W O R L D H E A L T H

ORCANlZATiON

ORGANISAT lON MONDIALE

DE LA S A N T ~

REGIONAL OFFlCE FOR THE - - .--- - 1+1 &YIId dl BUREAU R f G i O N A L DE LA EASTERN MEDITERRANEAN -- - -- - - - -- -- MEDITERRAN~E ORIENTALE

REGIONAL C O W - FOR THE EAsmRN MEDITERRANEAN

Twenty-third Session

SUB-COMTIfEE: A

Bl/~~23A/Min. 1 November 1973

ENGLISH

MlNUTES OF THE, mRST MEETING

Held i n the Auditorium of Damascus University, Damascus, on Saturday, 8 September 1973$ a t 9.30 a.m.

and ( l a t e r ) in- Grand Hotel, Bludan, Syrfan Arab Republic a t 11.30 a.m.

CHAIRMAN: i%. A.W. Al-Mufti (lraq)

Later: H.E. Dr. M. El-Khiyami (Syria)

CONDWI'S

I. Opening of the Session

2. Election of Officers 8

3 . Adoption of the Agenu 9

4. Organization of Work 9

5. Appointment of the Sub-Division on Programme 9

6 . Annual Report of the Regional Director t o the 10 Twenty-third Session of the Regional Committee: Statements and Reports by Representatives of Member S ta t e s

Representatives of Member States

Govemen t

AFGHANISTMJ

Representative, Alternate o r Adviser

Professor A.M. Khoshbeen M r . Y. M . Mo J addedi Dr. I. Yacoob

D r . V.P. Vassilopoulos

H.E. Dr. A.A. El-Daly

H.E. Dr. F1.M. Mahfouz Dr. M.L. Hassan M r . A . Fayed Dr. A.F. Shatvki Dr. (Mrs. ) A. Ayoub Mrs. S. Ragheb

IRAN

IRAQ

, J o m t

LEBANON

OMAN

QATAR

SAUDI ARABIA

H.E. Dr. t4.H. Morshed M r . A. Amir-Ahmadi

Dr. A.W. Al-Mufti

H.E. Dr. F. Kilani D r . S. Subeihi D r . A.R. Rawabdel~

H.E. Dr. A.Z. Al-Adwani D r . A . A1 Rifai

H.E. M r . 0 . Al-Dana D r . J. Anouti Dy. H.H. J a l lou l

Dr. A.A. Sherif D r . A. Gebreel M r . F.1. Khatib

Dr. G. Sami

H.E. S.K.X. A 1 Manea M r . M.G. Al-Fain D r . S.A. Tajeldeen

D r . H . -Abclul-Ghaf f ar Dr. H.S. El-Dabbe1 D r . A.S. Tabba'a

Representatives of Member S t a t e s (cont 'd.) , -

Government Representative, Alternate o r Adviser

SOMALIA

sum\J

M r . O.A. Hassan

D r . A. Mukhtar C.

SYRIAN ARAB REPUELIC H.E. Dr. M. El-Kl~iyami Dr. N. -&mzi D r . M.A. El-Yafi D r . M.Y. Y i f t s h

TUNISIA H.E. M r . M. Mzali D r . M.T. Hachicha

UNITED ARAB EMIRATES H.E. Sheik11 Sultm-BLn Ahmad-Al-Mu ' alla D r . S. A 1 Mahmood M r . S.R. Al-Khariji

YEMEN Mr. M. i ~ l - I < ? . w l Mr. I. El Iriany D r . A.M. Ateeq

World Health Organization

Secretary t o the i)r. A.H. Taba, Regional Director Sub-Corrmittcc (ex-of f icio)

Representative of tile Dr . ii.3. Env l~v , Assis tant Director-General Direc tor-General

Representatives of United Nations Organizations

UNITED NATIOIJS D r . V.J. Ram

UNITED NATIONS DEVELOPMENT M r . H.B. Danisman PROGRAME (UNDP)

UNITED NATIONS CHILDFEN ' S M r . R. Kole i la t m~ (UNICEF) M r . S. Tayara

UNITED NATIONS ECONOMIC MJD D r . V. J. Ram SOCIAL OFFICE, iEIRUT (UNESGB)

UNITED NATIONS RELIEF AND D r . M. Sharif TIIOHKS AGEI\.CY FOR PALESTINE ~ F U G ~ S (UNRI.JA)

Representatives and Observers of Inter-Governmental, International Non-Governmental m d National Organizations

LFAGUE OF ARAB STATES Dr. G. Al-Zerikly Representative

INTERNATIONAL DENTAL 'FR2F:RATION Dr. M. Diab Representative

I i u i A T I O N A L COt.?ITI'EE OF Dr. S. Jundi Representative MILITARY ~'EDIc?NE AND PHARMACY

LNmRNATIONAL PLANPBD Mr. A. Dallczl Representative PAErnTHOOD 2"EDERP,TICnJ

WORLD VEmRLNAHY ASSOCIATION

AMERICAN UNTVE%ITY OF EEIRUT

Dr. E. Nehrne Representative

Dr. L.J. Verhoestraete Observer

l3 '4 /~~23~/Min . 1 page 5

1. OPENING OF TEE SESSION: Item 1 of the Agenda

D r . AL-MUFTI: ( I r a q ) declared Sub-cormittee A of the Twenty-third

Session of the Regional Committee f o r the Eastern Mediterranean open,

and introduced H i s Excellency Dr. Madani R1-Khiyami, Minister of Health

o f th.e Syrian Arab Re-public.

Dr. AL-KHIYAMI (Syrian Arab ~ e p u b l i c ) , i n the name of the President

of the Syrian Arab Republic, vrho had graciously consented t o sponsor the

meeting, welcomed the Representatives, the Regional Direc-tor, the repre-

sentat ive of the Director-General, and the representat ives of special ized

agencies and members of the sec re t a r i a t , and conveyed the President 's

greetings t o them. He welcomed a l l peoples believing i n peace and just ice,

and ~velcumed them as one budy, f u r if p a r t u f the budy w a s u1If1ealtl1y9 a l l

would suf fer . Under i t s President, Syria had made g rea t achievements i n

the f i e l d of health, and hoped soon t o have completed the preliminary s t q e s

t h a t would lead t o self-suff ic iency i n medicine.

Drawing at tent iol i t o S y r i a ' s five-year plan f o r public heal th , he spid

t h a t grea t s t r i d e s had been taken, and ce r t a in mistakes made during t l l e

previous five-year plan were being corrected. The r a t i o of physicians t o

population was now higher tinan had been expected. It w a s possible t o yay

high s a l a r i e s t o Syrian s p e c i a l i s t s who had l e f t the country t o encourage

them t o re turn home. One of the goals of tile five-year plan was to have

one hospi ta l bed m a i l a b l e f o r every 700 members of the population a t taie

end of the period. Another goal was t o increase the s a l a r i e s paid t o

nurses; and another - whlch was of cvcn greater importance than the n ~ b e r

of physicians - iras t o increase the number of technicians. A new building

t o be used f o r the t ra in ing of technicians was under construction and it :ras

hoped t h a t it would be cmple ted by the end of 1973. In recent years medical

E M / R c ~ ~ A & ~ ~ . 1 Page 6

education had undergone a great expansion; the number of physicians

graduating had been doubled and many new urits had been added t o the.

Faculty of Medfaine of the University of Damascus. Tnere remained, of

course, much t o be donep including the construction of nerr provincial

hospitals and the improveaent o f supplles of pb.arrnaceuticals.

The importance of heal th i n the l i f e of the people could-not be

overemphasized. The c i t izen rrho was not healthy was not a useful c i t izen .

For t h i s reason heal th - and the budget of the Ministry of Health - had t o be given the highest pr ior i ty . He looked forward with c~nf idence t o the

guidance of the Sub-committee, and sa id t h a t i ts deliberations would be

the subject of great i n t e r e s t on the p a r t of the President of the Syrian

Arab Republic.

D r . TAM, Regional Director, welcomed a l l present and expressed h i s

grat i tude t o the Government of the Syrian Arab Republic fo r t h e i r hospi-

t a l i t y . The Syrian Arab Republic had been one of the f i r s t countries i n

the Region t o join WHO, and i ts experience would provide an added stimulus

t o the deliberations of the Sub-committee.

The a c t i v i t i e s of WHO i n the past 25 years ref lected the changing

needs and p r i o r i t i e s i n the Region. The number of countries i n the Region

tha t were members of kJHL) nor? numbered 24> meaning t h a t every nation within

the boundaries of the Region was now a member of the Organization. WHO

had sponsored over 700 health projects i n the Region and had awarded almost

7 000fellowships, making z sizeable contribution t o progress i n public health.

Good progress had been made against communicable diseases. A l U w u & much

remained t o be done, many of the age-old diseases were on the way t o being

eradicated. The number of medical schools had increased from 12 t o 45,

the number of pharmacy schools from 6 t o 16, and the number of dent i s t ry

schools from 4 t o 13. Scores of other t raining ins t i tu t ions had been s e t up

t o f o r auxi l ia ry hea l th personnel of a l l categories. However, the

achievements t h a t had been made f a r from met the need f o r medical and

public hea l th personnel; and the problem w a s not so much quantitative

as qua l i ta t ive . He was, he f e l t sure, voicing the fee l ing of a l l present

when he s a i a t h a t education missed its purpose unless it was designed t o

meet l oca l needs and demands, and WHO was promoting t h i s concept a s f a r a s

possible. The Organization offered no blueprint f o r reform, but could and

d id a s s i s t goverments and educators t o work out and implement solut ions

su i ted t o spec i f ic needs and circumstances.

Over the pas t 25 years the population of the Region had increased by

about 100 million, bringing the t o t a l t o more than 230 million; and unless

the present b i r t h r a t e was checked, the population would be 560 million by

the year 2000. This forecast was a challenge t o the already hard-pressed

hea l th services of the Region. Several countries, including Egypt, Iran,

Pakistan, and Tunisia, had already establ ished broad-hasad family pl-ing

programmes within the frr;mewurk of t h e i r hea l th services.

Another f ac to r t h a t was bound t o c a l l f o r increasing a t ten t ion was the

problem of the environment, which was c lose ly connected t o disease control.

Increasing urbanization and indus t r ia l iza t ion brought attendant hea l th hazards,

and far-reaching development projects such a s S y r i a ' s Euphrates Dam and

Egypt 's Lake Nasser could hardly f u l f i l t h e i r purpose without proper a t t en t ion

t o such hazards. I-t was encouragiw to notc the current stepping up uf 1iedt.h

measures by the nat ional and in te rna t iona l bodies involved.in such projects .

Increasing a t t en t ion was being given %o diseases of childhood and youth

and t o malignant, cardiovascular, and metabolic diseases. Radiation medicine

and occupational hea l th were a l so moving ahead.

E M / R ~ 2 w i n . 1 page 8

The pace of change i n the Region was now so swi f t t h a t the everyday

l i f e of man had, i n la rge areas, undergone grea te r change i n the past

25 years than in the previous two centuries. W E 0 had grown also, but its

change i n outlook had been even grea te r than i ts increase i n s ize. Medical

research had assmed - and continued t o assume - a more important place i n

the ~ r g a n i z a t i o n ' s programmes, and t h i s had paved the way f o r a more enligh-

tened approach t o many hea l th problems, both old and new. There was a

de f in i t e t rend away from dispersed e f f o r t s towards a co-ordinated approach

t o hea l th promotion within the framework of overa l l socio-economic development.

fit there was no ju s t i f i ca t ion f o r any relaxat ion of e f f o r t , s ince many un-

resolved medical problems remained. The coming years i~ould undoubtedly see

new challenges t o hea l th i n the countries of the Region. He therefore looked

forward t o the advice and guidance of the hea l th leaders assembled f o r the

Sub-committee meeting concerning the Organization ' s programme. Dr . PAVIXV, Assistant Director-General, extended to all Representatives

the warmest greet ing and bes t h-ishes of the Director-General. He f e l t con-

f i den t t h a t the de l ibera t ions of the Sub-Cornittee would be successful.

He thanked the hos t country f o r inv i t ing the meeting.

2. ELECTION O F OFFTCERS: I t e m 2 of the Agenda

Dr. AL-MUFTI ca l led f o r nominations f o r Chairman of the Sub-Committee.

Dr. ANOU?II: (Lebanon), seconded by Dr. MORSHED ( I ran) , proposed t h a t

k. A l - I ( h i y a m i be elected Gl~ai~mmn.

, Decision: Dr. Al-Khiyami was elected unanimously.

Dr. Al-Khiyami took the Chair.

The CHAIRMAN ca l led f o r nominations f o r two vice-chairmen,

M r . WSSAN (Somalia), seconded by Dr. VASSILOPOULOS (Cyprus), nominated

Dr. Ki lani (Jordan) and Dr. Morshed ( I r an ) ,

Decision: Dr. Kilani and Dr. Morshed were elected unanimously.

The CHAIRMAN ca l led f o r nominations f o r the o f f i ce of Chairman of

the Sub-Division on Programme.

Dr. VASSILQPOULOS (Cypms), seconded by M r . HASSAN (Somalia).

nominated Dr. Anouti (Lebanon).

Ceclslon: Dr. Anoutl was e lec tea unanimously.

The CHAIRMAN ca l led f o r nominations fo r the o f f i ce of Chairman of

the Technical Discussions.

Dr. ANOUTI (~ebanon ) , seconded by Dr. AL-:LL!!I (yemen) nominated

Dr. A1-Daly (Democratic Yemen).

Decision: Dr. Al-Daly was elected unanimously.

The meeting adjourned a t 10.00 n.171.

The meeting resumed i n Bludan a t 11.30 a.m.

3 . ACOPl?lON OF THE AGmDA: Item 3 of the Agenda

The Agenda (Document EM/RC~~A/~) was ado_~!-&e_d.

4. ORGANIZATION OF WORK

D r . TAM, Regional Director, suggested that the Sub-committee should

meet from 9 a.m. t o 2 p.n>. each day, with 2 30-minute coffee break a t

11.30 a.m. It might begin by discussing agenda items 5, 6, and 7.

Items 8 and 9 ~ ~ o u l d be considered by the Sub-Division on Programme.

It vas so agreed.

5. APPODiDENT OF THE SUB-i.lIVISION ON PROGRAMME: Ttem 4 of the Agenda

The mGIONAL BIRECMR proposed t h a t i n accordance with usual prac t ice

the Sub-Division on Programme should cons is t of representat ives of a l l the

delegations attending the session.

It was so decided.

EM/RC23A/bin. 1,' - page 10

6. ANNtJAL REPOKF OF TKE REGIONAL DlX3CMR 'IS) THE 'l3.IENTY-TKIRD SESSION OF THE REGIONAL COW-: Item 5 of the Agenda (%cumen t m/RC23/2 )

Dr. TAM, Regional Tlirector, in t roducing his annual r e p o r t ( h c u m e n t

EN/RC23/2), s a id t h a t WHO'S programme of work i n the Region had made g r a t i -

fying progress i n 1972-73 despi te the unse t t led p o l i t i c a l s i t ua t ion i n

ce r t a in parts .

He s t ressed the g rea t d ive r s i t y of WHO'S assis tance i n a Region w i t h

an i n f i n i t e var ie ty of climat i cy topographic, and demographic conditions

not only i n d i f f e r en t countr ies but even i n the various pa r t s of l a rge r

countries. There was a l so a considerable difference i n the countr ies '

l eve l of development. Some countries were beset primarily by high infan t

mortality, comnunicable diseases, poor sani tat ion, malnutrit ion, and low

l eve l of education, while others were experiencing the new problems of urban-

i za t ion and indus t r ia l iza t ion , though a l l shared the common fac to r of a rapid

r a t e of development and some have probably the highest rate of economic and

general growth i n the world. A s communicable diseases were brought under

control, hea l th problems pa r t l y a t t r i bu tab le t o a longer l i fe-span emerged:

chronic degenarative diseases, cardiovascular diseases, carcinomas and meta-

bol ic infect ions, mental i l l nes ses , pollution, and indus t r i a l and t r a f f i c

accidents. WHO'S programme inust be adjusted t o meet the changing needs.

WHO'S ass is tance was more e f fec t ive when given within the context of

a nat ional hea l th plan. The g rea t majority of countrics o f thc Region

( a l l but th ree) now had hea l th plans f o r periods varying from three t o ten,

many of which were integrated in to the general soc i a l and economid develop-

ment plan. I n some countries, bEI0 had helped t o t r a i n hea l th planners o r

t o prepare the hea l th plans. I n general, governments gave in su f f i c i en t

emphasis t o investment i n the hea l th sector, and p l m e r s perhaps f a i l e d t o

i31/R~23~/Min. 1 page 11

recognize the t rue place of hea l th a s a fac tor i n general development and

Ministr ies of Heal+&- should therefore ensure representation i n t h e i r couz-

t r i e s ' planning bodies. 'v\THO ' s assis tance i n the preparation of nat ional heal th plans would continue t o receive priorit jr .

In that ~ o i m e x i ~ l ~ , 11e st i-es~ed the 11eeJ. for iiilpruveii~ent uT s t a t i s t i ca l

and information systems i n the Region. WHO'S assis tance i n t h a t f i e l d was

growing. Many fellowships were being awarded f o r t ra in ing i n s t a t i s t i c s ,

including computer sciences. I n l a t e 1972 a seminar on hea l th s t a t i s t i c s

had been held i n Damascus. The Regional Office rras co l lec t ing hea l th da ta

on a l l the countries end had prepared a document containing the information

f o r each country col lected from a l l available sources. He invi ted na t iona l

heal th au thor i t ies t o collaborate with the Regional Office i n keeping the

documents up t o date; it was hoped t o present a pamphlet containing basic

hea l th data t o the Regional Committee a t its next session.

While p r i o r i t i e s and problems differed, nat ional hea l th plans shared

many common objectives. The major emphasis l ay on the inost e f fec t ive u t i -

l i z a t i o n of ex is t ing f a c i l i t i e s and resources, self-suff ic iency i n the

t ra in ing of na t iona l hea l th manpower a t a l l levels , and the rapid provision

of e s sen t i a l hea l th services t o the ru ra l population.

To provide managerial s k i l l f o r the implen~entation of hea l th programmes

WHO had awarded many Tellocrships t o senior public hea l th administrators and

hea l th o f f i c i a l s . A seminar was being held i n Cairo i n October 19715 t o d is -

cuss modern rnanage~nent methods i n hea l th services. IdHC was a l so collaborating

w i t h the Government o f I r an In a project i n West Azerbaijan on the itlost

e f fec t ive way of bringing hea l th services t o r u r a l areas. The findings of

the project were expected t o be usefu l f o r other countries.

EM/~c23~/Min. 1 page 12

Referring t o UNDP' s introduction of country programming, he noted

t h a t the hea l th portion of the UNDP programme i n some countr ies had declined

recently. It was important t h a t min is t r ies of hea l th should be s t rongly

represented, preferably by the minis ter himself, on the na t iona l body co-

ordinating programmes to he reqi~e~.t.~d from ext.emal smirreF. HP reminded

the Suh-Committee t h a t i n addition t o UNICEF, FAO, UNESCO and IM, sizeable

resources i n support of hea l th projects were avai lable from the World Food

Programme, I E R D and UNFPA, and help could be obtained from the UN Volunteers.

I n the l i g h t of the work of those bodies, WHO'S cons t i tu t iona l ro l e i n co-

ordinating in te rna t iona l ly a s s i s t ed heal th a c t i v i t i e s i n the countr ies was

becoming increasingly important. Thus more WHO representat ives were being

posted to larger countries or countries with a sizeable ~~ programme.

A s t o the main hea l th projects a s s i s t ed by W O , communicable diseases

remained a major problem i n most countries of the Region. While campaigns

against spec i f ic diseases still had a plzce, countries were general ly being

a s s i s t ed t o strengthen basic epidemiological control and survei l lance services

a s pa r t of t h e i r general hea l th services. WHO had continued t o a s s i s t i n

the t ra in ing of epidemiologists through fellowships and t r a in ing courses.

He s t ressed the importance of hea l th laboratory services and s t a t i s t i c s i n

epidemiological work. limo was giving subs tan t ia l assis tance t o the promotion

of hea l th laboratory services i n a l l countries. He was happy t c note t h a t

the most recent pilgrimage t o Mecca had proved f r ee of quarantinable diseases.

The tab le and map on pages 38 and 39 of h i s report showed the s i t ua t ion

regarding malaria eradication in the Region. The inoidence varied from

complete absence of transmission i n some countries t o almost epidemic t rans-

mission i n some areas of Afghanistan and Pakistan. The current problems i n

control were ab r in i s t r a t i ve and f inancial , r a the r than technical . He drew

a t t en t ion to the increased use of larviciding i n the Region and noted that no

resis tance t o an t i -na le r ia drugs had been reported i n the malaria paras i te

i n the Region. integration of malaria programes within the hea l th

servioes should be approached c a u t i o u ~ l y , and only when pcriphcral hca l th

services were adequate.

Achievements i n smallpox eradicat ion had been impressive. It vias

hoped t h a t "he two remaining endemic foci , i n Ethiopia and Pakistan, would

be eliminated by the end of 1974 i f present progress was maintained.

Afghanistan was now f r e e of smallpox and the s i t ua t ion i n south Sudan,

where WHO was no!.; developing a subs tan t ia l programme, was also sa t i s fac tory ,

Cholera was regret tably now endemic i n pa r t o f the Region, m d shor t

outbreaks had been reported during the past year but prompt measures by

nat ional au thor i t ies , with WHO assis tance a s required, had brought them

under control. An inter-regional seminar on cholera and smallpo:: eradica-

t i on had been held i n Malaysia a d Singapore, where the l imited value of

vaccina-[;ion saa ins t cholera and the great importance of san i ta t ion , health

education, enviromental hea l th and epidemiclogical survei l lance had been

s t ressed.

A control led c l i n i c a l t r i a l of a new polysaccharide A type vaccine

against cerebrospinal meningitis had been car r ied o u t with WHO assis tance

i n Egypt and Sudan i n late 1972. A follosr-up t r i a l car r ied out i n Sudan

i n March-April 19n covering 42 000 people had indicated t h a t the new vaccine

might be ef fec t ive . It f'urther c o n f i ~ ~ ~ l e d , it w i l l be I n i p u r t a n t fur- a l l

countries s i t ua t ed i n the so-called cerebrospinal meningitis be l t .

Despite improvements, communicable eye diseases were s t i l l widespread

i n the Region. Health education, environii~ental sani tat ion, b e t t e r school

hea l th services and mass programmes i n most countries had reduced the incidence

of various types of conjunct ivi t is , including trachoma. An example of the

m/Rc23A/hin. 1) - page 14 .

decline of act ive trachoma i n chidren aged under 10 years i n a r u r a l area

of Sudan was shown i n the f igure on page 49 of h i s report. The control

programme had or ig ina l ly been ass is ted by W H O . However, a new type of

v i rus disease - epidemic haemorrhagic conjunct ivi t is - was becoming more prevalent in the Region. Although the disease was self- l imit ing and of

r e l a t ive ly shor t duration, it temporarily incapacitated a large proportion

of the population. The Regional Office had prepared a comprehensive report

on the disease, giving epidemiological and c l i n i c a l information.

The education and training of hea l th manpower continued t o be a prio-

r i t y area of WHO assistance i n view of the shortage of a l l categories of

hea l th workers throughout the Region. The f igures on pages 19-21 of h i s

report illustrated the situation for professional p~sonnel. mare was

also the problen of rnaldistribution; many r u r a l areas were completely with-

out heal th personnel. The aim of the countries and of WHO was t o t r a i n

the r igh t kind of heal th personnel i n approprislte numbers. It was also

important t o ensure coiimunity orientat ion among health personnel, and t o

apply recent advances i n educational technology and pedagogy, The t ra in ing

of teachers f o r nedical schools was receiving growing at tent ion. If exis t -

ing medical schools were t o provide adequate coverage it had been estimated

t h a t over5 LOOadditional teachers would be needed, and t h a t need would grow

a s new schools were opened. Accordingly, WHO was giving more fellowships

f o r medical educators not only f o r t ra in ing i n t h e i r specialty, but a l so t o

bring them i n touch with modem technology. Tne two workshops held a t the

Regional Teacher Training Centre a t Pahlavi University, Shiraz, Iran, had

proved of assistance t o selected medical educators from the Region. The

Centre would also help t o promote departcients of medical education i n other

univers i t ies and organize national teacher t ra in ing centres a t the request

of governments. WHO was ass is t ing the newly-established centre f o r

educational planning i n hea l th sciences i n Cairo, where audiovisual

teaching mater ial f o r use i n t ra in ing programmes i n Egypt would be developed.

It ;$as hoped t h a t the project would also prove of value t o other Arabic

speaking countries. A symposium on research i n medical education would be

held i n Alexandria, Egypt, l a t e r i n 1973.

The shortage of middle l e v e l and auxi l ia ry hea l th personnel was even

filore acute than t h e t of professional personnel. Duties were of ten carr ied

out by physicians t h a t aux i l i a r i e s could perform adequately. That was an

expensive waste; i t was a l so f rus t r a t ing t o the physician md could be a

f ac to r i n the "brain drain". The t ra in ing of auxi l ia ry personnel. therefore

continued t o receive WHO ' s p r i o r i t y at tent ion, and up- to-date information had recent ly been co l lec ted on auxi l ia ry t r a in ing schemes i n the Region, of

which there were sode 500. 'Ti0 was a l so supporting pro jec ts emphasi~i~ng

the need f o r training teams of workers at institutes in a nunber of countries

such a s the i n s t i t u t e s i n Democratic Yemen, Ec32iopia, Libya, Sornalia znd

Yemen.

Assistance i n dental and pharmacy education had been increased.

Exchange v i s i t s by educators from dental schools of the Region had been pro-

moted and a seminar on dental education had been held i n -dad i n 1972.

Similar l i n e s of act ion were being followed i n education i n pharmacy. The

shortage of nurses i n the Region was acute and IdHO assis tance f o r the t r a in -

ing of nurses occupied a large par t of i t s programme. The Organization

was as s i s t i ng nursing education pro jec ts i n nearly a l l countries of the

Region, and a paper on i t s policy f o r nursing education i n the Region had

recent ly been prepared and comments have been invi ted froill leading nat ional

nurses. A semin= on problems of nursing i n the Region was scheduled f o r

1974. He emphasized the iii~portance of close collaboration between the

producers of heal th manpower ( the un ive r s i t i e s and t r a in ing schools) and the

EPT/Rc~~A/M in. 1 page 16

consumers ( the minis t r ies of hea l th o r other hea l th i n s t i t u t i o n s ) .

In 1972, 1WO's fellowship programme continued t o be an important component

of its programme a s a whole i n the Region, es the f igures on pages 51-3

of h i s report shotfed. h r i n g the year,s87 fellowships had been awarded

and the expenditure from the regular bu%et had been over 2 million dollars,

o r 22.61% of t h a t budget. Of the fellowships, 158 had been given t o teach-

e r s of medicine wid a l l i e d hea l th subjects, xh i l e 90 undergraduates were

studying under bJHO sponsorship. The project f o r the exchange of v i s i t i n g

professors bettieen un ive r s i t i e s of the Region had proved very successful.

I n 1972, 33 professors had made such v i s i t s , and between 1 January and end

August 1973, 38 more v i s i t s had been approved.

Folluwirg the corisideratlon o r the fe l lonship programme In the Reglon

during the Technical Discussions a t the Sub-Committee's previous session,

fu r the r e f f o r t s had been made t o improve the programme. However, there

was still room f o r b e t t e r select ion of candidates, e a r l i e r appl icat ions f o r

fellowships, and b e t t e r u t i l i z a t i o n of r e 1 l o . r ~ on t h e i r return. He f e l t

t h a t the number of awards of fellowships l a s t i n g more than one year should

be limited. He was concerned a t the increasing number of requests f o r

fellovrships l a s t i n g 2 o r 3 years, espec ia l ly f o r doctoral degrees. The

regulat ions of ce r t a in un ive r s i t i e s under which no senior teaching post

could be obtained without a doctoral degree was a f ac to r i n those requests;

the need f o r such regulations was worth reconsidering.

The problems of environmental hea l th the provision of basic

sanitary facilities on a national basis still required the urgent attention

of most governments. Progress must be accelerated i f the expanding needs

of both urban and r u r a l populations were t o be met. Contributing t o t he

problems were rapid indus t r i a l i za t ion and urbanization and the expanded use

of pest ic ides , An inter-regional seminar on pes t ic ides had been held i n

Cairo i n 1972. Although the respons ib i l i ty f o r envirormental programmes

often did not l i e e n t i r e l y with minis ters of health, they would have t o

exercise more leadership t o bring about the necessary improvements. He

s tressed the a v a i l a b i l i t y of assis tance fron UNDP and I m , which were

s u p p o r t i x many projeote i n t hc f i c l d of c n ~ i r o ~ i c n t e l heal th , pa r t i cu l a r ly

i n community water supply and waste disposal. A seminar on water pollu-

t ion control had Seen held i n Khartoum i n 1972.

Population increase was a p r i o r i t y problem i n some p a r t s of the Region.

Egypt, Iran, P&istan and Tunisiit have well es tabl ished f m i l y planning

programmes i n 'rhich WHO end other in te rna t iona l agencies were co-operating.

Other countr ies h ~ d recognized the value of fatnily planning a s a preventive

hsa l l i rileasure, especially a s pa r t of maternity and chl ld hea l th services.

Research i n t o epidemiological aspects of human reproduction was being . car r ied out i n Egypt a d I r an with WHO'S assistance. He s t ressed the i m -

portance of UNFPA resources, no t only i n f an i ly planning progrmnes, but

a lso i n the development of f a n i l y hea l th programmes.

Mental hea l th services i n the Region generally f e l l shor t o f the

mounting needs. The image of mental hospi ta l s looked iarge, and the

general heal th services were separeted from psychiatr ic i n s t i t u t ions .

WHO'S ass is tance i n the t ra in ing of mental hea l th workers and planning of

services titas expected t o grow. The pmblen of drug dependence was demand-

ing increasing a t ten t ion a s the hazards of opium dependence, hashish smok-

ing, khat chewing and alcohol were recognized. Governments were taking

steps i n hca l th education and i n the treatment and r ehab i l i t a t i on of addicts.

A meeting of senior mental hea l th workers hcd bzen held i n Aiexandria i n l a t e

1972, and an inter-regional seminar on the organization of mental hea l th

services would be held i n Addis Ababa i n November 1973.

EM/~c23A/'Min. 1 page 18

The incidence of cardiovascular disease was r i s i n g a s a consequence of

longer l i f e spans, chmges i n nu t r i t i ona l habi ts , and g rea t e r mental s t r e s s .

W H O ' S ass is tance i n the epidemiology of cardiovascular disease m d the estab-

lishment of intensive care units was increasing. A seminar on cardiovascular

diseases had been held in Teheran in late 1972.

With regard t o cmcer , the survey of gas t ro- in tes t ina l lymphomas i n the

Region had continued and the findings would be discussed a t a seminar t o be

held i n Tunisia i n March 1974. Assistance t o c m c e r i n s t i t u t e s i n the Region,

especial ly f o r the t r c in ing of cytopathologists and cytotechnologists, had

continued, and WHO was c o l l a b o r a t i q i n s tud ies by govemlents on the preva-

lence of cer ta in growths, pa r t i cu l a r ly cnrcinoma of the bladder and oesophagus.

Hc d r c w attcntion to Anncx I11 of his annual rcport which contained a

f u l l list of repor t s issued by the Region i n the period under review and urged *

Representatives t o request repor t s on seminars and meetings i n par t icu lar those

which would be of i n t e r e s t and guidance t o them.

The publicction of the quarter ly Arabic ed i t ion of the WHO magazine

World Health had continued. He thanked the Governments of Kuweit, Libya and -- Egypt, vrhich i n turn had covered the cos t f o r one year. However, the f i r s t

3 years would come t o an end i n June 1974, and he inv i ted g o v e m e n t s t o con-.

s ide r giving fu r the r assis tance t o continue the edi t ion, cf which 5 000 copies

were now bein@; d is t r ibu ted .

Since the preparation of h i s annucl report, severe floods had s t ruck

large areas of Pakistan, with considerable hea l th implications. WHO was

pxrticipating i n t h e vast r e l i e f o p e r ~ . t i o n s undertaken by international

b i l a t e r a l agencies. The d i sns t e r was very serious, and hea l th and r e l i e f

ass i s tance would be required f o r m a y months. The Government had mobilized

a l l i t s resources and it was hoped t h a t endemic diseases such a s cholera,

smallpox m d nnlar ia would be kept under control. He expressed h i s own

and the Organization's deep sWlpathy t o the Government and people of

Pakistan.

Concluding h i s introduction, i n which he had commented on only some

of WHO'S activitica in the Region, he Iil~a~I~ecl uvur iLr les f o r their Constant

co-operntion, which he was confident would continue i n the future.

D r . ANOUTI (~ebanon) , expressing h i s appreciation of the Regional

Di rec tor ' s mnud. report, s t ressed the need t o re-evaluate the hea l th s i t ua -

t i on i n each country i n the l i g h t of new problems and the experience i n o ther

countries. In the Eastern Mediterranean Region, p r i o r i t y had t r ad i t i ona l ly

been a l l o t t e d t o the control of communicable diseases, but some of these had

been er-uclLcated o r were regressing. Uther hea l tn problerfis had not ye t re -

ceived enough a t ten t ion . Thus, in Lebanon, road accidents, cancer, oardio-

vascular diseases, diabetes, mental disturbances, malnutrition, renal &is-

eases, dental car ies , drug nddiction, soc i a l ,and occupational health, and

environmental s a n i t ~ t i o n were much more important than colilmunicable diseases

and deserved 2 higher p r io r i t y . However, survei l lance was necessary t o

present epidemic diseases from becoming endemic. A l l countries should have

a heal th plan a d there was rn urgent need f o r special ized henl th centres t o

t r e a t those conditions a s well as such grave heal th problems a s rheumatism.

Venereal diseases were increasing throughout the world and cons t i tu ted a

menace a l so t o fu ture generations. Specialized nat ional o r internat ional

centres already ex is ted f o r cmcer , cardicvascular diseases, diabetes, and

other dieeascs, and some countries hcd developed measures f o r soc i a l m U

occupational heal th . There was z grea t need f o r t r a in ing nurses m d labo-

ra tory personnel.

Dr. VASSIIDPOWS (Cyprus) s a id t h a t WHO'S pol icy of hea l th planning

enzbled the bes t possible r e s u l t s t o be cchievcd with the resources avai l -

able . The advanced course f a r WHO Representatives r?as praiseworthy.

Emphasis should be l a i d on the improvement of s t a t i s t i c a l and laboratory

aervices. The more prac t ica l cnd ef fec t ive approach t o malnutrition had

given encouraging r e s u l t s ,

Dr. MUKHTAR ( ~ u d m ) sa id t h a t many of the WHO-assisted pro jec ts i n $

Sudan ruere progressing despi t c the shortzge of' personnel 2nd t ransport .

More projects were needed t o eradicate cer tz in endemic diseases. The

f i g h t against malaria needed t o be in t ens i f i ed a s it imperilled the heal th

of ag r i cu l tu ra l workers. He commended the WHO Representative i n Sudan f o r

promoting the project i n South Sudan and a general improvement i n heal th

services.

M r . HASSM (Somalia) l ~ i d par t icu lar s t r e s s on hea l th planning and

r u r a l hea l th development. The needs of each country needed t o be s tudied

individually: there was no blueprint f o r hea l th services. Rapid progress

was being made i n the Region m d a f l ex ib l e approach t o planning was necessary

t o meet the changing s i tuc t ion . The hea l th problems of t h e nomadic peoples

i n Somalia had prompted 2 campaign of hea l th education among mothers, leaders,

and young pecple, which had helped t o re l ieve the trorlcload of hea l th personnel.

The intensive t ra in ing of midwives had resul ted within a few months i n a

reduction of tetanus among the newborn t o one.-twentieth of i t s previous ra te .

M r . MZALI ('I'unisia) s a id t h a t the Regimal Direc tor ' s repor t was both

c lcar and objective. He agreed t h a t healtll mi i~ i s t e r s should assunle res-

pons ib i l i ty f o r the hea l th e f f e c t s of pol lut ion but hoped t h a t the d iv is ion

of r e spons ib i l i t i e s a t the in te rna t iona l l e v e l would be c l a r i f i e d a s various

pol lut ion problems were d e a l t with by d i f f e r en t organizations; thus W W was

EZvl/~~23A/hin. 1 page 21

responsible f o r the heal th aspects. He s t ressed tha importance o f family

planning. Tne population of the Region had increased frcm 100 mil l ion t o

230 mil l ion i n 25 years. I f t h a t trend continued, there t~ould be 560

mill ion people i n the Region by the year 2000. The f igure was t e r r i fy ing

m d there was a c l ea r need f o r the countries of the Ree;ion t o abandon thcir

"Mektoubs' a t t i t u d e (be l i e f i n f a t e ) 2nd co-operate i n an attempt t o s top the

population increase, otherwise it would be impossible t o improve hea l th

services . WHO should give the problem the p r i o r i t y t h a t it deserved.

The CHAIFWiN sa id t h a t the overpopulation problem w a s pa r t i cu l a r ly

severe i n Syria. Other regions of the world t h z t had an excessive demo-

graphic expansion should a l so recsive advice. #

Dr. MORSHED (Trnn) noted that t h o Rcgional D i r e c t o r ' s a u ~ u a l r e p u r l

showed many improvements i n public health, especial ly i n the f i e l d s of

health protect ion m d promotion, m d environmental heal th . Attention

should be switched from cornrnunicabl~ diseases t o a higher phase of' public

health. S t a t i s t i c 2 1 analysis i n several provinces had shoim t h a t the pr i -

mary c a s e of death i n I r en was cardiovasculnr diseasss. A spec ia l depart-

ment f o r those diseases h2d been s e t up a t the Ministry of Health a d was

studying, -- i n t e r a l i a , the morbidity mong Teheran schoolchildren aged 5-17 years. The inorbidity r a t e f o r rheun~atic hear t disease i n Iran was now

2.6 p w thousand. Another new i n s t i t u t e w a s dealing with t rea t~nent , t ra in ing ,

and research i n cancer, and a cancer r eg i s t ry system hczd been s e t up i n

collaboration with IARC. One of the main problems was population growth:

50% of the populntion was now under 15 ye,-rs o f age, whioh created cconornic

and soc ia l d i f f i c u l t i e s . As ragards family p lCming , the r e s u l t s of s tud ies

of thc e f f icacy of various contraceptives, car r ied out i n Europe and the

Americas, could not be applied d i r e c t t o Iran. An i n s t i t u t e f o r research

E M / ~ ~ 2 3 ~ f i l n . 1 page 22

in to human reproduction had therefore been established there. The budget

of the f i f t h 5-year health plan of Iran, which began i n March 1973, r~ould

exceed those f o r the previous four combined; f a ~ i l y planning and maternal

,and child health would receive a high p r io r i ty and t h e i r coverage would be

3.5 times tha t o f the fourth p1,a.n: cc.mrn11ni rahl e disease control groprammes

would aim a t complete control b r even eradication; the network s f basic

heal th services would be expanded, i n both ru ra l and urban areas, so a s t o

cover almost 85% cf the population; medical care would be further expanded

through health centres i n rural areas and through the u t i l i z a t i ~ n s f private

as well a s public hospitals i n c i t i e s ; the t raining programme w ~ u l d be in-

tensified, increasing the existing health manpower threefold; and the 5-year

plan would i r l l u t hi511 pr ibr i ty t o nut r i t ion cad t o public health researoh.

He expressed h i s sorrow a t the flood disas ter i n Pakistan and pledged

h i s country's aid.

Finally, he wished it t c be placed on record t h a t he would be commenting

a t the appropriate time on the progrmmes f o r I rzn figuring i n the proposed

programme and budget for 1975.

Dr. KH0SHEIEF;N (Afghanistan) said tha t the recent po l i t i ca l and other

chages i n h i s country vrguld n ~ t af fec t henlL'I a c t i v i t i e s c r be ctn obstacle

t o WHO assistance. The mcin heal th problems i n h i s country were malaria,

which was on tha incraase, and administrative and f inancial d i f f i cu l t i e s .

The new government would pursue the f igh t against communicable diseases and

give p r i o r i t y t o reinforcing the basic health centres a d integrat ing other

health a c t i v i t i e s i n k those centres. It also aimed t o increase both the

budget and personnel fclr health.

E2I/RC23A/bin. 1 page 23

Dr. KILANI ( ~ ~ r d a n ) , commending the Regional Director f o r h i s annual

report, sa id t h a t thc 1973-75 health plan of Jordan l a i d s t r e s s on the dis-

t r ibution of epidemiological data and on the training of heal th personnel.

He drew at tent ion to the new hospital i n Amman, A1 Hussein Medical City,

and auxil iary health ins t i tu te : a mental health hoepital and drug control

centre would also be established i n 1973, and the number of polyclinics

would be increased. The health s i tua t ion i n Jordan was improving, althou@

many people l iv ing i n the occupied t e r r i t o r i e s were deprived of basic neces-

s i t i e s . The refugees should be allowed t o return t o t h e i r country and

internat ional organizations should adopt a firmer a t t i tude towards the

o c cupant s . b. MAHFOUZ (Egypt) cxpreased aatisfactiurl u L the presence of so many

ministers of health. He said tha t the training of health manpower deserved

p r io r i ty among regional ac t iv i t i e s . Health services could be improved only

by strengthening education and training, especially the training of auxil iary

heal th workers. The r~hcle university system needed to be revised as regards

medical education. Locel resources and methods should be used i n preference

t o importing -them. Egypt was taking all , these principles in to consideration,

par t icular ly with regard t o the training of nurses. An audiovisual centre

had been s e t up t o t r a i n health workers i n health education of the public and

he hoped t h a t the centre would become a regional project. He stressed the

need fo r health planning so as t o ensure the co-ordination of heal th needs

v d t h resources. The Irasli,vl project on modem administrative methods con-

corded with the Egyptian plan f o r certain provinccs, set up in cul lzbus .s t ion

with UNICEF. The importance tf such methods f o r good planning warranted an

exchange of views Jn the resul t s . Progress had been made towards solving

various heal th problems of the Region, e.g. smallpux hnd disappeared and the

EM/RC23A/Min. 1 page 24

WH~/Sudan polysaccharide study had yielded encouraging r e s u l t s , However,

the endemicity of cholera i n the Region, and eye diseases, were causes of

concern; seminars on those problenis would be usef'ul. Malnutrit ion was

one of the main problems i n the developing countries, 2nd it was unacceptable

that millions should 80 hungry in a world of plenty.

Dr. FlAMZI (Syria) s a id t h a t h i s country's second !?-year hea l th plan began

i n 1971 and was being concerted with economic and soc i z l development. There

was a need t o strengthen the basic hea l th services a t a11 l eve l s so a s t o

meet the hea l th needs o f the people i n a l l regicns i n Syria. An agreement

had been drawn up between the Syrian Government, UNICEF, m d WHO t o develop

those services. The eradicat ion of malaria could only be achieved gradually,

111 LegraLlr~g r n i i l a r i t l activities intu the basic l1ealtl-1. services. Therefore

the basic hea l th services would have t o be increased and more personnel

t ra ined f o r malaria rrork. Further improvements could be made within the

framework of the plan elaborated by the Regional Office and Headquarters.

I f progress were toc slow, cer ta in countries i n the Region might abandon the

project on account of the cost. With regard t o cholera, Syria attaohed l e s s

importance t o vaccinntion than t o c ther preventive measures, such a s environ-

mental health, personal hygiene, sampling of high-risk groups, and water supply.

The r i s k of b i lha rz i a s i s f o c i i n connexion with the Euphrates dam project made

it necessary t o include a b i lha rz i a s i s progr~mne i n the dam project. Develop-

ing countries i n process of indus t r ia l iza t ion were experiencing new hea l th

problems, such a s the pol iut ion of coasts and r ivars , and the dangers of using

insccticidca m d pesticides on a vast scale. Mental health was also an in-

creasing problem i n such countries. I n view of the shortage of spec i a l i s t s ,

p r i o r i t y should be given t o special izat ion. More a t ten t ion should be devoted

t o road accidents, which were the most important cause of death i n Syria.

m/RC23A/hin.l - page 25

The REGIONAL DIFECTO2, r e fe r r ing t o the statement of H.E. M r . Mzali,

said t h a t although neal th minis ters did not bear the e n t i r e respons ib i l i ty

fo r environrcental heal th problems, they should however play a g rea t e r ro l e

i n heal th aspects and co-ordination of e f f o r t s with other nat ional authori-

t i c s involved. Not only pollutiul-I, but alsu waler' supply, Wastes alsposal ,

noise and other areas, were involved. A s an example he re fer red t o the

seminar on pest ic ides t h a t had been held i n Cairo. FAO, UNDP, and other

organizations a l so were concerned and co-sponsored the seminar j o in t ly with

WID. It had been s t a t e d t h a t the d iv is ion of r e spons ib i l i t i e s a t the i n t e r -

nat ional l eve l was not c l ea r and he agreed t o a ce r t a in extent . However,

the terms of reference of d i f f e r en t United Nations agencies was determined

by the l r governing bodies, composed of governments. It was the general

assemblies of these special ized agencies, represented by pert inent depart-

ments of governments which draw the au tho r i t i e s of ezch agency's work and

policy and he agreed t h a t there was a t t i n e s some overlap o r duplication.

For instance the co-ordination of work between F?HG and FA0 i n the f i e l d of

Nutrit ion, b'JH0 anci IAEA i n Radication and Cancer, IvHG and UNESCO i n Medical

Kanpower Treining, o r with newly establ ished UIN e~v i ro rwen ta l organization i n

Environmental Health and a nuliiber of other exainples, where f u l l co-ordination

o f work and du t i e s is necessary, i f duplicetion is t o be avoided. He sug-

gested t h a t t h i s overlap and need f o r proper co-ordination exis ted also,

perhaps even t o l a rge r extent, i n some areas of hea l th z c t i v i t i e s a s mentioned

above a t the nat ional l eve l and between nat ional departments. There was

defini tely s o m e room for ir,~proverner~t u f tillis co-ordination.

EM/Rc23~/~in. 1 P e e 26

He agreed about the need f o r integrat ion, but s a id t h a t it could be

achieved only if governments improved t h e i r heal th inf ras t ruc ture and

basic hea l th services. Finally, he expressed sa t i s f ac t ion a t the presence

of s o many heal th ministers, which l e n t addi t ional s t a t u s t o the Regional

Committee and provided het.t.er guidance t o the Regional Office.

The meeting rose a t 2.15 p.m.