W O B L D H E A L T H

OBGA.NIU4TION

REGIONAL OFFICE FOR THE BUREAU REGIONAL DE LA

EASTERN MEDITERRANEAN .* MEDITERRANBE ORIENTAL.

REG1- THE EASTEEhI MEDITfFZWEAN

Nineteenth Session

SUB-CCMPIITTEE A

MTNVI'ES OF THE FJRST M!BTING

1 -1969 Original: ENGLISH

Held a t the Regional Office, Alexandria on Monday, 6 October 1969, a t 10.00 a.m

CHADMAN: D r . V. Vassilopoulos (Cyprus) l a t e r Dr. H. E l Kadi (united Arab ~ e p u b l i c )

Opening of the Session

Election of Officers .

Address by the Minister of Health of the United Arab Republic

Address by the Regional Director

Address by the Elected Chairman ( ~ r . E l Kadi)

Address by the Head of the Afghanistan Delegation

Adoption of the Agenda

Hours of Work

Election of Chairman of Technical Discussions

Appointment of the Sub-Division on F'rogrannne

Programme of Work

Annual Report of the Reglonal Director t o the Nineteenth Session of the Regional Committee: Statements and Reports by Representatives of Member S ta tes

EM/RClgAMn. 1 page 2

R e p r e s e n t a t i v e s o f Member States

G o v e r n m e n t

AFGHANISTAN

IRAQ

JORDAN

LEBANON

I;IBYAN ARAB mmLrc

PAKISTAN

SAUDI ARABIA

SOUTHERN YEMEN

SUDAN

SYRIAN ARAB REPUBLIC

T W S I A

UNITED ARAB REPUBLIC

R e p r e s e n t a t i v e , A l t e r n a t e o r A d v i s e r

Professor A. hnar D r . R. R o a s h a n

D r . V. V a s s i l o p o u l o s

H.E. Do Jaslnach.G..-T&Le?mruariat A t o L u l s e g e d M e n g i s t e

D r . M. Ibrahim

H.E. D r . A.S. E l Majali D r . T. wadshy Dr . M. B a s h i r

Mr. B.H. A l - B a r g a s D r . A. Al-Awadi

D r . H.H. J a l l o u l

D r . F. E l G e r b i D r . A. K r e w i

B r i g a d i e r C.K. H a s a n D r . S. H a s a n

D r . H. A b d u l G h a I ' f a r D r . A.S. E l T a b b a ' a

Dlr. B.U. G h e d i D r . S.M. A l i D r . A. D e r i a M r . A.H. A d a n

H.E. D r . A.A. A l - D a l y

D r . H.A. K u s W s h

D r . A. B u d e i r .

D r . M. B a h r i

D r . H.M. E l K a d i D r . A. Wagdi Dr . R.A.A. Gurna'a D r . A.M. E l Akkad. D r . M.L. I b r a h i m Dr . A.F. A b o u Z e i d Dr . I . A b d e l H a m i d Osman Dr . I. Z a g h l o u l Imam D r . I. B a s y o u n i D r . A. H a s a n A b d a l l a

Representatives mf )?ember S t a t e s ( con t td l

Government Representative, A l t e r n a t ~ o r Adviser

YEPIEN PRAB REPUBLIC H.E. . H. E l Makti.a.d D r . M.K. E l Aghbari

Representatives of Associate Member S ta tes

BAHRAIN

QfiTAR

D r . I. Yacoub

D r . F.S. E l Goweini D r . S. Tag e l Din

World Health Organization

Secretary t o the Sub- Co.,mittee (ex-officio) Dr . A.H. Taba, Regional Director

Representative of the D r . J . Karefa-Smart, Assistant Director-General Diredtor-General

Representatives of United Nations Organizations

UNITED NATIONS

-D%LTED NATIONS DEVEMPMENT PROCRAMME (UNDP)

UNITED NATIONS ~ I D R E N ' S ?3JND (UNICEF)

UItlITED NATIONS R E D AM, WORKS AGENCY FOii PALESTINE REFUGEES (U~JRI~IA)

D r . M. Sharif Director, UNRWA Health Department, Beirut

I%-. K.P. Dalal Deputy UNDP Resident Representative, Cairo

. R. Moltu UNICEF Area Representative, Cairo

D r . M. Sharif Director, UNRWA Health Department, Beirut

RepresenLatives and Observers of Interigwornmental , In te rna t iona l Non-Governmsntal ami :!ational Organizations

LEAGL'E OF ARAB STATES D r . G. E l Zereikly

INTEFJiATIONAL STATISTICL EDUCATION C E N ~ ~ E (ISEC) . F. E l Khowi

US NAVAL MEDICAL RESEPPl CH WT NO. 3 (NAMRU 3) Dr . D.C. Kent

INPERNATIONAL COMMITJXE OF MIIXTARY MEDICINE AND PfL4FNAcY Colonel Hussein Kame1

I N T ~ A T I O N ~ L FEDEHfTIOI\T OT G n B C O m Y AP'D OSSTETFiLCS.

INTERNATIONAL HOSPITAL FEDERATION

WORLD NFD1CE.L PSSOCIATIOI?I:

I rnERNATIONAL COUNCIL OB rnFS

IIEERNATIONAL PDLNNEL PDBF&ITHOOD FEDEFATION

LFAGUE OF RED CROSS S O c I r n I E S

ARRB PHARMACZVl'ICAL UNION

EGYYF1.W MEDICAL ASSOCIATION

EG!fETAN PUaLIC HEBLTH M S O C I A T I O N

Professor M.S. Foda

D r . A.K. Mazsn

D r . H u s s e l n . K. Toppozada

Mrs. N. iibou E l S e o u d .

D r . I . N a z e r

D r . M.A.M. H a r n z a

DT. M.M. M o t a w i e

D r . H.K. T o p p o z a d a

D r . A.M. K a n a 1

1. OPENING OF THE SESSION: Item 1 of the Provisional Agenda

The CHAIRMAN declared the Session open.

2. ELECTION OF OFFICERS: Item 2 of the Provisional Agenda

The CHAIRMAN invited nominations for the office of Chairman of the

Sub-Committee.

Brigadier HASAN (Pakistan) proposed Dr. El Kadi , Under-Secretary of State for the Ministry of Health of the United Arab Republic.

The C H A I W , speaking as representative of Cyprus, seconded the

proposal.

Decision: Dr. El Kadi was unanimously elected Chairman.

Dr. El Kadi took the chair.

The CHAIRMAN invited nominations for the two posts of vice-ahaim,

Dr. IBRAHIM (~raq), seconded by Dr. VASSIMWULOS (Cyprus), proposed

Professor Omar (Afghanistan) ; and Dr. Karadshy (dordan) , seconded by Dr. VASSIMPO15X (Cyprus), proposed H.E. Mr. Hawarfat (~thiopia).

Decision: Frofessor Omar and H.E. Mr. Hawariat were unanimously

elected Vice-Chairmen.

The CWIRVI4N invited nominations for the office of Chairman of the

Sub-Division on Programme.

Dr. WAGDI (United Arab Republic), seconded by Dr. F!AHF$ (Tuni~ia) , proposed Brigadier Hasan (Pakistan) .

Decision: Brigadier Hasan was uminimously elected Chairman of tile

Sub-Division on Programme.

3. ADDRESS BY H.E. DR. ABDOU SALIAM, MINIS333 OF HEALTH OF THE UNITED ARAB R E m C

H.E. Dr. AEDOU SAILAM, fidster of Health of the United Arab Republic,

extended a warm welcome to all the Representatives on behalf of the UAR

Delegation and the people and Government of t h e WAR. He a l s6 welcomed

Afghanistan, which was taking pa r t i n the Sub-Committee Meeting f o r the

f i r s t time a f t e r b a n s f e r r i n g t o the Eastern Mediterranean Region of W E ,

He a lso extended a welcome t o D r . J. karefa-Smart, representative of

the Director-General of WHO, and a grecting t o D r . A.H. Taba, the Regional

Director and his colleagues i n the Regional Office.

The present Session coincided with the completion by hKO of i t s f i r s t

twenty years of ac t iv i ty , the great achievements of which were due t o the

Organization's r e l en t l e s s e f f o r t s t o bring welfare t o the people and t o

r a i s e t h e i r heal th standards. The type of heal th care provided had

depended largely and basical ly on the s p i r i t of co-operation prevail ing

among the peoples of the Region, whether r i c h o r poor, and on the good co-

ordination of e f fo r t s and resources i n the various countries of the world,

without impediment of any nature, whether po l ie ica l , r a c i a l or material.

The Region was proud th+t through cc-operation,;co-ordination, c r e a t i o n

and development i n t he f i e l d s of publ ic .hea l th j ; the Regional Office f o r the

Eastern P led i te~anean had achieved a ,great deal f o r the welfare of the people

of the Region. Thanks, grati tude and appreciation were therefore due t o

that Office.

I n the United Arab Republic, the landmarks had been s e t f o r heal th

services provided t o t he people by the State . The National Charter, announced

t o the people by President Gamal Eibdel Nasser, Leader of the Revolution and

Pioneer of the country's development, had secured the "r ight of every c i t i zen

t o heal th care, which s h a l l by no means be considered, whether i n the form

of treatment o r drug, a s a mere commodity l i a b l e t o be sold or purchased, but

a s the guaranteed, materially unconditional right of a l l c i t i zens , who shall

have access t o it w i t h ease and adequacy, throughout the country; towards

this end, heal th insurance should necessarily be expmcLea so a s t o crver a l l

citizens".

That conunitmEn in the f i e l d of heal th services interpreted sincerely

the fvnd'amentais of the Soc ia l i s t i c Democratic Co-operative System, which

viewed hea l th as a v i t a l requirement and an essent ia l element i n the

development of thh- iiational economy. It was cn t h a t basis t h a t the State

had developed am3 expanded i t s health services by soundplannirigto achieve

the objectives sjught.

Representa-Lives were welconc t o v i s i t a w of the preventive or curative

inst iLut ions, or t o discuss any medical subject vrith any of the experts or

administrators. He proposed. t o s t a t e br ie f ly some of his country's

achievements i n the f i e l d of health.

The budgpt of the Ministry of Heaith a c h had been l e s s than

L.E. 6 700 000 i n 1952 (vrhen the Revolution s ta r ted) had been increased to

L.E. 39 677 000 i n the current year, meaning a r i s e i n the per capi ta share

of the budget of the Ministry of Health from 30 t o 115 piastres. On the basis

of the t o t a l government expenditure on heal th services , the per capi ta share

would be 180 p ias t res i n the present year.

Ninety per cent of the r u r a l population now had access t o safe drinking

water, compared with only 11 per cent before the Revolution. A s a r e s u l t of

the sTrenuous e f f o r t s exerted i n t h a t a d other f i e l d s , infant mortality

r a t e s had dropped from 1% per thousand before the Revolution t o 10, per

thousand a t the present time; and general mortali ty r a t e s from 22 per thousand

t o about 14 per thousand. Life expectancy r a t e s on b i r t h had increased from

41.4 i n 1948 t o 51.6 i n 1960.

The GovernrYznt had devoted coilsiderable a t ten t ion t o the provision of

hea l th services t o the r u r a l connuunity which had been lacking i n the past .

The number of rural heal th units had not exceeded 300 i n 1952, namely,one

unit per 50 000 of the r u r a l population, The Gwernr,ent had now implemented

a plan t o expand the scope of hea l th services i n rural areas so as t o provide

one u n i t per 5 000 ci t izens. The t o t a l number of r u r a l heal th units a t present

available amounted t o 1 750, namely one u n i t per 10 000 of the rural population

w'no were a t present covered by preventive and curative inedical services ,

Maternairand Child Health Services and endemic diseases control . A full-

time heal.tl1 physician, selected ailong the grauuates of the seven Facul t ies

of Medicine i n the United Arab Republic was assigned t c each un i t and

r e s i d e d i n it. Physicians selected f o r the purpcse had a six-year education,

i n addi t ion t o one-year t ra in ing i n university or general hospi ta ls an6 a

two-month t ra in ing i n the Ministry of ilealth. Xach p.hysician was ass i s ted

by two midwives, one laboratory a s s i s t an t , one sani tar ian and a number of

attendants.

Rural health services were a l so linked gradually with higlher treatment

levels i n cen t ra l , general and specialized hospi ta is i n towns and c i ~ i e s .

The number of beds available i n the hospi ta ls ef the Ministry of Health

amounted t o about 50 000, wnile toe t c t a l of beds available i n the country

amounted to.72 900, about 2.25 beds per 1 000 population, An average of

1.8 of those beds was assign& f o r general medical treatment and an average of

0.45 f o r specialized treatment.

The law of compulso~j health insurance, passed i n 1964, had f i r s t come

i n t o e f f e c t i n the Governorates cfCair$ hlexaiiuria, ICalyubia and Giza. Its

benefic iar ies included we=*sor~lel of the Government, public organizations and

in s t i t u t i ogs and a t p r e s e n t tq ia l led about 2 8 ~ 000 enployees. Each employee

contributed 1 per cent of h i s wages a d . the Oovernment contributed 4 per cent

of such wages. The health insurance scheme u t i l i zed the services of general

prac-Litioners and spec i a l i s t s , and provided hospi ta l treatment, drugs,.

prosthet ic appliances, ant*. and 2pos.l-natal ca re , an2 domiciliary treatment,

a s required. Care of sc:lool chi;.d?en a t a l l l eve ls of education ranked

among the p r i o r i t y subjects undertake3 by t h e Ministry of Health. Medical

care t o school children was provided thrcu&h school heaith un i t s , which

to t a l l ed l t14 in towns, compared wixh only 24 in.1952. School heal th services

had been extended t o cover ru ra l areas through the establishment of r u r a l

healL& uni ts . Spec i a l i zedc l in i c s had a l so been s e t up t o deal with diseases

prevail ing a t schoo!? age, such as tiie ear and t o n d e diseases , strabismus,

psychiatric diseases and hear t rheumatism. The number of maternal and chi ld

heal th centres i n c i t i e s had increased from 97 i n 1960 t o 197 a t the present

time. MCH services were a l so provided t o the r u r a l comnunity a s par t of the

functions of the r u r a l hea l th un i t s which a l so carnie6 out immunization of

the new-born and infants against a l l in fan t i le diseases, provided them with

care and raised t h e i r nu t r i t ion standards. Those centres a l so provided care

throughout the period of pregnancy, and. during and a f t e r delivery.

The most important heal th problems i n the UAR were schlstesomiasis,

tuberculosis and ophthalmias and the Government was making every e f f o r t t o

control those diseases. I n the f i e l d of schistosomiasis contro:, the nunber

of 'curat ive un i t s had been increased during the past decade from 43 t o 1 270.

Snai l control a c t i v i t i e s were carr ied out simultaneously w i t h t r e ~ t m e n t of

pat ients and improvement -~f t h e i r environment.

I n research i n the f i e l d of endemic diseases, the United Arab Republic

was considered a s a pioneer. A research i n s t i t u t e f o r endemic diseases and

t rop ica l medicine had been i n existence since 1930.

The Ministry of Health, i n collaboration with ME0 experts, had carr ied

out':mui?h research and study i n the f i e l d of malaria control, so a s t o prepare

f o r t h e implementation of an integrated progrvnthe f o r malaria e rad ica t~on.

Centres fo r t ra in ing the required number of technicians and workers hadbeen

established. Studies had been undertaken on We ecslogical aspects of We-

vector and its suscept ib i l i ty t o inseoticides. -Anintegrated programme % a s

being carrLed o u t b y the Ministry of Health f o r the eliminatian.of tuberculosis

i n the nea r fu tu re . There were 10 -000 beds assigned t o t u b e r c u l o s i s ~ a t i e n t s .

I n e a c h Governorate, a main centre had-been established f o r the X-ray

examination..of..the c i t izens and t h e i r vaccination with B q . A mass BCG

campaign, .,comprising 29 mobile un i t s , was conducting t h e examination o f about . .. .. .

1 000 000 c i t i zens with a . view t o detecting nevi cases. . More than 80 chest

disease unlts now existed in::tovuns and c i t i e s , equipped with a l l f a c i l i t i e s

fo r diagnosis,, laboratory. tes t@; treatment and soc ia l work t o rehabi l i ta te

EM/RCigA/bn page 10

tuberculosis pat ionis both vocationally and socially. Ijomiciiiary

treatment was a!sc ~ r ~ v i d e c ' t o those whose s t a t e of heal~th did nut require

t h e i r admission t o sanatoria.

Great e f fo r t s were being exer~ted. by the Gcverlun-:?t f\;r the treatment of

psychiatric diseases i n accciriance with modern sc i en t i f i c ciethods. Physical

an6 psychiatric treatment was bein2 introduced i n psychiatric c l i n i c s and

sanatoria. The concept of soc ia l treatment had been introauced, which

offered pa t ien ts an opportunity t o achieve Lure within +he shortes t period

of time. Treatment was a l so given k o u g h work and recreation, Clubs

equipped with recreat ional , work anG~ sports f a c i l i t i e s had been established

I n the f i e l d of preventive hea:.th, the Ninistry had succeeded i n

protecting the cbuitrg from epidemiological and imported diseases. For t h a t

purpose, quarantine s ta t ions ir. por~ts and a i rpo r t s had been strengthened.

Health off ices i n towns had been increased i n number an6 now to t a l l ed 286.

Rural hea l th units, which were now spread t h r ~ u & ~ o u t the country, performed

the functions of urban heal th off ices and were considered the first l i n e of

defence i n protect:ng the country agaiilst disease.

The above un i t s had made it possible f o r the Miniztry t o ex-cend compulsory

vaccination against diphtheria throu&out the country, whereas such imnmization

had formerly been res t r ic ted t o he c i t i e s . Simiiarly, general vaccination

against poliomyelitis and tuberculosis was being applied a l so , and

vaccination against-measles was beinz Introduced.

It was na tura l , with the vast expansion i n heal th services , t h a t the

.number of heal th workers had increased, ' W l e the number of physicians i n the

Ministry of -Heal..h had been about 2 000 i n 1952, there were now about 8 000

medical o f f icers , 600 dental o f f icers , 600 pharmacists and 8 500 nurses i n

the employment of the Ministry of Health. The increase i n s ta f f requirements

had a lsb n e c e a i t a t e d an increase i n the number of f acu l t i e s of nedicine

pharmacy, dental medicine and o f . i n s t i t u t e s of nurses, midv~ives, healch

auxi l ia i i -e i , And other types of technician. There were now seven FacuLties

EM/RClgA&Ln. 1 page 11

of Medicine i n the United Arab Republic, graduating about 1 5 0 0 physicians

per year (including stLlieiits from khe Ara> ard fr iendly countries i n the

Region).. The H i & I n s t i t u t e of Public Health i n Alexandria had been

es-tablished t o prepare spec i a l i s t s i n a l l f i e l d s of public health. Two

High I n s t i t u t e of Nursing had bedn establishrid t o i;rain nurses a t the

graduate level .

The provision of druks t o c i t i zens was on2 of the subjocts t o which the

Govemnent had devoted considerable a t tent ion. Pharmaceutical industr ies

had been established on sound aid economical bases and loca l production had

increased more than f i f ty-fold; whereas it had formerly supplied only

10 per cent of ;.ocal conswnptiori (L.E. 4 800 000 a t the time the evolution s t a r t e d ) , it now supplied 87 per cen-t of loca l consumption which amounted

t o about L.E. 40 000 000.

A special centre f o r pharmaceutical research and qual i ty control had

been established i n the Pharmaeeucical Organization i n order t o strengthen

research and control a c t i v i t i e s a t the country level , guarantee the sa fe ty of

pharmaceutical preparations, and increasingly imprsve t h e i r quali ty.

The S ta te had shown great i n t e r e s t i n s c i e n t i f i c research which was

considered e s sen t i a l fo r the development of the country. To that end, the

Government had developed and strengthened research i n s t i t u t e s under the

Ministry of Sc i en t i f i c Research, the Naiisnal Research Centre, the Atomic

Energy Organization and the Sciences Suprene Council. Substantial support

had been given t o a l l s c i e n t i f i c i n s t i t u t e s and research centres, whezher

attached t o un ivers i t i es , minis t r ies or other i n s t l t u t l m s .

Medical research was another f i c l d t o which the Ministry of Health k@

devoted a great deal of atzention with a view t o develspLng i t s services

concomitantly with the advances i n the f i e l d of science and technology, and

t o developing its heal th plans en a s c i e n t i f i c basis i n the l i g h t of experi-

ments and applied research. To t h a t end, an Under-Secretariat ef S t a t e was

being established t o deal with a l l matters pertaining zo s c i e n t i f i c research

i n the f i e l d of nealth.

Considerable research i n the f i e l d s of medicine and heal-th was being

undertaken by the Ministry through,-i ts f i e l d research un i t s and specialized

research i n s t i t u t e s , including the Research I n s t i t u t e f o r Endemic Diseases

and Tropical Medicine, the N u t r i t i w I n s t i t u t e , the Oph-thalmic Research

I n s t i t u 2 ~ e , the Research I n s t i t u t e of Medical Entomology, the Poliomyelitis

and Physiotherapy I n s t i t u t e , the Heart and Cardiovascular Diseases

I n s t i t u t e , -the I n s t i t u t e of Ruditicn and Speech, the F i e X Research

Department and the Laboratory Research Units. Those I n s t i t u t e s co-ordinated

t h e i r ac-Livities with s c i en t i f i c organizations, univer'sities and research

centres within the country, and co-operated f u l l y w i t h in terenat ional

organiza-Lions, par t icu la r ly WHO and UNICEF.

The present meeting, although a t r ad i t i ona l WHO meeting, offered a

good opportunity t o discuss the hea l th a f f a i r s of the people of the Regim.

He was confident that the discussions would be guided by a keen endeavour

t o derive the greates t possible benef i t from the World Health Organization,

and t o co-operate f u l l y with it i n a l l f ie lds . The countries of the Region

were a l l developing countries facing soc ia l and economical problems which

influenced t h e i r heal th sizuation and were i n tu rn influenced by it. Their

problems, which were iden t ica l , needed t o be solved i n order t h a t objectives

could be achieved on a sound basis.

He re i te ra ted h i s hearty welcome and his bes t wishes f o r a happy s tay

i n h i s country, and wished the Sub-committee a l l success.

4. ADDRESS BY REGIONAL DIRECTOR

The REGIONAL DIRECTOR extended a welcome t o representatives on behalf

af the World Health Organization. He expressed his warmest thanks t o

H.E. D r . Abdou Sallam, Minister of Health of the United Arab Republic, f o r

his personal i n to re s t i n WHO, and h i s deep appreciation t o the Government of

the United Arab Republic, the host ccuntry, whose co-operation through the

years had helped so much i n fur ther ing the Regional Office's work. He a l so

welco.mea H.E. D r . A.W. Borollosy, Minister of Higher Education of the United

Arab Republic.

He welcomed the Representative of Afghanistan, one of WHO'S oldest

Member S ta tes and the newest member of the Region. The session would

undoubtedly benefit from the added stimulus of Afghanistan's long

experience of WHO work.

The holding of the Session a t the headquarters of the Regional Office,

Just cwenty years a f t e r i t s establishment i n Alexandria, afforded a timely

opportunity t o assess b r i e f ly the hea l th s i tua t ion as the co-operative

e f f o r t sponsored by WHO i n the Eastern Mediterranean Re@on was passing

the twenty-year mark.

I n the introduction t o h i s Annual Report, which the Sub-committee would

be reviewing l a t z r i n the session, he had outlined i n br ief the progress made

and the problems met by member countries since the early days of t h e i r

jo in t ac t ion ass i s ted by WHO. The forward sweep of medical science and

technology i n the past twen-cy years had been accompanied by tangible progress

i n the countries of the Region.

There had been an average four-fold increase i n medical manpower; a

marked drop i n infan t mortality r a t e s ; def in i te advances i n the malaria

eradication dr ive , which already protected some 160 mill ion people;

experimental breakthroughs i n trachoma and schis tosomiasi~ control, and a

stepping up of measures against new hazards s t e d n g from indus t r ia l iza t ian

and soc ia l change.

such achievements, shared i n many instances with 1dH0, bore witness t o

the Region's capacity t o make fur ther headway. The 600-odd heal th projects

alreadylaunched with WHO assistance had s e t the s t age ' fo r a more enlightened

attac:t.on disease and a more r e a l i s t i c approach t o countless problems.

Health was gaining on disease. But the task ahead, accentuated as it was

by a soaring population increase, d i d n o t allow any lessening of effor t .

-While some of the age-old diseases still survived i n cer ta in areas:, the new

s t resses and s t r a ins of modern l i f e were bringing more commitments i n f i e l d s

long l e f t unexplored.

EM/RClgA/blin. I page 14

The past twenty years' education dr ive backed by im0 HO prcxiuced

s izable contingents of sk i l l ed wori;ers, but the availcble manpower was f a r

from meeting the requirements of sa t i s fac tc ry medical care. I'Jide areas were

not adequately covered by hea!.tJi s e ~ v i c e s , and much re-mined t.3 be done ts

ensure t ha t the f u l l potent ia l of msdical scii:nce reached everybody

everywhere.

Frogess i n t h a t respect depcnaed foremosb oil the devolopment of heal th

manpower. DespiLe und-eniable and cviin s t r ik ing advances toward. t n a t goal,

it remained evident t ha t thz ,tianpowor po ten t ia l of mcst Zastern Mediterranean

countries was f a r from being realized.

The shortage of doctors, f o r instance, was s t i l l acute, despi te

outstanding e f f o r t s towards promotion of medical education. Medical schools

had increased i n number from 12 t o 38 i n the past.twe!:t;l gears , but an

estimated 6 :more schools would be required t o meef present heal th needs.

The s i t ua t ion was a s c r i t i c a l i n other categories of heal th s t a f f . Indeed,

the manpower problem was on0 cf the great challenges which would tax resources

and endeavours i l l , the years t o come.

Medical, research was another f i e l d which held promise-of fur ther heal th

advance i n the Region, where many problems, from cholera 's renewed threa t

t o a&r pol lut ion 's r i s ing menace' hung on the laboi-atory verdict . Research

was -Lhe !sey t o the control of the Region's deeprooted communicable diseases,

jus t as it was the main avenue -to the solution of the proble;,is of cardio-

vascular disease and cancer.

An expansion of exis t ing resoarch f a c i l i t i e s was therefcre indispensable

f o r improving heal th i n the Region, where heal th wor;rci-s inersasingly turned

t o medicai research f o r answers t o t h e i r problems. A var ie ty of public heal th

problems had already been investiga.ked with the support of hKO.in the past

two decadas, and there w a s e-*erg prospect t h a t medical researchwould be

stepped up i n years t o come.

EM/RCl9A/bTin. 1 page ' 15

WHO, with i t s wide array of s c i en t i f i c monitoring and assistance

devices, could be i n s t m e n t a l i n making those advances applicable t o

soc ia l and heal th conditions i n the countries of the Region. Judging

from the i r e f f o r t s i n past yea;.stoboost medical research and s tep in to

the mainstream of modern cechnologgr, it would be reasonable t o view the

future with hope.

P. greater ava i lab i l i ty of neclical care through mope e f f i c i en t health

services could be forecast , and a general impro;ement i n environmental

conditions, provided e f fo r t s were not outpaced by a soaring demographic

growth.

But populations would s t i l l be exposed t o a multitude of influences which,

unless controlled, could deter those expected advances. The list included

polluted a i r , s o i l and water; squalor and soc ia l maladJustment of unplanned

urbanization; occupational and environmental hazards linked wlth rapid

indus t r ia l iza t ion ; unknown changes i n man's biological pat tern caused by h i s

present-day exposure t o ionizing radiat ion and chemical subs-canoes; and

drug abuse - t o mention only a few.

Kuch of the Organization's current programme had foreseen those

challenges. It covere* a s-ceadily broadening scope of assistance a s new

prcblems arose i n the walce of bio-social changes taking place i n the Region.

He earnest1.y hoped t h a t passing the twenty-year mark, and taking stock

of successes and shortcomings i n ihe pas t , would spar everyone t o greater

accomplishrients i n the future. The advice and guidance of the heal th leaders

of the Region now assembled would, he was sure , prove most valuable i n

helping members t o achieve tha t goal.

The CHELRMAN said it was a privilege t o welcome a l l the Representatives

t o his country and thanked the Sub-committee f o r the honour it had done him

i n appointing kim Chairman. He welcomed the new member of EMR, Afghanistan,

EM/RClgA@n. l page 16

which, he was sure , would make a useful contribution t o the work of the

Region. Xc a l so welcomed D r . Karefa-Smart, the Representative o f t h e

Director-General of WHO, and wis:~.ed, through him, t o extend the Sub-

Gommittee's good wishes t o D r . Candau.

The Meeting of the Sub-Comqittee i n Alexandria coincided with the

completion of twenty years of ac i iv i ty by WHO cnd was an occasion t o

rsmind the Members of the great e f fo r t s exerted by h e Eastern Med-iterranean

Regional Office and. i t s Director t o solve the problems of the Region and

r a i s e the standards of public heal th i n the area. Fcr example, the

Organization had given much assistance and made many services available

t o the UAR which was one of the cffect ive fac tors i n the success and

achievejnents of the UbR Health Plans. It had a lso provided fellowships i n

a l l f i e l d s of Specializa-tion, and ha@. ass i s ted i n many projects , including

the production of freeze-dried smallpox vaccine project , Virus Research,

Quality Control of Drugs, Tuberculosis, Schistosomiasisand others.

WHO had a l so helped t o es tab l i sh two Higher I n s t i t u t e s f o r Nursing,

one of which had already graduated over 400 new nurses. It had a l so been

instrumental i n cnnsolidating the Training Centre f o r Nurses i n Ahmed Maher

Hospital. It had previously ass i s ted the High I n s t i t u t e of Public Health

i n Alexandria, which contributed i n providing the councr:-, a s well as mther

neighbouring countries, with Public Health Spec ia l i s t s , whether uoctors,

engineers or others.

Experts i n virus and other diseases were being trained under the WHO

Training Programmes f o r the Region and the 1968/69 programme was now being

completed. WHO had also provided, e i t he r through He&-quarters or the Regional

Office, experts and technicians f o r various Seminars and Courses held i n the

UAR, on major heal th topics such a s schistosomiasis and family planning,

paedia t r i c s , etc.

I n an attempt co ensure zhe highest heal th standards f o r a l l peoples,

WHO was now as s i s t i ng the developing countries which were i n the ear ly stages

of p l a r d n g hea l th services i n administrative and research critters. It

was providing fellowships and organizing courses and seminars t o t r a i n

experts, nurses and other categories of heal th gersonncl i n planning

methods, the organization of operational research i n heal-th services, heal th

manpower planning, heal th economics, v i t a l and health s t a t i s t i c s and basic

hea l th services , ai; univers i t ies i n countries with experience i n such

matters.

A t the end of 1959 Representatives from the Eestern Mediterranean and

other WHO Regions would be ~neeting in Alexandria during a WHO-sponsored

course on National Health and Manpower Planning, where they would benefi t

by an exchange of experiences on common problems. Every e f f o r t must be

made t o consolidate heal th programmes and t o exchange technicians, experts,

l ec turers and research workers w i t h countries whose problems were similar.

Such exchanges would be more useflil i f carried out between the f acu l t i e s

of medicine i n the Region whose professors could beneficial ly exchange

references, researches and lectures , and could carry out p i l o t and demonstra-

t i o n projects on mutual problems.

The National Charter established by President Nasser s e t out the policy

t o be pursued, namely prosperity f o r a l l , which required co-operation among

peoples. !l'hat policy was a l so a contribution t o peace. The UAR was ready

t o co-operate with a l l the countries of the world thr3ugh the United Nations

and primarily WHO.

Now s t a r t i n g on the third five-year plan for economic and soc ia l

development, h i s c o u n t ~ j would continue 00-operating closely with WHO and

benefit ing from i t s various available resources, After the horizontal

expansion i n services , more v e r t i c a l expansion was needed. The f i r s t s teps

i n expanding the specialized services had been taken and were now being

developed i n , f o r instance, hear t surgery, rehabi l i ta t ion, speech and hearing

defects and screening and treatment of cancerous diseases. Modern methods

such a s cobalt and X-ray treatment were being used i n co-operation w i t h

EM/RClg.l/Ejtin. 1 page 18

Universities and medical services. Mcntal and psychiatric! scrvices have

also been develoued a116 modernized.

Tile Sub-committee wmld be discussing vital issues and he hoped the

results of these discussions woul?. be most fruitful.

He again welcorned Represen-katives end expresses his ~Lhancs to the

staff of the Regional Office. He a l s ~ paid special tributc -Lo the work

done by Dr. Taba, the Regional Director.

6 . ADDRESS BY PROFESSOR R3DULLP.H OPVR, Representative of Afghanis%an (Vice-Chairman)

Professor ABL)WH OKp.Fl said he was deeply movfd by the Sub-Committee's

expression of confidence in h i m , and consequently in his country, in

electing him Vice-chairman. He hoped that Afghaniscari's new links with

the countries of the Eastern Mediterranean Region would benefit al!. &be

countries of that Region.

Afghanistan was a lanclocked, inountainous country covering 657 500

square '.ilometres, with 16 million :'ik~bitants. It was divided from

north-east to south-west by the Hindu Kush Range. Its capital, Kabul,

was at an altitude of 1 800 metres.

It had a healthy climate, vras proud of i-ts his-tory ?.nd traditions of

freedom, was on good terms with i-ts neighbours and bcionged to no politically-

backed organization. It was a Moslci; country with hospitable traditions,

enthusiastic for the progress and deve!.opment of its people.

It had greatly benefited by its twenty-two years mecqbership of WHO

and he hoped -that the changeaver from the South-East ilsian to the Eastern

Mediterranean Region woul6be profitable to all concerned.

7. ADOFTION OF THE AGENDA: Item 3 o f , the Provisional Agenda (Document EM/RClg/l/Rev. 1)

The CHAIRMMT invi ted comments on the provisional agenda.

There were none.

Decision: The Provisional Agencia was adopted.

8. HOUAS OF

The REGIONAL DIRECTOR s ta ted t h a t it was customary fo r the Sub-Cormnittee

t o meet from 9.00 a.m. t o 1.3 p.m. and suggested tha t the Representatives

might wish t o follow the same hours of work.

It was so agreed.

9. ELECTION OF THE CHAIRMAN OF THE TECHNICAL DISCUSSIONS

The CHNFNAN invi ted nominatio~s f o r the off ice of 'the Chairman of

the Technical Discussions.

Dr. VASSIMFWIS ( ~ ~ ~ m s ) proposed D r . Mahmoud I b r a h i m ( ~ r a q ) .

Decision: D r . Mahmoud Ibrahim ( I rad was unanimously elected Chairman

of the Technical Discussions.

10. APPOINTMENT OF THE SUB-DMSION ON PFiWFANbE: Item ': of the Agenda

The RGGIONAL DIRECTOR proposed thet, a s i n previous sessions, the Sub-

Division on Programme should be composed of the Sub-committee a s a whole and

should, if the Sub-Committee so agreed, deal with agenda iteins 9 and 10.

I t was so agreed.

11. PRmm OF WORK

The REGIONALDIRECTOR proposed that the d is t r ibu t ion of work of the Sub-

C o d t t e e should be as follows: Wednesday would be reserved f o r the Sub-Division

on Programme, Thurs@ay f o r Technical Discussions and the remaining items would

be dea l t with on the days of Monday, Tuesday and Friday, i f necessary.

It was so agrsed.

12. i"W.IL REPORT OF TfE RZIO>IAL DIRECTOFi TO THE N I l ' m SESSION OF THE REGIONAL COMMITTEE: STATEMENTS ME REPORTS BY REPRESENTt,TIVES OF EMBER STATES - Item 5 of the Agenda (Document ~M/Rc19/2)

D r . TABI, Regional Direc-tor, sa id th.t the Annual Report covered WHO'S

work f o r the l a s t s i x months of 1968 and the f i r s t s i x months of 19@.

No mention appeared i n the Report of P,fghanistanfs a c t i v i t i e s a s the

l a t t e r had joined a f t e r comple~ion of the Report. A s was known, thc

decision tha t Afghanistan shouid join the Eastern Mediberranean Region had

been ta!:en a t the Twenty-second Korld Health Assembly i n Boston i n Ju ly 1969

a t the request of the Government of Afghanistan. He welcomed the new Member

and loolced forward t o close co-operation with it within the fanlily of EMR.

.2s the 19% meeting coincided with the twentiezh anniversary of the

Regional Office, the Introduction not only mentioned developments over the

past twelve months, but a l so contained a reference t o i t s ovzral l ddvelopment

during the past twenty years.

The General Review con-cained an account of the main a c t i v i t i e s and technical

and administrative developments. The l a s t par t l i s t e d the projects of the

various countries, and a t the end a l ist of agreements signed by Governments

during the twelve-month period would be found.

EMRO had developed a great deal since 1949. It had then had twelve

members and today it had twenty-two. The presence of Dhe ~ e ~ r e s e n t a t i v e s w a s

very useful t o himself and h i s collaborators t o exchange views-on the

programmes i n operation, as well a s programmes they intended t o plan, o r

joint ly plan, f o r the future. During t h i s period over 600 projects had been

iaunched with WHO assistance. A t present there were 102 i n operation and

119 a% the act ive planning stage. The needs of t h s various countries varied

with developmeni; fac tors and the geographical s i tua t ion , and WHO assistance

EM/RCl9G/Kin. 1 page 21

was e;:panui~?g accordingly. Rapid zconornic and soc ia l development was.

common t o a l l thc coli?%rles i n thccFe&ton, Alr:o, t he Ficgion had one of the

f a s t e s t ra-tes of growth iil thc world. .'nother fac tor wSch was general i n

the Region, and explosive i n some cou.ntries; ivas ;he r i s ing b i r t h r a t e , t o

which -the Gcverments were attaching a l o t of importance.

F l e x i b i l i t j was needer.1 i n programcie p l ann in~ . The Sub-Committee would

be discussinz the 1971 progrz::!mc ar.d allowance wouid have t o bc made f o r

possiblc readjv.stm~nts necessary hz.kween now and then. Nat,ional hea i th

plans were n helpful fac tor . Sor,!e ccuntries had alrea6.y in s t i t u t ed such

programmes and o-thers were prepari~lg t o 60 so. It was e s sen t i a l t o es tab l i sh

a national policy on p r io r i t i e s . I n par t icu la r it was necessary '60 conslder

the expansion of hea l th services , mainly i n rural areas, and ava i l ab i l i t y

of resources. The aim was t o iaprove the eff ic iency of both general and

spec-ialized heal th services. Evaluation was of great importance, as was

readjustment on the bas i s of findings which took account of how the plan

had worked. and what were the f r e sh needs. Health deve:.opment must be integrated

i n t o the country's overal l development plan, a s heal th and soc ia l and economic

development were interdependent. There cpuld be no soc ia l and economic

development i f mortali ty and morbidity r a t e s were high, nor could there be

heal th development uniess the necessary funds were forthcoming.

A general problem i n tfie Regioii, varying i n extent 'from one country t o

anoAher, was the deficiency of hea l th manpower: medical, 'professional and

aGi1iai-y. m e education and. t ra in ing of hea i th personnel 'Was thus con5ideredi

a p r i o r i t y , and accorclingly a special emphasis was placed i n recent years on

heal-th-mangower t ra in ing projects , e i t he r d i r ec t ly or indirectly. Over f i f t y

per cent df a l l funds were being devoted t o the educa-tior. a d . t ra in ing of hea i th

personnel. .?lthough the budget f igure f o r education and t ra in ing was oilly

t h i r t y per cen t , many prc jec t s include< ail education ancl t ra in ing component

such a s nursing sohmfs, sad* wneerl--,-faculties,--etc. , as w e l l as-~

seminars and t r a in ing courses which figured under the various d i sc ip l ines

concerned.

EM/RC19PL/fVlin. 1 page 22

Medical education was of pri,nerg i:nportance. I n i?i!$ there had been

twelve medical s c h o ~ l s i n t%c Region, vinile Loda:,~ !;here were thir ty-eight ,

not t o mention the two exisking i n Afghan;.sLan, b r i n ~ i n g :;;he fig;.re -GO 40.

WHO was a s s i s t i ng with the ectabl ishrsxt of nediczl schools i n Jordan,

Saudi Fzabia, Libya an? Kuwait, the l a t t e r two being; in th.2 ~ c - t i v e scagc of

estab1ish~e:l t .

Over the same p e ~ i o d the ilm?ber of Pharmacy S c h ~ o l r !led increased from

s i x t o eighteen; nursing schocls fro(? ten t o l i 4 , i::~lu<ing sir: a t University

leve l ; den t i s t ry schools from four l o eleven an6 schools of sani tary engineering

from two t o seven.

While the s i tua t ion with regard i-o physicians was be t t e r than i ~ c had

been t en years ago, there were s t i l l f a r toc few. On an average, there was

one physician t o 4 500 people. There was a lso a maldis-tribution of physicians.

Everywhere c i t i e s were be t t e r serve6 -than r u r a l areas , and there were vast

areas of the Region with no medical coverage - not even by auxi l iar ies .

I f there was t o bc on2 nezical sch2ol per two t o three mill ion population,

another s ix ty would have t o be s e t up. Allowing f o r the population increase - it was expected t h a t the.populntion would have doubled by the tu rn of the

century - another 160 would he needed. The problzn with regard t o paramedical

personnel, including nurses, waseven (:.ore serious. The programae showed -that

WHO was as s i s t i ng t ra in ing p r o p a ~ m e s f o r nurses i n a h o s t every country i n the

.?agh, The h r t a g e of nurses v m s e- en g rea t e r than that of doctors, and the

l eve l of W3Qassistance h a d t o be varied t o meet the needs and requests of

governments. The programme shaged c lear ly the Importance of auxi.liary$ersonnel

which could provide e s sen t i a l services until>.qualified physicians could take over. . .

WHO ass is tance, aiming a.t stren~&hening medical schools i n the countries,

was vi- ta l f o r the t ra in ing of t h e i r own nationals andthose from countries

possessing no meQjcal gchools. This type of a s s i s tmce was extended not only

t o medical schools, but a l so covered schools of public heal th , schools of

den t i s t ry , pharmacy, sarxi.Sary cngincering, rimsing a^dschools of veterinary

public healA&. O f the 275 WHO f i e l d s taff i n the Region during 1968 (which

excluded Afghanistan), 110 rrere attached t o teaching ins t i tu t ions . I n 1968

WHO had a l so provided 72 fellowships t o allow teachers t o go abroad fo r

fur ther promotion of t h e i r knovricdp.

Siace l a s t year an exchangc programme f o r members of medical facul t ies

and i n s t i t u t e s of public hca l th i n he Region had been i n existence, and

courses i n medical teaching, as well as seminars and symposia, were being

sponsored. They were of the g r e a t e s ~ assistance i n allowing an exchange

of views on comon problems an6 any adjustment of curr icula as required.

The considerable supplies and. equipmen.t provided f o r medical schosls

inciuded not only a great deal of laboratory equipment, l i t e r a t u r e and t e x t

books, but a l so audio-visual equipment fo r renovation of teaching. I n view

of the dear-th of teaching s t a f f , the l a t t e r was of great importance.

Iil addition t o the assistance provided under the FEIO budget, Governments

could make use of the Revolving -Fund. According t o an.lssembly Resolution

passed four years ago, WHO could purchase teaching a d laboratory equipment

i n hard currency t1rou;h the Revolving Fund and the countries concerned could

pay back i n t h e i r own loca l currency.

He then referred t o tho meeting held I n IChartoum i n December a t which

the Daans of Medical Schools had, a f t e r discussing general Oeaching and

student problems, decided t o s e t up an association of medical schools fo r the

Middle :Zast. It was a l so proposed. t o es tabl ish an association of schools of 1

public hea l th i n ths SoothMEast Astan, African, Eastorn Mediterranean and

Western Pacific Regions. Therc was t o be a meeting i n Alexandria i n the

coming week of the Deans of Schools o fPub l i c Heal-'& of those four Regions

t o discuss ways and meens of promoting teaching of Public Health and various

problems involved. It was believed t h a t active steps woul6 be talien i n the

estblishment of the association during this meeting, whish would a l so be

attended b;r observers from the t.sssciations of Public Health Schools i n Europe

and liorA& and South America.

EM/RC19Afin. 1 page 24

He then drew the Represen~tatives' atten.tion t o 'ihc vast increase i n

the number .of fellowship awards. From 1949 t o 1953 only ninety fellowships

had been awarded, whereas 493 had been awaruea i n 1968 alone. There were

a l so ninetjr undergraduates s tudgiw n WHO fellowships who would be returning

-to t h e i r OIW country where 110 medical. schools existed. Altoge-ther d u r i n ~ the

twenty previous years, 4 416 fellowships had. been awarded.

The f igure of 1.5 mill ion do l la rs spent l a s t year on fellowships showed

the importance of thzt work and -the amount of budget funds i t required.

There must be no wastage of fellowship funds and, 50 prevci~t 'chat, once every

two years an evaluation of the programme was carr ied,out a t the Regional Office or,

a l te rna t ive ly , a consultant was scn; t o two or three countries t o ineet the ex-

fellows, see how they were being u t i l i zed and a l so syddgr the whole fellowship

prograrmne i n general.

Wherever possible, candidates should be enabled t o study within the

regions with problems similar t o those ex is t ing i n t h e i r own country. That

would a l so help t o ensure thakcan6idates returned home. Occasionally, even

WHO fell.owship holders f a i l s 6 t o do so end tha t could crea-be problems.

The important problem of non-rfturn and the lo s s of brainpower and

s c i e n t i f i c workers t o the outside world could a lso be obviated i f Governments

provided be t t e r f a c i l i t i e s i n t h e i r own country fur criiployment and research,

a s well a s in~provement of sa la r ies , and employment conditions. The poss ib i l i ty

of granting WHd fellowships 'GO undergraduates studying i n h r i r own countrf

was a l so being considered. I f e fellow i n a country !where distances were

grea-t - a s , f o r instance, i n Pakistan - f e l t t h a t f a c i l i t i e s existed i n a

dis-cant area of his own country, WHO might possibly a s s i s t w i t h a fellowship,

and such arrangements would hel~p i n not dis locat ing the individuals from t h e i r

enviro-nmcnt. However, the prac t ica l applice-tion of any such scheme would need

very serious consideration.

The trend i n the Regioil w a s f o r communicabtc diseases control o r

eradication projccts -to +a'& up a snlaller par t of the budget. Onc of che

reasons was t h a t originaLly Ib,,J0 h a i r~rganized Cemonstrati on :ind t rz in ing

pro joctLs which had now been talcen over bg the governmer.:,~. A s a resul.t,

more -- ad hoc short-term he3.p v ~ r . ~ b2ir:g given t c countries, ?a-ther than l w

term assistance. Ano~bher rcason :*~as t ha t there had been much s c i e n t i f i c

progress i n the diagnosis, treatiner~t and preventio:~ of comi;liunicable di-seases;

new immunological techniques hzc! been developed, thrx-2 haci been advances i n

biochemistry and microbiology, and. great progress i n trcatr?eilt through chemo-

therapeutic agents and an t ib io t ics . Health laboratories were much b e t t e r

developed, apthou& there was s t i l l considerable roo:^; f o r improvement i n

the l a b o r a t o ~ ~ i c s cf the Region, a s well as i n heal th s t a t i s t i c s ; most countries

were weak i n both those areas. I n sp i t e of the general improvement, endemic

and even quarantinable diseases were prevalen-t i n the Region and epidemics

could ar@ did occur. Assistance i n the control znd eradication of communicable

diseases was therefore s t i l l an important par t of WHO'S work and would continue

t o be so f o r years t o come. Before -the s i tua t ion could he improved, the heal-kh

services would. have t o be extended and there would need t o be a be t t e r

coverage of the population, especially i n r u r a l areas , a~icl more vigorous

i~muniza t ion campaigns. Many mass campaigns were i n progress i n the Region

with WO assis tance, the smallpox eradication campaigns being mentioned ic

d e t a i l i n the Report. I n r e l a t i on t o malaria ~ r a d i c a t i o n , the Twenty-second

World Hoa1:ch Assembly had coi1fir:cli.d WHO'S global s i ; ra . tca on malaria

eraclica~tioii, assigned it top p r i o r i t y , and authorized WHO t o a s s i s t ceuntries

i n malaria control where no eradicaiion campaigns were feasible . It-had

also o m m r r o d tho importance of integratfng the malaria

eradication services with the general r u r z l peripheral heal th services as

soon a s condi-tions permitted. Malaria eradication s t i l l constctuted a s izable

pa r t of the Regional o f f i ce ' s bu&get. The combination of tuberculosis and. ' ~

smallpox campaigns was not tcchnicaily ob jcc t ionabl~ ; i f well planned, it would . ~

save money and manpower, provided tha t the a&irLstr?.tivc and technical

f e a s i b i l i t y of in tegra t ion i s studied and found suitable.

EM/RC19A/NAn. 1 page 26

??be grolsth of the populo-kiln was a probloni of the ; ~ c i o t e s t urgency i n

sons coun-hies an!d i n ?,he !.ong run it wou16. become a problem i n a l l ~Lh,.:

countries ol' the Region. It brougkl. :.rith it problems cf a11 k i i l d ~ . I n

nu-tritiion, fo r example , the R:.~icn a1reaci:r had riot c!lou~h f ooc'. produc-iion

f o r an-.adequate and wcll-baknoed d i e t . Though food p~oduuction had inereased,

it w2.s outpaced -by popu.lation growbh. ?.'I?.lrn*trition i.:as prevalent and. i t was

estimated t h c i alnost 5C ncr cent ;f deaths .:.n clli:.drcr. wer- a i r c c t l y or

i n d i ~ e c t l ~ r di.e t o it. Thz Sc.,?inar hc:.d earl;. in lgbg ::n b;eanins Problems

had proved very useful i n b l - i n ~ i n ~ ; h b of nuLrili:m t o the a t ten t ion

of the countries i n ~ h e Rcaon. Eolnc countries, inclut!ing Zthiopia, had

developed a cheap and wcll-balanced viianing fooZ. Algcrie ( i n EURO) had done

the same *hing and. WHO was helping other :07atr ies i n this Regioi? i n the same

f i e ld . WHO odvioe was a l so being given i n r e l a t i on -Lo food storage, since

defective food storage led t o heavy losses of v i t a l foods; consultants were

being sent -to countries t c advise:on improvement of storage f a c i l i t i e s .

Nutri t ion i n s t i t u t e s were being helped i.n relatio:: t o the 1y0i"k they were

doing and. i n training.

The rapid development 01" the countries of the Region inevitably brcught

growing pains and problems. Intus.?rialization and urbc,'ization led t o over-

crowding, t r a f f i c accident?.; er17rirolli?ental pol lut ion, and disturbances of

soc ia l l i f e . The greal,cr l i f e ex~eotnne;. led t c chronic degenerztive diseases

and t o psychiatric ~?roblet?s. A l i those factors werc ref lected i n thc

prograrmes of the Region, ~ n 6 ~hereforc f lexibLli ty w c s nccdec..

Apart from b i l a t e r a l a id , which was obi7iously vaiuable, coun-cries could

obtain resources frnm'dH0 2nd oLther members of thi. United N,?t&qns: f+mi,l.x such

a s FAO, ILO and UNESCO. UNICEF gave assistarlce d i rec t ly by :zroviding

supplies a.nd equipment, and helped tvi-th training projects. -b,LHO was a l so

giving greater assistance with supplies andyequipment; i n 1968 it had

providcd 13 916 items t o the value of abou-t US $ 1 500 000, some of which

came from our own budget (both rcgu!.ar and TA) and somc from the WHO Revolving

Fund, which was mentioned ea r l i e r . An important for;il of ass i s tance was

l i t e racure fo r the various kinds of medical and paramedical educational

ins t i tu t ions . WHO zlso supp l~ed laboratory equipmenz and various forms

of vaccine. By 1 October 1959, the provision f o r supplies and equipment

had already exceeded t h a t f o r 1958.

Other available sources of a i r e c t assistance f o r health purposes were

funds from W P and the Special Fund component- of UNDP. The al locat ions t o

countries from the WDP were based on projects formula",^ within the countries

themselves, and i f the health au~i;hurities were welL represented i n the

conmitteGpreparing the overal l country projects the allocations f o r health.

purposes should not be going down, as they appeared t o be doing. Since the

inception of the Special Fund, more than US $ 900 inillion had been disbursed,

but the amount given for health had only been US $ 23 million, i.e. l e s s

than 21/2 per cent. The need t o help countries formula-te t h e i r requests

f o r assistance from UNDP and the Special Fund had led t o the decision t o

appoint an adviser i n the Regional Office for that purpose. Special Fund

contribu-tions had i n the past been made f o r productive programmes on a large

sea$ and had t o be matched by governments. Now, however, more l a t i t ude had

been allowed and such heal th programmes as t ra in ing prograrmnes qualified

f o r assistance. An example was the I n s t i t u t e of Health Manpower i n Southern

Yernen, and public heal th i n s t i t u t e s and the l i ke , and even some communicable

diseases pro jec-ts, were now acceptable. It was essent ia l that requests

should be well formulated, and the Regional Office would be glad t o help any

countries t h a t wanted assistance fo r t ha t purpose.

Another important source of funds to countries i n the Region was the

World Food Programme, which provided food f o r MCH centres, hospi ta ls , schools,

workers i n mass campaigns, resettlement projects and raining ins t i tu t ions .

The provision of food led t o a saving of government money wi-Lch could be

u t i l i z e d i,r the construction of hcspi ta ls , special projects , or be t t e r

s taff ing. The World Fgod Progmune also gave assistance i n such emergencies

a s droughts, floods , earthquaces, e t c .

EM/RClgA/Mln. 1 page 28

I n conclusion, the achievement of WRO i n the Region was d.ue t o the

excellent collaboration of the governmen-is, which was indeed t h e mosl;

important fac tor of a l l . Hz wculd be very grateful f o r the views of the

delegations on the Annual R?pcrt.

D r . YACOUB (Bahrain) nsted t h a t his country had not beenmentioned i n

the Report although it had ?laye& an act ive par t i n 1;HO concerns since it

had joimd :,HO as an iissociat; M.;-iiber.

D r . VASSILOPOULOS (Cyprus) congratuj-ated the Chairman and the Vice-

Chairmen on t h e i r e lec t ion and e x ~ r z s s e d h i s thanks f o r t h ~ cordial

reception given by the United Arab Republic t o the mc~~bers of the Regional

Commitice. The remarkable report of the RegLonal Dirsc-tor contained a wealth

of valuable information of -the grea tss t i n t e r e s t t o tine hea l th au thor i t i zs

of a l l the countries of the Region, and it waul.?: play a considerable pa r t i n

shaping t h e i r heal th polici;.s. I n his d~el.,zgation's view, education and

t ra in ing should b e a top p r io r i t y and should. be re-progra~rmed t o s u i t loca l

conditions, and hea l th planning should be integrated wi-kh economic and soc ia l

planning. He congratulated the Regional Director and his collaborat?rs *n

good work and unt i r ing e f f o r t s i n the prevention of air-case and the promotion

of heal th i n the Region.

D r . AEDUL (Saudi Arabia) a lso congratulated the Chairman and the

Vicc-Chai~men on t h e i r e lect ion and welcomed the delegation of Afghanistan.

He complimented the Organization, through -the Regional Director and h i s

coll2"bora-tors, fo r &he go&. e f fo r t s i n favour of the Begion. H i s country had

heal-th problems and require]-lent3 - tb . t were very similar t o h o s e of oJhcr

countries i n the Region, and it had had considerable si;ccess i n overco;~ing

them, thanl:s t o VjWO assistance. It had fur ther heal th prcjects i n ,nind, which

he would discuss with -the Regional Director.

D r . KUSHKUSH (Sudan) associated himself r ~ t h previous ~ p e a k e r s i n

congratulating the Chairrmai-i an6 the Vice-Chairmen on t h e i r e lec t ion and s t ressed

the close bonds of friendship bctwcer~ his country an2 the United Arab Republic.

The Regional Director ' s Report indiea.ted the dynamic progress WHO was making

and he recal led with pleasure t h a t his country had of ten been a beneficiary of

WHO assistance. A recent s i w f i c e n t advance had been the appointment of a

WX6 Representative t o Sudan, who would help i n the administration and co-

ordination of projects.

The Health services of his country were being reorganized, beginning with

the Ministry of Health, i n which emphasis w a s being placcd on public health

and soc ia l medicine. Health administration was being decentralized, the

country being divided i n t o s i x regioris, each w i t h a d i rec tor and qualified

s t a f f . A special development pro&ran3e was being organized fo r the southern

areas. Post-paduate studies were bcing developed. Basic hea l th services were

being established i n the ru ra l arcss , with multiple functions. Medical facul t ies

were being doubled, the medlcal student entry being 110 as against 50 i n

prevlous years. He hoped that assistance would be forthcoming from WHO and

other sources i n his country's reorganization plans.

He concluded by welcoming Afghanistan t o the Eastern Mediterranean Region.

Dr . JAJLOUL (Lebanon) extended his congratulations t o the Chairman and t o

the Vice-Chairmen on t h e i r e lect ion aM3 welcomed the delegation of Afghanistan.

Like previous speakers, he appreciated the work of the Regional Office, which

provided tangible services t o heal th i n accordance with the needs of the countries

of the Region. What w a s most needed was technically qualified s t a f f and com-

prehensive planning. Close co-operation with 'WO would help the countries of the

Region t o solve t h e i r problems an? t o reach the hea l th standards of the developed

countries.

Brigadier HASAN (Pakistan) associated himself with the congratulations ex-

pressed by previous speakers and with the thanks t o the Government of the United

Arab Republic. The Emual Report 3f the Regional Director was a comprehensive

and elaborate document indicating t h a t the heal th in te rez ts of the countries of

the Region were being well looked af te r .

Some points i n the Report re la t ing t o Pakistan deserved a l i t t l e explanation.

I n connection with fellowships, Pakistan had not been able t o u t i l i z e a l l those

offered t o it because there had not been enough sui table candidates. The reason

f o r that had been that doctors had been reluctant t o specialize i n public health.

The posit ion, however, was now changing because of recent improvements i n the pay

and conditions of the ?ublic heal th service and because of the r e l a t ive saturat ion

of c l i n i c a l pract ice i n the urban areas. H i s country would be glad t o be associated

with the evaluation of fellowships referred t o by the Regional Director.

With regard t o thc malaLqia eradica'don programr;c, prohlems haa a r i sen

i n the maintenarai: ph?.~: heceuc? of th'? inadequacy of chc her;lLh infras t ructure .

Normally surveillance was taken ovir by the basic hcal ih services , but as

they were insuf f ic ien t two s.;lutions had been atseilpicd. O x , t r i e d out i n

East Pakistan, involved a w i l o i pre-maii~tcnanci phase i n uihicll sev i ra l sub-

sectors were placed undcr supzrvisors vjho visiteci fevzr-repor.:ing posts manned

by voluntary workers. The o-ihcr, i n West Pakistan, in-~r,lve6. in tegrat ion with

a smallpox vaccination cafilpaign an6 aontnly house-to-house inspection. The

r e s u l t s had been encouraging and the Govcrmeilt was wor::ing out plans f o r

extending 'he scheme. A large number of malaria erac.ication workers were

being employed.

With regard t o smallpox crad.lcation, he wished ?tc the;d< WHO f o r i - ts

valuable technical advice and f o r the s~!pplies an6 t:quipment it had provided.

Legislation had been introduced i n t he country makiilg the re fusa l of

vaccinaLicn a punishable offence.

I n r e l a t i on t o eye diszases, a iiationa? society ha$. been established for

the prcven-tion and treatmen-'; c;f blindness. Free crc Cai!?pS and nobile eye

un i t s had been ffitablished, especially near Iiaracki . D r . WW2GDI (United Arab Repub:.ic) extcnSed h i s congratulations -to tha

Chairman and. -the Vice-Chairmen and welcomed the delega-Lion of :;fghanistan.

The Annual Report of the Regional Director was excellent. The t ra in ing

progrmilcs had had great inportance on the t ra in in3 of nurses i n h i s country.

It was hoped t o establisk 3. course for the t ra in ing of the teaching s t a f f , with

the help of WHO ai:d UhTCEF. The United Arab Republic had. an important

program;le f o r ru ra l improvemen'; i n heal+h, inc'ucling den~kal hea l th , and he

hoped t h a t Ul\TCEF would ccxtinue to c s s i s t -the r u r a l heal-th un-ts. The

book "Man and Medicine i n Kiddle East" had been of p e a t value i n

disseminating heal th awarencss. As a basis f o r the p l m l i n g and evaluation

of the hea1t.n services, 11lH0 could help by providing experts iil environmental

h e a l t h , h-al th s t a t i s t i c s ani the l i k e , a s well. as the equipment n5eded. He

hoped t h a t the idea of an i n s t i t u t e of heal th s t a t i s t i c s i n e i the r the

United Arab Republic or elsewhere i n the Region would come t o f ru i t ion . The

def ini t ion of s t a t i s t i c a l terms needed t o be standardized and d f o r m i t y

i n s t a t i s t i c s introduced.

His country furnished an expample of what could be done i n heal th

administration. It had decentralized the healzh departments i n a l l c i t i e s

and towns, made the hospi ta l boards autonomous, based budgeting on performance

rather than on items, and established heal th :aboraLaries f o r diagnosis and

prevention i n a l l governorates covering spec ia l t ies i n a l l f ic lds . It had

provided 150 scholarships fo r study t o enable the labora-tories t o be s taffed

as quickly a s possible.

He par t icu lar ly wished t o thank the Regional Director fo r the effect ive

assistance t o the Regional Virology Training Progrmi~?e conducted during the

year, and hoped t h a t such programmes would be repeated and expanded.

The REGIONAL DIRECTOR sta-ted tha t he vdshed t o reply t o the statement

by the Representative of Bahrain before the adJournment of the meeting. He

said tha t Bahrain had, i n f ac t , been mentioned on pages 28 and 33, i n the

graphs de ta i l ing the s t a tus of fellov~ships and development of malaria

eradication. There had not beer. any mention i n the project l i s t annexed

t o the report i n view of the f a c t t h a t the list onig covered long-term projec'ts.

Since Bahrain had joined WO a s Asssciate Member i n 1968, assistance had been

provided i n the form of ad hoe short--tern consultants a s r e q a r e d , or through

v i s i t s by Regional Advisers. Such assistance was not Listed individually.

The meeting rose a t 1.30 p.m.