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W O R L D H E A L T H
O R G A N I Z A T I O N
O R C A N I S A T I O N M O N D I A L E
DE L A S A N T ~
REGIONAL OFFICE FOR THE , , BUREAU REGIONAL DE LA
EASTERN MEDITERRANEAN - MEDITERRAN~E ORIENTALE -
REGIONAL c m m FOR 'ME EASTERN MEDITERRANEAN
Twenty-fourth Session
smc-rn A
MINm OF THE FIRST MEETING
@l/Rc24A/hin. 1 10 September 1974
ENGLISH ONIX
Held a t the WHO Regional Office f o r the Eastern Mediterranean,
Alexandria, E m
on Tuesday, 10 September 1974 a t 9.30 a.m.
Chairman: H.E. D r H.Morshed (1ran)
Later : Dr A.K. Mazen (Egypt)
Opening of the Session
Election of the Officers
Inaugural address by the Regional Director
Adoption of the Agenda
Appointment of the Sub-Division on Programme
Organization of Work - Annual Report of the Regional Director t o the Twenty-fourth Session of the Regional Committee
Page
Statements and reports by Representatives of Member States
Reoresentatives of Member States
Government
AFGHANISTAN
CYPRUS
EGYPT
FRANCE
lRAN
IRAQ
JORDAN
Representative, Alternate or Adviser
Professor Mohammed Ibrahim Azeem D r Raouf Roashan
D r Ibrahim 'Yacoob M r Zuhur E l Hassan
M r S o t i r i s El l inas
Dr Mmed Kame1 Mazen I)r E l Muataz Bil lah bbbarak D r Ahmed Fayed D r Abdel Moneim Mohamed A l i Dr Ahmed Mohamed E l Akkad D r Wafik Ashraf Hassouna I 2 Amin E l Gamal Dr Ali ~ S S O U ~
Mrs mataza Nazif
D r M. Charpin
Dr Abdul Wadood Al-mft i
Dr Tawf'ik Karadsheh i)r Ahmad Massadeh
Dr Abdullah Al-Rifai
Dr El ias Hayek iW Mahmoud Hallab
Dr Abdul Majid Abdul-Hadi Ivh- Mohamed Ibrahim El Khatib
Representatives of Member S ta tes (cont 'd)
Government
OMAN
Representative, Alternate or Adviser
D r Murthada Jaf f e r Sulieman &.Riffat Mahmood
PAKISTAN Brigadier L A . Chowdhry
QATAR
SAUDI m m
SOMALIA
SUDAN
SYRIA
llNDXD ARAB EMDUTES
YEm
World Health Organization
Secretary t o the Sub-Comittee (ex-of f ic io)
H.E. Sayed Khaled Mohammad A 1 Maneh D r Abdulla Abdul Rahman A 1 Bakr M r Mohamed Ghulum A 1 Fein D r Sayed A. Tajeldin
D r Hashem Abdel-Ghaf f ar Dr Ahrned E l Tabba'a
Dr Abbas Mukhtar
Dr Mustafa Baath D r M.A. El-Yafi
D r A,R, Farah Mtne J a l i l a Daghfous
Dr Juma B i l a l Fairouz
D r Mohamed Kaid El-Aghbari I%- Mohamed Hatem El-Khawi
Dr A.H. Taba, Regional Director
Representatives of United Nations Organizations
U N m NATIONS DEVELOPMENT M r Hatsuya Azumi PROCRAMME (UNDP)
UNITED NATIONS CHILDREN'S Mr Rachid Koleilat w (UNICEF) M r Y.G.Lee
lk Assadi Baiki
UNITED NATIONS RELEF AND Dr M. Sharif WORKS AGENCY FOR PALESTINE RFFUGEES (UNRWA)
Representatives and Observers of Inter-Governmental, International Non-Governmental and National Organizations
LEAGUE OF ARAB STATES D r Geith El-Zerifly
ORGANIZATION OF AFRICAN Mr Mamadou Diarra UNITY (OAU)
3NIERNATIONAL UNION OF Dr Hassan Abdine Tawfik PURE AND APPLIED CHEMISTRY
INTERNATIONAL DENTAL FEDERATION
INTERNATIONAL FEDERATION OF Professor A l i M. rvPLkhlouf GYNECOLOGY AND OBSmICS
INTERNATIONAL UNION FOR Dr 1,Missak Wassef HEALTH EDUCATION
WORLD FEDERATION OF HEMOPHILIA
D r Buthaina &El Shinnawi
lNERNATIONAL HOSPITAL D r Y.S. Raafat FEDERATION
Representatives and Observers of Inter-Governmental, Internationsl Non-Governmental and National Organizations (cont 'd)
WORLD MEDICAL ASSOCIATION Professor ASH, Mousa
WORLD FEDERATION W MEDICAL Dr M. Gamal E l Din Massoud EDUCATION
lNTBNATIONAL CO- OF Brigadier Dr bhamed R i a . El-Gibali MILITARY MEDICINE Am PHARMACY
INTERNATIONALCOUNCILOF NURSES hks Aida Kabil
LEAGUE OF RED CROSS SCCmIES D r Y.S.Raafat
INTERNATIONAL FEDERATION OF I2 N. Paparescos SPaRTS MEDICINE
JXIERNATIONAL ORGANIZATION Dr Mohammad Mohyi-El-Din Said AGAINST TRACHOMA
AMERICAN UNIVE3ISITY OF EEIRUT Lk L. J. Verhoestraete
UNITED STATES NAVAL MEDICAL Dr David Edman HESEARCH UNIT' No. 3 ( N A ~ u )
EGYPTIAN MXDICAL ASSOCIATION Profeseor A.H.Mousa
1. OPZNING O F THE SESSION: Item 1 of the Agenda
D r MORSHED (Iran), Vice-Chairman of Sub-committee A of the Twenty-third
Session, declared Sub-committee A of the Twenty-fourth Session of the Regional
Committee fo r the Eastern Mediterranean open, wishing it every success i n i ts
de l i j e r a t i ons and thanked t he Government of the Arab Republic of Egypt f o r thei r
hosp i ta l i ty . He invi ted Dr Ahrned Kame1 Mazen, F i r s t Under-Secretary of Health,
Ministry of Health, Egypt, t o read an inaugural address on behalf of
H,E. Dr Mahmoud Mohamed Mahfouz, Minister of Public Health of Egypt.
D r MAZEN (Egypt) sa id t h a t the statement he was about t o make had been
prepared personally by D r Mahfouz, Minister of Health of Egypt, who was unfor-
tunate ly unable t o at tend the session due t o compelling du t ies ,
He welcomed the representa t ives to h i s country, which belonged t o a Region 1 I .
r i c h i n human f e a t s and cu l t u r a l accomplishments t h a t had influenced the whole
world. The Region was the s ea t of s p i r i t u a l messages t h a t had radia ted t o
d i f f e r en t p a r t s of the earth, carrying with them a cu l t u r a l heri tage. 1
The Sub-Committee's session coincided with the s i l v e r anniversary of the 1
Regional Office, which had begun i ts a c t i v i t i e s twenty-five years ago with t en
Member Co l~n t r~es . It was gra t i fy ing t h a t those activSt3-es now extended t o
twenty-four Men~ber Sta tes , whose populstion of some 250 mil l ion were linked by
t i e s of blood, hope and suffering. He welcomed the i nv i t a t i on t o the Palest ine
Liberation Organization t o take i ts r i g h t f u l place i n t he meeting and thus
contr ibute t o the heal th development of the Pa les t in ian people.
Looking back a t pas t a c t i v i t i e s , it was c l ea r t h a t the Regional Office had
exerted tremendous e f f o r t s f o r the development of hea l th i n the Region. It
had constantly drawn a t t en t i on t o the need t o focus s t r a t eg i c plans on fur ther
act ion and d e c e n t r e l i ~ a t i o n ~ He expressed h i s g ra t i tude fo r those e f f o r t s and . ' stressed the need f o r countr ies t o co-operate s t i l l futher t o achie+e the
f?egionl s hea l th aims.
It was important t h a t Member S t a t e s unif ied a c t i v i t i e s f o r the hea l th
development of the Region, The preparation of a Regional programme depended
on two fac to rs : the ex i s t ing problems;. and. the p r i o r i t i e s and po ten t ia l f o r
action. The approsch t o hea l th development could then be defined i n r e l a t i o n
t o overal l socioeconomic devel.opment and i n the l i g h t of the in te rna t iona l
p o l i t i c a l s i t ua t i on . A t present there were t a c t i c a l ga.ps, f o r example i n
equipment, hea l t h s t a t i s t i c s and qua l i f i ed manpower. Fortunately the Region's
s p i r i t u a l values had never stood i n the way of development. Moreover,
regiona.1 organizations such as the A r a b League a ~ t r l the Organization of African
Unity h2d exerted a good influence on hea l th development.
The p o l i t i c a l climate prevai l ing since the war of October 1973, which was
now characterized by the search f o r peace based on jus t i ce , would fu r the r
contr ibute t o hea l th development, While s p i r i t u a l values ca l l ed f o r love and
peace, they a l so sa.nctioned the use of force t o r e s t o r e jus t i ce , f o r the re
could be no l i f e without honour.
Egypt was glad t h a t it had been able t o a s s i s t the Regional Office over
the pa s t twenty-five years and would do i ts be s t to contr ibute t o future
a c t i v i t i e s .
I)r MORSIBD ( I ran) , invi ted H.E, Mr Abdel Tawab Hudeib, Governor of'
Alexandria, t o address the Sub-Committee,
MI- HUDEIB extended a. w a r m welcome t o a l l p a r t i c i pan t s on behalf of the
people of Alexandria. The representa t ives w e r e doing t h e i r utmost t o r e l i e v e
the suf fe r ing of mankind i n the Region and Alexandria, an ancient c i t y t h a t
had long stood out a s a beacon of cu l tu re and c iv i l i z a t i on , welcomed the honour.
of ac t ing a s hos t t o the session. He expressed h i s g ra t i tude f o r the various
meetings held by WHO, f o r hea l t h was the ba s i s of l i f e and the theme running
through a.11 the meetings was the need f o r a sound mind i n a sound bodyo
He had no doubt t h a t the Sub-Committee's e f f o r t s would be crowned with
success. He placed the f a c i l i t i e s of the Governorate of Alexandria a t the ser.
vice of therepresenta t ives , and wished them a very pleasant stay.
2 EmCTION OF OFFICERS: Item 2 of t he Agenda
D r MORSHED ran) ca l led f o r nominations f o r Chairman of the Sub-committee.
Speaking as the representa t ive of Iran, he proposed t h a t D r Mazen (Egypt) be
e lected Chairman.
Nr HASAN (Somalia) and Dr ABDZLGHAFFAR (Saudi Arabia) seconded t h a t
proposal.
Decision: I2 Mazen was e lected unanimously,
D r Mazen took the Chair.
The CHAIRMAN, a f t e r thanking the Sub-committee f o r t h e i r confidence i n
h i m , ca l l ed fo r nominations fo r two Vice-Chairmen.
D r YACOOB (Bahrain), seconded by Dr MORSHED (Iran) and Dr ELAGEBAR1 (yemen)
nominated Professor Azeern ( ~ f g h a n i s t a n ) and Dr Hayek (Lebanon).
Decision: Professor Azcem and D r Hayek were e lected unanimously,
The CHAIRMAN cal led f o r nominations f o r the o f f ice of Chairman of the
Sub-Division on Programme.
Dr YACOOB ahra rain), seconded by Dr MUFMWK ( E a p t ) and Dr M[TI(IF-IAR (~udan) ,
nominated D r Abdel-Ghaff ar ( ~ a u d i Arabia).
Decision: D r Abdel-Ghaffar was elected unanimously.
The CHALRMAN ca l led f o r nominations f o r the o f f i c e of Chairman of the
Technical Discussions,
Speaking as the Representative of Egypt, he nominated D r A l - R i f a i (Kuwait),
Dr YACOOB (~ah-tain), D r ELAGR'3ARI (yemen) and M r HASAN (~oma l i a ) seconded
the proposal.
Decision: 3r Al-Rifai was e lected unanimously.
3 . INAUGURAL ADDRESS BY THE RZGIONAL DIRECTOR
Dr TABA, Regional Director, welcomed representa t ives t o the session, which
was being he ld ,a f te r many years, a t the Regional Office. He took t he
opportunity t o thank the Egyptian Government f o r i t s hosp i t a l i t y i n hosting
the Regional Office and f o r the cord ia l r e l a t i o n s t h a t exis ted between the
Regional O f f i c e and the author i t ies .
The Region was important because it contained many of the most challenging
problems now facing the world, It was composed of a very diverse group of
countries. It w a s not simply t h a t some countr ies were r i c h while o thers were
less r i ch , or t h a t some had reached a more advanced s tage of soc i a l and
economic development. Completely new phenomena were appearing; f o r example,
tine wealth of a country was no longer d i r e c t l y r e l a t ed t o i ts l eve l of soc i a l
development. The a b i l i t y of nat ional hea l t h services t o respond t o t h e i r
populations' t r i ~ e needs was as much a problem i n the r i che r a s i n the poorer
countries, However, many hea l th problems were common t o the whole Region, even
thou@;h the so lu t ions might d i f f e r i n each country. I
WHO had a continuing process of assessing i t s achievements and re-examining
the wa.ys i n which it provided ass is tance t o Member S ta tes . While there had
been &reat.successes i n the twenty-five years of the Organization's existence,
t h e problems that remained were g rea te r than those t h a t had been solved.
Basic hea l t h services were s t i l l beyond the reach of a vas t proport icn of the
population i n most countries. I n a s e r i e s of experiments i n var ious p a r t s sf
the world, including the Eastern lvkditerranean Region, WHO was seeking new w ~ s
of developing hea l th systems t h a t would be t r u l y responsive t o the actual needs
of the people. More and more of i ts a c t i v i t i e s were concentrated on tne
design of such hea l th se rv ices and the preparation of the s t a f f t o man t'nem.
E Y @ C ~ ~ A / M I n, 1 page 10
The shortage of' hea l th manpower and its inadequate d i s t r i b u t i o n was common t o
every country of the Region. Furthermore, the majority of those being trained
were not su f f i c i en t l y aware of t h e i r countr ies ' r e d hea l th problems. Doctors,
nurses and other workers continued t o be t ra ined along l i n e s developed long ago
t o meet qu i te d i f f e r e n t needs i n d i f f e r e n t places. Too l i t t l e of the training
took account of e i t he r advances i n educational science o r progress i n the
understanding of how communities changed and grew. Properly designed
education and t r a i n ing of the hea l th workers of the fu tu re was an overriding
p r i o r i t y ,
A s 'a0 strove t o improve the qua l i t y of its programme i n t he Region and
t o provide the ass is tance requested by Governments, he was always conscious
of the c lose r e l a t i o n s between t he Regional Office and the countr ies it served.
There was no question i n t he Region t h a t WHO would ever attempt t o impose ideas
fkom t'ne outside. W e r ea l i zed t h a t t he Organization's work was constantly
being e v a l u a t e d by the countries, and he w a s encouraged by the support it
received, On several occasions each year, a t the World Health Assembly, the
sess ions of the Executive Board and a t the annual meetings i n t he Region, views
were exchanged with every country on,what should be done, when, ard how. I n
between those meetings, he and h i s colleagues v i s i t e d the countr ies t o evaluate
the progress of WHO'S j o in t work with the hea l t h au thor i t i e s , He oherished
t h a t sense of continuing and f r u i t f u l contact, and was g ra t e fu l f o r the support
and encouragement of Member Countries.
It was pa r t i cu l a r l y a.t the Sub-Committee's meeting each year t h a t he
looked forward t o guidance on WHO'S a c t i v i t i e s and t o a de t a i l ed review of
suggestions f o r fu tu re collaboration. He hoped t h a t the sess ion would prove
useful t o the j o in t programme, He w a s sure t h a t t he de l ibe ra t ions would again
inspLre a l l those committed t o improving the hea l t h of a l l the people of t he
E M / R c ~ ~ A / M ~ ~ . 1 page 11
Region.
The meeting adjourned a t 10,lO a.m.
and resumed a t 10.40 a,m.
4. ADOPTION OF THE AGENDA: Item 3 of the Agenda.
The Agenda (~ocument EM/FIC~~A/~ Rev.1) was adopted.
5. APPOINTMEW OF T G SUB-DIVISION ON PROGRAMME: Item 4 of t he Agenda
A t the i nv i t a t i on of the CHAmMAN, the Regional Director proposed t ha t ,
i n accordance wit'n the usual pract ice , the Sub-Division on Programme should
consis t of representa t ives of a l l the delegations at tending the session.
It was s o decided,
6 ORGADjIZATIOI~ OF WORK
Dr TABA, Eiegional Girector, suggested t h a t the Sub-committee should meet
from 9.00 a.m. t o 1.30 p.m. each day, with a shor t coffee break a t about 11.00
a.m. The Sub-Division on Programme might meet on Thursday t o consider agenda
Items 8 and 9, the Technical Discussions being held on Friday, a f t e r which the
closing meeting would take place,
I t was so decided.
7. AIJUAL REPORT OF THE REGIONAL DIRECTOR M THE 'IWENTY-FOURTH SESSION OF THE REGIONAL COMMITTEE: Stem 5 of t h e Agenda. (Document EM/RC24/2)
.Dr TmA, Regional Director, introducing h i s annual r epo r t
(~ocument E P \ / E C ~ ~ / ~ ) , s a id th'at i n the introduction lie had t r i e d t o h igh l igh t
some of the main developments i n the p a s t twenty-five years, as 1974 was the
25th anni.versary of the Regional Office. He found it appropriate t o take
stock of the work done so fm, WHO had recorded considerable achievements
i n the Region desp i te na tu ra l d i s a s t e r s and warfare. The Region was
s t r a t e z i c a l l y placed and many countr ies had had t h e i r ??ogress hampered.
N e v e r t h e L e s s , t h t in ter rupt ion or work nad usuaj-ly beell temporarily. He drew
a t t en t i on t o the i ab l e on page iii of the introduction t o h i s repor t , which
E M / R C ~ ~ A / M ~ ~ . 1 page 12
portrayed i n f lgures the hea l th development of the Region, In 1950 there had
been t e n Member countries; now there were twenty-four. The population had
gone up markedly, even though some of the o r ig ina l countr ies no longer belonged
t o the Region. The budget f o r the Region had r i s e n subs tan t ia l ly , much work
had been devoted t o smallpox atad malaria control. and the number of medical
schools had r i s e n from twelve t o 49. Since the r epo r t was prepared a fu r the r t w schools had been opened bringing the present total t o 51.
He noted t h a t the regional programme f o l b e d the programme l a i d down by the
World Health Assembly f o r t he current five-year period and t h e decis ions of the
Regional Committee. A s he had already said, the re was great d ive r s i t y within
the Region with regard t o geography, t he l e v e l of socioeconomic development
and population. Most countr ies had t h e i r own nat ional hea l t h plans, which were
o f ten well prepared. I n some cases WHO had a s s i s t ed i n preparing hea l t h plans
and i n the t r a i n ing of planners; a j o i n t course f o r t h a t purpose had been held
a t the Schoold of Public Health, Teheran and a t t he High I n s t i t u t e of Public
Health, Alexandria. Fellowships had a l so been awarded f o r personnel t o a.ttend
planning courses outside the Region. WHO would continue t o assist i n t h a t
respect and Minis t r ies of Health should take advantage of qua l i f i ed persons
i n their Univers i t ies and Health Institutes t o assist them in t h e i r planning.
Many cons t ra in t s af fected the development of hea l th services. A l l countr ies
f e l t the l ack of manpower, even where f inanc ia l resources were available.
The Organization w a s a s s i s t i n g countr ies i n the search f o r new approaches,
the formulntion of projects , the evaluation of the ex i s t i ng system 'and the
development of management. For example, it had a s s i s t ed Afghanistan and Sudan
i n country hea l t h programming, ca r r i ed out a management survey of the hea l th
t r a i n ing programmes i n the Yemen Arab Republic and helped the United Arab
Emirates t o prepare its f i r s t comprehensive hea l th plan,
EPlC24A/Min. 1 page 13
In 1973 he had reported on a j o i n t p ro jec t between WHO and the Government
of Iran, i n West Azerbaijan, t o invest igate methods of hea l th care del ivery
through the co-ordination of a l l organizations providing health care, includjng
voluntary bodies. I n October 1973, a seminilr had been held i n Cairo t o d iscuss
the importance of new management techniques i n improving heal th servl.ces.
I n May 1974, the World Healtn Assembly had adopted a reso lu t ion
emphasizing the importance of mass vaccination. He hoped t h a t the programme
in communicable d iseases would be fu r t he r promoted so that a number of preven-
table d iseases could be tackled e f f ec t i ve ly by the countr ies of the Regicn.
It was intended t o hold a meeting on the subject i n due course.
Despite vaccination and improvements i n hea l th education and environmentai
sani ta t ion, some communicable d iseases pe rs i s t ed i n many countries. Tie maps
on pages v i i i and i x of his repor t showed the s t a t u s uf mvlaria i n the Region
i n 1958 and 19'74. I n 1958 only 195; of the population a t r i s k had been covered
by anti-malaria programmes. By 1974 t h a t f igure had r i s e n t o 93%. However,
i n a t l e a s t two countr ies the incidence of malaria was again on the increase,
so t h a t much remained t o be done. WHO'S r ecen t change of emphasis from
eradicat ion t o control had helped the countr ies and f a c i l i t a t e d the
Organization's assistance. Tne malaria si tua. t ion d i f fe red g rea t ly from
country t o country. The disease had been completely eradicated i n Cyprus,
I s r ae l , Jordan, Lebanon arrd Libyan Arab Republic. It was hoped t h a t the f u l l
range of control methods coupled with b e t t e r survei l lance would reduce the
incidence elsewhere.
The s i t u a t i o n regarding smallpox was much more gra t i fy ing, a s the maps
on pages x i v anJ. xv indicated, 'Rle d isease pers i s t ed i n only two countr ies
of the Region, Ethiopia and Pzkistan. Ethiopia w a s the only country i n A f b i c a
where smallpox was s t i l l endemic, while i n the Indian subcontinent Bangladesh,
India and Pakistan remained affected. The incidence of smallpox was fa l l ing
rapidly i n Pakistan and Ethiopia. He had j u s t received a very promising
cabled repor t from the WHO smallpox team i n Pakistan suggesting t h a t smallpox
might disappear from tha t country by the end of the present month. Regrettably
there was an epidemic i n two provinces of India a t the moment, bu t he hoped
t h a t t he disease would a l so be conquered i n Bangladesh and India. It should
be controlled by the middle of 1975 i n Ethiopia,
Cerebrospinal meningitis was a ser ious problem i n some countr ies of the
Region, especia l ly Sudan. The new polysaccharide A vaccine had proved
promising i n trials i n Egypt and Sudan, and might be a breakthrough i n preven-
t ion. The disease was widespread; an epidemic was now i n progress i n Brazil.
Health 1a.boratory services played an inportant p a r t i n medical care,
epidemiological work and surveillance, The strengthening of such services,
and especia l ly t h e i r extension t o the periphery, had received much a t t en t ion
from WHO. To a l l ev i3 te the lack of t ra ined personnel, the Regional Office
had provided 740 fellowships i n t h a t f i e l d over the pas t 25 years, which
represented 11% of the t o t a l WHO regional fellowship programme. In addit ion, - courses were provided i n Amman and Beirut, together with ad hoc courses i n
other countries.
High p r i o r i t y was attached by a l l countr ies t o maternal and ch i ld health.
Although in fan t mortal i ty had been reduced, the figures w e r e st i l l high ane.
fur ther progress could be made. He thanked UNICEF f o r its help i n t h a t
aspect of WHO'S work, Among the many meetings held t o promote maternal. and
ch i id health, he c i t e d the seminar held i n Baghdad i n March 1974 on school
heal th services and the meeting a t Mogadishu i n Ju ly 1974 on hea l th services
fo r the p r e - s cho~ l child.
E M / R C ~ ~ A / M ~ ~ . 1 15
A t the same time e f f o r t s were being made t o assist countries a s p a r t of
family hea l th and i n accordance with t he o f f i c i a l mandate from the World Health
Assembly, i n family planning, the spacing of pregnancy and similar subjects i n
co-operation with the governments concerned. Four countr ies ( ~ g y p t , Iran,
Pakistan and 'Tunisia) had established po l ic ies f o r population control t o reduce
the r a t e of increase, Other countr ies had no population control programmes
but wanted t o s e t up services -t;o advise parents. The United Nations Fund f o r
Popula.tion Ac t iv i t i e s had been very helpful.
The important question of drugs and pharmaceutical products i n the
treatment of d isease would be f u l l y covered i n t he Technical Discussions.
Most countr ies were anxious t o e s t ab i i sh a proper system fo r the control of
pharmaceuticals and t o have l eg i s l a t i on on t h e i r use.
The importance of heal th s t a t i s t i c s required no emphesis, because without
them planning and evaluation were impossible, WHO was therefore giving
considerable a t t en t i on t o the strengthening of heal th s t a t i s t i c a l services and
had helped many countries, It had given assistance i n the keeping of hosp i ta l
records and w a s s t a r t i n g a col;lrse on medical records i n Alexandria, Egypt, i n
October 1974. The course w a s being organized with the aid of the High
I n s t i t u t e of Public Health i n Alexandria and would lead t o a diploma. He
hoped t h a t a l l countr ies would take advantage of the fellowships offered, t o
take p a r t i n t h i s course. The Regional Office had prepared a document
containing data fo r a l l countr ies of the Region, based on i n fo rmt ion obtained
from a l l avai lable sources. The present session offered representa t ives an
opportunity t o review the data fo r t h e i r own countr ies and t o provide any
addi t ional information. It was Important t h a t da t a should be in te rna t iona l ly
compara.ble .
E M / R c ~ ~ A / M ~ ~ . I page 16
Another f i e l d receiving increasing a t t en t i on from WHO was t h a t of mental
health, including the psychiat2'ic aspects of crime and Juvenile delinquency,
dependence on alcohol and other drugs, and d i f f i c u l t i e s a t school and work.
The whole concept of mental hea l th care was changing. The incarcera t ion of
pa t i en t s i n large i n s t i t u t i o n s f o r cus todia l care was tending t o be abandoned,
and in-pat ient psychia t r ic care was being in tegrated wi-thin general hospi ta ls ,
despi te the res i s t ance of some t r a d i t i o n a l i s t s . Community psychiatry, the
discovery of potent psychotropic drugs and new approaches i n treatment were
. being stressed. The shortage of qua l i f i ed manpower a t a l l l eve l s was a major
obstacle t o the development of mental hea l th services.
The impz"ovement of environmental s an i t a t i on was an expensive en te rpr i se
and hence might not receive the necessary p r i o r i t y from nat ional f inanc ie l
au thor i t i e s . Health departments should do a l l they could t o ensure t h a t
Governments a l located adequate Pmds. I n add i t ion t o b i l a t e r a l aid, m a n y
in te rna t iona l agencies - e.g, UNDP, UNICEF, IBIRD, a.nd the regional development
banks such as the Af'rican kvel6pment Bank ard the Asia Development Bank were
po t en t i a l sources of funds f o r the i n s t a l l a t i o n of water supplies, waste
disposal , sewerage f a c i l i t i e s and so for th , Any request f o r a i d needed t o be
well formulated and WHO w a s ready t o provide assistance. I n many countries,
bas ic f a c i l i t i e s were t o t a l l y lacking. It was estimated t h a t by the end of
1980, a t l e a s t 5476 of the urban and 94% of the r u r a l population would s t i l l be
without services, e spec ia l ly waste d i sposa l s and sewage systems. The intro-
duction of water suppl ies w a s progressing be t t e r .
Referring t o the shortage of hea l th personnel, he sa id t h a t t r a i n ing was
given g r ea t p r i o r i t y by the Organization and considerable help had already been
given i n t h a t f i e l d , About one-third of the t o t a l programme of t h e Regional
Office was devoted t o ass is tance i n the t r a i n ing of hea l t h personnel,
Now t h a t countries themselves were playing a greater p a r t i n $he control cf
communicable diseases, more funds could be a l located t o t rz ining,
Concerning t ra in ing i n s t i t u t e s i n the Region, he sa id t h a t Liere were now
more than f i f t y medical schools a.nd more were being added reguiar ly , Whenever
countries had requested WHO advice on the s e t t i ng up of medicai schools, sxch
advice had been given frankly. For example, R~wa.it had wished t o s e t up s
medical school f i v e years ago, but on the advice of two W O groups t h a t had
v i s i t ed the country, fu r ther de t a i l ed planning had been car r ied out an3 the
medical school would open i n two years ' time,
Referring t o the imbalance i n hea l th manpower t h a t he hadmentioned
e a r l i e r , he sa id t h a t i n fu tu re WHO would give g rea te r emphasis t o the t ra in ing
of' personnel a t the medium o r lower levels. Thus i n addi t ion t o helping with
t he education of doctors, \+THO would a l so help with the t ra in ing of awci l imy
personnel, more a t t en t i on being given t o the development of t e rn s of hea l th
workers under the supervision of physicians,
There was a l s o a g rea t need t o t ra . in teachers i n medical schools i n the
a . r t o f education, Good surgeons d id not necessar i ly make g o d teachers of I
surgery and the same was t rue f o r the other heal th professions, In t h a t
f i e l d the Regional Teacher Training Centre a t Shiraz had been very successful,
The workshops t h a t had been organized In Shiraz, a.nd i n other countries, had
been of g r ea t help t o teachers of medicine, especia l ly concerning the use of
audiovisual methods, The workshops i n Alexandria, Khartown and Addis-Ababa
had been very successful and he understood t h a t the University of Alexandria
intended t o s e t up a nat ional teacher t ra in ing centre t o serve a l l Egypt ,
me centre i n Shiraz issued per iodical ly a pamphlet e n t i t l e d '"The earner" which
had been found very useful and was being d i s t r i bu t ed t o hea l th profess iok.1
educators throwhout the Region,
~M/Rc24A/Mln. 1 page 18
There had been a ser ies of meetings on medical education i n the l a s t few
years, the f i r s t a t Teheran i n 1962. The report of tha t meeting emphasized i n
par t icular the two main aims of medical education - sa i en t i f i c and social.
That meeting had been followed by meetings i n Alexandria i n 1963, i n Baghdad
i n 1967, and i n Khartoum i n 1968. A t the Khartoum meeting, the Regional
Association of Medical Schools of the Middle East (AMSME) was established,
Further meetings had been held i n Teheran in 1970 and i n Alexaniria in 1972
and 1974. The meeting i n Alexandria i n 1974 had discussed d i f fe rent aspects
of research i n medical education and it had become c lear tha t there was a need
t o revise medical curricula. Many curricula had been imported many years ago
and now needed thorough revision t o r e f l e c t the needs of the countries.
Concerning the trrain-drain, he said tha t the Region was losing many
valuable heal th personnel. Medical educators could do much t o help health
authori t ies reduce tha t loss. Qualified health personnel were l o s t not only
t o other countrieg, sometimes outside the Region, but a lso from the ru ra l areas
t o the towns.
The Region was weak in the f i e l d of'nursing both quantitatively and
qualitatively. The provision of nurses was a complex problem t o which a
sat isfactory solution had not yet been found i n the Region. The whole problem
was being given serious at tent ion and nursing curricula were being reviewed,
There were graduate nursing schools i n Alexandria, Cairo and Baghdad and schools
tha t gave diplomas i n nursing i n several other countries. Ins t i tu t e s for the
training of auxiliary nurses were being given assistance i n many countries,
In Egypt there were 130 secondary technical nursing schools fo r the training
of technical nurses and large numbers of medium leve l nurses were being trained,
?he f i r s t batch would complete training next year.
Concerning the fellowships programme, Dr Taba explained t h a t tne purpose
of the programme was t o provide a pool of well t ra ined and well prepared experts
i n the hea l th professions. Experience had shown, however, t h a t sometimes
the fellows were not well selected and were not properly used a f t e r the t r a i n i n g
During the l a s t twenty-five years, 7257 fellowships had been granted, 667 of
them in 1973. Thus the provision of fellowships was an important aspect of
the work of the F.egfona1 Office, $2 mil l ion having been spent on the provision
of fellowships last year out of a t o t a l budget of $11 million. The fellow-
ships o f f ice rs from the countr ies should meet regu la r ly t o review the whole
programme with a view t o introducing improvements, Detai ls of tine fellowships
were given i n the Annual Report, by five-year period arid by country. The
number of fellows i n each country did not necessari ly r e f l e c t expenditure on
fellowships a s some were of shor t durat ion and some were long, The .general
policy of tine Regional Office was t o grant fellowships of not more than 12 - 18
months. It was real ized t h a t the re w a s a need f o r s p e c i a l i s t s with higher
qua l i f i ca t ions but it was f e l t t h a t most of t h a t t r a in ing should be carr ied
out i n the home country with only shor t periods abroad f o r spec ia l purposes.
'Clus t he provision of f a c i l t t i e s i n each country f o r post-graduate education
was very 3.mportant and w a s a field i n which WHO could provide assistance.
He w a s pleased t o be abre t o &ate that the Arabic ed i t i on of World Health
would be continued. It would be produced once every three months, The
Arabic ed i t i on had received f inanc ia l support from the Qvernments of Kuwait,
Egypt and Saudi Arabia, each f o r or_e year and the Government of Libya f o r two
years, It w a s hoped t h a t other countr ies would a l s o contr ibute t o the costs.
Two months ago the first number of World Health i n Persian had been produced - with f inanc ia l support from the Government of li.an.
E M / R c ~ ~ A / M ~ ~ . 1 page 20
Conce rm three subjects on which there had been resolut ions a t the
previous Session of Sub-Committee A of the fiegional Committee, he re fe r red t o
t he hea l th conditions of the displaced persons and the persons l i v ing i n the
occupied t e r r i t o r i e s (Fiesolution EM/RC~~A,/R.~). m a t problem had been followed
up by t he Executive 3oard a d the World Health Assembl-y and a specia l committee
assigned by the Executive Board had v i s i t ed the countr ies involved, except
I s rae l , i n May 1974. They had r ev i s i t ed the countries, except I s r ae l , i n
August 1974. The Report of the f i r s t v i s i t had been presented t o the World
Health Assembly and the Rt?port of the second v i s i t was awaited, The other
subjects concerned the decentra l izat ion of the work of WHO (Resolution
~m~23A/R.4) and t h e establishment of a fund f o r voluntary contributions
(Fiesolution ~ r n ~ 2 3 ~ D . 8 and 9 ) t o enable the Regional Office t o dea l with
spec ia l hea l th problems, such as those r e su l t i ng f'rom na tura l d i sas te r s ,
He had already wr i t t en t o the governments of c e r t a in countr ies t o ask fo r ! voluntary contributions t o such a fund, t h i s ac t ion being i n accordance with
Art ic le 50 ( f ) of the 'WHO Constitution, Recently the Regional Office had been
able t o o f fe r ass is tance t o the Government of Cyprus, t o dea l with the problem
of w a r casualties, from the regular regional budget. It would be a g rea t help
t o the work of the Regional Office i f a sum of $ 25 mill ion were t o become
avai lable i n the next f i ve yems. Such a sum would enable the Regional Office
t o promote specia l addi t ional p ro jec t s and t o o f fe r ass is tance i n cases of
natural d i sas te r s ,
The conclusions that he ancl h i s staff had &a.m from the review of the
twenty-five years ' work were t o be found on pp. XXXIV-X)(XVII of the Annual
Report and he would be glad t o have comments on those conclusions.
EM/Rc24A/~in. 1 page 21
I n conclusion, he thanked a l l governments f o r t h e i r very helpful , close and
intimate col laborat ion with the Regional Office and with the WHO f i e l d s t a f f i n
the Region, assuring them t h a t t h e i r comments would be welcomed.
Dr ROASHAN (Afghanistan) expressing t he appreciat ion of h i s delegation of
the Report of the Regional Director and of t h e work of WHO i n t he Eastern Medi-
terranean Region, commented b r i e f l y on ce r t a i n aspects of hea l th work i n h i s
country s ince the advent of the new regime i n Ju ly 1973. The Government of
Afghanistan intended t o complete the hea l th in f ras t ruc tu re and gradually t o
in tegrate r e l a t e d programmes and services . The control of communicable d iseases
would a l so receive g r ea t e r a t t en t i on and t h e t r a i n ing of medical and paramedical
personnel would be given p r i o r i t y . The hea l th programme had been introduced i n
1973 with the ob jec t not only of t r a i n ing doctors and a l l ca tegor ies of pararne-
d ical personnel i n post-graduate s tud ies but a l so of extending t he control of
communicable d iseases and of providing a be t t e r and more economical service t o the
consumer. H i s delegation would r e f e r l a t e r t o the problem of the provision of
drugs.
He mentioned some fea tu res t h a t gave r i s e t o t he hope t h a t the young Republic
of Afghanistan would soon achieve ce r t a i n r e a l i s t i c goals i n the f i e l d of heal th :
the establishment of t he National I n s t i t u t e of Tuberculosis, the new Division of
Family Health, the I n s t i t u t e of Histopathology, the separation of the research and
t ra in ing aspects of laboratory services , t he countrywide provision of laboratory
services, and t he placing of more emphasis on the planning and implementation of
basic hea l t h services.
There were s t i l l some d i f f i c u l t i e s with regard t o the malaria control p ro jec t
largely because of lack of support f o r the pro jec t by other r e l a t e d organizations.
WHO'S ass is tance with t h a t p ro jec t was very much appreciated. H i s Government was
now looking forward t o approval of UNDP ass is tance f o r a three-year programme of . .
action, which already enjoyed WHO'S technical approval.
E M / R c ~ ~ A / M ~ ~ . 1 page 22
He drew at tent ion t o the f a c t t ha t some of the posts for WHO advisers in
h i s country had been vacant for some time. On the other hand, h i s Government
was grateful tha t WHO had continued t o support the fellowship programme, His
G.overnment would l ike to see tha t programme expanded.
Mr ELLINAS (~yprus) expressed h i s regret t ha t the Government of the
Republic of Cyprus could not send a delegation from i ts Ministry of Health
because of the Turkish invasion of Cyprus, H i s Government thanked the Director- '
General and the Regional Director for their action i n sending D r Cvjetanovic
and Mr Pinto t o study the heal th s i tua t ion i n the refugee camps i n Cyprus i n
which 200 000 refugees were accommodated. He a lso thanked the Organization
for other assistance it had given, including the supply of drugs,
The CHAIRMAN said he wished t o place on record tha t the heads of a l l
delegations supported the people of Cyprus i n the present t ragic situation.
Dr MUBARAK ( ~ g y p t ) congratulated the Regional Director on h i s Annual
Report and said it was useful t o review the achievements of the past twenty--
f ive years, It was pleasing t o note the increase i n the number of Member
Countries i n the Region and he was part iaular ly pleased t o welcome the part ic i -
pation o f a Representative of the Palestine Liberation Organization i n the
meeting. He looked forward t o the time when the Palestinian people could be
properly represented on the Sub-Committee. 0
A t a time wben there were so many health and economic ahallenges, it was
essent ia l t o ensure tha t the resources available t o the Regional Office were
used t o the best advantage. The advice and guidance of WHO would be most
valuable i n tha t respect,
I n the f i e l d of smallpox eradication a l l countries had exerted great
effor ts . It would be most valuable if a l l health problems could be tackled
with the same s p i r i t of co-operation. A t a time when the= were large
discrepancies between the ava i lab i l i ty of and the demands for health services,
more ra t iona l use of resources was essential , He agreed with the Regional
Director's proposal t ha t p r i o r i t i e s snould be determined a t the regional level only
and n o v a t the national level, Planning should be undertaken fo r the Region
as a whole, and perhaps some iessons could be learned by studying the methods
used i n the Region of the Americas.
The Egyptian delegation t o the World Health Assembly had raised the
question of decentralization of the work of WHO, on the basis of the efficiency
of the Regional Offices, while recognizing tha t cer ta in functions would s t i l l
have t o be carried out a t Headquarters. ?he proposal of the Regional Director
to set up a fund fo r regional development was worthy of serious consideration.
Problems related t o environmental heal th needed f w t h e r e f f o r t a t b time when
pollution of the a i r , sea and land was increasing. Regional Office programmes
had helped with the'development of health manpower i n the Region and he asked
that those programmes should be expanded. I n r e l a t ion t o the programmes
within the Region, he asked t h a t p r io r i ty should be given t o recrui t ing nation- . a l s of the countries i n the Region,
The observation made by the Regional Director concerning the decrease i n
UNDP a.ssistance i n the heal th field since 1971 was of great concern. Such a
decrease w a s not logical a t a time of increasing demands a d the Member Countries,
the Regional Offfce and the UNDP should t r y t o find a solution t o tha t problem.
In response t o the Regional ~ i r e c t o r ' s thanks t o the Egyptian Government
for being host t o the Regional Office, he said it was a duty and a pleasure
f o r h i s Government. They would also like t o place a t the disposal of the
Regional Office and of the Member Countries i n the Region, t he i r experiences in
E M / R c ~ ~ A / M ~ ~ , 1 page 24
a l l f i e l d s of health. A s of next year, the programme fo r t ra in ing nurses i n
Egypt would s t a r t t o provide large numbers of nurses. That programme had
required g r ea t e f fo r t s , i n pa r t i cu l a r i n r e l a t i o n t o the provision of modern
textbooks and educational materials , A t present about 14 000 student nurses
were being t ra ined and from 1975 onwards about 6 000 would graduate each year,
The graduate nurses would have the opportunity t o continue higher nursing
studies, He extended an i nv i t a t i on t o a l l representa t ives t o v i s i t one of
the secondary nursing schools.
H,E, Dr MORSHED (Iran) sa id t h a t he had l i s t ened with g r ea t i n t e r e s t t o
the Regional Director ' s introduction t o h i s Annual Report and on the occasion
of the 25th anniversary of the establishment of the Regional Office he expressed
h i s deep appreciat ion of the work t h a t had been undertaken t o improve the public
heal th services i n the Region, t o control diseases, and t o reduce suffer ing
among the inhabi tants of the Region. The t ra in ing programmes were par t i cu la r ly
valuable, but the question of environmental heal th s t i l l caused a great deal of
anxiety. I n view of the Regional ~ i r e c t o r 's estimate tha t , by the en3 of 1980,
a t l e a s t 54% of the urban population and 94% of the rural population i n t he
Region would s t i l l not have access t o sa fe water and proper sani ta t ion, he asked
the Regional Director t o dea l vigorously with t h a t fundamental scourge of public
health. Hc w a s glad t h a t a specia l paper on the "Place of san i ta t ion i n the
control of ga s t ro in t e s t i na l diseasest ' would be discussed during the present
session.
A royal decree had been promulgated i n I ran i n lilarch 1974 t h a t a l l preven-
t ab l e diseases should come under s t r i c t control and should be prevented by a l l
p r ac t i c a l public heal th measures, including hea l th education arYl the promotion
of environmental health, A hea l th card w a s t o be issued t o a l l I ranian
c i t i z ens t h a t would give a b r i e f medical h is tory .
~l$R~24A/Mln. 1 Page 25
Another decree emphasized tha t special a t tent ion should be paid t o
nutr i t ion programmes and tha t a l l children a t elementary schools should be
given f ree meals of milk and biscuits. The dis t r ibut ion of f ree m i l k and
vitamins t o mothers and chilciren should continue a s before a t the Maternal and
Child Health Centres throughout the country.
On page 221 of the Proposed Programme and Budget Estimates fo r 1976/~7
(~ocument E M / R C ~ ~ / ~ ) representatives would find a summary of Iran's Fifth
Five-Year Plan. I n tha t section there was a small e r ror i n the amount of
money allocated for health programmes i n the period 1973-78, which he asked
the secre tar ia t t o comect. A t the end of the f i r s t paragraph it was
mentioned tha t 22 000 million rials would be allocated fo r the five-year
programme5 i n f a c t t h e amount would be about 160 000 million r i a l s , Tke Plan
had recently been revised and the share of public heal th programmes had been
almost doubled and the amount foreseen was now about 238 000 million r i a l s .
Dr &MUFTI (Iraq) said he had examined w i t h great i n t e re s t the review
of the work of WHO i n the Region over the past twenty-five years, He
congratulated the Regional Director on the successes that had been achieved,
I n Iraq, the Ministry of Health had adopted sc i en t i f i c planning methods
and had s e t up a health plan according t o the s ize and importance of the
d i f fe rent problems. The main emphasis had been placed on the t raining of
health manpower and those e f fo r t s should complement those of the s i s t e r Arab
countries. In l ine with the soc ia l i s t nature of the Government of his
uountry, fur ther progress would be made w i t h social security plans, Although
training for the basic heal th services had been given top pr ior i ty , there had
also been expansion i n postgraduate studies which now covered almost a l l
aspects of medicine and public health,
E M / R c ~ ~ A / N ~ ~ . 1 page 26
The heal+,h situa2ion of the refugees and the inhabitants of the occupied
t e r r i t o r i e s had declined seriously because the occupying forces had ignored
, a l l the United Nations and bRf resnixtions. should do a l l it could t o
help those people.
Dr KAW. E,SrIEE: ( .~or( ien) saj s1:a.t the present Session was of particular
s i g ~ i f i c a n c e becp.use of 'np rplries -f t h e achievements over the past twenty-
f ive years, mat reviex niade :',? clear t h a t the work of tine Regional Office
hsd helped t o raise the health s ta tus 3f the peoples i n the Region.
He expressed the thanks of the Governnent of Jordan t o WHO for the
assistance it iiad given i n ttle setting up of the Wmsing School and the Instl-
tute of Auxiliary Servicss, ma in "he eradication of communicable diseases,
Referring t~ tne peoples 1Svlng i n the occupied t e r r i t o r i e s on the west
bank of the RiLver Jordan, he said ~ k s t the health s i tua t ion had declined and
was now intolerabie. Israei Ras overlooked a l l the resolutions passed by
the United Natio:,~ an2 the World qealth Assembly and t ha t fact should be taken
into account i n any new resolution.
Jr AEEYJL HAD1 (Libya) congratulated the Chairman, the Vice-Chairmen,
and the Cl~airmen of the Sub-Division on F'rogramve and Technical Discussions
on the i r election. Congratulations were also due t o ik Taba for his compre-
hensive ard valuable Report, wnich evaluated and reviewed what had been
achieved during the pas t twenty-f ive gears i n the Region. One always needed
t~ pause periodical-f;)r t o evaluate one's e f fo r t s and see whether one was follo-
wing the r i g h t pa.th or whetiner tnat path should be adjusted, Such an approach
was commendable and should be adopted a s routine i n the Region,
He thanked D r Taba, h i s assis tants , and Dr Awni Arif, WHO Representative
i n Libya, for the i r valuable services t o h i s country,
The Report of Dr Taba merited thorough discussion, Unfortunately, time
did not permit a l l the questions raised t o be taken up. He would touch on
only a few points,
F i r s t , the most sa l ien t change i n the l a s t twenty-five years had been the
change i n the concept of health standards, with a s h i f t i n emphasis from
individual health t o the health of the group or community. He hoped the
Organization would pursue tha t change even further,
Second, it was crucial t ha t the Organization was stressing manpower and
t raining a t a l l levels. The Libyan view had always been tha t manpower and
training deserved top p r i o r i t y i n the Region, par t icular ly since most of i ts
countries, regardless of t h e i r wealth or poverty, lacked manpower E a r essent ia l
health services. The qual i ta t ive aspects of health personnel, ard not only
the i r numbers, needed consideration,
He begged t o d i f f e r with D r Taba over the question of the "brain-drain",
The flow of trained personnel t o countries outside the Region was irdeed a
brain-drain; it would be valuable fo r WHO t o study tha t problem and make the
r e su l t s of t he i r study available t o a l l countries affected by it, However,
the flow of trained personnel within the Region was not a "brain-drain" but
rather a form of intra-regional co-operation. It could not be denied t h a t
. health standards i n the Region had r i sen a s a r e s u l t of it. In h i s own
country, only @ of doctors were Libyan nationals; under such circumstances
how could the Libyan population be cared for without the assistance of doctors
from other countries of the Region? The u t i l i za t ion of health manpower
needed t o be made more rat ional , That called for close collaboration between
~ r ~ ~ f i ~ 2 4 ~ / ~ i n . 1 page 28
countr ies so t h a t excess manpower i n one f i e l d o r country could be used t o
compensate f o r manpower shortage^ i n another f i e l d or country,
The CHAIRMAN pointed out t h a t the Regional Cirector i n h i s statement had
not c r i t i c i z e d such in t ra-regional co-operation but supported it wholeheartedly,
What the Regional Off i ce was r e a l l y caztioning agains t w a s thel' brain-draint ' to
countr ies outside the Region.
Dr A L r R I F A I (Kuwait) offered h i s s incere congratulat ions t o the Chairman,
Vice-Chairmen, and other o f f i c e r s on t h e i r e lec t ion , ard hoped t h a t the Session
would prove successful.
He thanked Taba f o r his comprehensive Report, i n which negative a s
wel l as pos i t ive aspects were duly noted. The Regional Director had hit the
n a i l on the head by r e f e r r i ng t o the gap between the planning and the
r e a l i z a t i o n of hea l t h proJects , stemming from laak of manpower, Although
pro jec t s were weli conceived and pianned, su i t ab l e personnel were o f ten lacking
f o r implementation. That ca l l ed f o r increased emphasis on manpower t ra in ing
and proper t r a in ing curr icula .
An important milestone i n the Region was the consolidation and develop-
ment of hea l t h departments, pa r t i cu l a r l y i n countr ies where such services
had only recen t ly been introduced,
D r A l - R i f a i welcomed the representa t ive of the Pa les t ine Liberation
Organization a s an observer and looked forward t o the day when Pa les t in ians
would be ac t ive members of the Regional Committee,
Brigadier CHOWDHRY (Pakistan) congratulated the Chairman and Vice-Chairmen
on t h e i r e lec t ion,
Referring t o the Annual Report, he f e l t that I t w a s very thoughtful of the
Regional Director t o look back over the pas t twenty-five years and see how far
the Region had come i n achieving i ts basic goal - t o ensure tha t the whole
population of the Region enjoyed the highest standard of healtn possible,
Progress towmd tha t goal had been f a i r l y impressive. Given the dedication
and zeal of the Regional Office under the direct ion of Trr Taba, and the
increasing in t e res t of Member Countries, he was sure tha t future progress would
be even more rapid.
There had been a great expansion of medical educatbn. I n Pakistan, the
number of medical colleges had almost doubled i n the pas t few years; it now
stood a t thirteen. H i s country f ina l ly could, moreover, largely meet i t s own
needs f o r heal th professional teachers, who, a s pointed out i n the Report,
needed more than the s k i l l s required of a good medical practi t ioner, The WHO
Regional Teacher Training Centre a t Pahlavi University, Shiraz, was playing
an important ro le i n developing proficiency i n educational science, and the
planned se r i e s of workshops on medical education would a lso be of great value
to educators. He hoped too tha t the rat ional izat ion of t ra ining would be given
due emphasis, 'Ihe type of medical education now being offered i n the Region
had been adopted from countries with very d i f fe rent heal th problems, and was
not optimally suited t o the Region.
It was undeniable and unfortunate tha t top public heal th administrators
were not usually given an opportunity t o acquire managerial sk i l l s . WHO'S
e f fo r t s t o introduce modern management concepts and techniques were therefore
laudable.
Regarding manpower, he f e l t t ha t Pakistan would benefit great ly from
manpower s tudies such a s were being carried out i n Yemen and Iran, and sugges-
ted tha t a ser ies of workshops be held on health manpower i n the Region.
Despite vigorous e f fo r t s by Pakistan t o control c o ~ i c a b l e diseases,
the lack of health education was making tha t task extremely d i f f i cu l t ,
Health education was especially necessary i n view of the limited resources wi th
which h i s country had t o work. He asked WHO and the Regional Office t o
extend a l l possible help t o h i s country i n tha t f ie ld.
It was common knowledge t h a t drugs were registered, sold and prescribed
by t h e i r generic names i n Pakistan, and e f fo r t s i n tha t direct ion were beim
pursued even further, However, h i s country s t i l l needed WHO assistance to
establ ish a sound quality control system.
With respect t o malaria, owing t o financial problems and vector resistance
t o insecticides, the goal of eradication was further away, Tnere was a need
fo r extensive research t o find cheaper methods of malaria control.
Referring t o the great economic benefi ts accruing t o cer ta in countries of
the Region from exploitation of the i r naturalresources,he re i te ra ted D r Taba's
statement i n h i s Report t ha t diseases did not recognize international boundarie
and endorsed wholeheartedly the idea of creating a " ~ e a l t h Development Bank",
a " ~ e g i o n a l cooperative" and a Special Voluntary Fund.
In conclusion he thanked the Organization for i t s valuable assistance
t o h i s country.
D r HASAN (~omalia) offered h i s congratulations t o the Chairman
on h i s election.
In the introduction t o h i s Annual Report the Regional Director had mentio-
ned a point t ha t was regarded i n h i s country a s being of great and universal
interest , namely, the t ra ining of health personnel. I n t h e i r view, over-
t ra ining w a s just a s undesirable a s undertraining; an overtrained worker
would unwittingly harm the health services of h i s country, They believed thay
had developed a formula. for dealing with tha.t problem. A campaign against
i l l i t e r a c y had recently been launched, during which, a l l schools i n the country
E P J / R C ~ ~ A / ~ E ~ . 1 Page 31
had been closed for one yeas and the students - most of them from urban areas - had been sent t o the vi l lages t o help educate t he i r l e s s fortunate peers.
The Ministry of Health had seized the opportunity t o send national physicians,
who had f o r the most par t been trained i n Europe, t o the countryside for
retraining. Their work consisted of carrying out health education, vaccinating
vi l lagers against smallpox and tuberculosis ( for which he thanked UNICEF for
the i r timely shipment of vaacine), t reat ing the sick and t ra ining local health
auxi l ia r ies who would remain i n the ru ra l areas. It was hoped tha t the
presence of those auxi l ia r ies would stimulate the demand of the l e s s privileged
for health services and thus enable the country t o readapt those services.
The auxi l ia r ies should a l so permit them t o assess r e a l i s t i c a l l y a number of
diseases whose extent had never before been measured. During a 6 - 8 month
programme, the consumers of health services would sarutinfze health service
delivery and hopefully provide guidance on possible needed changes.
With regard t o manpower training, the curricula i n a l l t ra ining ins t i tu-
t ions had been changed t o emphasize c o m i t y health rather than the health of
the irxlividual.
H i s country was very grateful t o the Regional Office f o r thew assistance
and was proud t o be a Member of the WHO Eastern Mediterranean Region.
D r MUKXTAR (~udan) thanked Egypt, which twenty-five years e a r l i e r had
offered a build& which served a s host for the Regional Off ice, where the
present Session of Sub-Committee A was taking place.
The table on page iii of the Introduction t o D r ~ a b a ' s Report showed
the progress made over those twenty-five years. Therein lay the importance
of allocating budgets mainly for services instead of squandering resources on
personnel, That was a good example t o be followed,
D r Mukhtar referred t o the endemic, epidemic and other communicable
diseases .present i n the Region. With regard t o malaria, insuff ic lent resources
had made some countries unable t o achieve the i r control targets. He hoped that
would not lead t o a drop i n external assistance but rather t o an increase.
He also aBed WHO ?nd the Regional Office t o give greater a t tent ion t o the
eradication of schistosomiasis i n the Region, which was a cruo?al factor i n the
many aountries tha t were agricultural ,
The successful experiment i n smallpox eradication i n most countries of
the Region should spur s i m i l a r intensified campaigns t o overcome other diseases.
In collaboration with WHO, Sudan had carried out experiments with a new cerebro-spinal
/meningitis vaccine. He hoped the i r r e su l t s would benefit other countries
suffering fYom tha t disease.
H l s country gave considerable at tent ion to manpower training and had a
number of t ra ining ins t i tu t e s for health personnel a t various levels. Sudan
was fu l ly prepared' t o cooperate with s i s t e r countries desiring t o benefit from
the services of i ts ins t i tu tes ,
He concluded by wishing the Region every sucaess on i t s 25th anniversary,
D r BAATH (Syria) congratulated a l l the off icers on the i r e lect ion and hoped
tha t the sub-Committee's deliberations would be crowned with success. The
Regional Director was t o be specially congratulated for the b r i l l i a n t speech
introducing the Annual Report. A nwnber of points t o which Dr Taba had drawn
at tent ion deserved mention, Health services i n the Region had been developed
thanks t o the Regional Off ice ' s assistance over the l a s t twenty-five years.
The establishment of a " ~ e a l t h Development Bank" was a most important suggestion
for producing regionally a l l pesticides, drugs and other substances having a
direct impact on health, The Sub-committee should adopt a resolution cal1.ir-g
f o r studies on the implementation of such a bank,
E ~ ? I / R c ~ ~ A / M ~ ~ . 1 page 33
The Regional Director had talked about thettbrain-drain: which was one of
the most serious threa ts t o the Third World. Syria was suffentng from the
outflow of sc i en t i f i c and medical personnel. About 300 Syrian doctors were
l iving i n the Federal Republic of Germany alone, and there were even more i n
the United States of America. It was d i f f i c u l t for Third World Countries t o
offer such personnel competitive rewards. H i s Government believed tha t close
collaboration between governments, aided by WHO, would be needed t o find a
solution t o the problem.
There had been a consolidation of nurse training courses, and Syria had
established a school for male nurses, The construction of additional schools
ancl the expansion of existing schools were being planned, and health auxi l ia r ies
were being trained with a one-year course, It was hoped thereby t o overcome
the shortage of auxi l ia r ies and nurses,
The third mediaal faculty i n Syria had Just been opened i n 1974. The
Ministries of Health and Education were making serious e f fo r t s t o emphasize
public health and environmental health i n t h e i r curricula, He was pleased t o
mention a p i l o t project carried out by medical students and their professors,
who organized "medical aamps" i n remote areas of the country an3 uder took
a c t i v i t i e s including analysls of the loca l water t o detect endemic diseases and
assessment of loca l heal th conditions. It was hoped t o expand the a c t i v i t i e s
of those camps i n the future t o include more public health aspects.
No cases of quarantinable diseases had been reported last year, but health
au thor i t ies were cautious because some areas would be flooded a f t e r construction
of the Euphrates Dam, and assistance was being requested in advance from WHO,
Some success had also been aahieved i n the malaria campaign.
E W R C ~ ~ A / M ~ ~ . 1 page 34
I a s t l g , he wished t o draw a t t en t i on t o the de t e r i o r a t i on of hea l th
condit ions i n the occupied t e r r i to r ies ,where the Zionis t forces had refused fo r
the second time t o permit WHO observers t o examine hea l t h conditions. Along
with the des t ruct ion of the torin of ICuneitra, t h a t w a s an example of the Fascis t
a t r o c i t i e s committed by the Zionists .
T)r FARAH (Tunisia) congratulated the Chairman and other o f f i c e r s on t n e i r
e lec t ion. The Regional Director was a l s o t o be congratulated - the number of
p ro jec t s had mult ipl ied by a fac to r of f i f t y over the pa s t twenty-five years
while the number of personnel had increased only fourfold, and the budget only
by a f a c to r of twenty.
With reference t o the t r a i n ing of doctors, a s mentioned i n the Regional
Di rec to r ' s Report, everyone was aware t h a t medical school cur r i cu la needed t o
be examined every few years and readapted t o changing l o c a l needs, In Tunis
such cz~x r i cu lm reform w a s being c w r i e d out,
The Regional Director had a l s o dwelt l i g h t l y on communicable diseases,
which deserved a high p r io r i ty . The i n t e r e s t at tached t o such control was
evidenced by the e f f o r t s t o overcome recent oubreaks of cholera which were a
cause f o r concern,
The hea l th problem regarded as most important i n Tunisia was family p lan-
nin6~;. P r izes had Seen es tabl ished f o r regions with the be s t r e su l t s . Active
family planning programmes should be combined with improvement of socio-economic
condit ions and treatment of i n f e r t i l i t y - those were a l l aspects of one end the
same problem.
D r EEAGHBAliI (yemen) congratulated the o f f i c e r s on t h e i r e l e c t l on and
wished them a l l success i n t h e i r tasks. He had examined the Annual Report with
grea t a t t en t i on and congratulated. the Regional Director on the accomplishments
E M / R C ~ ~ A / M ~ ~ . 1 Paw 35
of those twenty-five years. He a lso thanked Dr Taba and h i s ass i s tan ts for
the i r deep understanding of the problems faced by the countries of the Region. 11
Referring t o the brain-drain: Dr El-Aghbari said tha t the intra-regional
f l o w of personnel could correctly be termed cooperation. Despite t h e i r great
effor ts , however, Yemen had secured only a small number of doctors, which
other countries were trying t o entice away. Yemen was trying nonetheless t ~ ,
improve the i r material and finanoial conditions. He thanked Dr Partow, the
WHO Representative i n Yemen, for h i s valuable collaboration with the Ministry
of Health.
Considerable success had been achieved despite limited resources but much
remained t o be done i n the country. They were now embarked on a three-year
programme tha t aimed, i n t e r a l ia , a t a consolidation of existing health
services, emphasizing basic health services and heal th manpower and training.
The basic health services project, ass is ted by WHO, had successfltlly expanded
those services.
Unfortunately, there were vacancies i n some WHO projects t h a t needed t o be
f i l l e d rapldly. ?he Ministry of Health was concerned a t the insufficiency
of spare p a r t s and repair of medical equipment, ard they looked forward t o the
t raining of Yemeni nationals t o undertake tha t work,
He thanked WHO for its assistance i n auxiliary training but said t ha t Yemen
would not be able t o open a medical faculty i n the near future. He called
on other countries i n the Region t o al locate a cer tain nwnber of places i n
t h e i r medical facul t ies t o Yemeni nationals with secondary school education
He a lso called for an expansion of fellowships.
Dr El-Aghbari concluded by thanking WHO, UNDP, UNICEF and other organi-
zations fo r their help and looked forward t o increased cooperation t o improve
health conditions i n h is country and the Region as a whole.
~M/Rc24A/Min. 1 page 36
The CHAIRMAN hoped tha t Yemen would receive the number of doctors it
needed, He found it wcrthy of note tha t the Regional Office looked on health
manpower problems a s regional problems and not a s the problems of individual
countries,
D r TABA, Regional Director, said tha t he would be br ief as no speoific
questions had been raised about the Report. He thanked the representatives
for the i r useful oomments and guidance, and for the i r words of appreciation t o
h i s colleagues and himself, A l l the points mentioned would be borne i n mind,
and he hoped t h a t he or h i s colleagues would be able t o see a l l the representa-
t ives individua.11~ i n the next few days.
The distinguished representative of Egypt had mentioned the drop i n UMlP
allocetions t o health, and tha t was i n f a c t the case. WHO fu l ly shared h i s
concern, I n many countries the percentage of the i d i c a t i v e planning figure
a,llocated t o health was almost ni l . It should not be forgotten, however,
tha t decisions on what percentage of those funds t o devote t o health were made
a t the country level through country programming exercises by a national
coordinating body t h a t formulated the programmes t o be assis ted from external
sources. A country might consider, fo r example, t h a t industry or agriculture
had economic pr ior i ty , But it was incumbent upon the health authori t ies t o
explain t o the coordinating body the economic importance of heal th developmerit.
In some countries, unfortunately, that coordinating body had no representation
from health authorit ies.
The CHAIRMAN thanked Dr Taba fo r h i s comments. He then drew a t ten t ion t o
the d r a f t resolution on the Annual Report of the Regional Director, which read
as follows:
Having reviewed the Annual Report of the Regional Director for tk period 1 July 1973 t o 30 June 1974;
Considering the progress achieved i n the provision of heal th services i n a l l countries of the Region during the l a s t twenty-five years since the estab- lishment of the WHO Eastern Mediterranean Region;
Noting the d i spa r i t i e s between the levels of development of health services of the Member States owing t o the d i f fe rent stages reached i n the social and economic development; and taking in to consideration tha t improvement and protection of health can be f ac i l i t a t ed through harmonious development of health services;
Reoognizing that it i s up t o Member States t o determine the i r p r i o r i t i e s and to make the necessary f inancial and technical investment f o r solving i n a comprehensive manner the many arCl varied health problems;
Confirming the need t o concentrate WHO'S e f fo r t s i n ass i s t ing governments t o di rec t the* health services programme towards t h e i r major health objectives with pr ior i ty given t o the rapid and effective development of the health delivery system i n the l i g h t of specific economic and soc ia l context of each country, and t o support simuLtaneously continuous training and instructions of the necessary national health personnel,
1. ENDORSES the need t o continue a l l possible e f for t s t o improve the health status of the populations of a l l Member States, through joint e f fo r t s a t oountry, inter-country and regional levels;
2. REAFFIRMS its appreciation of the manner i n which the regional programme has been planned, directed and implemented, emphasizing the provision of maximum direct assistance t o countries i n t h e i r e f f o r t s t o promote the health of the people;
3, COMMENDs the Regional Director on a clear desoription of the progress of health i n h i s Report on countries of the Region.
The Chairman invited aomments on the d r a f t resolution.
Dr HASAN (~omalia) wondered whether the polnt Jus t ra ised by the Regional
Director should not be introduced into the d r a f t resolution as a recommendation
t o the United Nations agencies.
In rteply, D r Taba, Regional Director, f e l t t ha t h i s po in t was i n f a c t
covered by the fourth preambular paragraph of the d r a f t resolution. It was
very d i f f i c u l t t o make such a recommendation t o United Nations Development
Programme because sovereignty had t o r e s t with the individual country.
m e t h e r a railway pro jec t or malar ia . control had p r i o r i t y was up t o the Govern- I
ment t o decide, as provided f o r i n the country programming procedure. It was
up t o nat ional hea l th min is t r i es t o ensure t h a t hea l th was not neglected i n
the country programme. The question could not be looked a t f'rom a narrow heal th
perspective since many other sec tors - education, agr icul ture , industry - were
competing fo r funds with health.
The CHAIRDIAN, speaking a s a representa t ive of Egypt, noted t h a t no reference
had been made t o the question of decentral ization. Did the Sub-committee agree
t h a t the d r a f t r eso lu t ion should r e f l e c t t h a t point? Decentral ization had been
c l ea r ly emphasized i n the Regional ~ i r e c t o r ' s repor t , by individual speakers i n
the present meeting and i n a reso lu t ion adopted by the last sess ion of t he
Sub-Committee, He therefore proposed adding a clause supporting the trend
toward decentral ization.
D r Ai3DEL-GHAFFAR (Saudi Arabia) invi ted the representa t ive of E m t , as a
proponent of decentra l izat ion within the Organization and of giving more power
t o Regional Offices, t o comment on the amendment proposed by the Chairman,
In reply, Dr MUBARAK ( ~ g y p t ) proposed a wording of an amendment along these l ines :
Dr TABA, Regional Director, wished t o make three general points. F i r s t ,
he f e l t t h a t t he question of decen t r a l im t ion was inappropriate f o r inclusion
i n the d r a f t r eso lu t ion under discussion, which re fe r red basical ly to the ~ e g i o n ' s
achievements described i n the Annual Report. Secondly, the Consti tut ion of 1JHO
already provided f o r regional izat ion and decentral ization. Lastly, he d id not
th ink t h a t a Sub-Committee of a Regional Committee could adopt a reso lu t ion on
decen t ra l i za t ion within the Organization a s a whole- t h a t would be the function
of the World Health Assembly - but only on decentra l izat ion within the Region,
programmes t o the WHO Representatives.
He theref ore suggested including i n the preamble a clause noting t h a t
decentra l izat ion i n \AM0 had been helpful f o r the achievements reported i n t he
Annual Report of the Regional Director, leaving the wording of t h a t clause up
t o the Secre ta r ia t .
Dr MUEWW ( ~ g y p t ) w a s well aware t h a t the Regional Office w a s conuerned
t o do what it could toward decentral ization. H i s only in ten t ion was t o place
on record t he sub-Ccmrnittee's concern.
The CHAE3MAN pointed out t h a t the Sub-Oommittee had before it the Regional
~irector's suggestion t o leave the wording of the amendment t o the d r a f t
resolut ion t o the Secre ta r ia t and asked whet5er there were any fur ther
suggestions o r amendments.
D r P R W A Y (Egypt) suggested the following clause be inser ted a f t e r the
"Realizing that decentra l izat ion and regional izat ion of WHO have g r ea t l y contributed towards the achievements outl ined i n the Regional ~ i r e c t o r ' s report;".
The REGIONAL DIRECTOR browlit t o the a t t en t i on of the Committee the re levant
study conducted by the Executive Board a& suggested t h a t t he i n se r t i on be a s
f ollaws :
"~0t in .g with s a t i s f ac t i on t h a t the Executive Board is following ao t ive ly its organizational study on the "Interre la t ionship between the cen t r a l technical services of WHO and pro@;rammes of d i r e c t ass is tance t o Member states;".
After f'urthgr discussion it was proposed t h a t t he clause proposed by the
Regional Director should be inser ted a f t e r the second preambular paragraph.
Decision: m e resolution, as thus amended, was adopted,