í^rn World Health Organization ^^ Organisation mondiale de la Santé

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1 4. Rapport du Président général des Discussions Techniques 4 ii í^rn World Health Organization ^^ Organisation mondiale de la Santé FORTY-SEVENTH WORLD HEALTH ASSEMBLY A47/VR/11 QUARANTE-SEPTIEME ASSEMBLEE MONDIALE DE LA SANTE 9 May mai 1994 PROVISIONAL VERBATIM RECORD OF THE ELEVENTH PLENARY MEETING Monday, 9 May 1994, at 12h00 Palais des Nations, Geneva President: Mr B.K. TEMANE (Botswana) COMPTE RENDU IN EXTENSO PROVISOIRE DE LA ONZIEME SEANCE PLENIERE Lundi, 9 mai 1994,à 12 heures Palais des Nations, Genève Président : M. B.K. TEMANE (Botswana) CONTENTS 1. Second report of the Committee on Credentials 3 2. First report of Committee A 3 3. Election of Members entitiëct to designate a person ta serve on the Executive Board - -» 4 4. Report by the General Chairman of the Technical Discussions 4 SOMMAIRE Page 1. Deuxième rapport de la Commission de Vérification des Pouvoirs 3 2. Premier rapport de la Commission A 3 3. Election de Membres habilités à designer une personne devant faire partie du Conseil Exécutif 4

2 Note: In this provisional verbatim record speeches delivered in Arabic, Chinese, English, French, Russian or Spanish are reproduced in the language used by the speaker; speeches delivered in other languages are given in the English or French interpretation. This record is regarded as provisional because the texts of speeches have not yet been approved by the speakers. Corrections for inclusion in the final version should be handed in to the Conference Officer or sent to the Records Service (Room 4113, WHO headquarters), in writing, before the end of the session. Alternatively, they may be forwarded to Chief, Office of Publications, World Health Organization, 1211 Geneva 27, Switzerland, before 1 July Note : Le présent compte rendu in extenso provisoire reproduit dans la langue utilisée par Porateur les discours prononcés en anglais, arabe, chinois, espagnol, français ou russe, et dans leur interprétation anglaise ou française les discours prononcés dans d'autres langues. Ce compte rendu est considéré comme un document provisoire, le texte des interventions n'ayant pas encore été approuvé par les auteurs de celles-ci. Les rectifications à inclure dans la version définitive doivent, jusqu'à la fin de la session, soit être remises par écrit à l'administrateur du service des Conférences, soit être envoyées au service des Comptes rendus (bureau 4113, Siège de l'oms). Elles peuvent aussi être adressées au Chef du Bureau des Publications, Organisation mondiale de la Santé, 1211 Genève 27, cela avant le 1 er juillet Примечание: В настоящем предварительном стенографическом отчете о заседании выступления на английском, арабском, испанском, китайском, русском или французском языках воспроизводятся на языке оратора; выступления на других языках воспроизводятся в переводе на английский или французский языки. Настоящий протокол является предварительным, так как тексты выступлений еще не были одобрены докладчиками. Поправки для включения в окончательный вариант протокола должны быть представлены в письменном виде сотруднику по обслуживанию конференций или направлены в Отдел документации (комната 4113, штаб-квартира ВОЗ) до окончания сессии. Они могут быть также вручены до 1 июля 1994 г. заведующему редакционно-издательскими службами, Всемирная организация здравоохранения, 1211 Женева 27, Швейцария. Nota: En la presente acta taquigráfica provisional, los discursos pronunciados en árabe, chino, español, francés, inglés o ruso se reproducen en el idioma utilizado por el orador. De los pronunciados en otros idiomas se reproduce la interpretación al francés o al inglés. La presente acta tiene carácter provisional porque los textos de los discursos no han sido aún aprobados por los oradores. Las correcciones que hayan de incluirse en la versión definitiva deberán entregarse, por escrito, al oficial de Conferencias o enviarse al Servicio de Actas (despacho 4113, sede de la OMS) antes de que termine la reunión. A partir de ese momento, pueden enviarse al Jefe de la Oficina de Publicaciones, Organización Mundial de la Salud, 1211 Ginebra 27, Suiza, antes del 1 de julio de 'ÍL^JIJ^I / L J 1 /L D-^^JJL J^JI C^LJSJI J-, 二 ci^'yj] ^ S J I IJLA ^ : 己 L J 5 J 1 L i. l^oaj-cu^. ^ J l '. JJI J^JLL, /l y J I /l I ^ I d-jr^-jsjsjvl;. ji^ jj^-j. I I JLA ^ ti I 匕.-Ч1л.о-1 1 d J LUAJ I ^O JlA-^. яг/ Cl^ t.o ^O^AOJ qv I jjáj У^Зум j^ L>u>J1 I jüb Я^ j L J\ 0\ScÍ\. 6 J3^J\ JJà ('i^jujj ^^^Jl jul, i) ) Y ^UuJI ' ^b ^! «D < I jaaj^y^u «Ç V.-1 V 1 ) i LKJ I <L>w4OJ1 ci/l ^j-^^p ^ I 说明 : nií 凡是阿拉伯文 中文 英文 法文 俄文或西班牙文的发言, 将以发言人所用 的语种在本临时逐字记录中刊印 ; 其他语种的发言, 将以其英文或法文的译文刊印 本记录属临时性质, 因为发言稿的文本未经发言人审阅 需要列人最后文本的 修改, 应在本届会议结束以前书面提交会务官员或送记录办公室 ( 世界卫生组织总 部 4113 室 ), 或者在 1 明 4 年 7 月 1 日以前寄给瑞士 1211 日内瓦 27, 世界卫生组织出版 办公室负责人 6516 > JJi

3 1. SECOND REPORT OF THE COMMUTEE ON CREDENTIALS DEUXIEME RAPPORT DE LA COMMISSION DE VERIFICATION DES POUVOIRS The meeting is called to order. I invite Dr Shamlaye, Rapporteur of the Committee on Credentials to come to the rostrum and read out the second report of the Committee on Credentials, which is contained in document A47/45. Dr SHAMLAYE (Rapporteur of the Committee on Credentials): The Committee on Credentials met on 6 May 1994, under the Chairmanship of Dr M. Hamdan (United Arab Emirates). Dr С. Shamlaye (Seychelles) was Rapporteur. Delegates of the following Members were present: Canada, Namibia, Netherlands, Samoa,Seychelles, Tunisia, United Arab Emirates. The Committee examined the formal credentials of the delegates of Afghanistan, Bosnia and Herzegovina, Georgia, Greece, Japan, Kyrghyzstan, Latvia, Malawi, Mauritius, Pakistan, Papua New Guinea, Republic of Moldova and Vanuatu who had been seated provisionally in the World Health Assembly pending the arrival of their formal credentials. These credentials were found to be in conformity with the Rules of Procedure, and the Committee therefore proposes that the World Health Assembly recognize their validity. The Committee also examined the formal credentials of Liberia and Saint Lucia which were found to be in conformity with the Rules of Procedure, and the Committee therefore proposes that the Health Assembly recognize their validity, thus enabling the delegations of Liberia and Saint Lucia to participate with fullrightsin the World Health Assembly. Lastly, the Committee examined the credentials submitted by Nauru and Niue, whose applications for membership were accepted during the eighth plenary meeting of the World Health Assembly. These credentials were found to be in conformity with the Rules of Procedure. The Committee therefore proposes that the Health Assembly recognize their validity, thus enabling these delegations to participate with full rights in the World Health Assembly as soon as the memberships of Nauru and Niue become effective upon deposit of their instruments of acceptance of the WHO Constitution with the Secretary-General of the United Nations. Thank you, Dr Shamlaye. Are there any comments? In the absence of any comments, I take it that the Assembly accepts the second report of the Committee on Credentials. 2. FIRST REPORT OF COMMITTEE A PREMIER RAPPORT DE LA COMMISSION A We shall now consider the first report of Committee A, as contained in document A47/48; please disregard the word "Draft" as this report was adopted by the Committee without amendments. This report contains two resolutions which I shall invite the Assembly to adopt one after the other. Is the Assembly willing to adopt the first resolution entitled: "Ninth General Programme of Work covering a specific period ( )"? In the absence of any objections, the resolution is adopted. The second resolution is entitled: "Infant and young child nutrition". Is the Assembly willing to adopt this resolution? In the absence of any objections, the resolution is adopted and the Assembly has therefore approved the first report of Committee A.

4 3. ELECTION OF MEMBERS ENTITLED TO DESIGNATE A PERSON TO SERVE ON THE EXECUTIVE BOARD ELECTION DE MEMBRES HABILITES A DESIGNER UNE PERSONNE DEVANT FAIRE PARTIE DU CONSEIL EXECUTIF The next item on our agenda is item 12: Election of Members entitled to designate a person to serve on the Executive Board contained in document A47/44. I draw your attention to the list of 10 Members, drawn up by the General Committee in accordance with Rule 102 of the Rules of Procedure. In the General Committee's opinion these 10 Members would provide, if elected, a balanced distribution of the Board as a whole. These Members are,in the English alphabetical order: China, Cuba, Finland, France, Kuwait, Pakistan, Russian Federation, Thailand, United States of America, Zambia. Are there any comments or any objections concerning the list of the 10 Members as drawn up by the General Committee? In the absence of any objections, may I conclude that, in accordance with Rule 80 of the Rules of Procedure, the Assembly accepts the list of 10 Members as proposed by the General Committee? I see no objection. I therefore declare the ten Members elected. This election will be duly recorded in the records of the Assembly. May I take this opportunity to invite Members to pay due regard to the provisions of Article 24 of the Constitution when appointing a person to serve on the Executive Board. 4. REPORT BY THE GENERAL CHAIRMAN OF THE TECHNICAL DISCUSSIONS RAPPORT DU PRESIDENT GENERAL DES DISCUSSIONS TECHNIQUES We now come to the report of the Technical Discussions, and I have much pleasure in inviting Mrs Kardinah Soepardjo Roestam, General Chairman of the Technical Discussions to present the report on the Technical Discussions on "Community Action for Health". Mrs Roestam, you have the floor. Mrs ROESTAM (General Chairman, Technical Discussions): Mr President, Dr Nakajima, your excellencies, ministers of health, distinguished participants, ladies and gentlemen, it has been a great pleasure to have served as the Chairperson of the Technical Discussions at the Forty-seventh World Health Assembly. Those Discussions have now been successfully completed and I am happy to present to you today the report that has been prepared. As you might imagine, the Discussions have covered a range of topics relating to the role that the community can and should play in health development, the role the health sector should play in support of the community, and the role that other sectors can play in concert with the health sector and the community. The report which it is my pleasure to present to you deals with the basic principles underlying the concept and the need for community action for health; a discussion of the way in which it works and what it involves; and the consideration of the implications for further action that are now called for. The report recognizes that while community involvement in health is not a new phenomenon, a series of social, demographic and economic factors and conditions have made the subject more relevant and important today than ever before. The increasing availability of modern communications, a better educated public, the spiral in costs of curative care, and the widening gap in many countries between the health care sector and the public, have all contributed to a growing commitment to change and the search for new avenues of health development. The emergence of new social groups, or of groups of which we are more aware today than we have ever been before, has also sensitized us to the need for tailoring health activities to the real and perceived needs of communities, no matter what their form or size. The poor, the elderly, the young, refugees, indigenous populations - all these have relatively unique characteristics and special needs. Only by working

5 with them as partners and creating mechanisms that truly reflect these needs and respond to them will we be able to look forward to achieving health for all and greater equity. The need for solidarity between the health sector and the community has never been more obvious, nor indeed has the need for the greater involvement of other sectors in health development. The Discussions highlighted the complexity of the problem as well as the opportunities that present themselves. It is clear, for example, that unless the formal sector and its personnel are able to work closely with the community, listening to them, seeing them as equals, and engaging them in the planning and decision-making process, there will be little real progress. For this to happen calls, on the one hand for new attitudes and approaches on the part of health staff, and on the other, it calls for a better informed and motivated public. The first will only come about when the training of health and other formal sector personnel is itself modified to accommodate and respond to the need for community-based action. The second will only materialize when we learn how to reach all members of the community with information and education with which they can identify and incorporate into their everyday lives. The role and responsibility of other sectors must also be reconsidered. The Technical Discussions last week emphasized, time and time again, that health development is not the prerogative or the responsibility solely of the health sector. Health development is and must be seen as the product of better communications, better education, better environmental conditions, better economic opportunities, regular food availability,and access to clean and plentiful water. If all these conditions are to be met, other sectors will need to participate fully. They too, must also learn to work with and for the community, sharing with the health sector common goals and objectives, as well as a share of the budget resources. Operational approaches must, therefore, be promoted to stimulate the allocation to health development of budgetary resources originating from other sectors. The outline of the technical guidance for the health development programme in other sectors should, however, remain the responsibility of the health sector. Our Discussions also highlighted the important role that women and women's groups have consistently played in promoting and protecting the health and well-being of families and communities. Women must now become beneficiaries as well as agents of health change. They must become more clearly involved in responding to this health development challenge and must be recognized as central to the achievement of greater equity in health. The development of a community-based health information system has been encouraged in the Discussions, to permit the building-up of a capacity for decision-making and planning in health and related matters and to allow the community to identify and express particular needs and to negotiate appropriate solutions. Such a system is also important as a way of stimulating decentralization. In all this, the work and the place of nongovernmental and private organizations must receive greater recognition. The task before us is not one that we will ever be able to take up without the organized involvement of public interest groups. Nongovernmental organizations have consistently demonstrated their capacity to reflect the interests of the community and,in so doing, must also become equal partners in the development of new approaches to health. No matter how active communities are, however, their actions can only be sustained when there is a true national commitment to their work and to their role. Community action for health should never be seen as a means of reducing the responsibility of the formal sector, but rather as an initiative designed to complement the work of the health and other sectors. In this regard, the financing of community action for health must become a new focus of attention, and all sectors must learn how to allocate economic as well as technical resources in support of community action for health. Community action for health should also be seen in the light of the scientific and technical contributions which all communities can and do regularly make. And in this regard, we also believe that the work of communities in support of health development must be systematically evaluate in terms of its effectiveness, its cost, and the alternative approaches that can be taken to initiating and sustaining it. The need for health service research that focuses on community action for health was highlighted throughout our Discussions. Our deliberations last week also highlighted the need for WHO to take a leadership role in promoting and in supporting community action for health. The need for guidelines that can be adapted to local and national conditions, as well as the need for a concerted long-term commitment by the Organization was

6 pressed by many participants in the Discussions. In this regard, I am sure that the Executive Board at its session in January 1995 will wish to consider how best WHO should integrate community action for health philosophy in all its activities and programmes. With these few words I would like to thank the Secretariat, moderators and rapporteurs who took part in these Technical Discussions. All of them worked extraordinarily hard, resulting in extremely productive and positive Technical Discussions. It has been a pleasure for me to chair the Technical Discussions at the Forty-seventh World Health Assembly and it is an honour for me today to submit for your consideration the report of those Discussions. Thank you very much. Thank you, Mrs Roestam. I am confident that I am e^ressing the feeling of each and every member of this Assembly when I thank you most sincerely for presenting this excellent report, which reflects the importance of the subject. The comprehensive background documentation and the video testimonials on selective issues on health within the community clearly set the tone for the Discussions. Participants brought to bear their expertise on the issues under discussion and demonstrated their commitment to seeküig concrete actions that would make a difference in the health care system by tackling problems at its lowest level, that is the community level. As one can see, pertinent actions are highlighted in the final report. I would like to take this opportunity on behalf of the Assembly to congratulate all those who have been involved in the preparation for and organization of these Technical Discussions. Before adjourning, I should like to remind you that the General Committee will meet after this meeting, to decide on the programme of work for the remaining duration of the Assembly. I also have two announcements to make. At 13h00 today there will be a briefing on malaria control in Room VIII with interpretation into English and French, and this afternoon the two main committees will meet at 14h30. The next plenary meeting will be held tomorrow, Tuesday, 10 May, at llhlo. The meeting is adjourned. The meeting rose at 12h30. La seance est levée à 12h30.