspects of planning and implementation of health promotion components of national 1\.10S prevention and control programmes.
Promotion of sociocultural research had received great attention, with a workshop held on the subject, and preparation of research protocols suitable for the cultural background of the Region.
EMRO continued its efforts to disseminate information in national languages of the Region and had prepared special material for this purpose . in addition to the translation and adaptation of materials prepared by the Global Programme on AIDS (GPA).
As of end of June 1989, close to 170 000 AIDS cases had been reported to the GPA from 148 countries. However, because of significant incomplete reporting and delays, the actual total of AIDS cases estimated to have occurred worldwide, as of June 1989, was probably closer to 400 000 .
Although sero-surveys had still indicated low infection rates in most Member States of the Region, no country in EMR was entirely free of HIV infection.
EM/RC36/2l-E page 20
It was concluded that a lthough blood and blood products were no more of serious concern, HIV infection was spreading in the Region and there was evidence of more indigenous transmission.
Discussions
Most of the speakers stressed the importance of health education. one representative mentioned the use of condoms as a means of AIDS control. Another discussed the support provided by his government to the Regional Programme on AIDS, and the effect of transplants and of trading in human body organs in the spreading of AIDS. A third representative mentioned that panic and indifference in connection with this disease prevailed in certain countries, and emphasized the necessity of frankness in this respect. He also requested that the phasing of serosurvey be modified, and proceeded to discuss the role of blood and blood products in transmitting the disease. A fourth representative stressed the importance of quality control and of training in this field. A fifth raised the problem of the cost of tests, and stressed that it was important to provide psychological and social care to AIDS patients and carriers. He emphasized that they should not be isolated from society and that we must gain their confidence so as to ensure positive responses on their part to the efforts exerted to limit the spread of AIDS . A sixth representative asserted that it was necessary for every country to have national AIDS control plans, and proposed that the number of seropositive cases, as wel l as the cases which have been tested, be added in the table on AIDS cases.
One representative referred to the •AIDS-free• certificate. Another representative said that his country had ceased to import blood three years before AIDS was discovered, but due to the demographic structure of the country and the rapid movement of the population, particularly manpower, there was a need to provide blood donation and transfusion equipment, and to examine all pregnant women as wel l as people applying for work.
Commenting on the discussions, Dr Wahdan confirmed EMRO 's interest in health education, and that it had established, within the framework of the AIDS control programme, a new post for a health educator and another for a social worker . The organization seeks to identify a 'WHO Collaborating centre for col lecting and evaluating information and education materials within the Region .
Or Wahdan pointed out that the use of condoms had two aspects. First, it could be a means to protect an uninfected person from an infected one. Second, the promotion of its use could be in conflict with the social traditions and concepts of the Region . He added that the organization had drawn attention to the dangerous aspects of the transplant of, and trade in, human organs in some countries (including the spread of AIDS) , and had made some guidelines in this connection .
Dr Wahdan confirmed that the method used in conducting serosurveys at present needed to be revised, because the random examination of blood specimens of travel lers or blood donors, as is being done now , cannot give an accurate picture of the epidemiological situation . Therefore, 'WHO had prepared a manual on how to select and test blood specimens and understand the results. He pointed out that the role played by blood/blood products in the transmission of AIDS was limited, not exceeding 5\ of a l l cases . However, it stil l was important since it could be •controlled•, as was already happening in most countries in the Region.
EMIRC36/21-E page 21
He pointed out that the Regional Office was preparing courses for t raining laboratory "WOrkers emphasiz ing the need for quality contro l , and affirmed that the aim of the organization was to ensure that every country should become self-suff icient in the field of detect ion of HIV infection . Reference centres were not the intermediary for this , but s tood ready t o support national cent res .
He ment ioned that the cost of laboratory tests for the detection of HIV infect ion was influenced by certain companies , and that WHO was doing its bes t to reduce the cos t per test . He confirmed that WHO believed that attent ion to and psychosocial care of AIDS patients and HIV carriers were not jus t a humanitar ian action, but were also important prevent ive measures that could limit the spread of the infection .
He also indicated that the number of sero-positives and those examined was intentionally not included in the table on AIDS cases , as different countries examined diffe rent population groups : hence , the inclus ion of such figures 'WOuld give a wrong impress ion. He expressed the hope that the question of the AIDS certificate 'WOUld not be pursued . In p revious discussions of the commit tee and of an Expert commit tee it was made clear that this measure had had a minimal effect in preventing introduct ion or spread of the virus .
V-4 . PROGRESS REPORT : POLIOMYELITIS ERADICATION IN THE EASTERN MEDITERRANEAN REGION (Agenda item 10, document EM/RC36/8: resolution EM/RC36/R . 6 )
A progress report on achievements so far made i n r esponse to the Regional Committee ' s Resolution EM/RC35/R. 14, passed in october 1988, was presented by Dr M.H. Wahdan , Director , Disease Prevent ion and Contro l .
The following main actions were implemented during 1988/89 :
support to help formulate nat ional programmes ; at present , there were 11 countries that had nat ional programmes with well-defined targets and plans of action. In addition , more countries were in the preparatory stages of nat ional programme formulation;
Accelerat ion of immunizat ion o f infants continued , with over 71\ of children completing three doses of Triple oral Polio Vaccine (TOPV) before their first birthday; as a result , a decrease in the incidence of polio cont inued during the report ing period ;
A Manual on Polio Eradication was recently published , a imed a t providing necessary technical advice on how t o s t rengthen surveillance , outbreak inves tigation and control measures , and on the necessary laboratories to be des ignat ed in the very near future :
Strengthening of poliomyelitis ; and
laboratory services for d iagnosis of
The Regional Office has ensured that financial resources would not be lacking for the programme , and the Technical Advisory Group (TAG) on Poliomyelitis Eradicat ion, a t its second meeting in
Discussions
EMIRCJ6/21-E page 22
June 1989, studied the developments expressed its satisfaction with reaffirming recommendations that Thirty-fifth Regional committee.
in t he Regional Programme and progress so far achieved, had been accepted by the
One of the representat ives raised the point of collaboration between neighbouring countries to achieve polio eradication, and referred to the lack of knowledge on the part of vaccinators concerning cont raindications of vaccination . Another representative described his country ' s achievements in the area of polio control, indicating that even one case discovered was considered equivalent to an outbreak. A third representat ive doubted t he possibility of polio "eradication• due· to there being no vaccine that could withstand climatic and geographic factors, and these factors were also the cause of vaccination waste. A fourth represent ative described achievements in vaccine production in his country, including polio vaccine, and would be prepared t o collaborate in meeting the Region ' s vaccine requirements as a step towards achieving Regional self-sufficiency. A fifth representative described difficulties encountered with polio vaccination in his country and asked for the assistance of the Organization in providing cold chain equipment and vehicles to transport vaccines to remote areas. A sixth representat ive stressed the importance of cooperation between neighbouring countries in developing a polio control plan, and raised the matter of polio-vaccination side-effects and their implications in respect to other vaccinations. He said that problems had also been encountered in his country with the storage of vaccine , particularly arising from lack of electricity at times.
Dr Wahdan, comment ing on the abovP. discussions, emphasized the importance of collaboration among Regional groups and neighbouring countries, whom he urged should emulate the Maghreb St ates. He mentioned, in particular, the Gulf States as an example of such Regional groups. He also stressed the import ance of considering any polio case as an outbreak, since the existence of one case meant that there were at least one hundred persons infected.
He stressed that it was possible for the oral poliomyelitis vaccine to lead to the eradication of the disease ; this having been proved t rue in many countries such as the United States, some in EUrope and some in the Eastern Mediterranean Region. He explained that what he intended to convey by •eradication• was the disappearance of the wild virus, which causes the disease, and not the disappearance of polio patients. In dealing wit h the problem of vaccine waste, Dr Wahdan said that it depended to a large extent on the size of t he vials used, and that vaccine stored in small vials was less likely to lose its potency than that kept in larger containers. He then expressed his hope that Pakistan would continue , and increase the progress it has already achieved, with t he production of vaccines, and thus contribute to the self-sufficiency of the Region in this respect .
Dr Wahdan indicated that there were two reasons for the side-effects which follow t he administration of the BCG (bacille Calmet te Guerin ) vaccine . First, vaccine maladministrat ion : second, the quality of the vaccine used . Since t he dose differed in quantity from one vaccine t o another, the dose should be accurately defined, especially when shifting to vaccines from other sources.
EM/RC36/21-E page 23
In connection with vaccine waste due to lack of electricity. Dr Wahdan noted that a great advance had been achieved in kerosene- and gas-powered refrigerators. In respect of national EPI programme support , Dr Wahdan said that the Regional Director had established an ad hoc post for the sake of three Regional countries , namely Democratic Yemen, Sudan and Yemen.
Dr Wahdan said that there were no contra-indications to vaccination as long as a child could report to a vaccination unit, even if suffering from, say, diarrhoea. It would be advisable in such cases to repeat the dose later . Finally, Dr Wahdan indicated that a 4-6 week interval between doses would be sufficient, but failing to observe this interval did not necessitate dose repetition.
V-5. REPORT ON PROGRESS OF WHO-SPONSORED RESEARCH ACTIVITIES IN THE EASTERN MEDITERRANEAN REGION (Agenda item 11, document EMIRC36/9: resolution EM/RC36/R.8)
This agenda item was presented by Dr B. Jayaweera, WHO consultant , Research Promotion and Development, who stated that the report had examined progress of WHO-sponsored research activities , which were primarily aimed at strengthening the national research capability of Member States to solve problems related to their attaiMent of Health for All goals with primary health care as the basic approach . The emphasis was currently on health systems research, which was urgently needed for accelerated implementation of Health for All strategies in the next decade·.
The implementation of this Regional health research strategy was facilitated through Task Force visits established for this purpose in 1986.
In view of the proposal that the Task Force approach be popularized , the Regional Office prepared a publication analyzing the Task Force approach as a guideline for possible use by other countries and by other WHO Regions.
Besides Task Force activities , v isits of short-term consultants and WHO staff has had considerable influence in specific research promotional activities.
EMRO continued to support research applications on priority problems . TWenty research proposals were supported by EMRO during the past year. These were in addition to those supported by the WHO Special Programmes on Human Reproduction , Tropical Diseases and Diarrhoeal Diseases . Besides these , Member States and other bilateral and donor agencies had funded research.
Research training remains a priority concern for EMRO. Training opportunities were being provided through research training grants and visiting scientist grants , attendance at international and national research meetings . attendance at research workshops and the WHO Fellowship Programme , under the WHO country provision on Health systems Research (HSR) and Research Promotion and Development (RPD) projects. Training under the Research Fellowship Progranune was primarily in the field of HSR. A few research training grants also had been awarded.
Learning material relevant to HSR in Arable and in other local languages was in use and was being further developed�
Also. a manual of case studies on HSR for use in national workshops was nearing completion.
EM/RC36/21-E page 2 4
To help support 'WHO programmes, part icularly those of the F.MR, 28 collaborating centres had been designated in the Region . These included ten recently designated centres covering the following areas: psychological medicine, AIDS, lymphoma research, nuclear medic ine, maintenance and repair of health care equipment , health systems research, cardiovascular diseases, pesticide analysis and health manpower development .
The WHO Special Programme for Research and Training in Trop ical Diseases (TDR) had developed many initiatives. The need for greater participation by the countries in the Region was desirable . The Advisory Committee on Health Research (ACHR) expressed concern and suggested that EMRO should encourage Member States to obtain the assistance of this Programme for research support , as well as for training of their scientists .
The 'WHO Special Programme for Research, Development and Research Training in Htunan Reproduct ion (HRP) was conducting research and developing new technology related to human reproduction and the needs of family planning programmes. The three col laborating HRP centres located in the Region were contribut ing towards Regional and global efforts. However, there was scope for further collaborat ion among Member states in this Programme .
As regards the Diarrhoeal Diseases Control Programme, most research was now being conducted and supported at the global level. While several Regional research proposals were being supported, there was a need to accelerate the involvement of all Member States in this important research programme.
Final ly, Dr Jayaweera presented somP. highlights of follow-up actions taken on previous recommendat ions by the Advisory Committee on Health Research (ACHR) and by other bodies.
Discussions
A representat ive expressed the great interest given in his country to collaboration with EMRO in the area of research training .
V-6 . REPORT ON THE TUBERCULOSIS SITU�TION IN THE EASTERN MEDITERRANEAN REGION (Agenda item 12, document EM/RC36/10: resolution EM/RC36/R . l2)
Dr M.H. Wahdan , Director, D isease Prevention and Control, presented to the Regional committee a report on the tuberculosis situat ion and the development of control programmes in the Eastern Mediterranean Region.
He reported that tuberculosis cont inued to be a major public health problem for many countries of the Region. Although some rout ine stat ist ics were available, they were far from being complete or reliable , particularly due to differences in criteria used for diagnosis, and failure to diagnose a large proportion of cases .
Available information indicated that there were nearly 350 000 cases under treatment and that new ones reported annually were approximately 40 000 smear-posit ive cases of pulmonary tuberculosis.
Using the most reliable indicator of the magnitude of tuberculosis, namely the annual infect ion rate to estimate the number of cases , it was found that there were at least 250 000 new cases a year, and that the total number of cases in the Region requiring treatment approached 1 000 000 .
EM/RC36/2 1-E page 2 5
The presentation emphasized the importance of a strategy for tuberculosis control of combined case findings and chemotherapy . The returns in case findings would best be achieved through bacteriological examination of sputum and, hence, the necessity to provide for microscopic examination of sputum at all levels of basic health services . As far as treatment was concerned, the importance of adequate ambulatory chemotherapy that would meet the need of every case, preferably the short course self-administered regimen, was emphasized, coupled with active follow-up to defaulters .
Discussions
One of the representatives summed up the achievements made by the National Tuberculosis Control Programme in his country, mentioning that there were three factors which impeded the .activities of developing countries in the field of tuberculosis cont rol , namely : money, manpower and motivation. He proposed that the third recommendation, which rela ted to the control of tuberculosis, be modified so as to provide for the adoption of a short three-month treatment regimen, using potent drugs. He also enquired about the mode- of action of the BCG vaccine.
The Representative of Palestine stated that the occupying forces had closed some tuberculosis health centres, and requested WHO to provide support to the Tuberculosis control Programme in the Occupied Territories.
Dr Hussein A . Gezairy, Regional Director, indicated that tuberculosis was closely connected to social conditions and related indicators such as housing, income and nutrition . In European countries, for instance, the rate of tuberculosis incidence had decreased, even before the discovery of the recent drugs used for the treatment of the disease. He emphasized that the necessary requirements for controlling the disease were available and that all obstacles met were merely procedural matters . He further stated that one of the main problems in this respect was that of defaulters , and went on to say that it had been possible to overcome this problem through nongovernmental societies that applied a daily follow-up of patients to ensure drug administration . He also affirmed that the short three-month treatment regimen, using potent drugs, though more costly, yielded better results i.n the long run. He called upon the Regional Committee to adopt a recommendation concerning the use of this treatment regimen . He stressed that assistance should be provided to the less developed countries in this respect, and indicated that the bulk purchase of drugs would greatly reduce costs.
A third representative mentioned that, in addition to the three previously mentioned impeding factors, he would like to citP. a fourth factor, namely, the management of tuberculosis control activities.
A fourth representative mentioned that his country had recently prepared a drug formulary which included a number of essential drugs for the treatment of tuberculosis, and that it had been possible for his country to buy these drugs at much lower prices than those on the international market.
A fifth representative emphasized the importance of involving the community in tuberculosis control activities, and inquired about the treatment of chronic patients , these being a continuous source of infection.
Dr M .H. Wahdan commented on the points raised, stressing the importance of the short treat�ent regimen of tuberculosis. He indicated that the closing
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of tuberculosis treatment centres should not treatment of tuberculosis in ho:Jses , with close better results than treatment in hospitals , required.
cause much worry, as the medical surveillance, yielded though hospitals were often
He also stated that WHO had a training programme for tuberculosis, and that the training materials necessary for that would be available by the middle of 1990 .
He confirmed that the community should be involved in the control and treatment of tuberculosis, and ended by explaining the philosophy of the short-term treatment of tuberculosis, and the mode of action of the BCG vaccine.
V-7. REPORT ON THE REGIONAL PROGRAMME FOR EMERGENCY PREPAREDNESS (Agenda item 13, document EM/RC36/ll : resolution EM/RCJ6/R.l l)
The report was presented by Dr 1\ . Khogali, Director, Programme Management, who stated that EMRO had strengthened its activities in Emergency Preparedness and Response (EPR). EPR " s medium-term programme for 1990-1995 had been fortified with the Regional Programme now introduced to you.
The main activities of EMRO were to assist Member States in formulating their national plans, and to start training and education in the Region, also to produce training material relevant for the Region and available in Arabic . Providing appropriate training material and assistance to the countries would be one of the main tasks for EMRO. ln preparedness areas, not only natural disasters, but also accidents like petrochemical catastrophes , which were prone to occur in this Region, were included in the programme topics, as WP.11 as environmental health aspects .
The human- side of disaster effects had been taken into account in the programme by paying special attention to the psychosocial aspects of disasters . The programme also included establishment of a WHO Collaborating Centre for Research and Training in the Eastern Mediterranean. Establishment of a Regional emergency supplies s tock store for use by all Member States in emergencies was being planned in the programme .
1\ data bank of emergency-oriented information, as well as a local expert roster, would enhance the response to emergencies, and computerizing would accelerate the response from WHO 's side .
The coming decade was nominated as the International Decade for Natural Disaster Reduction. The activities for the decade were included in the programme frame and would , to a large extent, be implemented as part of the general EPR programme . The role of the health sector should be clear and visible in the decade activities . among all the other sectors involved in disaster-relief operations .
As regards recent activities in EPR , an intercountry workshop was held in Hammamet, Tunisia, from 30 October to J November 1988, with the participation of EPR focal points from 11 Member States. A national workshop was held in Sudan in August 1988, and two others were being planned for this year (one in Somalia and one in Sudan ) . Assistance in formulating a national EPR plan for Somalia was given, and an associate professional officer was working full-time . for EPR in Sudan . Country visits to collect information from Menber States had been started .
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1\ssistance to countries in formulating or strengthening their health sector, national-level EPR plans and providing training were of an urgent nature for the Regional Programme to enhance preparedness to cope with disasters .
Discussions
One of the representatives said that the name of his country had not been cited among those which had established national committees on emergency preparedness. He added that two years ago, an intersectoral committee had been established in his country, but they did not envisage for the time-being, creating such a committee at the Ministry of Health level. He also mentioned that his country· would participate in the next meeting that will be held on emergency preparedness .
The representative of Palestine indicated that the occupational forces used gases and . toxic chemical substances in the Occupied Territories. This , he continued, had caused the deaths of 139 martyrs , i . e. , 14\ of the total number of martyrs killed during the inteladeh, as well as 6000 miscarriages . He further stressed that the occupational forces deliberately threw gas bombs into houses where they knew women were living. He added that he had mentioned these incidents to illustrate the need for training health personnel in the occupied Territories to deal with such disasters .
A third representative indicated that the subject of emergency · preparedness was very important, but at the same time difficult and full of pitfalls . He also referred to the various geographical terrains which are found in the Region and cause different disasters such as floods, earthquakes and hurricanes, in addition to the problem of locusts. He further stated that there should be a distinction between the disasters which countries can manage on their own, and those which necessitate technical assistance from WHO to deal with. He proposed that EMRO should establish a pool of experts to provide training in the management of disasters , and assistance to disaster-stricken countries .
A fourth representative suggested that an additional recommendation be attached to those already formulated, on the creation of a special account for disasters in each country ' s treasury, and that in his own country a draft law had been submitted to the legislative authorities with a view to creating, what he called, a national fund for the management of disasters .
A fifth representative discussed the problem of the poll_ution of coasts with toxic waste, and said he believed that WHO should coordinate the efforts exerted by Member States, not only for the purpose of protecting the environment, but in order to prevent the population from being poisoned by eating fish contaminated by toxic waste. He asked whether WHO had taken any steps so as to re-distribute the remaining resources to the disaster-stricken countries, and inquired about the terms of reference of WHO officials in providing assistance in cases of disaster.
A sixth representative emphasized the importance of establishing emergency preparedness plans in advance. and of creating an 1.ntersectoral committee in every country. He indicated that his country earmarked funds in its budget for the assistance of neighbouring countries in disaster cases. He also called upon WHO to assist Member States in establishing different programmes and plans for training personnel in the Region in the field of emergen:y preparedness • .
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The representative of the organization of Afr ican Unity ( OAU) said that the OAU had established a Centre for Disaster Preparedness in Addis Ababa. In collaboration with the OAU, the centre holds seminars on methods of developing action plans for responding to emergency situations. In 1985, member nations of OAU established an Emergency Assistance Fund for expediting the assis tance needed in s tr icken countries due to natural disasters . He said that during the current month, OAU wonld organize an inter-agency meeting on t.he mobilization of funds and development of plans for emergency preparedness .
comment ing on the above discussions, Dr Khogali said that WHO spared no effort to provide all possible suppor t for the Palest inian people. He supported the proposal to establish a pool of experts to give assistance for Regional countries in disaster cases , and indicated that this proposal was in agreement with the Regional plan. Indeed , WHO had requested Member States to provide it w ith information on persons responsible for emergency preparedness in disaster situations, not only for establishing an exper t pool to provide assistance in disaster cases, but to provide them with training if needed. The organization had written to Member States requesting information on whatever plans or programmes they had for disaster preparedness, bear ing in mind the importance of such information for WHO to play its role in this respect. But information thus far received was not sufficient.
Dr Khogali expressed his appreciation for the proposal to add a recommendation that a national fund for disaster response be established , and said that the proposed recommendation could be added to the other recommendat ions, if the Commit tee so decided.
Dr Khogali made it clear that the resources provided by WHO to assist countries were limited, the main role of the Organization being to coordir.ate with the funding agencies.
Emergency preparedness , Dr Khogali concluded, should be given greater attention, in order that we might devote more effort and resources for strengthening health services : s ince disasters absorb a large part of resources which could otherwise be directed towards the improvement o f health services and achieving human welfare in the Region.
V-8. MONITORING PROGRESS IN THE IMPLEMENTATION OF HEALTH FOR ALL STRATEGI�S (Agenda item 14, document EM/RC36/12: resolution EM/RC36/R. 10)
Dr Esmat I . Hammoud, WHO consultant , Health Situation and Trend Assessment, presented this agenda item . He referred to monitoring and evaluat ion of Health for All s trategies, and to Resolution EM/RC35/R. 7 , adopted in 1988, following the review o f the second Report on Monitoring Progress in the Implementation of HFA strategies . The resolution had requested, inter a11a, the Regional Director " to conduct a s tudy to ident ify Regional targe ts for HFA and report to the Thirty-sixth Session of the Regional Committee." Hence , the report under consideration.
The starting point in the methodology was the four pr ior ity areas in the use of WO' s resources, as defined in the Regional Programme Budget Policy adopted by the Regional Committee in 1986. Global and Regional indicators relevant to each priority area were identified. For each of these indicators there was a careful analysis of the related country data available in the second Monitoring Report o f 1983 and the First Evaluation Repor t of 1985. on the basis of that . analysis, it was possible to assess progress achieved so
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far- in countries of the Region, compared wit h the •desired levels• stated in the Global Strategy, and to estimate feasible targets by the yea r- 2000 for the Eastern Mediterranean Region.
The report submit ted 11 targets, but during presentation it was suggested to add one more, to give a total of 12 targets for EMRO: ( 1 ) urban water supply; ( 2 ) rural water supply; (J ) urban sanitat ion; ( 4 ) rural sanitation; ( 5 ) immunization: (6) poliomyelitis; ( 7 ) local health care ; ( 8 ) care during pregnancy and at childbirth; (9) trained traditional birth attendants ; ( 10) infant care ; ( 1 1 ) infant mortalit y ; and (12 ) maternal mortality.
., . It was proposed that the listed targets be adopted as EMR targets for HFA/2000, on the understanding that they should be periodically reviewed. This list of targets is at tached as an Annex to Resolution EM/RC36/R . 10.
At the end of the presentation, Dr Hammoud referred to a number of tables, including statistical data on Member States, which were distributed to the part icipants.
Discussions
some of t he representatives discussed the issue of whether it was possible to add other indicators to those mentioned in the document , or whether it was possible to replace some by others. A second representative wondered whether it was wise to have different indicators for urban and rural areas, and whether this might be construed as evidence of existing inequality among citizens. A third representative asked why t here were targets for drinking water supply and sanitation coverage when these lay outside the sphere of competence of the Minist ries of Health.
Dr E. Hammoud commented saying that the global indicators included in the HFA Global Strategy had already been approved by the World Health Assembly, and� consequently could not be changed. As for adding more indicators, this depended first and foremost on the availabilit y of the basic data required for the proposed indicators in t he Member States.
He also stated that the present situation seemed to indicate that there was a great discrepancy between urban and rural areas, mainly as regards sanitation coverage , and to a lesser degree. drinking wate r supply. Accordingly, fixing the same targets for urban and rural areas would be impract ical. He then indicated that intersectoral coordination was an essent ial prerequisite for the HFA Global strategy, and that t he Ministry of Health was responsible for ensuring that such coordination existed with ot her sectors, such as water and sanitation sectors.
At the end of the discussion, Dr Hammoud asserted that the regional indicators listed in the document should be reviewed in the future, in the light of the healt h situation prevailing at that t ime, and consequently, such indicators should not be considered as final.
The Regional Director requested the participants to state t heir views on the Regional targets listed i n t he document , and to indicate whether they thought them practical and sufficient for the Region. some of the part icipants mentioned that they believed some coverage targets should be set higher, so as to enable the Ministries of Health to exert some pressure on
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the bodies concerned, as r egards t he allocation of more financial resources required for solving exsiting problems .
V-9. PROGRESS REPORT: HEALTH SYSTEMS RESEARCH AS PART OF THE MANAGERIAL PROCESS IN SUPPORT OF THE STRATEGY FOR HEALTH FOR ALL (Agenda item 15, document EM/RC36/13 : resolution EM/RC36/R. 9 )
The report was presented by Dr B . Jayaweera, WHO consultant , Research Promotion and Development , who stated that the report reviewed follow-up action taken on the managerial process in support of the strategy for Health for All, and Resolution EM/RC34/R. 11, adopted by the Regional Committee in this regard in 1987 .
Health systems research (HSR) was - being accepted increasingly by Member States as an integral part of the managerial process for health development . The Eastern Mediterranean Task Force for Health Research Strategy was promoting t his� further reinforced by visits of consultants and Regional Office staff.
Several national activities had taken place to promote and strengthen HSR. These included workshops for policy-makers, courses on research methodology for young scientists, t raining of trainers, development of teaching/learning material such as case studies, translation of learning materials into :l\rabic and other local languages as feasible and conduct of t raining courses in local languages .
The Fourth Intercount ry Meeting of National Officers Responsible for Health Research was held in January 1989 in Cyprus, and the participants prepared plans for the possible institutionalization of HSR on a more sound footing.
The importance given to HSR by Member states was reflected in the Joint GOvernment/WHO Programme Review Missions (JPRMs) and in the preparation of national plans for the 1990/91 biennium.
Discussions
A representative stated t hat health systems research was an important tool for the achievement of HFA/2000 . However, in his country there were difficulties in this area because of the scarcity of people who could undertake research because of t he lack of time.
Another representative asked EMRO to give more emphasis to training nationals in how to undertake this type of research. In some countries HSR is still not considered as a possible approach to solving their problems. Universities could do a lot in health research, but it was the duty of ministries and executives to support HSR. In his country they considered HSR as an inherent part of their health proj ects with involvement of health managers t herein with posit ive resul ts .
Another representative said that workshops were not enough and believed that a health systems researcher must be totally involved and familiar with t he research methodology.
Dr Jayaweera replied saying that note had been taken concerning the need for training. He also agreed fully with other remarks concerning the
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importance o f inc luding HSR within the structure o f health programmes . This was indeed very usefu l , not only technically but also financially, with better use of research results. What was required in coun� rles was to s t rengthen institutions . It was important for universi t ies to be famil iar with the methodology of research and to col laborate with health managers in a spirit of partnership .
VI-1 . HEALTHY LIFESTYLES
EM/RC36/21-E page 3 2
VI . TECHNICAL DISCUSSIONS
(Agenda item 18, document EMIRC36/Tech.Disc. l: resolution EM/RC36/R.7 )
Dr M.H. Khayat , Director, Health Protection and Promotion, presented the paper . He briefly reviewed the current definitions of •health• and • ufestyle•. He pointed out that the concept of health had undergone a significant shift in the twentieth century. Whereas, in the last century health generally had been viewed in a •mechanistic" way, with the main emphasis on disease and its treatment of the individual, the emphasis now had shifted to the role of the environment and prevention of the disease process. Recent work strongly indicated that a healthy lifestyle was a vital link between the individual and his/her environment , both physical and psychosocial. Human behaviour seemed to be a crucial factor which determined the balance between health and disease.
The influence of health-damaging behaviour was by now well recognized and documented. These included excessive and imbalanced consumption of food , use of tobacco, alcohol and many other psycho-active substances, risk- taking behaviour. like dangerous driving , promiscuous sexual behaviour, excessive mental stress, et c. On the other hand, the positive effect on health of exercise, maintaining optimal weight and relaxation were well recognized. However, it must be accepted that there were limits to the choices open to an individual; lifestyles were intimately bound up with the values, priorities , practical opportunities and constraints of a given socio-economic and cultural situation. For success in promoting a healthy lifes tyle, equal a t tention must be paid to t he physical and social environment .
�ong sociocultural factors, perhaps religion plays a crucial role in guiding human behaviour. Most of the countries in EMR have a common heritage of Islam, which emphasizes a healthy lifestyle. In his presentation, Dr Khayat referred to a recent meeting on R islamic LifestyleR , held in Amman, Jordan, which made important recommendations in this regard, including a . special Amman Declaration highlighting Islamic principles, which forms the basis of a healthy lifestyle.
Discussions
some of the representatives stated that changing one' s lifestyle for the better was not an easy task, but that, nevertheless , we should begin this process as soon as possible. some others pointed out that the developing countries had begun to adopt the unhealthy lifestyles of t he West, particularly with the increase in urbanization and industrialization, and highlighted the implications , among which were an increase in heart disease, accidents, diseases stemming _ from the R malnutrition of affluence" , as well as illnesses aris ing from a too sedentary lifestyle, due to lack of exercise and too much reliance on the automobile. They indicated that i t was necessary to analyse these new phenomena and to propose suitable solutions for t hem.
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�nother representative mentioned that we should encourage participatory sports activities , and not just spectator sports, and we should intervene in order to prevent the •misuse• or exploitation of sports for advertising and promoting many items that are damaging to health. The representative of Palestine mentioned the practices used in the occupied Territories that propagate an unhealthy lifestyle among the population, particularly among children. He added, however, that such practices had begun to subside since the start of the !ntefadeh , a fact that reflected the importance placed on positive personal attitudes in the adoption of a healthy lifestyle, and avoidance of a negative one. He also stated that occupying authority physicians did not always abide by the ethics of medical practice, allowing, for example, patients to become addicted to sedatives and stupefacients. one of the participants requested that the Region be informed in writing of such practices, so as to take the necessary remedial action.
commenting on the discussions, Dr Khayat indicated that EMRO had started to utilize the •religion channel• to reach the public and ·affect its behaviour. In this respect, EMRO had approached Moslem religious leaders, with whom meetings had been held. Similar meetings with Christian religious leaders are planned for early next year. •proper• behaviour without discriminating among religions, was the main focus of EMRO.
Dr Khayat stressed the importance of strengthening the social relations network by urging individuals to interact in a positive manner with one ' s environment, thus positively affecting others around him or her.
Dr Khayat said that EMRO had an accident control programme within which a Regional strategy and guidelines had been formulated. The Office had also arranged a meeting some months ago, to consider affluence-caused ailments, on which a technical publication will be prepared and sent to countries soon.
Dr Khayat emphasized the necessity to start to change one's lifestyle towards health promotion, whatever the difficulties encountered. Any effort initiated to change one' s lifestyle for the better would undoubtedly yield results.
The majority of representatives supported all the . recommendations submitted. However, the representative of cyprus proposed that the sixth recommendation should call . for the adoption of the Amman Declaration on Health Promotion by a majority of Member States, whose prevailing religion is Islam.
VI-2. SUBJECTS OF TECHNICAL DISCUSSIONS AND TECHNICAL PAPERS IN 1992 and 1993 (Agenda 1tem ·22(a) : document EMIRC36/WP2)
Dr A. Khogali, Director, Programme Management, presented this item stating that at its Thirty-fifth session in 1988, the Regional Committee had adopted Resolution EM/RC35/R. 17 regarding subjects of Technical Discussions and Technical Papers for 1990 and 1991, as recommended by the Regional consultative committee (RCC) at its ninth meeting in 1\rnman, Jordan, from 31 March to 1 April 1988 . These subjects are:
In 1990 :
Technical Discussions - Programmes in support of Health for All
In 1990: (cont ' d)
Technical Papers
In 1991:
EM/RC36/2l-E page 34
- Iodine deficiency disorders Mediterranean Region
- Malaria
in the Eastern
Technical Discussions - Health economics
Technical Papers - Health of the elderly and problems of the handicapped
- Integration occupational pesticides, basic surgery
into primary health care health, use and toxic effects
peripheral laboratory services
of or
and
The RCC also recommended the following subjects for consideration for future sessions : The role of women in support of Health for All; and Advocacy for Health for All among medical practitioners.
The RCC at its next (thirteenth) meeting in March/April 1990, will consider and recommend subjects for Technical Discussions and Technical Papers for 1992/93. Any suggestions for subjects from Regional committee representatives would be welcomed.
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VII. OTHER MATl'ERS
VIl- 1 . REPORTS OF THE REGIONAL CONSULTATIVE COMMITTEE (Agenda item 7 , document EM/RC36/5 : resolution EMIRC36/R . 4)
Dr A. Khogali, Director, Programme Management, presented this agenda item, stating that the Regional Consultative committee (RCC ) had held its eleventh meeting in Amman, Jordan, 13-14 April 1989, during which time it reviewed the progress achieved in implementing the recommendations of its tenth meeting. · The main agenda items discussed at the eleventh meeting included :
Basic minimum needs (BMN) as an approach for achieving Health for All by the Year 2000 :
A progress report on the action-oriented school health curriculum; and
A proposed modification in the format of the Regional Director's Biennial Report to the RC.
The RCC took note of actions taken in implementing the recommendations of its tenth meeting which had been sent by F..MRO to Nat ional Decade focal points.
The Rec also noted work being done by the Centre for Environmental Health Activities (CEHA) in Amman, which included, inter alia, preparation of a biennial work plan.
Follow-up of RCC recommendations on the disposal of hazardous waste was also presented to the RCC.
In addition, members of the RCC discussed a comprehensive presentation on BMN given by Dr R. Chical, WHO consultant. The discussion also covered ways and means of analyzing and solving possible implementation problems.
The RCC recommended that BMN should continue as a research and development approach in those countries wishing to use it. WHO should continue to help in this respect , and assist in generating resources and in integrating health programmes so that additional resources could be found for implementing the BMN approach. EMRO should also develop a Regional BMN Plan that would ensure Regional self-reliance in this respect.
The RCC discussed the progress achieved regarding the promotion and use of the action-oriented school health curriculum. The outcome of the first and second strategy meetings and of visits by the Regional Director to selected countries was noted. The RCC was also informed that curriculum material had been translated and printed into Arabic, French and other languages. During discussions , it wa_s recommended that WHO should follow up the implementation
EMIRC36/2l-E page 36
of the programme and support the Ministries of Health to put pressure on the Ministries of Education to speed up the process o f imp lementation, and to ensure the proper training of teachers .
At the RCC's twelfth meeting, held 25-26 September 1989 , in Nicosia , cyprus, the following three items were discussed:
( 1 ) The objectives, format, periodicity , contents and distribution of the RD 's Report were critically discussed during the meeting . It was recommended to reduce the size of the report by concentrating on major issues , and making its format and presentation more attractive and clearly written, with more graphic presentations and coloured pictures . tt was recommended to produce annual reports covering calendar years under the title of "The Work of the World Health organization in the Eastern Mediterranean Region - Annual Report of the Regional Director". The report would also include data and information on countries • health situations and examples of interesting experiences . Besides the present target audience , the readers of the RD's report should also include heal th and health-related workers in various ministries, institutions and NGOs . In order to make statistical data more credible , and in view o f felt general weakness in the area of recording and reporting , the RCC recommended that this subject be further discussed in a future RCC and/or RC meeting .
(11) HBI programme: The discussion of this programme dur ing the RCC meeting covered the areas of its policies , objectives, selectivity , quality , target audience , cost and managerial aspec ts .
The RCC realized the impor tance of this programme and supported its set policies , objectives and targets and emphasized the importance of its regular monitoring and adaptation to the countries ' priority needs. Format and presentation of material should be more attractive and should be tailored to a wider audience , including besides Ministries of Health, other health and health-related workers at different levels such as those working in NGOs, media people and the public a t large. WHO input should be directed towards promoting countr ies ' self-reliance in various aspects of HBI and assisting them in implementing their national plans.
The RCC commended the ef forts directed towards the promotion of the use of 1\rabic and other national languages in the health and medical education and recommended that this be continued. Simple Arabic terminology should be used.
(iii) EMRO' s Fortieth �nniversary commemorat ive Book : After reviewing its draft , the RCC recommended that the contents of the book be further revised ; that it should include more information about health developments at the country level, and that thP. f inal product should be produced with the guidance of professional editors and designers , so as to be more attractive and easily readable .
The Regional Director invited the v iews of the Regional Committee on the RCC reports, saying that they would hopefully assist him in taking the necessary decisions and measures .
He noted that often only the introduction or certain chapters of his reports were actually read . He therefore hoped that EMRO would be able to prepare reports more interesting to the readers.
EMIRC36/21-E page 37
Referring to the commemorative Book being prepared by the Regional Office on the occasion of its Fortieth Anniversary, the Regional Director said that a copy had already been sent to each Member State for comments . He hoped that EMRO would receive replies as soon as possible, so as to be able to publish the book before the end of the year.
Discussions
one of the representatives mentioned the problem of env ironmental pollution and called for cooperation with other international organizations and centres, in this respect. He then stated that his country had been applying the people 's management or self-management approach in all institutions 1 an approach similar to that of basic minimum needs (BMN ) . However. his country suffered from a ·shortage of trained manpower . Another representative requested that terms such as PHC (primary health care ), BHC (basic health care) and BMN (basic minimum needs ), be defined more clearly. A third related the great success which the implementation of the BMN approach has had in his country. He expressed the hope that the approach would be adopted in other parts of his country.
The Regional Director commented that the Organization had evolved from a policy of dealing almost exclusively with specific disease entities to a philosophy which emphasizes a broad-based preventive approach with the emphasis on health rather than disease . Earlier, WHO efforts had tended to be disease-focused and treatment-oriented. BHC was an example of this approach.
Today, however, PHC emphasizes the health-focused approach, including its eight elements . It also places importance on community involvement and intersectoral collaboration .
BMN 1s only one approach to the implementation of PHC being tried out in the Region . It is an operational approach at the v illage level that emphasizes the wholeness of development, integrating health as a part of the overall development needs as expressed by affected communities . It is also a way of obtaining the collaboration at the community level of the various service sectors such as agriculture, education, health, etc . The levels of PHC or BMN are not important ; what is important is the •operationalization• of the principles of PHC at the community level .
VII-2. RESOLUTIONS AND DECISIONS OF REGIONAL INTEREST ADOPTED BY THE FORTY-SECOND WORLD HEALTH ASSEMBLY AND BY THE EXECUTIVE BOARD AT ITS EIGHTY-THIRD AND EIGHTY- FOURTH SESSIONS (Agenda item 6, document EM/RC36/4 : decision 3 )
The Regional Director drew attention to f ive resolutions and decisions adopted by the Executive Board at its Eighty-third and Eighty-fourth sessions, and 33 resolutions adopted by the Forty-second World Health Assembly, highlighting their implications for the Region . He outlined the action being taken by the Regional Office to implement the resolutions and urged Member States to report on their own response.
Discussions
one of the representatives proposed that the report of the Regional Director on the activities of the Regional Office include an annex listing the measures taken as regards the •Resolutions and Decisions of Regional
EM/RC36/21-E page 38
Interest Adopted by WA and EB• , in view of the fact that several of these resolutions were related to the items on the present agenda.
A second representative suggested that EMRO should establish some guidelines for Member States to follow when preparing their health policies, and elaborate a detailed programme that would be suitable to the nature of the Region (e.g. , its climate , population and capabilities).
A third representative mentioned that the resolutions and decisions reviewed did not include Resolution WHA42.5 , which dealt with the role of human body organs and which, i f of no importance to the majority of the countries in the region , was of interest to some, including his .
A fourth representative proposed , in view of the numerous subjects of these resolutions and decisions , and the wide scope of some of them , that some subcommittees be formed to discuss these subjects , as this would greatly facilitate the work of the Regional Committee.
A fifth representative requested that the import of foodstuffs be monitored by WHO so as to ensure that such foodstuffs would be safe and free from various forms of contamination.
Finally , a representative requested that EMRO should pay more attention to the subjects of health administration , health economics , and health and medical education. He added that some countries, particularly those with limited resources , had been negatively affected by the WHO decision concerning the non-provision of countries with vehicles. He requested that WHO should reconsider this decision .
The Regional Director commented on the points raised , saying that he would see to it that his report includes in the future some , but not all , the resolutions and decisions of Regional interest , as some were redundant. He also stated that HFA strategies had been discussed at country , regional and global levels , and accordingly , certain regional and global indicators had been established to facilitate the evaluation of the progress achieved. He pointed out that it was impossible to assist each country separately in the preparation of its strategy . but that EMRO was prepared to provide any assistance in this respect , if and when required. He added that the indicators used in other regions could be utilized in our Region , and c i ted that EURO had established , for instance , 38 indicators for the purpose of evaluating annual progress achieved.
In connection w ith monitoring foodstuff imports by WHO, the Regional Director said that the Organization was not in a position to act as a purchasing agent , and that its role in this respect was to support public health laboratories in Member States , with a view to enabling them to undertake the task of quality control of imported food.
Concerning the provision of vehicles for Member States , the Regional Director said that EMRO would be ready to meet limited needs in this regard from extra-budgetary resources , or sometimes from the revolving fund , with countries shouldering the cost of maintenance and fuel. This should be viewed as the exception and not the rule.
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VII-3. PROGRESS REPORT: WHO' S PUBLIC IMJ\GE 1\ND ADVOCACY FOR HEALTH FOR ALL (Agenda item 16, document EM/RC36/l4: resolution EMIRC36/R. 13)
Mr A. Salahi, Public Information Officer, EMRO, in hls presentat ion of the progress report , briefly reviewed efforts belng undertaken by Member States and the Regional Office to promote WHO' s public image . He pointed out that the Fortieth Anniversary of WHO and the Tenth Anniversary of J\lma-Ata had been successfully utilized in bringing the message of health home to people. Now that two annual events had been institutionalized, namely, World AIDS Day and World No-Tobacco Day, these two events and World Health Day should be used to drive home the concept of health advocated by WHO, in addition to the particular message chosen for the particular event .
World Health Day should continue , - however, to be the main annual event, and the practice by some Member States in celebrating it for an entire week should be followed throughout the Region.
Partnerships with other sectors should be forged so that an e nd is put to the situation when different interested sectors pull in opposite directions with regard to issues, particularly those dealing with health.
The partnership between health and the media should be given enough impetus so as to herald a firm, genuine and wide-ranging collaboration. one of the results which such collaboration should aim at is unity of purpose. Direct and indirect media messages in relation to health should reinforce one another. National , intercountry and Regional round tables should be organized where the two sectors meet on equal terms to discuss how their collaboration should work.
Partnerships with other sectors should be forged also, but the one with the sports sector is thought to be of particular importance, in _ view of its •captivating• influence on youth and the public at large. since tobacco companies are still using sports sponsorship for promoting their harmful products, WHO ' should seek to counter their efforts by making sports an advocate of health.
Discussions
one representative supported the idea of extending world Health Day for an entire week , to give people the chance to organize varied activities. Another commented that there should be no hesitation in promoting WHO' s public image , since WHO is an organization of its Member states, and i t was right to emphasize achievements. Perhaps what we needed, he said, was to promote the image of the authorities that actually deliver health services. He also mentioned that a health affairs unit was now shown regularly on hls national TV network. A third representative said that he accepted that there was a need to widen the scope of the interrelationship between health and the media.
one representative spoke of the good response that was received on No-Tobacco Day after screening the EMRO film on smoking and the national TV programme produced for the occasion. She spoke of the success of t he Maghreb committee on Immunization which groups together health and i nformation authorities. The need was felt for the establishment with the Ministry of Health of a specialized information office which could be highly effective. She emphasized the . need to cooperate with the education sector.
EMIRC36 /2l-E page 40
one representative ment ioned that WHO ' s public image over the past forty years had not suffered a decline . He ment ioned that tobacco companies were ext remely powerful and warned that sports personal i t ies may not be very helpful in delivering health messages, calling them •mercenaries• .
The Regional Director expressed his satisfaction that the Regional Committee was finally addressing issues ! There was the need , he said , for p romoting the true nature of WHO and its role so that people would come to accept it as the principal authority in the field of health.
VII-4 . SPECIAL PROGRAMME FOR RESEARH AND TRAINING IN TROPICAL DISEASES -NOMINATION OF A MEMBER FROM THE EASTERN MEDITERRANEAN REGION TO THE JOINT COORDINATING BOARD ( Agenda item 19 , document EM/RC36/17 : decision 4 )
The Regional Commit t ee nominated Democrat ic Yemen t o fill the vacancy for the EMR ori the Joint Coordinating Board of the Special Programme for Research and Training in Tropical Diseases , for a term commencing f rom 1 January 1990 to 31 December 1992.
VII-5 . PROGRESS REPORT : REGIONAL OFFICE ACCOMMODATION (Agenda item 20 , document EM/RC36/18 }
Mr R . He lmholz , Director , support Programme , referred t o the extensive documentation concerning the space limitations of the Regional office which the Regional Commit tee reviewed in 1987 . It had , at that t ime , been agreed to extend the building in Alexandria , and at the Forty-first World Health Assembly ( 1988 ) , an architectural and p lanning study of various options was approved .
On the basis of that study now completed , the Commit tee was informed that the Regional office had prepared a submiss ion to the January 1990 Session of the Executive Board , and , hence , to the next Health Assembly , soliciting financing from the Real Estate FUnd for a n extension o f 3 0 office , conference and library facilities to the present building . Total cos t is estimated at US$2 381 000.
Member States were informed that any assistance in the financing of this extension would great ly s trengthen the hand of the Regional Director in submit t ing the request for funding to the Execut ive Board and Health Assembly.
VII-6 . INTERIM REPORT ON LEADERSHIP DEVELOPMENT PROGRAMME IN INTERNATIONAL HEALTH
(Agenda item 22(b) , document EM/RC36 / l9 and Add . l : resolut ion EM/RC36/R . 15
Dr 0.1 .H. Omer , Director , Health Manpower Deve lopment , int roduced this agenda item. The Regional Commi ttee , in Resolut ion EM/RC33/R . 5 , had resolved that 10\ of the country general fellowship a llocat ion "be used to recruit nat ionals for the purpose of providing them with on-the-job t raining in international health work and in the planning and implementation of various technical programmes" . On the basis of that mandate , the Regional D irector organized a ten-month Leadership Development Programme ( LDP) in International Health , which started S March 1989 and ends 28 December 1989 . with seven participants from seven count ries of the Region , and will submi t an Interim Report with an addendum on the implementation of this programme . The Regional
EM/RC36/21-E page 41
Committee was asked to give its views on this important programme and to help its evaluation to fully take place in 1990, and the preparation of the second session of the LOP planned for 1991. A full report on the First session will be submitted to the 1990 meeting of the Regional Committee.
VII-7. RESCHEDULING THE MEETINGS OF THE WHO GOVERNING BODIES (Agenda - item 22(c ) , document EMIRC36/20 )
Dr Hussein A. Gezairy introduced the subject referring to the background for this agenda item. Mr R . Helmholz, Director, Support Programme, provided additional information referr ing to document EM/RC36/20 and describing the options prepared by the Director-General describing rescheduling of the World Health Assembly and consequently, perhaps, of the Executive Board and the Regional Committee.
Three of four options prepared by the Director-General were described as relevant to EMR· and the advantages/disadvantages of each were reviewed.
The Regional committee was informed that the third option of shifting the World Health Assembly to OCtober/November, the Executive Board to May/June, and the Regional Committee to either January/February/March had increased advantages over the first two with fewer · disadvantages, and was asked to express its views concerning such a rescheduling. It was likely that although the Executive Board had already decided that the Forty-third World Health Assembly would be held in May 1990, it was possible that the next Executive Board could modify this decision and that transition to a new scheduling could occur in 1990/91.
Finally, within the context of such a transition , should RC37 occur later than 31 october 1990 ( the date of expiration of the term of membership of cyprus to the AIDS Management COmmittee) , it was proposed that the report of the Regional Committee reflect agreement, in the absence of any proposal to the contrary. to the extension of the membership of cyprus to the AIDS Management Committee through the end of the month in which RC37 is held.
Discussions
Nine representatives participated in the discussion of this item. Five indicated no objection to rescheduling the Health Assembly to October/ November, thP. Executive Board to May/June and the Regional committee to .January/February/March, with due regard to national holidays as well as to the representatives being involved in preparing final accounts for the budget of the current year , and making necessary preparations for next year ' s budget at the national level. Some representatives considered that to change a system which had proved successful for forty years should be based on weighty reasons , and should be preceded by a lengthy evaluation and objective analysis of the s tatus quo. several representatives had reservations on political subjects being used as a reason for proposing to reschedule the meetings of the Governing Bodies.
In particular , the representative from the Libyan Arab Jamahiriya felt that the justifications for changed scheduling which were referred to in the Director-General ' s working paper as being political in nature, were not in fact political . Further, the truly political issues which did arise in the Health Assembly were not of sufficient importance to warrdnt a rescheduling exercise.
EM/RC36/21-E page 42
The Regional Director said that the Director-General felt that a rescheduling of the Governing Bodies was intended to only help streaml ine the running of the organization's business ; not avoid discussions of all concerns having political implications which, after all, existed in several Regions. He felt, however, that in the proposed rescheduling of the Governing Bodies . there was practical benefit to the Region, particularly concerning budget preparation and in his own reporting to the Regional Committee. Finally , the Regional Director indicated that no decision was required of the Regional Committee, but that the views of the Member States on this issue would be communicated to the Director-General for his report to the Executive Board next January.
EM/RC36/21-E page 43
VIII . CLOSING SESSION
VIII- 1 . PLACE J\ND DATE OF THE THIRTY-SEVENTH SESSION OF THE REGIONAL COMMITTEE , 1990 (Agenda item 21: resolution EM/RC36/R . 16 )
The Regional Director pointed that the date of the Thirty-seventh Session was contingent upon the decision to be taken by the WHO Executive Board in its next meeting in January 1990 concerning the rescheduling of the meetings of the WHO Governing Bodies. If WHA43 is held in May 199 0 , the Thirty-seventh Session of the Regional Committee will be held from 6 to 10 october 1990 . But i f it is decided that WHA43 should be rescheduled to OCtober/November 1990, the Thirty-seventh session of tlte Regional Committee will then be held in January or February 1991 .
The Regional Director also pointed out that the Regional Office had so far not received an invitation from any of the Member States to host the next Regional committee Session. He wondered if any country had the intention to host the Session? He added that unless the Regional office received such an invitation, the Thirty-seventh Session of the Regional Committee would be held at EMRO, Alexandria.
The Representative of the Syrian Arab Republic extended an initial invitation from his country to host the session in Damascus. AnothP.r Representative (Islamic Republic of Iran) requested that the session be held in WHO/HQ, Geneva, i f it could not be held in Damascus.
The Regional Committee adopted Resolution EM/RC36/R. 16.
VIII-2. ADOPTION OF THE REPORT (Agenda item 23 : decision 6)
The Committee adopted the draft report of its Thirty-sixth session .
VIII-3 . CLOSING (�genda item 23 : decision 5)
The Committee adopted a decision extending its sincere gratitude to His Eminence President of the Islamic Republic of Iran . for the warm welcome received on the occasion of the Thirty-sixth Session of the Regional committee.
It also extended its thanks to the Government of the Islamic Republic of Iran and to the Ministry of Health and Medical Education for the generous hospitality afforded to the visiting national delegations and the WHO secretariat, and for the excellent facilities placed at their disposal.
EM/RC36/21-E page 44
The Regional committee expressed its thanks to the Regiona l Director and the secretariat for facilitating the work of the Committee, and requested the Regional Director to deal with its report in accordance w lth the Rules of Procedure.
THE MEETING WAS THEN CLOSED
EM/RC36/21-E page 45
IX. RESOI..trrIONS AND DECISIONS
The resolutions and decisions adopted by the Thirty-sixth Session of the Regional Committee for the Eastern Mediterranean are reproduced below (resolutions EMIRCJ6/R.l to EM/RC36/R. 16 and decisions 1-6 ) .
IX-1 . RESOLUTIONS
EMIRC36/R. 1 BIENNIAL REPORT OF THE REGIONAL DIRECTOR TO THE THIRTY-SIXTH SESSION OF THE REGIONAL COMMITTEE FOR THE EASTERN MEDITERRANEAN
The Regional Committee,
Having reviewed the Biennial Report of the Regional Director for the period 1 July 1987 - 30 June-1989, *
Appreciating the continued and effective effort in s trengthening the collaboration and dialogue between the Member States and the Eastern Mediterranean Region,
l. WELCOMES the new directions and innovative approaches the Regional Director succeeded to introduce for support of HFA strategies in t he Region :
2 . REAFFIRMS the commitment of Member states to strengthen the HFA movement ;
3 . URGES Member States to take necessary action to advocate among medical practitioners and the public at large the role 'WHO 1s playing in support of HFA:
4. PROPOSES that Member States continue to update their HFA s trategies and ensure t hat adequate health resources are utilized at all levels, particularly t he peripheral level;
5. CORROBORATES the involvement of the community in health act ion through effective social marketing and by strengthening the health information and education component. of their programmes;
6. INVITES the Regional Director to continue his efforts in assisting the countries t o improve t heir health programmes :
7. CALLS UPON the Member States and the Regional Director to maintain their support to health manpower development programmes and to enhance efficiency of health personnel by orientating t hem to contribute effectively to the implementation of HFA strategies;
8. ADOP'l'S the Biennial Report of the Regional Director.
• Document EM/RC36i2.
EM/RC36/21-E page 46
EMIRC36/R.2 J\CQUIRED IMMUNODEFICIENCY SYNDROME (AIDS) - PROGRESS REPORT ON SI'!iJATION IN THE EASTERN MEDITERRANEAN REGION MD ON
IMPLEMENTATION OF REGIONAL COMMITTEE RESOLt.rrIONS
The Regional Committee,
Having reviewed the progress report submitted by t he Regional Director in pursuit of its resolution EM/RC35/R.12, *
Sharing the concern expressed by t he Regional Director about the global and Regional situation of AIDS and the expected development s in t his pandemic,
Noting with satisfaction the steps taken by WHO in national programme support , par ticularly in relation to developing national and Regional capabilities,
Acknowledging efforts made by national authorities and WHO in the field of dissemination of the right information on HIV infection and AIDS ,
Concerned about the hesitation of some Member States to exchange information with other countries and WHO particularly in relation to the epidemiologic situation of HIV infect ion,
1 . THANKS the Regional Director for the interesting and helpful report and for the efforts made in implementing the Regional Committee's resolutions concerning AIDS ;
2. URGES Member states to:
2 . 1 . continue their efforts to achieve the development of national capabilities in various aspects of control of AIDS :
2 . 2. increase national efforts for health education promot ion;
2.3 . exchange information on the epidemiologic situation of HIV infect ion and on experiences, especially in the fields of information, education and communication;
2 . 4 . promote research in the fields of social and behavioural aspects, related to AIDS , especially in regard to defining prevention and control strategies;
2 . 5 undertake properly planned sero-surveys for the detec tion of HIV infection, adopt the survey designs recommended by WHO, and refrain from undertaking ad hoc surveys;
3. REQUESTS the Regional Director to:
3 . 1. continue his efforts to support national programmes in all its aspects, including efforts to secure the necessary external financial support needed;
3 . 2. continue to keep the status of both the global and Regional situation under surveillance and report regularly to the Regional Committee.
* Document EM/RC36/7.
!M/RC36/R .3 VIRAL HEPATITIS
The Regional committee ,
EM/RC36/21-E page 47
Having studied with interest the paper on Viral Hepatitis presented, *
Recognizing the magnitude of the problem in the Region and its serious dimensions ,
Noting with satisfaction the Regional Plan and the fact that some countries are giving priority to preventive measures , including hepatitis B vaccination,
1. THANKS the Regional Director for the comprehensive report ;
2. ENDORSES the Regional Plan;
3. URGES Member States to:
3. 1 . develop and strengthen national plans for the control of viral hepatitis, including particularly the following:
- surveillance and epidemiological investigations: - screening of blood and blood products to certify their safety in relation
to transmission of hepatitis ; - ensure rigorous observation of complete sterilization of syringes and
needles , and making provision for the use of disposable syringes and needles whenever possible ;
3 . 2 . introduce where and when possible mass vaccination of infants as an essential tool to prevent hepatitis B;
4 . REQUESTS the Regional Director to :
4.1. continue to strengthen and further develop the Regional network of national and Regional hepatitis centres ;
4. 2. continue to disseminate available technical information o n viral hepatitis;
4.3. support and encourage Regional production of hepatitis B vaccine and to promote Regional training programmes;
4.4 . secure the necessary funds for these activities ;
4 . 5 . keep the Regional Committee informed periodically of developments in this regard .
• Document EM/RC36/15.
EM/RCJ6/21-E page 48
EM/RC36/R.4 REPORTS OF THE REGIONAL CONSULTATIVE COMMITl'EE
(Eleventh and Twelfth M�t1 ngs)
The Regional committee .
Having considered the reports of the Eleventh and TWelfth Meetings of the Regional Consultative Committee . *
1. COMMENDS the Regional consultative Committee for the advisory support it continues to provide to the Region;
2 . TAKES NOTE of the two reports of the Regional consultative committee.
EMIRC36/R .5 JOINT GOVERNMENT/WHO PROGRAMME REVIEW MISSIONS
The Regional Committee ,
Having reviewed the report on the Joint Government/WHO Programme Review Missions for 1989, **
l . RECOMMENDS that :
1 . 1. Joint Government/WHO Programme Review Missions continue to be carried out every two years ;
1. 2. Joint Government/WHO Programme Review Missions be utilized to introduce new innovative programmes addressing priority areas , integration of existing compatible programmes and solving of existing problems facing the implementation of the HFA Strategy;
1 . 3. Member States inltiate preparatory action at least six months prior to the initiation of the review, and that this preparatory phase be utilized to review all existing programmes and propose new programmes that will address p roblems facing HFA Strategy;
2. REQUESTS the Regional Director to :
2. 1 . provide all necessary support to countries to implement this resolution, and to continue his efforts in assisting the updating of national HFA strategies;
2 . 2. consider the possibility of including a member who is a national of another country in the team representing WHO in the Joint Programme Review Mission.
EMIRC36/R. 6 POLIOMYELITIS ERADICATION IN THE EASTERN MEDITERRANEAN
REGION - PROGRESS REPORT
The Regional Comm"l.ttee ,
Having reviewed the Progress Report on the situation of Poliomyelitis Eradication in the Eastern Mediterranean Region*** and the report of the Regional Technical Advisory Group on Poliomyelitis Eradication, and in pursuit of its resolution EMIRC35/R. 14 ,
* Doc•Jrnents EM/RC36/5 and EM/RCCll/4 and EMIRCC12/4. * * Document EMIRC36/6.
* * * Document EM/RC36/B .
EM/RC36/21-E page 49
Appreciating the accomplishments and progress achieved so far in the implementation of the Regional plan,
Noting with satisfaction that many Member States have already set national targets for poliomyel itis eradication by the year 2000,
Recognizing, however, with concern that some countries have not maintained their achieved immunization coverage during the past year,
Realizing that achieving poliomyelitis eradication depends primarily on v igorous efforts to strengthen immunization programmes and maintain high levels of immunization coverage all through the years,
1 . COMMENDS the Regional Director for the efforts made to achieve the target of poliomyelitis eradication set by the Regional committee in its resolution EM/RC35/R . 14:
2. THANKS the members of the Regional Technical Advisory Group for their efforts, and endorses their recommendations taken during the second meeting held in Rabat, Morocco, from 12-14 June 1989;
3. ACKNOWLEOOES the support of international agencies and particularly the partnership with UNICEF in all efforts related to the Expanded Programme on Immunization in general and polio eradication in particular:
4. URGES Member States:
4.1 . who have not as yet developed national polio eradication plans, to do so during the coming year:
4. 2 . to cont inue their efforts to maintain and accelerate immunization act ivities to achieve the targeted immunization coverage against poliomyelitis for individual geographically identified areas and particularly for populations at risk:
4 . 3 . to continue to strengthen poliomyelitis survei llance, investigation and control :
outbreak
4.4. to continue to develop and improve laboratory diagnostic facilities :
4 . 5 . to introduce or develop rehabilitation act ivities for victims of poliomyelitis:
5 . REQUESTS the Regional Director to cont inue to:
5.1 . pursue the Regional Committee • s resolut ion EM/RC35/R. 14 with respect to supporting national poliomyelitis eradication programmes, formulation, planning, implementation and evaluation:
5 . 2. provide the necessary budgetary support required for these activities:
5 .3. keep the Regional committee informed regularly of the progress in the implementation of the plan for the eradication of poliomyelitis from the Region.
EMIRC36/21-E page 50
EM/RC36/R.7 HEALTHY LIFESTYLES
The Regional Committee,
Having reviewed Lifestyles•, •
the Technical Discussions document, "Healthy
convinced that lifestyles are of crucial importance for the p romotion of health as well as for the prevention and treatment of disease,
Aware that psychosocial and behavioural factors have to be given sufficient attention as determinants for health by health care authorities and those responsible for the training of health workers,
Appreciating the importance of the spiritual dimension in the promotion of healthy lifestyles ,
Having read with appreciation the Amman Declaration on Health Promotion,
1. URGES Member states to:
1 . 1 . incorporate within existing development and health programmes, policies and strategies to promote healthy lifestyles in their countries ;
1.2. involve the different sectors and non-governmental and voluntary organizations in the implementation of these strategies :
1. 3 . take guidance in the development of these strategies from the rurunan Declaration on Health Promotion which ls considered suitable for the majority of the countries of the Region;
2. REQUESTS the Regional Director to:
2.1. carry out a review of current training of health workers in behav iour and psychosocial factors to make recommendations about improved training in this field;
2 .2. stimulate and support operational research on healthy lifestyles and behavioural factors at Regional and country levels;
2.3. help Member States to produce educational material in national languages that can be used in the training of health personnel and by the media ln promoting healthy lifestyles:
2.4. convey to the WHO Executive Board the wish of the Regional Committee to mediate with the International Civil Aviation Organization (ICAO) to inform air travellers upon the switching off of the "No Smoking" sign that "smoking is very harmful to health, and a proven cause of a number of serious diseases, and that not only the smoker , but those around him/her are at risk. smokers are, therefore, kindly requested to refrain from smoking during the flight or to reduce their smoking to a minimumw:
* Document EM/RC36/Tech.Disc . l .
EM/RC36/21-E page 51
2.5. help Member States to promote all forms of participatory sports and to see to it t hat sports do not promote products that are harmful to health. Also, to convey to the WHO Executive Board the wish of the Regional committee for the Eastern Mediterranean to mediate with World and Regional Sports Unions and organizers of sports matches , so as not to allow the exploitation of sports events or prominent sports persons in promoting smoking and other unhealthy behavioural patterns :
2.6 . report to the Regional committee in 1992 about the progress of programmes to promote healthy lifestyles.
F.M/RC36/R.8 REPORT ON PROGRESS OF WHO-SPONSORED RESEARCH ACTIVITIES IN EASTERN MEDITERRANEAN REGION
The Regional Committee,
Having revlewed the progress of WHO-sponsored research activities of the Eastern Mediterranean Region* , in response to the request by the Thirty-second session of the Regional Committee in 1985, and in view of the importance of research for t he solution of health problems, particularly research required for attaining the goals of HFA by the year 2000 , with special emphasis on Health Systems Research (HSR) and other emerging health problems,
Appreciating the progress made and ext ending its felicitations to the Advisory Committee on Health Research for its efforts in this field;
1 . RECOMMENDS that Member States:
1 . 1. continue to review the total process of research promotion and development in the light of the - research needs for attaining HFA goals, and keep under surveillance policy options and priorities for research and streamline the organizational structure and mechanisms required to facilitate research, especially HSR;
1 .2. continue to build up a critical mass of multidisciplinary scientists for undertaking research, especially of the HSR type;
1 .3 . continue to develop the teaching/learning material required for research t raining of the different categories of health workers, the material being in compliance with the socio-cultural background of Member States and language requirement;
1 . 4. continue to collaborate closely with the Regional Office in undertaking research of priority concern to the countries and the Region, and share information among countries in a spirit of partnership. The EMR Health Services Journal should be used as one of the means of disseminating research results of general interest to the Region:
1.5. collaborate still further with the Regional Offices and WHO/HQ in the WHO Special Programmes, namely: WHO Special Programme for Research and Training in Tropical Diseases (TOR) and WHO Special Programme for Research, Development and Research Training in Human Reproduction (HRP) :
1.6 . consider additional support to research, especially HSR, by allocating an appropriate portion of the country budget for research;
• Document EM/RC36/9 .
EMIRC36/21-E page 52
2 . REQUESTS the Regional Director to:
2. 1. continue to support Member States in each and all the above:
2 .2 . continue the uti lization of the Task Force approach for further implementation of the Health Research Strategy :
2.3. report the progress of research at future Regional Commit tee sessions.
EM/RC36/R.9 HEALTH SYSTEMS RESEJ\RCH AS PART OF THE MANAGERIAL PROCESS IH SUPPORT OF THE STRATEGY FOR HFA - PROGRESS REPORT
The Regional Commit tee,
Having reviewed the progress report on the follow-up act ion taken on "Health systems Research as Part of the Managerial Process in support of the Strategy for He.al th for All", * and Resolution EM/RC34/R.ll,
Appreciating the progress made in this field,
1 . ENDORSES the HSR progress report :
2. URGES Member States to give increasing attention to HSR as a useful management tool for health development :
3. REQUESTS Member States to:
3.1 . undertake periodic activities such as seminars and workshops to sustain awareness of the need and use of HSR among policy-makers, administrators and scientists;
3.2. give special attention to creating a critical mass of multidisciplinary experts to undertake HSR and to func tion as trainers :
3.3 . ensure the development of teaching/learning material required for training and to make these available i n Arabic and other nat ional languages as feasible :
3 . 4 . provide the required funds for undertaking decision-linked HSR and the opportunity for their evaluation, and use its results as appropriate :
4. REQUESTS the Regional Director to continue to support the Member States in the promotion and development of HSR .
EM/RC36/R . 10 MONITORING PROGRESS IN THE IMPLEMENTATION OF HFA STRATEGIES -REPORT ON A STUDY TO IDENTIFY REGIONAL TM.GETS
The Regional Committee,
Having reviewed the document EM/RC36/12, entit led "Monitoring Progress ln the Implementation of m·A Strategies - Repor t on a S tudy to Identify Regional Targets" ,
* Document F.M./RC36/13.
EM/RC36/2l-E page 53
Recalling resolution EM/RC35/R.7 ,
Reaf finning resolutions WHA34. 36 . WHA35. 23 and WHJ\39 . 7 concerning the Global strategy for Health for All and its implementation ,
concerned at the present great disparity between rural and urban areas in the delivery of health sP.rvices , and in fulfilment of the principle of social justice in providing these services to all citizens on an equitable basis ,
Being aware of the magnitude of the overall task within the rather short period left to achieve the goal of Health for All by the Year 2000 , and the need to set achievable specific targets for the WHO Eastern Mediterranean Region,
conscious that the commitment of Member States and the enhancement of mutual trust and collaboration among themselves and between them and the oranization are essential for the effective implementation of the national and Regional strategies, 1
1 . COMMENDS the report submitted by the Regional Director:
2. ADOPTS the targets included in the document annexed to this resolution as the Eastern Mediterranean Regional Targets Towards Health for All :
3 . URGES Member States to:
3 . 1 . exert all efforts to achieve the set targets , as applicable to each individual Member State ;
3 . 2 . mobilize all resources , national, Regional and international , and to use them optimally, directing them to the main stream of activities required in order to achieve the set targets;
3 . 3 . continue monitoring and evaluation of their s trategies as part of their managerial process for national health development ;
3 .4 . further strengthen the managerial capabilities of their health systems , including the generation, analysis and utilization of information:
4. REQUESTS the Regional Director to:
4 .1 . extend to Member States all possible support , including collaboration in promoting the national use and mobilization of resources (national , Regional and international) towards achieving the set targets , particularly in the areas where progress so far made leaves much to be done to achieve these targets;
4 .2 . continuously monitor progress towards achieving these targets, on the basis of periodic reports and other sources of information to be received from Member States ;
4 . 3 . present a review of such progress , and any proposals for a revision of the set targets if necessary, in conjunction with the periodic reviews in future by the Regional committee , of monitoring and evaluation of s trategies , according to the tµietable defined in standing resolutions;
EM/RC36/21-E page 54
4.4. include relevant Regional indicators in the second Common Framework for Evaluation, to be repor ted on in 1991.
Annex to EM/RC36/R. 10
REGIONAL TARGETS FOR HFA STRATEGY -WHO EASTERN MEDITERRANEAN REGION
Targets I and II: Safe drinking water supply (urban and rural)
1 . countries that have already achieved a coverage rate exceeding 90\ , to maintain or improve this rate so as to achieve a coverage rate between 98\ and 100\ by the year 2000 .
2 . Countries that have already achieved a coverage rate between 50\ and 90\, to achieve a coverage rate of 95\ by the year 2000 .
3 . countries that have achieved a coverage rate of less than 50\, to achieve a coverage rate of 65\ by the year 1995, and 75\ by the year 2000.
4. In brief, safe drinking water should be available to at least 95\ of the population by the year 2000 .
Targets III and IV: Sanitation (urban and rural)
l. countries that have already achieved a coverage rate exceeding 80\ , to maintain or improve this rate so as to achieve a coverage, rate of at least 95\ by the year 2000 .
2 . countries that have achieved a coverage rate between 50\ and 80\ , to improve this rate by at least 25-50\ of their current levels by the year 2000.
3. Countries that have achieved a coverage rate of less than 50\, to improve this rate by at least 25-50\ of their current levels, or to achieVP. a coverage rate of 50\, whichever is higher.
4. In general, sanitation coverage rate to be at least 85\ by the year 2000.
Target V: Immunization
1 . For infants, the lowest coverage rate by any antigen to be a t least 95\ by the year 1995.
2 . Coverage rate for women to be at least 95\ by the year 1995.
Target VI: Poliomyelitis
Poliomyeli tis to be eradicated from the Region by the year 2000.
Target VII : Local health care
To achieve a coverage rate of not less than 95\ of the population by the year 2000.
EM/RC36/21-E page 55
Targets VIII and X : Care for pregnant women and infants
l . countries that have achieved almost total coverage, to maintain that rate .
2. Countries that have achieved a coverage rate of 75-89\, to achieve a rate of not less than 95\ by the year 199 5 , and achieve total coverage by the year 2000.
3. countries that have not achieved a coverage rate of 25\, to double the current rate by the year 1995, and to treble or quadruple that rate by the year 2000 .
4 . All other countries to increase their rate of coverage by not less than 50\ of the current levels by the year 1995, and to achieve a coverage rate of at least 90\ by the year 2000.
5 . That the average Regional coverage rate be at least 85\ by the year 1995 and at least 90\ by the year 2000 .
Target IX : Traditional Birth Attendants
That every village have at least one trained traditional birth attendant, if no other qualified or better trained health personnel is available, to provide the required care to women during pregnancy and at the · time of delivery.
Target XI : Infant Mortality
1 . Countries that have reduced the infant mortality rate (IMR) to 50 per 1000 live births, to further reduce the rate by 25\ of the current level by the year 2000 .
2 . countries with an IMR of 50-100 per 1000 live births, to reduce the rate by one-third of the current level , or achieve an IMR of 50 per 1000 live births, whichever is less, by the year 2000 .
3 . countries with an IMR above 100 per 1000 live births, to reduce the rate ·by half or reach 70 per 1000 live births, whichever is less, by the year 200 0 .
4 . That the Regional tMR not exceed 5 0 per 1000 live births . by the year 2000 .
Target XII: Maternal Mortality
To reduce the present level of maternal mortality rate by 50\ at least, by the year 2000 .
EMIRC36/R.ll REPORT ON THE REGIONAL PROGRYIME FOR EMERGENCY PREPAREDNESS
The Regional Committee,
Having reviewed the Regional Programme for Emergency Preparedness and Response and the progress report, * and in view of the need to overcome the obstacles and difficulties impeding emergency preparedness and response in the Member States of the Region,
* Document EMIRC36/ll .
EMIRC36/21-E page 56
l. ENDORSES the Regional Programme for Emergency Preparedness;
2 . URGES Member States to give increasing attention and to follow-up the implementation of the recommendations of this resolution;
3. REQUESTS Member States to give special emphasis to Emergency Preparedness activities and to provide co�tinuous support for the development of policies and strategies in all aspects of health sector emergency preparedness, including:
3. 1. seeking to formulate a national Emergency Preparedness Programme for the health sector;
3.2. the establishment of an Emergency Preparedness Unit in the Ministry of Health to coordinate activities both in the preparedness and response phases ;
J.J. the inclusion of Emergency Preparedness in the curricula of health sector education at all levels;
3.4. support the implementation of activ ities of the International Decade for National Disaster Reduction.
4 . REQUESTS the Regional Director to:
4. 1 . provide the necessary support to the Member states;
4 .2 . implement the Regional Programme for Emergency Preparedness and Response.
EM/RC36/R . 12 REPORT ON THE TUBERCULOSIS SITUATION IN THE EASTERN
MEDITERRANEAN REGION
The Regional committee,
Noting the report of the Regional Director on the Tuberculosis Situation in the Eastern Mediterranean Region, •
Recognizing the significant achievements in tuberculosis control in a few countries,
Concerned about the magnitude of the problem of tuberculosis in most countries of the Region ,
Satisfied by the fact that all Member States have become more aware of the problem and have started to intensify their efforts for tuberculosis control,
l. COMMENDS the Regional Director for his report on this subject;
2 . THANKS the partners collaborating in tuberculosis control in the Region;
3 . Ul{GES Member states, particularly those where tuberculosis is a major problem , to :
3 . 1. develop and strengthen national tuberculosis control programmes;
* Docun:r•nt EM/RC36/10.
EM/RC36/21-E page 57
3 .2. strengthen microscopic examination through development of peripheral laborat ories to ensure the provision of microscopic examination of sputum at all levels of health care services .and ensure satisfactory supervision of this basic service :
3 . 3 . ensure provision of adequate chemotherapy to every diagnosed patient until complete -cure is achieved, . through the administration of short-term chemotherapy using effective drugs ;
3 . 4 . maintain BCG vaccination within EPI and ensure high vaccine quality and trained vaccinators so as to limit complications;
4. REQUESTS the Regional Director to:
4. 1 . strengthen the Regional technical capabilities in tuberculosis control to respond to the increasing demands from countries in the areas of programme planning, training, implementation, monitoring and evaluation;
4 .2. continue to mobilize resources from both the Regular Budget and extrabudgetary sources to support tuberculosis control efforts :
4. 3. continue to strengthen the development of the necessary technical capabilities within Member States ;
4 .4 . monitor developments in tuberculosis control and. report to the Regional conunittee after five years about the progress achieved, particularly in terms of reduction of morbidity from tuberculosis among the population of the Region.
EM/RC36 /R . 13 WHO' S PUBLIC IMAGE ANO ADVOCACY FOR HEALTH FOR ALL
The Regional Committee,
Having considered the progress report on WHO's Public Image and Advocacy for Health for All, *
Aware that a high profile publtc image of WHO enhances acceptability of its health message and increases community and individual participation in efforts undertaken to promote health,
Noting that advocacy for Health for All is an essential, ongoing endeavour of vital importance,
1 . THANKS the Regional Director for the progress report:
2. REQUESTS the Regional Director to:
2 . 1 . develop and strengthen the capabilities of the Regional office to produce varied suitable information material on health issues for public dissemination, particularly in connection with World Health Day, World AIDS Day and World No-Tobacco Day :
2.2. col laborate with Member States in promoting a partnership with the media and other sectors to increase health awareness among the public;
* DOcument EM/RC36/14.
3 . URGES Member states to:
EMIRC36/21-E page 58
3 . 1 . extend, if possible, their marking of World Health Day to one week;
3.2. include information about WHO activities in the educational and training programmes for the different categories of health personnel�
3 . 3 . take active steps to make the health and the information sectors more aware of each other' s needs in order to enhance collaboration in health advocacy:
3 . 4 . develop partnership with relevant sectors, particularly sport in the field of advocacy for health.
EM/RC36/R.14 ORAL HEAL"m
The Regional Committee ,
Having studied with interest the paper on Oral Health, *
Recognizing the magnitude of the oral health problem, especially dental caries and periodontal diseases, in most countries of the Region,
Noting with concern the usual tendency ;. in most countries of giving priority to curative-oriented services rather than the preventive approach,
Appreciating the role of the Regional Demonstration Research and Training Centre in Oral Health in Damascus in assisting countries of the Region in reorientating dental services towards a preventive approach,
1 . URGES Member States to:
1 .1 . formulate national oral health policies and plans relevant to the concept of primary health care and fully integrate them into health care activities. National oral health plans will endorse WHO/FDI ( International Dental Federation) global goals for oral health and adjust them according to disease levels and trends with an aim to reduce or halt the increasing prevalence of oral disease among populations of Member States:
1 . 2 . reorient dental services towards primary prevention of oral diseases rather than their treatment, and develop oral health manpower relevant to the national needs:
1.3. utilize the Regional Demonstration Training Research centre for Oral Health in Damascus for reorienting oral health personnel towards preventive measures and for conducting applied research for facilitating delivery of oral health care:
2. REQUESTS the Regional Director to :
2. 1. support completion of oral health situation analyses in Member States:
2 . 2 . assist Member States in the development of national policies and plans for oral health and the monitoring of their implementation :
* Document EM/RC36/16.
EM./RC36/21-E page 59
2.3 . promote collaboration with other agencies, both within and outside the Region, in order to provide technical and extrabudgetary resources to Member States for promotion of oral health.
BM/RC36/R. l5 LEADERSHIP D!VELOPMENT PROGRAMMB IN INTERNATIONAL HEALTH
The Regional Committee,
Notes with satisfaction the Interim Report of the Regional Director on the Leadership Development Programme in International Health, * and looks forward to the full report of its first 1989 session during the coming Regional committee Meeting in 1990, based on thorough evaluation and giving details on the preparatory work of the second ( 1991) session.
EM/Rc36/R.16 PLACE . AND DATE OF THE THIRTY-SEVEN'l'lt SESSION OF THE REGIONAL COMMITrEE
The Regional Committee ,
Thanking the Government of the Syrian Arab Republic for the off er to host the Thirty-seventh Session of the Regional Committee for the Eastern Mediterranean in Damascus,
1. DECIDES , subject to confirmation by the Government of the Syrian Arab Republic and consultation between the Regional Director and the Chairman of the Regional Committee, and to the scheduling of WHJ\43 in M.ay 1990, that the Thirty-seventh Session of the Regional Committee will be held in Damascus from Saturday , 6 OCtober to Wednesday , 10 October 1990;
2. FURTHER DECIDES that i f WHA43 13 rescheduled to October/November 1990, the Thirty-seventh Session of the Regional Committee wl.ll then be held in January or February 1991� the exact date to be determined following consultations between the Regional Director, the host country, and the Chairman of the Regional Committee.
IX-2 . DECISIONS
DECISION 1. ELECTION OF OFFICERS
The Regional Committee elected its officers as follows :
Chairman: Vice-Chairmen:
H.E. Dr Iraj Fazel ( Islamic Republic of Iran) H.E . Dr Saeed Sharaf Badr, First Vice-Chairman (Democratic Yemen) Dr Mustafa Mohamed El Zaidi, Second Vice-Chairman ( Libyan Arab Jamahiriya)
For the Technical Discussions, the Committee elected as
Chairman: Dr Imdad Hussain Baloch (Pakistan)
DECISION 2. JUX>PTION OF THE AGENDA
The Regional committee adopted the provisional agenda without changes (EM./RC36/l Rev . 2) .
* Document EM/RC36/19 and Add.l.
DECISION 3.
EM/RC36/21-E page 60
RESOLt.rrIONS AND DECISIONS OF REGIONAL INTEREST ADOPTED BY THE FORTY-SECOND WORLD HEALTH ASSEMBLY AND BY THE EXECUTIVE B01\RD AT ITS EIGHTY-THIRD AND EIGHTY-FOUR'nt SESSIONS
The Reg ional Commit tee took not e of the resolutions and dec isions of Regional interes t adopted by the Forty-second World J-tealth Assembly and by the Execut ive Board a t its Eighty-third and Eighty- fourth Sessions , as wel l as o f the act ion taken in the Region to implement the resolut ion in this connect ion .
DECISION 4 . SPECIAL PROGRAMME FOR RESEARCH AND TRAINING IN TROPICAL DISEASES - NOMINATION OF A MEMBER STATE TO THE JOINT COORDINATING BOARD
1.'he Regional Commit tee nominated Democratic Yemen to fill the vacancy for the Eas tern Mediterranean Region on the Joint Coordina t ing Board of the Special Programme for Research and Training in Tropical Diseases for the years 1990 , 1991 and 1992 .
DECISION 5 . VOTE OF THANKS
1.'he Reg ional Commit tee extended its sincere gra t itude to His Eminence , the Pres ident of the Is lamic Republic o f Iran, for the warm welcome received on the occasion of its Thirty-sixth Sess ion .
l t also extended its thanks to the Gove rnment of the Is lamic Republic o f Iran and t o the Minist ry of Health for the generous hospitality accorded to the v is i t ing nat ional delegat ions and to the WHO Secretaria t , and for the excel lent facilit ies p laced at their disposal.
'l'he Regional Commit tee expressed its thanks to the Regiona l Director and the secretar iat for faci litat ing the work of the Commit tee .
DECISION 6 . ADOPTION OP THE REPORT
1.'he Reg ional Commit tee adopted its repor t and requested the Regional Director to deal with i t in accordance with the Rules of Procedure of the Regional Commi ttee .
REGIONAL COMMITI'EE FOR THE EASTERN MEDITERRANEAN
Thirty-sixth Session
EMIRC36/21-E page 63
ANNEX I
Teheran, 30 September - 4 october 1989
A G E N D A
l . Opening of the Session
2. Election of Officers
3. Adoption of the Agenda
4 . Biennial Report of the Regional Director to the Thirty-sixth Session of the Regional COmmittee for the Eastern Mediterranean
5 . Changes to the Programme Budget for the Financial Period 1990-1991
6. Resolutions and Decisions of Regional Interest adopted by the Forty-second world Health Assembly and by the Executive Board at its Eighty-third and Eighty-fourth Sessions
7. Reports of the Regional consultative Committee (Eleventh and Twelfth Meetings)
8. Report on the Joint Government/WO Programme Review Missions, 1989
9. Acquired Immunodeficiency syndrome ( AIDS ) -Progress Report on Situation in the Eastern Mediterranean Region and on Implementation of Regional Committee Resolutions
10 . Poliomyelitis Eradication in the EMR - Progress Report
11. Report on Progress of WO-sponsored Research Activities in the EMR
EM/RC36/l Rev 3 30 September 1989
ORIGINAL: ENGLISH
EM/RC36/l Rev.3
EM/RC36/2
EM/RC36/3
EM/RC36/4
EMIRC36/5
EMIRC36/6
EM/RC36/7
EM/RC36/8
EM/RC36/9
EM/RC36/21-E page 64
12. Report on the Tuberculosis Situation in the Eastern Mediterranean Region
13. Report on the Regional Programme for Emergency Preparedness
14. Monitoring Progress in the Implementation of Health for All strategies: Report on a study to Identify Regional Targets
15. Health Systems Research as part of the Managerial Process in Support of the Strategy for Healt h for All - Progress Report
16 . WHO' s Public Image and Advocacy for Health for All - Progress Report
17. Technical Matters:
( a ) Viral hepatitis
( b ) Oral health
18. Technical Discussions:
Healthy lifestyles
19. Special Programme for Research and Training in Tropical Diseases - Nomination of a member from the Eastern Mediterranean Region to the Joint Coordinating Board
20. Regional Office accommodation - Progress Report
21. Place and date of Thirty-seventh Session of the Regional Committee , 1990
22 . Other Matters :
( a ) subjects of Technical Discussions and Technical Papers in 1992 and 1993
( b ) Interim Report on Leadership Development Programme in International Health
(c ) Rescheduling the Meetings of the WHO Governing Bodies
(d) Other business
23. Adoption of the Report and Resolut ions -Closing of the Session
EM/RCJ6/10
EMIRC36/ll
EMIRCJ6/12
EMIRC36/13
EM/RC36/14
EM/RC36/15
EM/RC36/16
EM/RC36/Tech.Disc. l
EMIRC36/17
EM/RC36/18
EM/RC36/WP2
EM/RC36/19 and Add. l
EM/RC36/20
EM/RC36/21-E page 65
MNEX II
LIST OP' REPRESENTATIVES , ALTERNATES , ADVISERS, OBSERVERS AND SECRETARIAT TO THE THIRTY-SIXTH SESSION OF THE
REGIONAL COMMITTEE FOR THE EASTERN MEDITERRJIJJEAN'
REPRESENTATIVES, ALTERNATES AND ADVISERS OF MEMBER STAT�S
Representative
AFGHANISTAN , REPUBLIC OF
H.E. Dr Sayed l\mir Zara
Alternate
Representative
Representative
Alternate
Adviser
Minister of Public Health Kabul
Dr Sayed Hessam Mal President Foreign Relations Department Ministry of Public Health Kabul
CYPRUS
Dr Michael Voniatis Senior Medical Officer Ministry of Health Nicosia
Dfll!OCRATIC YEMEN
H.E. Dr Saeed Sharaf Badr Minister of Public Health Aden
Mr Abdul Aziz Al Sakkaf Director of Health Manpower Development Department Ministry of Public Health Aden
Dr Abdul Kader Ahmed Al Bakri Director of Pharmaceutical Department Ministry of Public Health Aden
Representative
Alternate
Advisers
EM/RC36/21-E page 66
151'.MIC REPUBLIC OF IRAN
H .E. Dr Iraj Fazel Minister of Health and Medical Education Teheran
Dr Bijan Sadrizadeh Adviser to the Minister Ministry of Health and Medical Education Teheran
Dr Behrouz Nabaie Under-Secretary for Health Affairs Ministry of Health and Medical Education Teheran
Dr Masha-Allah Aein Under-Secretary for Administrative and
Finance Affairs Ministry of Health and Medical Education Teheran
Dr Reza Malekzadeh Under-Secretary for Education Ministry of Health and Medical Education Teheran
Dr Mohammed Reza Zali Under-secretary for Research Ministry of Health and Medical Education Teheran
or Alireza Marandi Adviser to the Minister of Health and
Medical Education Ministry of Health and Medical Education Teheran
Dr Hossein Malek-Afzali Deputy Minister to the PHC system Ministry of Health and Medical Education Teheran
Or Fereidoon Azizi Chancellor Shahid Beheshti University of Medical Sciences Teheran
Mr Mohammad Ali Abbassi Tehrani Director-General International Relations Department Ministry of Health and Medical Education Teheran
EM/RC36/2l-E page 67
ISLAMIC REPUBLIC OF IRAN (cont 'd)
Advisers (cont 'd ) Dr Hassan Vakil Director
Representative
centre for Educational Planning & Research Ministry of Health and Medical Education Teheran
Dr Mohammad Taghi Cheraghchi Bashi Deputy Director-General General Department for Disease Control Ministry of Health and Medical Education Teheran
Dr Saeed Haghighi Director-General Food and Drug Control Laboratory Ministry o f Health and Medical Education Teheran
Dr Mohammad Hossein Khoshnevisan Director, Oral Health Ministry of Health and Medical Education Teheran
Dr Javad Tabatabaee Adnant TUberculosis Expert Ministry of Health and Medical Education Teheran
Dr Oarakhshandeh Nategh Professor o f Virology School of Public Health University of Teheran Teheran
Dr Pourandokht Nozari Associate Professor School of Public Health University of Teheran Teheran
Dr Kamel Shadpour senior Health Expert Ministry of Health and Medical Education Teheran
Dr H . Sadeghi Shoja ChancellQr Tabriz University of Medical Sciences Tabriz
KUWAIT
H.E. Dr Abdul Rahman Al-Awadi .Minister of Planning and Acting Minister of Public Health Kuwait
Alternate
Advisers
Representative
A lternate
Representative
Alternate
EM/RCJ6/21-E page 68
KUWAIT (cont'd )
Dr Abdulla Mubarak Al Refai Secretary General of the Kuwait Institute for
Medical Specialization Ministry of Public Health Kuwait
Dr Rashed Al Roshoud Director, Jahra Health Region Kuwait
Mr Mohammed Yehia Abu El Futouh Legal Adviser Ministry of Public Health Kuwait
Dr Abdul Aziz Khalaf Head, QUality Control Department Ministry of Public Health Kuwait
Mr Bader Al Othman Secretary to H.E . The Minister of Public Health Ministry of Public Health Kuwait
LEBANON
H.E. Mr Jaafar Moavi Ambassador of Lebanon to
the Islamic Republic of Iran Teheran
Mr Wafic Rahime First Secretary Embassy of Lebanon Teheran
LIBYAN ARAB JAMAHIRIYA
Dr Mustafa Mohammed El Zaidi Secretary, General People's Committee for Health Tripoli
Dr Fatma Khalifa Al Megarmed Chief , Department of Conferences and
International organizations � General People 's Committee for Health Tripoli
Advisers
Representative
Alternate
Adviser
Representative
Alternate
Representative
EM/RC36/2l-E page 69
LIBYAN 1\RAB JAMAHIRIYA (cont'd)
Dr Mokhtar Abdulla Hodeida Physician community Medicine Department General People's Committee for Health Tripoli
Mr one r Al Zaidi Secretary to the secretary,
General People ' s committee for Health Tripoli
OMAN
H.E . Dr Ali Bin Mohammed Bin Moosa Minister of Health Muscat
Or Ahmed Bin Abdul- Kader Al-Ghassani Director , Department of Preventive Medicine Ministry o f Health Muscat
Mr Zakariya Bin Mahfoodh Al Manthri Director of H .E . The Minister of Health Office Ministry of Health Muscat
PAKISTAN
Dr Imdad Hussain Baloch Director-General (Health) Ministry of Health,
Special Education and social Welfare Pakistan secretariat Block •c• Islamabad
Dr Aminuddin Deputy Director-General (Health) Ministry of Health, Special Education
and Social Welfare Pakistan secretariat Block •c• Islamabad
QATAR
H.E . Sheikh Khaled Ben Mohamed Al-Thant Minister of Public Health Doha
Alternate
Advisers
Representative
Alternate
Representative
Alternate
Adviser
Representative
EM/RC36/21-E page 70
QATAA ( cont 'd)
Dr Abdul-Jalil Mohamed Salman Assistant Under-secretary for Technical Affairs Ministry of Public Health Doha
Mr Ahmed Khalifeh Al-Assiri Assis tant Under-Secretary for
Administrative and Financial Affairs Ministry of Public Health Doha
Mr Khalid Abdulla Al-Mahmoud Director of H.E . The Minister ' s Office Ministry of Public Health Doha
SOMALIA
Dr Abdullahi Mohamed Siad Vice Minister of Health Ministry of Health Mogadishu
Dr Ibrahim Ali Kore Director, Primary Health care Minis try of Health Mogadishu
SYRIAN ARAB REPUBLIC
H.E. Dr Mohamed Iyad El Chatty Minister of Health Damascus
Dr Mustapha Kamal Baath Vice-Minister of Health Ministry of Health Damascus
·Dr Walid El Haj Hussein Director , International Relations Ministry of Health Damascus
TUNISIA
Professeur Taoufik Nacef Directeur general de la sante Ministere de la sante publique Tunis
Alternate
Representative
Alternate
Advisers
EM/RC36/21- E pa"ge 7 1
TUNISIA (cont 'd)
Mr Hichem Gribaa Charge de mission Cabinet du Ministre Ministere de la sante publique TUnis
UNITED ARAB EMIRATES
H.E . Mr Hamad Abdul-Rahman Al-Madfa Minister of Health Abu Dhabi
Mr Eid Khamis Al Muha iry Director, Foreign Relations and
International Health Ministry of Health Abu Dhabi
Dr Abdel Kader Ahmad Ali Shelabi Director Preventive Medicine
. El Ain Medical District 1U Ain
Dr Mohamed Hamdan Abdulla Director of Dental Department
and Planning Ministry of Health l\bu Dhabi
O B S E R V E R S
Observers invi ted in accordance wi th Resolution NHA27.37
Observers
PALESTINE
Dr Emad Saeed Taraweia Vice-President Palestine Red crescent society 64, Al Thawra Street Cairo
H.E. Mr Salah El tawawi 1\mbassador of Palestine
to the Islamic Republic of Iran Teheran
Dr Bassam Mohamed Qassrawy Member of the Executive Committee
of Palestine Red Crescent Society care centre for the Handicapped
. Aslibkhat Kuwait
F.M/RC36/2l-E' page 72
Observers representing Uni ted Nations Organizations
UNITED NATIONS CHILDREN ' S FUND (IDlICEF)
Mr Richard Reid Regional Director UNICEF Middle East and
North Africa Regional Office J\lmnan JORDAN
UNITED NATIONS RELIEF P.ND WORKS AGENCY FOR PALESTINB RBFUGEES IN THE NDR EAST (UNRVA)
Dr Robert Cook Director of Health UNRWA Vienna AUSTRIA
UNITED NATIONS HIGH ca•tUSSIONER FOR REFUGEES (UNHCR)
Mr Andrew R. Sokiri Charge de Mission in
the Islamic Republic of Iran UNHCR Teheran ISU\MIC REPUBLIC OF IRAN
Observers representing 1nter-goverrunental , non-governmental and national organ!zc1tions
ORGANIZATION OF AFRICAN UNITY (OAU)
Mr wawa-ossay Leba Directeur, Departement Education,
Science, culture, Affaires sociales, sante et Environnement (ESCAS)
Organisation Unite Africaine Addis Ababa ETHIOPIA
INTERNATIONAL SOCIETY OP' BLOOD TRANSFUSION ( ISBT)
Dr Mirza-Agha Eftekhari Medical Advisor Iranian National Blood Transfusion Service 138, Avenue Villa Teheran ISLAMIC REPUBLIC OF IRAN
Dr Houri Rezvan Head of Quality cont rol Department Iranian National Blood Transfusion 138, Avenue Villa Teheran ISLAMIC REPUBLIC OF IRAN
EM/RCJ6/2 1-E page 73
INTERNATIONAL DENTAL FEDERATION
Dr H. Na'kaj ima Dr H . A. Oezairy Dr A. K.hogali Mr R. Helmholz Dr M. H. Wahdan Dr o.I.H. omer Dr M.H. Khayat Dr A .M .M. Aly Or o. 8ule1man Dr A.H. Mehryar
Dr B. Jayaweera Dr E. Hammoud Mr A. Salahi Ms S.A. Fellows Dr K. Rothwell Dr S.A. Hussein Mr A . Kaldas Mrs s . Miskjian Mr R. Hirt
Translators
Mr H.N. Abdalla Mr I . A . Hassan Mrs w. El Saadany
Secretarial Sta.££
Mr I. Abdel-Aziz Mrs s. Ahmed Mrs A. El Didi
Dr E. Khamessi President Iranian Dental Association P.O . Box 14155-3695 Teheran ISU\MlC REPUBLIC OF IRAN
LIST OF WHO SECRETARIAT
Director-General Regional Director Director , Programme Management Director, Support Programme Director, Disease Prevention and Control Director, Health Manpower Development Director, Health Protection and Promot ion STC, Health and Biomedical Information Regional Adviser , HPO and HFA Strategy coordination Global Programme on AIDS/Social and
Behavioural Research STC, Research Promotion and Development STC, Health Situation and Trend Assessment Public Information Officer Reports Officer STC, Editor WHO Medical Officer, Oral Health, Damascus conference officer Administrat ive Assistant, Regional Director's Office Technician, Interpretation Equipment
Interpreters
English Booth: Or M. Ayad Mr Y. Gouda Mrs N .Abou Rida
French Booth : Mrs L. El Hakim Mrs A . Korra Mrs s. Khallaf
Arabic Booth: Mr H.T. Kllany Miss M. El Sariakoussy Mrs A.M. Ghorayeb
Mrs N. Sirry Mrs R. Ben Hassine-Zribi
Mrs N. Khoury Mrs o. Mahmoud
EM/RC36/21-E page 74
ANNEX III
In the name of God, the Compassionate, the Merciful
Opening Address by
DR HUSSEIN A . GEZAIRY
REGIONAL DIRECTOR
WHO EASTERN MEDITERRANEAN REGION
to
THE THIRn-SIXTH SESSION OF THE REGIONAL COMMITTEE
Teheran, Islamic Republic of Iran,
30 September - 4 October 1989
Your Excellencies, Director-General, Ladies and Gentlemen,
I am very pleased that we are assembled here in Teheran under the hospitable auspices of the Government of the Islamic Republic of Iran , to whom I extend my thanks for the splendid arrangements made in hosting this, the Thirty-sixth Session of the Regional Committee.
I feel it is appropriate here, before commencing our proceedings, to observe silence in honour of the memory of the late Head of State and spiritual leader of this sister country, the Imam Khomeini, may his soul rest in peace.
I extend my heartfelt welcome to all of you gathered here at this, the most meaningful and significant of all our Regional gatherings, the concourse of our Governing Body.
I know that you will all share my great appreciation of the presence here of our Director-General, Dr Hiroshi Nakajima. I am happy also to see so many heads of Regional Health Ministries and other leading figures in EMR health work.
Since we last met at the Thirty-fifth Session in Geneva last year, many developments have taken place in our Region. In some countries, including in the Islamic Republic of Iran, new leadership has been elected to assume the burdens of national responsibility, with the tremendous challenges that go with it . We wish them well in all the strenuous work that they must confront in the interests of their people's well-being, including, of course, in the sphere of health.
EMIRC36/2l-E page 75
The last time we met , we were observing several occasions with due solemnity and legitimate rejoicing. These were the anniversaries of Smallpox Eradication, the 1\lma-Ata Declaration, and that of the founding of WHO in 1948 . We still rejoice, of course, at the achievements of WHO, and of our Region and Regional Office , which celebrates its own •fortieth" this year, an event being observed with due modesty. We have reason to be gladdened by the achievements of WHO and EMR. Even their sheer existence is in itself no mean success of the human race in its elevated yearnings for health - concentrated in latter years into the concept "Health for 1\11 • . Yes , we note these milestones with rejoicing and, of course, thanksgiving. We should not be human if we did not mark or commemorate our own achievement . But official celebrations are mere symbols compared with the deep satisfaction we take in the very rer1l health attainments that have accrued to this Region's credit over the past four decades. We pray that they will continue and be augmented with many more triumphs against disease and everything that is •not- health• -a daunting array of enemies, but one which we feel we can •take on• with sound hope of victory.
However, surveying the Region overall, it saddens me to observe so much conflict and suffering still afflicting so many of our populations. some of this is in the form of armed strife: another is the heroic struggle against cruel oppression as in the 1nttfadeh ; stil l another is natural catastrophe and its aftermath of refugee problems, famine and other dire hardship. The related blows and setbacks in the health sphere sometimes seem nearly insuperable . Ve need to marshal all our resources, with the utmos t husbandry and management, if we are to stand a chance of getting millions of sufferers back on the road to health.
It is against this solemn background that we view our successes , and it is in the light of this challenge that we have to go ahead, undeterred, with all our various programmes.
We are not without support in the fight. First and foremost is the presence and help of Almighty God Who gives what is needed to all who are struggling in His cause. our cause of health is no exception. Then we know that we have solidly behind us the support of all our Member States , represented b y you, yourselves, each one deeply committed to the welfare, including health in all its aspects, of its people, and thereby the peoples of all the Region and indeed the world. None of us workers in health can afford to be in any sense • isolationist• as we stand on the brink of the last decade of this twentieth century.
A new century and a new millennium await with their •unknowns• -demanding of health people as much courage and dedication, skil l and knowledge , as space demands of astronauts. It has long been a platitude that viruses and their like respect no frontiers : this concept has recently been alarmingly widened to include such threats as global pollution, the greenhouse effect and depletion of the ozone layer - which I already stressed at last year ' s Regional Committee. Never before has it been more obvious that we, the whole of humankind, are the inhabitants of •one planet• which is relyin1 on us for her very survival, and which is so inextricably linked with our own. In fact, if we don ' t save the earth, we can' t save ourselves : it amounts to that s tark truth. Does it not state in the Holy QUr ' an that the earth will speak and •tell her news• and that man will ask •what ails her• ?• · What clearer evidence is needed of this planet' s rights?
* Surat Al zt lzal (The Earthquake).
EM/RC36/2 1-E page 76
The various environmental issues now receiving so much l imelight worldwide serve to focus all the more on the crucial question of world health. we in WHO, almost by definition as it were, are at the epicentre of such issues .
We all have to be 100\ sure that we use every resource--time, manpower. money, dedication, energy- -everything--to ensure that we do not fail . Again, as I signalled last year, nothing less than world survival is at stake .
•ttealth for AU• has been our slogan for some years now, and at every Regional committee we have been noting that we are getting closer and closer to the target, time-wise. But what about reality-wise? Are we indeed, every year and every biennium, getting nearer to the realization of that aim: the enjoyment . by every citizen of this globe, of health in all its dimensions-physical, mental, social and spiritual--as well as all those character istics so familiar to us all in WHO's constitution?
We have celebrated, but we must not rest on our laurels . we cannot be truly happy if a single human being in our Region is not in possession of health, a basic minimum need .
That is why we are going on . proudly and at the same time humbly . with our Programme of Work. so much of it is described, vividly and in detail, in the items on the Agenda which lies before us.
In presenting my Biennial Report to you this year, I am especially conscious of the forty years of EMR and EMRO that lie behind : a moving and interesting s�ga of achievement. Since EMRO 's founding in 1949, a great deal of important developments have taken place--some of these during my period in office, and others during those of my illustr ious predecessors, the late Dr A.T. shousha and Dr A.H. Taba--may their souls rest in peace . Here again , humility tempers our pride, because it is such a tremendous task with which we are entrusted--namely, to protect and promote the health of some 350 million people . Since 1949, this task has never been shirked by the Office or the Region. We trust we shall go on meeting and overcoming all problems and constraints, no matter how difficult they may seem .
Although we are not presenting a Proposed Programme Budget this year, nevertheless some budgetary changes for the forthcoming biennium are being placed before you for your information.
I am sure that you will all be interested in the Resolutions and Decisions o f Regional Interest adopted by the most recent World Health Assembly and sessions of the Executive Board . These are matters which concern all of us : it is our duty to keep abreast of them and take appropriate action where required .
since the last Regional Committee session, the Regional consultative Committee, which is a most important element in our Regional functioning, has he ld two meetings, its Eleventh and TWelfth, and the relevant reports are before you. These deliberations have a very significant bearing upon our Regional course of action, guiding us most valuably in our decision-making. The reports cover some fundamental and thought-provoking issues upon which we again welcome feedback from you.
EM/RC36/21-E page 77
Equally important in determining our policies and progress are the Joint Programme Review Missions ( JPRMs ) and the related visits of senior national officials to the Regional Office. JPRMs are invaluable and form part of the very fabric of our Regional work. I trust that you will closely scrutinize the document which covers their various fields of action over the year 1989.
*
I come now to the technical items on the Agenda.
You will all, no doubt, be very eager to learn the exact status of our Regionwide onslaught against ,.IDS . The EMR, although not one of the most severely afflicted parts of the world, due largely to the prevailing cultures, beliefs and way of life that · act as a barrier against the spread of this • pandemic, nevertheless, has been on the alert to protect its populations. As, at present, there is no known cure, greater emphasis (even than that which WHO normally places on prevention) has to be exerted . This has been done by multipronged endeavours, foremost among which is health education and, indeed , communication. some noteworthy efforts have been made by national authorities and WHO , including adaptation of tools and methods used elsewhere; it was apparent from the beginning of this crisis -that the type of health message used in •permissive• societies would not be applicable in this Region. We have therefore modified guidance on this subject to be culturally acceptable, for example the Regional version of the WHO film on AIDS.
Another scourge that because of its dire effects has, at times, received almost as much publicity as AIDS is poliomyelitis . You all know of the recently launched WHO initiative to achieve Eradication of Polio by . the year 2000 - yet another target •for that date. In the paper covering this agenda item you will read of the exact position regarding polio Regionwide -and of all the measures being undertaken to ensure scoring the goal. It is hoped and believed that a triumph will be won equalling the victory over smallpox. It will require the same dedication, as well as expertise, from every health •soldier• in the battle.
Research is one of the areas which impinges on every programme: p rogress in this field means progress in so many others. WHO EMRO never ceases to encourage research efforts in this Region, especially those geared towards the afflictions to which EMR is especially prone, including tropical diseases, as well as. of course, its great emphasis on health sys-terns research (outlined in an Information Document available for your perusal).
Your committee last year made a request for a situation analysis of tuberculosis in the Region. In EMR this disease is unfortunately still an important public health problem which is not beyond control , but it does not lend itself to the concept of eradication. It requires a great deal. essentially the provision of needed medical tools, particularly those leading to early diagnosis and treatment that facilitates compliance of patients.
I come now to Emergency Preparedness and Response, a relatively new area of EMRO activity, but one which is increasingly necessary, especially in view of the varying forms of disaster that strike so many of our Member States . These occurrences cannot exactly be foreseen, but the machinery to deal with them can be brought into existence with the application of foresight based on knowledge and experience.
EMIRCJ6/21-E page 78
Our Health for All (HFA) progress continues, as always, to be subject to the need for monitoring: without this tool we cannot hope to plot our position or take required action against shortfalls. A study has been performed to identify Regional targets ; this, we are confident , will help all our countries to keep on-course towards the main objective.
The Progress Report listed as Agenda Item No. 15 underlines that we cannot have any HFA strategy without management, of which health systems research is a very vital component.
Another prominent HFA aspect is advocacy . It has been increasingly realised that, for this to be effective, WltO' s public image needs to be highprofiled and ever untarnished. You will read some insightful material on this in the relevant agenda item document.
Now we come to the climax, as it were, of our technical papers.
The •Technical Matters• this year deal with two subjects : Viral Hepatitis and oral Health.
As far as the firs t is concerned, as you are all aware, this has been growing in importance over the last few years as a focus of medical and epidemiological attention, especially in this Region. The question of vaccination against hepatitis B and its inclusion in EPI is receiving particular attention. You will read state-of-the-art information in this paper . It is a matter which will be more and more prominent in WHO EMRO technical endeavours in the coming decade.
oral health is at last receiving the highlighting it merits. In the past, the label of Dental Health seemed · to imply that only teeth were involved ! Now, with the emphasis on oral hygiene, as well as dental hygiene, and stomatology, the scope has been properly widened. The situation analyses plentifully quoted in this technical paper reveal the status of oral health in our member countries and the heartening fact that much of the prevalent oral ill-health is highly preventable as well as curable. our Regional Training and Demonstration centre in Damascus has played, and continues to play, a key role in furthering this aim.
Now we come to the subject of our Technical Discussions which , this year, is •Healthy Lifestyles•. A broad topic indeed and one which will appeal to the informed lay reader, as well as the specialist, but nonetheless with an abundance of technical significance.
Emanating from· every page of this paper is the fact that the way we live is part and parcel of our health/disease picture, and that it lies very largely in our own hands whether or not we are to be well or s ick. If it is our duty, as WHO EMR staff, to protect the health of the Region' s people, surely it is equally our duty, each one of us as individuals, to protect, and build up, our own health ! Yet this glaringly obvious fact can be easily overlooked. So I urge you to peruse this paper very closely and, of course, in your deliberations, make available to this concourse any advice which you feel to be valuable about •how to lead a healthy life•.
I should also not neglect to emphasize the very significant contribution which Islam makes to healthful living, as described in this paper and especially focused upon in •The Amman Declaration• annexed to it .
EM/RC36/2 1-E page 79 -
Other mat ters to which you will be giving your attention include the very important one of the Regional Office accommodation . It goes without saying that , unless suitably accommodated , out" office would not be able to funct ion properly and this would affect our contributions towards the goal of hea lth Regionwide .
You will also be stu�ying a report on the Leadership Development Programme in Internat ional Health . It is well known that great importance is placed on this drive : you wlll see that it has , by and large , been going according to schedule , and your comments and construct ive criticism are sought .
Another administ rative matter is the rescheduling of meetings of WHO Governing Bodies . Naturally this too is something which concerns the smoother and more efficient running of our Organization , and will require your very careful consideration.
• • "'
1 feel that I have g iven in the preceding words a foretaste of the discussions upon which you are about to embark .
I will not take up much more of your time , which 1s already at a premium. You have a very full and challenging Agenda before you.
I look fot"Ward to the frank and thought-provoking exchange of views which is always characte r is t ic of the Regional COmmit tee .
I end with the prayer that God wil l prosper these deliberations and all our work for the welfare of our Regional peoples.
EM/RC36/21- E page 80
ANNEX IV
Address by
DR HIROSHI NAKAJIMA
DIRECTOR-GENERAL
WORLD HEALTH ORGANIZATIOH
to
THE THDrn-SIXTH SESSION OF THE REGIONAL COMMITrEE FOR
THE EASTERN MEDITERRANEAN'
Teheran, 30 September - 4 october 1989
Mr Chairman, Excellencies, Honourable Representatives, Ladies and Gentlemen, Colleagues and Friends
It is a pleasure for me to j oin you at this thirty-s ixth sess ion o f the
Regional Committee for the Eastern Mediterranean .
Last year I shared with you some o f my thoughts about our YHO and about
certain organizational changes needed to better respond to changing health ,
social and economic conditions . Today I should like to extend that l ine of
thinking to the year 2000 and beyond.
We are often caught be tween opposing views of human progress . One is
unbridled optimism about the potential future of mankind and the
possibility of health for all ; the other is marked pess imism about poverty ,
economic decline and the des truction of our environment , which would s eem
to place our aspirations out o f reach . But I am convinced that reality
lies somewhere between the two extremes .
I urge a balanced view . Ye all know that a bas ic principle o f the WO
Cons titution , elaborated on in the Declaration of Alma-Ata , is the
fundamental r ight of every human be ing to lead a socially and economically
productive l i fe . As a health organization , we must place health realities
above political and economic realities , while recognizing the ir
interrelationship .
EMIRC36/21-E page 81
The world p icture is far from bleak. Ye see around us significant
change in the global political reality . For example , a new sp irit o f
openness is emerging among many countries . There i s greater willingness to
enter into dialogue and greater respect for the validity of different
sys tems and viewpo ints . There are opportunities for resolving intercountry
and internal confl icts that have international repercussions . Initiatives
are under way for the reduction of armaments , yielding enomous potential
savings of resources . Welcome e fforts are being made to reduce the debt
crisis in many countries . These trends could serve the cause o f human
health , social and economic development to the year 2000 and beyond .
At the same time , we are confronted with confl icting trends . In many
countries there is unprecedented industrial and economic development which
stimulates human energy and raises the economic and political aspirations
of the population. Yet all too often this development fails to take into
account the fragile ecosystem of our small planet. I speak of uncontrolled
development without regard to the environment on which depend the future
health , safety and existence of mankind .
I t has been our hope that economic development would narrow the gap
between rich and poor , but too o ften it has widened i t . While we have made
progress in some areas , we still have a long way to go to reach our goal of
social equity with sustainable development. WO has a mandate to address I
this challenge , for even its Constitution recognizes that unequal
development in different countries in the promotion o f health and control
of disease is a common danger .
Some may think this problem could be resolved by s imply transferring
limited resources from the •haves• to the •have nots• . As a result , the
rich would become less rich , and the poor a l ittle less poor. But 'how much
would this achieve for human development? Is this the social equity we
want? Certainly not in my view, and , I am sure , not in yours .
EMIRC36/21-E page 82
We have to pursue a greater vis ion. I believe we must seek the
development of the human potential to its fullest . Ye must strive not only
to obtain l inear growth , but more " importantly the multipl ier effect that
leads to geometric expansion . As an Organization of Member States , we have
at least three ways of encouraging this :
(1) Ve can foster peoples 1 participation and cooperation - encouraging
them to make choices , and to decide on their � development and
the optimum use of all available energy and resources . This i s
what . the primary health care approach i s all about .
(2 ) Ye can transfer technologies , and this , far from costing more ,
will !_!!! resources , Thus our technical programmes must be
increas ingly engaged in results - oriented research , the tes ting and
trans fer of technologies and service models that are applicable ,
affordable and sustainable . And we must facilitate thei r
appropriation and optimum use i n countries of the Region.
( 3 ) Ve can mobilize and rational ize the resources that are available ,
and minimize waste . Ye have to redouble our efforts to allocate a
fairer share of resources for health , and use them wisely, paying
extra attention to the people most in need or suffering in
emergencies , in every country in the Region.
As a health organization, we need not engage in fruitless debate , for
example , on the merits of economic ideologies of free market versus
centrally planned development , Our unity is based on the fact that we
recognize the existence of diverse political systems . Ye look for the mos t
cost-effective solutions , not forgetting that the human be ing must be
central to all these cons iderations . In every country a better argument
can be made for giving more attention to health concerns . In our view,
investment in health should not be regarded as a burden on economic
development ; i t is a means towards , and the very purpose of , development
itself .
EM/RC36/21-E page 83
Many countries have elaborated plans for health system development at
national , district or community level , only to find their hopes for
implementation dashed on the rocks of economic and political reality .
internal and external . Among the hardest hit are the health professionals
and other human resources on which the health system depends . Ve must
encourage our medlcal doctors , the nursing profession and others to take a
new look at the total health system o� whlch they are such an important
part. Some countries may choose to readj ust their political concepts ,
economic structures or social welfare systems , as appropriate. For
example , they may have to find the right balance between private
fee-for-service and publi� free health care delivery, in a more
participatory, mutual health care system, suitable to the conditions of the
country.
If our Organization is going to promote health in the context of
economic and political reality , we have to be able to deal with the full
range of social , economic and environmental issues that bear on health
development , even when they appear to be outside the conventional •health
sector• . That is why I have commissioned an independent s tudy of what WO
can do , or should do , in respect of the interdependence of the world
economy and health development . It is also why I am taking steps to
convene a high-level technical expert commission on health and the
environment , the results of which will shape our future work and contribute
to the United Natio?VI Conference on Environment and Development in 1992.
Considering that good nutrition is essential to human welfare , we are
propos ing to cosponsor , with the Food and Agriculture Organization of the
United Nations and. other interested parties , an international conference on
nutrition , at which the current situation will be reviewed and new problems
and strategic solutions for the future will be anticipated.
EMIRC36/21-E page 84
How we run our Organization internally will make a great difference to
the influence it has externally . Looking at our experience over the past
year 1 think we have learned some key lessons . Ye have seen , once again ,
the value o f dialogue as a means o f achieving uni ty at all l evels , and
between regions . Ye recognize the importance of consistency and clarity in
our message s , Ye see the need for a better flow o f information to and from
Member States , and within the Secretariat . Ye must have gre4ter coherence
in cooperation between our programmes . We need constantly to improve the
management and e fficient use o f lJHO ' s resources , and the timeliness of
programme delivery in response to the needs of Member States . In
emergencies or when the needs relate to rehab ilitation and reconstruction
thi s becomes particularly important , even in the face of various political
realities .
The 1990s have been de signated the International Decade for Natural
Disasters Reduction, with five main strategies ; to improve national
capacity ; to develop s trategies ; to foster scientific endeavours ; to
disseminate information; and to assess results . In response to resolution
YHA.42 . 16 , I have decided to strengthen the Organization ' s response to
emergency situations by e stabl ishing a new Emergency Rel ie f Operations
programme in Geneva . This programme is poised to respond in a t imely ,
flexible and effective manner to requests reflec ting the evolving needs of
countries and Regional Offices .
The role of WO is not just to relieve poverty and the immediate
conditions of ill-health ; it is to bring about longer-term, sustainable
health development. This means that we have to be aware of new trends and
what they mean for the state of health of people throughout the world in
the future . Ye have to prepare the ground now to deal with such
developments as rapid urbariization , an aging population , new patterns of
human behaviour , diseases of affluence , and a changing natural environment ,
even as we continue to deal with the basics of water supply , nutrition,
prevention of communicable diseases , and the development of health
infrastructure and health manpower in the developing countries .
EM/RCJ6/2l-E page 85
The steps I _have taken to reorganize structures and programmes at
headquarters are intended to improve their effectiveness in supporting
regions and countries . For example , _ the transfer of global responsibility
for the health of the elderly to Geneva was made to facilitate technical
support for your efforts in the regions , in response to new challenges.
We are undertaking new interregional initiatives , as for example a
conference on •�ity Health : Challenge of Social Justice• , to be held later
this year , involving participants from at least twenty countries around the
world, to debate the challenges of rapid urbanization . In mos t regions we
have focused on the rural population, but in fact there are as many
problems in the urban slums.
In response to several resolutions of the World Health Assembly , our
programmes of international cooperation and strengthening of health
services , in consultation with the Regional Offices and countries
concerned , are helping to address economics issues , develop new approaches
to economic adjustment , improve resource allocations and rationalize the
financing of health care . The mobilization of additional resources on
behalf of programmes at all levels of the Organization is being
intensified. In times of continuing economic and financial uncertainty , we
must reasonably match programme plans with potential resources , and explore
every avenue of potential external support.
I should like to see mutually supportive relations among all levels of
our Organization , among regions , and among programmes . Experience shows
that no disease or condition of ill health can be dealt with in isolation
from other health and social issues . The knowledge , technology, activities
and resources generated by one level , office or programme of WO can have a
mutually reinforcing effect on all others - what I referred to earlier as a
•multiplier• effect , that is , a value greater than the sum of its parts.
EM/RC36/21-E page 86
The reorganization I have mentioned at global level mus t be accompanied
by redefinition and contin•1ous evaluation of WO ' s managerial processes and
operational programme delivery in the regions , to be tter support our Member
States , In this connection I wish to express my appreciation to the Member
States of this Region , to you , Dr Gezairy, as Regional Director , and to
your s taff , for the progress being made .
The work of this Regional Committee testifies to the value of WO ' s
unique decentralized s tructure , foreseen by our Cons titution , which allows
us to deal with health , social and economic development in a manner tha t
bes t corresponds t o the realities , needs and priorities of each region. At
the same time , each Member State is able to draw support from every level
of our Organization, and play a role in the definition of health policies
at regional and global levels .
I am sure the good work and technical standing of WO speak for
themse lves , but we have to deal with political reality , and we have to
devote some energy and resources to making sure that the image of WO i s
not only consis tent with our ideals and obj ec tives , but worthy o f support .
In times of advers ity our best defence and greatest s trength lie in unity .
I appeal to everyone to spare our Organization , and the World Health
Assembly , from political issues that are not directly related to
international health work . It is in this context that I shall welcome your
views on the proposal to reschedule future sess ions of the World Health
Assembly, and consequently of the Executive Board and the regional
committees . I know this will not solve all our problems , but it will help
to alleviate them , and will provide other benefits as well . Moreover , it
will demonstrate solidarity wi thin our decentralized structure .
EMIRC36/21-E page 87
As we enter the final decade o f the twentieth century, 1 call on all of
us to redouble our e fforts to build a world our descendants will be pleased
and proud to inherit in the twenty-first century . Let us pass a torch that
will grow brighter in the coming years. 1 know that your deliberations
during this session of the Regional Committee will be successful , and I
thank you all .
*
* *
REGIONAL COMMITrEE FOR THE EASTERN MEDITERRANEAN
Thirtv-sixth Session
I. COMMlTrEE DOCUMENTS
EMIRC36/l Rev.3
EMIRC36/2
EM/RC36/3
EMIRC36/4
EMIRC36/5
EM/RC36/6
EM/RC36/7
EM/RC36/8
EM/RC36/9
EM/RC36/10
EM/RC36/21-E page 88
MNEX V
F.M/RC36/22 3 0 October 1989
FINAL LIST OF DOCUMENTS
Agenda
Biennial Report of the Regional Director to the Thirty-sixth session of the Regional Commit tee for the Eastern Mediterranean
Changes to the Programme Budget for the Financial Period 1990-1991
Resolutions and Decisions of Regional Interest adopted by the Forty-second World Health Assembly and by the Executive Board a t its Eighty-third and Eighty-fourth Sessions
Reports of the Regional consultative commit tee (Eleventh and 'l'Welfth Meetings)
Report on the Joint Government/WHO Programme Review Missions, 1989
Acquired Immunodeficiency Syndrome (AIDS) Progress Report on Situation in the Eastern Mediterranean Region and on Implementation of Regional committee Resolutions
Poliomyelitis Eradication in the Mediterranean Region - Progress Report
Eastern
Report on Progress of WHO-sponsored Research Activities in the Eastern Mediterranean Region
Report on the Tuberculosis Situation in the Eastern Mediterranean Region
EM/RC36/ll
EM/RC36/12
EM/RC36/13
EMIRC36/l4
EMIRC36/15
EMIRC36/16
EM/RC36/17
EM/RC36/18
EM/RC36/19 and Add. 1
EM/RC36/20
EMIRC36/21
EM/RC36/22
Technical Discussions
EM/RC36/Tech.Disc . l
working Paper
_EMIRC36/WP2
EM/RC36 /21-E page 89
Report on the Regional Programme for Emergency Preparedness
Monitoring Progress in the Implementation of Health for All Strategies: Report on a Study to Identify Regional Targets
Health Systems Research as part of the Managerial Process in Support of the Strategy for Health 'for All - Progress Report
WHO' s Public Image and Advocacy for Health for All - Progress Report
Viral hepatitis
Oral health
special Programme for Research and Training in Tropical Diseases - Nomination of a member from the Eastern Mediterranean Region to the Joint Coordinating Board
Regional office accommodation - Progress Report
Interim Report on Leadership Development Programme in International Health
Rescheduling the Meetings of the WHO Governing Bodies
Report of the Thirty-sixth session of the Regional COmmittee for the Eastern Mediterranean
Final list of documents
Healthy Lifestyles
subjects of Technical Discussions and Technical Papers in 1992 and 1993
II. RESOLUTIONS
EM/RC36/R. l
EMIRC36/R. 2
EM/RC36/R.3
EM/RC36/R.4
EM/RC36/R.5
EM/RC36/R.6
EMIRC36/R.7
EM/RC36/R. 8
EMIRC36/R. 9
EM/RC36/R. 1O
Annex to EMIRC36/R. 1O
EMIRC36/R. ll
EM/RC36/R. 12
F.M/RC36/R. 13
EM/RC36/R . 14
EM/RC36/R . 15
F.M/RC36/R. 16
EM/RCJ6/21-E page 90
Biennial Report of the Regional Director to the Thirty-sixth Session of the Regional committee for the Eastern Mediterranean
Acquired Immunodeficiency Syndrome (AIDS) Progress Report on Situation and on Implementation of Regional Committee Resolutions
viral Hepatitis
Reports of the Regional consultative Committee
Joint Government/WHO Programme Review Missions
Poliomyelitis Eradication in the EMR - Progress report
Healthy Lifestyles
Report on Progress of WHO-Sponsored Research Activities in the Eastern Mediterranean Region
Health systems Research as Part of the Managerial Process in Support of the Strategy for HFA -Progress Report
Monitoring Progress in the Implementation of HFA strategies - Report on a Study to Identify Regional Targets
Regional Targets for HFA Strategy - WHO Eastern Mediterranean Region
Report on the Regional Programme for Emergency Preparedenss
Report on the TUberculosis Situation in the Eastern Mediterranean Region
WHO's Public Image and Advocacy for Health for All
oral Health
Leadership Development Programme in International Health
Place and Date of the Thirty-Seventh Session of the Regional Committee
III. DECISIONS
Decision 1
Decision 2
Decision 3
Decision 4
Decision 5
Decision 6
EM/RC36/21-E page 91
Election of Officers
Adoption of the Agenda
iesolutions and Decisions of Regional Interest Adopted by the Forty-first world Health Assembly and by the Executive Borad at its Eighty-third and Eighty-fourth sessions.
Special Programme for Research and Training in Tropical Diseases - Nomination of a Member State to the Joint coordinating Board
Vote of Thanks
Adoption of the Report