WHA51 I 1998/REC/2
WORLD HEALTH ORGANIZATION ORGANISATION MONDIAL£ DE LA SANTE
FIFTY-FIRST WORLD HEALTH ASSEMBLY GENEVA, 11-16 MAY 1998
VERBATIM RECORDS OF PLENARY MEETINGS
CINQUANTE ET UNIEME' ASSEMBLEE MONDIALE DEIASANTE" GENEVE, 11-16 MAl 1998
COMPTES RENDUS IN EXTENSO DESSEANCESPLENIERES
GENEVA GENEVE 1999 WHA51/1998/REC/2
WORLD HEALTH ORGANIZATION ORGANISATION MONDIALE DE LA SANTE
FIFTY-FIRST WORLD HEALTH ASSEMBLY GENEVA, 11-16 MAY 1998
VERBATIM RECORDS OF PLENARY MEETINGS
CINQUANTE ET UNIEME' ASSEMBLEE MONDIALE DELASANTE GENEVE, 11-16 MAl 1998
COMPTESRENDUSINEXTENSO DESSEANCESPLENIERES
GENEVA GENEVE 1999 PREFACE
The Fifty-first World Health Assembly was held at the Palais des Nations, Geneva, from 11 to 16 May 1998, in accordance with the decision of the Executive Board at its I OOth session. Its proceedings are published in three volumes, containing, in addition to other relevant material:
Resolutions, decisions and annexes- document WHASI/1998/REC/1
Verbatim records ofplenary meetings and list of participants- document WHASI/1998/REC/2
Summary records and reports of committees- document WHASI/1998/REC/3
For a list of abbreviations used in these volumes, the officers of the Health Assembly and membership of its committees, the agenda and the list of documents for the session, see preliminary pages of document WHA51 /1998/REC/1.
In these verbatim records, 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. The texts include corrections received up to July 1998, the cut-off date announced in the provisional version, and are thus regarded as final.
AV ANT -PROPOS
La Cinquante et Unieme Assemblee mondiale de la Sante s'est tenue au Palais des Nations a Geneve du 11 au 16 mai 1998, conformement a la decision adoptee par le Conseil executif a sa centieme session. Ses actes sont pub lies dans trois volumes contenant notamment :
les resolutions et decisions et les annexes qui s'y rapportent - document WHASI/1998/REC/1,
les comptes rendus in extenso des seances plenieres et la liste des participants - document WHA51 /1998/REC/2,
les proces-verbaux et les rapports des commissions- document WHA51/1998/REC/3.
On trouvera dans les pages preliminaires du document WHA51 /1998/REC/1 une liste des abreviations employees dans la documentation de l'OMS, l'ordre du jour et la liste des documents de la session ainsi que la presidence et le secretariat de l'Assemblee de la Sante et la composition de ses commissions.
Les presents comptes rendus in extenso reproduisent dans la langue utilisee par l'orateur les discours prononces en anglais, arabe, chinois, espagnol, franyais ou russe, et dans leur interpretation anglaise ou franyaise les discours prononces dans d'autres langues. Ces comptes rendus comprennent les rectifications reyues jusqu'au debut juillet 1998, date limite annoncee dans leur version proviso ire, et sont done consideres comme finals.
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- iv- INTRODUCCION
La 51" Asamblea Mundial de la Salud se celebr6 en el Palais des Nations, Ginebra, del 11 al 16 de mayo de 1998, de acuerdo con la decisi6n adoptada por el Consejo Ejecutivo en su 100" reuni6n. Sus debates se publican en tres volumenes que contienen, entre otras cosas, el material siguiente:
Resoluciones, decisiones y anexos: documento WHA51 /1998/REC/1
Aetas taquigraticas de las sesiones plenarias y lista de participantes: documento WHASl/1998/REC/2
Aetas resumidas e informes de las comisiones: documento WHASl/1998/REC/3
En las paginas preliminares del documento WHA51/1998/REC/l figuran una lista de las siglas empleadas en estos volumenes, la composici6n de la Mesa de la Asamblea y de sus comisiones, el orden del dia, y la lista de documentos de la reuni6n.
En las presentes aetas taquigraticas Ios discursos pronunciados en arabe, chino, espafiol, fiances, ingles o ruso se reproducen en el idioma utilizado por el orador. De Ios pronunciados en otros idiomas se reproduce la interpreta ci6n al fiances o al ingles. Las aetas contienen las correcciones recibidas hasta julio de 1998, fecha limite anunciada en la versi6n provisional, y por consiguiente se consideran definitivas.
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Address by the Director-General of the United Nations at Geneva ...... 4 4. Address by the President of the Fiftieth World Health Assembly ...... 6 5. Appointment of the Committee on Credentials ...... 6 6. Election of the Committee on Nominations ...... 7 Second plenary meeting I. First report of the Committee on Nominations ...... 8 2. Second report of the Committee on Nominations ...... 9 Third plenary meeting 1. Presidential address ...... 11 2. Adoption of the agenda and allocation of items to the main committees ...... 14 3. Announcement ...... 31 Fourth plenary meeting 1. Programme of work ofthe Health Assembly ...... 32 2. Review and approval ofthe reports ofthe Executive Board on its 100th and 101st sessions . . . . . 33 3. Review of The world health report 1998 ...... 35 4. First report of Committee B ...... 39 5. Debate on the reports of the Executive Board on its 1OOth and 101 st sessions and on The world health report 1998 ...... 45 Fifth plenary meeting Debate on the reports of the Executive Board on its 1OOth and 101 st sessions and on The world health report 1998 (continued) ...... 65 Sixth plenary meeting 1. Programme of work of the Health Assembly ...... 93 2. First report of the Committee on Credentials ...... 94 3. Director-General ...... 96 - ix- Page Seventh plenary meeting Debate on the reports of the Executive Board on its 1OOth and 101 st sessions and on The world health report 1998 (continued) ...... 108 Eighth plenary meeting Fiftieth anniversary of WHO 151 Ninth plenary meeting 1. Awards ...... 166 Presentation ofthe Sasakawa Health Prize...... 166 Presentation ofthe United Arab Emirates Health Foundation Prize ...... 172 2. Election ofMembers entitled to designate a person to serve on the Executive Board ...... 177 Tenth plenary meeting 1. First report of Committee A ...... 178 2. Second report of Committee A ...... 178 3. Third report of Committee A ...... 179 4. Fourth report of Committee A ...... 179 5. Fifth report of Committee A ...... 180 6. Second report of Committee B ...... 181 7. Third report ofCommittee B ...... 181 8. Fourth report of Committee B ...... 182 9. Fifth report of Committee B ...... 182 10. Second report of the Committee on Credentials ...... 184 11. Fifth report of Committee B (resumed) ...... 185 12. Sixth report of Committee B ...... 185 13. Review and approval ofthe reports of the Executive Board on its 100th and 101 st sessions (continued) ...... 185 14. Selection of the country or region in which the Fifty-second World Health Assembly will be held ...... 186 15. Statement of the Director-General ...... 186 16. Announcement ...... 187 Eleventh plenary meeting Closure of the session ...... 188 MEMBERSHIP OF THE HEALTH ASSEMBLY List of delegates and other participants ...... 197 Representatives of the Executive Board ...... 249 Participants in the commemoration of the Fiftieth Anniversary of the World Health Organization . . . . . 249 Indexes (Names ofspeakers; countries and organizations) ...... 251 -X- TABLE DES MATIERES Pages Avant-propos ...... iii COMPTES RENDUS IN EXTENSO DES SEANCES PLENIERES Premiere seance pleniere I. Ouverture de la session ...... I 2. Allocution du President de la Suisse ...... 2 3. Allocution du Directeur general de I'Office des Nations Unies a Geneve ...... 4 4. Allocution du President de la Cinquantieme Assemblee mondiale de la Sante ...... 6 5. Constitution de la Commission de Verification des Pouvoirs ...... 6 6. Election de la Commission des Designations 7 Deuxieme seance pleniere I. Premier rapport de la Commission des Designations ...... 8 2. Deuxieme rapport de la Commission des Designations ...... 9 Troisieme seance pleniere I. Discours du President de I' Assemblee ...... 11 2. Adoption de l'ordre dujour et repartition des points entre les commissions principales ...... 14 3. Communication ...... 31 Quatrieme seance pleniere I. Programme de travail de I' Assemblee de la Sante ...... 32 2. Examen et approbation des rapports du Conseil executif sur ses centieme et cent unieme sessions ...... 33 3. Examen du Rapport sur la sante dans le monde, 1998 ...... 35 4. Premier rapport de la Commission B ...... 39 5. De bat sur Jes rapports du Conseil executif sur ses centieme et cent unieme sessions et sur le Rapport sur la sante dans le monde, 1998 ...... 45 Cinquieme seance pleniere Debat sur les rapports du Conseil executif sur ses centieme et cent unieme sessions et sur le Rapport sur la sante dans le monde, 1998 (suite) ...... 65 Sixieme seance pleniere I. Programme de travail de I' Assemblee de la Sante ...... 93 2. Premier rapport de la Commission de Verification des Pouvoirs ...... 94 3. Directeur general ...... 96 -xi- Pages Septieme seance pleniere Debat sur les rapports du Conseil executif sur ses centieme et cent unieme sessions et sur le Rapport sur la sante dans le monde, 1998 (suite) ...... 108 Huitieme seance pleniere Cinquantieme anniversaire de l'OMS 151 Neuvieme seance pleniere 1. Distinctions ...... 166 Remise du Prix Sasakawa pour la Sante ...... 166 Remise du Prix de la Fondation des Emirats arabes unis pour la Sante ...... 172 2. Election de Membres habilites a designer une personne devant faire partie du Conseil executif . 177 Dixieme seance pleniere 1. Premier rapport de la Commission A ...... 178 2. Deuxieme rapport de la Commission A ...... 178 3. Troisieme rapport de la Commission A ...... 179 4. Quatrieme rapport de la Commision A ...... 179 5. Cinquieme rapport de la Commission A ...... 180 6. Deuxieme rapport de la Commission B ...... 181 7. Troisieme rapport de la Commission B ...... 181 8. Quatrieme rapport de la Commission B ...... 182 9. Cinquieme rapport de la Commission B ...... 182 10. Deuxieme rapport de la Commission de Verification des Pouvoirs ...... 184 11. Cinquieme rapport de la Commission B (reprise) ...... 185 12. Sixieme rapport de la Commission B ...... 185 13. Examen et approbation des rapports du Conseil executif sur ses centieme et cent unieme sessions (suite) ...... 185 14. Choix du pays ou de la Region oil se tiendra la Cinquante-Deuxieme Assemblee mondiale de la Sante ...... 186 15. Declaration du Directeur general ...... 186 16. Communication ...... 187 Onzieme seance pleniere Cloture de la session ...... 188 COMPOSITION DE L' ASSEMBLEE DE LA SANTE Liste des delegues et autres participants ...... 197 Representants du Conseil executif ...... 249 Participants a la celebration du cinquantieme anniversaire de I' Organisation mondiale de la Sante . . . 249 Index des noms des orateurs ...... 251 Index des pays et organisations ...... 257 - xii- A51NRI1 page 1 VERBATIM RECORDS OF PLENARY MEETINGS COMPTES RENDUS IN EXTENSO DESSEANCESPLENIERES FIRST PLENARY MEETING Monday, 11 May 1998, at 10:00 President: Mr S.l. SHERVANI (India) PREMIERE SEANCE PLENIERE Lundi 11 mai 1998, 10 heures President: M. S.l. SHERVANI (Inde) 1. OPENING OF THE SESSION OUVERTURE DE LA SESSION ... The PRESIDENT: The Assembly is called to order. Distinguished delegates, ladies and gentlemen, as President of the Fiftieth World Health Assembly, I have the honour to open the Fifty-first World Health Assembly. On this occasion of the fiftieth anniversary of our Organization, we are honoured to have the President of the Swiss Confederation, Mr Flavio Cotti, attend this opening session. Permit me, therefore, to suspend the meeting very briefly while the Director-General and I receive our distinguished guest. The meeting was suspended at 10:05 and resumed at 10:10. La seance est suspendue a 10h05 et reprend a 10h10. The meeting is resumed. Having previously opened this Fifty-first World Health Assembly, I welcome with great pleasure, on behalf of the Assembly and the World Health Organization, Mr Flavio Cotti, President of the Swiss Confederation and I thank you warmly, Mr Cotti, for having honoured us with your presence here today. I also welcome Mr Paolo Janke, Mr Cotti's assistant. I also have pleasure in welcoming: Mr Vladimir Petrovsky, Director-General of the United Nations Office at Geneva, and representing the Secretary-General of the United Nations; Mr M. Ulklimen, Chief of Protocol, United Nations Office at Geneva; Mr Guy-Olivier Segond, State Councillor, Republic and Canton of Geneva, representing the Geneva State Council; Mr Waiter Gyger, Ambassador, Permanent Representative of Switzerland to the International Organizations at Geneva and Permanent Observer to the United Nations; Mr Michel Rossetti, Mayor of Geneva; Mr Jerome Koechlin, Chief of Protocol, Republic and Canton of Geneva; Madame Marie-Francc Spielmann, President of the Municipal Council of Geneva; Professor Peter Suter, Dean of the Faculty of Medicine; Mr Pekka Tarjanne, Secretary General, International Telecommunications Union; Mr Tyrone Sutherland, representing the Secretary-General of the World Meteorological Organization; Dr Brian Gushulak, representing the Director-General of the A51NR/1 page2 International Organization for Migration; Mr Cornelio Sommaruga, President, International Committee of the Red Cross; Mr George Weber, Secretary-General of the International Federation of Red Cross and Red Crescent Societies; the representatives of the United Nations specialized agencies and the representatives of the various United Nations bodies; and the delegates ofMember States. I also welcome the observers of non-Member States, the observers from the Order of Malta, the International Committee of the Red Cross and from Palestine; and the representatives of intergovernmental and nongovernmental organizations in official relations with WHO. I welcome also the representatives of the Executive Board. It is also an honour to have with us on this commemorative occasion several presidents of previous Assemblies, and I warmly welcome them. 2. ADDRESS BY THE PRESIDENT OF SWITZERLAND ALLOCUTION DU PRESIDENT DE LA SUISSE The PRESIDENT: I now give the floor to Mr Flavio Cotti, President of the Swiss Confederation. M. COTTI (President de la Confederation suisse) : Monsieur le President, Monsieur le Directeur general, Mesdames et Messieurs les representants du Gouvernement cantonal de Geneve et de la Ville de Geneve, Excellences, Mesdames et Messieurs les representants des organisations non gouvernementales, Mesdames et Messieurs, c'est un reel honneur que je ressens aujourd'hui, et un grand plaisir, celui qui m'est donne de vous transmettre les meilleurs voeux du Gouvernement suisse a)'occasion du cinquantenaire de )'Organisation mondiale de la Sante. Cet honneur et ce plaisir sont d'autant plus significatifs que je n'ai pas oublie, Monsieur le Directeur general, les six annees et demie que j'ai passees dans ce pays en tant que Ministre de la Sante. Le contexte dans lequel s'est inscrite la creation de l'OMS il y a cinquante ans etait - nous le savons bien - radicalement different de la situation actuelle. A l'epoque, le paludisme sevissait encore a quelques centaines de kilometres de Geneve, le spectre de la poliomyelite planait encore et la propagation des virus grippaux vouait a une mort certaine d'innombrables personnes. Je rappelle que la grippe espagnole a elle seule, en 1918-1919, a fait plus de victimes que la Premiere Guerre mondiale prise dans son ensemble. Et lorsque I'OMS a ete creee, le monde sortait d'une nouvelle guerre mondiale d'une terrible atrocite. La faim ou la penurie regnait encore dans toute !'Europe, la mortalite infantile etait tres elevee, tandis que l'esperance de vie avait enormement baisse. Depuis lors, l'etat de sante des populations s'est considerablement ameliore, tant en Europe que dans les autres regions du monde, non seulement dans les pays industrialises ou I' esperance de vie depasse presque partout 75 ans, mais aussi dans les pays en developpement. Pres des quatre cinquiemes de la population des pays en developpement ont aujourd'hui acces a de !'eau potable et a des soins medicaux de base, d'ou une reduction de pres de la moitie de la mortalite infantile au cours des trente-cinq dernieres annees. Quant a I' esperance de vie, elle a augmente de plus de quinze ans depuis 1960 et, dans le meme temps, le nombre moyen d'enfants a considerablement diminue dans ces regions pour la premiere fois de leur histoire. Une serie de progres, qui sont bien sur le fruit - il faut le souligner - des efforts consentis par tous les Etats concernes, mais )'action menee par I'OMS dans le monde entier y a aussi largement contribue. Elle a permis de faire reculer diverses maladies infectieuses, voire de les eradiquer, comme la variole. Et des millions d'enfants doivent leur survie ade grandes campagnes de vaccination. L'OMS peut etre fiere aujourd'hui de ses cinquante ans d'activites. Elle compte au nombre des organisations internationales qui apportent des ameliorations concretes et essentielles aux conditions de vie dans le monde entier. Aider ceux qui sont malades est l'une des taches les plus nobles de l'etre humain. L'OMS est une institution qui remplit cette tache sans distinction de nationalite, de religion ou de race. Elle marque ainsi un prodigieux progres de I'humanite car, pour la premiere fois de son histoire, la communaute internationale essaye de tout mettre en oeuvre pour que tout etre humain atteint d'une maladie curable ait une chance d'en etre delivre, ou qu'il vive dans ce monde. Cet effort exceptionnel vaut aI'OMS la reconnaissance la plus profonde du Gouvernement et du Conseil federal suisses. Mais n'oublions pas que, malgre les efforts deployesjusqu'ici, la situation sanitaire mondiale presente encore des contrastes criants. Alors que, dans les pays industrialises, le diagnostic assiste par ordinateur et la A51NR/1 page3 microchirurgie sont depuis longtemps des actes medicaux courants, des millions d'etres humains n'ont meme pas acces a des soins de sante primaires dans d'autres regions du monde. Dans les pays pauvres, pres de 250 000 enfants meurent encore chaque semaine de maladies carentielles, que des soins de sante primaires pourraient guerir avec une relative facilite. Alors que les pays du Nord peuvent depenser pres de 2000 dollars par habitant et par an pour les soins medicaux, 1' Afrique noire, par exemple, peut y consacrer a peine plus de vingt dollars par habitant. Et tandis qu'en Europe nous avons un medecin pour mille habitants, le ratio medecin par habitant est de 1 sur 20 000 dans d' autres regions du monde. Ainsi, je me permets de tirer une conclusion : la sante et la pauvrete sont manifestement liees. En effet, le constat est amer : malgre tous les efforts deployes jusqu'ici, la sante reste encore souvent l'apanage des nantis. Dans certaines regions du monde, la maladie va de pair avec la misere, les inegalites sociales et le sous-developpement. En bref, la pauvrete est un fleau pour la sante. La conscience de !'importance de la sante dans la vie de chacun nous engage clairement a intensifier notre action politique contre la pauvrete, et le Secretaire general de !'Organisation des Nations Unies, M. Kofi Annan, a vise juste lorsqu 'il a affirme il y a plus d'un an, et je le cite : "The best defence against new global ills is a society based on equal opportunity, social justice, human rights and democracy". La realisation de cet objectif constitue, en effet, un formidable defi pour la communaute intemationale, mais je suis convaincu que nous ne pourrons remplir notre mission, c'est-a-dire assurer une meilleure assistance medicate aux habitants de ce monde, que si nous luttons contre les principales causes de maladies, et - je le repete - la pauvrete est une de ces causes principales. Depuis 1981, les activites de I'OMS s'inscrivent dans la strategie definie comme "la sante pour tous". Cette strategie implique done un engagement en faveur d'un developpement durable, et la sensibilite a cette interdependance a fortement augmente au cours des demieres annees grace, justement, a la sante pour to us. La mise en place de partenariats avec des organisations professionnelles ainsi qu'avec d'autres organisations non gouvernementales oeuvrant dans le domaine de la sante, comme les ligues de la sante, a contribue a porter dans le public la reflexion qui est a la base de la strategie de la sante pour tous. A cet egard, le Dr Nakajima, qui quittera ses fonctions cet ete apres dix ans de travaux couronnes de succes, a joue un role tres important. Je voudrais saisir cette occasion pour vous remercier, Docteur Nakajima, au nom du Gouvemement suisse, pour le travail que vous avez accompli et aussi pour l'excellente collaboration de l'OMS avec notre pays. 11 est clair que la sante pour tous est difficilement realisable. En definitive, la maladie fait partie de la vie, tout comme la sante, mais la contribution personnelle du Dr Nakajima a marque un pas important vers la realisation de 1' objectif de so ins medicaux dignes pour to us. Je voudrais aussi dire combien je me felicite que le Conseil executif de I'OMS propose la candidature de Mme Gro Harlem Brundtland a la succession du Dr Nakajima. 11 y a quelques annees, alors que j'etais Ministre suisse de I'Environnement,j'ai ete appele a collaborer etroitement avec Mme Brundtland. Fort de cette experience, je puis done attester qu' elle est une personne exceptionnelle qui presente toutes les qualites requises pour relever les defis auxquels j'ai fait allusion en m'exprimant aujourd'hui. Mesdames et Messieurs, permettez-moi de formuler une demiere remarque au sujet des relations entre la Suisse et !'Organisation des Nations Unies. L'OMS - nous l'avons vu - jouit d'un prestige extraordinaire aussi en Suisse. Nous sommes tiers que Geneve ait ete choisie comme siege de cette fondamentale institution specialisee de I'ONU il y a cinquante ans. La Suisse aura toujours a coeur d'asseoir la vocation intemationale de Geneve, lieu de rencontre multilateral et veritable forum universe!. La Geneve intemationale reste un engagement permanent, perpetuel de mon pays. La fonction de la Suisse en tant que Membre observateur de l'ONU et sa participation aux travaux des institutions specialisees rappellent en effet quotidiennement a notre pays !'importance de la cooperation multilaterale. Ainsi, il est d'autant plus regrettable que mon pays ne soit pas encore Membre a part entiere de I'ONU alors que, comme je le disais, il est Membre de toutes les institutions specialisees et qu'il compte aussi parmi les principaux contributeurs des Nations Unies. 11 y a quelques jours - vous l'avez peut-etre appris - le lancement d'une initiative populaire importante, dans le cadre de la democratie directe et referendaire de la Suisse, demandant I' adhesion de la Suisse a !'Organisation des Nations Unies a ete annonce dans mon pays et, de fait, je suis tout a fait convaincu que le moment est venu pour la Suisse de participer pleinement aux activites des Nations Unies. L'adhesion de la Suisse a I'ONU constitue en effet I'un des objectifs fixes par le Conseil federal en matiere de politique etrangere. Je suis convaincu, Monsieur le Sous Secretaire general Petrovsky, que cette volonte politique ainsi que le succes probable de la collecte des signatures pour !'initiative populaire permettront de progresser plus rapidement sur la voie de la realisation de cet objectif, que nous considerons essentiel. C'etait le demier message, Excellences, Mesdames et Messieurs, que je voulais vous adresser au nom du Conseil federal a !'occasion de ce cinquantieme anniversaire de I'OMS. Soyez remercies de votre attention. A51NR/1 page4 The PRESIDENT: Thank you, Mr Cotti, for your very inspiring speech. 3. ADDRESS BY THE DIRECTOR-GENERAL OF THE UNITED NATIONS OFFICE AT GENEVA ALLOCUTION DU DIRECTEUR GENERAL DE L'OFFICE DES NATIONS UNIES A GENEVE The PRESIDENT: Mr Petrovsky, Director-General of the United Nations Office in Geneva, and representing the Secretary General of the United Nations, will now address the Assembly. Mr PETROVSKY (Director-General of the United Nations Office at Geneva): Mr President of the Swiss Confederation, Mr President of the Health Assembly, Mr Director-General of the World Health Organization, Excellencies, ladies and gentlemen. It is an honour and privilege for me to address this distinguished Assembly on the occasion of the fiftieth anniversary of the World Health Organization. I have the honour to convey to you the good wishes of the Secretary-General of the United Nations, Mr Kofi Annan. He, and the United Nations family as a whole, admire the vital work of this Organization whose guiding principle is elegantly stated in its Constitution: "The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition." These words have a special resonance this year which also marks the fiftieth anniversary of the Universal Declaration of Human Rights. During the past five decades, WHO has made great strides in promoting health and health awareness worldwide. Thanks to efforts ofthis Organization, health is at the forefront of the political, social and economic agenda in all countries. The goal ofhealth for all, based on equality and social justice, has become familiar not just in ministries of health in capitals of large countries, but in towns and villages in the least developed countries. The World Health Organization may look back with pride on its many achievements in health, notably in the eradication of smallpox and immunization against childhood diseases. Significant progress has also been made towards the eradication of poliomyelitis and measles and in the elimination of leprosy as a public health problem by the year 2000. The task today is to respond effectively to new health challenges requiring global mobilization to combat relatively new diseases such as AIDS and Ebola virus and to redouble efforts against all too familiar diseases such as malaria, tuberculosis, plague, cholera, dysentery, Rift Valley fever and bacterial and viral meningitis. Not to maintain the creative and integrative efforts against such scourges would have disastrous consequences for human and economic development. It is appropriate to recall that, according to the WHO Constitution, "the health of all peoples is fundamental to the attainment of peace and security and is dependent upon the fullest cooperation of individuals and States". One might interpret this also to include cooperation among international organizations, among which WHO sets a wonderful example. In reviewing and updating its mandate in the field of emergency and humanitarian assistance, WHO continues to make an essential contribution to assist the United Nations undertaking in this field. It has placed new emphasis on rapid mitigation of the health consequences of both natural and man-made disasters and on provision of technical guidance and training personnel in emergency preparedness. In February of this year, addressing the organizational session of the Economic and Social Council, the Secretary-General of the United Nations, Mr Kofi Annan, highlighted the need to utilize the Administrative Committee on Coordination as an appropriate forum for harnessing the specialized capacities and constituencies of various agencies to meet the economic and social objectives of the United Nations Charter and to advance security and development. This point was reiterated at the most recent session of ACC, which was held here in Geneva last March. At its Fifty-first session, the World Health Assembly will consider a new Declaration on Global Health and a new health-for-all policy, which would be adopted as a framework for WHO activities in the twenty-first A51NR/1 pages century. The draft Declaration reaffirms the principle that people's health and we11-being are the ultimate aim of social and economic development. Action for health and development is intended to benefit each individual, as we11 as each community, society and nation, allowing people to participate fully in economic and social life. In pursuit of health for a11, governments are committed to sustainable use of resources and a healthy environment. It is evident that there can be no sustained economic growth or social development without health. At the same time, WHO opportunities to promote the health-for-a11 strategy are affected by gaps in economic development and poverty and we cannot close our eyes to this. In this era of globalization and political, economic and social transition within the countries and across the continents, in fact, events which affect all of us as we approach the new mi11ennium- it is essential to offer more than short-term or stop-gap solutions. We must also focus on strategic, long-term goals and policies which wiii ensure a constructive vision of health and pragmatic and effective approach to the elimination of poverty. Reflecting on the development aspects of health -and not claiming originality in this assessment- I cannot help but remark that poverty is perpetuated, and sometimes caused, by ill-health. If a programme of action aims solely at reducing the harshest aspects of poverty and addresses only the most basic health needs, it tacitly accepts that some individuals and, possibly, entire communities will remain marginalized and excluded from the mainstream of human and economic development. This may a11eviate poverty but it may also have the unintended impact of prolonging it. I believe that this concern should be addressed at the highest level. Ministers ofhealth, as well as Heads of State and Government, should attach top priority to this aspect of public policy. As for practical steps aimed at attacking the underlying causes of poverty and disease, attention should be drawn to the United Nations system-wide special initiative on Africa and, in particular, to WHO's active involvement in areas such as nutrition, vector control and development of basic sanitation, including water supplies and waste-disposal systems. It is important to conceive new and imaginative approaches to the development financing. Today's role of civil society, including the private sector, is widely regarded as a vital partner in multilateral activities, including many aspects of the work of the United Nations system. The Secretary-General of the United Nations, Mr Kofi Annan, stated in Dallas this year, and I quote: "The UN system provides such a global framework and agreed set of standards and objectives that enjoy worldwide acceptance and within which markets are able to function. I have no hesitation in declaring that a strong United Nations is good for business." As an example of successful cooperation, he referred to the World Rotary Clubs, which have given more than US$ 40 million to WHO efforts to eradicate poliomyelitis. In a turbulent world the need for a new health partnership is all the more pressing since the financial constraints of the Organization have not been overcome. WHO's goals cannot be realized without partnership involving governments, international organizations, the private sector and civil society as a whole. Moreover, health cannot be quantified as just another commodity, nor can one fail to acknowledge the impact of escalating health costs on public expenditure. Economic downturns, increased unemployment and the general ageing of the world population raise the question of the long-term sustainability of health services and their financing by a proportionally shrinking labour force. These factors will clearly have to be taken into account in any strategy for health in the twenty-first century. In keeping up with the pace of globalization, it is all the more essential to meet health requirements by adhering to the priorities outlined in the WHO Reform. I am confident that the celebration of the fiftieth anniversary will encourage hard work and an innovative approach to the implementation of far-reaching reforms within the Organization, which will, in turn, make a significant contribution to the revitalization and strengthening of the United Nations system as a whole. At this session of the Health Assembly, Member States will confirm the selection of the Executive Board for the post of Director-General. The change in WHO's leadership and the nomination of Dr Gro Harlem Brundtland, will I am certain, meet the needs and expectations of the Organization in pursuit of a new health-for-all strategy and a response to the health challenges of the twenty-first century. On this occasion, I would like also to note with profound appreciation the endeavour, skill and dedication with which the outgoing Director-General, Dr Nakajima, has guided WHO for almost I 0 years and has established a good example for all the international organizations. In conclusion, I wish you every success and pledge my full support in your efforts to advance the goal of WHO for all the peoples of the world. The PRESIDENT: Thank you Mr Petrovsky. A51NR/1 pages 4. ADDRESS BY THE PRESIDENT OF THE FIFTIETH WORLD HEALTH ASSEMBLY ALLOCUTION DU PRESIDENT DE LA CINQUANTIEME ASSEMBLEE MONDIALE DE LA SANTE The PRESIDENT: Mr Cotti, President of Switzerland, Director-General, Excellencies, distinguished delegates, ladies and gentlemen. It is a great honour for me to preside at the opening of the Fifty-first World Health Assembly. Distinguished delegates, ladies and gentlemen, this Fifty-first World Health Assembly assumes a particular significance for all of us. This year we celebrate the fiftieth anniversary of our Organization, the World Health Organization. A number of Heads of State and Government have accepted to join us personally in commemorating our 50 years of service to the health of the world. A special event has been organized to take place this week, in which our special guests will have an opportunity to share with us their vision and future expectations of our Organization. We all look forward with enthusiasm to these celebrations. Distinguished delegates, at this Assembly we will also consider a document on Health for all in the twenty first century. This document has been designed to realize the vision of health for all, as conceived at the Alma Ata Conference in 1978. It reasserts that primary health care constitutes the cornerstone for attaining the goal of health for all. It restates that health for all is a condition where all peoples can have access to safe, effective and affordable health care, and it reconfirms the mission of the World Health Organization as the directing and coordinating agency in the field of international health. The document points out, among other things, that health for all depends on the will and action of diverse sectors and partners, for health must be seen from its global perspective. International health policies must evolve from common concerns. WHO's mission must continue to draw its strength from a process that integrates the contribution of its partners in development. It is indeed my view that our efforts in the health field can make an impact only if we work in alliance with others. Let us therefore carry forward this mission of health for all in the twenty-first century with more vigour. The opportunity for renewing this commitment will be enshrined when, during the present Assembly, we endorse the World Health Declaration which the Executive Board, at its JOist session, recommended for adoption by the Fifty-first World Health Assembly. This will symbolize our resolve; this will give meaning to our hope, and this will edify our action and strengthen our inspiration and vision. Distinguished delegates, as this is the last time I will be addressing this Assembly, I would like to pay a tribute to Dr Nakajima, the Director-General, who retires in July this year. Dr Nakajima, may I express to you our deep appreciation for your contribution to the work of the Organization, particularly during the period of reform. I also take this opportunity, as we look into the future, to extend a warm welcome to Dr Brundtland, whose nomination, to the post of Director-General by the Executive Board at its lOlst session will be considered by the Fifty-first World Health Assembly. 5. APPOINTMENT OF THE COMMITTEE ON CREDENTIALS CONSTITUTION DE LA COMMISSION DE VERIFICATION DES POUVOIRS The PRESIDENT: We shall now proceed with item 2 of the provisional agenda: "Appointment of the Committee on Credentials". The Assembly is required to appoint a Committee on Credentials in accordance with Rule 23 of the Rules of Procedure. In conformity with this Rule, I propose for your approval the following 12 Member States: Austria, Belgium, Bolivia, Democratic People's Republic of Korea, Democratic Republic of the Congo, Gabon, Islamic Republic of Iran, Japan, Paraguay, Qatar, Senegal and The former Yugoslav Republic of Macedonia. Are there any objections? If there are no objections, I declare the Committee on Credentials, as proposed by me, appointed by the Assembly. Subject to the decision of the General Committee, and in conformity with resolution WHA20.2, this Committee will hold its first meeting on Tuesday, 12 May at 14:30. A51NR/1 page? 6. ELECTION OF THE COMMITTEE ON NOMINATIONS ELECTION DE LA COMMISSION DES DESIGNATIONS The PRESIDENT: We now come to item 3: Election ofthe Committee on Nominations. This item is governed by Rule 24 ofthe Rules of Procedure of the Assembly. In accordance with this Rule, a list consisting of24 Member States and the President ex officio has been drawn up, and I shall submit it to the Assembly for its consideration. May I explain that, in compiling this list, the following distribution by Region has been applied: Africa: six Members; Americas: five Members; South-East Asia: two Members; Europe: six Members; Eastern Mediterranean: three Members; Western Pacific: three Members. I therefore propose to you the following Member States: Bahamas, Cameroon, Canada, Comoros, Djibouti, Equatorial Guinea, Estonia, France, Guatemala, Malta, Mauritania, Palau, Peru, Philippines, Russian Federation, Sao Tome and Principe, Swaziland, Thailand, United Arab Emirates, United Kingdom of Great Britain and Northern Ireland, Uruguay, Uzbekistan, VietNam and Yemen. Are there any observations or additions to the list? In the absence of observations, I declare the Committee on Nominations elected. As you know, Rule 25 of the Rules of Procedure, which defines the mandate ofthe Committee on Nominations, also states that "the proposals of the Committee on Nominations shall be forthwith communicated to the Health Assembly". The Committee on Nominations will meet at 11:00 in Room VII. The next plenary meeting will be held at 12 noon. May I request delegates to remain seated while the Director General accompanies our distinguished guests from the hall. The meeting is adjourned. The meeting rose at 10:55. La seance est levee a 10h55. A51NR/2 pageS SECOND PLENARY MEETING Monday, 11 May 1998, at 12:00 President: Mr S.l. SHERVANI (India) later: Dr F.R. AL-MOUSAWI (Bahrain) DEUXIEME SEANCE PLENIERE Lundi 11 mai 1998, 12 heures President: M. S.l. SHERVANI (lnde) puis: Dr F.R. AL-MOUSAWI (Bahrein) 1. FIRST REPORT OF THE COMMITTEE ON NOMINATIONS1 PREMIER RAPPORT DE LA COMMISSION DES DESIGNATIONS1 The PRESIDENT: The Assembly is called to order. The first item on our agenda this afternoon is the consideration of the first report ofthe Committee on Nominations. This report is contained in document ASI/28 which I will now read. The Committee on Nominations, consisting of delegates of the following Member States: Bahamas, Cameroon, Canada, Comoros, Djibouti, Equatorial Guinea, Estonia, France, Guatemala, Malta, Mauritania, Palau, Peru, Philippines, Russian Federation, Sao Tome and Principe, Swaziland, Thailand, United Arab Emirates, United Kingdom of Great Britain and Northern Ireland, Uruguay, Uzbekistan, VietNam, Yemen and MrS. Shervani, India (ex officio) met on 11 May 1998. In accordance with Rule 25 of the Rules of Procedure of the Health Assembly and respecting the practice of regional rotation that the Assembly has followed for many years in this regard, the Committee decided to propose to the Assembly the nomination ofDr F.R. Al-Mousawi (Bahrain) for the Office of President of the Fifty-first World Health Assembly. Election of the President Election du President de I' Assemblee The PRESIDENT: Are there any observations? In the absence of any observations, and as it appears that there are no other proposals, it will not be necessary to proceed to a vote since only one candidate has been put forward. In accordance with Rule 80 of the Rules of Procedure, I therefore suggest that the Assembly approves the nomination submitted by the Committee and elects its President by acclamation. (Applause/Applaudissements) Dr Faisal Radhi Al-Mousawi is thereby elected President of the Fifty-first World Health Assembly and I invite him to take his seat on the rostrum. 1 See reports of committees in document WHA51!1998/REC/3. 1 Voir les rapports des commissions dans le document WHA51/1998/REC/3. A51NR/2 page9 Dr F.R. AI-Mousawi took the presidential chair. Le Dr F.R. AI-Mousawi prend place au fauteuil presidentiel. The PRESIDENT: 0\ ;) Ji ·iL..JI _r.-LJI ~~ ,0.J-!J..u.JI o;)L...J\ ,~\_,A-ll o;)L....l\ ,0_,... .r.JI ~IJj}l o;)L....l\ ,JlA...ll yl>....,.:.\ .~IJ ~;)W\ ~WI a:.....all ~ ~ J ~.j-L>.;:;4 L!-41 ~ Ji ~I aAill o~l ~I oltJ ~4 i...lZi 2. SECOND REPORT OF THE COMMITTEE ON NOMINATIONS1 DEUXIEME RAPPORT DE LA COMMISSION DES DESIGNATIONS1 The PRESIDENT: .·..r.' •)\ Election of the five Vice-Presidents Election des cinq vice-presidents de I' Assemblee The PRESIDENT: :~)1 (Applause/Applaudissements) __,-;)1 ~ J~ 1~1 a....U)I J_; ~)I ylj ,y .WJ ~<,.>.ill ~)1 ~_,4)4 0'11 ;)..b-LJ d~ ~ .:.r-- ~ \...... J a...l...aA;.. ..:,UJ) ~ J.;; a...... :.JI ~)I ylj ~L...... i .:...$' ...W •..:,L...kJI ~ v4-o jA.!; ,~;i....,... ~ cr L. Jj JP...u1 Jl.!ll '~ J...u1 ~J~~ cr ~ JL. 0L. j~ JP...u1 J}-11 J~ \'I .~ _,Al4 . ~;,:; J~ .:.r-- ~; _r. Jy-5 ...UI _y. u--L>..!IJ ,0~J~T ,:r J jl....i\ ~l:;... \11 ~1)1 , 0\.j y. ,:r ~ ~~ ~1.!!1 .(o..b-.,.JI 4;.:;J~ ..::,4\'J) :JWI ~)\ ~ ~t-.. IJ.b:-4 0i ~)\ ylj ,y 0'11 ~ .:.r-- ~L>. )I . ~; _r. JP...UI ~ J _,;L.....il ~l:;... \11 ~ ,_}.; JP...UI ~ L. Jj JP...UI ~ \'} 0L.j~ JP...UI ·~~lA,.. .b:.i ~)\ y\j .!.1\.. :.o. ~t-.. 1J.1.:.4 0iJ ~~ Jl ~~4 1~ 0i 0'11 ~)I yl_,; o;)L....l\ ,:r r-) 1 See reports of committees in document WHA5111998/REC/3. 1 Voir les rapports des commissions dans le document WHA5111998/REC/3. A51NR/2 page 10 Election of the Chairmen of the main committees Election des presidents des commissions principales The PRESIDENT: .·....r-' •)\ (Applause/Applaudissements) (Applause/Applaudissements) Establishment of the General Committee Constitution du Bureau de I' Assemblee The PRESIDENT: .·....r-' •)\ "L...... i ~I..UI rWI .:r- r' o~L...U LU J .:...~ _;:!1 W .::..>-_rjl ..U J .a...WI 4..:>..lll "W-j\ _j ~ u\'IJ ~J .a.·~ d.-oWl 4..:>..lll :V.;. .h.. r-+z~l ~ .:r...UI ~I "~i Jl a;L.,;:.':J4 l_,.fu..u.. ~I~ _r.s. ~ oL y~l ~i if\.; .:...Ui>-~ ~f .!l~ J.; ~ 1;,1.; ,a...WI 4..:>..lll j>b J~~ _jl.).>. C:!:jf Js- .:...L> _;:.WI o..La. ,uw ,tS:::.t...l>. ')~ - y;. d .••.i.} '...T' _;; ,4§" ,~\ ,c.j.JJ ).JY. 'u"' ).)~ ,~}'11 :I/') r ~\ u\...1.4}1 .:...~';J_,JIJ ~L.-..!JI l~.r.fJ ~\ ~~_). o~l ~\ d.L~&) ,~~j ,u_,.Jift"" '(,5""' J)l ~L-;';J\ ,_NI . .-~rf..jlo~l ,, ~.:...~ .)1 .:.,.l.;l.p\ ~I .!J~ jA ~LW\ L::..J.ll "~iJ ._r.s. ~I u\...1.4}1 o..La. y~l ~ 4-if ~i ~~.; .:...Ui>~ c.ji .!l~ J.; ~ 1;,1 o¥-L... .:r...UIJ :V..r. .h.. ~~I .:r...UI _r.s. ~I 01...1.4}1 y..)..u.. J ~)I ~I L...J .J) <4lj J ~I ~.J ,~1 ,uW ,~t...~>. 'J~- y;. d .••.i) 'uP_;; ,4§" ,~1 ,c.?.JJJ.;Y. 'u"'J.J~ '~.Jf..j1 :u\'1 ~L-i o~l .:...~)I_,JIJ ~L.-..!JI I~)J ~\ ~~_). o~l a5:i...JI d~} ,~~f ,u_,.Jift"" 'LS""'J)I ~t.-;)11 • -~_r~l .:r o...b-1_,)1 a&.L..J\ _j ~ ~ d.-oWl 4..:>..lll u~ ~_,s--;,i ui ~} a...... l:..JI o..La. C!.; J.:i J 'i\.:;;.ill ~ J ~I J ~.;l.WI o~WI Js- V a&.WI .:r y ,;J4 ~J~I .J+! _j .:.,.L.;.jJ~ t)~ J , V a&.WI J ..,.J:ill ~ ~f u"YI.) ·r~\ H ~ .:r ....WI) ~L!ll a&.L..J\ J ~I a...W\ a...... L:..JI ~) .a...... L:..JI o..La. C!J L.~ d.-oWl . a...... l:..JI o..La. C!.) The meeting rose at 12:20. La seance est levee a 12h20. A51NR/3 page11 THIRD PLENARY MEETING Monday, 11 May 1998, at 14:30 President: Dr F.R. AL-MOUSAWI (Bahrain) TROISIEME SEANCE PLENIERE Lundi 11 mai 1998, 14h30 President: Dr F.R. AL-MOUSAWI (Bahrein) 1. PRESIDENTIAL ADDRESS DISCOURS DU PRESIDENT DEL'ASSEMBLEE The PRESIDENT: =..r.! )I r...WI L....:>-lS"Li ~ J.r.!" .;p...Ui JlA.. ,.) _,; )1 ~L... j.; o.)lA....l\J JlA.JI y~i ,~)1 -:r>)I .ill! r ~I i...l..Zi 0i J~ ....u.;J ,...;\S":r.J .ill\ ~ .JJ ~ {>WI ,-;;.)W\J ._:..\~\ 4-:i ,.) _,; )1 ~~i o.)W\ 'iWI ~ ~ ~ 'Y ~? .Y'J ~IJ ~.)W\ ~WI ~I ~ a....u J'. ~_r;.:l .r.iliiJ ~I ~~ J->-l.:.r-- ~ 0J~ 04 J-"1 JS'J ,:t.pl.> .y.~l alJ...UJ ,a,.~ ..6..... _r.JI J_,..;; ~I JJ...U ~_?.; y..}. ,~ ~~I j..iii 0i J~ LS' .o.)~\ J\..u.~\ Jl Jr::')IJ ~I o.l;. ._;;~ ~ iiw.JI i4-JI a.;\5" j\.>...j\ ~ J . as' _;I .•:: • .J\ .) _,;)I ~~iJ .) _,; _,ll ~L... j.; o.)lA....l\J JlA.JI y~i Jl ~ J a..~ c.r-~1 if 0lif' J f....l4j J1 0L..L.. 0-' ~pi .r-- ifJ c.r-~1 aly fl"i ~ J1 0L.L.:,; ~~I _,...... JI '-:->"L,.:. if :t.pl> ~WI ~I L..1i:.J ~yiJ ,..y..J\ ~ J ~ J1 ~ .:r. ..t..> ~I .r--J , } _,...!I ;l.;j)l ..r.!.; ~ ~I ~I ~ ~I a.;.)4-)\ ~l)_;l ~ J ~I ..;..Lp.-y a.;ls:J c.r-~1 ~...U ~4wJ .)\...L...JIJ ~ _,.14 -~4 ~~~~ JJ...UI Y _y-:;, ;w o.i;. ~G ~I 0~.lll ~ ~WI ~I~ vi) liiJ v"L> j1_?4 ~i ,;;.)W\J ._:..\~14-:i 0i ~ ,\..:...... ~ ~ iiy._;JI ~WI 0~ ~4 ~~I i...l4ji 0i ~~ Y. ~ ~IJ if ~iJ ~I~: .JP ...u~ I.;J.)"""" J ~ J_r...... ;;.; .JP ...u~ ~~~ iW\ .r...WI ~ ~ ly.iW c.r-.lli ;; y-'YI .r.ili4 ~IJ .r.>J4 ~~\ .r.ilil ~~ ,~4 ,~\ i...l4j~ ~WI o.i;. ~i 0i .) } <,?.lll ¥\S"Li .;p..Ut; ~~~J )PoL. .;p...UIJ Jl...u\5" ~i if ii_? .j )..ci4 ~I.)~ 0i 4-)'Y..> tlk.;....IJ ,~WI _r..ll ..;..1_,:-liLS...L.o ~ 4-).l; ~I.).-~\~ ~ J _,.! <,?~1 ~I ~ if ~.; .)1 ...u')'.;;j JJ'. ~ .;IJ. J.? ;; .;p.ill .)\~ J ~ y J5' ~~J ,..;..\_,:All ~tji ~ J ~'YI c.r-.r...WI ...,...... ~ l_,ly ::r..lll ii_r'YI ~ Jl .r.ili4 "->-yi LS' .a...)W\ ii_riLJ iWI .r...WI ,~L..... ~ ~ 0\S" ..W ,~WI ~I ..;..1_,:-ll t..5...L.o ~ ~I o.i;. .j \~ c.r-.lll ~ JIJ ~I ~ J L.~ ~ j')L.:. J ·c.r-r-JI 0y-AJI 0--" p> ~\ J...... dl \.1;. ~ ~I ..;..\j\.>...j\ .j ,..;.. ~ J!..;.. ~ ~l_r.->- yil>. 0--" ~I ~IJ ~~~\ JJ...U\ .) -*"" j.aA; ~ _r.SJI ~ ~ ~ ~~ lil..u.l ~\ ~ ~~ .J~·UiJ a::..: if .us' ~WI ~ ~ 0L.....i'YI ~. J_,.-t. ..k.....p J iir.f ~.)4j ~ ..::....;lS"J .~1 -:r-; I...I.J> _,-JI J yL.. ..6..... p .j ii y.-AJI 01 .!.D~ Jl J-P\ , \ ~ ~ o a;... .j L..~ ~ J a...... > Jl ..;..~\ ~\--4 LS' . \ ~ ~ o a;... L.~ ? ~~ Jl \ ~ o o a;... L..~ c.r-?J a...... > if ..::.....a.lZ ..U ~WI 01-lWIJ a....l4:.JI 01-lWI c: ~ ~ r f\ r ~ t ~ ~· t~ ·~ ~ 1 t~ ~ .~.,. .. t~- .r s t1 ~t:·1·1.\ t 11.. c: .r t.~ ~- .c·1. ~·c;.,. { ~ ~ ~ r~ l G •. ~tl. ~ ~~ ~~- ~tl. r~ ~lo·~~~j.\. r· ~ Gt~ (• ): .[ £· ~ t~ E }~ 't· ~:'r:~ ~ ~< '"-~·. \- tJ~:t~1~~- ~ r~-~ ~'l{tt~:; cf~. ~ {, ri~· ki:~~ 'f. ~'t~-~l r( ·, rf~t!.li "~ \. [_ 0 rr - .c- C.· ~ " ~-- - 0 ~ ~ c... l. c C.· - .t t- C.· f t .~ .,__ ~ 2. ADOPTION OF THE AGENDA AND ALLOCATION OF ITEMS TO THE MAIN COMMITTEES ADOPTION DE L'ORDRE DU JOUR ET REPARTITION DES POINTS ENTRE LES COMMISSIONS PRINCIPALES The PRESIDENT: .·.._r.! •)\ 0~-=>WI .~)I ~I ~ .:>~I ~jyJ J~i JJ..u,. )__,JI _y. J A ~I Jl ~ 0\IIJ d_f..;;. ~j.fJ J~\11 JJ..u,. )..,JI J.r> A~~ r i~l 1.1.a. ~ ~ (,?.iJI J}ll ~~ 01 .J>I..UI il.\:i.:.!l .:r rtJ rr a....WI ~I ..::.-. J-=> ..L.AJ . i ~I \.La. C.~ J J \11 4-:-...k ,_j a..WI ~I .d J~ (,?.iJI v-:. ))I ~I J; -=> _r:ll (,?~1 ~~ u~r ~~ ¥~ ,;o'c ~)1 ~~J a..-=>WI yw1 ~~ ~ ..:..Jy. J~l JJ..~.>. -=>))\ ..:..Jy J~i JJ..~.>. J.>- a,J\.:!1 ...:.J')'--!.~1 Jl>-=>~ a..WI ~I ~JIJ .. ~\11 JJ..UI ~ Jl .Jt....) (5_;>.) . , I o , c ~)I ,_;_ :.r- , , o o.:>LJIJ .)_,::...... UI .:r, o.:>WI ~ o~..~.>. ~ .. ~r JyJ .. ~r Jy J~ '' ~~ .....;~ :'1Ji . .:>..L..Jl 1-4; o~..l.>. ...:.JWJ.. 4-:i a...1i:.JI Jl;;; ~ ~I J>I..UI il.\:i.:.!l . , ~ ~ ~-, ~~A o_rill -=>~'11 yly.i lf.:l ...:.J')'--!._,.,...:!1 t-r r ~~ .....;~ :~~ . \ ~ ~ ~- \ ~~A a,JWI o_rill ~I ~l_r.JI '1'- H ~I J~ : l!l~ .o~...l>...ll ~\ .. ~\11 JJ..UIJ .. ~\11 JJ..U\ ...:.Jl.S"Ipl .r....l.Z \ -'1' o ~\ J~ ~...:.J~_,:;ll o..La. J.>- ~ ~\y _p. . ~.)lA.. a..i (5) '1 .\.La. J.>- ~ly. 0~1 ~ ~ wLPI ,_j ~i u )i; a..WI ~I 0i ~I E.i 0i .:> Ji J~\11 JJ..~.>. )}\ Jl -l..Jt.i 0i ~ i_y-=>" 01~ J~\11 JJ..~.>. Jl ~ ~ a;t..pl c.lfl'll 0\.S"J iWI .r...WI olAt c.lfll J.>- >-l.:; J~\11 JJ..~.>. Jl J.J_rJI a..WI ~I u.b:..iiJ. \...ilr ~ 4.:-JWI ~I~ J~i ,_} !.11~'11 Jl (01y.G) ~I 4-:J~ JJ..u,. ~ J....YI lh c_IJ.:>I i~ ...:.-..,.:. JiJ .GI~ c.l_r..i'll ..::.-il; L....~ ~WI iWI ,_} ~ ,;.1.:..;1 (,?.iJI ,;\~ .J~\11 ...L..o..l.>. ~ (,?i a;t..p\ 0 J-=> al...u....ll ~ ..:..J _;.jl J~\11 JJ..~.>. )}I J.>- ~\y ~\ 0i v'=" pi 0i J _p. • ~y>-1 ~ (,?i )\ I . I ~ al ..U ~I b ·.YJ . J ~c.i El Dr. PRADO (Nicaragua): Senor Presidente, senoras y senores, miembros de la Mesa. Senor Presidente, en aras de ahorrar nuestro valioso tiempo, considerando lo extensivo de Ios puntos que abordaremos en esta 51 • Asamblea Mundial de la Salud, a esta intervenci6n se unen Ios hermanos paises de El Salvador, la Republica Dominicana, Haiti, Granada, Dominica y Honduras. Ante todo, Senor Presidente, permitame felicitarle por su elecci6n como Presidente de la Asamblea, de tanta importancia hist6rica para toda la comunidad intemacional. Con plena confianza ponemos nuestra fe en sus manos. Seguro que usted dirigira esta Asamblea con justicia y eficiencia. Senor Presidente, respecto al informe de la Mesa, lamentamos profundamente que nuestra propuesta de incluir como punto suplementario del orden del dia que se invite a la Republica de China (Taiwan) a participar en la Asamblea Mundial de la Salud como observador, enviada al Sr. Director General, Dr. Nakajima, conforme al articulo 12 del Reglamento Interior de la Asamblea Mundial de la Salud, no haya sido aceptada por la Mesa. Fundamentamos nuestra recomendaci6n para garantizar la salud, ya que la salud no es un asunto politico. Ninguna naci6n deberia ser excluida; es una petici6n a la sensibilidad humana, pues la enfermedad no tiene fronteras. Afirmo el aporte de la Republica de China (Taiwan) a Ios paises en desarrollo que han solicitado la cooperaci6n y el intercambio bilateral en el area de ayuda medica y humanitaria. Creemos que mas de 21 mi llones de personas deben estar formalmente representadas y gozar del beneficia y del honor de ser miembro de esta magna comunidad intemacional de Naciones Unidas en la aspiraci6n de alcanzar un mejor nivel de salud para sus habitantes. A51NR/3 page 15 Vemos en esta declaracion una oportunidad para que otros paises en desarrollo puedan beneficiarse de una relacion amistosa y de cooperacion en materia sanitaria. Por otro lado, hay que reconocer la universalidad de Ios derechos humanos. Estamos ingresando en el siglo XXI y debemos unirnos para propiciar un cambio de mentalidad, ya que el reto que hoy asumimos es el de vivir armoniosamente, como nos enseii.aron Ios antiguos filosofos chinos, en esta tierra, en este planeta, nuestra nave en la que surcamos Ios espacios, olvidando fronteras y aspirando alcanzar una humanidad unida y prospera. La union de la especie humana, sin distingo de razas, sexo, religion u opinion politica, es nuestro porvenir. Somos cada vez mas conscientes de Ios grandes retos que tendremos que veneer juntos a la vista de Ios cambios ambientales y de sus adversidades, que colocan en una inmensa presion al globo terraqueo y a su capacidad de albergarnos. Con todo respeto, estimados delegados ante esta Asamblea Mundial, expongo esta realidad para el beneficia sin distingo del genero humano. Que Dios Ios bendiga a todos. Muchas gracias, Senor Presidente. Mrs NJIE-SAIDY (Gambia): Your Excellencies, distinguished delegates, let me first and foremost congratulate you, Mr President, and members of the Bureau on your election, and express the belief that you will steer the deliberations of the Fifty first World Health Assembly with competence given your vast experience in this area. Furthermore, on behalf of my colleagues from Burkina Faso, Malawi, Senegal, the Solomon Islands, Swaziland and Tonga, I wish to take note ofthe General Committee's report. However, we share a sense of regret and disappointment that the Republic of China (Taiwan) - always a responsive and indeed responsible country in the international community- is yet to be accepted in our global WHO family, even at the level of an observer. As we all know the relief programmes require the spontaneous but also often sustained involvement of countries that have resources to spare. However, the international community is not always in a position to respond to localized outbreaks of disease and to control them before they cross borders. The development of a global surveillance programme will improve this situation, and, as the third and most advanced nation in information technology, Taiwan is eminently qualified to provide significant assistance in this respect. Thus the continued exclusion of Taiwan from WHO leaves a void in the international health system. If, for example a contagious disease were detected in the People's Republic of China or in one of its Asian/Pacific neighbours, what action would the international community be prepared to take in order to prevent its spread to other countries? For example, would Taiwan be quarantined and left to fend for itself? Would assistance from Taiwan be rejected in responding to the situation in the neighbouring country? Such scenarios must be considered and therefore caution us to have an open membership policy. For WHO is a functional organization and not a political one, and diseases know no boundaries. Mr President, Burkina Faso, Malawi, Senegal, the Solomon Islands, Swaziland, Tonga and Gambia believe that an effective contribution by Member States of the international community towards the attainment of the goal for health for all includes financial, technological and human resources. We have to mobilize all resources at our disposal. We are also convinced that Taiwan is ready and willing to provide such a contribution in the form of financial assistance, technology, equipment, as well as the services of medical staff to help other countries to improve their standard of health and medical care. This is particularly important for countries with limited capacities and unfulfilled health needs. We are staunch friends of the Republic of China (Taiwan) and therefore wish to appeal once again to the World Health Organization to give the 22 million people on the island State an opportunity to collaborate with the members of the international community for realization of the lofty human goals and ideals of the World Health Organization. Mr JAVED HASHMI (Pakistan): Mr President, I wish to make a few comments on the issue raised by the delegates of Nicaragua and Gambia. The question ofthe representation of China was settled by the international community 27 years ago. United Nations General Assembly resolution 2758 of November 1971 recognized that the People's Republic of China is the sole representative of the Chinese people; under the same resolution it was decided to expel forthwith the representative of Chiang Kai-Shek from the United Nations. In resolution WHA25.1 of 1972, the twenty-fifth World Health Assembly also decided to restore all rights to the People's Republic of China and recognize the representative of its commune as the only legitimate representative of China to the World Health Organization. A51NR/3 page 16 Pakistan and the vast majority of the membership recognize that there is only one China, the People's Republic of China and that Taiwan is part of China. The World Health Organization regulation concerning membership clearly stipulates that only a sovereign State is entitled to apply to join the Organization. Being a province of China, Taiwan does not qualify to join the World Health Organization in any capacity whatsoever. The proposal to consider observer status for Taiwan is therefore in conflict with WHO's own Constitution as well as the relevant resolution of the United Nations General Assembly and the World Health Assembly. Moreover, this is a political issue which is not appropriate for consideration by the World Health Assembly. The proposal was rejected last year by 128 countries. Clearly, the overwhelming majority of the States do not wish to burden this Assembly with consideration of this artificial issue, which had been raised for political reasons. Pakistan therefore fully endorses the recommendations of the General Committee that the World Health Assembly decide without a vote not to include this item on the agenda. We sincerely hope that this matter will not be raised again in the future. M. KEDELLA (Tchad) : Monsieur le President, je voudrais tout d'abord, au nom de la delegation du Tchad que j'ai l'honneur et le grand plaisir de conduire a cette tribune, vous feliciter pour votre brillante election a la presidence de cette assise et vous souhaiter plein succes dans votre noble mission. La delegation du Tchad intervient dans le meme ordre d'idees que celle du Nicaragua, fortement appuyee par la delegation de la Gambie, apropos de la demande de la Chine-Tai"wan. No us no us insurgeons contre ce refus systematique du statut d'observateur a la Chine-Tai"wan et nous aurions souhaite que le Bureau retienne tout simplement la demande et la soumette a la sanction de I' Assemb!ee, qui, en toute souverainete et en toute liberte, pourrait !'examiner et decider s'il faut la rejeter ou la retenir, mais nous savons que cette demande peut susciter des reactions de la part de quelques pays. Cependant, nous ne sommes pas venus ici pour faire plaisir a des pays mais plutot pour resoudre des problemes de sante de nos populations. C'est pourquoi nous estimons qu'il est injuste et injustifie de refuser ce statut d'observateur a la Chine-Tai"wan. Dans tous les cas, nous affirmons sans ambages qu'aujourd'hui la Chine-Tai"wan est une realite, un pays a part entiere comme les autres et un pays avec lequel il faut compter. C'est pourquoi nous demandons que sa demande soit retenue par le Bureau et soit soumise a la sanction de l'Assemblee. Je vous remercie. Dr ZHANG Wenkang (China): ~it~:Jltt ±: .:£ )if; ;E 1. ' .~,f--jlc1_, :k±1fJ' ;E 1.1fJ: -a ;E, ~ ~ o/ oo 1-tf( mFi1 ~ ->c ~ r.HJL jf ;® , .:t )if; ;E 1. , ~ :1! n* j) * 4- FiJ.:t)lf;. ~~~~;®Fi}~~~' *-j):Jc%-~%~~00~~~- o/OO~*ffi*~~~~l%*f~~*~~*M~"~~~-l~ft~*" ~A'*-ji:fc%~~FiJ~~, ~+MM#~~-+~MM, W~~·~~~l% ~:k%1*ffM~#~7~~FiJMM. ~m~~~,~**%~ ~~-*~FiJ E~la, -~7~~~l%*f~*~-~A:k%~~FiJ~~- +A.MFiJ~, +•~~~~X~~-®OO*N**~+MM~ili, ~~ ~*j]*%I~Fil-#T-~. ••••~iliFiJ~, tm~#~~±~ilif~~ §Fi}, ~·~~~~1.-~~~§*~~~~"-+o/00"~"-o/-~", ~ A51NR/3 page 17 ~~oo~~~~«±~~, ~~±~~**~oo~•*~~m~. ~*~~~ ~*~~**~~ff~, ~~~~~~~~- ~oox~-~, ~~~~oo~-~~, ~~oo~~~~~R~. ~~~~ ~il~);~ tE ~~00 ~~7111~*~00-t fl;jj1¥J, ~~if~~ 00 ~ -~41'' ~ ~~~ :tf-ii~~ ~~ ffbX.fl~ ffL ~fM+~~~~~~•t~~~~mM~•~•, am~~-~~*~· ~·~~~~~-~~oo~m~~~~~~~-ili~•, am~~-~-~ Jt ~~ ~ j~ £- -t ff¥Pj{: jr 5i. The PRESIDENT: .·,.,r-' •)1 ~ ~ ~t..5:JI ~ _,!1 L:l}y: ~) ·tyP_,..jl lj_., _j ~~~. 1~\k. ~~~I ~i 0\ 0). ~ ·t_,....p_,..JI lh ~ ~_,.a:ll ~ ~ :>l...!..i YJ..l..:.o 01 £jl 01 :>Ji ~u ,4-Jwl JJ..L>. .. ~1 .:r ~~ ~~~ ~L JL:llu ~yaill ~ '-?i ,~i w-- ,.!\~ .r-l0~u ,w,)I a..~..::.> _,s::...Ju ~ ~ ~ L;..;> L. • . .~WI OJ)..UI .:r--P ~I lj_., CIJ:>I i~J ~I lj_., J.>- ~_,.a:ll i~ J.>- ..:....UIJ. ~~I 01 . ..L:.l:t; y J..l..:.o ._r:-1 t_,.p y ~ ..:..~ ..L:.l:L:l ws:JI ~I 0~1) Mr KRIT GARNJANA-GOONCHORN (Thailand): Mr President, thank you for allowing me to make an intervention with regard to item 27.2. On behalf of all the delegations of the South-East Asia Region I would like to launch an appeal to you and all delegations here today. We highly appreciate the recommendations made by the General Committee to adopt the draft agenda. We also respect the deliberations of the special group of the Executive Board and the latter's conclusion that this session of the World Health Assembly should deal with regional allocations in accordance with resolution EBIOl.RlO under agenda item 27.2: "Review of the Constitution and regional arrangements of the World Health Organization." We would also like to highlight that this year's Health Assembly is auspicious since it celebrates 50 years of the Organization's activity. It is an occasion which should be marked by unity and solidarity rather than controversy and divisiveness over the means to an end. Mr President, the principle of a rational approach to regional allocations is well accepted, however, more time is needed to work out the means of applying such a principle. The proposed formula is not a good one. Please allow me to underscore my point. First, if this Assembly accepts the preparations to date on this issue, 96 countries will undergo budget cuts. Twenty-six out of 48 countries in the so-called least developed category will be negatively affected. Second, all five least developed countries in the South-East Asia Region will lose 62% of their country allocation. Four regions, as a whole, will experience an overall loss of well over 100 million dollars. Third, the South-East Asia Region is home to 30% of the world's drug-resistant malaria, 40% of global tuberculosis and 70% of the world's leprosy cases; and this Region stands to lose at least 50% of its WHO regular budget despite its heavy disease burden. Fourth, the South-East Asia Region is currently undergoing an economic crisis of unprecedented magnitude which is having serious effects on health services. Is a withdrawal of WHO support at this time an appropriate action? We would say that it is not so much the funds that count, but the reduced ability to provide much needed technical collaboration to improve the health of our people which is important to us. With 70% of the world's poliomyelitis cases, the ability of this Region to fulfil its commitment to the Organization's goal of poliomyelitis eradication, which is moving so well at present, has to be seriously doubted if the Organization slashes its support to the extent currently envisaged. Furthermore, the fact that the use of the human development index is not even used for the allocation of funds A51NR/3 page 18 by the agency which has developed it, raises certain crucial questions, especially about its suitability for the purpose, as proposed by the Executive Board. We also note that approximately one third of the Organization's total regular budget resources is exempted from any redistribution, those belonging to the headquarters; and the use of that formula places regions such as South-East Asia, which devote a larger proportion of allocations to their country programmes, at a disadvantage. Finally, no assessment to determine the impact on all countries of the measures proposed has seriously been undertaken. I have cited only a few of the many questions and concerns which may be raised. I am not calling into question the principle but merely wish to make the point that too many issues have not been given adequate consideration for this Assembly to reach a general consensus and a wise conclusion. Such an important matter should not be considered on a hastily assembled proposition, especially since we are all looking forward to seeing the new Director-General's policies to revitalize our Organization. Surely an issue such as regional allocations should take shape in the light of such policies rather than on the basis of precedent. We should not place the cart before the horse. On behalf of the South-East Asia delegations I request the deferral of agenda item 27.2, pending a wider process of consultation and consensus-building among Member States and in regional committees. We hope that our honourable colleagues will take the same view on the issue thereby continuing the cherished tradition of working by consensus on items which are of such vital importance to us all. Mr YUSUF (Bangladesh): First of all, I congratulate you on your election as President for this session. I take the floor to add my voice to the proposal made by the distinguished delegate of Thailand on behalf of the South-East Asia Region, to defer consideration of Executive Board resolution EB 10 1.R1 0 to the next Health Assembly, for the following reasons. We are of the view that the resolution was adopted by the Executive Board in haste, without detailed study of its adverse impact on the affected countries. This is a key issue for the affected countries. The proposal merits serious consideration at all levels by Member States and the regional committees, before the Executive Board makes any recommendations. Since this budget will be operational in the years 2000-2001, we still have time for further study and consultation on this issue. The new Director-General may also wish to examine seriously the pros and cons of the proposed recommendation. In our view, the formula used for examining this reduction is neither a scientific nor a foolproof one. A more rational formula based on scientifically proven indicators acceptable to all Member States should be used to determine future regulations concerning Member countries. We also consider that the size of the total population, the number of needy persons, the extent of the disease burden, morbidity and mortality rates and the overall level of socioeconomic development should be accorded due consideration in the reallocation of the budget of different regions. It is unfortunate that 26 out of 48 least developed countries are affected by this proposed recommendation at a time when the United Nations and other international organizations have accorded special assistance to least developed countries to meet their growing demands and needs. The Executive Board has recommended budget reductions even for these countries. In view of the above, we strongly support the proposal made by Thailand and believe that the matter should be sent back to the Executive Board for further consideration. We feel that before making a recommendation, the Executive Board should have a clear idea of the impact the budget reduction will have on countries. Mr President, this year we are celebrating the fiftieth anniversary of WHO. On this happy occasion, we should not resort to a mechanism which will reduce resources for health development and which, more importantly, tends to divide the Member States. Rather, we need a mechanism that can guide us in the optimal utilization of our present scarce resources. We need ideas and issues that will unite us, not ones which will divide. Mr TOPPING (Legal Counsel): Thank you Mr President. Perhaps I should, on the basis of the last two interventions, make a clarification. We are considering at the moment the adoption of the agenda, and the agenda item that is being called into question is item 27 .2, entitled "Review of the Constitution and regional arrangements of the World Health Organization". At the moment, there are two aspects to this agenda item: one is a report by the representative of the Executive Board on what the Executive Board has done so far on the issue of the review of the Constitution. There is also another resolution adopted by the Executive Board, recommending a resolution to this Health Assembly, and that is EB 1OI.Rl 0. I believe that at least one intervention so far has asked for that A51NR/3 page 19 resolution to be considered at another time. The normal course of events is that, when there is a particular proposal that some part of an agenda item should not be dealt with at this Health Assembly, the matter should be considered by the committee dealing with that agenda item. This Health Assembly is considering whether or not the agenda item as a whole, which may contain many subitems, should be adopted. So, if there are further interventions on this issue, it would be better for delegates to limit themselves to the issue of whether this agenda item as a whole should be considered at this Health Assembly. Mr NGEDUP (Bhutan): Mr President, Director-General and distinguished delegates, it gives me particular pride to see you presiding over the Fifty-first World Health Assembly, particularly as we are in a very festive mood to celebrate our Organization's fiftieth anniversary. I am aware of your extraordinary qualities and I have full confidence that the Fifty-first World Health Assembly will be guided with excellence. We take note of the views of the Legal Counsel. Our delegation fully endorses the statement made by Thailand on behalf of the South-East Asia Region on the regional allocation of WHO's regular budget. We believe that the proposed resolution will have a negative impact on the countries affected, particularly the least developed countries. If the resolution is adopted, the budget cut facing Bhutan will put many priority programmes like reproductive health, human resources development and health systems development in serious difficulty, since WHO financial and technical assistance will be withdrawn. The disruption ofWHO collaboration in these areas will seriously undermine and jeopardize the momentum gained in improving the health status of our people. Therefore, we would like to join the Thai delegate in appealing to the World Health Assembly not to discuss this issue on the auspicious occasion of the fiftieth anniversary of the World Health Organization. Instead, we recommend that this issue should be reviewed by the Executive Board taking into consideration a thorough impact analysis on the countries affected. Thereafter the regional committees should be consulted before the matter is referred back to this Assembly. . #)\ The PRESIDENT: ·...r-' Mr YIMER (Ethiopia): Mr President, are we adopting the agenda? There seems to be some irregularity in the procedure, despite the statement made by the Legal Counsel. Have we adopted the agenda or are we discussing substantive issues without adopting the agenda? I do not believe this is how WHO operates; or are there different rules of procedure? We are adopting the agenda. If somebody objects to the inclusion of an item in the agenda then they should propose its deletion which will be put to the vote. We believe this item should be on the agenda. That is the sole issue we should discuss. We cannot enter into the substance. It is highly irregular for people to discuss items that should be discussed at committee level. The question is should WHO discuss this item this year, in other words, should it be included in the agenda. Mr President, could you please request partici.pants taking the floor to confine themselves to the issue of whether this item should be on the agenda. It IS not complicated, it is as simple as that. . •)\ The PRESIDENT: ·...r-' A51NR/3 page20 Dr. AL-KUW ARI (Qatar): ,~)If.,?~ I~ Y-YV -tYY ~ ~ :,r.._r:-'iiJ ~U' YJ..w.. ..t:-ll-j.J"P i""""i ~ljJ ~J ~~\ ~ ~i 'YJi l..i..J. ~ ~l_r..JI ~lj,ij J:)-;) ~\ _,;till .!1]~ J 0\.>.J.II J ,_;;>- ..:..~LW\ J Dr CALMAN (United Kingdom of Great Britain and Northern Ireland): Mr President, may I congratulate you on your presidency. May I speak very strongly against deferral of this item. It is a major issue and one which should be considered in Committee B. It has already been considered in great detail by the Executive Board over a period of two years. It is a major issue; it is one which will require discussion, but it is one which is about resourcing Africa appropriately and that is the issue which I think we should be discussing in Committee B. The resolution allows for flexibility and development of the model and for redistribution and allocation of resources, and that is an issue which a future Executive Board and Director-General can take up; but may I ask again that this item should be considered in Committee B at this Health Assembly. Dr BADRAN (Egypt): I would like to join my colleagues from Thailand and from Qatar in asking that the decision about this agenda item should be postponed for further discussion, and I see no contradiction. If we are going to postpone it, we have to explain why, so we are not going into the details of the matter, but just explaining why we are asking for that, and there is no contradiction between the two. We think that the formula that was proposed is unfair and has not really been accepted by many countries, and that it will affect many of the countries most in need and least developed. We have no objection to increasing the allocations to Africa. In fact, in the Eastern Mediterranean area there are several African countries, although they belong to another regional committee. We are saying that the way Africa's allocations should be increased is not at the expense of allocations to other regions, which actually will affect the country allocations rather than those of the Region itself. So what we are asking for is that we postpone this for further discussion, because I think that the formula is not really the best formula that we can achieve. Ifwe can delete resolution EBIOI.RIO from the agenda item, that would satisfy us; but if this is constitutionally not possible, then we would like to defer the introduction of the whole item into the agenda of Committee B. Mr A YE (Myanmar): In line with some speakers who have taken the floor before me, I also request that this item be deferred to a later date. The Myanmar delegation, in common with other delegations from the South-East Asia Region, is deeply concerned about the recommendation of the Executive Board that the World Health Assembly should adopt resolution EB I 0 l.R I 0. Reductions in the regular budget allocation to our Region under this recommendation would adversely affect the capability of countries within the Region, especially the least developed countries, successfully to implement WHO programmes. We understand that the initiative of the Executive Board in this matter stems initially from the efforts of some countries to make necessary changes within WHO. Other countries also desire changes within WHO in the broader context of the general United Nations reform package. We are fully aware of the need for reforms that will make the Organization more efficient. However, change should not in any way hinder the momentum either of ongoing programmes or of future ones already being worked out under the existing system in any country. My delegation is of the view that, before recommendations aimed at bringing about important changes are drawn up, an intensive study of the situation is needed which will take into account all the factors involved. This should be followed by rounds A51NR/3 page21 of extensive discussion among all parties concerned in a transparent manner, allowing for adequate time to arrive at a correct decision. Unfortunately, this has not been done with the important issue under consideration. We find that the recommendations of the Executive Board require further improvement. Hence, Mr President, my delegation would like to add its voice to and fully endorse the submission presented on behalf of countries of the South-East Asia Region requesting the deferral of agenda item 27.2 on regional allocations to a subsequent Health Assembly to allow for a wider process of consultation and consensus-building. Mr CICOGNA (Italy): We are fully convinced that item 27.2 should remain on the agenda. In order to save time in this discussion we wish to add that we endorse the arguments put forward by the distinguished delegate of the United Kingdom in this regard. · 1-H 3EJIEHKEBll4 (Benapycb): Mr ZELENKEVICH (Belarus): Yaa>KaeMbiH r-H Ilpe.nce.naTeJib, SI .nyMaiO, ..no Heo6xo.nHMO no.n.nep>KaTb MHeHHe ieHepaJibHoro KOMHTeTa, H, llOCKOJibKY HeT npeAJIO>KeHHH llOCTaBHTb 3TOT BOllpOC Ha rOJIOCOBaHHe, SI cqHTaiO, qTo HaAO yqeCTb AByxJieTHIOIO pa60TY 11CllOJIKOMa H 3KCnepTOB H npHHSITb perneHHe 0 BKJIIOqeHHH B llOBeCTKY AHSI. CnacH6o. Ms INGRAM (Australia): Mr President, may I add my congratulations on your appointment. Could I also thank the Legal Counsel for his clarification. I think it is a very important one. It is the whole agenda item that we are considering here in terms of its inclusion or exclusion from the agenda. I wish to reiterate the history of the work on constitutional review referred to by the distinguished delegate of the United Kingdom. The special group for the review of the Constitution of the World Health Organization was set up by the Health Assembly in 1995 and over the last two-and-a-half years has engaged in extensive deliberations. The mandate for regional arrangements was given to the special group by the Executive Board in January 1997 and confirmed by the Health Assembly and its deliberations on those matters were opened to all members of the Health Assembly. So there has been an extensive period of consultation and participation. The work that has been done by that special group has now come before this meeting of the Health Assembly. I respect your advice that we should not argue the merits of the resolution or the merits of the items before the Assembly in this forum. The committees of the Health Assembly have been set up to deal with matters of detail, such as the business before us, and then to refer their findings back to a plenary meeting. So I think we should allow this matter to be properly considered in Committee B as set out in the agenda. That Committee can deliberate fully the merits of the matters, draw its conclusions and refer them back to a plenary meeting. So I would add my voice to those who wish to see the item retained in the agenda. Professor REINER (Croatia): Mr President, I would like to congratulate you and the Vice-Presidents on your election. I would also add my voice to those distinguished delegates who wish this issue to be considered in Committee B and to be included in our agenda too. However, there is no need for any further discussion outside Committee B and this Health Assembly, nor is there any need for a wider process of consultation, as some distinguished delegates have suggested, because such a process has already taken place. We held many discussions in the special group and the Executive Board. There were several expert groups that worked very hard and elaborated different scenarios; a thorough impact analysis has also been prepared. So there is absolutely no need for this issue to be given further consideration by the Executive Board, because I do not believe there would be any substantial improvements. I would recall that the regional committees have discussed this issue. The Organization's fiftieth anniversary would seem the appropriate time to bring an end to former practices based on traditions, impressions and precedents and to start anew with some objective criteria of which we are all in favour. Furthermore, the deletion of this agenda item would indicate that we do not have confidence in the Executive Board or the A51NR/3 page22 General Committee, for it was the Executive Board which suggested that this item should be included on the agenda of this Health Assembly and that suggestion was endorsed by the General Committee. . •)\ The PRESIDENT: ·...r-' Dr BROOKMAN-AMISSAH (Ghana): Mr President please allow me to offer my congratulations to you on your appointment. I wish to support the stand taken by the Ethiopian delegate and other delegates ":ho have advo~ated}he r~tention of this ~ge~da item. The issue at stake, Mr President, is whether the agenda Item 27.2, entitled RevieW of the c_o~stltut!On and regional arrangements of the World Health Organizat~on", shoul~ be included in the agenda. Th1s IS not the time to discuss the details of the agenda item. The Ghanman delegatiOn suggests that we adopt the a?enda and request the appropriate committee, which I believe is C?~mittee B, _to discuss the ~tern in more deta1l to allow the whole Health Assembly to take an informed dec1s10n. That IS the proper time and the forum for that discussion. We are opposed to the deletion of the item from the agenda. Dr SIMKHADA (Nepal): Mr President, my delegation would first of all like to associate itself with the others who have congratulated you on your election. My delegation will offer its full cooperation in all your endeavours. We are discussing an item of tremendous importance to my delegation and to a number of speakers before me. The pros and cons of the issue have been discussed. However, the importance ofthis agenda item is such that we believe that delegations and countries that are adversely affected by the implications of this agenda item should be heard. My delegation has taken the floor fully to endorse the views expressed by the distinguished delegate of Thailand on behalf of the South-East Asia Region, the distinguished delegates of Qatar and Egypt and a number of other delegations, and to request this Health Assembly, in view of the gravity of the problem, to defer this agenda item and not to put the matter to the vote in this very important year of the fiftieth anniversary of WHO. Mr JA VED HASHMI (Pakistan): The Pakistan delegation is of the view that such a reduction would adversely affect those countries which are in greatest need of WHO assistance. Therefore item 27.2 should be postponed. Mr PALIHAKKARA (Sri Lanka): Mr President, my delegation would like to join others in congratulating you. We have full confidence in your ability. My delegation fully endorses the sentiments expressed here by a number of countries which are likely to be severely affected, in fact the whole region affected by the new resource allocation suggested in the Executive Board resolution EB I 0 l.R I 0. In fact, the issue here is whether the affected countries and the regional committees have had sufficient time for consultations about this as yet untested procedure. The aim, therefore, is to obtain more time for this particular subitem, not for the whole agenda item as others have said. As for the modalities we should use to obtain that deferral, my delegation, like the delegation of Egypt, remains flexible. A51NR/3 page23 El Dr. MARTiN MORENO (Espana): Senor Presidente, me uno a Ios oradores que me han precedido para felicitarle por su eleccion como Presidente y desearle todo lo mejor en el desarrollo de esta Asamblea. Querriamos haber respetado lo que se nos ha pedido, y estabamos dispuestos a no intervenir, pero como el debate se ha reabierto, vamos a exponer nuestro punto de vista. Sin entrar en Ios aspectos tecnicos de la resolucion, sino en la idoneidad del punto 27.2 (Revision de la Constitucion y arreglos regionales de la Organizacion Mundial de la Salud), estamos a favor de que se examine este punto en la Comision B. No creemos que la discusion se deba posponer. La sostenibilidad de areas en desarrollo debe de estudiarse desde una perspectiva solidaria y para todas las regiones, no desde una sola perspectiva que puede sentirse preliminarmente afectada, sino todas las que estan actualmente con serios problemas. Con todo respeto a Ios distinguidos delegados que han expresado su opinion contraria, permitame decir que no hay que tener miedo a tratar este asunto en la Comision B. Hay que promover la comunicacion abierta, y propongo por ello que se mantenga en el orden del dia este punto. Muchas gracias, Senor Presidente. Mr VOIGTLANDER (Germany): I would like to support what has been said by the distinguished delegate of the United Kingdom, the distinguished delegate of Ethiopia and many other speakers, that this item should not be removed from the agenda. I would also like to support the opinion expressed by the Legal Counsel. The question is not whether we are in favour of a specific resolution or not. Nor is the question whether some solution is favourable to one region, or less favourable to another region. The World Health Assembly has requested us to review the Constitution, and I have in the discussion up to now not heard one reason why we should not do so. The review of the Constitution includes many items and, therefore, I would be against the deferral of this review of the Constitution, i.e. item 27.2. Dr W AHEED (Maldives): Let me congratulate you, Mr President, on your election as the President of this Assembly. The delegation of Maldives would like to express its support for the proposal made by Thailand and request the deferral of agenda item 27.2 until a future World Health Assembly, after further study by the Executive Board. My country, the Mal dives, one of the least developed countries, is likely to lose 77% of its regular budget if this resolution is adopted. Similarly, many other least developed countries are going to be adversely affected. The question is, should we discuss such a divisive issue on a momentous occasion like this? This is the golden jubilee of WHO. It is a celebration; let us not make it into a funeral, the funeral of our health programmes and the funeral of those in our countries who are poor and sick. Professor NKANDU LUO (Zambia): I would like to add my voice to those who have congratulated you on your election. I would also like to add my voice to those who have said that this agenda item 27.2 should not be deferred. I also represent a region which has many underprivileged and least developed countries, but I feel that Committee B is the best committee to look at the modalities and details of this agenda item. I appreciate the number of years taken to come up with agenda item 27.2, and I think it would be unfortunate to defer it yet again until the next Health Assembly. Let Committee B look at the details and bring it back to us for our approval. Dr SIKOSANA (Zimbabwe): Mr President, I would like to add my voice to those who have congratulated you on your appointment, and at the same time, to those who think the item should remain on the agenda. As those of us who are on the Executive Board know, the issue was extensively discussed and, for those who do not seem to understand the essence of the new formula, it is a good opportunity for them to discuss the item this year, so that whatever information gaps there are can be filled and people can take an informed decision. So the item should remain on the agenda. A51NR/3 page24 Mr SELEBI (South Africa): I am one of those who think that the matter must be kept on the agenda precisely because it is an important matter. We must not merely celebrate, even when people are dying: we must also deal with a matter that is of importance to many countries, including those in Africa. I do not think that we can postpone the needs that are out there simply because we need more time to be heard. I think that, in Committee B, all those delegations which think that they will be adversely affected should be given a chance to be heard. It is therefore proper that the matter should be put on the agenda, so that in Committee B we can hear those who are going to be adversely affected. The matter has been thoroughly dealt with, and I do not see how a postponement of it will help us to achieve the goal of ensuring that we help where the needs of the people are clearly crying for help. 0 •)\ The PRESIDENT: -~ . ·l_,..,. r-11 -.i i~~ ~ <->.;>-i aJ )~ ~i cl.;;l J..W 0i 0? c?~ I.L. o~yj i~ ~~I 01 l_,_olj 01 ~ ..,....U.t.t t_,.;:> rJI _j o...b..:;;;.... <.>_,>-\ al y ' ' 0\11 ifl..\ .~...LJ\ ~___,PI_?\ ~i !J~ JP> ,y-SI_rJI ,L...... i) '~)~\ ,~jl__,....., d~.r.i, 0\.r.l ~ y~ ~I_$')~~\__,:) y.).;.;.,. ~ 0\11 -~~ .a, t_,.;:> rJI ~ ~ ,~\) ,~\ aJ.I__,A....a...UI 4.;§' a..;~) a.~ y--51 ~__,.JI ~\ ~~~ ~ 0_,A;\j ~ .d..P.;t...... a.l .!}~ <.5) \1 .I~}J llA ~ JP> 4}£.:..t> J ~~ u~ j . \1 ~i .a, c.....c.JI y~ j..W J y) \1 ~iJ I~ JiJ 4}£;,) ~\ 4i_?~ L. ,.P. u~ j . ~I_,:) a..;~ .))...U\ ~) 0\11 J-4::; Professor GRABAUSKAS (Lithuania): Congratulations, Mr President, on your election to the presidency of this Health Assembly. I also want to thank the Legal Counsel for his explanation of agenda item 27.2. As we approach the next millennium, I think this Health Assembly is the proper time to deal with issues which are so important to many Member States of our Organization. With all respect to the distinguished delegations of the South-East Asia Region, I think there is a slight difference in their definition of solidarity, and I will explain what I have in mind. From the preliminary calculations, it appears that more than 80 countries may potentially benefit from a more objective distribution of the funds of this Organization. So, for me, there is no point in postponing the agenda item which is so important for those in most need. This is why the Lithuanian delegation joins those who want to see this agenda item discussed in Committee B in more detail. Mrs KIZILDELI (Turkey): My delegation wishes to associate itself with the statements made by Ghana, Zambia and South Africa. This is an important issue. It is a landmark decision for WHO, therefore we would not like it to be deferred. We have to deal with the issue during this Health Assembly for a very practical reason. If this draft resolution is adopted, it will be applicable from 2000, which is the beginning of the next budgetary and financial period for WHO. The budget for the years 2000-2001 is being prepared by the Director-General and his staff. If we defer the issue until next year, the budget for 2000-2001 will have been approved by the Executive Board in January and will come to the next Health Assembly, and it will be too late for us to make any changes in the next biennium's budget- we will not be able to reflect anything we discuss there. Therefore it is imperative that we discuss it during this Health Assembly and come to a compromise, conclusion or solution to this issue. We understand the concerns of some groups of countries and regions which are losing some of their allocations through this arrangement, but I think it deserves at least to be discussed, even if we cannot agree with each other. I think the countries concerned will also be aware of the need to discuss it with others in Committee B. Therefore my delegation will be very happy if we do not defer this item, but keep it on the agenda of Committee B. A51NR/3 page25 Mr A YINLA (Nigeria): Mr President, I would like to join all my colleagues in congratulating you on your appointment as President of this Health Assembly. A lot has been said about agenda item 27.2. In order to save time, I would like to say that we identify with the views of Ghana and all those who have spoken in favour of retaining this item on the agenda. It is of very significant importance to Africa and we do not think any further deferment is in our interest. We would like to discuss it and thrash out the issues in Committee B and then forward it to the Health Assembly for ratification. Mr ZIARAN (Islamic Republic of Iran): Mr President, may I congratulate you on your election as the President of the Fifty-first World Health Assembly. I wish to join previous speakers in requesting the deferral of agenda item 27.2. The rationale is that countries in four regions are going to be adversely affected as a result of this decision. Given the possible implications, further discussion by the Executive Board is required on this issue. We recognize the special and urgent needs of African countries and believe that we should explore ways and means of addressing these needs without imposing any burden on other developing countries including the least developed countries. Mr CREGAN (Ireland): Mr President, our congratulations on your election and for your patience. Our deliberations on this matter this afternoon go to the heart of how the Organization deals with its business. The Executive Board has conscientiously considered the matter at hand, its special group on the review of the Constitution has exhaustively examined the issues involved and has come up with solutions. The matter has also been considered at the regional level. So I would respectfully suggest that this Health Assembly must heed the recommendations of its Executive Board and the committees it sets up to expedite its business, not to mention the views of the Legal Counsel. Mr Chairman, on the occasion of this World Health Assembly, we should be prepared to discuss substantive issues and should not postpone matters which raise difficulties. This procedural issue is a test of this Organization's nerve and of its willingness to take up the immense challenges facing it. I believe that significant progress has been made on the analysis of the issues involved, in terms of equity and in terms of meeting the demands of the least developed countries. However, the place to debate such matters is Committee B and so we therefore support the retention of this agenda item. Dr DLAMINI (Swaziland): Mr President, I join other delegations in congratulating you and your team. My delegation feels that the Executive Board used a very scientific and objective formula in deciding on the inclusion of this item in the agenda. The deferral of agenda item 27.2 could adversely affect some countries that would otherwise benefit. We believe that the World Health Organization is becoming sensitive to the disease burden which is increasing in some regions. We support Croatia, Italy, United Kingdom of Great Britain and Northern Ireland and other countries which have proposed that this item should be included in the agenda and be further discussed in Committee B. It is that Committee which will discuss the pros and cons in detail. We believe that deferring this item may actually have a damaging effect and that differences and difficulties are not resolved by postponing them, but rather through discussion and hopefully reaching consensus. Professor MOELOEK (Indonesia): Mr President, let me extend my delegation's congratulations on your election. My congratulations also go to the members of the bureau of this Health Assembly. My delegation fully supports the statement by the delegate of Thailand on the deferral of agenda item 27.2, taking into account the views expressed by some other delegates, particularly those from South-East Asia, Egypt and other countries. A51NR/3 page26 Le Professeur GIRARD (France) : Merci, Monsieur le President. Merci de votre autorite et de votre patience. Dans ce debat, tout a ete dit. La question des reallocations est une question difficile sur le fond, mais le probleme n'est pas hl. Le probleme conceme le debat actuel. De quoi s'agit-il? De !'inscription d'un point a l'ordre dujour? Et en plus, ce n'est pas n'importe que! point! Ce n'est pas un point propose a la sauvette par une delegation isolee, c'est un point sur lequelle Conseil executiftravaille depuis deux ans et demi, un point sur lequel le Bureau s'est prononce explicitement en debut d'apres-midi, et le probleme est la. Est-ce que vraiment nous voulons desavouer le Conseil executif? Est-ce que nous voulons desavouer le Bureau? Oui, bien sur, il faut qu'il y ait un vote parce que c'est une question difficile. Mais le vote doit intervenir sur le fond, soyons honnetes, et non pas sur le fait que nous soyons capables ou non de discuter d'un poin~ difficile. Done, en clair, ce n'est pas uniquement un probleme de procedure - je ne suis pas dupe -, mais on peut se servir de la procedure. 11 faut discuter de ce probleme sur le fond. C'est une question difficile, c'est une question qui conceme !'ensemble des Regions, !'ensemble des pays, et pas seulement ceux qui sont dans les situations les plus difficiles, mais c'est une question qui merite un debat global au sein de la Commission B -oil nous aurons le temps de nous exprimer - et qui puisse debaucher sur un vote. Et la, par contre, je suis d'accord qu'il est necessaire qu'il y ait un vote. Mais, de grace, ne faisons pas voter cette Assemblee simplement pour savoir si nous aurons le courage de debattre. Merci, Monsieur le President. Le Professeur GUIDOUM (Algerie): Merci, Monsieur le President. Puisque je m'exprime pour la premiere fois, permettez-moi de vous presenter toutes mes felicitations pour votre election a la presidence de la Cinquante et Unieme Assemblee mondiale de la Sante. Nous appuyons totalement la declaration faite au nom de I' Afrique par mon distingue collegue de I' Afrique du Sud, rejoint en cela par d'autres pays, au sujet de !'allocation des credits par Region. Je crois utile de rappeler que le Conseil a largement debattu cette question durant plusieurs sessions et qu'un consensus a ete enregistre a cet egard. Plusieurs criteres objectifs ont permis de proposer une repartition des credits. Parmi ceux-ci, il y a lieu de citer premierement le taux de couverture vaccinale, deuxiemement le taux de mortalite infantile, troisiemement le lissage logarithmique, quatriemement le produit national brut. Nous ne voyons pas aujourd'hui quelles raisons nous pousseraient a revenir sur les termes du consensus deja etabli. C'est pourquoi ma delegation insiste particulierement sur le maintien du point 27.2 a l'ordre du jour. Je vous remercie. Dr. AL-KHALDI (Saudi Arabia): .. y\5"" )lt a.y..J\ ~\ o.l;. o_;b\ _;, ~yjlt ~ yX>) ~ ,~_;.JI ...rJ) \~ ~ .;Ju..::!IJ j.-l.::!IJ LI.;...U~ .:r" .~Y Jl C~ .;JI ~l_r-JI -l>i t_yP _r-JI \.1;. 0i a>J....Ji ..U J ~ _)I C~ Jlj~ t_~_r-JI \..w. 0\ JJ..U\ ..:;Wl5:_. J':>G:- .y J-4 .jSJJ ~\J J~J ii_?:AJ\ ~ ~ JJ...U\ .I~ J '\'-'\'V~\ \.1;. ~lilt.t ..:;~\.j .;JI JJ...U\ ~Y.J a>J....J\ ..U J c.S.r.. ~.ili ,a....I.;...UI .y ~y Mr TAE GUN RI (Democratic People's Republic of Korea): Mr President, my delegation would like to associate itself with the remarks of other delegations concerning your election as President of this session. We fully endorse the statement made by the Thai delegate on behalf of the South-East Asia Region. We are also of the opinion that discussion of the Executive Board's recommendation should be postponed until the possible impact ofthis recommendation has been assessed. Mr SINGH (India): Mr President, allow also us to join others in extending our warm felicitations to you on your election as President of the Fifty-first World Health Assembly. I will be very brief. We fully support the statement made by Thailand on behalf of the countries of the South-East Asia Region and would like to join others in requesting deferral of consideration of agenda item 27.7. This is not the appropriate time to make a substantive comment A51NR/3 page27 on this issue. Nevertheless, it is worth noting that the South-East Asia Region has a population of 1.5 billion, which represents 25% of the world's population. The disease burden in this Region is very well known and is among the highest in the world. The proposal for budgetary allocations would cut the funding for this Region by 50%, in effect meaning that one-quarter of the world's population is dependent on less than 10% of the resources of this Organization. We do not believe that proposals of this nature result in the equity and objectivity in handling health issues to which WHO is apparently committed. Finally, I would like to add that the issue at stake is not one of deletion, but rather of deferring consideration of this particular aspect to a future Health Assembly. By then we will all have had the opportunity to study the matter further, bearing in mind its importance, namely to establish criteria for allocations, which will have far-reaching implications for WHO. We hope that the decisions reached at this Health Assembly will help WHO to continue its activity based on the criteria of equity, objectivity and to examine in a rational and objective way the disease burden on poulations of various countries. Dr KIYONGA (Uganda): Mr President, we would also like to congratulate you on your election. All of us are familiar with the world health situation, not just by global averages, but country by country and region by region. I believe that our distinguished Executive Board examined such facts in devising an objective formula on how resources should be allocated. As I listen to the delegates who are opposed to discussing this point, they appear to have views to the contrary. I believe that the right place for us to articulate these views is in our organ Committee B. Therefore, Uganda strongly supports keeping this item on the agenda and its discussion in Committee B. Mrs NOVAK (Hungary): Mr President, may we congratulate you on your election and express the Hungarian delegation's full support for the discussion of this agenda item in Committee Bat this Health Assembly. M. RUBENS SICATO (Angola) : Monsieur le President, nous voulons d'abord vous feliciter pour votre election a la presidence de I' Assemblee mondiale de la Sante. Notre pays, !'Angola, pense qu'il s'agit d'une question tres importante car nous sommes en train de parler de I'instauration de la sante pour tous au XXI• siecle. L' Angola se prononce pour le maintien du point 27.2 a I' ordre du jour de notre session. Nous appuyons toutes les declarations qui ont ete faites precedemment et qui ont defendu cette position. Ne voulons-nous pas l'equite dans )'esprit de notre Organisation? Nous ne voyons pas pourquoi nous devons ajoumer cette discussion. 11 faut eclaircir ce probleme et la Commission B doit se prononcer sur ce point. Je vous remercie de votre attention. The PRESIDENT: . ,r.:' ')\ Mr TOPPING (Legal Counsel): The General Committee has recommended a provisional agenda to the Assembly, which includes agenda item 27.2, entitled "Review of the Constitution and regional arrangements of the World Health Organization". T~ere has been a proposal to defer this agenda item 27.2. In effect, that means its deletion from the agenda of th1s Health Assembly. We must therefore vote on the proposal to delete agenda item 27.2. If the agenda item is deleted, it means that all items which would normally come under this agenda item may not be discussed at this Health Assembly. So neither the report of the Executive Board representative on what the Executive Board A51NR/3 page28 has done under this constitutional reform nor resolution EBIOI.RlO dealing with regional allocation of the regular budget will be considered. If the item is retained, then Committee B will consider these items (including the possibility ofthe deferral of resolution EBlOl.RlO). So, to summarize, at this point we will take a vote. All those in favour of deleting agenda item 27.2 will vote yes, all those in favour of retaining it will vote no. I hope that is clear to everyone. Thank you. The PRESIDENT: Mr SINGH (India): Mr President, I would just like to know who has actually asked for the vote, because there were a number of position statements made on agenda item 27.2. However, has a vote actually been requested on this matter? The PRESIDENT: ~ ~~ ..::...... y.a.:\1 ..,_J1. .)1 uW ~ J ·t..,.P _,.JI llA _;.I.Z ~1--4 _j ~y.a.:\1 ~\.j y J...L:..o ~ ..ul .~\;cl?\ Mr JUNOR (Jamaica): Mr President, first of all let me congratulate you on your election. I take it we are going to put the matter to the vote. For ifthere is any doubt about whether a vote is necessary, r woufd propose that we should put the matter to the vote. The PRESIDENT: :~)I Ll;i ~ ~~ 1.5 .r>i o.r-- t_.,.P _,.JI c> 1J~ ui L..i ,~1 ~ ~ l.;j\.j itJ:i; ~ ..:;..j\.5" 1~1 4~ ..:;..j\.5" \~\.j ~L-.~1 1:\J:l\ yl; j.U Js- hlA;\ crJ ...!:J~ ui ~} I.S__,>i JJ:l !l~ 0~ i..JI ~ '1....; y ·i~\ J> I ~)a·· _; itJ:i; ~ If ~~ ui ~} Mr A YINLA (Nigeria): Mr President, I wanted to suggest that the vote should be taken on the basis of retention. Retention should be yes, and deletion should be no. Thank you. The PRESIDENT: :~)\ Mr KRIT GARNJANA-GOONCHORN (Thailand): Mr President, I need a clarification on the voting strength that will be applied for this vote. A51NR/3 page29 The PRESIDENT: :~)I ·t.Y:.. _,.JI \lA J ~i_r. J..l:l J jUl\ Jw.:;._jl Jl ~L Mr TOPPING (Legal Counsel): Mr Chairman, I will deal first with the question raised by Nigeria. A recommendation was made by the General Committee to have this item included in the agenda. There has subsequently been a proposal to defer it, or in other words, to delete it. In accordance with our rules of procedure the second proposal, the one farthest away from the first proposal, has to be voted on first. So we are voting on the proposal to delete the agenda item. The only way to do that is to vote yes, in favour of deletion, or no, against deletion. In response to the question by the delegate of Thailand as to what is the voting strength, the decision will be taken by a simple majority. Thank you. Mr KRIT GARNJANA-GOONCHORN (Thailand): I am sorry, but my question needs further clarification. Are we referring to current voting strength? Who will be entitled to vote? What of Members whose voting rights have been suspended? Mr TOPPING (Legal Counsel): For the time being, the Health Assembly has not decided on the issue of whether to restore exceptionally the right to vote for this Health Assembly to those that have otherwise lost the right to vote. The issue is to be considered by Committee B, hopefully later this afternoon, and subsequently by a plenary meeting tomorrow morning. Therefore, those that have lost the right to vote in connection or as a result of prior Health Assembly resolutions will not have the right to vote on this issue now. Thank you. The PRESIDENT: :~)I • .0~\~~IJI~ 11 11 .4-=Jy ~\ c!.J )\LP>~ c!.J '-,} ~\ J_~i JJ..l.>.- :.r ~\\lA--:~ J ..___;:. _; ~\ JJJ.ll ~ .~1 \.u. '-'...l> J ..___;:._;~I uly.o\'1 ~ ~ ~ ~J -.1.>.-)IJ • • • 0 11 11. 0 0 -~~i Jlfl 0~1 ~ -~l>) )\ ~~\ C;:!J y t:>.JJI ~ t.Y:.. _,..JI l.u. UJ\.:.. 0 )~f.. -:r...UI ~ Jl :y ~ 0~1 11 . ~l>) 0 _yd f.. "y t:>.JJI J t.Y:.. _,..JI \lA UJ\.:.. 0)~f.. -:r...UI . r-"'.:l~ 1.5;) ~ 01 ~ t..i'> ~.) _; 0 )_r::.-:. - .0~1 ~l>) Ji;l ~ .0\'1 ~l> J c!.) ~~~ :r- r Ji ~~ ~~ JJJ.ll :.r ~) -~~i Y" ~ ~\ JJJ.ll . .k..U o...l>IJ ~ J.:l !I ~..:A -~~\ ~)> J.>- illi; a,6.A.; rS'J~I ~ (The President continued in English.) (Le President poursuit en anglais.) Egypt, I will give you the point of order after the announcement of the results. A51NR/3 page30 Dr BADRAN (Egypt): I think, Mr President, that there has been a lot of confusion. Also, what we said about the countries that do not have the right to vote has not been taken into consideration and so I ask for a roll-call vote. The PRESIDENT: . r..r.:' ')\ Mr YIMER (Ethiopia): Mr President, the point of order raised by Egypt is rather strange. The delegation of Egypt was here when we were raising our hands to vote. That question should have been put to you before we started to vote, not after we have finished the vote when you are going to announce the result. Maybe people think that the vote is going against them and so they are trying to postpone it. I strongly object, Mr President. This has nothing to do with the way the vote was conducted. The rules of procedure are clear. Any point of order should be on the way the vote was conducted. Now, the question raised by the delegate of Egypt could have been raised before you asked for a vote, before we raised our name plates, and you should have said: "Who are the people who are not entitled to vote?" That was the time when you should have put the question. This is highly irregular, Mr President. I strongly object to your announcing the result. That is the following step. With all due respect, Mr President, let us be decisive. The PRESIDENT: .•r..r.:' ')\ Mrs KIZILDELI (Turkey): The delegation of Turkey also feels that it is rather irregular. According to the rules of procedure, after the voting is finished, no delegation can make statements before the result of the voting is announced. So we are waiting for you to announce the results of the voting before discussing this matter any further. The PRESIDENT: .•r..r.:' •)\ J-.....ll ~ ~ ...;>- lt) ~~ ~1..$\11 JJ.ill <:?r-JI ._,.;\..,.:..:;~\ JJL;;:j a..~ :U~ ~ ~i ui ;~ Ji L.. .).>- ~ \ A-o. t_J'c_ )_;JI J 4-l<...u.; 1..5,;>- LS J>-I..UI rl..l:i~!l .y \ . \ o;~W\ ·<:?~1 ~I J \~ :J4 r...L.A:!I ~ ~) ~\ ~~\11 JJ..LJ\ Jl ~)\ ~ ~\ ~ ul.;y .y a.;~~ o.;y J5' a.l..lJ ~ - r..LZ ui ~\~I~ j...... ll ~ ~ yJ ~ ~\ ~1..$\11 JJ.ill <,?..,._ll y\..,.:..:;~l; ~-..:..l>l_;jl; .:.r--- ~L... 'I' t jJ~ ~ ~ y J a..WI a.:,..D\ ~.; Jl ..:..l>i_;j~l oh~ ui ~J .a..WI a.:,..D\ Jl ~l>-1_?1 ~..L4i ~ u ~ .1- .:r::..UI ;~~)I ~~i o;~L...J\J .:..I~ I _r;i .!J]..U . o;~W\ o-4J iliJ .!JJ~ .y u~~~ ~)I rlJ ~ ~ .:r-" d...... oWI ~L..JI ol.....ail ~ y ~ a.:,..D\ ~I ~\...... Jl ~ y~ ui ..:..l;\..,.:..:;~\ o...u. u~ ..::..l>-1_?1 . ..:..l;l..,.:..:;~\ oh uW.. ~I Jl ~~ y e::P) t k;,. ~I .:.r a..WI a.:,..D\ ~ .!JJ~) y.L.. I.;4i ' 'I' ~\..,~\ ~~ ~ ~i ui ;~} ,Jw.\11 JJ.A>.- J ~ ~ c_l.;;~l .).>- ~~ -:....WI 1~1 .j...JI ~\.j..r. u':JIJ • ~~~~ JJ..U\ .:..U~ ~ L-; o.;.AA..JI ..:..lS"'Ip~l ~ a.ll>. '1'--:H' ~I JJ~ ~k;,.\ J a..WI a.:,..D\ ~I _,.j2.;; J .,- .(V- t \ t_ J' C )_;-AJI) .;~..UI .:.r--- V o;~W\ r~l ~ .Jfi J.>. Jl ~lS"'Ipl ;~\..L.... ~ of"" LW\ ~ .:..lJ~) ~yA\ ...;>- ~1..$\11 JJ..UI ~ ~ d.v) <,?~\ ~\ "-! r..l4i (,>.lll cl_?~\ J ny" a.:,..D\ ui..S' L.J ~I lh ~~I~ :YWI .:lJ_;.;.)IJ ~l.r.JIJ o.;b~l a.:,..D ..l;~ ulS"' .!..ii ~J . ..lW rWI I-4J d,J\..:!::...1 ~ a..W1 a.:,..D1 a..uly ...l.;J .!ll~ ~ J ·r~~ ~ 4-:>lil ..::.. .;.hi a.L..JI .:..I~~~ _,11 ut;~~ r y. ~ .!ll~ ~ y. ~G _,11 ~ _; ~ ~L.. t A .;J.r- o;l~ ~ ~~ ' o o;~LJI ~ ..::....u Ji ~1..U1 rl..l:i.:ll .:.r ' o o;~WI r~ \1 .Jl:ll ~~ J.>- ~L.~I ..oJI r~ j...JI ~\.j..r. u_p:..;., J .Jw.\11 JJ.A>.- J ~~ ~L:..J 3. ANNOUNCEMENT COMMUNICATION . •)\ The PRESIDENT: ·..r-' The meeting rose at 17:05. La seance est levee a 17h05. A51NR/4 page32 FOURTH PLENARY MEETING Tuesday, 12 May 1998, at 9:00 President: Dr F.R. AL-MOUSAWI (Bahrain) later: Dr A. GUZMAN MARCELINO (Dominican Republic) Dr N.C. DLAMINI ZUMA (South Africa) QUATRIEME SEANCE PLENIERE Mardi 12 mai 1998, 9 heures President: Dr F.R. AL-MOUSAWI (Bahrein) puis: Dr A. GUZMAN MARCELINO (Republique dominicaine) Dr N.C. DLAMINI ZUMA (Afrique du Sud) 1. PROGRAMME OF WORK OF THE HEALTH ASSEMBLY PROGRAMME DE TRAVAIL DEL' ASSEMBLEE DE LA SANTE The PRESIDENT: I would like to inform the Assembly of the proposed procedures for tomorrow, 13 May. When it takes up item 12, Director-General, the Assembly meets in private and subsequently in public. After my announcement of the results of the election, I shall give the floor to each Vice-President and to a delegate from the Eastern Mediterranean Region, who will speak on behalf of their respective regions. I trust the Assembly can agree to the procedure which, in view of our limited schedule, will avoid loss of time with speeches from individual delegates. Does the Assembly agree to this proposal? I see no comments; so it is decided. (The President continued in Arabic.) (Le President poursuit en arabe.) uWI .Lot; o..u-1)1_, uW1 ...... ;.)y ~ <,>~\~~<.>f.._;; __,.al_r:...l :t""t:ll ..L:.:l4 r y.ll a...... 1.,. ~ .J~4 C_r;i 0i :;_,i ,<,>~\ ~~ j.t..J a....KJ\ ~i 0i ~J ·.Jy...... U\ .y (:J) \A o:;W\ .4-# wl_rJI_, !l ~ t..:l ~~ .:U~) ,-.....A; ~\ .J):; .:U£) ~\ ~ ..; <.:>~! ~\ ~ ..., ~ <,>.ill .J)..U\ .a.JL-J\ o..U. 0~ :;_;)1 ~ :;)\) ...U a .1.·.11 .JY....:; C: ~ .:U~ _, ,a...WI ~~ ~ 0 _,_r. ~ .j "-' ~ rLP> .JJ:; <,>~\ ~ ,<,>~\ U.j\.p.- ~ j-JI_, ,4"L...1.,:-J ~\ ~ ..:...\.J~ i_.;;.; "-# ~ ~\ 0i ~~<,>.ill ~ ~L:; ..:..L> fo ~...lAi ~~ .!..U£ _y--L ~~_, ,41 c!J ~~ ~~~..; ~~ ~ o.Jr-JI ('"":!...lAiJ <.:>~~ ~~ y _,...L;.. .JY_, ,~w1 ~~ ~ ..; o~ ~~r ~) ~~ ~ ~ .:r _, ,a....:,w1 ...;\.):;~ __,...,JI .!..U£J ..:..L..J.Jl:..J\ JJG:. ..:... ~f -?1 4 • .. ) )I 4W4 ~~ y- ~~ ~ ~W\ ~~ ~ ab~\ Y" U'"L...i CrZJ ,y_J ~\ ~ r~l .f'~ 0i ~ ~\ :;r.il ~ ~Gi ~\ ..:..WL:.. :;\..... <,>ll\ rWI o.L. ~ ~\ ~ ~ ..:..Wl:..J\ Jj6:.) . ~ )d ~\ Jl <,>~\ ~\ ~~ ..:..>~ y ~j ~) ~ .fl 4~ !l~ 0i 1_,~ L...l5""' .Jlli J,LA; ~j ~ :; )I .:lJ£ <,>~\ ~\ -.1--'...L;.. .y c} _p.. ...;~_; ,~\_rJI ~ ~\ J ~~r ~ 0y~ lf-ll\ <,>~\ ~\ ~ ~ ~\ ._:.,lj~\j ,~\ o.b:..;\ .....Oy A51NR/4 page33 2. REVIEW AND APPROVAL OF THE REPORTS OF THE EXECUTIVE BOARD ON ITS lOOTH AND lOlST SESSIONS EXAMEN ET APPROBATION DES RAPPORTS DU CONSEIL EXECUTIF SUR SES CENTIEME ET CENT UNIEME SESSIONS Le Professeur ABERKANE (representant du Conseil executif) : Monsieur le President, Monsieur le Directeur general, Mesdames et Messieurs les delegues, Excellences, Mesdames et Messieurs, en vous invitant adiriger ses travaux, Monsieur le President, Madame et Messieurs les Vice-Presidents, I' Assemblee vous a temoigne sa con fiance et je vous en felicite. Un rapport resumant les travaux du Conseil executif pendant ses centieme et cent unieme sessions vous est presente sous la cote A51 /2. Les representants du Conseil executif sont a votre disposition pour repondre a toutes questions que vous souhaiteriez leur poser au sujet des deliberations du Conseil. Je saisis !'occasion qui m' est offerte aujourd'hui pour vous faire part de mes reflexions sur l'activite du Conseil executif pendant mon mandat de President et de quelques idees sur les questionnements essentiels de !'Organisation mondiale de la Sante. En ce qui conceme la centieme session, le Conseil a examine les travaux en cours depuis maintenant quatre annees sur les reformes a!'Organisation, l'examen de la Constitution, le role des bureaux de l'OMS et il a aussi debattu des ressources extrabudgetaires et des priorites de !'Organisation. C'est qu'en effet, la question des priorites est naturellement ressentie par nous tous comme hautement strategique pour l'OMS. Elle est au coeur des conflits, des tensions ou des tendances qui habitent !'Organisation et qui influent sur son efficacite, sur sa legitimite et sur son avenir. Il s'agit de la capacite d'arbitrage de l'OMS face aux conflits de solidarite, aux contradictions des societes et des nations, ala rapidite des mutations socio-economiques et demographiques. Il est question de la fa~on dont notre Organisation saura ou non faire entendre son message pour peser sur les choix ethiques, sur I'equite et sur l 'egalite devant les so ins entre les plus riches et les plus pauvres, a l' echelle de la planete ou a l'interieur d'un meme pays. Il est question de la fa~on dont l'OMS sera ressentie comme l'avocat de la sante menacee par la mecanique implacable du denuement et de la multiplication des frontieres sociales et economiques, de la fa~on dont l'OMS combattra les pathologies et les maladies qui proliferent clans les zones les plus desheritees du monde, repoussees tout comme les guerres et les violences nouvelles de cette fin de siecle aux peripheries de l'industrie et du progres. C'est pourquoi le Conseil, apres avoir traite des priorites, a prepare pour I' Assemblee une etude sur les systemes de sante pour l'avenir. A sa cent unieme session, le Conseil a poursuivi l'examen des reformes, de la Constitution et des arrangements regionaux. Des propositions concretes sont aujourd'hui soumises a l' Assemblee sous forme d'amendements examines et retenus. Des resolutions de grande importance, capables de transformer positivement la capacite de l'OMS a remplir sa mission, sont proposees a l' Assemblee. Ainsi, la tres importante resolution EBlOl.RlO sur les credits alloues aux Regions au titre du budget ordinaire, resolution qui a ete preparee apres un travail de plus de deux annees et qui va probablement etre l'un des principaux indicateurs de la volonte de reforme et d'equite a !'Organisation. Ainsi, le renforcement du processus democratique et du mode de fonctionnement du Conseil executif par le passage de 32 a 34 membres. Ainsi, le document sur la politique de la sante pour tous au XXI< siecle, qui devrait conforter le plaidoyer de l'OMS contre les nouvelles segregations sanitaires, spatiales et financieres qui eloignent de l'universalisme genereux contenu clans la definition de la sante par l'OMS en 1946 ou clans les grandes declarations visant a prendre en charge la sante du monde en reference a des valeurs et des principes valables pour toutes les races, pour tous les continents et pour toutes les cultures. L 'acceptation des reformes par les interesses - Etats Membres ou grands contributeurs du systeme des Nations Unies - et par ceux dont on se preoccupe - les pays, les communautes, les malades - exige que les objectifs de ces reformes et leurs ambitions soient ressentis comme les instruments de valeur indiscutables et legitimes, et il me semble que l' objectif d'une meilleure gestion et d'un combat contre les situations rentieres qui peuvent exister al'OMS, que ce soit au niveau du Siege, des Regions ou des pays, doit etre le resultat de ces A51NR/4 page34 ambitions et non pas une fin en soi car il n'est en rien une valeur. 11 faut done a I'OMS une communication intense, une concertation, un discours et une pratique qui placent les soucis economiques de !'Organisation - certes graves, mais, tout compte fait, guere plus importants que ceux d'un grand hopital d'un pays riche - apres ses objectifs humanistes, ethiques et politiques. Le Conseil a recommande a I' Assemblee des resolutions pour qu'elle puisse se prononcer sur des questions strategiques, comme la sante dans le developpement, !'amelioration de la cooperation technique entre pays en developpement, la prevention de la violence, le developpement des systemes de sante, la strategie pharmaceutique revisee, la publicite, la promotion et la vente transfrontieres de produits medicaux par Internet, les consequences ethiques, scientifiques et sociales du clonage dans le domaine de la sante humaine, la promotion de la sante, la nutrition chez le nourrisson et le jeune enfant, la tuberculose, !'elimination du trachome, de la maladie de Chagas et de la lepre, la lutte contre les maladies non transmissibles et la resistance aux antimicrobiens. Le Conseil a aussi adopte une resolution demandant au Directeur general de faire rapport a I' Assemblee sur le plan d' economies pour I' exercice 1998-1999, afin qu' apparaissent clairement les economies a realiser et les programmes prioritaires auxquels ces sommes devront etre reaffectees. Le Conseil a debattu du recouvrement des contributions financieres des Etats Membres. Ce recouvrement s'insere dans la vision globale des possibilites financieres de l'OMS, que celles-ci dependent du budget ordinaire ou des ressources extrabudgetaires, et s'articule autour de la capacite de !'Organisation a garder l'entiere maltrise des priorites et du respect de sa mission globale. 11 y a, en effet, un debat delicat sur la problematique du non-paiement ou des retards programmes de paiement des contributions par les nations les plus puissantes et les plus riches, dont certaines sont membres quasi permanents du Conseil executif. S'ajoutant a la question de l'accroissement du pourcentage des ressources extrabudgetaires, qui sont, elles, de moins en moins controlees par l'OMS et de plus en plus independantes des priorites definies par !'Organisation et par I' Assemblee, cette situation est en opposition avec la mission de l'OMS. Elle !'oblige, parfois, a executer des politiques et des programmes mal compris et qui, a I' extreme, reserveraient uniquement la promotion de la sante et la prevention aux plus demunis, et reconnaltraient aux plus riches le droit a la promotion de la sante, I' education, la prevention ainsi que les so ins et la recherche, au Nord la prothese informatisee et au Sud la jambe de bois. Le Conseil a aussi fait, dans un esprit de solidarite, une recommandation pour que I' Assemblee restitue le droit de vote a to us les Etats Membres qui l'ont perdu, afin que le cinquantieme anniversaire de !'Organisation marque la vision globale de l'OMS, sa sollicitude pour les communautes et les pays qui ont le plus besoin de son assistance et une conception juste de sa mission et de sa vocation. J'ai cru bon, Monsieur le President, de garder dans cet expose cette marque du travail fait par le Conseil executif, bien que ce point ait deja ete examine et traite hier par la Commission B. Chacun de nous sait bien, en effet, que clans la pratique reelle, ce sont essentiellement le tiers et le quart monde qui sont les cibles veritables des programmes de l'OMS et si ces programmes sont per~us comme une politique pour les pays pauvres, soutenue par les pays riches, en verite, cette situation decoule pour une grande part de la repartition intemationale de plus en plus desequilibree des ressources et des pouvoirs et du creusement des ecarts, avec la marginalisation des plus pauvres. L'intelligence de !'Organisation doit la conduire a rechercher la conciliation entre les objectifs universels et les specificites des differents pays, des differentes Regions et des communautes. Mais cette conciliation ne devrait pas, de mon point de vue, signifier le report permanent ou I' edulcoration supplementaire de propositions qui sont deja de laborieux et modestes compromis, ni le maintien de dispositifs d'utilisation des ressources non seulement iniques mais aussi archalques. De plus en plus de voix s'elevent, en effet, pour que notre Organisation s' emancipe totalement de certaines considerations qui ont pu jalonner ses cinquante annees d'existence fetees aujourd'hui. Je pense aux argumentations culturalistes, raciales, voire racistes, qui poussaient, parfois au nom de fausses sciences et parfois au nom d'un juridisme pointilleux, a n'offrir que des solutions specifiques aux peuples colonises ou auxjeunes nations independantes. Les exemples de justifications scientifiques fallacieuses a des politiques contraires a I' ethique abondent et ont me me re~u par le passe le label de l'OMS. Il ne faut plus que des avatars modemes du temps des colonies viennent discrediter encore l'OMS, comme ces medecins qui, clans des livres edites par !'Organisation en 1953, affirmaient l'inferiorite physiologique en fonction des races. Le Conseil a eu, enfin, la delicate et tres sensible mission d'examiner la question de la designation d'un nouveau Directeur general a la tete de !'Organisation. Avant de soumettre sa proposition a I'Assemblee, le Conseil a pris toutes les mesures necessaires pour que ce choix so it a la mesure de la noblesse et du niveau moral et scientifique de notre Organisation. C'est ainsi que, dans une transparence absolue, dans un climat de grande serenite et de democratie, le Conseil a choisi le Dr Gro Harlem Brundtland pour le poste de Directeur general de l'OMS en remplacement du Dr Nakajima, qui est propose au titre de Directeur generalemerite a dater de son depart a la retraite. Et puisque c'est au Conseil executif, que j'ai eu l'honneur de presider, qu'est revenue la A51NR/4 page35 Iourde responsabilite de choisir parmi des candidats aux grandes qualites le nouveau Directeur general, qui fera entrer I'OMS dans le troisieme millenaire, je souhaite saisir cette occasion pour exprimer encore une fois mes sentiments d'admiration pour le travail effectue partous les membres du Conseil, au sein duquelj'ai pu constater que des problemes et des principes universels sont debattus dans la pluralite et le respect mutuel, et mes remerciements atous Ies personnels de cette Organisation pour leurs capacites et leur devouement. Au nom du Conseil,je tiens a dire notre reconnaissance d'avoir pu presenter ce rapport a I' Assemblee et je souhaite un bon anniversaire a !'Organisation mondiale de la Sante. 3. REVIEW OF THE WORLD HEALTH REPORT 1998 EXAMEN DU RAPPORT SUR LA SANTE DANS LE MONDE 1998 The PRESIDENT: :~)1 The DIRECTOR-GENERAL: Mr President, excellencies, honourable delegates, ladies and gentlemen, The Constitution of the World Health Organization came into force on 7 April 1948, with its acceptance by 26 States Members of the United Nations. That was 50 years ago, when the estimated infant mortality rate worldwide was more than 160 per 1000 live births; now it is 57 per 1000. Average life expectancy was about 46 years then, now it is 66. Smallpox was still a dreaded scourge, now it is 20 years since the last person died of that disease. Paralysis from poliomyelitis struck the rich and the poor alike, now this disease is close to being eradicated worldwide. The prospects are also good for eliminating leprosy, measles, dracunculiasis, Chagas disease, neonatal tetanus and micronutrient deficiencies. New initiatives are being launched against onchocerciasis, lymphatic filariasis and trachoma. We have accumulated a large body of knowledge on the relation between health, lifestyles and the environment, which has given us the basis for effective prevention and control strategies. As pointed out in The world health report 1998, we can look forward to a future that holds the promise not merely of longer life but also of better quality of life, with less disease and disability. For the world as a whole, human health has improved more during the last half century than in any other period we know about. This reflects remarkable achievements in the health sector as well as the much wider process of economic and social development. The World Health Organization, with 191 Member States now, is justly proud of the leading role it has played in helping to make these achievements possible through international cooperation. Fifty years ago, WHO was given the core responsibility, within the United Nations system, of directing and coordinating international health work. Its purpose was to help ensure that all people, in all countries, could have access to the highest attainable standard of health, expressed by our Constitution in terms of physical, mental and social well-being. This asserted the right of all human beings not just to basic health security but to the opportunity of developing their individual potential to the fullest. At the same time, the founders of WHO recognized the interdependence of the peoples and countries of the world in their struggle for sustainable health, peace and prosperity. In the words ofDr Scheele, Surgeon-General of the United States Public Health Service and President of the Health Assembly in 1951, "The world cannot remain half healthy and half sick and still maintain its economic, moral and spiritual equilibrium". In the post-war period, in many countries everything had to be built or rebuilt virtually from scratch: policy, infrastructure, public services, staff and training. During its first 10 years, WHO made an enormous contribution, with the help of the whole scientific community, to this work of reconstruction. Already in the 1960s however, the limitations of an exclusively biomedical approach to public health were becoming obvious. A51NR/4 page36 Similarly, it was becoming clear that international cooperation was not a matter of simply transferring technologies and policies that had been designed for other societies and situations. These perceptions at last found their expression in 1978 with the Alma-Ata Declaration on primary health care as the way to achieve health for all. It marked a turning point in WHO's history and in health cooperation. It outlined a new approach to health care, especially in developing countries, and drew attention to the much greater social and economic effort which health development required. Sensing the need to move away from traditional aid policies, it emphasized self-reliance and the development of national health systems. It underscored the responsibility of governments in this regard. It stressed the importance of community participation and the need for appropriate technology and access to essential drugs and vaccines. There was strong commitment by national health ministries to this approach but they had to contend with major obstacles. These included severe shortages of trained human resources, particularly in countries that had recently become independent, lack of baseline data for adequate planning and monitoring of health efforts, and continued overemphasis of hospital care and technology with the escalating costs involved. In addition, both nationally and internationally, most institutions and decision-making processes remained firmly centralized. This left little room and few resources for involving local communities in defining priorities and taking the necessary action. Lastly, many countries were faced with great difficulties related to the global economic situation, the debt crisis and the highly negative social effects of structural adjustment measures. WHO itself, since 1986, has had to function with a zero growth budget in real terms although the demands placed upon it have continued to increase steadily. Thus, at the end of the 1980s, in spite of significant improvements in global health indicators, the situation was one of growing inequities in health status and actual access to care. A new major threat to public health was emerging in the form ofHIV/AIDS, and diseases whose strength had been underestimated, such as malaria and tuberculosis, were returning with renewed virulence. An effective response to problems of such magnitude and complexity could not be provided by health services alone. A broader understanding of the health sector was required, and new partnerships for health had to be established to mobilize and coordinate the efforts of other agencies, the private sector and nongovernmental organizations. Fostering such partnerships has become a central role for WHO. The Global Tuberculosis Programme, the Intergovernmental Forum on Chemical Safety, and the Global Programme for Vaccines and Immunization are examples of the new partnerships that have been set up during the past 10 years, putting to good use the experience we have gained in such areas as research on cancer, maternal and child health, human reproduction, tropical diseases, food safety and humanitarian assistance. WHO has also put in place innovative networks for epidemiological surveillance and response to emerging diseases, antimicrobial resistance, and epidemics. The role of WHO collaborating centres within such networks and partnerships is proving crucial. Special campaigns against diseases such as leprosy, poliomyelitis and onchocerciasis have brought together the efforts of national health services, private foundations, local and international organizations and the general public. These campaigns have often provided a first point of contact between health workers and underserved population groups and thus an opportunity to build up mutual understanding and the primary health care approach. Our experience in the Global Programme on AIDS, in particular, has demonstrated the need to recognize the users of the health system as key partners for health development and local empowerment. Empowering people and local communities on a much larger scale with the necessary information and skills to take care of their own health would contribute significantly to reducing some of the health disparities that still face us. Mortality among children under five years old has been reduced from 21 million in 1955 to 10 million in 1997, but the figure remains unacceptably high. For some countries, representing over 50 million people, average life expectancy is still less than 45 years. About 585 000 women still die each year of pregnancy-related causes, 99% ofthem in developing countries. The risk of maternal death is one in 1400 in Europe, one in 65 in Asia, and one in 16 in Africa. Between two and three million adults die of tuberculosis every year although an effective and affordable cure for this disease exists. Infectious and parasitic diseases continue to be a major threat for all, especially in developing countries. We welcome the commitment made by the foreign ministers of the Group of Eight last week in London to support WHO in developing global surveillance networks and building up the capacity of countries to control these diseases. Poverty remains a major factor of ill-health and lack of access to health services, but new approaches to health development and cooperation can significantly reduce this problem by making better use of current resources and human potential. Our analysis of achievements and shortcomings in the implementation of the health-for-all policy has helped us to define some of these approaches. They include: first, the provision of integrated care throughout the life span; second, intersectoral and interdisciplinary collaboration; and third, A51NR/4 page37 advocacy for health in social and economic development. New partnerships, at different levels and in different areas of activity, open up the way for all three of these mutually supportive approaches. (1) The provision of integrated care throughout the life span is necessary to overcome the limitations of a piecemeal approach to diseases, services and age groups. Ensuring a continuum of care to all will enable us to improve not just the figures for selected indicators but the actual health status and well-being of individuals. Health is multidimensional: problems of infection, nutrition, psychology, allergy or genetic predisposition may coexist and reinforce or trigger other conditions. Health gains can also be reversed at any time in the event of failure to maintain access to essential drugs and adequate care and living conditions. This was shown in the recent past by the actual decrease in life expectancy experienced until 1995 in 16 countries with a total population of about 300 million. Similarly, HIV infection could cancel out some ofthe major gains achieved in child health over the past 50 years; it is estimated that, last year alone, 590 000 under-15-year-olds became infected with HIV. In addition, health status is influenced by health events which occurred in the previous generation or at an earlier stage in life. Women's health and their access to reproductive health care and counselling largely determine the health status of their babies. Proper care and nutrition in the first years of life are not only important for resistance to childhood diseases but also prepare the way for improved adolescent and adult health. Substance abuse and other risk-taking behaviour in youth have a far-reaching influence on health status in middle age and later life. For example, because of early and prolonged use of tobacco, lung cancer in women has increased fourfold over the last 30 years in many industrialized countries and is also on the rise in developing countries. Ageing, changes in lifestyle, and the concomitant worldwide increase in noncommunicable diseases such as cancer, diabetes, cardiovascular diseases and mental disorders, make the need for integrated care and lifelong health promotion more urgently felt in all countries. Within the next 30 years, increases of up to 300% of the older population are expected in many developing countries, especially in Latin America and Asia. By 2025, there will be more than 800 million people in the world who are over 65 years old - twice as many as today, and two-thirds of them will be in developing countries. One of the biggest challenges in all countries will be to find out how best to prevent and postpone disease and disability and to maintain the health and autonomy of an ageing population. Because of these trends, improving efficiency in the financing and delivery of health care has become a major concern of all countries, and many have introduced reforms to their health systems in an effort to ensure that they are functional and sustainable. Containing health care costs is a necessary objective but must not result in the rationing of essential health care and services. Much of the sickness and disablement which consume health budgets can be avoided through rational investment in preventive care. Recent trends in industrialized countries have shown the effectiveness of health promotion activities in preventing, delaying and reducing the severity of chronic diseases and related disability. Disease prevention should be recognized as an essential component of all cost containment strategies. (2) Regarding our second approach to health development - intersectoral and interdisciplinary collaboration - it reflects the growing recognition that many important health determinants are beyond the direct control ofthe health sector. Partnerships make it possible to monitor relevant developments in other sectors and disciplines, anticipate related risks and opportunities for health, and provide technical advice on policies and activities accordingly. Thus WHO's work on environmental health, chemical safety, housing, sanitation, occupational health, and prevention of violence and substance abuse has been done in collaboration with partners in areas such as education, agriculture, engineering, town planning, consumer associations and the media. This has proved indispensable for the control not only of epidemics but also of noncommunicable diseases and the health consequences of natural and man-made disasters. The incidence of many infectious diseases such as malaria, Ebola-type haemorrhagic fever, schistosomiasis and Rift Valley fever, is closely linked to a variety offactors such as migration, climate, and water and land use patterns. These need to be analysed and tackled in a coordinated fashion. Compartmentalization and communication gaps between experts and institutions can cause major problems as was seen during the outbreaks of bovine spongiform encephalopathy and E. coli 0157. Last year, the Health Assembly urged WHO to continue to lead and coordinate work on chemical risk assessment, with special attention to persistent organic pollutants (POP), their potential endocrine-related health effects, and their possible causal links with cancer and reproductive, neurological and immunological disorders. Intersectoral collaboration is also critical for research on health development. The importance of basic biomedical research must be strongly reasserted, but it is equally indispensable to mobilize other disciplines to A51NR/4 page38 take into account the behavioural, social, anthropological, technological, economic and legal aspects of health development. (3) An important and complementary aspect of WHO's responsibility is to uphold the requirements of health in a rapidly changing global environment. This defines our third approach, of advocacy for health in social and economic development. In fact, advocacy for health development has always been one of WHO's responsibilities as an intergovernmental body, and has been put into practice in our involvement in research, information exchange, policy-making, technical cooperation, capacity-building and standard-setting. But until recently, WHO's work in this area has been done essentially with the health professions and ministries of health and for their own immediate use and that of their "natural" partners in health-related fields. Aimed mainly at the health community, WHO's advocacy work has been conducted within its own expert committees and governing bodies, and, to some extent, within the internal coordination committees of the United Nations system. In the past 10 years, approaches to development work and international cooperation have changed tremendously. A mark of this change is the recent series of "summit" conferences on practically the whole spectrum of activities ofthe United Nations system. These include the environment (Rio), population (Cairo), social and economic development (Copenhagen), women's empowerment (Beijing), food (Rome), and human settlement (Istanbul). It is noteworthy that, whatever their original technical brief, all these meetings ended up dealing with the issue of sustainable development, that is development for the whole of humanity, throughout the world, and for future generations. WHO has been actively involved in all these conferences, their preparation, and the follow up now in progress. Another important feature of these world conferences, and a major departure from the past, has been their opening up to the huge body of nongovernmental organizations which has emerged and multiplied worldwide, reflecting a new determination on the part of civil society to be involved not only in local development activities but also in political decision-making at both national and global levels. This strongly felt need for increased democratization in health work and development is also shaping WHO's own new policy and partnerships for health. The reforms currently in progress in WHO are aimed at increasing effectiveness at country level precisely through this wider sharing of knowledge and responsibility. The nature and scope of WHO's work for advocacy and standard-setting are being further redefined by powerful trends such as privatization in the health sector and globalization in the world economy, financial flows, trade, labour, technology, and information systems. Important international forums and interest groups have emerged at regional and global level, and the decisions they make have far-reaching implications for health and development in our Member States. It is WHO's responsibility to represent the interests of health - of all people's health - in these forums and interest groups, and to uphold the technical and policy requirements for equitable and sustainable health development. WHO has the moral and scientific authority to do so, and the obligation to do so is placed upon it by its Constitution, although the environment in which it must be fulfilled has greatly changed. Since its inception, the Organization has been involved in setting technical standards and proposing guidelines and codes of practice in many important areas of health, including pharmaceuticals, breast-milk substitutes, organ transplants and biological standards. More recently, countries and regional groupings have been turning to WHO for scientific advice on global standards for safety and quality assurance in the trade of food, health products and services. We have been working on such issues with a large variety of partners, including UNCTAD, the World Trade Organization, the Group ofEight, the Organization of African Unity, the European Union, ASEAN and MERCOSUR. In these activities, WHO's role must be to protect the health of consumers while facilitating trade in the interests of all people worldwide. We have to insist that the pursuit of profitability and resource generation does not overrule the requirements of safety and justice. For we must always remember that our responsibility is not just technical. Research and health care raise major ethical issues in areas such as clinical trials involving human subjects, cloning, xenotransplantation, patients' rights, genetics, confidentiality of data and intellectual property issues. In all cases, what must prevail is concern for people's health, their safety and their autonomy. In our commitment to health work and international cooperation, respect for the equal worth and dignity of all human beings must be our guiding principle. The World Health Declaration submitted to you for adoption reaffirms this principle and the values embedded in WHO's Constitution. It reiterates the interdependence of all people and nations and their shared responsibility in working towards health for all. The new health-for-all policy, which you will also be considering for adoption, sets out the main directions for our work in the twenty-first century. It is part of an ongoing planning process and must be seen as a starting point, a flexible framework rather than a fixed A51NR/4 page39 programme. Most importantly, it reaffirms our commitment to international cooperation in health development, based on the values of equity, solidarity and respect. The World Health Organization has achieved a great deal in its 50 years of existence, and has enormous potential to serve the world in the coming century. I have full confidence in its strength and adaptability, and in the wisdom and skill of its future leaders. Most of my professional life has been dedicated to WHO and to working with our Member States in the pursuit of health for all. I am deeply grateful for these many years of sometimes difficult but always rewarding work. I want to pay special tribute to WHO staff, my colleagues, to the high quality of their work and to their devotion to the goals and values of the Organization. I wish to thank them all for the support they have given me throughout these years. Mr President, It has been a very special honour to serve the Member States of the Organization. Their commitment to health - from officials at the highest political level to workers in the most remote communities - has always been and always will be the one essential ingredient of our success. I warmly thank all those of you who, in your different capacities, have worked with us in friendship and determination to improve the health of the peoples of the world, towards peace and prosperity in the twenty-first century. 4. FIRST REPORT OF COMMITTEE B1 PREMIER RAPPORT DE LA COMMISSION B1 . •)1 The PRESIDENT: ·~ .~1 ~ws-- J>- ¥'.5"'\.j JP...ill ~~ .L>~ o~ ~.,WI ~L.....JI ~ i~l ~ ~~~ w~.;. 0~ ~ ~~ 0i -'Ji L.~.~.0i ~ yi;S' ~L.J.S"' r-=t...IZ ~ ~~ ~J...u.JI o.:lL...... II ~ c.?l 01 ., Jl ,~ Jl. u J..J.>.. J>- l_,b (,?.lll ~WJ 1)2; J ~I ~L.....l5' J~l ,~WS"' ~\All~ 0~f.. .:r..lll ,.:r-u...L:..JI Jl ~I 0bJI LS ,~1 ~~ -l+J~~J ,~1 ~ o.r.f oJ~ ~ ~~ ,...L>- ~.,1 - ·i"'I.All ~I i y.. ~ .-P "'~ 1 ~ -')_,JIJ ,"._,.,"~I .G~i (,?.UI J}JI f.._;:ll ~ _)2.:; Uy-' '\ • J Q, .:r-~1 UJ\..:.. ~ tr 01 ~ ~ J _;4 r-;5 r._;:ll 1.U. J~l ~L>. )Li ,~ 0 J~ .Y> LS f-_;:11 l.h. ~~~ 6..:>...ill . n I o 'c ;u.; )1 - . _r-':JI _,t ...L>-1)1 0':11 4J ~ ~I)} a.~ J>- f.. _;:I I (,.> ~ • o.:l ~ ~l...PI_?I (,?i ~j ~ 1::,1 ~"oJ..u...JI ~1.5'1~"11 ~ a.JL>" 0_r-...J1 )_;JI -'~1 ~~}JP>_ .)_;JI ~ o.:lWI i~i ~ J.r./. ...\.>- J~ ~IS'Irl .,u..... ~ o_r-t:JI ~~~~ JJ..ll1".0~y ~ Jl!ll )-tl L.i .)_;JI ~ ,~l.pl_?l (,?I!)~~~ 1::,1 ~)_;JI I..U. _,~"} o..u.;;....,. O_;J_r-JI ~JP>' J~~l .y V .... 01_y ~ -.:J\.!!1 )_;JI \...1 6..:!_rll ~ ~)~ y J...l:.o Dr. BADRAN (Egypt): c>-> .r 0L.. _rJI .r ~~'}I 0~ 0i ~ JJ..lll .y _r.S" .fl JU;I !l~ 01.5' ~~ _):;i )_;JI I-4J ~\.; lh j>-.-i ut; I-4J J ,~~~ iWI f.....WI ~I y\.:>.::j"} .1W ~ J ,~1 o.h. Jwi ~ Jl I~ ~~I . d.;)WI ~ )_;JI J>- ~IJi "} J 1 See reports of committees in document WHA51 /1998/REC/3. 1 Voir les rapports des commissions dans le document WHA51/1998/REC/3. A51NR/4 page40 The PRESIDENT: :~)I ~~ ui ~I o_r.>-G ~L>. )t; •u~l ~ <~....>- ~ ~ (,>.UI <.!Jl!ll )__,AJI ,_? ~ ~ u~ ~i ui ~} .o~y er V o~WI r~i ~ Jfi ...l> Jl 4JlS'I_,;:.ZI ~I....L... ,_} o_?UI ~L....a>-~1 JJ..UI" .o..il_y J <.!Jl!ll )_;)1 u~l -~_r\1 ~ ~J~ YJ...l:-t Y)_;)l I~ ~~:1 ~~~\~.''lay ~_,..a=ll ...:...ljl..;-ol ;;~~\ :J_,:;...... UI Dr. BADRAN (Egypt): er ~~:11 u~ ui ,_? ..:....WI ..u ,;._j\5' ·~l_r.Jl; 4...,.:.WI a.:.:...lll J ,JJ..UI er 1~ ui er .cli ui J.:- ~ ui djjjJ •rl.JI y-:t..WI y~l ,_} .h.O ~ J a...WI ~\ o~ J~i ~ Jl I~ ~_,..a=ll J> er u~ _rJI ,LW\ ~I oh J~i ~I 1::W..... ~~:11 I~ u~ ui ~iJ .~WI ~ )_;)I ,_? ~\y r~ ~i .\~) The PRESIDENT: :~)\ Dr STAMPS (Zimbabwe): Thank you, Mr President. We associate our sentiments with those expressed by the delegate of Egypt and would like to propose an amendment because it appears that the reason for depriving Member States of their voting rights is to induce timely payment of dues. Our amendment reads "that any State in arrears in excess of the sum of US$ 6 million shall be deprived of voting rights until that excess is reduced". The PRESIDENT: Mr TOPPING (Legal Counsel): Thank you, Mr President. As I understand the proposed amendment by Zimbabwe, the effect is to make this resolution into one also depriving States of the right to vote in the case where they are in arrears beyond a certain sum. The Health Assembly has just considered a resolution depriving certain States of the right to vote. I would consider that the amendment proposed by Zimbabwe would relate to the resolution just adopted and it would not be appropriate to consider the same subject under this resolution. If the same subject of depriving the right to vote of certain Members for being in arrears is to be reopened, and since we have already considered this issue, it would have to be reopened under a motion for reconsideration which would require a two-thirds vote of this Assembly. So, if I could summarize, Mr President, I think you should rule that the proposed amendment would not be appropriate under this resolution. The PRESIDENT: Thank you for this explanation. Any comments? Jamaica, please. Mr JUNOR (Jamaica): Mr President, it would seem to me that the amendment goes to the fundamentals in relation to a constitutional provision. I would wish to be informed by the Legal Counsel as to how one goes about changing or imposing sanctions as is being proposed by Zimbabwe. What would be the constitutional position? A51NR/4 page41 . •)\ The PRESIDENT: ·...r.:' Dr BADRAN (Egypt): I am sorry I disagree with what was explained. We have a draft resolution that is in front of the Health Assembly. It has been discussed and proposed. So the matter of the principle of suspending this non_-voting situation for some countries is for us to consider. I think it is the right of the Health Assembly to look mto the decisions of the committees, or else there would be no need for us here to consider them. So, in considering the recommendation of Committee B on the draft resolution, I would like to propose the change, which has been seconded by Zimbabwe, that is not to delete the provision that this restoration of voting rights applies only to the election of the Director-General. The PRESIDENT: :..r.f )1 .4,!i_r. J~ <.S..f'"i ;;__,... J jW\ Jw.:...... J.l JL>...JI ~ Mr TOPPING (Legal Counsel): Thank you, Mr President. In response to the question by Jamaica, the constitutional basis for depriving Member States of the right to vote is found in Article 7 of the Constitution which reads "If a Member fails to meet its financial obligations to the Organization or in any other exceptional circumstances, the Health Assembly may, on such conditions as it thinks proper, suspend the voting privileges and services to which a Member is entitled. The Health Assembly shall have the authority to restore such voting privileges and services." Over a period of years, the Assembly has adopted a series of resolutions which have set forth a fairly complete framework on how it deals with this issue. At the Eighth World Health Assembly it was decided that the threshold of two years in arrears would be the point at which it would consider suspending the right to vote. The Forty-first World Health Assembly established a system whereby after the two years' arrears had been reached, the Health Assembly would consider a resolution which would, if the Member was still in arrears the following Health Assembly, come into effect and the Member would be deprived of the right to vote. So, in effect, Members would be given three years before they would actually be deprived of the right to vote. As I said earlier, the issue of the suspension of the right to vote has been considered by this Health Assembly in the preceding resolution. I therefore maintain the position that the issue of depriving certain Members of the right to vote has already been considered by this Health Assembly. To consider it again would require a motion to reconsider, which would have to be passed by a vote of two-thirds. In the case of the proposal made by the delegate of Egypt, I now understand it to be an amendment to return to the original wording, I assume, of the draft resolution as it was first considered by Committee B. Egypt should correct me ifl am wrong on that. If that is the case, then it is a correct and perfectly appropriate amendment to make. This Assembly should consider that amendment first, before considering the resolution as a whole. The PRESIDENT: Thank you. I give the floor now to the delegate of the United Kingdom. Dr CALMAN (United Kingdom of Great Britain and Northern Ireland): Thank you, Mr President. This was an item which was discussed fully and openly in Committee B yesterday. There was a clear vote in favour of the amendment and the subsequent resolution was approved by consensus. The vote was for the restoration of votes for individual countries for item 12 only. May I suggest, to save the time of this meeting, that, although this is an important item, we should proceed directly to a vote on this, once again to clear this as quickly as possible. A51NR/4 page42 The PRESIDENT: :~)I ·~Y)~ Dr BADRAN (Egypt): According to the regulations, as I understand them, if there is a proposal for some amendment in the resolution that is in front of us, then voting has to be on that change and not on the whole draft resolution. El Sr. NGUEMA OWONO (Guinea Ecuatorial): Senor Presidente, pienso que si se restablece provisionalmente el derecho de voto tiene que ser para todas las cuestiones, porque todas las cuestiones son muy importantes, una cosa no puede ser y no ser. The PRESIDENT: I think, to save time, that it is better to proceed and vote on the matter as suggested by the delegates of the United Kingdom and Zimbabwe. As we are going to vote on this, I wanted to ask for an explanation of how we are voting, but I will take a point of order from Zimbabwe first. Dr STAMPS (Zimbabwe): Mr President, we take exception to the suggestion by the Legal Counsel that an amendment of the nature proposed either by myself or by Egypt is irregular, and that we would need to return the resolution for further discussion. The suggestion to merely restore the voting privileges for one item is equally grossly in conflict with the developed syndrome of depriving States of the vote if they are two years in arrears. It is even more irregular, I submit, than the original resolution which was proposed by the Executive Board, or the amendment from Zimbabwe, which wished to identify the real cause for the problems in budgeting in this Organization, which Article 7 seeks to deal with. So I would ask the Legal Counsel to withdraw the comment that an amendment to this resolution being put forward before the Assembly is improper. Dr. A. BADRAN (Egypt): jL->.:~1 ~I .:;-- -Gi ~ Jily. ~i 'J _,;WI Jl..!..::...... JI ~I ~ 0'" ~ LS' ,~i ,~ )1 ~I ~ ~~~ 0u ,L. )} J; ~...u-.; J~.>-.:~1 c...r'l 1~1 ,~~.; ~i w--J ,,.?J_y.-.:~ __,...i 1~ 0iJ ,}_,All 1~ J; ~...u-.; .!.U..U J . "y" ~~ ~.; -} .:~ )J ~ w-- ,.u...s-l~ }_,All J; ~~~ Jl ;~~ fo 0i -y ~...u.:11 1-4-; i~ 0i .ob-;a1 ~.,>..UI ~...u.:ll,}; ~~~ ~ 0i ~i ui The PRESIDENT: :~)I .~i;. J-4 JjWI JW.:...... U JL:....JI 0~1 ~i Mr TOPPING (Legal Counsel): Thank you, Mr President. Yes, I should clarify what I said. I have agreed that the proposal by Egypt to amend the resolution so that it applies to restoration of the right to vote to all the remaining agenda items of this Assembly, is perfectly in order. This was first considered in Committee B. Committee B decided to restrict restoration to agenda item 12 alone. It is perfectly permissible for this plenary to change its mind and go back to the original text. I will read out the text so everyone understands what we are considering. In response to Dr Stamps, Minister of Health of Zimbabwe, my original intervention concerned the inappropriateness of adding an amendment to this resolution which would have the effect of withdrawing the right to vote and, as I understood his proposal, would create a new category for suspending the right of Members A51NR/4 page43 to vote. As we have just considered that issue in a preceding resolution, I said that it would not be appropriate to bring it up at this stage. But certainly, the amendment of the resolution to include all items of the agenda for the remainder of the Assembly is perfectly in order. If I could just clarify now, the text of the first operative paragraph of the resolution currently reads: "DECIDES to restore on a temporary basis only for agenda item 12 of the Fifty-first World Health Assembly," and then the text continues. If the amendment proposed by Egypt is adopted, it would read "DECIDES to restore on a temporary basis for the remaining duration ofthe Fifty-first World Health Assembly only" and then the text continues. The second operative paragraph, which reads now "CONFIRMS that such restoration is without prejudice (1) to application of the aforesaid Health Assembly resolutions for all other agenda items of the Fifty first World Health Assembly", would read: "CONFIRMS that such restoration is without prejudice to application of the aforesaid Health Assembly resolutions beyond the closure of the Fifty-first World Health Assembly". This would make the restoration applicable for the remainder of this Health Assembly, and then previous resolutions that have deprived States of the right to vote would immediately come into effect after the closure of this Health Assembly. This is a proposed amendment. The procedures require that we consider the amendment first. So when the President asks how many are in favour, you are going to vote on whether you are in favour of this amendment to extend the restoration of voting rights to all agenda items. When he asks how many are against, it is again whether you are against the amendment. Then we will consider the resolution as a whole. I should add that when we proceed to vote, only those States that have the right to vote should raise their name plates. The PRESIDENT: :~)I 'v•·~ -J'i ''1 ...... J-...L:..o El Profesor PICO (Argentina): Senor Presidente, solamente queria saber quienes podian votary c6mo se iba a votar, en que forma se iba a votar. . ')1 The PRESIDENT: ·~ Dr SHALALA (United States of America): We agree that the Egyptian amendment is in order. We also agree with the United Kingdom that the issue to restore all the voting rights for Members was fully discussed. We will vote to uphold the decision of Committee B and therefore vote against the amendment. The PRESIDENT: ·~J~I YJ..c..JI JjW.}; bJ I~!..?~~~ c!J. ~pi 0~ d~ ·i\.j~yJ...L:..o M. NGO V AN HOP (VietNam) : Monsieur le President,je crois qu'il faut d'abord discuter de la procedure de vote et nous informer de la liste des Membres qui n'ont pas le droit de vote, qui n'ont pas paye leur contribution. J'estime qu'il faut ensuite voter, non pas en Ievant les pancartes, parce que dans ce cas on ne peut pas savoir qui a perdu le droit de vote. C'est pourquoi je propose qu'on appelle les Etats Membres qui ont le droit de vote, l'un apres !'autre. Merci. The PRESIDENT: :~)1 4>_ril ~I ~>l4 ~ya:ll ~ ~i i\.j ' • .:..; y J...L:..o J; ~i ~t.; ..:.J _,ll -} ) j 0i ~ ,_i> ~ . ..,._....WI .,;:._; _,ll ~ ~ ~4-il ~ ,_i> J ..:.J _,ll ~ ~ ,_i> !..?~~~ c!J. .;J~ 0i ~ WIJ A51NR/4 page44 .:;-- 0~ ...L..U ~~_, 1~1 ~ ~-' r.?~'il ~.r. ~~~ ~_,b Jl t....L L.;~.; ~ly. ulS" 1~1.; 0\11 u_,_r:-6 . ~~ ~ J r L.il.; <.f _,Ailj' 1~~.; _y; ~...w1 0f..; ~~~ J>- 4.1 ~ ~~ J_,...UI _? .li ul 'i _,I~ f..;1 J-> yJ v-;l ~I J_,..WI ~~~ ~~ ul JjWI 1 ~1 .:r ~~ u~l \'lh ~ J:>l_?l r.?i !lb. JP> ·~~~ Mr TOPPING (Legal Counsel): Thank you, Mr President. The following is a list of the countries not entitled to vote: Afghanistan, Antigua and Barbuda, Armenia, Azerbaijan, Bosnia and Herzegovina, Central African Republic, Chad, Comoros, Djibouti, Dominican Republic, Equatorial Guinea, Georgia, Guinea-Bissau, Iraq, Kazakhstan, Kyrgyzstan, Latvia, Liberia, Niger, Republic of Moldova, Somalia, Tajikistan, Turkmenistan, Ukraine and Yugoslavia. The PRESIDENT: .·..r.:' ')1 Mr TOPPING (Legal Counsel): Thank you, Mr President. We are now voting on the amendment to extend the resolution to include all remaining items on the agenda of this Health Assembly rather than agenda item 12 only. So those that will be voting in favour are in favour of the amendment; those that vote against are against the amendment. We will consider after the vote on the amendment whether the resolution as a whole should be adopted. The PRESIDENT: !.? ~~~I ~~I ~ L>.-)I . ~ _,~ ~ \.-.. i u _,AJ J.. _}...ut:dl JP u _,A; I_,.JI , ~~ i u _,AJ J.. _}. ..ut:dl JP u _,Ail y. .y. .UI . ..:.>1_,....,~1 ...\;.~,_;>as. j .r . ~1-ll.t ..;..L,..) uyo:. J.. uyP JlA.JI . J _,...UI ...~;. .y ~~'il ,_;> _,i ~\.-..~I ...~;. ~ ,_;> as. j .r ..;..t.,.. _,1)1 ~\.ltl ~I.>. )I • ..;..L,.. _,1)1 Jljl ~I.>. )I . ...WI a.~ ,_;> r.- ) as. j f ~ hJ~t.,..) u_,AJ J.._ ~~I y- u~I . ..;..1_,....,~1 ...~;. ...u.; ~~ ~ ~ _, .u'il ..;..t.:.. _,1)1 JIJI ~~.>.)I The PRESIDENT: The result of the voting is as follows: number of Members present and voting 121. Majority required is 61. Votes for the amendment, 20. Votes against the amendment, 101. Abstentions, 5. The amendment has been defeated. Now I would like to ask you to accept the resolution by consensus as it appears in the report of Committee B. Is there any objection? The PRESIDENT: Dr A. Guzman Marcelino (Dominican Republic), Vice-President, took the presidential chair. Le Dr A. Guzman Marcelino (Republique dominicaine), Vice-Presidente, assume la presidence. A51NR/4 page45 5. DEBATE ON THE REPORTS OF THE EXECUTIVE BOARD ON ITS tOOTH AND 101ST SESSIONS AND ON THE WORLD HEALTH REPORT 1998 DEBAT SUR LES RAPPORTS DU CONSEIL EXECUTIF SUR SES CENTIEME ET CENT UNIEME SESSIONS ET SUR LE RAPPORT SUR LA SANTE DANS LE MONDE, 1998 La PRESIDENTA: A continuaci6n nos ocuparemos de Ios puntos 9 (Examen y aprobaci6n de Ios informes del Consejo Ejecutivo sobre sus 100" y 101" reuniones) y 10 (Examen del lnforme sobre la salud en el mundo 1998). Recordamos a las delegaciones que deben referirse especificamente a estos puntos, y que aquellas delegaciones que deseen informar acerca de aspectos destacados de sus actividades sanitarias pueden presentar sus informes por escrito para que consten en acta, y ello en virtud de la resoluci6n WHA20.2. Ademas, distinguidos colegas, les recordamos que, de conformidad con la resoluci6n WHA50.18, cada delegado podra utilizar la tribuna un maximo de cinco minutos. Mr ORTENDAHL (Sweden): Madam President, Dr Nakajima, distinguished delegates, it is an honour for me to address the Fifty-first World Health Assembly. Mr President, I congratulate you and you, Madam Vice-President and all the other Vice-Presidents elected to steer this important meeting. This year's world health report gives us the opportunity both to take stock of the achievements of the past 50 years, and to ponder on ways to go forward. We are in a real sense at a crossroads. A new millennium is approaching. We will adopt a health-for-all policy for the twenty-first century, and elect a new Director-General. However, before looking at future challenges, let me pay tribute to the dedicated work of all the excellent people, whose achievements we proudly look back on at this fiftieth anniversary. One of them is Dr Hiroshi Nakajima, our out-going Director-General, who has served WHO during a very long career. Thank you Dr Nakajima! Sweden, one of the founding Members, has since the inception of WHO wholeheartedly supported the Organization's work. For the Government, for the health profession, for the general public, WHO stands for expertise and solidarity in health. Reforms, effectiveness, and coordination within the United Nations system are imperative to stepping up actions for health. With this in mind, Sweden will continue to support WHO and is prepared to increase its voluntary contributions. It is my Government's firm belief that WHO in the years to come should play a lead role in reforming the international collective action of health. The world health report in front of us shows that progress is possible. And it urges us to renew our determination to reduce unacceptable gaps in health. WHO must now play a more decisive role in proving the case for health in development. We need solid arguments and facts on health determinants in order to coordinate, raise support and form partnerships for health. This is necessary, as we aspire to combat poverty, promote health in all settings, align sectoral policies for health, and put health into sustainable development planning. To this end the analytical capacity of WHO needs to be strengthened. We look forward to a valid synthesis of knowledge, strong policy statements and intensive advocacy to place health firmly on the development agenda. Poverty is the most important cause of disease and disability, and the first victims are children. Ten million children die under the age of five unnecessarily each year, largely due to lack of inexpensive treatment and prevention. Opportunities for all children to survive, grow and develop must be as important for the future as they were to the founders of WHO in 1948. Each child's right to health is at the core of equity and the equal value of all human beings. We cannot be content with merely treating the sick child. We must prevent disease and disability. Children must have the chance to play, go to school and develop socially. WHO must also take part in efforts to defend children against all forms of exploitation. In the new health-for-all policy, a most welcome and crucial principle is the incorporation of a gender perspective into health policies and programmes. A vision for all means a vision that encompasses both boys and girls, men and women. In order to meet the new challenges, WHO has to be more flexible in using its resources, and more daring in setting priorities, and should clearly present its proposals for key activities. WHO has provided us with some excellent methods and programmes to use. It should, however, provide us with much better analysis and normative guidance on health systems development. Progress and failures alike need to be better understood, A51NR/4 page46 particularly with a view to supporting improvement of the health systems of individual countries. WHO deserves our commitment as Member States to do our utmost to ease its passage into the new millennium. What we contribute in terms of political will, expertise and resources, will be there for all people to share. Let me finally confirm that Sweden looks forward to Dr Gro Harlem Brundtland's assumption of the leadership of WHO. With her in charge, I am convinced we can step confidently into the new century. Mr FARRUGIA (Malta): Madam President, Director-General, distinguished delegates, on behalf of the Government of Malta I would like to congratulate the President on his appointment. The Maltese Government and particularly my Ministry promises its support in his onerous task. I would like to thank the delegate of Zambia, called upon to speak in the name of the Southern Africa Development Community, for letting me have the opportunity to speak now. I would also like to congratulate the Director-General and WHO on their dedication, which is reflected in the excellent work performed by the Organization. Our thanks go to all WHO staff for their contribution to improving the health of citizens of this world we live in. We are sure that all the regional offices have made a substantial contribution, often against all odds and sometimes at risk to their lives, to fulfil the task and mission of this Organization. Throughout this year I have had particular first-hand experience with our European Regional Office and I must say that their work is done with dedication and great efficiency. During this Fifty-first Assembly, we will be seeing Dr Nakajima end his term of office as Director General. We would like to thank him and acknowledge all the work he has done over the past years. We are however happy to note that his seat is being taken by an able physician and politician. As we have pledged our support in the past, I can assure Dr Brundtland that my Government will continue supporting her in her efforts to improve global health. Today's Assembly also sees our Organization celebrate its fiftieth anniversary. This occasion has been twinned with the final draft of the document "Health for all in the twenty-first century", a document based on past achievements and which sets practicable guidelines and policies for health at all levels. This shows a good vision for the coming millennium and augurs well for the future of global health. As we had already proposed at regional level, we hope to see all the countries sharing their operational research and experience, with WHO acting as a clearinghouse. Thus WHO can act as a monitor and see to the effective accomplishment of goals. We must be ready to share expertise, human resources and health costs. New developments in the world and deterioration in socioeconomic conditions in Africa and in many countries of the eastern part of the European Region are our present challenges. Budget allocations to the various WHO regions must reflect the principle of equity in health. As one of the smallest States in WHO, we are called upon to put forth the issue of small States. There is need to consider our specific problems, which do not necessarily arise from health problems but purely from the size of our population. Certain initiatives and decisions taken by the Assembly and by WHO can pose financial and strategic problems to small Member States and this should be recognized by our Organization. The world health report 1998 focuses on health through the entire human life span. I am pleased that a special focus is given to women's health. In line with the topic of this year's World Health Day, my Ministry organized a month-long project promoting women's health. With this campaign we forged a link between themes related to International Women's Day in March and World Health Day in April. From the risks associated with stress to the benefits of exercise, from the harmful effects of smoking to the benefits of healthy eating habits, this campaign reached its goals. With the substantial progress in disease prevention and control, my country like the rest of the world is facing an increase in the number of elderly citizens. As a matter of fact, average life expectancy at birth in Malta is 78.5 years. This is higher than the world average. To meet this challenge my Government is exploring new avenues of collaboration with local nongovernmental organizations, the private sector and the United Nations Institute for Ageing, which is based in Malta. No effort is being spared to keep our elderly in the community. We are committed to provide the best services to all our citizens. We consider this to be one of the foundations of our social policy. Furthermore, Malta has now developed a good pre-, intra- and postnatal health service. Consequently, infant mortality is low, however our major problem in childhood is obesity. This is an ever-increasing problem and has become one of our public health priorities. This is where we will be focusing much of our health promoting activities and with the help of the "Health Promoting Schools" and the "Healthy Cities" projects we hope to reach our aim in the near future. We are placing emphasis on childhood obesity, as we know that this risk factor plays an important part in the etiology of most noncommunicable diseases, particularly diabetes. A51NR/4 page47 At a time when the superhighways of electronic technology are making our world a global village, we must remain sensitive to all developments in medicine. Finally, my delegation reiterates its support for the conclusions and the priority areas identified in this document and we would also appeal to all the other Member States to join together in a concerted effort to support WHO in its proposals. I would also like to once again pledge my full support to Dr Brundtland. Dr SHALALA (United States of America): Madam President, Mr Director-General, distinguished delegates, it is an honour to address the World Health Assembly in our fifty-first session. Madam President, we join you in thanking Dr Nakajima for his hard work and wise leadership of WHO. We wish him good health and happiness in the future. Around the time of the first session, 50 years ago, the American President, Harry Truman, looked back on the Second World War and settled an age-old question. He said that, "Individuals make history, and not the other way around. Progress occurs when courageous, skilful leaders seize the opportunity to change things for the better." A year ago, we looked into the future of WHO, and imagined the kind of Director-General we needed to lead us there. We called for a leader to set quality health standards for nations, someone like Truman's hero a courageous, skilful leader who would seize the opportunity to change things for the better. Last year we called for a Director-General who would build on the real progress Dr Nakajima has made with his characteristic determination. We called for a new leader who would make WHO the global force for health in the twenty-first century, and find new ways of meeting new health challenges. We called for a passionate advocate for health, to reach the minds and hearts of every political and financial leader in the world. We called for a tough, smart, strong manager. To lead and inspire a vital and diverse staff. To make the most of a tight budget. To make every programme efficient and effective. An advocate for our most vulnerable citizens. In other words, we called for a new Director-General with a tight fist, a large heart, a clear vision and a strong voice. We asked our new Director-General to be a lot of things. The Executive Board has put forth an outstanding nominee. Dr Gro Harlem Brundtland has proven herself a courageous, skilful leader. We know she will seize the opportunity to change things for the better. And we are strongly committed to her success. Today, history and human progress have redefined the meaning of success for WHO. Humanity is less divided by what the Indian poet Tagore called our "narrow domestic walls". These falling walls give our generation a new chance, and a new challenge. The chance to pursue a new vision for public health ... and the challenge to pursue this vision together for all people. We have before us a world health declaration that puts this vision in writing. But this declaration is not a treatise. It is a test. A test for WHO and the global health community. We know all about the world's health problems. We have some solutions. Our Declaration demands action. And that we put both our will and our wallets into action. We know that our citizens are living longer. We must find new ways of protecting their health. We know how we treat the planet affects our health. We must find ways to protect the environment. We support women claiming their full human rights. We must ensure their access to health services. We must stop female genital mutilation, and the trafficking of women and girls. We possess new techniques and technology to fight the spread of emerging and infectious diseases. We must link up our national and regional surveillance systems, to forge global partnerships, and harness health experts from every organization into powerful teams led by WHO. We know that AIDS remains the most serious health challenge in history. We must sustain our support for UNAIDS, and contribute to global efforts to develop an HIV/AIDS vaccine. We know we can wipe poliomyelitis off the face ofthe earth. We applaud Dr Nakajima for WHO's role in the 440 million children immunized last year. We have reduced poliomyelitis cases by 90% over the last 10 years. The United States is committed to helping WHO reach 100% by the end of the century. We know noncommunicable diseases are now the leading cause of death and disability. We must find new ways of educating our citizens to prevent them. Certainly, we must protect our children from tobacco. Diseases associated with smoking could very well triple throughout the world over the next quarter of a century. Tobacco could kill more people than AIDS, tuberculosis or any other disease. The United States is redoubling its efforts to curb tobacco use by children. But we will not simply shove this public health crisis offshore and say to the world, "It's your problem. Good luck." The United States will work with WHO to help stop the global pandemic of tobacco-related disease and death. Tobacco is just one world health problem that requires a global health solution. A solution without borders. You will notice that A51NR/4 page48 President Truman did not say human progress comes from a single person acting alone. He said individuals make history. It takes courageous, skilful leaders to change things for the better. And so, the challenge of leading WHO into the future does not belong to the Director-General alone. It takes many leaders and individuals. From the humblest clinics to the grandest capitals. Government and nongovernment. Public and private. Academic and research. Scientists and public health experts - it takes all of us, from every nation, large and small. When the history of our time is written, let i~ sa~ we came together, we worked together, and together, we lifted the lives of every man and woman and child m the world. BbiCTYTIJIEHHE npo$. MOCKBifqEBA (POCCHACKASI E,D;EP A.Ulf.SI): Professor MOSKIVICHYOV (Russian Federation): YBa>KaeMhli-l r-H llpe.n;ce.n;aTeJJb, ysa>KaeMbli-t r-H reHepaJJbHbli-t .ZJ;HpeKTop, ysa>KaeMbie KOJJJJerH, .ZJ;aMhl H rocno.n;a, Ce.llbMOro anpeJJSI :noro ro.n;a HcnoJJHHJJOCb 50 neT Harnei-t OpraHHJawm, npespaTHBIIIei-tcSI Ja 3TOT nepHo.n; B KpynHei-trnee cneUHaJJH3HpoBaHHoe yqpe>KJteHHe OOH. PoccHi-lCKaSI 0praHH3aiJHH pa3BHBaJia CBOIO ,lleHTeJibHOCTb B YCJIOBHHX HyJieBOfO peaJibHOro POCTa 6IO.ll>KeTa, Haqa.JICH npoQeCC pe«J>opMHpOBaHHH a,llMHHHCTpaTHBH0-6IO.ll>KeTHOif H $HHaHCOBOH .uesrTeJibHOCTH B03. 3TOT npOQeCC Tpe6yeT ycKopeHHH, H Mbl CBH3biBaeM 60JibWHe Ha,lle>K,llbl B 3TOM oTHoweHHH c npHxo.uoM a OpraHH3aQHIO .u-pa r.x. EpyTJiaH.u. Mbi aceMepHo noMep>KHaaeM peKoMeH.llaQHIO l1cnonKoMa B03 H36paTb ee Ha nocT leHepaJibHoro .llHpeKTopa BceMHpHOH opraHH3aiJHH 3.llpaaooxpaHeHHH. B03 .llOJI>KHa 6onee aKTHBHO co.ueifcTaoaaTb YMeHbWeHHIO coQHaJibH0-3KOHOMHqecKHx pa3JIHqHH Me>K,lly rocy.uapCTBaMH H BHYTPH rocy.uapCTB. Bo MHOrHX CTpaHaX MHpa pOJib a.uopoabH a paaaHTHH o6mecTaa ace eme He.uooueHHBaeTcH, a J.upaaooxpaHeHHe He nonyqaeT ,llOCTaTOqHoro BHHMaHHH H pecypcOB, B KOTOpbiX OHO Hy>K,llaeTCH. Mbi llO.ll,llep>KHBaeM YCHJIHH leHepaJibHOro .llHpeKTopa H aceif. Haweif OpraHH3aQHH. HanpaaneHHble Ha yKpenneHHe Me>KCeKTOpaJibHbiX CBH3eH BCeX rocy.uapCTBeHHbiX H 06QleCTBeHHbiX CTpyKTyp, HMeiOQlHX Henocpe,llCTBeHHOe BJIHHHHe Ha $opMHpOBaHHe COCTOHHHH 3.llOPOBbH KaK OT,lleJibHOfO qenoaeKa, TaK H acero o6mecTaa. Ba>KHoe 3HaqeHHe a no.UHHTHH cTaTyca "3.upaaooxpaHeHHH" HrpaeT llOJIHTHqecKaH BOJIH pyKOBO,llHTeJieH rocy.uapCTB H 3aKOHO,llaTeJieif. PoccHifcKasr .ueneraQHH npHBeTcTayeT npoBO.llHMYIO pa6oTy no «J>opMynHpoaaHHIO Hoaoif rno6aJibHOif nonHTHKH .uocTH>KeHHH 3.llOPOBbH .unsr acex. Mbi o>KH.uaeM TaK>Ke ycHJieHHH ponH B03 a 3KcnepTH3e peayJibTaTOB HayqHbiX Hccne.uoaaHHH .llJIH HX HcnoJib30BaHHH aceMH rocy.uapcTBaMH - qneHaMH B03. Mbi yaepeHbl, qTo BQ3 COBMeCTHO CO CBOHMH rocy.uapCTBaMH-qJieHaMH H llO.ll HX pyKOBO.llCTBOM BOH,lleT B 21-e CTOJieTHe KaqecTBeHHO 06HOBJieHHOH, fOTOBOH K peweHHIO HOBbiX, He MeHee CJIO>KHbiX 3a,llaq. Professor MOELOEK (Indonesia): Madam President, Mr Director-General, distinguished delegates, ladies and gentlemen, allow me first, on behalf of the Government of the Republic of Indonesia and on my own behalf, to congratulate the President on his election as President of the Fifty-first session of the World Health Assembly. My delegation is confident that under his presidency the work of this session will be fruitful. I should also like to express the deepest appreciation of my delegation for the work of WHO on reaching its fiftieth year of existence. In this regard I wish to reaffirm my country's strong commitment to the ideas of the Organization. As a Member country of WHO, Indonesia cannot but highly commend the efforts undertaken to reform the health sector as well as to renew the Organization's strategies for more effective, focused and flexible organization in achieving our eternal aspiration, namely health for all. It should go without saying that WHO's contribution to the betterment of the world health status during its 50 years of existence is deeply acknowledged. Unfortunately, various unprecedented events occurring in many Member countries, developing and developed, such as political turmoil or the economic disintegration in Asia today, render the realization of health for all by the year 2000 a difficult task, to be deferred to the twenty-first century. In anticipation of this situation, the South-East Asia Region adopted in 1997 a Declaration on Health Development in the South-East Asia Region for the twenty-first century. Like the era preceding it, the beginning of the twenty-first century will be marked by global liberalization of trade, rapid advancement of science and technology, ethical issues, heavy environmental pollution, as well as a heavy burden of chronic noninfectious diseases. The new era will inevitably favour those in possession of the advantages of a free and competitive market, and those capable of producing quality goods and services at the highest level of efficiency. In this regard, my delegation is concerned about the adverse effects that liberalization of trade may have on the access to health of the populations of developing countries. We therefore call upon WHO to make appropriate arrangements to promote full access to health services at an affordable price for all. Health, as we know, plays a central role in the free market since it directly influences the quality and productivity of human resources. Yet in many countries, particularly in the developing countries, health has been deteriorating. If appropriate measures are not taken rapidly, the gap in health status between developing and developed countries will continue to widen. In this regard, WHO has already initiated various reforms, including reforms to amend its own Constitution to this effect. One realizes that this is not an easy task and that it will most certainly take several years to become effective. A51NR/4 page 50 On the reforms of WHO, I would like to reaffirm my delegation's support to the work of the Executive Board in dealing with the review of WHO's Constitution and regional arrangements of the Organization, a process that dates back to the ninety-third session of the Executive Board. However, one of the recommendations of the Executive Board to the Health Assembly this year, namely resolution EB 10 l.Rl 0 on regular budget allocations to regions, is of great concern to my delegation. Several aspects of the resolution's applicability appear inconsistent and the resolution may have the effect of heavily reducing certain regional budgets, thereby adversely affecting some countries and their programmed budget allocations. In view of this, my delegation favours a further review of this resolution and consideration of the views expressed by Member States during the deliberations of this session of the World Health Assembly. Reforms should also be added to the agenda of Member countries. Since health is inextricably related with other development sectors, we should intensively advocate health. Health should be highly placed on the political and social agendas of both governments and peoples and become the focal point for development. Health rights, and therefore ethics, are important, increasingly complex issues which deserve our utmost attention. As such, the latest scientific and technological advancements in tertiary health care should in no way imply the exploitation of the poorest and underprivileged sections of the population. Partnerships in health development are indispensable and while existing ones should be strengthened, new ones should be developed. In this regard, communities should become active partners in health development programmes, in their planning, implementation and monitoring. Improved access to health services, especially for the poor, depends on reforming the funding of such services. New schemes aimed at enhancing equity, quality and costs must be instituted. Their cost-effectiveness would hence be greatly improved by putting the emphasis on preventive and promotive measures. In conclusion, I wish to express my sincere and deep appreciation to the current Director-General, Dr Hiroshi Nakajima, for his endless dedication and hard work at making WHO a meaningful Organization. Last but not least, as we are about to appoint the next Director-General of the Organization, I would like to welcome Mrs Gro Harlem Brundtland. I am confident that under her leadership, the World Health Organization will be able to deliver the highest level of technical expertise required for health development at the turn of the century. La PRESIDENTA: El delegado de Qatar intervendra en nombre del Consejo de Ministros de Salud de l?s Estados del Consejo de Cooperaci6n para Ios Estados Arabes del Golfo: Arabia Saudita, Bahrein, Emiratos Arabes Unidos, Kuwait, Oman y en nombre de su propio pais. Mr HARADA (Japan): Madam President, Mr Director-General, distinguished delegates, ladies and gentlemen, on behalf of the Government of Japan, it is my pleasure to present its position concerning the promotion of world health. The world health report 1998 well describes substantial gains in world health achieved through persistent efforts made with WHO playing a central role. These efforts and gains should be highly appreciated. At the same time, we are faced with far-reaching global changes such as outbreaks of emerging and re-emerging infectious diseases; unprecedented ageing of populations; increasing gaps between developing and developed countries, and so on. The Government of Japan has been active in its effort to promote international cooperation in regard to social and health policies through the Initiative for a Caring World which has been advocated by Japan's Prime Minister Hashimoto. This Initiative is meant to provide a collaborative framework through which countries all over the world share their experiences and lessons learned in the fields of social and health policies. A salient aspect of this Initiative is Japan's commitment to support developing countries build sound health systems of their own, !ncl_uding strengthening human resources for health. Parasitic diseases, including malaria, are among the most s1gmficant global health burdens, causing suffering to as many as 3.5 billion people throughout the world. Prime Minister Hashimoto will vigorously lead the discussion to jointly tackle them at the Birmingham summit talks of this week. I am greatly concerned about the current economic crisis faced by so many countries in Asia. Despite its current economic difficulties, Japan is determined to make every effort to support these countries to prevent the A51NRI4 page 51 negative effects of economic crisis on health. With respect to the allocation of the WHO budget to regions, we believe in the principles of objectivity and transparency as set forth in the Executive Board proposal. However, the proposal has serious problems. According to this proposal, the allocation to the Western Pacific Region will decrease by 34% and in the case of the South-East Asia Region the decrease will be as much as 48%; would it ever be possible to implement programmes adequately in Asian countries under economic crisis, should such a drastic budget reduction be imposed? Thus, Japan plans to propose, jointly with other sponsoring countries, an amendment which solves these problems. In the Western Pacific Region, the election is scheduled to take place in September this year to nominate a new Regional Director. We thoroughly appreciate to the highest degree the achievements accomplished under the leadership of the current Regional Director. But, it is our belief that a new leadership is now called for to comply with the spirit embodied in the principle agreed at the Executive Board that limits terms of office to two. Now, the Government of Japan is pleased to announce the candidature of Or Shigeru Omi for the post of Regional Director. Or Omi has an excellent reputation for his devotion and contribution to the fight against infectious diseases in the Region. During his service over eight years, he led the poliomyelitis eradication initiative to success, addressed the problem of emerging infectious diseases effectively, and contributed to a number of other important developments. We firmly believe that he is the person who can draw on the achievements to date and further strengthen the regional capacity of the Organization. Finally, I would like to express my whole-hearted gratitude and appreciation to Or Hiroshi Nakajima for the tremendous achievements he has made over many years. And now the Government of Japan would like to express its strong support of the appointment of Or Brundtland to the post of Director-General. We sincerely feel confident that her dedication to the work of WHO will lead this Organization to great success. Dr. AL-KUW ARI (Qatar): .,j,j\.5""J.J .ull :t....> J) ~ i')\...JI 'J::-1.- _;I~ 'lfl!J..l:..JI o::.WI ~1_,..4.> ,~ )1 ~I ~ JJ..U ~I ~\JjJ ~ JJ::, ('""""""4 ~ '-:--'""" )J ~f 0f oj->._rJI t.JS:J1 o.h. ,j J~ U y J _rki U J::, J 0W. t;.6L J ~::, _,-...JI 4.:!~1 aS:..l.....JIJ 'l.f.~l a.l J::, ,o~l 4.:!~1 ~I).. ')U ~I 0 Jt..::ll Ly>J ""-!lj J ~ )1 ~ U::-4 ,..::-.JI JJ..UI o.h. ::, _j J ~~iJ ~I.- JJ J4 if' d.;~J ~ if' a.lL.,..'.J4 ~}JI ._,.....k..jl ~ .:r ~) J;. ~')\;; JJ. oJp..ill ~4 i..lZf W"" .o.h. Lo;I~W jW.I o)::.') ~ JY>I J;. ~I )::.f iJ..UI l...:>--1.5""1.; JP..UI ::. ~ ~ ~.; _.r...lZ y- 4_,.... J ,::.I..L.... J ~ y J5"' 4) l:f.-IJ iWI _.r...WI .....-.w (,?~1 ~l.t ~ ~J ,l..:: J~ LS" .)..t.:;;IJ ~ ~WI ~1_,:.-}1 J? ~ JJ.A'.JI..YI.A.. 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J Jl~ U y:J j. Jl+:ll j::J~J ..:..I_;L.. ..;JI (!_; ,)>- ~~ ~4 i _r.ll Wl.A.:>I ~ )li ~ JjJ o~l ~~~ ;;... ~ J-ll ,)>- \J..,. ~ 0i ~J Wt.: ..:.Jijl.. Li ~ _)I ~~ 0fJ J._,b J JW. L:..L.i ~)JI 0~ ~ly j>:, J _;..:, a...-..al4 ~~ ~ ~ ya J ':JI !.1 _r.;..jl L.a..u. ~ J>-f er l.i:J-*"'" ~ J l.i::J )y ~ SiJ o::J~ ~]Al yl.....> ~ill~ \J~ ':Ji ~ Lfj~l_r..e ~ ~:J ,)>-1_,....; j;~l ~}~\ JJ..UI ~ 0i _;._;L.u )'L;;\ .a..WI ~~ J:_,:. ~pi~}>,)>- :J~J ~~ ::J~I J5" !.\}~ \Jf JLi .illiJ lS_r:-~1 ~li~l _j 1_,....; j;~l JJ..UI .~ts"J.J .ill\ ~ .JJ ~ i')WIJ Dr N.C. Dlamini Zuma (South Africa), Vice-President, took the presidential chair. Le Dr N.C. Dlamini Zuma (Afrique du Sud), Vice-Presidente, assume la presidence. El Dr. COSTA BAUER (Peru): Senora Presidenta de la Asamblea Mundial de la Salud, senor Director General de la Organizaci6n Mundial de la Salud, senoras y senores: En todos Ios paises la mortalidad temprana de ninos y adultos j6venes se ha reducido tan acentuadamente que a cada nacimiento le corresponde ahora el doble de anos de vida que en el ano de 1900. Este asombroso avance es fruto de Ios esfuerzos orientados a mejorar la salud en el interior de cada pais, pero tambien es consecuencia de ubicar a la salud dentro de las prioridades permanentes de cada gobiemo. Todos reconocen el avance cientifico y tecnol6gico desplegado por la medicina y la biologia en este siglo, pero no se ha dado suficiente enfasis al papel preponderante de las politicas publicas para lograr acciones de impacto sanitario a nivel de las poblaciones. Asi, mientras que el descubrimiento de la vacuna contra la viruela es un mito de la actividad cientifica del siglo XIX, la erradicaci6n de esta enfermedad de la faz de la Tierra en este siglo demuestra el exito de la acci6n politica desarrollada por todos Ios paises con este fin. Por esta raz6n, entre otras, el siglo XX marca en la historia de la humanidad la epoca en la que se instaur6 como interes y como preocupaci6n explicita de todas las naciones disponer de Ios medios que garanticen la salud individual y la salud colectiva de todos Ios habitantes. En esta vision del pasado inmediato sin duda destaca el papel cumplido por la Organizaci6n Mundial de la Salud para canalizar y estimular la acci6n eficaz de las A51NR/4 page 53 naciones en el campo de la salud. En la celebraci6n de su quincuagesimo aniversario el Peru presenta su reconocimiento y sus parabienes a la OMS en su canicter de comunidad de naciones, y Ios hace extensivos a la direcci6n de la Organizaci6n yen especial a la persona de su actual Director General, el Dr. Hiroshi Nakajima. Teniendo estos antecedentes inmediatos, el tercer milenio plasma perspectivas ineditas para toda la humanidad en el campo de la salud. En cada pais no s6lo ban variado el perfil demogratico y epidemiol6gico sino que tambien ban cambiado !as posibilidades de !as tecnologias y las capacidades de las organizaciones sociales y de Ios gobiernos para enfrentar estas nuevas realidades. Bajo este nuevo horizonte destaca nitidamente una relaci6n entre el individuo y el Estado replanteada dentro de un nuevo marco de libertades y responsabilidades del ciudadano de modo tal que cobran mayor importancia el respeto a Ios derechos de la persona a la libertad de elecci6n, al derecho a la informaci6n y el consentimiento debido. Estos nuevos paradigmas no s6lo modifican Ios roles del Estado y del gobierno sino que tambien modifican el papel y el significado de las organizaciones. Portal raz6n, y como adaptaci6n a esta nueva l6gica, en casi todos Ios paises se vienen llevando a cabo procesos de reforma en el campo de la salud. En la pnictica, el siglo XXI significani que ademas de enfrentar las necesidades sefialadas por la demografia y la epidemiologia tambien deberan atenderse nuevas exigencias que surgen de Ios modos para satisfacer dichas necesidades. En efecto, cada vez que la innovaci6n tecnol6gica introduce una intervenci6n eficaz para solucionar problemas, tambien ocurre una migraci6n de Ios problemas que estaba en el terreno del conocimiento biomedico y se instala en Ios campos del gobierno, del financiamiento y de la prestaci6n. El avance cientifico ha logrado durante las ultimas decadas de este siglo anticipar fundamentalmente que innumerables intervenciones seran en el futuro basicamente un problema de factibilidad o de sostenibilidad. Bajo estas premisas, para Ios paises del Tercer Mundo uno de Ios mayores problemas del proximo siglo puede ser que existan soluciones para numerosos problemas sanitarios que antes no lo tenian, pero que estas nuevas soluciones no sean econ6micamente factibles. En el caso de paises como el Peru el reto significa nuevas y mayores exigencias, porque ademas de dar atenci6n a Ios problemas persistentes como la mortalidad materna y problemas emergentes como el SIDA y las enfermedades cr6nicas debemos tambien replantear el modo de conducir el sector salud bajo nuevos marcos de financiamiento y de prestaciones. En las ultimas decadas, el Peru ha logrado importantes avances en el campo sanitario. Para mantenerlos y acentuar tales progresos es conveniente replantear el sentido de la cooperaci6n internacional de modo que Ios cambios que ya se estan haciendo, especialmente en la OMS, puedan profundizarse y nos permitan responder mejor a las nuevas exigencias. En el Peru la contribuci6n de la OMS, y especialmente a traves de su organismo regional que es la Organizaci6n Panamericana de la Salud, bajo la eficaz direcci6n de su Director Regional, a qui en agradezco su colaboraci6n con nuestro pais, ha servido de importante facilitador para erradicar o controlar las enfermedades transmisibles, para mejorar el saneamiento ambiental y el mejoramiento de la nutrici6n y para obtener importantes avances en salud maternoinfantil, especialmente en el desarrollo de la planificaci6n familiar dentro de un esquema de paternidad responsable compatible con nuestra identidad cultural. Para concluir, quiero expresar la simpatia del Peru por la acci6n de la OMS durante sus primeros 50 afios y manifestar nuestra confianza en Ios cambios que estan en marcha dentro de la Organizaci6n. Deseo sefialar asimismo nuestra confianza a la nueva Directora General, la Dra. Gro Harlem Brundtland, a quien deseamos el mayor de Ios exitos en su gesti6n, para que en concordancia con las directivas de Ios Estados Miembros puedan contribuir a dar respuestas a Ios retos que se vislumbran en el umbra! del milenio. Mme BINDI (Italie) (interpretation de l'italien) :1 Madame la Presidente, Monsieur le Directeur general, Mesdames et Messieurs les delegues, permettez-moi tout d'abord de feliciter le President et les Vice-Presidents de cette Assemblee, ainsi que les Presidents des Commissions, pour leur election et de leur assurer le plein soutien de la delegation italienne. J'aimerais egalement saisir cette occasion pour saluer ici le Directeur general sortant, M. Nakajima, et le feliciter au nom du Gouvemement italien pour l'oeuvre accomplie au sein de cette Organisation. A Mme Brundtland, Directeur general designe, j 'adresse to us mes voeux de succes pour sa nouvelle tache. Comme l'a indique le Directeur general dans son rapport exhaustiftres apprecie, !'evolution de la situation sanitaire en general durant ces 50 demieres annees nous permet de constater certains progres importants et essentiels pour la sante publique mondiale, comme !'augmentation de l'esperance de vie a la naissance, la diminution des taux de mortalite infantile et des enfants de moins de cinq ans, !'augmentation considerable du I Conforrnement a !'article 89 du Reglement interieur. ·A51NR/4 page 54 niveau de couverture vaccinate et la subsequente eradication de certaines maladies, ainsi que les victoires remportees contre d'autres maladies graves repandues. Toutefois, de serieux defis et des menaces pour la sante publique mondiale demeurent. Je citerai la propagation de la tuberculose, !'aggravation de la situation_du paludisme, l'epidemie de SIDA, les maladies cardio-vasculaires, le cancer, les maladies respiratoires chroniques obstructives et les maladies mentales. De plus, les problemes sanitaires dus aux accidents, a la deterioration des modes de vie et a la degradation de l'environnement subsistent et, parfois meme, augmentent. C'est pourquoi un appel global a la solidarite est d'une importance fondamentale. Le succes de la collaboration intemationale represente le vrai defi que nous devons relever afin de preserver le droit a la sante, la dignite humaine et I' equite social e. L'Italie s'est pleinement engagee dans ce but par le passe et prevoit d'intensifier son action plus encore dans le futur. 11 faut, par exemple, rappeler )'engagement de la cooperation sanitaire italienne en faveur, notamment, des programmes de lutte contre les maladies infectieuses, du secteur mere-enfant ainsi que du renforcement des systemes de sante dans les pays en developpement. Un aspect important qui ressort du rapport du Directeur general et qui merite une attention toute particuliere est celui du vieillissement progressif de la population mondiale. La prevention des maladies et des limitations liees au troisieme age, ainsi que la garantie d'une assistance sanitaire correcte, constituent sans doute l'un des plus grands defis pour la sante au XXI• siecle. Beaucoup de pathologies chroniques et de problemes a long terrne, caracteristiques des personnes agees, peuvent etre prevenus, diagnostiques et so ignes avec succes. Cependant, cela entraine des couts eleves pour la societe et de fortes pressions sur les services sanitaires et sociaux, et pourrait meme, si ces pathologies ne devaient pas etre suivies adequatement, generer de nouvelles couches de pauvrete. 11 faudra done privilegier le developpement de strategies de prevention et d'intervention en faveur du troisieme age, tout en evaluant les modalites les plus favorables pour ameliorer )'organisation concrete des services socio-sanitaires, augmenter l'autonomie physique et psychique de la population agee et la soustraire, autant que possible, au risque de devenir passive, dependante et isolee socialement, evitant ainsi une hospitalisation injustifiee. Le mandat que I'OMS se voit confier par cette Assemblee des Etats Membres confirrne la reconnaissance du role directeur de !'Organisation au niveau international et s'enrichit de nouveaux elements qui, en renfor~ant la valeur des principes enonces dans la Declaration d' Alma-Ata, la Charte d'Ottawa et les strategies de la sante pour to us, sont orienres vers la creation d' initiatives locales, vers des mesures de protection de I' environnement, des actions de prevention et des politiques sanitaires plus proches des citoyens. A )'occasion du cinquantieme anniversaire de I'OMS, je pense qu'il est particulierement opportun que I' Organisation et les Etats Membres examinent et debattent I' actualisation de la strategie de la sante pour to us pour le XXI" siecle .. Dans cette optique et pour reaffirrner son role de "conscience sanitaire mondiale", comme le document sur la sante pour tous au XXI• siecle le dit si bien, ainsi que son role directeur, I'OMS doit avant tout atteindre un niveau plus eleve d' experience, de professionnalisme et de capacite technique, de connaissances et de competences. 11 est egalement indispensable que s'instaure une meilleure collaboration avec Ies autres organismes intemationaux actifs dans le domaine de la sante, condition fondamentale pour eviter competitions inutiles, chevauchements et fragmentations d'activites et gaspillage de ressourc.es. 11 faut pour cela savoir intervenir avec coherence dans les secteurs ou I'OMS, avec ses 50 annees d'experience, est effectivement en mesure de foumir une "valeur ajoutee" aux ressources professionnelles disponibles et aux methodes d'intervention deja consolidees. Le nouveau mandat confie a I'OMS se fonde aussi sur une vaste convergence d'opinions basees sur le fait que la sante represente un reel investissement social, indispensable au developpement et a la croissance economique des pays ainsi que sur le principe selon lequel la democratie, le developpement, la solidarite et le respect des droits humains et des libertes fondamentales sont tous des elements interdependants et d'importance vitale pour le futur de l'humanite. Et c'estjustement au nom de ces principes et de ces convictions que I'OMS et ses Etats Membres doivent renouveler leur engagement et assumer leurs propres responsabilites envers la sante de la population mondiale. Dr FARHEDI (Islamic Republic of Iran): In the name of God, the Compassionate, the Merciful. Madam President, Mr Director-General, honourable delegates, ladies and gentlemen, at the outset, I would like to congratulate the President and Vice-Presidents on their elections. I should also thank the Director- A51NR/4 page 55 General for his excellent report. I would like to express appreciation for the tireless efforts of Dr Nakajima during his tenure and welcome the nomination ofDr Brundtlanp as the new Director-General of WHO. In the last quarter of this century the "Health for all by the year 2000" slogan was presented and the primary health care system was initiated and implemented as the best strategy for achieving equitable access of the public to health through the "Health for all" context in many countries. In spite of all these achievements, we have a long way to go to attain the health-for-all goal. What we have not been able to achieve in the past century, we, as well as the future generations, should try to compensate for and fulfil our commitments in the twenty-first century. I believe the following aspects can arm us with a basis for a common vision in this respect: health, as the basic undeniable right of man, regardless of nationality, race, religion, language and culture, should be man-centred and all types of discrimination should be eliminated; discrimination against certain vulnerable groups, in particular women, should be removed and they should enjoy equal opportunity in benefiting from health facilities, nutrition and other social rights, such as participation in social activities and suitable occupation; poverty should be eliminated through the strengthening of an efficient social security system so that every individual in the community can benefit from an acceptable standard of living; priority should be given to the most important, but neglected, components of health, in particular to its spiritual dimension, and religious values should be encouraged in order to promote social, mental as well as physical health; individuals, as well as developmental sectors, should be encouraged to actively participate in health affairs so that solidarity in health can be achieved; all Member States should devote enough resources to health from their national budget based on their gross national product. Let me conclude by quoting from the statement of his Excellency Seyed Mohammad Khatami, President of the Islamic Republic of Iran, in his address to the forty-fourth session of the Regional Committee for the Eastern Mediterranean, in Teheran, in October 1997. "The key to our success lies in the identification ofthe factors that lead to health problems, while embarking on solving them through creative and healthy dialogue. Fulfilment of basic human health needs as a prerequisite to survival is a primary step in human development and will result in supreme excellence for mankind and society. Tackling the problematic issues in health will guarantee continued, coordinated and comprehensive development of communities which can be attained through the collaboration of all." Herewith I would like to reiterate the Islamic Republic oflran's commitments to the sublime objectives set by WHO and declare our readiness to share our experiences gained in health aspects with other countries. I also wish to state the fact that, concerning technical cooperation among developing countries, fruitful results are expected to be achieved through close collaboration between the Organization of the Islamic Conference and WHO. The Islamic Republic oflran, as the chair of the Organization of the Islamic Conference, will spare no effort to fulfil the commitments undertaken. Once again the Islamic Republic of Iran expresses concern over the Palestinian people's health status in the occupied lands and draws WHO's attention to their case. Let us hope that the twenty-first century will be the century of peace, prosperity and health for humankind. Dr KIM (Republic of Korea): Madam President, Mr Director-General, distinguished delegates, ladies and gentlemen, first of all, on behalf of the delegation of the Republic of Korea, I would like to congratulate the President of the World Health Assembly on his election. My special thanks go to the Director-General, Dr Hiroshi Nakajima, who has contributed to improving world health over the last 10 years. My delegation welcomes the proposal of the Executive Board that DrNakajima be designated Director-General Emeritus from the date ofhis retirement. In addition, I would like to congratulate Dr Gro Harlem Brundtland on her nomination to the position of Director-General. We believe that her strong leadership and brilliant expertise will bring greater advances in global health in the twenty-first century. The contributions which WHO has made to the promotion of human well-being over the last 50 years are among the most visible achievements of the United Nations system. In particular, there has been remarkable progress in the Western Pacific Region. The Republic of Korea is pleased to have been an important partner in the work done by providing technical expertise and other resources. We believe that such accomplishments would not have been possible without strong leadership from the Regional Director and the devoted efforts of his secretariat. The year 2000 is approaching rapidly and this is the time for us to prepare for the new millennium. In this context, my delegation sincerely hopes that WHO will recapture its position as a world leader and coordinate A51NR/4 page 56 international efforts in the field ofhealth. Revitalization of the Organization is one of the most important steps to be taken, as stressed by Dr Brundtland. To do this, WHO needs to prepare new strategies to face both internal and external challenges. A structural reform of WHO is essential. In addition, we must devote special attention to the renewal of the "Health for all" policy to take us into the twenty-first century, giving particular importance to primary health care and the health of infants and women. These major areas require greater efforts not only from WHO, but also greater commitment from Member States themselves, which must make appropriate resource allocation in their national budgets. The Secretariat cannot achieve all this alone. It is time for all Member States to participate in the reform process as strong partners. In this era of globalization, personal endeavours alone will not suffice; cooperative efforts between regions, countries and international societies are crucial. It is in this context that the International Vaccine Institute, the world's first non-profit vaccine-related international organization, was established in the Republic of Korea last year and is expected to play a very important role. As of now 32 countries have joined in this noble cause and we expect that the Institute, the first international cooperation movement in the vaccine field, will enjoy the full participation and support of all Members of WHO. The newly established Korean Government will strongly pursue socioeconomic and health care reforms and has placed a special emphasis on improving the quality of life, while enhancing equity of access to health care services. Furthermore, I am very pleased to say that, despite recent economic difficulties, the Korean Government remains willing to share its experience through provision of expertise and resources to WHO. No other gift is more precious to our next generation than good health. It is the vision that we have to achieve. If we stand hand in hand and share our burdens together, we will be able to overcome all kinds of difficulties. Then this vision will come true in the near future. Mr RAKKIET SUGTHANA (Thailand) (interpretation from the Thai): 1 Madam President, Mr Director-General, distinguished delegates, ladies and gentlemen, 7 April of this year marks the fiftieth anniversary of the World Health Organization whose goal is the attainment of good health for every human being in the world. It is thus most gratifying to witness the substantial progress made towards health improvement of people throughout the world. This success is the result of cooperation of the world community under the leadership of the World Health Organization and all its officers. I therefore would like to take this opportunity to extend my sincere congratulations and great admiration to the Organization for these achievements. Madam President, in the twenty-first century, we will surely witness numerous momentous changes. But there is one issue which will be essential to the achievement of peace, socioeconomic progress, culture and the health development of the world population. That is the increasing role of women at family, community, national and global levels. I would like to congratulate the Executive Board of the World Health Organization for its resolution (to be endorsed by this Assembly) to nominate Dr Gro Harlem Brundtland as the new Director General of WHO. I am convinced that her strong leadership will make it possible for the Organization to move confidently into the next century. There are still people with inadequate health status and life expectancy. There are people who have no or inadequate access to essential health care, in particular, children, women, the aged, the poor, migrants and the underprivileged in many developing countries. Furthermore we are well aware that health is total well-being, which means that it is closely linked to peace and socioeconomic development. Over the past century, we have experienced two world wars and countless battles at regional and country levels. I believe that there will be more wars and unrest in the coming century, if the inequity and injustice of resource distribution still exist. In addition to conventional wars, a new pattern of war and conflict is emerging. It may be termed the "economic war", with severe and brutal competition for business profits and the wealth of countries. It is a war aimed at moving resources from less developed countries and communities to stronger, and more developed ones. There may be no apparent mortality from the fighting and destruction in these new wars. But there will be increasing illness, suffering, and death caused by famine and lack of access to essential basic social services. 1 In accordance with Rule 89 of the Rules of Procedure. A51NR/4 page 57 I believe in Albert Einstein's saying that "We shall need a radically new manner of thinking if mankind is to survive." Indeed, new strategies in the new century must consider strengthening essential social ethics for sustainable global development at individual, family, community, country and global levels. It is the ethic that recognizes societal interests before self interests, the ethic that will enable the sharing of suffering and happiness, the ethic that will take good care and seriously address the plight of the underprivileged, the ethic that will prevent taking inappropriate advantages regarding economic, social, cultural and technological development. The World Health Assembly and the World Health Organization need to respond promptly in developing strategies, in creating the necessary ethics. In this regard we need to create ways to avoid increasing bureaucracies in governments and international organizations and do this by supporting the community and civil society roles in strengthening both public and corporate good governance. To be successful in building this new approach and in strengthening social ethics, we need to enlist the cooperation of the world community, including the Members of this World Health Organization. At this Assembly, we are hoping to take note of the Executive Board's decision to propose a new model for budget allocation to the regions, with the purpose of creating equity in resource distribution. Such an effort would be greatly appreciated and supported if it really enhances more equitable resource allocation. However, it appears that the South-East Asia Region, which, although it consists of only I 0 countries, possesses almost one third of the world population, more than half of the world's poor and carries the biggest diseases burden, will be affected by a budget reduction of almost 50%. Even though the South-East Asia Region is composed of only 10 Member countries, it has always cooperated vigorously with this Organization and the world health community. It is obvious that investment in the health of this Region is demonstrably cost effective. Thus, any change that will cause inequitable resource allocation is definitely unacceptable to all Member countries of the Region. Therefore if we really implement the new budget allocation model, WHO may soon be faced in the next century with a great loss of its leadership for health development of the needy and the most vulnerable people in the world. I am confident that the unacceptability of this new budget allocation model is a common feeling shared by many countries and regions as it is a global issue which not only affects Thailand and South-East Asia, but also the international community. I think we may have a better way of building up a spirit of solidarity and strength of our communities and of avoiding conflicts and disagreement among countries. May I propose to this Assembly three approaches for addressing this important issue. Firstly, we should consider exploring additional budgetary resources in order to support all regions with new needs, without adversely affecting the regular budget currently allocated to the regions, for instance by requesting Member countries to increase their financial contributions to WHO. Secondly, we must consider the reduction and cessation of certain ongoing projects, programmes and some working units of the central administration both at headquarters and regional offices. Thirdly, we must carefully review the formula of regional budget allocations, as proposed by the Executive Board in an attempt to minimize or ameliorate negative effects upon the afflicted regions and countries. Particularly during the economic crisis there should not be any reduction in budget allocation at all. These three proposed alternatives may be taken concurrently. Although it is not an easy task, I believe that with the wisdom and goodwill of the international community, coupled with the leadership of this Organization, my proposal will be found acceptable and put into concrete action in the near future. By working together in a spirit of partnership and as the world health community, we need to share love, sincerity and compassion, all of which are essential nourishment for our growth and continued success in overcoming all obstacles and achieving the universal goal of health for all. I trust that all Member countries of this community share the required mutual respect, concern, and generosity. I also trust that my proposals will be kindly considered and translated into pragmatic and successful action. In concluding, I would like once again to express my felicitations for the achievements and progress of the World Health Organization on the occasion of its half-century anniversary. Mr ABDUL AZIZ UMAR (Brunei Darussalam): Madam President, Director-General, excellencies, ladies and gentlemen, on behalf of the Brunei delegation, I would like to congratulate you, and the officials of your Bureau on your elections. The world health report 1998 -life in the 21st century: a vision for all, is a great tribute to the work of WHO and the Director-General. We are very much encouraged to note from the report, that despite harsh realities, the new millennium offers better health for the global population. A51NR/4 page 58 We are also pleased to note that there have been significant developments and achievements globally, especially in communicable disease control and life expectancy. Of particular relevance to us are the concerted efforts and tremendous progress made by all regions to eradicate poliomyelitis. The Western Pacific Region is now close to achieving the goal of poliomyelitis eradication by the year 2000. This remarkable progress must be safeguarded and we are very optimistic that the global eradication of poliomyelitis will represent one of WHO's greatest achievements for the twenty-first century. WHO's mandate as the directing and coordinating agency in international health work remains as valid today as when the Organization was created 50 years ago. But today, we face a more complex and difficult environment. Many developing countries still face, and will continue to face, the difficult task of having to allocate scarce resources to cope with the double burden of infectious diseases, as well as chronic noncommunicable diseases, among which is the ever-growing challenge of the continuing spread of HIVI AIDS. At the same time, the world's population is ageing rapidly. It is important to achieve not only life expectancy, but also "health expectancy", by preventing disability due to chronic conditions. The growing impact of poverty and malnutrition has far-reaching repercussions on development in general and on health in particular. Thus, alleviation of poverty through sustainable human resource development strategies, must be high on the agenda of every country. Significant gains have been achieved globally in the pursuit of the goal of health for all by the year 2000. However, a gap exists between minimum global targets and their achievement in many countries. It is recognized that health for all is not achievable by the year 2000 in many countries. WHO plays a crucial role in advocacy, for renewing the "health-for-all" strategy as an integral part of national health development plans of Member States. Strong partnership in health must be continued. Improvements of global health require our joint efforts and mobilization of our resources. In this respect, we wish to congratulate WHO through its regional offices for the Western Pacific and for South-East Asia for entering into a memorandum of understanding with the Association of South East Asian Nations (ASEAN), of which Brunei Darussalam is a member. This memorandum of understanding provides for close collaboration in key areas, including prevention of communicable diseases and environmental health. The memorandum of understanding has already produced fruitful collaborative activities under the work plans of the ASEAN Sub-Committee on Health and Nutrition and Asean Task Force On Aids. With reference to the haze situation affecting some countries in our Region, such as Indonesia, Malaysia, Singapore and Brunei Darussalam, concerted international awareness, research and action are needed to combat this phenomenon, which may have lasting effects on health, especially that of our young generation. The WHO Regional Office may like to lead and coordinate in this important area. At this juncture, I would like to place on record our sincere appreciation and recognition for Dr Hiroshi Nakajima's dedication, hard work, perseverance and personal contributions to the many impressive achievements of WHO during the last 10 years he has served in his high office, and especially those years in which he served as Regional Director for the Western Pacific. We wish to extend our best wishes to Dr Nakajima for his future endeavours as Director-General Emeritus of WHO as from the date of his retirement. At the same time, we look forward to a new leadership from the incoming Director-General, Dr Gro Harlem Brundtland, and we are fully confident that, under her able leadership, WHO will continue to make further progress in the years ahead, building on the solid foundations which have already been laid by the unprecedented advances in health during this century. Before concluding, I wish to express our deep appreciation to the Director of the Western Pacific Region, for his untiring efforts devoted to health developments in my country, Brunei Darussalam, in particular, and in the Region as a whole. Lastly, I wish to assure you all of Brunei Darussalam' s strong commitment to this Organization, whose continued existence remains as essential as ever. WHO's future in the twenty-first century depends on its capacity to remain relevant and effective, to respond to demands of current and new changes and challenges, yet at the same time remain true to its objective to attain the highest possible level of health for all. The PRESIDENT: I give the floor to the delegate of Zambia and invite the delegate of Australia to come to the rostrum. The delegate of Zambia will speak on behalf of the Southern Africa Development Community which includes Angola, Botswana, Lesotho, Malawi, Mauritius, Mozambique, Namibia, South Africa, Swaziland, United Republic of Tanzania, Zambia and Zimbabwe. The time limit will be 10 minutes. A51NRI4 page 59 Dr NKANDU LUO (Zambia): Thank you, Madam President. Your excellencies, Dr Hiroshi Nakajima, honourable ministers present, distinguished guests, ladies and gentlemen, I have the rare honour and privilege to have been elected to speak on behalf of the Southern African Development Community (SADC). In doing so, I wish to convey to the Fifty first World Health Assembly warm and fraternal greetings from our SADC Presidents and their people in general. SADC joins other distinguished delegates in congratulating you, Madam President, for being elected Vice-President of the World Health Assembly. We would also like to congratulate the World Health Organization on its fiftieth anniversary. We also congratulate Dr Brundtland on her nomination as Director General elect. Although Dr Brundtland was nominated on merit, we should nevertheless commend WHO for registering a positive milestone in global gender sensitivity. We would like to take this opportunity to thank and commend the Director-General, Dr Hiroshi Nakajima, for his tireless effort, commitment and faith to WHO vision and its aspirations. We in SADC will remember you, Dr Nakajima, for your total commitment to the control of malaria. SADC Member States include Angola, Botswana, Lesotho, Malawi, Mauritius, Mozambique, Namibia, South Africa, Swaziland, United Republic of Tanzania, Zambia and Zimbabwe. SADC was born out of a positive experience of close cooperation among governments and peoples of southern Africa. During the 1960s the struggle for political independence gained momentum in the region. Strong bonds of solidarity grew out of a sense of common purpose and collective action against colonialism and racism. The need to work together became increasingly apparent to the leadership of southern Africa, as a precondition for political survival, economic development and social advancement. Countries began to seek areas of mutual interest, first through bilateral cooperation and later through groupings of frontline States. One area that posed concern to SADC was that of health, which is characterized by high maternal mortality rates ranging from 200 to 800 per I 00 000 live births. The principal causes of high maternal mortality and morbidity in SADC are anaemia, sexually transmitted diseases (including HIV), toxaemia, hypertension, malaria and complications of pregnancies and delivery. The sad observation is that the principal causes of all these diseases are preventable. HIVIAIDS has grown to such epidemic proportions that it is now undermining the gains made in child survival over the past decade. We now see high levels of malnutrition, diarrhoea! diseases and acute respiratory tract infection. Inadequate control measures and environmental degradation are contributing factors to malaria which, in many places, is a leading cause of morbidity and mortality. Above all, resistance to commonly used drugs is an increasing problem. Noncommunicable diseases which are related to lifestyles and diet constitute a growing public health problem in our region. Drug trafficking and substance abuse is an increasing problem as well. It is against this background that a holistic and coordinated approach to health development was conceptualized, which culminated in the birth of the SADC health sector in August 1996. The Government of the Republic of South Africa was chosen to coordinate the sector. The main objectives of the sector include harmonizing health policies and health legislation; coordinating and supporting activities that have potential to influence health from a regional context, for example disaster and epidemics preparedness and mapping; human resource development and utilization; databases; and strengthening of public health programmes in the region. The specific areas of focus include reproductive health (including safe motherhood), childhood and adolescent health, prevention and control of violence, improvement of environmental and living conditions, development of integrated occupational health services, health systems research and epidemiological surveillance, disaster preparedness and management, health laboratory services, health information systems and health promotion, medical equipment, referral systems, pharmaceuticals and health resource mobilization. Your excellencies, as we enter the second millennium, the plight of women and children in SADC and developing countries as a whole is a particular scandal of our times. Statistics from the WHO Regional Office for Africa indicate that any woman of reproductive age in Africa south ofthe Sahara, has a one in 20 chance of dying from pregnancy, as compared to one chance in 4000 to 10 000 in developed countries. In addition, it is estimated that, every three minutes of each day, a woman dies somewhere on our continent as a result of pregnancy. Given the above situation, we would like to commend WHO for focusing its attention on this by declaring "safe motherhood" as this year's theme for World Health Day. The need to utilize meagre resources judiciously is a critical theme to us in SADC. However, in the process of implementing these radical changes in our health programmes, we have decided to embark on health A51NR/4 page60 reforms which, in fact as we implement them, pose the following questions: how do we improve criteria for equitable resource allocation so as to maximize benefits from sector-wide involvement of all stakeholders, which is vital to improve the status, health and education of people and in particular women and children? What can a World Health Assembly such as this one suggest to promote the "healthy women" concept in today's electronic age, operating in a different world challenged by new lethal epidemics? What can the World Health Assembly suggest to promote the concept of healthy families in times of deteriorating economic performance and diminishing health budgets in real terms? Within health reforms we are questioning medical orthodoxy, testing innovations, developing capacity for health planning and management at districts and below, exploring appropriate hospital reforms and so on. We are not satisfied with our achievements in the creation and involvement of healthy neighbourhoods. Neither are we satisfied with our achievements in the area of investments in health through enhanced government input and donor coordination in our region. In SADC we recognize that we have a long way to go. Therefore we call for your support and your contribution to improved health in our region. SADC, while appreciating the important role WHO has played in the region, wishes the World Health Assembly to take note of the following concerns: Africa in general and the sub-Saharan region in particular accounts for the huge disease burden in the world. We would like special focus given to malaria control, respiratory tract diseases and HIVI AIDS, which is killing a lot of people on the continent. In conclusion, in an environment of competing needs and demands and limited resources, there is really a great need for continuous emphasis on the importance of health in the developing countries. WHO needs to play an important role in mobilizing support internationally and nationally in this area. We therefore wish to continue active participation in the work ofthe Organization as SADC, so as to strengthen our voice. The SADC health programme can mature to become an effective support and coordinating group and to have very important impact, especially in the area of advocacy. Professor WHITWORTH (Australia): Madam President, Dr Nakajima, distinguished delegates, I would like to begin by acknowledging the significance of this World Health Assembly, which marks the fiftieth anniversary of WHO. It is appropriate on this occasion that we pay tribute to the significant achievements of the Organization since its inception in 1948. We often highlight disease eradication. Less often heralded is WHO's critical work in research, in the development of standards and in health systems development. Yet this work, quietly and incrementally, has led to enormous improvements in the health of the world's people. Australia, like all countries represented here, has shared in the benefits of this work. On this landmark occasion it seems timely not only to mark past achievements, but to look at future directions. Due to the combination of the work of WHO in successfully implementing disease-specific programmes, scientific and technological advances, and global economic growth, the world has witnessed decreases in child mortality rates and a general trend towards increased life expectancy. However, the disturbing reality is that there are vastly different life expectancies between populations in rich and poor nations, and between the rich and the poor within countries. Poverty is one of the major determinants of individual, family and community ill-health, and poor health is a major obstacle to development. Poverty increases the incidence of ill-health, which further marginalizes the poor, and so a poverty/ill-health cycle emerges. Economic investment alone is not enough to break this cycle. We must invest in the health ofpopulations if they, and their countries, are to prosper. Investment in health has both immediate and longer term positive health effects. For example, tackling low birth weight has potential to lower the consequent incidence of cardiovascular disease and diabetes in those individuals as adults. The world health report 1998 concentrated on the inequities in health and in access to health care across the world and on the need to address poverty as the main cause of these inequities. Raising living standards alone is not necessarily the answer. New research is showing that, within countries, relative poverty correlates more closely with poor health status than absolute poverty. That is, where the gap between the poor and the wealthy grows more marked, the health status of the poor is worse. So we are looking at a complex interaction of social and economic factors of social exclusion and poverty. Let me then outline our vision for the type of international health organization needed to meet our global health needs in the year 2000 and beyond. New policies and initiatives need to be implemented to reach the vision of "health for all". To be effective, these policies need to take account of the determinants of health. A51NRI4 page 61 Policies and programmes outside the health sector can make major contributions to the improvement of health. The health-for-all vision will be realized only through an approach to health which stresses intersectoral links. It is now well recognized that sustainable economic growth cannot be achieved unless issues such as equity of resource distribution, high population growth rates and the high morbidity and mortality rates of poor countries are addressed. Social and economic development are interdependent. Aid programmes must promote the involvement of communities in developing, implementing and monitoring health activities, while also strengthening the capacity of central and local governments. Our vision for the twenty-first century includes the continuing work of WHO in setting the global health agenda and coordinating international health initiatives. We do not see this as happening in isolation. It is now time for WHO to reconsider its role as one of a number of agencies active in international health. To remain the pre-eminent international health organization, WHO must work at the centre of its mandate. This must be demonstrated by having a clear statement of its core business and priorities. This needs to be reflected in the structure, management and transparency of the Organization. There are a number of core functions that should form the basis for WHO's work- dissemination of research and technology of global importance, development and implementation of technical and normative standards, the provision of assistance and support to vulnerable populations, the establishment of effective mechanisms for information-sharing, the surveillance and control of critical diseases. WHO has a strong and widely recognized comparative advantage in its biomedical knowledge, its scientific knowledge base, its surveillance and normative regulations, and its data collection. There is no other organization that produces such a range of quality scientific information and knowledge and which also has the potential to disseminate it credibly worldwide. This is what makes WHO stand out vis-a-vis other organizations active in international health. By continuing to excel in these areas in the years ahead, WHO and its Members can look forward to another 50 years of notable achievements. The PRESIDENT: I give the floor to the delegate of Ghana and invite the delegate of Brazil to come to the rostrum. Brazil will be the last speaker. The delegate of Ghana will speak on behalf of the West African Health Community, which comprises Gambia, Liberia, Nigeria, Sierra Leone and on behalf of his own country. The time limit is 10 minutes. Dr BROOKMAN-AMISSAH (Ghana): I thank you, Madam President. Madam President, Director-General, distinguished delegates, on behalf of the Assembly of Health Ministers of the West African Health Community, I wish to congratulate the President, and the other members of the Bureau, on his election and to express our full confidence in his competence and able leadership of the Fifty-first Assembly. We would also like to congratulate the Director-General and his staff for the comprehensive report on the theme "Life in the 21st century: a vision for all", which sets out global priorities and targets for the realization of WHO's vision of health for all, as we approach the next millennium. We take this opportunity to express our appreciation to the Director-General, Dr Hiroshi Nakajima, for his dedication to duty and for his leadership of WHO during his term of office. We wish him continuing good health and every success in his future endeavours. Thank you Dr Nakajima. We welcome the nomination of Dr Gro Harlem Brundtland by the Executive Board of WHO as the Director-General elect and look forward to the endorsement by this Assembly of her nomination. As we prepare to enter the twenty-first century, there is a widely shared sense of optimism that global economic trends will offer new opportunities for the promotion of health. Indeed, the globalization of trade, technology and communication could contribute in no small measure in transforming health systems and facilitate new partnerships for the promotion of health. In spite of these and other positive developments in this regard, we cannot overlook the widening gap between the developed and developing countries and the further marginalization of developing countries. Any optimism must be set against the uncertainties and threats posed to these countries - uncertainties and threats which, in the absence of a serious effort to address them, could erode the gains already made in the health sector. It needs to be borne in mind that the structural adjustment programmes embarked upon by all the countries of the West African Health Community have not been without some adverse effect on our health delivery A51NR/4 page62 systems. Unemployment and poverty have made it difficult for the masses of our people to access health services. The poverty alleviation programmes embarked upon by our countries in the past have helped to mitigate the situation to some extent, but need to be expanded to address the reduction of social risk factors. In the light of this, we wish to urge WHO to devote greater attention and resources to the health situation in our subregion, and to sub-Saharan Africa as a whole. We fully support the recommendation of the I 0 I st session of the Executive Board on the regular budget allocations to regions, as contained in resolution EBIOI.RIO. We believe that the model and criteria agreed upon by the Executive Board represent an objective and realistic basis for an equitable and judicious allocation of budgetary funds, which corresponds to the real needs of countries and regions. While we endorse the proposed organizational reforms, we are concerned that it should not be at the expense of country-based programmes. Countries of the West African Health Community have a commonality of challenges in the health sector, which we have endeavoured to address collectively. We continue to respond to the changing needs of our peoples on matters of health. In this regard, we have received assistance from our partners and collaborators who have a major stake in the health sector. Our policies are focused on the basic needs of our communities, with the aim of improving the health indices of our countries. In order to meet the challenges, the Member countries of the West African Health Community have formulated national strategies which reflect the consensus reached on the way forward for the health sector. In all our countries, community participation in health-services planning and delivery continues to be vigorously pursued. To this end, primary health care activities are being effectively implemented at the grass-roots level. In order to bring improved health to the community, the logistical and technical competence as well as the managerial skills of the district health facilities are being addressed by our governments, in the light of the important role which the district health services play in our health-for-all strategy. In the recent past, our subregion has experienced political upheaval, civil war and conflict. The impact of these has been felt most in the health sector, which has witnessed the destruction of health infrastructures and services. Refugees and internally displaced persons place an enormous burden on the health sector within national frontiers and in neighbouring countries. It is our fervent hope that the evolving new era of peace would be sustained, in recognition of the fact that peace and good governance are indispensable ingredients for the development of a sound and vibrant health sector. It is against this background that we urge our partners in development to assist in the reconstruction and rehabilitation of the health sector in the war-affected areas of Liberia and Sierra Leone. It is also our hope that the resultant peace dividend would be used to make a positive contribution to the health-care delivery services in our communities. The control of vaccine-preventable diseases such as measles, poliomyelitis, tetanus, tuberculosis and pertussis continue to pose a major heath challenge to the subregion. Major endemic diseases such as malaria, dracunculiasis and onchocerciasis are being tackled with the appropriate national control eradication strategies with some success. HIV/AIDS incidence has continued to increase in our subregion despite our control efforts. We acknowledge the support of WHO in these activities. To enhance this support, it is vital that WHO's technical cooperation for the control of these diseases is, as far as possible, channelled directly to the field, that is, to the country level. The resurgence of epidemic diseases such as cerebrospinal meningitis, cholera and yellow fever continues to be a cause of great concern. Subregional cooperation and collaboration in the management and control ofthese epidemics are being pursued and further assistance is required in this area. In this regard, we welcome the efforts by the Economic Community of West African States to merge the two subregional health organizations to form a single health organization, the West African Health Organization (W AHO). Such a merger will reinforce the cooperation and collaboration amongst the Members of the Community. Diseases know no national boundaries, nor do they accord respect to sovereignty. It is also for this reason that political considerations and sanctions should not be extended to the health sector. As a result of the rapid urbanization and change in lifestyles in our communities, the risk of noncommunicable diseases such as cardiovascular diseases, diabetes and mental disorders are increasing. In dealing with this problem, we are focusing our actions on the creation of community awareness of the preventable nature of these diseases. Other related issues, which engage our attention, are the effects of environmental degradation and the negative impact of tobacco on health. Governments in the subregion are also encouraging intersectoral collaboration and private sector involvement in the health sector, particularly in the areas of water, sanitation, housing, female education and food security. In the area of maternal health and child survival, appropriate strategies are being developed in order to reduce maternal and infant morbidity and mortality. Steps have been taken to increase awareness in our communities of the public health implications of gender violence. Governments in the subregion are A51NR/4 page63 increasingly attaching importance to gender considerations in the formulation of national health policies and strategies. This concern for gender sensitivity in decision-making is indicative of the level of priority which we accord to women's health. In this regard, we commend WHO for the foresight in establishing the Global Commission on Women's Health in 1993 in response to resolution WHA45.25 on "Women, health and development". The Global Commission on Women's Health has, through its advocacy role, helped to increase awareness ofthe need to assess the impact of policies in the socioeconomic and health sectors on women's health and to ensure that women's health issues remain high on national and international agendas. In addressing health issues affecting women, the Global Commission has adopted a life-span perspective, since health conditions in one phase of a woman's life not only affect subsequent phases of her own life, but also have an impact on future generations. We commend the Global Commission, and express the firm hope that, given the current and future challenges, it will be accorded even greater priority status and given the commensurate support which it so clearly deserves. The West African Health Community attaches great importance to the development of suitable human resources, without which health services cannot be delivered. We are, therefore, implementing appropriate programmes in this regard. The continued cooperation of WHO in this area is crucial to further strengthening the efforts of the Community, especially in the training of health professionals. We in the West Africa Health Community continue to have confidence in the World Health Organization and remain steadfast in our commitment to its objectives. Together with the rest of the world, we stand on the threshold of a new millennium - a threshold which is, indeed, a period oftransition marked by unprecedented opportunities. Together, we must seize these opportunities to make and reinforce the inescapable linkages between health and the other sectors, and forge new partnerships as we strive to fulfil our vision of reaching and maintaining the highest attainable level of health for all our peoples. Dr SERRA (Brazil): Madam President, Mr Director-General, delegates, on behalf of the Brazilian delegation it is with satisfaction that I congratulate the President on his election. I am sure that under his guidance we will be able to achieve the results that we are aiming at in this forum. I thank the Director-General and his staff for the report presented on the health situation in the world. I agree with the assumption of the document that the twenty-first century offers us a promising prospect to improve the health status of the nations, with better indicators of quality of life as a consequence of reductions in the incidence of diseases and disabilities. I totally agree, as well, with the statement that despite all the progress that has been achieved, we still have a series of challenges and difficulties to overcome. The obstacles we have to face to attain the main goals in health care are properly identified in the report, when it analyses the present demographic situation in the world and its trends and impacts on health policies and programmes. It also provides a realistic picture of health indicators throughout the world and recommends a set of urgent measures that we must adopt in order to answer the specific demands of each age group. Particularly inspiring, in my view, is the proposal to introduce the notion of health expectancy in designing policies to improve health-care services. The special concern of women's health stresses the commitment we have to eradicate any vestige of discrimination that still exists and highlights the essential role of women in promoting sustainable development. The report is therefore a useful and adequate framework for the designing of strategies to improve and to expand the access of the population to health-care services. I take this opportunity, however, to observe that the report might place more emphasis on certain worrying situations that overburden the developing countries, such as, first, the increase of violence as a negative factor for health and life expectancy indicators due to high levels of homicide and external causes of death; second, the impacts of social and economic disparities on health systems; third, the overall crisis of the welfare State both in its traditional and comprehensive forms and its precarious and incomplete expressions in the South, and fourth and finally I identify a lack offull recognition of the extra burden on the health systems of developing countries due to growing and diversifying demand, the drastic increase in health-care costs and the scarcity of available resources. In short, I believe that these points should be enhanced if you wish to have a true picture of the difficulties to be overcome. Since Brazil is facing these problems, I would like to raise a few issues which, in my opinion, should be considered in any effort to design global strategies related to health. The first is health promotion, understood as an effective instrument to inform, improve awareness and stimulate healthy life-styles, through programmes A51NR/4 page64 such as "healthy cities" and "healthy schools", and provide special assistance to meet the specific demands of young adults, women and the elderly. Another important aspect is the adoption of an intersectoral approach for the formulation of health policies and programmes, including incentives to international organizations, agencies and other actors that deal with technical cooperation in health, to systematically coordinate their activities. Finally, all participants of United Nations world conferences on social issues should be reminded that they should fully comply with the commitments and decisions that have been approved regarding health issues. WHO should adopt an innovative view on the cooperation it offers, based on partnerships between providers and recipients, and it should be supported by a global network of collaborating centres whose assignments and responsibilities should be reviewed and strengthened. The Government of Brazil has been working to improve its health-care system through a series of successful experiences. I will present some of them for your consideration as a contribution to the discussions we are about to start, as well as to indicate our needs in cooperation with WHO and with the international community in general. Decentralization of management and provision ofhealth services is a priority issue in the construction of our new national health system. A persistent and strong effort is enabling provincial and local governments to take the responsibility for their health-care systems, while keeping the unified dimensions and principles of the system as a whole and promoting greater equity. But local governments are entities with political power and administrative capabilities which need to find ways to preserve their governance. Therefore we cannot ignore the difficulties that exist to obtain an equitable transfer of resources from the central government to the state and local levels. In fact, we found out that even in a country like Brazil, where one can find high levels of quality in health care, a considerable number of citizens have limited access to health services, and we are strongly committed to correcting the situation. We count on international cooperation to fulfil this endeavour. In addition to the decentralizing process and as part of our obstinate search for equality, we decided to launch the Family Health Programme. It is a new strategy that allows provision of family health care within communities. As a result, we can review demands for reassessed use of expensive medical procedures, favouring intensive and extensive health protection and promotion that will for sure help in strengthening equity and efficiency. Other efforts are being concentrated on the provision of comprehensive health care to women, with a gender approach, including all social needs and relationships between men and women taking care of the whole cycle of women's life and their reproductive rights. We are convinced that investments to improve women's quality of life are the most valuable in social terms, because of their impact upon the community as a whole. Our goals are ambitious and international collaboration to help us in achieving them is most welcome. In short, we need daring solutions to overcome serious problems and to promote development with social justice and WHO is a valuable partner to assist us in reaching these goals. I take this opportunity to express the recognition of the Brazilian delegation on the activities carried out by Dr Nakajima. I would like to wish him personal happiness and professional success. To the Director-General designate, Dr Gro Harlem Brundtland, I would like to affirm my confidence and the expectations of all Brazilians on the reforms which are necessary and that she intends to undertake in order to adapt WHO to this period of profound transformations through which we are living. In conclusion, I join the celebrations for the fiftieth anniversary of WHO. I recall the key role of Brazil in the creation ofWHO at the San Francisco Conference in 1946, when my country suggested the establishment of a world organization to deal exclusively with the multiple aspects ofhealth. Moreover, I have in mind that a good number of Brazilian citizens have taken over important posts in the Organization, even the post of Director-General for 20 years. In view of this background, I reaffirm the interest of Brazil in supporting the new administration. I declare that Brazil is looking forward to adding its contribution to the deliberations of WHO. Our purpose is to help the renewal of the Organization with a view towards the future and its preparation to lead the international community in the effort to guarantee the highest levels of health throughout the world - the Organization's main and broad mission. The PRESIDENT: Thank you. I will remind you that the Committee on Credentials will also meet at 14:30. It is now 13:00 hours and we shall adjourn. The next Plenary is this afternoon at 14:30. The meeting is adjourned. The meeting rose at 13:05. La seance est levee a 13h05. A51NR/5 page65 FIFTH PLENARY MEETING Tuesday, 12 May 1998, at 14:30 President: Dr F.R. AL-MOUSAWI (Bahrain) later: Mr J. Y. THINLEY (Bhutan) Professor A. INSANOV (Azerbaijan) Mr E.K. PRETRICK (Federated States of Micronesia) CINQUIEME SEANCE PLENIERE Mardi 12 mai 1998, 14h30 President: Dr F.R. AL-MOUSAWI (Bahrein) puis: M. J.Y. THINLEY (Bhoutan) Professeur A. INSANOV (Azerba!djan) M. E.K. PRETRICK (Etats federes de Micronesie) DEBATE ON THE REPORTS OF THE EXECUTIVE BOARD ON ITS tOOTH AND 101ST SESSIONS AND ON THE WORLD HEALTH REPORT 1998 (continued) DEBAT SUR LES RAPPORTS DU CONSEIL EXECUTIF SUR SES CENTIEME ET CENT UNIEME SESSIONS ET SUR LE RAPPORT SUR LA SANTE DANS LE MONDE, 1998 (suite) Mr J.Y. Thinley (Bhutan), Vice-President, took the presidential chair. M. J.Y. Thinley (Bhoutan), Vice-President, assume la presidence. The PRESIDENT: I am pleased to take over the presidency and we shall now continue with the debate of items 9 and 10. The next two speakers on my list are the delegates of New Zealand and Samoa. Please come to the rostrum. I give the floor to the delegate of New Zealand. Ms EARP (New Zealand): Mr President, Mr Director-General, New Zealand would like to commend WHO on its work in preparing The world health report 1998. Life in the 21st century: a vision for all. The report concentrates on how the global health situation is likely to develop during the first quarter of the twenty-first century, and highlights some excellent work carried out by WHO in the past 50 years. New Zealand attaches considerable importance to WHO, its global policy and surveillance function, its technical expertise, and its humanitarian work. We also perceive the general United Nations reform process as imperative to making United Nations agencies more efficient, responsive, relevant and legitimate. We would like to see WHO retain its position as the world's leading health organization- providing functions that no other international body can, and focusing on functions where WHO has a comparative advantage. In an environment of financial restraint and tight budgets, the Organization would benefit from concentrating its efforts on crucial core areas where it has a comparative advantage. This should include a clearer emphasis on global health policy; the global surveillance function; a health promotion and prevention approach; technical cooperation; and the normative functions of setting standards for health services, equity of access, health status and quality of life. A51NR/5 page66 We believe harmonious, collaborative and cooperative relationships between the regions and headquarters would improve the functioning of the Organization. There is a general concern that the regions are too autonomous and not fully accountable to WHO headquarters in Geneva. WHO should act as one corporate body, with headquarters and the regions united in a common purpose and in common policies. A more consistent role for regions could be to offer advice to WHO headquarters, while concentrating on the implementation of WHO policy through the country offices. To be able to face the challenges of the twenty-first century, we would be keen to see the role of the Executive Board change from a technical body to a body providing strategic direction to the Director-General. We agree with the main thrust of the recent Oslo report, a study on WHO's support to programmes at country level, which recommends that WHO should review its "essential presence" in countries according to the needs and capacity of each individual country. Indigenous health issues are a high priority area for New Zealand. The particular needs and interests of indigenous people could be better incorporated into WHO policies, programmes and initiatives. Technical capacity on indigenous health issues should be built up within WHO, and indigenous health should be incorporated into country programmes. Another initiative would be the sharing of models of good practice in indigenous health. The recent Third Healing Our Spirits Worldwide Conference, hosted in Rotorua, New Zealand, which focused on substance abuse among indigenous people, was a good example of such sharing of experiences. Many of the recommendations in our draft World Health Assembly resolution on indigenous health also came out of that Conference. We recognize that the "megacountries" of the world have a range of health problems that emanate from the vast human populations, many times the size of New Zealand's total population, living in high density. While recognizing the importance of the pressing health problems that arise in these environments, we ask WHO not to forget the health issues that arise in "microcountries", such as ourselves and other countries in the Pacific. Microcountries have a scarce technical resource which is thinly spread across a range of health issues with little depth and many gaps. They have to find ways to deliver health services and infrastructure to small populations dispersed over wide geographical areas. The health problems of microcountries are as challenging as those of megacountries. New Zealand will continue to encourage women's health as an important priority for WHO and also participation of women in the work of WHO. The development of a gender policy for the Organization would provide a useful tool to raise awareness of gender issues and encourage the use of gender analysis in all programme planning and evaluation. The gender analysis guideline produced by the New Zealand Ministry of Women's Affairs could serve as a good model for this. The target of 50% women in professional positions in WHO still has a long way to go to be achieved, and remains a challenging task for all of us, including Member States. I note that headquarters and several regional offices are close to, or have reached the point of 30% women in professional positions. They should be commended for this. In conclusion, the New Zealand delegation welcomes the nomination of Dr Brundtland as Director General of WHO. We recognize that expectations that she will reform and strengthen WHO as the pre-eminent global health organization are high. This task is, however, a collective responsibility of us all. We look forward to working with her on reforming the Organization to ensure that WHO retains the leading edge as the much needed global health organization for the twenty-first century. The PRESIDENT: I thank the delegate of New Zealand and call the delegate of Mal dives to the rostrum. I now give the floor to the delegate of Samoa. The delegate of Samoa will speak on behalf of Pacific Island countries: Cook Islands, Fiji, Kiribati, Federated States of Micronesia, Palau, Papua New Guinea, Solomon Islands, Tonga, Tuvalu, Vanuatu and on behalf of his own country. The delegates of the Member States will be seated on the rostrum. A time limit of I 0 minutes has been allocated to the speaker as he will speak in the name of 11 countries. In order to save the Assembly's time, the delegates of these countries will not take the floor. I give the floor to the delegate of Samoa. Mr TELEFONI RETZLAFF (Samoa): Mr President, Vice-Presidents, Dr Nakajima, distinguished delegates, ladies and gentlemen, on behalf of the Pacific Island nations, I would like to extend our warm congratulations to the President and would like to A51NR/5 page67 assure you of our continued support. We are proud to be members, albeit small island nation members, of the WHO family, and especially, we consider it a real privilege to be present in Geneva to help you all celebrate this fiftieth anniversary of WHO. And what a 50 years it has been! So much achieved, and so many more health problems to try and overcome. We eradicate smallpox, and then we have to contend with an HIV/AIDS pandemic. The Pacific Island nations are still young, many of us younger than WHO. All of us immediately joined WHO on gaining our independence, and all of us have benefited so much from that membership. Life expectancy at birth has risen considerably in all our countries. Under-five mortality rates have improved over 100%. Infant mortality rates are less than halfwhat they used to be. Our average immunization rates all exceed 80% and some of us have achieved between 95% and 98%. Quite an achievement! Quite a commitment in terms of giving priority to health in allocating our scarce resources. Poliomyelitis and tetanus have all but been eradicated in our Region. Leprosy and tuberculosis are well under control. Lymphatic filariasis should be eradicated by the start of the new millennium. We are all now exploiting the new technologies in combined vaccines and exploring ways of administering mass vitamin A applications to children under five. More importantly, we have embraced gender equality, especially the empowerment of our women, and we have made the necessary changes in our cultures, although it has been difficult, to ensure true gender equality, offering equal opportunities to women in education, health and all other areas. In all these achievements, we must thank WHO and all our traditional partners, who have done so much for our Region in improving not only our life spans, but just as importantly, our lifestyles. We would like to particularly acknowledge the strong leadership of our Regional Director, truly a man ofthe Pacific. We fully accept in the Pacific Island nations that we must not only ensure that our people live longer, but that they feel better as well. For this reason, we have all taken major steps to ensure that health promotion gets the commitment, and budget, it deserves. In this regard, we have been forced to take the unpopular step of convincing our peoples to stop, not start, and even reduce tobacco use. If our peoples are to live longer, we want them to do so breathing freely, with the capacity to really enjoy their old age. We urge WHO to spearhead and assist in the efforts of the United States Government. However, we all want to benefit from tobacco company payouts! We have embraced WHO's commitment to health for all- but we have added our own concept- our Healthy Islands goals. This commitment has been given legal force, and we believe we are unique in that at the meeting in August 1997, when we met as a WHO family, we signed jointly the Rarotonga Agreement, which committed all our island nations to treaty obligations - particularly human resource development for health care, health promotion and disease prevention, and the concept of bulk purchasing in order to reduce our ever increasing costs in purchasing drugs. The agreement also took cultural recognition of our traditional healers and medicines - only where appropriate of course. Although we can claim to be - slightly, in most cases, and perhaps greatly, in others - ahead of the achievements set out in The world health report 1998, we must face the reality that in spite of these improvements, changing disease patterns represent new challenges for health services. Rapid economic growth, urbanization, and changing lifestyles (and eating habits) have made noncommunicable diseases, such as diabetes, cardiovascular, respiratory diseases and cancer, our new killers, replacing our old killers - infectious diseases such as pneumonia, measles and influenza. As most of the countries of the Pacific are in the tropical zone, we are still affected by tropical diseases, such as malaria, dengue fever and filariasis. Working with WHO and the Pacific community, we now have a clearer and faster information system to keep each other informed on disease outbreaks. We have also been able to develop, with WHO, a system of stockpiling equipment and supplies for disease outbreak control. The image of a Pacific Island with clean air, clear water and abundant natural resources is, of course, our ideal. It is, however, a very fragile ideal. As I said before, many of the issues that have a negative impact on our situation are beyond our control, but of course many of them are not. Populations are increasingly urban, and face problems common to urban populations all over the world- a safe water supply, solid-waste management and overcrowding of facilities. Our populations have also become more dependent on imported food and other goods for everyday life. Healthy islands is our approach to sustaining the overall environment of our countries and ensuring that the future health of our people will be better than it is today. In conclusion, this Assembly sees the rounding off of 50 years of achievement in public health and turns us towards the next millennium. It also marks the end of an era during which Dr Nakajima has ably led this Organization, and the beginning of a new era with new leadership. We, the countries of the Pacific, would like to pay tribute to Dr Nakajima for his contribution to the health of all our people, first as our Regional Director and, of course, lately as Director-General. We would also like to pledge our support and offer our A51NR/5 page68 congratulations to the incoming Director-General, Dr Brundtland. We look forward to working with you to reaffirm and strengthen the work of WHO in our Region. We also reaffirm our continuing commitment and collaboration with WHO in facing the health challenges of the twenty-first century. Mr ABDULLAH (Maldives): Mr President, Director-General, distinguished delegates, ladies and gentlemen, I extend warm congratulations to the President of this historic Assembly on his well-deserved election. I also congratulate the Executive Board for its excellent work. On this momentous occasion, it gives me great pleasure to extend to all of you sincere felicitations and good wishes. I join my colleagues in applauding WHO for its achievements and pay tribute to all those associated in the making of WHO and its proud history. Fifty years ago, on 7 April, the nations of the world signed a charter, which gave rise to the birth of this Organization. It is not a long time in world history, but in this short span of time, WHO has achieved much. The world was quite different in 1948, recovering from the aftermath of a devastating war. Diseases, poverty and malnutrition were widespread. In the absence of proper direction or leadership in international health, there were no accepted policies for public health. Standards for quarantine and international travel were lacking. It was against this backdrop that WHO embarked on an arduous journey. A historic turning point was the adoption of the principles of primary health care and health-for-all goals in 1978. As the year 2000 approaches, all the health-for-all goals may not be achieved. The health-for-all goals and primary health care have brought with them a unified and universally accepted approach to public health and shaped global health policies profoundly. As a result, the global health situation has improved dramatically. Mortality rates have declined and life expectancy rates have increased. In 50 years, WHO's achievements have been indeed phenomenal. The Expanded Programme on Immunization achieved more than 80% coverage by 1995. Poliomyelitis and neonatal tetanus are likely to be eradicated and leprosy eliminated by the turn of the century. Despite these strides, we still face many challenges, particularly antimicrobial resistance and communicable diseases such as dengue, hepatitis, AIDS, malaria and tuberculosis. While maternal mortality, noncommunicable diseases, drugs and violence are among other urgent problems, poverty remains a root cause of disease and ill-health. At the same time, environmental degradation and atmospheric pollution are leading to climatic changes. These are, in turn, resulting in droughts and crop failures and increased health risks and diseases. The South-East Asia Region is home to a quarter of the world's population. It also shares a proportionately large percentage of the global disease burden. But successes are slowly coming its way, as a result of a fruitful partnership with WHO. WHO's continued leadership and support are, therefore, imperative to carry out this work and consolidate our gains. At a time of dwindling resources, there is indeed a pressing need to utilize WHO funds rationally and effectively at global, regional and national levels. A more rational approach is required for budget allocation to regions and countries. But such a change should be gradual. A drastic reduction in the present level of funding would seriously jeopardize our ability to fight disease. We are deeply concerned about the new criteria that have been proposed for regional allocations. The criteria need to be revised in order to reflect real needs. When WHO is facing unprecedented challenges, reform is imperative. We must applaud these reforms. But reform should be based on past experiences and be responsive to current problems and future needs. We are at the threshold of a new miilennium. We must make a new resolve to carry forward our successes and health-for-all momentum. We must arm ourselves fully in the same way we did in the past to win the battle against disease. More than ever, we should mobilize a massive campaign to promote healthy behaviours and lifestyles from womb to tomb. Governments, WHO and agencies alone cannot accomplish such a daunting task. All must join hands, including all sectors, communities, nongovernmental organizations and the private sector, to achieve sustainable health. It is a matter of grave concern that commercialization and abuse of health services, supply of substandard and fake drugs and promotion of tobacco in major sports events are increasing at an alarming rate. These challenges demand our urgent action. In conclusion, I would like to congratulate Dr Nakajima for his commendable service to WHO. Dr Nakajima deserves our sincere appreciation for his dedication and significant contribution to WHO over the past I 0 years. Let me also congratulate Dr Brundtland on her nomination as our new Director-General. With her wealth of experience and leadership qualities to guide her, I wish her good luck in the challenging task ahead. Let us work as one for health for all and all for health. A51NR/5 page69 Mr HOYBRA TEN (Norway): Mr President, Mr Director-General, distinguished delegates, it is a great pleasure and honour for me to address you this afternoon. As the World Health Organization is celebrating its fiftieth anniversary this year, I would like to express my country's gratitude to WHO and to the women and men who work so hard for the benefit of better health for all. Norway has taken an active part in the work of the Organization from the very beginning. Norway, as all the Member States, has profited from the work of the Organization. We are therefore only continuing a tradition when we now commit ourselves strongly to the challenges of the future. Fifty years' experience in international health and its unparalleled association with the international scientific community have put WHO in a unique position to provide essential leadership for a healthier world. Such leadership is all the more required as international cooperation to achieve human dignity in a healthier world faces unprecedented challenges. To quote a giant in the global fight for human dignity, Mother Theresa: "The greatest threat today is selfishness, greed and unwillingness to share. In the moment we start to share, we also start to love." Health is a fundamental right for every human being. The goals of health for all in the twenty-first century can only be realized if support for key values, including human rights, equity, ethics and gender sensitivity, is strengthened. Like the rest of the United Nations system, WHO is undergoing comprehensive reform. Norway has taken an active part in the reform process, including that of WHO. Reform, I believe, is about improving the way WHO manages its human and financial resources. It is also about enhancing the governance of the Organization. This Health Assembly will consider WHO reform under a subsequent agenda item. The Executive Board has reviewed the Constitution and regional arrangements of WHO and submitted a number of proposals. Let me here only mention a few issues of importance. Firstly, it is my firm conviction that in order to abide by the principles of equity, the allocations of the Organization's regular budget to regions and countries must be based on rational criteria. Current practice disregards dramatic changes in socioeconomic conditions, which have taken place in many parts of the world. This practice must be brought to an end. Secondly, enhanced governance implies effective involvement of Member States in all governing bodies of the Organization, including the Executive Board. There should be no doubt that Board members are representing the governments that have appointed them. The key test of any reform is the extent to which it strengthens WHO's capacity to support health development in Member countries. The test is on the ground. I believe that it is of crucial importance that the WHO reform process addresses the critical issues identified at the country level. Norway has - together with other countries- sponsored an independent study of WHO's support to programmes at country level. I would like to emphasize that, in my view, providing access for all to basic health services must be a key component of any strategy to combat poverty and to enhance human dignity. This is also an important aspect of the 20/20 initiative, to which my Government has a strong commitment. An international meeting to follow up this initiative is scheduled to take place in Hanoi in October this year. On the fiftieth anniversary, let us be inspired by the enthusiasm of those who created this Organization, let us work to fulfil their vision to make the impossible feasible, with concrete action, by taking one step at a time. Let us make ours the words of one of the initiators, Dr Szeming Sze (of China) as he pronounced them in an interview with the World Health Forum in 1988: "Of course we can all learn from history. We learn from the mistakes made if not from the successes; learning the reasons why certain things happened often saves us from making the same mistakes again." The PRESIDENT: I now give the floor to the delegate of Benin who will speak on behalf of a group of countries namely, Burkina Faso, Burundi, Cameroon, Congo, Cote d'Ivoire, Equatorial Guinea, Gabon, Guinea, Guinea-Bissau, Madagascar, Mali, Mauritania, Niger, Senegal, Togo and on behalf of her own country. A time limit of I 0 minutes has been allocated to the speaker as she will speak in the name of 16 countries. You have the floor. Mme d' ALMEIDA MASSOUGBODJI (Benin) : Monsieur le President de seance, Mesdames et Messieurs les Ministres, Monsieur le Directeur general, honorables delegues, Mesdames et Messieurs, c'est pour moi un grand honneur de prendre la parole devant cette auguste Assemblee au nom de seize pays de la Region africaine : Burkina Faso, Cameroun, Congo, Cote A51NR/5 page70 d'Ivoire, Gabon, Guinee, Guinee-Bissau, Guinee equatoriale, Madagascar, Mali, Mauritanie, Niger, Republique centrafricaine, Senegal, Togo et Benin. Je voudrais saisir cette occasion pour adresser au President mes vives felicitations pour son election a la presidence de la Cinquante et Unit~me Assemblee mondiale de la Sante. Nos pays voudraient egalement, par ma voix, exprimer leurs sinceres remerciements au Dr Hiroshi Nakajima, Directeur general de l'OMS, pour ses initiatives et pour son engagement en faveur de la sante durant les annees passees a la tete de notre Organisation commune. Nos pays saisissent aussi cette occasion pour feliciter Mme Gro Harlem Brundtland, qui a ete designee par le Conseil executifpour conduire les destinees de l'OMS. Nous celebrons cette annee le cinquantieme anniversaire de notre Organisation : 50 ans deja, 50 ans qui ont certainement permis d'accumuler assez d'experience pour que l'OMS conduise l'humanite vers un meilleur etat de sante. Si les perspectives a l'aube du XXI• siecle sont encourageantes grace aux progres deja enregistres dans le domaine de la sante, les defis qui restent a relever sont encore nombreux. Nous citerons, entre autres, la transition epidemiologique dans nos pays aujourd'hui confrontes au double fardeau des maladies infectieuses et des maladies chroniques, )'aggravation de l'epidemie d'infection a VIH/SIDA, l'eclosion d'epidemies meurtrieres comme celle de la fievre Ebola, )'emergence et la reemergence de certaines maladies telles que la tuberculose, I'aggravation de la pauvrete (70 a 80% des populations africaines vivent en dessous du seuil de la pauvrete), Ies conflits sociopolitiques avec leurs consequences, la degradation de l'environnement et des conditions climatiques marquees par un rechauffement implacable de la terre et une pluviometrie de plus en plus capricieuse, avec son cortege de malnutrition, voire de famine, pour les populations les plus demunies. Le rapport sur la sante dans le monde en 1998 fait ressortir que, sur les seize pays du monde qui auront la plus faible esperance de vie en l'an 2025, quinze sont africains. Ces defis, malgre leur caractere dramatique, ne sont pas insurmontables. lis appellent tant des pays africains eux-memes que des partenaires au developpement une mobilisation accrue de ressources. En effet, nos Etats, malgre les multiples efforts appreciables consentis pour le developpement, sont encore confrontes a des besoins importants de financement pour garantir la sante de leurs populations pour le siecle a venir. Nos pays adherent a la politique de la sante pour tous au XXI• si eel e. lis se proposent de mettre la sante au coeur du developpement avec des systemes de sante durables pour repondre aux besoins des populations. Nous devons tous ensemble oeuvrer a faire de l'equite en matiere de sante une realite afin que les prestations de so ins soient disponibles pour les populations selon leurs besoins, et notamment pour les femmes et les enfants. Nos pays apprecient l'appui de notre Organisation dans les domaines suscites pour amplifier le plaidoyer et redonner confiance aux populations. Nos pays s' attellent a construire des espaces sanitaires regionaux et sous regionaux pour potentialiser les actions d'initiatives telles que le plan accelere de lutte contre le paludisme, !'eradication de la poliomyelite et de la dracunculose, la lutte contre les epidemies et la reforme du secteur de la sante. Dans ce contexte, les pays dont je suis le porte-parole exhortent la communaute intemationale a redynamiser !'initiative des Nations Unies pour I' Afrique afin de consolider nos acquis. Nous souhaitons au nouveau Directeur general du courage et beaucoup de chance dans le combat pour la sante pour to us. La voie menant a une meilleure sante de nos populations demeure longue et difficile. Cependant, les succes remportes dans certains domaines, tels que les progres vers !'elimination de l'onchocercose et de la lepre, les realisations du Programme elargi de Vaccination et !'amelioration de la couverture sanitaire, constituent un gage d'espoir. C'est pourquoije reitere la volonte de certains pays de cooperer avec tousles pays epris de paix et de justice, dans un esprit de solidarite, d' equite et de respect mutuel, pour une meilleure sante en Afrique et clans le monde. Nous souhaitons plein succes au nouveau Directeur general de I'OMS et beaucoup de courage pour I' accomplissement de sa noble mission. El Dr. DE LA FUENTE (Mexico): Senor Presidente, senor Director General, senoras y senores delegados: Deseo en primer lugar expresar, en nombre de mi pais, un reconocimiento a la labor desarrollada al frente de la Organizaci6n Mundial de la Salud durante Ios ultimos anos por el Dr. Hiroshi Nakajima, en su calidad de Director General. Mexico, como miembro fundador de la OMS, se congratula de celebrar su 50° aniversario, a la vista de un positivo balance de acciones desarrolladas en favor de la humanidad. Nuestro pais ha participado activamente en las diversas acciones de prevenci6n y control de enfermedades impulsadas por la Organizaci6n, asi como en la elaboraci6n de normas, criterios intemacionales y programas de formaci6n de recursos humanos. En Mexico hemos impulsado una amplia reforma del sector salud para hacer frente a Ios retos demograticos y epidemiol6gicos que nuestras condiciones imponen, asi como a Ios problemas ocasionados por el centralismo excesivo, las duplicidades en la atenci6n, la calidad insuficiente y la cobertura limitada de Ios servicios. Uno de Ios grandes lineamientos de este programa de reforma se ha orientado a la descentralizaci6n de Ios servicios A51NR/5 page71 para la poblacion abierta, la cual se ha concluido y ha permitido conformar sistemas estatales de salud capaces de responder con agilidad y eficiencia a las condiciones propias de cada region y tomar las decisiones necesarias y oportunas justamente en ellugar donde se generan Ios problemas. Otro gran lineamiento de la reforma del sector lo constituye la ampliacion de la cobertura a la poblacion con acceso limitado a Ios servicios. AI inicio del actual gobiemo se identifico que cerea de 10 mill ones de habitantes no tenian acceso regular a Ios servicios basicos de salud. En respuesta, se implanto un programa de ampliacion de cobertura como estrategia para llevar servicios de salud a ese nucleo de poblacion dispersa. En menos de tres afios, el programa llego a Ios 600 municipios mas pobres y ha beneficiado a poco mas de seis millones de personas. Para el afio 2000, se estima que toda la poblacion de Mexico tendra acceso a Ios servicios basicos de salud. Para lograrlo, se ha disefiado un conjunto irreductible de acciones de bajo costo y alto impacto, enfocadas a solucionar Ios problemas mas comunes: un paquete basico de servicios de salud, que incluye acciones de promocion, prevencion y curacion. Gradualmente, y sustentadas en diagnosticos regionales, se establecieron con precision prioridades en la prevencion y el control de enfermedades, favoreciendo un enfoque integral a traves de diversos programas, entre Ios que destacan: el de atencion a la salud del nifio mediante acciones de vacunacion universal con un esquema ampliado, y de prevencion y manejo oportuno de diarreas e infecciones respiratorias agudas y el cuidado de la nutricion, lo que ha permitido mantener nuestro territorio libre de poliovirus salvajes, eliminar la difteria, estar en vias de hacer lo propio con el sarampion y haber evitado aproximadamente 180 000 defunciones de menores de cinco aiios de edad durante Ios ultimos afios; el de atencion a la salud del adulto y el anciano, considerando que esta es la poblacion que mas rapidamente va creciendo en nuestro pais; el de prevencion y control del VIH/SIDA y otras enfermedades de transmision sexual que, junto con el de salud reproductiva y el de prevencion y control de !as adicciones, se sustentan en una politica de informacion clara y respetuosa a la poblacion, con enfasis en Ios adolescentes. Con el prop6sito de impulsar una vida mas digna y equitativa en !as mujeres mexicanas, se desarrollo la Cartilla Nacional de Salud de la Mujer, instrumento mediante el cual se dara seguimiento a !as acciones de salud dirigidas a este sector de la poblacion, entre !as que se destacan !as de planificacion familiar, vida gestacional, climaterio y deteccion del cancer cervicouterino y mamario. La promocion de la salud se ha consolidado como una funcion prioritaria dentro del sector y como una linea estrategica que cruza y enlaza practicamente a todos Ios programas, proyectos y acciones. Una muestra de ello es el acelerado crecimiento del Programa de Municipios Saludables, en el que se ha logrado involucrar a mas de 1000 municipios, siendo la Red Mexicana de Municipios por la Salud la mas grande del mundo. Otra muestra de nuestro compromiso en la materia fue la reciente realizacion del Foro Latinoamericano de Promocion de la Salud, al que asistieron representantes de 20 paises de la region, para analizar !as conclusiones emanadas de la Cuarta Conferencia y de la Declaracion de Yakarta. Por ello, ademas del alto honor que significa habemos constituido en sede del mencionado Foro, es muy estimulante que hayamos recibido la encomienda de organizar la Quinta Conferencia Mundial de Promocion de la Salud, a realizarse en Mexico en el aiio 2000. Agradecemos esta distincion y hacemos propicia la ocasion para extender a ustedes una cordial invitacion para que nos acompafien en esta proxima Conferencia, que, mas que cerrar un siglo, esperamos sirva para abrir !as puertas a un generoso porvenir de la salud y a un mayor bienestar en todo el m undo. Dr BARANY! (Romania): Mr President, Director-General, ladies and gentlemen, I am highly honoured to express my most sincere congratulations to the distinguished President of the Fifty-first World Health Assembly and to wish him full success in accomplishing his mission. T?e report o~ ~he Director-General showed a very clear picture of the world health status, with special emphasts o~ exammmg recent developments and on the way in which the global health situation is likely to develop dun~~ the first quarter ?fthe twenty-~rst c~ntury. Increased life expectancy is indeed a major objective of health pohctes, but a longer hfe should be hved m better health. As we get closer to the new millennium the health s~tus ~f the populatio? inde~d looks better when compared to the situation of, let us say, 50 years ~go. The mam achtevements mentioned m the report give us the confidence to step into the new millennium, although we are aware that the future will pose many new as well as continuing challenges. As the Direct~r-General ~entioned in hi~ rep~rt, despite the important achievements and progress being made, there are sttll some regiOns or countrtes, hke Romania, where we are facing serious public health A51NR/5 page72 problems due to deep social, political and economic changes. I would mention only two: increasing tuberculosis incidence -the highest in Europe- and a high rate of infant mortality. A high level of chronic disease and disability and higher public expectations with strong views on the need for choice and quality in health services, have also put upward pressure on overall health-related expenditure. Romania began its health care reform process with a daunting array of problems, such as a chronically underfunded health care system and lack of resources. Changes have been started with caution. We are now at the stage of implementing the legislation and regulations meant to create a sustainable health system which would meet the needs of the population. Mainly we have to focus on the following goals: the strengthening of primary health care as a pathway to better quality and efficiency, and the privatization of certain health services, not a goal in itself, but as a means of continuing the decentralization process. Also, I would mention here the involvement of the community in the policy-making and decision-making processes, to further democratic development. My Government is trying to develop a coherent policy based on the health-for-all values. We see health for all for the twenty-first century as an important tool for adjusting, harmonizing and reshaping our national policies. Globalization processes urge us to strengthen and broaden the partnership for health. Only in this way will the World Health Organization and governments be effective in ensuring that policies lead to substantial improvements in health. We need our policy to be flexible enough to give us the right tools for action when we are faced with either old or new problems. Looking at the agenda of the World Health Assembly I can only express my satisfaction that the Executive Board and the World Health Assembly, through their resolutions and decisions, which we are called upon to discuss and adopt, have taken a realistic approach to the different socioeconomic developments in the regions. A comprehensive strategy and equitable financial support can help us cross the threshold into the next millennium. I would like to express Romania's wish and availability to further support and take part in WHO's programmes. Dr. AL-KURDI (Jordan): ,__;~\...... ) _;I~ ,o~I.A....JIJ JlJ...JI y~i ,~ )1 r..j~ ~\j o~L....JIJ ~i 't-J )I , . a·. 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J.>- ~~WIt) ~4 U""~l .r._;::ll ~ .J)f" 1.5_? ~ ~WI ~I ~~~I \.l,. if r tl\)\ r y.-11 .j ,o~WIJ ..::;\~\ ~I t-"_,11 J.>- _;p J uljl-j)ll .:r ~ ~ W ~l.r J j.-G a.u J .:r ~WI o.l,. _; 1J J.;)IJ .1.~.--":-""G J.>- ~...~ .~WI.j~l ._,.,~ ~ o~l 1.5y.-.o ~ a:;t5:..4 ~~t;J ~WI Jy ._,.,~ 1.5...U ~f JL.T a....1i:.JI r~ ~I_; ..lAJ o~ ~\...; 0L..J':>\J a.....,., _rill 4..>-t;IJ ~~ u4y.-.o c!.JJ ulJ)1 .:r ...l:>JIJ J:>l_r~l J.>- ~)a.:..J4 Fi ~WI 0LS' if::liJ a....-11 Jw..... ~ ~ ~~ ..::;ljl-j)'4 l_p>- 0 J~l ~~ ..u J . ..:.U~ J.--.1 1... J:> ~~ .:r ~\..>. ~_;L....JI J:>I.J""'"~I .:;--- ~ ~ o~l ,~\)I jl!.JI ~ J.>- ,..::;\jl-j)f\ o.l,. .yJ 4J Jw _;y ~ .:r ~t; )1 ~\...... i Jl.!.:S"'I Jl .;.U~ .j ~)I ~I ~ ftJ ·r~ J5' J CIJ_; ~I .:.r-~ ~ ..::..jl5"' ~I ~.k.JIJ ..U) ,J:>\.J""'"~\ ~ ..::;~ ll;\.A)\ ~y.:-JI ..::;bl..a..JI Jl.!.:S"'IJ V. _r.?) ~\) ~) ~\ a....~4 J:>l_r~l .!.lli ~LA....; I ~ '\ W A r~ ,_} J . \ ~V~ r~ t) l;~ r..j _;~I J:> .r J.>- ._L..,a.A.l4 a....1i:.JI 0~4 ..::;ljl-j)'\ .!.lli ..::...>. y; r..j..UIJ'I' ••• ru J~ ~~I fl-y J~ t__H L>~ ~J~I ~I ~~)I ~I r..j..UI t;T Wi ~y . .1..0 rWI J...a.i J .:r.--~ 1.5 r ~ ~ ~ ~ _p Le : _p 4-J~ J ~LA.ll ._;kL...:.. a;tS"" ,_} ~\ ,y ~ J_;-.JI 1.5...U 0W J5' J.>- _;)-4 r..j..UI JIJ-liJ c-P _,11 ..::;~L.a>-1 ~ ~r" o)i; 01 \'~ ~~ ~ _; J.-i !lt.:;. JljL. ~ J \'0':JI ~WI ~~ e:;P )1 41 ~ ..:-lljL...J ~ r..j..UI J~\ ~ t) o.r.f u4Y'""" ~Y.J £ y a;tS"" ~WI Jy ~ J ~\ A51NRIS page73 ,~.:lf Ji .:.r--- j yU -.::..;LS" ~I ,4....:...t-J1J ~JL...J\ uP\_,}~\ Js- o)a.:..Jli .t+.JI ~ _;!I JJ...UI a;\.5' J a.....\:i.:.JI 0J..L;;}\ J-!.- ,a.....81 o~l ~ ~f ~f ~ 0LS" ~~ '-"'1_,..~u .~ t...... ~~ _?i 0'11 ~f L:..T 4~ .:l~\'1 01.5' JkL;.. J .:...rl ~l_ri..all ~IJ I.)}JI J!.- (.5_,>-i uPiriJ J~ 0'11 .:....:ll>. '4J~IJ ':J o..L.:..b:- '-"'l_rti )~ uw.1 .LtJ c~l ;_p.. ~ ~ ~ L..l..i ~Y~ a..JLA.. ~f '-"'1_,..~1 ~J .4-:-- uPr" Q\..L.>I ~ (..)_,..;>.~\ ~l.rJIJ ~I yL+:)I Mr DE SIL V A (Sri Lanka): Mr President, Director-General, distinguished delegates, it is indeed a pleasure and a privilege for me to address this august assembly on the occasion of the fiftieth anniversary of the World Health Organization. "Life in the 21st century: a vision for all" the theme of our discussion is indeed very thought provoking and very relevant to those of us who are responsible for the development of health in our countries. Life in the twenty first century will continue to be influenced by a variety of factors. Current epidemiological, demographic, socioeconomic, political, technological, environmental, global and institutional developments are likely to have a significant impact, particularly on health. Then what is our mission? I wish to propose that the world community commits itself to providing every opportunity for our people to have equitable access to basic health care of acceptable quality in the twenty-first century. Those of us who are responsible for the development of health in our communities must convince our A51NR/5 page74 governments as well as the regional and international agencies to adopt this proposal. We must strive to minimize inequities of access to health care for reasons of age, gender, race, type of health problem, geography, education or for any other reason. We must strive to facilitate the freedom of choice, respect of dignity and the exercise of human rights in relation to health care. What are the challenges which are ahead of us? As I foresee it, in achieving our mission the most important challenge we confront in the twenty-first century is the development of an efficient, effective, sustainable and humane health care organization which is responsive to the emerging health needs of our communities. We have been traditionally oriented towards a health care system predominantly based on the professional model characterized by focus on disease. We have to realize that many of the emerging health problems and the modem concepts of health, cannot be adequately explained on the basis of traditional models of disease and health. Therefore, it is essential to develop a new framework or a paradigm to conceptualize issues related to health. In my view, the traditional institutions, training methods, management structures, financial mechanisms and professional approaches are inadequate to deal with the new health issues. Therefore, there is a great need for innovation in the development of a caring health system to achieve our mission. What should be our new approach? Let me focus on elements I believe are essential in the development of health services to meet the emerging needs. In order to develop a health service responsive to emerging needs, major changes in the health care organization are required. These are unlikely to be possible unless there is a strong and committed political leadership. In my own country, we have recently embarked on a very ambitious health reform process initiated at the highest political level. It is indispensable to have a wider perspective of health far beyond the disease model. We must develop services based on this model if we are to deal with the emerging problems successfully. The psychological, social and spiritual aspects of life cannot be relegated to the margins of health care. Based on the wider concept of health, it is essential to develop a more comprehensive health care organization with the traditional ministry ofhealth playing the role of the leader, facilitator, regulator and coordinator of the health care organization. The health ministry will have to work in very close coordination with the private and the nongovemmental sector as well as other agencies to promote health and health services. Development of efficient resource management procedures with the idea of optimum utilization of resources is essential at a time when resources are scarce. We will have to develop innovative approaches to secure additional finances, both locally and internationally. In this respect, the World Health Organization, which has played a key role in the health sector, has a great responsibility to support the mobilization of additional resources to meet the future challenges of the Member States. The development of partnerships with other donor agencies would be particularly desirable for the mobilization of resources. The high cost of technology is often a constraint on the development of health care, especially in less developed countries. New ways have to be contrived to ensure the supply of good quality pharmaceuticals, vaccines, medical equipment and the technical know-how to developing countries at affordable prices. Most of us come from countries which have traditional medical systems in addition to modem medical systems. In my own country, ayurveda, homeopathy and acupuncture systems have contributed immensely towards meeting the health needs of our people. It is up to us to develop and utilize these systems more effectively and in a creative manner. No health system could sustain itself without the active involvement of people and communities. Therefore it is vital that we make every attempt to work with the public, communities and nongovemmental organizations to carry out our mission. In conclusion, let me congratulate the World Health Organization for successfully completing half a century of valuable service to developing health and health care in the world. Much work remains to be done to meet the emerging health problems. I also would like to place on record our appreciation for the excellent and generous contribution made by the Director-General, Dr Hiroshi Nakajima, and his staff. I am confident that under the able leadership of the Director-General designate, Dr Brundtland, the World Health Organization will emerge as a dynamic and a vibrant institution capable of guiding the Member States in responding successfully to the challenges in the twenty-first century. Le Dr KOUCHNER (France): Monsieur le President, Monsieur le Directeur general, Mesdames et Messieurs Ies delegues, Mesdames, Messieurs, je suis tres honore de m'adresser au nom de la France a toutes les delegations qui sont reunies aujourd'hui pour celebrer le cinquantenaire de )'Organisation mondiale de la Sante. La fondation de I'OMS fut elle-meme le fruit d'une longue histoire, qui remonte a la fameuse epidemie de cholera qui frappa )'Europe en 1832. Deja, on y retrouvait deux idees, deux principes, qui doivent fonder de A51NR/5 page75 fayon perenne notre action commune. D'abord, !'exigence ethique. Comme le dit la Constitution de l'OMS, "La possession du meilleur etat de sante qu'il est capable d'atteindre constitue l'un des droits fondamentaux de tout etre humain, quelles que soient sa race, sa religion, ses opinions politiques, sa condition economique ou sociale.". Cette exigence - je pourrais dire cette urgence - reste d'une actualite terriblement brulante lorsque I' on me sure I' inegalite qui subsiste entre les hommes face aux grands fleaux de notre temps, comme le paludisme ou comme le SIDA, dont les courbes de mortalite se croisent. Je rappelle qu'en 1997 ces deux maladies ont cause deux millions de morts. Et demain, helas, le SIDA risque de l'emporter dans cette sinistre competition. Autre principe evoque jadis, affirme aujourd'hui : la sante publique s'impose comme une dimension de plus en plus essentielle, de plus en plus evidente, de la globalisation. Les marchandises, les services, les capitaux circulent de plus en plus librement, les personnes les accompagnent ou les precedent : comment imaginer que les maladies respectent les frontieres? La fievre Ebola, la maladie de la "vache folie", le SIDA encore sont les exemples les plus frappants de cette realite qui fait de notre monde un petit village ou la solidarite doit prevaloir. C' etait deja - je le repete - le constat de nos predecesseurs, qui se reunirent a Paris en 1851 pour la Premiere Conference sanitaire intemationale, ancetre de l'OMS. L'Organisation a su !utter efficacement contre de nombreux fleaux infectieux: !'eradication de la variole en est un des resultats remarquables. L'OMS a precise la notion de developpement sanitaire par opposition a la simple delivrance des soins medicaux. Elle nous a ainsi conduits a la Conference d' Alma-Ata, etape importante dans I' elaboration de la politique sanitaire, et a I' adoption de la strategie mondiale de la sante pour to us. Beaucoup de choses ont done ete faites au cours de ce demi-siecle, et particulierement pendant le mandat du Or Nakajima. L'OMS, a l'aube du XXI• siecle, peut etre fiere du chemin parcouru. Pourtant, l'avenir est menace par de nouvelles maladies infectieuses, connues a ce jour ou encore inconnues, notamment !'infection par le VIH, agent responsable du SIDA qui a - comme vous nous l'avez rappele, Monsieur le Directeur general - les plus graves repercussions sur la planete, mais qui entraine aussi - il faut le dire - un sursaut remarquable des chercheurs, des associations, de la communaute tout entiere. La lutte contre ce fleau incame avec force les deux principes que je rappelais tout a l'heure : !'exigence ethique et la solidarite mondiale face a une menace mondiale. L'OMS, dans les annees 80, a ete le fer de lance des mesures prises pour alerter les autorites sanitaires mondiales et, en collaboration avec l'ONUSIDA, elle remplit trois roles dans ce domaine: soutenir la recherche, negocier avec l'industrie pour que les produits de cette recherche soient mis a la disposition de ceux qui en ont besoin, et enfin encourager la prevention et la recherche sur le vaccin. Prevention, soins medicaux et accompagnement socio-economique constituent le triptyque sur lequel repose la lutte contre le SIDA. Ces actions se renforcent mutuellement. Nous maintenons que la prevention demeure essentielle, mais il est illusoire de penser qu'une politique basee sur la seule prevention puisse etre durablement efficace et pleinement efficiente si elle n'est pas articulee avec une veritable offre therapeutique. Nous l'avons constate, nous le verifions encore dans nos pays ou nous sommes passes, grace a des therapeutiques enfin actives, de la mort a l'espoir. C'est le sens de I' initiative de solidarite therapeutique intemationale, que la France a presentee a Abidjan en novembre demier et que !'Union europeenne a faite sienne a Luxembourg en decembre. Le projet en est simple : il existe maintenant des therapeutiques modemes qui permettent de pro longer la vie des malades. Ces therapies permettent en outre, chez la femme enceinte, de reduire de fayon notable la transmission du VIH de la mere a !'enfant, grace a des traitements de courte duree administres le demier mois de la grossesse. Or, l'inegalite d'acces au traitement, liee au cout eleve des medicaments, accentue le fosse entre le Nord et le Sud, avec le risque de voir se developper une epidemie a deux vitesses. Mais aucune ressource ne devra etre detoumee de la prevention et de la prise en charge d'autres maladies. 11 faudra consentir de nouveaux efforts. De nouvelles ressources publiques et privees devront etre mobilisees. Nous souhaitons, dans un mouvement de solidarite globale du monde, un mouvement de solidarite therapeutique, que ces mesures preventives, destinees a sauver des enfants dans les pays de 1' Afrique, de I' Asie, de 1' Amerique latine, de !'Europe, soient mises en oeuvre au plus vite. La mise en place de cette initiative devra se faire progressivement, par des projets selectionnes par l'ONUSIDA en etroite collaboration avec les Etats concemes et en s'appuyant sur les equipes locales presentes sur le terrain. Nous devons agir efficacement, sans creer de structures bureaucratiques ni de systemes de sante paralleles. L'amelioration de la prise en charge du SIDA pourra contribuer puissamment a ameliorer le savoir-faire des professionnels de sante et a creer une dynamique en faveur de la sante publique tout entiere, comme ce fut le cas dans nos pays plus riches. C'est pourquoi I' initiative de solidarite therapeutique doit etre d'emblee intemationale, ouverte et operationnelle. C'est le sens des propositions concretes que la France a formulees dans un memorandum qu'elle a remis au Directeur general. A51NR/5 page76 La France, en presentant cette initiative, entend ainsi manifester son attachement profond aux principes qu'incame I'OMS. Elle est fiere de prendre part, aux cotes des Etats Membres, au bilan positif de ces cinquante demieres annees. Elle reaffirme la volonte de s'engager dans cette perspective pour tous qu'est "la vie au XXI• siecle", car il s'agit bien de donner de la vie aux annees et de l'espoir anos peuples. Je sais qu'il faut !utter partout contre toutes les maladies, mais, medecin de terrain, je sais aussi que, dans certains pays peu nantis, en posant la main sur la tete d'un bebe, j'ai une chance sur deux de porter attention a un enfant seropositif. Ne le supportons plus. Pour accomplir cette tache, difficile mais exaltante, !'Organisation se propose de choisir, en la personne de Mme Gro Harlem Brundtland, un Directeur general, un medecin, un vrai personnage politique, une femme energique et visionnaire, qui a su montrer sa capacite a identifier et a affronter les grands defis de la planete et de son avenir. Je lui souhaite bonne chance etje tiens a!'assurer du soutien indefectible de la France. Professor A. Insanov (Azerbaijan), Vice-President, took the presidential chair. Le Professeur A. Insanov (Azerbaidjan), Vice-President, assume la presidence. BbiCTYnJIEHHE llPE.D;CE.D;ATEJI.H: The PRESIDENT: Enaro.nap10 .neneraTa Mr. EL FASSI (Morocco): ,~\J ~.:>WI ~WI ~I ~ ._r;J ~J.:- '~)I .:r> )I .ill\ r ,;.:>L..JIJ •.:A.l::-- ••ll ul.r'a>- ,-=> _,; )1 s:.l...$iJ s:.L... JJ ..:;1~\J o.:>L..JI ,~\ s:.IJjJ J~.A.. 'iWI ..r...WI ~I oJJ...UI ol....cJ l....JJ "-!t>.;;;l ~~ J4::JI ?~ ._r;)l ~I Jl i..tZi 0i ~_;....)\ as':.L...JI -liJ ('"'""'~~A .~\ o.l;. 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Jl ~ .JJI L:.UJ El Sr. SOSA RAMIREZ (Guatemala): Senor Presidente, senores Vicepresidentes, senores Jefes de Delegacion, senoras y senores: Ha sido depositado en mi el honor de hablar en nombre de Ios Ministros de Salud de Centroamerica (Be lice, Costa Rica, El Salvador, Honduras, Nicaragua, Panama y en el de mi propio pais, Guatemala) en esta 51" Asamblea Mundial de la Salud. El momento no puede ser mas propicio para compartir con la comunidad intemacional Ios logros y retos que enfrentan Ios paises centroamericanos en su anhelo de lograr el mejor estado de salud de sus poblaciones. La subregion centroamericana ha experimentado cambios trascendentales en Ios ultimos anos. Las guerras intemas han concluido en todos Ios paises del istmo, luego que el Gobiemo de Guatemala y la Unidad Revolucionaria Nacional Guatemalteca suscribieran a fines de 1996 el acuerdo que dio fin al conflicto armado en America Latina. En todos Ios paises centroamericanos hay ahora gobiemos democraticamente electos, habiendo dejado para la historia la fuerza y el autoritarismo como forma de expresion de poder de grupos minoritarios. La conciliacion de la paz y la democracia han permitido, en la mayoria de Ios paises, crear las condiciones para superar las profundas inequidades sociales alln presentes en la subregion. A Ios problemas de salud, derivados de las precarias condiciones de vida de la poblacion, se han sumado nuevas epidemias como la del SIDA, y patologias sociales emergentes como la violencia y problemas asociados con alteraciones de la conducta. Centroamerica comparte con muchos paises latinoamericanos, asiaticos y africanos el complejo perfil epidemiologico de una coexistencia de patologias propias de paises con una creciente industrializacion y urbanizacion, sin haber abandonado la agricultura y la explotacion de Ios recursos naturales como medios importantes para la subsistencia de grandes sectores de la poblacion. Los gobiemos de Ios paises centroamericanos, bajo la rectoria de sus ministerios de salud, estan enfrentando estos complejos problemas con la mayor decision. A pesar de la debilidad economica de la gran mayoria de nuestras poblaciones, se hart hecho avances que se reflejan en un descenso en la mortalidad infantil y mayores coberturas de vacunacion, lo que nos ha permitido compartir con el resto de paises de las Americas el privilegio de haber liberado al continente del flagelo de la poliomielitis. Ademas, todos estamos trabajando arduamente para eliminar el sarampion antes del ano 2000. En Centroamerica reconocemos que la nueva salud publica no puede restringirse solo al quehacer gubemamental. Se requiere contar con un amplio apoyo de la sociedad y de Ios diferentes sectores, a fin de ampliar con su pleno concurso la urgente necesidad de expandir de forma universal la cobertura de servicios basicos de salud, atendiendo asi a las demandas de una poblacion tradicionalmente postergada. A51NR/5 page78 Cada uno de Ios paises centroamericanos, con gran sacrificio, estamos progresivamente elevando nuestros presupuestos destinados a la salud, pero tal vez lo mas importante que debemos resaltar es la busqueda incesante de un gasto con calidad de Ios escasos recursos disponibles, de tal forma que Ios beneficios de salud lleguen a todos. La cooperacion intemacional en salud ha jugado un papel fundamental en ellogro de estos importantes resultados. Fue precisamente la Organizacion Panamericana de la Salud quien lanzo en la decada pasada la iniciativa «Salud: un puente para la paz», que logro, ademas de movilizar recursos tecnicos y financieros en beneficio de la salud de Ios centroamericanos, silenciar en mas de una ocasion Ios fusiles de las partes en conflicto durante las campafias de vacunacion y otras actividades en salud. La OMS, a traves de su Oficina Regional para las Americas, ha estado presente en las mayores iniciativas de salud que Ios paises centroamericanos hemos emprendido, contribuyendo a fortalecer nuestras incipientes democracias y esfuerzos para la integracion de nuestras agendas sociales. A futuro, sin embargo, la cooperacion tecnica en salud enfrenta nuevos desafios que nos hacen prever una agenda distinta para el proximo milenio. La globalizacion de las economias trae consigo el incremento de Ios flujos migratorios de personas y capitales y el aumento del comercio intemacional de bienes y servicios de salud. Los problemas de salud locales tienen ahora repercusiones globales y enfrentarlos demanda soluciones acordadas por todos Ios paises del mundo. La cooperacion de la OMS es ahora mas necesaria que nunca. El nuevo siglo nos depara un mundo con una cultura universal, donde las barreras geograficas tendran importancia solo en Ios mapas y donde un descubrimiento cientifico en salud beneficiara inmediatamente a la mayor parte de la humanidad; pero tambien donde las epidemias se propagaran a la velocidad de Ios medios de transporte. Son estos desafios Ios que las generaciones futuras de nuestros paises tendran que enfrentar con el apoyo tecnico de una cooperacion intemacional en salud no prescriptiva, ni condicionada, con ideas nuevas y comprometidas con aquellos que mas lo necesitan. La OMS concluira este siglo e iniciara el proximo con la mejor persona para impulsar esta ambiciosa agenda. Cuente usted desde ya, doctora Gro Harlem Brundtland, con el apoyo y colaboracion de Ios paises centroamericanos en esta ardua tarea que ahora usted inicia. Asimismo, queremos patentizar nuestro agradecimiento al Dr. Nakajima por Ios esfuerzos realizados durante su gestion en pro de la salud. Mr MA TZA (Israel): Mr President, Director-General, distinguished delegates, the Israeli delegation and I congratulate the President on his election to preside over this Fifty-first World Health Assembly and conduct its business. I also wish to offer special congratulations to Dr Nakajima on his nomination as Director-General Emeritus of the World Health Organization. We are sure that your knowledge and experience will continue to serve this noble Organization for many years to come. In addition, I wish to extend our felicitations to Dr Brundtland on her designation as the next Director-General of the World Health Organization. Your wide experience and proven skills in the fields of medicine, management and politics should be a great advantage as you lead WHO from this century into the next millennium. The theme of this year's World Health Day was "Safe motherhood". Pregnancy and childbirth are perhaps the most important moments in a family's life and is one of the themes in The world health report 1998, which is an excellent report. WHO, together with many nongovernmental organizations and Member States, engage in daily activities to improve medical care for women living in developing countries. However, the problem of shrinking budgets, coupled with depleted resources, makes it harder every day for these women to receive the necessary services that are virtually taken for granted by their counterparts in the developed States. I hope that, this year, the World Health Day on safe motherhood has heightened the understanding of Member States of the problems of motherhood and will result in the allocation of the necessary proportion of budgets and the channelling of resources to bring about a marked change for the better. Our aim now and in the twenty-first century is "a vision for all" which encompasses the health-for-all concept and projects it well into the coming new century. At the turn of this century we recognize how the prudent use of resources and allocation of finances is of the highest importance to the world of medicine. Health insurance and health tax systems are now crumbling in many places around the world. No country has yet found that elusive combination of high quality services at affordable prices. In developing countries incomes are so low that the ordinary citizen's annual salary is less than a month's health insurance coverage in a developed country. The need for a combined world effort to find a solution to this problem is now more urgent than ever. A51NR/5 page79 In the meantime, since finances and resources remain scarce, developing countries continue to rely on international donors and volunteer work. WHO, as a leader in these areas of volunteer work for the delivery of health and medical care and services, has, in our opinion, saved more sick and infirm people than any fully paid and covered medical centre anywhere in the world. It is shameful that the budget of WHO is decreasing as the population around the world increases. WHO's role in bringing together collaborative work between the various Member States in order to discuss, evaluate and generate resolutions for performance is crucial. Today, we look at a world completely changed from what it was 50 years ago - globalization is in full swing; transportation and communications technology have brought countries closer to one another than ever before. At the same time, violence and injury escalate in proportion to the technology of weapons, while human problems and frailties remain the same. WHO's future role is not just one of supporting the developing countries through international cooperation and volunteer work. WHO has actively to seek solutions that will allow developing countries access to the technologies presently available to developed States. Mr President, the importance of childbirth shines out in this context. It is the exact opposite of disease. Whereas midwives and doctors give life, those that treat disease are trying to avert death while endeavouring to raise the quality of life. Israel, with its vast experience and knowledge of newcomers from eastern Europe and from Africa and Asia, is now collaborating with WHO to raise the level of motherhood care in Member States. Investing in safe motherhood is investing in life. May I conclude by saying that we desire cooperative development for the good and the health of all people. It is our hope and prayer that further cooperation and stronger binding of cooperation by Member States will bring about a greater benefit to the whole. May this Assembly be conducted in a spirit of constructive dialogue and collaboration, and may we all be successful in our deliberations to achieve progress towards the common goal of health for all. Mr KET SEIN (Myanmar): Mr Vice-President, honourable ministers, distinguished delegates, on behalf of the Government and the people of the Union ofMyanmar, I would like to convey warm greetings to you all. Allow me to join the other delegations in expressing my heartiest congratulations to the President on his unanimous election to the high office of the Fifty-first World Health Assembly. Congratulations are also extended to the other members of the bureau for their deserved elections. We congratulate Dr Gro Harlem Brundtland on her nomination as Director General of the World Health Organization. Our appreciation and gratitude go to Dr Nakajima, Director-General of WHO, for his invaluable services rendered for many years to the Organization. On this fiftieth anniversary of WHO I would like to express my appreciation for the excellent work which WHO has carried out all over the world since its formation five decades ago. As a result of WHO's dedication and tireless efforts, numerous remarkable results could be achieved. The value of health in overall development has considerably increased. Reforms are being introduced for ensuring that good quality health services are made accessible to all. Some communicable diseases have been eradicated, others have been brought under control. However, some new diseases continue to emerge and old ones re-emerge, thereby causing serious public health problems. WHO's input, its policy guidance and technical support are crucial for successfully tackling these health problems. I appreciate the excellent report which is before us for our deliberation. It reflects our achievements and our aspirations. It also reflects the difficulties and problems which we are facing. In Myanmar we have successfully carried out three rounds of national immunization days. Poliomyelitis vaccine was administered to all children under five years of age. The secret of this success lies in broad social mobilization with the full involvement of basic health workers, voluntary health workers, and the active participation of national and international nongovernmental organizations, donors and the community. As our country is in transition from a centralized to a market-oriented economic system, we also have to think about new approaches. We have started carrying out health sector reforms which include schemes for sharing health care expenditures with the community. In this process, we see it as our responsibility to ensure that the poor and vulnerable will not be deprived of their basic right to health and health care. When talking about communicable diseases, we are aware that these scourges are shared between countries and across borders. Therefore, we have to tackle them in close collaboration with our neighbours, with the other countries in our Region. Our concerns are old challenges like malaria, new epidemics like HIVI AIDS, and re-emerging diseases like tuberculosis. There are of course more, including so-called common diseases like acute respiratory infections and diarrhoea! diseases, which still take a heavy toll, particularly among children. A51NR/5 page SO The Ministry of Health, along with its partners, is committed to the spirit and the objectives of the Declaration on Health Development in the South-East Asia Region in the 21st Century which was adopted by the health ministers of the countries of our Region during the fifteenth meeting held in Bangkok in August 1997. We feel that this document, this declaration, gives us a chance to open new avenues in health development. But we also feel that the burden we are carrying is quite heavy. This can easily be seen from our Regional Health Report. The support from WHO is most essential for ensuring the success of our programmes. If we are to implement our visions for the twenty-first century, we need this support in future, too. The discussions which came to our attention during the past months are, however, not suited to raising the level of our optimism. I do not think there is a special need to mention that this is related to the budget discussion. I think many of us are both confused and concerned. Confused because it is difficult to understand the rationale of the indicators which are being applied for determining the future level of financial support to the regions and the country programmes, and which imply certain contradictions in themselves. Concerned because the proposed drastic reduction of budgetary allocations to our Region would, no doubt, have extremely negative consequences for major priority programmes in a region which has to cope with a high percentage of the global disease burden. This would be particularly severe for countries with limited access to external resources. Myanmar is one of them. While fully understanding the need for a reconsideration of the budget allocation in the context of solidarity among the Member States of WHO, I would like to urge the delegates, and particularly the ones who shoulder the responsibility of working in Committee B, to once more highlight this issue from all sides and to come to a conclusion and recommendations which are in the interest of us all. Coming to the end of my address, let me please once more express my conviction that this august meeting provides a unique opportunity for the exchange of ideas and experience on important health and related issues being faced collectively by Member States. In conclusion, may I once again thank the Director-General, Dr Nakajima, not only for his outstanding contribution to the work of our Organization, but also for promoting a spirit of better understanding and close relationship between the World Health Organization and its Member States. At the same time, I would like to assure the newly nominated Director-General, Dr Brundtland, of our continued constructive cooperation. The Union ofMyanmar stands ready and willing to join hands with WHO and Member countries for the task ahead. El Profesor PICO (Argentina): Senor Presidente: Lo felicitamos, asi como a Ios Vicepresidentes, por su elecci6n y les deseamos el mayor exito en su gesti6n. Nuestro pais se suma a Ios festejos de Ios 50 afios de la Organizaci6n Mundial de la Salud, reconociendo la importante labor desarrollada en favor de la salud de la poblaci6n mundial a lo largo de estos aiios. Agradecemos a! Sr. Director General, Dr. Hiroshi Nakajima, el documento sobre ccLa salud para todos en el siglo XXI» que constituye un valioso aporte, orientador y motivador, para el analisis de un tema trascendente y sensible para la sociedad en su conjunto. En relaci6n con el lnforme sobre la salud en el mundo 1998 ccLa vida en el siglo XXI, una perspectiva para todos», queremos hacer unos breves comentarios, reiterando nuestra posici6n sobre algunas orientaciones politicas y estrategicas relacionadas con aspectos estructurales de la problematica sanitaria, actual y futura. En tal sentido, consideramos de fundamental importancia profundizar el analisis interpretativo de !as causas y consecuencias de Ios exitos y fracasos de la gesti6n sanitaria, y simultaneamente avanzar en forma sistemica en el analisis de probables problemas futuros, y de esta manera pasar de la ret6rica de !as palabras a la concreci6n de Ios hechos. En el marco delliderazgo que ejerce la OMS a nivel mundial, coincidimos en que la salud debe ser un elemento central del desarrollo sostenible y un componente fortalecedor de la democracia participativa. La realidad sanitaria, como todos conocemos, esta fuertemente influenciada por agentes exteriores al sector, que se iran incrementando en Ios pr6ximos afios, generando un nuevo escenario que requiere necesariamente nuevos actores y nuevas estrategias. Es por ello que consideramos importante la incorporaci6n de actores clave destinados a intensificar las relaciones intra y extrasectoriales. El gran desafio en el siglo XXI continuara siendo la busqueda de la equidad; mediante el desarrollo de nuevas estrategias especialmente basadas en el binomio eficiencia y calidad de Ios servicios. Estamos convencidos de que con eficiencia y calidad resulta mas factible alcanzar la equidad en el marco de la etica biomedica. Asimismo, es necesario que prioricemos las orientaciones estrategicas y programaticas del sector en el marco de politicas sociales que interactuen en la defensa de la dignidad de la persona humana, con el fin de lograr la plena vigencia del derecho a la salud, centrando en el hombre y la familia el accionar sanitario. El respeto por la realidad del medio y por las pautas y valores culturales de la poblaci6n, asi como A51NRI5 page81 la plena vigencia de la justicia social, son componentes esenciales que de ben privilegiar Ios sistemas de salud para enfrentar Ios desafios del siglo XXI, caracterizado por la globalizaci6n y Ios problemas culturales que genera todo cambio social. A la transici6n demognifica y a Ios cambios epidemiol6gicos se inin sumando en el siglo XXI nuevos desafios generados por Ios continuos avances tecnol6gicos y por el impacto de la propia acci6n sanitaria. La planificaci6n estrategica del sector debe centrarse, ademas de avanzar en Ios cam bios iniciados, en profundizar la vigilancia y el control de las enfermedades transmisibles, y en especial, en poner atenci6n a la problematica creciente de las enfermedades cr6nicas, en particular las degenerativas, las invalidantes, las cardiovasculares, la violencia y Ios accidentes, las enfermedades mentales, el alcoholismo, el tabaquismo y las adicciones, asi como las enfermedades de origen genetico y Ios problemas relacionados con Ios alimentos y la nutrici6n. El logro de Ios objetivos propuestos requiere que el sector salud asuma un mayor protagonismo, transformando en lo posible las politicas sectoriales en politicas de Estado, y para ello resulta de fundamental importancia que el sector salud desarrolle un liderazgo, asi como la continuidad de su gesti6n. Asimismo, es imprescindible mejorar la eficiencia sectorial y dotar de mayor flexibilidad Ios presupuestos, con el objeto de dar rapidas respuestas a las necesidades mas urgentes en forma oportuna. Se de ben profundizar Ios cambios estructurales iniciados, con el objeto de fortalecer el accionar sanitario, asi como la necesidad de identificar y desarrollar, con criterio etico y humanista, Ios programas prioritarios de la Organizaci6n, con el fin de disminuir las desigualdades y de ese modo contribuir a mejorar el nivel y calidad de vida, el bienestar de la poblaci6n y la paz en el mundo. Asimismo debemos profundizar en la importancia de la funci6n rectora y normatizadora indelegable de la Organizaci6n a nivel mundial, y la funci6n de promoci6n de la investigaci6n cientifica, del uso racional de Ios recursos y del desarrollo de la tecnologia apropiada, asumiendo, de este modo, la invalorable funci6n de administrador y difusor del conocimiento cientifico, y de apoyo y sosten de todos Ios Estados Miembros. En este sentido, algunos instrumentos que consideramos necesarios son: el trabajo intersectorial destinado a mejorar la calidad ambiental, asi como la acci6n concurrente de Ios distintos sectores sobre Ios determinantes del nivel de salud de la poblaci6n; profundizar la estrategia de atenci6n primaria con el objeto de asegurar la accesibilidad de la poblaci6n a Ios servicios de salud; la cooperaci6n tecnica horizontal entre Ios paises, las alianzas estrategicas intra y extrasectoriales; desarrollar la funci6n indelegable del sector en el control de alimentos, medicamentos y tecnologia medica; promover la educaci6n sanitaria, con el fin de lograr estilos y conductas de vida saludables, desarrollando programas con la activa participaci6n de la comunidad y en particular con el sector de la educaci6n, transformando a la escuela en un multiplicador del mensaje sanitario; asimismo, se debe avanzar en el proceso de adecuaci6n del desarrollo de Ios recursos humanos a la realidad sanitaria, promoviendo la efectiva articulaci6n entre Ios organismos formadores y utilizadores de Ios mismos. Consideramos fundamental tener en cuenta estos conceptos en la renovaci6n de la meta de salud para todos y en Ios procesos de reforma que estamos llevando a cabo cada uno de nuestros paises. Las politicas de equidad y solidaridad del sector, basadas en la defensa del interes comun, deben atender racionalmente las necesidades urgentes de Ios mas necesitados y a Ios programas prioritarios de salud de nuestros paises. En este marco, nuestro pais renueva el compromiso del trabajo solidario y se adhiere al esfuerzo que esta realizando la Organizaci6n con el fin de alcanzar la meta de salud para todos y por todos. Desde hace seis aiios, el Ministerio de Salud de nuestro pais viene desarrollando una profunda reforma sectorial. Para ello, hemos contado con la inestimable colaboraci6n de la Organizaci6n Mundial de la Salud y de la Organizaci6n Panamericana de la Salud, que mucho agradecemos; y nos encuentra trabajando en forma conjunta con paises hermanos, en especial Ios que integran el MERCOSUR. Por ultimo, queremos agradecer al Dr. Hiroshi Nakajima el importante aporte a la Organizaci6n durante estos 10 aiios y le deseamos un futuro feliz. Asimismo, queremos felicitar a la Dra. Brundtland y desearle una gesti6n exitosa al frente de nuestra Organizaci6n y comprometemos el apoyo desde ya de nuestro pais. Dr ROITHOV A (Czech Republic): Mr President, Director-General, excellencies, distinguished delegates, ladies and gentlemen, the main topic of the Fifty-first World Health Assembly is the prospect of health-for-all for the twenty-first century. For the Czech Republic this means establishing conditions for people worldwide to reach and maintain the highest attainable level of health throughout their lives. If we want to guarantee the accessibility of health care to all citizens, as is the case in the Czech Republic now, we have to answer the basic question of how much society A51NR/5 page82 intends to invest in health care systems, be it in the form of solidarity insurance or through the tax system. Expenditure on health care has steadily grown, but as a percentage of annual GDP it has been decreasing in the majority of European developed countries, including the Czech Republic, since 1993. It is a harsh reality that mortality rates reflect the percentage of GDP spent on health care. The relative decrease in expenditure on health care runs the risk of limiting financial resources for research and development in medicine. It is the dream of any health minister to provide free health care of an increasingly high standard to all. Unfortunately, we continuously face the objective fact that expenditure on health care continues to rise. This is the result of developments in medicine, and the use of drugs, diagnostic devices and therapeutic technologies which are becoming increasingly expensive. Success in medicine continues to prolong the lives of people, which again leads to growth in expenditure. I feel there is one more very specific reason why expenditure continues to grow: it is because patients do not directly cover the costs of their medical treatment. Our current health system is, in fact, based on the reality that it is not regulated by patients, who are on the demand side, but by the physicians, who are the providers of health care services on the supply side. It seems that demand in the health sector is generated by supply, and not vice versa as it is in other sectors. Countries which try to regulate health care to a certain degree have no other choice than to limit its accessibility in the interest of guaranteeing its quality. The ultimate goal therefore is to find an equilibrium between the quality and accessibility of health care when financial resources are limited. Health care systems all over the world are analysing key factors in search of substantial measures to increase their effectiveness. This effectiveness is extremely difficult to measure and is frequently sacrificed to short-term reductions in costs. The transformation of the Czech health care system is going through a difficult process in which falling expenditure on health care unfortunately leads, in many cases, to limitations in highly specialized medicine. We all know that this trend should be reversed, but the issue is how to do it. It seems that a key element would be to introduce standardized processes and permanent monitoring of the results and outputs of these processes. Measurement of output not only brings comparisons of quality among health care providers but also facilitates statistical evaluation of the various technologies used. Our ambition is to find the most effective processes and put them on the list of health care accessible to all who are covered by public solidarity funds. It seems that the vision for the twenty-first century is one of systematic work with data for continuous analysis in the long term. We have a major task to quantify progress in terms of quality-adjusted life years and disability-adjusted life years. Current possibilities in medicine are almost unlimited, while financial resources will continue to be in short supply. The medicine of the twenty-first century will probably be a permanent process of compromise between growing medical possibilities and financial coverage. Patients and the whole of society should be involved in this process, which encompasses, among other issues, medical ethics and the rights of patients. This also requires the concerted efforts ofthe international community. I believe that only through the long-term and coordinated efforts of the international community, reflected in the considerations and programmes of the World Health Organization, will many of these problems be solved. Mr JAVED HASHMI (Pakistan): Mr President, Director-General, excellencies, distinguished delegates, ladies and gentlemen, allow me first of all to congratulate the President and Vice-Presidents of this Assembly as well as the Chairmen of the Committees on their election. My delegation is confident that under your guidance, this World Health Assembly will achieve its objectives successfully. I would like to thank the Director-General and his staff for the presentation of a comprehensive World health report 1998 entitled "Life in the 21st century: a vision for all". The report has successfully highlighted the achievements of WHO in the last 50 years, and has identified priority areas which need the attention of all the Member States. My delegation would also like to congratulate WHO on the occasion of its fiftieth anniversary. Pakistan also celebrated its Golden Jubilee last year. During these 50 years, Pakistan, like WHO, has grown, fought crises, and struggled for the promotion of health along with other Member States and, like WHO, Pakistan is proud of its achievements. Pakistan took the lead in eradicating smallpox and guinea-worm disease in the subcontinent. The Accelerated Health Programme of Pakistan was used as a model by WHO to provide maximum immunization coverage to children in the shortest possible time. We recently started the Prime Minister's Programme for Family Planning and Primary Health Care, which establishes linkages between the communities and first-level health care facilities through the training and deployment of 45 000 women health workers. These health workers are active in their own communities in rural and underserved urban areas of the country as "agents of change". An important element of primary health care is basic minimum needs (basic A51NR/5 page83 development needs), which we included in our national health policy as a poverty alleviation programme. This reflects our keen interest in the activities of WHO. We are hopeful that we will present a cost-effective, replicable and sustainable model of this programme to the world. I would like to share with the World Health Assembly Pakistan's perspective in regard to some of the issues raised in the world health report and say how these issues should be addressed by the global fraternity. We have to launch concerted efforts against emerging and re-emerging diseases so that they do not pose a risk to future generations. The re-emergence of diseases such as tuberculosis, malaria, plague and cholera is a consequence of inadequate infrastructure and health services in the past. We must also give due attention to starting innovative programmes to access remote and disadvantaged areas and populations and to bring a positive change in health behaviour, especially among rural populations. Some of the areas which need emphasis in this regard include health education, health promotion and social mobilization. There is also an urgent need to promote awareness at the global level that health is the first and foremost component of socioeconomic development. Health is the most important component of quality of life. An unhealthy world cannot even dream of achieving development. Therefore, health needs to be placed high on the development agenda. The question is how can this objective be achieved? We know that we can accomplish this by working for equity of access to health, social equity including gender equity, and reduced poverty and its health consequences, and by placing greater emphasis on the primary health care approach and empowering communities through health education and promotion. In Pakistan, our health budget has grown fourfold; 75% of this budget goes towards primary health care. We are in the· process of carrying out the universal iodization of salt. Medical education is being reoriented towards a more community-based approach. A comprehensive new health policy has been approved which will promote health care as part of the overall socioeconomic development process in our country. The question of reforms, both in the workings ofWHO and those ofthe health sector, has been discussed during previous Health Assemblies. We feel there is a need to review WHO's constitutional and functional parameters and enhance its capabilities to respond in more effective ways to new challenges. WHO must give new directions to its activities to bridge the gaps and correct the deficiencies of the past. Its focus should be on the most vulnerable and those in greatest need. The reforms must also underscore the principles of equity, efficiency and, above all, accountability. I am sure that when I convey these sentiments on behalf of Pakistan, I represent the feelings of all Member States who are equally committed to WHO's goals for health for all. I conclude my statement in the hope that the world community will be able to give new directions to health care reforms for the betterment of global health. Pakistan greatly values WHO's cooperation and support and would like to place on record its deep appreciation for Or Hiroshi Nakajima and his excellent leadership of the World Health Organization. I would also like to extend felicitations to Or Gro Harlem Brundtland, the Director-General designate, and assure her of our cooperation and support in her endeavours. I also convey our gratitude to the Regional Director for the Eastern Mediterranean, for his support and guidance to the efforts directed at health sector reform in Pakistan. My delegation would also like to convey our appreciation to all the other international and bilateral agencies concerned for their valuable assistance for the improvement of health of people in Pakistan. BbiCTYllJlEHHE llPE)lCE)lATEJl.H: The PRESIDENT: EnaroJlapiO }leneraTa naKHCTaHa. llpHrnaWaiO Ha TpH6yHy }leneraTa .HMaiiKH. )leneraT .HMaJiKH 6yJleT BbiCTynaTb OT HMeHH rpynnbl KapH6CKHX CTpaH: Eap6anoca, )loMHHHKaHCKOH Pecny6nHKH, rpeHa}lbl, CeHT-KHTCa H HesHca, CeHT-JliOCHH, CypHHaMa H OT HMeHH csoeii cTpaHbi. )leneraToB oT 3THX cTpaH SI TaK>I Mr JUNOR (Jamaica): Mr President, distinguished delegates, ladies and gentlemen, I congratulate the Director-General designate and I wish to commend the current Director-General on behalf of the governments and peoples of the Bahamas' Barbados, Dominica, Grenada, Jamaica, Saint Kitts and Nevis, Saint Lucia and Suriname. We also wish t~ A51NR/5 page84 commend the World Health Organization for its dynamic role in enhancing the health status of peoples around the globe over the past 50 years. New disease challenges face us, and in this new information age we have certainly improved the techniques by which people communicate; but, importantly, I think we still need to understand how people behave. We urgently need a better appreciation of people's health-related behaviour and their social and cultural responses. With that understanding, we will be able to develop more effective health promotion in all its dimensions inclusive of policy, planning, programmes and personnel. Health promotion should be a priority, we suggest, for nations and WHO. We recognize that the major health problems which face us in the Caribbean are directly related to how people live. Hence, the question of whether they pursue healthy lifestyles and maintain healthy communities is critical to national development. In our countries, we have been aggressively pursuing a health reform programme to overcome our challenges and meet the health care needs projected for the twenty-first century. Speaking for Jamaica, our health system has been decentralized into four regions, which enjoy statutory autonomy, and the management and delivery of quality care has been placed in the hands of professionals at the regional, parish and community levels. It is our belief that this autonomy will make the system more efficient and responsive to people at the community level. Others of us in the Caribbean are implementing various models of reorganization to achieve greater efficiency. A critical component of the Caribbean health reform programme is the establishment of a sustainable financing mechanism such as national health insurance, to ensure that everyone has access to health care. To guide us in our endeavours, we are in the process of defining a mission statement for health in the Caribbean and, consistent with that health mission, we are redefining our vision and objectives for the twenty first century to ensure that we increase individual responsibility for health; encourage the development of healthy lifestyles; foster a client-oriented health service; maintain a healthy environment; provide universal access to health care at reduced costs; and establish caring communities. I wish to alert colleagues to a danger which we perceive nationally, regionally and internationally, and indeed, in this very forum, which is politicization and bureaucratization of health. We must have a clear vision of health in the twenty-first century, and establish and keep focused our health goals and outcomes. One of the major health challenges we face is the fact that our resources are limited. But this is a challenge, I suppose, which faces many other nations. We recognize the equality of all humanity and the need for efforts to ensure equal opportunity in human development. We appeal to all nations and the international community to focus greater attention on equity as a fundamental principle and goal. We appeal to the international bodies in considering the issue of equity, to take into account the vulnerability of small States to possible negative effects of the unbridled globalization of the market, which threaten to undermine the gains we have achieved. At the same time, the social sector needs to take an integrated approach to human development and social services delivery at community, regional and national levels, because it is a more efficient way to use resources, particularly in our developing countries. Another challenge is that many countries, including ours, face significant problems in respect of conflict resolution and injuries resulting from violence. It is clear that this is an area in which we need to establish effective systems of surveillance; and to implement programmes which can prevent and control violence. This must also be an important focus of WHO, if nations around the world are to build on the health status which they have achieved. In our countries, there has been a significant increase in life expectancy. Up to the late 1960s our life expectancy was approximately 65 years of age. Today, that figure is over 70 years. In the area of family planning, we have reduced our fertility rates considerably; however, we still have to address the issue of teenage pregnancies. In terms of immunization, we have achieved an overall coverage rate of over 90%. Since 1982, we have not recorded a case of poliomyelitis; and since 1992, we have not recorded a case of indigenous measles. At the regional level in the Caribbean, we have established a Council for Human and Social Development, with an expanded mandate, under which the ministers of health, education, housing, social security, labour, sport, youth, culture and women's affairs have come together to take an integrated approach to human and social development. At the first ministerial meeting of this Council, held in Kingston, Jamaica, in April, the historic decision was taken to eliminate rubella and congenital rubella syndrome from the Caribbean community by the end of the year 2000 through a mass immunization campaign. The Bahamas spearheaded the resolution and has led the way by already conducting a mass immunization campaign, including adults, which they completed in 1997. Jamaica, Barbados and Suriname will start their campaigns later this year and other countries will ensure coverage of susceptible populations to meet the goal by the year 2000. A51NRI5 page85 We are alert to new and re-emerging diseases, hence greater emphasis will be placed on reducing sexually transmitted diseases, particularly HIV/AIDS. Our programmes will target young people; and we will also increase our resources to combat the rising trend of tuberculosis in the region. We commend PAHO and WHO and other international agencies, as well as our bilateral partners, for the technical and financial support they provide for our national and regional health initiatives. Their contribution has resulted in the achievement of new milestones in health care delivery. As we look to the future, we must give priority to the promotion of healthy lifestyles and redouble our efforts to control HIV I AIDS and other sexually transmitted diseases. We must seek innovative ways to deal with violence and its effects. And we must adopt an integrated approach to realize the vision of health and social development in the twenty-first century. Dr KOSMAC (Slovenia): Mr President, distinguished delegates, ladies and gentlemen, on behalf of the Government of Slovenia it is my great honour to greet all of you present here at the Fifty-first World Health Assembly. This session is especially remarkable, because it marks 50 years of planning and implementing programmes dedicated to improving the health of the population of our planet. Cooperation in solving global health problems has brought together the most respected experts and, furthermore, implementation of health reforms has connected political structures of various nations. But the great successes which WHO has experienced in the past also represent an obligation for the future. We are exhilarated about our expectations as we make the transition from one millennium to the next, a most auspicious occasion which we will be fortunate enough to witness. It will be a truly glorious moment when we all wish each other happiness, good health, peace of mind, healthy working and living conditions and an undamaged natural environment. How to achieve our goals and fulfil our debt to future generations is the most important task which must be planned at this Assembly. We are undoubtedly entering a period when it will be of the utmost importance to reinforce ties between all the countries of the globe in the areas of knowledge and financing. This will ensure, to the highest possible degree, conditions for the promotion of health. And the place where these interests meet is at WHO. Its motto, health for all by the year 2000, lays the foundation for creating the conditions for a policy of accelerating improvement in health, for reducing the differences in health opportunities for various population groups, reaffirming personal responsibility for health, ensuring the right to a living environment which will guarantee the highest possible level of health, and upgrading the quality of health care and research on health problems. The policy for health in the twenty-first century will certainly be a continuation of these activities in the areas of health promotion and balanced social policy. In the developed countries we can expect the greatest dilemma to arise in the area of social development. Demographic changes, increasing unemployment and poverty, increasing physical and mental morbidity, the growth of new infectious diseases and, along with them, growing needs and expectations, will require more resources (financial, material and human) to ensure an adequate level of social security. All nations, including the more affluent, will be confronted by a lack of resources. We will be faced with many health reforms which will, in view of their importance, strongly affect the future development and stability of developed societies. Managing the reforms of health care systems, defining their composition, and realizing intersectoral and interdepartmental cooperation in matters related to health and health care will be the primary task in the 'implementation of successful health policies. On 18 June 1996 the Ljubljana Charter was signed by the ministers of health and their representatives in Ljubljana, the capital of Slovenia. This charter addresses health care reforms in the specific context of Europe for the beginning of the next century. Health care reforms must be governed by principles of human dignity, equity, solidarity and professional ethics. They should address citizens needs and at the same time motivate them to share responsibility for their own health. The reforms must be aimed at continuous improvement in the quality of health care provided, and must be based on sound financing and oriented towards primary health care. The protection and promotion of health should be the primary concern of all societies. In the name of the Government ofSlovenia I affirm that we will devote our ultimate efforts to support the WHO guidelines defined in The world health report 1998. Life in the 21st century: a vision for all, and that we will utilize all our knowledge in actively participating in the realization of our goals, in our desire to cooperate in the promotion ofhealth and in establishing the highest possible level of prosperity. I thank the World Health Organization for all it has contributed to the welfare of mankind. A51NR/5 page86 Mr E.K. Pretrick (Federated States of Micronesia), Vice-President, took the presidential chair. M. E.K. Pretrick (Etats federt~s de Micronesie), Vice-President, assume la presidence. The PRESIDENT: With great pleasure I take over the presidency to continue with the debate. The next speaker on my list is the delegate of Bangladesh. Mr YUSUF (Bangladesh): I congratulate you, Mr President and other distinguished officials, upon your election. I share a sense of pride because Bahrain and Bangladesh enjoy such brotherly ties. The outgoing President deserves appreciation for his able stewardship of the last Assembly. I also wish to thank our Director-General, Dr Hiroshi Nakajima, for his significant contribution to the worldwide development of health throughout his tenure. Warm felicitations are also due to Dr Gro Harlem Brundtland upon her nomination for election to this high office. As we approach the next millennium, we have a vision of a better life and better health for all in the twenty-first century. Today, it is a matter of concern for us that a vast majority of the global population still live in poverty. They continue to suffer from hunger, malnutrition, disease, unemployment and social violence. Women remain particularly vulnerable. More than 50% of the pregnant women in developing countries are anaemic. Every year 585 000 women die due to pregnancy-related causes. These statistics bring us no credit. They must be seriously addressed, and altered for the better. It is a happy sign that we are now seized of the matter. In our own Region, health ministers have adopted the Declaration on Health Development in the South-East Asia Region for the 21st century. This Region accounts for nearly one-quarter of the total global population, contains 40% of the world's poor, includes five countries which are on the list of the world's least developed, and bears the larger portion of the disease burden in comparison with any other WHO region. We, therefore, believe that this Assembly will appreciate our genuine need for continued assistance and support. In our own country, Bangladesh, the Government of Prime Minister Sheikh Hasina has taken some bold and effective measures in the area of health. We have achieved notable progress in oral rehydration therapy and immunization coverage. The average national coverage for immunization is almost 98%. The infant mortality rate has been substantially reduced as a result of oral rehydration therapy and success in the Expanded Programme on Immunization. The present contraceptive prevalence rate is about 49%. In 1997, the total fertility rate declined to 3.2 and the population growth rate fell to 1.6%. Yet the problems persist, due to high population, a low literacy rate, malnutrition, poverty and consequent environmental degradation. Despite the gradual improvement in the health care delivery systems there is high prevalence of communicable and preventable diseases, especially among children under the age of five. Recently arsenic contamination in groundwater has emerged as a major health hazard in some parts of the country. The Government has initiated action to counter this with assistance from UNICEF, UNDP, the Department for International Development of the United Kingdom, the World Bank and WHO. Enhanced technical and financial assistance from WHO and system-wide cooperation are essential to address this menacing hazard, as well as to preserve and protect the environment. Ensuring provision of basic health care services to the entire population, particularly in rural areas, has been a consistent policy of our Government. The successful Five Year Plans and the Three Year Rolling Plans emphasized this key approach. From 1 July 1998, the Government will introduce a massive reform package which will focus on reproductive health, child health, endemic disease control, family planning and limited curative care at all levels. Our Prime Minister has committed her Government to the cause of safe motherhood and, as of now, 28 May is to be observed as "Safe Motherhood Day" in Bangladesh. We are currently involved in preparing a national health policy for our entire population. We have also undertaken a preventive programme, approved by the Cabinet with regard to AIDS. On tuberculosis control, with successful implementation of directly observed treatment, short course, and achievement of 85% cure rate, Bangladesh can be viewed as a model. On the eradication of poliomyelitis, we are on the threshold of a breakthrough. But in all these efforts, Bangladesh, along with other least developed countries, will require strong WHO support, particularly if we are to achieve, as we envisage, health for all by the year 2020. A51NR/5 page87 My delegation shares the view that WHO budgets need to take into account the growing needs of different regions on the basis of objective criteria. Increased allocation to some regions should not be at the cost of others. A more rational formula based on scientifically proven indicators may be used to determine future allocations to Member countries in great need. Consideration must be given to the size of total population, disease burden, and the level of socioeconomic development ofthe country. The special needs ofthe least developed countries should also be accorded due attention. The proposed recommendation of the Executive Board will adversely affect many of our programmes. For instance, Bangladesh, with the proposed 65% reduction in WHO allocation, will have to roll back many of its projects. This we can ill afford to do. WHO will also thereby lose its leadership role in health sector development. It is our view, therefore, that the proposed recommendation of the Executive Board will require further consultation and study. Again, since the budget will be operational in the year 2000-2001, it is our hope that the new Director-General will also make it the subject of serious examination. Our goals are noble, and we are steadfast in our determination to achieve them. Better health for our people is an expectation that accompanies the march of civilization. Let our joint endeavours - among regions, countries, governments, nongovemmental organizations and the private sector - be directed towards achieving this common hope. Let WHO lead the way. This should be our resolve on our fiftieth anniversary, M. JUNEAU (Canada) : Monsieur le President de seance, Docteur Nakajima, collegues delegues, Mesdames et Messieurs, permettez-moi tout d'abord de saisir cette occasion pour remercier le Dr Nakajima de sa contribution a I'OMS et notamment au processus de reforme. J' aimerais aussi feliciter le Dr Gro Harlem Brundtland de sa designation. Le Canada collaborera avec plaisir avec elle a la realisation des objectifs de I'OMS que nous avons conjointement fixes. A l'aube d'un nouveau millenaire, )'occasion nous est offerte de reflechir au monde vers lequel tendent tous nos efforts et tous nos espoirs, un monde de paix entre tous les pays, ou la sante pour tous sera devenue realite. Cette annee, nous celebrons le cinquantieme anniversaire de )'Organisation mondiale de la Sante. Le moment est done bien choisi pour passer en revue ces cinquante annees d'existence et tirer les lefi:ons du passe afin de mieux tracer la voie a suivre. Depuis la Premiere Assemblee mondiale de la Sante en 1948, le monde a connu des progres et des changements fulgurants, changements tant politiques, demographiques et technologiques qu'epidemiologiques. L'OMS nous a aides a faire face aces changements et, en cours de route, elle s'est naturellement transformee. 11 y a cinquante ans, I'OMS adoptait les priorites suivantes: I) lutte contre le paludisme, la tuberculose et les maladies sexuellement transmissibles, 2) amelioration de la sante et de la nutrition de la mere et de )'enfant, et 3) amelioration de )'hygiene du milieu. 11 convient de se demander si nous avons progresse dans ces domaines autant que nous aurions du le faire. Oui et non. A bien des egards, notamment en ce qui conceme la mortalite infantile, l'esperance de vie et la vaccination, nous avons atteint de nouveaux sommets, mais nous avons encore beaucoup de chemin a faire avant de realiser notre objectif commun de la sante pour to us. On ne saurait reprocher a ceux qui nous ont precedes d'avoir ete moins engages ou moins soucieux de ces problemes. Maisje crois que nous avons appris qu'il etait necessaire d'assurer la durabilite de notre travail. Le maintien de la forte couverture vaccinate obtenue malgre une croissance demographique incessante peut se revel er une tache aussi difficile que I' a ete celle d' atteindre cet objectif au depart. Pour y arriver, no us devrons unir nos efforts. (L'orateur poursuit en anglais.) (The speaker continued in English.) Mr President, I would like to take this opportunity to thank Dr Nakajima for his contribution to WHO and notably to the reform process. May I also warmly welcome the nomination ofDr Gro Harlem Brundtland to lead WHO into the twenty-first century. Canada will be pleased to work with Dr Brundtland to achieve the goals we have jointly set for WHO. As we stand on the threshold of a new millennium, we have an opportunity to reflect on the world we all strive and hope for, a world of peace among all countries, where health for all will have become a reality. This ·year, we celebrate the fiftieth anniversary of the World Health Organization. It is fitting, therefore, that we take a moment to reflect on the first 50 years of WHO and see how the lessons of the past can help us chart the course of the next 50 years. A51NR/5 page88 Since the first Health Assembly in 1948, the world has witnessed major advances and dramatic changes - politically, demographically, technologically and epidemiologically. WHO has helped us cope with these changes, and in the process, our Organization has become very different from what it was 50 years ago. Half a century ago, WHO adopted the following three priorities: firstly, fighting malaria, tuberculosis and sexually transmitted diseases; secondly, strengthening maternal and child health, and nutrition; and finally, improving environmental hygiene. We may well stop and ask ourselves now if we have progressed as much as we should have. The answer is twofold. On many fronts, particularly infant mortality, life expectancy and immunization, we have reached new heights. But we still have a long way to go to reach our common goal of health for all. It is not that those who came before us did poor work, or that they were less caring or committed than we are. But I believe we have learned about the need to ensure the sustainability of our work. Maintaining the high levels of immunization, which we have achieved in the face of continuing population growth, may be as difficult as achieving those levels in the first instance. To succeed, we must undertake the task together. Solidarity and interdependence are not new concepts in our Organization. Almost 50 years ago, the first Director-General of WHO and, I might add, a great Canadian, Dr Brock Chisholm said, "Each one of us must learn that the welfare of his own nation today depends on the welfare of all nations, and that therefore we must acquire, and above all help our children to acquire an equal degree of concern for the welfare of all members of the world community." Indeed our vision for the twenty-first century should be one of solidarity, equity and health. This vision is at the core of the new global health policy which Canada will strongly support later this week. WHO must also give priority to the design of collective solutions to health problems common to its Member States. The work of the Organization in the development of an effective global disease surveillance system is a good illustration of this important role for WHO. Another global health problem the international community needs to take more seriously is the tobacco epidemic. Canada views with particular alarm recent increases in smoking rates among young people and particularly very young women. Therefore, the Canadian Tobacco Control Strategy, which includes a comprehensive legislative initiative, focuses on young people. We believe WHO must assign a greater priority to work in this area especially to the Framework Convention on Tobacco. Finally, Mr President, WHO's role is to deliver specialized technical cooperation in response to the needs of its Member States and in accordance with our policy decisions on priorities, management rigour and accountability. Canada has signalled its commitment to these priorities by action. As an example, through our International Development Agency, Canada will give$ 21 million to WHO over the next five years for the immunization programme. This latter amount is part of a $ 50 million international immunization initiative announced today in Toronto, Canada. The amount of$ 21 million will also be provided to UNICEF and we are delighted to see the growing collaboration between WHO and UNICEF in this area. In closing, we have a strong Organization with a strong health-for-all policy. I believe we have the will and the means to implement our collective vision for the twenty-first century under the leadership I know Dr Brundtland will provide. Le Professeur GUIDOUM (Aigerie): Monsieur le President de seance, Monsieur le Directeur general, Excellences, honorables delegues, Mesdames, Messieurs, avant tout, permettez-moi de presenter mes felicitations au President a I' occasion de son election a la tete de cette Cinquante et Unieme Assemblee mondiale de la Sante. Je suis convaincu que cette session sera couronnee de succes grace a I' experience et a la competence qui lui sont personnellement reconnues. Je saisis aussi cette occasion pour feliciter Mme Gro Harlem Brundtland pour sa designation au poste de Directeur general de I'OMS. Son predecesseur, le Dr Nakajima, a fourni des efforts meritoires, notamment en matiere de reforme organisationnelle et d'adaptation de notre Organisation aux changements de cette fin de siecle, et son elevation a la dignite de Directeur general emerite est un hommage legitime rendu a sa personne. A cet egard,je suis convaincu que le nouveau Directeur general de I'OMS saura mener notre Organisation a la conquete du troisieme millenaire et realiser l'ambitionjuste et legitime de la sante pour tous. Le parcours qu'elle a accompli et sa vaste experience nous confortent dans notre conviction qu'avec !'aide et la cooperation de tous, les defis seront releves. A l'aube du troisieme millenaire, !'Organisation mondiale de la Sante fete le cinquantenaire de sa creation. Le chemin parcouru depuis 1948 est certes jalonne de succes. Des maladies ont ete eradiquees, I' esperance de vie a partout augmente et les taux de deces evitables connaissent globalement une tendance reguliere a la baisse. Cependant, des maladies anciennes refont surface, des maladies nouvelles emergent et, dans de vastes regions du globe, beaucoup d'indicateurs sanitaires se degradent. S'il est vrai que cette fin de siecle a mis en evidence A51NR/5 page89 la relation liant le systeme de sante au niveau du developpement economique et social, relation qui a genere une deterioration de la couverture sanitaire particulierement dans les pays en developpement, il n'en demeure pas moins que la non-concretisation du reve d' Alma-Ata nous interpelle quant aux raisons qui nous obligent a reporter au prochain millenaire I' objectif de la sante pour to us. Au-dela des insuffisances nationales et regionales a l'origine de ce constat, il est evident que les logiques basees sur la strategie globale ont montre leurs limites. Les pays du tiers monde ne sont plus ce qu'ils etaient en 1974. Leur niveau de developpement exige une revision de l'approche initiale. Les transitions epidemiologiques et socio-economiques ont induit dans de nombreux pays de !'hemisphere Sud une situation nouvelle ou, en plus de la demande de soins primaires, s'expriment des besoins sans cesse croissants pour des soins de haut niveau impliquant des technologies avancees aux couts eleves. La sante pour tous peut-elle rester confinee a la perception du "paquet minimum" ? Par-dela les couts, et si tant est que le principe de la solidarite universelle en matiere de sante ne saurait relever du simple discours de circonstance, la sante pour tous devrait elle exclure l'offre equitable de soins de haut niveau dans les pays du tiers monde? Enfin, peut-on accepter que la medecine soit a deux vitesses au niveau mondial ? Denoncer cette situation aux plans regional et local doit logiquement induire une implication plus grande de l'OMS au niveau des bilans consolides a l'echelle mondiale, qui est son apanage. La reflexion autour du concept de sante pour to us do it etre recentree des lors que notre entendement est unanime pour affirmer qu'il est moralement inacceptable de mettre en place des mecanismes qui se traduiront ineluctablement par !'exclusion des pays du Sud des objectifs essentiels de performance et de renouvellement indispensable des connaissances. Cette reflexion doit etre basee sur !'idee fondamentale de l'equite et de la solidarite. Elle doit aussi etre associee a notre devoir de porter aide et assistance a toutes les categories vulnerables dans les pays soumis a un embargo. Par sa resolution WHA49.25, I' Assemblee mondiale de la Sante a fait de la prevention de la violence une des priorites de la sante publique. Pour cela, notre Organisation a adopte une serie de mesures tendant a en identifier les causes afin de mettre en place les mecanismes adequats pour !utter contre ce phenomene qui, si nous n'y prenons pas garde, finira inexorablement par gangrener !'ensemble des societes humaines. Si !'effort precite est louable en soi, a-t-on reellement donne a notre Organisation les moyens suffisants pour combattre ce fleau ? Existe-t-il pour autant un reel engagement de tous les Etats pour combattre la violence sous toutes ses formes, pour mettre fin a toutes les formes de terreur violente negatrices du droit a la vie ? Et de fait, peut-on parler de droit a la sante lorsque ce droit a la vie est quotidiennement nie, viole, et que des enfants, des femmes et des vieillards sont chaque jour victimes de cette barbarie sans nom qui s' exprime par des actions terroristes multiformes en ce monde? Peut-on parler de droits de l'homme si le droit elementaire, sacre, le droit de vivre en paix est continuellement bafoue et que les auteurs de ces actes immondes sont accueillis 9a et la par certains pays qui brandissent l'etendard des droits de l'homme et aupres desquels les commanditaires des actes terroristes, agissant a visage decouvert, trouvent refuge et protection ? Au nom de que! ideal, au nom de que! principe, en vertu de quelles arguties protege-t-on encore ceux qui, chaque jour, continuent d'immoler des dizaines de victimes innocentes, souvent au matin de leur vie, en des actes d'une barbarie insensee? Ce cinquantenaire de la creation de l'OMS doit etre un moment privilegie de rearticulation de notre reflexion pour adopter une strategie adaptee au troisieme millenaire, une strategie realiste eloignee de toute forme d'utopie, une strategie qui consacre dans les faits le principe de la solidarite universelle, afin que l'humanite du XXI• siecle, toute l'humanite, beneficie de l'equite en matiere de soins et que, partout, les enfants, les femmes et les hommes n' aient plus a a voir peur pour leur present ni a croire incertains leurs lendemains. Dr F.R. AI-Mousawi, President, resumed the presidential chair. Le Dr F.R. AI-Mousawi, President de I' Assemblee, reprend la presidence. The PRESIDENT: :~)I u--o o_,...... U LA ~ ~)I ;·-:-'!yj ~WI 1.,? _?-.;, ,y ylf\11 a.....kJI al..,.:. I_,.- _y :. } ,JlrJI y J~ 1_?-.;, j-.PiyjJ -~-~ t-l Mr SOLOMIS (Cyprus): Mr President, distinguished delegates, ladies and gentlemen, 50 years have passed since the foundation of the World Health Organization. Throughout its existence the Organization has made tremendous progress with substantial gains, mainly in the increase of life expectancy, an improved quality of life and the control of infectious diseases. Cyprus is convinced that WHO will continue its successful course well into the new millennium and further gains and achievements will be obtained in the field of health. We welcome the decision of the Executive Board to nominate Dr Gro Harlem Brundtland as the new Director-General of the Organization. Cyprus is confident that her dynamic personality and exceptional qualifications will further enhance the endeavours of our Organization in pursuing the noble goal of health for all the peoples of the world. I also take this opportunity to express our sincere thanks and appreciation to Dr Hiroshi Nakajima for his remarkable contribution to the achievements of the Organization. His work and contribution are greatly appreciated by all. Mr President, this year's world health report, "Life in the 21st century: a vision for health", is an exceptional one. Not only does it give a complete picture of the status of world health and WHO's activities for this year, but it also describes the situation as it was 50 years ago. By studying past trends, it predicts the developments likely to occur during the first quarter of the twenty-first century, when poverty, with its detrimental impact on health, will be one of the most difficult problems to resolve. Epidemiological transition, with its double burden of infectious and chronic noncommunicable diseases, will continue to absorb the scarce resources of almost all nations. One of the biggest challenges of the twenty-first century remains the prevention and postponement of disease and disability and the maintenance of health independence and mobility of an increasingly ageing population. Unfortunately, very few countries will be able to meet the costs of proper health care, rehabilitation and cure. The prevention and reduction of premature mortality, morbidity and disability through education, development of life skills and healthy lifestyles remain high on the agenda of problems which need to be faced early in the twenty-first century. Special emphasis must be placed on the health of women, in order to guarantee a healthy future young generation. These are only some indications of the problems on the unfinished agenda of WHO. These are some of our common future problems. This year's annual report allows us to study and focus our attention on the main problems expected in the coming years and gives us the chance to resolve them, both collectively and individually. Developed countries must share their knowledge, expertise and experience in health with developing countries. All countries need to learn, plan and invest in their health priorities in an effort to fulfil the commitment to achieve health for all of our people. These are only a few of the major challenges facing WHO. Cyprus is firmly convinced that its 50-year history of achievements guarantees that the Organization will be able to meet and effectively combat the challenges ahead and will lead us to a better world and a brighter future. The PRESIDENT: :...,...;)I a...5:1....JI YJ..W.. ~\ ~fJ c....lS" '-UN a...... a.....U 4....>.-pl ~\ lt_,s" YJ...l:.A _y,:,iJ 'vP.r.i YJ..L:.J I~ .a....k..ll o.l.P. _j ~~ _r:.T0~ o..bWJI ~\ YJ...l:.A 0~ ~ ,~\ Jl 4>-pl o..bWJI El Dr. DOTRES MARTfNEZ (Cuba): Distinguido senor Presidente:' Le felicito por su elecci6n como Presidente y permitarne transmitirle la seguridad de que la delegaci6n cubana colaborara con usted durante esta Asamblea. Senor Director General, distinguidos colegas, senoras y senores: Aun cuando vemos con optimismo el futuro de la humanidad, tenemos muchas razones para reflexionar sobre algunas crudas realidades que nos conmueven y que Ios que aqui hoy nos reunimos debemos enfrentar, porque ademas de constituir nuestro principal deber, competen al mas importante de Ios derechos, el derecho a una vida saludable. A la poblaci6n del mundo se ofrecen dos situaciones de salud muy diferentes: para unos, la perspectiva es de mas larga vida con mejor calidad, con acceso a notables avances cientificos y tecno16gicos en sus servicios de salud; para otros, alrededor de 1500 millones de personas que viven en la pobreza extrema, la expectativa es ver agudizada su pobreza y contemplar c6mo las reformas del sector salud de perfil neoliberal no dan soluci6n a la inequidad, a la insuficiente cobertura o a la ausencia de solidaridad en Ios servicios de salud. Cuba se dispone por voluntad y decisi6n politicas, a pesar de las circunstancias excepcionales en que el Sistema Nacional de Salud ha tenido que desarrollarse y por principios de justicia social, a continuar A51NR/5 page91 privilegiando la salud de su pueblo como lo ha venido haciendo desde el triunfo de la revoluci6n de 1959. Hemos logrado 1 medico por cada 17 6 habitantes, una tasa de mortalidad infantil de 7,2 por 1000 nacidos vivos, y una perspectiva de vida de 75 afios, entre otros importantes indicadores de salud. En el sistema de salud se ven materializadas muchas de las estrategias anheladas por la salud para todos, como son la garantia de la accesibilidad efectiva a todos sus componentes, la cobertura total a la poblaci6n, la equidad, el relevante papel de la atenci6n primaria de salud, que logra su mayor expresi6n en el contexto del modelo del medico y la enfermera de la familia como centro de nuestro sistema, Ios cuales ban sido factores determinantes de Ios cambios ocurridos en el estado de salud de nuestra poblaci6n y en el cumplimiento exitoso de las metas de Salud para Todos en el Afio 2000, tan temprano como desde el afio 1983. Nuestra reforma de salud esta sustentada en un sistema nacional de salud futico, equitativo, con acceso universal, gratuito y con financiamiento estatal. Vemos c6mo la principal estrategia, junto a la participaci6n comunitaria, es la atenci6n primaria de salud, estrategia viable para todos Ios paises, pero especialmente importante para Ios paises pobres. Senor Presidente, distinguidos colegas: Deseo destacar en nombre de Cuba el esfuerzo de la OMS en estos 50 afios, por sus acciones por la salud mundial, y en particular destacar la dedicaci6n del Dr. Nakajima, asi como dar la bienvenida a la Dra. Brundtland a la conducci6n de nuestra Organizaci6n. Asimismo, mi pais agradece la contribuci6n de personalidades, instituciones, gobiernos y agencias por Ios logros alcanzados en salud y reitera su disposici6n de seguir contribuyendo y cooperando a la noble tarea de trabajar en bien de la salud internacional uniendose hoy, en esta Asamblea, al exito general que deseamos para la misma y al de todos mis colegas ministros en tan dificil situaci6n de mantener y mejorar, en el mayor grado posible, la salud y el bienestar para nuestros pueblos. Mrs JOWELL (United Kingdom of Great Britain and Northern Ireland): As the United Kingdom is one of the founding Member States of the World Health Organization, it is a great privilege to address this Assembly in its fiftieth anniversary year. The occasion has an added poignancy in that the United Kingdom is the current holder of the Presidency of the European Union and I am honoured to speak on behalf of the 15 Member States of the European Union. It is time to reflect on the distance travelled in this great partnership dedicated to the improvement of world health and to consider the challenges which lie ahead. Thanks to the vigilance, the commitment, and tenacity of WHO, diseases which cut great swathes through the world population 50 years ago, such as smallpox, have been eradicated. Others, such as poliomyelitis and guinea-worm are well on their way to eradication. In their place we face new challenges, such as the emergence ofHIV/AIDS, the effects of pollution on health, and increasing rates of heart disease and cancer. And, of course, there is the planned roll back malaria initiative. Over the years the emphasis of WHO's agenda has broadened from tackling head-on violently contagious disease to include more sophisticated goals. For example, we are working to improve planning, to bolster immunization programmes, to engage in active health promotion and education, to monitor, contain and prevent disease and to address the underlying causes of ill-health, such as poverty, pollution and inequality. Diseases and their underlying causes know no boundaries. Neither do their solutions. WHO's great strength, like that of the European Union, lies in working together, in pooling our best resources, sharing our experience and insights. Together we have made a difference and will continue to make a difference. The European Union has embarked on a process of enlargement to include countries of central and eastern Europe. We look forward to welcoming and uniting with them as they bring their individual experience, vision and skills for the benefit of a wider population. The health output of enlargement cannot be overlooked and will be taken into account as the accession negotiations proceed. Partnership between the European Community and WHO at headquarters and regional levels, has grown steadily over the years. Successful initiatives, such as the healthy settings and the work the Regional Office for Europe is doing with the accession countries, are testament to this collaboration. Together we are building a firm foundation for a future mutually supportive of initiatives as the Community develops a new framework for action in the field of public health. Since the last World Health Assembly, the Health Council met in December under the Luxembourg Presidency and again two weeks ago; Member States of the European Union agreed to shift from a fragmented set of public health initiatives to a much more coherent approach. The Commission has proposed that the community should concentrate on three strands of action. They are, firstly, improving information for the development of public health; secondly, reacting rapidly to threats to health; and thirdly, tackling health A51NR/5 page92 determinants of health promotion and disease prevention. These are priorities for all of us here. Together, with other health-related community activity, they underpin the new global health-for-all policy for the twenty-first century and complement the draft European regional policy, for which the Regional Director and his staff deserve much credit. Support by this Assembly for the Executive Board resolution on the allocation of resources will help those countries in greatest need in the African and European regions and ensure international cooperation brings real and lasting benefits to all. These are ambitious and far-reaching policies. New approaches are required, making full use of technological advances, to translate these policies into better health in practice. Our aim as individual States, as Members of the European Union and as Members of WHO, must be to ensure that our policies are coherent and secure a healthier life for the people we serve. Before closing, I would like to say a few words as the Minister for Public Health of the United Kingdom. This week the G8 leaders meet in Birmingham. They are expected to give broad support to the planned "roll back" malaria initiative, advocated by Dr Brundtland. WHO, with its experience and contacts, is best placed to lead this initiative. Our combined efforts should reduce considerably the burden of this terrible disease, whilst supporting the further development of national health systems to sustain the fight against all forms of disease. This year, we will be celebrating the fiftieth anniversary of the foundation of our National Health Service. We are proud of our health service and value the contribution of the many staff down the years. The NHS is being equipped to meet the challenges of the twenty-first century with strong emphasis on quality of care, efficiency and equality of access. But we are also determined to tackle the root causes of ill-health and to reduce health inequalities. Our programme demands concerted action across government and in partnership with local communities, organizations and individuals. Our people expect and will receive a modem and dependable health service. We took a major step towards improving our nation's health earlier this year with the launch of our new public health policy. We will focus on heart disease and stroke, accidents, cancer and mental health and have national contracts for health focusing on these areas. The contracts will set out the balance between government action, local action and informed individual action to achieve better health. It will also target healthy schools, workplaces and neighbourhoods. A multisectoral approach will ensure more effective prevention and better health. My final remarks concern tomorrow's election. We look forward to Dr Brundtland receiving unanimous support from the Assembly. This will send out an important signal. The strength of WHO comes from the commitment of its Member States working together, united in pursuing common policies. We look forward to working with her and her colleagues and offer her our very best wishes for the future. In conclusion, worldwide our health services are developing and flourishing within the context of the traditions and policies of our own particular countries. At the same time, we share a common public health agenda and we must seize the opportunity for collaboration, cooperation and sharing information. Because 50 years ago we could never have envisaged the extraordinary pace of progress, both in terms of technological advance and the treatment of disease. And I believe that in I 0 years' time, let alone 50, there will be further advances which we can barely dream of now. This great partnership which is WHO, will play a key part in delivering that dream to the people we serve. The PRESIDENT: .·<...1"'=' •)\ u ~I r--"4 ~i ~~ -?IJ a.;ll.-.::JI I~)) ~\ ~tk._r.l ~..I...>..WI a...s:J....JI ~J...L:..J I~ LW\ a...:...J.ll ._~i ~~\!!\~..LW LW\ a...:...J.l a-_;All d.:.-Li;J a.....kJI o.h. r;!f-" c.>'JIJ 4.::lJ.JJ'JI ~L.JI ~ ~l.:dl LW\ d...... k..l ...u..:__; \...U:. L.i ·cYI.i~ J~ ~~\....;:,.\ ~I i~ ~ V ~WI Jl yi..P>ll4 .l>-~ ~l.:dl .a.....kJI ~.J The meeting rose at 17:50. La ~eance est levee a 17h50. A51NR/6 page93 SIXTH PLENARY MEETING Wednesday, 13 May 1998, at 9:00 President: Dr F.R. AL-MOUSA WI (Bahrain) SIXIEM'E SEANCE PLENIERE Mercredi 13 mai 1998, 9 heures President: Dr F .R. AL-MOUSA WI (Bahrein) 1. PROGRAMME OF WORK OF THE HEALTH ASSEMBLY PROGRAMME DE TRAVAIL DEL' ASSEMBLEE DE LA SANTE The PRESIDENT: ~~ ;.M.D ~~ ~ ~t; f. .; y.L. IJ4i \ " u--i 1¥~1 .; ...:; )ii a..WI ~~ 0i ~i 0i ::. Ji _;.l~'i ~)I ~I ~J e:_-- JJI..!.::ll ~~ ~Y.J JGI ~t;).l clfll ~ ~IJ 'tfr"'f.yl .y -~~ ..;;) ~lj ).1 ~) 4W i..\Z -~~ J_;; ..W _;.1?1 ~i 1..5) 'i ~ydl I.:U. ~ ~\ ~ ~\ ._;;ly ~ y-1iill L.,..l>- a...... l:.,. _j ~\ ~ ~~ ~), ::.~'il JIJ)i ~ J)f.y\ _i-_;:11 _j iy.-\1 ~\ ~ ~ a...... WI a...... k.JI ::. _,u J ,t.,.:.WI a...... k...\1 ~ ,y- 0~')\J :t.-1$. a...... k. ..LW ~~ ~J , "rWI_r...WI" : \ '\' ~I ,.} . ~~~ ..;:..;)I ,.} "i" ~I ~ 4. ' \ . ) '\ .:r-~1 ~tl.o Jl dl~ ~ t~'il ~~::._,..A> 0i L;.. ~ 1.L.J ,~ 0JAJ.} .y;~1 wu ~ Jlj\... 2. FIRST REPORT OF THE COMMITTEE ON CREDENTIALS1 PREMIER RAPPORT DE LA COMMISSION DE VERIFICATION DES POUVOIRS1 Dr SHANGULA (Namibia): I refer to document ASl/31, Annex. We have noted that the name Namibia is missing from the list of countries whose credentials have been accepted. The PRESIDENT: .I~ ~ ~ 01 ,~ ,a.d.A.ll o_,.u.ll o~l} ~ ~~ _;; d...,.f;i....; r .;11 ~l:ll :_,.u.11 ~ ~L>.I u~ .1_?.j,J .<.S_r:-1 o_r ~w uf ,.!.1.11_;.....1 :.J !l~ ~~l>. .:r J~ l.l.P> y. JIJ} ~ ~ ~ JIJJ~I oh ~J ,L.P>::.\.~1 JIJ} ..;_....U yl:ll ~l...a&-~1 JJ..UI ui a.iL..~I ~i yl:ll ::.L....::&-~1\ JIJJi ~ ..::...... j ,~LJI ~ .y J.--11 <.S_r>. ~ ~J .jl..,aj)'\ _j tb:J ~ :.~)'\ ,~_,;1 ,~ '4):. ,uk-_,11 ~)i ~J~ ,0\.::....j\.Aif :.~\ JIJJi r,/'J ,J>-I...tll rt.\::i.:.ll C:: w\p ~...l>.-JJ Jl.i;_).IJ ,o..~.>_,..JI 4.~J~ .:;.,4_)JJJ 'Jfr.?"" ,~) :~l:ll ~~~~ JJ...UI a.lt>. _.; L..i .~lj ,~\.j ,ut:....>ljiS'" ~ J :.~\ JIJJi ~ uf ~ )I Lf.ii )'I ,~1 .ft!J...L:..JI ~t...... l .:,r.& .:;.,\}k>· )'I ul.i ,u\..:;....S'L>.\.1 J 0 ~~.ft'"" J ~ J_,.»...ll )~~~CO _,l..:;j_;.. :.j)l o.l.P> as'J\...!.... JA ~~ ~} .!.1.1~ C:: ~i )11 ,J>-I...tll rU:i.:.!l JiJ -~ )1\..P>:.~\ JIJ} j...z; ~J ~\ ~~lr- )'I l.l.P> ~ ~\ Jil.f y. .~ \.jf ..::...... i .jl :.~)'\ JIJ} aiLPI C:: _;._;:.\1 ~ l..i.l ,.:;.,L.p\~1 (,?i <.S) )I .4J~i ~I Jjl::...:.... J a..WI a....WI o.l.P> u\11 c!JL . ~\,; y J..l:.e Professor PAKDEE POTHISIRI (Thailand): Before you adjourn the Plenary, I would like to ask for a point of clarification regarding some of the announcements in today's Journal. On page 3, there was an announcement that there will be a consultation meeting on agenda item 27.2 in Room XVII, immediately after we finish item 12 in plenary. Mr President, I wonder about these consultations: how could this happen, I mean without our knowledge? I think a number of other delegates also share my concern. So I have several points for clarification. What kind of consultation is this going to be? What kind of procedure is going to be followed? What is the objective of setting up this consultation, and what would be its outcome? The PRESIDENT: . ')\ ·~ Mr AITKEN (Assistant Director-General): Yesterday afternoon in the General Committee, the Chairman of Committee B reported on progress in the Committee. He advised that the timetable was very tight and, in discussion, he proposed that nevertheless in order to clear the way for what was likely to be a controversial item, we might consider item 27 .2, in particular regional allocations, on Friday. However, in the General Committee there was some concern about the timetable, and another suggestion was made that, in addition to consideration either on Thursday or Friday of the substantive item in full Committee, informal consultation might take place earlier. The Chairman of Committee B indicated that he would have no objection to such informal consultations, and the Legal Counsel 1 See reports of committees in document WHA5111998/REC/3. 1 Voir les rapports des commissions dans le document WHASl/1998/REC/3. A51NR/6 page95 indicated that it was the normal practice of the Organization to hold such consultations informally in order for work to progress. The President at that time indicated his concurrence with these informal consultations and the text was added to the Journal. It is our intention at the consultations, as the Secretariat, to indicate to those attending the state of the documentation on the matter and to respond to any questions raised. Then the Chairman will need to determine whether any further progress can be made in achieving consensus amongst Member States in order to prepare for the full session on this item of Committee B, which is expected to take place either tomorrow afternoon or on Friday morning. The PRESIDENT: :~)I ~ ~ jl....; ~ \lA yl>. i ~ d.f-.:;. -~lj YJ...L:.o Professor PAKDEE POTHISIRI (Thailand): I am sorry to disturb you once more. I think the members of Committee B should at least be consulted on establishment of this kind of informal consultation before making a decision on it. This is just my comment. I do not want to prolong any further discussion on this, but I would like this to be put on record. . •)\ The PRESIDENT: ·..r-' . J _,;\.All 1 L.!.:;...... )I Jl t_.,.P _,.JI \lA j:>L Mr TOPPING (Legal Counsel): I confirm that it has been the common practice for the Assembly to hold informal consultations to facilitate the work of the various committees. These are not decision-making bodies, these are facilitating bodies. The Chairman of Committee B in the end took the decision that this was an acceptable mechanism given the fact that there have been proposals tabled in his Committee, and it is his implied power as Chairman to direct the debates and to facilitate the work of the Committee. That is why it was felt, when it was discussed in the General Committee, that this was an acceptable procedure and was not inconsistent with any of the Rules of Procedure and, in particular, it is consistent with the implied powers of the Chairman under rule 27. .·..r-' •)\ The PRESIDENT: Professor PAKDEE POTHISIRI (Thailand): Mr President, I am not very familiar with the Rules of Procedure of the Assembly, but I rather doubt whether this kind of establishment of informal consultation during the Assembly could be regularly or legitimately made by decision of the General Committee, instead of informing this General Assembly and asking for endorsement or approval. So I also need clarification of the Rule of Procedure that has been referred to. The PRESIDENT: :~)1 Dr SHISANA (South Africa): We also concur with the position that has been stated by Thailand because we believe that if an item is going to be discussed informally, that should be a decision of a formally constituted meeting, in a committee. And if the Committee has not mandated that informal discussion, the legitimacy of its outcome will necessarily A51NR/6 page96 become questionable. For that reason, we strongly believe that it would be better for a matter to come first to the Committee for discussion, the process agreed upon at a meeting and, thereafter, the outcome of that discussion be tabled in the Committee as a formal document. ' The PRESIDENT: The public meeting was adjourned at 9:40. La seance publique est levee a 9h40. 3. DIRECTOR-GENERAL DIRECTEUR GENERAL The meeting was held in private from 9:40 to 11:50, and resumed in public session at 11:55. L' Assemblee se reunit en seance privee de 9h40 a 11h50; la seance publique reprend a 11h55. . ')\ The PRESIDENT: ·~ .a...WI a...... kJI c_Lcil ~i ~ t_,....Py 0L!.; ~ a...... WI L..k..\1 ~ LA_r. .h. o~~l ~ -;lll )_}ll ~ _,l;i 0i J~ ·iWI..r...WI ,0~\J ~~WI ~WI ~I~ .~WI ~~ ~ w~ l..r....L.t .,l;')\.:; J.r. ~.Jt..o. J.J- o.JpJJI ~,-;~I~~~; JP r.L:; :.o...a.i llP. iWI ..r...WI ~ JPllii_,.J~ ~~\)}a.,.,~.> 4...... 1.,. J t..a:i ~I..::..>~\) ,0~\J ~~WI ~WI ~I~ ,.1, )~ ~~ -;.lJI ...I.....WI ~ ~\ ~ J>"IJJ\ i\.1i:.ll ,.:.r \ • ~ o~WIJ .J_,:;...JJI :y i \ o~W~ ~ iWI ..r...WI .!.I.Jt..::.: ~ - \ : ~~ t~l JP Jl.:ll j:...u.::ll a;~...p\ ?::: 1.5 _r:- ~I <~.Jl..a:_,.u J ~I.JJ iWI ..r...WI ~ i~iJ ~\ ~lS ~\ ..::..>tS'I~~\ ,jl..PI ~_rS' ~) o~l ~~\ ~_,.J .!.I_;.WI -;~li:ll JJ~\ J ~\JJI iWI .:.r- \ \" ;;~LJ~ ~ ,L;~ .~ tS').... ~ iL..JI ..r...WI 0t5") ~li:l\ JJ..U.... 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J5"" 4J .JJ.Z J r) . ~I )_}JI ~\.>..;\ JP ~ 0 )~\ ~ ~~ __;; J .~WI r.~i ~ J 4-! ~ ~I ~l..l..a.A.IIJ ~ o _r..jl JI...LJ>~I ~ ~) U"~\ J J.-~1) d.A!:ll t.J) a....)~ ..1.,!-l>.- 0} ~JP~~ ~ILP>J ·U"rl- c!IJ Jl ~ ~~ P.f ~).J ~fiJ oy.~l ~~ ~ _,p.JI JP 4-tS'U if-JP"' .JPJJ\ ~I Jl ..r.iliiJ ~~ )ly. i.J.Zi 0i ~WI o~ ~ ~ ~J ~ ~) ~~ J\..w.~IJ (..5"~~~ ~ ~w1 ~~JP...... ,?) cr.r.JI 0.;J1 :.r .r.>-~1 .l.w1 11P. ~ 4-JJ; · · .o~l...... JIJ ~~ .J_; _,. .J ~ 4-!ly.i JP 0'11 ~ ~~-" ••• . <~.JtS'f.) .ill\ d...> .J) ~ i')LJIJ .~_r~\ ~~\ :_r d.;~~ ~\ J}-il ~ )\ ..,_JU yJ-.JL. 0t-..}; o.Jp.ill 0'11 a...J5JI ~i A51NR/6 page97 La Dra. GUZMAN MARCELINO (Republica Dominicana) : Distinguida doctora Brundtland, Directora General electa de la Organizacion Mundial de la Salud; doctor Nakajima, Director General de esta Organizacion Mundial de la Salud, a quien debemos reconocer la labor que ha venido realizando al frente de nuestra OMS; senor Presidente de la Asamblea; senor Director Regional para las Americas; distinguidos miembros de la Mesa; distinguidos delegados, distinguidas delegadas, senoras y senores: Ante todo doy las gracias a la Asamblea por haber acogido la propuesta de la Comision de Candidaturas en el sentido de presentarnos como Vicepresidenta de esta y en representacion de la Region de las Americas. Nuestros paises tienen un gran reto para Ios anos que nos restan de este siglo y para Ios anos del siglo XXI que se nos aproxima. El reto de seguir mejorando Ios indices de calidad de vida es mayor para una gran parte de nuestros paises, ya que nuestra pobreza es mayor y, como bien se ha expresado aqui, una forma de mostrar la reduccion de pobreza es presentar mejores indices de salud. Tenemos que bajar nuestras tasas de mortalidad materna y de mortalidad infantil. Tenemos que bajar la morbilidad de nuestras enfermedades tropicales. Tenemos que mostrar estadisticas sin tuberculosis. Debemos detener el VIHISIDA. Debemos mejorar la salud de nuestros trabajadores. Por otra parte, afrontamos las realidades que acompanan al avance hacia el desarrollo, como son la discapacidad, las muertes por accidentes de transito y la violencia en sentido general. Pero ademas, gran parte del aporte a nuestro producto bruto interno procede del turismo, por lo tanto cada vez debemos mejorar mas nuestra salud ambiental. Por ultimo, y muy en especial, nosotras las mujeres y ustedes, hombres, hijos de mujeres, debemos aunar grandes esfuerzos en favor de la salud de la mujer, reducir el cancer de mama, reducir el cancer del cuello uterino y reducir, mejor dicho aniquilar, la violencia domestica y contribuir con todo nuestro esfuerzo a que ellas, dentro de Ios pobres, dejen de ser las mas pobres. Distinguidos amigos, distinguidas amigas, doctora Brundtland, ante esta realidad no estamos solos. Grandes naciones muestran en la practica su solidaridad y ademas sabemos que podemos contar con organismos internacionales, como es el caso de la Organizacion Mundial de la Salud, que a traves de su dirigenta maxima, Dra. Brundtland, colocara la salud en el primer punto de la agenda politica de todos Ios Estados Miembros. Sus oficinas regionales trabajan dia a dia, han vencido obstaculos y han tenido exitos, pero tambien fracasos. El desafio que tenemos por delante es muy grande, como hemos expresado. Como mujer me siento muy optimista frente a estos grandes retos. En efecto, una mujer, la Dra. Brundtland, asumira el timon de esta Organizacion y en cada momento dejara bien claro su rol de lucha por la salud de todos; una mujer a la cual hoy conocemos personalmente, pero a la que ayer conocimos por sus referencias; que es una persona conocedora de las particularidades de cada region, conocedora de que Las Americas, aunque con problemas comunes a las otras regiones del mundo, tiene sus caracteristicas, caracteristicas muy especiales. Ella es conocedora, ademas, de que en nuestra Region afrontamos el flagelo de la deuda externa, de que, ademas, debemos insertarnos en ese proceso que se inicio luego de la guerra fria, la globalizacion, pero que ademas debemos pagar una gran deuda social acumulada y concomitantemente mirar hacia el futuro, mirar y continuar hacia el desarrollo. Doctora Brundtland, le hacemos una formal invitacion a nuestra Region. Nuestro continente es muy variado, de grandes selvas unos paises y de grandes desiertos otros. Son paises pequenos y paises grandes; algunos ricos; paises de nieves y paises de tropico; paises de grandes inequidades; paises con diferentes musicas, unos de rock, otros de salsa, otros de samba, otros de cumbia, otros rancheros y otros de merengue. De grandes inequidades deciamos, pero tambien de un gran potencial en nuestros recursos humanos y naturales. Queremos invitarla a conocer nuestra rica cultura, nuestra diversa experiencia y nuestro espiritu solidario y hospitalario. La invitacion, doctora Brundtland, la hacemos hoy de manera formal y si puede pasar por la Republica Dominicana y las islas del Caribe, recibira ese sol que dia a dia le daremos. The PRESIDENT: :~)1 Dr DLAMINI ZUMA (South Africa): Honourable delegates, President, Dr Nakajima, Dr Brundtland, it is indeed an honour and a privilege for me to address you on behalf of the African Regional Committee, the African Region and on behalf of my own country. May I begin by recognizing Dr Nakajima's commitment and many contributions to world health and A51NR/6 page98 wish him well in his future endeavours. Indeed it gives me great pleasure to congratulate Or Gro Harlem Brundtland, on behalf of the African Region, on being the first woman Director-General of the World Health Organization. Or Brundtland, as we all know, is well qualified for this position, first as a woman, as a mother, a medical doctor and a public health expert, a leader, an international negotiator and former Prime Minister of Norway. In all these capacities she has excelled and we hope that experience will enrich our Organization. This daughter of Norway and Scandinavia has a long and proud tradition of providing support for development and just struggles. My country and many other countries in Africa and in other developing parts of the world bear testimony to that. This tradition of solidarity is evident in the election manifesto of Dr Brundtland which had as its central theme the issues of equity and justice. As Africans, we welcome her resolve to focus on the health problems of those in greatest need. This indeed epitomizes the age-old African tradition of Wuntu which has at its centre the essential elements of caring, sharing and solidarity. However, I am sure that you will agree with me that these good intentions would have to be accompanied by strong, yet sensitive, leadership if WHO is to re-establish itself as a premier organization in world health. It will require her skilful negotiating skills but, at times, it will require courage to speak and act in defiance of convention and tradition in order to create new traditions and appropriate conventions. The world we live in today is very different from the one that existed 50 years ago at the founding of this Organization. The progress of global liberalization of trade continues to present a myriad of challenges to public health. These challenges require a coordinated response led by the health sector, but with the activ'b participation of stakeholders from all sectors. Who can be better suited to build such consensus than someone who has headed a coalition government for 10 years? However, in order to succeed, Dr Brundtland will need the support of a strong cadre of committed health ministers and Member States who have the courage of their convictions and are prepared to back courage by word and deed. She will also need staff, more staff from developing countries who are committed to contributing to the efforts of WHO, but also to going back to their countries and enriching them with their international experience. The interest of public health will require a strong voice and a united effort if it has to be protected from the ravages of unrestrained commercial interest. However, an efficient WHO would be equal to these challenges. In conclusion, speaking as I do on behalf of the Region with grinding poverty, two-thirds of the world's HIVI AIDS cases, the majority of infectious disease problems, the majority of poor women, displaced women and children and refugees, I wish to declare my Region's support and commitment to working tirelessly with you and with WHO under your leadership to solve the problems of our continent. I would like to congratulate you and tell you it will be turbulent at times, but our collective effort will make WHO an organization well suited, under your leadership, to ushering us into the new millennium and making the African renaissance a reality. I thank you. . •)\ The PRESIDENT: ·~· .:..~ (.,)l.JI ~}J ..!JL!ll ~Wll ,~ ·[. ~ 0-:JI ~I ~i) ,L..)j r.;:--'1;) o.Jp..ill I~ .~T J_r;. Y.F ~I If~~~ Mr THINLEY (Bhutan): Mr President, Or Nakajima, Madam Brundtland, Director of the South-East Asia Region, distinguished delegates, I have the honour to speak on behalf of the countries of the South-East Asia Region and on behalf of my own country, the Kingdom of Bhutan. Festive bells have been rung. This Assembly has just exercised one of its most important rights, the right to choose in the most democratic fashion the next leader of the World Health Organization. I believe that, as in the past, in exercising this right the countries of my Region, and indeed all Member States, have demonstrated the common desire to place the leadership of this Organization, with the responsibility for promoting global human health, upon the shoulders of the most worthy and capable person that is available. The wise selection of dedicated, visionary and skilful leaders in the past has made this Organization indeed indispensable. The countries of the South-East Asia Region are deeply appreciative of the many contributions Or Hiroshi Nakajima has made both in his official and personal capacities. We wish him well as he assumes the position ofDirector-General Emeritus and continues his association with the Organization of which he has become an inextricable part. We would like him to accept this position as a token of our appreciation for the services he has rendered to the 191 Member States. It is also a symbol of our high esteem for his personal and A51NR/6 page99 professional qualities. Dr Gro Harlem Brundtland is now our unanimous choice to lead this Organization into the twenty-first century. The south-east Asian countries join the other regions in extending to her the heartiest felicitations upon her election. We find it most auspicious that on the occasion of WHO's fiftieth anniversary, and as we share our hopes and aspirations for the well-being of human society in the first quarter of the next century, we should all feel exhilarated and optimistic upon the election of our new Director-General. We welcome her as a Norwegian woman of great courage, imagination and vision. Having distinguished herself as a medical practitioner, head of government and indeed as a powerful advocate of human progress, she brings with her considerable knowledge, experience and skills of a level and nature that are now essential to the World Health Organization. We are confident that she will build on the many strengths and past accomplishments and that she will inspire and lead the Organization to greater heights of glory as she fulfils the powerful mandate that she has received from this Assembly today. The tasks ahead are indeed daunting. As all humanity transits into the global village, the emergent health situations will demand greater dynamism and far more rapid response capability. The dynamics of the evolving environment and the resultant changes in human behaviour, lifestyles and demands will challenge the capacity of medical science itself to stay relevant and proactive. And there will always be the constraint of resources both for the activities of the headquarters as well as for the regional and country programmes. My Region, which is the home of one-quarter ofthe world's population and bears the largest disease burden, continues to struggle for a better health status of its people. Just as we look for her guidance and support, we would like her to know that she will receive our unstinting support and cooperation both in spirit and material terms. Lastly, on the occasion of the fiftieth anniversary and on this particular occasion, I would like to pay homage to the dedicated and highly-competent professionals and other staff of the World Health Organization at headquarters, regional and country offices for their services. They deserve our heartfelt gratitude. Once again, we wish to congratulate Dr Brundtland upon her unanimous election and wish her success and satisfaction in the fulfilment of her most important mandate. The PRESIDENT: :~)I ~\'1 ~ a.y.l4 ~ <,?lll ~_)j tll)l ..,_JWI J j\...... jl ~\.:....~ 0\11 a....l>JI ~iJ ,~ ..l:-lll~ ·~J.JJ~I BbiCTYllREHHE r-na MHCAHOBA (A3EP6AA:,ll)I(AH): Professor INSANOV (Azerbaijan): Ysa>KaeMbiH llpe.nce.naTenh .n-p Anh MycasH, rny6oKoysa>KaeMbiH renepanbHhiH .D;HpeKTop B03 .n-p 6pyTnaH.D;, Ysa>~ llpe>K.ll:e scero paapemHTe nepe.naTh BaM cep.n;eqnhle H HCKpeHHHe noa.npasneHIDI llpeaH.nenTa Aaep6ait.n)f(aHcKoH Pecny6nHKH Ero llpesocxo.nHTenhcTsa r-na reit.napa AnHesa no cnyqaiO DHTH.necHTHReTnero I06HneH BceMHPHOH opraHHaawm a.npasooxpaHeHHH H naqana pa6oThl llHTh.necHT nepsoit ceccHH BceMHPHOH accaM6neH a.npasooxpaHeHHH. noasonhTe oT HMeHH llpasHTenhcTBa Aaep6aH.D;)f(aHa, OT CBOero HMeHH Bhipa3HTh OrpOMHYIO 6naro.napHOCTh 3a OKa3aHHYJO MHe BbiCOKYIO qecTh 6h1Th Ha6paHHbiM s KaqecTse BHue-llpeaH.n;eHTa llHTh.necHT nepsoit ceccHH BceMHpHoii accaM6neH a.npasooxpaHeHHH. Cero.nHH npoHaomno oqeHh sa)f(HOe MH BceMHpHoii opraHH3auHH a.npasooxpaHeHHH co6biTHe: Ha nocT reHepanhHoro .n;HpeKTopa B03 BceMHPHaH accaM6neH a.npasooxpaHeHHH H36pana r-)f(y rpy XapneM DPYTRaH.D;. Jl-p DPYTRaH.D; ORHUeTBOpHeT pyKOBO.D;HTeRH, 8 KOTOPOM coqeTaJoTCH BCe KaqecTBa COBpeMeHHOfO RH.D;epa, a HMeHHO: rH6KOCTh YMa, YMeHHe 6biCTpO pearHpOBaTh Ha DOCTOHHHO MeHHIOIJ.IHeCH YCROBHH COBpeMeHHOii )f(HJHH 06IUeCTBa, npeKpaCHOe 3HaHHe npo6neM 3.D;paBOOXpaHeHHH, OpHBep)f(eHHOCTh DORHTHKe .D;OCTH)f(eHHH a.noposbH .nnH scex, y.n;aqHoe coqeTaHHe onhiTa npesocxo.n;Horo nonHTHKa H spaqa. ~ocTaToqHo cKaaaTb, qTo .n-p DPYTRaH.n 6hiRa MHHHCTpoM oKpy)f(aiOIUeH cpe.nhl. qneHoM Hopse)f(CKoro napnaMeHTa H TPY>K.ll:hl H36Hpanach llpeMhep-MHHHCTPOM HopserHH. Hcnonh3YH cso10 nonHTHqecKYJO Kaphepy, .n-p BpYTnaH.n aKTHBHo no.n.nep)f(Hsana a.npasooxpaHeHHe, o6paaosaHHe H npo6neMbl ceMhH. HaM oqeHh HMDOHHpyeT TOT cj>aKT, qTo r-)f(a BpyTnaH.n HBRHeTcH npe.ncTaBHTeneM EsponeiicKoro A51NR/6 page 100 perHOHa. 0Ha SIBJISieTCSI nepBbiM BHeiiiHHM KaH.[{H,llaTOM, H36paHHbiM Ha nOCT ieHepaJibHOfO ,llHpeKTOpa B03. 11 HaKOHeU, HaM O'leHb npHSITHO, 'ITO OHa SIBJISieTCSI nepBOH >KeHijJHHOH, H36paHHOH Ha TaKOH BbiCOKHH noCT BO BceMHpHOH opraHH3aQHH 3,llpasooxpaHeHHSI. KacaSJ:Cb coTPYAHH'IeCTBa B03 c A3ep6ai1.n>KaHoM, xoTeJIOCb 6hl c 6oJibiiiOH 6naro.napHOCTbiO OTMeTHTb nOMOijJb H no.n.nep>KKy EsponeHCKOfO perHOHaJibHOfO 610p0 H ero YBa>KaeMOfO .[lHpeKTOpa .n-pa AcBaJIJia, B pe3yJibTaTe KOTOpblx HaM YAaJIOCb JIHKBHAHposaTb noJIHOMHeJIHT, AH Mr PRETRICK (Federated States of Micronesia): Mr President, Director-General, Dr Brundtland, excellencies, distinguished delegates, ladies and gentlemen. On behalf of the countries of the Western Pacific Region, I would like to offer our sincere congratulations to you, Dr Brundtland, on your election to the post of Director-General of the World Health Organization. This is indeed an auspicious year for WHO. As we celebrate the Organization's fiftieth anniversary during this Assembly, we are also addressing important issues of reform in WHO - the review of the WHO Constitution and the reallocation of the WHO regional budget to ensure that resources are focused on those in greatest need. We will also be considering a new health-for-all policy that will lead us into the twenty-first century. And to help us face these new challenges, we have just elected a new Director-General. The Western Pacific Region is the most diverse of all the regions of WHO. It counts among its Members the country with the biggest population in the world, China with its 1.2 billion inhabitants and small island countries like Nuie with a population of less than 2000. Our Region ranges in membership from some of the least developed countries to some of the most developed. In spite of this diversity the countries of the Western Pacific Region are bound by one common objective: to ensure the health and well-being of the people of our Region. Together we are preparing for the health issues of the twenty-first century, building on our common features and utilizing lessons from our diversity. The countries of the Western Pacific have benefited greatly from their membership of WHO and as we develop, our contribution to the Organization in terms of expertise and experience increases. Dr Brundtland, on behalf of the Member States of the Western Pacific Region, may I take this opportunity to extend to you our pledge of support and collaboration to ensure further success for the World Health Organization and for the health of all peoples of the world under your leadership. A51NR/6 page 101 The PRESIDENT: :~)1 Dr SALLAM (Egypt): Mr President, excellencies, distinguished delegates, Dr Brundtland, ladies and gentlemen. I am speaking on behalf of the Eastern Mediterranean Region and I would like to express my thanks and gratitude to the delegates for asking me to make this speech which I will make very short. I would like to express our sincere congratulations to Dr Brundtland on her appointment as Director-General of the World Health Organization. We have strong confidence and faith in her efficient management, in the coming years, of the high goals that we have put together for a better future for our Organization. Sometimes our goals may appear to require miracles to achieve, especially in the face of numerous, tedious challenges all over the world. Some of these challenges are out of our hands but Dr Brundtland, you will not be alone. All of us are standing behind you, all of us are supporting you and all of us will be sharing the challenges with you. The goal of health for all can be achieved if there is much more active sharing and working together. Dr Brundtland, you have seen the warm reception from everybody and I am not surprised that the tire alarm went off, obviously because of the heat coming from this forum! I am sure everybody is very optimistic, everybody feels that we are heading in the right direction. Dr Brundtland, I would like to express our sincere wishes for you, all the luck. I would also like to take this opportunity to express our thanks and appreciation to Dr Nakajima for all his efforts and achievements in the last 10 years. The PRESIDENT: .·i..J'"'=' ')\ ~~ ..w")\;:;J_r. ~.;u J~ o_;p...UI ~ .:r ~~ .,bi ~ Jl 0~1 JAz.:.IJ i":A- .YL..-1 .;P..ill~~ ~a...WI ~I .y;. ...::...UIJ (.)..iJ\ ...\.A.Ji .,~...,a...IJ ~WI ~I~ \....I.P l.r....v op>.J O._r. L a...WI ~I 4¥ ~ ~.) ..::..~ ;) .J>.<-" ~.;l.:i ~ ~..~.>. 1 ~.P .r....v ~ .:r ~~ .,bi ~ :,1 ~~ 0i ~i 0~ J _y. i~ p J iL.JI .r...WI JJ...U ~WI J J...U\ l:'\,6.ll ,_}>- ~ ~\ ~ ~ JY:'...UI :lly .y ~l-1 o:l\.... ,_}>- ;)~ 0i ~i ~Ji 0i :lJiJ .(,?~1 ~I Ji ~I I~ ~I c)> akL '4\ .y ..::..~ iWI .r...WI .jt jly .r-:!..w1 ~ r4-- ~ iY- ~~ 4-Jy.l-- 04.r" i~ ~ _y; ~ .li")\;;;J_r. ~.)~.;:. J~ o.;p...01 ~ ~~ ~~ .J:U L ~I -.i )i (,?..iJI ...\.A.Ji i~l; ~ iWI .r , , -, J , • - , ~;)L.J\ ~ ~ vP ~~ ~~ ., bi ~~ .li")\;:; Jf. ~ _;\.;:. J~ o.;P ...UI 0~1 y:li. - ._;y...... Ui .y 0_,")1.!\IJ ~WI o:lWl; ~ ~~ ~ _,..J (..S""'l-~1 rl.ldl .~1 iL..i a...lS"' .,tAJI Jl .li")\;;; Jf. o.;p...01 _y;i 0~1 (Applause/Applaudissements) Dr Gro Harlem Brundtland took her place on the rostrum. Le Dr Gro Harlem Brundtland prend place a la tribune. Dr BRUNDTLAND (Director-General elect): I solemnly swear to exercise, in all loyalty, discretion and conscience, the functions entrusted to me as an international civil servant of the World Health Organization, to discharge those functions and regulate my conduct with the interests of the World Health Organization only in view and not to seek or accept instructions, in regard to the performance of my duties, from any government or other authority external to the Organization. (Applause/Applaudissements) (The Director-General elect continued in French.) (Le Directeur general elu poursuit en fran~ais.) A51NR/6 page102 Monsieur le President, perrnettez-moi de remercier I' Assemblee mondiale de la Sante pour ce vote de confiance. Perrnettez-moi aussi de saluer les milliers d'hommes et de femmes qui ont contribue au travail de notre Organisation durant ses cinquante annees d'existence. En ce moment particulier, je souhaite saluer notre Directeur general, le Dr Hiroshi Nakajima, pour tousles services qu'il a rendus a la cause de la sante pour tous durant ses longues annees au service de I'OMS comme Directeur regional et, surtout, pendant ses deux mandats en tant que Directeur general. Merci, merci beaucoup. (Applause/Applaudissements) (The Director-General elect continued in English.) (Le Directeur general elu poursuit en anglais.) Mr President, This is a special moment of responsibility. You have given me confidence and I feel responsible towards all of you and to the peoples that you represent. Since I made my basic choices in life I have thought of myself as a doctor who wanted to heal and who wanted to change. Not least to change the causes of suffering and injustice. I believed that societies can be changed and that poverty can be fought. That people working together can achieve impressive results. This I still think and know. We can harness the resources. We can mobilize the will. We can inspire the extra effort. I feel that I can ask for, and that the peoples of the United Nations have the right to count on your support and active participation in the future work of the World Health Organization. That support will be needed. There is hard work ahead. I may ask for more than you have been used to being asked. You represent the owners of WHO, the shareholders and the stakeholders, all those who need us to succeed. We need political guidelines from this Assembly. We depend on how Member States follow up at home. We depend on how they live up to the imperative of equity and social justice, expressed in health for all. The challenge goes to all of us. WHO can and must change. It must become more effective, more accountable, more transparent and more receptive to a changing world. Member States must take responsibility for the targets they set and provide resources. They must practise what they preach from this rostrum. I believe we can forge stronger relations with Member States. Keeping you better informed of how WHO develops, seeking your advice and when needed asking you for an extra contribution. Without a sense of partnership between the Organization and its owners, our work will prove exceedingly difficult. With a unity of purpose we can unleash real momentum for health. That momentum will be needed as we approach a new century where WHO must cope with complex processes of transition. The transition from one century to another sees changes which will be faster and more dramatic from an economic, social and health perspective. The twentieth century gave the world more health advances than in the entire previous history of mankind. Still we are faced with daunting challenges. Above all they are linked to the persistence of poverty. The imbalances are striking. People in developing countries carry over 90% of the disease burden, yet have access to only I 0% of the resources used for health. This is unacceptable. This has to change. Wealthier countries will benefit by contributing and they have the moral obligation. Governments in poorer countries must acknowledge their responsibility, they have a moral obligation to give priority to health and to equitable distribution of health services. We have another transition, the transition from the communicable to the noncommunicable diseases. They cannot be seen as competing tasks. They are complementary. We need to fight both. The burden of disease is the burden of unfulfilled human development. I hear some say that infectious disease is becoming yesterday's problem. But is that correct? I don't believe so. There is an unfinished agenda of eradication and rolling back diseases. No one should underestimate childhood infections, HlV/ATDS, TB, malaria, polio and the other new and emerging diseases. They may hit us all in this small world- but above all they keep ravaging the lives of the poor. A51NR/6 page 103 WHO must be an enduring advocate in the fight against infectious diseases. And WHO must help governments face the daunting challenge from the new epidemic of noncommunicable diseases, now spreading in the low- and middle-income countries. We need to anchor health in a broad setting. Globalization is opening up new opportunities for growth and progress. But the benefits are not adequately distributed. Globalization has also brought new and critical threats to health and the environment. We have to reach out to new arenas critical for the health of billions. The next century may well be one of great environmental crises. But it need not be. We still have the opportunity to make timely decisions before we have to pay the bills of overburdening the capacity ofthe planet, its resources and most importantly - the health of its people. World trade, environmental changes, lifestyles and culture; in all these fields we must be able to analyse the driving forces and speak out for health and development. The world is in transition. So accordingly WHO must be in transition. Looking ahead. Our Constitution provides us with a broad and impressive mandate. But a mandate is no roadmap. It must be made according to the needs - of the people, the communities and the nations we are meant to serve. We need to focus our work. Poverty is the greatest threat to people's health. Ill-health leads to poverty- and poverty breeds ill-health. Governments must take it seriously. Childhood diseases, malnutrition, spreading infections and excess fertility, we know the results. Only a broad alliance can manage this critical task. WHO must be the health component of that alliance impatient and ready to lead when required, our special contribution being to fight ill-health. In this process of transition - what is our key mission? I see our role as being the moral voice and the technical leader in improving the health of the people of the world. Ready and able to give advice - not on every issue - but on the key issues that can unleash development and alleviate suffering. I see our purpose to be combating disease and ill-health - promoting sustainable and equitable health systems in all countries. What should be our motivation? My answer is short: Making a difference. We should measure our work in full transparency - sharing and learning from successes and failures - our own and those of others. There are two roads we must follow: One road leads to our work on the ground. We must combat disease, premature death and disability. We must give advice on best practices to achieve equity and quality, set standards and norms. We must encourage, support and trigger the best research and development. The other road leads to the levels of political decision-making where the broader agenda for development is set. We must speak out for health in development, bringing health to the core of the development agenda. That is where it belongs, as the key to poverty reduction and development underpinned by the values of equity, human dignity and human rights. This is why I wish to focus the technical support and normative work of the World Health Organization and at the same time bring the Organization more firmly into the political arena. I wish to organize our programmes and activities around key functions that tell a clear story of what business we are in. I wish to concentrate our resources in a way which enables us to do fully what we decide to do- and to let go what we decide not to do- either because others do it better or because we simply can't do all. In the reorganization - which I intend to start implementing from the very first day - I will focus on four areas of concern: • WHO will help monitor, roll back and where possible eradicate communicable diseases. • WHO will help fight and reduce the burden ofnoncommunicable diseases. • WHO will help countries build sustainable health systems that can help reach equity targets and render quality services to all, with a particular emphasis on the situation of women and mothers who are so critical for giving children a safe and healthy start in life. • WHO will speak out for health, back its case with solid evidence and thereby be a better advocate for health towards a broader audience of decision-makers. To succeed in this endeavour we must be able to say: WHO is one. Not two - meaning one financed by the regular budget and one financed by extrabudgetary funds. Not seven - meaning Geneva and the six regional offices. Not more than fifty - meaning the individual programmes. WHO must be one: Setting its priorities as one, raising additional financial resources as one, speaking out as one. And then -but only then -can we act effectively in our decentralized diversity through skilled A51NR/6 page 104 presence at the country level, through regional guidance by the regional offices and through global direction by the headquarters and the governing bodies. With this structure and spirit in place I am ready to give a short answer when asked about my priorities: The World Health Organization is my priority. A WHO that can engage where the needs are greatest. A WHO that is trusted to maximize its resources. A WHO with excellence. A WHO that can truly make a difference. With this structure and spirit in place WHO will be the lead agency in world health. But we need a change in attitude. We cannot point to our Constitution and say: We have the right to be the lead agency. We must earn our leadership. We must demonstrate through the way we plan, structure and carry out our work that we make a difference that we and others can measure. To succeed there are a few basic requirements: First, we need a stronger partnership with the Member States. Countries must report back to us on their health status. We need to improve our work at the country level, especially in developing countries - in cooperation with national authorities but also by drawing on and expanding the contact with collaborating centres. Technical cooperation must be relevant and address the needs. We will need a much stronger focus on how health sectors are tailored to sustain activities that secure the quality and distribution of services. I will propose that health sector development becomes an integral part of all our activities. Each of our disease control units will have to identify sectoral issues where they can contribute and capacities that must be strengthened for them to do their jobs. We should not engage unless our work can make a direct contribution to the overriding purpose of building and strengthening the health sector. Second, we must reach out to others. The global health field has seen a steady increase in the number of actors and stakeholders. This we should not fear. I wish to invite those who have real contributions to make to join us. The other UN agencies are our closest partners. I pledge a strong support to the Secretary-General's call for more interagency cooperation. One obvious area is to lend full support to UNAIDS together with the other patrons of that programme. The regions most ravaged with AIDS are coming close to what most of Europe faced during the plagues of the fourteenth century. We must make an extra effort in the crucial combat against the HIV/ATDS pandemic, especially in the most vulnerable countries. We must help the health systems to cope. We must help make the scientific advances available also to the developing world. We must reach out to the international financial institutions, the W odd Bank, IMF and the regional development banks. They have a major role to play in financing sustainable development. They too are involved in health. They carry a major responsibility. We should welcome this, while reminding them of the need to safeguard health and social services. Our voice is needed to remind both governments and financial institutions that budget cuts should not be in critical sectors such as health and that the long-term expenses of disengaging in public he~lth will go beyond ~he short-term budgetary gains. We must reach out to the community of nongovernmental organizations. Their reach often goes beyond that of any official body. Where would the battle against leprosy, tuberculosis or blindness have been without the NGOs? I will convene a conference with the NGO community to draw up new guidelines for our cooperation to establish new mechanisms for interaction with civil society in Member States. We must reach out to the private sector. Countries need a well-performing public sector. Governments should ensure universal coverage of health services. We have seen evidence that growing reliance on private financing mechanisms, including private voluntary insurance, risks massive cost escalation. A key role for public finance of universal coverage results in greater equity but, also, in reduced waste and inefficiency. The private sector has an important role to play both in technology development and the provision of services. We need open and constructive relations with the private sector and industry, knowing where our roles differ and where they may complement each other. I invite industry to join in a dialogue on the key issues facing us. To this end I will propose the creation of a WHO-industry roundtable and convene a first meeting before the end of the year. Third, we must underpin our work with solid facts. For WHO to be the leading advocate for health we need to know the relevant facts, not only have the conviction that health is essential. Health is not only a moral obligation and a basic human right. Health is pure and sound economics. A51NR/6 page 105 In July I will establish a separate function on Evidence for Health Policy. We need to get our statistics right and keep them right through research and constant update. Reaching goals based on values is also measurable. We need to know the burden of disease and how health policy can contribute to change. We need to know the cost-effectiveness of intervention and we need to define our priorities accordingly. To be the leading advocate for health we need to take that evidence to decision-makers around the world. We will report on the news of fact. And the fact is that healthy people help build healthy economies. You - the Health Ministers - need no further convincing. But WHO - with you - should remind Presidents, Prime Ministers and Finance Ministers that they are truly health ministers themselves, key to the well-being of their people. Health investments are sound investments for poverty reduction and economic growth. Mr President, When I take office on 21 July my first task will be to respond to your call for reform here in Geneva and in the interaction with regions and countries. I said that WHO is my priority. Don't expect to see me constantly travelling to the four corners of the world in this first phase. I look forward to attending the meetings of the regional committees in September. Beyond that I will devote my attention to the running of the Organization. A first task will be to suggest certain amendments to the current budget built on the directions that I have already indicated. A next task will be to take these directions into the preparation of the 2000-2001 budget and to present my orientation for our next programme of work. I know that the timing is critical. But it can be done so that the regional committees can provide input in time for their September meetings. I strongly believe that WHO can say more with fewer volumes of documents, fewer reiterations of what we all agree and more focus on what we are here to do. I also believe we can do with a flatter structure and fewer layers. Information and communication must flow. I will gather the new senior management team around my table on a weekly basis - addressing an agenda which is well prepared - taking shared responsibility for projects and initiatives. I wish to meet more frequently with the Regional Directors, inviting them to take part in the management of the whole Organization. We will take advantage of new technologies which will allow us to meet on the information highway securing the unity of purpose that this Organization needs. I wish to establish more direct links to the country representatives seeing to it that they have a clear understanding of our priorities and their evidence base, and that we get their feedback. Through much closer interaction I wish to see a more concerted elaboration of our programmes and projects in countries that need them. I wish to see WHO attract the best expertise there is - inviting people to come - not all to spend a life-long career with us - but to share their knowledge and expertise and then move on with what they have learned. Sharing knowledge means a greater degree of mobility among staff - between the three levels of our Organization - and also between WHO and other agencies. Staff is WHO's prime resource. We should do more to offer staff opportunities to develop and refine their knowledge and expertise. In July I will propose a staff development package including training opportunities - not for the fortunate few - but for the many. And I will invite the Staff Associations into a structured dialogue on working conditions and arrangements. I wish to increase the number of women in the Organization. There is a long way to go to reach the targets set by the World Health Assembly and the Executive Board. But I will take targets seriously and I intend to make sure that we reach them. So here is the message to all women who have first-class expertise to contribute, especially women from the developing world: This is important work. Get in touch and let us know. I wish to strengthen our programmes. Not as independent units separated from each other. Not as separate fund-raising bodies sending different signals about our priorities, but as centres of excellence. Sometimes cosponsored by others, but always open to the rest of the Organization and to each other. Not overwhelmed by administrative functions, but encouraged and supported to bring our shared knowledge further. I believe there is a lot to gain from organizing part of our activities into projects. Not too many, but easy to define, easy to identify, open for our partners to cosponsor- and transparent for donors to lend their financial support to. Let me mention two such projects which I wish to start implementing from 21 July. I propose that together we Roll Back Malaria. Not as a revamped vertical programme but by developing a new health sector wide approach to combat the disease at global, regional and country and local levels. Why malaria? Many have asked this question. For my part the answer is simple, I have learned it from many in this room and by travelling to your countries, particularly in Africa. A51NR/6 page 106 Malaria is the single largest disease in Africa and a primary cause of poverty. Every day 3000 children die from malaria. Every year there are 500 million cases among children and adults. Who said that infectious diseases were becoming yesterday's problem? The human suffering is unacceptable and so is the economic burden and impediment to progress. Time has come to respond with a new approach. Time has come to Roll Back Malaria. Why now? Because the call is there. We have enough knowledge, skills and tools to launch a new concerted effort. Africa is responding. African leaders are committing to a renewed effort to control malaria. Africa should be spearheading the project. I believe we should answer Africa's call and that of other regions if they choose to engage. I will invite a broad range of stakeholders to join us in this initiative, UNICEF, the World Bank, industry, foundations and all others who have a stake, a commitment and a contribution to make. I encourage the leaders of the G8 countries to answer the call when they meet later this week. Let me stress: Roll Back Malaria will not exclude work on other diseases. To the contrary. Successful containment is no endpoint. Rolling Back Malaria is no victory unless health systems are equipped to sustain the gains. That means connecting the services with the primary location for action; the family - the home - and the mother. Efforts against all infectious diseases will benefit. Drawing upon what we learn we will be ready for a fast track on a future Roll Back TB - and a reinvigorated action against HIVI AIDS and the tropical diseases. My second emphasis is in the field on noncommunicable diseases. We need to address a major cause of premature death which is dramatically increasing - killing four million people this year - and - if we let it go on without action- 10 million people in 2030- half ofthem dying in middle age- not old age. The major focus of the epidemic is now shifting to the developing countries. I refer to tobacco. I am a doctor. I believe in science and evidence. Let me state here today. Tobacco is a killer. We need a broad alliance against tobacco, calling on a wide range of partners to halt the relentless increase in global tobacco consumption. Children are the most vulnerable. Habits start in youth. The tobacco industry knows it and acts accordingly. This is a medical challenge, but also a cultural challenge. Tobacco shouldn't be advertised, subsidized or glamorized. Mr President, I wish to get to work on 21 July on a challenging agenda, demonstrating that we can make a real difference. There are important achievements to build on: Child mortality is decreasing. We must push the numbers further down. Immunization rates have taken a dip. We must push the numbers further up. Mental health is slowly gaining acceptance as a major public health concern. We must push for the evidence and the best policy advice. Women are the prime caretakers. We must push for real change for women, children and families. The Cairo Summit put population and reproductive health on the agenda but there is still so much to do. We must help doing it. My motivation will be this: Making a difference. I see that as a privilege - being able to make an effort - being one of many dedicated people working together for what we believe in. I envisage a world where solidarity binds the fortunate with those less favoured. Where our collective efforts will help roll back all the diseases of the poor. Where our collective efforts assure universal access to compassionate and competent health care. Bringing the world one step closer to that goal is our call for action. The PRESIDENT: :._r-})1 . ~~ 4W -c:-~ 4J ~ Ji ~~ a.:1)1 ~ ~ ...u~ J.r. ~J~_., )_;. oJP ..ill ~~ :.wlpJ ,o~~~ ~~ ~~~ ~~ I..S""'"""'JI .;~; ,_; _,lQ.ill o_y..Lo ~~J ,~ J...-1_,.:..... 0"YIJ . \/..:...~/\'\'\A/\·\ ..:...i ~ )1 J ~ ~ J.. 4.-IS'U if' JP"' JP..ill J..ilil ,y ylf-"YI" ~}_,All l.iP. ~~"Y o.a::...... ~~ ~ .}_,All~ 0~1 ,..;..W,I~I ~~ .J.>..y.. "Y A51NR/6 page107 ~\ ~~ U_~-.AZ ,~ ~l;) '0:!~\ (,?.il; ~l;) ,~\ ~l; ,~ ~l; ~i 0i ~Ji ~ _,_..; J ~_r-1 ..u J . 0\... )I er ~ j")l.:. a.J:i.:.JI a..-~.> _;, 4--..u ~~ uw~IJ , ~l5'lj ~ J.r.!" JP...01 4-5~ . .~\ J.r" ~id) '~JJ...UI ~~ ft>. ~ ~)~1 \..,. ~ :/' ,f-WIJ ~L::l\ -:r-~1. a.;.;~ ~~i ,o-4~ )'\ ~ ~~ ~~ )'\ ,~l5'lj JP..ill t_b) ul.....l.S:; ~)'~)'\ _;, 0~ ..r. ~)...~.:.A..!\ er b~ 01 ._; _r-1 \j\) - . ..;>-)I ~ y t_} ~\ rCi ~ ~\All; rWI_~-.WI r ~ 0i ...L.t; )I\ d)~ I..,.W. ...LA; J...... d\) ~W\ ~L.J\ ~ i~\AJ\ ~~\ ~ "y" ~\ 0i ~~~~ 0i ~ )i ,a.....kJ\ o.h. c}J ~) ~ 0\ G~Ul\ GW\ L....k..l\ ...L.t; "1" ~\ ~) ,a_.~\A]\ a..W\ a.....W\ .y ~ (,?..UI <~,j\~ ~ }\ t_} __,..w1 ~~J ~ iy.)l o-4_,.,J1 ~ ~ J;;i ~~J 'y" ~~ ~~~ ~)l.r.j oJJL!...J\ 0i dJ~ ~ij .~}\ • ~\ ..U a..W\ a.....W\ o..V. ...\Jt; oJ_;... ..::..jl5' .a.....kJ\ o.h. ~~\ J;;i) ,__,..w\ ...\Jt; ._A...a.:ll) ~W\ ~L.J\ ~ ~\} The meeting rose at 13:30. La seance est levee a 13h30. A51NR/7 page 108 SEVENTH PLENARY MEETING Wednesday, 13 May 1998, at 14:30 President: Dr F.R. AL-MOUSA WI (Bahrain) later: Mr E.K. PRETRICK (Federated States of Micronesia) SEPTIEME SEANCE PLENIERE Mercredi 13 mai 1998, 14h30 President: Dr F.R. AL-MOUSAWI (Bahrein) puis: M. E.K. PRETRICK (Etats federes de Micronesie) DEBATE ON THE REPORTS OF THE EXECUTIVE BOARD ON ITS tOOTH AND 101ST SESSIONS AND ON THE WORLD HEALTH REPORT 1998 (continued) DEBAT SUR LES RAPPORTS DU CONSEIL EXECUTIF SUR SES CENTIEME ET CENT UNIEME SESSIONS ET SUR LE RAPPORT SUR LA SANTE DANS LE MONDE, 1998 (suite) . •)\ The PRESIDENT: ·<..!""=' Mr GEITONAS (Greece): Mr President, Director-General, fellow delegates, ladies and gentlemen. Since I am the first speaker, allow me to give my hearty congratulations to Dr Brundtland on her election and on her opening speech. She will have the full support of my Government. All of us believe she will lead WHO successfully in the coming era. I am particularly happy and honoured that I have the opportunity to address this Assembly, which marks the fiftieth year of WHO's enormous contribution to humanity in its struggle to combat disease and to create conditions for better health and a better life. Today the state of health in our societies, as manifested in many health indicators presented in The world health report 1998, shows impressive improvements, and gives us a strong basis on which to continue to work towards health for all in the twenty-first century, with less disability and disease. This optimistic view should not by any means make us complacent. On the threshold of the new millennium, many problems still exist and new challenges must be faced. I refer here to the growing demographic problem, with profound negative implications for all age groups; the double burden of chronic and infectious diseases, which continue to be a major threat for our health; and the increasing inequalities in health between regions, countries and different social groups. These three problems in conjunction with current major political, economic and social developments, require new approaches and different strategies and tools, which are gradually reshaping the role of WHO. The report rightly stresses, and outlines clearly, the health implications of these trends for all age groups, and especially for women. On this issue, let me single out the younger age group, and stress the need to protect their health by the promotion of sex education and the avoidance of risk-taking behaviour. Global health in the twenty-first century will depend a great deal on our commitment to investing in the health of the younger generation. Alongside this, I would underline the significance of the family as the basic nucleus of our society and one of the important A51NRI7 page 109 determinants of human health. I would like also to re-emphasize the need for an international outlook, both individually and as members of the family of WHO. Many of the major health problems today have not only their roots but also their solutions outside national boundaries. It is therefore imperative that we strengthen international cooperation and display an active solidarity on health matters. This brings me to the commitments of the Greek Government, which are an indication of our desire to make continuing efforts to develop our health care system and also to cooperate with other countries, especially with our neighbours in the Balkan region. Among our priorities are the reorganization and restructuring of public health and primary health care; the development of conditions for better quality of care and new forms of accountability and management; the strengthening of norms for safeguarding patients' rights; and the development of a comprehensive system of epidemiological surveillance and intervention. Concerning international cooperation, Greece plays an important role, especially as a member of the partnership for dealing with health problems in the Balkan region. The twenty-first century needs not only a new vision, but also a greater effort from all of us to continue the struggle for better health and for the elimination of poverty. The challenge is before us. Finally, Mr President, I would like to express appreciation to Dr Nakajima for the excellent work he has done. BbiCTYTIJIEHHE r-HA L{EB51TKO (PECllYEJIHKA KA3AXCTAH): Mr DEVYA TKO (KAZAKHSTAN): r-H llpe.nce.naTeJib, r-H reHepaJibHblit ,llHpeKTop, }'BIDKaeMble ,lleJieraTbl, .llaMbl H rOCUO,lla! OT HMeHH .nenerawm Pecny6JIHKH KaaaxcTaH H xoTeJI 6hl noa.npaaHTb llpe.nce.naTeJIH u acex 3aMeCTHTeJieit C HX H36paHHeM Ha 3TH BbiCOKHe UOCTbl H UO>KeJiaTb ycnexa B pa6oTe. ll03BOJibTe MHe Bbipa3HTb OT HMeHH npaBHTeJibCTBa Moeit CTpaHbl rJiy60KYJO npH3HaTeJibHOCTb .n-py Xupocu HaKa.nanMe aa ero .necHTHJieTHHit peayJibTaTHBHbiit CaMOOTBep>KeHHbiH Tpy.n Ha nocTy reHepaJibHOrO ,llHpeKTopa B03 B O,llHH H3 CaMbiX CJIO>KHbiX H HHTepeCHbiX nepHO,llOB pa3BHTHH Mnpoaoro coo6mecTaa. MHe TaK>Ke xoTeJIOCb 6hl OT HMeHH npaaHTeJibCTBa Pecny6JIHKH KaaaxcTaH H OT ce6H JIHqHo no>KeJiaTb BHOBb H36HpaeMOMY reHepaJibHOMY ,llHpeKTopy r->Ke BpyTJiaH,ll ycnexoa B HanpaaJieHHH ,llOCTH>KeHHH CTpaTeruqecKHX ijeJieit BceMHPHOit opraHH3aijHH 3.llPaBOOXpaHeHHH, KOTOpaH HBJIHeTCH nu.nepoM paaBHTHH a.npaaooxpaHeHHH acex cTpaH MHpa. KoHeij 20-ro BeKa 03HaMeHOBaJICH UOHBJieHHeM MHOrHX HOBbiX He3aBHCHMbiX rocy.napCTB, Haxo.nHJUHXCH Ha TPY.llHOM DYTH nepexo.nHoro nepuo.na, xapaKTepH3YJOJUerocH B03HHKHOBeHueM MHOrHX 06'heKTHBHbiX npo6JieM, B TOM qncJie H CBH3aHHbiX C oxpaHOH 3.llOPOBbH Hapo.na. Pecny6JIHKa KaaaxcTaH, cTaB a 1992 r. a KaqecTae c)'BepeHHoro rocy.napcTaa 180-M rocy.napcTBOM - qJieHOM B03, Ha cero.nHHWHHit .neHh Mo>KeT c )'BepeHHOCTbiO aaHBHTb, qTo coTpy.nHnqecTao co BceMHpHoit opraHuaauueit a.npaaooxpaHeHHH npuo6peno ycTouquahlit xapaKTep u HMeeT .llJIH Hac orpoMHoe aHaqeHue. Pecny6JIHKa KaaaxcTaH aceueno npuaeTcTayeT u noMep>KuaaeT KoHuenuniO "3.nopoahe JlJIH acex B XXI cToJieTuu", npoaoarnaweHHYJO EaponeitcKHM peruoHaJibHbiM 610po B03, H aocnpHHHMaeT H,lleH 3TOit KOHijeDijHH B KaqeCTBe OpHeHTHPOB pa3BHTHH 3,llpaBOOXpaHeHHH Haweit CTpaHbl H .llPYfHX CTpaH UOCTCOBeTCKOfO npOCTpaHCTBa. llOJib3YHCb CJiyqaeM, MHe XOTeJIOCb 6bl Bblpa3HTb npnaHaTeJihHOCTb EaponeucKoMy peruoHaJibHOMY 610po aa aKTHBHYJO noMeP>KKY npoueccoa pe B qaCTHOCTH, O,llHOH HJ TaKHX CTapbiX npo6neM, KOTOpaH B nOCJie,llHee BpeMH npHo6pena OC06YJO OCTpOTY ,llJIH MHOrHX CTpaH, HBJIHeTCH Ty6epKyJieJ. Ha aJITapb 3TOH 6oJieJHH qeJIOBeqeCTBO e>Kero.nHo npHHOCHT nopH.nKa 3 MHJIJIHOHOB >KHJHeH. B 1997 r. Ja6onesaeMOCTb Ty6epKyneJOM B Pecny6nHKe KaJaxcTaH .nocTHrna 90 cnyqaes Ha 100 000 HaceneHHH, norH6no oKono 6000 qenoaeK. BHe.npeHHe HOBoro no.nxo.na, paJpa6oTaHHoro B03, BHyrnaeT o6ocHoBaHHbiH onTHMHJM. .HCTOpHqecKHH OnbiT noKaJbiBaeT, qTo peiiieHHe CTOJib MaCIIITa6HbiX npo6JieM BOJMO>KHO TOJibKO npH cocpe,llOTOqeHHH CHJI H pecypCOB BCeX CTpaH MHpa, H pOJib BceMHpHOH opraHHJayHH J,llpaBOOXpaHeHHH KaK KOOp,llHHaTopa 3THX YCHJIHH BH,llHTCH HaM O,llHOH H3 rJiaBHbiX. ,[{JIH scero qenoaeqecTsa B 3noxy MacmTa6Horo npoMbiiiiJieHHoro paJBHTHH, noKopeHHH KOCMHqecKOrO npOCTpaHCTBa H OKeaHCKHX He,llp BCe 60JibiiiYJO JHaqHMOCTb npHo6peTaeT TaKOH Ba>KHbiH acneKT, KaK COCTOHHHe OKpy>KaiOijleH cpe,llbl H ee BJIHHHHe Ha COCTOHHHe 3.llOPOBbH. Pecny6JIHKa KaJaxCTaH HCnbiTbiBaeT B CBHJH c 3THM yeJibiH KoMnneKc npo6neM, O.llHOH HJ KoTophlx ocTaeTcH KaTacTpo The PRESIDENT: ui ~•)J Mr E.K. Pretrick (Federated States of Micronesia), Vice-President, took the presidential chair. M. E.K. Pretrick (Etats federes de Micronesie), Vice-President, assume la presidence. The PRESIDENT: I continue with pleasure in the absence of the President. I thank the delegate ofKazakhstan and call upon China to come to the rostrum. May I now invite Colombia to take the floor. La Dra. FORERO DE SAADE (Colombia): Senor Presidente, senores miembros de la Mesa de la Asamblea, senores ministros, delegados, damas y caballeros: En nombre del Movimiento de Ios Paises No Alineados, y en el de mi pais, Colombia, permitanme expresarles un cordial saludo y mis mejores deseos por una Asamblea fructifera en beneficia de la salud de todos Ios pueblos del mundo. Esta Asamblea tiene una especial significaci6n por la conmemoraci6n del primer cincuentenario de la Organizaci6n Mundial de la Salud y por la iniciaci6n de un nuevo periodo de direcci6n y liderazgo en la Organizaci6n. Es, en consecuencia, el momento propicio y el auditoria mas indicado para reconocer la influencia fecunda de la OMS en las trascendentales modificaciones en la vida social y en la promoci6n de Ios valores positivos de la salud en este ultimo medio siglo. AI mismo tiempo, es nuestro deber reconocer Ios problemas que no se han podido solucionar y Ios retos hacia el futuro. El documento preparado por la OMS con motivo de esta Asamblea, «Salud para todos en el siglo XXI», constituye un excelente punto de referenda para ese analisis. En este contexto, es de destacar Ios problemas por la falta de equidad en la salud, que son cruciales al analizar las politicas y la situaci6n en el mundo. Esta ha sido la gran preocupaci6n del Gobiemo de Colombia que dirige el Presidente Emesto Samper. La desigualdad en las condiciones de salud entre Ios paises, y en el interior de Ios mismos, es un hecho que reclama nuestra acci6n. La persistencia de diferencias abismales en la probabilidad de vivir, de enfermar y morir entre diferentes colectividades es inaceptable. Ello debe ser motivo fundamental de preocupaci6n y acci6n en todos Ios niveles, particularmente en las instituciones intemacionales que en una u otra forma tienen que ver con la salud individual o colectiva. En el mundo de hoy es bien evidente c6mo Ios avances y Ios logros en salud no se distribuyen en forma equitativa. Para quienes estamos aqui reunidos es un deber primordial evidenciar y analizar criticamente las causas mas relevantes de esta infortunada realidad, con miras a crear estrategias novedosas y agresivas para su soluci6n. En este contexto, y en relaci6n al documento «Salud para todos en el siglo XXI», no hay duda de que existe la necesidad de reafirmar, como base politica, este concepto. El contenido de la Declaraci6n de Alma-Ata, asi como las estrategias que de ellas se derivan, son inobjetables y constituyen el «desideratum» para el proximo siglo. No obstante, hemos agotado las formas aplicativas y se imponen, por tanto, nuevas estrategias en relaci6n con las modalidades y Ios esquemas que Ios paises han desarrollado para financiar, organizar y prestar Ios servicios de salud. Desde esta perspectiva, el «que» de la salud ha sido y continua siendo claro. Sin embargo, es indispensable reconsiderar el «c6mo» se logra. En ese contexto, destaco el ejemplo de buscar nuevos recursos para la salud, financieros y humanos, y el de renovar el interes de la sociedad hacia este tema tan prioritario para Ios pueblos. Esta es la acepci6n de la reforma del sector salud que quiero transmitir a ustedes como el reto mas importante de Ios paises en desarrollo de cara al siglo XXI. Es un imperativo que cada pais se ocupe de la reforma del sector salud, y es necesario que todos Ios organismos intemacionales examinen con cuidado y con espiritu innovativo las estrategias tradicionales de formulaci6n de politicas y de cooperaci6n tecnica y financiera. Las expectativas de Ios paises miembros del Movimiento de Ios Paises No Alineados, que estoy seguro ustedes comparten, son hacia la continuidad y el fortalecimiento delliderazgo de la OMS. Para el prop6sito anterior, es necesario un cambio sustancial y la ocasi6n no puede ser mejor para lograrlo. Se deberia invitar a Ios paises en desarrollo a A51NRI7 page 112 participar activamente en la revision y reforma de las estructuras y metodos de la Organizacion, con la seguridad de obtener una valiosa colaboracion en la busqueda de soluciones adecuadas. La iniciacion de la gestion de la Ora. Brundtland es una circunstancia muy auspiciosa; sus antecedentes ilustres como persona, como profesional, como figura publica nos hacen ser muy optimistas. Como vocera del Movimiento de Ios Pafses No Alineados, deseo manifestar a la Ora. Brundtland la preocupacion de este numeroso grupo de pafses por la forma en que estaremos vinculados a las definiciones que la nueva direccion de la Organizacion habra de tomar en el ejercicio de sus funciones. De ninguna manera me refiero a la representacion burocratica, sino a las formas y mecanismos que se desarrollaran para que este importante grupo de pafses pueda expresar sus necesidades, sus expectativas, y entregar sus contribuciones para lograr una continuidad renovada de la importante mision de la OMS en la consecucion del ideal de la equidad universal en salud. En este momento se celebra la XXII Reunion de Ios Ministros de Salud de Ios Pafses No Alineados y otros Pafses en Desarrollo, a la cual me es grato invitar cordialmente a Ios Estados Miembros. En esa reunion se buscaran altemativas para implementar la cooperacion tecnica horizontal entre Ios pafses del Movimiento a traves de la creacion de una red de instituciones en salud, con el apoyo del PNUD y la colaboracion de la OMS. Los resultados del debate se plasmaran en un proyecto de resolucion que sera presentado a esta augusta Asamblea, para cuya adopcion solicitamos el apoyo de todos ustedes. El contenido de la resolucion claramente demuestra la importancia que Ios pafses miembros del Movimiento otorgan a la busqueda de la equidad en salud como valor social y empeii.o fundamentales a lograr en las decadas iniciales del siglo XXI. Dr ZHANG Wenkang (China): tf:~i.lif;!!: jf.f:~tflGt7fi\t.±: 41i1~*~ *±11'1 ~ !ifJ ~~~X!M~~~5~·~~,4~l~~*~*~• ;(£ ~ fi ~ s f3 l\ jt'J aef , I t -i? 1f ~ 51 Jii ~ ~ X !£ :k 4 , lill J®L~, t§ 50. *~~X !£ If¥ ~ ~ ~ , *~ l* if 21 ~ ~i: X !£'}:_Ne fiJ ~ *~~o~~,~:k41f*~~, t:fl$A~*~~~Jit;~~~ ~*'fi~M~A~~t:k4~$Rf.it±~~f·tfl·7f it±' M~~Xi~.ll~~~50ffij •~ ~~~t~51)ii~~Xi:k 4 ~ -g 1f * IF t& ?.!{ fJ(J ~ 1l o 50. *, mf ~~X !£ ~11. ~ ~ 41 ~M~ ~ ~ - l!t I ~ ~11. ~~#~-~-h,~~X!£1~'J:.!£1g_:k{l(Jf~oa~• ~ ~ :t ~~ , 50. t:p , -tit~ ill!£ -if- t~ M~ jj iift ~~£fA 46~ !f8 -K: ~~ ~~,*~~-A~--~#*~~~-~~~-~~~~~ A51NRI7 page 113 1C 1t ~ if ~ It t~ x , "A A f. 1=f J!. !l i% tt ~ It ~ ~ " ~ ~ .ft , ~*~~~1~m~~~~*~~~~~~i**'~~~m Jk , ~ #1 ]_ !l , tt *ilt :IJ1 ~ Jji J: it , ~ 21-lli: ~e. -tlt $- ]_ !l ~ tl Jt ~ 1 ~ Jf ~ £ ~ o t:p $A~#~ 00 * R1 ~t-&: $- J!. !l ~!AA 501f- J1t ilt:IJ1~I!JI!lJ:if~g*~-~f~~~-~, ~~, ~tp· *•±-t~~jffMM~-tlt$-JI!lmAA~itili~~ili~M* ~~~~~~0 t:pOO**~*m*~~~*~•~#*~*~ •±~~~~-~-tlt$-JI!lmAAjffo~ffi~~,*~*~ -±~~~f·,*~~~~&-~~~A~---~1tili~ -~~¥fl{J~ifilo ~mEM{f~~~~~MC~o~~~x&•%~~~~ 1 ~ ~ -tlt $- ~ m. ~ A o ~ #. 4 ~ ~ !l ~ t ~ ~ ~t 21 ~ ~ J!. !l ~ J:~tf&fl{J•~, ~m~-~~~m~w~~F~~~, ~~ ft1f1-tft¥;fJtl, 21-ftl.:~~ JtlJ1t~~ ~ A~~!t~m, :ikJu~~ tt•Jk~·~~~*1=f~~-oftm•~~~~lf-~~x&• % t:p ~itff1 21~ ~~rtJI &~J: ~~~, # ~ ~m:li~ f3 ~~i r.p $A ~ # ~ 00 § 19491¥- ~ .ft ~ *, ~ 1Jc ~ J. :.it% 501f- ~ m~o{ft.ftOO*~~~~T',{fk~~J!.!lXit~#~*~ft ~r, t:pOO~JI&•~~~Y~~A~~r~-tltl¥3~~~0 f3 ~ ft 00 ~ :i:~ M~ if 4ft ~ r&. mJt 00 w~ 35 # 1t. Jtl70 # , 1- JL JE -c *- rif200%o r ~ JU 31. 4%o, qz. t ~ JE -c *- rl:f1500/107i r ~ Jtl&l. 9/107i, A~ tt•Jk-'f~ Jtl.l t• 1\li o tftl!I~~~JI&mAA•~~~~OO~-o*M~*' t~ ~~~~~]_&mAA•.ft~~-~*~~~*~' ~m-t~m ~G~~~~~, ~-tlt~]_&mAA~~JtJ!.!l~~¥3#~~~ ~~ili1§G~~Mo t:pl@~~~~-lli:~J!.&~AA~~OO*~~ ~~oo~•~~**~•~tJr-~~~~~~A~tt••~~ ~Jl~tHJJr{fJ~}Jo *±m~~&m,tt•~A~*•~~*~~~oo*~~ 0Aatl~4l~ott••~~~~·~~A~!m~·~f~ A51NRI7 page 114 t t: # it , ~ ~ J1f ~ :f± 4 tif # ~ ~At tfJ t t: 1* liE o 50df tu" tfJ 4' ~,~~~!MAAtfJ~~·~"~~~~A~~~--~~tfJ ••"~~~~tfJ*W,lla~A~~A~tfJ~-#~tfJ~I Wt-fJ, ~~21~~A~:f±4~7Jt~··~%W~ lliS;flifJ~it! Mr GAJDOS (Slovakia): Mr President, distinguished delegates and guests, on behalf of the delegation of the Slovak Republic allow me to express my warmest greetings to the Fifty-first World Health Assembly. This year the Assembly is very special. As we commemorate the fiftieth anniversary of the World Health Organization, we will draw the world's attention to the Organization's past, present and future contributions to international health development. During its fifty-year history of success, the Organization currently has convincingly proved that it is one of the most successful specialized agencies within the United Nations system. It created a solid basis for the cooperation of Member States from all over the world. Fifty years ofjoint efforts resulted in the solving of many health problems. The past decades have seen the final defeat of smallpox and the gradual elimination of poliomyelitis, neonatal tetanus and others. The broad campaign of WHO advocating higher quality of life and better health based on the global health-for-all strategy by the year 2000 succeeded in changing the understanding of approaches to health. Health sectors have won over new partners, not only in the sectors of environment, agriculture, education, welfare and industry, but also in individuals, families and communities. The fiftieth anniversary of WHO gives the Government and people of the Slovak Republic an opportunity to express their great esteem for its work and mission. The WHO health-for-all strategy has become a basis for public health policy, and health attracted the attention of all sectors of our society. However, the result of this joint effort depends primarily on the attitude of individuals towards their own health. Smoking, sedentary lifestyles, unhealthy diets and stress have plagued the daily life of our people. On the threshold of the twenty first century, inhabitants of the Slovak Republic are afflicted by cardiovascular disease, cancer, diabetes and other diseases related to lifestyles. The world health report 1998 indicates that most countries have to cope with the steady growing cost of health care services independent of their funding methods. Slovakia is facing such a problem. Perhaps more investments in health promotion and emphasis on the responsibilities of individuals as well as communities, and their active involvement in health, could be one of the right solutions. Adopting healthy lifestyles in childhood will help prevent health problems later in adult age. It might result in a continuous reduction in the demand for costly cures. The report gives the hope that people will live longer, be healthier and that the quality of their life will be higher in the twenty-first century. Solving the major health problems of this century will enable us to focus greater attention on the quality of health care, on health promotion and protection. This will depend, however, on general commitment and consensus, particularly with reference to women and children today. Our adoption of the World Health Declaration will send a clear message to the world that health will be the basic right of every human being in the twenty-first century too. Principles of equity, solidarity and social justice will remain the basic pillars of global, regional as well as national health policies. We will enter the new millennium with a new health-for-all strategy. The election of the new Director-General gives us confidence that this new strategy will be transformed into action and that WHO will be led to greater excellence in future. Slovakia will support Dr Brundtland in her endeavours to achieve better health and welfare of the people in the whole world. In conclusion, I would like to express my deepest appreciation to Dr Nakajima for his personal contribution to the success of WHO. Monsefior LOZANO BARRAGAN (Santa Sede): Senor Presidente, distinguidas delegadas, distinguidos delegados: En nombre de la delegaci6n de la Santa Sede que me honro en presidir, deseo felicitar ampliamente a la Organizaci6n Mundial de la Salud, y en especial a su cuerpo directivo, por estos 50 afios de denodada y eficaz labor que ha llevado a cabo en el campo A51NRf1 page 115 de la salud en el mundo. La Iglesia cat6lica ha querido colaborar con la OMS a traves de sus 22 000 instituciones sanitarias en todo el m undo en las labores en pro de la salud en el mundo actual; ayer lo hacia para suplir las carencias existentes en el campo de la salud, boy sigue haciendolo donde asi se requiera. De hecho, en algunos paises el 70% de las prestaciones sanitarias todavia son erogadas por centros de salud de la Iglesia cat6lica; y lo continua realizando en general para comunicar una vision especial del hombre, de la salud y de la vida como se propone en la Revelaci6n evangelica. Apoyamos a la OMS en su finalidad de la Salud para todos para el siglo XXI, aunque somos conscientes de Ias grandes dificultades que atraviesa para realizarla, en especial debido a la mundializaci6n de la economia, que deja sentir su peso en el campo de la medicina y de la salud. Deseamos veneer lo negativo que trae la globalizaci6n y aprovechar todos sus aspectos positivos en cuanto que se racionalicen mas Ios recursos medicos, se siga fomentando el desarrollo de las ciencias y tecnicas de la salud, en especial en favor de Ios mas pobres y desprotegidos, propiciando una divulgaci6n mayor de las posibilidades de curaci6n para mas grande numero de naciones y de gentes; deseamos que de la globalizaci6n pasemos a la verdadera unidad de todo el mundo y podamos pensar en un autentico bien comun internacional de la salud sin discriminaci6n alguna. Para ello necesitamos enfrentar el problema de Ios costos excesivos de Ios cuidados medicos y de Ios servicios sanitarios, necesitamos una mas justa distribuci6n de Ios recursos mundiales naturales y de la riqueza entre paises ricos y pobres; un mas equitativo acceso a Ios cuidados primarios de la salud, a Ios medicamentos y, masque todo, necesitamos la difusi6n en toda la comunidad intemacional de un profundo sentido de solidaridad entre Ios pueblos, la verdadera mundializaci6n de la solidaridad. Auguramos una nueva aurora en el siglo XXI, en la que entre todos superemos Ios obstaculos para hacer feliz realidad la salud para todos. Que esta sea nuestra mas cordial felicitaci6n para la Organizaci6n Mundial de la Salud. Mrs KUNADI (lndia): 1 Mr President, excellencies, honourable ministers, Director-General, distinguished delegates, it is an honour for me to address the Fifty-first World Health Assembly, the highest and most representative body established by the comity of nations to reflect on critical issues related the field of health and to the work of WHO. In addition to sharing the views and perspectives of my Government on the global development of the health sector, I hope to benefit from useful insights into emerging trends, including those likely to affect our region in general and my country in particular. I would like to congratulate Dr Hiroshi Nakajima on his stewardship of WHO over the last I 0 years. To the incoming Director-General, who will assume office in a couple of months, I would like to offer our support and best wishes for the challenging tasks which lie ahead. Dr Brundtland's election to the post wiii be a signal honour for women the world over, and I am certain that she will provide a new focus to the special problems that beset miilions of people in developing countries, particularly those who have yet to overcome a huge burden of communicable diseases and infant and maternal mortality, while addressing emerging areas such as HIV/AIDS as well as the rise ofnoncommunicable diseases. I represent here today the ideals and aspirations of the people oflndia, who constitute 16% of the world's population. Ours is a dynamic society in transition. While old traditions, customs and practices continue to influence the family and the community, particularly in rural areas, technological, economic and social achievements have brought in their wake urban lifestyles and the disintegration of the joint family system, which was a source of strength for young and old alike. The control, if not the eradication, of communicable diseases is our fundamental concern. In addressing our principal challenges for the next century, we wiii also continue to give the highest priority to reducing infant and under-five mortality rates, which continue to be high. The South-East Asia Region as a whole has jointly agreed to address the problem of high maternal mortality rates, which account for a quarter of a million deaths each year. Added to this, unsafe drinking-water, poor ventilation, inadequate sanitation and contaminated food are among the problems that are responsible for the majority of illnesses which afflict our region and are preventable. Because of the rapid and massive migration of populations from rural to urban areas, municipal services are often unable to keep pace with urban growth, creating public health hazards. It is therefore of the utmost importance to us that the promotion of health be given the strongest emphasis, so that every citizen is empowered to take care of his or her health and that of the community through powerful advocacy of prevention of health hazards. We also need to focus on the health 1 The following is the full text of the speech delivered by Mrs Kunadi in shortened form. A51NRI7 page 116 responsibilities of large employers as an integral part of their social responsibilities, as well as to see to it that policy-makers make it their goal to reduce inadequacies of access to health and disparities in health status. In August of last year, the ministers of the South-East Asia Region adopted a regional declaration, affirming their unwavering commitment to ensuring access to health for all. While recognizing the close inter relationship between poverty and ill-health, the ministers agreed that people have a right to health information and education in order to protect and promote their own health and take control over factors that determine it. We look to the Director-General and to WHO to play a catalytic role in encouraging all concerned, including large employers and industry, to assume responsibility for decisions which may have a bearing on public health. I would now like to share with you some of the major achievements in the health sector in India over the last year. First, a strategic plan for prevention and control of HIVI AIDS has been developed. Some 815 blood banks have been modernized and national and state-level blood transfusion councils set up. Clinical management capabilities are being strengthened to reduce the future impact of the spread of the disease. In pursuing the goal of elimination of leprosy by the year 2000, the prevalence rate has been reduced from 57 cases per 10 000 in 1981 to 5.75 per 10 000 in 1997. Some 482 000 patients have been detected and another 514 000 cured with the help of multi-drug therapy, and the duration of the course has been reduced by half. The elimination of leprosy by the year 2000 now appears attainable. The National Tuberculosis Control Programme has been accorded the highest priority. Budgetary allocations have trebled in the last four years, and 271 million people located in 102 districts of the country are being brought under the revised Programme, which envisages treatment by short-course chemotherapy under direct observation. This will require a massive mobilization of men and materials, but pilot efforts have reinforced our vision that this approach can effectively meet the challenge. India has a very high burden of cases of cataract blindness, which affects about I 0 million people. From conservative beginnings, the National Blindness Control Programme has progressed to performing 2.7 million cataract surgeries during the last year. In combating malaria, we are now implementing an enhanced programme, and have begun adopting new strategies involving the use of impregnated bed nets, newer insecticides and the participation of our local self government systems. In the fiftieth year of India's independence, one of the special programmes undertaken has been the organization of mega eye-camps in underserved areas. We have a target of performing 500 000 additional cataract operations over a period of two weeks during the year. Another novel scheme has been to run two railway trains traversing the length and breadth of the country through which mobile health exhibitions have been organized at hundreds oflocations, simultaneously affording check-ups and preventive health care know how to millions. Further, our federal and State-level institutions have launched community-based programmes for people with hearing and speech disabilities and for screening mentally sick patients. Finally, our National Immunization Programme, which started in 1985, has gained new momentum with the adoption ofNational Immunization Days, which aim to achieve the eradication of poliomyelitis by the year 2000. In 1997 and 1998 alone, 120 million children below five years were covered in two immunization days observed across the country. Turning now to some of the major issues which are to be taken up in this session of the Assembly, my delegation would like to offer some brief comments. In connection with the proposal to expand the Executive Board from 32 to 34 members, we believe that the time has come for a thorough discussion of all issues related to the powers and functions of the Executive Board. Perhaps what is needed is a fundamental shift, so that the main decision-making organ of WHO is in a better position to take into account the concerns and expectations of those facing high mortality and morbidity. A mechanism must be found to ensure that it voices the opinion of all countries in each region. Decisions relating to resource allocation, health priorities, strategies for disease control, ethical issues, prescription of standards and reporting under the International Health Regulations have a major impact globally, and we must devise ways to consider all aspects of the problem in a transparent and much more representative manner than is the practice at present. The South-East Asia Region of WHO is a group ofjust 10 countries, including India, but accounts for 25% of the world's population, 40% of the world's poor and 41% of estimated mortality due to infectious diseases. Seen in this context, the Executive Board's resolution relating to the regular budget allocation to the regions does not, in our opinion, satisfy the spirit of equity and assistance to those in greatest need. Time-honoured paradigms based on population and the burden of disease ought not be altered on tenuous mathematical assumptions, as the outcomes can only militate against the constitutional mandate of WHO and the spirit of Alma-Ata, which affirmed an abiding commitment to removing gross inequities in health status. For 50 years WHO has dealt with regional allocation of funds in a gradual manner, and has been open and transparent in its decision-making. We are now faced with a prospect whereby the Executive Board appears to have decided to A51NRI7 page 117 reallocate funds by means of an untested formula, based on questionable criteria, which cannot provide the basis for effecting such a major change. This matter requires proper reconsideration and a process of consultation taking all views into account. My delegation would urge the Assembly to defer a decision on this resolution, and to send the proposal back to the Board for re-examination in close consultation with the regional committees. I must also invite the attention of WHO to our repeated suggestion that it give an impetus to indigenous and traditional systems of medicine, which are the mainstay for countless people in our Region. A division should be set up at headquarters to give a meaningful direction to this important arm of good health and healing. India is in a position to offer a package for the development and promotion of traditional systems of medicine to other countries, focusing on education, standardization of drugs, the survey and cultivation of medicinal plants, research and development. WHO could consider establishing training centres in India and other countries where traditional systems of medicine could be taught in their proper perspective, backed by standards administered by professional councils. An annual meeting should also be convened by WHO with the sole aim of providing a platform for discussing issues and problems relating to traditional systems of medicine. In conclusion, my delegation would like to call upon the Assembly to renew its focus on the poor and the underprivileged; and to call for a human, supportive approach that will strengthen capacities to assess the just entitlement of those in real need, as well as for a collaborative approach between nations as we work together and evolve a health policy framework that is founded on the principle of social justice. Only such an approach can reduce inequities, underscore ethical values, promote self-reliance and enable individuals, communities and nations to rise to their full potential. We remain confident that such a vision can create conditions that will promote a healthier and happier future for all mankind. El Dr. MARINKOVIC UZQUEDA (Bolivia): Seiior Presidente, seiior Director General Adjunto interino, senores miembros de la Mesa de la Asamblea: Quiero empezar felicitando a la Directora General electa, en la seguridad que se alcanzanin importantes logros y avances para el futuro de la Organizacion, y expresarles a ustedes que Bolivia y su Gobiemo estan empeiiados en una reforma de la salud. Una reforma en profundidad, que enfrente la problematica estructural que tiene el sector salud, dados Ios preocupantes indicadores de salud existentes, que a pesar de Ios esfuerzos realizados en Ios ultimos aiios por mejorarlos, persisten en niveles extremadamente preocupantes. Estos cambios deben ser de una real proyeccion al proximo milenio, y no solo cambios parciales o remiendos en el modelo sanitario o en la burocracia administrativa. Nuestra reforma del actual modelo sanitario esta basada en crear las condiciones para un acceso universal a Ios servicios, redistribuyendo Ios recursos economicos y nuestros mejores recursos humanos hacia la atencion primaria de salud, con la medicina familiar y comunitaria como el instrumento estrategico fundamental, en un profundo respeto de las condiciones de diversidad cultural y de igualdad de genero, con la esperanza de que en esta epoca de cambio y de renovacion en la OMS tendremos un adecuado eco, comprension y decidido apoyo en su nueva direccion. AI celebrar este cincuentenario reconocemos Ios avances importantes y el aporte de la OMS, pero como paises del Tercer Mundo quisieramos acelerar el proceso que permita superar Ios efectos perversos del modelo y disminuir las brechas entre las regiones y paises, convenciendo a Ios gobiemos de que Ios recursos destinados al sector salud son inversion y no gasto, y que la salud, junto con la educacion, de ben ser Ios ejes centrales de una politica de desarrollo sostenible, solidaria y equitativa. La OMS debe alcanzar un mayor protagonismo, y quisieramos planteamo·s la interrogante e introducir como elemento de reflexion si no hemos tenido una permisividad negligente para que otras instituciones y organismos asuman mayores responsabilidades y protagonismos en relacion a !as politicas de salud. Bolivia ha estado trabajando y esta trabajando en una intensa coordinacion con la representacion regional, asi como en el marco de Ios organismos regionales del Mercosur y del Pacto Andino, como a nivel de convenios bilaterales, fundamentalmente con nuestros paises vecinos, que permitan acciones conjuntas y concertadas, para mejorar la calidad de vida y la salud de nuestros pueblos. Tambien estamos trabajando en el marco de la intersectoriali dad, porque estamos absolutamente convencidos de la necesidad de la accion conjunta con otros sectores, porque solos, como sector, no podremos mejorar la salud en nuestros paises. AI terminar queremos expresar nuestros mejores deseos de exito a la nueva direccion de la OMS, encabezada por la Dra. Brundtland. Es el momento de no reconstruir el pasado, sino de enfrentarnos a construir un nuevo futuro para que el siglo XXI permita el reinado de la paz, la justicia, la salud, la solidaridad y la prosperidad. A51NRI7 page 118 Dr. SALLAM (Egypt): :(~) i~ ~~~JP ...UI ~L:.. }~I G....all ~ ~~ ..t:J~ ~~ 0i ~ ~1.1; _;, ~} ,~ _,; )1 ~~~ J ~L..., JJ JLA.. ,~ )1 ~~ aJL... J <~..>.- Ji 0i ~ ~ ")J ,~ Lo~ l_.r.:l.. ~) ~ ...u~ J.f. o~l \.5-"''y, a_;_;JI oh *i LS' ,~WI - .~WI ._::..\_,...... , _r.JI j')L>. ~~ o~-*'" .__? ¥1S'Li JP.ill _.r...l4j J ~ G....all • J...l;> ~ J 0LS::.. JS' _j. 0t.....;")\ ~ :t:~J j>.i ,y ~WI ~~I il..;:.1.1.; ~L:; ,..r.J )I ~I !\L:;. 01 ,_)J"Y.I ~\ :~L...,\ ~ Dr PIATKIEWICZ (Poland): Mr President, distinguished delegates, ladies and gentlemen, allow me first on behalf of the delegation of Poland and on my own behalfto congratulate you on your election and to extend our congratulations to all our A51NRI7 page 119 colleagues who have been elected to the highest offices of the Fifty-first World Health Assembly on the fiftieth anniversary of our Organization. Allow me also to congratulate the Director-General and his staff for the comprehensive report, The world health report 1998, which looks back over the past 50 years and provides a vision for the twenty-first century. I would like to congratulate also Dr Gro Harlem Brundtland on her election as the new Director-General who, together with all of us, will make the vision which she has presented so clearly and so eloquently today, a reality. The report indicates clearly that the social and economic advances that the world has witnessed during the late twentieth century have brought better living standards to many but not to all people. Many of yesterday's infectious diseases still remain prevalent or are re-emerging while new infectious diseases emerge. If instead of infectious diseases we use the term "health problems", then we have at hand old unsolved problems, re-emerging problems and new health problems, and all these problems are harsh realities and challenges. All these challenges call for urgent action now, otherwise they may cause irrevocable damage far beyond the year 2025. As we are all aware, many Member States, among them my country Poland, are engaged more or less intensively in the difficult process of health care system reform, trying to respond to the growing expectations and demands of their population, as well as to the growing financial constraints in health expenditure. The same applies to WHO, where the process of change was initiated several years ago and now has a chance to be accelerated. We all know, not only from theory, that changes occur first when there is a need; secondly, opportunity, that is the existence of different methods and new ideas; thirdly, resources to implement new methods and ideas; fourthly, motivation of relevant people to act; and fifthly, when all the four conditions coincide, which they rarely do. We are sure that three out of the first four conditions coincide at present. The remaining fourth condition concerns resources, but we hope that the new Director-General will promote the solution of this one too and that health will become fully recognized as an important element of socioeconomic development all over the world. The challenges of tomorrow call for the strengthening ofmultisectoral approaches to health, including environmental health problems and the fullest possible utilization of modem health technology for all. We recognize the importance of appropriate utilization of available resources as the main problem of health care service delivery. Within this context, our main function is a management function, but we are aware that in addition we also perform social, educational and political functions, all of which provide credit or discredit to the government, depending on the level of our efficiency. In conclusion, I would like to declare that Poland, both as an individual State and as a Member State of WHO, is committed to the speeding up of the planned changes. Dr NASHER (Yemen): Mr President, excellencies, colleagues, ladies and gentlemen, as we get closer to a new century, we observe that there have been great advances in the health of the people of the world, with longer and improved quality of life. However, the harsh reality in the least developed countries is that infectious diseases, re emerging diseases and noncommunicable diseases continue to take their toll, and the double burden continues. The vision of equity in health and access to sustainable health systems and services are goals still to be reached in the coming century. On behalf of the Government of Yemen, I would like to congratulate the Director-General on The world health report 1998. This important report provides the latest assessment of the global health situation and gives us a technical and analytical basis for national assessment. In the same light, the document "Health for all in the twenty-first century" enriches the still valid primary health care concept by adding new dimensions, like human rights, ethics, equity and gender. We have found this strategy paper to be very useful and give it our full support. I would like to draw the attention of the Assembly to two issues: firstly, this year, on 7 April, all the countries celebrated World Health Day. It is significant that this year, the year that marks the fiftieth anniversary of the Organization, the theme of World Health Day was "Safe motherhood". This was a very appropriate choice. Despite considerable gains in health that have been achieved over the past 50 years, this particular agenda remains unfinished - an outstanding challenge to us all. There are enormous disparities in the developing world when it comes to death in childbirth, far exceeding disparities in other health and socioeconomic indicators that are commonly used to compare levels of development around the world. In my country, Yemen, despite the considerable gains made in improving health, it is estimated that one woman out of eight will die as a result of complications arising during pregnancy and delivery. This is one of the highest risks of maternal death anywhere in the world. Secondly, malaria. A disease of the past in most countries has become a serious A51NR/7 page 120 health threat in our country. It has an incidence of 10% of the population, that is 1.8 million, and a death toll of about 18 000 per year, mostly children. It threatens the lives of individuals and families, as well as socioeconomic development. With regard to these two issues, reduction of maternal mortality and morbidity and fighting malaria, we are in need of international and regional solidarity and technical support more than ever. As we enter the twenty-first century, reduction of inequities and fighting poverty should be a common goal to all people. Finally, on behalf of 18 million Yemenis, I wish to thank WHO and its outgoing Director-General, Dr Nakajima, for all the great efforts, assistance and support offered to all countries, in particular the developing and the least developed ones, in fighting disease and raising the standards of health care. Simultaneously, I wish to congratulate the Organization on its fiftieth birthday and on its Director-General elect, the outstanding lady, Dr Gro Harlem Brundtland, whom we will all support. I wish her all the best and success for the future. As long as we try to share the same vision and continue to work together, life on our planet will become more attractive and health for all in the twenty-first century will be more equitable, accessible, affordable and, above all, sustainable. Dr ABU BAKAR BIN SULEIMAN (Malaysia): Mr President, distinguished delegates, ladies and gentlemen, first I would like to congratulate you, Mr President, and your colleagues on your election to your high positions of office. I am appreciative of this opportunity to address the Assembly and make some remarks on The World Health Report 1998. The Malaysian delegation would like to join the many speakers before me in thanking and congratulating the Director-General on this highly informative and stimulating report. I was not one of those at Alma-Ata, but I have no doubt in my mind that historical meeting and the landmark Declaration on health for all must surely be WHO's most well known, motivating, long-lasting and impact-making slogan of all times. Its cornerstone, the primary health care concept, has been accepted and institutionalized in the majority of countries that make up the WHO membership. A great deal has been done and more has been said, but this is not enough. It is not serendipity behind the coining of the phrase "by the year 2000". It is merely a reflection of the reality of the situation and acceptance of the fact that equity in health, the ultimate goal of health for all, is a moving target than cannot be forcibly held down in the face of the people's rising expectations, ever-increasing, costlier health technology and, the failure ofthe global community and of individual countries to come to grips with the catalogue of wars that challenge humanity. The completion of a twenty-year programme is certainly a time for analysis and stocktaking, a time for consolidation of gains, a time for identification of strengths and weaknesses. It is certainly a time for putting in place new policies, strategies and goals for the future. We will have to operate not only on the basis of yesterday's experiences and today's realities, but, most importantly, on tomorrow's probabilities. As a nation that has always fully supported the policies and activities of WHO, enjoyed many benefits from its programmes and also contributed within our capacity towards its successes, we wholeheartedly welcome the report's assertion of continued leadership in health for the Organization into the twenty-first century. This is so, even as we increasingly recognize the contribution and impact of health that is and can be made by other sectors, and the role played by non-health determinants on health. We must realize that unless we deal concertedly with many of these issues our efforts in the health sector alone will have less than the desired impact. It is a time, therefore, to translate into action the constant call for intersectoral collaboration. In this regard, we look forward to being able to witness, learn and emulate such a truly working relationship at the global level. The advice, exhortations and proposals that come from a plethora of international voices can be confusing and give mixed signals to us at country level. It is akin to one tired horse being made to run on a long journey with a succession ofjockeys, some trying to ride it at the same time. What we need then, at the global level and national levels, are true and genuine alliances more concerned about partnerships than ownership. Even the best-laid plans would be limited in their success by a shortage of resources. Resources determine outcomes. Unexpected economic and political upheavals drive down the worth of resources where and when they matter most. Collective international action is needed to tide over troubled times in order that the hardwon health gains over decades are not wantonly sacrificed. This is therefore, the time for the wealthy and the "haves" to translate the high-level moral and intellectual position into real financial and/or in-kind support. The recipient countries, on their part, must put in place mechanisms to ensure that limited resources are used most optimally and the dollar spent on health buys the best value. Research, therefore, must be used not only to produce new technology and interventions but, even more importantly, to decide how best these can be employed and how best gaps between existing knowledge and its application can be filled. This would require priority-setting A51NRI7 page 121 mechanisms and, when this is done, both at global and national levels, we should not be afraid of controversy. If an issue is not controversial, it is likely that it might not be of high priority. In the introduction of new technology there appears to be too much focus on the technology itself and such a fixation causes us to lose track of the raison d'etre for the technology in the first place. Knowing how a word processor works does not make one an author. That is why, when we planned our blueprint for the introduction of telemedicine in Malaysia, we focused more on its potential as a tool to integrate curative, preventive and promotive programmes incorporating health management, health education, continuing medical education, health information systems, and customized life-long health plans, in addition to teleconsultation. We feel it is thus more appropriate to call this tool of integrated health "telehealth". We hope that our efforts in this will provide a model of information technology, of how information technology can be exploited as an enabler to formulate integrated programmes in an economic and cost-effective way. In conclusion, we would like to reiterate that we wholeheartedly support WHO's efforts to renew the health-for-all programme and together all of us should look towards the horizon for a clear vision for health in the twenty-first century, while giving due regard to reality by keeping our feet firmly on the ground. Dr OZSOY (Turkey) (interpretation from the Turkish): 1 Mr President, Mr Director-General, excellencies, ladies and gentlemen, I am particularly honoured to address the Fifty-first World Health Assembly, which coincides with the fiftieth anniversary of the World Health Organization. On this occasion, I have great pleasure in extending my Government's congratulations to WHO, and I also wish every success to my colleagues who have been elected to the Bureau. The world health report 1998 presents us with a new vision for the twenty-first century on the basis of past experience. I wish to pay tribute to the Director-General and his team for preparing this most important report. I am convinced that WHO, through its normative and technical cooperation functions, contributes considerably to global achievement of the objectives and targets ofthe health-for-all policy. In order to ensure universal acceptance of and compliance with these normative functions, I believe that further efforts are necessary to encourage active participation of all countries, and particularly the developing countries, in these activities. As regards technical cooperation, priority should be given to those regions and countries where health needs require greater assistance on the basis of objective criteria. In the twentieth century, life expectancy and the quality of life - as the highest universal value - has increased almost everywhere. Such progress has been achieved not only through developments in health but also through a complex and multisectoral interaction of various factors, such as per capita income and its distribution, basic education, clean water and sanitation, basic nutrition, demographic structures, sociocultural developments, shelter, urbanization, environment, industrialization and employment. I wish to underline here two issues which I consider vital in terms of their importance and impact. The first is the eradication of poverty, which will have a very considerable impact on the development ofhealth. The second is the education of women. Studies clearly establish that a 10% increase in the literacy rate of women could result in a I 0% decrease in the infant mortality rate, besides a considerable improvement in their own health. We are happy to see that the new health-for-all policy document submitted to this Assembly is based on the principles of the Alma-Ata Declaration of 1978. We believe that our successes in the area of health are to a certain extent attributable to WHO's health-for-all policies. Our governments no longer consider the improvement of the health status of their citizens only in terms of improvements in the health care services. In this globalizing world the State has still an important role to play in such areas as advancing democracy, participatory political life and human rights, as well as in alleviating the inequalities between its citizens and regions, extending basic education, and improving the physical environment, employment and social safety-nets, which are vital factors for health development. We believe that such an understanding is essential for progress in our societies, not only in the area of health but also in other sectors. Dear colleagues, the fight against communicable diseases is an area in which WHO has recorded significant successes. However, the prevalence of new and re-emerging communicable diseases such as malaria and tuberculosis compels us to continue our prevention and control measures. Immunization has evolved as the most effective instrument in our fight against such diseases. However, I wish to underline here our concern 1 In accordance with Article 89 of the Rules of Procedure. A51NRI7 page 122 about the emergence of antibiotic resistance, which hampers their control. Equally important is the fight against noncommunicable diseases. We have to make progress in this area as well, through health education, promoting healthy lifestyles, early diagnosis and quality health care. Achievement of these objectives calls for improvements in the provision of health services and for reforms in health systems. I welcome the selection of the theme "Safe motherhood" for this year's World Health Day. I consider this selection very meaningful, and congratulate WHO upon it. It is our most sincere hope and wish that the recent conflicts and wars which have destroyed all human rights, including the right to health, in our regions, will be replaced by peace and cooperation. I wish to underline the importance of peace for health, and health for peace, for the whole world in the twenty-first century. It would be remiss if I concluded my statement without paying tribute to Dr Nakajima, who has served the Organization with great capability over the past 10 years. He will always be remembered for his important contribution to transforming WHO into an Organization more responsive to collective challenges. On behalf of my Government and myself I thank him, and wish him happiness and good health for the future. It is also a great pleasure for me to extend my Government's best wishes for the success ofDr Gro Harlem Brundtland, Director-General elect. We are sure that she will take the torch from Dr Nakajima and continue this marathon in the best possible manner. I strongly believe that our future collaboration with WHO under her leadership will be very fruitful. El Dr. PIERUZZI SANCHEZ (Venezuela): Sefior Presidente, sefiores directores, delegados, amigas y amigos. «La vida: hoy se sabe que es una cadena de reacciones quimicas misteriosamente unidas a partir del mundo mineral del que el agua es el obligado soporte.» «La base de la subsistencia es la posibilidad de acceso a Ios bienes culturales, materiales y afectivos.» «No hay nada debajo del sol que no sea politico.» Con estas tres premisas, una biol6gica, otra econ6mica y la ultima politica e ideol6gica, abordamos la existencia en el siglo XXI. Nos movemos en el contexto de los desafios de la globalizaci6n, la crisis de paradigmas y en el proceso epistemol6gico de repensar nuestro saber y pnictica en salud desde la ineludible utopia concreta y esperanzadora de salud para todos. Este enfoque de la vida en el siglo XXI debe verse y comprenderse en el contexto de la situacion econ6mica y social de Ios paises y en el marco de la gobernabilidad caracterizada por presiones e incertidumbres en un entorno politico complejo, que ponen en entredicho la propia raz6n de vivir en la tierra y en la sociedad y que son derechos inherentes a la democracia. Pertenecemos a la globalizaci6n en cuanto consumidores, pero no se puede ser consumidor sin ser solvente en el mercado. Esta es la paradoja. Se nos invita al consumo de manera universal, pero carecemos de ingresos suficientes para ello por la negaci6n del acceso al trabajo de ese nivel competitivo. Se deriva asi un darwinismo socioecon6mico entre empresas y S()ciedades y una gran concentraci6n del poder financiero y de Ios vendedores de bienes y servicios de consumo globalizado. Hoy Ios Estados nacionales son desbordados por realidades supranacionales que condicionan y no dejan alternativas exitosas distintas a su propuesta, dejando de cumplir su rol sustantivo de protecci6n para las mayorias, y nos preguntamos por que tantas dificultades para Ios cambios en Ios Estados, y nos respondemos: porque han sido apropiados por grupos de conciencia individualista, una elite de misi6n privatizadora, ademas con un gran peso burocratico, que viven del Estado sin prestar servicio eficiente a la poblaci6n. La pobreza se incrementa con un Estado inepto y apropiado privadamente por intereses particulares. Qebemos rescatar la relaci6n dialectica entre Estado y sociedad civil, asumiendo un nuevo sentido de lo publico para beneficio de la poblaci6n en terminos de competitividad, de empleo, de ciudadania y de gobernabilidad. Todos Ios actores deben contribuir a ello. La lucha en favor de la salud no es s6lo un lider, es una construcci6n de todos, como fundamentalmente lo ha demostrado el Hder de nuestra Region, George Alleyne, por lo cual estamos orgullosos. Los paises de ben colocar una ideologia de contenido social en sus planes nacionales de salud, en defensa de la doctrina de la atenci6n primaria en salud, eliminando rigideces conceptuales y organizativas de la reforma, dotandola de nuevos instrumentos de planificaci6n y de gesti6n que posibiliten su progreso y que enfrenten la idea neoliberal privatizadora, la inequidad y la exclusion. Por lo tanto, se deben hacer proyectos concretos de formaci6n, dinamica empresarial y empleo, que son las fuentes de la equidad y justicia social, para que la mayoria sea capaz de producir bienes y servicios de calidad para una vida de aceptable bienestar, mas construida que importada. Hay que prestar atenci6n a Ios cambios culturales, educativos y de valores, mas que a Ios macroecon6micos. El Estado no puede trabajar s6lo en la direcci6n de tener a una minoria bien preparada de profesionales, de trabajadores y de empresarios para que se inserten exitosamente en la economia global, por A51NR/7 page123 cuanto existe una mayoria de excluidos y para Ios cuales el Estado de be mediar para potenciarlos, reforzando su educaci6n, el desarrollo de su talento en organizaci6n, eficiencia productiva y en ciudadania. Concluyamos sin desanimo con la mirada y el coraz6n puestos en el horizonte de la esperanza: construir un mundo apto para la vida y donde la salud sea fundamental empresa colectiva. Felicitamos al Director General saliente, Dr. Nakajima, por la labor cumplida, especialmente por unos excelentes documentos doctrinarios, como son el Iriforme sobre la salud en el mundo 1998, y su categoria fundamental, la vida, «La salud para todos en el siglo XXI» y la Declaraci6n Mundial de la Salud. Con palabras del poeta hindu Tagore despedimos al compafiero Nakajima y recibimos a la compafiera Gro Harlem Brundtland. «Dormia y sofiaba que la vida era alegria; me desperte y vi que la vida era servicio; servi y vi que el servicio era alegria.» M. KEDELLA (Tchad) : Monsieur le President de seance, Monsieur le Directeur general et Messieurs les Directeurs regionaux de l'OMS, Mesdames et Messieurs les Ministres, honorables delegues, Mesdames et Messieurs, c'est pour moi un grand honneur et un reel plaisir de prendre la parole devant cette auguste Assemblee mondiale de la Sante. Au nom du Gouvernement de la Republique du Tchad et au nom de la delegation qui m'accompagne, je vous adresse a tous mes tres sinceres salutations et une cordiale bienvenue ici a Geneve. 11 m'est agreable de saisir cette occasion pour feliciter tres vivement le President de sa brillante election a la tete de cette tres importante Assemblee et pour lui souhaiter plein succes dans sa lourde et exaltante mission. La Cinquante et Unieme Assemblee mondiale de la Sante aura marque plus que jamais l'histoire de notre Organisation pour plusieurs raisons : elle coincide avec le cinquantieme anniversaire de l'OMS, elle constate l'echange de flambeau de !'Organisation entre le Directeur general sortant et son successeur, et elle est marquee par la presence de plusieurs personnalites eminentes, dont des chefs d'Etat et de gouvemement. Elle constitue, en un mot, un evenement particulierement important dans la vie de l'OMS. En effet, le monde entier avait, en janvier 1998, acclame la brillante designation de Mme Gro Harlem Brundtland au poste de Directeur general de l'OMS. Je voudrais, au nom du Gouvernement demon pays, lui adresser mes tres vives felicitations et mes encouragements. Madame le Directeur general elu, compte tenu de vos brillantes qualites, de votre courage et de votre dynamisme, il y a lieu de croire que votre avenement a la tete de notre Organisation lui donnera un nouvel elan dans la prestation de la sante et de la qualite de vie dans le monde. En tant que pays Membre de l'OMS, la Republique du Tchad ne manquera pas de vous appuyer dans l' accomplissement de votre mission. Je voudrais egalement saisir cette occasion pour rendre un hommage merite au Dr Nakajima et a toute son equipe qui, par leur savoir-faire et leur savoir-etre, ont su, malgre d'innombrables obstacles, insuffler un esprit d'innovation a l'OMS et contribuer sans menager leurs efforts aux principales realisations de I'Organisation, notamment l'action visant a eradiquer la poliomyelite, la dracunculose et la lepre et a assurer la promotion des so ins de sante primaires et des medicaments essentiels. Je voudrais ici rassurer le Dr Nakajima en lui disant que, meme s'il quitte la direction generale de l'OMS, son nom sera grave ajamais dans l'histoire de l'humanite tout entiere en matiere de sante. Nous devons aussi nous rejouir de !'immense travail accompli par cette Organisation au cours des cinquante premieres annees de son existence pour ameliorer la sante des populations du monde entier, mais il faut noter que ces progres, perceptibles ailleurs, ne le sont pas pour autant dans les pays en developpement, notamment dans les regions de I' Afrique, del' Asie du Sud-Est, du Moyen-Orient et del' Amerique latine. Cette situation doit nous amener a redoubler d'efforts en vue d'assurer la maitrise des maladies emergentes et reemergentes, bacteriennes et virales, de poursuivre le processus d' eradication de certaines maladies deja ciblees, telles que la poliomyelite, !'infestation par lever de Guinee et les filariases, d'offrir des soins de base de qualite aux populations, de rendre !'eau potable accessible a tous et d'endiguer les maladies non infectieuses, source de souffrance et de deces de milliers de personnes. Monsieur le President de seance, honorables delegues, je ne pourrais laisser passer cette occasion sans saluer le dynamisme du Directeur de la Region africaine qui, malgre la dislocation de son equipe pour cause de conflits armes, a fait un travail remarquable en mettant en oeuvre les resolutions et les decisions de I' Assemblee mondiale de la Sante. Je voudrais ici insister sur !'importance de la resolution WHA50.4 relative a la publicite, la promotion et la vente transfrontieres de produits medicaux, et de la resolution WHA50.37 relative au clonage dans le domaine de la reproduction humaine. S'agissant de la vente transfrontaliere des medicaments, il faut noter que la Region africaine vit une situation extremement grave, extremement dangereuse. Les medicaments, rentres de toutes parts A51NRI7 page 124 dans le continent, sont vendus par les marchands ambulants sur les tablettes au marche, aux abords des routes, dans les cabarets et debits de boissons. Les conditions de conservation et de reconditionnement, les dates de fabrication et de peremption ne sont pas connues. Une reglementation de ce marche au niveau mondial mettrait les Etats a l'abri de cette proliferation illicite de medicaments. Quant aux consequences sociales, ethiques et scientifiques du clonage dans le domaine de la reproduction humaine, il faut noter que la position actuelle de l'OMS est salutaire et merite d'etre appuyee. Le temps apportera sa part dans la comprehension du phenomene. La presente Assemblee va aborder des questions tres importantes si !'on se refere a son ordre dujour. Nous devons sortir de ces assises des decisions et des resolutions a la hauteur de l'attente des populations que nous representons ici. En ce qui concerne la revision du Reglement sanitaire international, il faut la faire en tenant compte de !'importance du brassage des populations a travers le monde d'une part, et d'autre part des tendances epidemiologiques des maladies transmissibles, notamment !'apparition de nouvelles maladies telles que le SIDA et autres maladies sexuellement transmissibles et les fievres virales hemorragiques. La declaration par syndrome proposee par l'OMS va raccourcir le delai de transmission des donnees du niveau peripherique vers les centres, surtout dans les pays en developpement ou les moyens de diagnostic font souvent defaut. Le Tchad a adopte ce systeme depuis 1986 pour son systeme d'information sanitaire. 11 me plait de souligner que le probleme de la sante reproductive et familiale preoccupe particulierement mon pays. C'est ainsi qu'ayant adhere a !'initiative pour une maternite sans risque lancee il y a dix ans par la communaute internationale pour combattre la surmortalite maternelle, le Tchad a mis en place un programme de so ins maternels et infantiles et du bien-etre familial, un projet de maternite sans risque avec I' appui de I' OMS, de !'UNICEF et de la Banque mondiale, le marketing social du preservatif dans le cadre de la lutte contre les maladies sexuellement transmissibles et le SIDA, une association tchadienne du bien-etre social, un centre de prise en charge des sujets atteints de maladies sexuellement transmissibles, source de sterilite et de surinfection de l'appareil urino-genital, enfin des moyens de formation pour renforcer les capacites du personnel. Cependant, il est encore trop tot pour par! er de I' evaluation de ces activites. Pour conclure, je saisis cette occasion pour adresser du haut de cette tribune a to us nos partenaires au developpement sanitaire, et tout particulierement a l'OMS, nos remerciements les plus sinceres pour avoir ete toujours disponibles pour nous apporter l'appui technique et financier necessaire a la resolution de nos problemes de sante. Dr KERESZTY (Hungary): Mr President, Director-General, distinguished delegates, ladies and gentlemen, may I first congratulate the President, Vice-Presidents and Rapporteurs of the plenary sessions and the committees on being elected to hold these highly important functions during this very special World Health Assembly. Secondly, may I congratulate the new Director-General. I wish her a fruitful service here at WHO, and the support and cooperation of the Member States. · To characterize this Assembly as a "very special" event is justified by several reasons, the first being the fact that we are celebrating the fiftieth birthday of the World Health Organization. This half century has not passed without results; no, it brought real success in promoting better health of the population worldwide. A number of infectious diseases can now be controlled, international standards and norms have been elaborated and implemented in different fields of health care, real support has been given to Member States in formulating their health policy and strategy ... and I could and should continue this list for a long time more. Perhaps one of the greatest successes of the Organization was the recognition and the statement of the fact that health is a complex concept, involving the physical, psychological and social factors equally. Thus health care is not a mere medical, but an intersectoral and interactive, public responsibility. It is natural that during this long period, parallel to the above-mentioned successes, failures or weaknesses have also been revealed. Nevertheless, while acknowledging that the renewal of the Organization is necessary and will surely be beneficial, the leading role of WHO in questions of health and health-related affairs is indisputable. This leads us to another reason why this Assembly is really a special one. We are now living through a deep-rooted reform and reinforcement of the United Nations family, in which WHO as a member, has to re-establish and strengthen its leading role in health-related issues, taking into consideration all three main factors of health: the well-being of the body, the soul and social environment. This is not an easy task. However, I am sure that the new leadership of WHO will bring new ideas and management techniques to take further the already achieved results, and so to strengthen the position of the A51NR!7 page 125 Organization within the United Nations family. To reach this goal, strong cooperation, and at the same time a precise share of responsibilities have to be established and exercised between headquarters, the regional offices and Member States. It is our conviction that, while headquarters has the major task of elaborating, monitoring and evaluating global strategies for health, the regional offices have the inevitable responsibility of adapting these to their specific needs and means, fulfilling not only principal, but also operational tasks, and supporting Member States in doing so on national and local levels. Please allow me to relate a new approach at the national level in our country, Hungary. Following the Jakarta Conference, which gave us a new impetus in health promotion, and also the very fruitful mission of the European Region for the evaluation of"Investment for health" in Hungary, which made useful recommendations for us, a new pamphlet, entitled The health promotion strategy in Hungary for the year 2010, was recently published. This publication is based not only on the new global and regional health-for-all targets, but also on the Jakarta Declaration, and one of its aims is to ensure continuity in partnership for health for the 12-year period. We plan to distribute and discuss it with a broad audience, professionals and nonprofessionals, those who serve and those who are served, equally. Last but not least, it is my pleasant duty to congratulate the Director-General and WHO for the excellent work in preparing this anniversary Health Assembly and the excellent 1998 world health report as a basis for further discussion. It was an honour for me to address this Assembly and to have an opportunity to wish WHO not only a happy birthday, but also many happy returns. El Dr. DULLAK (Paraguay): Senor Presidente, senor Director General, Excelencias, distinguidos delegados, senoras y senores: Quiero antes que nada ofrecer mis mas sinceras felicitaciones al Presidente por su elecci6n a la presidencia de esta 51" Asamblea Mundial de la Salud. Hago extensiva estas felicitaciones a Ios Vicepresidentes, asi como a Ios presidentes de las diferentes comisiones conformadas en este encuentro. Les deseo a todos exitos en sus respectivas tareas. Agradezco y felicito al Sr. Director General por el excelente lnforme sobre la salud en el mundo preparado para esta Asamblea. La llegada del nuevo milenio se presenta como un punto propicio para el analisis retrospectivo de lo realizado y dentro del proceso evaluativo de estos ultimos anos del segundo milenio, nos encontramos que aun seguimos luchando contra la mayorfa de Ios desafios que motivaron a esta Organizaci6n en su busqueda conjunta de soluciones a Ios problemas de salud publica que aquejan a nuestros pafses. Es mas, se han agregado algunos problemas que se constituyen en verdaderos desafios a Ios conocimientos y la tecnologfa, asf como la recrudescencia de muchos problemas que se consideraban resueltos o al menos mitigados. Hablamos hoy dia de esa forma lie las enfermedades emergentes y reemergentes. Es dable pensar que la respuesta a dar debe centrarse en nuevas perspectivas de trabajo en el area de la salud, con el enfasis puesto en una adecuaci6n de nuestros sistemas de salud a las nuevas realidades que se dan no solo en el sector, sino que aparecen en el campo social y politico con Ios cambios en las estructuras de gobiemo de nuestros pafses, la democracia y la participaci6n social y comunitaria para enfrentar !as multiples situaciones que a diario se ven, asi como la persistencia e incluso el aumento de la pobreza. Salud para todos en el siglo XXI se constituye en un imperativo para nuestras naciones. La experiencia del enfoque dado a la anterior meta de salud para todos en el ano 2000 y Ios avances obtenidos, asi como Ios obstaculos, pueden enriquecer nuestra estrategia para establecer nuevas metas con el mismo objetivo. Debe destacarse con claridad la necesidad de constituir a la salud en el elemento central del desarrollo, en el marco del desarrollo humano sostenible. La experiencia con las enfermedades reemergentes debe damos la perspectiva de que no podemos cejar en nuestros esfuerzos. Los recursos destinados a la lucha por la salud de nuestros pueblos deben ser mantenidos y aun incrementados, pues el riesgo del retroceso en Ios logros implica que Ios esfuerzos deben ser redoblados, constituyendose en situaciones dificiles de soportar por !as fragiles economias de nuestros paises en vias de desarrollo. En esta perspectiva de be primar en nosotros un enfoque positivista para continuar en la lucha, y aquf me gustaria resaltar una cita del documento cc La salud para todos en el siglo XXI» en el que se dice que ccAunque en el siglo XXI se afrontaran nuevas amenazas, tambien estan surgiendo nuevas oportunidades y enfoques para eliminarlas». En Ios pocos anos recorridos desde Alma-Ata hemos aprendido mucho. Se han dado muchas situaciones positivas y negativas, pero es evidente que el concepto de atenci6n primaria de salud, piedra angular del concepto de salud para todos, ha prendido, y a pesar de Ios obstaculos para su progreso, ha demostrado ser una herramienta util y su aplicaci6n se ha expandido. A51NRf7 page 126 El proceso de reforma sectorial en salud en mi pais, el Paraguay, se constituye en un ejemplo de este hecho, pues se han tornado todos Ios elementos de la atenci6n primaria de salud para constituir un Sistema Nacional de Salud dentro de Ios principios de la democracia participativa y solidaria, en busca de la equidad y para mejorar !as condiciones de salud de sus habitantes. En este sistema se estructura un esquema de coordinaci6n del subsector publico y el privado, en un entorno descentralizado, sustentado en la participaci6n social y comunitaria, con el apoyo manifiesto del gobierno central, y redefiniendo !as funciones del Ministerio de Salud, fortalecido en su rol de rectoria sectorial. Debe destacarse la importancia que tiene la actividad de la Organizaci6n Mundial de la Salud, a traves de sus oficinas regionales, en el soporte tecnico de estos procesos, asi como de Ios diferentes programas de salud publica en nuestros paises; debiendo resaltarse el efecto catalizador de Ios recursos aportados, que motivan a Ios gobiernos y a otros organismos de cooperaci6n bilateral y multilateral para incrementar Ios recursos aportados al sector. Para finalizar, deseo expresar nuestro aprecio y apoyo al liderazgo de la Organizaci6n Mundial de la Salud en su tarea de mejorar !as condiciones de salud y vida de la humanidad, y tambien desear exitos a la nueva Directora General en su trabajo. Professor REINER (Croatia): Ladies and gentlemen, I would also like to join in the congratulations to the President and Vice-Presidents as well as the Director-General and the new Director-General, Dr Brundtland. I wish her a lot of success. I particularly applaud the selection of the topics for today's discussion on The world health report 1998. I am very pleased that the entire text shows great optimism from the very first sentence of the report, which reads "The 21st century offers a bright vision ofbetter health for all." My delegation certainly shares this optimism, bearing in mind that my country got independence only eight years ago and immediately became victim of aggression, and all the consequences of this horrible war are still very much present. Despite that, we are full of optimism and join the spirit of this report in anticipating further progress in the years ahead. We are especially impressed by the proposed position of WHO for the next century, namely its call for not just longer life but a better quality of life, with less disability and disease. This optimism has been supported also by the inspiring words of Dr Brundtland this morning. Looking back we can be proud when we analyse the impressive evidence of health gains achieved over the years with the help of WHO. Everybody can be justifiably impressed by the fact that the global life expectancy has increased by 25 years in the last 43 years and that the infant mortality rate has decreased from 148 per I 000 live births to 59 in the same period. The fact that 80% of children are now immunized against seven major childhood diseases contributed greatly to this 250% decrease. The great health centre movements of the last decade have also significantly contributed to such health gains. Our famous policy and strategy, health for all, and the primary health care movement are just a few of them. We are witnessing an unprecedented rate of change - physical, cultural, social and environmental. There is need for an adequate response on the part of health systems, for both the health needs of the population and its expectations for better health have also undergone a substantial change. This all means new challenges to the health systems and demand on them to perform continuous reforms. This is where I also see the basis for our vision of health in the twenty-first century. In my country we have witnessed another phenomenon that fills us with optimism. Some observers have already called it the Croatian paradox. Judging from common experience regarding the influence of general conditions on health status, Croatia should have experienced a deterioration in its health status due to the war, the many refugees we hosted, transition period, economic troubles, decline of health standards, unfavourable environmental conditions and other factors. However, quite the contrary happened. The health parameters and indices from infant mortality and life expectancy rates to age-standardized mortality rates and age-specific mortality rates for people of 65 and over show an unexpected improvement, much exceeding the average parameters in countries in transition, and indeed Europe as a whole. Despite the war-induced suffering Croatia has gone through, even the number of suicides dropped and is now below the European average and below the average of almost all the neighbouring countries. This may indicate that my fellow Croatians are optimistic, which is a good basis for building up positive visions for general development, health care and development in the next century. We have completed a large portion of this task by enacting the Croatian policy and health-for-all strategy by the year 2005. We have also developed an implementation document entitled "The master plan" and are completing our national environmental health action plan. This all contributes to a positive vision of development of health in the twenty-first century. A51NR/7 page 127 In conclusion, I would like to paraphrase the opening statement of this excellent report as it pertains to the situation in my country. In Croatia, the twenty-first century offers a bright vision of better health for all. With this vision, we are also sending the most appropriate message of congratulations to our Organization on its anniversary. Mr. M'HENNI (Tunisia): ·~ )1 .:r>-)I .JJI r ~) y ~i ~i ·~~i-t; J •J ~ ,;;.:>WI; ~~~I d_,..a>- .~WI h...all ~ ~ J ~\ W' .oJJ...UI o..l.l> Jwi o).:>l ,_} ~_,:11 iL..; .J ~I 0\J <~;\.;.:._:;;~ o}>-..li ~~ ,y- ~IJ ~.:>WI h...all ~ ·~.:>~~I lS_/..UI o.h. J •J 1_,.,_.....,1) .~~:I~ .:r...UI ~J ~)\ ylj o.:>WI tr'~ ~~ 01 ~~ ~ ~J .U_r....lAi _r-$' ,y- 4J ~L...... ll j5:J Yfl 0\J -~ ..:...,.t; ~~ a.LJ>-Ji Jw.\1~ c_jl 01 ~ ,YI "->- yf ~\) ,;wt; ;;,.US::, ~ J:; p ~ -*'"" (,.)..UI ¥1.5'U ~ J.r.!" J.JS' ..ill (,.)-=>'Yu. 0bl fW..... ,y ~1 ,jJ ..;..:Jb.J\ ~ ,j \.j,:)')\; o~ (,)JJI (,),:)~:11 _,...:]1 01 ,~\_; ·~ l.'>_;s"iJ ._:..l;ii·ll J,:)iJ ..;..L....b'JI o...l:>-4 ~~ ..;..Lo...b'J~ J.-k;J 1~ ...Lit.; Le y.. ~~ ,:)\,:) _;..; ..;..t...... J.:>..j 1w1 ~ 'v"'L> ...... ,.,. y. ~~J ~L....aJI JG,.... L...:> ~ ,..;..L....b'JI t_ lk,; ..!.1]~ ,j ~ 'Ct::;:J\ ._:..~\.k,; JS' f..~ _r ~WI ....,.,._,:.11 01 ,L...... \.>. :~~:11 ·tt1AJI \.1;. j..~ Js- .:.r" y ~\ ~ i _HI ~l..U L. Jl ~_}jl _;_,.a>JI _)i; ..::..AJi 0i ,~ W\.>. ,j ,,:) } ,~)I (,)~ . _ .r ~\ J->.i .r j..--; 0i ~ L:#) ~\) ~L....J\) JL..il..~l if .r.f ,:)~ ~ y.. ~ ~ ... J'L. Jl_r)l _,....:bly ~~ Le U~ :1 LS' ,~ 4.,j \-.; ,~1 ~__,.JI -?I_; ~I 0~ _? jj~ ~IJ ~\.jlA..o ·ij~l if _?i Jlk J Jlk (,)JJIJ ~ ._;, J_;...JI }...=JI ~ ~\ ~__,.JI ~~k..JIJ .1')L.JIJ ,o~:ll .:r--> Js- ~ I~ El Sr. CASTELLON (Espana) : Senor Presidente, excelentisimos senores, distinguidos delegados y delegadas, senoras y senores: Me es muy grato dirigirme a ustedes en esta 51" Asamblea Mundial de la Salud en la que estamos celebrando el cincuentenario de la Organizacion. Esta ultima circunstancia nos llena de satisfaccion y entendemos que es un marco de referenda que transmite la gran trascendencia e importancia de Ios propios fines de la Organizacion: ccalcanzar para todos Ios pueblos el grado mas alto posible de salud». Quisiera expresar nuestra felicitacion al Sr. Presidente y Ios Sres. Vicepresidentes por haber sido nombrados para dirigir esta singular Asamblea y disculpar ante todos ustedes la ausencia del Excmo. Sr. Ministro de Sanidad y Consumo del Gobiemo de Espafia, D. Jose Manuel Romay Beccaria, al que por motivos institucionales sobrevenidos le ha sido imposible estar con nosotros en la tarde de hoy. La necesidad de sintetizar las intervenciones en el limitado tiempo del que disponemos me obliga a esquematizar nuestra vision sobre las tendencias previsibles en Ios albores del siglo XXI, aunque parto de la premisa de que estas previsiones deberan ser reexaminadas de forma dinamica, pues creo firmemente que en el mundo sanitario es valida la reflexion segun la cual «mas que confirmar verdades tenemos que refutar errores». La globalizacion es una situacion de hecho y existe el riesgo de que un mundo sin fronteras economicas conlleve no solo aspectos positivos, sino tambien problemas de desarraigo y confusion ideologica y nos hallemos en un espacio planetaria sin relieve ni horizonte cultural e intelectual. Como elemento esperanzador, hay que reconocer Ios avances experimentados en Ios ultimos anos en el sector de la educacion, hecho que se ha producido en la mayor parte de las regiones del mundo. La educacion es la clave para el desarrollo y debemos promover que estos avances no solo se mantengan, sino que se incrementen. En Ios proximos decenios, Ios avances tecnologicos originaran cambios sensibles en la vida economica, social, cultural y sanitaria. La implantacion de nuevas tecnicas sanitarias constituye un factor complejo, al cuestionar Ios metodos anteriores e introducir nuevos costes que habra siempre que evaluar, pero abre esperanzadores horizontes de nuevas capacidades y oportunidades. Por otro lado, descubrimientos tales como la fecundacion in vitro y la clonacion han dado y daran origen a nuevas formas de intervencion en Ios procesos de reproduccion humana, lo que plantea conflictos que habran de ser abordados desde s6lidos esquemas eticos y juridicos. En lo referente a las perspectivas de Ios servicios sanitarios, se tiende a pronosticar que, en general, asistiremos a una relativa descentralizaci6n de Ios servicios de salud. Los sistemas sanitarios seguiran enfrentandose a presiones comunes en todos Ios paises: el aumento de Ios costes de la asistencia sanitaria, Ios cambios en Ios patrones de las enfermedades, el crecimiento de las expectativas de Ios ciudadanos, Ios avances de la ciencia y las tecnologias medicas y el envejecimiento progresivo de la poblaci6n. En consecuencia, el gasto sanitario seguira aumentando por encima de la inflaci6n y del crecimiento econ6mico. Los profesionales sanitarios, en el siglo XXI, no deberan limitarse a tratar la enfermedad, sino que tendran que ampliar sus funciones para poder atender a la poblaci6n con la mayor eficacia, bajo la filosofia de la atenci6n basada en la persona, y deberan utilizar las tecnicas de comunicaci6n para promover estilos de vida saludables. Tambien tendran que tomar decisiones no solo clinicas o sanitarias, sino econ6micas y sociales en relaci6n con la atencion de la salud de Ios ciudadanos. Vemos pues, que la situaci6n de la salud es el resultado de diferentes actividades de desarrollos y conductas. Su direccion y responsabilidad no recae, en exclusividad, en el sector sanitario y requiere la colaboraci6n interdisciplinaria e intersectorial. La salud de Ios nifios y adolescentes y el respeto de su derecho al mejor acceso a Ios servicios de salud debe ser un objetivo prioritario de la comunidad sanitaria intemacional y de los gobiemos. Se debe potenciar la estrecha cooperaci6n entre la OMS y otros organismos de la Naciones Unidas para promocionar y garantizar A51NR/7 page 129 el cumplimiento de la Convencion sobre Ios Derechos del Nino. La marcha mundial que culminani aqui en Ginebra el proximo 1 de junio debe movemos a la reflexion y a la accion decidida y concertada en ese objetivo. De la misma forma, nos preocupa garantizar el acceso de la mujer a Ios servicios de salud de forma integral, promoviendo su desarrollo como personas y evitando toda suerte de discriminaciones. Junto a ello, la promocion de mejores niveles de salud matemoinfantil de be ser reto prioritario de la salud en el siglo XXI. En este sentido, aplaudimos la iniciativa de la Organizacion de dedicar este ano el dia Mundial de la Salud a la mejora de la salud matemoinfantil. Senoras y senores dele gad~ permitanme hacer explicito nuestro deseo de trabajar en favor de la salud para todos, en el marco de nuestros compromisos intemacionales como pais miembro de la Union Europea. En este sentido, quisiera asociarme al contenido de la intervencion del Jefe de la delegacion britanica, en tanto que Presidente del Consejo de Ministros de la Union. Quisiera explicitar asimismo nuestro apoyo a Ios trabajos de la Oficina Regional de la OMS para Europa, dirigidos por el Dr. Asvall, en cuanto a su labor en general yen particular a la que esta desarrollando con Ios paises de Europa central y del este. AI mismo tiempo, quisiera reconocer nuestra especial vinculaci6n con !as naciones iberoamericanas, con las que compartimos una base cultural e historica comun. Quiero recordar aqui que Espana disfruta de un sistema nacional de salud de caracter universal, que constituye una conquista social ampliamente asumida por nuestros ciudadanos. Nuestro sistema sanitario ofrece una amplia gama de prestaciones e incorpora tecnologias avanzadas, siendo gratuita en su practica totalidad y sin requisitos limitativos previos. Nuestros centros asistenciales disfrutan de un alto nivel de equipamiento, incluso en determinadas areas, como Ios trasplantes de organos, y disponen de un personal sanitario sin duda muy bien cualificado. Sin embargo, ni podemos ni queremos ocultar que hay problemas y retos pendientes de afrontar. Consecuentemente, y de acuerdo a la realidad social y economica, el Parlamento espanol entiende que han de abordarse cuatro grandes retos para garantizar, en el futuro, una evaluacion y una consolidacion adecuada de nuestro sistema sanitario. Estos retos serian Ios siguientes: definicion de la responsabilidad del Estado y Ios individuos ante las necesidades de salud; suficiencia financiera, que permita hacer frente a las necesidades actuates, a las nuevas demandas a las que el sistema sanitaria debera responder en un futuro y la equidad en el reparto territorial; flexibilizacion en la provision de servicios sanitarios con un impulso a la autonomia de Ios centros sanitarios; y pleno desarrollo del modelo sanitario descentralizado previsto en la Ley General de Sanidad, y la adecuada participacion de todos Ios agentes publicos en la configuraci6n del sistema. Senor Presidente, permitame transmitirle la honda preocupacion del Gobiemo espanol, que le consta es compartida por Ios paises hispanoamericanos, por el deterioro en el cumplimiento de las disposiciones que regulan el estatuto del idioma espafiol en la OMS y Ios retrasos que en demasiadas ocasiones se producen en la traduccion de Ios documentos de la Organizacion al idioma espanol. Quisiera por ello reiterar nuestra peticion de que la OMS mantenga y refuerce el apoyo en recursos materiales para que nuestro idioma tenga, en pie de igualdad con todos Ios demas idiomas oficiales, el tratamiento previsto en las normas de la Organizacion vigentes al respecto. Senor Presidente, a! ser esta la ultima Asamblea en la que el Dr. Nakajima ocupara el puesto de Director General, quisiera expresar el reconocimiento de la delegacion espafiola por su labor al frente de la Organizacion en un periodo no exento de situaciones dificiles de gestionar y desearle mucho exito en sus actividades futuras. Quisiera igualmente, senor Presidente, reiterar a traves de usted a la Sra. Gro Harlem Brundtland nuestra felicitacion por su eleccion, hoy, por esta Asamblea para el cargo de Director General. El numero masque expresivo, diria casi universal, de apoyos recibidos augura una etapa de solidas realizaciones por l~1 Organizacion y la delegacion de Espana le expresa sus deseos de exito en su nueva labor, en la que podra contar, siempre con la plena colaboracion de nuestro Gobiemo. M. COLLA (Belgique): Monsieur le President de seance, Mesdames, Messieurs, le cinquantieme anniversaire de l'OMS est une occasion de reflexion et de gratitude. Gratitude parce que j'aimerais remercier tout d'abord ces femmes et ces hommes qui ont donne de leur personne afin de promouvoir l'OMS. Je tiens egalement a remercier l'equipe sortante et, en particulier, le Dr Nakajima. Moment de reflexion aussi. Ce matin, nous avons elu un nouveau Directeur general. C'est le moment par excellence d'agir et de donner un nouveau souffle anotre Organisation. I1 n'existe aucun doute, je pense, au sujet des priorites fondamentales de l'OMS : les so ins de sante primaires, une attention toute particuliere a la situation des peuples Jes plus demunis, ou encore !'elaboration d'une politique de prevention. A51NR/7 page 130 Mais, Mesdames, Messieurs, n5aliser les objectifs essentiels suppose deux genres d'action prealable : renforcer !'impact politique de notre Organisation et renforcer notre capacite organisationnelle. Premierement, il faut renforcer notre impact politique. Ace propos, quelqu'un m'a dit: si les chefs d'Etat etaient convaincus du pouvoir politique de la sante, la sante publique serait tres vite une des priorites absolues a l'ordre dujour du debat politique. Alors, comme Mme Brundtland l'a tres bien indique ce matin, la conclusion est evidente : il faut convaincre les chefs d'Etat, les premiers ministres, les ministres des finances, il faut convaincre aussi les responsables de differentes organisations mondiales, il faut creer des alliances strategiques avec, par exemple, la Banque mondiale et le Fonds monetaire international, parce qu'ils ont le pouvoir et la possibilite de reorienter les investissements en donnant plus de priorite a la sante. Il faut egalement intensifier la cooperation avec les instances regionales. Aujourd'hui, la cooperation entre !'Organisation mondiale de la Sante et !'Union europeenne, par exemple, laisse a desirer. Elle doit done etre resserree, et la representation et I' action politique de l'OMS aupres de !'Union europeenne meritent d'etre developpees. Deuxiemement, il faut renforcer notre capacite organisationnelle. C' est necessaire mais ne ce sera pas facile. L'OMS a besoin d'une veritable strategie de communication, tant a l'interieur qu'a l'exterieur. Elle a besoin d'urgence d'un reseau de communication efficace, par exemple, entre les centres collaborateurs. Elle a aussi besoin d'une strategie d'information, simplement parce que nous avons besoin de millions d'hommes et de femmes bien informes, bien motives pour realiser nos objectifs de sante. A la veille de l'an 2000, les defis devant lesquels nous sommes places sont multiples et importants. Il y a, par exemple, I' influence negative de notre mode de vie et de la pollution sur la sante des gens. Mes chers collegues africains, Mesdames et Messieurs les delegues des pays soi-disant chauds, apres deux jours de canicule, on annonce en France et en Belgique une alerte a !'ozone. Cela signifie qu'il faut dire aux enfants de rester a la maison et, done, de ne pas profiter du beau temps. Incroyable, mais vrai ! Il y a - autre exemple - le domaine essentiel des medicaments, domaine delicat que je ne mentionne pas par hasard. Pour repondre aux besoins legitimes en medicaments, il faut un equilibre entre la viabilite financiere de la recherche scientifique et le droit a des medicaments a un prix acceptable. En ce qui me concerne, il faut bien sur garantir la qualite, il faut sauvegarder l'idee de medicaments essentiels, il faut promouvoir les soi-disant generiques, en sachant que le medicament est aussi un produit commercial et qu'il y a des regles commerciales et internationales. Il ne faut jamais oublier que le medicament est tout d'abord un outil de sante. Prendre alors les mesures qui s'imposent, cela suppose du courage politique, mais c'est le devoir legitime des responsables politiques. Neanmoins, je suis optimiste, je crois qu'on peut, clans le cadre d'un partenariat avec l'industrie pharmaceutique, trouver des solutions adequates. Moi, vous savez, j'aime l'industrie a condition que l'industrie m'aime aussi un peu. En diminuant un peu les depenses promotionnelles, quand meme importantes, peut-etre pourrait-on deja resoudre pas mal de problemes. Et, toujours clans ce domaine delicat des medicaments, il y a deux problemes qui me preoccupent beaucoup: la disponibilite des medicaments rares pour faire face aux maladies rares et l'acces pour tous aux medicaments, ce qui suppose I' organisation de systemes d'achat et de distribution. A cet egard, mon pays - la Belgique - est pret a collaborer avec les pays qui le veulent. En conclusion, je lance un appel a mes collegues des pays soi-disant developpes. Nous donnons trop souvent !'impression de ne pas avoir besoin de l'OMS. C'est une erreur, c'est une faute grave. Nous avons tous besoin de l'OMS, et par solidarite et par necessite. Seule l'OMS est capable de resoudre les problemes de sante qui se posent au niveau mondial. C'est pourquoi, par exemple, la Belgique a propose et soutenu une resolution qui vise a proscrire les effets negatifs de la vente de medicaments par Internet et une resolution qui vise a elaborer un plan d'action contre les mines antipersonnel. Seule une organisation comme l'OMS, a condition que nous participions tous a son action, est capable de relever l'enorme defi pose par les maladies transmissibles. Qu'il s'agisse de la tuberculose, qui revient en force, notamment en Europe, ou qu'il s'agisse du SIDA, maladie qui nous concerne tous. C'est ici, d'ailleurs, que de nouvelles formes de collaboration doivent se mettre en place. Etje pense a l'exemple de l'ONUSIDA qui nous a donne la preuve qu'une collaboration intersectorielle peut aboutir a des resultats concrets et positifs. Monsieur le President de seance, Mesdames et Messieurs, mon propos est done de soutenir une OMS forte, ambitieuse et dynamisante. J'ai confiance clans notre capacite collective. Une nouvelle generation se prepare pour prendre en main l'OMS etje voudrais ici souligner l'appui demon pays au nouveau Directeur general et exprimer mon soutien personnel au Dr Brundtland. A51NRI7 page 131 Dr. MUBARAK (Iraq): ,~)I .:r>-)1 .JJI r .:_r---> i\...L..p JJuJI ~)I ~~ -::..~ ~I ~i 0i 6.:1~1 J. ~A ,;;.:lWIJ -::..1~1 ,~)I ~I ~.:lWI ~WI ~I~ LU) ~L?..::JI ~ ~ 01 1.p~ ...\_jJ ~LoS' ,J\_r.ll :l.:.J~ ~.J .~IJ ~l-j~\ J\~ ~l; J:> ~ ;; .JJ..UI oh J~i C. bi4 ~ 6.:\.).:l J ;; _r.> .y "-! 0 ~ L. 0~ ~ ,_}>- L:;\ vk-JIJ 1WI _r...WI ~\ 4J~ _)I ~l.:!:;....,':J\ .:l~l ,_}>- ~i 0i J_r.. w'.~ Jl ~~_)I~\ a.JJ • -11 ;j_,...l:>,. <:- Lo "-"'J ·bj\J a.....w1 .., I..A::ll j 1.5..i....A..::l1 a..;l-j~\• -~- ~ ..r ,~-::..~ .) -::..1.1~. 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' ~ ~ v ,~ r r, . r Jl ' ~ ~ • ,~ '!. t, o .:r 11J;- # u-" ~\ .) -::.>l:i )IJ d..PI_rlj ~)I ~I ~ jlj':J :l.:.JWI J:>l.r~l 0i ~ .JJ.j WJ J ,v-J )I <,?~ ~I J')L,.:. ~ J , ~ ~J; u=\1 .:l _,p.Jj 015' ..U J . .h.... _pjl J _rJ ~I J y uP\>. ~J ~WI J J...UI ~J ;;~\ ~l..r.J JL.;)\ ..t..p)l ~ J.yUJ ~.:l ~ J:>l.r~l .:r ~\ ~ ;;~\ J ~\ )~\ '~~\ .:,LJ~J :l.:.JWI J:>l.r~l .y ~I "ljl y:.T ..la; L.y. .:lbj Jl.rJI ~I oljlA... 01 ~I.~ c::--.rJI <::"Li).l 4:--...LU Jl_rll -::.. )j ~\ ~l,...j':J\ -::..~1 ~ ..;£i L. lhJ ,)WI .Jl.a>JI ~ fi _}I ~l,...j~\ _r.? J JP\ ~ 4,#- o_h-....JI ...:.-..; ..U ..:...;IS' J:>l.ri .J~ -::.>.:l~ ..UJ .JI_rJI J a.L.WI o~l r-'~1 -::..':JIS'J _r.}Z ..;£i w' ' t t "'\ t ~_#I vi" r" J 4_;\...p\ ~ 0 ~ t Y.)".>WI vi" .r'. -::..41...,.:.~\ .:l~ t_l; ~ ·.)l.a>JI ~ _)I -::..ly-)1 J - t • fly~\J Dr. AL-CHATTJ (Syrian Arab Republic): '~ i')l...JI ,o~L....J\J ...:...\~\ 'iWI _r....WI ~I ,~)I ~I ~I ~I ~ 0l>...lll "\..... JJJ ~ )\ yljJ ~)1 ~\ Jl ~4::}4 i..tA;i ~J_,...JI ~_;JI ~J~\ r-""4 - • . ·~ t)-c_l>.dl ~ ~ ~WI ~I~ ~41 ~Ji ak..;;..;iJ ~WI t) ~I c:P }J l>-_r., .\~ ~.ll\J ~WI J ~4 U""WI _r.._;::ll ~~'"Yu. ..U J -f~\ ..U J Jy:$' ..UI .w..U W U_r....tA; ~ y ~ 01 ~ j J .~ ~W~I ..:...lilk.:....lJ ~}:i ~ ~.ll\J ~WI ~I ~ . 0W~I ~ J ..;::>- ~ W ~WI ~I JS' J'Y.>:- ~WIJ ~)~\ ~ ft>. if oj JLA... J ~l.S"U ~ Jft" ~ ~WI ~I ~ ~~ _r...J..S 4;l>..:;;~ ~~ JJ. o~l Jl ~4 i..tA;i 0i ~} ~WI o.l;. t)J - .~W~\ ~\ o.l;. t} c_l>.diJ ~ _,=)1 4J 4 ~ JP..Ui ~WI ~~ ~ .b.., _,:...)1 J _r;J ~~~ _r....WI y ~I ._k_.i>.L! i..u.::; ~.15' 01~ ~I ..:...~..WI _r.._# ~ t) I...Lf.:>.- 0J?.J.J.. ~ .:r..lll ~~\ ..,£J1 t) ~WI ~J ~)l_rjl Jlj)l .ol.S" ~~~ 't:!}JI ji>JI ~i ,~)I ~\ JJ..UI ~ £ _;; J ~WI ~I ~ 4; ..::_..li ~~ ~I J~~l ...Ll>.:i d...Lb ~~ r4~1 o.l;. ~ .~\ "L.!.i~ ~\ c.5_?'.lll ~L;... 1./'J ~i 0W~I ~ d.....l>- ~ t) "-1 ~ ~.lll JW~I J-.4>- ~ 0 ~~ I.L. 4r .r.->- ~~ C:l)l t) ~ ~ .1 _rl. ~ 4Jr ~..u, t) ~~ e::P )1 JP ..uJ ~_rJI ~J~\ ~ J ...L.... ~~ .lUb- ~ )1 y ~~ o~~~ Jl o~ .r \..... _,..1. IJ_# ~~ ..:...~..WI t_lki L..~l 4JJ-""' ~ LW\ ...:...~\ ~ ..:J Ji i.ll .~WI )J.IJ 0W~\ ~~J .r-9 y t) ~}JI Mrs HUTTU-JUNTUNEN (Finland): Delegates, ladies and gentlemen, on behalf of the Government of Finland let me first congratulate the President and the Vice-Presidents on their election. I want to use this opportunity to convey my very sincere - and also sisterly - congratulations and best wishes to Dr Gro Harlem Brundtland, the new Director-General. Knowing her qualities and record, we are pleased to continue to work within WHO under her leadership. May I use this opportunity to thank Dr Hiroshi Nakajima, the present Director-General, for his honoured and dedicated service for I 0 years, for leading and defending the Organization through a difficult and turbulent period. This year we are attending a very special Health Assembly. It is time for celebration; it is also time for reflection on the past and visioning for the future; and it is a time for change of guards at the most important leadership post in world health. The 50 years of WHO have been a success story by many standards. It has been an unparalleled record in terms of organizing the collective wisdom and political will of Member States to combat disease and to foster health. We are well aware of the backlashes of the past, the daunting challenges ahead, and the volatile complexity of the political and economic environment in which we work for the health of the future. In the context of the United Nations family, WHO is a good example of what intergovernmental multilateralism in a United Nations specialized agency can accomplish. Looking back, I think there are important lessons to be learned. We, the Member States of this Organization, have been successful in an organized effort to tackle specific diseases through specific preventive measures, but we have been less successful in tackling the major determinants of ill-health and the consequences of ill-health through well-functioning health care. Prime examples thereof are poverty, bad sanitation and housing, hunger and malnutrition, poor education and the low status of women. It appears that we have not been effective enough intersectorally at the global, regional and national levels. The delegation of Finland is of the opinion that the lessons to be learned for the future are obvious. It is of utmost importance that we reaffirm as clearly and strongly as we can the values, visions and principles required to guide our collective effort for a healthier world into the next century. This is exactly what we are doing with the renewal of the global health policy: health for all in the twenty-first century. However we must recall that a policy cannot be successful unless it is fully implemented. Let me give a few examples. In order to tackle effectively the intersectoral challenges which comprise major determinants of ill-health such as poverty, environment, lifestyles, conditions of work and housing, we need a health sector that is strong and skilful enough to work together with others, to communicate, to convince, to persuade and to stand up for its case in an often cross-pressured environment. This applies to old problems as well as new ones. Among the latter, the prime example among determinants of avoidable noncommunicable diseases is tobacco. In a globalized world which puts emphasis on commercial interests, the challenge cannot be faced single-handedly by nations. A global response is necessary. The will is there as shown by the decision of this Assembly two years ago on a framework convention on tobacco. Again, good intentions are not enough. The true test lies in the action to follow. Dr F.R. AI-Mousawi (Bahrain) resumed the presidential chair. Le Dr F.R. Al-Mousawi (Bahrein) reprend la presidence. . •)\ The PRESIDENT: ·~ .a...J_,...JI ~_rJI a...J~\ y J..L;.j l.fv; . \..lJ .Y> y J~ ~\ ~iJ a...a.:..JI Jl \..cl. Ji y J...L:.o _y~iJ Dr SCHNEIDER (Netherlands): 1 Mr President, on behalf of Erica Terpstra, our State Secretary for Health, Welfare, and Sport, I join other speakers in appreciation of the role and achievements of WHO in the last 50 years. I also want to join in congratulating Dr Brundtland on her election as Director-General, and to wish WHO all the best for the future. 1 The text that follows was submitted by the delegation of the Netherlands for inclusion in the verbatim records in accordance with resolution WHA20.2 . A51NRI7 page 134 The theme of this year's world health report is indeed very timely. The global community is preparing for the new millennium by formulating its vision of life in the twenty-first century and presenting new ideas and policies. I will add my voice to those expressing their visions, and present some thoughts from the Netherlands' perspective. Healthy living in the twenty-first century implies that we have to solve the most urgent health problems of present and future citizens ofthe world, especially the most deprived among them. These problems include, for instance, changing patterns of lifestyle, the ageing of the population, migration, and rising patient expectations. How can we reconcile these needs with accessibility of health care and cost containment? Furthermore, such problems are embedded in a context of changing social networks and family structures. How then should we deal with these twenty-first century problems? And what should be our guiding principles for public health policy? I will mention five of them. First, we must realise that the health of a population is determined by many factors, only one of which is health care. Other factors include physical and socioeconomic environment, lifestyle, nutrition, education, gender aspects and genetic predisposition. For public policy, this implies "going beyond the medical" from early childhood till the "fourth age". The new challenge is to develop health policies based on equity and focused on people in their physical environment. Secondly, the health problems of the twenty-first century, such as chronic and infectious diseases and mental health problems, require sound public policies. The role of governments in developing and implementing policies is changing. In the twenty-first century we shall have to concentrate more on core activities and less on actual execution. This means putting a stronger emphasis on setting standards and monitoring outcomes. In other words, we ought to "row less, and steer more!" Thirdly, an ongoing concern should be the step-by-step introduction of changes and innovations on the basis of data on health status and health needs. The balance between vision and reality is achieved by focusing not on lofty ideals, but on clear objectives for everyday reality, and attempting to translate them into verifiable criteria. Subsequently, these criteria will be the touchstone for new policies and programmes. Fourthly, in an era of scarce resources, every public investment must be sufficiently justified. More than before, the international sharing of knowledge and expertise on, for instance, health status determinants and best practices, should be enhanced in our global village. Universal knowledge will have to be adapted to specific situations in order to provide appropriate, cost-effective and sustainable solutions. In other words, there must be no boundaries to the worldwide exchange of information and experience or international cooperation in research and development. Fifthly, another ongoing concern is the building of constructive "win-win" joint undertakings, in other words partnerships between parties within and outside the health sector at all levels, from stakeholders to shareholders. It is much easier to cooperate in well-defined "health action zones" if you know and appreciate each other. It is obvious that in the next century WHO will have an important role in guiding public health policy according to the principles just mentioned. The new health-for-all strategy in the twenty-first century is an important first step. Implementation of the new strategy is a challenge for all of us here, and for all shareholders worldwide. I am truly convinced that WHO, under its new leadership, can and must play an important advocatory and guiding role in reaching the goal of health for all. Or KIYONGA (Uganda): It is gratifYing to note from The world health report 1998 that the state of health in the world is improving, and is likely to continue to improve in the twenty-first century. However, a significant number of our developing countries still have infant and child mortality rates well above the global average. Although statistics show a global decline in infectious and parasitic diseases, a number of Member States have recently had to deal with epidemics of cholera, malaria, HIVI AIDS and meningitis. Most of our people in poor countries are being killed by parasitic and infectious diseases. In Uganda, the infant mortality rate, although falling, is still high. In 1989 it was estimated at 122 per I 000 live births, while in 1995 it had fallen to 97 per 1000 live births. It is therefore important that the world health report has analysed health information by geography. It is quite clear that there is no equity yet in world health care delivery. For us to achieve health for all in the twenty-first century, health care resources must be focused on those whose need is greatest, and it is important to note here the very strong message brought by the Director-General elect that 90% of the disease burden is borne by poor countries and that therefore resources must be focused there. The Ugandan delegation strongly recommends that the African Region, which shows A51NRf7 page 135 the worst health situation, should get a substantial increase in the regular budget of WHO, and that development partners in the North should increase their bilateral aid packages for health to Third World countries. Malaria, as has been said before, is probably the single disease that accounts for the biggest share of the disease burden in most of sub-Saharan Africa. In Uganda malaria accounts for 25% of outpatient attendances at health facilities. The annual mortalities caused by this single disease are estimated at between 80 000 and I 00 000 people a year. It is also estimated that between 1.5 million and 2.5 million people die of malaria annually in Africa. Ninety per cent of the burden of malaria in terms of morbidity, mortality and damage to the economy is found on the African continent. It is against this background that this Assembly should view the resolution of the Organization of African Unity Summit last year in Harare. The African Heads of State resolved to make malaria control and prevention a top priority issue, and directed their governments accordingly. It will also be recalled that the Regional Director for Africa has been developing the African initiative for the control of malaria since his appointment in 1995. The Director-General elect, Dr Brundtland, this morning spoke strongly on the subject and announced the roll back malaria initiative, which is intended to be supportive of the African initiative. The Ugandan delegation hopes that these renewed efforts at malaria control and prevention will be supported by increasing resources from WHO and the developed countries. This will benefit not only Africa, but also the rest of the world. We are saying this in the realization of the fact that although malaria's negative effects are mainly in Africa, the disease is a global problem. Uganda recommends that the role back malaria initiative and African initiative for malaria control should reinforce one another, and should use Africa as the spearhead for the control and prevention of malaria. Apart from the continuing burden of infectious diseases, Uganda is also experiencing a marked upsurge in the occurrence ofnoncommunicable diseases such as hypertension, cancer, diabetes and heart disease. It is therefore having to contend with the diseases of poverty as well as with the rapidly emerging diseases of affluence. Although emphasis in health care must of necessity continue to focus on the infectious diseases, it is considered necessary at this stage to adopt an integrated and comprehensive approach to all key determinants of ill-health in Uganda, including the major noncommunicable diseases contributing to the national burden of disease. In Uganda, access to health care is still poor, with only 49% of the population being within 5 kilometres of a health unit. Ugandan health policy is accordingly designed to ensure increased access to health care facilities by the population. Emphasis is being placed on achieving an appropriate balance between curative measures, disease prevention, and health-promoting health care practices. The Government of Uganda has therefore decided to encourage greater harmony and collaboration among all players in health care delivery in the country. These include the public sector, nongovernmental organizations and traditional and private health practitioners. We believe this coalition will ensure equity and remove wasteful duplication and competition. The health sector in Uganda is also working closely with other ministries and agencies to ensure that these too contribute to improving the health of the population. In conclusion, Mr President, Uganda welcomes the strategy of health for all in the twenty-first century. For this objective to be achieved, resources will have to be allocated to countries with the highest burden of disease. It is in this respect that Uganda strongly supports the revision of the formula for the allocation of the WHO regular budget so that Africa gets a substantial increase in its share. We also call upon development partners to increase the resource flow to Africa in order to strengthen health care delivery systems and poverty alleviation. Mr GURUNG (Nepal): Mr President, Director-General, excellencies, distinguished delegates, ladies and gentlemen, I would like to offer my most sincere congratulations to the President on his unanimous election to the presidency of the Fifty-first World Health Assembly. Congratulations also are extended to the Vice-Presidents, the Chairmen of the main committees and the other officials who have been elected to lead this Assembly. As we gather here for the Fifty-first World Health Assembly, we would like to record our sincere appreciation to Dr Hiroshi Nakajima, the outgoing Director-General, for his valuable contribution in leading this Organization during the last decade. We also welcome the appointment of Dr Gro Harlem Brundtland of Norway as the incoming Director-General of this Organization. My delegation looks forward to working closely with her in the years to come. A51NRf7 page136 As we approach the twenty-first century, Member States are presented with new challenges and opportunities for improving the health of their peoples. Noncommunicable and lifestyle diseases such as cardiovascular disease, cancer, diabetes, mental disorders, as well as problems related to substance abuse and problems of the elderly are assuming greater significance. Violence, accidents and injuries are also increasing at an alarming rate Concerning the need to address the new challenges of living in the twenty-first century, I hope that the Assembly's deliberations are tempered with an awareness, sensitivity and appreciation of the continuing challenges confronting the developing and least developed countries. Too many of our mothers still die unnecessarily because of pregnancy-related conditions that are either preventable or treatable. The health of too many of our daughters still is being neglected because of gender bias. Too many of our children are condemned to battling infectious diseases while hobbled by malnutrition or micronutrient deficiencies that are controllable with minimal investment. Too many of our brothers and sisters still are being denied the benefits of our health care systems because they live in rural areas, or because they are poor or underprivileged. As noted by my fellow ministers in the Declaration on Health Development in the South-East Asia Region in the 21st Century, too many health professionals and policy-makers continue to attach low priority to primary health care, health promotion and prevention, resulting in insufficient allocation of resources to these areas. Scarce human and financial resources too often are directed to high-cost, low-impact interventions that make a small contribution to reducing morbidity and mortality rates. As the Assembly seeks to devise effective strategies for living in the twenty-first century, I am hopeful that in these times of severe financial constraints Member States will not abandon or diminish their commitment to health-for-all principles and beliefs and will ensure that the basic health needs of the most vulnerable groups, the poor, females, and the rural population are not neglected in the rush to meet the new challenges which the new century brings. My Government and I are seriously concerned at the possible implications of proposed reallocations of the budget for the South-East Asia Region, which would mean a reduction of over 60% in the future allocation to Nepal at a time when we are trying hard to extend primary health care to all our people. Reductions in resources will adversely affect major collaborative programmes in Nepal. We think any increase resource allocation to other regions should be done without affecting the allocation to regions which are equally in need, and in particular allocation to least developed countries like Nepal. Nepal at present is in a dilemma. We are facing double burden of diseases - we are facing the burden of traditional communicable diseases and at the same time emerging and re-emerging diseases are on the rise. In this situation we are in need of increased resources. It is in this context that we feel the proposed guideline for regional allocations should be reconsidered. We strongly urge this August Assembly that while considering the subject of regional allocations, stage of development, poverty, topography and disease burden should be taken into account as major factors. Finally, on behalf of His Majesty's Government of Nepal and on my own behalf, I would like to express our appreciation for the leadership, active support and effective technical cooperation provided by WHO in our health develooment. Mr KAL WEO (Kenya): Mr President, Director-General, ladies and gentlemen, on behalf of the Kenyan delegation, I would like to congratulate you on your election as President of the Fifty-first World Health Assembly. Please accept our best wishes as you steer the deliberations of this Assembly and during your term as President. I wish also to welcome the election of the new Director-General, Or Gro Harlem Brundtland. At the same time, I join other Member States in reaffirming our total commitment to working with your team. I would also like to register our sincere appreciation for the excellent work performed by the outgoing Director-General, Or Hiroshi Nakajima. In this regard, Kenya wishes to endorse the resolution of the Executive Board to have Or Nakajima declared Director-General Emeritus of the World Health Organization from the date of his retirement. I wish to register our appreciation for the support Kenya continues to receive from WHO. This support has been mostly timely, especially in the fight against new and re-emerging diseases such as Rift Valley fever, cholera and malaria among others associated with the recent El Nifio climatic phenomenon. Other major health problems which threaten to reverse the gains we have made in health care development include malaria, sexually transmitted diseases, HIV/AIDS, diarrhoea! diseases and malnutrition. Kenya is, nonetheless, collaborating with multilateral agencies and bilateral donor countries to implement health sector reforms that would help to stem such threats. We fully endorse the recommendations of the Executive Board on developing a health-for-all A51NRI7 page 137 policy for the new century. The proposed policy should provide a relevant framework, focusing on development of such health care approaches as global coalition, intersectoral collaboration and promotion of regional health groupings. The broad-based nature of this new policy has root in the recognition that improvement of the health and well-being of people is the ultimate aim of social and economic development in any given country. In Kenya, we are committed to the moral concepts of equity, solidarity and social justice and to the incorporation of a gender perspective into our health care strategies. To this end, we shall continue to emphasize the importance of reducing social, economic and health care inequalities by paying the greatest attention to those most in need. In this regard, therefore, we would like to propose that financial resources meant to support health care development be distributed among Member States on the basis of the country's priority health burdens and needs. Indeed, Kenya will continue to implement the primary health care strategy as defined in the Alma-Ata Declaration of 1978 and in the health-for-all policy for the twenty-first century. In this connection, we shall continue working in partnership with other key players in the health sector in order to achieve our set objectives much faster. In concluding, I wish to congratulate the Director-General and his team for the excellent job done in analysing and compiling the progress reports on the implementation of Health Assembly resolutions and decisions. These decisions are critical to the provision of health care services the world over. We are certain that when the issues covered under the Director-General's report are adequately tackled, the current burden of disease will be reduced drastically for the good of us all. El Dr. BUSTOS (Uruguay): Senor Presidente: En primer lugar, permitame presentarle mis felicitaciones por su eleccion y hacerlas extensivas a Ios demas integrantes de la Mesa. Asimismo, quisiera, en nombre de mi pais y del mio propio, manifestar mi reconocimiento y agradecimiento al actual Director General, Dr. Nakajima, por su esfuerzo y particular dedicacion a la causa de la salud a lo largo de todo su mandato. Quisiera tambien augurar.a la futura Directora General, Dra. Brundtland, el mayor de Ios exitos en la conduccion de Ios destinos de esta Organizacion, a la vez que presentarle el apoyo de nuestro pais en la labor futura de la OMS. El advenimiento del siglo XXI, etapa que no deja de ser una nueva forma de ver o cuantificar el tiempo que corre en forma permanente, tiene implicito como desafios mejorar las condiciones sanitarias que se vienen heredando de tiempos anteriores y enfrentar Ios nuevos elementos negativos que sin duda surgiran en el siglo venidero. Uno de Ios mayores problemas existentes, que dista mucho de haberse resuelto, es la diferente situacion entre Ios paises desarrollados y Ios que estan en vias de desarrollo: inequidad que se perfila en aumento en el tiempo futuro si no se realizan medidas urgentes y concretas para rebatirlo. Para poder revertir la situacion es necesario que las poblaciones de dichos paises cuenten con Ios instrumentos que permitan disminuir esa brecha y avanzar en la estrategia de salud para todos en el proximo siglo. Uno de estos instrumentos es la informacion, que, correctamente utilizada, permitira educar y transformar a las poblaciones para permitir su propio crecimiento. Esto signitica utilizar la experiencia de Ios paises mas desarrollados para trabajar y mejorar a partir de ella. La reunion consultiva organizada por la OMS ya reconocia que Ios avances en la atencion de salud son un requisito basico para el desarrollo tanto social como economico y humano de Ios paises. La difusion de la informacion que existe actualmente es y sera en el futuro, fundamental, y dicha difusion es posible realizarla mediante Ios avances tecnologicos en el campo de las comunicaciones, por lo que la telematica de la salud brinda oportunidades nuevas, tanto a la educaci6n y promoci6n sanitaria como a la propia atenci6n de la salud. La telemedicina tiene un potencial de gran impacto en el futuro de la salud, mas que cualquier otra especialidad: es habilitadora de una nueva forma practica y efectiva de hacer llegar a mas gente la medicina de siempre. No podemos obviar la importancia de las tres mayores de sus aplicaciones vinculadas actualmente con la intervenci6n clinica, la gesti6n administrativa y la educacion sanitaria. Mejorar el cuidado de la salud es una responsabilidad de Ios paises, y la planificacion de las politicas nacionales de salud ira incorporando progresivamente sus beneficios para el mejor uso de Ios recursos. Sus aplicaciones han permitido mejorar el acceso a Ios cuidados de salud de mas gente, la reduccion de Ios costos de traslado, la disminucion de tiempos improductivos, la mejora de proveedores primarios de salud y la mayor comodidad para el usuario. Para lograr la extension de tales herramientas es necesario apoyar a Ios paises, especialmente aquellos con mayores dificultades economicas y sociales: Ios paises en desarrollo. Es requisito que se establezcan Ios mecanismos indispensables para permitir desarrollar redes informaticas, infraestructura y entrenamiento del personal a efectos de lograr efectivas comunicaciones. El desarrollo de la telematica y por A51NRf7 page 138 lo tanto de la infonnaci6n, se constituye en un pilar fundamental para el mejoramiento de la atenci6n medica en todos sus aspectos, sin limites ni barreras. Asf como las comunicaciones cambiaron en siglos pasados Ios patrones epidemiol6gicos de la distribuci6n de las enfennedades en el mundo, la telematica y la telemedicina deben actualmente cambiar Ios patrones de lucha contra ellas. A nivel de nuestros paises es necesario impulsar Ios siguientes elementos estrategicos: generar ambitos de desarrollo para la infonnatica de la salud; fomentar la infonnatica en la fonnaci6n curricular de Ios profesionales de la salud; crear e integrar nexos multidisciplinarios; institucionalizar Ios contactos de intercambio entre paises; difundir entre Ios profesionales de la salud la importancia del manejo correcto de la infonnatica; proponer Ios cambios en la legislaci6n actual tendente a aceptar Ios registros infonnaticos como validos con las garantias requeridas. Alguna de las explicaciones indicadas, las que nuestras necesidades indiquen o las que la Cl,'eatividad de nuestros tecnicos verifiquen como soluciones, si son bien diseiiadas e implementadas y usadas, crearan las condiciones de una mayor equidad, calidad, efectividad y eficacia en Ios procesos del cuidado de la salud de nuestras poblaciones. Por ultimo, el pasado mes de diciembre comenz6 a funcionar la pagina web del Ministerio de Salud Publica del Uruguay. En ella se brinda infonnaci6n sobre la situaci6n sanitaria de la poblaci6n, estudios e investigaciones relativos a temas de actualidad, asi como infonnaci6n sobre el funcionamiento de Ios servicios dependientes de esta Secretaria de Estado. Ademas, se puso a disposici6n del usuario un sistema de consultas electr6nicas, a traves del cual puede recibir oportunamente respuestas a sus inquietudes sanitarias, que son contestadas por tecnicos del organismo. Dr. F. ARAFAT (Palestine): A51NRI7 page 139 ~ ~ ~ ~_r;JI V'"..ull ~~ J ~~ a;.k . loll Ld y ~~ Jl ~ ~ ,~i ~l.r"":JI ~~J .I~J ....U\ ~W; 01 i.)\.AJ\ iWI J o)_,.JI ~ J ;;J...ts::.\1 ~~J iJWl; ,~WI y~ J5' ~ ,~1 M. JO SUNG JU (Republique populaire democratique de Coree): Monsieur le President, honorables delegues, permettez-moi tout d'abord d'adresser mes plus vives felicitations a vous-meme, Monsieur le President, et aux autres membres du bureau elus a la tete de notre Assemblee. Mes salutations vont egalement aMme le Dr Gro Harlem Brundtland pour son election au poste de Directeur general de I'Organisation. Nous sommes convaincus que ses competences et sa capacite de direction Iui permettront de mener a bien une nouvelle strategie sanitaire. Enfin, je ne manquerai pas d'adresser mes remerciements au Or Hiroshi Nakajima, Directeur general sortant, pour ses efforts consacres a I'accomplissement de la mission et de la tache de I' Organisation. Aujourd'hui, alors que nous celebrons au seuil du XXI• siecle le cinquantieme anniversaire de I'Organisation mondiale de la Sante, nous nous rendons davantage compte de I' importance reelle du theme de notre conference : "La vie au XXI• siecle - une perspective pour to us". Le rapport sur la sante dans le monde, publie en 1998, fait une analyse generale des tendances sociales, economiques et demographiques qui vont influencer la sante humaine, ainsi que des defis a relever dans le domaine de la sante publique au XXI• siecle. Comme indique dans le rapport, I'Organisation peut etre fiere, a juste titre, des resultats positifs qu'elle a obtenus en remplissant brillamment ses fonctions et ses roles en vertu de son noble mandat. L 'eradication complete de la variole, qui mena~ait l'humanite, et I' ouverture de perspectives sures concemant l'elimination de la lepre et de la poliomyelite sont des grands succes de I' Organisation. Une de ses realisations Ies plus marquantes est, sans doute, l'adoption de la strategie mondiale de la sante pour tous d'ici I'an 2000 et la promotion active des soins de sante primaires, consideres comme le moyen principal de mettre en oeuvre cette strategie, ce qui a eu comme resultats I' allongement de I' esperance de vie, la reduction spectaculaire de la mortalite des nourrissons et l'acces des populations aux soins medicaux primaires partout dans le monde. Grace aux succes enregistres par I'Organisation des le debut de sa creation et depuis lors, l'hurnanite peut envisager un avenir radieux au seuil du XXI• siecle. Nous sommes surs que, meme au XXI• siecle, on ouvrira une large perspective a la sante humaine, en surmontant certains des obstacles auxquels elle devra faire face. Les conditions socio-economiques et demographiques defavorables dans le domaine de la sante vont avoir une incidence croissante sur la propagation de certaines maladies. La pauvrete et d'autres problemes du XX• siecle feront toujours l'objet de preoccupations au siecle suivant. Au XXI• siecle, le combat contre les maladies chroniques devra etre mene simultanement sur deux fronts : celui des maladies infectieuses et celui des maladies non transmissibles. Afin de se debarrasser des defis du XXI• siecle, I'Organisation est appelee arenforcer encore plus son role et sa fonction, en s'appuyant sur les succes et l'experience acquis dans le passe. Dans un esprit d'egalite, de solidarite et de justice sociale et selon les objectifs de sa strategie, qui prevoit la promotion de I' equite en matiere de sante entre les pays et aI' interieur des pays en vue de la sante pour to us, I' augmentation de I' esperance de vie et l'acces a des services de sante de bonne qualite, I'Organisation devra definir des politiquesjudicieuses et renforcer encore davantage son role directeur et coordonnateur dans les activites sanitaires intemationales et promouvoir la cooperation fonctionnelle avec les Etats Membres. Le Gouvemement de la Republique populaire democratique de Coree appliquera pleinement la politique de sante selon l'ideologie Juche, instauree par le respecte Camarade Kim Il Sung et approfondie et developpee aujourd'hui par le grand dirigeant, le Camarade Kim Jong Il, en vue d'ouvrir une perspective sure pour la promotion de la sante du peuple au XXI• siecle. Profitant de cette heureuse occasion qui nous est offerte, au nom du Gouvemement de la Republique populaire democratique de Coree, ma delegation tient, encore une fois, a remercier vivement tous les organismes des Nations Unies, y compris l'OMS, ainsi que les organisations gouvernementales et non gouvernementales, pour leur cooperation et l'aide alimentaire et les medicaments qu'ils ont fournis a notre peuple, victime de catastrophes naturelles depuis plusieurs annees. Dr RAFEEQ (Trinidad and Tobago): Mr President, Director-General, distinguished ladies and gentlemen, as I stand here on the auspicious occasion of the Fifty-first World Health Assembly, I cannot help but reflect with mixed feelings on the 50 years A51NRI7 page 140 this great Organization has been striving to help its Member States improve the health and well-being of their respective peoples. There can be no doubt that we have genuine cause for pride when we look at the achievements made during these 50 years of WHO's work, but that sense of rejoicing is necessarily tempered with the sobering realization of our yet unfinished work and the enormous task that lies ahead. A quick perusal of The world health report 1998. Life in the 21st century: a vision for all brings home this dual perspective in the starkest possible manner. However, let me first convey warm congratulations from the Government and people of Trinidad and Tobago to the leadership and staff of the Organization on their untiring work over five decades to accomplish positive results which are indisputable. I would also like to place on record our sincere appreciation of the efforts of the current Director-General, Dr Hiroshi Nakajima, who has shouldered the critical responsibility of directing the work of WHO for nearly a decade. Permit me to extend hearty congratulations to Dr Gro Harlem Brundtland on her election as the next Director-General, and very best wishes to her for success in this onerous task. Mr President, let me extend felicitations to you on your election as President of the Fifty-first World Health Assembly, and also to extend a special word of welcome to a past President of the World Health Assembly, Mr Kamaluddin Mohammed from Trinidad and Tobago, who was President in 1978, the year of Alma-Ata. Let me now return to the mixed feelings of pride and sobriety which I mentioned. Is it not remarkable that the world health report offers a bright vision of better health for all in the next century, and simultaneously talks about the disturbing finding that two-fifths of all deaths this year will be premature? Does it not boggle our minds to read about the spectacular advances in the control and prevention of diseases, and about countless other medical and scientific innovations, and, a few paragraphs later, about the growing impact on health of poverty and malnutrition and about widening health inequalities between rich and poor? When we compare today's situation with that of 50 years ago when modem-day weapons against diseases did not exist, is there not a greater sense of discomfort in the knowledge that the state of poor health in substantial populations is unacceptable, given the state ofthe art? As averages mask the wide variations in global statistics, we must recognize that most underdeveloped societies have not enjoyed the benefits of this global progress nearly enough. Thankfully, Trinidad and Tobago no longer has the health problems of less fortunate countries in the least developed category. We have made great strides in improving our health indicators, such as life expectancy at birth, which is 72.8 years for females and 71.6 for males, and infant mortality rate, which was 17.1 per I 000 live births in 1995. However, as the country has gown economically, so have the people's expectations about access to quality health care, expectations which are forcing us to think in terms of enhancing the efficiency of our service delivery. Of course, another result of economic development, even at middle-income level, is that noncommunicable diseases have become dominant. Emerging and re-emerging infectious diseases such as HIV/AIDS, tuberculosis, and dengue are equally significant in our context. The problem of dealing with this double burden of disease seems to be a universal reality, despite the variations in the specific epidemiology between countries. Against this background, I would like to stress two points. The first is the need for international cooperation in combating HIV I AIDS. It is impossible to deal with this deadly scourge except by truly concerted action by all nations. Equally important is the fact that efforts to control this disease have to be intersectoral and community-based. This means that we must coapt every relevant international and national agency and pull together. In this regard, I would like to cite the establishment of UNAIDS as a model for interagency cooperation within the United Nations system, in addition to the various examples of global partnership mentioned in the summary of The world health report 1998. Trinidad and Tobago is keen to collaborate with UNAIDS, and to use that agency as a forum for sharing experiences for the mutual benefit of our people. We appreciate WHO's sponsorship of UNAIDS and hope for its continued strong role in the activities of that organization. My second point relates to the progress we are making on health sector reform. In my statement to the Health Assembly last year, I referred to the health sector reform programme that the Republic of Trinidad and Tobago has embarked upon. I am now pleased to report that we have made considerable headway in this regard, despite strong challenges and resistance - as might be expected in the case of any fundamental reform. We have decentralized service provision to five semi-autonomous regional health authorities, and are restructuring the Ministry of Health into an agency responsible for policy, planning, monitoring, regulating and purchasing services from the regional health authorities. We are placing greater emphasis on primary care strategies, and rationalizing services accordingly. We are also in the process of developing a human resource strategy and a comprehensive financing plan. We are bound to face greater hurdles on our path to reform, and would certainly benefit immensely by mutual exchanges of experience. A51NR17 page 141 Lastly, Mr President, we reflect today on our past and look forward to the future with cautious optimism, and with a resolve to play our role in the larger effort to improve the health status of the peoples of the world. Trinidad and Tobago is happy to be a part of the WHO family. El Dr. MuNOZ (Chile): Senor Presidente, senor Director General, senoras y senores delegados: En nombre del Gobierno de Chile, he estimado necesario compartir con ustedes un breve comentario acerca del estado de la salud en el ,mundo a cincuenta aiios de la fundaci6n de la OMS y, especialmente, acerca del futuro de la Organizaci6n y de sus perspectivas de exito en la misi6n que compartimos. Junto con felicitar al Sr. Director General y a su equipo de trabajo por el informe que han sometido a consideraci6n de la Asamblea, deseo resaltar Ios avances y, en particular, Ios enormes desafios que tenemos por delante. Hemos hablado mucho acerca de Ios dramaticos cambios del perfil epidemiol6gico y demografico que se han producido en estos anos, asi como acerca de lo que estos implican en materia de factores de riesgo ligados a nuestros estilos de vida y a las caracteristicas de nuestros modelos de desarrollo econ6mico. Sin embargo, creemos que no se ha enfatizado suficientemente el hecho de que dichos estilos de vida no saludables y el dano derivado de la alteraci6n negativa del ambiente son mas relevantes entre los pobres y en aquellas sociedades que pugnan por alcanzar niveles de crecimiento econ6mico que les permitan precisamente disminuir la pobreza de sus habitantes. A este respecto, pensamos que, junto a la necesidad de proseguir nuestros esfuerzos para proteger a las personas mas vulnerables contra las inclemencias del medio, deberemos velar por lograr el mejor equilibrio que haga posible el desarrollo sustentable de nuestras economias. El instrumento con que contamos para avanzar en pos de estos objetivos son nuestros sistemas y servicios de salud. Estos servicios deberan seguir siendo efectivos y eficientes en aquellas acciones que no requieren mas que organizaci6n y recursos, extendiendo las coberturas e interactuando con comunidades que, organizadamente, colaboren para lograr un mayor acceso alas tecnologias que permitan prevenir y controlar la enfermedad. Desde una perspectiva mas relacionada con la «cultura» de las organizaciones, Ios servicios deberan entender que las personas seran cada vez mas exigentes en materia de calidad de Ios servicios que reciben. De pacientes pasaran crecientemente a clientes, capaces de exigir sus derechos: efectividad, eficiencia y, sobre todo, humanidad en Ios servicios. El rol del Estado resulta esencial para lograr estos objetivos, ya que los mismos no pueden ser alcanzados por ellibre juego del mercado como asignador de bienes en la sociedad: sin un Estado fuerte y moderno, capaz de regular el imperfecta mercado de la salud y de asegurar el acceso de las personas a servicios de calidad, sera imposible lograr equidad en salud, y por ende, en el conjunto de la estructura social de nuestros paises. Chile insta a la Organizaci6n a enfrentar el nuevo siglo con renovada preocupaci6n por el desarrollo de servicios de salud que cumplan con el rol esencial que las personas esperan de ellos. La garantia del derecho a la salud sera la mayor demanda que se hara a nuestros gobiernos y por ende a la OMS. Nuestra delegaci6n felicita a la Ora. Gro Harlem Brundtland por su elecci6n, que le permitira dirigir la Organizaci6n durante el dificil pero apasionante periodo que se inicia. Para colaborar con sus prop6sitos, que son tambien Ios nuestros, Chile aspira a ingresar en el Consejo Ejecutivo de la OMS, en el que haremos nuestros mejores esfuerzos por compartir nuestra experiencia, nuestros logros y nuestras carencias con el conjunto de la comunidad internacional, con el fin de alcanzar nuestro comun prop6sito de justicia y equidad en salud y en el conjunto de la vida social de nuestros paises. Mr. NIMIR (Sudan): :(0b_,....)1) ~ ~ ~~ ~~ ;:,~\J :L-jJ ..::..1~1-/ o.:~L..JI ,;,l~j~l -~~~ y~f o.:~WI ,v-J )I ~I 'r-:> )I ,:r>-)I .ill! ~ ~ 4.lL.,.:.I ,..::..~\11 tJ..L.piJ JI+JI r-4 i..,L4jl 01 J~ ,~ts'J.J ....UI 4....>-JJ ~ i')WI 't:!}JI J_,.a>JI .:~ _;_,ll o...LJ> t_ ~ "} ~IJ 0b.UI ;,l.... j)J ~ _r:-JI ~1_,:) J t:!}JI ~ ,0b_,....)1 ~.:~~ ~ J y- a,~ J ~ .oJJ...UI a...... \:i.WI ~t; ~ ..::.. r ...U J il.JI IL 0 _,...... >JIJ 4.t.:~WI ~WI ~I ~ ..l..U.:; ,v-J )I ~~ ..::..y~ ~L...:;. ..:.JijL.... 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J ~JJ_,Kll JLW ~I ~ 0b.,..JI 4..-~ 0biJ ~I ~~ i..u:; ~I L;;IJ . .:lJW4 ~IJJIJ (,>)I ~ J _r.$J1 (::"pi C: 0b.,..JIS' iwJ 4J')WI a...-;~ ~.:lWI ~l_r.JI JLJ,I r:__}> ~}\1 ~I <~J-..l.l ~\S'lj ./"J.r-P' JP..l.ll iWI ;...WI ~'11 ~IJ ,~ ~WI ~I a....\2.:..J 4A;l::ll ~)..WI -.f:>l_r\11 ~ts::... o).:l'-1 'l_,.....y ~I~' '\'\V 0i y.)J , 0b_,_1} j-.olpJ ~ ~,;) .:;-- The PRESIDENT: :~)1 El Dr. DE LA TORRE (Ecuador) : Ante todo, un saludo especial al Dr. Hiroshi Nakajima, que ha sido un extraordinario anfitri6n de esta Asamblea. Seiior Presidente de la 51 • Asamblea Mundial de la Salud, la delegaci6n del Ecuador le felicita por su atinada elecci6n; de igual manera releva la designaci6n de distinguidos profesionales en la calidad de A51NR/7 page 143 Vicepresidentes de esta Asamblea. Asimismo, nos solidarizamos con la Organizacion Mundial de la Salud en el cincuentenario de servicios, a la vez que hacemos votos por el exito de esta reunion a las puertas del nuevo milenio. Expresamos la felicitacion a la Dra. Brundtland por la designacion como Directora General de la Organizacion Mundial de la Salud. La crisis que experimentan nuestros paises en el campo de la salud hace imprescindibles el amllisis de desarrollo de nuevos enfoques para enfrentar Ios desafios pasados, presentes y futuros, en el marco de una perspectiva mas amplia de la salud que considere Ios cambios del rol del Estado, Ios procesos de descentralizacion y la creciente participacion ciudadana en busca de condiciones dignas de vida y salud, entre otros. En nuestro caso, como producto de un largo proceso social y politico, se ha llegado al convencimiento de la necesidad de promover cambios que propicien ellogro de un autentico desarrollo economicosocial basado en la equidad, eficiencia, solidaridad y sostenibilidad, principios que son mas urgentes de aplicacion en el campo de la salud. En consecuencia, en estos momentos se ha considerado imprescindible sentar bases solidas para establecer un nuevo marco para la formulacion, gestion y evaluacion de politicas de salud, recuperando y reafirmando el rol del Estado como indiscutible garante de la salud de la poblacion y revalorizando el principio etico de la equidad como eje del accionar de la salud. Esto, que obliga a partir de una concepcion del desarrollo humano integral y sostenible en tomo a un ambiente saludable en que la salud es un componente fundamental de la calidad de vida y el bienestar social, implica la integracion de una vision sectorial y un marco de desarrollo intersectorial y territorial en Ios diferentes espacios y organizaciones del pais. Un primer elemento en la construccion de un sistema nacional de salud que responda a Ios retos del escenario social, politico y tecnologico actual es la estructuracion de un mandato legal constitucional que permita el desarrollo regulador del Estado a traves del Ministerio de Salud, de impulsar la integracion de tin concepto mas amplio de la salud que involucre la nocion de responsabilidad social compartida, y la coexistencia de modelos de financiamiento y atencion que integren lo publico y lo privado y la consecuci6n de coberturas universales y equitativas de la atencion de salud de la poblacion. Uno de Ios pasos fundamentales en este sentido ha sido la aprobacion por parte de la Asamblea Constituyente de las reformas constitucionales en el campo de la salud que basicamente definen a la salud como un derecho ciudadano y la creaci6n de un sistema nacional de salud como una responsabilidad social; la necesidad de caminar hacia un sistema universal de aseguramiento; la descentralizaci6n y desconcentracion y autonomia crecientes y la diferenciacion de la capacidad de pago de Ios usuarios. Este hecho trascendente en la historia de la salud del Ecuador obliga, en primera instancia, a la elaboracion en Ios proximos meses de la ley para la creaci6n del sistema de salud, con vision sectorial y con organizacion de la oferta y el financiamiento direccionadas hacia Ios problemas y necesidades de la salud de poblaciones ecuatorianas con equidad, eficiencia y calidad. En este marco, a partir de un ejercicio de participacion nacional desarrollado durante siete meses en 1997 en busqueda de fortalecer la instancia estatal rectora de salud, el Ministerio de Salud Publica se formula la siguiente vision: buscamos un Ministerio de Salud que garantice a la poblacion condiciones de vida saludables y acceso equitativo y oportuno a Ios servicios de salud, que tenga capacidad de rector y de liderazgo sectorial y que impulse procesos sostenidos de cambio orientados a promover la cobertura universal de prestaciones de salud con calidad, equidad, eficiencia y solidaridad. Un Ministerio de Salud con capacidad de gestion desconcentrada, modema y despolitizada, con recursos humanos suficientes altamente calificados, capacitados, bien remunerados, comprometidos y estables, que cuenten con el respaldo politico, legal y financiero del Estado y la participacion activa de un conjunto de la sociedad civil, respetando las particularidades de cada realidad local. Nuestra misi6n, por tanto, sera promover las condiciones de vida saludables para toda la poblacion y construir el sistema nacional de salud en conjunto con las entidades del sector de salud, para garantizar el acceso universal a servicios eficientes y de calidad, especialmente a Ios grupos de mayor riesgo biol6gico y social; para ello el Ministerio formula una politica planificada y ejecuta y evalua las acciones de salud a traves de una gesti6n transparente, desconcentrada y participativa con una adecuada conducci6n de regulaci6n y control del sector. Con estos antecederites, la conformaci6n de un sistema nacional de salud s61ido y capaz de responder a Ios retos del proximo milenio requiere partir de algunas consideraciones de realidad nacional; establecer Ios indices macroecon6micos, dinamizar acciones de modemizacion del Estado en ambitos particularmente criticos; impulsar y concretar el cambio de las bases constitucionales que regiran Ios destinos nacionales y lograr mejores perspectivas en cuanto a la asignaci6n de recursos econ6micos para Ios sectores de educaci6n y salud en el presupuesto del Estado, enfrentando a la vez la conflictividad, demandas laborales y paralizaciones de servicios publicos, buscando formulas de concertacion crecientes y, por ultimo, principalmente, enfrentar el embate del fen6meno de la corriente El Niiio, que ha tenido para nosotros efectos economicosociales realmente graves y devastadores. A51NRfl page 144 Mr THINLEY (Bhutan): 1 Mr President, on behalf of my delegation and on my own behalf, I would like to offer to you our congratulations upon your election to preside over this historic session of the World Health Assembly. We have the highest confidence in your ability to guide the work of this Assembly to a fruitful conclusion. From the high Himalayas, I bring to this August gathering the greetings and warm felicitations of His Majesty King Jigme Singye Wangchuck and of the people of the Kingdom of Bhutan, on the occasion of the fiftieth anniversary of the World Health Organization. Going by The world health report 1998 and, more importantly, by the highly acclaimed role WHO has played in the last two and a half decades of its existence, the Organization and, indeed, all humanity have good reasons for jubilation. The fact that the world community finds reasons to celebrate is evidence of the wisdom with which this Assembly has chosen the very best of leaders to head this Organization. As we praise the past Directors General, I would like to pay special tribute to Dr Hiroshi Nakajima who has led WHO over the last 10 years, during which our national and collective will and capacity to meet health challenges of unprecedented scale have been tested to the very limits of our resources. Throughout this period, Or Nakajima and his dedicated and, indeed, highly competent team at the headquarters, the regional and national offices have provided unfailing guidance, inspiration and timely support and intervention. As Dr Nakajima leaves WHO and moves on to devote his talents to other worthy causes, I would like to convey to him the deepest appreciation and good wishes of all the Bhutanese people. The mantle of leadership of this great Organization will now pass into the able hands of a woman whose extraordinary abilities as a world leader are well known and whose broad vision of a future world we all share. In taking pride in our selection ofMrs Gro Harlem Brundtland as the next Director-General, we know that she will bring to WHO greater vision and vitality to meet the daunting challenges that lie ahead. Bhutan's expectations of her are, indeed, high, with good reason, and its support for her is full and unwavering. Upon nearing the end of a millennium and a most eventful century, it is natural that we should all find ourselves gazing into the future. What will life be like in the twenty-first century? Based on the latest expert assessment of the global health situation and resultant projections, the future holds the promise of better health of longer life, of less disability and diseases. However, while the world health report lists the great strides we have taken in advancing the health status of the average human being, it is equally illuminating with regard to certain disturbing findings: the fact that we are left with an unfinished agenda of public health actions and that developing countries will advance to be faced with the double threat of undefeated infectious diseases and greater onslaught of chronic maladies. The prospects of increasing life expectancy and falling fertility rates are just as worrying as the implications of growing urbanization. Then there is poverty, the progenitor of diseases. All of these demand sustained multisectoral approaches. The full impact on human health of a changing world under the combined forces of rapidly advancing technology and globalization are yet to be fathomed. It would be realistic to accept that advancement in medical science may never overtake the pace at which new health challenges will rise from the dynamics of the evolving environment and the resultant changes in human behavioural patterns and lifestyles. Just as vexing and unsettling is the fact that our refusal to accept the frailty of our mortal body have raised unresolved questions of ethics with regard to the right to die and human replication. It is, therefore, comforting to note that amid a sense of optimism, there is shared caution among the delegations. Many have spoken, as I do now, of the need to avoid being complacent; and to build upon our vast collective resources of knowledge, technology and professionals to battle the known and unyielding adversaries to health and be better prepared to subdue and eradicate those that will emerge, before they cause extensive harm. A special concern that has been raised in the world health report is the question of"safeguarding the gains already achieved in health". In this regard, we heard a lengthy debate on the proposal for a new formula for the regional allocation of WHO regular budgets. The new formula threatens the sustainability of the efforts and achievements being made in many developing countries to improve the health status of the people. While I shall refrain from repeating the justifications on the side of those appealing against it, I would like to add that this resolution could greatly limit the freedom of the new Director-General to exercise the powerful mandate which she is certain to secure. 1 The text that follows was submitted by the delegation of Bhutan for inclusion in the verbatim records in accordance with resolution WHA20.2. A51NR/7 page 145 Le Professeur BOYADJIEV (Bulgarie) :1 Monsieur le President, Madame et Messieurs les Vice-Presidents, Monsieur le Directeur general, Mesdames et Messieurs Ies delegues, tout d' abord, au nom de la delegation bulgare, je voudrais vous feliciter, Monsieur le President, Madame et Messieurs les Vice-Presidents, d'avoir ete elus pour conduire les travaux de cette Cinquante et Unieme Assemblee mondiale de la Sante. Je tiens aussi a vous transmettre nos voeux sinceres de succes pour l'accomplissement de votre importante mission. Permettez-moi, ensuite, au nom de la delegation bulgare, de vous faire part de notre appreciation de l'analyse et des idees exprimees dans les documents de travail de cette seance et d'exprimer notre accord de principe sur les conclusions et les recommandations. Ces documents concement les domaines complexes de la sante et de la sante publique au cours des premieres decennies du XXI• siecle. lis contiennent des idees nouvelles et de grande valeur qui ont un reel pouvoir de mobilisation et de motivation et qui pourraient se traduire en actions immediates. Au cours des demieres annees du present millenaire et durant les premieres annees du millenaire prochain, l'humanite doit faire face aux defis importants poses par le nouvel environnement mondial. Pour relever ces defis, il faut creer les conditions d'un developpement humanise et riche de nouvelles valeurs. La politique globale et holistique de la sante, telle que presentee dans le document intitule "La sante pour tous au XXI• siecle", est la base de ce developpement. Le succes d'une strategic efficace dans le domaine de la sante est determine par la mise en oeuvre de l'idee forte, consistant a maitriser les principaux facteurs de risque du XXI• siecle par I' adoption de nouvelles opportunites et de nouvelles approches. La strategic de la sante pour to us au XXI• siecle a fixe dix cibles mondiales, fondees sur les resultats d'une vaste recherche epidemiologique, dont les domaines et les actions concretes sont adaptes aux nouvelles conditions. Les priorites pratiques du projet ne doivent pas etre considerees comme des contraintes. Ce sont des points de repere communs aux programmes de sante aux niveaux mondial, national et regional, fondes sur la distribution equitable des ressources, !'observation pertinente des indicateurs du progres et des criteres efficaces de realisation des objectifs. Cette seance pleniere me donne la possibilite de souligner encore une fois les resultats positifs des activites du Directeur regional, du Secretariat et des collaborateurs du Bureau regional europeen de I'OMS. Leurs efforts ont contribue a la realisation par etapes en Europe des programmes et des plans d'action adaptes aux priorites regionales, ainsi qu'a l'echange d'informations et a la collaboration entre les Etats Membres. Monsieur le President, Mesdames et Messieurs, je voudrais souligner que, depuis la Cinquantieme Assemblee mondiale de la Sante, le Gouvemement de la Republique de Bulgarie a concentre ses efforts sur la realisation coh6rente et determinee d'un programme de reformes radicales pour la stabilisation et le renforcement du processus democratique, la mise en place acceleree de I' economic de marc he et le developpement de la societe civile. Malgre les difficultes, en 1997, le Gouvemement a lance une r6forme systematique dans le domaine de la sante par des actions de grande envergure. Les raisons pour lesquelles ces mesures ont ete prises sont les suivantes : premierement, la tendance continue a la deterioration de I' etat de sante de la population, deuxiemement, l'inefficacite du systeme de sante publique, troisiemement, la necessite de transposer les acquis, les normes et les criteres des pays de I' Union europeenne au niveau national. La politique de la sante en Bulgarie est actuellement orientee vers la mise en place d'un modete pluraliste en ce qui conceme les formes d' aide medicate et vers une r6forme structure lie, mettant I' accent sur I' amelioration des so ins de sante primaires et la privatisation. 11 est prevu de changer le systeme de financement par !'introduction de l'assurance maladie et de contrats entre les foumisseurs des services medicaux et la Caisse d'assurance-maladie. Un fort accent est mis sur la promotion de la sante et la prophylaxie ainsi que sur l'amelioration de la gestion de la sante publique par la decentralisation. La realisation de ces objectifs s'appuie sur la collaboration intersectorielle, la participation de la communautelocale et I' engagement des associations medicates. Ce programme de r6formes que je vous ai brievement presente se fonde sur une nouvelle politique legislative coh6rente. Compte tenu de tout cela,je voudrais remercier !'Organisation mondiale de la Sante, son Secretariat ainsi que le Bureau regional de I'Europe et ses services pour l'appui qu'ils nous accorde et pour le role positif qu'ils ont joue et continuent de jouer. Pour conclure, Monsieur le President, j'aimerais souligner la determination de !'engagement du Gouvemement bulgare en faveur de la realisation d'une reforme reelle, coherente et efficace du systeme de sante publique qui reponde aux imperatifs humains fondamentaux, a savoir promouvoir, maintenir et retablir la sante de la population bulgare. 1 Le texte qui suit a ete remis par la delegation de la Bulgarie pour insertion dans le compte rendu conformement a la resolution WHA20.2. ' A51NR/7 page146 Mrs PALMADOTTIR (lceland):1 Mr President, Mr Director-General, distinguished delegates, ladies and gentlemen, allow me to congratulate the President and the officers of the Fifty-first World Health Assembly on their election. Congratulations are also extended to the Vice-Presidents, the Chairmen of the main Committees and other officials. My delegation would like to extend its appreciation to the Director-General, Dr Hiroshi Nakajima, for his leadership and his eminent work for WHO during the last decade. I would also like to extend a warm welcome to the new Director-General, Mrs Gro Harlem Brundtland, and assure her of my country's cooperation in the coming years. Allow me to congratulate the Director-General and his staff on the concise but comprehensive report presented to us, The world health report 1998. The report provides a clear review of the past 50 years, and attempts to predict the global health situation during the first 25 years in the coming century. As the Director General emphasized in the world health reports in 1996 and 1997, the struggle against ill-health will have to be fought on two main fronts: infectious diseases and chronic, noncommunicable diseases. Our attention should be drawn to the fact that current prospects are extremely poor for many developing countries, which are likely to be increasingly afflicted with both types of illnesses. WHO's half a century of existence is indeed a success story. Improvements in child health, greater emphasis on safe motherhood, family planning programmes, public health efforts and health promotion are examples of successes. Other examples are the introduction of the essential drugs concept, improvements in working conditions, increased research, education and training of health personnel, and greater availability of vaccines. During those 50 years, WHO has positively influenced the health policy in Iceland and the development of our health care system. In the early 1970s, Iceland started building a comprehensive primary health care system. This task was supported by constructive advice from WHO. As demonstrated in our health statistics, this system has undoubtedly led to progressive improvements in the health of the entire population. The fiftieth anniversary of WHO not only provides an opportunity to look back on the work of the Organization, but is also an opportunity to set new goals for the future. As the Director-General has pointed out, most of us in our everyday lives overlook facts concerning health improvements. These include the fact that average life expectancy at birth, since the 1950s, has risen from around 46 years to almost 65 years in the world. At the same time, we should be aware of the fact that working for better health is an on-going process rather than a one-off effort. At this Assembly we are planning for the future and discussing how to meet new challenges. Health for all in the twenty-first century is a document of high standard and we are especially pleased to see that even stronger emphasis is now laid on health as a fundamental human right. Therefore, we urge all governments to renew and strengthen their commitment to achieving health-for-all goals and adopting policies and strategies accordingly. Mr President, I would like to conclude my address by assuring you, once again, of the commitment of the Government oflceland in contributing to constructive efforts to fulfil WHO's noble mission to improve health for all people of the world. Le Dr HANSEN-KOENIG (Luxembourg):2 Monsieur le President, Monsieur le Directeur general, Mesdames et Messieurs les delegues, Mesdames, Messieurs, permettez-moi, Monsieur le President, de vous exprimer tout d'abord mes vives felicitations pour votre election ala presidence de cette Cinquante et Unieme Assemblee mondiale de la Sante, qui promet d'etre particulierement interessante et determinante pour l'avenir de notre Organisation. Parmi les nombreuses missions de l'OMS, )'assistance humanitaire n'est certainement pas la plus importante. Cependant, notre Organisation se doit de conjuguer son expertise et ses moyens avec ceux d'autres instances et ceux de tous les Etats Membres pour parer a des situations d'urgence et aider les pays a organiser ou reorganiser leurs services de sante. 1 The text that follows was submitted by the delegation oflceland for inclusion in the verbatim records in accordance with resolution WHA20.2. 2 Le texte qui suit a ete remis par la delegation du Luxembourg pour insertion dans le compte rendu, conformement a la resolution WHA20.2. A51NRn page 147 Depuis 1985, le Gouvemement luxembourgeois a fait des efforts considerables en matiere de cooperation au developpement, et il a decide d'augmenter encore les credits pour y consacrer en l'an 2000 0,7% de son produit national brut. L'orientation sectorielle de !'aide reflete l'interet particulier que le Luxembourg porte aux projets clans le domaine de la sante. Les foods accordes se soot eleves a plus de US $60 millions en 1997, et les contributions extraordinaires apportees aux differents programmes de l'OMS ont connu une augmentation de plus de 50 % par rapport a 1996, pour atteindre plus de US $2 millions. Ces contributions soot presque exclusivement dediees au soutien de programmes visant essentiellement les pays les moins avances. La cooperation avec les pays les moins avances nous est dictee par la raison. Les deplacements de nos populations et les migrations de plus en plus nombreuses des populations fuyant des regions de crise ou des conditions de privation font que les pays industrialises partagent clans une plus large mesure et de fa9on plus immediate les problemes de sante des pays en developpement. 11 importe de lutter ensemble contre les menaces transnationales pour la sante liees aux echanges commerciaux, aux voyages et aux communications et d'elaborer les instruments susceptibles de promouvoir la sante mondiale, element primordial du developpement durable. L' Assemblee mondiale de cette annee est un evenement d'importance particuliere pour au moins trois raisons. D'abord, nous avons !'occasion de feter ensemble le cinquantieme anniversaire de notre Organisation. C'est done le moment de faire le bilan du demi-siecle ecoule, d'essayer de tirer des conclusions du passe et de reflechir sur les perspectives de notre action commune. C'est ce que fait le Directeur general clans son Rapport sur la sante dans le monde, 1998, qui, cette annee, s'oriente resolument vers l'avenir puisqu'il a pour theme "La vie au XXI• siecle - une perspective pour tous". Pour la premiere fois, no us lisons clans un rapport sur la sante clans le monde que les perspectives sanitaires n'ontjamais ete aussi favorables pour la population mondiale et que les progres sans precedent realises au cours du xx· siecle clans le domaine de la sante ouvrent la voie a d'autres succes clans les annees a venir. La moyenne mondiale de l'esperance de vie se situe actuellement a 66 ans, une amelioration de 50% par rapport a la moyenne de 1955. Le taux de mortalite infantile est passe de 148 en 1955 a 59 en 1995 et celui de la mortalite des moins de cinq ans de 210 a 78 pour 1000. Ce soot des resultats spectaculaires, certes, et on peut feliciter l'OMS, qui y a certainement contribue. Cependant, une large part de ces 10 millions de deces annuels d'enfants de moins de cinq ans, dont 97 %deplores clans les pays en developpement, soot evitables. Des disparites inacceptables persistent et les ecarts entre riches et pauvres se creusent inexorablement. Nous commen9ons a mesurer le caractere ambitieux et fort complexe du premier objectif de la sante pour tous: l'equite en matiere de sante. Cet objectif demeure un defi pour nous tous au niveau de nos pays et un defi sur le plan mondial. 11 est done evident que le principe d'equite reste la premiere cible sanitaire mondiale clans la nouvelle strategie de la sante pour tous au XXI• siecle, document que nous aurons 1' occasion de discuter durant les prochains jours, et c'est une deuxieme raison pour laquelle je considere cette Assemblee comme particulierement importante. Finalement, nous elirons un nouveau Directeur general etje crois qu'en la personne du Dr Gro Harlem Brundtland, designee par le Conseil executif, nous avons la chance d'avoir trouve la personne capable de reprendre le flambeau des mains de notre Directeur general, le Dr Nakajima, que j'aimerais remercier sincerement de tout le travail accompli pour notre Organisation durant les dix demieres annees. Je suis convaincue que le Dr Brundtland a toutes les qualites pour faire jouer a l'OMS le role eminent qui lui revient, c'est-a-dire le role d'une Organisation forte, chargee d'amener tousles peuples du monde au niveau de sante le plus eleve possible. Monsieur le President,je tiens a confirmer l'appui apporte par le Luxembourg a l'Organisation mondiale de la Sante et a souhaiter beaucoup de courage, de perseverance et de succes au nouveau Directeur general clans l'interet de la sante pour tous. Mr AYINLA (Nigeria): 1 Mr President, Vice-Presidents, Director-General, Regional Directors, honourable ministers of health, distinguished delegates, distinguished guests, ladies and gentlemen, may I seize this opportunity to congratulate the newly elected President of the World Health Assembly and also to welcome the incoming Director-General, Dr Gro Harlem Brundtland, and wish her a fruitful and successful tenure. I convey to you, and this Assembly, 1 The text that follows was submitted by the delegation of the Federal Republic ofNigeria for inclusion in the verbatim records in accordance with resolution WHA20.2. A51NR/7 page 148 greetings and well wishes ofthe Head of State and people ofthe Federal Republic ofNigeria. During the visit of the Director-General, Or Nakajima, and the WHO Regional Director, to Nigeria in 1997, we took the opportunity to exchange views on the way forward regarding the improvement of the health of our people. We are grateful for those visits and look forward to the implementation of programmes and actions discussed and agreed upon. Mr President, permit me to brief the Assembly on the current health situation in Nigeria and make proposals for improvement both in my country and in the African Region as a whole. In the last few years, Nigeria has recorded some successes towards making health care accessible, acceptable and affordable for its citizens. On assumption of office as the Minister of Health, I have endeavoured to consolidate the gains made in our health care delivery system. Primary health care remains the cornerstone of our health care delivery system. Strengthening of our health institutions and empowerment of the community, particularly women and the rural populace, to actively participate in health care delivery at all levels was pursued vigorously. From 1996 to date the Government ofNigeria has contributed the sum of US$ 104 million to child survival programmes. This has led to the immediate increase in our immunization coverage and reduction of disease occurrence. Nigeria is implementing its poliomyelitis eradication programme through the conduct of national immunization days (NIDs). In the year 1997, a total of 20 217 367 children were immunized against poliomyelitis. This constitutes 95% of the target population. The NID campaigns have gone a long way to creating awareness among the populace. The facilities provided for the NIDs have facilitated the strengthening of routine immunization, surveillance and other health intervention and disease control programmes. We intend to improve on our achievements this year so as to ensure successful poliomyelitis eradication by the year 2000. Additionally, well over five million people have been immunized between September 1997 and April 1998 against both cerebrospinal meningitis and yellow fever through selective mass immunization. This has led to the avoidance of a large outbreak of meningitis in the high-risk regions of our country this year. All we have now are sporadic cases of meningitis, which are being successfully contained. These campaigns are ongoing, and all vaccines required were provided by the Nigerian Government. Malaria, tuberculosis and leprosy control have also received a boost during the last year. With the support ofWHO, management of severe cases of malaria has been improved nationwide and mortality was reduced to well below 10% in 1997. We welcome the accelerated malaria control initiative and hope that WHO will adequately support and fund it. We shall support this initiative through the African malaria initiative. Despite our efforts, tuberculosis cases have continued to increase due to the spread of HIVI AIDS. The introduction of directly-observed treatment, short course and supply of free drugs has contributed immensely in reducing the spread of tuberculosis. Lately, HIVI AIDS has been increasing in our country at an alarming rate. I have directed that efforts towards HIVIAIDS control be doubled to curtail the spread of this disease in Nigeria. The health education and national blood transfusion programmes have been strengthened to meet the challenge. Leprosy control has received a boost. The Government has increased its efforts and we have made remarkable progress. Guinea-worm eradication is receiving adequate attention and, in collaboration with Global 2000, we have reduced the number of cases from 12 000 to 11 143, between 1996 and 1997. Total eradication is being addressed through increased funding and supply of potable water to the communities affected. Also, with the introduction of the community-directed ivermectin treatment strategy, our Onchocerciasis Control Programme had achieved substantial disease reduction. To prevent the frequent occurrence of emergency situations such as epidemics of preventable diseases, we have adopted the following as our main strategy: stocking of a strategic quantity of yellow fever and cerebrospinal meningitis vaccines; improvement of vaccination coverage; institution of continuous training of personnel; strengthening of our surveillance system and laboratory services; and intensified public health education nationwide. As regards noncommunicable disease control and prevention, our focus is on risk factor control and early detection of disease. Integrated prevention and control of noncommunicable diseases of public health importance such as diabetes and hypertension are presently receiving the utmost attention. To consolidate our gains in the area of disease control, integrated disease surveillance of communicable diseases in line with the African Region's policy has been adopted as a new strategy for our disease control activities. A comprehensive national health management information system has been developed and built around the concept of national minimum data sets for health. Capacity for information support for decision-making at all levels has been enhanced. A51NRI7 page 149 In the last two years the health budget has consistently been well above 5% of the total budget of the country. The Government has made available special funds for the refurbishment and completion of key teaching and specialist hospitals in the country, which also are sources of health manpower development for the nation. The Petroleum (Special) Trust Fund, an agency established by the Government to improve social services, has also increased its health budget for this year and it has since begun upgrading all our primary and secondary health institutions. It is hoped that at the end of this exercise our health institutions will meet international standards to further enhance the referral system and overall delivery of health services. There has been a substantial improvement in the drug supply situation and the pharmaceutical industry has enhanced its capacity. Our research institutions have succeeded in developing effective drugs using our local herbs and other raw materials. In addition to these, the national food and drug administration and control has been strengthened and empowered to ensure strict food and drug control, a job that this agency has been performing to the satisfaction of all. The Head of State successfully launched the National Health Insurance Scheme last year with funds made available for the immediate take-off of the scheme. Along with this, the health policy has been revised to fall in line with national targets envisioned for the year 2010. Hopefully this scheme will complement health care financing and provide economic access to health services for all Nigerians. Additionally, various programmes targeted towards alleviating poverty and empowerment of our communities are being pursued. The Family Economic Advancement Programme recently introduced by our First Lady has gone a long way towards achieving this. I urge this noble body to continue the good work it has been doing for the greater benefit of mankind, while bearing in mind that we in Africa face particularly challenging situations that call for special consideration. The scourge of communicable and noncommunicable diseases has continued to negate efforts of the African Region to achieve sustainable development. While all the countries in this region continue to improve the delivery of health care services, there is need to further strengthen the WHO Regional Office and the country offices in the Region to enable them to respond adequately to the needs of our countries. It is in this light that we welcome the ongoing United Nations and WHO reforms, which we hope will streamline their operations and enhance efficiency in achieving the set goals as we approach the next millennium. Once again, let me, on behalf of the Government and people ofNigeria congratulate the Director-General, Dr Nakajima, for his momentous contributions during his tenure. Nigeria welcomes the new Director-General, Dr Brundtland and pledges her support for her new assignment. We use this occasion to solicit support and request that she concentrates her efforts on regions where the problems are overwhelming. Le DIRECTEUR GENERAL : Monsieur le President, Excellences, honorables delegues, Mesdames et Messieurs, au moment oil s' acheve le de bat general sur les points 9 et 10 de I' ordre du jour, je souhaite vous remercier tres sincerement de votre participation tres active acette reflexion collective que !'Organisation mondiale de la Sante a engagee avec ses Etats Membres sur l'avenir de la sante clans le monde et sur les moyens dont la cooperation internationale doit se doter pour mener a bien la tache considerable qui reste a accomplir. Monsieur le President, vous allez adopter clans cette Assemblee la Declaration mondiale sur la sante et le cadre general de la politique nouvelle proposee pour I' instauration de la sante pour to us, qui est un des themes de reflexion de votre debat sur les points 9 et 10. Demain, nous celebrerons le cinquantieme anniversaire de !'Organisation mondiale de la Sante clans l'amitie et lajoie, etje suis certain que l'OMS, ses Etats Membres et la communaute scientifique tout entiere sauront trouver les moyens materiels et la volonte politique d'avancer vers la realisation de leur objectif, qui est cl' assurer la sante, la paix et la prosperite pour tous avec la pleine participation de tous. Je vous remercie des reflexions et des propositions d'action tres precieuses que vous avez partagees avec nous au cours de ce debat, dont l'OMS pourra pleinement tirer parti clans l'annee qui vient. Je vous remercie, Monsieur le President, Mesdames et Messieurs les delegues, des paroles d'amitie et des gestes de reconnaissance que vous avez eus pour moi. J' en suis extremement touche et je souhaite dire a chacun toute ma gratitude. J'adresse mes felicitations chaleureuses au Dr Gro Harlem Brundtland pour son election au poste de Directeur general de !'Organisation mondiale de la Sante. Je sais la force de ses convictions. J'ai la certitude qu'avec ses remarquables competences et sa longue experience de la sante et des affaires publiques, elle servira le bien de !'Organisation et tous ses Membres. Mes voeux les plus sinceres l'accompagnent clans l'accomplissement de sa tache. Monsieur le President, Madame et Messieurs les Vice-Presidents, je vous remercie surtout pour la haute tenue de ce debat, que vous avez dirige d'une favon remarquable et d'une maniere excellente. A51NRI7 page150 The PRESIDENT: :~)I .o~l a.,.,~\ o,L,. ~ ¥-tS::; J.P' .ill\~ \J""WI .r._,A::ly ~ W ~I ~ a,~ (,?f)l y- y ~ uf u'JI ~t5:...~ .f.!J...l:.JI ..:;t;y ~lA.,..~\ ~ . '\\A iW ~WI -,i ~4 .:.;->- LAW. J .:.;->- yl~'¥1 ~ ~) ~\ u4 e:--"'1)1 t_ ~~\ ~..U .:~ js _,JI ~ ..::;~ t. L...... ~ .~_..JI J~~\ ~ ~\ ..::;':>\.- J ~~ UJ..J.j JyJ ·iWI 1-4\ a.J.i.WI ~t;f. 4; ,lQj ~\ ~\ ~J ~IJ a-...81 ~L...JI ...WI C.~ ~I a..WI L.k.JI ..U..:.... J i ~I l-4\ ~ ~i ..li u'JI u ~ I~J ~I J )iill o~WI ~WI J u~ 0-l.U\ ~L....j)l J~J ~ ~\.:.:v IJ~ uf ~ ~l>.)l; ,L>~ a.¥.:~ ."~WI ~I a.J.i.W u_,.-.>JI ~1" JL.s-~1 JJ..l>. .y r u--WI . .GlS'f.J ....UI ~ JJ ~ i')W\J .L.k.JieJ The meeting rose at 18:45. La seance est levee a 18h45. A51NR/8 page 151 EIGHTH PLENARY MEETING Thursday, 14 May 1998, at 10:00 President: Dr F.R. AL-MOUSAWI (Bahrain) HUITIEME SEANCE PLENIERE Jeudi 14 mai 1998, 10 heures President: Dr F.R. AL-MOUSAWI (Bahrein) FIFfiETH ANNIVERSARY OF WHO CINQUANTIEME ANNIVERSAIRE DE L'OMS The PRESIDENT: The Assembly is called to order. On this very special occasion of the fiftieth anniversary of WHO, it is a great honour and a pleasure for me on behalf of this Assembly to extend a welcome to Mrs Ruth Dreifuss, Vice-President of Switzerland; His Excellency Fidel Castro, President of Cuba; His Excellency Henri Konan Bedie, President of Cote d'Ivoire; and The Honourable Tofilau Eti Alesana, Prime Minister of Samoa. We are also pleased to welcome several Presidents of previous Assemblies. I am informed that His Excellency Mamoon Abdul Gayoon, President of the Maldives, had been expected to attend this Forum but at the last moment was unfortunately unable to be present due to unforeseen circumstances. He has sent a message which will be included in the records of the Assembly. The World Health Organization and the Fifty-first World Health Assembly have received a number of messages of congratulations and good wishes from Member States for the fiftieth anniversary. These include messages from the President of China, the First Deputy Prime Minister ofKazakhstan, and the Prime Minister of my country, Bahrain. On behalf of WHO and the Fifty-first World Health Assembly, I wish to extend my warmest thanks for the expressions of confidence and good will addressed to us on this auspicious occasion. Mr GAYOON (President of the Republic ofMaldives):1 On the occasion of the fiftieth anniversary of the World Health Organization, I would like to extend, on behalf of the Government and the people of the Republic ofMaldives, sincere congratulations and best wishes to the Director-General, his able staff, and the hundreds of dedicated men and women who work for WHO worldwide. I would also like to thank the Director-General for having invited me to attend this historic Forum. I regret that I am unable to be present with you here today. I am sure that the Forum will benefit immensely from the collective wisdom, deep insight and the wide experience of the Heads of State and Government participating in these deliberations. I wish your meeting every success. Over the past 50 years, WHO has achieved many successes, eradicating or reducing the prevalence of deadly and other serious diseases that afflict mankind. The strategy of primary health care pursued under the Alma-Ata goal of health for all by the year 2000 has provided an ideal model of community-based service which has increased access to health care on an equitable basis in many parts of the world. However, in many countries, health care for all still remains an elusive goal, for poverty and underdevelopment have a pervasive 1 Text of the message sent by the President of the Republic ofMaldives. A51NR/8 page 152 impact on health. Wars and violence create tragic and traumatic setbacks. And, as we look to the future, we must also recognize that environmental safety and sustainability are abiding concerns. Only through development, enduring peace, and environmental safety can a good quality of life be assured. The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being. It is one that is necessary for the full enjoyment of other rights. Indeed, good health is essential for personal development and crucial for society's progress and development. Our strategies must, therefore, be formulated in the most effective manner to attain this objective. Health for all through primary health care aimed at providing preventive and basic curative services to all within easy distance from home remains an important target, one that is particularly appropriate to bringing in the principle of equity to health care. As we approach the twenty-first century, we must be alert to the challenges that lie ahead and be quick to seize the new opportunities that become available in order to make health care more effective and equitable. Developments in mass communications and breakthroughs in research should be marshalled to advance health care for all. Increasing awareness about the sensitivity of the ecosystem to human action should be used to reduce short-term and long-term threats to health. Appropriate and comprehensive population policies should be pursued to ensure the best physical and mental health for all age groups everywhere. It is vitally important that more work be done to promote child health and welfare. Equally, a comprehensive health policy for women, including safe motherhood, family planning and healthy lifestyles, should be given high priority. Moreover, we must be responsive to the impact of our economic policies on health: we must not let the market-place determine our public health priorities, for health for all cannot be achieved unless we are committed to the ethical concepts of equity, solidarity and social justice. WHO and the Maldives have worked closely together for nearly 40 years, and accomplished many advances, such as the eradication of malaria, poliomyelitis and neonatal tetanus in the country. Between 1978 and 1997, the infant mortality rate in the Maldives has come down from 120 per 1000 live births to 27 per 1000, and life expectancy at birth has increased from 48 to 71 years. Universal immunization was reached in 1989, and has been maintained since. A mass literacy campaign begun in 1981 has succeeded in raising the literacy rate to over 98%, enabling effective health education to be achieved. In recent years, the population growth rate has begun to decline sharply. Health infrastructure and capacity has also been increased. Despite the outstanding achievements of WHO, all ofus are concerned about the threat of the spread ofHIV/AIDS and re emerging diseases all over the world. As is the case with many other countries, assuring mental health, reducing micronutrient deficiency, combating substance abuse, reducing tobacco use, and promoting healthy lifestyles are all matters high on our national health agenda. At the same time, the adverse impacts on health from climate change and global warming, widespread flooding and destruction of infrastructure and food sources are a serious concern. Together, these call for a far-sighted and carefully executed health policy, for which sufficient resources should continue to be allocated. The partnership between WHO and the Maldives has been an eminently successful one. Given the constrained circumstances of a resource-poor, widely dispersed, and developing archipelagian State, the relationship is, indeed, an indispensable one, in order to ensure affordability of health care services to all and to increase national capacity to address health threats. The Government and the people of the Maldives, therefore, remain firmly committed to working with WHO in ensuring the highest attainable standard of health for all Maldivians for now and in the time to come. The PRESIDENT: I now take pleasure in welcoming Fionnuala Sweeney, the London-based anchor-person of CNN International, with whom many are familiar through her presentations on the CNN daily breakfast programme "This Morning" and the weekend magazine show "Inside Europe". Ms Sweeney has been requested to assist me by moderating this Forum. Ms Sweeney, you have the floor. MsSWEENEY: Thank you, Mr President. Let me begin, Mr President, excellencies, delegates, ladies and gentlemen, by saying thank you for the opportunity to take part in this very special moment in WHO history. Fifty years is a cause for celebration, but it is also a time to take stock and to look forward. We are very fortunate to have with us this morning, three Heads of State or Government to take part in this Forum, and to share with us some of their insights into health in the twenty-first century. But let us begin WHO's fiftieth anniversary Forum for Heads of State or Government with a musical tribute from two young performers from Benin, Ms Anne Teko and her brother Just. A51NR/8 page 153 Mlle TEKO (chanteuse beninoise): Monsieur le Directeur general, Madame le Directeur general elu, cheres autorites, chers invites, soyez les bienvenus. Je suis trt!s heureuse de partager mes joies avec vous a I' occasion du cinquantieme anniversaire de l'OMS. Comme vous le savez mieux que moi, on ne peut rien faire sans la sante. Je vous remercie. ODEAL'OMS Refrain OMS, je chante pour tes 50 ans. OMS, je chante pour ton Anniversaire. Merci de t'occuper dans le monde des problemes de sante. Bon Anniversaire, Bon Anniversaire, Bon Anniversaire. Couplet I Creee en 1948, Tu as pour mission de nous faire avoir un meilleur niveau de sante. Tes grands programmes I' ont demontre : Lutte contre la maladie La prevention La promotion La readaptation. Couplet 11 Grace a toi, OMS, Ma generation ne connaltra jamais la variole. Tu lances un defi au SIDA. Tu eradiqueras la polio, le tetanos grace aux vaccinations. Forte de ces succes, tu grandiras toujours, OMS. Couplet Ill A Alma-Ata, tu as opte pour les soins de sante primaires pour atteindre I' objectif Sante pour to us, Sante pour to us. Nous, les enfants du monde entier, Gardons l'espoir d'avoir une meilleure sante. Engageons-nous dans des actions hardies Pour le triomphe de la vie. SAUVEZ LES ENFANTS DE LA RUE Couplet I Ce fut un petit matin que je naquis en cachette. Et par manque de moyens, je fus Jetee au bord d'une poubelle. Et les passants de la rue se frappaient la poitrine de chagrin. Et soudain dans la cour, un coeur contrit me tendit la main. Moi, enfant de la rue, n'ai-je Pas le droit a la vie ? Et pourtant, mes parents m'ont Jetee par terre. Je fuis. Refrain Dieu Tout-Puissant, mets un peu plus d'amour dans le coeur des hommes. Les enfants de la rue, c' est une honte pour les heureux hommes. Nul n'a le droit de se rejouir tout seul, aidez-nous a vivre, apres cela nous nous rejouirons tous sur terre. Dieu Tout-Puissant, viens, s'il te plait, a notre secours. Soutiens les hommes au coeur plein A51NR/8 page 154 d'amour, qui se privent parfois de joie pour notre bonheur; ce faisant, la joie sera plus gran de sur terre. Couplet 11 Moi, enfant de la rue, j 'ai ma couchette au bord des rues, dans les baraques, les carcasses de voitures, c'est lama couchette. Aux marches et devant les magasins, c'est lama couchette. Et les mets delaisses par les autres, Ce sont mes repas. Et mes vetements, rien que des loques que je traine en tout temps et partout ou je passe. Voila ma vie. MsSWEENEY: Thank you both very much. Over half a century ago the founders of the World Health Organization embarked on a crusade, and in the 50 years of WHO there has been much to celebrate. Global life expectancy has increased, smallpox - the disease which once killed or disfigured millions - has been eradicated and more will hopefully soon follow. The fiftieth anniversary of WHO comes at a dramatic period in world history. Since I have been working as a journalist, as well as more recently as an anchor for CNN International, we have all witnessed, for example, the turmoil in the Great Lakes region in Africa and, even now, a critical situation in Sudan. Yet even in a world ravaged by inequity and strife it has been possible to ensure that 80% of the world's children have been immunized to protect them from six of the most common killer diseases. Smallpox was eradicated by a mass vaccination campaign, and the eradication of poliomyelitis and measles are within reach. In the past few years there has been a serious attempt by the scientific community to establish a global surveillance system for emerging and re-emerging diseases. Global life expectancy has improved, but diseases which were once declining are on the move again. In the WHO Constitution, which came into force in 1948, health is defined as a "state of complete physical, mental and social well-being and not merely the absence of disease or infirmity", but the vision of the founding fathers of WHO of the attainment by all people of the highest possible level of health has remained elusive. As the world's health conscience, WHO has lobbied for the broader changes that are needed to achieve health for all. It believes that this ambitious goal cannot be achieved without major changes in politics, economics and human behaviour across the planet. We are very fortunate today to have with us some Heads of State or Government, who are in a position in their own countries and on a wider international field to make a real impact on the future health status of millions of people. I will now give the floor to each Head of State or Government, who will in turn address the Assembly on the subject of health for all in the twenty-first century, after which I shall ask a few questions for answers by each of our distinguished guests. So, on behalf of WHO, I would now like to invite the Honourable Tofilau Eti Alesana, Prime Minister of Samoa, to address the World Health Assembly. Mr ALESANA (Prime Minister of Samoa): Your excellencies, Heads of States and Heads of Government, Mr Director-General, distinguished delegates, ladies and gentlemen, I am addressing this special session of the World Health Assembly on behalf of my country, Samoa, and also as a representative of the Western Pacific Region, in particular, the island countries of the Pacific. Most of the Member States in the Western Pacific joined the World Health Organization during the past 30 years, although our collaboration with the Organization goes back further than that. Pacific island countries share many common features, such as our history, small scattered populations and fragile ecosystems. Many countries are also currently undergoing economic difficulties. For the countries of the Pacific, WHO has played and continues to play a very important role in our health development, particularly in training our human resources and in provision of technical support. In 1995 the Pacific island countries made a commitment to work collectively to promote health in the region through a "settings" approach known as A51NR/8 page 155 Healthy Islands. The 1995 the Yanuca Island Declaration concluded that "all countries in the Pacific must strive to work together towards a healthy island state through sharing of information, technology and expertise for the betterment of the environment and health status of the people of these island nations". This commitment was reiterated in the Rarotonga Agreement in August 1997 when countries reaffirmed the importance of partnerships among communities, government departments and other sectors in resolving priority health concerns. The meetings that led to these agreements were both sponsored by the World Health Organization. Many factors influence a person's health and well~being and there are increasing roles for the individual, the family and the community in health matters. Public policies must reflect this and must seek both to protect the health of people by providing accessible and high quality health care and to ensure a living and working environment conducive to health. Social action can help to protect the young from violence and substance abuse, ensure that working conditions are conducive to health, promote healthy diets and recreation, and create a school environment that supports learning, good health and personal growth. People need knowledge, awareness and skills to keep themselves and their families healthy. Through health promotion, people must be encouraged to help themselves to avoid disease and disability, and to develop lifestyles and environments that support positive health. In the Pacific we also face the continuing burden of communicable diseases, including severe outbreaks. Dengue fever is a common cause of morbidity in the Pacific, and here again we are grateful to the World Health Organization for its support in facilitating rapid shipment of insecticides during outbreaks. Malaria affects several countries in the Pacific, and the partnership between malaria endemic countries and the World Health Organization has been the basis for extensive control programmes. In Samoa, filariasis has been a problem for many years; together with WHO we have undertaken an intensive programme of vector control, mass drug administration and surveillance for the whole population and are now close to eliminating this debilitating disease from our islands. I was Minister of Health in Samoa in 1962 when my country joined the World Health Organization. Now as Samoa's Prime Minister, on the occasion of WHO's fiftieth anniversary, I again congratulate the Organization whose partnership has been so important to my country and to the Pacific. MsSWEENEY: Thank you, Prime Minister. I would now invite His Excellency Henri Konan Bedie, President of Cote d'Ivoire to address the Assembly. M. KONAN BEDIE (President de la Cote d'Ivoire): Monsieur le President de la Republique de Cuba, Monsieur le Premier Ministre de Samoa, Madame la Vice~Presidente de la Confederation helvetique, Monsieur le President de la Cinquante et Unieme Assemblee mondiale de la Sante, Monsieur le Directeur general de l'OMS, honorables delegues, Mesdames et Messieurs, permettez~moi, tout d'abord, de m'acquitter de l'agreable devoir de remercier, non seulement au nom du peuple ivoirien, mais egalement de celui de tousles Africains, I' Organisation mondiale de la Sante et son Directeur general, le Dr Hiroshi Nakajima, de l'invitation qu'il a adressee amon pays et, atravers lui, atousles pays de la zone Afrique de l'OMS a l'occasion de la celebration du cinquantenaire de notre Organisation. C'est egalement au nom de tous ces pays que j'adresse mes vives felicitations au Dr Gro Harlem Brundtland pour sa brillante election a la tete de l'OMS. Nous sommes certains que sa grande experience professionnelle et son engagement personnellui permettront de conduire tous les peuples du monde vers la sante pour tous au XXI• siecle. Je voudrais l'assurer, des a present, que l'ensemble du continent africain lui apportera son soutien afin de faire de ce defi une veritable aventure commune. Excellences, Mesdames et Messieurs, le defi de la sante pour tous au XXI• siecle sera releve en puisant la matiere dans les experiences accumulees depuis la Conference historique d' Alma~Ata, en 1978, au cours de laquelle ont ete jetees les bases de la strategie des soins de sante primaires, qui postule un developpement sanitaire participatif adapte aux contraintes des pays les plus demunis. Grace a cette strategie, des resultats importants ont ete obtenus dans des domaines prioritaires comme la vaccination des enfants. Ces performances ne masquent cependant pas les ecarts encore tres importants entre les indicateurs de sante des pays du Nord et ceux enregistres sur le continent africain. L'effort doit etre poursuivi au regard des souffrances eprouvees durant cette fin de siecle par l'ensemble du continent africain, frappe a la fois par la crise economique et financiere la plus grave de son histoire et par des conflits fratricides accentuant la pauvrete de ses populations. Les systemes sanitaires nationaux ont ete A51NR/8 page 156 gravement atteints a cause, non seulement de l'insuffisance des credits d'entretien, mais egalement de la demotivation des personnels qui en est resultee, entrainant a son tour une baisse sensible de la qualite des prestations. Les politiques d'ajustement structure! mises en oeuvre pour combattre la crise financiere, tout en remediant aux graves desequilibres macro-economiques, ont mis en Jumiere la montee implacable de la pauvrete dans !'ensemble des populations. L'arret brutal des efforts de developpement educatif et sanitaire ont conduit Jes gouvemements et la communaute intemationale a promouvoir de veritables programmes de valorisation des ressources humaines afin de relancer le developpement sur des bases durables et equitables, dans Jesquels la promotion de la sante occupe une place de choix et pour laquelle des credits importants sont progressivement mobilises. La sante trouve done, a I' aube du XXI• siecle, une opposition strategique, dans le but de satisfaire aux exigences de plus en plus pressantes de ce droit fondamental des populations ajouir tout au long de Jeur vie du niveau de sante le plus eleve possible. Dans le cadre des actions de developpement, Jes Etats d' Afrique prennent de plus en plus en compte les investissements qui assurent I' acces de to us ades systemes et services de sante efficaces. lis organisent la participation des communautes a!'effort de sante pour tous. En Afrique subsaharienne, plus que partout ailleurs, nous sommes concemes par ce defi car nous sommes confrontes au phenomene de la transition epidemiologique, qui cumule la charge des endemies traditionnelles de nos milieux et des pathologies issues du developpement et de la vie urbaine ou, encore, de nouvelles maladies jadis inconnues, comme Jes ulceres a mycobacteries, appeles plus communement ulceres de Buruli, qui constituent un nouveau probleme de sante publique. Nous sommes aussi, helas, confrontes, plus que partout ailleurs, aux ravages de la pandemie de SIDA qui fauche litteralement nos jeunes generations, les generations Jes plus productives. Cette pandemie pourrait faire regresser l'esperance de vie des Africains d'une bonne decennie si les tendances actuelles persistaient. C'est pourquoi nous avons, lors de la demiere Conference sur le SIDA et les maladies sexuellement transmissibles en Afrique, en decembre demier aAbidjan, lance !'idee d'un fonds africain de solidarite pour le traitement du SIDA. C' est pour cela que je serais tente de dire que le succes du programme de sante pour to us au XXI• siecle sera conditionne autant par la capacite de nos politiques nationales aprendre en compte la dimension sociale de la sante dans le sens d'une large implication de la communaute dans sa promotion au quotidien et d'un elan de solidarite entre Jes nations. "Nul n'a le droit d'etre heureux tout seul", disait Raoul Follereau en Ianyant le defi de !'elimination de la Jepre. La sante pour tous au XXI• siecle, pour devenir realite, doit etre la forme la plus achevee de la solidarite nationale et intemationale. L'Organisation mondiale de la Sante a toujours su defendre, avec la plus haute competence et la plus grande energie, la sante des Africains. Je suis sur que la meme conviction et la meme force continueront a I' animer pour guider et conseiller to us les Etats Membres dans leur quete de la sante pour to us. Je vous remercie de votre attention. MsSWEENEY: Thank you, Mr President. I would now ask the President of Cuba, His Excellency Fidel Castro, to address the World Health Assembly. El Dr. CASTRO, Presidente de Cuba: Excelencias, autoridades de la OMS, distinguidas delegaciones. Honor a la Organizaci6n Mundial de la Salud, que junto al UNICEF ayud6 a salvar la vida de cientos de millones de nifios y de mill ones de madres, que alivi6 Ios sufrimientos y salvo de la muerte a otros muchos millones de seres humanos. Estas dos instituciones, junto con la FAO, el PNUD, la UNCTAD, el PMA, el FNUAP, la UNESCO y otras, tan combatidas por aquellos que quisieran borrar de la tierra !as nobles ideas que inspiraron la creaci6n de las Naciones Unidas, han contribuido decisivamente a forjar una conciencia universal de Ios graves problemas del m undo de hoy y de Ios grandes desafios que tenemos por delante. Si la economfa mundial, segt1n calculos de prestigiosos analistas, creci6 seis veces y la producci6n de bienes y servicios pas6 de menos de cinco billones (millones de millones) a mas de 29 billones de do lares entre 1950 y 1997 l,por que mueren todavia cada afio 12 millones de nifios menores de cinco aiios, es decir, 33 000 A51NRI8 page 157 por dia, que podrian salvarse en su inmensa mayoria? En ningun lugar del mundo, en ningun genocidio, en ninguna guerra se matan tantas personas por minuto, por hora y por dia como las que mata el hambre y la pobreza en nuestro planeta 53 afios despues de creada la Organizacion de las Naciones Unidas. Los nifios que mueren y podrian salvarse son casi en un 100% pobres y, de Ios que sobreviven l,por que cada afio 500 000 nifios quedan ciegos por falta de una simple vitamina que cuesta al afio menos que una caja de cigarrillos? l,Por que 200 millones de nifios menores de cinco afios estan desnutridos? l,Por que 250 millones de nifios y adolescentes trabajan? l,Por que 110 mill ones no asisten a la escuela primaria y 275 mill ones estan fuera de la escuela secundaria? l,Por que 2 millones de nifias son prostituidas cada aiio? l,Por que en ese mundo que produce ya casi 30 billones de dolares en bienes y servicios por afio, 1300 millones de seres humanos viven en la pobreza absoluta? l,Por que reciben menos de un dolar diario per capita cuando hay quienes reciben mas de 1 millon de dolares cada dia? l,Por que 800 millones carecen de Ios mas elementales servicios de salud? l,Por que de Ios 50 millones de personas que en total fallecen cada afio en el m undo, adultos o nifios, 17 mill ones, es decir aproximadamente 50 000 cada dia, mueren de enfermedades infecciosas que podrian casi todas curarse o, mejor todavia, prevenirse a tiempo, muchas de ellas a un costo que a veces no rebasa un dolar per capita? l,Cual es el precio de una vida humana? l,Cuanto cuesta a la humanidad el injusto e insoportable orden economico establecido en el mundo? 585 000 mujeres fallecieron en 1996 durante el embarazo o el parto, el 99% en el Tercer Mundo, y 70 000 por abortos en malas condiciones en America Latina, Africa y Asia. Aparte de la diferencia abismal en la calidad de vida, en Ios paises ricos las personas viven como promedio 12 afios masque en Ios paises pobres. En determinadas naciones Ias diferencias entre Ios mas ricos y Ios mas pobres es de 20 a 35 afios. Es muy triste pensar que, solo en la esfera maternoinfantil, a pesar de Ios esfuerzos de la OMS y del UNICEF, en Ios ultimos 50 afios murieron por falta de servicios medicos mas de 600 millones de nifios y 25 millones de madres que pudieron sobrevivir. Ello habria requerido un mundo mas racional y justo. Durante ese mismo periodo de postguerra, en la esfera de Ios gastos militares se invirtieron mas de 30 millones de millones de dolares. Segun estimaciones de las Naciones Unidas, el costo de lograr el acceso universal a Ios servicios basicos de salud equivaldria a 25 000 millones de dolares anuales, un 3% de Ios 800 000 millones de dolares que actualmente se invierten en gastos militares, y ya no hay guerra fria. El comercio de armas, que son para matar, no se detiene y Ios medicamentos, que salvan vidas, se venden cada vez mas caros. El mercado de medicamentos ascendio en 1995 a 280 000 millones de dolares. Los paises desarrollados, con el 14,6% de la poblacion mundial, 824 millones de habitantes, consumen el 82% de Ios medicamentos; el resto del mundo, 4815 millones, consumen solo el 18%. Los precios son realmente inaccesibles para el Tercer Mundo, donde solo Ios sectores privilegiados pueden consumirlos. El control de las patentes y Ios mercados por las grandes transnacionales les permite elevar esos precios hasta 10 veces su costo de produccion. Algunos antibioticos de ultima generacion tienen en el mercado un precio 50 veces mayor que su costo. Pero la humanidad sigue creciendo. Somos ya casi 6000 mill ones. Crecemos a un ritmo de 80 mill ones por afio. Los primeros 1000 millones tardaron en alcanzarse dos mill ones de afios; Ios segundos 1000 mill ones, 100 afios; Ios ultimos 1000 millones, once afios. En 50 afios mas habra 4000 mill ones de nuevos moradores en el planeta. Viejas enfermedades volvieron a emerger. Surgen otras nuevas: SIDA, Ebola, encefalopatia espongiforme bovina, mas de 30, segun Ios especialistas. 0 derrotamos al SIDA, o el SIDA acabara con muchos paises del Tercer Mundo. Ningun enfermo pobre puede pagar Ios 10 000 dolares por persona al afio que cuestan Ios actuales tratamientos que, aunque prolongan la vida, no curan la enfermedad. Cambia el clima, se calientan Ios mares y la atmosfera, se contaminan el aire y las aguas, se erosionan Ios suelos, crecen Ios desiertos, desaparecen Ios bosques, escasean las aguas l,quien salvara a nuestra especie? l,Las leyes ciegas e incontrolables del mercado, la globalizacion neoliberal, una economia que crece por si y para si como un cancer que devora al hombre y destruye la naturaleza? :Ese no puede ser el camino, o Io sera solo durante un periodo muy breve de la historia. Contra estas realidades lucha heroicamente la Organizacion Mundial de la Salud, y tiene ademas el deber de ser optimista. Como cubano y como revolucionario, comparto su optimismo. Cuba, con una mortalidad infantil de 7,2 por 1000 nacidos vivos en el primer afio de vida, un medico cada 176 habitantes, que es el indice mas elevado del mundo, y una perspectiva de vida que rebasa Ios 75 afios, cumplio ya desde 1983 la estrategia de salud para todos en el afio 2000, a pesar del cruel bloqueo que sufre desde hace casi 40 afios y a pesar de ser un pais pobre del Tercer Mundo. El intento de practicar el genocidio contra nuestro pueblo nos hizo multiplicar nuestras fuerzas y nuestra voluntad de sobrevivir. El mundo tambien puede luchar y veneer. Muchas gracias. A51NR/8 page 158 MsSWEENEY: Thank you very much, Mr President. I see you looking at your watch in concern that you may have taken up more time than you had anticipated, but we in fact were running a little early so you have brought us exactly up to time. Finally, in this part of our proceedings, I invite Mrs Ruth Dreiffus, Vice-President of Switzerland, our host country, to address the fiftieth anniversary World Health Assembly. Mme DREIFUSS (Vice-Presidente de la Suisse): Monsieur le President, Monsieur le Directeur general, Mesdames et Messieurs les delegues, Excellences, Mesdames et Messieurs, c'est un grand honneur pour mon pays et pour moi que de pouvoir prendre la parole a cette tribune, de m'exprimer apres les chefs d'Etat et de gouvemement de la Republique de Cote d'Ivoire et du Samoa-Occidental et, maintenant, a la suite du President de la Republique de Cuba. Vous nous invitez, Monsieur le Directeur general, a un echange d'experiences et cela illustre bien la place decisive que chacun des Membres, grands ou petits, est appele ajouer au sein de !'Organisation mondiale de la Sante. Chacun a des experiences a apporter qui sont utiles pour determiner ensuite notre strategie commune. Si j 'ai la joie de parier ici, c' est bien sur en tant que representant du pays h6te mais certainement a us si en tant que representant d'un des Membres fondateurs de I'OMS, et pour representee la Region europeenne. Je suis persuadee que )'experience demon pays est assez representative de ce continent pour foumir une indication interessante en vue de la discussion que nous allons avoir. Monsieur le Directeur general, le cinquantenaire de notre Organisation est une fete et nous avons des succes a feter, mais nous avons certainement aussi encore des echecs et des limites a placer devant nos yeux, comme vient de le faire le President Castro. C'est pourquoi le cinquantenaire de notre Organisation est surtout une occasion de manifester notre volonte commune de realiser la strategie nouvelle en vue de l'instauration de la sante pour to us, que vous, Monsieur le Directeur general, nous presentez a I' occasion de ce jubile, et je vous en remercie. Vous passez bientot le temoin a Mme Gro Harlem Brundtland. C'est sous son autorite que nous poursuivrons cet objectif et je tiens a remercier la Directrice generale elue d' a voir accepte de no us guider to us ensemble dans cette croisade pour la sante. Mesdames et Messieurs, mon pays, la Suisse, peut certainement etre considere comme un des pays jouissant d'un tres haut niveau de sante. 11 vaut certainement la peine de s'arreter aux causes de cette reussite et d'en montrer aussi les limites et les difficultes. D'une part, )'amelioration spectaculaire de la sante de la population depuis la deuxieme moitie du siecle demier n' est pas due au premier chef aux progres de la medecine, et surtout de la medecine curative, mais, dans une large mesure, a )'amelioration des conditions de vie, d'hygiene, de logement, d'alimentation et, bien sur aussi, aux progres de la prevention et en particulier aux campagnes de vaccination. D'autre part, notre systeme de soins de sante a evolue selon sa propre logique, une logique dirigee par le progres des sciences medicales et par une medecine ambulatoire liberale, couplee a un equipement hospitalier tres decentralise et dont nous devons sans doute constater aujourd'hui qu'il est disproportionne par rapport aux besoins de la population. Et )'articulation entre I'extra-hospitalier et l'hospitalier, entre le marche et la necessaire planification pour repondre aux besoins de la population est certainement un des defis auxquels se trouvent confrontes mon pays et beaucoup de pays europeens avec Iui. Cependant, si le niveau de sante de la population est eleve, nous sommes bien obliges de faire le meme constat que l'OMS fait sur le plan international: l'egalite des chances n'estjamais definitivement acquise, elle est menacee aujourd'hui par la precarite qui va s'accentuant, precarite du travail et par consequent des moyens financiers des individus et des families, precarite des reseaux de soutien social, precarite aussi d'un environnement soumis par la croissance economique a une rude epreuve. L'inegalite devant la maladie et devant la mort est le reflet des multiples disparites sociales et economiques sur Ies plans de )'instruction, de la profession, des conditions de travail et de logement, de l'alimentation, pour ne citer que quelques exemples. Et les maladies dites de civilisation qui grevent fortement le budget de la sante publique et qui sont pour une large part imputables a notre mode de vie traduisent, elles aussi, les inegalites sociales. Pour reprendre un concept de I'OMS, le "choix plus sain" depend aussi des ressources, des aptitudes et de la marge de manoeuvre dont l'individu dispose. Et c'est bien a cette reflexion globale, et non pas seulement medicale et technique, que Ies pays ou la technologie medicale n'est pas tres developpee nous invitent. Grace a eux, nous devons et nous pouvons reapprendre a considerer les troubles de la sante dans le contexte global de la vie de I' individu, son passe, son mode de vie, son milieu social, son environnement. Par ou commencer pour ameliorer le systeme que nous avons actuellement? Nous avons I'avantage de pouvoir nous appuyer sur les conceptions et les solutions pratiques exposees par I'OMS dans sa nouvelle A51NR/8 page 159 strategie de la sante pour tous, et je me rerere particulierement ici aux propositions pour un developpement durable des systemes de sante. Concretement, cela signifie que l'amelioration de la qualite de la vie et la promotion de la sante seront les objectifs prioritaires de nos interventions. Toute intervention professionnelle devra done aussi apporter au patient et a ses proches une meilleure connaissance de la maladie en vue de la vaincre et de renforcer la confiance en soi. Agir dans le souci du developpement durable signifie aussi utiliser les ressources et les prestations en fonction des besoins. Cependant, ce n'est pas seulement au moment du choix d'une technologie de pointe ou de mesures prolongeant la vie humaine que se pose la question de !'utilisation optimale des moyens; elle se pose deja en amont, lors du choix des modeles de so ins, qui devront etre moins axes sur la consommation de prestations medicales que sur la preservation de la sante. Enfin, le principe du developpement durable implique un financement fonde sur la solidarite. Il n'y a pas d'equite en matiere d'acces a un systeme viable de soins si chacun ne contribue pas solidairement a I' effort financier. C'est pourquoi nous avons institue en Suisse - tardivement, mais nous l'avons fait - l'assurance-maladie obligatoire generale et une solidarite rigoureuse pour son financement. Au cours de ces dernieres annees, nous avons defini ponctuellement des buts de politique de la sante et developpe des strategies pour les atteindre. Nous entendons utiliser maintenant ces approches sur une base plus large. Permettez-moi d'en esquisser les elements les plus importants. Premierement, il faut informer !'opinion publique sur les problemes lies a la sante, parce que l'inegalite devant la sante est souvent le reflet et la consequence des inegalites sociales, sur lesquelles la politique de la sante ne peut pas agir directement. Mais cela ne signifie pas qu'elle doive s'en accommoder pas plus qu'elle ne doit s'accommoder des risques pour la sante qui relevent d'autres secteurs. Bien au contraire, il s'agit de mettre en evidence ces influences, de les rendre visibles a !'opinion publique qui, ainsi informee, sera a meme de debattre des responsabilites et des mesures a prendre. Deuxiemement, il faut instaurer des partenariats sur la base la plus large possible. Nous avons appris que, pour realiser une politique de la sante coherente et efficace, il faut prendre en consideration les opinions et les interets de tous les partenaires potentiels. Ce prealable est la condition pour susciter un large debat et permettre d'harmoniser les objectifs, de respecter les competences specifiques, de faire la balance entre les valeurs ideelles et les interets economiques. Troisiemement, il faut etablir I'evidence scientifique et la transparence. Un developpement durable en matiere de sante publique suppose notamment que l'on puisse verifier si les prestations et les biens sont produits d'une maniere efficace et si les ressources sont reparties selon le critere de l'efficience. Nous devons egalement connaitre le point de vue de l'utilisateur, en tant que citoyen, consommateur et patient. Pour prendre les bonnes decisions dans ce contexte et etre en mesure de les mettre en oeuvre, deux conditions au moins doivent etre remplies : une argumentation so tide, etayee scientifiquement, et la transparence la plus grande possible quant aux interets et quanta l'enjeu, la sante pour tous. Mesdames et Messieurs, solidarite, participation, transparence, voila les fondements de la politique de sante que nous menons dans notre pays et avec nos partenaires dans le monde entier. Ce sont la des conditions pour que la maladie ne soit pas subie, mais pour que la sante soit l'oeuvre de tous. Je vous remercie de votre attention. MsSWEENEY: Thank you, Madam Vice-President. As we have heard, there is no easy answer to global health problems in this rapidly changing world; fast-acting diseases will hit the headlines while slower-acting environmental hazards such as air pollution, climate change, and hazardous products and waste will continue to threaten our health. We now have some questions for our distinguished guests, and I would invite each of you to feel free to comment, perhaps, or expand, on anything you feel that another distinguished guest may have contributed to our discussion. As we have heard and often hear, alleviating poverty is frequently put forward as a prerequisite for health for all, but in many cases, and at best, it will be a long-term goal. President Castro, in your speech you outlined many of your own country's achievements in the field ofhealth in the face of pressing economic forces. I wonder if you would care to expand on that, on how your country has managed to have such success on the ground. El Dr. CASTRO, Presidente de Cuba: En primer lugar, con voluntad polftica: hay que querer hacerlo, y nada mas. Esa voluntad surge en un proceso hist6rico. Hubo una revoluci6n en Cuba, no es un secreto. Estamos pagando todavia las consecuencias A51NR/8 page 160 y desde muy temprano tuvimos conciencia de la necesidad de atender a la salud como una de las cosas mas necesarias y humanas. La conocimos en el seno del pueblo, en el campo y en las montafias donde luchamos. La conocimos incluso desde antes, meditando, pensando, observando lo que ocurria en nuestro pais; y ya desde 1953, cuando nos juzgaron por las actividades revolucionarias y nos enviaron a la prisi6n, hablamos del problema de la salud y, efectivamente, cuando triunf6la revoluci6n se dedic6 una atenci6n especialisima a la salud como un compromiso sagrado con nuestro pueblo. Es importante, ademas de la voluntad politica, una segunda idea: la convicci6n de que con muy poco se puede hacer mucho en materia de salud. Con muy poco, lo sabemos, y ustedes en la Organizaci6n Mundial de la Salud lo han estado probando, principalmente con las vacunas, y esa ha sido una gran batalla; medidas preventivas, como las sales de rehidrataci6n oral, que han salvado a millones de persona a un costo infimo, y que fueron una iniciativa de la OMS. Asi que, con pocos recursos preventivos y curativos se puede hacer mucho. Otras metas serian mas dificiles. Estoy convencido de que bajar la mortalidad infantil en el primer afio de vida hasta 20 por 1000 nacidos vivos es perfectamente posible con pocos recursos; bajar de 20 a 15, y de 15 a 10, y de 10 a menos es mucho mas costoso y requiere una medicina mas cara, mas sofisticada. Nosotros no vacilamos en emplear algunos de esos recursos para bajar de 10, pese a que teniamos la inc6gnita, de si seria posible bajar de 10 la mortalidad infantil en Ios paises tropicales. l,Por que? Por el clima, Ios mosquitos, todas las cosas que sabemos Ios africanos, Ios caribefios, Ios que vivimos en paises tropicales; el calor, la humedad relativa, Ios hongos, las bacterias, Ios vectores, todas esas cosas que no se padecen, por ejemplo, en Suiza, de lo cual nos alegramos mucho. Aqui no hay paludismo; no hay Aedes aegypti en ninguno de estos Iagos, luego no hay dengue, no hay paludismo, no hay otras muchas cosas. Pero nosotros padecemos todas esas calamidades, ademas del calory de un clima que cambia. Ayer me dijeron que la temperatura tenia que ser aqui de alrededor de 15 oc, y era de 25 oc, y me digo, pronto podran sembrar platanos. Quiero decir que vivimos en condiciones climaticas muy dificiles, y ademas el clima cambia. Si yo fuera un ciudadano de Siberia esperaria obtener algun beneficio de la llegada del calor. Pero en Cuba las condiciones son tremendas, y agravan la situaci6n, incluso econ6mica: mas ciclones, mas lluvias. Por ejemplo, el fen6meno del Nifio; todo el mundo habra leido el dafio que esta ocasionando a Ios paises, las vidas que cuesta. Todos estos fen6menos afectan a la economia, a la agricultura, y ello a nivel mundial, lo cual influye en la salud. Me preguntaba: l,podremos bajar de 10 la mortalidad infantil? Me preguntaba tambien: l,existira un potencial genetico en cuanto a la capacidad de supervivencia o la capacidad de resistir a determinadas enfermedades? Porque veia Ios indices: Suecia, 6 6 7; Jap6n, menos de 10, y lo mismo otros paises. l,Tendran acaso alguna herencia, resultado de la evoluci6n, que haga mas fuertes a unos que a otros? Todos esos problemas nos Ios hemos planteado: l,Cual es el potencial genetico para sobrevivir? Para mi fue realmente una gran sorpresa, una gran satisfacci6n, comprobar que en el tr6pico, incluso en las condiciones de un pais pobre, un dia llegamos a 10, y seguimos, y bajamos de 10 a 9, y a 8, y el ultimo afio fue 7,2. Y todo el mundo esta pendiente de eso, toda la comunidad, todo el pueblo. Es una experiencia aplicable: hay que involucrar en esa tarea a la comunidad, a las organizaciones de masa, a todo el mundo. Hoy todo el m undo vigila, lleva la cuenta; c6mo va el primer trimestre, el segundo, el ultimo; con estadisticas rigurosas. Alii si que el que nace vivo, aunque viva dos horas, pasa a la estadistica de Ios fallecidos en el primer aiio de vida. Son muy rigurosas las estadisticas. Pero lo esencial, bajar a 20, es econ6mico, no hacen falta terapias intensivas neonatales o terapias intensivas infantiles, que exigen recursos, equipos sofisticados, etc. No, con pocos recursos, que es nuestro problema; porque no es nada facilla soluci6n de este y de otros muchos problemas que tenemos en el mundo de hoy. Pero con pocos recursos l,C6mo hacerlo? Esa es la cuesti6n esencial. En nuestro caso la medicina preventiva fue la clave, eso que ustedes han hecho tan bien. Tu mencionaste con satisfacci6n, y nos alegramos mucho y lo reconocemos, que han logrado seis vacunas para el 80% de Ios niiios; eso es un gran avance. Nosotros lo hicimos desde muy temprano. Desarrollamos las investigaciones y la producci6n de vacunas y hoy disponemos de 12 vacunas. Cierto que es un poco mas caro. En realidad, el costo de las seis vacunas es de alrededor de US$ 1,5. En el grupo de 12 vacunas ya hay otras que pueden ser un poco m as caras, pero Ias vacunas siguen aumentando. Ya se planean vacunas contra el SIDA, que dan mucho trabajo y que deben ser la soluci6n definitiva. Estan apareciendo vacunas hasta contra el cancer: en nuestro propio pais se est;in haciendo ya algunos experimentos de vacunaciones contra determinados tipo de cancer, con todo el rigor cientifico y todas las pruebas necesarias. Es decir, la medicina preventiva va a seguir desarrollandose. Ustedes pueden lograr grandes avances con muy poco dinero. l,De d6nde puede salir ese dinero? Recuerdo que las Naciones Unidas un dia sofiaron con la contribuci6n del 0,7% de Ios paises desarrollados. Algunos dieron mas, algunos llegaron hasta el 1%. Ahora todo eso se esta reduciendo. Estaba en 0,34%; de 0,34 baj6 a 0,24, y el mas rico de todos, que no quiero mencionar porque no quiero lastimar a nadie aqui, da el A51NR/8 page 161 0,20%. Bastaria volver de 0,24 a 0,34 y utilizar ese 0,10% en la salud. Hay un gasto de infraestructura, hay que preparar personal, porque si no hay medicos (en algunos paises hay un medico por cada 20 000 habitantes) tienen que organizar programas de preparaci6n de auxiliares de salud, que en cursos breves aprendan a trabajar con ese medico para cada 20 000 6 30 000 6 40 000 habitantes. Ademas, esta el problema de la acumu1aci6n de Ios medicos en las capitales. Hay que organizar programas de higiene y de salud, que deben ser divulgados tanto como se divulga el fUtbol; miles de millones saben que va a haber un campeonato; hay que emplear la divulgaci6n y la educaci6n tambien en este campo. Hacen falta medios. Nosotros hemos llevado al Tercer Mundo 26 000 medicos cubanos, que han prestado servicio fundamentalmente en Africa, y gratuitamente. Hoy no estamos en condiciones de hacerlo gratuitamente, porque es imposible en la situaci6n que estamos viviendo, pero en un periodo de unos 30 afi.os pasaron 26 000 medicos cubanos por el Tercer Mundo, y todavia quedan muchos. Entre nuestros proyectos de preparaci6n de medicos habia l 0 000 para trabajar en el Tercer M undo como contribuci6n de Cuba a la salud, y aun hoy dia si hiciera falta podriamos movilizar l 000 medicos. En Sudafrica, en las aldeas, hay 400 medicos cubanos; tuvieron que aprender ingles, se examinaron, y cuando llegaron a las aldeas nadie hablaba ingles. Es decir, que hasta el idioma no es un obstaculo, pues en poco tiempo aprendieron el dialecto de la aldea y atienden a la gente. Se puede hacer en el m undo una movilizaci6n de medicos. Y o te digo que Cuba puede aportar miles, porque estan educados para ir a cualquier lugar del mundo donde hagan falta. A las montafi.as, al campo. AI principio, nuestros medicos no iban ni siquiera al campo. Los que formamos despues van lo mismo a Viet Nam, al Africa, a cualquier parte, y en el mundo hay mucha gente buena, y hay millones de medicos. Se podria hacer una movilizaci6n de cientos de miles de medicos, se puede calcular cuanto cuesta eso, ademas de Ios programas de vacunas, pero te digo que con el 0,10% de Ios paises desarrollados, lo cual alcanzaria una cifra de mas de 20 000 millones de d6lares por afi.o, se podria alcanzar para el Tercer Mundo en un periodo que no tiene que ser de medio siglo, ni siquiera de un cuarto de siglo, hasta menos, una salud igual a la de Ios paises desarrollados. MsSWEENEY: Mr President, thank you very much for that contribution. My only fear was that we have a number of questions to get through, although I think you have touched on almost all of them, but we will soldier on. One of the last points that you made ... El Dr. CASTRO, Presidente de Cuba: Yo puedo hablar una hora mas si tU quieres, hay tema. Es que tus preguntas son medio subversivas. Y o lei el cuestionario l,que conclusion saque? Digo, l,la entrevistadora sera revolucionaria? Porque plantea que se hagan cosas revolucionarias. Las preguntas son peligrosas y corres el riesgo de que te acusen de terrorista. MsSWEENEY: Well, please don't tell Ted Turner, ever, that you think I might be revolutionary. We will move on to the next question, which President Castro did touch on just before he finished. The globalization of trade, travel, technology and communication as we all know can yield very positive benefits. But what can be done to make sure that the health of people who live in the smaller, poorer countries and who perhaps do not reap these economic rewards is not jeopardized by the actions of the global market and the drive for economic gain? I would like to put that question to President Bedie of Cote d'Ivoire, ifl may. M. KONAN BEDIE (President de la Cote d'Ivoire) : Pour ma part, je pense que la mondialisation des marches et les imperatifs du profit ne constituent pas des menaces pour la sante des pays pauvres. Au contraire, en faisant jouer la concurrence, on perm et la baisse des cofits et, par consequent, une plus grande accessibilite aux biens et aux services. Un exemple evocateur est celui des medicaments essentiels generiques dont les prix de revient sont nettement inferieurs aceux des specialites correspondantes. La mondialisation des marches ne peut etre une menace pour la sante des pays en developpement que si cela debouche sur la reduction de leurs revenus avec, pour corollaire, des investissements moindres dans les secteurs sociaux comme celui de la sante. La refonte des economies nationales africaines A51NR/8 page162 visant la transformation des matieres premieres et la constitution d'espaces economiques regionaux, d'espaces plus fiables, plus homogenes sont deux voies interessantes pour I' Afrique a l'oree du nouveau siecle. Ce sont la quelques considerations que je vous livre en reponse a la question precise qui m'a ete posee. MsSWEENEY: Madam Vice-President, I would ask you, as a representative of a country which is one of the wealthier nations of the world, to give us your thoughts on the point and the question that has been addressed. Mme DREIFUSS (Vice-Presidente de la Suisse): Volontiers. Toute la discussion que nous menons actuellement est bien sur une discussion sur les liens entre la sante et l'inegalite sociale. Et le President Castro a raison: vous posez des questions subversives, mais vous faites bien de les poser parce que poser les problemes de sante c'est forcement etre subversif. 11 s'agit la, en effet, de la mesure exacte des consequences de l'inegalite, puisque c'est une mesure en duree de vie, c'est une mesure en mortalite infantile, c'est une mesure existentielle. Et vous avez raison de poser la question des effets sur des societes fragiles et sur des economies fragiles des coups de boutoir que peut porter la mondialisation. Effectivement, la mondialisation, et pas seulement celle du commerce, peut avoir des effets devastateurs. Je pense la, par exemple, a un probleme que l'OMS et d'autres organisations specialisees suivent avec inquietude et preoccupation. C'est toute la question de )'exploitation qui peut etre faite de la difference de niveau de vie, )'exploitation sexuelle, par exemple, qui peut etre faite dans des pays pauvres, avec tout son cortege de maladies. Bien sur, la mondialisation, c'est aussi la possibilite de mettre a disposition les progres medicaux dans I' ensemble du monde et nous devons tout simplement veiller ace que cela se fasse dans ce conflit ou cette tension que j'evoquais tout a l'heure entre marche et planification, tant il est vrai que l'on ne regie pas les problemes de sante uniquement en recourant aux lois du marche. Mais la mondialisation, c' est aussi la mondialisation de I' information, et laje dois dire que, tout au long des decennies de vie de l'OMS, la conscience des problemes de sante du monde et la conscience de I' interaction entre les situations de maladie ou d'epidemie dans une region par rapport aux autres ont egalement cru. Et cette mondialisation est absolument essentielle pour que nous puissions aborder ensemble les problemes de sante du monde . . Ms SWEENEY: Thank you Madam Vice-President. My next question I would like to address to the Prime Minister of Samoa. We have very many examples of diseases, such as HIV, cholera and Escherichia coli infections, that demonstrate that disease does not respect borders at all. We often hear a lot of discussion at summit after summit about international solidarity and cooperation. I would like to ask you whether you think this cooperation is really effective, or are there other factors standing in the way of better health care promotion? Mr ALESANA (Prime Minister of Samoa): I think what is involved here is not limited to collaboration, it also affects cooperation between WHO, the national government and, also, the responsible authorities in outlying areas, who can render support to ensure the continuation and day-to-day nursing of programmes that have already been implemented and introduced. For example, with regard to maternal health, my country has set up some years ago already, committees that are well-known - here in this hall, in the United Nations, in the Pacific - called women's health committees. Whenever there is an issue involving health care for children as well as mothers, questions of immediate environment, the Government refers it to the village authorities, who can help, without any compensation. They freely give it. I think I am quite safe in saying this, since the Director-General has himself visited Samoa, over a number of years, not only after his appointment as Director-General, but when he was Regional Director for the Pacific Region. So he has seen for himself what I have said. Secondly, it is for the government of the day to set priorities, as we did just after our general election in 1996. We announced to the country, and also to the Treasury department, that we should give priority to health and education; this is going well now. As you can see, the Minister who is here used to occupy a different portfolio, but we shifted him from there to the Health Department in order to ensure that the wishes of the Government would be duly implemented. I hope I have answered your question. A51NR/8 page 163 MsSWEENEY: Thank you Prime Minister, and in fact, you lead us very nicely on to the next question I had in mind when you spoke about the commitment of governments and your general election a couple of years ago. It also touches on something that the Vice-President of Switzerland alluded to earlier on, namely globalization, which should help to provide better health care throughout our world. There is also growing debate about the role of the free market in health care, and I would like again to ask you, Madam Vice-President, if you believe that health can be left to the private sector, and if so, how we can ensure universal access to health care. Mme DREIFUSS (Vice-Presidente de la Suisse): Oui,je suis persuadee qu'une grande part des services de sante peuvent etre assures par le secteur prive. A cet egard, l'exemple de mon pays est, je crois, evident. Nous avons la possibilite d'offrir des soins ambulatoires selon un systeme tout a fait liberal : c'est une rencontre directe entre le medecin et le patient. Nous avons, bien sur aussi, la possibilite de formuler de grands espoirs, d'elaborer de nouveaux medicaments et de nouveaux types de soins et d'acquerir de nouvelles connaissances en ce qui conceme des maladies qui ont resiste jusqu'a present a nos efforts, grace a l'industrie pharmaceutique, par exemple, qui vit et fonctionne largement selon les regles du liberalisme national et international, tout en sachant bien sur que c'est sur des systemes de sante publique efficaces qu'elle peut compter pour pouvoir ensuite atteindre les personnes pour lesquelles elle cherche des solutions. En d'autres termes,je crois que c'est vraiment dans une articulation entre la responsabilite de l'Etat, la responsabilite collective et les possibilites de donner, a l'interieur de ce cadre, aux agents de sante le libre epanouissement de leurs activites que se trouvent les solutions. Celles-ci ne seront sans doute pas les memes d'un pays a l'autre, selon les ressources disponibles ou, au contraire, selon la rarete de ces ressources. 11 est certain qu'un pays riche comme la Suisse aura une part beaucoup plus importante d'intervention du secteur prive, parce que l'on peut vraiment partir de l'idee que le libre choix n'est pas un luxe mais une qualite supplementaire du systeme, alors que d'autres pays ou regions devront certainement utiliser de fa~on beaucoup plus econome les ressources disponibles et avoir un secteur public peut-etre plus important. En d'autres termes, je suis persuadee que, dans le domaine de la sante, il serait totalement errone de choisir l'un ou l' autre des deux systemes d'organisation et de croire que tout peut etre laisse au marcbe ou, au contraire, que tout peut etre tout simplement pris en main par l'Etat. C'est dans l'equilibre entre ces deux secteurs, je crois, que l'on trouve le systeme optimal propre a chaque pays et a son niveau de developpement. MsSWEENEY: Thank you, Madam Vice-President. I wonder ifl could ask President Castro to comment on this collective responsibility. The linkage between the responsibility of the State and the collective responsibility that Mrs Dreifuss spoke about. El Dr. CASTRO, Presidente de Cuba: Me quieren poner a polemizar con la distinguida Vicepresidente. Comparar la situaci6n de Suiza, el pais mas rico del mundo per capita, con una tradicional industria farmaceutica de mucho prestigio, con Cuba, una islita alii, en el Caribe, subdesarrollada, que no tenia industria medica de ninguna clase, a la que le vendian los medicamentos ... porque se ha hablado aqui de que se abarataban Ios precios ... con todo el respeto por mi colega de Cote d'Ivoire: lo que nosotros vimos fue el monopolio de los precios y una de las causas por las cuales pudimos disponer de medicamentos fue precisamente porque desarrollamos Ios laboratorios nacionales, y a partir de las formulas genericas empezamos a producir los medicamentos nosotros. Hicimos una lista de medicamentos esenciales, porque hay miles y miles y decenas de miles de marcas, porque la misma cosa se vende con cuarenta nombres diferentes en el mundo, y esta probado, la Organizaci6n Mundial de la Salud ya lo demostr6, que bastan 800. Nosotros tenemos alrededor de 1200 y siempre estamos al tanto de la ultima que aparezca, el ultimo antibi6tico que sea capaz de resolver el problema de la resistencia bacteriana y otras muchas cosas. Abaratabamos el costo de Ios medicamentos en un 80% desde el momento en que Ios produciamos, porque nuestro problema era disponer de divisas para traer esas materias primas. Produciamos algunas materias primas, pero muchas las teniamos que traer. Ypara fabricarlas bubo que crear la industria, Ios centros de investigaci6n cientifica y Ios centros de farmacia. Los cre6 el Estado, por que A51NR/8 page 164 se lo vamos a negar: en nuestro pais la medicina es publica. Estoy convencido de que en un pais como Cuba, y en Ios que esten en circunstancias como las de Cuba, la soluci6n no se puede buscar a traves de la privatizaci6n de la medicina. Para nosotros seria un paso atnis. l,Que fue lo que hicimos, prohibir la medicina privada? No. Comprometimos a todos Ios estudiantes a medida que se iban graduando. Fue un trabajo de conciencia, fue un trabajo politico. Todavia hay medicos privados en Cuba, quedan unas cuantas decenas. Pasado el tiempo, todos Ios que se fueron graduando hacian, junto con el juramento de Hip6crates, el juramento de no ejercer la medicina privada, es decir, de practicar la medicina al servicio publico. Si nosotros hubieramos tenido o hubieramos buscado un sistema como ese, no tendriamos Ios indices de salud que tiene Estados Unidos. Hemos alcanzado en perspectiva de vida, en mortalidad infantil y en otros muchos indices, el mismo nivel que tiene Estados Unidos, y ellos gastan ni se sabe cwinto dinero en la medicina, mientras que nosotros lo hacemos con un costo minimo. No lo habriamos logrado sin Ios programas de salud dirigidos por el Estado. l,Para que va a quedar el Estado, nada masque para hacer guerra, y gastar dinero? l,Si el Estado no se ocupa de la salud, de que se va a ocupar? l,Si no se ocupa de la educaci6n, de que se va a ocupar? Porque estan empatadas las dos cosas. Con un 30% de analfabetismo que tenia Cuba, y un 60% de semianalfabetos que no llegaban a sexto grado l,C6mo se pueden tener mas de 60 000 medicos, como tiene Cuba hoy? Veintiuna facultades de medicina, donde yo estudie; no solo medicos, tambien enfermeras de nivel superior. Las primeras pasaron de sexto grado a estudiar farmacia. Sin haber brindado la batalla a la salud, no se habria podido tener el sistema medico que tenemos ni el personal medico que tenemos. l,Quien hizo eso? No lo hicieron las instituciones privadas: en America Latina llevan 200 afios de independencia la mayor parte de Ios paises y no han podido resolver totalmente el analfabetismo. Nosotros lo resolvimos en unos pocos afios: pusimos a Ios estudiantes a ensefiar como maestros, fue todo un programa de educaci6n y de salud; de otro modo no lo habriamos podido alcanzar, esa es nuestra experiencia, aunque respeto la de Suiza. No me den a mi la tarea, por ejemplo, de Ministro de Educaci6n en Suiza, porque puede que todos Ios indices se echaran para atras; yo no sabria manejar tanto dinero como el de ustedes. Ustedes conocen este pais, yo conozco el mio, y muchos, muchos mas de cien que estan en condiciones similares a las de mi pais. MsSWEENEY: Thank you, Mr President. My final question, because we have just a few moments left, I would like to address to both the President of Cote d'Ivoire and the Prime Minister of Samoa, but first to the Prime Minister of Samoa for it is something he talked about a few moments ago when he spoke of raising the profile ofhealth in the context of development and referred to his Government's role in this. I would like to ask him to what extent he thinks health should be a concern of government as a whole and not just the ministry of health? Mr ALESANA (Prime Minister of Samoa): My reply, Madam, is that, as I said in the course of my first remarks, health and education take priority, so when it comes to the question of appropriations, they have received the most money from our coffers in every year starting from 1996. M. KONAN BEDIE (President de la Cote d'Ivoire): En Cote d'Ivoire, nous sommes bien conscients que le developpement cree les conditions propices a une meilleure sante, mais aussi, a !'inverse, que la sante contribue a un developpement plus soutenu et plus durable. Autant que le developpement, la sante est multiforme. Elle vise en dernier ressort I' epanouissement des individus et des communautes. Dans ce sens, la sante devrait etre au coeur du developpement et faire l'objet d'une attention speciale de la part du Gouvernement dans son ensemble. Ce n'est pas un voeu pieux, c'est la volonte politique du Gouvernement de la Cote d'Ivoire, et on peut le constater egalement au niveau de la politique suivie par tous les Etats africains. En effet, les efforts d'industrialisation s'accompagnent souvent d'une degradation de l'environnement, qui peut entralner !'apparition ou !'extension de certaines maladies. Les amenagements agropastoraux dont I' Afrique a un grand besoin doivent considerer les retombees sur le systeme ecologique et viser la minimisation des risques lies a la sante. 11 n'est pas de secteur jusqu'a la justice et la legislation qui ne soit concerne par la sante. A la limite, toute action ou projet de developpement devrait comporter un aspect de sante, et !'evaluation de !'impact sur la sante devrait etre inscrite dans ces initiatives. Done, pour nous, la connexion entre la sante et A51NR/8 page 165 le developpement est evidente et !'engagement de l'Etat est total pour faire de !'application de la politique de la sante non seulement l'affaire du ministere de la sante appuye par l'OMS, mais aussi une affaire nationale. Je voudrais, puisque j'ai la parole, saisir !'occasion pour revenir sur la question qui a ete longuement debattue, a savoir le lien entre la sante et le developpement, autrement dit, le probleme de la coexistence dans le domaine de la sante du secteur prive et du secteur public. En Cote d'Ivoire, ces deux secteurs peuvent coexister, et ils coexistent. Au debut de l'independance, nous nous sommes engages dans la voie de la sante con~ue comme un service public, done dispense, organise, anime par les pouvoirs publics, mais, au fur et a mesure que nous avons rencontre des succes dans la formation des elites et des cadres, nous nous sommes trouves devant des medecins diplomes qui n' avaient pas necessairement leur place dans le secteur public, compte tenu des contraintes budgetaires. Done, no us avons ouvert plus largement le secteur prive aux medecins ivoiriens pour la pratique de la sante, pour l'exercice du metier de medecin. Par la suite et tres recemment, nous avons, dans la continuation de cette politique, instaure une collaboration entre la medecine traditionnelle et la medecine modeme. Vous savez que les pays en developpement, toutes les societes relevant du monde antique ont toujours eu leurs medecins, leurs praticiens. La medecine modeme est celle que nos medecins, nos pharmaciens sont venus apprendre dans des universites occidentales et aussi de !'Est. Aujourd'hui, nous operons lajonction entre cette science modeme et la medecine traditionnelle, qui est le recueil de toutes les recettes de sante de I' Afrique multiseculaire. Vous savez que l'Afrique est le plus vieux continent du monde. L'existence de l'homme sur le continent africain, qu'on appelle aussi le continent matemel, remonte aplus de 10 000 ans. La preuve la plus ancienne de !'existence de l'homme n'existe qu'en Afrique, pour le moment. Done ce probleme, nous l'avons tranche en reconnaissant tout simplement que, dans le domaine de la sante et de la medecine, il peut exister un secteur public, qui correspond au role de l'Etat, et aussi un secteur prive, qui detient la liberte d'entreprendre et qui contribue egalement a titre tout a fait complementaire aux efforts de l'Etat. MsSWEENEY: Thank you very much, Mr President. I think we have heard many ideas and insights from our distinguished guests today of the gaps between North and South, how to achieve health promotion in the face of economic adversity and how globalization and free trade can be better used to promote health care for all. These are just some of the issues which we have touched upon. Now I would like to thank each of our distinguished guests for their contribution this morning and pass you over immediately to the President of the Assembly, Dr Al-Mousawi. Thank you very much. The PRESIDENT: Thank you, Ms Sweeney. That concludes our consideration of item 15. The meeting rose at 12:00. La seance est levee a 12 heures. A51NR/9 page 166 NINTH PLENARY MEETING Thursday, 14 May 1998, at 14:45 President: Dr F.R. AL-MOUSAWI (Bahrain) NEUVIEME SEANCE PLENIERE Jeudi 14 mai 1998, 14h45 President: Dr F.R. AL-MOUSAWI (Bahrein) 1. AWARDS DISTINCTIONS The PRESIDENT: The Assembly is called to order. We are going now to deal with item 14, Awards. Excellencies, distinguished delegates, ladies and gentlemen, another important event during this memorable day of celebration of the fiftieth anniversary of WHO is the presentation of the Sasakawa Health Prize and of the United Arab Emirates Health Foundation Prize. I have much pleasure in welcoming among us the distinguished winners of these prestigious prizes: Ms Roselyn Mokgantsho Mazibuko; Dr Ahmed Abdul Qadr AI Ghassani; Dr Tesfaye Tessema, representing the Gondar College of Medical Sciences; and Mrs Hillary Rodham Clinton. I am also very pleased to greet Mr Yohei Sasakawa, President of the Nippon Foundation representing the Sasakawa Memorial Health Foundation. He is accompanied by Professor Kenzo Kiikuni, Executive Directing Manager of the Sasakawa Memorial Health Foundation. I also greet Mr H.A. AI-Midfaa, Minister of Health of the United Arab Emirates, accompanied by Dr M. Fikri, Assistant Under-Secretary for Preventive Medicine, Ministry of Health of the United Arab Emirates, representing the Founder of the United Arab Emirates Health Foundation. I should also like to welcome Ms Fionnuala Sweeney, anchor-person at CNN's London Bureau, who has been requested to assist with the proceedings this afternoon. I give the floor to Ms Sweeney. Presentation of the Sasakawa Health Prize Remise du Prix Sasakawa pour la Sante MsSWEENEY: Thank you, Mr President. Excellencies, distinguished delegates, ladies and gentlemen, we shall start with the presentation of the Sasakawa Health Prize. The Sasakawa Health Prize rewards outstanding, innovative work in health development and aims at encouraging the further development of such work. It gives me much pleasure to announce that, in view of their exceptional achievements, the 1998 Sasakawa Health Prize has been jointly awarded to: Ms Roselyn Mokgantsho Mazibuko of South Africa; Dr Ahmed Abdul Qadr AI Ghassani of Oman; and Gondar College of Medical Sciences in Ethiopia. But let me first of all invite Mr Sasakawa and Professor Kiikuni to come to the rostrum, please. Prior to presenting the distinguished laureates, I shall invite the representative of the Sasakawa Health Prize, Mr Yohei Sasakawa, President of the Nippon Foundation, to address the Assembly. A51NR/9 page 167 Mr SASAKA WA: Mr President of the World Health Assembly, Dr Nakajima, distinguished delegates, colleagues and friends, I am greatly honoured to be here with you, on this memorable day, to celebrate the fiftieth anniversary of the World Health Organization. For the last 23 years, nearly half the time of WHO's history, the Nippon Foundation has enjoyed a strong relationship with this distinguished Organization. Over this period, the Nippon Foundation has been privileged to provide support to WHO totalling US$ 180 million. At the same time, the Nippon Foundation has been endeavouring to ensure that we act, not merely as a nongovernmental organization of donor agencies, but also as an intermediary between WHO and the people active in endemic countries. Towards this end, we established the Sasakawa Health Trust Fund and the Sasakawa Leprosy Elimination Fund within WHO, complementing the activities of the Japan-based Sasakawa Memorial Health Foundation, which also works at the international level. In our attempts to be more than just another nongovernmental donor, we have tried to be an intermediary between WHO and the people active at the grassroots level. The Nippon Foundation is proud to be not only a WHO donor, but also a peace-loving partner of the people in the field, who are working hard to achieve the goal of health for all. Today, three distinguished individuals will receive the Sasakawa Health Prize. It gives me tremendous pleasure to present this award personally, which seems appropriate since it was established thirteen years ago as a result of the personal friendship between my late father, Ryoichi Sasakawa, and Dr Mahler, who was then Director-General of WHO. The three winners of this year's Sasakawa Health Prize are being acknowledged as pioneers in promoting primary health care. By primary health care, I mean health care based on practical uncomplicated methods and technology, which can be made universally accessible to all people, not only to specialists. Of the numerous collaborative programmes between the Nippon Foundation and WHO aimed at establishing primary health care, the Nippon Foundation is concentrating on worldwide elimination of leprosy by the year 2000. With the excellent leadership of its Director-General and the efforts of the staff, WHO will, no doubt, achieve this goal. Leprosy is an old disease, a disease noted in the Bible and also in the writings of Confucius. Leprosy was especially feared for its ability to deform victims, who were shunned due to ignorance about how the disease is caused and transmitted. Today, leprosy is neither incurable nor very contagious because of the development of a powerful tool to combat the disease. This tool is a combination of three drugs in a treatment called multi drug therapy, which is used to suppress the disease. With the development of multi-drug therapy, the elimination of leprosy has moved out of the domain of specialist and into the field of primary health care which can be spread widely throughout society. I would like to remind the award winners and everyone else participating in primary health care in the world that we are very near to the complete elimination of leprosy. If we decrease our efforts now, however, abominable times may return. We must, therefore, be steadfast as the achievement of our goal is in sight. Once we attain this goal, then we can turn our attention to strengthening primary health care in order to eliminate other emerging diseases. I close with my warmest congratulations and deep gratitude to the award winners. MsSWEENEY: I now have pleasure in presenting to you the first laureate of the Prize, Ms Roselyn Mokgantsho Mazibuko of South Africa. Prior to taking up her present position as Chief Director of Primary Health Care, Policy and Planning, in the Department of Health and Welfare of her country, Ms Mazibuko served for five years as Director of the Hlatlolanang Health and Nutrition Education Centre, which is situated in a remote area of the Northern Province and has a population of about 1.1 million people. She has made a major and innovative contribution to the development of primary health care in this underserved part of the country. The underlying principle of her work has been the promotion of people's self-reliance with addressing disease problems related to poverty. Highlights ofMs Mazibuko' s accomplishments are: the establishment of a community safety centre which integrates primary health care and child care services with education, counselling and provision of information resources; the integration of the Hlatlolanang scheme of health care and education into government health services in a child care and development programme - early childhood development centres were set up in villages, run by specially trained semi-literate women; the creation of primary health care systems through the mobilization of villagers, in particular women, for addressing key health issues and health education concerns, and establishment of income-generation groups in villages; and also the development of tailor-made university courses on health promotion for primary health care. A51NR/9 page 168 Ms Mazibuko will use the Prize money to develop the Hlatlolanang Centre into a national nutrition surveillance centre as well as a centre for integrated primary health care development. She demonstrates her exemplary devotion to rural health development by continuing to work with the Centre on a ~oluntary_basis. It is now with much pleasure that I invite Ms Mazibuko to come to the rostrum to receive her pnze. Amid applause, the President handed the Sasakawa Health Prize to Ms R.M. Mazibuko. Le President remet le Prix Sasakawa pour la Sante a Mme R.M. Mazibuko. (Applaudissements) MsSWEENEY: Ms Mazibuko, I would invite you to take the floor please to say a few words. Ms MAZIBUKO: Mr President, the Director-General Dr Nakajima, ladies and gentlemen, I would like to heartily thank you for giving me this opportunity to address this august session. The gratitude I bring is on behalf of the people of Ga-Sekhukhune in the northern province in South Africa, together with whom and through whom my achievements are today being recognized and honoured by this body. It is the gratitude of the people of South Africa who have gained the respect of humankind the world over by tirelessly doing their bit to fight injustice for over three hundred years. For those people and for me these actions were carried out not for anyone to see but to tackle a state of helplessness at the time. It is therefore with a great sense of humility and awe to find ourselves addressing a world body such as this one simply because of the actions and deeds that we performed when we were in a state of desperation. When we set out to set up the Hlatlolanang Health and Nutrition Education Centre - "Hlatlolanang" means we share the burden - we did so in a situation of extreme poverty. Some of the ordinary people we were working with would have wished the world not to know of their shameful state of poverty. This is exemplified by the ladies who would not run the risk of being seen in daylight for their state was so ragged they could easily have been mistaken for witches; in our area they get rid of you if you are identified as a witch. These ladies would opt to go out at night to look for some food for their children and themselves, and today many of these ladies have achieved something which, though insignificant by the world's standard of living, is important to them. For them and the majority of the people of South Africa and for the continent of Africa the struggle against poverty continues. This struggle continues on the foundations that the people have built in institutions such as Hlatlolanang through which I am being given this prize. I personally believe that these foundations have been laid to stand the people of South Africa in good stead, through the rest of the struggle they have to fight. I believe so because our approach at Hlatlolanang was to go out and touch the human spirit in its deepest essence. We believed that rekindled in this manner, the people themselves would form a conscious movement that would wage an inexorable struggle against poverty. Much of the problems of our country today lie in the legacy of the apartheid system that fundamentally set out to destroy the confidence and self-worth of the majority of the people in our country. For the ordinary people in Ga-Sekhukhune, African renaissance starts with restoring the value of life by making it a quality life and restoring human dignity. For this reason the Hlatlolanang Centre has over the years set itself the task of becoming a one-stop community centre. It offered a wide range of services which included primary health care, child care, education, counselling, skills development, information resource, legal advice, and others. Today we are deeply honoured because most of these initiatives have been recognized by our new Government, by universities and by many other bodies that have incorporated them into their own programmes. The conferring of this prize is therefore like a cherry on the top of a cake, that we have and can eat at the same time. The people ofGa-Sekhukhune and myself in particular are especially grateful to the Minister of Health of the Republic of South Africa, Dr Nkosazana Zuma, for the work she is doing for our country. The Minister of Health in South Africa also visits the villages and the people actually know her. She has personally, through the work of her Department, greatly supported and publicized the work ofHiatlolanang. As a woman, she is a symbol of resistance and fortitude that women who are still living in poverty look to for strength. The recognition and support of our work by her Department led it to nominate me for this award. In this regard, I would greatly like to thank Dr Olive Shisana, Director-General of the Department of Health of the Republic of South Africa, for having gone through all the nominations and for finding me to be the worthy representative of our country. A51NR/9 page 169 We are grateful for the various universities in South Africa and other parts of the world. They have supported our work during its infancy and today they recognize the same work as a good basis for learning in the programmes they offer. These include the University of the North, the University of Witwatersrand, the University of Cape Town, and the University of Liverpool in the United Kingdom of Great Britain and Northern Ireland. I would like also to thank the women of Jane Furse, for among the pioneers with whom our work started were the members of the Women's Union of the Lutheran Church in Jane Furse. These simple women, who are the core of the 44 centres that form the Hlatlolanang network, were seen by many visitors that have witnessed how they have managed to stand up on their own and have an impact in the villages. We also thank all the foundations that have supported the Hlatlolanang initiative, notably the Kaizer Family Foundation, and the European Union through the Kagiso trust. We also want to thank the Independent Development Trust of South Africa. Last but not least among the donors, we want to thank the community of Ga-Sekhukhune themselves because they also contributed in kind although not necessarily in monetary terms. I would like to thank this audience for listening to this speech for which I receive this award. MsSWEENEY: Dr Ahmed Abdul Qadr AI Ghassani, from Oman, in his position as Under-Secretary for Health Affairs in the Ministry of Health, has exerted a marked influence on his country's strategies in the areas of maternal and child health and nutrition, health education and immunization, and the provision of health care for the entire population. His major achievements include the expansion of postgraduate medical education to include specialization in family health; nationwide institution of iodization and vitamin A supplementation (for infants 9 to 12 months); strengthening of the disease surveillance system leading to a significant decline in the endemicity of the diseases targeted; and improvements in maternal and child services, malaria control, immunization coverage for children under one year of age, and the child-spacing and school health programmes. Dr AI Ghassani will use the prize money to further improve Oman's health programmes, in particular the national cancer programme, the training and continuing education of primary health care workers; the enhancement of community-based programmes, and the expanded programme on immunization. Dr AI Ghassani's work in Oman has resulted in improved health care facilities in general and in increased self reliance in curative services in particular. Through his collaborative approach he has brought together several government sectors to focus on health, resulting in significant improvements in the population's health status. I have pleasure in asking Dr AI Ghassani to come and join us here to receive his prize. Amid applause, the President handed the Sasakawa Health Prize to Dr A.A.Q. AI Ghassani. Le President remet le Prix Sasakawa pour la Saute au Dr A.A.Q. AI Ghassani. (Applaudissements) MsSWEENEY: I invite Dr AI Ghassani to take the floor and say a few words. Dr. AL GHASSANI: A51NR/9 page 170 ~ )1 ~ ~ .:r._,...!.JIJ (,.pL:...ll 0 ~\ yly.i J.A; ~ J ,~\y L;# ji; (,.).iJI _r-$jl (,.)~1 0i ..l:! ...... ; >(,.)r ~) aAlS"' (,.)~) -=...;) (,.)r J ~ ~ ~ _; a..~~ ~ J¥- a..J....S ~~ Jl ..,...t.:.ll oP) ~~ '~ljl ~)_;...... ~ ~ ..:.JL ...... :.....JIJ .:ll_;-i~l JJ.:l ~ 4L:l1J ~ ~\ ~Li.JI ~) 01 )_,..k:!IJ ~w1 ~ ~JU ~ a:1 J~l ~~ ~~)1 ..:;~w y.yo; ye:, 0w ~ J ,:) _,..,.JI a;l5' ~~ ~ ..::; _,.....u ~~ a....Lt_,bjl ....,.. J...UI o~ ..:.Jl5' ~~ \.,L,. .:r J .oiJL.....JIJ a.li...WI .:r ...r-1 ji; J ~ . ..:;\jl~l .:r .J ~ ~ ~ ~ ~ (,.).iJI i _r.ll ~l>.- ~ ~l..l>-1 L,.lj ')\..l5:; ~ a:JJ~I ~\ ~~)l jl.t...iJI ~..tll 0ts ,0_,...1..; LS ,o.:li...JIJ ..::;\~\ ~i ,~)I ~I ~\ YJ~\ .:,r) .~~\) ~ ~~\ ojW\ ..::;\~ (..)__,>~\ ..::;~tkA.\1 J,b:....) ~\ t_tkA.\1 ~ u.;) l.i)lA;') MsSWEENEY: The third laureate of the 1998 Sasakawa Health Prize is the Gondar College of Medical Sciences, Ethiopia. Gondar College of Medical Sciences was established in 1954 to provide training for different categories of qualified health personnel. It became part of Addis Ababa University in 1961 and was transformed in 1976 to train medical doctors. It also trains laboratory technicians and midwives as well as health officers and nurses. A51NR/9 page 171 In addition to its training activities, Gondar College is involved in the provision of health services in North Gondar and adjacent zones comprising some three million people. It is also involved in the conduct of health and health-related research; the identification of public health problems, design of solutions and dissemination of approaches to care providers; and the provision of information on health services improvements and development of human resources. The prize money will be used to further develop three major projects undertaken by Gondar College. The first is related to team training, which allows health officers, public health nurses and sanitarians to acquire team-building skills and to learn how to address the health problems of the community through the use of cooperative processes. Through a mix of classroom and field training in villages and health centres, the personnel is able to set up and provide primary health care in communities. The prize money will also help strengthen the surveillance system covering health and demographic characteristics, which was established in a selected district in North Gondar for a sample population of over 25 000 people, in order to design cost-effective intervention programmes targeting common health problems. Finally, the prize money will contribute to develop further the chronic-illness care project, which allows patients with incurable chronic illnesses to be treated in their nearest primary health care centres. The work programme of Gondar College is a good example of a comprehensive community-oriented approach pursued by an educational institution. Its active outreach approach to the development of health services has attracted the support of foreign educational and development institutions and international agencies. Dr Tesfaye Tessema, Academic Vice-Dean and Dean Delegate will receive the Sasakawa Health Prize on behalf of the Gondar College of Medical Sciences. I have pleasure in inviting him to come to the rostrum. Amid applause, the President handed the Sasakawa Health Prize to the representative of the Gondar College of Medical Sciences. Le President remet le Prix Sasakawa pour la Sante au representant du College des Sciences medicales de Gondar. (Applaudissements) Ms SWEENEY: I would like to invite Dr Tesfaye to say a few words to the Assembly please. Dr TESF A YE TESSEMA: Mr President of the Fifty-first World Health Assembly, Director-General of the World Health Organization, honourable ministers, distinguished delegates, ladies and gentlemen, I feel highly honoured and delighted to represent the Gondar College of Medical Sciences on this grand occasion. And, on behalf of the College community, I would like to thank the Executive Board of the World Health Organization for nominating the College for the 1998 Sasakawa Health Prize award. The Gondar College of Medical Sciences is a public institution in Ethiopia founded in 1954 with the objectives of training health workers, providing health services and conducting research. At the moment, it has 700 students and 110 faculty members. The College referral hospital has 350 beds and provides out-patient services to over 200 people a day. As a matter of fact, it is meant to serve more than three million people. Ethiopia is one of the countries in the world with high infant maternal mortality rates and very low health service coverage. Institutions like the Gondar College of Medical Sciences are responsible for producing the skilled human resources the country needs as well as providing health care to the public. As such, in addition to carrying out its major objective, the College is obliged to design a variety of projects which are held to enhance the quality of training and services and submit them to donors for funding. Three of our projects were earlier submitted for consideration for the Sasakawa Health Prize contest. These projects were, first, the team trl).ining project. This is a project where students in different disciplines undergo training in teams in order to develop team spirit which they require during the actual practice. The training scheme has already been successfully implemented for public health nurses, sanitary science and health officer trainees, and it will soon be offered to students in the rest of the disciplines. The second project was a chronic illness care project. Although the College is expected to provide health services only on the hospital premises, the staff designed a project for training and supervising responsible health workers so that patients with chronic illness can undergo treatment in their nearby centres. This saves the time and money of the patients who used to travel more than 300 kilometres for simple monthly check-ups. The third project was the Dabat Health Project. This is a project where surveillance ofnealth and demographi~characteristies )s established in. A51NR/9 page 172 a district 75 kilometres from Gondar and serves as a community laboratory. The main purpose ofthe project is providing sample frames and a database for studies, especially in intervention studies within the community. In addition, it helps in the planning and evaluation of health services. Baseline surveys of social demographic characteristics, health service utilization and perceived cause of morbidity and mortality, have already been conducted. In fact, this database is found to be attractive for research. Scientists and researchers from all over the world who are interested in working with the College staff are warmly welcome. Mr President, ladies and gentlemen, the whole community of the College is very much delighted by the award we have received. Such an award for the College means worldwide recognition which all staff is striving for, and this will further motivate the staff for other innovative work for the good of the people. I am sure that this motivation will not be limited to the College but will extend to similar institutions in our country as well as throughout the world. And this, I am sure, is one of the objectives of such a prize. Once again, I would like to extend my deepest gratitude to the Sasakawa Memorial Health Foundation for such a prize and also to the World Health Organization for nominating us. I also wish to congratulate the staff of the Gondar College of Medical Sciences for their innovative work and to organizations which collaborated in the work, namely the Ethiopian Science and Technology Commission, the Tropical Health and Education Trust ofLondon, and the Ministry of Health and Education of Ethiopia. Finally, I would like to take this opportunity to promise to you that ti1e prize we are awarded will serve the purpose it is intended for. Presentation ofthe United Arab Emirates Health Foundation Prize Remise du Prix de la Fondation des Emirats arabes unis pour la Sante Ms SWEENEY: · Excellencies, Mr President, distinguished delegates, ladies and gentlemen, we now come to the presentation of the United Arab Emirates Health Foundation Prize. The United Arab Emirates Health Foundation Prize is awarded for outstanding contributions to health development, and this year the Prize is awarded to Mrs Hillary Rodham Clinton of the United States of America. Before presenting the Prize to this distinguished laureate, I invite Mr H.A. Al-Midfaa, Minister of Health of the United Arab Emirates to come to the rostrum and address the Assembly on behalf of the Founder of the United Arab Emirates Health Foundation Prize. Mr AI-Midfaa, you have the floor. 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L.... ,~)1 ~ J..UI ~I \JJ. j_r.:; ;;~ JJlS'J .~WI ~I a.J:i.W t...~ l_r.~ ..li')\;:; Jf. 4..>.-J ~ ~w1 ~~ ~J ,a...~ o~l r--"'11 ~ "-llj..w,L;j t...J ~ L;j~ -1 o_,....t...JI ol_rll "-l r.,Z .~1 ~~ o~l Jb..o ,_} ol_rll as--Jw...J 'vP~I ~ ~WI ~I ~ ~ ~ ~I If-;,~\ ~ J -:r-L-WI ;, ~ ~~.. :.i. 0i J .M l_r.>-i J 0L...,...j)l\ 01 :D...l.ll ~ .::..IJL..)II a.]J;, v-!'J a.l~ I..W._r...... -J ,0\...... i\'1 ~l;J) ~ j>-1 ,y -::..\j\.•:•.;)1\ ,y ~_;.JI .J..)l ~\;;)_?\_JP> ~4 ~ ~ ~~ ~iJ ,~.r-'11 o~l -=..t.;\'}l JJ'll ;;~1 ,ai.pl..ill ;;~ J4=ll ~l>J - ... lA....>.~~\ .r.>- c.J w ~ ell\ I..:..U) .;;;,t...... J\) .~l.S"' f.) ell\ 6....> J) ~ r~IJ MsSWEENEY: Mrs Clinton, the distinguished laureate of the 1998 United Arab Emirates Health Foundation Prize, has an impressive record of contributions and achievements in the field of health and social welfare and is well known for her pioneering work on behalf of women, children and their families. As a staff attorney for the Children's Defence Fund, then as Chairperson of the Board of Directors of this Fund for several years, Mrs Clinton has been a tireless advocate on children's issues and at the forefront of numerous major initiatives to improve the lives of children and their families. As First Lady of the State of Arkansas for twelve years, Mrs Clinton led efforts for educational reform and increased childhood development. She was concerned about the fact that the educational level of the mother was of critical importance to the child's performance at school. This led to the development of a model home-visiting parental-training programme for early childhood and school readiness that has played a significant part in improving the health of families and children across the country. Mrs Clinton may be best known for her work as Chairperson of the Task Force on National Health Care Reform. During the work of the Task Force, Mrs Clinton consulted leaders in the field of public health, medical care and social service delivery. The plan that emerged not only set forth the goal of universal coverage but recommended to the nation a comprehensive plan for achieving that goal. Mrs Clinton has shown unfailing support for low-income and other vulnerable groups. At the Legal Services Corporation, in the fight for universal health coverage, as an eloquent spokesperson for America's children, Mrs Clinton has effectively championed new possibilities for the vulnerable groups. The project "Community Involvement in Reducing Death in Childbirth - Kigoma Region, Tanzania" has been designated by the Director-General to receive the Prize money in the name of Mrs Clinton. We are pleased to invite Mrs Hillary Rodham Clinton to come to the rostrum to receive the Prize. Amid applause, the President handed the United Arab Emirates Health Foundation Prize to Mrs Hillary Rodham Clinton. Le President remet a Mme Hillary Rodham Clinton le Prix de la Fondation des Emirats arabes unis pour la Saute. (Applaudissements) A51NR/9 page 174 MsSWEENEY: I now invite Mrs Clinton to address the Assembly. Mrs Clinton you have the floor. Mrs CLINTON: Mr President, Director General, ministers, ambassadors, other distinguished guests. It is indeed a great honour to receive this award and to join all of you here today in celebrating the World Health Organization's fifty years of leadership. I want to thank the United Arab Emirates Health Foundation for this award, and for the generous gift to the Safe Motherhood Initiative which will save the lives of countless women and children. Let me also congratulate the distinguished recipients of the Sasakawa Health Prize, for the work you do every day to put quality health care within the grasp of all people. I also want to pay special tribute for his decades of service to WHO and his lifetime of dedication to improving health throughout our world, to Or Nakajima. Thank you, Or Nakajima, for your service and leadership. And, to the incoming Director-General, Or Gro Harlem Brundtland, let me congratulate you on your election. Your expertise and leadership will help make WHO's vision a reality in the twenty-first century. As we speak, at this very moment, children are being born in Africa, in Asia, in Australia, in the Americas, in Europe. What will their lives be like in the twenty-first century? Will they live with dignity and health- or be degraded by poverty, war, injustice and premature death? Will there be health for all? The answers to these questions depend upon all of us. Heads of State, ministers, parliamentarians, experts, physicians, nurses, researchers, village health workers and citizens all. Many of you in this room are the authors of the success stories of the twentieth century. But the answers for tomorrow depend not just on what we say today as individuals but on what we do tomorrow as a community of nations. When public health leaders first started meeting internationally more than one hundred years ago, they had seen first hand the devastation left in the wake of the yellow fever epidemic that swept across the Southern Cone in the late 1800s. They had experienced cholera overrunning Europe, malaria, terrible sanitation conditions, unsafe food and water. Infectious diseases and diarrhoea that robbed babies of any chance at life. No nation was safe from the epidemics that travelled across national boundaries. Yet no one really knew about the causes of infant mortality. There were no immunizations or antibiotics. No oral rehydration therapies or adequate prenatal care. But now, thanks to the World Health Organization and many other public health pioneers, researchers, scientists and so many others, a dramatically different world welcomes the 365 000 children born each day. It is far less likely that we will have to look into the eyes of children dying of infectious diseases and know that their lives could have been saved had they only received a simple vaccination. Because smallpox is now found only in the history books, children today will not have to endure the blindness, the disfigurement or death that once plagued 15 million people a year, and if we refuse to give up, poliomyelitis will soon be eradicated. Children today are far more likely to live past their fifth birthday, and some born today will even be around to see the twenty-second century dawn. Standing as we are at the border between one century and the next, we have the opportunity for the first time in history to alleviate and end much ofhuman suffering and prevent millions of premature deaths. We have every reason to reject the doom-sayers who paint a picture of a twenty-first century with environmental degradation, rampant poverty and untold suffering from new diseases. As your new world health report makes clear, we can choose an optimistic vision of the future and work to make it a reality, so that at the end of the next century our successors will look back at what we did for the children born this very day. They will, I hope, see public health hazards overcome and diseases like cancer conquered, and see children living not only longer but better-quality lives. Now, whether we see that vision or not is really the question we face today. We certainly have the means within our reach. Just as immunizations, antibiotics and clean water revolutionized lives in this century, children are being born today into a world in which telemedicine on the Internet provides life-saving information in a matter of seconds. A world of biology, where research is allowing us to map the human genome and unlock the mysteries behind chronic diseases and our greatest killers. But we know that this promise of progress will only be possible if our ethics and self-interest compel us to act. If we apply ancient values and morality to new frontiers of discovery. If we master the political will and summon the economic resources to ensure that all citizens reap the benefits of advances in health care. If we heed yesterday's lessons to meet new challenges tomorrow. Now, some of what we need to do is not complicated. It is to apply the best practices that are proven to work in every place that needs them. As I have been privileged to travel around the world, I have seen what A51NR/9 page 175 people can accomplish when they use simple public health techniques and community action to improve health and save lives. In Bolivia I visited with expectant mothers at a primary health centre run by a nongovernmental organization with support from the Government. They had created a safe place for very poor women to come and get health care. The women - with their ruddy faces and bowler hats - were receiving prenatal check ups and having their infants immunized on the day that I visited. They were also learning about family planning and how to space births so that they could more likely have their children survive, and themselves. Some of what we need to do is to provide better information and education so that people can make better health decisions for themselves and their children. On the recent trip my husband and I took to Africa I met with women and two men from the Malicounda Bambara village in Senegal. These people had accomplished something extraordinary. Although female genital mutilation affects less than 20% of women in Senegal, in villages like theirs it is considered a right of passage for all girls. The women decided that female genital mutilation had for far too long harmed their daughters' bodies and spirits. They decided that it was time to end the haemorrhaging, the AIDS, the childbirth complications caused by this tradition. During our discussion they showed me the skit they had used to educate their religious leaders, their neighbours and husbands. As a result of their efforts this village voted to ban this long-standing cultural ritual. Not only that, they are inspiring others to do the same. A 66 year-old man told me how he walks from village to village spreading the word about the dangers of female genital mutilation. Recently 13 other surrounding villages representing 8000 people joined together to end female genital mutilation in their communities. They petitioned their Government, and now the President is working to enact a new law to abolish it throughout the country. When I asked one woman what drove these people to change such a longstanding tradition, she simply replied: "We studied human rights and particularly the right to health". What better time than now here at the Palace of Nations on the fiftieth anniversary not only of WHO but of the United Nations Declaration of Human Rights to make clear that health care is a basic right, a basic human right that all men and women are entitled to. As Dr Martin Luther King Jr once said, "of all the forms of inequality, injustice in health is the most shocking and the most inhumane". For the children being born today, let us all declare, their basic health should no longer depend on where they live or how much money their parents have. Some of what we have to do is to attack the inequities that deprive children in one area from enjoying the health care that is available to their neighbours. We know that child malnutrition varies greatly from continent to continent. The number of physicians and nurses varies greatly depending on the wealth of a country. And even in rich countries there are pockets of despair. To improve health for all, we must make progress in the fight against poverty. To fight poverty we must ensure health care for all. That is part of the unfinished business of this century. And when we talk about health equity, we must talk about equity between countries and within countries. Men, women and children come from all over the globe to be treated in the great medical centres of the United States, and yet we have more than 41 million Americans who are uninsured. Now, to be sure, their emergency needs are usually taken care of, but often well after they should have received primary care, and frequently at a greater cost. A country such as mine can have the most cutting-edge technology in the world, or a country that is poor can have cutting-edge technology for the rich of that poor country. But it will not matter to the people who still die and suffer because they do not have access to the services they need. Some of what we have to do is to face up to the difficult issues posed in every country on how we finance and deliver health care. As populations age, thanks to the wonderful progress we have made in health care, then every country, whether or not it currently has a universal system, will face greater cost pressures to meet overall needs. Many countries with universal systems are now unable to afford the facilities they have, or the technology they need, and will have to face hard choices about how to restructure their systems. Other countries are in danger of having their existing health structures collapse under the huge weight of case loads from HIV, AIDS or tuberculosis. And we find many parts of many countries cutting back on necessary basic services just to make ends meet. Some of what we have to do is to join together to combat a new array of global health threats. Increases in foodborne illnesses mean families have more reason to worry about whether the dinner they have just served their children will make them sick or worse. Parents are worrying about tobacco addicting their children, stealing their health and often their lives. My husband is working hard to save children in our country from the death grip of big tobacco. But none of us can rest until we save all children from the advertising and other enticements that seduce them, and I applaud Dr Brundtland for her strong statement yesterday. Across the globe, people are worrying about infectious diseases, and with good reason. They remain the leading cause of death. In the last 20 years, we have witnessed the birth of at least 30 new infectious diseases, like Ebola. The HIV/AIDS pandemic continues to strike at citizens without regard to sex or station in life, and increasingly, women and children are the targets. We also see old scourges like tuberculosis re-emerging with A51NR/9 page176 new force. We have treatments that work for tuberculosis but more people will die from the disease this year - two million- than in any other year in history. We also have antimalarial drugs, but resistance to them, and other factors, have led to alarming increases in malaria, which is now moving into previously unaffected regions. Infant and child mortality could be decreased by 20% to 30% if malaria were eradicated, and I want to thank Dr Brundtland for her commitment to roll back malaria once and for all. We know there are no magic bullets, no solutions that we can take from the sky. We need to share information, share responses, share surveillance. What would have happened if we had had an excellent surveillance system in Africa, for example, when the AIDS outbreak first occurred? I hope we never have to ask that question about any other disease in any part of the world again. Some of what we have to do is end discrimination against girls and women, the health of children must never again depend on whether they are boys or girls. The last WHO event I attended was a forum at the Beijing Conference about women and health security. There were people from all over the world sending the message that the health of women and girls could no longer be divorced from progress on other economic and social issues. For how can we have progress when half the population of any country is underfed, undervalued or denied care when they are sick? How can we have progress when women live in fear of violence at the hands of strangers or relatives, when they are trafficked across State lines like drugs and sold into modem-day slavery? How can we have progress when women do not have access to the family planning they need to protect their health and make fundamental choices about when and if to have children? How can we have progress when every single minute that goes by somewhere on this globe a woman is dying of complications from pregnancy and childbirth? At a small clinic in Nepal, I saw a safe home delivery kit that is given to expectant mothers. Inside is a bar of soap, twine, wax, a plastic sheet and a razor blade. Its purpose is to reduce the two major causes of maternal and neonatal deaths - tetanus and sepsis - by promoting the "three cleans" principle - clean hands, clean surfaces, clean umbilical care. These kits are made locally by a micro-enterprise owned by women. And these kits, as well as the entire Safe Motherhood Initiative, teach us about the importance of investing in prevention. We will reap great human dividends if we give people the power to protect their health with prenatal care, nutrition and family planning. Most maternal deaths can be prevented by spending less than two dollars a year per person. These safe motherhood kits are emblematic; they remind us that women's health, like all health issues, are not soft or marginal issues, but are very important issues and moral obligations, as well as practical necessities that every society must face. Our political leaders must understand that unless we address the health care needs of our citizens, we will not have the quality of life, the economic growth, the justice and equity that make democracies and economies thrive. Our leaders should be just as worried about reducing infant mortality as increasing trade. They should be just as concerned about maternal mortality as military might. They must see women's health as part of the overall development of every nation. Because good health is linked to every other tool of opportunity - to jobs, loans to start micro-enterprises, legal protections and, above all else, education. When a woman can read and write, she is more likely to live through childbirth, her child is more likely to live, and her family is more likely to be healthy. Above all else, what we must do is to call on the private, public and non-profit sectors represented here, to join together to meet all of the challenges ofthe twenty-first century. Just as concerned people have done in this great city before - when they have banded together to ensure peace, or work towards universal human rights; just as nations and public and private institutions did during the twentieth century, when they invested in the research and training that gave birth to the advances we celebrate today. We must put our hearts, our minds and our resources in action, to meet the needs - whether it is finding a vaccine for diseases like AIDS or malaria, closing the equity gaps that plague our health care systems, or making it clear that issues like maternal mortality and tobacco are not peripheral concerns but central ones. I would hope that, on the occasion of WHO's lOOth anniversary in 2048, our successors would look back at what has been accomplished. Instead of an apocalyptic twenty-first century, as predicted by some, of overpopulation, pollution, disease and poverty, I hope they will see that, for the first time in human history, all people had access to the tools they needed to live longer and better lives in peace. We do not have a minute or a child to waste. We have only one World Health Assembly left in this century. The children of the next century being born today in Africa, in Asia, in Australia, in the Americas and in Europe, come into our world with every reason to expect they will be wanted and loved by their families and valued by the societies they join. We should not, we dare not disappoint them. Yes, there will be obstacles and setbacks, but we cannot be discouraged. We have the technology, we have the know-how, we have the resources. We only need the will to act. With the World Health Organization to lead the way, I know that we all will turn the vision of health for all into a reality in the twenty-first century. And those children born today will thank all of you. A51NR/9 page 177 MsSWEENEY: Thank you, Mrs Clinton and thank you, Mr President, for allowing me to assist in this award ceremony. I now hand over to you, Or Al-Mousawi. The PRESIDENT: Thank you, Mrs Sweeney. We have now completed item 14. I should like to ask delegates to remain in their seats while our distinguished guests are escorted from the room. 2. 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 PRESIDENT: Let us now return to our agenda and consider item 13, Election of Members entitled to designate a person to serve on the Executive Board. I draw your attention to the list of 12 Members, drawn up by the General Committee in accordance with Rule 102 of the Rules of Procedure. In the General Committee's opinion these 12 Members would provide, if elected, a balanced distribution of the Board as a whole. These members are, in the English alphabetical order: Bangladesh, Cape Verde, Central African Republic, Chile, China, France, Lao People's Democratic Republic, Qatar, Russian Federation, Trinidad and Tobago, United States of America and Yemen. Are there any comments or any objections concerning the list of 12 Members as drawn up by the General Committee? In the absence of any objections, may I conclude that, in accordance with Rule 80 ofthe Rules of Procedure, the Assembly accepts the list of 12 Members as proposed by the General Committee? I see no objection. I therefore declare the 12 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. I shall now adjourn the Plenary and both Committees A and B will meet. The next Plenary will be held on Saturday at 15h30. The meeting is adjourned. The meeting rose at 16:15. La seance est levee a 16h15. A51NR/10 page 178 TENTH PLENARY MEETING Saturday, 16 May 1998, at 11:30 President: Dr F.R. AL-MOUSA WI (Bahrain) DIXIEME SEANCE PLENIERE Samedi 16 mai 1998, llh30 President: Dr F.R. AL-MOUSA WI (Bahrein) 1. FIRST REPORT COMMITTEE A1 PREMIER RAPPORT DE LA COMMISSION AI The PRESIDENT: :..rl)\ .4-W\ ~ 4.U\ ~ ~I.>. )I ,ro/o '~ ~}\ <} ~)}\ "i" 4..:>.Jl J}ll .r..;:lY i~ J '.J--- . .f)~\ .r.}Z )}y "::JJ\ ~~ ~\ ~j a....~" 4-i\p \)} .r-_;:11 ~J ,o~.W ~~ 0J~ .r-_;:11 o~\ 4..:>.Jl\ 0t.; ,"o~_,...... " a...... l5" J~l . ".y.#IJ <.pWI 0 _;jl <} ~ ~.r-_;:11 \.La. ~~'::a' 0~ ~\ jA . "i" 4..:>.J} JJt.;l .r-_;:11 ~ Jily.J '.;.!_;:!\ ~ !)~\ ,..;:J\...p\?1 ~~<.>)'::a' 2. SECOND REPORT OF COMMITTEE A1 DEUXIEME RAPPORT DE LA COMMISSION A1 The PRESIDENT: :..rl) ~L>. )\ .h.U I..L>\J \)~ JJ~ (,)l.JIJ , 'r A/ o '~ :i ~}I J ~ )}\ "i" 4..:>.Jl Jl!ll .r-_;:11 Jl 0':1\ JA::.i .o~-W ~~ 0J~ .r-_;:11 o}i 4..:>.Jl\ 0t.; "o~_,...... " a...... l5" J~l o~L..Q..J\ iLiJt.;l uP~ y _,-)1 a:...... all Jt-... J J-ll ~" 0 ~~ .;1_;31 ~~'::a' o~ ~~ jA • ~~\)')U ... o\...p\?1 ~~ ~ _r-J i..W 1)2.; . ~ JJ y J-lW a....Kll ~~ ,U-p CABEJibEB (Pocc~dkKaSI Cl>e.n.epaUHSI): Dr SA VELIEV (Russian Federation): ,UeneraQHSI PoccHikKOH Cl>e.n.epaUHH no.n.Tsep>K,IlaeT no3HUHJO, KoTopyiO oHa H3JIO>KHJia s KoMHTeTe npH paccMoTpeHHH npoeKTa .n.aHHOH pe30JIJOUHH. 1 See reports of committees in document WHA51/1998/REC/3. 1 Voir Ies rapports des commissions dans le document WHA5111998/REC/3. A51NR/10 page179 The PRESIDENT: 3. THIRD REPORT OF COMMITTEE A 1 TROISIEME RAPPORT DE LA COMMISSION A' . •)\ The PRESIDENT: ·~ 4. FOURTH REPORT OF COMMITTEE A' QUATRIEME RAPPORT DE LA COMMISSION A' . •)\ The PRESIDENT: ·~ L:>....l.ll 0f..j o~ ~ L..l5" Jwl ~w... )1 , t "1 o, c u.;_,11 ~L..i_, , "i" ~ ~l)l;.pl Jl 0'11 ~ ..;>- '11 ~ ...l:>-1}1 l,..,.~ .,;;\)} a....:- ;.pi ~J . .;;':>\.t..l..U a..i 0 y ;.pi ..;;~\ ,..\~\.;_, ~ _,..u.JI ~ ~J 4) ~_,_r.JI_, ~\ .,;;~\ ~ 0~~1" Jl:ll 01_,w1 ~ j_,f..jl )_;}I I ~.;,..- • '\.::.J _;;~I ~ ~)_;}I \lA~~~ o~ ~\ _y,. . )_;}I ~ 0~1 . .;;W.I?I a..i '.5) ~ ~\ J~ ,_;c.· L.....::;....~\ ~ ~_rJI ~1...:>.~1_, ~1_, 4J~f..j1 Jl.."\11" ulp ~J :Jt!ll )_;}I Y' ."a..~l ~)_;}I \.l,.,. ~~~ o~ ~\ _y,. .)_;}1 ~ ~ _, ,.;;W.I?I a..i '.5) ~ ."~WI (.5~1 ~~~I L.y:-1_;)1 .y ~\" Jl:ll 01_,w1 ..:Jt!ll )_;}I ~J ~)_;}I \.,L,. ~~~ o~ ~\ _y,. . ..:Jt!ll )_;}I ~ 0~1 ,.;;W.I?I a..i '.5) ~ ."~1 .l:iA>" 01p ~ 't!l)l )_;}I L.i ~~1)1 )_;}I ~~~ o~ ~\ _y,. . _):; a.l y y _,..u.J a.....l>JI ~i Dr. AL-KUWARI (Qatar): : (P) (,? )pJI JP..UI ~_;.JI ~ J_,..U ~\ ~IJjJ uy u-ll ,a.Jt>..; ~ ,~i ui ~_,i ~..L.all \~ .~)\ o~~ \~ ~~ ~ J.S y. uW.I \.l_.,. J . ~ _;.JI \lA J ~~~ Jl ~J ~ J t;~ ~\ ~IJjJ J..L.pi ~ 'if":A- ~I ~ ~I a....~ a..,..WI a.lt..All a.....l:-JI 0~ o~ .yy _, ~I .l:iA> J ~ ~I Jl ~ ~I J\.u.f..j\ ~ £y_, .J\.u.f..j\ oh~ .y yWI 01-lWI ~ 4;4-l\ .;;\~1..-JI ~ ui ~ 0:!~\J .b-l_,\1 up 01-LWJ a..}-!.:.... ~1_, a ;4-1\ .;;L...b'JI_, ,a;~\ ~} ~ _, a....'JI_, a.lt..All _r.ii.A.JI_, .;;l..lA...ll ~yJ a../'y.JI ~f..j1 ~ a.Jt..Al\ y_,..UI ~l_r....-~1 ~.L;.; ~ l_r.->i 0~1 JS'i LS' .~1 Jta.,. J ~W._,i y.yt:l (.~ ~\ 1 See reports of committees in document WHA51/1998/REC/3. 1 Voir Ies rapports des commissions dans le document WHA5111998/REC/3, A51NR/10 page 180 ~L:..ll ~}~1 ..::..~\ _r.JjJ ,y-Al)\ ~ ~L...Q.Aj\ J-!.- :4.:--L...\11 J""'LWI JJL.d ~} ~~ o~l) ~ ~\J i..u::J\ ~~ J.-4 0~1 0f W" '('""'")WI ~\) ~\ ~\) 'YrJl WL.all o~l) ,...,...... WI ~I..WIJ ~l; .:)a 1.;1 J;l.r"\'1 J~\'1 )_r:;....l .:r.--4 0YI 0t; l_r.>iJ ·#I} Jly.=-JI l:..WI ..::..\~ d.!J.J\11 a,JG-v J j_r.JI t LPJ\11 JYJJ ~\ ..::..~\ ~IJ ,~\r"" \' a;I_,....;..JI ..::.ol.... JL...JI .r.--4J '-.r-_;JI y_;:.\.A;J 0lY y y.J 0\' y.JIJ J J..UI ~t; _)1 ~~ J o~L...... JP JJ..UI J5' 0y1 ..:...:...:.J ,JJ~.:>. \'1 ~ y ~ ~~J ~~ \'IJ ~~l....ci\'1 ~ a.-__,All t..>,lj\' ,t..b..J\ a:.h loll ~~J \11 ~ ~IJ JU!!IJ ~~ \'IJ c.pl....ci\'1 Jjdl; ~~ ~\ ~IJjJ 0~ y l..l....A .~\ Jb,.. ,_} ..::..1~1....-JI 4J L.; ~J_,.;JI ..::..1~1....-JI if o~lA;;....\'1 if~\ .~ ~WI oJJ..UI _;...L1> JP t ~I ..w (,?..UI ~~\'1 ~I ~y JJ..U .I~J~i~\J The PRESIDENT: ·if~\'\ ~WI Jy .y a,yll; .!.JJ.:>..j' (,?..UIJ ,_p; y JJ..W 1~ \'c.>__,>i ..::.o~')l. ~r !l~ ~ .~1)1 )_;Ajl ~ ~) . ..::.o~')l. ~i c.>)\' ."j..JI" :J81 0\_rJI V""'"WI )_;jl ~J \'f.~\ 1.1.«. ~~\' ;;~ ~\ ~ .)_;jl ~ ~) ,.,::.ol.p\_?1 (,?i !l~ v-:1 ·"J"~W. ~b if~\" :J81 0\_,:.JI ~ J"~WI )_;jl L.i \')_;ll 1.1.«. ~~\' 0~ ~\ ~ .)_;jl ~ ~) ,.,::.ol.p\_?1 ~i ',?) \' . "~ _,.....ll ~I ..::..~if~ il.k..ll if~\" 0\_y ~ ~WI )_;jiJ \')_;jl 1.1.«. ~~\' 0~ ~ ~ . "i"~ ~1)1 f-_;:11 JP ._;tly.) )_;jl ~ ~) ,.,:..~')l.} .,::.ol.p\_?1 ~i c.>)\' 5. FIFTH REPORT OF COMMITTEE N CINQUIEME RAPPORT DE LA COMMISSION A1 The PRESIDENT: :~)1 0\1 , "o~ _,....-" a..$ J~l ~L>.)I . t t/ o '~ u;_,11 J ~ ))1 "i" ~ V""'"w1 J-_;:11 Jl ~m .a; ~ . . ..::.o')4...w- ~i 0 )~ f._;:! I ..::..~\ ~I ."~l.JI 01.t.4JI ~ ~\11 ~\ 0JL.:ll y.yo;" :J81 0\_rJI )_;jl ~ J....T :0\y.JI JP __,>T ')4...w ·"~LJI 01.t.4J1 ~ ~\ tUUll J ~\11 ~\ 0JL.:ll y.yo;" ;d,j\_y )_;jl \')_;jl 1.1.«. ~~\' ;;~ ~\ ~ . )_;jl 1.1.«. ~ ~) .,::.ol.p\_?1 ~i c.S) \' . "~l.r=JI ..::.obL.a.e a... J\..4... .~}-ll _;.lf"\11 if LP>~ J o~l _;.lf"\11" :0\_y ~ Jl!ll )_;jl L.i \')}\'\ 1.1.«. ~~\' 0~ ~ ~ . )_;jl ~ ~) ..::..~ ')l. Ji .,::.ol.p\_?1 ~i c.S) \' ."~t.s::_.J ~JWI ~ _;.IJ'"\11 if ~ti)l" :0\_y ~ ~ ..!Jl!ll )_;Ajl L.i \')_;ll 1.1.«. ~~\' 0~ ~\ ~ ·l..r"'"WI f-_;:11 JP ._;tly. J8l;J )_;jl ~ ~ J ..::..l.p\_?1 ~i c.>)\' • \..cl:; ..ti) if a..l.,.:.\.J..,. !l~ ·~~ 1 See reports of committees in document WHA5111998/REC/3. 1 Voir les rapports des commissions dans le document WHA51/1998/REC/3. A51NR/10 page 181 Ms RINKINEVA-HEIKKILA (Finland): Thank you Mr President. This has been a long and very intensive week and it has its cost. I am sorry I was late for the adoption of the second report of Committee A but, with your indulgence, I would like to make an explanation of vote to be included in the records of the meeting. Is that acceptable to you? Mr President, Finland joins the consensus in adopting the resolution on concerted public health action on anti-personnellandmines, even if we do consider that it contains elements which are right now being discussed in other international forums. Finland is committed to the objective of achieving a total ban on all anti-personnel landmines worldwide. The international community should work intensively on the anti-personnellandmine issue through various means, such as mine clearance and political efforts aimed at a total ban. We contribute to this work and we do hope that our concerted action will reduce, and finally put an end to, the humanitarian problem caused by the anti-personnel landmines. Thank you Mr President and special thanks for your indulgence. The PRESIDENT: .·.r-' •)1 6. SECOND REPORT OF COMMITTEE B' DEUXIEME RAPPORT DE LA COMMISSION B' The PRESIDENT: .·.r-' •)1 11 11 11 11 7. THIRD REPORT OF COMMITTEE B' TROISIEME RAPPORT DE LA COMMISSION B' The PRESIDENT: .·.r-' ')1 11 11 . 'i VI 0 ' c u;)I .} ;;_,))I ~ ...... ~ ..!Jl!ll .r..PI .JA 4J )iill i...l.iJI Jl::ll .r..PI 11 • . ...:J~..W ~i 0 y .r._;:ll ...:J )i ~I 1 See reports of committees in document WHA51 I 1998/REC/3. 1 Voir les rapports des commissions dans le document WHASl/1998/REC/3. A51NRI10 page 182 - 4J..UI y~l ..;;L....biWI JL.... C:J ;;~1 ~~~ a...)i:.- J>b 0JI.a:ll" :0\p ~ Jl!ll ;1.)}1 . "~I__,.JIJ JW:.~I ~ Y)_;JI lh J>- ~\ Jilj _p. ."y" ~ ..!Jl!ll .;:!_;:}\ J>- Jily. J84) )_)}\ ~ ~) .,;;\..p\_?1 ~i l>) 'J/ 8. FOURTH REPORT OF COMMITTEE B' QUATRIEME RAPPORT DE LA COMMISSION B' The PRESIDENT: . rQ,/o 'c u;_,11 ~ o.=~;l_,ll ~ "._,.." ~ ~1)1 J-_;:}1 JJL::i 0\'1J . ;;.=~ r-- ~ J Jl..fj ~ ~ ~ .:r J 4~ J-_;:}1 ~~ ...:;~\ . 1~\J l;l..f""\ IJ_;... J .,;;\)} a..~ J-_;:}1 ~ ..r- \'I _,1; ~1}1 4J ~ "J~..UI ,:r ~ o J ~ t o.:~WI J>- ..;;')4..w-" :0\p JJ~I )_)}1 ~ Y)_)}l lh .:~~'J/ .:~l..u.:..-1 J>- ~ _p. .JJ~\ )_)}\ ~ J84) ..:;\..p\_?1 ~i !}~ ~ "~WI ~ ~~\ 0t>:.....U J J..U\ .l.WI" :<~JI_y Jl!ll )_)}I Y)_)}l lh .:~~'J/ .:~l..u.:..-1 J>- ~~ _p. .Jl!ll )_)}I~ Jl:l4J ..:;\..p\_?1 ~i iS) 'J/ "iWI J....LJIJ ..:;6,.J..U\ ,p~l _r.P ~ _,.JI ~IJ/ :<~JI~ ..!Jl!ll )_)}I t...i Y)_)}I lh J>- ~\ Jilj _p. . ..!Jl!ll )_)}I ~ J84) ..:;\..p\_?1 ~i -l>.):! 'J/ <~Ji )~ ~~\ ~_,.J ~..u-\.A::ll ..;;W.l-.U !}_r.!...JI dJ..u...JI ~ ~ _:r~·: ~ t,;l.i""\ IJ_;... ~i ~\ .,;;.1:.:.;\ ~WI ~I ~ ~..u-I.A::ll ..:;W.l-..11 a.:-1 ~ ~ ~ o~l ..;;U.l-.U !} ~I .3 J..u...JI .} ~ v-··: ~ l;l.i""\ IJ_;... ~i ~\ ..:;.1:,:.;\ ,..!Jl!ll )_)}I ..:;.1:,:.;\ ~\j J_o. .~WI ~I a....k.J ~..u-\.A::ll ..:;U.l-..11 ~ ~ ~ ~J ,;;~1 ~~~ ~ _,.J ~..u-\.A::ll YJl.i"" 'J/1 J_;...JI lh J>- ~I •.!,.LJ~ J;z ..ill~) ,..;;\..p\_?1 ~i iS) 'J/ 11 11 -- 11 1)1 :-11 • • ...,.. ~ Cj J.r ~ ~ .:r J 9. FIFTH REPORT OF COMMITTEE B' CINQUIEME RAPPORT DE LA COMMISSION B' The PRESIDENT: ..;;ji ~I 0~ "o.:~r--" 4$ J~,A;I -.t>.-)1 ,t .fo\r_ u;_,11 ~ "y" ~ v--WI J-_;:}1 J~ 0\11 ~ J.f-.:1 ~~-~-..!'' 1 See reports of committees in document WHA5111998/REC/3. 1 Voir Ies rapports des commissions dans le document WHA5111998/REC/3. A51NR/10 page183 Mr LOFTIS (United States of America): Thank you Mr President. My delegation would like to take the floor to confirm its position that it took on this resolution yesterday. The United States is concerned for the health of Palestinians, which should be the sole concern of this resolution. We have provided millions of dollars in assistance for projects to provide potable water and adequate sewerage facilities in the Palestinian areas, for example. We have also encouraged others to help in this crucial area and we will continue to assist the Palestinian people in these ways. Unfortunately, the resolution before us seeks to inject purely political considerations into what should be a humanitarian issue. This is not the forum to try to create political facts. I think we can all agree that we should work to bring about a comprehensive, just and lasting peace in the Middle East, one which will end violence and enhance prosperity for all the peoples of the region, to give better opportunities for future generations. This is what my Government is trying to do right now. As you know, the Palestinians have accepted US ideas to end the current impasse in the peace process and move toward permanent status negotiations. We are working with Israelis to try to obtain Israeli agreement on the basis of our ideas. We realize the dangers of continued stalemate, and are trying to preclude them through negotiations. Those negotiations should be the forum for political issues, while we here look for practical means to improve the health situation for the Palestinian people. The PRESIDENT: . ')\ ·~ Mr MANOR (Israel): Thank you Mr President. In this explanation, we seek to make sure that there is no misunderstanding about Israel's position on the resolution which has just been adopted. Even though it was passed without vote, it has to be stated clearly for the record that Israel is opposed to the resolution, and therefore it was not accepted unanimously or by consensus. Israel already clearly indicated its opposition to the draft resolution in Committee B yesterday. But it is necessary for us to reiterate in Plenary something of the background and the reasons for our opposition. Delegations will recall that, for three years, in the mid-1990s, the PLO observer delegation was prepared to reduce the political component of this traditional resolution to the extent that we were able to reach a compromise on it. The compromise was far from being to Israel's full satisfaction, but with a view to promoting health assistance for the Palestinians and also in a spirit of cooperation between ourselves and the PLO, Israel went along with the language. Much to our regret, however, the Palestinian delegation decided last year to reintroduce an unacceptable political element into the draft, including reference to "Palestinian health institutions" in "East Jerusalem". This obliged us to oppose, already last year, what should in fact have been a purely professional resolution with a compromise text. In the course of this week, our Minister of Health indicated in discussions with the Palestinians that their insistence on mixing health with politics was downright unhealthy. Nonetheless, the Palestinians persisted in their politicization of the present resolution and indeed have only made matters worse. They have stepped up political reference to the construction of a residential quarter on Har Homa, despite the fact that this subject has clearly nothing whatsoever to do with Palestinian health conditions and despite the fact that this area is within the municipal limits of Jerusalem, and that building there is not precluded by the Oslo agreements. Moreover, they have disingenuously made a call for freedom of movement between part of the territory administered by the Palestinian authority and Jerusalem, blatantly ignoring the ongoing Palestinian terror which, from time to time, forces the Government oflsrael to place restrictions on Palestinian movement. For these reasons, Israel is even more opposed to the resolution than it was last year. Hence, we wish to underscore the fact that a consensus does not exist in this regard and that Israel is not and cannot be part of any such thing. This is not as Israel would have wished. We would have much preferred cooperation and compromise with the Palestinians here at the World Health Assembly. We are still open to such cooperation for the amelioration of the health of both our peoples and indeed for the better good of the Middle East peace process. The PRESIDENT: :~)\ A51NR/10 page184 Mr. KHOURI (Palestine): The PRESIDENT: Dr OTTO (Palau): Thank you, Mr President. My delegation wishes to reaffirm its position on this resolution in line with the comments made by the distinguished delegate of the United States of America. The PRESIDENT: 0~ oWI_r--1 :a ;.)1 jsL.-.!1" 0~1 ~L!ll }_,4ll ~ ~ 0'11J .oLb-".>\..JI oh J9 \~ .4.;1~ »- o'Y~'Y a..,;,~\ o~\ ~\..a) c~'YI ~ )_}jl ..1;. ,_); ~\ Jily J;. . )_}jl ~ ~ J oW>I_;:pl ~~ 1.5) 'Y ~ ~lA..::.-..IJ tWI _r.:-A a...A1..:.JI Jl-k.>\11 er ~_All ~I~~" 0~1 C::!l)l )_}jl .j 0'11 )id ~)_}31 lh J9 ~\ ~\y jl> -~J_,.A-1_;-}1 0JjJ\fl .)_}31 ~ JWL!J oW>I_;:pl ~~ 0 ) 'Y .0 _r:.\ll _,..;:.~1 ;;._1; o_r:.i ;;__,.. ~lfJ 10. SECOND REPORT OF THE COMMITTEE ON CREDENTIALS1 DEUXIEME RAPPORT DE LA COMMISSION DE VERIFICATION DES POUVOIRS1 The PRESIDENT: Before we proceed further, I am ready to consider the second report of the Committee on Credentials. You have before you document ASl/43 which contains this report. Does the Assembly have any comments? I see none; the report is therefore adopted. 1 See reports of committees in document WHA51 I 1998/REC/3. 1 Voir les rapports des commissions dans le document WHASl/1998/REC/3. A51NR/10 page 185 11. FIFTH REPORT OF COMMITTEE B (resumed) CINQUIEME RAPPORT DE LA COMMISSION B (reprise) The PRESIDENT: 12. SIXTH REPORT OF COMMITTEE B1 SIXIEME RAPPORT DE LA COMMISSION B1 The PRESIDENT: .·..r:' ')\ "o.:l.,_...... " a...... l5' jlli\ ~L..•• ,)\ ,to/o\c a~}\~ .:lJJ W" '-"';)W\ ..r;_;.;;l\ .Jii' "._,.," 4..;,...L!_r.>-\11 _;._;.;;l\ a....;\_r.J\ .:.r" ~U\1\ ..:,..~" 0\~ \).,r-i ~ _rl'> J .;...~..W ~\ 0 y 4..;,...ll\ ~ ,y ~\ _;._;.;;l\ 0\ ~ • • • ..;...LAJ..u ~~ .!)~ y. II~;)W\ ."y" 4..;,...L~ '-"';)W\ _;._;.;;l\ ~ ~\y. ~ J ,;~_.,Ajl ~ J84J .;...LAJ..u ~.,?i 1.5) "1 -~ ~,:) _,.._)\ ~_;J\ ~\ ..u.) ,y ~ .!)~ Dr. A. AL-KHATTABI (Saudi Arabia): The PRESIDENT: :~)\ .~.:l_,.._l\ ~_;J\ ~\ Y.)..l:.J \~ uW\ ~JY ,y ~.,?~\ ~\ i.,?_r.._? v"'\~\: ~ ~\ :w.;~ it=;,.:.\ Jl J..a.i aJ:i.>.yW\ o,l.,. .AA; .4# w\_r-l\J ~W\ ...u.; o..L>\}\J 13. REVIEW AND APPROVAL OF THE REPORTS OF THE EXECUTIVE BOARD ON ITS tOOth AND lOlst SESSIONS (continued) EXAMEN ET APPROBATION DES RAPPORTS DU CONSEIL EXECUTIF SUR SES CENTIEME ET CENT UNIEME SESSIONS (suite) The PRESIDENT: ~ J ~ ~ 0i L.; JJ~ 0w ~.,?l:dl ~~ '-:? ..r.? ~ ,:r 0~ )\ 0tz:,JJ1 ..;:_j.; JJJ 0'11 LJ \_rli; (.,?~\ ~~ ~ ~~ ~ ~;_ ~\ 0i ~~ ...::....:...L?i ~\ ..;...~\ Jl \:l;;w,\.) .;r._r._;.;;l\ -:r.-4< ·"-' ~~ ~~ i~\ ¥-} ~~ JLA:;l ~.,p. _r.JZ .:.r...,., ~. 0\J Jw\ .:.r ..., ~~ -~~ J? ..ili .;,..\....p\_?\ ~\ .:l_J>.J i..w p 1 See reports of committees in document WHA51/1998/REC/3. 1 Voir les rapports des commissions dans le document WHA51/1998/REC/3. A51NR/10 page 186 14. SELECTION OF THE COUNTRY OR REGION IN WHICH THE FIFTY-SECOND WORLD HEALTH ASSEMBLY WILL BE HELD CHOIX DU PAYS OU DE LA REGION OUSE TIENDRA LA CINQUANTE-DEUXIEME ASSEMBLEE MONDIALE DE LA SANTE The PRESIDENT: :~)I .0~1J ~l!ll ~WI ~I ~I~ ...LU;...., (,>..UI ~)11} ..LWI ..>~1 0\11 o..>Y JS" ~ ..1\::>.:j ..>Y...... UI .y \ t o~WI i~ f.y \.46 ~I ~ 0i Jl ~I iW.,.I ~_;..vi 0i ~} 0~ J ...L.;y J-> )I ..:.-i J ~ (,>~1 ~I ~~J .:Yt:dl a._,:...jl o..>J...UI ~ ...LU;...., (,>.lJI ~)!I } ..LWI a._,: JJ...UI ~ ~y ~~ \...... 0i Jl ~ .r.~IJ ~l!ll ~WI ~I~ 04 _?~i 0i dj£ ~}J .IA~LWI .~~)I ~I J ~I~~ .:r "-# ~..~~ ~ ).r-W')il >'~f.yl .l_r.r J ~IJ ~l!ll ~WI ~I ~ ~ ..::.. ..>}~I 0i ~i "-# J \'J-1_?1 Ji ~ (,>i ~~ ~ .dJ~ ..~.;; ..ill Jt:dt.) dj~ J9 J-1_?1 (,>i ($.) )I 15. STATEMENT BY THE DIRECTOR-GENERAL DECLARATION DU DIRECTEUR GENERAL The PRESIDENT: The DIRECTOR-GENERAL: Mr President, Mr Vice-President, distinguished delegates, ladies and gentlemen, when the Executive Board, and subsequent Assembly, decided to hold both the election of the new Director-General and the celebration of the fiftieth anniversary of the Organization within a one-week session of the Assembly, I and many colleagues in various Member States wondered whether it could be done. But, Mr President, under your able leadership and thanks to the spirit of cooperation which has prevailed during this fiftieth anniversary of WHO, the Assembly has been able to discharge all its duties and also to adopt some very important resolutions. The Chairman of Committee B, for example, mentioned the landmark resolution on regional arrangements and allocation of resources for regional budgets. As I see it, the importance of that debate has two aspects. One is that the Assembly remains autonomous in its decision, while taking sound and constructive technical advice into due consideration and respecting it. The other is that the Assembly also wants to ensure the harmonization ofthe work and decisions of the Organization at different levels. Where the Assembly cannot agree fully with a recommendation made by the Board, particularly on a complex issue involving intersectoral cooperation, it trusts the Board to take the matter up again and clarify it further. I also refer here to the decision taken by this Assembly to look further into issues such as the rational use of essential drugs and their supply and accessibility to developing countries, especially in relation to intellectual property rights. It was precisely in the area of drug management that I first worked, when I joined WHO 24 years ago and then developed the essential drug concept. Today, I am extremely moved to address you at the end of this Assembly - my last Assembly as the Director-General of the Organization. I wish to say how grateful I am to all delegates for their participation in our work and the constructive advice and suggestions with which they have provided us. I also want to express my heartfelt gratitude to all of you for the honour you have bestowed upon me by declaring me Director-General Emeritus. It is an honour not only for me but also for all my colleagues who have worked with me for the past 24 years, and particularly in the last I 0 years. This is WHO's fiftieth anniversary and, I am sorry Mr President if I now talk about myself. Today I am 70 years old. (Applause) Of course, I know that these days you are supposed not to use the word "elderly", but rather "older people". Thus, in 1999, the United Nations will celebrate the year (not of the elderly but) of"older people", and I will certainly participate in these celebrations, this time as a member of civil society. Coming back to this Fifty-first World Health Assembly, I would like to emphasize that it broke new ground and made some major and constructive decisions which will guide the work of the Organization in the A51NR/10 page 187 future. This includes the decision on regional arrangements and allocations, on which it was finally possible to reach a consensus after extensive discussions and in a true spirit of solidarity. This is the spirit of solidarity which is at the core of the new partnerships for health which we want to foster and which are developing not only with Member States but also with nongovemmental organizations and civil society, in other words all the people living on our planet. In this way, I am convinced, it will be possible to improve the health of all and thus contribute to peace and prosperity for all. At the end of this Fifty-first World Health Assembly, Mr President, I wish to thank you again very warmly for your able leadership, together with the Vice-Presidents and the chairmen, vice-chairmen and rapporteurs of Committees A and B and other bodies of the Assembly. I also wish to thank the delegates who actively participated not only in the formal meetings but also in the informal groups that worked late in the evening and early in the morning to help our work reach a positive conclusion. I also thank my colleagues, the Deputy Director-General and Assistant Directors-General, and in particular the Regional Directors who participated in the work not only on regional but also on global issues which will shape the future of the Organization. I thank my colleagues who prepared the documentation for this Assembly. You have generally found these documents more concise and easier to use than in the past, but we will continue to look for ways to improve both our documents and communication with Member States, in preparation for the sessions of our governing bodies. I trust that my colleagues will make every effort to propose helpful and innovative solutions in this regard. I extend my sincerest thanks to all of you. I congratulate the Fifty-first Assembly on what has been a very successful session. I wish all the best to you, Mr President and all delegates. I wish you a safe and happy return home and thank you all very much for your support. (Applause/Applaudissements) The PRESIDENT: :~)I . 4.-l.S"'L; .).P..ill l__,s:.;. 16. ANNOUNCEMENT COMMUNICATION The PRESIDENT: :~)1 .~WI ~I a...... ,b. The meeting rose at 12:25. La seance est levee a 12h25. A51NR/11 page188 ELEVENTH PLENARY MEETING Saturday, 16 May 1998, at 12:30 President: Dr F.R. AL-MOUSAWI (Bahrain) ONZIEME SEANCE PLENIERE Samedi 16 mai 1998, 12h30 President: Dr F.R. AL-MOUSAWI (Bahrein) CLOSURE OF THE SESSION CLOTURE DE LA SESSION The PRESIDENT: The meeting is called to order. I invite Dr Durham, Chairman of Committee A, to come to the rostrum and address the Assembly, to give us an overview of the work of Committee A. Dr DURHAM (New Zealand) (Chairman, Committee A): Mr President, Mr Director-General, fellow delegates, ladies and gentlemen. I have pleasure in presenting my perceptions of the debates in Committee A where we dealt with a very heavy agenda which included the health-for-all policy for the twenty-first century and 13 resolutions. The meeting was generally conducted in a good spirit of collaboration and cooperation among the delegates who worked particularly hard to complete our very packed programme of work. We considered issues vital to the strengthening of health systems, the promotion of health, the prevention of violence and the nutritional needs of infants and young children. We dealt with requests for WHO support in dealing with specific diseases, including HIV/AIDS, malaria and tuberculosis. We received clear signals that Member States expect WHO to make a difference in such controversial areas as cloning for human reproduction and the use of the Internet for the advertising, promotion and sale of medical products. We reaffirmed our commitment to the needs of vulnerable groups and acknowledge that these will include growing numbers of older people in the coming century. We also adopted resolutions to facilitate the Organization's drive to eliminate diseases of critical importance to developing countries, such as leprosy. My main regret was the great constraint on time imposed by the small number of meetings of Committee A. I do believe that our time out of the Committee was tremendously beneficial, certainly to my delegation and hopefully to the Organization. My delegation felt enormously invigorated by Dr Brundtland's speech and by the celebrations of WHO's fiftieth anniversary. These however, influenced the workplans for all of us. In the case of Committee A, the repercussions have been particularly severe in terms of lost meetings and lost time. To try to remedy this situation we were obliged to impose a number of extreme measures. As Chairman I personally regretted having to close the lists of speakers quickly, repeatedly insist that delegates be brief in their comments, and restrict the opportunity for nongovemmental organizations to make statements. I am convinced that some of the difficulties we encountered could have been averted had we benefited from more time. As is appropriate in a year that marks the fiftieth anniversary of WHO, our first debate, on the health-for all policy in the twenty-first century, was especially lively and constructive. Some 38 delegates and three A51NR/11 page 189 nongovernmental organizations took the floor to express appreciation of the Declaration, the policy document, its ethical principles, its clear targets and its vision for the future. The resolution which included the World Health Declaration was adopted, as amended, by consensus. We then turned, under item 20, to consider 11 progress reports on the implementation of resolutions and decisions and eight resolutions. Although our debates were painfully constrained by time, we repeatedly managed to reach consensus. Resolutions were adopted on concerted public health action, on anti-personnel mines, crossborder advertising, promotion and sale of medical products through the Internet, the ethical, scientific and social implications of cloning in human health, health promotion, tuberculosis and the global elimination of blinding trachoma. We also considered and adopted a new resolution calling for technical cooperation in health systems reform in developing countries. Our most difficult and divisive resolution proved to be the one on the revised drug strategy which was considered by the Committee after some 13 hours of work in a drafting group. I would especially like to thank Professor Girard from France and participants in this group for their dedication. In view of the many complex issues addressed in the resolutions and the vital importance of drugs to every population in the world, the Committee could not reach full agreement on all points of the resolution and decided it would be wisest to refer the matter back to the Executive Board. We were grateful to WHO for providing a clear description of the process to be followed once the matter is referred back. Many delegations provided helpful enhancements to this proposal and implementation wiii begin straight away. Under the item concerned with disease prevention and control, we discussed progress on the important revision of the International Health Regulations and considered an additional four subitems. As might be expected in this technical Committee, we reached quick consensus on these straightforward subitems. Encouraging resolutions were adopted on the elimination of transmission ofChagas disease and the elimination ofleprosy as a public health problem. Additional resolutions adopted by the Committee addressed the growing problem of antimicrobial resistance and the increasing need in every part of the world to prevent and control noncommunicable diseases, including those caused by tobacco. In conclusion, I would like to thank the distinguished delegates for this fine spirit of collaboration and consensus, especially when asked to consider extremely important issues with almost impossible speed. Although opinions differed on several issues, we nearly always found a way to agree. I would also like to thank the Vice-Chairman and Rapporteur and the secretariat of this Committee for its constant support and amazing workload during the considerations of the Committee. Finally, I should like to say that it has been an honour, both for me and for New Zealand, to have chaired this Committee. The PRESIDENT: Thank you, Dr Durham, I should like to congratulate you very warmly for your excellent presentation and also for the outstanding way in which you presided over the Committee. The next speaker wiii be Dr de Silva, Chairman of Committee B, who I invite to the rostrum to report on the work of Committee B. Dr DE SIL V A (Sri Lanka) (Chairman, Committee B): Mr President, Director-General, fellow delegates, ladies and gentlemen. It is a pleasure for me to present you an overview ofthe work of Committee B during this year's World Health Assembly. I shall try to be brief and concentrate my remarks on the highlights of the Committee's work as the full details can be found in the report. On the very first day, Committee B was called upon to discuss the proposal from the Administration, Budget, and Finance Committee to restore, on a temporary basis, voting privileges to Members in arrears in payment of their contributions. After discussion, the Committee felt that it would be an appropriate gesture on the occasion of the fiftieth anniversary of the Organization to do so under agenda item 12, the election of the new Director-General, and a resolution was adopted to that effect. Committee B's major concern throughout this short week was to find an acceptable solution to the problems arising out of the Executive Board's proposal concerning reallocation of resources to the different regional offices. Long hours of informal consultations were held with representatives from all the regions and all parties made a considerable effort to reach an agreement, which was painful in all cases. I can only express here my deep gratitude to those who made this possible, displaying once again the best of the spirit of the World Health Assembly. This is a historical occasion and a landmark, a wonderful present to our new Director General, Dr Gro Harlem Brundtland, and also a birthday gift to Dr Nakajima, who would appreciate that this A51NR/11 page 190 is a very special gift. Usually gifts are made out ofthe sweat and skill of persons, but this is a special gift made out of the skill, patience, tolerance and magnanimity of all the delegates who took part in the discussion and ultimately reached a consensus, keeping their personal interests low and the interests of the Organization very high. Dr Nakajima, this is a very special gift that one would not usually get on a birthday, and we are very happy to give it to you. I am sure that Dr Brundtland will also appreciate this, it will strengthen her. The present we have given to her is the responsibility to make WHO an Organization which will cater to the health needs of the whole world community in the twenty-first century. As usual the emphasis in the work of Committee B was on financial matters, including the financial report, the report of the external auditor and for the first time, the report of the internal auditor. Other routine financial matters discussed were the status of the collection of contributions, the use of casual income, the scale of assessment and the real estate fund. A resolution amending the financial regulation was adopted. Matters relating to the programme budget, such as the efficiency plan for the financial period 1998-1999 and programme budget evaluation were discussed. Items relating to WHO reform continue to be on Committee B's agenda, and this year particular attention was devoted to the review of the Constitution, which has been in progress since 1995. The recommendations by the Executive Board concerning the amendment of Articles 24 and 25 of the Constitution were considered and a resolution increasing the total number of seats on the Board to 34 was adopted, which allows for an additional seat each for the European and Western Pacific Regions. Also in that connection, a resolution was adopted to clarify the interpretation of Article 24 of the Constitution concerning the status of members of the Executive Board. It was decided that Member States entitled to designate representatives to the Executive Board should designate them as government representatives technically qualified in the field of health. Collaboration within the United Nations system and with other intergovernmental organizations covered a range of issues of global concern. There was considerable support for a resolution on the health of children and adolescence, which urges the Director-General to give high priority to this issue and to contribute to the collective efforts of the international community to promote the effective implementation of the Convention on the Rights of the Child. The International Decade of the World's Indigenous People continues to receive special attention here in WHO as it does in all specialized agencies of the United Nations system and other international bodies. Two environmental matters were debated: the strategy on the sanitation for high-risk communities and the protection of human health from the threat related to climate change and stratospheric ozone depletion; a resolution was adopted on each. The method of work of the Health Assembly was discussed and more particularly the availability of governing body documents on the Internet. A resolution on the subject was adopted. Other subjects include personnel matters. A resolution was adopted to adjust the remuneration of staff in ungraded posts and of the Director-General. Three representatives were appointed to the WHO staff pension committee, Dr Lariviere from Canada as a member, Dr Wasisto from Indonesia as an alternate member, and Professor Leowski from Poland to replace Professor Beat Roos. A resolution on the health conditions of and assistance to the Arab population in the occupied Arab territories, including Palestine, was adopted after a vote. Mr President, distinguished delegates, Director-General and staff of WHO, it has been an honour and privilege for me to serve as the Chairman of Committee B. Vitally important financial matters were settled in a spirit of conciliation and consensus, boding well for the future of this Organization. I would like to thank warmly all delegates who spared no effort to achieve this admirable result and who helped resolve these difficult issues. Smooth deliberations were made possible thanks to the unfailing support and cooperation of the secretariat of Committee B. Finally, I extend my thanks to you, Mr President, the Vice-Presidents and the Director-General for taking such an assiduous interest in our work. I wish you, Sir, and all the other officers and delegates, your families and, indeed, your countries, continued good health during the coming year. Have a good journey home. Bon voyage, adios y buen viaje, in my old language, suba gaman. The PRESIDENT: Thank you, Dr de Silva. Please accept my congratulations for your comprehensive report and for conducting so well the work of Committee B. Before I start with my closing remarks I have been informed that the delegate of Laos will give us a speech on behalf of countries of the Western Pacific Region. A51NR/11 page 191 Le Dr PONMEK DALALOY (Republique democratique populaire lao) : Monsieur le President, Monsieur le Directeur general, Madame le Directeur general elu, honorables delegues, Mesdames, Messieurs, en cette veille du XXI• siecle, a !'occasion du cinquantieme anniversaire de l'OMS, du haut de cette eminente tribune de I' Assemblee mondiale de la Sante, c'est pour moi un grand honneur d'avoir a representer les Etats Membres de la Region du Pacifique accidental et mon pays, la Republique democratique populaire Iao, et a exprimer notre appreciation et notre reconnaissance pour les innombrables et eminents services dignement rendus par le Dr Hiroshi Nakajima, notre Directeur general pendant dix ans et, anterieurement, notre Directeur regional, aussi pendant dix ans. Monsieur le President, si no us jetons un regard en arriere et considerons I' evolution qui a eu lieu durant ces dix dernieres annees, nous devons reconnaltre, en toute honnetete, que ce furent dix annees au cours desquelles le monde a connu de grands et profonds changements qui ont apporte, par voie de consequence, a la fois des opportunites et des defis. Durant ces dix longues et difficiles annees, malgre les complexites, malgre les obstacles, grace a son devouement, grace a sa determination, souvent grace a son courage, grace a ses activites inlassables, grace a son appui a la recherche, grace a sa foi dans !'utilisation des progres de la science et de la technique, grace asa comprehension de la cooperation et du partenariat avec tous les Etats Membres, avec tact, habilete et pragmatisme, le Dr Nakajima a su apporter sa part precieuse a la realisation des principaux objectifs de notre Organisation. A travers sa direction et sa coordination, la reforme de l'OMS s'est effectuee pas a pas. A la suite de cette reforme initiale, les activites de notre Organisation sont de plus en plus marquees par la qualite scientifique, par la competence et !'expertise, par la perseverance, par la tenacite et la continuite des actions. Le role, les fonctions, !'impact de l'OMS sont devenus de plus en plus ceux d'une reelle organisation de dimension mondiale. En tant qu'institution specialisee des Nations Unies, l'OMS a fortement et positivement contribue a I' amelioration de la sante de tous a travers tous Ies continents, notamment la sante de ceux qui sont les plus demunis, celle de la mere et des enfants. Par comparaison avec la situation de depart, les progres sont considerables. Nous evaluons a leur juste valeur tous ses precieux apports. C' est pour cela qu' au nom de tous les Etats Membres de la Region du Pacifique occidental et au nom de mon propre pays, nous voudrions exprimer au Dr Nakajima nos sinceres remerciements et notre profonde reconnaissance. Nous estimons qu'il est entierement et parfaitement digne de son titre de Directeur general emerite. 11 peut en etre fier. Nous lui souhaitons bonne sante et succes. Nous gardons de lui un souvenir merite et, encore aujourd'hui, nous lui souhaitons bon anniversaire. Monsieur le President, a ce tournant tres special du siecle, en regardant vers le passe, nous voyons que beaucoup a ete accompli, mais en regardant vers l'avenir, nous voyons qu'il reste tant a faire. En Asie, nous pensons qu' entre le passe, le present et le futur, les liens sont tres etroits et indissociables. Dans la transition pour la continuite, comme pour le changement, i1 convient d'unir etroitement les etapes, car les acquis du passe et du present peuvent servir de base et d'appui pour l'avenir. Nous sommes convaincus que notre Directeur general elu, le Dr Gro Harlem Brundtland, noblement motivee par son ideal, fermement armee par sa determination, efficacement enrichie par ses connaissances et experiences, saura, avec le soutien et le partenariat de tous Ies Etats Membres, mettre a profit les acquis du passe et du present. Nous sommes persuades qu' en tant que medecin, en tant que dirigeant, en tant que politicien et en tant que femme, grace a son intelligence, son energie et son habilete, elle saura developper ces qualites, leur donner un nouvel elan et Ies porter a un plus haut niveau pour faire de notre vision "la sante pour tous au XXI• siecle" une realite. Son message constitue un reel encouragement pour nous, car nous voyons que c'est avec resolution, responsabilite, volonte d'agir, de changer et de perfectionner qu'elle se prepare a prendre en mains ses fonctions. Nous sentons qu'a travers les difficultes et les obstacles, elle a su trouver ses chemins et solutions. Non seulement elle a pose clairement ses equations, mais elle a aussi ses idees et ses fa~ons pour les resoudre. L'OMS, sa priorite, est pour nous un vrai garant. Nous voudrions lui exprimer de nouveau notre plein appui. Pour la sante, pour une meilleure sante, pour ceux qui en ont le plus besoin, nous, dans la Region du Pacifique occidental, serons toujours a ses cotes. Dans cet esprit, nous lui souhaitons sante, travail et succes. The PRESIDENT: Thank you. I would like to call on the delegate of Turkey to speak on behalfofthe European Region. Mrs KIZILDELI (Turkey): Mr President, Madam Director-General elect, ladies and gentlemen, it is an honour and privilege for my delegation to deliver this statement to thank the Director-General, on behalf of the European Region, for his long A51NR/11 page 192 and dedicated service to WHO and to the health of humankind. I am also discharging this pleasant duty on behalf of my Minister, the President of the European Regional Committee, who had to leave yesterday on account of his engagements in Turkey. Mr Director-General, you assumed your duties 10 years ago, when the European Region consisted mainly of affluent donor countries with fairly stable structures and well established health systems. However, within a short time your tenure coincided with the most historic and tumultuous changes in our Region. The ensuing events took Europe through one of the greatest challenges of our century. The consequent political, social and economic transition has brought with it responsibilities for WHO as well as increased expectations of, and demands on, it. The European region now has 51 Member countries, with a great diversity of health needs. Europe at the end of the current millennium is a region which faces similar health challenges as the others. Under your leadership, WHO has responded to such challenges to the best of its capabilities, but more needs to be done in terms of analyses, resources and remedies. We are grateful to you for all the support you provided us all in our search for a more equitable system of sharing our common resources globally. Dr Nakajima, during your term the European Region, together with the rest of the world, faced the changes engendered by globalization and the technological revolution, and which had a dramatic impact on the health sector. We now have to redefine the responsibilities ofthe State and society in delivering the necessary health services to all. Trying to establish a balance between benefiting from the global liberalization of trade and stemming the possible negative impacts of this process has been no easy task, either for Member countries or for the Organization. In responding to these challenges WHO, in its health-for-all advocacy role, has had to revise its mission, functions and priorities. You successfully undertook this by renewing the health-for-all-policy for the twenty-first century, which we hope will achieve its ultimate aim of placing health at the centre of sustainable development. I have been asked to confine my statement to two or three minutes, therefore I will not try to enumerate all of Dr Nakajima's contributions to the work of WHO during his long career. However, I would like to mention a few, like his initiative to publish a yearly world health report, his efforts to put WHO in the forefront in its fight against infectious diseases, his activities to place the health of women and reproductive health on the international health agenda, which were all well appreciated. Mr Director-General, despite all the upheavals, both on global and regional scales, and in the face of the consequent demanding tasks, you undertook your duties with modesty, sincerity and a desire to listen, understand and respond. We wish to thank you most sincerely for leading this Organization through trying times, maintaining its credibility and reliability as the ultimate arbiter of health within the United Nations system. Please accept Mr Director-General, the best wishes of the European Region for good health and happiness for you and your family in the future. Taking this opportunity, I also wish you today a happy birthday and many happy returns. With the indulgence of our interpreters, I would like to say thank you and goodbye to you in your own language. The PRESIDENT: Thank you, I now call upon the delegate of Egypt to speak on behalf of the Eastern Mediterranean Region. Dr ZAHRAN (Egypt): A51NRI11 page 193 y f'~ a.,. _;Ajl o~ ~t; .a...k.WI o-4) l...t:.J.>.. L.~ l_r....v ~JL,. J~ o~l y~l ~ ~i ;;1J..UI o~ _j L>JW4 W...u.~i 0iJ ~)1 ~I I~ jfrll+.~4 JJ..UI ~I~ ~'YI JJ,:) 1'""'"4 JLc-:;11 uP\..,:. .y- 4J .~ _,::11 4J y.)J . 4--4-- ~bi _;. ~ j..-l5JI JJ..UI 4>-b..i ~~ ~~ ..::..L>.~\'1 J,ii· ... 11 _;. L,...w ~~ a...k.WI ~l.r. _; r.?IJ ui ~i Y,.;J 4-.rJIJ a;.k l.il\ ~~;~I~ 0~1 4J (.~ -~1 ~\ ..::..l>.~')\1 a.,.\..,:.~ _r..iJ a..~~ yL:ll ~I y~ ~IJ..UIJ c_')L...U 4...;.,.W1 oul_r .!,.U.lS"'J .ab-L... ~~ o;J..UI o~ _;. )} ~~ ;.J..p ~I a.b....JI · . ..::..4..,.WI ~ .:r l_r.5' lj~ L...!.A; '.Y~I ~ ..;4~ ,..::..4_,AA.U ~i-ll; vP ~ .~_,::11 iiJ,:)J ;;,:)lA.....liJ ~~ ~ y.)J ,~1 ~?- rS~i The PRESIDENT: Thank you. I now call upon the delegate oflndonesia to speak on behalf of the South-East Asia Region. Dr WASISTO (Indonesia): Mr President, distinguished delegates, ladies and gentlemen, on behalf of delegations of the South-East Asia Region, allow me to extend our thanks to all delegates to the World Health Assembly for their cooperation. Cooperation and tolerance developed in this Assembly will make this Organization stronger in the coming years. I would also like to thank the President and Vice-Presidents for steering the Assembly successfully. With your leadership, we have achieved a lot to strengthen our Organization. I would like to thank Dr Nakajima and WHO for giving us full support in the conduct of the plenary sessions as well as the committee meetings. Without your support it would have been impossible for us to hold successful discussions. Our thanks also go to the Chairmen and Vice-Chairmen of Committees A and B. Under your effective leadership, it was possible to resolve difficulties in the committee discussions. Much consensus was reached in those Committees. A lot has been done by this Assembly and this achievement will be beneficial for Members of the Organization in their effort to improve the health status of global populations. I wish to express our special thanks and appreciation to Dr Nakajima who will terminate his duties in July. Although you will no longer be with WHO, your contributions and thoughts are awaited. We are well aware of your great achievements during I 0 years of service as Director-General. Dr Brundtland, the new Director General, I would like to welcome you and assure you that the Member countries of the South-East Asia Region will closely cooperate with you in your next task. Finally, to friends and colleagues returning to their respective countries, I would like to say bon voyage and I hope we see you again next year in this Assembly. The PRESIDENT: Thank you. I now call upon the delegate of Argentina to speak on behalf of the Region of the Americas. El Profesor PICO (Argentina): Seiior Presidente: En primer termino queremos agradecer y felicitar a usted y a Ios seiiores Vicepresiden tes por el excelente trabajo realizado durante esta Asamblea. Tambien queremos agradecer a Ios seiiores Presidentes y Vicepresidentes de las Comisiones A y B, y fundamentalmente a todos Ios delegados que con un trabajo comprometido y responsable dieron el marco ideal para alcanzar Ios objetivos propuestos en esta Asamblea. En nombre de Ios pafses que integran la Region de las Americas, queremos rendir un merecido homenaje al Director General de nuestra Organizaci6n, Dr. Hiroshi Nakajima, por Ios diez aiios de intenso trabajo que ha dedicado a la Organizaci6n, por su idoneidad y, fundamentalmente, compromiso, entrega que mucho agradece mos, durante estos ultimos aiios como Director General. Es un testimonio que surge de lo mas profundo de nuestros corazones brindar al Dr. Nakajima este merecido homenaje, en especial por su dedicaci6n en favor de la salud de toda la poblaci6n del mundo. Durante estos aiios de labor del Dr. Nakajima, responsable y comprometida con Ios objetivos de nuestra Organizaci6n, hemos visto y compartido con el muchos avances hacia la ambiciosa meta de salud para todos. Es por ello, Dr. Nakajima, que queremos agradecer su calido trato, que en todo momento facilit6 nuestro desempeiio y el trabajo en com6n, buscando la convergencia de criterios en pos del consenso necesario entre A51NR/11 page 194 todos aquellos que en Ios distintos lugares del mundo trabajamos por un solo objetivo: dar mas y mejor salud a toda nuestra poblacion. Asimismo, Dr. Nakajima, queremos felicitarlo por su merecida designacion como Director Emerito de nuestra Organizacion en reconocimiento por la labor realizada. Que Dios lo bendiga a usted y a toda su familia, y le deseamos el mayor de Ios exitos en su futuro profesional y humano. Estamos seguros de que continuara trabajando y aportando sus conocimientos y capacidades con el fin de hacer mas facil la tarea en que todos estamos empeil.ados. Este seguro, Dr. Nakajima, de que lo vamos a tener siempre presente y lo vamos a extrail.ar; su aporte va a quedar en nuestro recuerdo. Muchas gracias por su deferente atencion, por su perma nente estimulo y por promover el trabajo en conjunto. Tambien queremos saludar en esta Asamblea a nuestra proxima Directora General, Dra. Brundtland, a quien comprometemos nuestro apoyo confiando en su capacidad de conduccion para continuar mejorando el proceso tecnicoadministrativo de gestion de nuestra Organizacion frente a Ios crecientes desafios del futuro. Su designacion ha posibilitado otro momento de nuestros 50 ail.os de vida y le brindamos nuestro apoyo y nuestra colaboracion. Por ultimo, a ustedes, a nuestros queridos amigos y compail.eros integrantes de las distintas delegaciones de todos Ios paises del mundo, les deseamos en nombre de Ios paises de la Region de las Americas un muy cordial saludo. Un deseo muy fraternal de un feliz regreso a sus hogares y que Dios quiera que el ail.o que viene nos pueda encontrar, tal vez no personalmente a nosotros, pero si a cada uno de nuestros paises, trabajando por el mismo objetivo: salud para todos y por todos. Muchas gracias. The PRESIDENT: Thank you. Now I give the floor to the delegate of South Africa to speak on behalf of the African Region. Dr DLAMINI ZUMA (South Africa): On behalf of the African Region, I would like to thank Dr Nakajima for his invaluable contribution to world health. When Dr Nakajima took office, some of the countries in our Region were still involved in the struggles for liberation and they received, under his leadership, a lot of support from WHO, which not only highlighted the plight of their people and the health conditions but also supported their struggle in general. Dr Nakajima has indeed played a key role in WHO health reform and we are grateful for his special attention to developing countries and countries in our Region in particular. And we have seen some of the results of his work in the decisions that were taken by this Assembly. We are also grateful for the fiftieth anniversary celebrations of the World Health Organization which have acted as an inspiration to all of us and have invigorated all of us involved in health in our respective countries. Congratulations on this wonderful and inspiring celebration, Dr Nakajima. We also know that it has not always been easy, but your patience, tenacity and dedication to world health have made it possible for the Organization, under your leadership, to achieve what has been highlighted right through this Assembly and during the fiftieth celebration. We wish you a happy seventieth birthday and we hope that you have many more happy years and a brighter future. We hope that, as Director-General Emeritus, you will look back on the past decade with pride and satisfaction for the time well spent in promoting health for all. We hope that WHO will continue to draw from Dr Nakajima's experience in the years ahead. We would like to thank all those who have worked with Dr Nakajima over the past I 0 years because we know that his achievements are a result of their hard work. A very warm thanks to all of you, and I hope that you will give the same support and dedication to the new Director-General. Dr Nakajima, as you pass the baton to the new Director-General, indeed WHO seems to be poised for greater achievements. On behalf of the African Region, I would like to say, Dr Nakajima, thank you very much for your leadership and I wish you all the best. The PRESIDENT: It is now my turn to give the closing remarks. Honourable guests, delegates, Director-General, ladies and gentlemen, we reach the end part of a very intensive week of work during which you were able to conclude the heavy agenda combining discussions of important issues, the celebration of the fiftieth anniversary of the World Health Organization and the election of a new Director-General. I feel honoured and proud to preside over this historical Fifty-first World Health Assembly. This honour transcends me personally to encompass my country, Bahrain, as well as the countries A51NR/11 page 195 of the Eastern Mediterranean Region. We had the privilege to listen to an optimistic World health report which highlights an encouraging improvement in the overall world health situation. The positive results should not, however, hide the enormous task ahead of us to continuously lower the burden of diseases and promote health and well-being throughout the world, paying special attention to countries and communities most in need. I am confident that through our collective commitment, action and cooperation we can make health for all a reality. Our receptiveness to the new health, social, economic and environmental challenges and the renewed framework for health for all in the twenty-first century should inspire us in this endeavour. We have elected a new Director-General, Or Gro Harlem Brundtland, to whom we reiterate our best wishes for success. At this point, let me express once again to Or Hiroshi Nakajima our gratitude for the remarkable services he has rendered to WHO and to the improvement of world health during his term of service. We had also the great privilege to celebrate the fiftieth anniversary of WHO with outstanding guests, many partners and, of course, with all of you. This anniversary is a pride to all of us and confirms that the health of the world needs WHO. Let us continue the celebration in our countries through dedicated work for the cause of health and by demonstrating and sharing our achievements. The Chairmen of Committees A and B have just outlined the major health issues and our resolutions debated in their Committees. I would like, on my own behalf and on behalf of the Vice-Presidents and the whole Assembly, to thank the Chairmen and Vice-Chairmen, Rapporteurs and Secretaries of both Committees for the excellent work done in a very limited time. Finally, I would like to extend my sincere thanks to all of those who have contributed to the work of the Fifty-first World Health Assembly, especially those behind the scenes and the interpreters, for their patience and willingness to cope with extended hours of work. I wish you success in pursuing your health development actions and safe return to your respective countries. I thank you for your attention and wish you all bon voyage and a safe journey home. The session closed at 13:30. La session est close a 13h30. A51NR page 197 COMPOSITION DE L'ASSEMBLEE DE LA SANTE MEMBERSHIP OF THE HEALTH ASSEMBLY LISTE DES DELEGUES ET AUTRES PARTICIPANTS LIST OF DELEGATES AND OTHER PARTICIPANTS DELEGATIONS DES ETATS ALBANIE - ALBANIA MEMBRES Chef de delegation - Chief delegate Or L. Solis DELEGATIONS OF MEMBER Minister of Health STATES Delegue(s) - Delegate(s) MrT.Melo Head, Foreign Relations and Coordination, Ministry of Health MrA. Gjonej AFGHANISTAN- AFGHANISTAN Ambassador, Permanent Representative, Geneva Chef de delegation - Chief delegate ALGERIE - ALGERIA M. H. Tandar Ministre conseiller, Charge d'affaires, Mission permanente, Geneve Chef de delegation - Chief delegate Professeur Y. Guidoum AFRIQUE DU SUO - SOUTH AFRICA Ministre de la Sante et de la Population Delegue(s) - Delegate(s) Chef de delegation - Chief delegate M. M.-S. Dembri Or N.C. Dlamini Zuma Ambassadeur, Representant permanent, Geneve Minister of Health Or A. Kara-Mostepha Delegue(s)- Delegate(s) lnspecteur general, Ministere de la Sante et de la Population Or 0. Shisana Director-General, Ministry of Health Suppleant(s) - Alternate(s) Professeur J.-P. Grangaud Mr J. Selebi Directeur de la Prevention, Ministere de la Sante et de la Population Ambassador, Permanent Representative, Geneva DrS. Mesbah Suppleant(s) - Alternate(s) Directeur general, lnstitut national de Sante publique Mr J.H.O. Pretorius Deputy Director-General, Department of Health M. A. Boucettas Charge d'Etudes et de Syntheses, Ministere de la Sante et de la Or J.M. van Heerden Population Chief Director, National Programmes M. M. Messaoui Mrs C. Makwakwa Ministre conseiller, Mission permanente, Geneve Director, International Health Liaison M. H. Khedouci Ms C. Mashego Chef du Protocole, Ministere de la Sante et de la Population Department of Health and Welfare Conseiller(s) - Adviser(s) ALLEMAGNE-GERMANY Ms S. Dubazani Private Secretary to the Minister Chef de delegation - Chief delegate MrV.R. Mabope Mr H. Voigtlllnder Chief Director, Health Systems Director, Directorate for EU Affairs, International Cooperation in the Field of Health, Federal Ministry of Health Ms R. Mazibuko Chief Director, Department of Health, Northern Province Delegue(s)- Delegate(s) MrH. Eberle Or D.K. Johns Health Attache Deputy Permanent Representative, Permanent Mission, Geneva Or M. Schaefer Ms B. Qwabe First Counsellor, Permanent Mission, Geneva Second Secretary, Permanent Mission, Geneva A51NR page 198 Suppleant(s) - Altemate(s) Or G.A. Miguel Expert du Ministere des Relations exteneures MrM.Debrus Head of Division, International Cooperation in the Field of Health, M. M. de Azevedo Constantino Language Services, Federal Ministry of Health Deuxieme Secretaire, Mission permanente, Geneve Mr W. Koschorrek Head of Division, Budgetary Matters of International and Supranational Organizations and the United Nations, Federal Ministry ARABlE SAOUDITE -SAUDI ARABIA of Finance Chef de delegation - Chief delegate Mr P. Silberberg Deputy Head of Division, Federal Foreign OffiCe Professor 0. Shobokshi Minister of Health DrBrummer Bavarian State Ministry for Labour and Social Affairs, Family Affairs, Delegue(s) - Delegate(s) Women and Health Professor KM. Makboul Or C. Luetkena Deputy Minister for Executive Affairs Head of Division, Hessian Ministry for Energy, Environment, Youth, Family Affairs and Health Or M.H. AI-Jefri Director-General, Parasitic and Infectious Diseases Mr U. Kalbilzer Counsellor, Permanent Mission, Geneva Suppleant(s) - Altemate(s) Or A.M. AI-Khaldi DrE.Aderhold Minister's Consultant First Secretary, Permanent Mission, Geneva Mr H.M. AI-Fakheri Ms H. Jirari Director-General, Planning Third Secretary, Permanent Mission, Geneva Mr A.O. AI-Khattabi Or R. Korte Director-General, International Health Department Head, Directorate General for Health, German Agency for Technical Cooperation, Eschbom Mr N.H. Qutub Conseiller(s) - Adviser(s) External Relations Director, Minister's OffiCe, Ministry of Health MsM.G'- Mr M.A. AI-Suraihi Advi&er, Permanent Mission, Geneva First Secretary, Permanent Mission, Geneva Mr A. At-Sheikh First Secretary, Permanent Mission, Geneva ANDORRE-ANDORRA Chef de delegation - Chief delegate ARGENTINE -ARGENTINA Mr J.M. Goicoechea Minister of Health and Welfare Chef de delegation - Chief delegate Delegue(s) - Delegate(s) Dr. A.J. Mazza Ministro de Salud y Acci6n Social Mrs R.M. Mandic6 Director of Health and Welfare Chef adjoint de la delegation - Deputy chief delegate Profesor A. L. Pico ANGOLA- ANGOLA Subsecretario de Politicas de Salud y Relaciones lnternacionales, Ministerio de Salud y Acci6n Social Chef de delegation - Chief delegate Delegue(s) - Delegate(s) M. A. Rubella Sicato Ministre de la Sante Sr. M. Benltez Ministro, RepreMntante Permanente Adjunto, Ginebra Delegue(s) - Delegate(s) Suppleant(s) - Altemate(s) M. L. da Costa e Silva Ministre conseiller, Charge d'affaires a.i., Mission permanente, Geneve Ora. M.M. Pico Asesora de la Subsecretarla de Salud y Relaciones lnternacionales, DrJ. Saweka Ministerio de Salud y Acci6n Social Directeur du Cabinet des Relations internationales Sr. E. Varela Suppleant(s) - Altemate(s) Consejero, Misi6n Permanente, Ginebra Or A.F.R. da Costa Hernbe Directrice nationale de la Sante publique, Ministere de la Sante Or J.V. Dlas Vandunem Directeur du Plan, Ministere de la Sante Or F. de Jesus Fortes Directeur national du ContrOie d'Endemie, Ministere de la Sante A51NR page 199 ARMENIE - ARMENIA Or S. Weinberger Federal Ministry of Labour, Health and Social Affairs, Department of Public Health Chef de delegation - Chief delegate Or B. Sayadyan Suppleant(s) - Altemate(s) Deputy Minister of Health Or H.-D. Rennau Minister, Federal Ministry of Foreign Affairs Delegue(s) - Delegate(s) Or A. Mkrtchian Mr U. Frank Director of the State Health Agency Secretary, Permanent Mission, Geneva Or A. Ter-Grigorian Director, Department of International Relations, Humanitarian AZERBAIDJAN - AZERBAIJAN Assistance and Foreign Investments, Ministry of Health Chef de delegation - Chief delegate AUSTRALIE -AUSTRALIA Professor A. lnsanov Minister of Health Chef de delegation - Chief delegate Delegue(s) - Delegate(s) Professor J. Whitworth Mrs S. Eivazova Chief Medical OffiCer, Department of Health and Family Services Ambassador, Permanent Representative, Geneva Chef adjoint de la delegation - Deputy chief Or A. Umnyaihkin delegate Chief Specialist on International Affairs, Ministry of Health Mr J. Campbell Suppleant(s) - Alternate(s) Ambassador, Permanent Representative, Geneva Or F. Abdullaev Delegue(s) - Delegate(s) Director, Institute of Pulmonology DrN.Biewett Mr T. Moussaev Australian High Commissioner, London Third Secretary, Permanent Mission, Geneva Suppleant(s) - Alternate(s) MsS.Ingram Assistant Secretary, Industry Development and International Branch, BAHAMAS-BAHAMAS Department of Health and Family Services Chef de delegation - Chief delegate Ms J. Bennett Assistant Secretary, National Public Health Planning, Mr L. Tumquest Department of Health and Family Services Parliamentary Secretary, Ministry of Health MrC.Knott Delegue(s) - Delegate(s) Director, International Organizations Section, Department of Health Or M. Dahi-Regis and Family Services Chief Medical Officer, Ministry of Health Mr A. Macdonald Counsellor (Development Assistance), Permanent Mission, Geneva BAHREIN - BAHRAIN Ms L. Petralia Multilateral Agencies and International Health Section, Australian Chef de delegation - Chief delegate Agency for International Development Or F.R. AI-Mousawi Mr E. van der Wal Minister of Health First Secretary, Permanent Mission, Geneva Delegue(s) - Delegate(s) Or A.A. Ahrned AUTRICHE - AUSTRIA Assistant Under-Secretary for Training and Planning Chef de delegation - Chief delegate Mr A.-M. AI-Haddad Ambassador, Permanent Representative, Geneva Or E. Fritz Director, Federal Ministry of Labour, Health and Social Affairs, Suppleant(s) - Altemate(s) Department of Public Health (Chef de delegation du 11 au 14 mal) Mr I.E. Akbari (Chief delegate from 11-14 May) Chief, International Health Relations Delegue(s) - Delegate(s) Mrs L. Abdui-Rahman Director, Pharmacy and Drug Control Or V. Gregorich-Schega Federal Ministry of Labour, Health and Social Affairs, Department of MrsKAI-Goud Public Health Chief, Nursing Services (Chef de clelegation du 15 au 16 mai) (Chief delegate from 15-16 May) Mr R.A. Dhaif Director, OffiCe of the Minister of Health A51NR page200 BANGLADESH-BANGLADESH BELGIQUE - BELGIUM Chef de delegation - Chief delegate Chef de delegation - Chief delegate Mr S.U. Yusuf M. M. Colla Minister for Health and Family Welfare Ministre de la Sante publique et des Pensions Delegue(s) - Delegate(s) Chef adjoint de la delegation - Deputy chief Or I.A. Chowdhury delegate Ambassador, Permanent Representative, Geneva M. J.-M. Noirfalisse Ambassadeur, Representant permanent, Geneve Professor A.KM. Nurul Anwar Director-General of Health Services, Ministry of Health and Family Delegue(s) - Delegate(s) Welfare Dr W. Brunson Suppleant(s) - Altemate(s) Directeur general de la Sante de la Communaute fra~ise Mr M.S. Islam Suppleant(s) - Alternate(s) Counsellor, Permanent Mission, Geneva Mrne C. Hoedemakers Conseiller(s) - Adviser(s) Chef de Cabinet adjoin! du Ministre DrK Rahrnan Mrne T. Belhouari Counsellor, Permanent Mission, Geneva Attachee au Cabinet du Ministre, charge de la Sante pour la Region de Bruxelles Professor S.R. Begum Professor of Gynecology, Dhaka M. A. Berwaerts Conseiller general, Ministere federal des Affaires sociales, de la Sante Professor S.M. AH publique et de rEnvironnement, Service des Relations internationales Director, National Institute of Opthalmology, Dhaka Mrne P. Megal Conseiller adjoin!, Ministere federal des Affaires sociales, de la Sante BARBADE-BARBADOS publique et de rEnvironnemenl, Service des Relations internationales M. G. Thiers Chef de delegation - Chief delegate Directeur, lnstitut scientifique de la Sante publique Louis Pasteur Mrs E. Thornpson Dr J. Laruelle Minister of Health and the Environment Charge du Bureau des Organismes specialises pour la Cooperation indirecte multilaterale de !'Administration generale de la Cooperation Delegue(s)- Delegate(s) au Developpement Or E. Ferdinand Chief Medical OffiCer, Ministry of Health and the Environment Mme S. Gerlo Ministre conseiller (Representante de !'Administration generale de la Miss L. Wharton Cooperation au Developpernenl), Mission perrnanente, Geneve Deputy Permanent Secretary, Ministry of Health and the Environment M. R. Lonfils Medecin-Directeur, Direction generale de la Sante de la Communaute fra~ise BELARUS - BELARUS M. T. Lahaye Chef de delegation - Chief delegate Conseiller adjoin!, Commission communautaire franc;aise Mr I. Zelenkevich M. J. Dams Minister of Health Adjoin! au Directeur, Direction Soins de Sante de la Communaute flamande Chef adjoint de la delegation - Deputy chief delegate M. Vinck Attache, Mission permanenle, Geneve Mr S. Agurtsou Ambassador, Permanent Representative, Geneva M. C. Bourgoignie Delegue de la Communaute franc;;aise Wallonie-Bruxelles, Mission Delegue(s) - Delegate(s) perrnanente, Geneve Mr E. Glazkov M. G. Schuermans Head, Foreign Relations Department, Ministry of Health Conseiller, Cabinet federal, Sante publique et des Pensions Conseiller(s) - Adviser(s) Conseiller(s) - Adviser(s) MrA.Ivanou Professeur F. Baro Counsellor, Permanent Mission, Geneva Directeur, St-Kamillus-lnstituut, Katholieke Universiteit Leuven Professeur R. Lagasse President, Ecole de Sante publique, Universite libre de Bruxelles Mme C. Gosset Chef de Travaux, Service de Sante publique et d'Epidemiologie, Universite de Liege A51NR page201 Professeur C.H. Thilly Suppleant(s) - Alternate(s) Professeur ordinaire, Ecole de Sante publique de runiversite libre de Bruxelles MsN. Wangmo Training Off~cer, Health Division, Ministry of Health and Education MrK. Singye BELIZE-BELIZE First Secretary, Permanent Mission, Geneva Chef de delegation - Chief delegate MrS. Tobgay Third Secretary, Permanent Mission, Geneva Mr s. Femandez Minister of Health and Sports Delegue(s)- Delegate(s) BOLIVIE - BOLIVIA DrM.Pitts Chef de delegation - Chief delegate Director, Health Services Dr. T. Marinkovic Uzqueda Mr J.F. Tamer Ministro de Salud Ambassadeur, Representant permanent, Geneve Delegue(s) - Delegate(s) Sra. S. Avila Seifert BENIN - BENIN Embajadora, Representante Permanente, Ginebra Chef de delegation - Chief delegate Dr. H. Chavez la Faye Secretario General y Asesor del Ministro de Salud Mme M. d'Aimeida Massougbodji Ministre de la Sante, de la Protection sociale et de la Condition Suppleant(s) - Altemate(s) feminine Sr. J. Loayza Barea Delegue(s) - Delegate(s) Ministro, Misi6n Permanente, Ginebra M. P. Dossou-Togbe Secretaire general, Ministere de la Sante, de la Protection sociale et de la Condition feminine BOSNIE-HERZEGOVINE - BOSNIA AND HERZEGOVINA Mme M.-S. V1eyra Directrice de la Protection sociale, Ministere de la Sante, de la Chef de delegation - Chief delegate Protection sociale et de la Condition feminine MrS. Fadzan Suppleant(s) - Altemate(s) Counsellor, Permanent Mission, Geneva Mme H. Kossou Delegue(s) - Delegate(s) Chef, Service Epidemiologie et Surveillance sanitaire, Ministere de la Sante, de la Protection sociale et de la Condition feminine Professor A. Smajkic Mme E. Traore Dr B. Hrabac Chef, Service Sante maternelle et infantile, Ministere de la Sante, de la Protection sociale et de la Condition feminine Suppleant(s) - Altemate(s) M. J.-M. Ahyi DrZ. Rodic Chef, Service Programmation, Reglementation et Documentation, Ministere de la Culture et de la Communication DrZ. Pavic M. H. Tchibozo Mrs N. Ruzdic Attache de Cabinet du Ministre de la Sante, de la Protection sociale et de la Condition feminine M. M. Beria BOTSWANA-BOTSWANA Attache de presse du Ministre de la Sante, de la Protection sociale et de la Condition feminine Chef de delegation - Chief delegate Mr C.J. Butale Minister of Health BHOUTAN - BHUTAN Delegue(s) - Delegate(s) Chef de delegation - Chief delegate Mr B. Mokgothu Mr J.Y. Thinley Assistant Minister of Local Government, lands and Housing Ambassador, Permanent Representative, Geneva Mrs W.G. Manyeneng Delegue(s) - Delegate(s) Assistant Director of Health Services, Primary Health Care, Ministry of Health MrS. Ngedup Deputy Minister, Ministry of Health and Education Dr S. Thinley Joint Director, Health Division, Ministry of Health and Education A51NR page202 Suppleant(s) - Altemate(s) Chef adjoint de la delegation - Deputy chief delegate Mrs M. Tselayakgosi Principal Planning Off1C81" Dato Mr Haji ldriss Ambassador, Permanent Representative, Geneva Miss M. Mackenzie (Chef de delegation adjoint du 11 au 14 mai) Chief Registered Nurse, Hukuntsi Primary Hospital (Deputy chief delegate from 11 to 14 May) Mr S. Ramotlhwa D81egue(s) - Delegate(s) Principal Pharmacist Or Hajah lntan Salleh Deputy Director of Health Services, Ministry of Health (Chef de delegation du 15 au 16 mai) BRESIL - BRAZIL (Chief delegate from 15 to 16 May) Chef de delegation - Chief delegate Suppl8ant(s) - Alternate(s) Mrs A. Jaafar DrJ.Sena Assistant, Director of Medical and Health Services, Ministry of Health Minister of Health Chef adjoint de la delegation - Deputy chief Mr Haji G. Osman Minister Counsellor, Charge d'affaires a.i., Permanent Mission, delegate Geneva Mr C. Lafer Ambassador, Permanent Representative, Geneva Mri.Aii Chief of Medical R-rch, Ministry of Health Delegue(s) - Delegate(s) Mr Haji A. Abu Suf1an Mr C.A. Simas Magalhles Second Secretary, Permanent Mission, Geneva Minister Counsellor, Permanent Mission, Geneva Suppl8ant(s) - AHemate(s) BULGARIE - BULGARIA Mr E.O. Rubarth Head, International Division, Ministry of Health Chef de d81egation - Chief delegate Mr F.S. Duque Estrada Meyer Professor P. Boyadjiev Counsellor, Permanent Mission, Geneva Minister of Health Or C.M. More! Chef adjoint de la d81egation - Deputy chief R-rcher. Oswaldo Cruz Foundation delegate Or J.C. Seixas MrV.Ivanov Professor, School of Public Health, University of SAo Paulo Head, Department of International Organizations and Human Rights, Ministry of Foreign Affairs DrJ. Yunes Professor, School of Public Health, University of SAo Paulo D81egue(s) - Delegate(s) Mr J. Barbosa da Silva Jr MrK Andreev Director, National Center of Epidemiology Deputy Permanent Representative, Geneva Ms L. Rodrigues Cannon Suppl8ant(s) - Alternate(s) Coordinator of the Secretary of Planning, Ministry of Health Or S. Koulaksazov Head, Department of Health Policy and International Cooperation, Mr P.J. deN~ Chequer Ministry of Health National Coordinator, Program on STD/AIDS Ms M. G. David Lopes President, Brazilian Nursing Association BURKINA FASO - BURKINA FASO Mr L. Coelho de Souza Chef de delegation - Chief delegate Second Secretary, Permanent Mission, Geneva M. AL. Tou MrM.Moraes Ministre de la Sante Director, National Institute of Cancer (INCA) Del8gue(s) - Delegate(s) Or B.M. Sombie BRUNEI DARUSSALAM - BRUNEI DARUSSALAM Or Zoundi M. Therese Guigui Chef de delegation - Chief delegate Mr P. Abdul Aziz Umar Minister of Health (Chef de delegation du 11 au 14 mai) (Chief delegate from 11 to 14 May) A51NR page203 BURUNDI - BURUNDI Conseiller(s) - Adviser(s) Mrs P. Picard Chef de delegation - Chief delegate Member of Parliament Or J.M. Kariburyo Mr J.-G. Finn Ministre de la Sante publique Deputy Minister of Health, Province of New Brunswick Delegue(s) - Delegate(s) Or Y. Bergevin Or L. Mboneko Health and Population, Policy Branch, Canadian International lnspecteur general de la Sante publique Development Agency M. A. Nahayo MrsA. Emond Ambassadeur, Representant permanent, Geneve Department of Health and Social Services, Province of Quebec Suppleant(s) - Alternate(s) Or M.E. Jeans Executive Director, Canadian Nurses Association Or T. Nyunguka Conseiller technique charge de la Planif~eation, Ministere de la Sante publique CAP-VERT - CAPE VERDE CAMEROUN-CAMEROON Chef de delegation - Chief delegate Or J.B. Ferreira Medina Chef de delegation - Chief delegate Ministre de la Sante et de la Promotion sociale Professeur G.L. Monekosso Delegue(s) - Delegate(s) Ministre de la Sante Or I.A. de Sousa Carvalho Chef adjoint de la delegation - Deputy chief Conseiller du Ministre delegate Mme A. F. Soares da Cruz M. F.X. Ngoubeyou Technicien superieur. Ministere de la Sante et de la Promotion sociale Ambassadeur, Representant permanent, Geneve Delegue(s) - Delegate(s) CHILl - CHILE Or Y. Boubakari Chef, Division de la Cooperation, Ministere de la Sante Chef de delegation - Chief delegate Suppleant(s) - Alternate(s) Dr. F. Mul\oz VICenlinistro de Salud DrO.E. Rene Directeur de la Sante communautaire, Ministere de la Sante Delegue(s)- Delegate(s) Professeur P.M. Ndumbe Sr. L. Lillo President du Comite national de la Lutte contre le Sida Representante Permanente Altemo, Ginebra Suppleant(s)- Alternate(s) CANADA-CANADA Sr. C. Anriquez Jefe de la Of~eina de Cooperaci6n y Asistencia lnternacional, Chef de delegation - Chief delegate Ministerio de Salud MrA. Juneau Sr. A. Labbe Assistant Deputy Minister, Policy and Consultation Branch Consejero, Misi6n Permanente, Ginebra Delegue(s) - Delegate(s) Srta. X. Ares Segundo Secretario, Misi6n Permanente, Ginebra MrM. Moher Ambassador, Permanent Representative, Geneva Suppleant(s) - Alternate(s) CHINE - CHINA Mr E. Aiston Director-General, International Affairs Directorate Chef de delegation - Chief delegate Or Zhang Wenkang Or J. Lariviere Minister of Health Senior Medical Adviser, International Affairs Directorate Delegue(s) - Delegate(s) Mr A. McAiister Deputy Permanent Representative, Geneva Mr Wu Jianmin Ambassador, Permanent Representative, Geneva MsJ. Perlin Counsellor, Permanent Mission, Geneva Mr Liu Peiiong Director-General, Department of International Cooperation, Ministry of Health A51NR page204 Suppleant(s) - Altemate(s) CHYPRE-CYPRUS Or Kan Xuegul Director-General, Department of Health Inspection, Ministry of Health Chef de d81egation - Chief delegate DrYu Uxuan MrC.Solornis Director-General, Provincial Department of Health Minister of Health Or Li Jianguo D81egue(s)- Delegate(s) Director, First Division, Department of Disease Control, Ministry of Mr A. Patzinakos Health Permanent Secretary, Ministry of Health Or Ql Qlngdong Mr P. Eltychiou Deputy Director, Division of International Organizations, Department Ambassador, Permanent Representative, Geneva of International Cooperation, Ministry of Health Suppleant(s)- Alternate(s) DrWang Liji Deputy Director, Division of General Administration, Department of Mr P. Kestoras International Cooperation, Ministry of Health Counsellor, Permanent Mission, Geneva Or LiNing Mrs C. Kornodiki Secretary, Department of General Administration, Ministry of Health Chief Health OffiCer, Ministry of Health MsWuJihong Mrs I. Atteshli First Secretary, Ministry of Foreign Affairs Director of Administration, Ministry of Health MrWu Huijun Conseiller(s)- Adviser(s) Second Secretary, Ministry of Foreign Affairs Or A. Vasiliou President, Pancyprian Medical Associatio~ Or M.F.C. Chan Director of Health, Department of Health, HK Special Administrative Region Mrs A. Tapakoudi President, Cyprus Nurses Association Mr Shi Yuanhua Deputy Permanent Representative, Geneva COLOMBIE -COLOMBIA Conseiller(s) - Adviser(s) Ms Liu Guangyuan Chef de d81egation - Chief delegate Programme OffiCer, Division of International Organizations, Department of International Cooperation, Ministry of Health Ora. M.T. Forero de Saade Ministra de Salud Ms Xue Puying Programme Officer, Division of International Organizations, D81egue(s)- Delegate(s) Department of International Cooperation, Ministry of Health Sr. G. Castro Guerrero Embajador, Representante Permanente, Ginebra Or Wei-Ling Lim Medical and Microbiological Adviser, Department of Health, HK Special Administrative Region Sra. A.A. Oviedo Arbelaez Ministra Consejera, Misi6n Permanente, Ginebra Mr Hou Zhenyi Suppleant(s) - Alternate(s) Counsellor, Permanent Mission, Geneva Sr. N. Osorio Mr Liu Xinsheng Misi6n Permanente, Ginebra First Secretary, Permanent Mission, Geneva Sr. J. Castellanos Robayo Mr Tong Xianguo Asesor, Ministerio de Salud First Secretary, Permanent Mission, Geneva Sra. A. Solano de Castro Mrs Zhao Yangling Misi6n Permanente, Ginebra First Secretary, Permanent Mission, Geneva Sr. R. Saade Mr Ll Xiaobin Ministerio de Salud First Secretary, Permanent Mission, Geneva Sra. B. Arbelaez Or Lu Rushan Misi6n Permanente, Ginebra Honorary Director, Institute of Medical Information of China, Academy of Medical Sciences Sr. A. Abella Attache, Misi6n Permanente, Ginebra A51NR page205 CONGO-CONGO Conseiller(s)- Adviser(s) MmeE. Koffi Chef de delegation - Chief delegate Journal isle M. M. Kamara Dekamo Ministre de la Sante et de la Population CROATIE - CROATIA Delegue(s) - Delegate(s) M. J. Nzikou Chef de delegation - Chief delegate Ambassadeur, Representant permanent, Geneve Professor Z. Reiner Deputy Minister, Ministry of Health Or D. Bodzongo Directeur general de la Sante publique Delegue(s) - Delegate(s) Suppleant(s)- Alternate(s) Or D. Bekic Ambassador, Permanent Representative, Geneva Or P. Nzaba Conseiller du Ministre de la Sante publique Conseiller(s)- Adviser(s) M. L.C. Mocko-Bangault Mrs S. Blazevic Attache, Permanent Mission, Geneva M. G. lssombo M. J. Moumbeti CUBA-CUBA M. J. Biabaroh-lboro Conseiller, Mission permanente, Geneve Chef de delegation - Chief delegate Dr. C. Dotres Martinez Ministro de Salud Publica COSTA RICA- COSTA RICA Chef adjoint de la delegation - Deputy chief Chef de delegation - Chief delegate delegate Sra. J. Del Vecchio Ugalde Sr. C. Amat Embajador, Representante Permanente, Ginebra Embajador, Representante Permanente, Ginebra Delegue(s) - Delegate(s) Delegue(s) - Delegate(s) Sr. J. Diaz Carmona Sr. E. Comendelro Hernandez Embajador, Representante Permanente Adjunto, Ginebra Director de Relaciones lnternacionales, Ministerio de Salud Publica Ora. E. Le6n Suppleant(s) - Alternate(s) Directora General de Salud, Ministerio de Salud Dr. R. Ruiz Armas Suppleant(s) - Alternate(s) Director de Atenci6n Medica, Ministerio de Salud Publica Sr. J. Alvarez Dr. J. Pil'l6n Vega Ministro Consejero, Misl6n Permanente, Ginebra Asesor del Ministro, Ministerio de Salud Publica Sr. A. Delgado Gonzalez Primer Secretario, Misi6n Permanente, Ginebra COTE D'IVOIRE -COTE D'IVOIRE Sra. M. E. Fiffe Cabreja Chef de delegation - Chief delegate Primer Secretario, Misi6n Permanente, Ginebra Professeur M. Kacou Guikahue Srta. A. Hernandez Quesada Ministre de la Sante publique Tercer Secretario, Misi6n Permanente, Ginebra Delegue(s) - Delegate(s) Dr. E.Zacca Director de Estadisticas, Ministerio de Salud Publica M. A. Essy Ministre des Affaires etrangeres Dr. J. Hadad Hadad Director de la Escuela Nacional de Salud Publica M. C. Bouah-Kamon Ambassadeur, Representant permanent, Geneve Dr. C. Ord61'1ez Suppleant(s) - Alternate(s) Ministerio de Salud Publica M. H.M. Kouassi Dr. P. Vilorio Premier conseiller, Mission permanente, Geneve Ministerio de Salud Publica Or A.R. Gbary Ora. A. Llop Directeur de la Sante communautaire, Ministere de la Sante publique Ministerio de Salud Publica M. C.Assi Dr. A. Garcia Chef, Service national de !'Information, de !'Education et de la Ministerio de Salud Publica Communication Dr. F. Sarson Ministerio de Salud Publica A51NR page206 Dr. I. Borrajero EGYPTE-EGYPT Ministerio de Salud Publica Chef de delegation - Chief delegate Drl. Sallam DANEMARK-DENMARK Minister of Health Chef de delegation - Chief delegate Delegue(s) - Delegate(s) Mr I. Valsborg DrM.Zahran Permanent Secretary, Ministry of Health Ambassador, Permanent Representative, Geneva Delegue(s) - Delegate(s) Professor W. Anwar Adviser to the Minister of Health and Population for ScientifiC Mr M. Jergensen Research and International Relations Director of International Affairs, Ministry of Health Suppleant(s) - Altemate(s) DrE.Krag Chief Medical OffiCe!', National Board of Health OrA. Badran Adviser to the Minister of Health and Population for Scientific Suppleant(s) - Altemate(s) Research and International Relations Mr H.H. Bruun Or Z. EI-Morsy Ambassador, Permanent Representative, Geneva Director, International Health Relation Department, Ministry of Health and Population Mr P.H. Rasmussen Minister Counsellor, Ministry of Foreign Affairs Conseiller(s) - Adviser(s) Mr 0. Torpegaard Hansen MrM. Tawlik Counsellor, Permanent Mission, Geneva Counsellor, Permanent Mission, Geneva Mr S. Thom&en MrT. Adel Head of Section, Ministry of Health First Secretary, Permanent Mission, Geneva Conseiller(s) - Adviser(s) Mr A. Youssef Third Secretary, Permanent Mission, Geneva Ms E. Vinding Chief Medical National Board of Health Deputy OffiCe!', MrA. Hafez Third Secretary, Permanent Mission, Geneva MsK. Ravn Chief Nursing OffiCe!', National Board of Health Or A.-M. Plesner EL SALVADOR - EL SALVADOR Staff Specialist, National Board of Health Chef de delegation - Chief delegate Ms C. Hansson Assistant Attach8, Permanent Mission, Geneva Dr. C.A. Rosales Director General de Salud Publica y Asister~eia Social, Ministerio de Salud Publica y Asistencia Social DJIBOUTI - DJIBOUTI Delegue(s) - Delegate(s) Chef de delegation - Chief delegate Sr. V.M. Lagos Pizzati Embajador, Representante Permanente, Ginebra M. A.M. Daoud Ministre de la Sante publique et des Affaires sociales Sr. M. Castro Grande Ministro Consejero, Misi6n Permanente, Ginebra Delegue(s) - Delegate(s) Or Kl. lbrahim EMIRATS ARABES UNIS- UNITED ARAB M. C.H. Houssein EMIRATES Chef de delegation - Chief delegate DOMINIQUE -DOMINICA Mr H.A. AI-Midfaa Minister of Health Chef de delegation - Chief delegate Mrs D. Paul Delegue(s)- Delegate(s) Minister of Health and Social Security Or M. Fikri Assistant Under-Secretary for Preventive Medicine, Ministry of Health Delegue(s) - Delegate(s) Or R. Nasiiro Mr N.S. AI Aboodi Chief Medical OffiCe!', Ministry of Health Ambassador, Permanent Representative, Geneva Or D. Artot Hospital Management Adviser A51NR page207 Suppleant(s) - Altemate(s) Conseiller(s) - Adviser(s) Mr A.M. AI Shamsi Sra. C. Garcia Alvarez Counsellor, Permanent Mission, Geneva Directora, Gabinete del Ministro de Sanidad y Consumo Mr N.K AI Bodour Sra. M. Saenz de Heredia Director, Foreign Relations Department and Ministry of HeaHh Subdirectora General de Organismos lntemacionales Tecnicos, Ministerio de Asuntos Exteriores Or Z.N. Khazal Preventive Medicine Expert Sr. P.A. Garcia Gonzalez Subdirector General de Relaciones lnternacionales, Ministerio de Or F. Bin Kalid AI Qasimi Sanidad y Consumo Assistant Under-Secretary, Ministry of HeaHh Sra. I. de la Mala Barranco Vocal, Asesora del Subsecretario de Sanidad y Consumo EQUATEUR-ECUADOR Sr. I. de Palacio Espana Consejero, Misi6n Permanente, Ginebra Chef de delegation - Chief delegate Sr. J.F. Baldieri Giannoni Dr. A. de la Torre Asesor de Prensa, Misi6n Permanente, Ginebra Ministro de Salud Publica Sra. E. Rodriguez Delegue(s) - Delegate(s) Jefe de Servicio de Asuntos lnternacionales, Minislerio de Sanidad y Consumo Sr. A. Rodas Pozo Ministro, Representante Permanente Adjunto, Ginebra Sr. F. Meneses Espinosa ESTONIE - ESTONIA Consejero, Misi6n Permanente, Ginebra Suppleant(s) - Altemate(s) Chef de delegation - Chief delegate Dr. M. Almeida MrA. Vask Asesor del Despacho, Ministerio de Salud Vice-Chancellor for HeaHh, Ministry of Social affairs Delegue(s) - Delegate(s) ERYTHREE - ERITREA Mr A. Kallikorm Head, European Integration and International Relations Department, Ministry of Social Affairs Chef de delegation - Chief delegate Or M. G. Hiwot Director of Clinical Services, Ministry of HeaHh ETATS-UNIS D'AMERIQUE- UNITED STATES Delegue(s) - Delegate(s) OF AMERICA Or M. Ghebrehiwet Chef de delegation - Chief delegate Director of Clinical Services, Ministry of HeaHh Or D.E. Shalala Or G. Tesfasellase Secretary of Health and Human Services Head, International Cooperation Office, Ministry of Health Chef adjoint de la delegation - Deputy chief Suppleant(s) - Altemate(s) delegate Mr B. Woldeyohannes Or D. Satcher Consul, Eritrean Consulate, Geneva Assistant Secretary of Health and Surgeon General, United States Public HeaHh Service, Department of HeaHh and Human Services ESPAGNE - SPAIN Delegue(s) - Delegate(s) Mr G. E. Moose Chef de delegation - Chief delegate Ambassador, Permanent Representative, Geneva Sr. R. Perez-Hemandez y Torra Suppleant(s)- Alternate(s) Embajador, Representante Permanente, Ginebra DrK Bemard Delegue(s)- Delegate(s) International Health Attache, Permanent Mission, Geneva Sr. E. Castell6n Mr N.A. Boyer Subsecretario, Minlsterio de Sanidad y Consumo Director for Health and Transportation Programs, Bureau of International and Organization Affairs, Department of State Sr. J.M. Martin Moreno Director, Escuela Nacional de Sanidad, Ministerio de Sanidad y Or N. Daulaire Consumo Deputy Assistant Administrator for Health, Population and Human Development Policy, Bureau for Policy and Programme Coordination, Agency for International Development Mr R.G. Loftis Counsellor for Political and Specialized Agencies Affairs, Permanent Mission, Geneva A51NR page208 Mrs L.A. Voget Chef adjoint de la delegation - Deputy chief Director, Office of International and Refugee Health, United States delegate Public Health Service, Department of Health and Human Services Mr G. Petreski Conseiller(s) - Adviser(s) Ambassador, Permanent Representative, Geneva Or W. Baldwln Delegue(s) - Delegate(s) Deputy Director for Extramural Research, National institutes of Health, Department of Health and Human Services Mrs B. Stefanovska-Sekovska First Secretary, Permanent Mission, Geneva Or S.B. Blount Assistant Director, Global Affairs, Centers for Disease Control and Suppleant(s) - Alternate(s) Prevention, Department of Health and Human Services Mr Z. Jolevski First Secretary, Permanent Mission, Geneva Mr E. Cummings Counsellor for Legal Affairs, Permanent Mission, Geneva Or S. llievska Counsellor, Ministry of Health Or H. Gayle Director, National Center for HIV, STD and TB Prevention, Centers for Disease Control and Prevention, Department of Health and Human Services FEDERATION DE RUSSIE - RUSSIAN Ms D. Gibb FEDERATION Human Resources Coordinator, OffiCe of Health and Nutrition, Bureau for Global Programmes, Field Support and Research, Agency Chef de delegation - Chief delegate for International Development Professor A.M. Moskvichyov Mrs K. Johnson First Deputy Minister of Health International Resource Management, Permanent Mission, Geneva Chef adjoint de la delegation - Deputy chief Or S. Nightingale delegate Associate Commissioner, Food and Drug Administration, United States Public Health Service, Department of Health and Human Mr V.S. Sidorov Services Ambassador, Permanent Representative, Geneva Or M. Akhler Delegue(s) - Delegate(s) Executive Director, American Public Health Association Or M. N. Saveliev Director, International Relations Department, Ministry of Health OrB. Malone President, American Nurses Association Suppleant(s) - Alternate(s) Mr I.N. Chtcherbak Deputy Permanent Representative, Geneva ETHIOPIE - ETHIOPIA Mr V.M. Zimianine Chef de d,l,gation - Chief delegate Senior Counsellor, Permanent Mission, Geneva Or A. lbrahim Mr S.V. Trifonov Minister of Health Consultant, Department of Health and Medical industry, Administration of the Government of the Russian Federation D'legue(s)- Delegate(s) Professor Y.F. lssakov MrF. Ylmer VICe-President, Russian Academy of Medical Sciences Ambassador, Permanent Representative, Geneva Conseiller(s) - Adviser(s) MrsA.Amha Counsellor, Permanent Mission, Geneva Or A.A. Monissov Director, Department of the State Sanitary and Epidemiological Suppl,ant(s) - Alternate(s) Surveillance, Ministry of Health MrA. Gesel Mr V. V. Agueev Team Leader of Planning and Budgeting, Ministry of Health Assistant to the Minister of Health Or L.l. Malychev EX-REPUBLIQUE YOUGOSLAVE DE Deputy Director, International Relations Department, Ministry of Health MACEDOINE Professor A. V. Karaulov THE FORMER YUGOSLAV REPUBLIC OF Chairman, Section of Medical and Sanitary Programmes, Russian MACEDONIA Association of the Assistance to the UN Or V.K. Riazantsev Chef de d'legation - Chief delegate Chief Specialist, International Relations Department, Ministry of Health Professor P. llievski Minister of Health Mrs E.A. Nesterenko Counsellor, Department of International Organizations, Ministry of Foreign Affairs Or A.V. Pavlov Counsellor, Permanent Mission, Geneva A51NR page209 MrV. Yudin MrJ. SOder Counsellor, Permanent Mission, Geneva Senior Counsellor, Department of Social and Health Services, Ministry of Social Affairs and Health Mr A. V. Kovalenko Second Secretary, Permanent Mission, Geneva Ms T. Mlkkola Senior Adviser, Division for International Affairs, Ministry of Social Mr A.P. Kizioun Affairs and Health Third Secretary, Permanent Mission, Geneva Ms A.-M. Korpi Mr R. V. Grishchenko Director, Division for UN Affairs, Ministry for Foreign Affairs Attache, Permanent Mission, Geneva Ms H. Rinkineva-Heikkilll Counsellor, Permanent Mission, Geneva FIDJI- FIJI Mr J. Tuovinen Assistant, Permanent Mission, Geneva Chef de delegation - Chief delegate Conseiller(s) - Adviser(s) Mr LB. Smith Minister for Health Or G. Blurnenthal Health and Population Adviser, Ministry for Foreign Affairs Chef adjoint de la delegation - Deputy chief delegate Ms S. Virtanen Special Adviser to the Minister, Ministry of Social Affairs and Health Mr L. Rokovada Permanent Secretary for Health Mr P. Leinikki Professor, National Public Health Institute Delegue(s) - Delegate(s) OrA. Milen Or A. Boladuadua Director, Health and Development Cooperation Group (Hedec), Director of Primary and Preventive Health Services National Research and Development Center for Welfare and Health MrM. Laiho FINLANDE - FINLAND Senior Adviser, Association of Finnish Authorities MrsM. Rask Chef de delegation - Chief delegate Member of Parliament Ms T. Huttu-Juntunen Minister of Social Affairs and Health Mrs P. Kairamo-Hella Member of Parliament (Chef de delegation du 12 au 14 mai) (Chief delegate from 12-14 May ) Chef adjoint de la delegation - Deputy chief FRANCE-FRANCE delegate Mr K Mitrunen Chef de delegation - Chief delegate Minister, Charge d'affaires a.i., Permanent Mission, Geneva Or B. Kouchner Delegue(s) - Delegate(s) Secretaire d'Etat a la Santa Mr J. Eskola Delegue(s) - Delegate(s) Director-General, Department of Promotion and Prevention, Ministry M. D. Bemard of Social Affairs and Health Ambassadeur, Representant permanent , Geneve (Chef de dillilgation le 11 mai et du 15 au 16 mai) (Chief delegate on 11 May and from 15-16 May) Professeur J. Menard Suppleant(s)- Alternate(s) Directeur general de la Sante Or K Leppo Suppleant(s) - Alternate(s) Director-General, Department of Social and Health Services, Ministry of Social Affairs and Health Professeur J.-F. Girard Conseiller d'Etat Ms L. Ollila Senior Counsellor for International Affairs, Ministry of Social Affairs M. M. Berthiaurne and Health Conseiller technique, Cabinet du Secretaire d'Etat a la Sante Ms M. Blanco-Sequeiros M. A. Sortais Deputy Director-General, Department of Social and Health Services, Representant permanent adjoint, Mission perrnanente, Geneve Ministry of Social Affairs and Health M. J. Prieur Ms K. Hasunen Detegue pour les Affaires europeennes et internationales Senior Counsellor, Department of Promotion and Prevention, Ministry of Social Affairs and Health M. P. Chevit Directeur, Ecole nationale de Sante publique Or M. Saarinen Senior Medical Offtcer, Department of Social and Health Services, M. J.R. Brunetiere Ministry of Social Affairs and Health Directeur, Agence du Medicament Mrne J. Harari A51NR page210 Or M. JeanfrallQOis D816gu6(s)- Delegate(s) MrS. Samba Or R. Lefait-Robin Permanent Secretary, Department of State for Health, Social Welfare and Women's Affairs Mme R. Deniau Agence du Medicament OrA. Gaye Director of Medical and Health Services M. P. Gamier Sous-Directeur de la Sante et du D8vetoppement social, Ministere de Suppl6ant(s) - Alternate(s) la Cooperation Mr N.S. Bah M. F. Poinsot Ambassador, France Direction des Nations-Unies Mrs F.A.K Njie Mme M. Boccoz Director of Protocol Conseiller, Mission permanente, Geneve Or J.-L Grandgeon Ministere de la Coop8ration GEORGIE- GEORGIA Or S. Blanchy Chef de d616gation - Chief delegate Direction g8nerale des Relations culturelles, sclentifJques et techniques Ms M. Gudushauri Deputy Minister of Health Or 0. Brasseur Directeur du Centre international de rEnfance Suppl6ant(s) - Alternate(s) Mr T. Kereselidze GABON-GABON Mr T. Bakradze Chef de d616gation - Chief delegate GHANA - GHANA M. F. Boukoubl Ministre de la Same publique et de la Population Chef de d616gation - Chief delegate D616gu6(s) - Delegate(s) Or E. Brookman-Amissah M. E. Mba Allo Minister of Health Ambas&adeur, Representant permanent, Geneve D616gue(s)- Delegate(s) Or Epigat Apinda Conseiller sp8cial du Pr8siclent de la Republique, charge de la Mrs A.Y. Aggrey-Orieans Coop8ration internalionale Ambassador, Permanent Representative, Geneva Suppl6ant(s) - Altemate(s) Or A. Asamoa-Baah Director of Medical Services Mme P. Moungengui Conseiller du Ministre, charge de rAdminlstration des Finances Suppl6ant(s) - Alternate(s) Or M. Toung-Mve Or H. Odoi-Agyarko Directeur general de 1a Sante Head, Maternal and Child Health, Ministry of Health Mme R. Enombo MrY. Adjei Directeur du Service national SMI Minister, Deputy Permanent Representative, Geneva M.A.Mabongo MrsM. Pobee Pharmaclen-Chef, Centre hospitalier, Ubreville Counsellor, Permanent Mission, Geneva M. A. Lengota Attach8 de Cabinet GRECE - GREECE Mme Angone-Abena Conseiller, Mission permanente, Geneve Chef de d61egation - Chief delegate Mr C. Geitonas Minister of Health and Welfare GAMBlE- GAMBIA Delegue(s) - Delegate(s) Chef de d616gation - Chief delegate Mr D. Karaiticlis Ambassador, Permanent Representative, Geneva Mrs I. Njie-Saidy Vice-President and Secretary of State for Health, Social Welfare and Or M. VIOiaki-Paraskeva Women's Affairs Honorary Director-General, Ministry of Health and Welfare A51NR page211 Suppleant(s) - Alternate(s) Delegue(s) - Delegate(s) Mr D. Coundoureas Dr J.C. Sa Nogueira First Counsellor, Permanent Mission, Geneva Directeur des Soins de Sante primaire Professor A. Sissouras DrM. Mane Adviser to the Minister of Health Directeur de la PlanifiCCition et de la Coordination Mr M. Theodorou Suppleant(s) - Alternate(s) Adviser to the Minister of Health M. A.P. Gomes Chef de Cabinet GRENADE - GRENADA GUINEE EQUATORIALE - EQUATORIAL Chef de delegation - Chief delegate GUINEA MrM.Isaac Minister of Health and the Environment Chef de delegation - Chief delegate Delegue(s) - Delegate(s) Sr. S. Nguema Owono Minlstro de Estado de Sanidad y Bienestar Social Dr B. Gittens Medical OffiCer of Health Delegue(s) - Delegate(s) Dr. E. Castar'lo Bizantino Director General de Salud Publica y Planificaci6n GUATEMALA-GUATEMALA Dr. M. Nguema Ntutumu Chef de delegation - Chief delegate Sr. M.T. Sosa Ramirez Ministro de Salud Publica y Asistencia Social HAITI - HAITI Delegue(s) - Delegate(s) Chef de delegation - Chief delegate Sr. J.C. Castro Quin6nez M. J.P. Antonio Asesor Ambassadeur, Representant permanent, Geneva Sr. LA. Padilla Menendez Chef adjoint de la delegation - Deputy chief Embajador, Representante Permanente, Ginebra delegate Suppleant(s) - Alternate(s) Or M. Amedee Gedeon Sra. C. Rodriguez de Fankhauser Oirecteur general, Ministere de la Sante publique et de la Population Ministro Consejero, Misi6n Permanente, Ginebra Delegue(s) - Delegate(s) Or H.-C. Voltaire Oirecteur general adjoint, Ministere de la Sante publique et de la GUINEE - GUINEA Population Chef de delegation - Chief delegate Suppleant(s) - Alternate(s) Dr K Drarne Dr G. Jean-Pierre Ministre de la Sante publique Oirecteur des Ressources humaines et de Contr61e des Professions de Sante Delegue(s) - Delegate(s) Or M. Laroche M. C. Loua Oirecteur departernental du Sud Conseiller charge de la Cooperation, Ministere de la Sante publique Or J.M. Julien Dr J. Austin Oirecteur departemental du Nord Directrice nationale de la Sante publique, Ministere de la Sante DrD.Henrys Suppleant(s) - Alternate(s) Oirecteur, Projet de Sante, Ministere de la Sante publique et de la M. S. Camara Population /IOA-Banque mondiale Charge d'affaires, Mission permanente, Geneve M. F. Gaspard Conseilier, Mission permanente, Geneva GUINEE-BISSAU - GUINEA-BISSAU Chef de delegation - Chief delegate Dr B. Gornes C6 Ministre de la Sante publique A51NR page212 HONDURAS-HONDURAS ILES SALOMON -SOLOMON ISLANDS Chef de delegation - Chief delegate Chef de delegation - Chief delegate Dr. M.A. Rosa Mr D. Warakohia Secrelario de Estado, Deepacho de Salud Publica Minister for Health and Medical Services D61egu6(s) - Delegate(s) D61egue(s)- Delegate(s) Dr. L.A. L6pez Benitez Or G.W. Malefoasi Asesor Under-Secretary Health Care, Ministry of Health and Medical Services Sra. G. Bu Figueroa Consejera, Encargada de Negocios, a.i., Misi6n Permanente, Ginebra INDE -INDIA Suppleant(s) - Altemate(s) Chef de delegation - Chief delegate Ora. M. Jl&ez Reynaud de Rosa Asesora del Ministro de Salud Mr D. Ezhilmalai Minister of State for Health and Family Welfare Chef adjoint de la delegation - Deputy chief HONGRIE - HUNGARY delegate Chef de delegation - Chief delegate Mr KB. Saxena Secretary, Ministry of Health DrM.Kilkeny Minister of Welfare Delegue(s) - Delegate(s) (Chef de d8l8gatlon le 12 mai) (Chief delegate on 12 May) Mrs S. Kunadi Ambassador, Permanent Representative, Geneva Chef adjoint de la delegation - Deputy chief delegate Suppleant(s) - Alternate(s) Or E. Kereszty Or S.P. Aggarwal Deputy state Secretary, Ministry of Welfare Director-General, Health Services (Chef de ~ation le 11 mai et du 13 au 16 mai) (Chief delegate on 11 May and from 13 to 16 May) MrH.K Singh Deputy Permanent Representative, Geneva D61egue(s) - Delegate(s) Mr R. Shahare Or P. N6ray First Secretary, Permanent Mission, Geneva Ambassador, Permanent Representative, Geneva Mrs S. Koshy Suppleant(s) - Altemate(s) Director, (IH) Mrs K Nov6k Mr R. Albert Director, Department of the International Cooperation and European Personal Secretary to the Minister of State Integration Coordination, Ministry of Welfare Mr S. Shervani DrP. Varga Former Union Minister of State for Health Senior Adviser to the Minister of Welfare MsK BUz6s First Secretary, Department of International Organizations, Ministry of INDONESIE - INDONESIA Foreign Affairs MrG. Szab6 Chef de delegation - Chief delegate First Secretary, Permanent Mission, Geneva Professor F.A. Moeloek Minister of Health ILES COOK- COOK ISLANDS Chef adjoint de la delegation - Deputy chief delegate Chef de delegation - Chief delegate Mr A. Tarmidzi Ambassador, Permanent Representative, Geneva Mr T. Faireka Minister of Health Delegue(s) - Delegate(s) Delegue(s) - Delegate(s) Mrs S.B.A. Syahruddin Deputy Permanent Representative, Geneva DrR. Daniel Secretary of Health Suppleant(s) - Alternate(s) Or N.K Rai Director-General of Community Health, Department of Health Or B. Wasisto Senior Adviser to the Minister of Health on Epidemiology, Department of Health A51NR page213 Dr D.S. Argadiredja Delegue(s) - Delegate(s) Head, Bureau of Planning, Department of Health DrN.H.Aii Conseiller(s) - Adviser(s) Director-General of Health Education and Planning Directorate Ministry of Health ' Mr E. Pratorno Counsellor, Permanent Mission, Geneva Mr A. V. Rashid Minister Plenipotentionary, Ministry of Foreign Affairs Mrs A. Lantu-Luhulima Third Secretary, Permanent Mission, Geneva Suppleant(s) - Alternate(s) Mr A. H. Oegroseno OrA. Hardan Director, Communicable Disease Control and Preventive Health Official, Directorate for International Organizations, Department of Foreign Affairs Department, Ministry of Health Mr A. G. AI-Kaissi First Secretary, Permanent Mission, Geneva IRAN (REPUBLIQUE ISLAMIQUE D') DrS. Salim IRAN (ISLAMIC REPUBLIC OF) Technical Department, Ministry of Health Chef de delegation - Chief delegate Dr M. Farhedi IRLANDE - IRELAND Minister of Health and Medical Education Chef adjoint de la delegation - Deputy chief Chef de delegation - Chief delegate delegate Mrs A. Anderson Ambassador, Permanent Representative, Geneva Dr A. Akbar Sayari Deputy Minister for Health Affairs Chef adjoint de la delegation - Deputy chief Delegue(s) - Delegate(s) delegate Mr A. Khorram Dr J. Kiely Ambassador, Permanent Representative, Geneva Chief Medical Officer, Department of Health and Children Suppleant(s) - Alternate(s) Delegue(s) - Delegate(s) Dr M. Eliasi Mr J. Cregan Health Committee Member, Islamic Consultative Assembly Department of Health and Children Suppleant(s) - Alternate(s) Dr M.H. Nicknam Director-General, Public Relations and International Affairs Ms M. Aylward Department of Health and Children Mr B. Ziaran Deputy Permanent Representative, Geneva Dr E. Connolly Department of Health and Children Mr H. Soleymanpour Deputy Permanent Representative, Geneva Ms A. O'Fiynn Legal Adviser, Department of Health and Children Conseiller(s) - Adviser(s) Dr M.T.C.B. Astaneh Mr N. Burgess Adviser to Deputy Minister for Health Affairs First Secretary, Permanent Mission, Geneva Mr M. Baharvand Mr P. Drury Third Secretary, Permanent Mission, Geneva Attache, Permanent Mission, Geneva MrH. Moeini Ms C. Kinsella Expert, Department of Specialized Agencies, Ministry of Foreign Permanent Mission, Geneva Affairs Ms A. Loughrey Mr H. Haghgooy Department of Health and Children Adviser, Ministry of Foreign Affairs ISLANDE - ICELAND IRAQ-IRAQ Chef de delegation -Chief delegate Chef de delegation - Chief delegate Mrs 1. Palmad6ttir Dr O.M. Mubarak Minister of Health and Social Security Minister of Health Chef adjoint de la delegation - Deputy chief delegate Mr D.A. Gunnarsson Secretary General, Ministry of Health and Social Security A51NR page214 Delegue(s) - Delegate(s) MrsM. Fried Permanent Miasion, Geneva Mr B. J6ns&on Amabassador, Permanent Repr-uative, Geneva Suppleant(s) - Alternate(s) ITALIE -ITALY Mr I. Einarsson Director of Planning and Development, Ministry of Health and Social Chef de deh!gation - Chief delegate Security Mrne R. Bindi Ministre de la Sante Mr 0. 61afsson Director-General of Public Health Delllgue(s) - Delegate(s) Mrs V. lng61fsd611ir M. V. Silano Chief Nurse, Directorate of Public Health Directeur general, Bureau des Relations internationales Mrs R. Amlj6tsd6ttir M. G. Benagiano Head of Division, Ministry of Health and Social Security Directeur, lnstitut sup8rieur de la Sante Mr G. B. Helgason Suppleant(s) - Alternate(s) First Secretary, Permanent Miasion, Geneva Mrne M. Di Gennaro Mr H. 61afsson Secretaire general du Conseil superieur de Sante Deputy Permanent Repr-uative, Permanent Mission, Geneva M.G.Majori Directeur du Laboratoire de Parasitologie, lnstitut superieur de la Sante ISRAEL - ISRAEL M. F. Cicogna Chef de delegation - Chief delegate Bureau des Relations internationales, Minlstere de la Sante MrY. Matza M. M. Leggerl Minister of Health Coordinateur pour la Cooperation multilaterale, Ministere des Affaires etrangeres Delegue(s) - Delegate(s) M. L. Baroncelli MrY. Lamdan Chef du Bureau pour la Cooperation multilaterale, Ministere des Ambasaador, Permanent Representative, Geneva Affaires etrangeres MrE. Oahaya M. R. Toscano Member of~ Representant permanent adjoint, Geneva Suppleant(s) - Alternate(s) M. G. Schiavonl Professor B. Rager Premier conseiller, Mission permanente, Geneve Chief Scientist, Ministry of Health Conseiller(s) - Adviser(s) MrY.Amikam M. M. Branca Deputy Director for General Information and International Relations, Chef de Cabinet, Ministere de la Sante Ministry of Health M. F. Oleari Mr P. Hubert Directeur general, Departernent pour la Prevention, Ministere de la Adviser to the Minister, Ministry of Health Sante MrY. Kohavi M. C. Rinaklini Adviser to the Minister, Ministry of Health Chef, Bureau de Presse, Ministere de la Sante MrU. Manor M. S. Moriconi Director, International Organizations Division, Ministry of Foreign Bureau des Relations internationales, Ministere de la Sante Affairs M. E. Rocco Or A. Leventhal Bureau des Relations internationales, Ministere de la Sante Head, Public Health SeiVices, Ministry of Health Mrne B. Schiavo DrY. Sever Bureau pour la Cooperation multilaterale, Ministere des Affaires Director, General Medicine Division, Ministry of Health etrangeres MrG. Koran Professeur G. Berllnguer Counsellor, Permanent Mission, Geneva Conseiller(s) - Adviser(s) Professor G. Torrigiani MrR.Azulay Second Secretary, Permanent Mission, Geneva Mr R. Keren Ministry of Foreign Affairs A51NR page215 JAMAHIRIYA ARABE LIBYENNE- LIBYAN JAPON-JAPAN ARAB JAMAHIRIYA Chef de delegation - Chief delegate Chef de delegation - Chief delegate MrY. Harada Parliamentary Vice-Minister, Ministry of Health and Welfare Mr S. Eleghmary Secretary of the General People's Committee for Health and Social Welfare Delegue(s) - Delegate(s) MrN. Akao Delegue(s) - Delegate(s) Ambassador, Permanent Representative, Geneva Mrs N. AI-Hallaji Charge d'affaires, Permanent Mission, Geneva Suppleant(s) - Alternate(s) MrY. Mine Or M. Fherna Minister, Permanent Mission, Geneva Medical Supplies Adviser and Counsellor of Secretary of Health DrM.Ito Suppleant(s) - Alternate(s) Counsellor for Science and Technology, Ministel's Secretariat, Or A. Abdulhadi Ministry of Health and Welfare Adviser for Health and Social Welfare MrS. Kaneko OrA. Rahil Director, International Affairs Division, Minister's Secretariat, Ministry Counsellor for Health Affairs, Permanent Mission, Geneva of Health and Welfare Or I. Betelrnal MrS. Sumi Assistant Director for Arab Association of Red Crescent and Director Counsellor, Permanent Mission, Geneva of Health Section, Bern Or M. Mugitani Conseiller(s) - Adviser(s) Director, OffiCe of International Cooperation, International Affairs Division, Minister's Secretariat, Ministry of Health and Welfare Mr K.F. Sharif General People's Committee for Health and Social Welfare MrM. Kuroda Director, Specialized Agencies' Administration Division, Multilateral Mrs N. AI Edodi Cooperation Department, Ministry of Foreign Affairs General People's Committee for Health and Social Welfare Conseiller(s) - Adviser(s) MrT. Uehara JAMAIQUE - JAMAICA First Secretary, Permanent Mission, Geneva DrE.Seki Chef de delegation - Chief delegate Deputy Director, International Affairs Division, Minister's Secretariat, MrJ. Junor Ministry of Health and Welfare Minister of Health MrS. Tsuda Delegue(s) - Delegate(s) Deputy Director, International Affairs Division, Minister's Secretariat, Ministry of Health and Welfare MrA. Hill Ambassador, Permanent Representative, Geneva Mr T. lkenaga First Secretary, Permanent Mission, Geneva Or P. Figueroa Chief Medical OffiCer, Ministry of Health Or S. Miyagawa Deputy Director, International Affairs Division, Minister's Secretariat, Suppleant(s) - Alternate(s) Ministry of Health and Welfare Mrs P. Brown International Health Coordinator, Ministry of Health DrT. Kasai International Infectious Disease Adviser/ Deputy Director, Tuberculosis and Infections Diseases Control Division, Health Service MsA. Stone Bureau, Ministry of Health and Welfare Minister Counsellor, Permanent Mission, Geneva Mr A. Yokornaku Mr F. Hall Deputy Director, International Affairs Division, Minister's Secretariat, Counsellor, Permanent Mission, Geneva Ministry of Health and Welfare Conseiller(s) - Adviser(s) Or E. Nakamura OrB. Wint Technical Adviser for International Cooperation, International Affairs Chief Medical OffiCer, Ministry of Health Division, Minister's Secretariat, Ministry of Health and Welfare DrS. Omi Technical Adviser for International Cooperation, International Affairs Division, Minister's Secretariat, Ministry of Health and Welfare Or T. Fukuhara Director-General, Medical Cooperation Department, Japan International Cooperation Agency DrY. Saito A51NR page216 JORDANIE - JORDAN Mrs M.W. Ngure Chief Nursing Office!", Ministry of Health Chef de delegation - Chief delegate Mr M.M. Hussein Professor A. AI-Kurdi Deputy Permanent Representative, Geneva Minister of Health and Health Care Mr D.O. Supuko D616gue(s) - Delegate(s) First Secretary, Permanent Mission, Geneva Dr A. Arbaji MrJ. Mulu Director, Division of Malaria and Bilharzia, Ministry of Health and Chief Information Office!", Ministry of Health Health Care MsH.Annab Chief, Division of Import-Export, Minister of Health and Health Care KIRGHIZISTAN - KYRGVZSTAN Suppleant(s) - Altemate(s) Chef de delegation - Chief delegate MrM.K.asaem MrN. Kasiev Chief, International Health, Ministry of Health and Health Care Minister of Health Mr A. Madadha Chef adjoint de la delegation - Deputy chief Ambassador, Permanent Representative, Geneva delegate MrK Masri Mr B. Dimitrov Second Secretary, Permanent Mission, Geneva Head, Department of External Relations Delegue(s) - Delegate(s) KAZAKHSTAN-KAZAKHSTAN Mr A. lmakbaev Adviser to the Minister Chef de delegation - Chief delegate Mr K Kosherbayev Minister of Education, Culture and Health Care KIRIBATI - KIRIBATI D616gue(s) - Delegate(s) Chef de delegation - Chief delegate MrR.KTokseitov Mr K Tekee Deputy Minister of Education, Culture and Public Minister of Health and Family Planning Mr B. Utemuratov Chef adjoint de la delegation - Deputy chief Ambassador, Permanent Representative, Geneva delegate Suppleant(s) - Altemate(s) Dr T. Kienene Permanent Secretary for Health and Family Planning Mr V. Devyatko Chairman, Committee of Public Health Mr A. Zhumadilov KOWEIT- KUWAIT Second Secretary, Permanent Mission, Geneva Chef de delegation - Chief delegate Dr A.K AI-Sabeeh KENYA- KENYA Minister of Health Chef de delegation - Chief delegate Delegue(s) - Delegate(s) Mr J.l. Kalweo Mr D.A.R. Razzooqi Minister for Health Ambassador, Permanent Representative, Geneva Chef adjoint de la delegation - Deputy chief Or A.A. AI-Awadhi delegate President, Islamic Organization for Medical Sciences Professor J.S. Meme Suppleant(s) - Alternate(s) Director of Medical Services Or A.Y. AI-Saif Delegue(s)- Delegate(s) Assistant Under-Secretary, Community Health and Environment Mr KA.A. Rana Dr KA. AI-Saqabi Ambassador, Permanent Representative, Geneva Director, Department of Planning and Follow-up Suppleant(s) - Alternate(s) Or I.A. AI-Abdul Hadi Director, Ahmadi Health Region Mrs M.M. Kuria Deputy Secretary (Finance and Administration), Ministry of Health Dr A. N. AI-Zaid Or A.K. Muita Director, International Health Relations Department Director, Kenyatta National Hospital Mr W. AI-Wuqayyan Director, Minister of Health Department A51NR page217 Mrs M.A. AI-Raqam LITUANIE - LITHUANIA Director, Nursing Services Department Mr A.H.H.H. AI-Jassam Chef de delegation - Chief delegate Third Secretary, Permanent Mission, Geneva Mr M.L. Stankevicius Minister of Health LESOTHO - LESOTHO Delegue(s) - Delegate(s) Mr A. Navikas Chef de delegation - Chief delegate Charge d'affaires a.l., Permanent Mission, Geneva MrT. Mabote Professor V. Grabauskas Minister of Health and Social Welfare Rector, Kaunas Medical Academy Chef adjoint de la delegation - Deputy chief delegate LUXEMBOURG-LUXEMBOURG Dr M. Mosotho Principal Secretary, Ministry of Health and Social Welfare Chef de delegation - Chief delegate Delegue(s) - Oelegate(s) Or G. Wohlfart Ministre de la Sante DrN.Mapetla {Chef de delegation le 11-12 mai) Services Director-General of Health (Chief delegate from 11 to 12 May) Suppleant(s) - Alternate(s) Chef adjoint de la delegation - Deputy chief MsM. Tiheli delegate Chief Nursing OffiCer Mme A. Schleder-Leuck Conseiller de Direction, Ministere de la Sante LETTONIE - LATVIA Delegue(s) - Delegate(s) Dr D. Hansen-Koenig Chef de delegation - Chief delegate Directeur de la Sante (Chef de delegation du 13 au 16 mai) Mr V. Jaksons (Chief delegate from 13 to 16 May) State Minister of Health Suppleant(s) - Alternate(s) M. J. Reuter LIBAN - LEBANON Ambassadeur, Representant permanent, Geneve Chef de delegation - Chief delegate M. P. Duhr Representant permanent adjoin!, Geneve DrW. Ammar Directeur general, Ministere de la Sante M. A. Weber Attache, Mission permanente, Geneve Delegue(s)- Delegate(s) Dr A. Joukhadar Conseiller du Ministre de la Sante MADAGASCAR-MADAGASCAR M. A. Nehme Attache de Presse, Bureau du Ministre Chef de delegation -Chief delegate Professeur H. Ratsimbazafimahefa Ministre de la Sante LIBERIA - LIBERIA Delegue(s) - Delegate(s) Chef de delegation - Chief delegate M. M. Zafera Ambassadeur, Representant permanent, Geneve Professor P. Coleman Minister of Health and Social Welfare DrD.Rabeson Directeur des Etudes et de la Planif~cation, Ministere de la Sante Delegue(s)- Oelegate(s) Mr H.D. Williamson Suppleant(s) - Alternate(s) Ambassador, Permanent Representative, Geneva Mme F. Rakotoniaina Representant permanent adjoint, Geneve Mrs N. Damachi Mr J. Ratsimbazafy Suppleant(s) - Alternate(s) Attache de Presse, Ministere de la Sante MrE. Clarke Mrs M. Gibson A51NR page218 MALAISIE - MALAYSIA MALl- MALl Chef de delegation - Chief delegate Chef de delegation - Chief delegate Mr Chua Jui Meng Mme D.F. N'Diaye Minister of Health Ministre de la Sante, des Personnes Agees et de la Solidarite Chef adjoint de la delegation - Deputy chief Delegue(s) - Delegate(s) delegate Professeur MA Maiga Dr Abu Bakar bin Suieiman Conseilier technique, Ministere de la Sante, des Personnes Agees et Director-General of Health Services de la Solidarite Delegue(s) - Delegate(s) Dr L. Konate Directeur national de la Sante publique Mr Harnidon Ali Ambassador, Permanent Representative, Geneva Suppleant(s) - Altemate(s) MALTE- MALTA Or Mohamad Taha bin Arlf Director of HeaHh, Sarawak Chef de delegation - Chief delegate Or M. Farrugia Dr Tee Ah Sian Minister of HeaHh, Care of the Elderly and Family Affairs Director, Vector Borne D~ Division Chef adjoint de la delegation - Deputy chief Ms Tan Lee Cheng delegate Principal Private Secretary to the Minister of HeaHh Dr J. Cachia Mr Ayatillah Ahmad Acting Chief Government Medical OffiCer Counsellor, Permanent Mission, Geneva Delegue(s) - Delegate(s) Mr Raja Nuahlrwan Zainal Abldin Second Secretary, Permanent Mission, Geneva Mr M. Bartolo Ambassador, Permanent Representative, Geneva Suppleant(s) - Altemate(s) MALAWI - MALAWI MrG. Xuereb Adviser to the Minister of Health, Care of the Elderly and Family Affairs Chef de delegation - Chief delegate Mr H.l. Thompeon Dr J. Aquilina First Secretary, Permanent Mission, Geneva Minister of Health and Population Chef adjoint de la delegation - Deputy chief Conseiller(s) - Adviser(s) delegate Mr M. Azzopardi Personal Secretary to the Minister of Health, Care of the Elderly and Dr W.O.O. Sangala Family Affairs Secretary for Health and Population Delegue(s)- Delegate(s) MAROC-MOROCCO Mrs L.D. Ng'orna Controller of Nursing Services Chef de delegation - Chief delegate Dr A. El Fassi MALDIVES - MALDIVES Ministre de la Sante Delegue(s) - Delegate(s) Chef de delegation - Chief delegate M. M. N. Benjelloun-Touimi Mr A. Abdullah Ambassadeur, Representant permanent, Geneva Minister of HeaHh DrF. Hamadi Chef adjoint de la delegation - Deputy chief Secretaire general, Ministere de la Sante delegate Suppleant(s) - Alternate(s) OrA. Waheed Director -General of Health Services, Ministry of HeaHh Or M. M. Ellsmani Lalaoui lnspecteur general, Ministere de la Sante Delegue(s) - Delegate(s) Or J. Mahjour MrA. Sallh Directeur de I'Epidemiologie et de la Lutte contre les Maladies, Deputy Director, Ministry of HeaHh Ministere de 1a sante MmeK Meshak Directeur de la Regiementation et du Contentieux, Ministere de la Sante A51NR page219 M.M.Benabla Suppleant(s) - Alternate(s) Chef de la Division de la Cooperation, Ministere de la Sante Sr. J.C. Nolle Santilhin Director de Desarrollo y Gesti6n lnternacional M. A. Allouch Premier Secretaire, Mission permanente, Geneve Sra. L. Sosa Marquez Tercer Secretario, Misi6n Perrnanente, Ginebra MAURICE - MAURITIUS Sr. A.R.A. de Parga Alvares Ugena Coordinador de Asesores del Secretario de Salud Chef de delegation - Chief delegate Mr N. Deerpalsingh MICRONESIE (ETATS FEDERES DE) Minister of Health and Quality of Life MICRONESIA (FEDERATED STATES OF) Chef adjoint de la delegation - Deputy chief delegate Chef de delegation - Chief delegate Mr KR. Mudhoo Mr E.K Pretrick Permanent Secretary, Ministry of Health and Quality of Life Secretary (Minister), Department of Health, Education and Social Affairs Delegue(s)- Delegate(s) Dr R.S. Sungkur Principal Medical OffiCer, Ministry of Health and Quality of Life MONACO - MONACO Suppleant(s) - Alternate(s) Chef de delegation - Chief delegate Mr D. Baichoo Ambassador, Permanent Representative, Geneva OrA. Negre Medecin de Sante publique, Direction de rAction sanitaire et sociale Mr A.Y. Lam Chlou Yee First Secretary, Permanent Mission, Geneva MONGOLIE-MONGOLIA Mr R. Munlsamy Attache, Permanent Mission, Geneva Chef de delegation - Chief delegate Mr s.-o. Bold MAURITANIE - MAURITANIA Ambassador, Permanent Representative, Geneva Chef adjoint de la delegation - Deputy chief Chef de delegation - Chief delegate delegate Mrne D. Ba Mr S.-S. Enkhbat Ministre de la Sante et des Affaires sociales Director, Department of Policy Coordination and International Delegue(s) - Delegate(s) Cooperation, Ministry of Health and Social Welfare Mr M.S.O.M. lemine Delegue(s) - Delegate(s) Ambassadeur, Representant permanent, Geneva Ms B. Bat-Otgon OffiCer, Department of Policy Coordination and International Dr D.O. Cheikh Cooperation, Ministry of Health and Social Welfare lnspecteur general, Ministere de la Sante et des Affaires sociales Suppleant(s) - Alternate(s) Suppleant(s) - Alternate(s) Mr B.-O. Erdenebulgan Mr A.O.M. lehblb Attache, Permanent Mission, Geneva Directeur de la Planiflcation, de la Cooperation et de la Statistique, Ministere de la Sante et des Affaires sociales Or C.B.O.M. Waled MOZAMBIQUE - MOZAMBIQUE Directeur du Centre national d'Orthopedie et de Reeducation fonctionnelle Chef de delegation - Chief delegate Mr A.R. Noormahorned MEXIQUE - MEXICO Deputy Minister of Health Delegue(s) - Delegate(s) Chef de delegation - Chief delegate Dr A. Manguele Dr. J.R. de la Fuente National Director for Health Secretario de Salud Mr J.F.M. Torno Delegue(s)- Delegate(s) Deputy Director for Planning and Cooperation Dr. R. Tapia Subsecretario de Prevenci6n y Control de Enfermedades Sr. J. Urblna Director General de Promoci6n de la Salud A51NR page220 MYANMAR- MYANMAR Chef adjoint de la delegation - Deputy chief delegate Chef de delegation - Chief delegate Mr B.R. Pokhrel Secretary, Ministry of Health Mr Ket Sein Minister of Health Delegue(s) - Delegate(s) Chef adjoint de la delegation - Deputy chief Or S.P. Bhattarai delegate Chief, Policy Planning, Foreign Aid and Monitoring Division, Ministry of Health MrAye Ambassador, Permanent Representative, Geneva Conseiller(s) - Adviser(s) Delegue(s) - Delegate(s) Or S.R. Simkhada Minister, Charge d'affaires a.i., Permanent Mission, Geneva Or Kyaw Myint Director-General, Department of Medical Sciences Or S. Koirala Rector, BPKoirala Institute of Health Sciences, Dharan Suppleant(s)- Altemate(s) DrTheinSwe Or V.K Sharma Rector, Institute of Community Health, Department of Medical President, Nepal Medical Association Sciences Mr S.P. Kattel DrWanMaung Third Secretary, Permanent Mission, Geneva Deputy Director-General, Department of Health Mr Denzil Abel NICARAGUA- NICARAGUA Deputy Permanent Representative, Geneva Mr Unn Myaing Chef de delegation - Chief delegate Counsellor, Permanent Mission, Geneva Dr. F. Prado Yeceministro de Salud DrOhn Kyaw Deputy Director, Ministry of Health Delegue(s)- Delegate(s) Mr Cho Pyone Thwin Sr. A. Montenegro MaUona Personal Staff Officer to the Minister, Ministry of Health Embajador, Representante Permanente, Ginebra Mr Aung Ba Kyu Suppleant(s) - Alternate(s) First Secretary, Permanent Mission, Geneva Sra. C. Sanchez Reyes Mr Kyaw Swe Tint Ministra Consejera, Misi6n Permanente, Ginebra Second Secretary, Permanent Mission, Geneva Mra L. Nang Tsan NIGER - NIGER Second Secretary, Permanent Mission, Geneva Chef de delegation - Chief delegate NAMIBIE - NAMIBIA Or I. Almoustapha Ministre de la Sante publique Chef de delegation - Chief delegate Delegue(s) - Delegate(s) Or L. Arnathlla Or M. Hamissou Minister of Health and Social Services Secn!taire general du Ministere de la Sante publique Delegue(s)- Delegate(s) DrD.G. Yaou Or K Shangula Directeur de la Sante familiale Permanent Secretary Suppleant(s) - Alternate(s) Ms M. Nghatanga Mrne R. Dania Director of Primary Health Care and Nursing Services Chef de Division Formations sanitaires, Direction de la Promotion de la Sante, Ministere de la Sante publique NEPAL - NEPAL Conseiller(s) - Adviser(s) Or A. IIIo Chef de delegation - Chief delegate Mr KB. Gurung Minister of Health A51NR page221 NIGERIA - NIGERIA DrP. Wium Adviser, Norwegian Board of Health Chef de delegation - Chief delegate Conseiller(s) - Adviser(s) Mr J. Ayinla Or T. Hetland Minister of Health Ministry of Health and Social Affairs Suppleant(s) - Alternate(s) MsM.Andrew MrA.T. Mani Director, Norwegian Board of Health Permanent Secretary, Federal Ministry of Health Or E. Helsing Mr E. Abuah Adviser, Norwegian Board of Health Ambassador, Permanent Representative, Geneva Or B. Austveg Conseiller(s) - Adviser(s) Adviser, Norwegian Board of Health Or A. Nasidi Ms L. Davoy Director Special Project, Technical Assistant to the Minister of Health President, Norwegian Nurses Association ore. Orjioke Ms T. Stangnes Director, Primary Health Care and Disease Control President, Norwegian Association of Health and Social Care Personel Mr A. Agbonwanegbe Special Assistant to the Minister of Health NOUVELLE-ZELANDE - NEW ZEALAND Or R.O. Barrow Director, Medical and Pharmaceutical Services Chef de delegation - Chief delegate MrT.Garba DrG.Durham Personal Assistant to the Minister of Health General Manager, Director Public Health Group, Ministry of Health Mrs M. Makanjuola Delegue(s) - Delegate(s) NTA Health Correspondence Ms R. Earp General Manager, Maori Health, Ministry of Health MrA. Hassan Senior Counsellor, Permanent Mission, Geneva Mr T. Krieble Assistant General Manager, Sector Policy, Ministry of Health NORVEGE - NORWAY Suppleant(s) - Alternate(s) Mr R. Farrell Chef de delegation - Chief delegate Ambassador, Permanent Representative, Geneva Mr D. HOybtiten Ms D. Geels Minister of Health and Social Affairs First Secretary, Permanent Mission, Geneva (Chef de delegation du 12 au 13 mai) (Chief delegate from 12-13 May) Conseiller(s) - Adviser(s) Delegue(s) - Delegate(s) Ms J. van Zanten Permanent Mission, Geneva OrA. Alvik Director-General, Norwegian Board of Health Mrs M. Farrell (Chef de delegation 11 mai et du 14 au 16 mai) Permanent Mission, Geneva · (Chief delegate 11 May and from 14-16 May) MrB. Skogmo Ambassador, Permanent Representative, Geneva OMAN-OMAN Suppleant(s) - Alternate(s) Chef de delegation - Chief delegate Ms H.C. Sundrehagen Director-General, Ministry of Health and Social Affairs Or A.M. Moosa Minister of Health MrS. Stokke Secretary General, Ministry of Health and Social Affairs Delegue(s)- Delegate(s) Or A.A.Q. AI-Ghassani Mr T.C. Hildan Under-Secretary for Health Affairs, Ministry of Health Minister Counsellor, Permanent Mission, Geneva Mr M.O.A. Aideed Or O.T. Christiansen Ambassador, Permanent Representative, Geneva Counsellor, Permanent Mission, Geneva Suppleant(s) - Alternate(s) MsM. Loe Adviser, Ministry of Foreign Affairs Or A.J.M. Sulaiman Director-General of Health Affairs, Ministry of Health Ms A.-S. Trosdahl Oraug Adviser, Ministry of Health and Social Affairs Mrs F.A. AI-Ghazali Director of Public Relations Department, Ministry of Health A51NR page222 Or S.T. AI-Ouaydi Suppleant(s) - Altemate(s) Head of AIDS Control Section and Supervisor of Epidemiological Surveillance Section, Ministry of Health Mr M.l. Qureshi Secretary, Health Department, Govemment of Punjab Mr H. AI-Ma'ani First Secretary, Permanent Mission, Geneva MrM.S. Khan Secretary, Health Department, Government of NWFP Mr H. AI-Gazali First Secretary, Permanent Mission, Geneva Mrs K Azhar Counsellor, Permanent Mission, Geneva MrS. Raza OUGANDA-UGANDA Permanent Mission, Geneva MissK VM!U Chef de delegation - Chief delegate Permanent Mission, Geneva Or C.W.C.B. Kiyonga Minister of Health Mr M.A. Ellahi Counsellor, Permanent Mission, Geneva Chef adjoint de la delegation - Deputy chief delegate Mr R.L. Pinazo Permanent Mission, Geneva Or N.O. Obore Permanent Secretary, Ministry of Health Delegue(s) - Delegate(s) PALAOS - PALAU MrA.Oseku Chef de delegation - Chief delegate Ambassador, Permanent RepreMI"IIative, Geneva ore. otto Suppleant(s) - Altemate(s) Director, OffiCe of Public Health, Ministry of Health Or D.K Apuuli Director-General of Health Services, Ministry of Health PANAMA-PANAMA Mrs G. Klnimi Commissioner of Nursing Services, Ministry of Health Chef de delegation - Chief delegate DrD.KW. Lwamafa Sr. L. Kam Commissioner for Health Services (Nutrition), Ministry of Health Embajaclor, Representante Permanente, Ginebra DrO.Okoth Delegue(s) - Delegate(s) Assistant Commiaaioner of Health Services, Ministry of Health Sr. J. Bonagas DrWanume Representante Adjunto, Misi6n Permanente, Ginebra Medical Superintendent, Jinja Hospital Sra. M. Garrido OrA. Onek Consejera, Misi6n Permanente, Ginebra Director, District Health Services, Gulu Hospital PAPOUASIE-NOUVELLE-GUINEE - PAPUA OUZBEKISTAN - UZBEKISTAN NEW GUINEA Chef de delegation - Chief delegate Chef de delegation - Chief delegate Or A. Sidikov Mr L. Mond Head of External Relations, Ministry of Health Minister of Health Delegue(s) - Delegate(s) PAKISTAN- PAKISTAN Or R. Taufa Director, Policy, Planning and Research Division, Department of Chef de delegation - Chief delegate Health Mr M.M. Javecl Hashmi Mr E. Posanai Federal Minister of Health Deputy Director, Family Health Services DMsion, Department of Health Delegue(s)- Delegate(s) Suppleant(s) - Altemate(s) MrM.Akram Ambassador, Permanent Representative, Geneva MrsR. Mond Professor G. H. Ayub Mr G. Kewande Director-General, Ministry of Health Ministerial Officer A51NR page223 PARAGUAY-PARAGUAY Conseiller(s) - Adviser(s) Mrs Y. Henriquz-cle Waal Chef de delegation - Chief delegate Senior Policy Adviser, Ministry of Heailh, Welfare and Sport Dr. R.E. Dullak V~eeministro de Salud, Minlsterio de Salud Publica y Bienestar Social PEROU-PERU Chef adjoint de la delegation - Deputy chief delegate Chef de delegation - Chief delegate Dr. E. Loizaga Caballero Dr. M. Costa Bauer Embajador, Representante Permanente, Ginebra Ministro de Salud Delegue(s) - Delegate(s) Delegue(s)- Delegate(s) Sr. R. Gauto Vielman Dr. A. Meloni Ministro, Misi6n Permanente, Ginebra Director General, OfiCina de Financiamiento, lnversiones y Cooperaci6n Externa, Ministerio de Salud Suppleant(s)- Alternate(s) Sra. B. Berendson Seminario Sr. G. L6pez Bello Consejera, Servicio Diplomatico de la Rep(Jblica Primer Secretario, Misi6n Permanente, Ginebra Suppleant(s) - Alternate(s) Sr. R. Ugarriza Primer Secretario, Misi6n Permanente, Glnebra Sr. G. Guillen Becker Primer Secretario, Misi6n Permanente, Ginebra Sra. L. Casati Primer Secretario, Misl6n Permanente, Ginebra PHILIPPINES - PHILIPPINES PAYS-BAS- NETHERLANDS Chef de delegation - Chief delegate Chef de delegation - Chief delegate Or C.N. Reodica Secretary, Department of Health Ms E.G. Terpstra State Secretary for Heailh, Welfare and Sport Chef adjoint de la delegation - Deputy chief delegate Delegue(s) - Delegate(s) Mrs L.R. Bautista Dr H.J. Schneider Ambassador, Permanent Representative, Geneva Director-General for HeaHh, Ministry of Heailh, Welfare and Sport Delegue(s)- Delegate(s) Ms E.L. Herfkens Ambassador, Permanent Representative, Geneva Dr M.L. Fernandez Under-Secretary, Department of Heailh Suppleant(s) - Alternate(s) Suppleant(s) - Alternate(s) Dr G.M. van EHen Head, International Affairs Division, Ministry of Heaith, Welfare and Ms R. Paulino Sport Director Ill, Internal Planning Services, Department of Heailh Mr P.P. van Wulfften PaHhe Conseiller(s) - Adviser(s) Deputy Permanent Representative, Geneva Ms M.E.G. Callangan Or G. Elzinga Second Secretary, Permanent Mission, Geneva Director of Public Heailh, National Institute of Public Heailh and Environmental Protection Or A. G. Romualdez Consultant, Department of Health Mr R. Elkhuizen Deputy Head, Coordination and Institutional Affairs, Division of the United Nations Department, Ministry of Foreign Affairs POLOGNE-POLAND Ms M.A.C.M. Middelhoff Senior Adviser, International Affairs Division, Ministry of Heailh, Chef de delegation - Chief delegate Welfare and Sport Dr W. Maksymowicz Minister of HeaHh and Social Welfare Mr J. Waslander First Secretary, Permanent Mission, Geneva Delegue(s) - Delegate(s) MrJ.P. Mout Mr K Jakubowski United Nations Department, Ministry of Foreign Affairs Ambassador, Permanent Representative, Geneva Mrs N.M. Leemhuis-de Regt Dr J .A. Plalklewlcz Senior Adviser, Directorate Social and Institutional Development, VICe-Minister of Health and Social Welfare Ministry of Foreign Affairs A51NR page224 Suppleant(s) - Altemate(s) REPUBLIQUE ARABE SYRIENNE - SYRIAN Professor J. Leowskl ARAB REPUBLIC Director, School of Public Health and Social Medicine, Medical Centre for Postgraduate Education, WarsaN Chef de delegation - Chief delegate MrA. Szelag Or M. I. AI Chatti Director, Political Cabinet, Ministry of Health and Social Welfare Minister of Health Mrs B. Bitner Dillegue(s) - Delegate(s) Director, Bureau of European Integration and Foreign Cooperation, Ministry of Health and Social Welfare Or S. El Yousef Deputy Minister of Health MrK Rozek Counsellor, Permanent Mission, Geneva Or H. Elhaj Hosein Director, Department of International Relations, Ministry of Health PORTUGAL-PORTUGAL REPUBLIQUE CENTRAFRICAINE - CENTRAL Chef de delegation - Chief delegate AFRICAN REPUBLIC Mme M. de Bel8m Roeeira Chef de delegation - Chief delegate Ministre de la Santa Mme F. Djengbot Olllegue(s)- Delegate(s) Ministre de la Sante publique et de la Population M. G. de Santa Cara Gomes Delegue(s) - Delegate(s) Ambassadeur, Representant permanent, Geneve M. J. Limbassa Professor C. Sakellarides lnspecteur general des Services de Sante Directeur general de la Sante M. E. Kiteze Suppleant(s) - Altemate(s) Directeur des Etudes et de la Planification Professor C. Pires Justo Sous-Directeur general de la Sante REPUBLIQUE DE COREE - REPUBLIC OF M. P. Madureira Representant permanent adjoin!, Geneva KOREA Mme P. Pinto da Fonseca Chef de delegation - Chief delegate Conseiller de Presse du Ministre de la Sante DrM.-1. Kim Mme D. Rogeiro Cruz Minister of Health and Welfare Chef de Services administratif& de la Cooperation intemationale, Direction generale de 1a Sante Chef adjoint de la delegation - Deputy chief delegate Professor J. Lopes Martin& Coordonnateur de la Cooperation internationale avec 1es PALOP, Mr M.-S. Chang Direction generale de 1a Sante Ambassador, Permanent Representative, Geneva Delegue(s)- Delegate(s) Mr Y.-H. Yang QATAR- QATAR Counsellor, Permanent Mission, Geneva Chef de delegation - Chief delegate Suppleant(s) - Alternate(s) Or A.R.S. AI-Kuwari Mr K-T. Moon Minister of Public Health Director-General, Bureau of Technology Cooperation, Ministry of Health and Welfare Dell!gue(s) - Delegate(s) Mr D.-K Oh Mr F.A. AI-Thani Director-General, Bureau of Health Resources Management, Ministry Ambassador, Permanent Representative, Geneva of Health and Welfare Or K. AI-Jaber Mr J.-H. Yuh Director of Health Prevention Director, Human Rights and Social Affairs Division, Ministry of Foreign Affairs and Trade Suppleant(s) - Alternate(s) Mr H.M. AI-Hatmi MrD.-J. Yoo Director, Ministry of Public Health Second Secretary, Permanent Mission, Geneva Mr A.H.A. AI-Abdalla Or Y.-J. Hur Head of Public and International Relations Deputy Director, Medical Officer, Communicable Disease Control Division, Ministry of Health and Welfare Mr A.A. AI-Kholiefi Assistant Director of Finance and Administration Affairs Mr W.-K. Moon Assistant Director, International Cooperation Division, Ministry of Health and Welfare A51NR page225 Or Y.-S. Shin REPUBLIQUE DOMINICAINE - DOMINICAN President, Korean Institute of Health Services Managements REPUBLIC Conseiller(s) - Adviser(s) Chef de delegation - Chief delegate Or D.-M. Rhie Ora. A. Guzman Marcelino Secretaria de Estado de Salud Publica y Asistencia Social REPUBLIQUE DEMOCRATIQUE DU CONGO Delegue(s) - Delegate(s) DEMOCRATIC REPUBLIC OF THE CONGO Dr. R. Schiffino Subsecretario de Estado de Salud Chef de delegation - Chief delegate Dr. S. Sarita Valdez Or J.-8. Sondji Subsecretario de Estado de Salud Ministre de la Sante publique Suppleant(s) - Alternate(s) Delegue(s) - Delegate(s) Ora. T. auezada Mr G. Mulume Marume Directors General de PlanifiCici6n y Sisternas de Salud de la Charge d'affaires a.i., Mission permanente, Geneve Secretaria de Estado de Salud Publica Or K Nsiku Sra. A. Bonetti Herrera Medecin charge de la Lutte contre les Maladies diarrheiques au PEV Embajadora, Representante Permanente, Ginebra Srta. I. Roman Maldonado REPUBLIQUE DEMOCRATIQUE POPULAIRE Ministra Consejera, Misi6n Permanente, Ginebra LAO LAO PEOPLE'S DEMOCRATIC REPUBLIC REPUBLIQUE POPULAIRE DEMOCRATIQUE Chef de delegation - Chief delegate DECOREE DEMOCRATIC PEOPLE'S REPUBLIC OF Or Ponmek Dalaloy Minister of Health KOREA Delegue(s) - Delegate(s) Chef de delegation - Chief delegate DrN.Boutta MrChol Ri Deputy Director, Ministry of Health Ambassador, Permanent Representative, Geneva Delegue(s) - Delegate(s) REPUBLIQUE DE MOLDOVA- REPUBLIC OF Mr Song 0. Hong MOLDOVA Expert, International Organizations Department, Ministry of Foreign Affairs Chef de delegation - Chief delegate MrTae Gun Ri Counsellor, Permanent Mission, Geneva MrM. Magdei Minister of Health Suppleant(s) - Alternate(s) Chef adjoint de la delegation - Deputy chief Mr Dong Chol Pak delegate Chief Instructor, Department of External Affairs, Ministry of Public Health MrV.Valovei Head of the Department of Reforms, Ministry of Health Delegue(s) - Delegate(s) REPUBLIQUE TCHEQUE - CZECH REPUBLIC Mr A. Cheptine Ambassador, Permanent Representative, Geneva Chef de delegation -Chief delegate Suppleant(s) - Alternate(s) Or z. Roithova Minister of Health MrA. Calmac Deputy Permanent Representative, Geneva Chef adjoint de la delegation - Deputy chief delegate Ms L. Negru First Secretary, Permanent Mission, Geneva DrM.Somol Ambassador, Permanent Representative, Geneva Delegue(s)- Delegate(s) Or L. Romanovska Director, International Relations Department, Ministry of Health A51NR page226 suppleant(s) -Alternate(a) ROYAUME-UNI DE GRANDE-BRETAGNE ET Mr I. Plnter D'IRLANDE DU NORD Ministry of Foreign Affairs UNITED KINGDOM OF GREAT BRITAIN AND Mr P. ~kocla NORTHERN IRELAND Second Secretary, Permanent Mission, Geneva Chef de delegation - Chief delegate Mrs T. Jowell REPUBLIQUE-UNIE DE TANZANIE Minister of Public Health UNITED REPUBLIC OF TANZANIA Delegue(s) - Delegate(s) Chef de delegation - Chief delegate DrK Calrnan Or A.D. Chlcluo Chief Medical Officer, Department of Health Minister of Health MrR. Lyne Chef adjoint de la delegation - Deputy chief Ambassador, Permanent Representative, Geneva delegate Suppl6ant(s) - Altemate(s) Or A.M. Sheln Or J.S. Metiers Deputy Minister of Health Deputy Chief Medical OffiCer, Department of Health D61egue(s)- Delegate(s) Mrs Y. Moores Mr R.A. Mrope Chief Nursing OffiCer, Department of Health Principal Secretary, Ministry of Health Mr R.A. Kingham Suppleant(s) - Alternate( a) International Branch, Department of Health Mr S.S. Osman Mr J. Ramsden Principal Secretary, Ministry of Health Deputy Permanent Representative, Geneva Or G.L. Upunda Mr G. Warrington Chief Medical Officer, Ministry of Health First Secretary, Permanent Mission, Geneva DrP.KIIirna Or D. Nabarro Director of Preventive Services, Ministry of Health Chief Health and Population Adviser, Department for International Development Or W. Mpanju-Shumbusho Coordinator, Reproductive Health CRHCS Conseiller(s) - Adviser(s) Mr F. Malambugi Mrs A. Maslin Minister Counsellor, Permanent Mission, Geneva Nursing OffiCer, International Branch, Department of Health DrW. Thorne Senior Medical OffiCer, Department of Health ROUMANIE -ROMANIA MsK Jarvie Chef de delegation - Chief delegate Private Secretary, Department of Health Or F. Baranyl Miss H. Frary Ministre de la Sant6 Third Secretary, Permanent Mission, Geneva Chef adjoint de la delegation - Deputy chief MrD. Walton delegate Legal Adviser, Permanent Mission, Geneva M. P. Arrnean Mr R. Thornpson Secretaire d'Etat au Ministere de la Sante First Secretary, Permanent Mission, Geneva D616gue(s) - Delegate(s) Mr M. Proctor Attache, Permanent Mission, Geneva M. P. Grecu Charge d'affaires a.i., Mission permanente, Geneva Or E. Taylor Suppleant(s) -Alternate(a) Health and Population Division, Department for International Development Mrne L. Popescu Direcleur, Departernent des Relations internationales, Ministere de la Or N. Squires Sante Health and Population Division, Department for International Development M. T. Negru Directeur general, Direction generale du Budget, Ministere de la Sante Or D. MacFadyen Adviser, Department of Health Mme G. Dimitriu Deuxleme Secretaire, Ministere des Affaires etrangeres M. A. Pacuretu Troisi6rne Secretaire, Mission permanente, Geneva A51NR page227 RWANDA- RWANDA SAINT-VINCENT -ET -GRENADINES SAINT VINCENT AND THE GRENADINES Chef de delegation - Chief delegate DrV. Biruta Chef de delegation - Chief delegate Ministre de la Sante Miss N. Dabinovic Honorary Consul, Geneva Delegue(s)- Delegate(s) M. E.-R. Gasana Charge d'affaires a.i., Mission permanente, Geneve SAMOA-SAMOA Dr P. Kamoso Directeur de Bactertologie Chef de delegation - Chief delegate Suppleant(s) - Alternate(s) Mr M. Telefoni Retzlaff Minister of Health M. L. Munyazogeye Administrateur, Mission permanente, Geneve Chef adjoint de la delegation - Deputy chief delegate Dr R. Sheppard SAINT-KITTS-ET-NEVIS - SAINT KITTS AND NEVIS SAO TOME-ET-PRINCIPE - SAO TOME AND Chef de delegation - Chief delegate PRINCIPE OrA. Martin Minister of Health and Women's Affairs Chef de delegation - Chief delegate Delegue(s) - Delegate(s) Dr E. Ferreira de Matos Ministre de la Sante Mr J. Harris Minister of Health, Nevis Island Administration Delegue(s) - Delegate(s) Mr St Clair Wallace Or A.S. Marques de Uma Permanent Secretary, Ministry of Health, Nevis Island Administration Directeur des Soins de Sante Suppleant(s) - Alternate(s) DrC. Lake SENEGAL-SENEGAL Medical Adviser, Ministry of Health, Nevis Island Administration Chef de delegation - Chief delegate Dr A. Ndiaye SAINT-MARIN - SAN MARINO Conseiller technique, Ministere de la Same publique et de rAction sociale Chef de delegation - Chief delegate Delegue(s) - Delegate(s) Dr S. Canducci Ministre de la Sante et de la Securtte sociate DrA.B. Gaye Chef du Service national des Grandes Endemies, Ministere de la Delegue(s)- Delegate(s) Sante publique et de rAction soclate M. D.E. Thomas M. I. Ndiaye Ambassadeur, Representant permanent, Geneva Ministre conseilter, Mission permanente, Geneve Mrne F. Bigl Suppleant(s) - Alternate(s) Representant permanent adjoin!, Geneva M. E.H.S. Niang Suppleant(s) - Alternate{s) Premier Secretaire, Mission permanente, Geneva Mrne H. Zeiler Conseilter, Mission permanente, Geneva SEYCHELLES-SEYCHELLES M. P. Mancini Coordonnateur du Departernent Sante et securtte sociate Chef de delegation - Chief delegate Mrne E. Lonfernini Mr J. Dugasse Secretaire priv6 du Ministre de la Sante et de la Securtte sociate Minister of Health Mrne D. Rotondaro Delegue(s) - Delegate(s) Ministere de la Sante et de la securtte sociale Mrs M.-A. Hoareau Principal Secretary, Ministry of Health Dr C. Shamlaye Special Adviser to the Minister of Health A51NR page228 SIERRA LEONE - SIERRA LEONE SLOVENIE - SLOVENIA Chef de delegation - Chief delegate Chef de delegation - Chief delegate MrE. Luy Or D.P. Kosm~ Consul for Sierra Leone, Geneva State Secretary, Ministry of Health Delegue(s) - Delegate(s) SINGAPOUR- SINGAPORE MrG.Zore Ambassador, Permanent Representative, Geneva Chef de delegation - Chief delegate MrM.F.Mikia Or C.Tiong Tee Tan Deputy Permanent Representative, Geneva Deputy Director, Medical Services (Service Regulation), Ministry of Health Suppleant(s) - Altemate(s) Or V.K Petric Delegue(s) - Delegate(s) Counsellor the the Minister, Ministry of Health Or Suok Kai Chew Director, Epidemiology and Diaease Control Department, Ministry of Health SOUDAN-SUDAN Suppleant(s) - Altemate(s) Chef de delegation - Chief delegate Mr Chak Mun See Ambassador, Permanent Representative, Geneva Mr M. B. Nimir Federal Minister of Health Mr P. Govindasamy First Secretary, Permanent Mission, Geneva Delegue(s)- Delegate(s) MrJ. Teo Or I.M. lbrahim First Secretary, Permanent Mission, Geneva Ambassador, Permanent Representative, Geneva Mr V. Ramakrishnan Professor Q.M. Ali Third Secretary, Permanent Mission, Geneva Federal Ministry of Health Suppleant(s) - Altemate(s) SLOVAQUIE - SLOVAKIA Or Z.A. Zeiddan Ministry of Federal Health Chef de delegation - Chief delegate DrA.A.RAii Ministry of Federal Health Mr L. Javorsi Mrs 1. Majerova Mr H.M.G.S. Palihakkara Ministry of Health Ambassador, Permanent Representative, Geneva Mr F. Rosocha Suppleant(s) - Alternate(s) Second Secretary, Permanent Mission, Geneva Or V. Jeganathan Director-General of Health Services Conseiller(s) - Adviser(s) Mrs D. Skackova Conseiller(s) - Adviser(s) Adviser, Minister of Health Professor N. Mendis Professor of Psychiatry, Faculty of Medicine, University of Colombo Mr S.S. Ganegama Arachchi First Secretary, Permanent Mission, Geneva Mr A.S.U. Mendis Second Secretary, Permanent Mission, Geneva A51NR page229 SUEDE - SWEDEN Mme D. Petter Premier Secretaire, Mission permanente, Geneve Chef de delegation - Chief delegate Mme M. Berger Mrs M. Wallstrom Service sectoriel Ressources humaines, Direction du Developpement Minister of Health and Social Affairs et de la Cooperation, Departement federal des Affaires etrangeres Chef adjoint de la delegation - Deputy chief M. J. Burri Section ONU/01, Division politique Ill, Departement federal des delegate Affaires etrangeres Mr C. Ortendahl Director-General, National Board of Health and Welfare Mme F. Gaillat Engeli Affaires intemationales, OffiCe federal de la Sante publique, Delegue(s) - Delegate(s) Departernent federal de l'lnterieur Ms A.-C. Filipsson Mme S. Ulmann Deputy Director, Ministry of Health and Social Affairs Section Affaires multilaterales, Direction du Developpernent et de la cooperation, Departement federal des Affaires etrangeres Suppleant(s)- Alternate(s) M. T. Weber MrH. Ceder Division Produits biologiques, OffiCe federal de la Sante publique, Director, Ministry of Health and Social Affairs Departement federal de rlnterieur Or L. Freij . . M. M. Elsig Head of Section, Swedish International Development Authority (Sida) Questions industrielles et technologiques intemationales, OffiCe federal des Affaires economiques exterieures, Departement federal de Mr L. Norberg rEconornie publique Ambassador, Permanent Representative, Geneva Mme T.-L. Tran Thi Professor E. Nordenfelt Chef, Affaires internationales, lnstitut federal de la Propriete Director-General, Swedish Institute for Infectious Disease Control intellectuelle, Departement federal de Justice et Police Mr Pedersen A. M. A. Jost Second Secretary, Permanent Mission, Geneva Directeur adjoin!, OffiCe intercantonal pour le Contr61e des Medicaments Mr B. Pettersson Senior Adviser for Health Promotion, National Institute of Public Health M. J. Martin Chef de Service, Direction du Developpement et de la Cooperation, Ms B. Schmidt Departement federal des Affaires etrangeres, Berne Administrative Director, National Board of Health and Welfare Ms U. Winroth Head of Section, Ministry of Health and Social Welfare SURINAME - SURINAME Mr T. Zetterberg Chef de delegation - Chief delegate Counsellor, Ministry for Foreign Affairs Mrs R.M. Codfried-Kranenburg Conseiller(s) - Adviser(s) Director, Ministry of Health OrA. Milton Chef adjoint de la delegation - Deputy chief Secretary General, Swedish Medical Association delegate Ms E. Femvall Mr T. Sowirono President, Swedish Association of Health Professionals Counsellor SUISSE - SWITZERLAND SWAZILAND - SWAZILAND Chef de delegation - Chief delegate Chef de delegation - Chief delegate M. T. Zeltner Or P.K. Dlamini Directeur de rOffiCe federal de la Sante publique Minister of Health and Social Welfare Delegue(s) - Delegate(s) Delegue(s) - Delegate(s) M. W. Gyger Mr S.S. Mdziniso Ambassadeur, Representant permanent, Geneve Under-Secretary, Ministry of Health and Social Welfare M. M. Kerker Or S. Shongwe Service sectoriel Ressources humaines, Direction du Developpement Acting Deputy Director of Health Services et de la Cooperation, Departement federal des Affaires etrangeres Suppleant(s) - Alternate(s) Suppleant(s) - Alternate(s) Mrs N. Shongwe Mme S. Zobrist Chief Nursing Officer, Health and Social Welfare Chef, Affaires intemationales, Office federal de la Sante publique, Departement federal de rlnterieur Mrs P. Kisanga Regional Coordinator, IBFAN A51NR page230 Mrs M. Dlarnini-Tyrer TOGO-TOGO Director, Swaziland Infant Nutrition Action (SINAN) Chef de delegation - Chief delegate TADJIKISTAN- TAJIKISTAN M. KSama Ministre de la Sante Chef de delegation - Chief delegate Delegue(s) - Delegate(s) Mrs Z.A. Mirzoeva M. E. Batchassi Deputy Minister of Health Directeur general de la Santa TCHAD-CHAD TONGA-TONGA Chef de delegation - Chief delegate Chef de delegation - Chief delegate M. Y.H. Kedella Or L. Malolo Ministre de 1a Santa publlque Director of Health Delegue(s) - Delegate(s) Or M. E. Baiong TRINITE-ET-TOBAGO - TRINIDAD AND Directeur g8n8ral adjoint de 1a Santa publique TOBAGO Or N.M. N'Delkoundam Chef de Division des Maladies transmissible& Chef de delegation - Chief delegate Suppleant(s) - Altemate(s) Or H. Rafeeq Minister of Health Or G. KDdlndo M8decin Chef, Maternlta de rH6pital g8n8ral DeJegue(s)- Delegate(s) Or R. Edwards Acting Chief Medical OffiCer, Ministry of Health THAILANDE - THAILAND Ms M.-A. Richards Chef de delegation - Chief delegate Deputy Permanent Representative, Geneva Mr Rakkiet Sugthana SuppJeant(s) - Alternate(s) Minister of Public Health Mr K Mohammed Chef adjoint de la delegation - Deputy chief Former Minister of Health delegate Mr Kril Gamjana-Goonchorn TUNISIE - TUNISIA Ambassador, Permanent Representative, Geneva Delegue(s) - Delegate(s) Chef de delegation - Chief delegate Or Prakrom Vuthipongse M. H. M'Henni Permanent Secretary, Ministry of Public Health Ministre de la Santa publique Suppleant(s) - Altemate(s) DeJegue(s) - Delegate(s) Professor Pakdee Pothisiri M. K Morjane Deputy Permanent Secretary, Ministry of Public Health Ambassadeur, Representant permanent, Geneve Or Suwit Wlbulpolprasert M. M. Baati Assistant Permanent Secretary, Ministry of Public Health Con&eiller des Affaires etrangeres, Mission permanente, Gen6ve Or Viroj Tangcharoensathien Suppleant(s) - Altemate(s) Senior Medical OffiCer, Health System Research Institute, Ministry of Mrne R. Ben Marzouk Public Health Sous-Directeur, Unite de la Cooperation technique Miss Vimolraj l Mr S. Wannamethee First Secretary, Permanent Mission, Geneva A51NR page231 TURQUIE - TURKEY UKRAINE - UKRAINE Chef de delegation - Chief delegate Chef de delegation - Chief delegate DrH.I. Ozsoy Mr A. Serdiuk Minister of Health Ministre de la Sante Chef adjoint de la delegation - Deputy chief Chef adjoint de la delegation - Deputy chief delegate delegate MrM. Sungar Mr M. Maimeskoul Ambassador, Permanent Representative, Geneva Ambassadeur, Representant permanent, Geneve Delegue(s) - Delegate(s) 061egue(s) - Delegate(s) DrC. Ozcan Mr V. Grynyshyn Director-General of Treatment Services, Ministry of Health Deuxierne Secretaire, Mission permanente, Geneve Suppleant(s) - Alternate(s) DrM.R. KOse URUGUAY-URUGUAY Director-General of Mother-Child Health Care and Family Planning, Ministry of Health Chef de delegation - Chief delegate DrN.CBkmak Dr. R. Bustos Deputy Director-General of Primary Health Care, Ministry of Health Ministro de Salud Publica Mrs S. Kizildeli Chef adjoint de la delegation - Deputy chief First Counsellor, Permanent Mission, Geneva delegate Mr Z. Gazloglu Sr. c. Perez del Castillo Counsellor-In-Charge of Special Political Affairs, Permanent Mission, Embajador, Representante Permanente, Glnebra Geneva Delegue(s) - Delegate(s) Mr B. Metin Head, Department of External Relations, Ministry of Health Dr. A. Chiesa Director General de la Salud Professor A. Akin Public Health Department, Faculty of Medicine, Hacettepe University Suppleant(s) - Alternate(s) Ora. B. Rivas MrV.T. Vural Directors de Cooperaci6n lnternacional, Ministerio de Salud Publica First Secretary, Permanent Mission, Geneva Sra. P. V1vas Mrl. Ozer Consejera, Mlsi6n Permanente, Glnebra Ministry of Health Sr. F. Perazza MrM. Varlik Secretario, Misi6n Permanente, Ginebra Expert, Under-Secretariat for State Planning Sr. C. Sgarbi MrR. ErgOn Ministro Consejero, Misi6n Permanente, Ginebra Director, Ministry of Health Sra. G. Sierra del Cioppo Subdirectora General de Secretaria, Ministerio de Salud Publica TUVALU - TUVALU Chef de delegation - Chief delegate VANUATU - VANUATU Mr I. lonatana Minister of Health, Women and Community Affairs Chef de delegation - Chief delegate Mr J.R. Alick Delegue(s) - Delegate(s) Minister of Health DrT. Puiusi Director of Health, Ministry of Health, Women and Community Affairs Chef adjoint de la delegation - Deputy chief delegate Mr P. Polapola Assistant Secretary for Healh, Women and Community Affairs, Mr J. Wabaiat Ministry of Health, Women and Community Affairs Director-General of Health, Department of Health A51NR page232 VENEZUELA-VENEZUELA ZAMBIE -ZAMBIA Chef de delegation - Chief delegate Chef de delegation - Chief delegate Dr. E. Pieruzzi S8nchez Profesaor N. Nkandu Luo Director General Sectorial de Salud Publica lnternacional, Ministerio Minister of Health de Sanldad y Aaiatencia Social Chef adjoint de la delegation - Deputy chief D818gue(s) - Delegate(s) delegate Sr. W. Corrales Leal Mr E. C. Mwansa Embajaclor, Representante Permanente, Ginebra Deputy Minister of Health Sr. V. Rodrlguez Cedetlo Delegue(s) - Delegate(s) Representante Permanente Altemo, Ginebra Mr P.N. Sinyinza Suppl8ant(s) - Altemate(s) Ambassador, Permanent Representative, Geneva Sr. N. Suarez Figueroa Suppl8ant(s) - Altemate(s) Ministro Con&ejero, Mi&i6n Permanente, Ginebra Mr N.L. Magolo Sra. I. Touron Lugo Deputy Permanent Secretary Agregada, Mlsi6n Permanente, Ginebra Or J.J. Banda Or D. Kasungami VIET NAM - VIET NAM Ms V. Shamoya Chef de delegation - Chief delegate Miss A. Kazhingu Profesaor Do Nguyen Phuong Second Secretary, Permanent Mission, Geneva Minister of Health Ms I. B. Fundafunda D818gue(s) - Delegate(s) Counsellor, Permanent Mission, Geneva Mr Nguyen Quy Binh Ambassador, Permanent Representative, Geneva ZIMBABWE -ZIMBABWE Mr Ngo Van Hop Director, Department of International Relations, Ministry of Health Chef de deh!gation - Chief delegate Suppl8ant(s) - Altemate(s) Or T.J. Stamps Mr Phung Dang Khoa Minister of Health and Child Welfare Expert, Department of International Relations, Ministry of Health Chef adjoint de la delegation - Deputy chief Mrs Vu Thi Bich Dzung delegate Third Secretary, Permanent Mission, Geneva Or T.J.B. Jokonya Ambassador, Permanent Representative, Geneva YEMEN -YEMEN Delegue(s)- Delegate(s) Or P.L.N. Sikosana Chef de delegation - Chief delegate Permanent Secretary, Ministry of Health and Child Welfare Or A.A. Nasher Suppleant(s) - Alternate(s) Minister of Public Health Mrs J. Tagwireyi Chef adjoint de la delegation - Deputy chief Director of Nutrition delegate Dr L. Charimari Or M.S. EI-Attar Provincial Medical Director Ambassador, Permanent Representative, Geneva MrT.T. Chifamba Delegue(s) - Delegate(s) Minister Counsellor, Permanent Mission, Geneva Or A.O. AI-Sallami Under-Secretary for Pharmaceuticals, Ministry of Public Health Mr M. Chikorowondo First Secretary, Permanent Mission, Geneva Suppl8ant(s) - Altemate(s) Mr N. Kanyowa Mr K AI Sakkaf First Secretary, Permanent Mission, Geneva Counsellor to the Minister of Health Or A.A. Abdullah Director, Technical Cooperation, Ministry of Public Health Mr F. AI-Ubathani First Secretary, Permanent Mission, Geneva A51NR page233 COMITE INTERNATIONAL DE LA CROIX ROUGE OBSERVATEURS D'UN ETAT NON INTERNATIONAL COMMITTEE OF THE RED MEMBRE CROSS Dr B. Eshaya-Chauvin OBSERVERS FOR A NON-MEMBER Chef, Division des Operations de Sante STATE M. D. Borel Chef de Secteur de la Division des Organisations internationales M. M. Studer Chef de Secteur de la Division des Organisations internationales SAINT-SIEGE - HOLY SEE Dr P. Perrin Medecin Chef Mgr J. Lozano Barragan President du Conseil Pontiftcal pour la Pastorale des Services de la Sante FEDERATION INTERNATIONALE DES Mgr G. Bertello SOCIETES DE LA CROIX-ROUGE ET DU Nonce Apostolique, Observateur permanent, Geneve CROISSANT-ROUGE MgrP. Magee INTERNATIONAL FEDERATION OF RED Conseiller, Mission perrnanente, Geneve CROSS AND RED CRESCENT SOCIETIES Mgr J.-M.M. Mpendawatu Expert Ms R. Ahluwalia Dr M. Ferrario Mr A. Senouci Expert Dr H. Sandbladh Mile A.-M. Colandrea Expert Dr A. Mahallati MrG. Gizaw MrM. Pelly OBSERVATEURS Mrl. Osman Mr T. Svenning OBSERVERS ORDRE DE MALTE- ORDER OF MALTA M. A. von BOselager Hospilalier M. E. Decazes Ambassadeur, Delegue permanent, Geneve M. G. de Pierredon Coordonnateur extraordinaire des Oeuvres de rOrdre Mrne M.-T. Piclet-AIIhann Premier Conseiller, Mission permanente, Geneve DrJ. Millan Conseiller technique A51NR page234 Mr A. Abraskewski VICe Chairman, Joint Inspection Unit, Geneva OBSERVATEURS INVITES MrS.Kuyarna CONFORMEMENT A LA Inspector, Joint Inspection Unit, Geneva RESOLUTION WHA27 .37 MrW. Munch Inspector, Joint inspection Unit, Geneva MrT.Riedy OBSERVERS INVITED IN United Nations Volunteers, Humanitarian Relief Unit and Liaison ACCORDANCE WITH RESOLUTION OffiCe, Geneva WHA27.37 Mr H. Hernandez Inspector, Joint Inspection Unit, Geneva MrK othrnan Inspector, Joint Inspection Unit, Geneva PALESTINE - PALESTINE Mr R. Quijano Inspector, Joint Inspection Unit, Geneva Or F. Arafllt President of the Palestine Council of Health MrsS. Nagy Reaearch Offk:er, Joint Inspection Unit, Geneva MrN.R~ Arnbaaudor, Permanent Obeerver, Geneva MrsE. Nunez Research OffiCer, Joint Inspection Unit, Geneva Or M. AI-Ciwif Mrs S. Derneke Or I. Tarawlyeh R-rch OffiCer, Joint Inspection Unit, Geneva DrR.Khourl Miss B. Orliz Associate Expert, United Nations Non-Governmental Liaison Service, Mr T. AI-Adjourl Geneva FONDS DES NATIONS UNIES POUR L'ENFANCE REPRESENTANTs· DE UNITED NATIONS CHILDREN'S FUND L'ORGANISATION DES NATIONS Mr D. Alnwick UNIES ET DES INSTITUTIONS Chief, Health Section APPARENTEES MsJ. Nelson Senior Programme Adviser REPRESENTATIVES OF THE Mr J. Glallbach Public Affairs OffiCer UNITED NATIONS AND RELATED MsM. Arts ORGANIZATIONS UNICEF OffiCe, Pakistan Mr H. C. Olsen Communication OffiCer, UNICEF OffiCe, Geneva ORGANISATION DES NATIONS UNIES UNITED NATIONS CONFERENCE DES NATIONS UNIES SUR LE COMMERCE ET LE DEVELOPPEMENT Mr S. Khmelnitskl UNITED NATIONS CONFERENCE ON TRADE External Relations and Inter-Agency Affairs OffiCer, Geneva AND DEVELOPMENT Mr P. Boulle Off~eer-in-Charge, Offk:e for the Coordination of Humanitarian Affairs, Geneva, Director of the Secretariat of the International Decade for Mr R. Uranga Natural Disasters Reduction United Nations Focal Point on Tobacco or Health Mr G. Putman-Cramer MrA. Behnam Trade and Development Board Chief, Di&asler Response Branch, OffiCe for the Coordination of Secretary, HurnanitarianAffmrs,Geneva MrD.Zupka Chief, Inter-Agency Standing Committee, liaison Unit, Geneva Mr E. Fontaine Orliz Executive Secretary, Joint Inspection Unit, Geneva A51NR page235 PROGRAMME DES NATIONS UNIES POUR PROGRAMME ALIMENTAIRE MONDIAL LE DEVELOPPEMENT WORLD FOOD PROGRAMME UNITED NATIONS DEVELOPMENT PROGRAMME Mr W. Schleiffer Director, WFP Liaison OffiCe, Geneva MrE. Bonev Mr B. Udas Senior Adviser, UNDP European OffiCe, Geneva Deputy Director, WFP Liaison Office, Geneva Ms C. Collina UNDP European OffiCe, Geneva OFFICE DE SECOURS ET DE TRAVAUX DES Ms S. de Coninck NATIONS UNIES POUR LES REFUGIES DE UNDP European OffiCe, Geneva PALESTINE DANS LE PROCHE-ORIENT UNITED NATIONS RELIEF AND WORKS PROGRAMME DES NATIONS UNIES POUR AGENCY FOR PALESTINE REFUGEES IN L'ENVIRONNEMENT THE NEAR EAST UNITED NATIONS ENVIRONMENT PROGRAMME Or M. Abdelrnou!Mne Deputy Comm~-General MrJ. Willis DrF.Mousa Director, Chemicals, UNEP, Geneva Director of Health MrS. Milad IRPTC/UNEP, Geneva HAUT COMMISSARIAT DES NATIONS UNIES POUR LES REFUGIES FONDS DES NATIONS UNIES POUR LA OFFICE OF THE UNITED NATIONS HIGH POPULATION COMMISSIONER FOR REFUGEES UNITED NATIONS POPULATION FUND DrM. Dualeh Senior Public Health OffiCer Mr A.L. MacDonald Chief, UNFPA European Liaison OffiCe, Geneva DrS.Male Senior Epidemiologist Mr D. Pierotli Senior Offecer, Emergency Relief Operations, UN FPA European Ms K Burns Liaison OffiCe, Geneva Senior Reproductive Health Officer Mr S. Baveiaar MrP. Mateu Senior External Relations Officer, UNFPA European Liaison Office, Senior Inter-Organization Affairs Offecer Geneva Ms J. Menning Ms N. Confalone Professional Assistant, Inter-Organization Affairs and Secretariat Junior Professional Officer, UNFPA European Liaison Office, Geneva Service Ms A. den Besten Junior Professional OffiCer, UNFPA European Liaison OffiCe, Geneva INSTITUT DE FORMATION ET DE MsH. Haug Junior Professional Offecer, Emergency Relief Operations, UN FPA RECHERCHE DES NATIONS UNIES European Liaison OffiCe, Geneva UNITED NATIONS INSTITUTE FOR TRAINING AND RESEARCH PROGRAMME DES NATIONS UNIES POUR Or J.W. Steinbart LE CONTROLE INTERNATIONAL DES DROGUES UNITED NATIONS INTERNATIONAL DRUG UNAIDS - UNAIDS CONTROL PROGRAMME Or P. Plot Executive Director MrS. Noyan Chief, External Relations Unit MrsS. Cowal Or A. Coli-Seck Or W. Sittitrai Or J. Esparza A51NR page236 Mrs R. Chahii-Graf BANQUE MONDIALE -WORLD BANK Or J. Perriens Or R.G.A. Feachem MsF. McCaul Director for Health, Nutrition and Population Ms A. Cordero Ms N. Sekhri MrJ. Uados FONDS MONETAIRE INTERNATIONAL Or L. Loures INTERNATIONAL MONETARY FUND Mrs N. Ferencic Mr A.A. Tail Special Trade Representative and Director, IMF OffiCe, Geneva Mr G. B. Taplin INSTITUTIONS SPECIALISEES Assistant Director, IMF OffiCe, Geneva MsS. Prowse Senior Economist, IMF OffiCe, Geneva SPECIALIZED AGENCIES UNION INTERNATIONALE DES TELECOMMUNICATIONS ORGANISATION INTERNATIONALE DU INTERNATIONAL TELECOMMUNICATION TRAVAIL UNION INTERNATIONAL LABOUR ORGANISATION M. M. Paratian Charge des Affaires exterieures DrS. Niu Service de la 5ecurite et de la Sante du Travail M. C. Perrin ORGANISATION METEOROLOGIQUE Bureau des Relations avec le& Organisations internationales MONDIALE M. D. O'Malley WORLD METEOROLOGICAL ORGANIZATION Bureau des Relations avec le& Organisations internationales Mr LE. Olsson M. A. Ducci Chief, World Climate Applications and Services Programme Division Dlrecteur, Relations avec le& Organisations internationales ORGANISATION MONDIALE DE LA ORGANISATION DES NATIONS UNIES POUR PROPRIETE INTELLECTUELLE L'ALIMENTATION ET L'AGRICULTURE WORLD INTELLECTUAL PROPERTY FOOD AND AGRICULTURE ORGANIZATION ORGANIZATION OF THE UNITED NATIONS MrneJ. Rage Mr A. Purcell Conseiller principal, Bureau de la PlanifiCation strategique et du Senior Liaison OffiCer, FAO Liaison OffiCe with the United Nations Geneva • Developpement des Politiques M. R. Wilder Ms N. Brandstrup Conseiller principal, Bureau des Affaires juridiques et structurelles Liaison OffiCer, FAO Liaison Office with the United Nations, Geneva MrD. Lawson Liaison OffiCer, FAO Liaison Office with the United Nations, Geneva ORGANISATION DES NATIONS UNIES POUR LE DEVELOPPEMENT INDUSTRIEL UNITED NATIONS INDUSTRIAL ORGANISATION DES NATIONS UNIES POUR DEVELOPMENT ORGANIZATION L'EDUCATION, LA SCIENCE ET LA CULTURE UNITED NATIONS EDUCATIONAL, MrM. Toure SCIENTIFIC AND CULTURAL ORGANIZATION Special Representative of the Director-General, UN IDO OffiCe, Geneva Mrne A. Cassam Ms F. Sidibe Directeur, Bureau de Liaison, Geneve UNIDO OffiCe, Geneva A51NR page237 AGENCE INTERNATIONALE DE L'ENERGIE OFFICE INTERNATIONAL DES EPIZOOTIES ATOMIQUE INTERNATIONAL ATOMIC ENERGY AGENCY Mr G. Sutherland Adjoint au Chef du Service administratif et financier Ms M. S. Opelz Head, IAEA OffiCe, Geneva ORGANISATION DE L'UNITE AFRICAINE Ms A. B. Webster ORGANIZATION OF AFRICAN UNITY IAEA OffiCe, Geneva MrA. Bensid Observateur permanent, Geneve ORGANISATION MONDIALE DU COMMERCE WORLD TRADE ORGANIZATION Mr V. Wege-Nzomwita Observateur permanent adjoin!, Geneve M.N.Carvalho MrM. Chatti Conseiller, Division de la propriete intellectuelle et des investissements AttacM, Geneve COMMISSION EUROPEENNE - EUROPEAN REPRESENTANTS D'AUTRES COMMISSION ORGANISATIONS OrA. Berlin Adviser, Directorate General for Employment and Social Affairs, INTERGOUVERNEMENTALES European Commission, Brussels Or A. Lacerda de Queiroz REPRESENTATIVES OF OTHER Principal Administrator, Directorate General for Employment and Social Affairs, European Commission, Brussels INTERGOVERNMENTAL Mr C. Dufour ORGANIZATIONS Permanent Delegation, Geneva Mr J. Stoodley Counsellor, Permanent Delegation, Geneva LIGUE DES ETATS ARABES - LEAGUE OF ARAB STATES CONSEIL DES MINISTRES DE LA SANTE, CONSEIL DE COOPERATION DES ETATS M. D. Swidan ARABES DU GOLFE Secretaire general adjoint HEALTH MINISTERS' COUNCIL FOR GULF M. S. Alfarargi COOPERATION COUNCIL STATES Ambassadeur, Observateur permanent, Geneve DrA.Safwat Or A.R. AI-Swailem Directeur, Departement de la Sante et de I'Environnement Executive Director DrH.Hamouda Mr R.l. AI Mousa Directeur, Departement de la Sante Or H.A. Gadalla M. S. Sef Alyazal Troisi8me Secretaire, oetegation permanente, Geneve ORGANISATION DE LA CONFERENCE Or 0. El Hajje Delegation permanente, Geneve ISLAMIQUE ORGANIZATION OF THE ISLAMIC M. S.Aeid Delegation permanente, Geneve CONFERENCE Mr N.S. Tarzi Ambassador, Permanent Observer, Permanent Delegation, Geneva MrJ. Olia Deputy Permanent Observer, Permanent Delegation, Geneva A51NR page238 ORGANISATION INTERNATIONALE DE PROTECTION CIVILE INTERNATIONAL CIVIL DEFENCE REPRESENTANTS DES ORGANIZATION ORGANISATIONS NON GOUVERNEMENTALES EN MrS.Znaldi Secretary-General RELATIONS OFFICIELLES AVEC L'OMS Mr V. Kakusha Assistant to the Secretary-General REPRESENTATIVES OF ORGANISATION INTERNATIONALE POUR NONGOVERNMENTAL LES MIGRATIONS ORGANIZATIONS IN OFFICIAL INTERNATIONAL ORGANIZATION FOR MIGRATION RELATIONS WITH WHO Or B. Guehulak Director, Medical Setvices Academie international& de Medecine legale Mr P. Schalzer Director, External Relations and Information International Academy of Legal Medicine Professeur P. Mangin SECRETARIAT DU COMMONWEALTH COMMONWEALTH SECRETARIAT Alliance international& des Femmes Profeslor S. A. MMIIn International Alliance of Women Director, Human R1801.1rCe Development Dlvi&ion DrP. Giles Or Q.Q. DIM1ini Special Adviller, Head of Health Department Ms G. Haupter Profea&or K Thalru Or R. Kircheisen Regional Secretary, Commonwealth Regional Health Community Secretariat for East, Central and Southern Africa MsM.Pal DrK T.Jolrw Ms J. Kehi-Lauff Execullve Director, West African Health Community Secretariat OrB. Win! Programme Manager, Health Sector Development, Caribbean Association du Commonwealth pour les Community Secretariat Handicaps mentaux et les lncapacites liees Mr K Stuart au developpement Commonwealth Association for Mental Handicap and Developmental Disabilities Or V.R. Pandurangi Or G. Supramaniam Mr A. Pandurangi Or R.M. Varma Or A.C. Sreeram Or I. Mathai Or V. Annavajijhala Or S. Mahashabde A51NR page239 Association interamericaine de Genie Association internationale des Femmes sanitaire et de I'Environnement Medecins lnter-American Association of Sanitary and Medical Women's International Association Environmental Engineering Or F. Manguyu Mr 0. Sperandio Or V. JOrgensen Or D. Ward Association internationale contre la Lepre International Leprosy Association DrC.Motzel Or W. Diekahaus DrY.Yo Association internationale de Sociologie Association internationale de Conseil en International Sociological Association Allaitement International Lactation Consultant Or E. B. Gallagher Association Ms M. Lehmann-Burt Association internationale des Medecins pour la Prevention de la Guerre nucleaire International Physicians for the Prevention of Association internationale de Logopedie et Nuclear War Phoniatrie International Association of Logopedics and MrB. Rawson Phoniatrics Ms M. Blokzijl Or A. Muller Association international& des Association internationale de Lutte contre la Techniciennes et Technicians dipiOmes en Mucoviscidose Electro-Radiologie medicale International Cystic Fibrosis (Mucoviscidosis) International Society of Radiographers and Association Radiological Technologists Ms L. Heidet MrA. Yule Association internationale de Medecine Association internationale des Technicians agricole et de Sante rurale de Laboratoire medical International Association of Agricultural International Association of Medical Medicine and Rural Health Laboratory Technologists Or A. Patil Mrs M.A. Hj81marsd6ttir MrsM. Haag Association internationale d'Epidemiologie International Epidemiological Association Association internationale d'lnformatique medica le DrR.Saracci International Medical lnformatics Association DrV.Griesser A51NR page240 Association international& pour la Prevention Association mondiale de Psychiatrie et le Depistage du Cancer World Psychiatric Association International Society for Preventive Oncology Professor N. Sartorius Or H.E. Nleburga Professor J.E. Mezzich Or L. Santl Association mondiale des Guides et des Association international& pour la Santa de la Eclaireuses Mere et du Nouveau-Ne World Association of Girl Guides and Girl International Association for Maternal and Scouts Neonatal Health Ms L. SchOrch Professor A. Campana Ms J. Crettaz Mr H. Wagener Ms N. Fischer MsS. V~gani Association international& pour I'Etude de la Douleur International Association for the Study of Pain Association mondiale des Societas de Pathologie (Anatomie pathologique et Professor T.S. Jensen Biologie medicale) World Association of Societies of Pathology (Anatomic and Clinical) Association italienne Amis de Raoul Follereau Italian Association of Friends of Raoul OrW.B. Zeiler Follereau OrE.Venza Association mondiale pour la Readaptation psychosocial& OrS.Deepak World Association for Psychosocial Rehabilitation Association medicale du Commonwealth Commonwealth Medical Association Or S. Flache Ms M. Haslegrave CMC- L'Action des Eglises pour la Santa Or J.O.J. Havard CMC - Churches' Action for Health Or R.KO. Asante Association medicale mondiale World Medical Association MsO.G. Smith Or E. Ombaka OrA. Milton OrO.Hurnan College international des Chirurgiens MsJ. Balfe International College of Surgeons Professor P.B. Hahnloser A51NR page241 Comite inter-africain sur les Pratiques Conseil des Organisations internationales traditionnelles ayant effet sur la Sante des des Sciences medicales Femmes et des Enfants Council for International Organizations of lnter-African Committee on Traditional Medical Sciences Practices affecting the Health of Women and Children Or Z. Bankowski Dr J.H. Bryant Mrs R. Bonner Professor M. Abdussalam Mrs J. Jett-Aii Dr J. Venule! Mrs B. Ras-Work Dr J. Gallagher Mrs H. Schatzmann Mr S.S. Fluss Commission electrotechnique internationale Professor J.C. Siim International Electrotechnical Commission Conseil international de I'Action sociale Mr J.-P. Brotons-Dias International Council on Social Welfare Confederation internationale des Sages Mr N. Dahlqvist Femmes Ms M. Greuter International Confederation of Midwives Miss J. Walker Conseil international des Femmes International Council of Women Ms R. Brauen Mrs P. Herzog Confederation mondiale de Physiotherapie World Confederation for Physical Therapy Conseil international des lnfirmieres International Council of Nurses Ms B.J. Myers Ms J.A. Oulton Conseil de la Recherche en Sante pour le Or T.Ghebrehiwet Developpement Council on Health Research for Development Ms F. Affara Mrs M. Kingma DrY. Nuyens MrT. Ride Dr M. Jegathesan MsS. Shaw Professor C. Suwanwela Ms C. Hyde-Price Professor R. Owor Ms M. Bertholet MsS. de Haan Mrs N. Vatn~ Mrs L. Arietti Conseil de l'lndustrie pour le Developpement Industry Council for Development Ms T. Teminsky Ms L. Sanchez Sweatman Or D.A. Jonas Ms U. Klein A51NR page242 Conseil international des Unions scientifiques Federation internationale de Cooperation des International Council of Scientific Unions Centres de Recherche sur les Systemes et Services de Sante Professor Y. Verhassett Federation for International Cooperation of Health Services and Systems Research Canters Conseil international sur les Problemes de I'Aicoolisme et des Toxicomanies DrP. Kekki International Council on Alcohol and Addictions Federation internationale de Gynecologie et OrE. Tongue d'Obstetrique International Federation of Gynecology and Obstetrics Conseil national pour la Santa internationale National Council for International Health Professor A. Campana DrM.Gwynne Federation internationale de la Vieillesse Or D. Smith International Federation on Ageing DrW.W. Kamel Or E. Wolfson Ms S. Crowley MsG.Iijima Or M. Proctor Ms R. Chopra Mr A.L. Hannah Ms J.T. DeSautelle Federation internationale de l'lndustrie du Or R.G. Wilson Medicament MsR. Golden International Federation of Pharmaceutical Manufacturers Associations Mr W.L. Prelesnik Or M. O'Donohue Or H. E. Bale Jr. MrT.Bombelles Consultation internationale sur les Maladies Mrs F. Buhl urologiques International Consultation on Urological Miss M. Cone Diseases Ms S. Crowley Mr J .-F. Gaulis Professor S. Khoury Mrs S. Brinchmann Mr A.J. TurnbuU Mr S. Sargent Federation internationale de Chimie clinique Mr G.H.A. Siemons International Federation of Clinical Chemistry Mrs A. Draper OrA. Deom Mr B. Lemoine Or M. Fathl MrB. Mesure DrO. Morln Mr M. PhiNppe MrK Sato Mr A. Aumonier MrN. Warma Ms E. Tyson A51NR page243 DrE.Norrls Federation internationale des Colleges de Chirurgie Mrs J. Hughes International Federation of Surgical Colleges DrN.Hill Or S.W.A. Gunn Mr C. Hardwick Professor M. Masellis Mr H.lund Mr M. Campolini Federation internationale des Femmes de DrT. Empkie Carrieres liberales et commerciales MsD. Namate International Federation of Business and Professional Women Ms K Hagemann Mrs P. Carlevaro Mrs M. Gerber Dr G. Kuesters Federation internationale des H6pitaux Dr C. Fink-Anthe International Hospital Federation OrB. BagnaH Dr G. von Glutz Federation internationale des Associations d'Etudiants en Medecine Federation internationale des Industries des International Federation of Medical Students Aliments dietetiques Associations International Special Dietary Foods Industries Mrs B. Thomsteindottlr Ms C. Ernerling Mr A. Bodiroza Ms B. Halchak MrK Manl MaJ. Keith Ms F. Porta Mr D. Speigel Ms M. RydeYik MrS. Tasher Mr T. Vllotljevlc Mr P. Borasio Ms P. Erba Or A. Bronner MrH. Wafa Mr M. de Skowronski Mr R. Vlsser MrG. Fookes MrJ. Krarup Mr N. Christiansen Mr 0. Hoffrnann MrKdeJong MaJ. Derwig Or D. Segal Ms E.-A. Antal Dr B. de Buzonniere Ms J. Zajeganovic Ms H. Mouchly-Weiss Ms A. C. do8 Anjos Ribelroa Ms K Bolognese Ms R. van Rooyen Dr l. Frade Ms M. Blokzljl Mr l. Bick MsS. Lund Ms M.-l. Gander Ms A.-S. Steiner A51NR page244 Federation internationale des Societas de Federation internationale pour la Fertilite Planification familiale International Federation of Fertility Societies International Planned Parenthood Federation Professor R. F. Harrlson Mrs I. Brueggemann Or P. Senanayake Federation internationale de Thalassemie MrC. Ritchie Thalassaemia International Federation Mr C. Papageorgiou Federation mondiale de Chiropratique World Federation of Chiropractic Federation internationale des Societas d'Oto Or L. Sportelli rhino-laryngologie International Federation of Oto-rhino DrS. Borges laryngological Societies DrP.Carey Or P. Alberti DrC. Diem DrJ. Grate Or B. Vaughan Mr D. Chapman-Smith Federation internationale du Diabete Or M. Alattar International Diabetes Federation DrR. Handly Ms H. WiiUams Or G. Auerbach Or F. Carbin Federation international& du Thermalisme et du Climatisme Federation mondiale de Medecine et Biologie International Federation of Hydrotherapy and des Ultrasons (WFUMB) Climatotherapy World Federation for Ultrasound in Medicine and Biology (WFUMB) Or G. Ebrard M. C. Ogay DrS. Hancke Professor H. Lutz Federation internationale pharmaceutique International Pharmaceutical Federation Federation mondiale des Anciens Combattants Mr A. Gallopin World Veterans Federation Mr J.-C. Filliez Mr C. Provoost Or H. lbrahim Mr H. Hoegh Or D. Steinbach Mr P. Blanc Federation mondiale des Associations de Mrs R. Filliez Centres antipoisons et de Toxicologie Mr A. Davidson clinique World Federation of Associations of Poison Miss A. Sutherland Centers and Clinical Toxicology Canters Or Jou-Fang Deng A51NR page245 Federation mondiale des Associations de la Federation mondiale des Associations pour Sante publique les Nations Unies World Federation of Public Health World Federation of United Nations Associations Associations MsM. Hilson Dr R. Masironi Professor K Mills MrM. Weydert Professor Huang Yongchang Dr L. Ciaffei Professor Zhang Jiaxl Dr J .W. Steinbart DrWang Peng Dr M. VIOiaki-Paraskeva Or Niu Shiru DrC. Kassa Federation mondiale des Societas d'Acupuncture Professor D. Zeegers-Paget The World Federation of Acupuncture Dr 5. Sarkar Moxibustion Societies Professor T. Nakahara Or Wang Xue Tai DrN.M. Khan Dr Chen You Bang Mr M.Z.M. Khan Dr Chen Shao Wu Professor M. Aslamkhan DrJ. Bossy Mr T.M. Anjum Dr D.P.J. Hung Professor C. Korczak Professor C.K.T. Cheung Dr J. Lozano Dr Tan Chwee Heng DrT. Abelin Professor Deng Liang Vue ProfessorW.L. Kilama Dr Shin Tae Ho Dr W. Mpanju-Shumbusho DrC. Rempp Dr B. Qureshi Professor A. Bangrazi Mrs 5. Qureshi DrWangYu Dr M. N. Akhter Dr Hoc Ku Huynh MsJ. Gunby Dr M.K. El Gogary Ms D. Kuntz Dr J. Goodman Dr P. Orris Or K Piaisted Mr R.L. Wiltenberg Dr C.A. Berte Dr J. Akhter Dr Huang Chen-Jen Dr C. Ferreyra Nunez DrMaYing Mr G.A. Karbanl Dr UZhenJi Dr E. E. Ferreyra Dr Shen Zhi Xiang Mrs E. Rornero Mr Kim Nam Soo DrM.Spasovski Mr Wu Zhen Dou Dr Fang Shu Ting Dr Xu Shu Qiang Dr Li Zhong Xiang A51NR page246 Or Zhang Ling Global Crop Protection Federation Ms Fan Ling Ling Global Crop Protection Federation Ms Zhang U Fang Mr W. Kaufmann MsWangYan Ms Xue Kui Yang lnstitut international des Sciences de la Vie International Life Sciences Institute MsJiHong Mrs 0. Gogary OrA.Malaspina Or Tien Hal Uu Ligue internationale contre I'Epilepsie Ms P. Filomena International League against Epilepsy OrJ. Cheung Or P. Jallon Mr Cho Yoon Ho Or Yuklo Kuroao Ligue internationale d'Associations pour la Or Kiichiro Tsutanl Rhumatologie Ms LE. Moran International League of Associations for Rheumatology Mr Song Dal Yong Mrs Hung LiUian Professor J. Dequeker Profesaor J.J. Rasker Federation mondiale pour la Santa mentale World Federation for Mental Health Ligue internationale des Societas dermatologiques OrS.FIIIche International League of Dermatological Profesaor Tsung Vi Un Societies Professor J.-H. Saurat Federation mondiale pour I'Enseignement de la Medecine World Federation for Medical Education Ligue internationale La Leche La Leche League International OrH.Karle Ms G. Laviolle Fondation Aga Khan - Aga Khan Foundation Ligue mondiale contre !'Hypertension Or J.B. Tomaro World Hypertension League Or J.H. Bryant Or T. Strasser Or M. Kadlr OrP. Nayanl Medicus Mundi lnternationalis (Organisation MsY. Amarsi internationale de Cooperation pour la Santa) Medicus Mundi lnternationalis (International OrS. Sohani Organization for Cooperation in Health Care) Mr M.A. Argal Or E. Bumier Or Eidenbenz MrG. Eskens Or A. Foracchia A51NR page247 DrU. KOpper Ms A. Linnecar DrG.Nietvelt Ms P. Rundall Mr B. Pastors Ms S. Thiagarajah Professor Pawlowskl MsA. Allain Dr G. Polak Ms B. Barry DrT.Puls Ms N.-J. Peck Dr N. Rehlls Ms E. Sterken Or G. Falslrollo Dr F. Vallone Dr S. Rypkema Ms H. Slingerland Ms M. Verhallen Dr M. Raijrnakers Ms F. Wijckmans Ms T. Lekkerkerk Ms I. Fernandez Organisation internationale de Normalisation Ms M. E. Hurtado International Organization for Standardization Mr T.J. Hancox Islamic Organization for Medical Sciences Islamic Organization for Medical Sciences Organisation internationale des Unions de Dr A.R. AI-Awadhl Consommateurs (Organisation internationale des Consommateurs) International Organization of Consumers Reseau des Etablissements de Formation en Unions (Consumers International) Sciences de la Sante orientes vers les Besoins de la Communaute Mr B. van der Heide Network of Community-oriented Educational Institutions for Health Sciences Ms B. Leach Ms L. Hayes DrP.Kekki MsE. Hoen Dr G. D. Majoor Mr K Balasubrarnaniam Mr A. Gul Kiani Rotary International - Rotary International Ms S. Aongsomwang Mr E. Jucker Mr R. Lopez Linares Mr G. Herrnann Mr G. Rojas Caro Mr J.A.C. de Barros Save the Children Fund (Royaume-Uni) Save the Children Fund (UK) MsG. Sanou MsE. Ombaka Ms L. Gostelow Mr D. Kimera Mrs L. Elliot Ms I. Aiszilniece MrJ. Love Ms M. Morsink Professor J. Andoh Dr R.E. de Arango Dr C. Karamagi A51NR page248 Societe internationale de Chirurgie Union intemationale des Organismes International Society of Surgery familiaux International Union of Family Organizations Professor S.W.A. Gunn Or D.N. Weber Kusztra Societe internationale d'Hematologie Or C. Zanotta Valladlo International Society of Hematology Or L. de Laat DrS. Miwa Or M.E. Shimazaki Soroptimist International - Soroptimist Union interparlementaire - Inter International Parliamentary Union Ms I.S. Nordback MrP. Comillon Mr s. Tchelnokov The International Society on Thrombosis and Haemostasis, Inc. Vision mondiale internationale The International Society on Thrombosis and World Vision International Haemostasis, Inc. OrE. Ram Or A. Tripocti Or 0. Nordberg Union internationale contre le Cancer DrG. Starky International Union against Cancer Mr N. Hallstrom Professor G. Berlinguer Mr A.J. Turnbull Or Sanders Mrs I. Mortars D. Or J. Tlongco Union internationale contre les Infections Ms R. Bloem transmises sexuellement International Union against Sexually Transmitted Infections World Self-Medication Industry World Self-Medication Industry Or G.M. Antal Or J.A. Reinstein Mr A.J. Jamison Union internationale de Promotion de la Sante et d'Education pour la Sante DrH. Cranz International Union for Health Promotion and MsS. Kelly Education Mr E.J. Gezzi Professor S. Hagard MsJ. Lee A51NR page249 REPRESENTATIVES OF THE EXECUTIVE BOARD Professor A. Aberkane Dr C.M. More! Dr A. Sanou Ira Dr B. Wasisto REPRESENTANTS DU CONSEIL EXECUTIF Professeur A. Aberkane Dr C. M. Morel Dr A. Sanou Ira Dr B. Wasisto PARTICIPANTS IN THE COMMEMORATION OF THE FIFTIETH ANNIVERSARY OF THE WORLD HEALTH ORGANIZATION The Honorable Tofilau Eti Alesana Prime Minister of Samoa His Excellency Mr Henri Konan Bedie President ofthe Republic of Cote d'Ivoire His Excellency Dr Fidel Castro President of the Republic of Cuba Mrs Ruth Dreifuss Member of the Swiss Federal Council PARTICIPANTS A LA CELEBRATION DU CINQUANTIEME ANNIVERSAIRE DE L'ORGANISATION MONDIALE DE LA SANTE M. Tofilau Eti Alesana Premier Ministre du Samoa M. Henri Konan Bedie President de la Republique de Cote d'lvoire M. Fidel Castro President de la Republique de Cuba Mme Ruth Dreifuss Membre du Conseil federal suisse A51NR page251 INDEX OF NAMES This index contains the names of speakers reported in the present volume. INDEX DES NOMS DES ORATEURS Cet index contient les noms des orateurs dont les interventions figurent dans le present volume. ABDUL AZIZ UMAR, P. (Brunei Darussalam/ COLLA, M. (Belgium/Belgique), 129 Brunei Darussalam), 57 COSTA-BAUER, M. (Peru/Perou), 52 ABDULLAH, A. (Maldives), 68 COTTI, F. (President of Swiss Confederation/ ABERKANE, A. (Representative of the Executive President de la Confederation suisse ), 2 Board/representant du Conseil executit), 33 CREGAN, J. (Ireland/lrlande), 25 ABU BAKAR BIN SULEIMAN (Malaysia/ Malaisie ), 120 AITKEN, D.G. (Assistant Director-General/ D' ALMEIDA MASSOUGBODJI, M. (Benin/ Sous-Directeur general), 94 Benin), 69 ALESANA, T.E. (Samoa), 154, 162, 164 DE LA FUENTE, J.R. (Mexico/Mexique), 70 ARAFAT, F. (Palestine), 138 DE LA TORRE, A (Ecuador/Equateur), 142 A YE (Myanmar), 20 DE SIL V A, N.S. (Sri Lanka), Chairman of AYINLA, J. (Nigeria/Nigeria), 25, 28, 147 Committee B/President de la Commission B, 73, 189 DEVYATKO, V. (Kazakhstan), 109 BADRAN, A. (Egypt/Egypte), 20, 30, 39, 40, 41, DIRECTOR-GENERAL/DIRECTEUR 42 GENERAL, 35, 149, 186 BARANY!, F. (Romania/Roumanie), 71 DIRECTOR-GENERAL ELECT/DIRECTEUR BEDIE, H.K. (Cote d'Ivoire), 155, 161, 164 GENERAL ELU, 101 BINDI, R. (Italy/ltalie), 53 DLAMINI, P.K. (Swaziland), 25 BOYADJIEV, P. (Bulgaria/Bulgarie), 145 DLAMINI ZUMA, N.C. (South Africa/Afrique du BROOKMAN-AMISSAH, E. (Ghana), 22,61 Sud), Vice-President of the Fifty-first BRUNDTLAND, G.H. (Director-General elect/ World Health AssemblyNice-Presidente Directeur general elu ), 101 de la Cinquante et Unieme Assemblee BUSTOS, R. (Uruguay), 137 mondiale de la Saute, 97, 194 DOTRES MARTINEZ, C. (Cuba), 90 DREIFUSS, R. (Switzerland/Suisse), 158, 162, CALMAN, K. (United Kingdom of Great Britain 163 and Northern Ireland/Royaume-Uni de DULLAK, R.E. (Paraguay), 125 Grande-Bretagne et d'Irlande du Nord), 20, DURHAM, G. (New Zealand/Nouvelle-Zelande), 41 Chairman of Committee A/President de CASTELLON, E. (Spain/Espagne), 128 la Commission A, 188 CASTRO, F. (Cuba), 156, 159, 161, 163 CHA TTI, M.l. AL- (Syrian Arab Republic/ Republique arabe syrienne), 132 EARP, R (New Zealand/Nouvelle-zelande), 65 CICOGNA, F. (ltaly/ltalie), 21 CLINTON, H.R. (United Arab Emirates Health Foundation Prize/Prix de la Fondation des F ARHEDI, M. (Islamic Republic of Iran/ Emirats arabes unis pour la Sante), 174 Republique islamique d'lran), 54 A51NR page252 FARRUGIA, M. (Malta!Malte), 46 KHATTABI, A.O. AL- (Saudi Arabia/Arabie FASSI, A. EL- (Morocco/Maroc), 76 saoudite ), 185 FORERO DE SAADE, M.T. (Colombia/ KHOURI, R. (Palestine), 184 Colombie), Ill KIM, M.-1. (Republic ofKorea/Republique de Coree), 55 KIYONGA, C.W.C.B. (Uganda/Ouganda), 27, GAJDOS, J. (Slovakia/Slovaquie), 114 134 GAYOON, M.A. (Maldives), 151 KIZILDELI, S. (Turkey/Turquie ), 24, 30, 191 GEITONAS, C. (Greece/Grece), 108 KOSMAC, D.P. (Slovenia/Slovenie), 85 GHASSANI, A.A.Q. AL- (Sasakawa Health KOUCHNER, B. (France), 74 Prize/Prix Sasakawa pour la Sante), 169 KRIT GARNJANA-GOONCHORN (Thailand/ GIRARD, J.-F. (France), 26 Tharlande), 17, 28, 29 GRABAUSKAS, V. (Lithuania/Lituanie), 24 KUNADI, S. (India/Inde), 115 GUIDOUM, Y. (Algeria/Algerie), 26, 88 KURDI, A. AL- (Jordan/Jordanie), 72 GURUNG, K.B. (Nepal/Nepal), 135 KUWARI, A.R.S. AL- (Qatar), 20, 51, 179 GUZMAN MARCELINO, A. (Dominican Republic/Republique dominicaine ), Vice President of the Fifty-first World LOFTIS, R.G. (United States of America/ Health AssemblyNice-Presidente de la Etats-Unis d' Amerique ), 183 Cinquante et Unieme Assemblee LOZANO BARRAGAN, J. (Holy See/ mondiale de la Sante, 97 Saint-Siege), 114 HANSEN-KOENIG, D. (Luxembourg), 146 MANOR, U. (Israel/Israel), 183 HARADA, Y. (Japan/Japon), 50 MARINKOVIC UZQUEDA, T. (Bolivia/Bolivie), HOYBRATEN, D. (Norway/Norvege), 69 117 HUTTU-JUNTUNEN, T. (Finland/Finlande), 133 MARTIN MORENO, J.M. (Spain/Espagne), 23 MATZA, Y. (Israel/Israel), 78 MAZIBUKO, R.M. (Sasakawa Health Prize/Prix INGRAM, S. (Australia/Australie), 21 Sasakawa pour la Sante), 168 INSANOV, A. (Azerbaijan/Azerba"idjan), M'HENNI, H. (Tunisia/Tunisie), 127 Vice-President of the Fifty-first World MIDF AA, H.A. AL- (United Arab Emirates/ Heal~h Assembly Nice-President de la Emirats arabes unis), 172 Cinquante et Unieme Assemblee MOELOEK, F.A. (Indonesia/Indonesie), 25, 49 mondiale de la Sante, 99 MOSKVICHYOV, A.M. (Russian Federation/ Federation de Russie), 48 MO USA WI, F .R. AL- (Bahrain/Bahrein), JAVED HASHMI, M.M. (Pakistan), 15, 22, 82 President of the Fifty-first World Health JO SUNG JU (Democratic People's Republic of Assembly/President de la Cinquante et Korea/Republique populaire democratique Unieme Assemblee mondiale de la Sante, de Coree), 139 11, 17, 19,22,27,30,43,94, 107,150 JOWELL, T. (United Kingdom of Great Britain MUBARAK, O.M. (Iraq), 131 and Northern Ireland/Royaume-Uni de MuNOZ, F. (Chile/Chili), 141 Grande-Bretagne et d'Irlande du Nord), 91 JUNEAU, A. (Canada), 87 JUNOR, J. (Jamaica!Jama"ique), 28, 40, 83 NASHER, A.A. (Y emen/Yem en), 119 NGEDUP, S. (Bhutan/Bhoutan), 19 NGO V AN HOP (VietNam), 43 KALWEO, J.l. (Kenya), 136 NGUEMA OWONO, S. (Equatorial Guinea/ KEDELLA, Y.H. (Chad/Tchad), 16, 123 Guinee equatoriale), 42 KERESZTY, E. (Hungary/Hongrie), 124 NIMIR, M.B. (Sudan/Soudan), 141 KET SEIN (Myanmar), 79 NJIE-SAIDY, I. (Gambia/Gambie), 15 KHALDI, A.M. AL- (Saudi Arabia/Arabie NKANDU LUO, P. (Zambia/Zambie), 59 saoudite ), 26 NOVAK, K. (Hungary/Hongrie), 27 A51NR page253 ORTENDAHL, C. (Sweden/Suede), 45 SERRA, J. (Brazil/Bresil), 63 OTTO, C. (Palau/Palaos), 184 SHALALA, D.E. (United States of America/ OZSOY, H.l. (Turkey/Turquie), 121 Etats-Unis d' Amerique), 43,47 SHANGULA, K. (Namibia/Namibie), 94 SHERVANI, S.l. (India/Inde ), President of PAKDEE POTHISIRI (Thailand/Thai"lande), 94, the Fiftieth World Health Assembly/ 95 President de la Cinquantieme Assemblee PALIHAKKARA, H.M.G.S. (Sri Lanka), 22 mondiale de la Saute, 1, 6 PALMADOTTIR, I. (Iceland/Islande), 146 SHISANA, 0. (South Africa/Afrique du Sud), 95 PETROVSKY, V. (Director-General ofthe United SIKOSANA, P.L.N. (Zimbabwe), 23 Nations Office at Geneva/Directeur general SIMKHADA, S.R. (Nepal/Nepal), 22 de !'Office des Nations Unies aGeneve), 4 SINGH, H.K. (lndia/Inde), 26, 28 PIATKIEWICZ, J.A. (Poland/Pologne), 118 SOLOMIS, C. (Cyprus/Chypre), 90 PICO, A.L. (Argentina/Argentine), 43, 80, 193 SOSA RAMIREZ, M.T. (Guatemala), 77 PIERUZZI SANCHEZ, E. (Venezuela), STAMPS, T.J. (Zimbabwe), 40,42 Vice-Chairman of Committee B/ Vice-President de la Commission B, 122 PONMEK DALALOY (Lao People's Democratic T AE GUN RI (Democratic People's Republic of Republic/Republique democratique Korea/Republique populaire democratique populaire lao ), 191 de Coree ), 26 PRADO, F. (Nicaragua), 14 TELEFONI RETZLAFF, M. (Samoa), 66 PRETRICK, E.K. (Federated States of TESF A YE TESSEMA (Sasakawa Health Prize/ Micronesia!Etats federes de Micronesie ), Prix Sasakawa pour la Sante), 171 Vice-President of the Fifty-first World THINLEY, J.Y. (Bhutan/Bhoutan), Health AssemblyNice-President de la Vice-President of the Fifty-first World Cinquante et Unieme Assemblee Health AssemblyNice-President de la mondiale de la Saute, 100 Cinquante et Unieme Assemblee mondiale de la Saute, 98, 144 TOPPING, T.S.R. (Legal Counsel/Conseiller juridique), 18, 27, 29, 40, 41, 42, 44,95 RAFEEQ, H. (Trinidad and Tobago/ Trinite-et-Tobago), 139 RAKKIET SUGTHANA (Thailand/Thai"lande), VOIGTLANDER, H. (Germany/AIIemagne), 23 56 REINER, Z. (Croatia/Croatie), 21, 126 RINKINEVA-HEIKKILA, H. (Finland/Finlande), WAHEED, A. (Maldives), 23 181 W ASISTO, B. (Indonesia/Indonesie ), 193 ROITHOV A, Z. (Czech Republic/Republique WHITWORTH, J. (Australia/Australie), 60 tcheque ), 81 RUB ENS SICA TO, A. (Angola), 27 YIMER, F. (Ethiopia/Ethiopie), 19,30 YUSUF, S.U. (Bangladesh), 86 SAL LAM, I. (Egypt/Egypte ), 101, 118 SASAKA WA, Y. (Nippon Foundation), 167 SAVELIEV, M.N. (Russian Federation/ ZELENKEVICH, I. (Belarus/Belarus), 21 Federation de Russie), 178 ZHANG Wenkang (China/Chine), 16, 112 SCHNEIDER, H.J. (Netherlands/Pays-Bas), 133 ZIARAN, B. (Islamic Republic oflran/ SELEBI, J. (South Africa/Afrique du Sud), 24 Republique islamique d'Iran), 25 A51NR page255 INDEX OF COUNTRIES AND ORGANIZATIONS This index lists the countries, organizations and bodies represented by the speakers whose names appear in the index on the preceding pages. ALGERIA, 26, 88 FINLAND, 133, 181 ANGOLA,27 FRANCE, 26, 74 ARGENTINA, 43, 80, 193 FRANCOPHONE AFRICA, 69 AUSTRALIA, 21,60 AZERBAIJAN, 99 GAMBIA, 15 GERMANY,23 BAHRAIN, 11 GHANA, 22, 61 BANGLADESH, 18, 86 GREECE, 108 BELARUS,21 GUATEMALA, 77 BELGIUM, 129 BENIN,69 BHUTAN, 19, 98, 144 HOLY SEE, 114 BOLIVIA, 117 HUNGARY, 27, 124 BRAZIL, 63 BRUNEI DARUSSALAM, 57 BULGARIA, 145 ICELAND, 146 INDIA, 1, 6, 26, 28, 115 INDONESIA, 25, 49, 193 CANADA,87 IRAN (ISLAMIC REPUBLIC OF), 25, 54 CARIBBEAN ISLANDS, 83 IRAQ, 131 CENTRAL AMERICA, 77 IRELAND,25 CHAD, 16, 123 ISRAEL, 78, 183 CHILE, 141 ITALY, 21.53 CHINA, 16, 112 COLOMBIA, 111 COTE D'IVOIRE, 155, 161, 164 JAMAICA, 28, 40, 83 CROATIA, 21, 126 JAPAN, 50 CUBA, 90, 156,159, 161, 163 JORDAN, 72 CYPRUS, 90 CZECH REPUBLIC, 81 KAZAKHSTAN, 109 KENYA, 136 DEMOCRATIC PEOPLE'S REPUBLIC OF KOREA, 26, 139 DOMINICAN REPUBLIC, 97 LAO PEOPLE'S DEMOCRATIC REPUBLIC, 191 LITHUANIA, 24 ECUADOR, 142 LUXEMBOURG, 146 EGYPT, 20, 30, 39, 40, 41, 42, 101, 118, 192 EQUATORIAL GUINEA, 42 ETHIOPIA, 19,30 MALAYSIA, 120 EUROPEAN UNION, 91 MALDIVES, 23, 68, 151 A51NR page256 MALTA,46 SOUTH AFRICA, 24, 95, 97, 194 MEXICO, 70 SOUTHERN AFRICAN DEVELOPMENT MICRONESIA (FEDERATED STATES OF), COMMUNITY, 59 100 SPAIN, 23, 128 MOROCCO, 76 SRI LANKA, 22, 73, 189 MYANMAR, 20, 79 SUDAN, 141 SWAZILAND, 25 SWEDEN,45 NAMIBIA, 94 SWITZERLAND, 2, 158, 162, 163 NEPAL, 22, 135 SYRIAN ARAB REPUBLIC, 132 NETHERLANDS, 133 NEW ZEALAND, 65,188 NICARAGUA, 14 THAILAND, 17, 28, 29, 56, 94, 95 NIGERIA, 25, 28, 147 TRINIDAD AND TOBAGO, 139 NON-ALIGNED MOVEMENT, Ill TUNISIA, 127 NORWAY,69 TURKEY, 24, 30, 121, 191 PACIFIC ISLANDS, 66 UGANDA, 27, 134 PAKISTAN, 15, 22, 82 UNITED KINGDOM OF GREAT BRITAIN PALAU, 184 AND NORTHERN IRELAND, 20, 41,91 PALESTINE, 138, 183 UNITED NATIONS OFFICE AT GENEVA, 4 PARAGUAY, 125 UNITED STATES OF AMERICA, 43, 47, 183 PERU, 52 URUGUAY,137 POLAND, 118 VENEZUELA, 122 QATAR, 20, 51, 179 VIETNAM,43 REPUBLIC OF KOREA, 55 ROMANIA, 71 WEST AFRICAN HEALTH COMMUNITY, 61 RUSSIAN FEDERATION, 48, 178 YEMEN, 119 SAMOA, 66, 154, 162, 164 SAUDI ARABIA, 26, 185 SLOVAKIA, 114 ZAMBIA, 59 SLOVENIA, 85 ZIMBABWE, 23, 40, 42 A51NR page257 INDEX DES PAYS ET ORGANISATIONS Cet index contient les noms des pays, organisations et organismes divers representes par les orateurs dont les noms figurent dans I' index precedent. AFRIQUE DU SUD, 24, 95, 97, 194 FEDERATION DE RUSSIE, 48, 178 AFRIQUE FRANCOPHONE, 69 FINLANDE, 133, 181 ALGERIE, 26, 88 FRANCE, 26, 74 ALLEMAGNE, 23 AMERIQUE CENTRALE, 77 ANGOLA,27 GAMBlE, 15 ARABlE SAOUDITE, 26, 185 GHANA, 22, 61 ARGENTINE, 43, 80, 193 GRECE, 108 AUSTRALIE, 21,60 GUATEMALA, 77 AZERBAIDJAN, 99 GUINEE EQUATORIALE, 42 BAHREIN, 11 HONGRIE, 27, 124 BANGLADESH, 18, 86 BELARUS, 21 BELGIQUE, 129 ILES DU PACIFIQUE, 66 BENIN, 69 INDE, 1, 6, 26, 28, 115 BHOUTAN, 19, 98, 144 INDONESIE, 25, 49, 193 BOLIVIE, 117 IRAN (REPUBLIQUE ISLAMIQUE D'), 25, 54 BRESIL, 63 IRAQ, 131 BRUNEI DARUSSALAM, 57 IRLANDE, 25 BULGARIE, 145 ISLANDE, 146 ISRAEL, 78, 183 ITALIE, 21, 53 CANADA, 87 CARAIBES, 83 CHILl, 141 JAMAIQUE, 28, 40, 83 CHINE, 16, 112 JAPON, 50 CHYPRE, 90 JORDANIE, 72 COLOMBIE, Ill COMMUNAUTE DE DEVELOPPEMENT DE L'AFRIQUE AUSTRALE, 59 KAZAKHSTAN, 109 COMMUNAUTE OUEST AFRICAINE POUR KENYA, 136 LA SANTE, 61 COTE D'IVOIRE, 155, 161, 164 CROATIE, 21, 126 LITUANIE, 24 CUBA, 90, 156, 159, 161, 163 LUXEMBOURG, 146 EGYPTE, 20, 30, 39, 40, 41, 42, 101, 118, 192 MALAISIE, 120 EQUATEUR, 142 MALDIVES, 23, 68, 151 ESPAGNE, 23, 128 MALTE,46 ETATS-UNIS D'AMERIQUE, 43, 47, 183 MAROC, 76 ETHIOPIE, 19, 30 MEXIQUE, 70 A51NR page258 MICRONESIE (ETATS FEDERES DE), 100 REPUBLIQUE TCHEQUE, 81 MOUVEMENT DES PAYS NON ALIGNES, ROUMANIE, 71 Ill ROYAUME-UNI DE GRANDE-BRETAGNE ET MYANMAR, 20, 79 D'IRLANDE DUNORD, 20, 41,91 NAMIBIE, 94 SAINT-SIEGE, 114 NEPAL, 22, 135 SAMOA, 66, 154, 162, 164 NICARAGUA, 14 SLOVAQUIE, 114 NIGERIA, 25, 28, 147 SLOVENIE, 85 NORVEGE,69 SOUDAN, 141 NOUVELLE-ZELANDE, 65, 188 SRI LANKA, 22, 73, 189 SUEDE,45 SUISSE, 2, 158, 162, 163 OFFICE DES NATIONS UNIES A GENEVE, 4 SWAZILAND, 25 OUGANDA, 27, 134 TCHAD, 16, 123 PAKISTAN, 15, 22, 82 THAILANDE, 17, 28, 29, 56, 94, 95 PALAOS, 184 TRINITE-ET-TOBAGO, 139 PALESTINE, 138, 183 TUNISIE, 127 PARAGUAY, 125 TURQUIE, 24, 30, 121, 191 PAYS-BAS, 133 PEROU, 52 POLOGNE, 118 UNION EUROPEENNE, 91 URUGUAY, 137 QATAR, 20, 51, 179 VENEZUELA, 122 VIETNAM,43 REPUBLIQUE ARABE SYRIENNE, 132 REPUBLIQUE DE COREE, 55 REPUBLIQUE DEMOCRATIQUE POPULAIRE YEMEN, 119 LAO, 191 REPUBLIQUE DOMINICAINE, 97 REPUBLIQUE POPULAIRE DEMOCRATIQUE ZAMBIE, 59 DE COREE, 26, 139 ZIMBABWE, 23, 40, 42